We are looking forward to the Christmas season! Thanksgiving will be a quick after work and school dinner with some of our friends here in Kijabe, then after a half day of school on Friday, Christmas break will begin. (For those who do not know our school runs on a trimester system with three month long breaks each year.) Some much deserved rest for Allison and the kids will be enjoyed afterward. Allison continues to work hard as Head of the Department for International Languages. It is a role with many responsibilities, some enjoyable, others not as much. She and her students inaugurated a Spanish Club which started the year with a Spanish Karaoke party that went off with moderate success. I wanted to get up and sing, but I didn’t want to be that Dad at the party, so I held back. I am now working as Head of Department for Internal Medicine at AIC Kijabe Mission Hospital. I continue to take call in the Obstetrics department, as well as in the ICU and the Internal Medicine wards. I enjoy the work a lot, and I hope that I can grow into the role of HOD. Administration has not always been my strong suit, but I feel privileged to serve, and I know it was a position that needed to be filled. The kids are doing well, and Allison and I are facing the the reality that David will be gone in just around 18 months! He is busy at school with Model United Nations, running a pizza delivery business, creating his vlog, and working at the Teddy’s, the student snack shop. Peter is doing well in his freshman year participating in choir, jazz band, and band as a trumpet player. He also quite fascinated with the guitar. Annie is in junior high band playing trombone. She loves drama and is excited to be a part of the field hockey team. Sarah is thriving as a sixth grader, the top of Titchie (elementary school). She plays piano and is venturing into saxophone. All of them are busy. As a family we try and get into Nairobi for good food when we can, and about once a month we try and head the other direction to Lake Naivasha to escape the hospital and relax in the best part of what Kenya has to offer (besides the awesome people of course), its natural beauty and wildlife. Thanks for thinking of us and praying for us. We trust God for the energy to live cross culturally and to do the good work he has given us to do.
Another night in the hospital last week has passed, and I again think about how weird and different practicing medicine is in Kenya, even in our great Kijabe Mission Hospital. The nigh of obstetric call started with handover. This is where the doctors who are leaving, but have covered the day, “hand over” the care of the patients in the hospital to the doctors covering the night. As I listened I felt my stomach drop a little as I realized the night would begin poorly. There was a young mother in the hospital whose baby had fetal hydrops which is a problem in which an en-utero infant for a multitude of reasons has swelling all over the body. These babies do not do well. She needed emergency delivery at 27 weeks of pregnancy, and we knew the baby would likely not be able to survive after delivery. Even more problematic was that she had a scar from a previous cesarean section which meant that we were going to do a preterm surgery. These usually go well, but they have their own increased risks. We took her back to the OR, and as I delivered the baby’s head through the uterine incision it looked so perfect, and I thought nervously that maybe we had the diagnosis wrong. But as the rest of the baby delivered the terrible swelling over the rest of the body was very obvious. He lived just 10 minutes before dying.
I came out of surgery to hear that a twin pregnancy that had arrived just a bit earlier had been evaluated and only one heart beat could be found. I placed the ultrasound on her abdomen and confirmed that one of the twins had passed. The mother cried as I told her, and her husband looked angry wondering what had changed in the last 10 days when her last appointment had shown two healthy babies. What could we say? She went quickly for an emergency surgery, and on delivery the first twin showed signs of having died several days prior. Its hard for a pregnant woman with twins to sort out the movements of her babies. She could not have known that all she was feeling were the movements of one of them.
Obstetrics can be a great joy when it goes well. But when it is bad, it is so sad. God help us all to show compassion!
I am back on the obstetrics service. Family doctors are good at floating in and out of different areas. Within the last year we have had family doctors working in pediatrics, internal medicine, obstetrics, the outpatient department and emergency room. For most of us it is a pleasure to move around the hospital. It keeps life interesting. The reason I am back on obstetrics is one of the volunteer obstetricians is leaving, and so the consultant staffing is a little bit low. So I am back to fill the needs of the hospital. We are starting this call right with a woman with severe pre-eclampsia, pulmonary embolism, and treatment with warfarin and one previous cesarean section scar needing an emergency surgery. She also has a large anterior uterine fibroid. Without explaining everything, let me say that is a tough case. Below is the team that will take care of it.
All my obstetric calls seem to take me on to places I do not want to go. My last call started with a older woman with severe high blood pressure at about 26 weeks pregnancy. These pressures were so high she was at risk of seizing, and her baby was not getting the blood flow through the placenta that it needed to live. So off to the operating room we went to deliver this too young baby. To complicate the matter there were big benign tumors all over her uterus. God is good and we were able to deliver her baby without too much difficulty. Unfortunately 2 days later her baby passed. 26 weeks is a threshold age for premature babies at our hospital where the chance of survival decreases. This same mother did end up seizing 2 days later from her pre-eclampsia, and is still in the ICU being treated for very high blood pressure. As this was going on we had a call that a patient was coming in with a molar pregnancy, which is a non-viable pregnancy that can transform to a cancer. She had been bleeding, although she was stable on arrival. Then another call came with a possible ectopic pregnancy arriving (an ectopic pregnancy is a non-viable pregnancy outside the uterus which can cause massive bleeding killing the mother). We started evaluating her, and a another call came in letting us know that a woman with a cancer of her hand (she was going for amputation of her entire arm the following day) who happened to be pregnant had unfortunately lost her baby. It is called an IUFD or intrauterine fetal demise. Did we need to induce now or wait until after surgery. We decided to wait and get the arm taken care of first. Another older woman rolled into the casualty (ER) with severe pelvic pain. We admitted her and it turned out that she had bilateral tubo-ovarian abcesses that were causing her to become septic. This are major infections of the female reproductive organs. Somewhere amidst all of this another woman arrived. She was 38 weeks pregnant, and she had a huge vulvar abcess due to an infected Bartholin’s gland. We admitted her to prepare her for surgery the following day. It was a busy night, and not all of it is exactly the bread and butter of family medicine. Oh yeah. I have just been switched off of medicine to do a month of full time obstetrics. The needs of the hospital must be met. 🙂 What have I got myself into?