A Day in the Life . . . Friday in the ICU

I walked the long way into work (its not long really) because we have closed off all but two entrances into the hospital so that all can be temperature screened before entering. It is nice to enjoy the very brisk morning air, watch the monkeys, and listen to a podcast.

8:30 AM     Time for the weekly audit of mortalities and close calls on the internal medicine service. This week a lot of time was spent discussing the COVID ward and some ICU complications from the past week. At the end I got a nice despedida with a coffee mug that I had been hoping to get with the Kijabe Hospital logo.

10:00 AM     Rounds in the ICU. In the last 2 days we have added 8 new patients. Yesterday was worse when I had six new patients in the span of just a few hours. Today it is just two new patients. Severe hyponatremia, a patient with a adrenalectomy in whom we have to closely watch the potassium and blood pressure, a myasthenia gravis with mucus plugging causing one lung to not function well (she got a tracheostomy yesterday), a traffic accident with a broken hip and ribs, status epilepticus, sepsis in a patient with esophageal cancer, another who has had her right shoulder and arm removed for cancer complications, severe diabetic ketoacidosis and sepsis . . . the list goes on!

12:30     Time to do some record keeping of the patient for the last week so that we have good records of what they presented with, how they did, how long they were in the hospital. We do this to see trends in our care and illness and improve quality over time.

2:00     No lunch today. It made me wish I had eaten breakfast. The coffee from the morning was serving me well. Time to teach EKG reading to my trainees. One is an orthopedic resident. The other is a medical intern (1st year out of medical school). They have been with me all week on the ICU service.

3:30    Afternoon rounds on all the patients from the morning to see how they have progressed. Everyone seems to be ok, although many are still sick. Several are well enough to leave the ICU.

4:15     I get a call from one of my ECCCOs (ICU clinical officer) stating there is a problem in one of the HDU (like an ICU but without a ventilator). One of the surgical patients we have been rounding on who had major spinal surgery now has a heart rate of 200! This is new to us. An EKG is ordered. She is stable, and I take the moment of getting the EKG to take Dr. Steve on rounds of all the patient in the ICU service. Steve is on call tonight, and I confess I am relieved that he can take the lead on dealing with the tachycardic patient. Is it a sinus tachycardia or atrial fibrillation with rapid ventricular response. Hopefully the EKG give him some clues.

5:00    Steve is in charge. I leave notes on all the patients for the weekend coverage doctor, and head home to start packing for my flight on Saturday. A pretty full day for my final ICU day for awhile.

Being at Kijabe has to be one of the best jobs in the world!

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Our Internal Medicine team after morning audit.

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Passing Head of Department duties happily off to Dr. Tony

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Friday Morning Internal Medicine Audit

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Teaching EKGs

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Schedules!!!!

I spend a lot of my time doing schedules. I “get” the pleasure of creating the weekly assignment for the internal medicine service as well as the call schedule for the internal medicine service, the outpatient department, and the COVID-19 ward. We are in tough times at the hospital. No volunteers, many of us leaving for our home countries. Staffing is short, and I try my best to be sure everyone gets some time off at some point. Everyone needs a break at times, no matter how much you feel called to the work or even love the work. So please pray for the endurance of the staff at Kijabe Mission Hospital. We are going to need a God-given strength to do the work he has put before us, especially as the COVID virus becomes more severe. God bless Kijabe Mission Hospital.

Having Cake is Fun

I love this! In Kenya we sing this song when we cut a cake. In Peru we had three songs we sang at birthdays! We have our songs in the US too, but there is something about the cutting cake song in Kenya that I especially enjoy!

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Eating cake is more fun in Kenya

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Anxious for COVID Results

We admit people to our COVID-19 ward nearly every day. We have partitioned half of our hospital to take care of all of our corona virus patients. We place all of our patients who present to the hospital with shortness of breath, fever, hypoxia (low oxygen levels) into this ward while we await their COVID virus tests to come back. When they come back negative, we move the patients to the normal ward. We try to get them out so that they are not there when the next patient arrives who might possibly be infected. So far we have been able to keep all admitted patients in separate rooms so that we do not cross-infect a negative patient from another who might test positive. Nobody has tested positive in the COVID ward, and we have been able to move them all over to the normal beds. Usually these patients “just” have tuberculosis. Once we start having positive patients we will not be able to transfer patients over to the normal ward, and all who end up the COVID ward will be staying there whether they are positive or not. Because once they are admitted into a ward that has COVID positive patients, they are considered exposed and possible transmitters. This desire to move patients to the normal ward makes us eager to get results, and so it means we make multiple trips to the lab with frequent calls to the lab manager asking if results are back. That is why you see Godfrey begging for results in the picture below. We want to get patients out of the COVID ward to the normal hospital where they belong!

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Tracking down labs

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Mudding our Way Through the End of April

Rainy season is in full swing! The kids have started back into their third trimester of the year. Both the school year and rainy season will end sometime in July. So far COVID is ok, but we are hearing sad stories from Tanzania just south of Kenya. I have a lighter schedule next week, and so I hope to get caught up on many mini-projects that I have on the brain. That is unless corona virus infections arrives. Then it is all hands on deck until it calms down. Keep praying for us! We are praying for you in return.

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Mudding through some rainy season blues!

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Home Office

There is not a lot of space at our house. When I work at home the porch that we built is my home office. The view is not bad!

Doing some COVID virus review

Do You Like to See People . . .

. . . hurt themselves in videos? I am a sucker for all those videos of people falling off swings, crashing skateboards, etc. This is not quite the same thing, but if you want to see someone suffer a little bit, here is a clip of me allowing the lab to practice doing a nasopharyngeal swab on me so that they can do adequate COVID virus tests. Its not comfortable.