I'm beginning to think that I need to take some pictures outside of the hospital so that I can provide a sense of the landscape, and not just the buildings where I work. But it's been a bit tricky of late to get good pictures outside. August is winter in Kenya, insofar as winter is actually a season here, and it's a very different experience from the weather in January through April, which is my prior frame of reference. For instance, most of this week, it has been sunny in the mornings (thank goodness, since my shower water tank is solar-heated!), but by the end of lunch, it's usually a race back to the hospital against the rain. And it's not the same as rainy season, either: during rainy season, the daily storms are intense but clear out pretty quickly so that the evening is often sunny again. Lately, afternoon storms have variably given way to a kind of cloudy chill. I'd be lost without my fleece. But it did make the fire in the Bemms' fireplace last night very cozy.
So far the weekend has been a bit of a mixed bag. I managed six hours of sleep last night after two neonatal resuscitations which ended happily (though one poor baby had a pretty impressive caput!) and made it up to the nursery shortly after 7 am to start rounding. Carol (one of the surgeons) replaced the silo in the gastroschisis baby on Friday, and his bowel is actually looking fairly viable, so one of my tasks for the weekend is to sort out an appropriate dilution for the TPN that Tenwek has in stock. And none of the babies were misbehaving badly this morning, which is always a relief. But upon arrival to the peds ward, a nurse and I were summoned to see a child whom we had discharged on Friday and hadn't yet left the ward (not an uncommon situation). This child, a six year old boy, had been admitted with what turned out to be profound liver failure and a liver mass which - because of the liver failure - could not be biopsied. As there was nothing we could do, we had explained his diagnosis as best we could to his parents, and I found his mother in tears this morning as she sat next to her gasping child. We took them into a side room, but mom elected to wait outside in the hall while he died. It's one of the interesting cultural contrasts I've often wondered about here, that parents so often don't want to be present for the death of their children. In the States, I feel like I've been trained over and over to do everything possible to have the parents present during all of their children's critical moments, but here, even when I offer, I'm often turned down. It's been a challenge for me to learn how to gracefully honor these parents' grieving process, too, in spite of my Western sensibilities.
Rounds were mostly uneventful otherwise, though I did decide to transfer a four-month-old boy named Kimutai upstairs to the ICU. He was admitted earlier this week with diarrhea and dehydration and has subsequently developed oliguric acute renal failure (=kidneys not working). Because of this, he has been accumulating fluid and has had progressive respiratory distress. Shortly after he arrived in the ICU, I was called to assess him for gasping respirations and I wound up intubating him, in spite of the fact that the two main ventilators were already in use. Thank God, once his oxygen levels improved, he began to breathe a little bit better on his own again. But unless we can support him until his kidneys recover (which could be in just a few days, or never), he will eventually die. Please pray for him and those of us who are caring for him.
In less mellow news, I discovered a Ziploc bag of chocolate chip cookies on my doorstep when I arrived home this afternoon. Apparently the Hershey's I brought over for the Osteens had already been put to good use, and they wanted to share the spoils. (I ate four right off the bat.) And then when I stopped by to thank them, I was promptly sat down and fed one of Jennifer's enchiladas... and then homemade spicy hummus and pita. So I didn't really have to worry about dinner tonight. And, perhaps selfishly, I've left the remainder of the Ziploc's contents downstairs in the guesthouse with Laura, my new English med student friend (and fellow VeggieTales fan), so hopefully she will succumb to the temptation and spare me from the rest!
Well, despite the eerie quiet of the evening, I should probably call up to the ICU to check on Kimutai. And then it might be appropriate to catch a nap before the inevitable page finally comes...
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