I'm up a little earlier than usual this morning, courtesy of a call around 6:15 to make me aware of a little preterm baby that had just been brought to the nursery. And I haven't blogged since Friday evening, so I thought I'd make myself a tall mug of coffee, enjoy some leftover cornbread, and take advantage of what will likely be one of my last chances to update. (Patti, if for some reason you are reading this, it was actually a good thing to get up fifteen minutes early, and I don't want you to feel bad.) But it appears that I'm down to my last two days at the compound, which is a very sad feeling. Last night I had horrible dreams about having to say goodbye, and it seemed like I could never find everyone to whom I wanted to say farewell, and there was a lot of crying. I suspect it's not that far off what will actually happen. :) But anyway, my last weekend on call is over, and as there wasn't one cohesive theme that emerged from the two days, I'll resort to the bits-and-pieces approach.
Around 3:00 on Friday afternoon, I was summoned to casualty to see a five-month-old baby named Kibet who had been brought in with gastroenteritis. By the time I saw him, he had received 60 ml/kg of fluid (in layman's terms, a lot), still looked somewhat lethargic, and hadn't had any urine output yet. Joshua Nderitu, the FP registrar who was working in casualty, told me that he had also obtained a history of herbal administration from the mother, and my heart sank a little as I remembered the little baby we lost two weeks ago with the same story. An hour later when the creatinine came back at 2.2 mg/dL, it sank a little further, and we cleared out an ICU bed for him as soon as we could. (It's the only place in the hospital where you can really get reliable ins and outs and be on a continuous monitor.) I think I must have bemoaned the lack of ability to get urine electrolytes about a dozen times that evening (in conjunction with bemoaning the widespread use of herbals) and second- and third- and fourth-guessed my decisions on fluid management. You have perhaps heard me say you have to be smarter to be a good doctor here since you can't just order tests for everything? This was one of those times. But I did the best I could and prayed for God to bring him through the rest of the way.
On Saturday, Mercy and I set a land-speed record for rounding on peds and finished up with both the ward and the nursery by 11:30, which was a particularly fortunate thing since I had woken up feeling a little green around the gills and had to sit down about every five minutes in order to think properly during most of rounds. God was definitely looking out for me. But Kibet's creatinine was up a little from admission, which lent credence to my suspicion that this was not just dehydration, but wasn't terribly reassuring, and I began to wonder when I should talk to the parents about transfer to Nairobi (while he was still stable on room air)...
Sadly, the green-ness of the gills prevented me from enjoying the two Kipagenges on Saturday, at least from a culinary perspective - by dinner, all the appetite I could muster was for a bottle of Sprite. But I did have fun getting to hang out with everyone, I think particularly since I hadn't been already stuck in meetings with the whole crew all day. And John and Krista offered me their supply of Pepto Bismol after dinner, which I took, in spite of the fact that I really detest Pepto. But it did result in some improvement, enough that I wanted to be awake, but not to think much, and so Laura and I borrowed Love Comes Softly (fine, laugh if you must!) from Krista and watched it before calling it bedtime. A last-minute call to the ICU for Kibet's evening creatinine results resulted in being told that the creatinine machine was currently out of order. Oops. But he had had a little bit of urine, maybe even not in response to Lasix, and so I was slightly encouraged.
Yesterday, Laura - who has been unable to sleep past 6:00 am for more than a week now - came up to the nursery with me to start rounding at 7:00. I was pleasantly surprised to discover that my nausea had really abated almost completely, and rounds were conducted in the usual upright position. Also, it turned out that the creatinine machine had been fixed, and Kibet's numbers were actually down! We weren't quite as fast as the day before (but did get mostly done prior to church at 9:00) and still had about three babies left in nursery by the time we had to get down to Mercy Rop's for lunch.
One of the small miracles of yesterday was that I discovered in the course of casual lunchtime conversation that Linner had been unexpectedly assigned to go to a week-long seminar on infant nutrition in Nakuru this week. I think I must have looked absolutely stricken when Mercy told me this, and she made several phone calls until she found Linner up at her office at the hospital. Which is where I immediately ran (as much as one can run up the hill to the hospital on a full stomach) to find her. There were at least five or six things I'd been saving up since Thursday to ask her - on Monday, I thought - and it would have been horrible not to be able to say goodbye. (I have a thing about goodbyes, if you haven't noticed.) She gave me advice, some keys, a few assignments, and a big hug. There are a lot of times when I think I would come back to Tenwek just for her...
Other random facts from yesterday: when I went to return the Pepto to the Fitzwaters (um... and get the next movie in the series), Krista told me that I had missed, by about ten minutes, some major excitement. Evidently a large crane with a mostly-detached wing had landed in the green space, and to put it out of its misery, Eric Miller chopped off its head... with a panga. And then put it in the trash can. Someone is going to get a nasty surprise when they empty the garbage containers today!
Also, because of a child who came to casualty in status epilepticus, I had to move little Kibet out of the ICU last night, at which point it looked like he might honestly, for real, be making some urine on his own and pharmacologically unprompted. Pray for him as he may be turning a corner! The funny part of the status case - if there can really be a funny part - is that I was in the middle of writing my seizure presentation for today when Agneta called me from casualty to tell me about the patient, whom she'd taken care of by virtue of being in the right place at the right time. As she gave me the history and told me what she'd done, I had to stifle a laugh, because it was almost as though she was reading through the slides of my presentation. The child even had the same name - Kiprono - as the child in my case scenario. I told her maybe she should go back to being an intern, as she was obviously very good at it! (I don't think she was all that amused.)
The most exciting news of today, though, is that Beth Stuebing is scheduled to arrive today at lunchtime! She is a good friend from medical school who is now a surgery resident at Brown and was meant to come in March of this year - well after I left from my Jan/Feb trip - but was delayed because of the post-election violence, and so I will actually get to see her for a couple of days, which is tremendously exciting. Getting to share someplace that has become so special with good friends is very cool.
So that turned out to be more of an excessively long narrative than a bits-and-pieces approach, but hopefully you made it through. I will try to write at least once more before my departure from Tenwek (and known internet access) on Wednesday morning. The plan is currently for Agneta, whose birthday it is on Wednesday, and me to go on safari for a couple of days and then head into Nairobi on Friday... I'd appreciate prayers that all the details would be worked out smoothly, because a few things are still a little up in the air.
Time to go talk about seizures!
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