In five minutes

I have only five minutes before the driver comes to take Kenji and me to Lake Nakuru. I picked him up in Nairobi on Thursday morning after an eventful last night on call Wednesday. Gotta love the 911 page at 1am to go immediately to the operating room but no one could tell me why. I was going through the senarios in my head as I ran up the hill in pitch-black pouring rain. I looked like a drowned rat by the time I got there plus I was having a full on asthma attack from the exertion and had forgotten my inhaler at home. Turns out, the page was to resuscitate a baby with thick meconium with decreased fetal movements and reported low heart rate on the monitor but no one could tell me what the heart rate was. They had already started the c-section on mom. Ok, I thought, I know what to do with this. I received a blue, floppy baby with no respirations-- the intern dried while I checked for a pulse. There wasn't one. Hmm, worse than I thought. I started chest compressions while the RN got Epinehprine ready and the intern bagged the baby. As I pulled back the now wet blue towel to get better access for chest compressions, I saw that the back of the baby was macerated and therefore had likely been dead for at least 12-24 hours. The operating intern was shocked that the baby had been dead for some time since he thought he had heard fetal heart tones. Good reminder for interns to check mom's pulse at the same time as trying to check baby's when it is that low and you are unsure. This was this lady's first baby and now she's had a c-section. Not the end of the world but it could have been prevented.

Immediately after the code that wasn't, the peds intern looked at me and my clearly wheezing, labored breathing and went to grab the pharmacist. They then proceeded to hook me up with a 30 shilling albuterol inhaler from the pharmacy (30 shillings is equivalent to about 40 cents.) Sweet. Then she told me about the preterm newborn with likely birth asphyxsia (apgars 2/5/7) who was now seizing in the nursery. Um, yeah, would have liked to have heard about that one a little earlier but oh well. I've decided that the best way to stay sane in this place is to try and fix only what you are given at the TIME. Not what you COULD have fixed had you been called earlier. If you attempt the latter, you will literally go crazy-- trust me, I've been there.

I arrived in the nursery a few minutes later and indeed, found a seizing newborn. I remembered what I was taught in medical school:
Step 1: check your own pulse--> super high, check. I'm clearly nervous but also have had about 10 puffs of albuterol so it's not all my psyche talking.
Step 2: check the clock--> there isn't one. Forgot my watch at home. Whatever, doesn't matter anyway, who knows how long this kid has really been seizing.
Step 3: What do I want to do and what of that list is available here?--> haha, this is the tricky part.

So, after I gave a loading dose of phenobarb and sent the nurse off for an LP kit, I asked for labs and blood cultures. The aid went over to the shelf and handed me the blood culture bottle and said, "ok, here you go Docteri." Ummmm...... this means you want ME to draw blood on this preterm kiddo? Now it was my turn to give the "blank stare" response. This was quickly followed by me literally laughing. I told her to call the intern immediately. Sometimes we all need to call for help!

Uh oh, driver is here, more later after a hopefully GREAT weekend at Lake Nakuru-- bring on the flamingoes!

Just Another Day in Kijabe

So, I found the only poorly behaved child in Kenya. He was hiding in the outpatient clinic waiting for an asthma follow up visit. The medical student needed a lung exam confirmation so after I listened to his lungs and agreed that his beclomethasone inhaler was working perfectly, I offered him a sticker for being good and he reached over and literally slapped me in the face. And I must say, that kid was strong! The mother then started hitting HIM to discipline him. I tried to stop her but I could tell it was no use. She was horrified and wouldn't look me in the eye for the rest of the visit. On my way out the door, I dodged another jab, this time a punch to the hip area. Gosh, and I thought I was good with kids.

Other than being beaten up by a skinny 6 year old, it was a typical day on the maternity ward. Started off with rounds where we discovered that a woman had come in with chickenpox the night before and delivered her first baby. The good news: the nurses had put her in REAL isolation (like, I didn't even think we were still in the hospital compound.) The bad news: they put the baby in isolation with her and have been letting him breastfeed with open chickenpox vesicles all over mom's nipples. My panicked look upon hearing this yielded blank stares that I interpreted as: "well, what else were we supposed to do?" <sigh> After much thinking, consulting, phone-calling, and more thinking, I finally decided to give the baby prophylactic acyclovir since there is no IVIG here-- the only way to make this happen is to break 200 mg pills into fourths and then pulverize them mixed with breastmilk (no IV or liquid PO acyclovir here.) The parents can't afford formula and there are no breast-pumps so mom was going to try to express her milk but she's a first time mom so not much was coming out. I hope I prevented badness in this little one... because this badness is B.A.D.

Rounds were followed by a few c-sections (one of which I was primary) and other various procedures. Just before he was heading off to the operating room, the Ob/Gyn glanced at me and said, "You can handle the two MacDonald cerclage stitches, right?" I think he needs a refresher course on what exactly my qualifications are. I felt guilty telling him that I'd never actually seen one placed before and that he should probably do it. I mean, sure, I will do cowboy things at times but this was pushing it.

My day ended with a few more admissions from the maternal child health clinic. A woman who thought she was 25 weeks by dates but who has a fetal demise at 19 weeks-- she will be induced tonight. The second was another sad case with twins but found to have one early twin demise on ultrasound and the other twin is anencephalic (basically, doesn't have a brain.) So, we are inducing her as well. On my way out I checked on my 5 day old 34 weeker with kernicterus (serious brain damage from neonatal jaundice) who was admitted last night with a bilirubin of 48. Yes, that's right, 48. We did an exchange transfusion on her and today it's down to 30. Given that she probably won't make it, we aren't exhanging her again. The most frustrating part is that she has been in a private hospital since her birth and they noticed she was becoming "more jaundiced" and transferred her to us. Umm, ya think!? Incredibly sad.

Since I don't like ending with sad things, I am happy to report that my mom with rheumatic heart disease I delivered via vacuum the other day is doing GREAT-- turns out, not every story here has a sad ending.

Comings and goings

I technically had a weekend off this week but really that means that I just didn't have to go to work on Sunday. And the highlight of my day off was sadly quite exciting around here and consisted of finding a bag of microwave popcorn and watching all four hours of "Anne of Avonlea." <sigh> I'm almost embarrassed at how much of a thrill that was.

In general, this is a week of flux. I am the only thing standing still it seems and others around me are either coming or going. Two new anesthesia residents from Vanderbilt arrived yesterday and they are in shock still. Phillip the current U of Texas anesthesia resident is on his way out and is in fact giving me all his uncooked vegetables today-- I am actually quite excited about this. Samantha the peds attending (she is only one year out) is leaving on Friday, Kenji is finally arriving on Thursday (YAY!) and my roommate the peds resident is leaving Saturday. I will stay here and hold down the fort. I am incredibly happy that Kenji is going to join me here but I am sad to see my three friends leave. It's been a rough go for the four of us, all trying to survive here and finally realizing in the last 1.5 weeks that we DO have things in common: we are all struggling and we all miss home. It's not a match made in heaven and I doubt that we would be friends in the real world but here in Kenya, we are all "good enough" for each other to cling to. I'll be sad when they leave me behind.

We were quite the team of residents today in the delivery room actually. We've had a patient on the maternity service for the past few days in heart failure from what we are presuming is mitral stenosis from rheumatic heart disease given her murmur and a very limited "heart ultrasound" which I won't even pretend was an ECHO. She was 37w4d today and during morning rounds was having contractions and found to be 4cm dilated already. When she was about 8cm, Phillip came by and gave her intrathecal demerol to try and help her pain since we don't have epidurals here and we wanted to keep her tachycardia as controlled as possible. Worked like a charm and soon she was snoozing american style! We were able to let her to labor down for about an hour and a half and then it was time. The OB/GYN was busy in surgery all day so he left me in charge of getting this woman delivered with a healthy baby. At least he left me a NEW Kiwi Vacuum. When it was time to start making things happen, I gathered my resident team of Phillip from anesthesia (to intubate in case she coded,) Sarah from Peds (to resusc the baby with what I knew would likely be a massive cephalohematoma with very little intrapartum monitoring) and myself with the vacuum in hand. I brought down one of the medicine attendings too to monitor vitals and push lasix and turn up the oxygen during pushing. Before I put the vacuum on at only +3 and no prior pushing, I thought to myself, "This is either going to go horribly wrong in every possible way or it's gonna be just fine. Nothing I can do now except PULL." Which is what I did, HARD, with about 15 people in the room watching me. 10 minutes later, we had a healthy 2.5kg baby boy with only two vacuum pop-offs and minimal maternal pushing to keep her heart from going into more failure than she already was. After repairing her almost inevitable 2nd degree laceration given the circumstances, we handed over this young woman's first baby, to be named Peter. She only gets two chances at having children so I'm glad I didn't screw this first one up.

Btw, Tuggy, do you think I can get signed off on vacuums when I get home?

The Terrible Twos

Have you ever seen a grown attending throw a hissy fit in the middle of the maternity ward? I'm talking on the scale of a poorly parented 2 year old complete with foot-stomping, fake collapsing on the floor, fist-pounding until mom gets you that extra piece of pie BEFORE dinner kind of fit. Well, I have. It was one of the more dreadful sights I've seen here in Kenya-- and that's saying A LOT. The only thing stopping me from telling him, "welcome to the club, now suck it up and take it like a man" was the fact that it would have only added to the complete lack of professionalism that was already unfolding in front of me. And it wasn't even over something WORTHY of such a tantrum. Apparently, he felt abandoned by the lack of both interns and clinical officers this weekend leaving only me, a clinical intern and the medical student to round with him. Yes, I was not happy either but did you see me going around stomping my feet? I told him I could handle things (he hadn't even bothered to show up for rounds the day before leaving me to be the attending) but he was insistent that he was needed. Honestly, when he's the attending on service, I manage everything anyway so the only thing I REALLY need him for is if someone has to go to c-section.

I then secretely relished when the clinical intern presented to me and asked me questions instead of him and the medical student stayed at my side the rest of the day to finish up the day's work. After the attending's outburst that had even unblocked laboring mothers paying attention, he barely said a word during rounds until the inevitable, "well, looks like it's tea time" statement rolled around. The worst part? He was wearing a Missouri Tigers t-shirt.... ugh! Stop representing my state while acting like a toddler!!

This was juxtaposed with hanging out on the peds ward the next day just for fun. Samantha and I brought in baby beany babies and bubbles for the kids and had a great time. Kids here are ridiculously well-behaved. And not just because they are sick, attached to oxygen, and have brain issues that don't allow them to get out of bed (which is also true, btw.) They are just... well behaved. The kids loved the bubbles and my favorite part was chatting with 13 year old Phillip who just came out of the ICU a few days ago after finally improving from steroid resistent nephrotic syndrome and PRES syndrome causing intractable seizures. He looks great now (much less like the Michelin man) and it was awesome to see him smile and hold onto that tiny bottle of bubbles like it was the best gift he'd gotten in his whole life. I think I might go visit him again tomorrow just to say hi-- he makes me happy in this crazy Kenyan world of medicine.

The day to day

I've come to the realization that while I'm frustrated by the hospital and I often don't know what I'm supposed to be doing, at least my work keeps my mind off the fact that I would rather be somewhere else. I've had a few work days in a row where I had plenty of things to do to keep busy and for that I am very thankful.

I came in to rounds the other day and noticed that everyone was in the middle of coding a young woman who came in with a 37 week fetal demise the night before and was being induced. They had been coding her for about 45 minutes at that point and no one had bothered to call despite the fact that I was ON-CALL. Umm, seriously interns, this is when YOU CALL SOMEONE!!! Whatever. At least the right people had managed to show up accidentally, from the anesthesiologist (who was just walking by) to the ICU doc (see below) to me (see above) and then the OB attending (that I called after I showed up.) Apparently, one of the interns went up to the ICU asking for amiodarone, which triggered Dr. Beth to politely inquire what exactly she needed it for.... these interns are out of control!! Anyway, I've never actually seen an amniotic fluid embolism before but given that she had an IUFD, witnessed sudden arrest,  followed by seizures and pulmonary edema, it's her most likely diagnosis. She is still up in the ICU intubated and not waking up despite her sedation being held. It's incredibly sad but also slightly miraculous that she is even still alive at all.

Later that day, I was up in the ICU checking on the above patient and noticed poor Dr. Beth bagging the 2 month old ex-28 weeker with the pulse-ox machine registering 40%. I stepped into the heated room to ask if she needed help and by the look in her eyes, I could tell I wasn't the only person feeling completely overwhelmed and outside of their expertise. Dr. Beth is internal med/critical care and she is acutely aware that kids are not just small-sized adults, especially this one. I swung into action knowing that two people with no clue of what to do were better than just one. We were about to stick in a 23 gauge needle with stop-cock into this kid's left chest to relieve a presumed pneumothorax (he already had a right sided chest tube) when we noticed that the ET tube had slipped-- we pulled it back and suddenly he had bilateral breath sounds again. Well, that was easy. Didn't help his lack of pupillary response or corneal reflex though. The crazy thing, though, is that this is the 5th time this little guy had coded and the next day he is always awake and looking around. He goes from living to dead to living again-- so when is enough, enough? As if it weren't hard enough of a thing to decide, this kid defies logic. Nurses call him a gift from God who was meant to live. And maybe he is. I just can't help wondering what his brain function is going to be like after such repeated anoxic insults.

I came home that day and found a woman lying on my grass in front of my house with her approx 18 month old little boy running around my yard. My first thought upon seeing her??? Great, she looks heavy, how am I going to carry her all the way up to the ED by myself to code HER as well? Turns out she was just tired and decided to take a nap in front of my house-- which she continued to do for the next hour or so as her toddler ran around free in the yard and then my kitchen when I opened the door to keep a better eye on him. Because honestly, I don't need a perfectly healthy toddler's accidental death by falling off a cliff or being attacked by baboons on my conscious as well....

Holiday

I'm sitting here remembering my day and eating pasta for about the 89th meal in a row. Ok, not really since I've only been out of the country for 12 days but it sure feels like it. It doesn't help that the one meal I ate at a restaurant since coming to Kenya was called "Trattoria" and guess what they served??? That's right: pasta. However, clever me got my wheat, tomato sauce, and meat in a different combo. Uh huh, you guessed it-- pizza. Way to think outside the box JGG!

Sarah, Phillip and I took a trip to Nairobi today and it was just the holiday we needed. It was Heroes' Day today in Kenya so that means we all rounded at the hospital and then hit the Toyota to the big city. Here's where it gets interesting: our tunes selection for the ENTIRE day? Gospel music by Dolly Parton. On repeat. It gets better. There were several duets with.... wait for it...: The Partrige Family. O...M...G...

First stop was the Orphaned Elephant Park where we saw baby elephants get fed with massive milk bottles (that's right, Carnation Goodstart SMA formula for these guys!!), followed by a little watertub time, then some leaves and tree branch fighting, followed by frolicking in the mud hole. Gotta say, the whole thing was pretty damn adorable. Oh, and on the way out, we saw a few orphaned warthogs as well. Pumba is much cuter in The Lion King than in real life.

Next up: Trattoria in Nairobi (not my idea, I swear.) However, all was not lost on my cultural adventure because our driver actually had never had pizza before-- enter looks of shock and horror from my two VERY American lunch companions. We fixed that situation right quick! Also, apparently high society members of the government frequent this place as well because there were two Kenyan Parliament members at the table next to us. I was going to ask them how they felt about the recent strike of Doctors at the National Hospital in Nairobi who are demanding a 600% pay increase or they will quit in two weeks. Decided against it, however, since I probably would demand a pay increase too and didn't want to betray my breathren no matter how ridiculous I think it sounds. I mean, I know you are supposed to start high in negotiations, but....

After the almost 2 hours it took us to have lunch, we went to City Market for some shopping (this was short-lived) and then headed over to the Giraffe Park where we got to feed giraffes up in a little tree-house portico. Who knew giraffes had such long tongues?? Also, giraffe saliva is sticky. Eww. Turns out that elephants are quite affectionate by nature and love to be petted and rubbed. Giraffes, not so much. It was great fun and probably the only time I will ever be within inches to a giraffe's face.

From there we headed over to the Verandah, a restaurant nearby that serves Tusker beer, which all three of us wanted to try before leaving since it's the most famous of the Kenyan beers. And why not celebrate the Heroes of the day? After we were nice and liquored up, it was time to shop at the Verandah's super expensive stores. Sarah bought a truck load, Phillip got nothing (typical) and I got two paintings framed in tinfoil (I'm not kidding, it looks like the stuff my grandma used to wash out and save on the kitchen counter to re-use.) Their saving grace is that the paintings were done by homeless teenage boys who joined the project to give them a way to make money instead of getting involved in gangs and crime. How can you say no to THAT!? Also, got a pretty scarf (which was probably made in India) and a necklace. Not too shabby.

Overall, a pretty great holiday. I really got a chance to see Nairobi in the daylight and spend a little time there which I'd been hoping to do before I left. And I'm actually not dreading going to work tomorrow. Now, since it did such magic today, I wonder if Phil the driver will let me borrow that CD for the plane ride home ;)

Blog Retraction

The lessons just keep on coming. This time, it's more personal.

First, I would like thank everyone who wrote me a personal email after my last post. They helped me immensely and it was truly nice to start hearing from so many! All of that being said, I have realized it's perhaps NOT a good idea to use a blog as a personal diary when many people who love you and literally live half-way across the world will read it and then become worried that you are so sad you are about to jump off Mount Longonot. Definitely not the case. Am I sad and lonely? For sure. Am I a little situationally depressed? Definitely. Am I clinically depressed and not able to get through my day without smiling and finding some good in the things I do? Certainly not! It's just taking me some time to realize what this is experience is actually going to be this month and how to come to terms with it while still enjoying myself. I'm trying but it's hard. That's all.

And for all this physical sickness business, it's nothing that I can't handle. Sure, it's not ideal but please don't think that I'm allowing myself to become a shriveled prune who just lies around and doesn't attempt to rehydrate or eat food. Not the case, I'm well taken care of here with the meds I brought from home. My recovery is just taking a little while longer than anticipated with some extra post-infectious complications. No biggie. No need to worry over there. I swear!

Ok, well, I think that's all I have to report today-- it's been pretty boring around here to tell you the truth. I was supposed to be off this weekend but I think I just got roped into doing intern's work on Saturday. Need to decide how I'm going to put a kabash on that in the next few days. Cuz I'm tellin' you right now, that ain't happening, no matter how pseudo-depressed I am!!!

The One Week Depression

I thought I was supposed to love it here. I have now come to terms with the fact that I don't. Right now, I'm not even sure that I LIKE it here, much less love it. I'm sure this is aided by the fact that I am going on day 4 of illness despite medication and the rainy season has started. However, even without those things aiding in my situational-depression, I'm just not feeling it. Everyone else who has been here from Seattle seems to have loved it so I'm trying not to feel inadequate or ungrateful or just downright a bad person. But, there it is. I can't hide from the truth any longer or I just might go insane.

It makes me feel better that at least I am not the only one here in Kijabe who feels this way because my missionary roommate, Sarah, cries about twice a day. She has even gone so far as to price an early ticket home but with the $2K price tag, has decided to wait out her two weeks. I oscillate between trying to comfort her by staying positive and wanting to just give in to my feelings and cry right along with her (those of you who know me well know that I DON'T cry easily.)
Is it that we feel like we have no place or purpose? We don't really.
Is it that there is no community here for us to feel a part of? Kijabe is NOT like the rest of Kenya.
Is it just plain old homesickness and loneliness? Definitely part of it.
Is it the frustration of the medicine? Also very likely.
Is it the lack of communication between the interns and us (the supposed attendings) who then have to go clean up the mess when things fall apart because no one called us sooner? For sure.
I'd like to add to my own personal list: likely electrolyte derrangements with dehydration, feeling totally isolated among the missionaries who talk about religion all the time (which makes me very uncomfortable,) and just purely missing my friends and family back home. I haven't felt this sad and lonely in a LONG time and I am truly struggling with how to deal with it and still maintain some semblance of a good time here.

I have a morning conference schedule which said that we had staff prayer today at 7am so I showed up at 8am hoping that I would "accidentally" miss it since I'm more of a "spiritual person" rather than an "organized religion" person. In fact, I'd say I have a DIY attitude about religion and like to both be left alone regarding my beliefs and to let others practice the way they feel is best for them. This, however, is not how they do things here. Turns out, my schedule was wrong, staff prayer started at 8 and rounds were at 8:30am instead. After I made an excuse about wanting to check on a patient in the women's ward that I admitted over the weekend (which is true, I did check, she died,) I then proceeded to try to hide in the basement to avoid the massive church services that I had to attend last week and instead spend that time introspectively soul searching for ways to psych myself up for another week and get out of this funk. Turns out, the medical staff prayer room was right next to my hiding place and not only did they snag me thinking I was just lost on my way there, but I also finally ran into the medical director whom I've been waiting to meet for a week. Not exactly the frame of mind I was hoping to be in when finally meeting him. Oh well, I put on a happy face.

Then, to my horror, staff prayer was way more involved than I anticipated and included me having to offer my prayers outloud to the whole group. Inside, my prayer went like this, "Dear God: Hi, it's me Juliann. I'm not sure if you remember me since I don't formally pray very often but in case you do, please GET ME THE HELL OUT OF HERE!!!!! Thanks. Umm, I mean, Amen." Luckily, for my actual spoken prayer, my Catholic school days kicked in and I avoided sounding like a female version of that horribly uncomfortable scene in Meet the Parents when Ben Stiller is asked to pray at the dinner table. By the time the service was over, I was sweating profusely despite it only being 70-something degrees and practically in tears (again.) Sarah looked refreshed and smiled at me before we went off to rounds. At least that's working out for her.

The rest of the day has been better and at least Wednesday of this week is a holiday so Sarah and I are planning on going to Nairobi for the day. I think Thursday I'm going to try to go out into the community again since that has been the one thing that I've done here that I really enjoyed-- I just need to find a way to make that happen. I'm still hoping that I will adjust and will one day look back on all this and think, "Yeah, I had a GREAT time in Kenya after I got over those first few bumps." Until that day comes, I'm just trying to take it a few hours at a time :)

Tummy Rumblings

Lesson learned today: Be careful what you wish for because you just might get it! I spent the whole day NOT in the operating room but in the gynecology clinic instead. 132 patients later, the intern, clinical officer and I were officially begging to be allowed back into the slow pace of surgery. I saw some interesting stuff and made a few diagnoses that the others hadn't heard of before (atrophic vaginitis, bartholin cyst abscess, etc) Also, did several VIAs (without lugols) and many cervical biopsies (with dull instruments and no monsel's) all with a broken light: step aside Tuggs and EHutch, JGG is coming back a master! Btw, those gyn/pap protocols should be added to the packing list because those would have been SUPER helpful today. I will also never underestimate the power of being able to do a wet mount again. Here, ANY type of vaginal discharge leaves the clinic with the "vag package:" doxy, flagyl and clotrimazole for 14 days. Yikes!

While seeing patient after patient and trying to figure out the management of a septated cystic pelvic mass without the aid of UpToDate or an actual Ob/Gyn, I realized something: I was DAMN thirsty. There is no water in the hospital that is drinkable. I then tried to remember the last time I drank water: 5:30am when I took my multivitamin. This triggered trying to remember the last time I peed: about that same time. It then dawned on me that I don't even know where a bathroom is located in the hospital. I've been working there 4 full days now from 7am until about 7pm and I've never even had the THOUGHT about wanting to pee. WHAT!?! I suddenly became panicked and envisioned myself going into renal failure and needing dialysis in the middle of Kenya. I think this is the sleep deprivation speaking. About two hours later, my tummy started to rumble and gurgle. Still seeing patients. Then a wave of nausea hit. More patients. Uh oh. This isn't good. 5 hours and four pepto-bismol later, I find myself in the beginning of the inevitable while on-call at the hospital for the next 72 hours. Awesome. Let's hope they keep oral rehydration packs at the hospital that I can take home and mix with my own potable water.

The Real Deal

Today, I truly felt like I was in Kenya. I was offered a respite from the daily grind of c-sections to go to a rural community clinic in a Masai Village in Sayipei. It's a clinic staffed by nurses every week but the doctor is only "in town" one time a month when they get someone to volunteer to come from Kijabe down to the village. On good weeks there is more than one doc who offers to take the trip-- including this one! This week, it was me and Warren Fisher, the ED doc from Northwest Hospital who is here in Kijabe for a year.

The trip started out in the usual Kenyan fashion, 25 minutes past our absolute departure time and continued in the typical manner of stopping at several stores, picking up other passengers, and making random errands along the way. By the time we were past the bumpy rode out of Kijabe, there were 11 people in the Range Rover and only the driver had a seat-belt. At least no one was hanging off the roof. The morning drive through the Rift Valley was beautiful although slightly desolate at that hour (both people and animals seemed to already be at their daily tasks.) We were almost to Sayipei when our ride inevitably broke down on the side of the highway (because when does a 2 hour drive in the Rift Valley NOT include running out of gas and being stranded on the side of the road amongst gazelles and a rain-water pond??)

We got to the clinic late but not late enough to skip tea before seeing patients (if you've ever been here, you wouldn't be surprised.) After I gulped down my chai, I started seeing the many patients that were already waiting in the holding area. I saw more disease today than I saw healthy although I don't know why I am surprised by this anymore. Diagnosed my first case of brucellosis, which I likely will never see again after I leave here. The clinic workers were shocked I had 1) never seen a case before and 2) didn't immediately know which drugs to treat it (one of which included chloramphenacol...) I did later end up giving my first dose of chlor, but this time for a raging case of PID/salphinitis with the husband refusing to also be treated despite my pleas that she's just going to get it again if he doesn't. I resisted the urge to give him directions to the infertility clinic when she can't get pregnant in a few months. I then saw some pretty standard stuff from my world: venous stasis ulcers that needed debriding (they looked at me like, you're gonna do WHAT with that scalpel??,) uncontrolled diabetes, GERD, rotator cuff injury and of course, diffuse abdominal pain from.... constipation. Back to the common for Kenya was the 2 year old girl with congenital hydrocephalus who wasn't meeting her developmental milestones (duh) and the 3 year old boy with horrendous clubbed feet such that he has been crawling his whole life. The crazy ones were actually the easiest to take care of because they just needed to be referred to Kijabe Hospital to get specialist care and surgery. It was the brucella case and the uncontrolled diabetic with high blood pressure, blurry vision, and polyuria with no ability to get a blood sugar, electrolytes or kidney function on that I was worried the most about. The patients went on and on and continued even after we left due to the fact that we wanted to drive back up to Kijabe in the daylight hours (I don't like to tempt fate either.) The drive back was actually quite beautiful with the blue sky, dusk lighting over Mount Longonot and even some giraffes by the roadside. And this time, enough gas to last us the whole way :)

I think the oddest part about my day was when a young Masai woman randomly reached out and started petting my head and inspecting my curls. A close second was writing my first prescription here on a blank piece of paper with no name, date of birth, and no official paper or ink required. Just the prescription and my signature. Sweet, less paperwork!

The clinic today was an amazing way to spend the day and I wish that I could go back rather than be stuck in the OR all day again tomorrow. I think working at that clinic is more similar to what I thought working in Kijabe would be like, with very little resources and having to really use your head at every turn, from what supplies you REALLY need to use and how to make do with what you have. Kijabe hospital is a resource poor hospital compared to the US, no question, but for the most part, you can get what you need when you need it. Unless of course, you want any sense of urgency or efficiency and then you are just out of luck. Best to just adjust and chillax about the time schedule unless it's life or death (which, it actually IS much of the time.)

I'm on call tomorrow for three days straight for medicine and peds and I have no idea what to expect. I'm not on either of those services so hopefully I won't royally screw anything up. At least I discovered how to get directly from my house to Causalty (the ER) today-- this will make my headlamp-lighted journey at 3am much easier since the nearest entrance is closed after 5pm. Now, all I have to do is figure out how to keep the trash monkeys from attacking me...

The Blank Stare

Today was my first day at the hospital. No one called me yesterday after I got to Kijabe to tell me when and where to show up or who to meet. When I arrived at 8:30am and found my way to Godfrey's office, he seemed to think I was arriving just on time and in the right place. Mind reader? I think so :)

That was until I was initiated to "the blank stare." It kinda catches you out of nowhere and even though I'd been warned by others that I would encounter this, for some reason I never thought it would happen to ME. I was down in the operating rooms trying to figure out my time schedule for if I should come back to assist on the last c-section of the day. I thought I asked a simple yes or no question but all I got in response was a blank stare. Soooooo..... that's a yes? Or a no? Did she not understand my question? Should I repeat it? Does she just hate me? Do she want me to go away and never come back? Do I have crap stuck in my teeth? WHAT!? What made it even worse was that she was in a surgical mask so all I had to go by were her calm and steady eyes looking directly at me with absolutely NO social or behavioral cues to help me. Now, I always thought I had a pretty good sense of reading people and understanding their feelings just through body language. But this intern had me stumped. I still don't know what I was supposed to do. In the end, I raced through my stuff and went back and did the C/S anyway.

Perhaps I will get better at interpreting the blank stare. But perhaps not. Maybe it's an invitation to make my own decision? We'll see how that goes... I just hope I don't piss anyone off more than I already have by never knowing what I'm supposed to be doing or where I'm supposed to be. It's like going back to Day 1 of MS3 year only I'm actually responsible for patients, don't speak the language and can't even find the grocery store. Tomorrow will be better, I'm sure of it. At least I have a plan for what to do when I encounter the inevitable blank stare :)

10 Things I've learned in the last 48-72 hours

1) Charge the laptop BEFORE you get to Kenya.
2) There is a right way to do things and there is a wrong way to do things. Then there is the Kenyan way of doing things. This can be said about every country but it was especially true on 10/10/10 at Nairobi Airport. I'm sure I will adjust.
3) Miracles DO happen: After waiting two hours in the customs line at the airport, my luggage was still around (miracle #1) and the driver who was picking me up was still waiting (massive miracle #2.) I have a lot to be thankful for around here and most of it revolves around getting here in one piece with all my stuff still in my possession.
4) My ___ was my travel face wash and my eyedrops. If that's it, I'm gonna venture to say I did a pretty damn good job packing. Go me.
5) Bags need wheels. Period.
6) Don't be Pakistani when trying to get into an African country. Even if you have a letter from both the Kenyan Red Cross and the Canadian Red Cross, it doesn't help. Did I mention yet that I am thankful?
7) iPhones do work in Kenya. I think I may have made a $40 2 minute phone call. But, at least my loved ones knew I was safe (refer to lesson #1 for how to avoid this situation in the first place.)
8) It's not necessarily the driving here that's scary, it's the random people and donkey-carts running across the concrete divided highway right in front of the car. Yikes.
9) Don't throw away that smashed rogue Reese's Peanut Butter Cup that accidently made it through customs. Chances are, that's dinner. And it was quite yummy.
10) They have Jiffy peanut butter and Welch's Grape Jelly at the grocery store?! I thought I was in Africa...

Is packing the hardest part?

It's the day before I leave and I am slowly marking things off my To Do list. Now I can check off one more because after so many people cornered me about blogging, I finally caved. Here it is. I still can't figure out how to make it private and if any of you blogging-geniuses would like to show me how in the next 23.5 hours before I leave for Kenya, let me know. You will find me furiously packing amongst an entire duffel bag full of suture materials, thermometers, and pulse ox machines piled on top of my usual hair-care routine and enough immodium and pepto to stop all the diarrhea in the entire Eastern half of Africa (thanks for the tip Dr Siegel!)

Trying not to forget anything but I know I will be halfway to Amsterdam when I realize I left my ____ at home. My goal is for _____ to not be essential for a month in Kijabe. That reminds me, must add extra contact lenses to the list. Alyson, why did you not put that on the packing list?!