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?