Wednesday, November 3, 2010

Not What I Was Expecting

While this altogether sums up my time here at Kijabe, it certainly applies to today. I went in this morning thinking, "this is going to be a long last day." Not because I was dreading it, necessarily, but because it was the last. Rounds did take forever this morning but I was sad to tell the two charge nurses that today was my last day. They truly do care about their patients and while things happen at a different pace here in Kenya, I've come to realize that these two amazing ladies have made it their mission to make sure things happen when it counts. This morning I was examining a baby who was clearly very dehydrated and I wanted the baby to either get formula or IV fluids sooner rather than later. I told the team we needed to tell peds right away so that they could come start orders. The charge nurse looked at me and said, "No, I'll just take the baby to them right now so it doesn't get missed." Was this happening before and I just didn't see it? Did I completely misjudge them? Or have they realized that sometimes an hour really does make a difference in a life?

I found this happening all day whenever I was telling people it was my last day. Some were sad, some wondered how it could be so soon, some kept telling me to come back right away. And I in return started thinking, "maybe I will come back someday" even though not even 24 hours ago I was rejoicing at the thought of being back home in familiar medicine and not having to deal with this anymore. Maybe all that pink-lemonade I've been drinking gave my contact lenses a rose-colored sheen? Or did I just adjust and finally learn to work within the system? Wait, was I really sad to be leaving? I think I might be...

I was pondering all this walking through the halls after lunch when my pager went off. It was the operating room, they wanted me for a c-section. I walked over and the Kenyan Ob/Gyn (whom I like very much) and I had the following discussion which brought me crashing back down to the hard, dusty Rift Valley earth:

Osoti: "So, there is a c-section going on in room 8 I'd like you to cover if you have time."
JGG: "Sure, no problem. Whom am I going to be doing it with?"
Osoti: "Oh, you want someone with you? Ok, I can give you the medical student."
JGG: <<perfectly mastered Kenyan blank stare with internal monologue going 1 million miles a minute with something like this: "Uhhhh, you mean Martin who has never even SEEN a C-section before and ME, alone, by myself, no-one else, on a real-live patient, who has a husband, and children, and a living baby inside and might die and again, by myself, no-one else, just me??? Are you crazy?? Did your mother drop you on your head when you were a child?? What are you thinking you crazy Kenyan OB/GYN who thinks I can do anything??! I know I am awesome but lets reel it in a little bit here!!">> I think I actually coughed to hide my fear.
Osoti: "So, is that OK? You'll take Martin. And I'll take Naomi (the intern) to help me with my case."
JGG: <meekly> "OK, I'll just go take a look at the patient's chart while they are doing the spinal."

Then I was flipping furiously through pages of handwritten notes and praying, yes, actually PRAYING that this is a primary c-section. Nope, two previous. And she wants her tubes tied in the same operation. This is when I lost it. Yup, over a silly tubal ligation which literally a monkey could do. Don't ask me why I thought I can take scalpel to abdomen and uterus and literally cut a living baby out of a human being but I mentally had a breakdown at the thought of tying some suture around her tubes and cutting in the middle.

Until this point in my medical career, I've lived by the motto: "Fake it till you make it." In fact, this has gotten me through my toughest spots (please refer to the seizing preterm newborn from a few nights ago or rheumatic heart disease delivery via vacuum.) But really? REALLY? This was no time to fake it. I don't care if I'm in Kenya. I don't care if I actually COULD do it all by myself. Why should I model to the interns that it's OK to do something outside your field of knowledge when there is someone two rooms away who has more experience than you and can help you LEARN how to do it so that next time, maybe you CAN do it all on your own? Upon this realization, I found myself marching with strong conviction down to Room 4 where Naomi and Osoti were prepping their patient.

JGG: "Hey, I change my mind. Would it be OK if I steal Naomi for a little bit and then when she is done with me you can have her back? It's just that this lady has two previous scars and I want someone OTHER than me who knows what they are doing in case there are a lot of adhesions." (I'm lying, I'm sweating bullets at the thought that he will say no and tell me I can handle it all by myself.)
Osoti: <knowingly smiles> "Ok, but make it quick, it's just a c-section!"

Naomi and I did the c-section and tubal together but I did every single part of it from start to finish. We even laughed at the end because while my incision was sewn together perfectly, more than 2/3 of it was on the right half of midline. We joked that I was trying to take out her appendix while I was in there. You see, in surgery, you can't fake it. There is no other option but to make it. And while the thrill of doing something as cowgirl as a repeat C-section by myself with no-one else in the room was oddly tempting, no baby or woman's life is worth that adrenaline rush. I hope that this is what the interns here have learned from me: You do what you know. And then you look for help wherever you can find it. Sometimes "making it" is actually realizing that you DO need help and that faking it when someone's life is on the line just won't cut it. It doesn't make you weak, it actally makes you a better doctor. And for many of the patients I helped care for this month, it actually would have saved peoples' lives if someone had just made that call.


  1. You're a strong woman! I'm so proud of you! Come out to Denver and I'll make you some chai!

  2. You know ... with all that amazing experience, I think you should do the OB fellowship ;)