Internet!!!

November 20, 2009

Internet! Finally! We've been trying for the last two days to connect with no success, and all the computers in the hospital are broken. I just tried to whine about it to Dustin, and he reminded me that we have running water "which would you rather have?" He's so wise... and such a smart ass.


Anyway, now that I have internet, here's the last entry from my word document. I don't want to try my luck, so I'll post fast! Missing everyone! And sorry to keep my "fans" waiting for this post!


November 18, 2009

I survived my first call! I managed to get a few hours of sleep last night (in spite of the barking dog that lives next door—I keep thinking about Dad, yelling at the neighbors’ dogs back home—could I get frustrated and sleep-deprived enough to yell out the window in Kijabe at 4am?)

My adventure began at around 10pm, when I decided to check on a patient I’d admitted with bleeding in pregnancy. She’d been bleeding for about 12 hours, and I suspected an abruption (separation of the placenta from the uterus), but her baby had been ok. She was supposed to get an ultrasound to decide how far along she was—no one seems to know their due date, since they usually do not see a doctor during pregnancy. But, just like so many of my orders here, that never happened, so I took her to the ultrasound myself and decided she was somewhere around 35 or 36 weeks along, and she was contracting and her cervix was dilating, so there was nothing to do about keeping the baby in longer. But when I came by at around 10pm, her bed was soaked with blood. As it turns out, patients have to pay for maxi-pads, and she couldn’t afford them, so she bled in the bed all day. I listened to the fetus for a minute, and realized it was tachycardic, so I dragged over the only monitor in the ward, and got a paper tracing that was pretty scary. I decided she needed a stat cesarean section. I called the consultant on call for OB, and he said “go ahead and do the c-section with the intern on call tonight” so we did. I walked into the OR and had to walk into 4 rooms to find anyone to ask about doing the operation. Unfortunately, the orthopedic surgeon was about to do an amputation on a patient, and there is only one OR team in the middle of the night. The orthopedic surgeon looked at me like I was speaking a different language (which, technically I was, since he is a Kenyan doctor) and grilled me about why the cesarean section needed to be done now, and why I didn’t do it earlier, and how long it would take, and if I thought his patient could wait… aaah! Time was ticking, and I was worried about this baby, but these people don’t know me, and obviously doubted my authority to have them to stop their operation and help me do mine. Fortunately, they did, and I delivered a very large baby boy, covered in thick meconium (baby poo) and attached to a completely abrupted placenta. The baby and mom are both doing well today—although I can’t say the same for myself. I pretty tired.

My other continuity delivery was a breech extraction of a 24 week demise. This mom is a 41yo G9P8 (she has delivered 8 babies, but has 6 living children, as the last 3 have died in utero). She came in to clinic yesterday and I saw her for decreased fetal movements, and found no heart beat and confirmed it on ultrasound. I’ll spare the long story, but I delivered her fetus this morning alone (scared, since I’ve never done this before) after monitoring her frighteningly high blood pressure and her emotional state all night. I’ll be tying her tubes next week.

Sorry for the depressing stories! I did get asked to marry one of my patient’s sons today, and I’m giving a talk for the staff tomorrow on cervical cancer screening, so that’s exciting. Dustin is cooking dinner for us tonight (curry? More goat?) and he promised me we’d get to watch an episode of Top Chef on his iphone tonight as well—he downloaded 10 episodes for us before we left, and it’s our little treat! It’s about the only time I completely forget where I am, and lose myself in reality TV!

Eric had asked about the weather—it’s their “short rains” season, so it’s pretty much gorgeous all day, from a pink sunrise to clear blue skies at 75 degrees all day, and then around 6pm every day, the wind picks up tremendously, and persists for a few more hours or long into the night. Then sometimes it rains during the night. It had been a drought for the last 3 years in Kenya, but this ended about a month before we arrived. You’d never know—there are amazing plants and everything seems very lush. But many of the plants are succulents—there are huge cacti everywhere. The dry, red soil is our only indication of recent drought, and our white coats are now stained slightly, along with all my white socks. Our trip last weekend to Naivasha was hot, since we were in the valley, and we all got sun-burned. Gotta love living on the equator!

I’m off to help Dustin with dinner! Hopefully the dog will be quiet tonight, so I can sleep… Too bad the Kenyans eat goat, and not dog….