December 4, 2009
I don't have much time to write (I'm taking a lunch break from our GYN clinic), but I wanted to give a quick update. Our last week here has flown by! Vy invited the interns who have been working with her on the pediatric service over for dinner this week-- it was so much fun! Vy made teriyaki, which none of the Kenyans had eaten before, but it was a hit. We talked about some of the challenges of working in the healthcare system in Kenya, including corrupt government hospitals that provide poor care and take money from patients to get better care. The interns may be assigned to work at one of the hospitals for the next three years until they can either pay for, or get accepted for a scholarship for a residency program. Vy, Dustin, and I also talked about some of the challenges we face in the US medical system, including corruption, wasted money, expense, and poor care. The next day, one of the interns who had come for dinner told Dustin that he was in “karaoke heaven”—he meant teriyaki heaven… so cute!
The rest of our week went as usual—we’ve really acclimated to the ways of Kijabe, and it’s amazing how comfortable I’m feeling here. I was in the OR on call the other night, and was the only white person in the hospital, and the only person who did not speak Swahili in the room, and I was doing a cesarean section, and felt more comfortable than I’ve felt in a US operating room ever.
I was also excited about acclimating to the elevation—I was eager to come home to sea-level and go running. I ruined that by donating blood a few days ago! I figured that I would not be allowed to donate once I returned to the US since I’ve been in Africa, and the need here is so incredible! The last time I tried to donate, I nearly passed out and I couldn’t fill the bag (that was in college)—but I did fine, and I’m O-positive, so I’m valuable too! But now I get winded going up our stairs… so much for running when I get home!
We are expecting some of the survivors from the suicide bombing in Somalia to arrive at our hospital today. What an amazingly sad story—I can’t even imagine a bombing at a medical school graduation—it’s nearly impossible to conceptualize the cruelty. It’s really hit home here.
On the other end of the spectrum, we leave for safari tomorrow morning—it sounds like it will be pretty fancy—meals brought to our tents, a pool at the camp site. We expect to see many big cats, but I’m holding out for the elephants…
Then we head back to the states! I’ll hopefully be able to email when I’m at the Masai Mare. See you all soon…
Friday, December 4, 2009
Tuesday, December 1, 2009
Mary
December 1, 2009
Well, I didn’t make it to Longonot last weekend. I got called in twice to the hospital Saturday night, and didn’t leave the second time until 4am. The 7am hike time was not looking good to me. Dustin managed to go, and took some amazing photos. But we’re a sorry looking bunch this week—Dustin hiked and then played ultimate frisbee on Sunday, and had donated a liter of blood to one of my patients last week, and I think got himself dehydrated, so has had a two-day headache and is looking paler than usual (which is hard to do…) Vy has a cold, although we tease her it’s malaria, or TB. I’m sleep deprived, and have some strange rash on my hand and a stye in my left eyelid (who gets a stye??)
Anyway, my call Saturday night involved running in for a quick vacuum delivery (leaving me feeling like the hero) and then a really difficult surgery afterwards. I got the call that one of my favorite patients, Mary, had started to bleed. She’s a 16 year old who’d been admitted about 10 days prior, weighing about 70 lbs with severe anemia (Hb of 3) and tachycardic to the 160s. She’d been bleeding since January (10months) after a pregnancy that resulted in a D&C because of some bleeding (she had to have the pregnancy terminated for a reason she didn’t know at an outside hospital). When she presented, she had a palpable mass in her uterus and a negative pregnancy test and bleeding. She was also very hyperthyroid, which is why her pulse was so fast, that and the blood loss. We gave her meds for her thyroid, and transfused her many units of blood, and took her to the OR for another D&C to see what this mass was—we realized immediately that this was cancer. The pathology came back Placental Site Trophoblastic Tumor or PSTT (very rare) and it results usually after a molar pregnancy (a complication that is also rare, and probably the reason she had to have the original D&C). PSTT has such a high HCG level that our urine pregnancy test was actually negative—too high for the test to read! And very high HCG can cause hyperthyroidism. We knew she’d need a hysterectomy for this, but it was hard, since she is 16, and she was not well enough for surgery. So we were transfusing her and she was looking better every day. Her family was so pleased that she was improving—they thought we were miracle workers.
Over last week, her blood count remained low—too low for surgery. And only her parents would donate blood, and they had exceeded their limit for donation. The blood bank at the hospital only gives out blood when the families also donate, so there was no blood left for her. So we started asking around, and Dustin donated a liter for her. Her surgery would have been today, except that she woke up Saturday night and went to the bathroom and passed a lot of blood. So my intern called me at 11:30pm to let me know Mary was bleeding, and that she was bleeding a lot. I told her to make sure she had IVs in place, fluids running, a new Hb, and to cross-match her for emergency blood if available, and I ran in. By midnight, she’d already bled about 1 liter, so I called the obstetrician. She was not on call, but I knew that Mary needed her hysterectomy, and that the general surgeon would not have been excited to do it. The obstetrician was confused, but I told her “hysterectomy now” and she came right in. I had to wake up a nurse anesthetist and a scrub tech too. Mary was on the operating table by 12:30am and had lost about 2.5 liters of blood.
Sadly, Mary had some tumor growing through her uterus, so she will definitely need chemo, which she may not be able to afford. Also, she did not stop bleeding. During our operation, we suspect that Mary went into DIC (her ability to clot was gone) and she continued to bleed and bleed, no matter what we did. At 3:30am, we decided that the more time we tried to stop the bleeding, the worse she was getting, so we made a patch with her peritoneum and stuffed some surgicel into the site to help her to clot, and closed her up and prayed (I really prayed!)
She needed fresh blood to treat her DIC (we have no platelets to give here) and so the obstetrician started calling people in the middle of the night who are on a registry to donate. She also announced it at church the next morning, and we got 5 people to come donate. And Mary is doing well today! It’s amazing… she asked me today if she could go home! I think we’ll keep her another few days, and then she will hopefully go to get chemo sometime soon.
Anyway, that’s why I didn’t climb Longonot… I’d say it’s an ok excuse. I spent the next day finishing the third book in the Twilight series—so good to lose yourself in a little American teenage drama amidst a very different, real life, Kenyan teenage drama.
Well, I didn’t make it to Longonot last weekend. I got called in twice to the hospital Saturday night, and didn’t leave the second time until 4am. The 7am hike time was not looking good to me. Dustin managed to go, and took some amazing photos. But we’re a sorry looking bunch this week—Dustin hiked and then played ultimate frisbee on Sunday, and had donated a liter of blood to one of my patients last week, and I think got himself dehydrated, so has had a two-day headache and is looking paler than usual (which is hard to do…) Vy has a cold, although we tease her it’s malaria, or TB. I’m sleep deprived, and have some strange rash on my hand and a stye in my left eyelid (who gets a stye??)
Anyway, my call Saturday night involved running in for a quick vacuum delivery (leaving me feeling like the hero) and then a really difficult surgery afterwards. I got the call that one of my favorite patients, Mary, had started to bleed. She’s a 16 year old who’d been admitted about 10 days prior, weighing about 70 lbs with severe anemia (Hb of 3) and tachycardic to the 160s. She’d been bleeding since January (10months) after a pregnancy that resulted in a D&C because of some bleeding (she had to have the pregnancy terminated for a reason she didn’t know at an outside hospital). When she presented, she had a palpable mass in her uterus and a negative pregnancy test and bleeding. She was also very hyperthyroid, which is why her pulse was so fast, that and the blood loss. We gave her meds for her thyroid, and transfused her many units of blood, and took her to the OR for another D&C to see what this mass was—we realized immediately that this was cancer. The pathology came back Placental Site Trophoblastic Tumor or PSTT (very rare) and it results usually after a molar pregnancy (a complication that is also rare, and probably the reason she had to have the original D&C). PSTT has such a high HCG level that our urine pregnancy test was actually negative—too high for the test to read! And very high HCG can cause hyperthyroidism. We knew she’d need a hysterectomy for this, but it was hard, since she is 16, and she was not well enough for surgery. So we were transfusing her and she was looking better every day. Her family was so pleased that she was improving—they thought we were miracle workers.
Over last week, her blood count remained low—too low for surgery. And only her parents would donate blood, and they had exceeded their limit for donation. The blood bank at the hospital only gives out blood when the families also donate, so there was no blood left for her. So we started asking around, and Dustin donated a liter for her. Her surgery would have been today, except that she woke up Saturday night and went to the bathroom and passed a lot of blood. So my intern called me at 11:30pm to let me know Mary was bleeding, and that she was bleeding a lot. I told her to make sure she had IVs in place, fluids running, a new Hb, and to cross-match her for emergency blood if available, and I ran in. By midnight, she’d already bled about 1 liter, so I called the obstetrician. She was not on call, but I knew that Mary needed her hysterectomy, and that the general surgeon would not have been excited to do it. The obstetrician was confused, but I told her “hysterectomy now” and she came right in. I had to wake up a nurse anesthetist and a scrub tech too. Mary was on the operating table by 12:30am and had lost about 2.5 liters of blood.
Sadly, Mary had some tumor growing through her uterus, so she will definitely need chemo, which she may not be able to afford. Also, she did not stop bleeding. During our operation, we suspect that Mary went into DIC (her ability to clot was gone) and she continued to bleed and bleed, no matter what we did. At 3:30am, we decided that the more time we tried to stop the bleeding, the worse she was getting, so we made a patch with her peritoneum and stuffed some surgicel into the site to help her to clot, and closed her up and prayed (I really prayed!)
She needed fresh blood to treat her DIC (we have no platelets to give here) and so the obstetrician started calling people in the middle of the night who are on a registry to donate. She also announced it at church the next morning, and we got 5 people to come donate. And Mary is doing well today! It’s amazing… she asked me today if she could go home! I think we’ll keep her another few days, and then she will hopefully go to get chemo sometime soon.
Anyway, that’s why I didn’t climb Longonot… I’d say it’s an ok excuse. I spent the next day finishing the third book in the Twilight series—so good to lose yourself in a little American teenage drama amidst a very different, real life, Kenyan teenage drama.
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