Wonderful Impossibility

The general ward in Kijabe is a conglomeration of wonderfully impossible conundrums.

A rundown of my service includes:

5 year with hemophilia (undiagnosed) and two  large spontaneous head bleeds who is begging me to play outside despite his double vision from the bleed

a 14 mo that weighs less than 10 lbs and is gulping down the milk we are giving him

a teenager with leukemia and a red blood cell count lower than I have ever seen (hgb 3.1 for the doctors reading)

a 1 year child with a tumor that is defying pathologic diagnosis who has the blood pressure of a 70 year old man and a belly larger than a pregnant woman

a 3 year old with a fluid around the heart from tuberculosis, sickle cell disease, and a new fever

a 4 mo child with DiGeorge syndrome which brings with it a weak immune system and severe hypocalcemia

a diabetic 8 year old

a 12 year old with typhoid fever

a 9 mo who we just diagnosed as blind and deaf when she came in for a fever and infection in her urine

4 kids on treatment for tuberculosis

2 kids with severe acute malnutrition

3 children with Down syndrome with cardiac complications or hypothyroidism

Several kids with gastroenteritis and dehydration

and a couple kids with bronchiolitis and

1 child with asthma.

For some of the children, where we live makes simple things difficult – I can’t order the confirmatory tests and my clinical impression makes the diagnosis. We don’t have a CT scanner or MRI. We can’t discharge home on short acting insulin to correct when a child with diabetes overeats. We don’t have chemotherapy, but are the only place in a three hour radius that can transfuse this week-  and we only get platelets on Thursdays. My neurology, cardiology, endocrine, hematology, and immunology consultants that I needed this week are (wonderfully) an email away, but can’t come to my bedside to lend their expertise.

For others, their condition would defy treatment even in the best Children’s hospital in the world. And so we sit, and pray, and improvise, and step by step, we walk day by day with the parents.

This is a place of daily challenge,  constant learning, and constant teamwork. In that way, medicine is not so different here. Every day, I feel that I must  have used everything I have learned – and then I find another thing tucked away somewhere in my brain – or more often, I pull up another article to read, teach, and apply.

So far this week, the children have slowly, slowly, improved and gone home. With grace and collaboration, we have sent children home smiling in their mothers’ arms with a cheer, and a hug and a thankful prayer. Many, I will see again – some are already becoming familiar names. All of them, though, are teaching me daily why I am so glad we are here. Why this odyssey across the globe has brought to a place of precise need.

And I am grateful.

(pictures below of resuscitation training Mardi and I did this morning before with our Emergency Medicine and Pediatric CO interns)