return from Safari
So Wednesday, David, the girls and I returned from a short elephant safari near Kilimanjaro where we sat in the outdoor cabana and played cards during the rainstorm, slept under the stars in the shadow of a breathtaking mountain, and found literally hundreds of elephants on our drive across Amboseli National Park. We returned to Kijabe by way of the most beautiful road I’ve ever driven, and then stopped for dinner at our favorite Nairobi pizza place.
I was on call Thursday, and I jumped right back in to the inpatient service. The kids on our service are incredibly sick right now, varied, complicated. . . Kijabe.
After a full day of refinding my bearings, I took check out on the nursery and ICU and began my call. Over the night, I ran back and forth between a critically ill 3 day old on our bubble CPAP in the nursery and a child who has complete respiratory failure due to TB in the ICU that we have cared for for years. . .both were testing every bit of my ICU knowledge, but were improving – slowly but surely. A child came in seizing to the ER, and my intern stabilized her brilliantly; I paused in the busyness to realize how much she had learned in her 4 weeks on pediatrics and smiled.
Then I got called back to nursery for a code on a precious two day old who was incredibly sick with infection and wept with her mom and dad and the nurses when we couldn’t bring her back to life. Then the 3 day old started dropping her oxygen again, and I rushed to her bedside to figure out the problem. Just as we removed the secretions blocking her nose, I was called to labor and delivery for a baby who had been born not crying. I pushed air into her lungs and she started to cry. I took her over to her mom and she beamed through the pain as she saw her daughter. Death, new life, sorrow and joy.
I sat and had chai with the nursery nurses at 2am and then went to ICU to check on the 3 patients there. They were all doing better, so I walked home in the brilliant moonlight at 4:30 in the morning. I curled up on the couch for an hour and a half under the winnie the pooh blanket my great grandma made for me when I was born. At 6am I woke up, made my coffee, put on some mascara, and walked back to the hospital to round with our interns for the day. . .
By 11 we had rounded on all of our patients and were running through them one by one.
I have a 7 year old with the brightest smile on my service who has transverse myelitis. Last week she woke up and couldn’t walk. She couldn’t hold her body up straight when she sat without support of her hands. And we were the 3rd and last stop in the family’s week long journey to get her care. . .When I met her she was scared, determined, and she reminded me of Annabelle. Yesterday, after her second steroid treatment she was giggling with me, clapping as she sat up on her own for the first time. She has a ways to go, but I am grateful for an answer for them. As I was helping her walk, I heard a scream from the room next door.
In the bed next door was a 13 year old with sickle cell disease – he came in because the sickled blood had clogged up his bones and he was having incredible pain. We gave him medicine and fluids, and he improved dramatically. But the day he was supposed to leave started screaming with a headache. We got a CT and it showed tiny strokes in the middle of his brain – from the same problem that had caused the bone pain, but far more serious. We called neurosurgery to help with films, explained the findings to the worried family, and ordered the treatment – a transfusion.
Next to him in our monitored unit was a 21 month old who is not walking or talking yet. He has been having fevers and diarrhea and while his neighbor was screaming with a headache, we became concerned that the fever in that patient was a part of a much more serious problem – septic shock. So Lilian, our clinical officer, and Kristell, our visiting ICU nurse practitioner worked with the surgeons to get an IV and give antibiotics and fluid while I took care of the child with a stroke.
Yesterday also happened to be the official opening ceremony for the new hospital, and when David walked in the the important visitors and his camera, we were feverishly working, each trying to be in 2 places at once to get answers.
The moment we were meeting the Kenyan bishop, the nurse came to me and said that my 2 year old with a dangerously low hemoglobin was reacting to his blood transfusion. Wheezing with facial swelling, for the second time in 2 days. I ducked away to tend to him while the visitors continued their tour.
Our visiting resident ran around, tending to all the other things we needed to follow up and graciously stepped away to get chapati for everyone for lunch while we continued to work. I checked on a baby we thought had chicken pox in the isolation room whose breathing had worsened. Then the chaplain came to me to discuss a bill on another baby who had finally recovered after a very long road – the father had left the mother for another woman when he found out how high it was . . .we puzzled over what to do, and then the labs from morning came back and we went through them one by one
David brought me chocolate cookies and water as we ran the list and then Ima came to let me check out an hour early so I could go home to sleep.
As I ran through the patients, I forgot simple words in my exhaustion, but was amazed as I realized that every patient had a diagnosis and had been stabilized. Nonstop work by all 10 of us in HDU had taken chaos and made it calmer, at least for the moment. Ima and I went over the more complicated kids in detail so we could collaborate on what to do to optimize their treatment. I talked through some social dilemmas, and I walked home grateful for her wisdom and friendship.
Exhausted, but smiling. The visions of elephant babies seemed weeks away along with the rest that had come with that memory. That night, two of the interns I am mentoring came to dinner, laughing, asking for advice, telling their stories.
And as we made pizza from scratch and drank mango juice, I found myself telling them how much I love what I do. They asked how we came to Kijabe, why I decided to do pediatrics, and they talked about their dreams, the difficulties of intern year, and the things they loved.
At 10, they headed out to another party to celebrate the end of their 2nd month of intern year. I kissed Madeline and Belle goodnight and climbed into bed waiting for the coffee to wear off, so I could close my eyes.
The last months have been peaks and valleys. And this 24 hours carried both them together in fluid motion. That is our rhythm here. Staggering connection as life it plays out in all it’s drama and emotion and glory. Deepening relationships and holy privilege. Elephants and thunderstorms. Life and death. Grace and mercy.