First night in the hospital. . .

Tuesday was my first night to be on call in the hospital here. My first call last year was pretty spectacular in its sheer craziness, so I was braced for impossibility, but instead, I found the steady busyness, mystery, dilemma, and reassurance.

The day started with a call from Sarah, my colleague, in Nairobi, saying that our amazing medical officer, Lilian, who helps run our outpatient clinic was carrying a patient with oxygen saturation of 30% from the clinic to the casualty (our emergency department). I sprinted down the stairs and up the long hallway, running through the possibly reasons in my head as I always do. . .but unsure what to expect.

My 2 year old patient was sitting on the bed with blue lips and hands and feet – but mad, and as he screamed, his oxygen number drifted lower and lower.  We placed a mask streaming oxygen over his face and I started to play peek-a-boo with the terrified child.  As he calmed, the number drifted up, up, slowly, slowly – from 20 to 40, 40 to 70.   All the extra muscles in his chest pulled to breathe. He calmed, suspicious but intrigued, and let us listen to him. . .his fingers, belly, and chest exam belied a serious problem with his heart.

I ran to get the ultrasound, and his heart looked eerily similar to a baby the week before, and his x-ray looked as if it had been pulled out of the textbook for a malformed heart – tetraology of fallot. We gave him medicine to help remove the extra fluids, and then, we started the most important part of treatment for a child with this malformation – to make him happy, because that would help his oxygen. His grandmother sat with stoic kindness at the bedside in full Maasai dress with shoulders draped in beautiful red fabric and intricate bead work adorning her ears and neck.  She helped me soothe him, and slowly slowly, this boy and I became friends. The medicine and laughter helped him and his oxygen began to improve.

As I walked out of the curtain surrounding his bed, the resident called me to the next bedside – an unresponsive 3 year old.  In the States, we would have intubated him, but here, with limited ventilators, I paused. His breathing was strangely easy, and the results of his blood work were normal.  We treated him for seizures and gave him antibiotics to help him fight the infection – we added treatment for malaria and continued his medicine for tuberculosis. I wished that our CT scanner was working and that children responded in the same way to fluids here that they do at home, and then I took a deep breath and we prayed. . .that night I walked back and forth from his bedside, judiciously putting fluids through his IV and watching as slowly, slowly, he woke up.

Next, I went to the private clinic where I examined a healthy 2 month old and learned her history with the mom – and then it was off to a delivery where the mom was struggling to bring her child into the world. She succeeded with a scream, the child cried, the mother smiled, and I was off to the next place.

The child with the strange heart was calm and more comfortable, the 3 year old continued to breathe – but around the corner was another teenager. “Can you help me?” the clinical officer asked.

Chicken pox, really impressive chicken pox. It looked different on African skin, but there was no question in the diagnosis.  I remembered the itchiness from when I was 9, but he was not phased by that – because he was struggling to breathe. Chicken pox can be deadly when it is complicated by pneumonia, and I knew immediately this would be his battle.  For now, though, his oxygen  saturation was okay and  his distress eased as we brought down his fever. The nurse searched for a place on his skin we could start an IV and gently coaxed the small tube into his arm.  I went to search  for a bed in our very full ward where he would no tbe able to infect another patient, and the intern ran for the medicine to help his body fight the disease. Around 11pm, we came up with a clear plan, I checked on the babies in the ICU, and then I ran home in the dark and wind to get dinner and some rest.

At 2 am I bolted up, wide awake, on the couch, and very worried about my patient with chicken pox.  At first, I thought it was paranoia of my first night on call. . .but the feeling settled deep in my heart and mind , so I put on my shoes and coat, not wanting to bother the residents with my worry. After 30 minutes of wandering from casualty to his first assigned bed (that was empty) to the isolation room on the ward, I found him, barely conscious  and as blue as the baby I had seen that morning.  I called the resident and rushed to find out how we could place him on oxygen and increase his fluids.  Within minutes his breathing slowed, and the finger pulse oximeter I had received as a gift right before leaving read 96%. His heart rate slowed and his glazed-over eyes cleared and met mine.

I walked out of the room and took a deep breath, thankful for a God who would wake me from deep sleep. . .it was a simple reassurance, humbling and powerful. I took a few minutes to teach the residents about viral pneumonia and its complications and then walked home to rest again.

I went in once more that night – to welcome another Kenyan to the world. As she came from her mom’s tummy by c-section, she twisted her face in protest and grabbed onto the surgical drape before the doctor cut her cord. I smiled as I watched the determination in such a new little one through the OR window.

This job I have, is a holy privilege. And, this thanksgiving week away from family and familiarity, I am thankful for those of you that are walking with us and making it possible.

Happy thanksgiving from Kenya. . .