• ashirk@gmail.com
  • Kijabe, Kenya
on 24 hours on call. . .

on 24 hours on call. . .

7:30 am: Woke up to Judy’s call call for handover on our 7 PICU and 25 NICU babies. Brushed my teeth and did my make up while I put on my blue scrubs and the best shoes to traverse the mud to the hospital.

8:15 am: Helped Madeline get breakfast ready for her 8 friends who had a Pride and Prejudice sleep over last night, hugged her good bye, grapped my stethoscope and headed in to the hospital

8:20 am: Popped my head in NICU to ask Nixon, our PECCCO, to arrange for Pediatric Surgery to help with the UVC for the new 28 week prem (3 months premature) and got updates on the three sickest babies. Glanced at the 18 monitors for any concerning alarms and made my way to PICU.

8:30 am: Talked to Jack, one of our PECCCO students about a sick kid in Casualty (the ER) and told him to go get them to wheel to PICU while I started rounds with our family medicine resident. I also called our financial director to get another child with pneumonia admitted to the floor despite them not being able to raise the $50 for the ER bill. He agreed and we will work with our Compassionate Committee to make sure they are cared for and can get home when they are discharged

8:50am Started PICU rounds

Bed 1 : Has critical heart defect and we talked about how best to care for the baby and the family. She is breathing on her own and much better than 3 days ago, but it is still not a lesion that can be cared for in Kenya.

Bed 2: This 13 year old with cerebral palsy had an abscess in her airway (Ludwig’s Angina for the medical people) and is intubated to let her body heal so she can breathe on her own. She is needing 3 sedation medications and lots of care to keep her airway secure and clear.  We adjusted her sedation medications and her antibiotics and fluids. 

Bed3: this is a newborn with hydrocephalus and spina bifida. He came in dehydrated and not breathing (apneic) 3 days ago. He is improving , but we need imaging of his head and antibiotics before he can get to surgery to fix his birth defects

Bed 5: This is the baby from casualty. She is very malnourished and her blood pressure is low – we start epinephrine through an IV in her arm and work to treat the infection and get her completely hydrated

Bed 6: 9 month old who came in with a blocked intestine (intussusception) and had to go to surgery to fix it. She is not tolerating her milk and we adjust her pain control, fluids and potassium, and talk to surgery

Bed 7 : 6 week old with prune belly syndrome and concerns for kidney failure. He was intubated last night because of infection and imbalance of almost all his electrolytes. I text the peds nephrologist in Nairobi to help with his management, adjust his peripheral epinephrine infusion and bicarbonate infusion and ventilator and update the parents

Bed 8: 15 year old who had a paraganglioma (tumor around the nerves that affects the blood pressure) removed two days ago by our surgeons. Her blood pressures have been up and down and she is begging me for water even though she has been vomiting. We adjust her fluids, ration her water, and talk to pediatric surgery about the next steps. Her blood pressures are high instead of low now and we adjust her medicines as I see my daughter in the determination in her eyes. 

11:30: I finish rounding on the patients above and check in with Millicent who is seeing 15 of the sickest patients on the floor. We have 50 right now, double what we normally carry. She has things well under control with our clinical officer intern, so I head to NICU to start rounds.

11:33: Nixon is finishing infection workups on two new admissions, so I sit down at another computer to start rounding on the 26 babies. I have been in NICU all week, so I know them well, and I begin one by one to look at all their vital signs, their weights, and see if they are doing well with their feeds and their oxygen support. Nixon and I put in all the orders, update the moms, and then he breaks away to try to put a central line in one of the new preemies from the night before while I finish up.

12:45 We graduate one prem who has hit 2 kgs. I transfer 2 babies to our kangaroo mother care unit. We isolate one baby who has multiple infections in the blood to keep her from spreading it to other babies. I reassure other moms, hug another, suction some noses and mouths, calm another crying baby until he is asleep and gently lay him on the resuscitaire.  

1pm: NICU rounds are done so I head back to PICU. Jack has done a gas on the super sick baby with kidney injury and we adjust blood pressure medications on two other babies. Millicent runs a couple cardiac kids by me on the floor and I update a few more family members. Every one in PICU is improving so I run home for lunch

1:15pm: I make coffee and do some dishes. I do my DuoLingo Swahili lesson and catch up with Madeline on the banquet (like prom) askings. We rearrange the furniture in the living room and put away some muddy shoes and do more dishes. . . She shares a quotation from the sermon with me “We can’t confuse the presence of a storm with the absence of God,” which seems especially apropos with the pouring rain outside and the strike ongoing.

2pm: I put away laundry on the porch, eat some leftover chocolate cake and text back and forth with Nixon and Jack about what is going on in the hospital. I check on David who is moving stones and concrete around on the road with our neighbors to try to make the road to our house passable again.

3pm: I head back into the hospital, trying to beat the rain from the giant black cloud above the hospital. I beat it by about 30 seconds. I say hi to the guard and look at the pile of donated clothes and blankets behind him and then quickly make my way to NICU.

3:10pm: Nixon and I run the list, look at culture results, and review bilirubin levels on 2 new admissions. We go over the changes from the morning and I update a new mom and dad with a baby born 2 months too early and explain all the tubes and lights and monitors

3:20pm: Jack and I run the list in PICU, we bring down a few more vasopressors, adjust some fluids and sedation, and one of the babies has a seizure so we add medicines and adjust the oxygen. 

3:45pm: I check on Casualty, which is quiet, take a call from peds surgery about a transfer, talk to one more family in the PICU and check on NICU one more time

5pm:  I head home in the rain and wish I had listened to David when he said to take an umbrella. The babies are all improving and the mom’s seem settled, but I feel the tension in my body knowing things can change at any moment.

6pm: Chelsea stops by to introduce me to her sister in law who just flew in and brought another monitor for PICU.  She sees the pile of dishes and they help me finish  cleaning and drying while Brittany gets to know Buddy. I help Madeline put her mattress back on her bed and sit down to check email and look at the schedule for next week.

6:30pm: I check on Jack to make sure he can get home in the rain and see if Frank has any questions. Things seem settled so I start working on this post.  Belle comes in and says she saw a frog hopping across the river running down our road. I heat up a third cup of coffee and lay down for a couple minutes while it heats

7pm: We lose IV access on a critical baby in PICU and have to place a needle in the bone to give critical fluids despite a our anesthetist and nurses best efforts.  I read about Sodium Bicarbonate infusions while running in in the rain and almost fall in a mud puddle while flicking a grasshopper off my umbrella

7:30pm While we are working on accessing a vein for that baby and holding the breathing tube in place, another baby starts seizing – We breathe for him, call our neurosurgical resident for help to remove extra fluid from the head, and ultimately intubate and place on the breathing machine.

8:45pm Pediatric Surgery has an admission. We transfer one baby to NICU and then I change the linens on one of the beds and push another outside to get ready to admit that one. 

9:15pm  I am called to NICU because one of our other babies with multiple congenital problems isn’t breathing well. I go there just as she stops breathing. We treat another seizure, give medicine to help remind the prem to breathe and suction. We translate what is happening to mom, who speaks neither Kiswahili nor English with the help of another mother.

10pm I go back to PICU to run through all the babies. We have been able to get another one off of vasopressors and he is tolerating his feeds. The teenager is still asking for water, and another one has a fever that we sort through. I check on a 30 week twin mama in labor and Kelvin and I rearrange the NICU to get ready for the new babies

1am: Kelvin goes in to a preterm delivery and I adjust monitors and  help find cords for everyone in ICU. I check in with our family medicine resident. We review labs and everyone is settling

1:30am: I run home in the rain, take a quick shower and lay down to go to sleep about 3

3am: I get a text that a NICU babies breathing has changed and get out of bed to go in and see. The baby needs some aggressive chest physiotherapy and suctioning and some rearrangement of the medications. I check in with a couple NICU mamas and go to ICU where there a few more babies with challenges needing sedation and lines. Everyone is exhausted. Frank and I debrief the week and how the night has gone and talk about how he will get home in the rain and how he can rest.

6am: Everything is settled, so I go home to get coffee. I end up forgetting it in the microwave and falling asleep for an hour.

8:12am I jump up, put on make-up and my favorite green dress that feels like pajamas but looks like I didn’t stay up running all night. 

9am: I walk in the hospital holding the monitor that a visitor brought last night, have two hallway meetings with our housing supervisor and one of our interns, and start rounds at 9:15 am. 

I have 8 hours to go before home – and a meeting about the flooding, about our TB training, and about our interns before then. I will be held afloat by my team offering me a chair, by a double cappuccino brought to me when I start flipping words in a meeting, and by my team being eager to learn even when I talk to fast post call

I am grateful for a day of babies who are improving and moving closer to home.  Every day, no matter how exhausting, is still a holy privilege. I am grateful for my team, for the changes and improvements I can see since the last strike, and for the systems that let us keep running in the midst of overwhelming odds. But I am also deliriously tired.

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