Day 11

a glimpse into my first call in Kenya. . .

Sunday, at 8am,   I rounded on the ICU patients, the nursery patients, and the ward patients - no residents, no long term people, just me. They were doing better than they had been doing the day before, and I enjoyed being able to just sit on the beds and play with the children and talk to the moms.

And then it began. . .

The ICU patients started getting worse, no explanation, just worse, and I sat at the bedside and prayed and listened to the nurses and gave medicines I would never give in the States, because the things I would normally give weren't working. . .

And then I got called to the nursery to fill out a death certificate, tap another child with fever, and then the 24wga (that's 6 mo preemie, and super tiny even for our NICU in the states), who they have been resuscitating and caring for so valiantly for the last 44 days in the nursery, stopped breathing and died - I could not get a heart rate back, could not get the oxygen up, and called in the long term missionary to help me tell this mom that her only child was dead.  And then one of the children in the ICU who had been breathing on his own all week needed to be put on the 1970s ventilator and I had to figure out the correct way to set it. . .and then I got called to the ER to admit two patients -

One was 50% oxygen on RA and had such a  large heart on chest x-ray that I could not see her lungs.  At 10 mos, she looked like an 80 year old man in florid heart failure with pulses in her neck and a liver I could feel all the way down to her hip bones. I gave medicine to help her pee off fluid, admitted her to the special care unit and turned around to see the next child. . .

this 9 mo had a heart rate of 230 and was gray and so sleepy, hands like ice, and blue on 5 liters of oxygen.  I ran to the ICU to tell them I needed a bed and told my intern to get the nurse to get an IV. When I returned the child had stopped breathing and his heart was slowing down - his hands were so cold we couldn't tell what the oxygen was, but he wasn't responding as we desperately stuck him trying to get an IV - we put lines in his bones and intubated but could still not get his heart rate up. . .. and I had to tell yet another mom that her child was dead . . .and she sobbed and held me and the father held the child and wept.

And the anesthesiologist that had helped me intubate, told me to call the chaplain because we were needed in "Theatre" (the OR) to help deliver twins - that shared one heart.  They had just completed the ultrasound to prepare for c-section and saw conjoined twins, full grown and inseparable.

So we went to the theatre and delivered two beautiful baby boys  - one crying in protest from  the minute he was born and the other silent, needed our help to remind him to breathe. They had perfect hands, perfect toes, beautifully rounded heads, and they they shared one chest-  one heart, two lungs for two baby boys. We rushed them to the nursery were the promptly peed on each other and then began to cry and stick their hands in each others eyes and mouths. We started an IV, and just sat in disbelief and marveled.  We looked up the statistics- baby boys, joined at the heart, delivered alive - about 1 in 10 million - and we were watched them breathe.

Then I got called back to the ICU because the boy on the ventilators blood pressure had sky rocketed and he wasn't peeing - and the combative baby I had admitted the day before was requiring more and more oxygen - and the nurses in the nursery made me tea and we prayed and then I walked up the long hallways, weary, exhausted, and sure that I was far too tired to know what to do next. . . 

I climbed into bed at 5:30 am, and at 7:15, I woke up to go into round.  Walking into the hospital, the neurosurgeon who has been there for years, changing lives of countless African children saw me -  "you look tired" he said. And I burst into tears. "could you have changed things?  save energy for the children you can. . . thank you for being here. . ." he spoke with kindness and with the peace of someone who fully knows how God works and the purpose He has. . .and with sincerity and compassion that I can only hope to someday have. . .

I went downstairs, barely composed, and met the doctor who just returned from a week of vacation - and introduced myself - an exhausted mess. And she spoke truth and prayed with such power and sincerity - that I had been pummeled, that it was bad night, but that I was a good doctor. . that the lies that were being spoken into my head had no weight. . .that these children were still in God's hands and their families were continually in his care. That the fact that this crazy, insane weekend made me want to do this kind of medicine even more was maybe a little bit crazy, but exactly the way she felt as well. . .

Then, I did rounds, without tears, with my residents, and came home to sleep as the other doctors covered my patients for the afternoon. Things are much better after a 6 hour nap.

 I woke up, wrote a blog post with girls to see what is in their heads from all of this and then we went to have dessert and one of the long term missionaries houses.

I'm being told this was an especially bad call.  It just happened to be my first - the care here in Kijabe is exceptional – and I have been able to do far more than I ever expected. The child in heart failure is weaning on medicine to go home, the twins are transferred to the capital, and my ICU patients are still very sick but I feel that I am providing great care for them. 

But there is still a lot I take for granted in the states that we cannot do. . . and that is hard. 

This is the type of medicine I have been training to do, the type of medicine that I cannot imagine not doing, and after such a hard night, I am content. We walked home from dessert with the girls Monday night - who are skipping now on the rocky roads in the dark - chatting away at the events of the day, and swinging their flashlights back and forth, and I knew that this could be our life.

pain and exhaustion, paradoxes, but also peace.