Monday, February 21, 2011

Me, me, ME!

Some people object to having a birthday.  Must have something to do with the idea of getting older.  I, however, still LOVE my birthday.  It symbolizes that I have survived another year......plus sometimes people get you presents.

The past few years, because of the timing of my mission trips, I have spent my birthday away from home.  This year - I am in Kenya and am preparing to go to Sudan.  It's not easy to have a celebration while shopping for supplies and buying medicines, but I am very excited about "my day" nonetheless.

This year, I have devised my own celebration and amusement.  I am truly thankful for the awesome experiences I have had over the past 31 years.  I feel lucky to have had the priveleges of travel, education and awesome friendships.  In the spirit of thanksgiving, I am including some of my favorite pictures from the past few years. And in the spirit of entertainment, I am including ten statements about myself.....

 AND to make it a bit more interesting, I have placed one FALSE statement...just to see if anyone can figure out which one it is.   (Sorry if this seems silly to some of you, but what can I say?  I don't own a TV anymore....)

Graduation 2010: Ob/Gyn Residency
1. When I was born, February 23, 1980, I was a breech vaginal delivery.

2.  Things I have wanted to be: a jockey, a forensic pathologist, a writer, an emergency room doctor.

Two babies delivered in Sudan, 2010

3.  Languages I speak: Spanish, French and Italian.

4. I love Thai food!

Making friends with the dolphins - Dolphin Cay, Bahamas, 2009

5. My favorite TV show - The Office!

6. I named Teddy after a US President.

Doing a C section, Tenwek, 2011

7.  I have been in the backseat of a police car.

8.  Secret addiction: Online shopping!

At an orphanage in Honduras, 2008
9.  I want to learn how to scuba dive.

10.  I have never seen the movie E.T..

.....And a picture by request  :-)



Sunday, February 20, 2011

Manna

This blog was previously written but unable to be published due to "technical difficulties."

The patient was unremarkable for Kenya. 

This was not her first pregnancy.  Or was it?  Honestly, it all starts to blur together.  Patient after patient, never speaking to any of them directly, only using interpretors, the turnover more rapid than triage at Good Slam Hospital. 

She had partial previa - where the placenta overlies the cervix.  She had vaginal bleeding when she presented at 25 weeks and a few days.  Her hemoglobin was 5.3.  We decided not to give dexamethsone (steroids) to enhance fetal lung maturity because the fetus was small and the limits of viability here are really around 26 weeks.

The limits of viability....this is when we expect that a fetus can theorectically survive outside the uterus.  But we don't typically intubate neonates here - longterm outcomes are bad and I suspect social and financial issues are at work.  In a place where death and dying is common and language barriers abound, it is not difficult to begin overlooking the privelege of personalized care.

This patient was hospitalized for several days, receiving blood transfusions and on bedrest - in hopes that she would maintain her pregnancy to viability.  On Thursday of last week she received steroids for the fetus.  Then on Saturday, I was on call.  At 0200, the call came that I had been dreading.

She has bled again.  Maybe it is just a small clot?  The baby is looking well.  Okay, let's watch for one hour.
One hour later - she is still bleeding.

Reluctantly, I know I must get out of bed and call a C section to end this pregnancy or she will continue to bleed.  I am thinking about this 26 week fetus, wondering if it has any chance.

I begin the C section.  The pediatrician is waiting to assess the baby and resusitate.  I can see the placenta bulging underneath the uterine wall, exactly where I want to cut.  I point it out to the intern.  She is not interested in learning at 3am.  Oh well.  I make my incision in the uterus and with just a little pressure, the placenta and fetus expels into my hand.  It appears that a partial or total abruption has also occurred.

**Sigh**

I feel completely defeated as a look at a baby that fits into one hand and weighs maybe one pound.  Very small- appearing for even a 26 weeks, with a thin and collapsed umbilical cord.  Great.  Probably bled out while she was being prepped and waiting.  The events of the previous week has just crashed down on me: two maternal deaths, several IUFDs, one quad dying, a term baby with birth asphixia.....the list goes on in my head and the frustration mainfests in the sentence that I speak, "Never mind.  It's too small."

As I reach to cut the cord, four tiny extremities extended and flexed.  Two eyes opened and an amazingly vigorous cry came from the small body in my hand. 

It was a total - "Are you talking about me?!" moment.  So, I gave the baby to the nurse and off to Peds she went.

I felt like an ass.  You ever been told off by a one pound baby?  That's what I felt like.  In a time that I was passing (clinical) judgement and surfing the sea of frustration - life was trying to happen.


There are many days here in Kenya when seredipity seems to govern the universe - I often don't know what it wrong with the patients who are sick, the ones who die OR the ones who get better!  It's a little challenging for the Type A control freak!  It is good to smart, good to be surgically competent, but here it is more vital to just be blessed

Back to baby with an attitude: she weighed 640 grams and she lived for ~ 4 days.  We do the best we can, with what we have and leave the rest is up to God.  In that moment, she was a reminder that focusing only on the impossibilities of this place may rob us of the miracles that are happening: DIC patients who survive, three remaining quads now on feeds and eclamptics who go home alive with live babies.  



"He humbled you, causing you to hunger and then feeding you with manna, which neither you nor your ancestors had known, to teach you that man does not live on bread alone but on every word that comes from the mouth of the LORD."   Deut 8:3 NIV

Houston, We Have A Problem

A few of you very astute blog-followers may have noticed an abrupt lapse in my blogging as of late.  I am alive and well - as is Teddy - but I have been plagued by technological problems.  First the computer died - cutting of my ability to efficiently email and bog.  Then the house phone died - making home call a rather unpleasant and costly ordeal, as I have been running through cell phone cards in a ridiculous fashion.  And of course, my woes were puctuated by the very sporatic power outages that we've been suffering here at Tenwek.

On the less-than-gloomy side, my computer seems to be recovering.  The power outages are getting more infrequent. And although the house phone is still dead dead dead - I am hoping that my time on the technology ash heap is coming to an end.

In the meantime, on Tuesday, I leave Tenwek to travel to Nairobi.  I will be preparing to jet off for my annual mission to southern Sudan on February 25.  Please be much in prayer for myself and my team!  Updates will soon be following - I hope!

Wednesday, February 2, 2011

A Safari With Style

Nothing cures the work week blues like a little trip to the Fairmont Safari Club!  Located at the edge of the Masai Mara Game reserve, the Safari Club is a plush hotel that combines great food with the awesome big game animals of Kenya. 

All the “rooms” were actually tents that were decked out in a “Out of Africa”/Pier 1 type motif.  Every evening a room attendant would come and turn down the beds, close the shades and put hot water bottles in the beds.  Each morning, hot coffee or tea would be delivered to the rooms.  The meals were all buffet style –  delicious and usually served on a deck that overlooked the Mara River with its many hippos basking in the Kenyan sun.
YES, that IS a lot of hippos!

Twice a day, everyone loaded into Jeeps to head into the tundra to see what animals were out.  We saw elephants, giraffe, lion, cheetah, hyenas, ostrich and many deer-like animals.  I also did a late night game drive – this was something new and pretty cool.  It was surreal to be out driving around in complete darkness, spotlighting for animals – mostly hippo, hyena and other small beasts.  I was hoping to see a lion attack and kill something, but no such luck.  Those hyenas were pretty scary though….
The "classic" African picture...

Giraffe

Is it just me - or does this feline resemble Teddy alittle?!


Cheetah hiding in a shady glen

Baby giraffes look weird.  Sorry - but they do.

The only zebra that did not turn his rear end towards my camera!

The remainder of my time was spent eating and napping.  And it was time WELL SPENT I must say!  Already I am wishing I were back in my cushy tent……