The Eagles Have Landed

1/22/2010
Day 15

The men folk have arrived! They are bleary-eyed, jet-lagged, and full of giddy energy. Sounds like they had a smooth trip here, complete with a 12 hour tour of London (all major sights were seen, bangers and mash were eaten, and quid were spent). They arrived in Nairobi around 6:30 am local time, headed to the Naukmatt (Nariobi’s Walmart), stocked up on much needed items (Cereal! Diet Coke! Cheese!), and made the drive to Kijabe. Around lunch time, in the middle of seeing a patient in clinic (children screaming in the background), I got a call from John, the driver, that the troops were on the premises. Julie and I both were able to steal away from clinic to greet the boys and have lunch. Then it was back to the hospital for us while they cleaned up and napped.

Things on the ward have been ebbing and flowing in the usual manner. We got three new kids handed over to us from the surgery team today. All of them are pre or post op (neural tube repair, VP shunt placement, or all of the above), have fever and/or seizure and/or respiratory distress. One patient is a one month old girl who came here from Uganda to get her encephalocele repaired (hole in the back of her skull with part of her brain hanging out, needs to be removed). She was prepared for surgery the past few days and went to the theatre today. Just prior to her procedure her temperature went to 38 degrees C (low grade temp). The surgeons decided they couldn’t operate on her as a result, and consulted us to work her up for infection. The peds consultant and I, though, both thought she looked pretty good, and she hasn’t had another temperature yet. We suspect the pre-op transfusion she had today was the culprit. The tragedy of it is that the neurosurgeons left this afternoon to return to the US (they were here for a few weeks and will come back late summer for a longer stint), and the patient has to reschedule for September. It is back to Uganda for them.

Some updates on patients from the week: The 2 year old cushingoid girl with galactosemia remains a mystery. Her mother could not afford many lab tests or x-rays and returned home. Our 16 year old boy with hematemsis and a duodenal mass? Lymphoma. Apparently he has a fairly good chance of survival. My 8 month old girl, Juliet, who was previously normal and now has lost all her developmental milestones, is unchanged. It looks like she does not have meningitis, but probably does need a VP shunt to relieve her hydrocephalus. There is a local neurosurgeon, I believe, who can place a shunt (since the other neurosurgeon has left) possibly next week.

One of our kids, Brian, has become quite ill over the past day or two. He is a 5 week old who has an infected meningomyelocele awaiting repair. He came to us from out outside hospital after being on many big gun antibiotics that are practically unheard of here. We have had him on the strongest antibiotics at Kijabe (Vancomycin and Zosyn, both saved for the very last resort, both very expensive) but nothing will clear his infection. He gets practically daily ventricular taps (they put a needle into the top of his head to draw out CSF) and each one looks increasingly infectious. Last night he seized and became much less responsive. This morning he had a worrisome breathing pattern (very strange indeed that I am so familiar with this type of terminal breathing pattern in infants at this point). We expected him to pass already but he is hanging on. It certainly looks grim, however.

I haven’t checked on the comatose 39 year old woman with TB meningitis today, but I did check in the lab for the other young woman I admitted with TB (the one with new diagnosis of HIV). Her CD4 count is 91. I will have to review both charts tomorrow.

Tomorrow (Saturday), my intern and I will come in to round on our patients. Our medical student, Amy, is off at the Masai Mara on safari. I hope to be done by lunch time so the boys and I can explore Kijabe a bit. On Sunday Matt, Ben and I are planning to visit Lake Naivasha. We hear it is a jungle out there (you can walk among the animals!) with giraffes, zebras, antelope, and hippos. Last weekend Julie made the jaunt and said it was great. Julie, unfortunately, is chained to the hospital this weekend for her 48 hour call marathon. I am relieved that my weekend call is behind me. At this point I only have one more call next week. It is definitely bitter sweet to be going into our last week here. The list of things I will miss is too long to enumerate at this time. To be blogged about at a later date!