Eclipse

1/15/2010
Day 10

Last night was a fitful night. We have been getting impressive wind storms every evening this week and last night’s was especially strong. Kijabe means wind (it’s the Chicago of Kenya!) and they weren’t kidding! All night long we hear gusts and howls as the wind rattles the window panes and blows right on through to chill our apartment. Usually I find it soothing, but last night I tossed and turned. I woke up a bit on the crabby side of the bed.

I was in a daze as I dressed and forgot my belt. Around 8:30 am I decided I couldn’t bear my pant hems dragging on the floor any longer (everything here picks up the brick red dust of the roads, not to mention the terribly resistant strains of bacteria that line the hospital halls). I headed home briefly to get my belt to find a group of about 8 people gathered in front of our building gazing sky-ward through x-rays. It was a very odd sight, indeed. It turns out this morning at exactly 8:27 local time there was a complete eclipse of the sun. Everyone excitedly explained this to me and handed me an x-ray to peer through (the dark part of the films are perfect for this purpose!). It was amazing. And to think, all because I was groggy this morning and forgot my belt.

Once back in the hospital it was back to the ICU to check on Jane. She continues to do poorly. We got some labs back showing her kidneys are failing and that she is extremely anemic (creatinine 2.8, hemoglobin 4). We are transfusing her today but if her lab values don’t improve tomorrow (which they very likely won’t) we will withdraw care. The ICU doc told me that people with multi organ system failure are actually not even intubation candidates at Kijabe because they never recover. This apparently is a new policy in an attempt to improve their successful extubation percentage. At the time of intubation, though, her only organ system failing was her lungs. And since Jane is such a young patient and was previously healthy before about 6 months ago, we of course wanted to give her a chance. It is certainly looking grim, though.

We are not sure if her kidney failure is due to hypoxia, hypovolemia, sepsis, or from the Amphotericin we were giving her (all of the above?). We are holding that medicine now. Her tracheal aspirate, as predicted, was low yield and came back with a negative gram stain, yeast, and AFB.

I met with Jane’s mom to discuss her prognosis. She began to cry and told me (via interpretor) that she recently lost her husband and older daughter. It was very difficult to watch her cry. Kenyans are so stoic that any display of emotion is very rare. She later met with the chaplain, Mercy, and they prayed together. Mercy told me that both she and Jane’s mom were very grateful to hear the truth about Jane’s prognosis. According to Mercy, oftentimes doctors here are very vague and give false hope. She said that Jane’s mom is coming to terms with her grief and has “given her daughter over to God.” In my first few days here, it was a bit jarring to witness faith being brought into so much of patient care. Now, though, it seems peaceful and appropriate.

I am on call this whole weekend and am certain that Jane will pass before Monday morning. And I am equally certain that we will never know her underlying diagnosis.

The rest of the peds patients on our ward are doing pretty well. My other Jane, the 3 yr old with congestive heart failure, left today. My Somali patient with abdominal distension and possible Hirshprung’s Disease left as well. The rectal biopsy that they waited days and days for came back inconclusive. Frustrating. He is clinically better, though, and is supposed to follow up in peds surgery clinic in about a week to see if they need to repeat the biopsy. This is the family that lives in the refugee camp far from here. I am not sure they will come back.

Oh, and that young woman I admitted my last call night with right lower quadrant pain and recent stroke who I thought had appendicitis? Turns out it was a TOA (abscess on her ovaries/fallopian tubes). So the surgery was not all for naught, but it does draw into question the accuracy of the ultrasonographer (“normal tubes and ovaries”). Never a dull moment here.

The wind has just started to pick up, meaning another day in Kijabe is drawing to a close. Should be an action-packed call weekend. Better take my Ambien tonight!