The Penultimate Hospital Adventure

1/29/2010
Day 22

Today is my last full day in the hospital. Tomorrow (Saturday) I’ll round on my patients in the morning and say my final farewells. It is definitely bittersweet. I have loved my time here at Kijabe Hospital but am certainly feeling run-down and in need of a reprieve. I am in awe of how the interns manage this schedule for a whole year and do so without a complaint. Kenyans aren’t big on whining. We could all take a lesson from that.

We continue to admit complex patients. Today we got a 10 year old boy with a VP shunt who has a fungal meningitis. He also started bleeding spontaneously from his nose and has few platelets to spare. At baseline he has severe developmental delay, though he seems a lot more altered now that he is ill. We don’t know his HIV status but a positive test would definitely explain a lot.

Speaking of HIV, my 5 year old boy with respiratory distress that I admitted on call this week is HIV positive. This was the family with the mom who said the boy (Charlie) is negative, the dad said he himself is negative but the mom is positive, and the mom denied being positive. The family drama is almost Dr. Phil worthy. Turns out they are all HIV positive (no big surprise given the amount of conflict surrounding the topic). Charlie’s CD4 count is 4 and mom’s is 86 (really low, really bad). So now he is being treated for TB, PCP, and bacterial pneumonia, all of which he likely has. His chest x-ray looks like a nodular snowstorm.

Juliet, my 8 month old patient who lost all her developmental milestones and is hypertonic (constantly in an extensor posture with rigid limbs), continues to be a mystery. It is heartbreaking to talk to her mom each morning and have to tell her we still have no explanation for how her formerly normal child is now neurologically devastated. She can’t really move or feed and lies in bed wailing a high-pitched cry. We are treating her for TB meningitis, and I did another lumbar puncture today (I’m getting good at those) to see if this reveals anything new.

Our 2 year old girl with burns covering her body was a nice comic break for us on rounds. I know it doesn’t seem that someone who was recently scalded with hot water would be a positive point in the day, but she is adorable. Her torso and arms are wrapped in gauze but that doesn’t stop her from climbing all over the bed and hamming it up for us. I took lots of pictures. Despite her wounds, she is a healthy, well-nourished, chubby girl (albeit mummy-like currently). It is strange that seeing rolly-poly kids is somewhat rare these days.

Ben rounded with our team this morning and seemed a little shell-shocked by the severity of illness. I am glad he got to see how the hospital functions. I think he would have liked to work here as well if he had more time. Last night he mentioned something about returning next year… we’ll see!

For right now, I am finishing off lunch at home (I stole away since clinic wasn’t too crazy), munching on some M and M’s that Julie hauled from Cincinnati for my birthday party last night. After clinic I might head to the lab and see if they want my blood. I believe I am AB negative, which actually is hardly used here (I’m so unique). They can’t store blood very long, and might have to discard of it. If that is the case, I might just keep my pint. It is likely I will pass out in the blood donating process. And I might need my red blood cells when we climb Mt. Longonot this weekend.

We have a full weekend of tourist activities planned. Hell’s Gate National Park on Saturday, Mt. Longonot on Sunday, and then it’s off to the Masai Mara on Monday. We start our long journey back to the US Wednesday night. I can’t believe it is drawing to a close so soon. I’ll try to squeeze in a few more blogs before then!