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1/20/2010
Day 15

Jane passed yesterday afternoon around 4:30 pm. I had just gone back to the hospital to check on her. Her mother came to the bedside and ran her hand from the top of Jane’s head to her toes. Then she crumpled and leaned onto the chaplain who said a long prayer. It was so sad and surreal to watch. Now Jane’s mom has to go to her family (which is small and consists of only her two grown sons and their families) and start collecting money to pay the medical bill, which I learned is about $1300 (97,000 KS). I was told by the nurses that they won’t release Jane’s body until the bill is paid. It seems so callous to talk about these things in this way, but this is the reality here.

I walked home as the wind picked up and red dirt blew around me. It is hard to even begin to process things that happen here. I decided to throw myself into cooking dinner and attempted to make pizza dough. I have heard that things don’t really rise here at 7500 ft unless you are an experienced high altitude baker. As a flatlander, I feared the worst for my dough ball. I used a recipe from a local cookbook (we were also told not to stray from that cook book when it comes to baking!). It called for 1 tablespoon of yeast which seemed like a lot to me. Finding the yeast was an adventure in and of itself. At the grocery store in Nairobi, no one could locate yeast and everyone ensured us that baking soda would be equivalent. Dubious. At the local store (called the “Duka”) I asked for yeast and got a small vacuum sealed pack with only Asian characters on the front. But it turns out it’s yeast! From China! And boy did my dough rise.

I had to venture to the local produce market which consists of about 7 ladies sitting in front of tables heaped with every type of veggie and fruit you can imagine. I am a little wary of this market because you have to buy something from each lady or they bicker with you and each other. They also manage to cajole me into buying 5 times as much as was planned. I headed there with the intention of buy some onions, garlic, and a few green peppers. I left with those (more than a few of each), zucchini, pineapple and a mango, and had only made it to 3 of the tables. I made a quick getaway promising to come back and patronize them soon.

I made tomato sauce, caramelized onions, and was preparing the mango and pineapple for a fruit salad (It’s hard to cut a pineapple! Especially with dull knives) when my phone rang. On the other line was one of the general surgeons working here. He had called to ask me if I wanted to put the chest tube in that patient I admitted over the weekend with a huge pleural effusion. What to do when such an offer presents itself and you are elbow deep in pineapple juice? Drop the fruit and run! I threw on some scrubs, grabbed a mask and gloves, and headed to theatre. I did, in fact, put in Solomon’s chest tube with Dr. Davis, all the while being grilled on things that only a surgeon would ask (like “What is the lethal dose of lidocaine?” and “How would you make a solution of lidocaine to be diluted to this particular amount?”). I hope I didn’t bumble through it too much (The technical part that is. The questions I most definitely bumbled through.). He did compliment me on my knot tying, which I took as a major victory.

After my first chest tube placement adventure (by the way we got a river of pus out and by the morning had gotten over 500cc), I headed back home to finish pizza making. We invited our neighbors over and ended up having a really lovely time. It was nice to end such a hard day with camaraderie.

Today, thus far, has not been quite as emotionally taxing as yesterday. It hasn’t been without a fair share of perplexing patients, though. We just saw a 2 year old girl in clinic with a previous diagnosis of galactosemia (unable to metabolize galactose – very rare). That diagnosis, of course, has been speculation, as there is not any newborn screening. She recently had, by mom’s report, a fracture of her L leg which was loosely splinted (and promptly fell off after a day or so. The splint, that is. Not the leg.). She now is refusing to bear weight on the R leg. On exam, the patient looks to have some sort of syndrome. We are wondering if there is some way to connect galactosemia, calcium deficiency/bone deminearalization, and her odd physical appearance, which can only be described as a very fat face with a small body, and terribly worn down teeth. She looks cushingoid, actually. The orthopedic surgeon examined her legs and thinks if anything it is hip pathology. Unfortunately, mom could not afford x-rays today, so we had to settle for a few basic labs. Stay tuned.

Our 16 year old boy with hematemesis (bloody vomit) and adominal pain had an OGD yesterday (that is the British way to say EGD or scope down the esophagus into the belly). Instead of finding ulcers as we thought, they found a duodenal mass that looks cancerous. Talk about a zebra (this is what we say in the States when the diagnosis is odd and rare). Or maybe in Africa I should say something like “Talk about a squirrel!” since zebras are pretty darned common. We will get the biopsy results in a few days.

And that 4 yr old girl with TB and a liver issue? Turns out she has Entamoeba Histolitica (this is an amebic (or amoebic as they write here!) infection that is rare to see in the US but common here). Anchovy paste liver! (So called because the abscesses that the ameba makes in the liver is actually not pus but just necrotic, digested liver and looks, apparently, like anchovy paste.) It is refreshing actually to know a diagnosis around here, and one that is treatable at that.

After clinic I ventured to the post office to send some post cards. I have attempted to go there many times only to find it closed, but not today! I bought stamps and inquired as to where the other mailboxes are. He clearly did not understand me, as he kept saying that I could mail them at any post office in Kenya. I have concluded that there are no free standing mailboxes here. I also asked the man how long he thought it would take for the cards to get to America. He said 5 days. I am dubious. I later asked our housekeeper what she thought about that. She said, “I think he was trying to make you happy.”

Then Julie came home and announced she was going running with one of our Kenyan intern friends. I tagged along for a jog. With the altitude, wind, and steep, rocky roads, it made for quite a jaunt. I think I’m ready for the Safaricom marathon (a marathon in Kenya where you run through predatory animal infested lands as helicopters watch over you in case of attack). Really what I’m ready for is a nap, though I’m on call now and I’m not sure it’s in the cards. We’ll see!

We are getting excited for the grand arrival of our men-folk. This Friday Ben and Matt make the trek to Kijabe. (Matt is Julie’s boyfriend. And if you are reading this and don’t know who Ben is that is just weird.) It will be great to share this amazing experience with them. Many more adventures to follow…