Rainy Saturday

1/9/2010
Kijabe Day 4

I just got home after a few hours of rounding on the peds patients. My poor Kenyan intern (whos name is Obonyo) was up all night on call for OB and dealing with OB emergencies. Those seem to be plentiful around here. There are 8 interns in the hospital, and they rotate call on a q4 schedule between OB and med/surg/ped (that’s one person covering those 3 things). They work really hard.

Update on my patients: Paul, my 5 yr old with the big spine surgery is doing pretty well. He is off oxygen and starting to eat. He still has a chest tube in (Did I mention during his major surgery involving removal of 4 vertebrae and placement of 2 metal rods they nicked his lung and gave him a pneumothorax?), but we are hoping to have it removed today. Then he might be able to transfer from the ICU to the floor.

Adam, my 8 month old with partial bowel obstruction and possible Hirshprung’s disease has gotten more interesting by the minute. (Did I mention he’s the one with congenital cataracts and maybe some sort of genetic syndrome?) He came in with a very high white count (29,000). He does not look infected, though. We rechecked the lab value today wondering if it was lab error. It was still just as high, and with a predominance of lymphocytes. Next on the differential after infection is lymphoma. He doesn’t have any large lymph nodes, though his chest xray shows a suspicious area in his right upper lobe. Might be a mass or infection (clinical correlation recommended!). There is no way to better image his chest, as the nearest CT scanner is in Nairobi and is prohibitively expensive. So our options are to do a peripheral blood smear or an ex-lap to look around in his belly. We’re going to start with the peripheral smear. But of course that will have to wait until Monday. Normal weekday labs take about a day to get back (a stat order might get done in half a day), and on the weekend it’s nearly impossible. I wandered back into the lab area to inquire about this and got a few evil eyes from the Kenyans working there. Meanwhile, Adam is looking fine. I just hope his bowel doesn’t perforate over the weekend (or ever for that matter).

I also rounded on the baby (a few weeks old) who had an the encephalocele repair (removed the 40% of her brain that was on the outside of her head and closed her skull) done a few days ago. Now there’s an interesting neuro exam. She has a disconjugate gaze, pinpt but irregular and non-reactive pupils, L eye is fixed medially, R eye is fixed inferiorly, and her L arm has no tone and no spontaneous movements. She is still very somnolent and it is hard to determine if that is her new neurologic baseline, or just post op, or from her anti seizure meds.

My other patient, the other Paul who is a 16 yr old paraplegic with lots of skin infections and decub ulcers is status quo. He probably needs a big debridement of his L hip where they took some skin grafts. It is draning some nasty looking fluid. But he is clinically stable and the peds surgeon wants to think about it. Apparently they have put a lot of effort and surgeries into trying to get him better but he hasn’t been too motivated to help care for himself. And his family isn’t very involved either. I just learned that he has been in the hospital since September.

Now I am resting a bit at home before we get picked up for our big trek to Lake Nakuru. It poured rain last night causing brick red rivers to run down the huge rifts in the streets. I can see why it is difficult to maintain the dirt roads here. I just figured out what the rain water reminds me of: Thai iced tea. It is that exact color. Probably doesn’t taste as sweet. It has stopped raining, though, which will make our drive to the lake a bit easier. I think we are going in a land cruiser. I hear the place we are staying is a 5 star hotel. I’ll be the judge of that! Let the next adventure begin!