999

    I was on ICU call last night (for the second time), and awoke at midnight to the sound of my pager. "02" was all the text read, but I knew it was probably supposed to read "302" since that was the number of the ICU. I chuckled to myself as I walked down the dark hallway to the landline. As I reached the kitchen, the pager went off again. "No doubt a correction page with the full number", I thought to myself. I glanced at the pager display and read: "02999".
    Now that may not make a lot of sense to those unfamiliar with the paging system here, but a page with 999 on it is essentially a "Code Blue", and I took it to mean such. I threw on non-sleepable clothes, went to Joe's room for the key to the door, and flew out into the night towards the hospital. When I arrived in the ICU, I found one of the four tenants receiving CPR. A mask was pressed against his face, his rhythm was coarse ventricular fibrillation, and his oxygen saturation was somewhere south of the 40s (if you can believe such things). I immediately asked for airway equipment and suggested defibrillation. It took a bit of coaxing to be able to get into position with all the right equipment. By the time I was intubating, Joe had found his way into the hospital and onto the chest. Joe reinforced the position that we should be treating with electricity, but it took a bit more coaxing to get everything available. We were able to get a passable rhythm only transiently after multiple rounds of CPR and defibrillation with epi boluses (and one lidocaine), and we eventually abandoned our efforts. I filled out a brief death form, and returned to the house and bed. This morning when I arrived for the workday, his bed was empty and the covering physician mentioned the events as one would an afterthought. People just die here in Africa. It's part of the way things are. The only bright spot was that we both got to use an older defibrillator with paddles. It made me feel like one of those ER doctors from the movies...

Shock Advised... Charging....

    After a rather eventful night, we resumed our evaluations in the OR today of the student nurse anesthetists.  This kept us busy all day, but we were able to sneak in some extracurricular OR management for one of the ICU patients (very tough case), as well as a few regional procedures that couldn't have gone better (one ankle surgery under regional, and one total knee replacement under spinal (then straight regional when the spinal wore off). I took a few interesting pictures from the OR. One is in homage to the gas we never use in the states (Halothane), and the other is the mechanism for bladder irrigation during cystoscopy.

"Decrease sympathetic receptor sensitivity, HAL."

"I'm sorry Dave, I'm afraid I can't do that"

Somewhere a Kenyan cow farm is missing a milking pail.

    We left the OR and stopped by the ICU to see how our patient from the OR was doing. She's still intubated, but has done remarkably well considering all she'd been through. The ICU team was struggling to figure out the right ventilator settings, but Joe was benevolent enough to help them out a bit (though not without a little fun on his part).

You're getting warmer.... warmer....

   
    All in all a good day, capped off by a nice walk along the two mile guard's trail inside the border fence surrounding RVA. We came back to fresh beef enchiladas by Irene. Hard to beat that, and it's just one more thing that keeps you going.

Also, scenes like this...

And especially this...