Block Party

    Today started much more smoothly than yesterday (probably because of the shower), and we quickly found ourselves involved in all manner of interesting regional procedures in the theatre. This is mostly because there were two total knee replacements scheduled today, and it was just the opportunity we have been looking for to put in some nerve catheters and fill up some bupivacaine infusion pumps for continuous patient analgesia after what is otherwise a very painful procedure. We also got Dr. Newton excited about regional anesthesia at Kijabe, and I took a bunch of good pictures of Joe going over the different techniques with him and one of the excellent Kijabe nurse anesthetists, Alice. Here's a few samples:

Inspecting the On-Q pump

Alice placing a femoral nerve catheter

Filling the On-Q

I also did some procedures. Here I am teaching the

patient the intricacies of human popliteal anatomy.

Here's Joe pointing out that I didn't have the ultrasound machine on.

Asleep in the doctor lounge. All we need to be real

anesthetists is a half-done crossword puzzle.

     That last picture was taken by Lydia, the Theatre Charge Nurse. She's the boss here, and I think we are on her good side. That's pretty important to be able to function here since she could make things pretty hard for us if she wanted to. Interestingly, the anesthesia providers rarely take their patient back to the ORs. Instead, Lydia or Mary will move patients to their rooms as soon as the last ones are out. I can't imagine the chaos that would occur at Vandy if the holding room nurses just dropped the patients in the ORs whenever they wanted.

Lydia: Don't Tread on Me.

    We had Chai and lunch as per usual. I'm realizing that people here talk about Chai time in the same way that drug users at home talk about their habits. They always ask: "Do you take tea?", and the phrase "Do you want to get Chai?" is a bit too close to a familiar question asked of many a peer-pressured high-schooler. Here's two shots I took from the Chai room for perspective.

Just outside the Chai room: The hospital boneyard.

Chai to the right. Evil water bottle to the left.

    At the end of the day, Joe was asked by one of the surgeons if he could put a central line or an IV in for a patient the medicine team was following for a GI bleed. Joe agreed, but asked the patient to be brought to the theatre for line placement. She arrived a few hours later, Joe popped in a quick PIV in her IJ, and then took her to PACU. In PACU, we realized she was really sick. Joe called Evelyn in the ICU and told her we wanted to bring the patient to the ICU. She agreed, and the patient was in the ICU within a few minutes. On arrival, she looked bad enough to warrant elective intubation. I won't go through all the details, but the best-laid plans in this case resulted in hypoxic bradycardia and eventually pulseless electrical activity. We got her back, and there was plenty of post-event teaching to be done afterwards.

"OK, Who hasn't done CPR today?"

    Seriously, though my ACLS skills have never been sharper than after this month in Kenya. We decided that running the code should be the last thing we do in the hospital today, so we went home to meet Rob and headed up to the guard trail around RVA (it's a 1.5 mile walk around the school that is a pretty good work-out with it's steep inclines). I took a few photos on the path, and then a few on the way to the store to get supplies after the walk.

Razor wire and sweeping vistas...  Ahhh... Africa...

Useless against the honey badger

The Super Duka... Kijabe's Super Walmart

Lung Tonic and Gripe Water... For Kids!

Rob critiquing a pineapple.

It was a B+

    We came home, ate cajun chicken pasta (REALLY good), and that's all. So I'm all caught up, and have only a few more days of blogging before we head to Tsavo and the Mara. We've got AM lectures lined up for the rest of the week, and will probably find some other interesting stuff to do, so keep checking back. Kwaheri!