This morning we went in to the hospital a bit early to avoid missing the 7:30am lecture to the student nurse anesthetists. Now, normally we wouldn't bother attending their didactics, but this morning we had some evidence that we might end up as the "guest lecturers" the OR Board had described from the day before. Unfortunately, as the lecture time neared, we were approached by one of the OR charge nurses and told that we were needed to help start two emergency C-sections. We barely had time to say "ok" when the OR doors swung open and a women on her hands and knees was rolled in on a stretcher with someone holding the baby's head off of the umbilical cord. We rushed to the OR and got an IV before quickly turning her supine and inducing. Within a few minutes, the baby was out and wisked away to the nursery. It was just as intense as the emergency sections at Vanderbilt, except Joe and I were the most senior anesthetists in the room.
Well, I guess it wasn't all that different from some of the stat sections back home.
We celebrated with Ndazi (again), and went back to the theatre to decide on blocks for the day.
"VP shunt revision? Yeah we can block that"
We got through a few blocks (with variable degrees of success), and I got to cancel a few cases (would you operate on a "potentially resectable" liver tumor in a 70+ year old guy with hepatorenal syndrome?). The surgeon's love that stuff for some reason. Suddenly, it was time for Chai. Now Joe has been pretty hardcore about making it upstairs for Chai, but I have been just tagging along for the water from the cooler. Yesterday I learned that the cooler water is not actually brought fresh from Nairobi everyday, and that it is really just tap water. There are some awesome microbiological organisms in east african tap water, and the realization that I have been drinking them made perfect sense given my GI status the last few days. Needless to say, I'm no longer drinking from the water cooler.
Back on Chai... also Ciprofloxacin.
Around lunch, we started to meet individually with the student anesthetists to talk with them about our evaluations of them over the past week. We're not completely done, so I don't want to say too much, but they have been generally very good. As we are all aware, being evaluated is stressful, especially by someone you have just met. I finished the day with a fantastic case of a very old gentleman with what appeared to be milliary tuberculosis. The original plan was for a general with endotracheal intubation for a BAL, but I insisted on an LMA with intermittent boluses of Propofol. It was the right decision, and he didn't need to go to the ICU intubated afterwards (a huge victory). On our way out, a flyer advertising lecture topics caught our eye and struck us as humorous, so I took a picture.
Three aortas and they all have aneurysms?!! Case report!
We went for a walk after getting home. A large portion of the population of Kijabe gets together on Friday afternoon to play soccer at one of the local fields. We had been asked to play during the last week, but only stopped by to cheer for the Theatre team. Good thing, too, as they take soccer seriously here, and we would have been decimated after only a few minutes.
Note that the kicking dude is wearing a brand new pair of Nike Air Nothings
It's like looking at Monday's ortho trauma lineup
We stopped by the Super Duka to get some supplies before heading home to (another) home-cooked meal by Irene. Despite the rough roads, walking around Kijabe in the evenings is quite enjoyable.
T. I. A.
Tomorrow we'll be hiking Mt. Longonot. We're keeping Sunday clear in case we need to be hospitalized after the hike.
Ouch on the water thing and good call switching to Chai!
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