Mondays... AmIRight?

    Alright, I'm a day behind, but I aim to rectify that tonight. So I get to begin by talking about yesterday (Monday), which by all accounts pretty much sucked during the day. As you will remember, we didn't get our water back until mid-day Monday, so that means that I went into the hospital on Monday morning with two days of unshowered bedhead and a few fresh swipes of deodorant. It was not a good way to start the day, but start it we did...

    We began the day by walking in to an unusual message scrawled on the Theatre Board. Being the nice guys we are (and trying to not let the lack of water at home become too much of a burden), we decided to help.

"Who will save us?"

Americans... That's Who.

    Unfortunately, our defenses against Monday were soon to unravel when we heard that two ORs needed anesthesia staff since the student anesthetists were taking a test. It's pretty hard to get excited about sitting in the OR all morning when there are plenty of interesting and borderline necessary blocks we could be doing, but I made the best of it.

Seriously, this is my best effort at "happy"

After a while the boredom leads you to start photographing unusual things:

In this case, my patient's hair in Macro.

    To my relief, the student anesthetists eventually finished their test and took over the rooms. We immediately scrambled to get some blocks in. We had a handful of good-looking blocks, and then stepped out for Mandazi (the plural of Ndazi, if I haven't mentioned it before). When we returned, I went to check on a femoral block we had done before leaving. As I walked into the block area of recovery, I was disappointed (though sadly not too surprised) to see this:

Was the block successful or not?... We'll never know.

    Now before you freak out and start accusing me of being a monster, you should know that he was just asleep (though that didn't stop me from very slowly lifting the blanket up from his face when I went over to talk to him). Creepy... A few of them have done this, and it really freaks you out when you see it. Anyways, we quickly went back to the business of regional anesthesia. Our next patient was a guy who was having a distal femoral debridement, and I talked with him about having a femoral nerve block before the procedure. He said he has had his leg worked on multiple times before, and preferred general anesthesia. I told him that that wouldn't be a problem, and that we would do a quick IV, a quick femoral block for post-op pain relief, and then a general anesthetic for the case. Well, the quick IV turned into a semireliable left arm line under ultrasound after 6 tries by Joe and myself, and the femoral nerve block was complicated by an initial intraneural injection. When we finally got him back to the OR, we induced with 200 of propofol, 25 of fentanyl, and 25 of ketamine. A normal man would have gone down with that. A normal water buffalo would have gone down with that. OUR guy just complained of terrible arm pain. Awesome. The arm, on closer inspection, was unmistakably huge and tight. Super Awesome. We did a quick inhalational induction and put new IVs in after he was asleep. I finished up in the OR by squeezing propofol from his arm.

From now on, everyone gets a central line.

    I felt a bit rough by then, so we headed out for the day. Joe was on-call for the ICU, so he went for sign-out while I waited at the pharmacy for a prescription of zofran (an anti-nausea drug we are planning to use on the bumpy flights around Kenya on safari next week). It was kind of surreal sitting amongst a huge group of Kenyans waiting to be called to the window to pay and pick up the drug. Whenever someone would cough I would hold my breath and wonder what kind of terrible malady I may be exposing myself too. The other interesting thing about the pharmacy is the newly-installed opaque screens in the window. Apparently armed gunman came into the hospital a few weeks before we arrived and demanded cash from (who else?) the cashier. The screens are a protective countermeasure against such actions in the future, because nothing stops automatic rifles like tinted plexiglass.

Check and Mate, evildoers.

    I came home, took a (glorious) shower with our renewed water supply, and waited for Joe to seek enough cover from his ICU black cloud before heading over to Dr. Newton's house for Dessert Night. This was our second (but final) Dessert Night, but it was a really good time. We played with a stargazing app and looked at the moons of Jupiter through some binoculars. It's really amazing how much of the night sky you can see in a place like Kijabe. It's actually an advantage of spotty electrical coverage.

    So that was it, a bit of a rough day in the OR, but it finished well enough. As a bonus, I'm including a series of photos I took during the day that highlight the various colors of the OR and ICU. I think they are pretty neat, and most people don't get to see blue mosquito netting in their local ICU.