Midnight Mayhem... again

    Wednesday in Kijabe. Every Wednesday brings an AM service at the hospital chapel that is quite well-attended. There is plenty of singing, some dancing, and acknowledgement of new arrivals to town. Sadly, I did not attend since it was one of the few times I've had recently to talk at length to Kate (since my phone here has been broken). Joe did go, and took a number of pictures in my stead.

Wazungu galore.

    We started in the OR with a few more assessments, and a few other interesting cases. One was a young Kenyan woman with leishmaniasis and (apparently) associated splenomegaly. She was extremely thrombocytopenic (low platelets), but came through the surgery just fine.

Though her spleen didn't

    We left the OR briefly for a trip to the cafeteria this morning. We were hoping to score some Ndazi (described as a mildly sweet, lightly fried thin bread). We've been trying to get ahold of some for a few days, but the caf. sells out early. Today was no exception, and we settled for samosas (which were pretty spectacular).

Prices are in shillings (1 shilling is appx. 1 penny)

    Evaluations continued during the day, and were only interrupted by a fascinating case which was essentially going to be a Whipple, but which was cancelled after opening. Since the patient was prepared for a longer surgery, she appeared weak on extubation (the pancuronium hadn't worn off despite reversal). We spent a long time in the OR with her getting worse and not waking up appropriately. Joe had the idea to give a whopping dose of the benzodiazepine reversal agent, flumazenil. We rarely use it, and it has some potentially dangerous side effects, but that wasn't going to stop him.

Honey Badger don't care, he doses what he wants.

    We still haven't succeeded in waking her up. But you can't spend your whole life in the OR or ICU waiting for people to get better, so we made plans to head out to Mama Chica's for some dinner. It's a small place, so even though there were only two other people seated inside, it was still crowded. Stew, ndazi, chapati and old-school bottled beverages were had by all. Of course, it's most dangerous to be the first person to get food...

Seconds later, Rob ripped of Jon's hands in a bid to get the chapati he was holding.

    We came back home and settled down for the night, but Joe and Rob went back in to see a new patient from the OR (aka "theatre"). Interestingly, I was typing the first part of this blog update when Joe called me and said that the new guy was herniating (his brain) and our patient from earlier (who wasn't waking up) had not had a blood pressure recorded in the last few hours (and had a thready pulse). By the time I got to the ICU, chest compressions were underway, and the end was in sight. We proceeded with a few attempts at defibrillation with our old friend from the previous blog post, but to no avail. The other lady was much worse neurologically, but we got her seemingly stable on dopamine and epi infusions. As Joe and Rob did the notes for the two patients, we watched the ICU team remove the body of the patient who had died. They have a very unique transportation cart for the deceased that looks remarkably like a BBQ from the side.

Not quite Weber quality.

    EVEN MORE INTERESTINGLY, as I was typing that last paragraph, we got called BACK into the ICU for the semi-stable lady. Long story short, she transitioned to complete hemodynamic stability during the time the nurse was changing the epi infusion over to a new syringe. I'm not quite sure how someone goes directly from normal sinus rhythm to asystole, but I don't know everything, I guess. Two deaths in two hours. It's like playing Russian Roulette with an automatic pistol over here.