Feeding Grass and Taking Names

    This was another pretty action-packed day (I kinda would like a day to take it easy at some point). As you will recall, Joe was on-call for the ICU last night. He was getting calls every hour about different patient issues, and he got a rather big one at about 5am. A very sick 10 day old newborn with labs that were insanely abnormal had been slowly decompensating all night until bradycardia/PEA set in. Joe woke up Jonathan (who has been covering Peds and who knew the kid), and I heard the commotion and decided to tag along. We gave it our best effort, but unfortunately her condition was unrecoverable. I doubt many people have started a day with the death of a newborn, but it certainly isn't an easy thing to see.
    Our plans for the day had been to tag along with Susan and Nora into Nairobi for a few items and some sightseeing, so Joe and I finished at the hospital, came home to clean up, and then headed over to Susan's to await our ride. While we waited, we noticed a pretty large fire burning on the side of Mt. Longonot.

Sadly, no giant spews of lava followed. 

    We waited until Susan finished rounds at the hospital, and then jumped in the car to Nairobi. An hour and a half later, we were pulling into an elephant orphan sanctuary. The have 15 or 16 young elephants that were found as orphans in the wild, and they raise then to be re-released in Tsavo once they are grown. Everyday between 11 and noon they trot them out for paying visitors to see. The hour time limit is to keep them from becoming too familiar and friendly with humans (so they won't get poached later on). It's a pretty neat sight to see, and they seemed like they were relishing the attention.

Susan perfectly recreates the form of a

slumbering baby elephant in one of their dens.

Somewhat single-file

Working on my tan...

Looks like a Mallampati 2

Slide to the left... Slide to the right... Criss cross... Criss Cross...

This one got a few wallets on his trips along the petting rail.

Marco...

    After the elephants had retired, there was open viewing of the conservatory's only rhino, a 6yo male rescued as a baby. He's completely blind, but intimidating nonetheless (especially with the large gaps between the bars of his cage).

Just try to pet me... I dare you.

    After those critters, we headed to a nearby mall to eat and do a little shopping. The mall itself was very nice and felt like being back in the States. The food was very good as well, though a little more pricey than the lunches at the Theatre.

The mark-up is because you get to choose the cow you want to eat.

A terrible shot of me drinking a diet coke under the shade of the umbrella.

    We then set out towards a highcow sanctuary. I know, we've already seen plenty of highcows, but this promised to be a unique experience. Unfortunately, we got caught in some terrible traffic on the way. It turns out, the lines on the road are more like suggestions than hard-and-fast rules...

This is a two-lane road (one each direction) that we turned into a one-way, four-lane parking lot.

    We finally arrived at the sanctuary and payed a 700 shilling entrance fee, but it was totally worth the expense.

Our arrows highcows will blot out the sun...

Dude.... I'm eating... Do you mind?

A wise-guy, eh? Get 'em boys!

Close-up of baby highcow eye.

In Joe's left hand is a saddle...

The rest of the sanctuary

YOU GOTTA WANT IT!

    We left the highcows and headed back to Nairobi to do some grocery shopping at a different mall. It was getting kind of late, so I called Jonathan and asked if he would be available for emergencies in the ICU (since our call started at 5pm). He agreed. What we didn't know was that we were going to get the full tour of Nairobi...

Downtown Nairobi

Central Park.

A large, outdoor market

    By the time we actually got to the grocery store mall, it was well past 5pm. We got a call from the surgical department director that he wanted us to evaluate a sick patient in the ICU, and he wasn't too happy when we told him that we were hours away from Kijabe. Jonathan did a fantastic job, and we were able to temper the situation which Susan and Nora stocked up on groceries.

Kate: Name that flower.

This is a really terrible picture I took of three guards armed with automatic rifles in the mall. 

Joe coaching Jonathan how to intubate from the parking lot.

Apparently, the remote ICU program began tonight...

    We came rushing back to the ICU as quickly as possible, but the situation sounded worse and worse as we got nearer. Two new patients, one with terrible hemoptysis and desaturations, the other with a hemoglobin level not compatible with life... Just badness. Of course, that didn't preclude me from snapping a quick picture as we were rushing down the hospital hall to the ICU...

Hang in there lab-value-not-compatible-with-life lady!

    We got to the ICU and got everything settled (for now). One mentionable highlight from the ICU tonight came from one of the ICU nurses. You see, the lack of supplies here has led us to use the phrase "T.I.A.", or "This Is Africa" relatively liberally as a way of venting the frustration of not having some basic things to save lives (or in some cases to justify the seemingly crazy things we do to keep people alive). Imagine my surprise when I asked the nurse for a tongue depressor and he looked at me with disdain and said: "Are you kidding? This is Africa." One can't help but smile...