I C U 2

    Pretty good day today (with the exception of one surprise this evening). We kicked it off by leading a discussion this morning with the student anesthetists to cover all the common deficiencies we identified during their evaluations. Our plan was to have them tell us about each deficiency, and then to assign any stray topics that they still hadn't wrapped their heads around for a follow-up discussion on Friday. Turns out, EVERY topic was a topic they hadn't wrapped their heads around, so Friday should be interesting. After this, we quickly ran to the Wednesday service in the hospital chapel. There was some spirited singing and then a petition for donations to the hospital's upcoming fundraiser. If you forgot from the previous post, the service looks like this:

Not the same without audio.

    We then hustled back to the Theatre to start the day. We had lots of fun cases, and I got plenty of good shots of the Kijabe crew taking care of business and generally dominating their respective fields of anesthesia and surgery.

Susan George takes good pictures.

...I mean REALLY good pictures.

(That's Joe giving a newborn's femoral line the old "Challenge Accepted")

Rocked it... Ready for another challenge.

Me getting crazy with the ultrasound for a difficult IV. 

Note the smiley face on the tape.

    After a busy morning of lines and refuting the myth of the "difficult airway", we went to Dr. Newton's house for lunch and some perspective. It was a great meal of ravioli, fresh bread and fresh salad (with feta blocks). It would be pretty easy to spend an entire day listening to his insight about the continent. I couldn't (and probably shouldn't) go into the details of the entire situation, but discussions like the one at lunch completely reshape your vision of Africa.

Our colorful patio lunch table.

Other perspectives were in attendance, too.

    We returned to the Theatre to finish out the cases for the day, and to get a few shots of our total knee patients from yesterday complete with the ON-Q infusion pumps attached. Both patients were pain-free with zero narcotics given since surgery. That's an impressive feat even by our standards of peri-operative care in the U.S.

Yah! On-Q! Give us free pumps!

Ready to walk out the door. Alice has been great in managing these patients.

    We came home thinking that we were done for the day, so we left the pagers on the counter and went out for a walk. I took a bunch of pictures on the trip, starting at a refreshing pitstop at the local watering hole.

Probably still safer than the water bottle in the Chai room.

The Rift Valley: Does it ever get old?

Cue the music from Gladiator

Baby Acacia tree in the grass

Backlit Joe climbing into the "No-Go" zone of the airfield

Ahhh... Africa

    We came home and quickly left again for Mama Chiku's for some samosas. I don't need to tell you how good they are...

That's us on the orange continent

    After dinner, we headed back to the house. On the way, Joe got a call from the ICU reporting some emergency. He politely told them he wasn't on call, and then said he'd find out who was and call back immediately. As we walked into the house, Jonathon informed me that my pager had just gone off, and I went back to discover that the ICU had tried to page me as well. You see where this is going... Apparently, someone put me on-call tonight and Joe on-call on Friday without telling us. What we had missed was the fact that the lady who we saved after hypoxic arrest yesterday had coded twice and died. A great way to find out that you are on-call. There was nothing else to do, so we got sign-out and stayed at home. A short time later, I got a page from Casualty that there was a patient in severe respiratory distress who would need to be intubated. We headed over, got the story (road traffic accident, of course), and got him to the ICU and ventilated without too much fuss. As I was writing the note, Joe was asked to evaluate a different ICU patient with a decreasing level of mental status. We don't tolerate even slight deviations from the plan to continue to get better, so that patient also got a breathing tube. I'm loosing track of whose turn it is to intubate.

Me and James... another life saved.

On the walk back to the house after our unanticipated endotracheal marathon. 

The guy with the Obama cap is Moses, the night gatekeeper.

All of our midnight trips to the ICU have allowed us to become good friends with him.

    So now I'm about to go to bed, but I'm still on ICU call. Depending on how the night goes, I may or may not be in good shape to provide our scheduled AM lecture to the ICU team. We've got a full day tomorrow, and probably on Friday, too (since Joe's on ICU call, apparently). Joe was a white cloud in the states, but seems to be a giant dark cloud here. It probably has something to do with the Coriolis Effect since we are south of the equator.