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Monday, March 05, 2012

Exponentially Monday

Today was about as Monday as it gets.  Which is why at 9:30 pm I am debriefing through my fingers (after assaulting my children with all the gory details at dinner, something they're quite used to).  Bear in mind that tomorrow Scott will finish our 7th call night in 11 days (5 together, 2 apart).  When you take time off to go to a conference (Feb) or organize a field-wide leadership meeting (March) it's like lifting up the edges and watching all the call days fall together in the middle.  Bear in mind this stretch oh-so-conveniently dovetailed with a health worker strike in Kenya, escalating the demand for services at faithful old Kijabe.  Bear in mind these have not been the kind of calls where one wisely imparts a little experiential wisdom over the phone.  They've been more of the blood-and-guts-at-2-a.m. type.  And bear in mind that the rest of life did not stop:  2 birthdays in the last week, 2 girls in a soccer tournament, 2 10th grade events, one sick kid, you get the idea.

I knew the morning would be difficult, because we had agreed to withdraw baby Malt from the ventilator because she showed no signs of brain activity.  Her dad, from a religion and culture that is supposed to be stoic, held onto my hand and wept.  (Crying men really get to me, two dads in one week, two decisions to stop aggressive care, is almost too much).  Malt had brainstem reflex gasps that kept her heart beating for a full hour and a half after I pulled her tube, which was cruelly agonizing, making me second-guess my decision and giving the family a false glimmer of hope that was dashed.  Two beds over we waited for the death of another child, 4 years old, a long and complicated story of malnutrition and a mysterious mass on his back that took weeks to diagnose as a mycobacterial infection.  After two months at Kijabe he was discharged back to a refugee camp on the Somali border where he got none of his ongoing care, developed an obstructed bowel that diverted out through the skin on his back, then lost his kidney function, and finally came back to Kijabe past the point of no return. Both these families are from remote areas to the northeast where they would almost certainly never encounter tangible witness to Jesus.  If I were planning it, I would have had both their children improbably and miraculously healed.  Instead their children slipped away to death.  I do think both families could see the extreme effort poured out on their child by strangers; the odd intimacy of being swept into the most crucial hours of someone's life may have more Jesus-witness in the long run than a proud victory.  I don't know, and I'm clearly not in control here.

That would have been enough for one day.  But the strike goes on, and we're packed.  In another one of those timing flukes ... in spite of my fantasies of perhaps a gentler post-weekend-call day, perhaps departing early . . . it turned out one person after another on the Paeds team had some sort of illness or family crisis or tiredness or whatever that took them out of reach for parts of the day.  So it was a non-stop day, except for running home to check on Acacia who had had a fever last night and missed school (she does feel better now, but pray for her).  At 3:30 I admitted a post-operative neurosurgical patient to the ICU (where I'm not really working but seem to spend a lot of my time).  I wonder if Kijabe is the only place in Africa a kid could have two world-leading neuro and craniofacial surgeons work on their skull and brain.  By 4 I was starting to think of the evening and rest, and deemed it wise to call the two new family medicine residents who will take call and give them a little sign-over and orientation.  We all introduced ourselves, washed hands, and I opened my mouth to tell them about the cozy humid little nursery where everyone was doing fairly well.  

Then all hell broke loose.  At that moment, a desperate call back up to ICU.  The xray I ordered ended with the little post-op patient's breathing tube being dislodged.  Only when I walked in I saw it was more than that--the little boy was pulseless and pretty much gone.  Mostly dead, but not all dead.  Another opportunity to use the PALS course skills from last month, running a full-scale code to get him back.  Which we did.  And just as that finished, a desperate call back from nursery.  Where there was another new admission of a mostly dead baby.  He had lost 1/3 of his body weight in his short 5 days of life, was blazing with fever, convulsing, and dry as a prune.  For you medical types: Na 180, K 6.4, Cr 3.1.  These are very bad numbers.  I pushed some fluids in an intra-osseous (in the bone) line until the Paeds surgery fellow who happened to walk in was recruited to get a real IV line.  It was one of those admissions where everything was harder than it should have been, no gloves, no lines, no nurses, just that time of day I guess.  Another distraught mom.  By 6 he was stabilized (though far from OK, he still may die) and I literally had my hand on the door latch to nursery when a nurse burst in with a 1 kg 29 week (very premature) baby in a cloth, just-delivered, dusky and wet and mewing slightly, heart rate falling.  Really?  This was the baby whose mom was, as per the last hour's report, no where near delivering tonight.  Yet here he was.  Thankful for Bob our clinical officer who stayed and helped me, we had to scoot one baby over to reach oxygen for this one, intubate and give the magical soapy surfactant mixture for his lungs.  It was dark, after 7, when we finally walked out the door.

Monday, to the max.  Time for some sleep.


J Stew said...

My heart is broken for the people you are caring for. My hope and prayer is for the Lord to sustain strengthen you for the hellish days. I hope that you find it encouraging that reading your blog has definitely strengthened my desire to pursue PA school and to then take those skills to be used how God sees fit. Thank you for sharing your life with me.

MTMartin said...

Hi - I am curious if you could respond to the viral medial Kony 2012 thing going on in the States all over FB. Kids are posting seems like an old story. Invisible Children seems controversial. Since you (were) there, can you comment? Thanks! (and as always, we fervently pray for you - ever since Garrett was in class with Caleb at Cambridge!)

Matthieu Blit said...

Dear Drs Scott and Jennifer Myhre,

My name is Matthieu Blit, and I work as an editor for a blog called The Naked Physician, which main objective is to give physicians a space to share their experiences.

I read with attention your "paradoxuganda" blog, especially this and the "A 24 hour life" posts, and they fit more or less exactly with what we had in mind when we created one of the blog category called A day in a physician's life: it tells from the inside what makes your "usual" working day, and gives the reader the opportunity to discover a different reality.

So I contact you to ask if you would be interested in collaborating with us by either writing a post about what a normal day looks like for a physician in Uganda; or allow us to reproduce one (or several) post(s) within our blog.

To avoid any misunderstandings:

- Even if the Naked Physician blog is managed by the Scionis company, it is not a promotion tool, and therefore, its content is not used to advertise our products. As explained above, the real and only objective of this blog is to provide information for medical professionals. So your eventual collaboration will not be used to promote anything.
- If you agree to collaborate, your participation will obviously be credited.

If you have any question, I would gladly answer them.

Thank you for your attention, and I hope we will be able to work together.

Best regards,
Matthieu BLIT