This week I had a lot of late nights, two on call and the rest scrambling to prepare our Nursery Audit a week early. Every week we enter data into spreadsheet, tracking every admission, the weights, the positive cultures, the diagnoses, the need for oxygen and phototherapy. Then once a quarter we review the data to see how we measure up, where we can improve. At the end of the year, I try to also collate the entire year's worth of data. And since we've been doing this for three years now, this represents the whole shebang. My presentation ended up having 70 slides. Everything from our goals and our team, to the proportion of males/females or the outcome of babies treated with surfactant, to tables documenting admissions and deaths by birthweight, gestational age, and place of birth for every quarter. After the summary stats, I went through all the deaths, focusing on about 4 or 5 that I felt we could have prevented with better care. This is how we learn, and change. Scrutiny, data, facing real facts, being vulnerable. Naming our mistakes.
The table above compares the survival of babies (preemies and term) at Kijabe to a brand new study of 22 Kenyan "teaching" hospitals where interns are trained. We're the top lighter-blue line. It was very encouraging to see that we are leading the way in what is possible. And a challenge to bring up the stats for the smallest babies. I love being part of a team that wants to do this. Data and life, crunching numbers and hands-on care. Data IS life, perhaps.
And it is very good to look at the big picture while slogging through the daily details of life in the trenches. Our 5-bed ICU has had 4 beds occupied by Paeds this week, meaning they are my responsibility. It is rare to come through a week in the ICU without walking down the agonizing road of death with a family. I am very grateful for your prayers, because there have been some remarkable glimmers of hope that have no other explanation. This baby I mentioned before, baby of J who is now named "Blessing". She had to be taken by CS two months early because her mother has severe heart disease. She's the one whose dad asked us to please try and help her survive. I spent a lot of the early week gingerly dialing her ventilator up and up as she got worse and worse from immature lungs. On Wednesday she became very still, not moving or breathing on her own at all. That evening, I told her dad that I thought we had reached the end. I offered to pray and he held her hand as we lifted her up to God. At that moment I thought of the dad in Mark: Lord I believe, help my unbelief. And I thought as I prayed, maybe this dad has faith for his daughter that I don't. I had lost hope. So when I came in Thursday morning and she was opening her eyes and moving her arms and legs and breathing over the ventilator, I was in holy awe. Then I did a blood gas on her and got the first decent numbers of the week. I literally did a little dance right there in ICU. She still has a long way to go and her lungs are beat up. But she's still fighting, so we'll fight for her.
Most of my patients have been tiny, but on Monday evening I was called to casualty for a 15 year old girl. She is bigger than I am I think. She was living her normal life until Friday when she developed neck pain along with a severe headache. By Saturday she ended up at another hospital with vomiting, and they started treatment for meningitis. Over the weekend she became less responsive until she wasn't talking, sitting, walking, anything. She arrived in a coma and with some worrisome neurologic signs. After admitting her to ICU, intubating and putting on a ventilator, we asked for a head CT(only available in Nairobi over an hour away). This is the case that got me embroiled in controversy and politics and phone calls, stepping on some toes in commandeering an ambulance meant for a private stable patient and arranging for a nurse-anesthetist to accompany her which is never popular. However her head CT gave us invaluable information: NOT meningitis, but a mass in her brain. Neurosurgery agreed to take her into theatre, and we all expected cancer. Instead they found TB, a tuberculoma of the posterior fossa for the medically curious. You may not think TB in your brain is good news, but it is much better news than cancer in your brain. She is on treatment and already waking up and moving a bit. When the pathologist texted me the results on Thursday, it was my second rejoicing dance of the morning.
And taking another premature baby off the ventilator was my third. Whenever I talk to baby T's mom, she listens to me tell all the problems then says: "But she's going to be OK, right?" "Yes, I think so, but she still has a long way to go." Jack and I were reading a devotion on Naaman. I can relate to the King of Israel, when he is sent the patient referral letter saying basically "here is my servant, heal him." And the King says, who am I to heal anyone? Yes! Amen. That's my life, referrals from hospitals that have hit their limits, parents who are desperate for hope, saying take this kid and make them well. And lots of weeks that seems impossible, but this week we've seen some great progress.
Last fun story, on Wednesday afternoon in the midst of baby Blessing looking like dying and the usual press, I had a phone call from an unknown number. It was an Ethiopian man who had come to Kijabe a few months ago because his wife was pregnant with quadruplets (IVF) and he wanted an affordable an safe place for her to deliver. He talked to Scott, who showed him around and helped him with cost estimates. And perhaps gave him my phone number. . . because somehow he was calling me to say that his wife was now 27 weeks and two of the four babies had died in utero, and could they come to deliver the other two? I quickly made sure we could open up an incubator, and said YES. Within two hours she had arrived from Nairobi. The OB team admitted her to prepare, and Dr. Ari and Bob received these two beautiful babies, a boy and a girl. At 27 weeks and less than 1000 grams we know they have about a 40% chance of survival here. So please pray for them. Their mom has clearly been through a lot to get them here.
Meanwhile in Liberia, Scott did an emergency surgery on a lady with an ectopic pregnancy, and another CS on a 15 year old girl who was seizing by the time they got her on the operating table from a condition called ecclampsia, which put her life and the baby's at risk. Not pretty, but both survived. It is good for him to sense the purpose in being there. Hopefully he'll give us more of the story by email. (contact me at email@example.com if you're not getting those and want to, and contact Serge at firstname.lastname@example.org with your mailing address if you want our new photo prayer card in the post and you don't normally get our Christmas letters).
This weekend I am off, and Jack has two friends staying with us, so I'm trading in my stethoscope for baking cookies and making dinners. And hopefully, some sleep.