Like my friend Sue Newton just wrote... WOW. I wish I could say something more profound, but... WOW! I don't even know where to begin. It's 11:30 pm and I'm just getting back to the room after the end of a long day and I'm so excited all I could think of was, I've got to get back and document all of this. By the way, I'm doing these daily posts for purely selfish reasons, which have nothing to do with any of you. I simply want to remember every detail of my time in Africa because of the work we're doing here, and I felt I needed to share it with all of you that are supporting me financially and spiritually. It's the most profound thing I've ever experienced (you were right Jan and Tom!) and it will be a sad day when I have to leave.
OK, a couple of updates on prior posts. I was able to very diplomatically get my roommate to move in with his surgeon because of his snoring. I wasn't quite sure how to broach the subject with him, because I didn't want to be a jerk or make him feel bad, but I can't do what we're doing here without sleeping each night. Well, the next day after surgery we were in the hospital auditorium listening to a lecture being given to the medical students and interns by one of our intensivists and this guy just starts snoring to beat the band. Of course, this was my opportunity, so after he totally embarrassed himself in front of the whole Tenwek Hospital medical staff, I asked him if he snored that much all the time. Then he launched into how he had to sleep 2 levels below his folks as a kid and he still kept them up. So he offered to move that night, and I didn't stop him.
Secondly - Gary; I promise not to pet any of the big yellow kitties on the safari next week.
OK, so sit down and pay attention, we have a lot of ground to cover. A couple of days ago I needed to print off my perfusion record and drug and flow calculations for my first case and the Chief Surgeon, Dr. White told me to come use his computer and printer in his office. When I got there this arrow head was laying on his desk, and it looked surprisingly like the one "we" just removed from Elvis the other day. After telling me that they are made out of 10 penny nails (I think I already told you that), he said he had heard that after the husband shot Elvis he chopped up his wife with a machete (I think I may have told you that also). Well she got brought into Tenwek today. The orthopedic surgeon had to amputate both arms and one leg from the trauma and he hit her in the face and head 8 different times with the machete and cut her ear off down to the skull. Evidently, there is a huge drinking problem with the men in Africa. There is no such thing as social drinking. You either don't drink at all, or you drink so much that you beat / mame / kill your wife(s).
In January when the cardiologist that set up this whole trip visited Tenwek, there was a political uprising between the tribes due to the presidential elections (their president is from the same tribe as our president - how weird is that?). There was footage on Kenyan National television of some Kukuyu tribe members stopping cars on some road between here and Nairobi and were killing passengers. I asked the surgeon how one tribe would know if someone else was from their tribe or someone else’s, and he said by the language. Most people in Africa speak English as well as Swahili, then they speak their tribal language. When one tribe is out to get another, they just ask them to speak. If they're not speaking their language, they kill them. During the presidential elections, the 2 main contenders were from 2 different tribes and the losers accused the winners of rigging the elections, so immediately a fter t his incident on the road, the Kukuyu and Lo-o tribes were at war with each other.
Dr. White went on to say, as he pointed out the picture window in this office that looked out over this beautiful Kenyan countryside, that one day he was looking out his office window and saw a tribe of Kukuyu's coming over the ridge headed for the hospital. OK, so maybe they were just coming in to get an arrow or two dislodged, right? He said that information on the rumor mill in Africa moves faster than using a telephone. They had gotten information that day that the Kukuyu's were on their way to Tenwek to kill all the hospital personnel that were from a different tribe, so Dr. White flew all the non-tribal members out of Bomet Province. As luck would have it, the "elders" of the village surrounding Tenwek turned the Kukuyu's away and the incident was averted.
Can you even imagine? I'm right here looking at the countryside and I still can't fathom that kind of barbaric behavior.
OK, so back to today. We had a little 12.5 kg (5 pound) 2 y/o Downs baby to do and the case went even smoother than yesterday’s case. It was a longer case and we stopped the heart this time (which I was worried about, because the medication I pump into the heart to stop it has ALWAYS come from the pharmacy right out of the refrigerator, and the stuff I was using was in someone’s suitcase from Rhode Island who arrived 4 or 5 days ago). But the ole ticker stopped on a dime when I started pumping it in. The CEO of the hospital came in and met the entire team today and it was a great case. The little girl did very well. There will be many pictures of all the patients for you to "meet" when I get back home to a DSL internet connection. I pieced the heart-lung machine circuit together and I was rather impressed myself this morning at how confusing all of the circuitry looked. The circuit I used today was one I had never seen o r used before, so that was kind of cool. It was even cooler when I went on bypass and everything worked like it was supposed to.
So after the case I was lazy and went back to the guest house for lunch before I tore down my circuit (the OR's are such an incredible mess that leaving a heart-lung machine sitting in the middle of the room with about 2 gallons of blood sitting in it wasn't even noticed). I got to spend some time reading everyone's responses today, which was very uplifting. They made me smile and, at times, laugh out loud. So now to the subject of the day...
When I went back into surgery to tear down my pump I went through the ICU to check on our patient and to be there for my other team mates who are in charge of the ICU. Not an easy task. These people are up 24 hrs/day monitoring and caring for the patient's we do in surgery - much harder than what I'm doing. Did I mention that they're all incredible? So every couple of days the cardiologists hold a clinic where they see the patients that come in to be evaluated for their cardiac disease and they we hold a subsequent meeting in the guest house after dinner that night where the cardiologist inform the surgeons about who they saw and what was wrong with them. Then they duke-it-out about who needs to be done and exactly what they're going to do to them. Well, I'm not as smart as some of you may think, and I sit in these conferences picking up only a fraction of the stuff they're talking about, and just when I think I'm getting SOME of it, they say some thing really stupid that makes absolutely no sense....
Dr. Mike, "we saw a 2 y/o Down's baby this morning with a secundum ASD and a cleft mitral valve who doesn't exhibit any signs of irreversible pulmonary hypertension. There's no VSD and we think this patient would be a strong candidate for surgery on Wednesday". OK, sounds good so far... "Of course, Mom says the baby snores so we can't check that here in Kenya". WHAT? What does snoring have to do with heart surgery? If snoring is an indication for heart surgery, then by all means operate on my roommate so I can get some sleep while he's recuperating in the ICU!
Anyway, the point is, we hear all this clinical talk about these "people" who are just notes on a page... until you put a face and a personality to the name. My patient for Thursday is a 10 year old boy that needs a Tetrology of Fallot repair. This is a repair that we do on the kids in the States when they're less than 6 months old. But the additional problem that this boy has is that his red blood cell count is so high that there is very little room left for the plasma in his blood, which contains the clotting factors that will help him not bleed to death. So he has a surgically repairable lesion, but he'll bleed to death while we try to do it. The answer is to give him an exchange transfusion prior to surgery, which involves putting an IV in his little African arm to drain the blood from. As I'm walking through the ICU to check on my morning patient, I see this 10 yr old in bed, in the process of getting an IV by one of our young nurses from the pediatric ICU at Vandy (Diedre). She's very much like Meghan and I immediately liked her when I met her months ago during our planning meetings.
The little boy is the cutest little thing you've ever laid eyes on and I could immediately tell that he was just terrified at what was going on. I didn't know if he spoke English or not, but there wasn't a parent in site and my heart just jumped up into my throat when I saw him. I stood at the end of the bed and watched for a moment to evaluate the situation, because I didn't want to be in the way. He was lying down with his arm stretched out at his side. Diedre was showing him the needle that she was going to stick him with (it even scared me!) I think because he was so intent on looking at everything that she was doing to his arm. But as she cleansed the site with iodine to prepare for the stick he started moving his head back and forth, not saying a word and not moving his arm at all. He was such a little warrior. I wanted to walk over and comfort the little guy but didn't want to overstep my bounds, until Diedre asked me to. I walked up to him on the other side so he would avert his attention from the needle stick (who needs to see that anyway?) and took his little hand in mine. He spoke English, so I asked him what his name was. Of course I had no idea what he said because the names here are ridiculous, and big crocodile tears started rolling down his face as I asked him how old he was. He had the most respectful little voice and accent, "10 years". Diedre got the vein in the first stick, but he was still scared because the angiocath (the plastic part) was sticking out of his arm, "Do you have any brothers and sisters?" I asked while I was holding his hand. "Yes, one brother and one sister" is the smallest possible little voice. Diedre and I told him what a big boy he was and how cool the port was in his arm and he just laid there and cried and it was everything I could possibly do to not cry along with him. I don't know how those nurses do it. Of course, there was a camera involved (I'm getting a reputation) and he told me I could take a picture of him and then we had some fun looking at him in the view finder (I made sure there were no barbed-wire fences in sight first). Before long he was chuckling along with me, and I had to leave to go cry in the hallway outside the ICU.
Several hours later when I was leaving to go back to eat dinner I stopped in the ICU to check up on him and he was coloring in a coloring book with a big smile on his face. Dierdre told me later tonight that he is the top student in his class. We're doing his case on Thursday morning; please pray for little what's-his-name. If I stay here much longer, I'm going to come home with one of these little guys.
It's 12:30 am and we have 2 cases to do tomorrow so I need to sign off, but I'm not done with my day yet. I'll have to continue tomorrow. Dr. White invited us to his house tonight to give us one of his lectures that he's prepared on Health Care at a Missions Hospital. You would not believe some of the stuff he told us and showed us. Of course, there was a camera involved (I have a reputation to maintain) so I did get some additional photos to share with all of you (I'm up to about 750 now - thanks again Meghan. Everyone thinks your camera is pretty cool). I took notes so I wouldn't forget anything so stay tuned for more.
The two cases tomorrow are not mine, so it will be a nice break for me. There is a cardiac surgeon and perfusionist (my ex-roommate) from Rhode Island, and they're going to do the adult cases down here. In the morning, before the open heart, I'll be teaching the medical students and interns how to run a cell saver so they can salvage the patient's own blood during surgical procedures (i.e. arrow-ectomies), process it and transfuse it back into them. This is especially important since banked blood is in such short supply out here.
I wish you could all be here with me...
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