Days 24 and 25

On Monday I woke up feeling not too great, definitely not as bad as what we affectionately refer to as “D-Day,” but still not 100%. I still headed to the hospital and back to peds with Anna, but this week we had a new group of med students to work with! I was sad to see Thomas and Tyler leave, but neither of them were particularly interested in peds in the long term plus the two new guys coming in seemed like they would work really well with the kiddos. We didn’t show up to the hospital until about 8:30, since we’ve learned the doctors don’t actually do anything in the morning, but when we showed up it was surprisingly crowded and busy! Apparently on Monday there are grand rounds, where the consultant, our pediatrician, shows up and thoroughly reviews every patient with all of the interns who are currently in peds. Usually in the morning Anna and I check on all of our critical kids while the doctors either sit in the back chatting or review random patients in the ward. 

It was so crowded though, that Anna and I couldn’t even get to half of our patients and could hardly hear when the doctor spoke. We had to spend a lot of time outside of the patient ward instead, waiting for some room to do something. We did see a few of our kiddos, checking their oxygen saturation and vitals, but in the end focused on one of our little babies who was very unresponsive. The mom originally called mine and Anna’s attention to her; even though we’re not doctors they seem to trust infinitely. Not only do the moms see Anna and I doing a lot of work the doctors should be doing, but also apparently here they seem to think white people can heal you within a day or two. Anyway, when the mom brought us over, she showed us how her daughter’s feet were really cold, showing poor perfusion, and how lethargic she was. I think she had been in the ward for a few days, but had been overlooked by the doctors. 

We of course paid attention and immediately called the intern’s attention to her as well. They decided she was hypoglycemic and immediately started preparing D10 (a 10% dextrose solution) to be given as an IV bolus. In nursing we learn always before administering any medication to check the systems the medication could potentially affect; in the case of administering sugar directly into this baby’s blood stream, my first instinct would be to check her blood sugar just as a reference and to ensure the correct action is being taken. I asked the doctor, can I please go get the glucometer that they keep in the laboratory, since there’s only one, and I was told no because hypoglycemia is more severe than hyperglycemia so either way they were planning to administer the dextrose. Although technically if the baby was a little hyperglycemic it wouldn’t be the end of the world, choosing to be ignorant about something that could so easily be checked made no sense to me. Eventually I convinced the doctor to let me go grab it and, as suspected, we found the baby’s blood sugar to be so low the glucometer couldn’t even read it. 

The doctor prepped 30 mL of D10 in an IV bolus and went to administer it, but then found the IV site in her head was no longer patent. We tried to find other sites in her hands, feet, arms, and neck (her jugular) but poor baby was so dehydrated that no veins were available. The baby couldn’t even properly cry she was so dehydrated, instead it was more of a long gasp. I think, like myself, the intern was starting to get nervous about how badly the patient was doing, so we put in an NG tube (feeding tube) and gave her oral dextrose. Afterward, they continued to look for an IV site and found a new one in her head and immediately administered an IV bolus as well. When we were done the doctor told us he actually thought he put the line in an artery instead of a vein, which was frustrating, but he said in reality it wouldn’t matter that much. Finally we hooked her up to a continuous IV of D5 and let her wait it out for an hour, hoping it would help. By that time it was lunch so Anna, Thomas, Audrey, and I all headed back to the house for lunch.

I still wasn’t feeling 100% by that point – slightly concerned with all the TB I’ve been exposed to (jk mom and dad, calm down) – so I decided to take the afternoon off to rest and relax, hoping that I’d regain enough energy to head back for a full day at the hospital on Tuesday. I spent the afternoon napping, reading, and hanging out, then later we watched a movie (featuring Mr. Bean, since Tyler thinks he’s literally the funniest person on the planet for whatever reason) and I headed to bed way early. Luckily, it worked and on Tuesday morning I was feeling much better than before!

Tuesday we were all way unmotivated heading to the hospital. I was up by 7:00 thanks to all the noises of Kenya – including a mosque doing the call to prayer every hour of the morning, church bells, and dogs barking – but we didn’t actually leave for the hospital until 8:30 ish. By the time we got to peds, shockingly rounds were going on again, which I was thrilled about even though it meant less for us to do. We checked on all of our kiddos again that we’ve been monitoring, and then Anna and I tried to create our own role today by reading through some of the patients charts, then doing head to toe assessments and informing the doctors of our findings. We looked mostly at our malnourished babies, checking for pressure ulcers and any other abnormal findings, but also a few other patients where we found some skin breakdown or joint pain that the doctors had overlooked. We did a few small procedures, like NG tubes and checking insulin, then discussed a few kiddos that had to be brought down to X-ray. 

Unlike in the hospitals at home, the patients have to be escorted down to X-ray because according to the interns, the patients will try to run away without paying if they’re let out of the ward. The patients and their families end up paying quite a bit to stay because not only do they pay for board and care, but also if the ward doesn’t have a certain medication or piece of equipment, the families have to go down to pharmacy to buy it. It makes sense since obviously hospitals in Africa aren’t the most affluent, but sometimes they can just get stingy; the people down in lab wanted the families to pay every time a patient needed their blood glucose tested, which I can’t imagine would cost more than a dollar and some families don’t even make that in a day. Anyway, we started bringing down our chest tube girl, who they suspected may still have some problems with her heart, for a chest x-ray. 

It seemed like she wasn’t doing half bad even though she wasn’t 100%, but when we checked her x-ray it showed that the other lung was now doing worse. They’re now planning to put in another chest tube for her on the other side, but they don’t do bilateral tubes so they’re going to take out her original tube and hoping that her lung won’t collapse again. I hate that she’s struggling so much, but she’s such a great sport about it and still will talk and sing to us, even when she’s having trouble breathing. I’m definitely going to be sad saying goodbye to her on my last day. 

We were told the rest of the inpatients had to go to x-ray at 2:00, so we left for lunch with intentions of returning at 2:00. We actually made it back by 2:45, but were able to get all of our kiddos down to x-ray successfully! Most of them have either TB or pneumonia – again, exposed – and hopefully the doctors will start taking action tomorrow. After work, we all headed to the market again to pick up skirts, get my last minute gifts, and pick up water. All of the women here wear their babies strapped on their backs with these cloths/scarves, so of course I had to get one 1) because they’re cute and 2) to prep for the future. Another relaxing night in store before the packing and craziness of travel – I can’t believe I only have one more day left! Everyone here is refusing to let me remember I’m leaving tomorrow, so I’m going to continue to pretend I’m staying until the last possible moment, even though I am excited to go home and eat real food!! Check back for my very last blog post tomorrow – eep!