Wednesday, March 23, 2011

Can I Leave?

I am writing this post with only six more days of work left until I leave back to Canada. I am coming home - this is a fact and I am looking forward to seeing my family and friends as well as going to fast food restaurants. However, I am sad to go. I have made many good friends and have loved my time here. I am also worried about what will happen when I go.

To illustrate that fact here is what happened today:
I was awoken up by my pager at 6:30am - the patient was not doing well and the resident would like some help. I got up the hill and find a patient who was not doing well - his heart rate was 170, respiratory rate was 50 and SpO2 was 75. I did what every RT does and fiddled with the vent settings for a bit with no improvement - take a listen to his chest and I discover that the air entry is poor. Asked about a CXR - the portable machine is broken. I then took the patient off and bagged - amazingly he was easy to bag (his PIP was 40). Thinking the machine was broken, I swapped out machines - seemed to help for a little while but then same problem again. We paralyzed him and finally he settled. This man has a head injury and was breathing so fast that the ventilators (both of which I tried) could not keep up. We managed to get this all sorted out in time for 730am rounds and 8am M&M (morbidity and mortality).

After M&M, I sneaked away from the hospital to have some breakfast - finished just in time as my pager went off, they needed my help in the nursery. Up the hill I climbed to discover the resident bagging a sick baby with poor SpO2 we bagged the baby for a while but we were unable to save him. I comforted the Mom and said a prayer with her and the chaplain. As I was leaving, I was told they were having trouble with a one year old on the pediatric floor. Off I went and found a grunty 1 year old just maintaining his SpO2 on a non-rebreather at 15lpm. So we took him to ICU - after making a stop off in x-ray to take a chest film as the machine was broken. In ICU he did not look much better and we were debating about intubating him or not; we went for a compromise and put him on CPAP. How do you CPAP a one year old in Kenya? You take your home BiPAP machine and an adult nasal mask and you are good to go. The child looked really cute (only a RT would say a kid looked cute with a mask). The SpO2 maintained and at a reasonable level and the child was able to rest his breathing muscles.

That done I was able to escape for lunch and some computer work. Came back after lunch to check up on the previous patients and teach the new visiting Doctor how to use our ventilators. I had a scheduled lecture for 3:15pm but was told (at 2:45pm) that the lecturer for 4:15pm was unable to make it so could I do her presentation as well. So off I went, reviewed her lecture (on Trach care) and gave lectures all afternoon. The day ended with a quick round to see how things were going. I headed into Casualty (ER) and saw two patients receiving side stream neb treatments - set up like a pipe. I was so excited as the nurse had set them up properly. Maybe I can leave after all.

So sorry if I bored and confused all you non medical people. Really, I am worried about how the staff and more importantly the patients will do when I am gone.
On a lighter note I had a great week last week my friend J was here and I had a great time working with her as well as taking of to the coast – Indian Ocean. I celebrated my birthday there and enjoyed a surprise birthday party from my friends at Tenwek when I returned. We have also been blessed with rain in the last week which means the grass is green, crops can now grow and the hydroelectric dam can give me power. On a sadder note my computer screen has died – I have been able to borrow the guesthouse computer but has made it difficult to post pictures on the blog – sorry, when I am back I will post some.

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