Monday, October 14, 2013

A weekend off, life and thanksgiving

Over the past few years I have discovered something about myself. I am a home body. I like being home where I can do my own thing, I don’t need to travel, and I can just relax. Some of you may be thinking really – is this the same girl who has taken 10 000km roadtrips, and moved across the world to Kenya. And the answer is yes. While I love to travel and visit people I highly value my own space and when I have been busy my favourite thing to do is to hide at home with a book. Living here that works some of the time but not all the time. I have a pager and it lives on my hip. As I am the only Respiratory Therapist I have told the missionaries and staff here that if something comes up on nights or weekends that is outside the ordinary and they can’t deal with it that they can call me. I am not called every weekend and it has been more than a week since I have been called out of bed but it is part of life here. The month of September was busy and I really felt the need for a break. I have learned the best way to do this is leave. So last weekend (the weekend before thanksgiving) I headed out to the big busy city of Nairobi to relax.

I stayed at a nice guesthouse that has communal meals so you can visit with other missionaries/visitors.  It is also close to many shopping centers so I can walk rather than take a cab.
Shortly after I arrived,I heard some sad news from home. A friend had died in a farm accident. This fellow, like my brothers, was a farmer and loved what he did. He was someone I grew up with as our families have always been close. I was thankful for the time away to shed tears, offer up prayers, spend time in God’s word and talk to family.
I was in Nairobi from Thursday late afternoon until Monday noon. I was able to eat lots of good food Chinese, KFC, Italian, frozen yogurt and American. Tenwek does not have much options for eating out. So if you can’t cook it you don’t eat it. It was great to eat some different food. I also did lots of shopping for everything to new CD’s to groceries and was able to visit my teachers from language school. It was great to see my teachers who I spent 3 months with at the beginning of the year we were able to catch up, and have some laughs as I demonstrated how much shang (Swahili slang) that I have learned while at Tenwek. I returned to Tenwek with food to fill the cupboard and freezer and a refreshed spirit to return to work.
KFC in Nairobi, part of my families thanksgiving tradition is to have KFC, I was glad I could too, and only a week early

The week since returning has been busy and fun. One of my friends braided my hair Kenyan style, its fun to see people’s reactions as I look quite different. I do appreciate the lack of maintenance this hairstyle gives me but I don’t think it will last long as my hair is much slipper than the Kenyans hair. A few weeks ago I had some of the interns over for pizza and I introduced them to the card game – Spoons. We had a blast and Friday was the second spoon tournament. There was about 10 of us at the home of one of the interns. We started with a supper of meat, ugali, greens, and salsa. I was shown how to make ugali and put to work stirring the mixture. After that was the spoons game it was fun and we had a lot of laughs.
Ugali in the making

2 of our Chefs for the evening - I contributed my standard of chocolate chip cookies

Nice calm game of spoons, yes that is me with the lines on my head

The spoon dive

Sunday we celebrated Thanksgiving. As Americans don’t celebrate until November I was happy to find 6 other Canadians to join in on the celebration as well as a few others to fill the table. We had a great evening filled with sharing of Thanks and wonderful food – Chicken (turkey is really expensive), mashed potatoes, broccoli, salads and of course pies. Hmm.
The last two weeks we have not had too many people on vents so my time has been spent doing other things.  We got new (to us monitors) for our ICU and HDU so I helped in the sorting of equipment and setting up and training. Some of that has included reading the configuration manual and changing the default alarm parameters – finding a balance between a machine that alarms when the patient needs attention and a machine that alarms some of the time. This is definitely not something I would ever do in Canada but here things are different. I also gave a lecture last week to the Doctors and Residents- titled  "ventilation beyond the basics." It was fun to talk about the more complicated things like PIP vs Pplat, auto PEEP in COPD, permissive hypercapnea etc.
Nice new ICU monitors

Ok so this post ended up being longer than I thought if you made it to the end pat yourself on the back.

Tuesday, October 1, 2013

Why I Do what I Do – Mary’s Story

I love what I do as a Respiratory Therapist, but the work has its difficulties. Most of my time is spent in the ICU working with the sickest of the sick. What I say here may offend some people – which is not my intent. I also need to state that I value life highly and am against euthanasia of any kind. Now that that is clearly stated I will explain why. I operate machines that breathe for people, people who without such machines would die. Now this may sound like a good thing but not everyone who goes on a breathing machine, in my opinion, should. I distinctly remember one Christmas in Canada where we had a 90 year old fellow with MS on a ventilator. We kept him alive with machines over Christmas and when the patient’s family realized he would not recover the machine was removed and he passed. Placing him on a machine did not prolong his life but his death. I, and my, co-workers all have many similar experiences and many of us have said if this happens we don’t want to be put on machines in certain situations. RT’s are often the first ones in the ER to ask the difficult question – how aggressive in this individual's care do we want to be? If this patient gets worse will they go to ICU? Why – will they get better?
This is the work that I do and given that it is easy to ask the question – why? Why - Because some patients have a high chance of getting better and without the care that I can help provide they would die. To illustrate this I will tell you Mary’s Story.
                I met Mary a week ago. She had been at Tenwek two weeks ago when she had a C-section for twins, at the time she suffered from pre-eclampsia (dangerously high blood pressure that can happen during pregnancy). After the C-section, for healthy twins, she was doing much better and was sent home. She returned with severe shortness of breath and dangerously low oxygen levels despite oxygen (Spo2 60s on NRM). Her chest x-ray showed pulmonary edema. We tried her on biPAP, a tight fitting mask to help her breathing (I used the servo 900C as my biPAP machine as my VPAP can’t give 100% O2) with no success so she required intubation and ventilation.  On the ventilator her oxygenation improved some but she required the maximum my machine would give her (I wish I had APRV). I checked on her over the weekend, with medication (lots of lasix) and time she slowly got better. After five days on the ventilator, she recovered and we weaned her off support from the ventilator, and just before we did rounds where the decision to take out the breathing tube would have been made – she made the decision for us and pulled out the tube herself. She did well breathing on her own and was discharged to the ward.
                So this is why I do what I do. This young lady would have not recovered without the care an ICU can offer.  She would have left two babies without a mother but now in a few days she will be able to go home to her babies and return to her life.

I cannot take the credit for her life although I worked hard, without God’s hand on this lady she would not have recovered.