A few tracks that are, as far as we can tell, very popular with the young people in Kenya. The first is a song by a Tanzanian singer named Z-Anto. The song is called "Binti Kiziwi", which translates roughly to "Deaf Girl". The music video will explain.
The second tune, called "Nyota Yako", is one that packed the dance floor at a club in town called Places, our late night destination last night. We were told today that Places caters to a "more mature" crowd than the club that is more popular with the medical students. Anne & I were the oldest people in the place. We were quick studies and blended in on the dancefloor in no time at all.
Furahi,
Joe
Saturday, March 7, 2009
Usiku katika Eldoret
Here's a taste of the live music scene in Eldoret at a club called Sesia. Joe and my dance moves fit right in...
Tuesday, March 3, 2009
Mount Elgon
We headed to Mt. Elgon last weekend, a national park on the border of Uganda, and Kenya's second highest peak. Mt. Elgon is home to elephants, buffalo, and other wildlife, although their numbers have been in decline for the past two decades because of illegal poaching. Our trip began serendipitously with this view early on in the drive.
We spent about three hours in the matatu being entertained by the sights and sounds of small town Kenya. The two videos below feature a real-life "looking out the window of a van" view... minus the bone-jarring man-sized potholes.
We arrived at the campsite after dark, and woke up leisurely to an incredible view of Endebess Bluff. Shortly, you will see views from the top of that very bluff... the end to a short but fairly burly uphill climb on Saturday. As evidence, one of our companions vomited on the hike both up & down... likely in large part due to an elevation above 11,000 feet. We set out from Eldoret with our sights set on climbing to the Mt. Elgon's highest point in Kenya, up above 14,000. As it turned out, the guide who assured us he could get us to the summit didn't know what he was doing. His matatu wasn't suited to get us much further than the park gate. To paraphrase Dr. Mamlin, living in Kenya is like being in a boat and bailing all the time... if you stop bailing, be prepared to swim. Swimming, in this particular instance, could not have gone better.
Dr. Mamlin, his wife Sarah Ellen, their Kenyan son, Dino, and his friend Dave were also staying in park cabins, or bandas, right next door. We had learned a few days prior that Sarah Ellen had first encountered Dino, while on a home visit several years ago. She was taken by his family's small house that had been turned into a museum. As a small child, Dino had collected hundreds of specimens of insects, butterflies, birds, fossils, and natural life, perfectly preserved and labeled. This amazing talent provoked the Mamlins to sponsor part of Dino's education, including an undergraduate degree from Indiana University. Dino (pictured below) is now finishing his Ph.D. at Harvard. We were happy to have him around, and he earned his title as the "premier naturalist in all of Kenya." He also wrote the parks service guidebook on Mt. Elgon. That's no exaggeration. He is the author of the official Kenya Wildlife Service's guide to Mt. Elgon, and he was our guide for the day. At one point, he slowed the car to observe a swarm of butterflies. When asked to identify them, he rattled off four different species present in the swarm. Headshaking and admiration followed.
The day began with a drive into the park, stopping for the a little "birding" from time to time.
With Dino, and his friend Dave, who happens to be a professor at Harvard, specialist in orchids, former rugby player and free diver, we explored the caves of Mt. Elgon. Kitum Cave is apparently the fictional origin of the Ebola virus, according to some book called the Hot Zone. We were assured that Ebola has never been documented in Kenya, though it was found in nearby northern Uganda. At no point since our time in Kitum Cave have Anne's or my mucosal surfaces hemorrhaged... which is encouraging.
It also had bats! They were screeching and zooming around, and really creeped me out.
We were able to see remnants of cape buffalo and droppings of elephants, but none in the flesh (which is probably a good thing)!
The second cave featured more bats, and some great photo ops. Here's our friend Barb.
It also had a waterfall that Joe indulged in.
In the afternoon, we were taken to a bamboo forest in the park, with blue monkeys, colobus monkeys, and olive babboons.
We then hiked to a vista from which you could see clear into Uganda.
We're beginning to think that the natural beauty of Kenya is endless.
We ended the day with a waterbuck sighting, actually several waterbuck sightings.
After the sunset, the group, principally Barb, fixed steak, potatoes, and roasted vegetables all over campfire. We talked over South African wine and Tuskers on Kenyan politics, medicine, and our experiences thus far.
We've been back to the wards the past few days, and I am already stumped on my first pediatric case. Anyone know why an afebrile patient on phenobarbital (for an unknown reason) with hepatitis would have a seizure?
Tutaongea badai,
Anne & Joe
We spent about three hours in the matatu being entertained by the sights and sounds of small town Kenya. The two videos below feature a real-life "looking out the window of a van" view... minus the bone-jarring man-sized potholes.
We arrived at the campsite after dark, and woke up leisurely to an incredible view of Endebess Bluff. Shortly, you will see views from the top of that very bluff... the end to a short but fairly burly uphill climb on Saturday. As evidence, one of our companions vomited on the hike both up & down... likely in large part due to an elevation above 11,000 feet. We set out from Eldoret with our sights set on climbing to the Mt. Elgon's highest point in Kenya, up above 14,000. As it turned out, the guide who assured us he could get us to the summit didn't know what he was doing. His matatu wasn't suited to get us much further than the park gate. To paraphrase Dr. Mamlin, living in Kenya is like being in a boat and bailing all the time... if you stop bailing, be prepared to swim. Swimming, in this particular instance, could not have gone better.
Dr. Mamlin, his wife Sarah Ellen, their Kenyan son, Dino, and his friend Dave were also staying in park cabins, or bandas, right next door. We had learned a few days prior that Sarah Ellen had first encountered Dino, while on a home visit several years ago. She was taken by his family's small house that had been turned into a museum. As a small child, Dino had collected hundreds of specimens of insects, butterflies, birds, fossils, and natural life, perfectly preserved and labeled. This amazing talent provoked the Mamlins to sponsor part of Dino's education, including an undergraduate degree from Indiana University. Dino (pictured below) is now finishing his Ph.D. at Harvard. We were happy to have him around, and he earned his title as the "premier naturalist in all of Kenya." He also wrote the parks service guidebook on Mt. Elgon. That's no exaggeration. He is the author of the official Kenya Wildlife Service's guide to Mt. Elgon, and he was our guide for the day. At one point, he slowed the car to observe a swarm of butterflies. When asked to identify them, he rattled off four different species present in the swarm. Headshaking and admiration followed.
The day began with a drive into the park, stopping for the a little "birding" from time to time.
With Dino, and his friend Dave, who happens to be a professor at Harvard, specialist in orchids, former rugby player and free diver, we explored the caves of Mt. Elgon. Kitum Cave is apparently the fictional origin of the Ebola virus, according to some book called the Hot Zone. We were assured that Ebola has never been documented in Kenya, though it was found in nearby northern Uganda. At no point since our time in Kitum Cave have Anne's or my mucosal surfaces hemorrhaged... which is encouraging.
It also had bats! They were screeching and zooming around, and really creeped me out.
We were able to see remnants of cape buffalo and droppings of elephants, but none in the flesh (which is probably a good thing)!
The second cave featured more bats, and some great photo ops. Here's our friend Barb.
It also had a waterfall that Joe indulged in.
In the afternoon, we were taken to a bamboo forest in the park, with blue monkeys, colobus monkeys, and olive babboons.
We then hiked to a vista from which you could see clear into Uganda.
We're beginning to think that the natural beauty of Kenya is endless.
We ended the day with a waterbuck sighting, actually several waterbuck sightings.
After the sunset, the group, principally Barb, fixed steak, potatoes, and roasted vegetables all over campfire. We talked over South African wine and Tuskers on Kenyan politics, medicine, and our experiences thus far.
We've been back to the wards the past few days, and I am already stumped on my first pediatric case. Anyone know why an afebrile patient on phenobarbital (for an unknown reason) with hepatitis would have a seizure?
Tutaongea badai,
Anne & Joe
Thursday, February 26, 2009
Amani Ward
Friday was my last day on the Amani ward, which serves up 50 or so adult women. Daily, we rounded at the bedside, usually a junior student presenting the patient, sure not to leave out any details.
The patients and patients' families do an extraordinary job of taking care of each other. Neighboring patients will pick up food for two, if their neighbor isn't able to walk. Families of patients will translate, if another patient doesn't speak Swahili. (Below is patient breakfast)
The stories of many of the patients I will carry with me for quite some time.
I met a patient my first week on the wards who was carried to the hospital by her sister. She was a cachectic, wasted, skeleton of a woman, sweating, and short of breath. She was found to be HIV positive, and put on treatment for a pretty nasty pneumonia, infectious diarrhea, and oral thrush. Later, she gained enough strength to take walks, eventually making all the way to the hospital entrance. Upon her impending discharge, she asked me for something to remember me by. Joe took this picture of the two of us, that we printed, and gave to her.
I had another patient whose grandchildren and great grandchildren brought her in for a headache and neck stiffness. The patient spoke only Nandi, the first language spoken in the region I traveled to last weekend. I asked the family how old the patient was, and a lively discussion erupted as to whether she was 80 or 90 years old. Regardless of her age, this patient was very sick, and the family very close. Kenyan patients have to pay for major services as they go, such as imaging and expensive drugs. We suspected that this patient might have a head bleed, and so asked the family if they could afford CT. They had the money together faster than any other family I've seen. I commented how quickly it happened, and they clued me into the fact that this patient had over 150 grandchildren and great-grandchildren, so it was relatively easy.
Her head CT confirmed our suspicions. By the end of her hospital course, the patient was more comfortable, and she thanked me for helping to take care of her. The family all gave me hugs, even after I explained to them that their loved-one might have a limited recovery, and prognosis.
A third memorable patient was an incredibly sweet 15 year old with Rheumatic Heart Disease (RHD). The incidence of RHD and Rheumatic Fever sharply declined in the West after the discovery and widespread availability of penicillin to treat streptococcal pharyngitis, of which RHD is a sequelae. This particular patient has had RHD since an undetermined, very young age, and is suffering from end-stage heart failure because of it. She came to the hospital with shortness of breath on exertion and swelling of her lower legs, as well as gross ascites (fluid around the liver). We were able to alleviate her immediate and severe symptoms, but to correct her disease, she really needs a heart valve replacement (and needed one years ago). Nairobi is the only place those are done in Kenya, and her mother, who was there day and night for her weeklong stay, is not able to pay for such a surgery.
The students on my team were hard-working and very caring. Here are the sixth years, who graduate in December 2009 (medical school admission is directly from high school and for a total of six years).
Next week I will begin pediatrics, which will frighteningly be some of my last training in the field before I start residency. My classmates and I are currently in the window period. We have submitted our final rank-lists to the national residency match program, but will not find out until March 19th. So keep your fingers crossed! More on our lovely weekend later. Lala salama.
- Anne
The patients and patients' families do an extraordinary job of taking care of each other. Neighboring patients will pick up food for two, if their neighbor isn't able to walk. Families of patients will translate, if another patient doesn't speak Swahili. (Below is patient breakfast)
The stories of many of the patients I will carry with me for quite some time.
I met a patient my first week on the wards who was carried to the hospital by her sister. She was a cachectic, wasted, skeleton of a woman, sweating, and short of breath. She was found to be HIV positive, and put on treatment for a pretty nasty pneumonia, infectious diarrhea, and oral thrush. Later, she gained enough strength to take walks, eventually making all the way to the hospital entrance. Upon her impending discharge, she asked me for something to remember me by. Joe took this picture of the two of us, that we printed, and gave to her.
I had another patient whose grandchildren and great grandchildren brought her in for a headache and neck stiffness. The patient spoke only Nandi, the first language spoken in the region I traveled to last weekend. I asked the family how old the patient was, and a lively discussion erupted as to whether she was 80 or 90 years old. Regardless of her age, this patient was very sick, and the family very close. Kenyan patients have to pay for major services as they go, such as imaging and expensive drugs. We suspected that this patient might have a head bleed, and so asked the family if they could afford CT. They had the money together faster than any other family I've seen. I commented how quickly it happened, and they clued me into the fact that this patient had over 150 grandchildren and great-grandchildren, so it was relatively easy.
Her head CT confirmed our suspicions. By the end of her hospital course, the patient was more comfortable, and she thanked me for helping to take care of her. The family all gave me hugs, even after I explained to them that their loved-one might have a limited recovery, and prognosis.
A third memorable patient was an incredibly sweet 15 year old with Rheumatic Heart Disease (RHD). The incidence of RHD and Rheumatic Fever sharply declined in the West after the discovery and widespread availability of penicillin to treat streptococcal pharyngitis, of which RHD is a sequelae. This particular patient has had RHD since an undetermined, very young age, and is suffering from end-stage heart failure because of it. She came to the hospital with shortness of breath on exertion and swelling of her lower legs, as well as gross ascites (fluid around the liver). We were able to alleviate her immediate and severe symptoms, but to correct her disease, she really needs a heart valve replacement (and needed one years ago). Nairobi is the only place those are done in Kenya, and her mother, who was there day and night for her weeklong stay, is not able to pay for such a surgery.
The students on my team were hard-working and very caring. Here are the sixth years, who graduate in December 2009 (medical school admission is directly from high school and for a total of six years).
Next week I will begin pediatrics, which will frighteningly be some of my last training in the field before I start residency. My classmates and I are currently in the window period. We have submitted our final rank-lists to the national residency match program, but will not find out until March 19th. So keep your fingers crossed! More on our lovely weekend later. Lala salama.
- Anne
Sarah Obama picked to lead tsetse fly fight
In Current Events Kenya, it appears that executive ability runs in the Obama family. Eighty-seven years old and still taking on new challenges. I, for one, am impressed.
Also, Iran's President continues to give beards a bad name... and in Kenya, no less.
Then, police death squads. For or against? Let the debate begin.
And finally, a sampler of the hottest new Nigerian pop star. All the young Kenyans are digging P-Square.
-joe
Also, Iran's President continues to give beards a bad name... and in Kenya, no less.
Then, police death squads. For or against? Let the debate begin.
And finally, a sampler of the hottest new Nigerian pop star. All the young Kenyans are digging P-Square.
-joe
Wiki tatu
My third full week on the wards was interrupted by a day spent with Dr. Joe Mamlin in his clinic at a rural health center in an area called Mosoriot. I tend to remember just how much I enjoy outpatient medicine each time I return to the clinic... be it in Providence or Mosoriot, and this day was one of my favorites during my time in Eldoret two years ago.
Dr. Mamlin and his wife, Sarah Ellen, are central to the story of all that has been accomplished since Indiana University first established a relationship with Moi University & its Kenyan physicians in 1989. At some point thereafter, the AIDS pandemic swept through Eldoret. To hear Dr. Mamlin speak of the experience is moving. He gives a tour to the students who accompany him each week to Mosoriot, pointing out the tiny room where AMPATH first set up shop. Starting with funding to treat just 15 HIV+ patients (the existence of whom village elders once denied), AMPATH today cares for upwards of 120,000 HIV+ Kenyans.
The AMPATH map with a map of Kenya below. Find Eldoret just below the "K" in Kenya.
I find that number staggering.. in a good way. Even moreso when followed by Dr. Mamlin's ambitious plans for the next few years. Two years ago, on the same strip of road back from the clinic & in the same car, Dr. Mamlin described his vision of a home-based HIV testing program. Those words are today a reality with a vast expansion planned in the near future. There is reason to take Dr. Mamlin at his word, it seems.
But for as much as I find big numbers and "never been done before" plans exciting, it all pales by comparison to meeting just one Kenyan patient who would have died years ago were it not for these efforts. One woman called Dr. Mamlin "her father". She had lost sight in one eye due to a zoster infection but described Dr. Mamlin's care bringing her back from blindness. An elderly man lit up each time Dr. Mamlin passed through the waiting area. This man has Parkinson's disease and is able to walk only because the Mamlins' imported a year's worth of PD medication. As we departed from introductions made to the Outreach team, Dr. Mamlin described meeting its leader years prior as she was carried in to the clinic, oxygen saturation of 70% with a P. jiroveci pneumonia... an opportunistic infection and an AIDS-defining illness.
One very sad young woman had been rejected by her parents, had her home sold out from under her by a husband who disappeared and was having trouble finding school fees let alone a roof for her child. A terribly difficult time in what has probably been a very difficult life. It's possible that the medical care, mental health services, social worker, food program and job training will help get her through it. I shudder to imagine the alternative. Sadly, that alternative is still more the rule than the exception. Eighteen clinics with more by the year care for many like her each & every day. In conclusion, yet another memorable experience at Mosoriot. I have the good fortune of working with Dr. Mamlin next week on the inpatient wards as well.
I presented the case of a 33-year-old father of four this morning at AM Report. Hepatitis B & hepatocellular carcinoma, and a discharge with hospice. I do hope that is what it sounds like though my definition of end-of-life care is surely quite America-centric. Neither do family meetings have the same place in the decision-making process here. My registrar was away this AM so I led rounds from start to finish. Both the presentation & rounds went fairly well. I briefly had thoughts of an attempt at humor in my presentation but gave up as the hour got late last night. I did save this fine picture and would like to share it. Tom, I'm sure you remember this gem of a movie. Meet Turbo & Ozone.
We travel tomorrow evening to an area called Mount Elgon, located near the Kenya-Uganda border (see map above). There will be plenty of hiking, hopefully a good deal of cooking and perhaps some spelunking. Surely, Anne will fill in the details on Sunday. As we head into "the bush" for the weekend, I'll make a wish for continued GI stability. The toilet paper here is named "TENA", or "Again" in Kiswahili, which I find ironic.
And finally, Philip & I were handed our IREC approval letter today. Four weeks after our arrival but infinitely earlier than some might have predicted, we will commence interviewing outright tomorrow.
Tutaonana baadai,
Joe
Dr. Mamlin and his wife, Sarah Ellen, are central to the story of all that has been accomplished since Indiana University first established a relationship with Moi University & its Kenyan physicians in 1989. At some point thereafter, the AIDS pandemic swept through Eldoret. To hear Dr. Mamlin speak of the experience is moving. He gives a tour to the students who accompany him each week to Mosoriot, pointing out the tiny room where AMPATH first set up shop. Starting with funding to treat just 15 HIV+ patients (the existence of whom village elders once denied), AMPATH today cares for upwards of 120,000 HIV+ Kenyans.
The AMPATH map with a map of Kenya below. Find Eldoret just below the "K" in Kenya.
I find that number staggering.. in a good way. Even moreso when followed by Dr. Mamlin's ambitious plans for the next few years. Two years ago, on the same strip of road back from the clinic & in the same car, Dr. Mamlin described his vision of a home-based HIV testing program. Those words are today a reality with a vast expansion planned in the near future. There is reason to take Dr. Mamlin at his word, it seems.
But for as much as I find big numbers and "never been done before" plans exciting, it all pales by comparison to meeting just one Kenyan patient who would have died years ago were it not for these efforts. One woman called Dr. Mamlin "her father". She had lost sight in one eye due to a zoster infection but described Dr. Mamlin's care bringing her back from blindness. An elderly man lit up each time Dr. Mamlin passed through the waiting area. This man has Parkinson's disease and is able to walk only because the Mamlins' imported a year's worth of PD medication. As we departed from introductions made to the Outreach team, Dr. Mamlin described meeting its leader years prior as she was carried in to the clinic, oxygen saturation of 70% with a P. jiroveci pneumonia... an opportunistic infection and an AIDS-defining illness.
One very sad young woman had been rejected by her parents, had her home sold out from under her by a husband who disappeared and was having trouble finding school fees let alone a roof for her child. A terribly difficult time in what has probably been a very difficult life. It's possible that the medical care, mental health services, social worker, food program and job training will help get her through it. I shudder to imagine the alternative. Sadly, that alternative is still more the rule than the exception. Eighteen clinics with more by the year care for many like her each & every day. In conclusion, yet another memorable experience at Mosoriot. I have the good fortune of working with Dr. Mamlin next week on the inpatient wards as well.
I presented the case of a 33-year-old father of four this morning at AM Report. Hepatitis B & hepatocellular carcinoma, and a discharge with hospice. I do hope that is what it sounds like though my definition of end-of-life care is surely quite America-centric. Neither do family meetings have the same place in the decision-making process here. My registrar was away this AM so I led rounds from start to finish. Both the presentation & rounds went fairly well. I briefly had thoughts of an attempt at humor in my presentation but gave up as the hour got late last night. I did save this fine picture and would like to share it. Tom, I'm sure you remember this gem of a movie. Meet Turbo & Ozone.
We travel tomorrow evening to an area called Mount Elgon, located near the Kenya-Uganda border (see map above). There will be plenty of hiking, hopefully a good deal of cooking and perhaps some spelunking. Surely, Anne will fill in the details on Sunday. As we head into "the bush" for the weekend, I'll make a wish for continued GI stability. The toilet paper here is named "TENA", or "Again" in Kiswahili, which I find ironic.
And finally, Philip & I were handed our IREC approval letter today. Four weeks after our arrival but infinitely earlier than some might have predicted, we will commence interviewing outright tomorrow.
Tutaonana baadai,
Joe
Monday, February 23, 2009
A week in the life...
Anne & I have been spending what feel like long hours in the hospital. We each round with our teams all morning and return in the afternoon, working until dinner. We walk to and from the hospital together each day... which is lovely. Views from my walk below.
We have been studying Kiswahili as often as possible with our teacher, Wycliffe. Nilijifunza Kiswahili kwa mlimu yangu Wycliffe. Nilikula maharagwe jana usiku na nilinyamba sana baada ya kulala. Pima, Anne.
A Morbidity & Mortality review held by the Medicine Department revealed that approximately one in seven patients admitted during the month of January died while in the hospital. As I was thinking, "Man...", the Chairman of the meeting and my Attending (present at rounds exactly three times in nearly three weeks) commented that the number was unusually low.
He conducted the meeting much the same way rounds proceed in his presence... A heavy emphasis on the less-than-important, a keen focus on failure and blame and an utter lack of decisions made or action taken. I didn't enjoy the meeting. I sensed that role models at the Attending level were lacking.
On a related but unrelated note, as a proud Rock for Riley alum, it is my sincere pleasure to take part in the announcement of Rock for Riley V... to be headlined by The Avett Brothers. This is one of my favorite Avett Bros. tunes in recognition of an often used but questionably effective teaching method.
Shame by The Avett Brothers
I spent last Friday morning working with one of the Radiology Attendings. Consultations are either very difficult to obtain or surprisingly easy & efficient. Said the Neurosurgeon, "We'll take him to the OR tomorrow." There's no middle ground on this. I introduced two cases to Dr. Wanene (who looked bizarrely identical to my landlord in Providence... but Kenyan) and he asked if I could get the patients to Radiology now. I agreed. A few corners may have been cut in regards to consent, time-outs, patient understanding of the purpose of the big needle and perhaps sterile technique... but overall both biopsies came off without a hitch. As I waited earlier that morning to speak with Dr. Wanene, a woman with the housekeeping staff requested a picture. I obliged.
It continues to feel very strange to know a very sick, young person is dying and then to watch them die. I believe I've written about this once already. I can create many explanations for why it is not feasible to resuscitate every dying patient at MTRH. There is plenty of room for spirited disagreement here. Nonetheless, it happens. Patients die while we round on the patient in the next bed.
I returned to rounds on Friday to catch the last few words of a discussion regarding a 36-year-old HIV+ man admitted with heart & renal failure. He had deteriorated overnight, pulmonary edema in the setting of an unrecordably low blood pressure was diagnosed and a rock & a hard place were noted. My Registrar and interns broke away from rounds minutes later to attempt resuscitation. Why this patient and not so many other patients, I don't know. I joined and attempted to help us clarify our options. At one point, my Registrar appeared offended by my clinical assessment and left. Others simply drifted away. It didn't go well, but unlike many others, this man did make it to an ICU bed... in which he passed away hours later.
I grumble at times about the occasional excessive use of critical care resources at home. I focus on this negative too often, I think. From here, well-trained critical care staff operating state-of-the-art equipment to save lives looks more like the vital resource that it is. Below, the three medical students who stuck it out throughout a long and unpleasant code. We shared a nice, long lunch... talking at length about George W. Bush, Barack Obama and politics both here and at home.
On Saturday, Anne & I were invited to church with our friends, Philip & Robina.
The service was very nice... and featured a fine, four-part harmony. Enjoy!
When Jesus Comes by the SDA Gospel Quartet
We have been studying Kiswahili as often as possible with our teacher, Wycliffe. Nilijifunza Kiswahili kwa mlimu yangu Wycliffe. Nilikula maharagwe jana usiku na nilinyamba sana baada ya kulala. Pima, Anne.
A Morbidity & Mortality review held by the Medicine Department revealed that approximately one in seven patients admitted during the month of January died while in the hospital. As I was thinking, "Man...", the Chairman of the meeting and my Attending (present at rounds exactly three times in nearly three weeks) commented that the number was unusually low.
He conducted the meeting much the same way rounds proceed in his presence... A heavy emphasis on the less-than-important, a keen focus on failure and blame and an utter lack of decisions made or action taken. I didn't enjoy the meeting. I sensed that role models at the Attending level were lacking.
On a related but unrelated note, as a proud Rock for Riley alum, it is my sincere pleasure to take part in the announcement of Rock for Riley V... to be headlined by The Avett Brothers. This is one of my favorite Avett Bros. tunes in recognition of an often used but questionably effective teaching method.
Shame by The Avett Brothers
I spent last Friday morning working with one of the Radiology Attendings. Consultations are either very difficult to obtain or surprisingly easy & efficient. Said the Neurosurgeon, "We'll take him to the OR tomorrow." There's no middle ground on this. I introduced two cases to Dr. Wanene (who looked bizarrely identical to my landlord in Providence... but Kenyan) and he asked if I could get the patients to Radiology now. I agreed. A few corners may have been cut in regards to consent, time-outs, patient understanding of the purpose of the big needle and perhaps sterile technique... but overall both biopsies came off without a hitch. As I waited earlier that morning to speak with Dr. Wanene, a woman with the housekeeping staff requested a picture. I obliged.
It continues to feel very strange to know a very sick, young person is dying and then to watch them die. I believe I've written about this once already. I can create many explanations for why it is not feasible to resuscitate every dying patient at MTRH. There is plenty of room for spirited disagreement here. Nonetheless, it happens. Patients die while we round on the patient in the next bed.
I returned to rounds on Friday to catch the last few words of a discussion regarding a 36-year-old HIV+ man admitted with heart & renal failure. He had deteriorated overnight, pulmonary edema in the setting of an unrecordably low blood pressure was diagnosed and a rock & a hard place were noted. My Registrar and interns broke away from rounds minutes later to attempt resuscitation. Why this patient and not so many other patients, I don't know. I joined and attempted to help us clarify our options. At one point, my Registrar appeared offended by my clinical assessment and left. Others simply drifted away. It didn't go well, but unlike many others, this man did make it to an ICU bed... in which he passed away hours later.
I grumble at times about the occasional excessive use of critical care resources at home. I focus on this negative too often, I think. From here, well-trained critical care staff operating state-of-the-art equipment to save lives looks more like the vital resource that it is. Below, the three medical students who stuck it out throughout a long and unpleasant code. We shared a nice, long lunch... talking at length about George W. Bush, Barack Obama and politics both here and at home.
On Saturday, Anne & I were invited to church with our friends, Philip & Robina.
The service was very nice... and featured a fine, four-part harmony. Enjoy!
When Jesus Comes by the SDA Gospel Quartet
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