Monday: An abundance of death. Over the weekend we had 4 children to pass away, three were from the NICU and one I had previously blogged about that was from peds. The child in the pediatric unit was one of my patients from last week. She was a 4 month baby girl whom presented with what we thought was pneumonia. After a few days of treatment the child was still hypoxic and presenting with a cough. The mom seemed to think the baby was getting better and clinically we thought she was making progress. Last Wednesday I ordered a repeat CBC and CXR under the suspicion that there might be something else going on...my attending, Dr Cheryl Lee, agreed with me. Thursday, the results from the tests showed miliary tuberculosis. Mortality rate for miliary TB are 16-38%, and if RDS (respiratory distress syndrome) develops mortality rises to 80-100%. Treatment was automatically transferred to provide coverage for TB. On Sunday the mother noticed the child had stopped breathing and a code was called...they were unable to resuscitate her. I was not present during the code, only on-call works on Sunday, but I was informed of the news when I returned to work on Monday. I was quite astonished...out of all the children on our service, she was not one that I expected to die. Dr Lee described our patients perfectly when she was asked how everyone was doing, "Everyone is stable, but borderline. It would not be surprising to see any of our children survive or die." Here at Tenwek Hospital you truly have to leave everything in God's hands each day! Our resources are limited and these children are severely ill. We can treat our patients to the best of our ability and resources, but it is in God's hands to heal them! In the US I often find that I must force or at least remind myself to rely on God throughout my day, here at Tenwek it is a necessity to get through the day! I hope to carry my new found reliance back to the US with me! God had a bigger plan for those 4 children, one that we may or may not understand. Ultimately though, my faith is in God and I trust in His works!
Tuesday: My break from Peds. As I had spoke with many of my friends about, I was initially under the impression that I was going to be doing Orthopedic Surgery here at Tenwek. A week before I left the states there was some confusion and I ended up in Pediatrics. I believe that God's hand played a part in some of the confusion that took place, because He is truly using me in the Peds Unit and NICU. Although I love my children and all the doctors on my service, I took a break on Tuesday to be part of the orthopedic team! Dr Trent Wilson is an orthopedic surgeon who is also a short-term missionary staying at the guesthouse. Once he found out I was interested in ortho, he was gracious enough to extend an invitation for me to join his service! Of course I accepted! Tuesday morning I scrubbed-in for my first surgery ever!!! I have been privileged enough to observe some surgeries, but I have never scrubbed-in!!! In the states these opportunities are rare due to the risk of lawsuits, but in Kenya any help is more than welcomed! Our first patient of the day was a female patient in her mid 30's that had been hit by a machete on her right humerus. And when I say hit by a machete, I mean the blow sliced through her arm and completely separated her humerus into two parts. The wound was left to heal over a 6-month period; needless to say it did not heal! As Trent and I scrubbed-in he mentioned to me that if I felt weak at any point just to make him aware...of course I was like haha, it happened once and it won't happen again! After about an hour into this stellar surgery I became very hot, nauseous, and starting getting very weak. I did not want to succumb to defeat, but it got to the point where my options were to step back and sit down or fall on top of our patient. The heat of being layered up and standing in a hot room for an hour finally overcame me. I ended up having to lay down with my legs propped up for about 30 minutes before I got enough energy to bear my weight. I decided to observe the rest of the patients until I was able to get some food at lunch. The next patient was a gunshot wound that had got infected. The patient had two huge holes going through his left thigh...an entry wound and an exit wound. On x-ray the proximal end of his femur was shattered. During lunch I was able to eat a large portion of food to regain my energy. As soon as I returned to theater (surgery) I was ready for round two! Dr Greene, a long-term missionary of Tenwek, was in need of an extra set of hands, so I stepped in to assist him! In 32 years of practice Dr Greene had never performed a nerve graft, and I was picked to assist him today!!!! Our patient was a 20 yo male who had also been attacked with a machete and had two defense lacerations on his left forearm. Repairs had been made the previous day to his ulna bone, but paralysis was noticed in the fingers his ulnar nerve supplied. When a repair was attempted yesterday it was unsuccessful because the ulnar nerve had been lacerated and the two ends of the nerve would not stretch far enough for reattachment. Today our objective was to remove the sural nerve from the leg and graft it into the ulnar nerve so that it would be continuously connected. In order to remove the sural nerve we had to make an incision on the posterior part of the left lower leg from the knee joint down to the ankle. Once the nerve was removed, incision was closed with stitches...staples do not exist at Tenwek because they are too expensive. Not only are your resources limited in Kenya, but part of the dilemma lies in the patient not being able to afford the right treatment. When treating your patients you often have to consider how much the treatment is going to cost the patient. After closing the leg, we quickly moved to our next incision site. Dr Greene reopened the previous wound and we cleaned out the site. The sural nerve that we pulled from the leg was tremendously smaller than the ulnar nerve, so we had to slice it into multiple shorter pieces. The work was tedious and meticulous, taking a total of 3 1/2 hours and inserting a total of 6 small segments between the two branches of the ulnar nerve. What may seem boring to some was one of the top most amazing things I have ever done throughout my life!!! It was a bit surreal! Needless to say I enjoyed my day very much and I plan on returning back to ortho one day next week for more experience! One of most amazing things I witnessed throughout my day in surgery was that prior to each surgery the team prayers with every patient! I can only imagine how much more at peace each patient must feel just knowing they are in God's presence!
The Humerus Repair!
The Gun Shot Wound!
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