The Hospital

Hello to all. I hope you are all doing well.
I have had an interesting last couple of days. Since my last post, the VBAC that was laboring developed fetal distress and we took her back for a C-section. Even though I knew it was what she needed, I hesitated because it was my first time making the decision myself. Then, the path to get a patient to the theater (OR) from the maternity ward is very interesting. The patient is placed on a "trolley" and wheeled along a bumpy path up two hills to get to the theater! I want to video it so that all of you can appreciate what I'm talking about. Everything went well and mom and baby are doing fine. I then got to do my first vaginal delivery, which also went well. I have to say - the women here are tough! I went into the labor room with 3 women laboring, all completely dilated and they were completely silent. Their pain tolerance is amazing. Wednesday evening I was invited for pizza at the Larson's. It was wonderful. We were also joined by 2 medical students from Nairobi who are rotating here. Then, after dessert (brownies and homemade ice cream), their kids put on a little show for us. It was great! Their house is always full of action - their kids are 7, 5, 2, and 5 month old twins!
Yesterday was a tough day. It started off well. We had 2 scheduled repeat cesarean sections. They both went wonderfully. When we were almost finished with the 2nd one (Betty), the scrub wanted to close skin, so I scrubbed out. After completing the paperwork (yes, there is paperwork here, too), I stuck my head in the OR, and they said everything was fine. So, I headed home to get some lunch. Apparently the nurses didn't have the right number to get ahold of me and were trying to call me. I ran into one of the nurse anesthetists on my way back to the hospital and he told me that they were looking for me because Betty was not doing well. Apparently, after I left, he noticed that she was having difficulty breathing and complaining of chest pain and coughing up blood. Her oxygen saturations were in the 60's (should be 95-100). Despite being on 4 liters of oxygen, her sats were still very low and her heart rate was 140-160. So, I rushed back to the hospital and found her on the maternity ward. Dr. Larson was there as well. She was definitely in respiratory distress, but her lungs sounded fine. We were both worried that she might have a pulmonary embolus, but there is no way to diagnose that here. We switched her to facemask and bumped her oxygen up to 10 liters. Her O2 sat came up to 88%, but she was still working to breath and her heart rate was still fast. After some quick decision making, we agreed to transfer her to Eldoret, where they have an ICU. Remember, Eldoret is a 2 hour, very bumpy drive. Also, we had no guarantees that when she got there, they would have a place for her. So, we all gathered around her and prayed for her. Then, relatively quickly, the ambulance was here and we prepared to send her. A nurse and one of the anesthetists went with her. She sounded very bad when they were pulling off. I talked with the anesthetist this morning, and he told me that she is now stable. Her BP when she arrived there was 220/120, though and her HR was close to 200. Praise the Lord, though, they had one ICU bed open and she got it! Please continue to pray that Betty will make a full recovery. So far, we do not have a diagnosis.
Another patient that has touched me already is Dorcas. She is a very sweet 37 year old lady who came to the clinic complaining of abdominal pain and distention for about the last year. On exam, she was noted to have large pelvic masses and was sent to us for ultrasound. On ultrasound, you can see at least one 12cm mass and on abdominal exam, you can feel mass all throughout her pelvis. She also had a lot of ascites (fluid in the abdomen) on the ultrasound. All of this is very concerning for ovarian cancer. She said that she was unable to eat because everything just came right back up. She was admitted to the hospital and initially the doctor taking care of her drained only a small amount of the fluid to send for diagnosis (will take 2 weeks for the results). However, she continued to have significant pain. So, I suggested that they drain as much fluid off as possible for comfort. Yesterday, they drained 4 liters of fluid out of her belly. She feels much better today and is able to eat. This is only temporary, though. A surgeon is coming today and we are going to discuss the case with him. In the US, it would be a no-brainer - do surgery, then chemo. Here, however, it is a much more difficult decision to make. There is chemotherapy available in Kenya, however she would have to be able to pay for it. Also, it will be a very big surgery and she would have a fair chance of not making it through the surgery or the recovery. So, please pray for her and for us as we discuss this with her.
I am really enjoying my time here. I cannot describe in words how beautiful the area is and the people are just as beautiful in spirit. Everyone keeps asking why I'm only staying 2 weeks. It does feel like a short time. However, I am continuing to pray about coming back here for the 2 years. I could definitely see myself here. We'll see what the Lord has in store.
Until the next post, I hope you all are safe and well. God Bless!