First call night

Friday the 17th and Saturday the 18th



The regular work day on Friday was less overwhelming as I felt that I was beginning to be able to contribute clinically to the pediatric team, though still not much on diseases like malaria, TB, and severe malnutrition. In the nursery, Dr. Jaster asked my opinion about a 28 week infant on CPAP (continuous positive airway pressure) who continues to have respiratory distress, with reflux and possibly aspiration contributing to the distress. The decision was made to try a prokinetic to encourage gastric emptying and perhaps improve the respiratory status. Erythromycin was chosen, so we will see if it helps or not. The mother looked at me as I examined the infant and said, “help my baby”. I very much wanted to tell her that everything would be all right, but I didn’t really know that. A 28 week infant without the benefit of early intubation, surfactant, and ventilation may not make it, though the fact that the baby has already made it over a month without the benefit of those interventions is encouraging. To me, it is rather amazing that an infant that premature had made it that far on CPAP alone.

Friday night came and my first call night began. I was rather apprehensive about all the possible things that might happen during the night. Two admissions came during the course of the night, but nothing emergent. The first admission was a 22 month child who had swelling around the eye for about a month. CT scan confirmed a mass in the soft-tissue consistent with lymphoma or fibromatosis. The CBC revealed a pancytopenia with a hemoglobin of 4.4 (!!!). He was transfused and the hemoglobin rose to 11 (much better). He had a calcium of 14.4 (very high) and a repeat level was ordered to confirm (which it did). He was also noted on exam to have splenomegaly. All these features combine to suggest that the mass is malignant, but he will need a biopsy to be certain.

The second admission was a 4 month old child with a history of seizures who was admitted for a fever with 4 seizures in a short time. The lumbar puncture came back clean, meaning no meningitis. The child will be covered for 48 hours on IV antibiotics and then likely discharged with oral.

Pediatric rounds on Saturday were notable for a child with severe dehydration, malnutrition, low potassium, and elevated creatinine, who seemed to be worsening somewhat. We were also consulted by surgery to talk to a mom about the fact that the child’s abdominal ultrasound was suggestive of malignancy (splenomegaly with enlarged retroperitoneal nodes). We were basically consulted to give the mom the bad news and tell her she had to go to Kenyatta Hospital in Nairobi for definitive diagnosis and treatment. And to write the referral letter for them.

On Saturday, we went up to Rift Valley Academy for lunch. The seniors were selling burgers, hot dogs, chicken sandwiches, and taco salads as a fundraiser for their senior trip. The kids went and played on the old school playground like we used to have. The playground had monkey bars, teeter-totters, swings, a merry-go-round, and a zip line. We talked with one of the security guards at RVA named Samuel, who is a Maasai. He came by the apartment later with crafts that his wife makes and sells. Among the items were very niced beaded items, as well as other fun items like war clubs. Take a guess what I settled on for myself. Let’s just say that I can now put the softball bat in the garage at home.

I went jogging for the first time since I have been here. Downhill was not too bad at all. It was the uphill trip home that required a break or two. The first few days in Kijabe, I found myself out of breath from walking up the hill from the hospital to the sitaplex (apartment). O.K., it was more than a few days. I checked my oxygen saturation after we got here and found it to be about 94%. I don’t know if that was all because of the elevation or if the sinus infection I brought with me was a factor, too. Either way, it improved once we were here for a little while.

I will try to post more in the next day ot two hopefully, maybe from the airport.