Just a few things to note from Thursday. ICU was full, so some patients had to be moved out so others could be moved in. A baby who was a footling breach baby was admitted to the ICU during the previous night after being resuscitated. A breach baby is one who presents to the birth canal butt first instead of head first. A breach delivery is far more difficult than a vertex (head first) delivery and carries much more risk. A footling breach baby presents with foot first and is even more difficult. This baby was a double footling breach, so both feet had been delivered prior to arrival at the hospital but the baby's shoulders had become stuck on the way out. Additionally, the umbilical cord was between the baby's legs, which meant that each contraction was compromising the blood supply to the baby. The baby was ultimately delivered by a talented physician via emergency "crash" c-section and was very difficult to extract since the footling breach delivery had already progressed so far. The baby required extensive resuscitation and was intubated and transferred to the ICU for ventilation and hopefully to recover, but the prognosis was poor.
Having an endotracheal tube in place is a very irritating thing, so most patients who have an ET tube in place require sedation so they are not continually gagging and trying to get the tube out. It is worrisome when an intubated patient does not require any sedation. This baby was not only requiring no sedation, but also showing very few positive neurologic features. The implication was that the child's brain was significantly injured prior to delivery. Later that day, it was decided that the child should be extubated since there was not any significant positive neurologic activity. As expected, the baby was unable to breathe adequately due to brain injury and later passed away.
The child who we had previously found with gasping respirations and intubated was once again found on rounds to have insufficient, gasping respirations and was reintubated and readmitted to ICU. His CSF actually was improved, but his neurologic status was not.
The next day was Friday, and I was thankful that we were going to be leaving early to go on safari. Up to this point, I had been almost constantly working or reading medical texts related to the work I was doing. I was looking forward to a couple of non-medical days. As Amy said, this would be my only "vacation" time of the trip.
After about 4 1/2 hours of driving across the great Rift Valley, the last 2 of which were spent on 61 kilometers of quite terrible dirt roads, we arrived at the Fairmont Mara Safari Club, where we were welcomed with wonderful glasses of mango juice. The staff was absolutely fantastic and our children were treated like celebrities while we were there. The accomodations, service, and food were superb and I would recommend the place to anyone without reservation (though you do want to have reservations!).
The first game drive on Friday evening was almost overwhelming. We saw an incredible array of wildlife in an incredibly short time span. We saw zebras, wildebeests by the thousands, Thompson's gazelles, elons, topis, elephants, cheetahs, lions, a leopard, hyenas, cape buffalo, and giraffes. We saw a lioness make a run at a wildebeest. She was unsuccessful, but it was very cool to see the attempt.
The beauty and the vastness of the savanna are two ways in which creation declares the glory of God. Other sights come to mind. The sheer numbers of wildebeests taking part in the great migration. The sun setting on the African plain. Watching the silhouette of a lone Maasai warrior striding confidently across the savanna at dusk, with only his staff to protect him from the predators that would be awakening about now. We were so blessed to be able to witness these things.
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