Tuesday and Wednesday Sept 21-22

Tuesday, September 21

So, a few patients stood out on Tuesday.  The first was a 13 year old girl who was transferred tous from another hospital for worsening muscle aches, weakness, and lethargy.  Studies done at the other hospital found calcifications in the brain and kidney stones.  She also has had a seizure disorder since about 6 months of age and periodically has been treated with anticonvulsants.  The first calcium done at Kijabe was around 2, which was very difficult to believe.  The level was repeated and found to be 7.5, still a bit low, but not unbelievable and unlikely to explain all of her symptoms.  Spinal tap was done to evaluate for meningitis because of the lethargy, but only showed 8 white blood cells.  Not technically normal, but also unlikely to explain what was going on.  I advised the team that we needed to evaluate her for the cause of the calcifications and low calcium.  Possible reasons include parathyroid disease, hypercalciuria, hyperoxaluria, and pyridoxine deficiency.

The second patient of note that day was an 80 day old former 28 week premie who had, quite remarkably, never been on a ventilator and had been maintained on CPAP (continuous positive airway pressure) successfully until now.  He acutely worsened and had to be intubated.  When the intern was unable to intubate, I had the opportunity to perform the procedure.  Thankfully, I was able to place the tube successfully, though a little deeper than ideal.  From the time the baby was intubated until the time that the ventilator was set up and the tube was confirmed to be in good position, three hours had passed.  Most of that three hours I spent bagging the baby while everything else was set up.

Wednesday the 22nd

I got to attend chapel at the hospital for the first time on Wednesday.  Because it was my first time, I had to give a greeting to the group.  Greetings are very important to the Kenyan people, both in formal situations such as this, and in less formal situations.  The greeting goes something like this:  Hi, my name is David Sprayberry.  I am saved.  I am a visiting pediatrician and will be serving here for three weeks.  Despite my dislike of public speaking, chapel was an enjoyable experience, with music both in English and in Swahili, and was a nice reminder that our purpose at the hospital extends beyond just providing medical care.

I spent more time in the ICU on Wednesday.  I was called in to the ICU in the afternoon because the ventilator was not working.  I had to troubleshoot the ventilator but could not get it to work correctly, so I had to switch ventilators.  Fortunately, Dr. Jaster had given me a crash course in the set up of these ventilators and I was able to switch them successfully.

We had a new admission to the nursery who had had a 30% weight loss since birth and a bilirubin of 20.  Another baby in the nursery had been previously admitted with an initial bilirubin of about 45, which is incredibly high.  That baby demonstrated opisthotonus, which is a sign of kernicterus (deposits of bilirubin in the brain).  Kernicterus can lead to long-term developmental problems, so it remains to be seen how this baby will be affected.  Feel free to pray for all three babies and for the family of the 13 year old, since she later passed away.