Greetings! Scott here.
Well, I just finished my first call weekend, and although it was a bit crazy and hectic, I survived, as did almost all of the patients. The call weekends here a tough, however, since you are on call for 48 consecutive hours, and the only medicine doctor available. Therefore, I had to cover the entire medical service, all the medicine consults, the ICUs, and all new admissions. In total, that included rounding on ~60 patients a day, which was exhausting, exciting, and of course interesting. I am slowly adapting to the lack of resources, and am learning on the go. I thought I would share a few brief stories below:
-On Saturday, we had a women present with a severe nose bleed. She had severe thrombocytopenia (low platelets) which prevented the bleeding from stopping. In the U.S., we could give a transfusion of platelets, but we do not have platelets here. Instead, in order to give platelets, a relative has to donate blood to be given. No relative was available with matching blood type. We proceeded to pack her nose with gauze, and held pressure, but she continued to bleed into her mouth, suggesting the bleed was coming from the posterior (back part) of the nose. In the States, we would use a “Rhino Rocket” (device that goes into the nose) or have the vessels cauterized by an ENT specialist. Unfortunately, she was losing blood fast and was developing hypovolemic shock (very low blood pressure) from the blood loss. On a whim, I grabbed a new Foley catheter (the type that goes into the bladder and is used to drain urine). I placed the catheter through her nose and into the back of her throat. Following that I was able to blow up the balloon of the Foley in the back of her throat, pull the Foley back out her nose, and the balloon caught against the back of the nose, compressing the bleeding spot. The bleeding stopped with this contraption long enough for us to be able to tranfuse her!
There have been several other situations in which I have been stretched medically, and have done things I have not previously done such as bone marrow biopsies, administering chemotherapy (typically done by oncologists…we don’t have them here), and I even did a pericardiocentesis. This procedure is typically done by trained cardiologist under imaging guidance, but again, no cardiologists here. We had a woman with a large buildup of fluid in the sac around the heart (likely from TB) causing pericardial tamponade, which means the fluid is making it difficult for the heart to beat. We attempted to treat the TB with hopes she would improve, but she worsened, and actually coded. I had read how to do the procedure just that day, and actually performed the procedure following the code. I inserted a syringe under the ribs, pointed toward the heart, advanced (praying I would not hit the lungs, blood vessels, or heart itself. Eventually, I reached the pericardial sac, and we were able to drain a few hundred milliliters of fluid and she initially improved, but unfortunately died two days later.
She was only 35, and she joined several other very young patients that have passed away. Amazingly, a few patients have gone against this trend, as we have had a 100 year old, 115 year old, and believe it or not, a 120 year old patient on service. It is crazy to think that the 120 year old patient was born in 1892, which likely makes her one of the oldest, if not the oldest living person in the world right now! She is still going too, after being discharged this weekend!
The daily death here can be difficult, but it offers a chance for amazing spiritual conversations and prayers with the patients and their family. The majority of patients are Christians, but many patients are not believers. In fact, just today, we had a 24 yo patient, with advanced cancer, give his life to Christ. He did not grow up Christian, but has been coming to Tenwek for the last few months for his care. He said that he noticed something different about the nurses, doctors, students, janitors, administration here, and he wanted to know what it was. He told us today, that he has discovered that what this “difference” was, was the love and peace of Jesus Christ. Today during our conversation, he told us that he wanted to give his life fully to Christ. We prayed with him, and he accepted Jesus as his savior! Praise God! It is amazing how as Christians, whether a doctor, nurse, teacher, custodian, administrator, business person, or anything else, our attitudes, conversations, and love can reflect Christ to the world.
There is so much more I want to share, but I once again have become quite long winded. Next post, I will share about a truly miraculous story of healing that I witnessed over the weekend, but I will save that for another time!
Anyways, thanks for reading if you made it this far. Below, I just wanted to share a few pics from a hike that Whitney and I did last week with a few other visiting missionaries.