The Safari Crew (Cindy, Sarah, Aaron, Ginnie, David, Jananne and me)

As I approach my last week here at Tenwek Hospital, I can’t help but reflect on my time here — the successes, challenges, blessings, miracles, deaths, lives saved, sleepless nights, friendships, and learning experiences. As I type this email, I feel as though the energy I arrived with on July 7th has been overshadowed by emotional and physical fatigue. The long on-call days and nights and unparalleled magnitude of witnessed deaths have taken their toll. Yet the sense of fulfillment that I’m leaving with cannot be compared to any other work experience I’ve had. It’s an amazing feeling to know that my daily work, prayers, and time are making a difference in people’s lives and to be able to see the fruits of my labor.

I was recently asked what the most memorable part of my experience has been. It didn’t take much thought to say, “the people.” The patients, long term missionaries, staff, and visiting medical students and physicians from across the world have my time priceless and have been permanently etched into my heart.

The people and staff native to this area welcomed me with open arms into their county and their homes. They shared their life stories, taught me some of the language, and treated me as family. I shared many laughs with interns on the wards, particularly Ronald, Hillary, Zahura, and Evans. The moments before rounds when I would drink chai and eat Mendazi’s (fried dough similar to donuts) with them or with the endoscopy suite staff (Reuben, David, Benard, and Robert) were invaluable. It was at those times that I learned the most about Kenyan culture.

Almost equally memorable are the meals and bible study time spent in fellowship with the long term missionary staff. These people have sacrificed some of the comforts of practicing medicine and surgery in the states, to devote their lives and those of their family to spreading the gospel and ministering to the people of Kenya through medicine. They have fostered an environment of faith and holiness here at Tenwek.

The most memorable people; however, have been those with whom I’ve spent the majority of my free time — namely, the guesthouse visiting staff and students, Patti Wamuyu, and Stephen Leimgruber.

Frank's birthday party in the guesthouse kitchen

The guesthouse is filled with people from all walks of life in the states and abroad, but who all have a common mission in being here. We have easily become friends and will likely remain so for a long time to come. Aaron, a surgery resident and future cardiothoracic surgeon who created this blog, and I bonded early during his stay here given our similar sense of humor. When he and his wife left, the guesthouse was never the same. Dave and Naomi were selfless in sharing their snacks and movies with me. Frank, a German medical student, and I got into an hour long discussion about relationships on his first day here. We became acquainted through our similar experiences of long distance relationships which would often be the topic of our conversations. Melissa and Jeff, newlywed medical students at VCU, were quite entertaining and gave me a new perspective on marriage. John, a medical student from Alabama, and I had many intense racquetball games and often exchanged jokes, particularly about the German’s obsession with David Hasselhoff, as we learned from an “E! True Hollywood Story.” The German medical students adamantly denied this though.

Patti, me and Mike

Nonetheless, my closest friends have been Patti and Stephen, two of the most generous, humorous, spiritual, and cool people I know. On any given evening, Stephen and I could be found at Patti’s house, eating her food, watching her TV, or both. We talked about any and everything. Nothing was off limits. They have been like my brother and sister and I will miss them dearly.

But brother is not the only name and role that I have adopted since being here. I have been called “doctarie” by the natives (as Swahili for doctor), “that cool doctor” by some of the interns, and a “prayer warrior” by one of the visiting staff.

Overall, this has been an unreal and blessed experience, and hopefully the first of many mission trips. Nonetheless, I’m ready to come home. I can’t wait to see family, friends, and undoubtedly Brittney. Communication via Skype has been fun, but I can’t wait to share my experiences and joy in person. Thank you all for your prayers and support. May God bless you.

Peace and blessings,

Darrell

He was a 35 year old Kenyan who was admitted last night secondary to heart failure. Though he was having mild respiratory difficulty last night, he was not in critical condition by far. This morning on rounds, I found him in respiratory distress, working hard to breathe and unable to talk because all of his energy was being used to breathe. No pulse oximeter (machine used to measure oxygen saturation) was anywhere close. I firmly asked the intern to start the patient on face mask oxygen immediately while I went to look for a pulse oximeter. I walked briskly to the female medical ward . . . .no pulse oximeter. I walked even faster to the pediatric ward . . . they had a pulse oximeter but no probe (vital for the measurement). I jogged to the ICU and they had what I need. Upon arriving back the bedside and examining the patient again, his breathing became more labored and his heart was beating at a lethal speed, 180 beats per minute. I asked the intern and closest nurse where the EKG machine was . . . no one knew. I ran to the ICU only to be told that the two EKG machines in the hospital were not functioning properly. So I ran back to the male medical ward, rummaging around for a defibrillator machine . . .my only hope for visualizing a heart rhythm was using the paddles on the defibrillator. I found one and hurried to the patient’s bedside . . . no power. I attempted to plug it in . . . no adapter for the electrical socket. Three minutes later an adapter is found and I aggressively placed the paddles on his chest . . .his heart was still beat 170-180 beats per minute and the rhythm looked like supraventricular tachycardia (SVT). I knew exactly what I needed . . . .Adenosine IV. There was no Adenosine in the code cart. I ran to the pharmacy . . .no Adenosine. I ran to the operating rooms . . .no Adenosine. I found some Propranolol, a poor substitute especially given that the patient was in acute heart failure as well. I get back to the patient, his bedside was crowded with interns and nurses who were attempting to help, and his heart stopped just as we were attempting to administer the medication. As on of the interns was bagging him (giving oxygen manually via a mask) and a nurse was giving emergency IV medications per my order, I performed chest compressions for 15 minutes (which felt like eternity. All the while I knew that there was no available ventilator and no room in the Intensive Care Unit) . . . .no heart rhythm, his pupils were fixed and dilated, he was dead. I was in such disbelief . . .everything had gone wrong. Sure, I have seen plenty of people die, but I knew that he should not have died like this. I took it hard. I had the leave the ward and outside for some fresh air. I sat in the outdoor chapel and prayed. When I gathered my composure, I returned to the ward, prayed over the patient, and then counseled and prayed for the family. Finally, I let it go and resumed rounds.
 
I found strength in 2 Corinthians 4:7-11, 16-18. “But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us. We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed. We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body. For we who are alive are always being given over to death for Jesus sake, so that his life may be revealed in our mortal body. vs 16 Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes  not on what is seen, but on what is unseen. For what is seen is temporary, but is unseen is eternal.”
 
Im headed back to work. Just had to get that off my chest and mind.
 
Peace and blessings,
 
Darrell

The ICU

The most memorable patients were two young ladies in the Intensive Care Unit, both of whom are now in glory. The first young woman had rabies, apparently contracted after being bitten by a rabid dog. This is a condition that carries a 100% mortality. Despite our aggressive care, she would eventually succumb to her illness. She had high fevers and excessive drooling until her time of death.

The second young lady had severe tetanus. She sustained an injury to her Achilles tendon but didn’t report to the hospital until the wound was gangrenous and he was experiencing diffuse spasms. Despite receiving appropriate antibiotics, sedatives, and paralytics, she continued to experience high fevers, respiratory distress, and frightening appearing spasms until the time of her death.

The Female Medical Ward

Performing a skin biopsy.

In my brief time in the field of medicine, I have seen things that nightmares are made of and have seemingly mastered the art of the “straight face” — never letting my internal reactions to putrid odors or skin crawling sights show on my face. However, when I saw this lady’s skin, I know she had to see “What in the world?!” written all over my face. **I will interrupt this message to give you a public service announcement — If you notice a rash that is seemingly eating away at your skin, DON’T WAIT UNTIL IT HAS SPREAD ALL OVER YOUR BODY!** Sorry, that was an aside. Now normally after a physician fully evaluates a patient, he or she makes a mental list of several possible diagnoses before initiating treatment.For this patient, I had a mental list of about 15 potential diagnoses. The good news was that though her skin looked horrific, she was not very ill. This was obviously a slow developing skin condition that she was not a risk of dying from on my watch. I knew that no matter what I prescribed her, it would not go away over night. Nonetheless, I gave her some medicine, took biopsies of her skin, made sure she was comfortable, and sent her home with the plan to return in 2 weeks when the biopsy results would be available and I could tailor her therapy.

Another dermatological rarity--cutaneous anthrax.

Casualty (The Emergency Room)

The following event occurred about 2 weeks ago. Have you ever been busy, totally immersed in something, only to be overcome with a feeling that someone is watching you? Well, one particular evening, I was in Casualty talking with my intern about a patient we had just seen when I felt as though someone was staring at me. I turned around and saw an expressionless young male standing behind me. I looked him over only to discover he was dripping blood on the floor from his right hand. On closer inspection, he was missing three fingers.

Penetrating trauma--arrow in the left flank.

Three fingers! And it seemed as if he was not in any pain. Apparently, he was riding a motorbike, tried to avoid some donkeys in the road, and crashed. Motorbike injuries are extremely common here and usually result in a lot more severe injuries than his. Other peculiar things that I have seen in Casualty include drunk men recently trampled by elephants, men shot with arrows over cattle, and women and men struck repeatedly by pangas (machetes). Again, all I could think was “How in the world did that happen?!”

On a more positive note, I received a scripture last Sunday that I marinated on all week and would like to leave with you. It is from Matthew 25:14-30. It is a very familiar passage of scripture known as the parable of the talents. Its a story of man who was going on a journey and entrusted property to his 3 servants. “To one he gave five talents of money, to another two talents, and to another one talent, each according to his ability . . . The man who had received the five talents went at once and put his money to work and gained five more. So also, the one with two talents gained two more. But the man who had received the one talent went off, dug a hole in the ground and hid his master’s money.” The story does go on to say that when the man returned from his journey, he was able to say “Well done good and faithful servant” to the two servants who had multiplied their money. To the other servant who had hid his money, the man said, “You wicked lazy servant!” As is written in the red letters of the Bible, Jesus says, ” For everyone who has will be given more, and he will have an abundance. Whoever does not have, even what he has will be taken from him.” So I pose the question, what will you do with the talents that God has blessed you with?

Thank you for your continued prayers and encouragement. I miss you all dearly and will return to the states in approximately 3 weeks.

Peace and blessings,

Darrell

“For we are to God the aroma of Christ among those who are being saved and those who are perishing.” 2 Corinthians 2:15

What a grand calling we have — to be “the aroma of Christ.” Despite the varying stressors of the work week, I have attempted to focus on being that aroma, such that the fragrance will overpower the stench of my worries,and those of whom I encounter on a daily basis.

The end of last week was especially challenging. Rounds one morning, a morning that will forever be etched into my memory, started with two female patients on either side of the room having seizures almost in tandem. One of the ladies was bleeding profusely through her urinary catheter and the other lady was so frail that her momentary violent seizure looked as if it would break her in two.

On the Female Ward

After resolving those issues, it was only minutes before I encountered another perplexing situation. I was called to another room in which I found a patient seemingly comatose. Though her vital signs were stable, her pupils were dilated and non-reactive and her whole body was rigid, all signs of a neurological insult. She had recently been transferred from the Gynecology ward to the Medicine ward given gingival bleeding and profound thrombocytopenia (low platelets; factors that contribute to blood clotting) of unclear etiology. In the next bed, an elderly female patient was in diabetic ketoacidosis ( a complication of uncontrolled diabetes) because the nurses weren’t giving her the appropriate medications in a timely fashion. I enjoy the intensity of the medical ward, but this was more than intense.

At that moment, I could feel the frustration growing, trying to undermine my sensibilities. But I closed my eyes just for a split second, long enough to say “Jesus.” I opened my eyes and the chaos seemingly became organized. I started thinking out loud, teaching, and making vital decisions all at the same time. In a calm tone, “Hillary, this patient is bleeding into her brain. A CT scan would confirm this but we don’t have that at our disposal. Start her on Mannitol and Dexamethasone NOW. Once you do that, inform the family of the change of events and of the poor prognosis.”  Next I found the nearest nurse and guided her to the bedside of the patient who was in DKA. ” I know you’re very busy and working hard, but realize that we all have a role to play in saving patients lives. You can save this lady! Would you please make sure that she gets her insulin and IV fluids as prescribed? Thank you”

We all face situations, people, bosses, bills, etc that make us lose our cool or create worry. It is at those moments that we should challenge ourselves to be the aroma of Christ. And remember, as my family would occasionally tell me, there are people watching you even when you don’t realize it. That reminds me of a scripture from 2 Corinthians 4:7-10. “But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us. We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted but not abandoned; struck down, but not destroyed. We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body.”

Good news! All the aforementioned patients are doing well. Specifically, to my surprise, the patient with the intracranial bleed markedly improved within 24 hours. She complained off a bad headache but was talking, walking, and ready to go home. The family wanted to go to Nairobi to seek the expertise of a Hematologist about the thrombocytopenia issue and so she left within 72 hours of that potentially fatal event.

I have found that its also very important to have an outlet. While here, I have been playing basketball, table tennis, and volleyball with local Kenyans to relieve the stresses of the day. It has also helped to build relationships and possibly lasting frienships with the people here. I feel so blessed to be here. I’m happy that everyday I can make a difference.

Have a blessed week. Remember 2 Corinthians 2:15.

Peace and blessings,

Darrell

Rainbow over the hospital grounds

Posted in Tenwek ]]> http://tenwekadventures.wordpress.com/2009/08/13/whats-that-smell/feed/ 3 Darrell Female ward Rainbow 1 http://tenwekadventures.wordpress.com/2009/08/10/a-cheerful-heart-is-good-medicine/ http://tenwekadventures.wordpress.com/2009/08/10/a-cheerful-heart-is-good-medicine/#comments Mon, 10 Aug 2009 14:48:57 +0000 Darrell http://tenwekadventures.wordpress.com/?p=51 ]]> Written on August 2, 2009

Proverbs 17: 22 ” A cheerful heart is good medicine . . .”

This week was just a busy, challenging, and emotionally straining as prior work weeks here. Yet, amidst my interacts with both sick and dying patients this week, who spoke Swahili, Kipsigis, and other tribal languages, I was able to communicate with them in a universal language for which I did not need a translator — love.

Something as simple as a smile or a kind word can bring healing. Often times, when I encounter patients or family of patients around the hospital and do not have anyone to translate for me, I just smile and find that it becomes contagious. In addition, when I’m rounding with interns and asking them questions to challenge their clinical knowledge and they do an excellent job, I tell them. Being in their shoes before, I know first hand how good it feels to have your superior/supervisor/attending to complement and/or encourage you. Interestingly, in bible study, when everyone was asked how their week was, one of the interns remarked on how nice it was to get positive feedback. That little bit of kindness cost me nothing, but was priceless to the recipient.

Thursday afternoon, soon after finishing lunch, I was paged by an intern to come to the bedside of a patient who had just died. This was an elderly lady who had been admitted to the hospital the previous night secondary to symptomatic severe anemia, but who also had developed acute onset of shortness of breath that morning before rounds. During rounds, upon seeing her, I knew that her prognosis was poor. She was in obvious respiratory distress and despite being given 10 liters of oxygen via a face mask, her oxygen saturation was in the 70s. There were no beds in the ICU and no available ventilators in the hospitals. I thoroughly examined her and reviewed her chest Xray. There was no evidence of pneumonia or tuberculosis. Her history and physical exam were most consistent with a pulmonary embolism, but there was no way to prove it without a CT scan or EKG. Unfortunately, the hospital pharmacy does not have lytics (medicine used to dissolve life threatening clots). All we could do was make her more comfortable. As we left her bedside to round on the next patient, I told my intern to call the chaplain as she didn’t not look like she was going to make it. Nonetheless, I was paged after lunch by another intern who was informed that my patient had died. I hurried to her bedside only to find her son, seemingly close in age to me, standing at the foot of her bed with an expression of unbelief. He was young. I couldn’t help but think that hat could have been my mother on the bed. Words escaped me. Anything I could have said, he might not have understood anyway. I looked at him and just gave him a hug. One of the interns soon came to the bedside and helped me to translate. I explained what I thought happened and led to his mother’s passing. More importantly, I let him know that I was praying for his strength and I that I was there for him. Though my time with him could not take away the pain of losing his mother, he was very grateful.

In the same way, I’m grateful for all of your encouragement and prayers. It means a lot  to know that you are proud of me. It means a lot to know that I have so many loved ones and friends supporting me. Thanks for all the emails.

I have to give a special shout-out to Brittney (my girlfriend for the few of you who may not know) who has stayed up late (given the 7 hour time difference) every night to talk to me on Skype and who never forgets to tell me how much she loves me and misses me.

I love you all. Remember Proverbs 17:22 as you begin another week.

Be blessed,

Darrell