Today when I walked into A&E, it
was chaos. I didn’t have time to set down my bag, and much less take a look
around the department, before the manager of the minor theater (really more of
a procedure area… where they do minor surgical type things. Stitches, chest
tubes, etc.) asked, “ You can put in a catheter, right?” I confirmed that she
meant a urinary catheter and that she wanted it put in the old fashioned way
(because they do suprapubic caths in the minor theater like it is no big thing
here). Then I said that I could. The man had a catheter in place that clearly
wasn’t doing its intended job. The bag was empty… actually dry. Not a drop in
there. And you could actually visualize this man’s bladder. Thin, scaphoid
abdomen with a round swelling at the base to almost halfway up to his
umbilicus. Really full bladder. I admit I kinda got a little worried. Clearly,
someone had botched this before. He was older… maybe he had a HUGE prostate or
worse, prostate cancer.
Luckily for me, the cath went really
easily. The previous cath had been blocked up by a long thin blood clot that was
clearly visible when I put the cath in and got 850 mL of urine immediately.
Poor guy must have felt so much better after getting that 2nd cath
in, in place of the 1st one.
Then, they asked to borrow my
penlight to check on a woman’s pupil reactivity… or well… more correctly the
lack thereof. Not only were her pupils fixed and dilated, she was cold
obviously having been dead for several hours and no one had noticed. I found
this disappointing but not surprising because regardless how precariously someone
is clinging to life, they aren’t monitored. There is 1 life-pak machine that is
used to take vitals and theoretically resuscitate someone (although I haven’t
seen it happen). What I was dismayed about was the fact that the MO intern
wrote a note saying that this woman had been “resuscitated vigorously” and had
failed resuscitation. What
resuscitation? She was found dead, and not just dead cold in the department.
She had come in the night before, deemed an acute abdomen, and that was it. No
nurses notes from overnight. No one had rechecked on her. I can’t even herald a
guess as to when she died, but I know it wasn’t the 8:30 AM that the MO intern
wrote down. I found the circumstances surrounding her death to be so sad. She
came into the hospital for help and seems like she didn’t get it (not because
it wasn’t available for once) because no one noticed her.
After that, we had a 5 year old
child with Down’s syndrome come in with burns to about 40-50% of his body. The estimation was complicated by the fact that
this is not a normal 5 year old as his size is much smaller than that of a
normal 5 year old. Fortunately, the burns were fairly superficial, but I’m
still concerned about the survivability of burns to such a significant surface
area of skin. My biggest concern for him was 2-fold. One, the shear surface
area that was burned and the amount of fluid I was already watching him lose.
Secondly, infection. His mother was putting forth a great effort trying to keep
the flies from landing on her son’s open wounds trying to drape a sheet around
his shoulders without touching his sensitive burns, but there were just so many
flies and he had so many places for them to land.
We learned that this child had
gotten a kettle of tea on himself. I admit that I initially had some concerns
for abuse (because of the circumstances and especially in a special needs
child… in Africa), but I was pleasantly surprised to see the way his parents
tried to calm him. Also he had a steady stream of extended family (more than
everyone else in the department) that came to see him during this stay in
A&E. This actually prompted a discussion between Caroline and I about
Down’s syndrome in developing countries, and how we thought this child was
probably the exception rather than the rule.
After the hospital, I took care of
something I have been itching to do for a while. Caroline, Charley, and I took
a matatu into the city center. We felt that it was important that we got a
picture of the single thing that Mombasa is most well-known for… 2 sets of
tusks that cross over the road. Okay so they are replicas of tusks, and much,
much larger, but it is supposed to be representative of some important event.
I’m not sure of the details but it has to do with a king and welcoming someone
into the city. See requisite tourist picture here.….
Now the real reason I wanted to go
back to the city center was to get a pair of flip-flops I had seen on previous
trips to the market. They have a dot that comes up between the big toe and the
remaining toes and then just a strap across the top of the foot. And this is
where it gets fun. Knowing that I’m heading back to residency and knowing that
I’m gonna be getting myself new shoes to work in the hospital with, I had
already concluded that the shoes I had worn each day to the hospital would not
be coming back to the US (and certainly wouldn’t drag through Egypt) with me.
So I had brought them from home thinking that they wouldn’t come back with me.
There was nothing wrong with them, but they had had their run with me, and it
was time. However, I had started to think over the course of my time here that
I might trade them for the shoes I had started to like in the market. Kill 2
birds with 1 stone… and save money doing it. Heck yeah!
I am proud to say that I now feel
like I’m getting good at bargaining (and trading). I ended up getting a even
swap… no money exchanged. My old shoes traded for a new pair of flip-fops.
We then had a special dinner at a
really yummy restaurant at Bamburi beach that I had been to with Sid and Gaurav
before called Yul’s. The girls insisted that I had to try the burger there. A
burger? At a seafood restaurant? In Kenya? I’m glad Ii did though because while
it was a burger, it was a Kenyan take on a burger and really good. Covered in
some sauce (not sure what). Then we just went back to the hostel the girls are
staying at to hang out, but mostly to
make sure that we got a henna session scheduled for the next day (after the
hospital, but before I left). All set.
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