Dessert Night

Tonight I went to Mark and Sue Newton's house for 'dessert night'--Mark is the anesthesiologist from Vanderbilt who spends all but 10 weeks of his year in Kijabe directing the anesthesia services and training Kenyan nurse anesthesia providers.  Monday nights give a chance for the short term physicians to meet up with those who are here on a more long term basis.  It was fantastic talking to Mark because he took a very similar path to the one that I am heading down--he did a pediatric fellowship at Denver Children's and did a pediatric cardiac anesthesiology fellowship before starting into practice.  He had some good insights into missions and training--I appreciated hearing them.

This past weekend I was on ICU call from late Saturday morning until signing out to my new friend, Hans Yehnert, with internal medicine on Monday morning.  It was a looong weekend.  Saturday night one of the general surgeons called me at home and asked me to come in and help him with a trauma case--a 32 year old girl who was hemorrhaging into her abdomen following a cab accident.  I came in and gave the anesthetic and then, since I was covering the ICU admitted her to the unit postoperatively.  While I was in the OR (or 'theater' as they call call it here), I was called emergently to the ER for a patient who was stroking and needed evaluation.  I would never leave a patient in the OR in the States in these circumstances but the trauma patient had responded well to resuscitation and had a conscientious surgeon and circulating nurse.  In the ER I find the poor fellow who is stroking--blown left pupil, agonal breathing...the whole bit.  We don't have a CT scanner, so the neurosurgeon's decision tree is based purely on physical exam findings in the acute phase.  It looked like a pontine hemorrhage and a big one--I agree to admit him to the unit for observation 'just in case' we're wrong, intubate him and head back to the OR.  As I'm trying to leave the ER, the clinical officer asked me to review some simple x-rays she'd ordered to see if I agreed.  Some skull films and a chest x-ray.  I told them, "you do realize that I am in ANESTHESiology and not RADiology, right?"  They didn't seem to care...ha!  So I gave my guarded opinion on them and it was back to the OR where Peter Bird, the australian generalist was finishing up with our trauma patient.  In spite of 5 units of whole blood (~2.5L of volume), she was still hypotensive on return to the ICU--I guess the disrupted bowel probably caused measure of bacteremia/septic response because she needed dopamine for the rest of the night.

Kenyan Registered Nurse Anesthetist students--lecture day: I asked them to let me pose, so I'd have proof that I did some teaching in Kenya.  They thought it was pretty funny.

Here I am with Steve and Joseph in the ICU over the weekend.  I thought they were interns because of their lab coats but no, definitely not (unfortunately, it would have been nice to have interns filtering the ICU calls!) 

Myelomeningocele child--you can probably see the spinal cord defect being scrubbed.   For perspective on the child's head (severe hydrocephalus), see the adult's hand to the right.  I think this kiddo was 2 months  old. 

Pediatric ventilator--old school but not actually a bad little ventilator.  Rate is set by adjusting the I:E times--kind of cool for nerdy anesthesia types, I guess.

A sweet cook named Hellen makes my dinners and leaves them in the refrigerator every M-F.  Tonight I found this specimen container labeled "path" which I'm afraid was a specimen container for surgical pathology at one point.  Tonight it contained delicious chili and thankfully, it did not smell like formaldehyde!  I was too hungry to worry about it for long.