October 20, 2016 – The more difficult side of medicine….

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More kids

More kids

We had our second day of clinic scheduled today at Rift Valley and had planned to leave a bit later in the morning as they had wanted us to stay later to see some children who were taking their exams in class. I was also supposed to hear from Soja this morning regarding our vehicle. Frank uses an expression here, “TIA” which isn’t what most neurologists think it is, but rather “this is Africa.” It encompasses life here which not only often unpredictable, but also most often not as expected. Time runs differently here and plans that have been made must often be changed to accommodate the unexpected. Having lived and traveled in this paradise now for a combined one year with all my trips I can attest to this as it has so often intersected with my life here in so many ways.

Dr. Laurita evaluating a patient

Dr. Laurita evaluating a patient

At morning report we learned of two patients that they wanted us to see in the wards, both admitted overnight, and both of whom were believed to have a neurological problem. Since I had to deal with the vehicle, I had Kelley and Laurita do the consults in the wards. Laurita’s patient was one who had come in with what was described as a psychotic episode and had a history of this occurring one before. He turned out to have a heavy alcohol history and each episode had occurred in the setting of heavy use. As she went to examine her patient, she immediately noted that his eyes were not conjugate (i.e. they didn’t move together) and, indeed, he had bilateral ophthalmoplegias which clearly defined his problem as a Wernicke’s encephalopathy secondary to thiamine deficiency as a result of his alcoholism. This is a potentially reversible problem by replacing thiamine before they receive any dextrose in their IV fluids, but unfortunately they had no thiamine in stock here. We had the pharmacy order it for us to come in by the following morning and meanwhile made sure they knew not to give him any dextrose containing IV fluids.

Dr. Kelley and Dr. Mary

Dr. Kelley and Dr. Mary

I had been unable to reach Soja regarding our vehicle which was not yet here, so I headed back to the wards to check on how the consults were going. I first visited Laurita who ran things by me and then entered the next room where Kelley’s patient was. Unfortunately, things were not going so well with this consult. As I entered, Kelley was doing chest compressions on the patient while he was being ventilated by a visiting nurse with an ambu bag. This had apparently been going on for about five minutes or so. Nurses from the ward and one clinical officer were also there. I helped with the code to the best of my ability (remember, we are neurologists) by sharing in the chest compressions and asked for the code cart and, eventually, Dr. Frank to intubate the patient. Without going into further details, I will tell you that the code was not successful and it was very tragic as this was a thirty-year-old patient who had come in late the night before with a poor mental status for which we had been asked to see him late that morning. When Kelley had gone into the room to do the consult he had thready pulse and irregular breathing. Despite intubating him we were never able to oxygenate him leading us to believe that this was likely a pulmonary embolus.

Dr. Kelley and Dr. Mary with a shy patient

Dr. Kelley and Dr. Mary with a shy patient

Certainly, the mood of our visit changed in one fell swoop and it quickly brought to us the often cold reality of life here. Despite our presence and our best efforts, we can only do so much. For Kelley, though, it was tough defeat way too close to home and as we stood in the room after it was over debriefing for a moment, I could see how personally she took it and knew she would need time by herself to gather her thoughts. Events like this can happen to anyone, anywhere, but when you spend your life training to save lives and reduce suffering, it is not something you can ever prepare for in any fashion. I knew that it would take some time for her to resolve things in her own mind and we needed to give her as much room as possible to do this on her own.

Young Thobias whom we have seen over the years

Young Thobias whom we have seen over the years

In this setting, I discovered that our vehicle still needed more repairs and was not ready so sought out Susan to see about borrowing one of FAME’s Land Rovers to use for our clinic which I knew wouldn’t be an issue. We all eventually piled into their stretch Rover and stopped by Soja’s on the way to get all the meds and supplies that had been left in our Land Cruiser and we would need for the day at Oldeani. It was another beautiful day and we arrived to RVCV about an hour later then we had anticipated originally. We began again to see our patients, though there were fewer than we had hoped. We had a wonderful lunch this day of homemade squash and carrot soup, homemade bread with tuna and cheese, potato and ham salad and a green salad. After lunch we saw the few remaining patients and then headed for home. We stopped by Soja’s on the way, but our vehicle was still being worked on so were on our way back to FAME without it again.

Dr. Laurita evaluating a non-compliant seizure patient

Dr. Laurita evaluating a non-compliant seizure patient

This night we had plans for dinner at Gibb’s Farm. It is another one of those magical places that is a must for us and I bring every volunteer here for dinner. It is a five star resort, but in an entirely local fashion where everything is as it was when it was a coffee plantation and they serve five star home grown food. Their veranda is spectacular with it’s view of Karatu from high above and off towards Lake Eyasi in the distance. It sits high on the Ngorongoro Crater rim and immediately adjacent to the Conservation Area. I know most of the waiters there and we sat on the veranda through sunset and dark having drinks prior to going inside for dinner. We were served an amazing four course meal with silverware than anyone could count. The homemade bread and butter melted in our mouths. Dinner took over two hours and it was so relaxing. We didn’t leave until after 10pm and were all more than ready for bed with the day’s activities before us. It was another incredible day and even with the events that occurred, we were still grateful to be here. As with anything, we are formed by those experiences we learn from and, in such a way, become who we are today and are better for it. We change the lives of those who we interact with and by doing so are changed ourselves.

Relaxing on the veranda at Gibb's Farm

Relaxing on the veranda at Gibb’s Farm

A nice panorama from the veranda

A nice panorama from the veranda

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