Saturday, March 16 – A wellness day at Gibb’s Farm and the Elephant Caves….

Standard

We arrived Saturday morning for report and met with Dr. Anne to hear about how the patients had done overnight. Of course, we were all waiting to find out how our stroke patient from the day before had fared as we had placed her on palliative care and the expectation was that she wouldn’t last the night…hopefully. Anne reported that her breathing had become very shallow and that she remained unresponsive to any verbal stimuli. Again, there was absolutely no question by any of the care team as to what we were dealing with (an intracranial hemorrhage and increased intracranial pressure) and what the outcome of the case was going to be (that she would be left totally dependent on others with severe neurological deficits if she were to survive). Following report, several of us went into the ward to check on her and, as if having been waiting for our permission, she became apneic and shortly thereafter expired. Following her death, Daniel found that perhaps the most positive outcome from the entire process was when the patient’s sister asked him to check her blood pressure to make sure that didn’t also have hypertension.

Our lunch table at the Gibb’s

The little child with the thrombocytopenia and anemia who we had kept at FAME to see if their platelets would respond to steroids, was doing well, but their platelets came back that morning at only 4 thousand, down from 5, but it wasn’t entirely clear that the therapy had kicked in yet or not. Both Marin and Dan were incredibly helpful as pediatricians on this case as I would have had no idea of what to recommend in this situation. The plan ultimately was to keep the child over the weekend, continuing the steroids and then rechecking counts on Monday morning. If the platelet count continued to remain low, then the plan was to send the patient to KCMC for a bony marrow aspirate which was the next procedure to be done.  Dr. Jackie had already them about the possibility and there was no reason to send the child over the weekend as they wouldn’t be able to do the aspirate until Monday, regardless, and their specialist, who could evaluate the child, would also be there on Monday.

The Elephant Cave crew and their guide, Brown

Some “wild” animals on the trail to the elephant caves

Our plan for the day was to work the morning and see as many patients as possible with the idea that we would try to finish at around noontime. I had made reservations for the seven of us to enjoy the wonderful lunch buffet at Gibb’s Farm and every one was going to climb to the elephant caves that are a short hike from Gibb’s up the Ngorongoro Conservation Area, or NCA. As is usually the case, we had packed everything up and were ready to head to the house and go for lunch when a young girl arrived who had been struck by a piki piki. At the time, she had apparently been knocked to the ground, struck her head and was unconscious for two hours. She had also developed some bloody discharge from one of her ears that had stopped and now had classic post concussive symptoms that included headaches, dizziness, and tinnitus. She had been referred to us for evaluation and a CT scan. Jon took a thorough history and performed a neurologically examination that was normal including a look in her ear that revealed some dried blood in the canal, but the tympanic membrane looked just fine. Our CT scanner was not yet up, but we didn’t feel that she needed a scan regardless, and so treated her conservatively. Given that she was from the village of Oldeani, nearby the Rift Valley Children’s Village where we’d be next week, we just asked her to come see us there to make certain she was still doing well.

Daniel, Marin and Adys

A view down the valley near the waterfall

We were finally off to Gibb’s Farm for our lunch and it was an absolutely gorgeous day for us. They had reserved a table for us on the veranda overlooking the coffee plantations and with a view to the distant mountain ranges of the Lake Eyasi region many hours away. Lunch here is also an event, very similar to the dinners, but in a much more relaxed and informal manner. They have dozens of selections of local and ethnic cuisine that have all be prepared to perfection by the wonderful kitchen staff. Their cheeses are made on site and all of the produce is grown there at the farm. The dessert selection is also an amazing affair with numerous selections including fresh fruit. We all sat at our table in one of the most beautiful locations of the world enjoying some most wonderful dishes that one can imagine.

Elephant caves panorama

A view looking down from the caves

When lunch was finally over and everyone had had their fill (and then some), it was time to head to the trailhead for the elephant caves. Since this hike takes you into the Ngorongoro Conservation Area (read, wild animals), you have to first check in at the ranger station and hire a guard. The cost is $18 per person for the walk and well worth the experience. The “caves” are really impressions in the hillside where the elephants come to dig out minerals from the soil that they need for their nutrition. You can see elephants there on occasion, but for the most part, the elephants come there at night so you don’t run into them. You other animals on the hike, though, such as the ubiquitous baboon and lots of birds. There is a very nice waterfall on the hike as well that you can walk up to the edge of and is quite a drop. Since I had been on this walk several times before, I decided to drive them the short distance to the gate and then head back to Gibb’s where I could spend the entire rest of the afternoon waiting for them to return from their hike all the while sipping on a Moscow Mule. Even better yet, I am well-known to the staff aft Gibb’s Farm as either they, their spouses or children come to see us for their neurological care, so they take very good care of me. It is almost too relaxing sitting there on the lawn in the shade to do reading or work, so I am certain that there were a few short naps interspersed with my blogging of the day early. Gibb’s Farm has to be one of the most unique places in the world and being able to come  back here time and time again is truly special. Even more special, though, is bringing the residents and others who accompany me to this place of beauty to experience it for their first time and see their reactions.

The pool leading to the waterfall

The elephant caves

The trip to the elephant caves lasted until the evening and it was quite close to sunset with the others arrived back to meet me, still sitting in my same chair and typing away. I had promised them come nice cold drinks on their return and most everyone decided to enjoy the sunset with some refreshments. Everyone had also wanted to speak with the artists, one of who I had purchased several things from over the years. It was quite late by the time we ventured back to Turtle to begin our journey home to FAME. We had plans to head to Ngorongoro Crater the next morning, leaving at 6 am, and still needed to make our lunches for the game drive, so there was much to be done to prepare for the day. Jon, Daniel, Adys and Sheena have become real pros in making all of this happen and once again we had everything made and packed up in short order and now it was just a matter of getting to bed with thoughts of the crater on our minds as we slept and the vivid Malarone dreams assisting in the whole process.

Sunset from the Gibb’s terrace

Tinga tinga art for sale at Gibb’s Farm

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