Daily Grind

Today started with a surgical conference on trauma and senior staff chapel, which is a like a mini-worship service. Then we had teaching rounds where the interns, Kenyan family medicine resident, the attending and I rounded on many of the ob patients together. The patients are in big rooms of about 8 beds each separated by thin curtains. My intern Pauline and I usually round on the post-surgical patients. Many of the patients are new each day so it’s a mystery to figure out what’s going on. It usually involves me looking for a baby in the mom’s bed and trying to decipher the paper chart (“file”) notes. (“Ok, so there’s no baby, probably not a c-section…hmmm, she doesn’t look pregnant… [flip through the chart some more]…aha! Ruptured ectopic pregnancy post salpingectomy!”) The ladies are far more gracious than I would be after sleeping in a room with 7 women and crying babies.

We have a few preeclamptic women in the 6 bed labor ward. I went with Sharon today to perform an ultrasound one of them who had with severe preeclampsia at 30 weeks gestation. The findings were not good -scant amniotic fluid (“licor”) and reverse end diastolic flow. My attending, Sharon, ordered a non-stress test which prompted a stat c-section. Unfortunately, the baby’s lungs were not mature enough, and he didn’t live despite a good attempt at resuscitation. Premature deliveries and fetal demises occur daily here.

I spent the afternoon in the maternal child health clinic. I’ve already said it’s chaotic, but in a very small space with about 10 exam rooms, there are 8-10 nursing students, several women carrying cute babies on their backs, a gaggle of medical students and residents, 5 geriatric men waiting with walking sticks, and a head nurse or two managing the cacophony. Exam rooms are scarce, and I have to throw some elbows to claim one. Once I’m in the room with the patient, the exam room door will be opened by various nursing students no less than 5 times. If I lock the door to perform a pelvic exam, incessant knocking will disrupt the visit until some essential supply can be removed from my room. Nonetheless, I am starting to grow very fond of the nursing students who often help interpret my Swahili visits. I would be even more lost without them. Thank goodness they know Naegle’s rule to calculate pregnancy due dates since I don’t have a due date calculator on my pocket PC. Sharon gave me a pregnancy wheel today, which is made of metal and 12 inches in diameter. (They usually fit in your pocket!) I am thinking of wearing it as a necklace.

I’m on call tomorrow with Pauline and hoping to be a part of the OB action.