You win some, you lose some.. (well ok, they die)

Today was one of those days that I really dread, which if fate chooses, do come pretty often. Another baby had died, and I had the unenviable task of examining the poor thing, confirming and certifying the death, and proceeding to inform the bewildered mother of the bad news.

This was particularly heart-wrenching since, it was one of a pair of twins, that I had admitted that long Sunday that I had had in the ward.

The diagnosis was pretty simple, GE in a severely dehydrated pt, to r/o Malaria. (Medical lingo for: a patient with vomiting and diarrhea who, as a result, is severely dehydrated, and since the patient complained of vomiting and fever among other shidaz, anti-malarial drugs have to be given, since we are in an endemic area.

Enough of that. Rehydration, replacement of electrolytes and quinine would sort out the problem, ideally anyway.

4 days later, while I was incidentally in the ward, the shell-shocked mother calls me and tells me that she had woken up only to find one of her babies ‘staring at her blankly’ and ‘didn’t look right’. A quick exam was conclusive. The baby had been dead for several minutes if not hours. The mother, by the way, had been staring at me intently all this time, hoping I would ease her mind from the horrible thoughts that must have been whirling around in there. The other twin was crying incessantly by now, almost as tho’ she knew what had just happened to her brother.

The part of the story I’d not told you is that this mother had delivered the twins at home 2 months ago and had not visited a clinic yet. Had not got any immunization shots. Apparently, she couldn’t carry both babies with her. Her husband was in police custody and her 6 other daughters, (yep, 6 daughters and now 8 kids) had not been at home to help her out. While her story didn’t sound particularly credible, it reminded of the many social issues that I have come across.

Many Kenyans, and probably herself as well, are not willing to spend that extra, no not extra, that last few hundred shillings to go to hospital for a problem that is not there. She’d rather spend it to buy food for tomorrow’s supper and use the rest to buy a couple of books for her other offspring that walk barefoot to school.

Poverty is easily the biggest disease in this country. This mother had lost a child from a very preventable condition that probably got worse as she hoped it would get better. Illiteracy comes in a close second. I’d tell you things mothers do to their babies that would make u scratch yo’ head, and roll your eyes. Lakini, that’s for another day. I’m on call tonite you know.

I spoke too soon. There goes my fone! Yet another sick Kenyan...

tHE mEdiCinEmAn.

Interns don't blog...

3 interns, 2 weeks and 1 weekend call have brought me to this conclusion. (Not that I care for it, by the way..) It’s been quite an experience so far, quite.

Well having been certified a medical graduate, given the power to read and do all that other sh*t, I landed in Thika, at the District Hospital, teeming with life and the not so full of life. According to the Medical Superintendent in charge of the joint, we are supposed to be the busiest hospital in Central Province, more than Nyeri (the Provincial HQ) … I didn’t say it, he did! There it was. We’d set our selves up for interesting times here.

After an episode of haggling, bargaining and luck, I ended up starting my department rotations in Paediatrics. (We have to rotate in all 4 dept’s for 3 months each as medical interns. Internal Medicine, Obstetrics/ Gyn and Surgery as well.) Wasn’t too bad, I argued. I’ll be doing Obs/Gyn next, easily the most hectic of the four, and then go on to Medicine and finish with Surgery. Hmm… this should work, I figured. We got a quick tour of the hospital to put into perspective what we would have to contend with for the next 52 weeks or so.

We were 12 interns in all from the Univ. of Nairobi, so 3 interns in each dept. And in our minds, we knew would be getting at least 4 more interns from Moi University’s med school, who hadn’t finished their exams yet. Which would bring the figure to 4 in each dept. We were later to find out, painfully by the way, that this was not going to happen. Something about only 25 of them passing their exams or something… Basically, this means, night and weekend calls are closer to each other, more work per person, and did I talk about the weekend calls?

I must have, coz I just finished one of the craziest weekends I have had in a very long time. Yours truly was on call, and from the experiences shared by my colleague who had covered the previous weekend, it was supposed to be a walk in the park. Started well. I was even able to leave the hospital for the whole morning before I was called to review a neonate in the nursery. Rushed back, 2 reviews and a couple of lines arduously fixed on newborns fragile wrists, I was done. This was better than I thought. As it turned out, this was the calm before the storm. Or more like a miniature tsunami.

I got to see another 2 cases in the ward that evening and that was it. Went to bed wondering if this could get any better! Ha!

10.00 am. I had just had breakfast, and I was on my computer working out some awe-inspiring design (I’m my greatest fan…) Me fone rang.

“Daktari, kuna patients ku-review kwa ward.”

Off I dashed. This could be over in a few minutes. A couple of touches on the design, a couple of episodes of 24 and a couple of hours to nap. Perfect, I thought.

I get to the ward.

“Wagonjwa?”

“Ndio sisi…”, the new admissions raised their hands. They were 3.

Arghh.. I’d have less time for my nap!
So the good doctor got down to work. Did I say walk in the park? It was now a trot across town. But I could be done soon and back home.

2 hours later, there were more than 7 more patients that had checked into the ward.
Oh dear, I thought. Lunch will have to be taken late. There’s good reason why so many doctors have horrid handwriting. It’s coz that’s all they do, and it can get monotonous a lot of the time.

Well, to cut a long story short, I wasn’t able to make it for lunch at whatever time. Not 2, not 3, not 4… The patients came one after the other. Made me wonder if Sunday is “siku ya kuenda hospital” for the local residents of Thika. 9 hours later, (yes 9 hrs) it was 7 pm and the 3^rd shift of nurses had just checked in. This was getting too much; I decided I might as well have something to eat at this rate. Dashed back home. (Thankfully this is a 5 min. walk away.) No one had made up their minds to cook, so no food, and I just had a glass of juice, and went back to the battle field. And there they were, 5 more patients on top of the 2 that I had left!!

WTF! I couldn’t believe this! Did I say trot across town? No, this was like a marathon across the Kalahari!

I did eat my supper that night. Much later, around 12 pm. By half past midnight, I’d passed out..

Talk about being thrown into the deep end..

Bidii Yangu (5 years worth...)

I think it must be all the time that i've spent during the last month partying that has kept me from my beloved blog this long! Yep, partying mbaya!!
Nilimaliza shule... Must have been that Surgery MCQ paper.. rumour has it ati only 3 people pita'd the 50% threshold mark, (aka: a pass, yo-ok-since-u'll-only-kill-half-yo'-patients mark... etc) ps: MCQ - multiple choice question. I've not sat for a harder paper than that in, well a very long time...

Some questions went like.. "the number of successful laparascopic procedures in specialist clinics in Guatemala was 85% ... True or False?" (ok, i'm kiddin about the Guatemala part.. lakini still!) I must have been the first person to finish the paper, coz enyewe, there's no need to try thinkin about stuff you've never read.. really. Everyone was complaining, ok, maybe not, coz i probably never got to talk to those 3 nut jobs that actually passed!

So when during my clinical exams, my confidence seemed to unfold, i felt a bit exposed... u know, shaken that i might not pass that exam..
It started with the long case. So i take a history from this dude. H was like 45 if i recall...

1 month history of yellowing of the eyes, similar period of pale stools and pruritus (med speak for itching..), and an tender hepatomegally (.. that's an enlarged liver that is painful to the touch.)

"Great!", i thought. "Surgical jaundice, secondary to gall stones..". Had read on it a while ago. Tho't it will be a walk in the park, this. Surgical jaundice simply means that the yellowing of his eyes (jaundice) has been caused by some sort of obstruction that requires surgical intervention to relieve it - hence the often other used term, obstructive jaundice. But enough with all this medical lingo.

I proceeded verify my diagnosis and the easiest thing to do, was simply to ask the patient what he had been told he has. Indeed, i was spot on. They were "mawe fulani. Walisema watatoa next week." Fabulous. Now i just had to have my story straight, do a proper system examination of the patient, and i'll be D.R in no time...

To cut a long story short, the examiners came and they insisted that this dude had cancer! Head of Pancreas cancer or Biliary tree (gall bladder) cancer. Which were actually on my list of differentials but further down than the stones. Apparently, the patient had lost weight during this time, but i tho't it was coz of the poor appetite he had developed. He had no abdominal masses, that would have pointed more to a tumor cozing the obstruction, or enlarged lymph nodes...

Any way, i gave in and admitted that that was wat he might be havin, altho' in my mind, i believed my line of thought was more consistent with findings on the patient. In med school, however, one thing you learn early on, is not to imagine that you know more than your consultants., or ever let them know that you think so... Saves you a lot of trouble.. and pain.

One week later, we camped for 5 hours (yes, 5!) outside the dean's office waiting for our results, to know whether we have been recommended to be awarded the degree, given the power to read, whether we were now doctors...

To say the wait was nerve-racking wouldn't come anywhere close to describing the feeling! It was terrifying... This was it. The last wait for results.. 5 years of work was coming to an end. The tension was palpable (i read that in a book, or was it someone's essay back in school? hmm...)

Hayawi hayawi huwa. After hours of waiting, the verdict was out...

Yes folks, it was then that i become a doctor!

Happy holidayz,
The latest mEDiCinEmAn in the hut.

tHE mEDiCinEmAn aka The WebDoc

hmm...
This blogging thing, this. So busy so little time. It's been dog years since i last wrote a post. Enyewe, doesn't feel nice letting down ma-fans, so i thot i should spare a few minutes of my eve' and confirm that i'm still alive and well. And the post on my trip to Paris will be coming very soon, papa hapa.

The break i've taken is actually from the books. Leo we started our end of year exams, yawa! Aii, kumbe hayawi hayawi huwa... the last leg is here with us. It's such a pity i have tonnes and tonnes of readin to do, and it just doesn't seem to end. It was a cold morning as i sat down to do my Internal Medicine essay paper. Management of thyrotoxicosis, anaemia in chronic renal failure... I mustn't bore u, but it was ok. 10 compulsory questions, 3 long hours and one tired med student.

Right now, niko juu ya mbuku (books by the way) mbaya. Head trauma and jejunojejunostomies. Crazy stuff. Kesho is Surgery essay. Na pia there is an ortho question humo.. all that readin for one question? Med school!

Oh, and one last thing..
Got tired with the alias 'The WebDoc', now i'm fondly known as 'tHe mEDiCinEmAn'. Forgive the camel text, but i thought it's sort of "different" and unique.

Otherwise, keep it blogged.
Adios amigos,
tHE mEDiCinEmAn aka The WebDoc.

Students In Free Enterprise

So much seems to be happening, keepin me so busy, away from my blog and all!! That's more or less the reason why i've not posted in ages. Today, however, i've decided to push aside a few things... to share the exciting... (ok, maybe not quite) , happeninings since i last wrote.

Well for one, i did pass the Ortho CAT i was telling you about. 53% was the score, being in med sch., i'm told gettin over 50 is enough for yo' patients (sic). We were quite a number of us who didn't make it all the way to 60, the bookworms, and the not so bookworms. Enough rationalising.

Back to wat's kept me so quite. Ever heard of SIFE? That's Students In Free Enterprise. What's it's all about is summarised by this extract from their site.

..SIFE team members leverage their personal educational experiences, the expertise of their faculty advisors, the support of their local business advisory boards, and the resources of their institutions to implement programs that create real economic opportunities for members of their communities. The effectiveness of their programs is judged at competition. Each national SIFE organization conducts a national competition, which is judged by leaders from its business community. At competition, SIFE teams present the results of their educational outreach projects and compete to determine which team was most successful at creating economic opportunity for others. SIFE National Champion teams advance to the top level of competition, the SIFE World Cup...

Being the business-minded fellow that i am, i promptly joined. I can't think of any other person from med sch. who felt this was worth their time.. boring lot! So indeed we went forth and "leveraged our personal educational experiences" and changed the world, took part in the National SIFE exposition with top business leaders in Kenya as judges. This is where we put together all our projects with a nice audiovisual presentation runnin in the bk ground (read powerpt presentation), and try and convince the judges that ours had the most impact to our communities.

Hours later, we got to the finals against USIU and Africa Nazarene University. Sadly for them, we were definitely better and UoN-SIFE was declared the winner of the 2006 Kenya National SIFE exposition!

Hurrah! We had a month and a half to put our passports in order, coz we were on our way to Paris, France, for the World Cup...

Keep it here, because when we return we find out,
.. shall i actually make it to France?
.. the university is broke.. again!
.. that'll be 3k for your visa..
.. then cough 20K if u want to survive in Europe!


and many more trials and tribulations that is my life..

Keep it blogged people,
Baadayez,
The WebDoc.