Wednesday, April 20, 2011

time out in mombasa....

Turquoise water, white sand, warm air, fresh fruit, monkeys, coconut dropping out of trees, rain, sun, bugs...fresh fish...constant requests for money, hawkers selling things we don't want or need, "mzungu, mzungu"(white person, white person), family friends, relaxation, exercise, snorkeling, reading, sleeping, sweating...walking, running, eating, drinking...talking, leading yoga sessions...
Our week of vacation in Mombasa...
Today we went into the old town of Mombasa where we saw the sights of movies and books...Swahili culture, slave caves, old forts and harbors, feral cats, dead rats, flies on fresh meat, spices of all colors including bright pink, burkas, an old Caprice Classic in the road...How did this get here?
We are staying in a true African beach chalet...on the beach, but not without ants, lizards, a cockroach or two, hermit crabs, monkey thieves, cats and fleas!? Today Warren asked that our mattress be changed out....hoping to get fewer flea bites tonight! Somehow he is getting eaten alive despite the mosquito net?? They have no interest in surprise.
Today I told Erika that I felt tired. She asked if I thought I might take a nap. I said,'no, i mean of this continent'. I was feeling wiped out by the day of travel and sightseeing, as in sight seeing...many sights, not all great. And an hour plus long wait for a ferry ride in incredibly hot conditions...with the ferry(s) in constant site...taking an assorted group of vehicles and people, but never quite getting to our line?!!?
Eventually we made it. It was a classic TIA episode.
But so was the fresh red snapper and garlic prawns that waited for us, cooked by our cook for the week, Hassani, who has whipped up an assortment of seafood and curry to die for all week long. So taking the bad with the good...we will enjoy another day of white sand and sunshine tomorrow, with plans to end the day at a restaurant inside a coral cave!

Thursday, April 14, 2011

kili images...

I tried. For some reason I can't get any more images to upload!? Oh well. Here are the Fisher nice!

Sunday, April 10, 2011

Hospital Stories

Hello to All,

In the past few weeks we have had some good outcome cases that came through the ED/ICU:

A 50yo diabetic/htn man came in with significant chf that brought him to the ICU. One of my colleagues was covering the ICU and at 4am I got a call that could I come and help with the case. On my arrival to the ICU the man was being bagged with difficulty, sat’s were low, and he had a bull neck that had difficult to intubate written all over him. After some fentanyl and valium and three unsuccessful attempts at passing the ET tube into the trachea I was fortunate to succeed on the fourth try. The cords never were visualized. The glide scope or an eschman would have come in handy. I put the patient on the ventilator at a rate of 20 breaths per minute and within 5 minutes his heart rate went to 30 with a widening QRS. I took him off the ventilator and bagged like crazy (difficult with high pressures) gave epi, bicarb, atropine and his rate came up and the QRS narrowed down to normal. Remember that we don’t have ABG’s to help guide acid-base decisions but I was pretty sure that he was Mr. acidotic. I put him back on the ventilator, this time with a rate of 30 per minute, and he maintained good vital signs. 2 days later he decided to pull out his tube and flew off the ventilator just fine. His repeat EKG showed an MI, but except for a hoarse voice he went home feeling fine in another 3 to 4 days.

Another man came in to the ED with decreased mental status and minimal respiratory drive. He was around 30 and we postulated he probably took an overdose of some pesticide; a relatively common scenario. He was admitted to the ICU and over the next three weeks developed pneumonia (likely aspiration/hospital acquired), was ventilator dependent to the point of needing a trach, developed an expanding pleural effusion that I relieved with a chest tube, but in spite of it all he finally decided to get better and was eventually sent home walking and talking like normal. I’m glad I didn’t take him off the ventilator around day 4 when he was showing no sign off neurologic recovery and I thought he would be one of those cases with big-time anoxic encephalopathy. I figured since he was so young I would give him a little more time.

I am looking forward to returning to my Northwest ED Family in a few months. I have missed you all and appreciate the support I have felt from home. Just a few days ago I showed my kids the video I was given from all you guys over the Christmas season; they were very impressed with such a huge effort and show of affection.

Thanks Again!


Thursday, April 7, 2011

top of africa!

sandra, warren, ali, erika, myles and john

Wednesday, April 6, 2011

it takes a village!

We did it! We summitted the big African mountain, and by summit I mean Uhuru! I had no idea what this meant before going there...There are two "summits". First you arrive at Gilman's Point, where the guides congratulate you as if you are finished...?? Then they ask if you want to continue to Uhuru, the real summit. We were all of the same mind...the top was the goal, so we continued around the crater rim...for 2 more hours!!! I think these were some of the hardest hours of our lives in terms of physical endurance and mental intensity. It was cold, we were tired (had been hiking for more than 6 hours already, starting at midnight) and we were HIGH...19000 feet high. Elevation provides a lot of new experiences and challenges for the body...
But we did it! And we are all so happy we did. So many factors have to work out when making plans like this, so to have it become reality made us really grateful.

It took 15 porters, a cook and 3 guides to get us up there! This sounds insane, and really it is...but when we realized what it would take for us to try and do this on our own, which isn't allowed anyway, we were able to understand it a bit better. Without guides and help with carrying, the trip would be totally different and almost impossible for people like us. We don't have the time or willingness to invest what it would take. We loved our group of support people and they seemed to be having fun along the way as well. The guides forced us to walk "pole pole"...very, very slowly!, the cook fixed us fabulous meals and kept us with safe drinking water, and the porters basically did the rest!...They seemed to race ahead and get everything set up for us, as if it was no trouble at all for them to physically run around at elevations where we found ourselves searching for air, losing our appetite and feeling a bit dizzy in the head. It is kind of embarrassing to require this much help, but we required a small village to make it up Mt Kili.

Having the time with Ali and Myles is especially sweet. We are so glad they have joined us in Africa for now.