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!
Warren
Sunday, April 10, 2011
Thursday, April 7, 2011
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.
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.
Monday, March 28, 2011
Sunday, March 27, 2011
moving on.
Ali and Myles arrived yesterday! It is so great to have them. Apparently the animals heard they were coming and came out to welcome them. In our walks/runs out and about today we saw baboons, monkeys, a chameleon lizard thing with three horns, a wandering tortoise...The baboons were out in force, as were the monkeys. We haven't seen this many in one day ever! The recent rains have made everything really green again. I think the animals like this too. Ali and Myles had amazing energy for the first day, fueled by the excitement of being here and the newness of everything?? Finally they felt the jet lag and the elevation and fell into bed. We were impressed!
Erika and I just returned from a few days in Ethiopia with a group of Seattle friends. We had a whirlwind tour of HIV/AIDS work going on there, all connected to many other efforts as well. It was amazing. It was a great distraction after our road episode a few weeks ago and a total change of pace. Just before that we had a road trip to Western Kenya with the same people. We thought we were going to see a clinic which might be an example of a self sustainable model...something we were interested in learning about. Instead we found patients lined up to see health care professionals...Communication has challenges! While the rest of the group worked at learning about the clinic from the perspective of funding etc. we saw an ever increasing line up of patients! When we got there 12-15 people were waiting. When we left there were about 30! I think this would have been the trend. But we only had a few hours. It felt like the edge of the world, on the shore of Lake Victoria and FAR off the beaten track.
In a few days we will leave for our climb of Mt Kilimanjaro! We are excited!
By the way, Erika had her hair twisted again. This time we went to a market in Nairobi. 4 women worked on her hair at the same time and it took just over 2 hours and cost half as much! Last time it took 2 full days!? She said it was painful the entire time, but the twists are back!
Erika and I just returned from a few days in Ethiopia with a group of Seattle friends. We had a whirlwind tour of HIV/AIDS work going on there, all connected to many other efforts as well. It was amazing. It was a great distraction after our road episode a few weeks ago and a total change of pace. Just before that we had a road trip to Western Kenya with the same people. We thought we were going to see a clinic which might be an example of a self sustainable model...something we were interested in learning about. Instead we found patients lined up to see health care professionals...Communication has challenges! While the rest of the group worked at learning about the clinic from the perspective of funding etc. we saw an ever increasing line up of patients! When we got there 12-15 people were waiting. When we left there were about 30! I think this would have been the trend. But we only had a few hours. It felt like the edge of the world, on the shore of Lake Victoria and FAR off the beaten track.
In a few days we will leave for our climb of Mt Kilimanjaro! We are excited!
By the way, Erika had her hair twisted again. This time we went to a market in Nairobi. 4 women worked on her hair at the same time and it took just over 2 hours and cost half as much! Last time it took 2 full days!? She said it was painful the entire time, but the twists are back!
Tuesday, March 8, 2011
TIA....another version, not so nice.
Erika and I had a scary experience today. Erika wrote about it.
www.erfisher.blogspot.com
About 45 minutes after this episode we were in an amazing center called Comfort the Children, listening to about 8 handicapped children sing to us with all their might. It was amazing and beautiful...
It is like there is amazing beauty, love, touching courage and strength...and what seems to be a very thin veneer over great tension and potential violence.
From Comfort the Children we went to a nearby IDP camp...Camps that were built by the UN 3 years ago after post election violence here in Kenya. Tribal groups broke out with violent acts against each other and people moved back to areas where their tribal group is dominant. This caused homelessness all over the country because many of these people had not lived in the areas they moved to for generations. The UN put up tent camps, and many people still live in these same tents. 3 years of wind, rain, sun...you can imagine the tents. Habitat for Humanity has built many houses as replacement living structures, but then there is the issue of sustainability. Having a house doesn't mean you have the ability to make a living.
Most of these camps are just women and children. They have no idea what happened to their men...killed? ran off? Seems like he would have found them by now if he was alive and looking for them? Some of them have many, many children. They have formed co-ops and are raising chickens, renting land and growing small crops...But it isn't enough. One of the HS age girls was around today. We asked her why she wasn't at school. She had been sent home because she was behind on her school fees.
Some people wonder why they don't go back to the places where they had been living. You know, seems like life is settled down, back to normal...But who could go back to a place where you have learned that your neighbor is capable of killing you if stressed, not personally threatened by you, but persuaded that your "group" is to blame for something?
And as we learned today....considering the reality that all is not as it seems is part of surviving here. This is Africa.
www.erfisher.blogspot.com
About 45 minutes after this episode we were in an amazing center called Comfort the Children, listening to about 8 handicapped children sing to us with all their might. It was amazing and beautiful...
It is like there is amazing beauty, love, touching courage and strength...and what seems to be a very thin veneer over great tension and potential violence.
From Comfort the Children we went to a nearby IDP camp...Camps that were built by the UN 3 years ago after post election violence here in Kenya. Tribal groups broke out with violent acts against each other and people moved back to areas where their tribal group is dominant. This caused homelessness all over the country because many of these people had not lived in the areas they moved to for generations. The UN put up tent camps, and many people still live in these same tents. 3 years of wind, rain, sun...you can imagine the tents. Habitat for Humanity has built many houses as replacement living structures, but then there is the issue of sustainability. Having a house doesn't mean you have the ability to make a living.
Most of these camps are just women and children. They have no idea what happened to their men...killed? ran off? Seems like he would have found them by now if he was alive and looking for them? Some of them have many, many children. They have formed co-ops and are raising chickens, renting land and growing small crops...But it isn't enough. One of the HS age girls was around today. We asked her why she wasn't at school. She had been sent home because she was behind on her school fees.
Some people wonder why they don't go back to the places where they had been living. You know, seems like life is settled down, back to normal...But who could go back to a place where you have learned that your neighbor is capable of killing you if stressed, not personally threatened by you, but persuaded that your "group" is to blame for something?
And as we learned today....considering the reality that all is not as it seems is part of surviving here. This is Africa.
Thursday, March 3, 2011
is it time yet....?
Sometimes it feels like it is time to go home....
Like when you get up early for a meeting, assuming that the focus will be on the fact that people are quitting at the hospital...including one of the main people in your department...with no notice! And it is never mentioned because it seems that direct communication, or using meetings for pertinent issues is not the way it is done here.
Or when you have to get ready for the day without any water...and you have to return to carry water so that you can flush your toilet and wash the dishes from last nights dinner...and when will there be water? "Soon, very soon...don't you have water yet?"
And in your mind you think..."prepare for 4 days!" It has been that long before...with the same "soon" business going on.
Or when your favorite people are leaving and going back to the Cameroon.
Or when you can tell that your kids are feeling lonely and counting the days, but are also anxious about returning home...
Or when you just miss your house and your bed and your COUCH and your FRIENDS! And predictability and efficiency and even cold weather and snow! And even your jobs! Warren said today..."i can't wait to get back to my job and my people..."
(how lucky are we that we can feel this way?!)
On the other hand...We still have a lot to look forward to. You are probably never more helpful than when you stick around as people are leaving! The hospital saw more than 500 people yesterday!? There is plenty to do.
Erika has coached the JV team to a successful season and they have had a great time.
John is soon to be headed off on a school trip where he will get certified in scuba diving...in Africa!
Our friend Libby has been here with us and is getting hooked up with organizations where she can use her soccer to empower girls...Her best hook ups came from getting a ball and starting to play...word spread. "That mzungu can play!"
Our Seattle church, UPC, is sending a group this month. We are going to get to see them and travel with them, learning about clinics in various parts of Kenya and hoping to get ideas to implement in projects elsewhere.
And we just heard that 7 college students from Seattle will be working in the Nairobi area this summer...some in the slums of Nairobi with our Kenyan friends, and some in an orphanage that is also quite close.
And BEST of all....It is only 24 more days until Alison will be here with us!, along with Myles...and only 27 more days until we leave for our climb up Mt Kilimanjaro.
So I am counting the days as well....and these are full of excitement!
In the meantime, it is time to go fetch some more water...
Like when you get up early for a meeting, assuming that the focus will be on the fact that people are quitting at the hospital...including one of the main people in your department...with no notice! And it is never mentioned because it seems that direct communication, or using meetings for pertinent issues is not the way it is done here.
Or when you have to get ready for the day without any water...and you have to return to carry water so that you can flush your toilet and wash the dishes from last nights dinner...and when will there be water? "Soon, very soon...don't you have water yet?"
And in your mind you think..."prepare for 4 days!" It has been that long before...with the same "soon" business going on.
Or when your favorite people are leaving and going back to the Cameroon.
Or when you can tell that your kids are feeling lonely and counting the days, but are also anxious about returning home...
Or when you just miss your house and your bed and your COUCH and your FRIENDS! And predictability and efficiency and even cold weather and snow! And even your jobs! Warren said today..."i can't wait to get back to my job and my people..."
(how lucky are we that we can feel this way?!)
On the other hand...We still have a lot to look forward to. You are probably never more helpful than when you stick around as people are leaving! The hospital saw more than 500 people yesterday!? There is plenty to do.
Erika has coached the JV team to a successful season and they have had a great time.
John is soon to be headed off on a school trip where he will get certified in scuba diving...in Africa!
Our friend Libby has been here with us and is getting hooked up with organizations where she can use her soccer to empower girls...Her best hook ups came from getting a ball and starting to play...word spread. "That mzungu can play!"
Our Seattle church, UPC, is sending a group this month. We are going to get to see them and travel with them, learning about clinics in various parts of Kenya and hoping to get ideas to implement in projects elsewhere.
And we just heard that 7 college students from Seattle will be working in the Nairobi area this summer...some in the slums of Nairobi with our Kenyan friends, and some in an orphanage that is also quite close.
And BEST of all....It is only 24 more days until Alison will be here with us!, along with Myles...and only 27 more days until we leave for our climb up Mt Kilimanjaro.
So I am counting the days as well....and these are full of excitement!
In the meantime, it is time to go fetch some more water...
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