Shop talk

Daktari here.  Checking in after the first couple of weeks on the wards at Tenwek.  Grateful for a rainy season Sunday afternoon off from work, and the mental space to sit for a minute to reflect.

Being a member of the medicine ward service is a great privilege.  I am continuously amazed at the passion and curiosity of the Kenyan interns, their eagerness to learn, it's a heady drug to a professorial type.  Their humility when approaching uncertainty in clinical decision-making (and there is a great deal of uncertainty) inspires and challenges me.  This time around I get to spend my afternoons with a Family Medicine resident from Congo, learning the ways of the intensive care unit, and the mathematics of pulmonology and nephrology; the light coming on as: CO = 2 x NA + 1.15 * GLU/18 + BUN/2.8 starts to make sense in light of a patient with toxic alcohol poisoning = bad home brew.

A couple of clinical stories from the ward: We have a young healthy 18-year-old who stepped on an acacia tree thorn.  He does not have his bottom two adult teeth pulled like many of the older generation Kenyans.  They used to pull those teeth to secure a way for delivering nutrition in case of illness such as this: lockjaw, tetanus.  The man who stepped on a thorn contracted bacteria from the soil called Clostridium tetani that releases the toxin tetanospasmin.   The toxin makes muscle fibers contract irreversibly, causing a terrible contortion of an arching back and every muscle of the body is contracted until the nerve endings that were killed by the toxin can regrow.  Thank God for the treatment: source control (wound debridement), immune globulin to bind circulating toxin, antibiotics to kill remaining bacteria, and sedatives and magnesium to counteract and relax the spasms. Also because his original dose of toxin was low enough, his reaction was not fatal.  Sometimes the spasms of tetanus can break one’s own bones.   He has been moved out of ICU and is now stabilized in a regular ward bed.  Working on loosening, stretching, strengthening those muscles once again.  Daktari loves vaccines, they are a gift

A 20-year-old young man with a congenital heart disease died last week.  Tetralogy of Fallot it's called. He had received a bridge procedure 10 years before as a sort of stop-gap that wouldn't fix the right-left shunt, but allow him to live for a few years.  His father was by his side throughout this time, and as he passed, said these words, "I thank God that He has given us the life of my son, and that He gives life to my son, even now, with a new heart in a resurrected body."  

I leave you with his words, and ask for you to pray today for healing specifically in a young man called Kevin, with what I believe to be kala-azar (visceral leishmaniasis): a parasite from the bite of a sand fly that causes liver, spleen, kidney, and bone marrow failure. The treatment is quite toxic and we don't know if it is going to work yet.  

Until next time, Daktari.