Taking care of patients.

Erin has done a good job at detailing how life looks around the house.  I thought that I'd try to describe a typical day at the hospital, as well as show some pictures of interesting patients I've run across in the one month I've been at Tenwek.

I usually wake up around 5:30 am and start my day early.  Three important things need to happen before I leave the house at 7:00.  1) Coffee.  2) Spend time studying the Bible and keeping my relationship up with God.  3) Utilize the faster internet (not a lot of users at this hour) and quiet house to get any odds and ends done.

Just before 7:00 I make the 5 minute walk up the hill to the hospital.  The bumpy dirt road is pretty steep, and after a month of this morning exercise, I'm no longer sucking wind once I reach the hospital. From 7-8 I make rounds with the residents.  Our team is made up of 3 residents, 2 interns, me, and one other consultant (attending surgeon) named Dr. Odera.  Usually we have a list of 20-30 surgery patients.  (If you do the math that equals 2 minutes per patient...so we move quick.)  There is another surgery team with another 20-30 patients, headed up by the other attendings.

The 8:00 hour is educational time, usually filled with M&M, a lecture, devotions or a case presentation. Surgery begins at 9:00, and depending on the day we will do between two to five cases during normal working hours.  Some cases are scheduled from the office, many are on patients admitted to the hospital through the ER (we call it casualty).  Most common so far...skin grafts for burns, exploratory laparotomies (abdominal surgery), three field esophagectomies for cancer, and thyroidectomies for goiters.

After the first case of the day we break for morning chai, which I have come to LOVE!!  If the first case is long and we miss the 10:00 chai time, someone usually brings a thermos of chai to the room so we don't miss out.  (No drinking during the case...we just don't want our chai to be drank by the other OR rooms.)  Lunch is from 1:00 to 2:00 and if I'm available, I will head home to eat with the family.

After lunch I'll head back to the hospital for more surgery.  We have an evening signout at 5:30 with the residents and they update me on the events of the day on the ward.  I head back down the hill around 6 and we have dinner at 6:30.  So far...the perfect job.
Clinic days are Thursdays, and I spend the whole day in the office seeing patients.  Speaking of patients, here are a few of the interesting cases I've come across thus far.

Here is a Maasai man who is showing off his scar after being operated on because he was gored by a "bison."  He was shepherding his cattle on the Maasai Mara game preserve (shouldn't be there!!) when he was chased down and gored by a bison, or as we Americans call it, a water buffalo.  He presented to the hospital with his small intestine hanging out, but nothing else injured.  Here he is post op, asking when he can go back to work.

This is a lady with a neck mass arising from her parotid gland.  She was able to afford a CT scan, which shows the extent of the mass.  I'm suspecting a lymphoma and the biopsy is pending.  

Now this is something you don't see much of in the U.S.  This is a Madura foot, caused by a longstanding fungal infection.  We were thinking maybe sarcoma, but the XRAY is about as odd looking as the foot.  The visiting radiologist told me his initial though was "Why did they XRAY this foot with the cast still on." We amputated his leg because no matter what the diagnosis, it was non functional.

 The big organ you see here is a spleen.  A normal spleen is about the size of your fist and it sits nicely under your ribs on the left side of your abdomen.  This guy's was extending all the way down into his pelvis.  It was so big that he complained he couldn't eat because he would get full too fast. There was no room in his belly for anything else.  Each surgery team took out a huge spleen on this particular day.

Here is my team.  Head nurse on the left, first assistant on the right, and scrub techs in the front.  I just need to find something for Tucker to do.

Thanks for all your support and prayers as we continue to serve in Kenya.  Many people are hearing the gospel and growing in their faith because of the great care that everyone provides at Tenwek Hospital.  I'm blessed to be a part of the team.