Familiar

Monday, October 7

I paused tonight before writing.  It was a full and busy day and yet I feel like I have nothing really to report.  No fascinating story, large triumph, crushing defeat. I feel redundant and boring.  Then I am hit with a funny reality. This is because this, Malawi, Nkhoma Hospital, has become familiar.  It is no longer new and different. It is my routine. In fact, tonday I had new nursing students and new medical students.  I was the old one. It is familiar to me and new to them. I don’t even really have pictures of the day because the wondering goats, crazy chickens, purple flowers, and skinny children are part of my normal scenery.  In some ways this is comforting not to have the jolt of newness all the time. But my bigger emotion is sadness. This is such an incredible adventure and I don’t want to stop seeing the uniqueness so quickly or to lose the sense of wonder at this place.  

We had 24 patients on the pediatric wards this morning and all new students.  This made for a full morning just of rounding. There were all of our long term patients.  Stella continues to hang in there. Blessings with the osteomyelitis was worse today and will have to return to the operating theatre in the morning.  Florida with nephrotic syndrome had blood pressures that were a little more reasonable today.

There were many new patients both from Friday and the weekend.  Lots of malaria. The one in a coma on Friday did awaken Saturday and headed home yesterday.  Ok-my fascination with that is not lost! The little one with the mastoiditis is better. Our malnourished kids are gaining weight for the most part.  We have several with pneumonia and/or bronchiolitis. Then there are all of those with crazy vague diagnoses like bacterial illness. Basically, in a place where you can’t run test or do cultures of any sort, you make a good guess and if you can’t you call it sepsis and cover for everything.  I would criticize but I can’t offer up a better alternative. I do a lot of teaching like, “we are calling it this, but this is not a good diagnosis because ….., in another setting you would……”. Understand, that other than the Malawian nursing students, most of my students are from resource rich countries.  Teaching is a presentation of what we do here and what we would do there.

I went and saw a few with Marleen in the NICU.  There were a few sad cases over the weekend. I will not include those pictures.  There was one born with a gastroschisis, meaning the intestines protruded out of the umbilical area.  They sent the baby to the central hospital because they thought a surgical repair could be done but upon arrival some of the bowel was already dying and they sent the baby back for palliative care.  The family went ahead and took the baby home to die. Telesa, Nicole’s newest little one was ready to head home today. We realized that the baby sitters were recording what she was supposed to eat not what she was eating.  That was the weight gain issues. Nicole assigned the most trustworthy sitter to make her eat and she has gained weight. You can see from the picture she is ready to fight. She will go in the next few weeks for her heart Echo to see what is going on. 

Lunch was a welcome break from the heat of the hospital.  The wind is nice and not hot but the still air in the hospital had me sweaty.  I feel much better today and was able to eat most of a sandwich. I just feel a little shaky and weak.  I did take notice of the return from school group. The guard is precious who walks this bunch home. It is like a Malawian version of “The Little Rascals” with a goat instead of a dog.  They all disappear into the children’s home and school uniforms are removed. Then a few inevitably escape before redressing occurs. Today it was Patricia with underwear on but waist in one leg hole leaving the waistband around one leg.  You can imagine the backside view. We just celebrate she attempted. Wearing panties has been a recent battle with her.  

The afternoon went quickly as well.  We had two new admissions. One is a 3 year old with malnutrition but also some puffiness.  Often this is secondary to low protein levels in the blood which cause them to leak fluid from in the vessels to the tissues but we will investigate other things as well.  The other is in with gastroenteritis and dehydration. The baby was limp and out of it but after some fluids perked up. Again, things we take for granted like making a Target run for some pedialyte. 

We do have a little 5 month old that was my stressor this afternoon.  She was admitted with bronchiolitis/pneumonia and has been on breathing treatments and antibiotics.  Early this am the clinical officer had been called in to see her for respiratory distress. I saw her later and she was comfortable but did have some moments of struggling.  I wondered if it was just congestion of her nose as she had respiratory effort but just struggling like upper airway issues. We did some saline drops and oxygen saturation’s were fine.  Then this afternoon one of the senior nurses called me to look at her. She was so fussy with the nasal cannula on so we thought maybe to remove it would help. This time I watched for longer and saw that crying she moved good air but when quiet she had a tug and retractions but didn’t really move air.  She would look distressed and start crying again. She was concerning enough that I acutually called to see if Dr. Catherine (different that clinical officer Catherine, which is confusing in my other writings) or Marleen were around and they both came. In further questioning, mom reported that the patient has always had funny breathing sounds from time to time and described some laryngomalacia.  Basically, the baby has a floppy airway and probably with this illness it is worsened. I gave her a steroid shot and a epinephrine nebulizer. The most helpful was that when I leaned her forward or put her on her belly she breathes comfortably. When we left for the day she was comfortable. I hate that I made Marleen and Catherine come, it just sometimes helps to have others to see and agree with your plan.  

Now it is the calm of the evening, lots of conversations going, the girls colored me a treasure, and lots of dogs and animals in the background.  Melissa has gotten confirmation that USCIS received her paperwork and will now begin processing. Continue sending emails and prayers for her family.  Pray for me, too, that I will make the most of these last weeks and that the familiarity I have with this place will not make me complacent in my work or attempts to love these people.