Let Them Eat Cake

Marie Antoinette was thought to have used this phrase during a famine caused by a bread shortage just prior to the French revolution in the late 18th century. Upon being alerted that her people were starving due to having little bread to eat, she is said to have replied, "Then let them eat cake."

Sometimes I think this is how the hospital staff feels about our patients. Work seems to be more frustrating by the day, and we seem to be falling further behind. In the states, in order to pass med school, internship, or residency, it is required to come to work everyday. This only makes sense. However, here, the medical students, medical interns, and medical residents generally come whenever they feel like it and this doesn’t seem to be very often.

I am nervous every morning as I walk to work because I don’t know how many of my patients survived the night and I’m generally upset as I walk home from the lack of progress we made throughout the day. I think the most upsetting loss was a 16 year old boy who was wrongly diagnosed with a glioblastoma causing an infarct of a portion of his brain. They do not treat this here and gave the boy little chance of survival on his own. As we watched him lay there day after day, he slowly became weak, stopped moving, became mute, and was unable to breathe completely on his own. He developed a new onset murmur, Janeway’s lesions on his palms and soles of his feet and Osler’s nodes on the pads of his fingertips. These are all classic signs of late stage infective endocarditis in which bacteria grows on the valve of the heart. He was placed on oxygen and had an x-ray of his chest that found a cardiac tamponade needing to be tapped and the fluid tested. Turns out the boy had thrown an emboli of bacteria into his brain causing an infarct while he slowly deteriorated as more of his brain died. His last chance was to tap the fluid and treat with appropriate antibiotics. Problem was, no one wanted to do this and, while they went back and forth about who’s job it was, the boy passed away. Such a loss. I’ve never felt so helpless watching him lay there suffering.

You always know in the hospital when a death has occurred. The culture states that if you do not mourn loudly and very audibly, then you are not grieving properly. So, every time a patient passes away, family members wail and cry loud enough to fill up all four wards. It’s very uncomfortable listening to someone in such distress and wondering if it could have all been easily prevented.

On a happier note, we do make many good saves and those stories are always a welcome relief from the normal day. We found a 16 year old boy with Non Hodgkin’s Lymphoma. I dosed his chemotherapy regimen (first time I’ve ever dosed chemo…a little scary, but I suppose you have to start somewhere) along with prescribing adequate fluids, antiemetics, and pain medications as the doctor did not think to add these (pharmacists can prescribe here). He received his first round of chemo yesterday while we were on the wards and Mercy, a Kenyan pharmacy student I recruited to help me speak Swahili, and I talked with him while he received it. He was very scared and crying, so we sat on his bed and talked with him until he fell asleep. Today he was looking slightly better and his father was there rocking him so he was in brighter spirits. I can only imagine how scary it is to be in the hospital all alone at 16 when you’re unaware of what to expect. I was very happy to see his father today.

We have been without electricity on and off both at the hospital and at our house the past few days. We had a wind storm (which here, during the dry season, equals a dust storm) and this easily knocked the electricity out for a majority of town. We got a good laugh when it went out while Avery was in the shower and he ran into the door. Unfortunately, this also means our internet goes on and off so its been touch and go the past few days.

Tonight (Friday night) we are going in town to listen to a live, authentic African band. Then, we are heading out early in the morning to go to the Masai Mara with a few other people. We will go on some game drives and hopefully see lots of animals. I’ll be sure to include some stories if everyone is interested.