These blog entries are the views and opinions of the residents during and after their international experiences, and do not necessarily reflect the opinions or positions of VIA or VUMC.
Week 1
Prior to beginning this first blog post, I reviewed the many other “first” blog posts from my predecessors. While each traveler’s first week on the job has been unique, I have also appreciated many themes that were repeated over the months and years since this blog began.
Like those before me, I boarded my flight from Nashville to Chicago with excitement mixed with a tincture of anxiety. While I have been abroad before and worked in underserved communities, each experience has been so different that I have learned to never make assumptions regarding the destination or job responsibilities.
From Chicago, we took an eight-hour flight across the Atlantic to London. We grabbed some coffees and croissants and prepared for our next leg of the trip, another eight-hour flight from London to Nairobi. Surprisingly we breezed through customs, grabbed our luggage from the turnstile, exited security, and found our driver without a single issue. Tired from travel, we arrived at the Methodist Guest House in Nairobi, checked into our rooms, showered, and fell asleep without issue.
The following morning after a well-deserved night’s rest, we hopped back into our driver’s van and made our way to our final destination, Kijabe, Kenya. We stocked up on groceries along the way and were blow away by the “instagramable” landscape that existed from every window of the vehicle. The views only got better as we approached our destination as we weaved through the valley to our accommodations within the Kijabe Hospital community.
Arriving at Roller (the name of our 3-bedroom home for the next month), we were relieved to have completed our journey here and excited for the possibilities and opportunities that awaited us these next four weeks. Chad, Drew, and I grabbed some chairs, headed to our front yard, and watched our first Kenyan sunset still a little in disbelief of how lucky we were for this once-in-a-lifetime adventure.
Week 2
One Thursday evening, coming from across the house we heard our hospital-issued phone ringing. At first, we thought nothing of it as we had received many calls throughout the week regarding orientation meetings with personnel in Kijabe.
Chad jumped up and made his way through the dining room to the kitchen where the phone was ringing on the counter. From the moment he answered, the tone of the evening shifted. Both Drew and I gleaned that something concerning was underway. Within 15 seconds, Chad had hung up the phone and told us there was an emergency at the hospital. While he had trouble discerning what was being said on the other end of the line, we all knew we needed to head to the hospital immediately.
We threw on our scrubs, grabbed our stethoscopes, locked our door, and bolted towards operating theater 6. When we arrived, we found a young woman, intubated, unresponsive, with a questionable rhythm on her EKG. Together as a team we immediately began collecting data from the providers in the room and attempted to distill what had transpired prior to our arrival, just as we had been trained while on call at Vanderbilt Medical Centers over the past three years.
Our first question, “Do we have a pulse?” No clear answer was heard; Chad quickly felt for a femoral pulse and could not feel one. Working under the assumption of PEA, we began chest compressions, called for the code cart, and readied the appropriate medications we would require (epinephrine, bicarbonate, calcium).
Concurrently, we elucidated the following information from the in-room providers:
32-year-old female
4-weeks postpartum
Recent hematemesis episodes of unclear etiology requiring an EGD
EGD had been scheduled emergently
Recent echo showed cardiomyopathy and an EF of 12-15% w/ MR
With ACLS underway, we began brainstorming possible etiologies. After working through a differential and covering the standard Hs and Ts, we suspected that she had coded on induction secondary to propofol and had underlying severe cardiomyopathy.
After nearly 20 minutes of chest compressions, several rounds of epinephrine, sodium bicarbonate, and calcium, the patient regained a perfuseable rhythm and was safe for transport to the ICU. With our limited resources, we transported the patient with a pulse oximeter while palpating the femoral artery, holding an epinephrine infusion above the patient to flow by gravity, and wheeling an oxygen cylinder behind the patient while hand-ventilating her.
We had worked hard and provided this patient with the best possible care we could provide in this setting. She is currently resting in the ICU under the supervision of ICU physicians there. We hope and pray that she makes a full recovery.
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