Home!

Sorry for the delay in posts. I hated that I left you with such a sad last post. We lost internet on Friday and I've just now gotten home to sit down on my computer. A short update on the last blog: we found out Dotto's body and his mom made it back to Tanzania with no problems. We were worried they would not allow him across the boarder but they did. He will be buried near his home and his 8 siblings will be able to be present. His mom said she understood that Dotto was very sick when she brought him to us. I continue to pray for his mom and his siblings who did not know they'd lost their brother until mom came back home without him. I can't imagine.

Kipchirchir!

Anyway, Thursday and Friday we continued with surgeries and all were successes! My days began to run together but we met several cuties. One guy, Kipchirchir, had a very very long surgery. He reminded me alittle of Hilary from week one. Kipchirchir got a tricuspic vavle replacement. The cardiologists described it as ebsteinoid-like which is pretty sick. During surgery they had trouble staying off of bypass due to severe pulmomary hyptertension. Kari, Kristen, and I spent a lot of time running around and calling people to find some flolan--no such luck! Malik put down an NG and we crushed up some sildenafil. They wait an hour for it to absorb and attempted to come off pump again. I don't know if it was the time, more surgical stuff, or the medicine but he was able to come off. I believe he went on and off pump 4 times? Either way, he came out of the OR very sick but by the next morning he was extubated and just on some milrinone. I continue to be amazed at how sick these patients are but they just keep exceeding all expectations. Post-operatively Kipchirchir required pacing wires and continuous pacing (originally his underlying rhythm was asystolic, eventually improved to an escape rhythm around 70). Aegneta (the 5th year resident at Tenwek who literally does everything) ordered a permanent pacer and when it arrives to Tenwek she will most likely place it this week. He was a quiet kiddo and I found out later he had an identical twin. Aegneta said Kipchirchir (which means "boy born during chaos") and his twin Kipkemoi (I think that means "boy born in the morning") would come into clinic and make Aegenta  guess who was who without listening to their hearts first. I thought that was cute haha

Kibet!

Some other little ones we saw we Mary, Chepkemoi, Chepkorir, and Kibet. They were all VSD or ASD closures and they all did so so well! Kibet had some rhythm issues that required him to stay with us for some time but by Sunday he was off his pacer and got to leave the ICU. Kibet was five and his  biggest concern while with us was that his mother never ever left his side. That quickly became my biggest concern too b/c if his mom left for a second Kibet screamed and cried. I found out the best way to calm him was play some Taylor Swift on my iphone and he chilled out....we aren't so different after all. Oh and Kibet's mom told us that he thought we were all Chinese. When we asked why she said it was because he'd seen a Jackie Chan movie and assumed all white people were Chinese. He was kind of awesome.

Little Mary was 9 months old and was super tiny but supppperr cute. I believe she was just a VSD closure. She did really well! Mary spent most of her time either eating or sleeping. Any other combination threw her for a loop and resulted in screaming.  She also required 24 hour mom-at-bedside orders. We made an excepetion for both her and Ian's mom to sleep in the bed with them so they coud feet and cuddle whenever necessary. I wish we could do that at Vandy...

Mary Mary! Cutie!

Our other two friends were Chepkorir (I THINK it's girl born during the rain but not positive) and Chepkemoi (girl born in the morning). They were both with us for a short period b/c they did so awesome. I actually didn't even meet Chepkemoi until I visited her in the ward b/c she did so well after surgery that she left the unit within 12 hours. All to say, I'm so thankful that they all recovered and were smiling!

Took a hike outside the entrance of the hospital. 

On Saturday most of the team left but Kristen, Brittany, Leah, Jenny, Mary, Michael, and myself stayed through the weekend to see the patients through. The last two patients went to the high dependency unit on Sunday so we were free to just enjoy Tenwek. We went on lots of hikes together and spent time just enjoying one anothers company. Monday morning we went for another 430am Motigo sunrise hike. Poor Aegneta wanted to go so bad but it never worked out so Kristen and I decided to go again and everyone else joined us! It was so fun. This sunrise was a little different. I liked it more for the hike itself rather than the runrise...that's not to say the sun rise was anything short of perfect. As we walked there wasn't a cloud in the sky and you could see the milky way. I've never seen so many stars...For real! I couldn't capture the stars and moon in a picture but I did manage to get a couple snaps at the top. After the hike we all showered, visited the patients one last time, and hopped on the vans to head to Nairobi. We got to the airport around 4 and the long travel began.

Some Motigo sunrise action.

We went from Nairobi to Amsterdam to Detroit then HOME! We were all counting down the minutes til the Detroit airport. We had already planned a Chili's lunch and starbucks stop before the next flight. We ate our weight in American food and coffee then boarded a small plan for home. I charged my computer just enough to watch one and a half episodes of The OC to pass the time. My sweet mom and dad greeted me at the airport. Later that evening my sister surprised me and showed up at my condo! I was literally walking to my bed at 630pm to crash when she knocked...it was the perfect surprise and gave me a 2nd... 3rd...4th boost of energy. She was so sweet and let me tell her all about what happened the day we lost Dotto. I think I needed the debrief. My mom picked up some dinner and my brother showed up, too. Just what I needed! I crashed around 930 and they snuck out some point later. Feeling rested now!

Again, thanks so much for your sweet words and heartfelt prayers. All in all, I think we did 25 surgeries(also includes 2 cath patients). It was a long trip but always so worth it. I made many new friends a long the way and grew deeper in my other friendships. In fact, I already miss everyone. Before the weeks were over we were already discussing next year. We will most likely go back the same time, but do two weeks of congenital cases. So, lots of little ones!! Thanks again! love to all!!

Doing some teaching with these awesome Cardiac books Kristen made! 

I blog today with a heavy heart. Most of you know what transpired yesterday evening, though some of you may not which is why I chose to blog. Yesterday was full of great joy but also great sorrow. 

The day started rough as we took sweet Ian to the OR and after sedating him and putting in the breathing tube we felt his lungs were too sick to go on with surgery. We spent a lot of time praying over him and discussing our options. Ultimately, if we did not do surgery Ian could go home and pass away...he could have months or years, we can't say. If we did surgery it could go well and his heart could be fixed, or it could go poorly and he may not survive. We spoke with his mom and she said she believed God was in control and to proceed with the surgery. We proceeded and Ian is doing AWESOME! Kari his currently patting his bottom as we try to track down his mom to feed him! He's the cutest little thing laying in this giant adult bed. What is amazing about Ian is he is the most complex surgery we've done here and praise God he's doing well!! 

As Ian was finishing up in surgery Dotto began getting sicker. Kari, Jenny, and I were in the OR to transfer Ian back to the unit. As we were waiting one of the Kenyan nurses came into the OR and said they needed us in the unit for Dotto. When we got in there we found Dotto had suddenly stopped breathing. Prior to this event he had developed a GI bleed on Tuesday that we'd been treating but he hadn't had any further symptoms of that yesterday afternoon. To make a long, very messy story short Dotto ended up in cardiac arrest. We put in a breathing tube, started CPR, gave a lot epi boluses, gave volume for low blood pressures, and started continuous infusions of blood pressure medicines(epi, dopa). We got him stable for about 10 minutes when all of a sudden we could not get a pulse or blood pressure again. We started CPR for a second time and increased all support. He was continuing to decompensate. During this Leah remembered that Brittany (Kristen's sister) was O-positive, which was also Dotto's blood type, so Brittany immediately ran to donate blood. She's so great!! We decided to scope his upper and lower GI and found a bleed in his colon. At this point I called Nez up to the unit for more help. Between Kari, Leah, and myself we weren't able to manage him, our cath patient (alhtough he was rockin it!), and our new post-op Ian. Kristen had worked the night before and was coming back at 7pm so we chose not to wake her. She arrived around 630pm and jumped right in to help us. Dotto stabled out enough so that we could all take turns going to eat dinner. Around 9pm things seemed to calm down though Dotto was still very sick. For my nursing friends he was on Epi 0.2 and Dopa of 10 with continuous blood and NS boluses and no longer responding neurologically. 

Leah, Kari, Brittany, and I headed home for bed after a long day while Nez, Kristen and Jenny stayed to manage the unit. Needless to say, none of us could go to sleep without knowing how Dotto was doing. I called up to the unit and Kristen told me through her tears they decided to withdrawal care on him. We all walked back up to the unit to be with them and say goodbye to our little friend. His mother was at his bedside praying and chanting over him through her tears the entire time. Kristen said they had added a Vaso gtt and even increased his Epi to 0.25. He had started to decompensate again and they decided there was nothing else we could do, at which point they called his mom into the room to be with him. They said when they stopped all the medicines and took out his breathing tube there was an overwhelming sense of peace that came over his body and they could tell he was no longer in pain. 

Dotto went to be with his Savior around 1030pm last night. For a 12 year old boy he was incredibly mature in his faith. As Kari says "he was an old soul". He would pray all day and ask us to pray with him. We found out later that Dotto had told his mom that morning to give his sister all his toys(we give them bags of goodies when they have surgery). It was as if he knew...which is what hurts me the most. He knew and he couldn't communicate that to us. I replay the day in my head and wonder what more we could have done or what we missed; but in my heart of hearts I know we did all we could and God has a bigger plan for Dotto. This isn't the first time I've lost a patient, not even here at Tenwek, but this time stings differently. We'd invested a lot into Dotto and even gotten to know him over the last week. We prayed with him, laughed with him, even bickered with him, and held his hand when he was scared. If I'm being completely honest, and vulnerable(KB-bravery point?), I'm feeling guilt. His mom and him praised God for "finding" us over and over. They were so gracious and it hurts to think Dotto is no longer here. It's difficult to understand for me that he came in with a "broken" heart that, surgically, was fixed, yet he died because of something different that we didn't know had been going on.  All to say, I'm still so thankful for little Dotto and his mom. I will praise Him for this 12 year old life that made us laugh and showed me a true faith. I'm so thankful for these Kenyan nurses that have been so supportive and even helped us during those moments of chaos. Without them this would not be possible. They're so generous, helpful, and joyful. I'm blessed to be a part of this team that cares so much and gives every bit of their energy towards one another and these patients. I'm so grateful God placed a desire on all of our hearts to come serve these people for His purpose...it's such an awesome team!

Interesting note: Kari just opened her Jesus Calling book to read todays message. As she read it I thought "that sounds strikingly similar to the passage Mary found last year after Roger passed"... I looked back in my blog and found Roger passed away this same day a year ago and it was the same passage on November 8th. Just weird. 

Anyway, the first surgery for today will come out shortly. It sounds like little Mary is doing super awesome! Our other kiddos Zebidi, Karen, Parmaut, Malvin, and Joyce are healing!! Parmout and Joyce were the first cath patients ever at Tenwek! Tom Doyle is cranking them out...it's so so cool to watch! All the cath kids come out super happy and fun! Despite the sadness of yesterday all of our patient's are rockin it! Such a blessing!! Pictures to come. Oh, also, I hope you all survived election day...not going to lie, I'm glad I wasn't there :) love to all!!!

Ready for round two

Just a short note before we head to bed and start a new week. The second wave of people arrived today around 1:00 and we got to spend some sweet time together before we get to work. We unpacked all the extra bags full of more supplies and re-stocked the ICU. The ICU and OR are ready for round two but we needed to meet as a team to discuss the patients. I'm not sure the exact number but I'd say we had a stack of papers on 50-60 kids, 28 of which we discussed doing surgery on...and that's not even including the ones that will show up this week in clinic in need of surgery. Sadly, the truth of it is that we can only do 2-3 cases a day, meaning around 12 patients total. So, of the potentially 100 children screened, 12 will get surgery and about 4 will be cathed. All to say, that's a HARD decision to make and one we have to remind ourselves that, ultimately, is not our decision. Tonight during our bible study we spent some time talking about how we felt like we were "playing God". It's tough to go down this list of names and cross names off knowing we (Mary, Mike, Ron, and Tom the cardiologists) have to tell them they are not a candidate for surgery and they may not live a long life.  I don't mean for this blog to be depressing but this is the reality and although there is SO much goodness here, I think it's important people understand that there is SO much more that needs to be done. We prayed for wisdom and discernment as we make tough decisions and trust these are the patients God has brought to us to treat. Tomorrow we are doing surgery on Dotto, the boy I mentioned in a previous blog. We will also do surgery on Chepkoech Songok, who is a VSD repair, and Malvin Mwangi, who has severe subaortic stenosis. I'll let you know how they do!

Tomorrow will come early as Kari, Kristen, Nez, Leah, Brittany, and myself are going to hike up to Montego at 430am to catch the sunrise. We have to get back by 8am to take Lilian, Agnus, and Julia to get their follow up echos before the go home. We have checked on all our patients each day and they're all doing great! They send their love to you all! Hope you have a blessed sunday and say a prayer that my fantasy team whoops up on Shelby's team ;) love to all!

Thirteen patients later!

It's been a couple of days since I updated but everythings well here! We have had a total of 13 patients, not including a few pacemaker placement patients, one of which was one of the first nurses here at Tenwek! There have been six more patients since I last updated. Charles, Chepkoech, Irene and Joyce were all mitral valve replacements and did well! Miss Chepkoech had a rough day due to some bleeding post operatively. She earned a trip back to the OR after dumping a liter, but after repairing the stitch she has done well! Our two other patients are little different. For my non-medical friends this may not make sense BUT it's interesting so I added it. Hillary came to us with severe aortic regurgitation and sinus of valsalva aneurysm.  The plan was to do an aortic root replacement but it was complicated by coronary ischemia which then required a CABG. He had an eight hour by-pass time during which the team contemplated calling it b/c his ejection fraction was 5. After his repair and a TEE we gave him an "optimistic" EF of 19 and he seperated from bypass easier than anticipated. Within 12 hours of this operation he was extubated and sitting up. I can't help but believe that in the states this just would not happen. There's something about these people. They're resilient, they have such a strong faith, and they are more than willing to do anything they need to get better. It's so clear to me God has his hand over this place.

Ron teach during Hilary's TEE in the OR! An optimistic EF of 19. Today we measured 28!

Another interesting patient was Dotto. He was a 12 year old (looked 5, Amy actually thought he was 4) from Tanzania. He showed up at our clinic on Wednesday and they pretty much immediately knew he was not well just by looking at him. His mom said someone from home heard about the Americans at Tenwek and they offered to pay their way here. You could tell by his appearance Dotto had severe ascites and his abdomen was HUGE; he could hardly breathe. They did an echo and found he had a huge pericardial effusion and large bilateral pleural effusions as well as severe ascites. The admitted him to our unit and tapped 3L off his belly. We discussed what to do about his effusions but were nervous he would decompansate. The following day we decided to evacuated fluid around his heart and lungs. Jenny put in a pericardial drain as Mary Taylor guided her with an echo. We got about 300mLs and he got pretty hypotensive and dropped his heart rate with it. Fortunately, we were able to volume resuscitate him pretty quickly. I'd be lying if I said I wasn't nervous during all of this! After that we drained his left pleural effusion and got about 800mLs...lets just say he could breath a lot better after that! He was such a sweet boy. He would call us "dada" over and over meaning "sisters". One of the Kenya nurses said he was praising God for "finding" us for him and was asking me to pray for him. That was a cool moment. He loved playing music on my iPhone and playing games on Sarah's iPad. Sadly, w don't know why he is accumulating all this fluid. It's kind of a mystery. We've sent several labs and test to try to find out so I'll keep you posted on Dotto!

Sarah playing games with Dotto! 

Jenny and I have been manning the ICU this morning. We started with five patients and are down to two! Charles and Chepkoech are moving along. Both sweet souls, very soft spoken, but getting better! They should go to the floor today. As we were rounding we found Julia, Agnus, Lilian, and my girl Peris basking in the sun with their incentive spirometers and gifts! It was AWESOME to see them laughing and smiling together. They've bonded this week. They each asked how long their surgery was and said they feel so happy. Peris said "I can even walk up the stairs now!" love it!! She has SUCH a beautiful smile, I wish you could all meet her!

Our sweet girls!! Julia, Agnus, Lilian(fist pumpin), Peris!

Sarah, Amy, Dr. Galat, and Luke are all headed back to the states today. I can honestly say I'm really sad to see them go! I spent a lot of time with Sarah and Amy this week so it's already weird without them. Luke is such an awesome guy. He genuinely cares for these patients and this whole mission. And Dr. Galat is an incredible surgeon and so willing to teach! Though I'm sad to say bye I'm super pumped Kristen, Brittany, Leah, Dave Bichell, and Lewis are en route to us! I think their smiling faces will be the perfect boost for round two!

Nez talking to Charles about his family back home over some lunch. 

Round two is pediatric congenital heart defect week!...aka what I actually do at home! I can't wait to see these sweet kiddos! I think our youngest is 3 months but we will discuss in conference tomorrow once the rest of the team arrives. Anyway, happy weekend to those of you at home and as a Kenyan just reminded me, tomorrows election day! She asked if I voted and I told her I've been here but my states red no matter what :) LOVE TO ALL!

"For it is God who is working in you, both to desire and to work out His good purpose. Do everything without grumbling and arguing." Philippians 2:13-14

My HotBox friend Rachel donated lots of soccer jerseys...Charles was eyeing this one!

"But let all who take refuge in You rejoice; let them shout for joy forever. May You shelter them, and may those who love Your name boast about You. For You, Lord, bless the righteous one; You surround him with favor like a shield" Psalm 5:11, 12