December 2nd, 2017 by georginagreen

Rift Valley, Kenya

Hello Mum! Hello Lisa (my favorite nurse)! Just want to acknowledge the two people who I know will actually read this blog, who want to know that I’m okay, who would like to to be stow-away mice in my pocket, like Stuart Little. I will try to share with you the days as they happen. The other thing I’d like to do is share information about an illness each day.

Written en route: The first illness is SHINGLES! Which I had one month prior to departure, on my face, which I didn’t know was shingles, which put this trip in jeopardy. On Oct 27th my boyfriend, Rich, was working in Western Kansas. The girls had the day off school, so I also took the day off work. That day I had my eyebrows tweezed at a cosmetology school. Two days later there was a small blister between my eyes and my left eyelid was itchy. I thought nothing of it.

The following day, the preauricular lymph node on the left near my jaw was tender and large, and there was swelling around the blister. I thought I was getting an infection in my face, possibly from dirty tweezers. One day 4, the left side of my face was visibly swelling and hurting. I could feel individual lymph nodes in my upper cheek. I went to an urgent care and was prescribed Augmentin. Each day for the next five days the symptoms got worse, I saw a different physician, and the antibiotics were increased (Rocephin, Bactrim…) On day 9, the swelling started to recede, and there was a pattern of lesions down the left side of my nose that looked like shingles. Herpes Zoster. Herpes, the great imitator.

On day 13, when I could no longer ignore my blurry vision, I went to an ophthalmologist who said there were lesions on the epithelium of my eye, so on my eye but not in my eye, and he started me on an anti-viral medication.

Written after my arrival: Official diagnosis is herpes zoster opthalmicus (cranial nerve V1). The blurriness has gone away and for the most part, I’m better. The pain was as though someone was leaning on the blunt end of a screwdriver in the middle of my forehead for over two weeks, plus the nerve and skin manifestations in the area. I could go on for hours about the pain, how humbling it was, how I wasn’t sure if I would be able to go on the trip, how people around you don’t seem to be empathetic enough, how frustrating it was to go without proper diagnosis and treatment, how I should have taken time off, about lessons learned. Dealing with shingles dominated late October and November.

On my first day in the hospital at Tenwek on Dec. 1st, the second patient I saw was a teenage boy with HIV who was admitted with shingles on the lower part of his body. He was quiet and patient through rounds as we talked about the plan for him and when he would be able to go home.

It’s not that my experience with shingles wasn’t important, but it pales in comparison to what I saw with just one patient. My recent experience gave me a small window of empathy, perhaps. But this child. His pain. His burden. It’s hard to take in. And before lunch I had seen TB meningitis, heart failure, malnutrition, pneumonias, etc., and seen a just-delivered preemie too young to survive. It was and is overwhelming.

Being at Research Medical Center for residency has been good preparation for illness and tragedy. Med school was helpful, too. But this place is new to me. I think there are over 20 (?) long-term physicians here on medical missions doing ophthalmology, cardiothoracic surgery, OB, primary care, etc. I wonder what it’s like when this is not new and overwhelming every day, when this is your home, and this is the way you get to practice medicine.

I’ve been placed on the pediatric service which also covers nursery and NICU. When we finished rounds I joined the medicine rounds seeing the adults. And this weekend I will spend some time in OB.

On rounds the residents prayed at the bedside of every patient with their families. It’s a missionary hospital, and I was also asked to lead some of the prayers. It’s humbling to be here. Also, I’m considered a consultant or attending here, which is interesting. I’m with the long-term staff who young, enthusiastic, whip-smart and evidence-based, and who are teaching me, too. I feel like the resident that I am. But a lucky one, because there is time for learning here. So I’m studying every day and loving the time to think and learn and sometimes also teach.