It's been a challenging few weeks.
I was manning the helm by myself for a little while, and it turns out that there was a lot to do. Mostly, there have been a lot of really sick patients at the hospital, and I've stayed late as we try to take care of them.
I've seen a handful of patients die during this trip in Kenya. They've all had advanced HIV disease, save one. While treatment is advancing by leaps and bounds in the developed world, with sustained hope for an eventual vaccine, the poor are still dying of preventable complications.
With each loss, I see ways we could have done better, and I hope that at the very least we can learn from them and do better the next time. The hardest life to see slip away was an adult man who came in with an allergic drug rash. The condition, called toxic epidermal necrolysis, is a severe form of the blistering condition known as Steven's-Johnson syndrome. He looked like he had been trapped in fire. Almost all of his skin was either blistered, eroded, or gangrenous, and due to the absence of his protective skin barrier, he was battling with a severe bacterial blood infection as well. He suffered under our care for almost a week as we struggled with IV lines, fluid boluses, antibiotics, and wound care. I went from amazed at his state but hopeful that we might help him, to wondering if I was just extending his suffering by not putting him on end-of-life care. Finally, when his kidneys stopped working, and with his relatives hoping that we would just let him be at peace, we decided with the family to withdraw aggressive measures. As if he had been waiting for that decision, he began to let go.
May we all take a break, be thankful for what we have, and enjoy the time we have with our loved ones.