On becoming the paediatrician I’ll need to be (12/3/11)

I’m starting to realise I’m actually moving to Kenya to be essentially a rural paediatrician. That’s a pretty big change from what I’ve been doing. For the last 10 years I’ve mostly been in the emergency department – decisions involving is this child actually sick? how sick – REALLY sick? do I send them home? do they need to stay? what do I do in the next 4 hours to stabilise them, to start their treatment? how can I get them out of my department so I can see the next one?

Thinking about working as a hospitalist, neonatologist, outpatient clinician and who knows what else in a country with diseases like dengue and schistosomiasis has been a little daunting. To know that I’ll be diagnosing and treating conditions that may be quite alien to me.
To know I’ll be making some of those long term management decisions that have not been mine to make for a long time.

So I am grateful for small encouragements in the last few months – experiences that remind me that I’m not alone in this, that God’s going with me and walks alongside me in the day to day.

For the experience of having a newborn baby that had a rare reaction to a drug I give often – a reaction I was aware of and prepared for, but horrible to actually see. To have a flash of “is this baby going to make it through this?”, to need to decide quickly what to do to ensure the baby would breathe again. I am grateful that the baby was OK at the end of it, and that God answered my silent prayer for wisdom. I am grateful that the reaction happened at all, to test my ability to handle the unexpected. I am grateful for the opportunity to have worked with a new retrieval service taking care of premature babies for the last 12 months, when it had been 7 years since I’d even held anyone that small.

For the experience of managing an 8 year old in cardiac arrest that we were able to resuscitate this week. Cardiac arrest in children isn’t all that common, and rarely has a good outcome, and it was nice for once to leave the resus room and say “Could you bring the mum back and tell her her son is alive?” rather than “Where are the parents? I need to tell them the bad news”. I am grateful to have been able to participate in this child having a good outcome, and for the nurse in the resus room who was silently praying for all of us. I am grateful to have learned so much through good and bad experiences, and to have the opportunity in this resus to test my ability to make decisions. I am grateful to have become a part of a strong, confident ED over the last 5 years, when it was less than that when I started here.

Kijabe Women's ward (www.theshirleys.blogspot.com)

For the experience of 2 weeks in Missouri last year, to learn a crash course in tropical medicine while connecting with an amazing group of passionate people who care deeply about helping to restore God’s creation through serving the poor and helpless around the world. To know that I’m walking in the footsteps of giants who have done this before me.

We leave in just over 4 weeks. I don’t think I’m really ready to be everything I think I need to be in Kenya.

But I can’t wait.

-M.