King Faisal Day #7

Monday evening I tried to post to the Blog but couldn't get a connection. Terry had mentioned a country wide outage, perhaps it was the normal bandwidth issues in the evenings so I wrote the blog but didn't post. When I awoke @ 4 a.m. and couldn't connect, , and decided to move to the closet where the computer router resides. Sometimes a direct connection to the router will work. No go direct connected...... Hmmmm Rwanda wouldn't be down for this long, , surely, , so I started looking at the router and although there are two green lights I think there are supposed to be three. I start searching the rats nest of cords and see a plug unplugged and re-plug it , , , no change. Then I see that the power strip has a switch for each individual plug and I trip the individual plug switch and two lights turn on at the wall socket for the Internet connection and a third light turns on on the router. No country wide outage, no bandwidth issues, , just a plug - unplugged. As we're getting ready each of the house guests ask if anybody got connected yesterday and we had all assumed bandwidth issues nobody had checked further.

Monday we had over twenty patients with a dozen of them Radiology patients. Today only 2 by lunch time. Unlike yesterday, I was wondering if it was lunch time when it was only 10 a.m. I worked with Seth for a bit preparing for the Physician seminar that's planned for next Monday & Tuesday. It was originally scheduled to be held a@ KHI but we really need an ultrasound unit and there is none at the school. I'm pretty sure if we can find a conference room @ King Faisal we could have access to the ultrasound unit. Seth takes me to see Nadine and in just a few minutes we've got a lovely conference room on the 3rd floor for both days. A quick call to John to confirm dates/times/attendance levels and it's a done deal. Now I'll just need to review the course content from the syllabus and modify my presentations to match this audience.

We scanned a couple of volunteers to keep the morning productive and talked about more theory. We reviewed a case from yesterday who was a return patient from my previous time here two weeks ago. At the initial study the kidney was indistinguishable as a discrete kidney but rather appeared as a large mass. The rapid onset of symptoms and patient fever made me suspect it wasn't a tumor mass but some infectious process but I hadn't been able to follow up. now 10 days later he's back for another ultrasound and he's had a CT. This time I can see a kidney with thick fluid surrounding it and the fluid appears totally contained within Gerota's fascia. The Radiologist believes it's a resolving hematoma and that would certainly be consistent with the ultrasound findings. Additionally I noticed a large diffuse bruise in the area of the kidney. I questioned the patient concerning trauma during the first exam and then again today and both times he denied any type of trauma. In later discussions with the Radiologist and Terry they both say it's likely the patient just doesn't want to admit to being beaten. Hmmmm

We'd made some arrangements to work with the OB/GYN doctors using the 3D but I haven't seen them either by 3:00 so Said and I go to CT to review anatomy. After an hour I'm ready to pack it in and say goodbye, , but what is this?? the OB Dr. has slipped into the U/S room and has 7 patients lined up to scan. Plus he's anxious for the promised 3D session. Plus there is now a Radiology sonogram which can't be done until after the 7 obstetrical studies....... This is a typical hospital :-) It's all good though because the Dr.s are very pleasant and engaging, , , the radiology staff are equally pleasant and what else will I do this evening anyway?? We stored the 3D acquisition data and I'll work on it after the patients are gone. We finally get to the Radiology patient who is positive for DVT which I can document from the external iliac down to the calf. It has all of the characteristics of sub-acute thrombus. When I sit down to do the 3D image manipulation we'd saved the images but not the data.... A call to the OB/GYN Dr. and he says he'll bring another patient down in a bit.

The sun is about to go down, , , the day is beginning to cool off and I walked out to one of the balconies of the hospital to look over the city while I'm waiting. I can hear a group of youngsters off in the distance playing soccer. I finally spot them about 1/2 mile away but I can tell when something good has happened by the shouts of happiness which travel clearly. I can also hear the occasional officials trilling whistle. Out this side of the hospital I can also see most of Kigali's beautiful golf course. On the surrounding hills I can see a series of construction projects of new homes and upscale housing developments. This could easily be America , , , except for the cry of a worried goat whose been staked out to the grassy area next to the hospital for it's evening feed, the sight of the hospital laundry folks taking the sheets off the lines at the back of the hospital for the evening and the typical low income housing interspersed wherever there is not development. It's a study in contrast. Now the Dr. is here and it's time to do that 3D. I've gotten faster and it's not long before I've got his image and have dissected away the extraneous tissue from the face. I'm still not thrilled with the quality of the final product and I'm not sure how much is me and how much is this specific ultrasound unit.

A nice walk home and an easy going evening with the other house guests. I enjoyed comparing experiences with Terry while we ate in the Cabana. Then we both had computer work to do and I was in bed before 9.