My Last Day at Shyira

I can't believe that today is my last day.  I just can't believe it.  Yes, I've packed and yes I'm ready to go, but I just don't think it's truly registering in my mind that I am leaving.  

I'm taking my patient with HIV and anemia to Kigali for a bone marrow aspirate.  The thought was, it's one day earlier than expected, but if I go in with this woman, they might take more of an initiative than if it was just another Rwandan nurse.  This may prove to be entertaining.  I'm imagining throwing a temper tantrum in my pigeon French and pathetic Kinyarwandan, saying "cette patiente a besoin d'un aspirate du marrow du os!"  I have no idea what the word for marrow, much less bone marrow aspirate, is in French.  I should try to figure that out before I head out in the morning.  

I will leave around 5:30 am, take the 3.5 hour ride into Kigali via ambulance, and then drop the patient off at the Centre Hopitale Universitaire de Kigali, which is always spoken as "Say-Ahsh-Kah" for the French pronunciation of "CHK."  The Universitare has only been recently added.  Once I'm sure that she is admitted and a bone marrow is planned, I get to go to my friend from grad school's house and chill with her.  We will then go to Gisenyi on Lac Kivu on Saturday and stay until Monday. 

But for my last day here, I had to give a presentation this morning.  Richard and I had seen a case of retinoblastoma that had unfortunately been missed.  It's an eye cancer that is 90% curable in the first stages, when it's located in only one eye, but if the diagnosis is missed  and the disease progresses, then it's a dismal prognosis.  I was so mad that the diagnosis was missed that I felt it was particularly important to do a presentation on it.  Instead of just the doctors, they also had the nurses sit in on it as they do a lot of the triage of patients.  It was rather simplistic and mostly done via chalkboard.  Caleb thankfully translated it into French for me.  

Then Richard and I went on rounds.  It was pretty cool.  We got to see that my little boy with a huge lymph node/abscess on his neck had gone down in size a lot.  We also got to see some follow up patients, one little asthmatic and a boy with pyelonephritis who were both better.  

We went to read about Buruli's ulcer a condition we think another patient might have had, when Louise called asking if either of us knew how to aspirate an ankle.  Richard did, so we went to go see this lady with HIV and swollen and tender ankles.  The main thing was to make sure it wasn't TB because we were going to put her on prednisone, an immunosuppressant that will just make things worse.  We managed to get 3 mls of straw colored fluid out, so we'll have to see what the tests show.  

Then I spent the rest of the afternoon taking a shower and then writing up my patient for CHUK, doing a sort of transfer-note so they can be sure to know what's going on with her.  Also, I met up with Richard at the end of the day to show him some articles I found on retinoblastoma.  

Then dinner at the Kings, followed by taking care of last minute details.  

I really can't believe I'm leaving.  But as Caleb said today in the staff meeting when I finished my presentation and announced my departure, goodbye doesn't have to be for forever.