Just wind me up and push the button!

I have had many occasions to give lectures over the years, participate in seminars, teach classes, etc but have not really done bedside teaching since my residency . . . until today.

The day started with neurosurgery rounds at the Kenyatta National Hospital, 2000 beds and 3000 patients (you get the picture). First rounds with the neurosurgery residents and attendings on 40 patients on the neurosurgery ward. A virtual neurosurgical museum. Then just the residents and I went to see 15-20 patients (new and old consults) ,on medical, pediatric, ob/gyn, general surgery, orthopedic services, plus one trauma patient in the E.R. I was observant at first, then interjecting subtle comments and suggestions (and alternative diagnoses). Finally on the non-neurosurgical wards I was greeted by superb presenting residents and their coterie of medical students. Here I took advantage of the opportunity to discuss subjects I have not confronted for decades. My reward was students sneaking from the group to follow me the remainder of the morning.

Rounds last 5 hours. One of the residents then took me cross town through horrendous typical Nairobi traffic (Los Angelinos have nothing to complain about) to the private Aga Khan Hospital. There I conducted a workshop (in the morgue) for several of the neurosurgical attendings, residents, an anesthesiologist and pain management specialist on the balloon compression treatment of trigeminal neuralgia.

I later had a lovely evening with Jaininder Singh (brother of internist Jetinder Singh in Kansas City) and his wife at a local Indian restaurant.

Let me give you some idea of the security issues for a tourist (or even a local Kenyan who may not look the same as those of tribal origin) in Nairobi (not true in the countryside). Jaininder took me on a brief auto tour of some the newer buildings in the downtown central business district (CBT). This is the only part of town (not much larger than downtown Kansas City) with stop lights. As we approached the first light, he warned me that he would not stop for the red light, nor did he stop for the next 5 or 10 that were red. The potential "tip" to pay off a cop who might stop him is much less than the risk of a mugging or carjacking while stopped at a red light.

Tomorrow I am giving two major lectures and will be seeing three patients with trigeminal neuralgia on whom I will be operating on Wednesday.

Good night to all.