A bloody dilemma

View of Kijabe Hospital

4-18-08; Leah is a 83 years old female with a two year history of a draining sinus on her left hip as well as probable chronic osteomyelitis (infection of the bone) . She also has concomitant anemia, diabetes, hypertension and dementia. We consulted Ortho to evaluate her for debridement and possible graft however they were reluctant to do so because of her Hgb of 6.2.

Dr Temple, attending physician from America, to the team, “Why can’t we get any blood for her?”

Dr Mbula, intern, responds, “ We’ve been trying for two weeks to get blood, but her family has not come to donate and we don’t have any of her blood type on hand.”

It is the usual practice in Kenya to have family members donate blood for patients, as there is not an extensive blood bank.

I reply, “Well what blood type is she?”

“O negative,” came the reply that I did not want to hear.

You see, this past nine months of fellowship and living in the dark, dampness of Seattle has been hard on the waistline of this physician. I attribute my weight gain to multiple etiologies; free meals in the cafeteria, late night morale-boosting milk shakes just to keep me going, Dr. Gamble enlightening me to the fact that I can get lattes with my meal card from the coffee stand. I also think that working for one year entirely with pregnant women, one cannot help but gain a healthy amount of weight. However of all the current fellows I am the one to put on the most pounds and that includes Dr. Parker who is now seven months pregnant!

So during this time of reprieve from the grind of fellowship as well as the cloudiness of Seattle I had set a goal of losing some weight while in Kenya. It is sunny and bright and despite my fear of leopards and baboons I have been running daily. Well, because we are at an altitude of six thousand feet, running places somewhat of a challenge to this out of shape Navy doc, it’s all I can do to get a half an hour in. I can’t imagine what it would be like now running at six thousand feet, down a pint of blood.

As this conversation and internal battle is going on in my mind I am brought back to the present conversation by Dr Mbula’s words, “Yes, without blood there is nothing else we can do.”

Before I can stop myself I say, “I’m O negative.”

Those of you who are O negative know too well the dilemma of having this blood type. For those who don’t know, while O neg is not the rarest of blood types it is the most coveted by blood banks as we can donate to all, however we can receive only our own type. Previously I have been a regular donor to the various blood banks, but over the past few years due to my travel, required military immunizations and living overseas I have not had the opportunity to donate. Now that I have been to an area where malaria is endemic, even the Red Cross won’t take my blood for six months.

No sooner had the words, “I’m O negative” crossed my lips and I was escorted down to the phlebotomist who withdrew one pint of my sea level adapted, only hope to survive this altitude and lose weight, blood. Gone were the double-blinded, super-secret questionnaires that delve into ones innermost secrets (i.e. Have you ever travelled to the Chang Rai triangle, eaten at Mamma Thai’s, utilizing a pink plate while the song “Beat It” played in the background?) I had been used to when previously donating blood.

Simply one question from the smiling phlebotomist, “What is your blood type?”

“Lie here, you’ll feel a poke, squeeze this, little more, hold this, thank you, free drink at the café.”

Well Leah’s post transfusion Hgb is 10.5, good enough for surgery, hopefully she’ll improve and no longer be bed-ridden.

As for me… I’m destined now to trudge through the jungles and up the hills of Kijabe, Kenya, not getting much exercise nor losing any weight... Well who am I kidding, through the years I’ve utilized most excuses known to mankind for being portly (I eat like a bird.. I don’t eat anything… Maybe it’s my thyroid…I’m big-boned). At least this is for a noble cause. Besides once I get TB I’m sure the weight will melt away…