Monday September 6

A decent sleep last night after I got used to the hum of the generator outside. I'm not sure if we have a generator at this house to ensure an uninterrupted supply of electricity for the air conditioning, etc., or because the is no electricity supply here. No matter...it did keep the a/c going all night, and that made sleeping much easier.

Mirrors: as I sit here in the living room, I see 2 large mirrors on the walls, and there is one over the dresser in my bedroom. But no mirror in the bathroom! I recall someone mentioning the same thing about the dorm last year...I wonder if the Liberians just don't like to look at themselves undressed!?

Adamah and I went to the hospital this morning, starting with the Chiefs of Service meeting. I was greeted very warmly by many who welcomed me and thanked me for coming back. Dr Moses was at the meeting and it was great to see him again; he said that they have a lot of cases lined up me. The meeting was interesting in that many problems and complaints are universal no matter what system is in place: bed control, or the problem of getting a patient discharged so that a new patient can be admitted, is an issue everywhere.

I left that meeting with Dr Konneh so that we could go to the ED to see some patients needing surgery. One was a man apparently trampled at the Liberia-Zimbabwe soccer game yesterday; he is hypotensive but stable and has blood in his abdomen by ultrasound. Another is a young man with a huge incarcerated inguinal hernia. We also saw a man who had been stabbed in the posterior chest, but he was getting a chest tube and probably will not require surgery.

We then went to the OR to start the day. The man who had been trampled didn't have blood ready yet, so Dr Moses and I did a man with a recurrent inguinal hernia putting in a piece of mesh. Then we did the trampled man, who turned out to have a lacerated right lobe of his liver. He had about 2 liters of blood in his abdomen; this liver laceration was oozing, so we put gel foam on it. We made a drain out of a Foley and left that in. Then we did the man with the incarcerated hernia, which turned out to be a strangulation of perhaps half of his small bowel. We resected that, but I am nervous about him.

It turns out that Moses and Konneh have really p,annex for these two weeks, and have developed a significant list of patients to be brought in for surgery. Many hernias, but also other interesting cases. We are hoping to do 4 cases a day, not including emergencies.

Tonight we had several HEARTT people for dinner: Erin, Nathan, and James are residents, and Daniel is an ER attending from Stanford. Also Ben from Cellcom was here, and another old friend of Adamah's whose name I didn't catch.

I learned in the course of the evening that the Internet service at the Administration Building is out, and that someone stole the modem and the printer from the dorm. So I will not be able to put this up on my blog for a while.