Monday September 26

Monday September 26

I slept surprisingly well despite the noise of the generator ! The noise canceling headphones proved difficult to sleep with, but the noise of e generator is a steady one, and I think I just tuned it out after a while.

After breakfast at the dorm, we went to JFK to attend morning report, then walk through the ED to see what was there before going to Grand Rounds. The trauma ED had a large population with several one stretchers on the floor; it was really nothing unexpected, but I think each time I come back I hope for some dramatic improvement. My mind tells me that improvements don't happen overnight, but my heart wishes that they would.

At morning report, and again at Grand Rounds, I was warmly greeted by many friends who welcomed me back; that felt very good. Ly was introduced at Grand Rounds, and afterwards several doctors approached him regarding particular patient problems. We then went with Moses to the Radiology Department, where they now have digital stays rather than film ! It is really quite amazing to see this technology in use at JFK ! We looked at fills of a man with 30 or pieces of buckshot in his abdominal wall who didn't
Want to go ho,e until they were all removed, a d a man who had been shot by someone with an AK-47. In both cases I recommended leaving well enough alone, and we then went to the floors to tell the patients so. Then we went to the OR to greet many old friends including, Priscilla, Barboo, The General, and many others.

Moses and I did a baby hernia, and then we were going to do an ex-lap on a young man with peritonitis....but his family said they wanted to "carry him". This was a new expression to me, and it means that his family decided to carry him to church for prayers to make him well rather than to undergo surgery. So we didn't operate on him, and the likelihood is that he will not survive.

We both saw several consults today: Dr.McDonald brought us to Radiology to see a 10 year old boy who reportedly had fallen off his bicycle last week, hurting his left elbow. We saw the boy, and his xrays, and the amount of callus formation made it pretty clear that the injury was at least several weeks old. The bones were well aligned, and Ly felt that nothing should be done now except to help him get some movement back in the joint through PT. Dr. McDonald then wanted me to see a woman with abnormal vaginal bleeding for a second opinion, but I told her "that's not my area" ! This produced howls of laughter from her and her aides, as one of President Sirleaf's popular phrases during this election is "That's my area!" when talking about economics or finance or women's development or whatever. I then saw a man in the ED with cirrhosis and a liver mass on ultrasound whose family wanted everything possible done for him; unfortunately there really wasn't much to do given his state, probable diagnosis of liver cancer, and no pathologist here to prove it by biopsy. Cathy Nelson, an ER resident from Wisconsin, thought the family would be ok that at least a surgeon had layer hands on him and said no. Then I helped Cathy put a chest tube back into a 10 year old with a recurrent pneumothorax following an empyema.
We went out to the Royal for dinner, then back to the bungalow around 10 PM. Tomorrow Moses has some cases for us, and we will try to plan when we will go to Redemption this week.