Thursday September 29

Thursday September 29

After breakfast at the dorm, we went to the OR. I did a 3 year old with a hydrocele with Moses, and then he went to the outpatient clinic . Ly and I then did the woman with the traumatic injury to her left foot that he had hoped to do last night. She had a chunk of her 4th and 5th metatarsals hanging by a short tissue pedicle, but Ly thought it was possible to reconstruct, so he put two pins in and we will hope for the best. Finding a pin cutter was something of an effort; they suggested a bone cutter, but it wasn't up to the task, and after opening several kits a pin cutter was found. After that, Ly and I did bilateral inguinal hernias in a 60 year old man.

Then we went to the clinic and saw a lot of pathology. Among the standouts: a 20 year old with a large umbilical hernia, a spleen extending to below his umbilicus, and diffuse adenopathy, seen by Moses last week; various tests were ordered and he came back this week for a reevaluation. Abdominal ultrasound showed a huge spleen, and a liven with multiple lesions. His WBC is 60K ! I didn't think a splenectomy would do much good, so we referred him to e medical clinic for further evaluation of his lymphoma or leukemia. Another patient was a 25 year old man with bad burns of his arms and hands; the burns occurred a year ago, and he now has a bad flexion contracture at his wrist which makes his left hand virtually useless. Ly wants to release the contracture and probably do a pedicle graft from his flank; this is the sort of surgery that no one currently practicing in Liberia would do, so I think it's important for him to do it. Fortunately everyone cooperated, and our angel social worker Mary made it all happen, I think. We will know for sure tomorrow, but I believe he was admitted to the hospital today.

After finishing clinic we went to Redemption Hospital with Adamah to see the OR and meet the staff. On the way there, we crossed paths with the President out campaigning; we stopped, and got out of the car to go over and say hello. As usual, she was very gracious in welcoming me back and in greeting Ly, and then she said she had to get back to campaigning ! The bridge was blocked off for her motorcade, but we snuck into it and then when they turned off we went straight ahead across the bridge with no traffic ! The people at Redemption were very excited about having us come to do surgery, so I think we will go there on Saturday to do some hernia repairs. We shall see how it all works out. The major downside to Redemption is that it is across town and over the bridge, so it will probably take an hour to get there most days. Coming home, the bridge was still backed up because of the President, so we had to go the long way around and it took us about 90 min to get back to JFK.

Tonight we went for dinner at The Boulevard, near the Royal. There were 9 of us celebrating Paell's birthday. We had a good time with interesting conversation. Paell was working up at a clinic in Robertsport where she came across an 18 year old with a recurrent hernia. We are trying to get him down here, perhaps to operate on him on Saturday at Redemption, since it would be totally free. At JFK he would most likely have to pay the admission fee of 2500LD (about $35) plus a drugs charge of 2000LD, for a total charge of about $65. If he couldn't pay that money, and we really want to operate on him, then HEARTT will pay the fees.

I am thrilled that everything is working out so well with Ly. I had some concerns before we came about how well it would work for him, but those concerns were obviously groundless. He is a star, and has been providing all sorts of advice to physicians, staff, and families as well as patients. They love the idea of having a plastic surgeon, and an orthopedic surgeon, here to help; he has responded wonderfully and generously, and I would have to say he is a home run ! Speaking of which, I wonder what has happened to my Red Sox? Unfortunately we don't get NESN on Liberian TV !
Oh, I have just received an email from my son indicating that the Red Sox will have to wait till next year...again. Oh well