Wednesday

Wednesday September 28

Even at my age, I am astonished that days which start out dull and boring can change very quickly. We started out by discovering this morning that we had little to do: the General Surgery room was being used by Dr. Golikae, Chief of Surgery and Dean of the Medical School. He had 5 cases scheduled, including a rectal prolapse, a thyroid, a urethral stricture, release of a burn contracture, and a skin graft to a burn. Apparently, he doesn't operate too many days, and it was important that he get his schedule taken care of. He came back to Liberia last year to become Dean; I remember meeting him in March. In any case, his style in the OR reminds me very much of Sid Luria, including the aversion to light handles and his general demeanor; many of you will know exactly what I mean ! Having said that, I was impressed with the speed of his partial thyroidectomy for a massive goiter in the left lobe. There was significant blood loss as one would expect from an unsuppressed thyroid, but he got the job done.

Ly assisted Dr. Muvu in removing a forearm plate, and then we seemed to be done, which was a rather unfulfilling day. Soon, however, we were busy seeing some interesting cases in the ED. One was a woman with an open fracture of her foot whom Ly wanted to take to the OR right away. We successfully negotiated to complexities of an anesthetist consult, getting a bed, getting her hemoglobin checked, etc, only to learn that after hours there is only one team of nurses on duty for the main hospital and the Maternity hospital. They had just gone to !Maternity for an ectopic pregnancy, and no one knew when they would be back, so we decided to defer her surgery till tomorrow. We also found a large hernia to do tomorrow, and an open ankle dislocation for Ly, so I think we will have a busy day tomorrow.

The availability of surgical beds is a limiting factor for admissions and surgery. Moses has been saying all week that there are no surgical beds, but miraculously yesterday I spoke to Dr Macdonald and Mary, and we have 8 beds empty and ready for us. They have also put up signs around the hospital advertising our presence, so I think the rest of this trip we will be quite busy.

Last night we had dinner at the Royal again.