Monday October 3

Monday October 3

After breakfast we went to JFK to check on Keita, who is doing very well fortunately. Then we went to the OR and did several cases : a 7 yr old with an undescended testis, a couple of hernias, and a chest wall mass in a 65 year old woman. The mass looked and felt like a lipoma, except that it was clearly deeper than usual. In the operation, I split the muscle and immediately encountered the mass, which showed itself to be highly vascular. I ended up scooping out the insides, which seemed necrotic to me, and then trying to figure out how to stop the profuse bleeding. I sutured a lot, and eventually it seemed safe to close. I took the inside material for pathological review back home; I'm guessing metastatic renal cell might be a possibility.

While I was doing those cases, Ly helped Dr. Muvu with a complicated femur fracture, and then did some plastic surgery. One of the JFK doctors brought his son who was about 10 years old and had a large keloid on his cheek which Ly removed. Then he did a guy with a severe wrist contracture from burns.

Emilie asked me to check out a woman in the Trauma ED: she had had a criminal abortion, and then got beat up by someone, incurring a blowout fracture of her left orbit. The reason for calling me was that she has a large abrasion on her right buttock, and a swollen right thigh with crepitus proximally.we spent a while talking about what the right thing to do was; I don't think there is any way to survive necrotizing fasciitis in Monrovia! LiberIa in 2011. Everyone agreed that aggressive debridement was unlikely to change the course of events and the likely outcome for her, so we elected to be conservative and just keep her on broad spectrum antibiotics.

Tonight we went to the Mamba Point Hotel for dinner, and it was very good. I wouldn't have guessed that I would be eating good sushi in Monrovia, but I did ! There were about 14 of us, including Dr Andy Pollock, Chief of Orthopedic Surgery at Maryland Shock Trauma,who is visiting or a few days. After we had eaten Tobias, the Administrator of Redemption, stopped by and we had a good conversation. A new 200 bed Redemption should be finished in a year or less; he pointed out that they are the biggest pediatric inpatient facility in the country , and thus they have a good reason to want to provide some basic pediatric surgery.
P