Sunday October 2

Sunday October 2

I slept till 9, and then Ly and I went to the dorm to make plans for a relaxing Sunday. We were going to go to the RLJ resort around noon...but then Michelle called and said the baby Ketia was worse. So I went back to the house and changed into scrubs, and then went to JFK , where I found that she was indeed correct. She was somnolent, and her abdomen was tender, and her repeat abdominal film was much worse. So we decided that she needed to go to the OR today.

We started the planning, trying to make sure we had all bases covered. I went to the OR and turned in the written Anesthesia consult, only to discover that there was a case going on. Michelle kindly offered to stay in the OR during the case to help the anesthetists, which I thought was a brilliant idea. I took her to the OR Pharmacy so she could see which drugs were available. She and I talked to the parents, explaining as best we could what was wrong and how we might fix it, and the substantial risks involved in operating. My feeling was that if we operated today, e baby had a 50-50 chance; if we waited till tomorrow,ere was probably only a 10% chance of survival.

Finally the other patient was moved out of the OR ( there is no Recovery Room nurse on e weekend, so patients recover in the OR), and the anesthetist went to see our patient. He said that we could not proceed because there was no bed for the baby; I knew I forgot something in all of our preparations ! Michelle called Adamah and Dr. Macdonald, and soon a bed was available in the Pediatric Surgery ward on the second floor.

The operation went very well. The Liberian anesthetists and Michelle worked well together, with Michelle managing the intubation and care. From my side of things, their care was a model of cooperation and teaching each other some tricks. We could find no evidence to support any abuse allegation. In the abdomen we found an intussusception which extended to her left colon. When I attempted to gently reduce it manually, the bowel wall split, indicating just how close she was to perforation. We ended up resecting a significant amount of her colon, and did a primary anastomosis. She was awake and extubated about 20 minutes after we finished closing; she was kept in the OR recovering for an hour and a half, and then we brought her down to the ward. I was thrilled to see that Gwendolyn was working overnight; she is an excellent, caring, smart nurse so I think Ketia is in good hands.

After a quick shower and change of clothes, Dewalt came and got us to go to the house of Adamah's brother Jess. Many people were there, and it was fun chatting with them. We came home around 10 PM to get ready for a busy day tomorrow.

Obviously there are many things that could go wrong with Ketia, but I am optimistic. The experience we had today is why I am here, because I think we really made a difference. It speaks to the importance of a team; having Michelle willing and able to assume responsibility for the anesthesia care, while at the same time working comfortably with the Liberian anesthetists, was a major factor in having it all work out as well as it did. Having Ly to assist me was a godsend also. We are all keeping our fingers crossed !

I also think this is a good example of why pediatric surgery should be done in a hospital where the appropriate personnel and equipment are available. Adamah has asked me to write something up about this which he will present to the Ministry of Health, and I am happy to do that.