Friday March 16

Friday March 16

Today is our last full day of operating on this tripa,nthough we will do some more cases tomorrow to finish up.
We started with Harriet, the 3 year old ( previously I said 4, but apparently she is 3) with the swollen abdomen that made her look like she has ascites. We were supposed to do her surgery earlier in the week, but she developed acute malaria last weekend,nso we had to postpone while she was treated for that. Today we did her surgery....and it turned out to be a huge cyst attached to the greater curve of her stomach, and which occupied her entire abdomen. We made a relatively small incision, and delivered it out of the abdominal cavity pretty easily. We then detached it from her stomach; there was no connection to the gastric lumen,nso I don't think it was a duplication cyst. It weighed nearly 9 pounds !! We closed her now shrunken abdomen with a subcuticular stitch and Dermabond.bwhen we fished, Santiago and I went downstairs to the Pedi ward to see her mother. She was in the waiting area and looked at me anxiously; I raised my thumbs, and she fell to the floor, crawling on her hands and knees to embrace my legs.mi don't believe I have ever had such a response to good news from a patients family before ! Later in the day we stopped by to check on her, and the grandmother was there, praising God, praising us, and just totally relieved by the outcome. She even had me talk to her husband on her cellphone so he could thank all of us. It turns out that they are from far away, and had been to 2 other district hospitals and a witch doctor trying to find a solution to Harriet's swollen belly; for them, coming to Monrovia was a last gasp. Harriet made the day for all of us !
John did a hernia with Konneh, and he was so excited at the end, because he actually did it ! His excitement is infectious, and that has been a wonderful addition to this trip. Then Santiago and Diego operated on Ophelia, a 48 year old woman with rectal cancer, very close to the anal verge. He was able to excise it, but with no adjuvant radiation or chemotherapy available, her prognosis is not very good. While he was finishing that case, they decided to start one of the two thyroids on the schedule. Santiago was planning to help, but since he was busy, I did it with John. The patient had had a previous left thyroidectomy for goiter, so that made the re-do somewhat more of a challenge. In addition, her right lobe was significantly substernal. Fortunately we were able to do what needed to be done, and hopefully we left enough thyroid behind to take care of her needs.
We decided it was too late to start the second thyroid, so we will do her tomorrow. We went to the Maternity Hospital to see Victoria, whom Santiago had operated on earlier in the week for her rectal stricture and rectovaginal fistula. She looks great and is ready to be discharged. He told her to contact me when I am back in September and hopefully we can decommission her ileostomy.
        After showering, Dewalt picked us up and took us to The Lagoon to meet up with Percilla and some others from the OR. Aftervdinnervand a couple if beers,new went in search of dancing. After a few false starts we ended at Sajj, and stayed till 1 am or so before coming home to bed.