March 6

March 6
    As usual, another interesting day at JFK, filled with frustration as well as satisfaction. We had planned a busy day with 8 cases to be done in 2 separate OR rooms. After rounds we went to the OR to discover that there was only one anesthetist available, since Anthony's son was sick. Anthony is the excellent anesthetist who helped us take care of Keita last September. So we were down to one room, and then we learned that Moses and Konneh were going somewhere to a lecture at noon, and Ainhoa was going to Redemption, so there would be no one to staff the clinic in the afternoon. So it was important for us to get through as many cases as possible in the morning...but the reality was that such an idea was pure fantasy.
   The first case was an 11 month old with hernias. They had a hard time with the intubation, and eventually decided that the child needed to be cancelled and rescheduled for Thursday. The next patient was a 4 year old girl with an inguinal hernia, and they had trouble intubating her also. Eventually they did, and we did her surgery fairly quickly, so that at 11:15 am we could say that we had finished one case finished. John and I were in the OR while Santiago and Diego were in the clinic with Moses and Konneh first, and then with Dr. Golokae. We had a 10 year old with a hernia to do, but anesthesia refused because there had not been a formal anesthesia consult requested the day before. Very frustrating for the patients mother as well as us. the next case was interesting: a 40 year old man with a hepatic abscess. He had been in the hospital on antibiotics for a month, but the abscess had not gone away. We explored him through a subcostal incision, and found that his liver felt fairly normal. So I had no idea where the abscess was, but I did know that by ultrasound it was 20 cm in diameter, so I ought to be able to find it. I stuck a needle in lateral to the gallbladder, and with penetration was able to aspirated pus, but it took nearly the full length of the needle. I then used the Bovie make a hole on the surface, followed by a long Kelly clamp into the substance of the liver...with great trepidation. But we hit the abscess, and drained probably a liter of pus out. ( My apologies to the non-medical readers, but the details are important !) I was quite pleased that we found the abscess, and drained it without causing major injury or bleeding; I think he will get better faster.
   On morning rounds we saw the man mentioned yesterday who had a bowel obstruction. His abdomen seemed worse, so we put him on the OR schedule for an emergency laparotomy, hoping that we would fit him into the schedule in the morning. Around noon the anesthetist told us that she wouldn't do him unless she had 3 units of blood for him; he only had 2 ordered, so the case was delayed while attempts were made to reach his family and get them to donate or pay for another unit. Later in the afternoon another anesthetist saw him who said he didn't care about another unit of blood, but we couldn't take him to the OR until his family made a downpayment on hospital expenses, especially drugs. We examined him again at that point, and his abdomen was less tender, so we decided we could observe him overnight.
    We went back to the Bungalow to eat, and soon after our meal Adamah called to say that they came back from Redemption with the accident victim as well as a young man with an incarcerated hernia who was getting worse. So we all came over to see him; Santiago and Diego ended up operating on him to do a small bowel resection and hernia repair. We got back home around 11. I had a good conversation with Santiago about being here, and then off to bed.
O