Saturday March 18

Saturday March 18

     All of our patients are looking well this morning, especially Peter, Cynthia, and Harriet. One of the peditricians told me yesterday that Harriet was not allowed to register for nursery school because her belly was so big, and they thought she was possessed by the devil. I'm very glad that we were able to help her.
     For surgery today, we had 5 cases scheduled. One of them is a 48 year old man with a goiter, but his thyroid is particularly hard and irregular, and he has a lot of adenopathy in his posterior neck.nafter thinking about it last night and this morning, I have decided not to operate on him. I am quite certain that he has thyroid cancer, and he really needs a total thyroidectomy sand functional right neck dissection; I don't think that is an appropriate operation for me to do here, and so I have suggested that perhaps he should go to Ghana. They do not have thyroid replacement (thyroxine) in Liberia, so no one gets a total thyroidectomy, but in his case I think it would be inappropriate.
       So the cases we did do today included a 2 year old with a hydrocele, and a 47 year old woman who had a mastectomy by Dr. Golekae; during that surgery they found that the tumor extended into her abdominal wall. Having no pathologist here, they had no idea what it was. But she was left with a 5-7 cm mass in her right lower abdomen which she wanted it gone before she would go home. We agreed to remove it, and thus get tissue for biopsy. Moses and I did the debunking surgery, and it is a strange looking tumor; I'm wondering if it perhaps is fibromatosis, which I have never seen before. I have specimens of it for our pathologists. 
     Santiago and John removed an enlarged submandibular gland from Percillas mother, and as I write he is removing a simple goiter from an obese woman with Diego and John. They have been at it for about 3 hours, and are close to finishing; I'm suspecting Santiago wishes he had never told me that he wanted to do the case !
      I saw Dr. Johnson, the Chief Medical Officer, on the ward this morning. He once again expressed his gratitude for our coming to JFK, and his hopes that these visits will continue. I have no doubt that they will, and in fact I have already lined up several cases to do when I return in September. 
      I think our total number of cases during this visit will be about 45, and that represents a significant amount of work. Looking at the OR log book, they usually do about 30-35 general surgery cases a month; to do 45 cases in 2 weeks required a lot of extra effort by the OR staff, anesthesia, and others, and we are very thankful that they were willing to do so. It made a huge difference for us, and for our patients.
       They finished the thyroid around 4 pm, and then we came back to the Bungalow. We had an Italian dinner with pasta and meatballs, and then went out for a few drinks at a new nightspot which was quite pleasant. Home for bed around 1 am.