Thursday March 15

Thursday March 15

      Today is another national holiday celebrating the birth of the first President of Liberia, but it isnt as important a holiday as yesterday, so we have more cases scheduled today than we did yesterday. After making rounds, and finding that our patients are all doing well, we went to the OR to find that they were down to one tank of oxygen and had no muscle relaxants. So the anesthetist Mr Hne wanted to do the kids on the schedule, and hopefully we would have gotten the oxygen and muscle relaxants by the time we were ready to do Santiago's case. So we did pediatric hernias under ketamine and spinal, and all 3 of them went well. Then Santiago and Diego did an adult hernia. When they were doing that, Noah called me about a patient in e ER with Ludwigs angina, which is an abscess in the neck which causes upper airway obstruction. The treatment for it is antibiotics, and a tracheostomy. So I went to the ER to see the patient,Benjamin Morris, who was in obvious distress, but I wasn't certain what to do. I have read about Ludwigs, but I had never seen a case until today. Anyway, Rachel Fowler, one of the ER attendings from Brown, was there; we discussed the dangers of waiting for the antibiotics to kick in, and I decided we should just do it. I went back to the OR, told them we needed to do an emergency trach, and within maybe 10 minutes we had the patient upstairs and ready to go. Diego and I did his trach under local with some Versed; it went very well, and within a half hour he was a changed man. As he was wheeled out of the OR, he smiled and shook my hand. I am pretty sure he had looked death in the face, and felt relieved to have survived!
     Then Santiago did the young woman referred from Redemption. He and Diego and John worked on her for about 5 hours; they found several holes in her small bowel, presumably the work of her abortionist. They ended up resecting a couple of feet of small bowel, and then creating a double barrel enterostomy. It was interesting, and noted, that Mr. Hne stayed till the end, which was about 9!pm, though I believe he was off as of 4 pm. Anthony is a caring soul, and quite a good anesthetist, and I'm happy when he is around.
      We were supposed to go out with the OR staff tonight, but because we were working till 9 pm we decided to try for tomorrow night. Dewalt called a couple of times to tell us about the Mayors function that night; she had invited all of us when she saw us at the Presidents house the other night. But we were all pretty well beat last night, so we had Dewalt take us to Sajj for dinner and then home.