Friday September 7, 2012

It rained all night, and sometimes very hard; I was surprised that we weren't swept away in a deluge ! Alfred picked us up around 8:15 and we went to the hospital, where we met with Dr. Kiiza, Moses, and Konneh to discuss the pans for the day. The woman with bilateral infra scapular masses, who I saw in the clinic on Tuesday, and who was admitted on Wednesday, was still not on the OR schedule for today because no one seemed to remember she was here. I made a it of a stink over it because she is taking up a bed that could be occupied by someone in greater need, and because it is just stupid that the people in charge don't have any idea who is occupying their beds. The second reason for frustration this morning was that we had suggested yesterday that the man with the ileostomy who looks cadaveric should have his electrolytes checked before surgery. Those tests were ordered yesterday; today we learned that they weren't done because the laboratory does not have the necessary reagents to perform the tests. Jonathan and I spent some time discussing the situation; i guess we could insist that we won't do the surgery till we see the results of the tests, but i think there is a good chance that he will die before the tests get done. So in the end we decided to proceed. First we did a 5 year old with a hernia; the OR booking said right, but his chart said left and my exam said left, so we did the left side ( which turned out to be the correct side)! Then we did ileostomy man: it wasn't easy,but it wasn't as difficult as it could have been. We resected a few feet of small bowel and did an ileocolic anastomosis using the EEA, he remained stable throughout the case. We are keeping our fingers crossed that he will recover. Next we did a 12 year old boy with appendicitis. He had been in the ED on antibiotics since Wednesday; fortunately he had not perforated, and it was relatively straight forward. I think we did him through the smallest McBurney incision ever seen at JFK ! We ended the day with surgery on a 32 year old woman who had also been in the ED for a couple of days awaiting a bed. She had developed abdominal pain and vomiting a couple of days earlier, and was thought to have an obstruction due to adhesions from a previous C section. When I saw her just before we brought her into the room she looked very toxic; I don't know how long she had looked that way. When we opened her up, we found gross foul smelling contamination with a greenish grey fluid containing vegetable matter and seeds. There was a huge collection inferior to the transverse mesocolon, and eventually we were able to identify a complete transaction/perforation of her ileum. The etiology remains unclea, but based on the appearance, I would guess that e perforation occurred several days ago. In any case we cleaned her out, resected that segment, and restored GI continuity with an EEA stapled end to side anastomosis. Another case where our fingers are crossed that she will be lucky, but as Konneh pointed out during the surgery, this scenario is generally not survivable at JFK. We then came back to the apartments for dinner and an early bed. We were both exhausted after a long day. We plan to do 2 cases tomorrow morning, and then hopefully Dewalt, Jonathan, and I will go to the Nigeria-Liberia football match tomorrow afternoon ! That should be interesting !