Tuesday, September 11, 2012

A painful date to write, filled with memories of a horrifying event that continues to affect the world, in good and bad ways. The memory of those who perished reminds us of the fleeting nature of our existence, and the need to make every day count. The traffic was really bad again this morning, and Jonathan figured out that it was because the children started back to school this week. Jonathan did a baby hernia with Moses this morning, and en I did the biopsy of the neck mass on Adam. If he is lucky it will be a Burkitts lymphoma, but I fear something worse. Then while Jonathan did another hernia, I went to see a woman with an acute abdomen admitted yesterday. Dr. Kiiza was with the medical students nearby, so we had a teaching session which I enjoyed. I think he is a great benefit to JFK, and I love seeing the interest of the medical students; their presence makes the work here more interesting and worthwhile for me. We scheduled the woman for surgery. I then went to the outpatient clinic to see a patient whom Diego and I had done a lumpectomy in March for presumed cancer. She had never come for follow-up until today, when she came because she had noticed a lump in her axilla; otherwise she feels well. Her breast feels normal, i.e. no recurrence at the surgical site. I couldn't remember the details of her pathology, so I called Jeff Pinco in Waterbury and he was able to refresh my memory. He couldn't find her ER/PR result, so he is going to run it again as he still has the tissue block. Back in the OR, a woman came up and introduced herself to me as Sandra Roberts; it took me a little while before I realized that she is the nurse with whom I have been exchanging emails for several months about her mother, who had a mastectomy by Dr. Golokai in the spring. Percillar sent me the tissue, and Dr.Pinco determined that it was indeed invasive breast cancer which is ER/PR positive. Dr. Golokai has been giving her chemotherapy consisting for Cyclophosphamide, Cisplatinum, and Tamoxifen. She was there with her daughter, and she looks very well; in Liberian fashion, displaying little modesty, she took off her top in the recovery room so that I could see there is no evidence of local or regional recurrence at this point ! I thought it was sweet of Sandra to seek me out and introduce me to her mother; I have no doubt that our correspondence will continue. Later I went back to the clinic to ask Konneh about someone, and he showed me a 3 year old boy named Joshua who has a huge ulcerated mass on his back. He has been operated on twice at outside hospitals, but it keeps recurring. His mother says it started as a little lump when he was a few months old. It extends nearly the full length of his back, and is almost as wide. It is ulcerated at the top. It doesn't seem to be causing him any pain; in fact, I had him laughing out loud when I was playing peek-a-boo with him. Unfortunately for us, he had already seen Dr.Golokai just before I got there, and plans were underway for him to do surgery next week. Very diplomatically Konneh suggested that if we could do the surgery before we leave, then we could take tissue back and find out what this is. However, Dr. Golokai was not the least bit receptive to that notion, and Konneh quite appropriately didn't want to press the point. I'm still hoping, but it seems unlikely. Jonathan and then did the woman with the acute abdomen, who turned out to have a perforated gastric ulcer. Happily for us, that was our working hypothesis, and we made an upper midline incision; afterwards Moses expressed his surprise that we felt confident enough abut the diagnosis to make a smallish incision in the right place ! After that We went over to the Maternity Hospital to see a patient whom we will do tomorrow. Jonathan saw her at Phebe Hospital last February; she has had a couple of surgeries for a colovaginal or rectovaginal fistula, and we are told that she is now ready to get rid of her colostomy and have GI continuity reestabliahed. So she and Victoria are on the schedule for tomorrow to have ostomies decommissioned; we will do them after we have breakfast with Madam President at her house. For our trip in March, I am going to do my best to keep us away from routine hernias because they really seem to clog the schedule, and they can be done easily when we aren't here. We will do pediatric hernias, and huge African hernias, but I think we need to maximize our benefit by taking on challenging and teaching point cases rather than too many routine ones. I'm not complaining about the case load this time, because it has been varied and good, but it could be better.