Tuesday September 4

This is rainy season, and it sure rained last night. I was awoken several times by the pounding of rain on the metal roof. It would pour for a few minutes, and then stop for a while...but by 7 am it had settled into a fairly steady downpour. Heavy rain here is kind of like snow at home; it delayed everything. Anyway, after we arrivid in the OR we did a child hernia, then excised seething that looked like a wart off a child's head, and then Jonathan and I did the 12 year old boy we saw yesterday. He had been operated on twice at Redemption for typhoid perforations over the summer, and then came to JFK with a bowel obstruction. That had resolved, and we thought we were just going to fix his incisional hernia today. However when we explored his abdomen we found that they had done a right colectomy with a sewn end-to-end anastomosis, and it appeared to be twisted. So we decided it needed to be redone, and we did that before fixing the incisional hernia primarily. After that we expected to do a mastectomy on a lady with breast cancer, but she got cold feet and said she didn't want it. A little while later she. Hanged her mind and said yes, but by en anesthesia had decidedmshenwould have to wait till tomorrow. We went to the maternity hospital with Mary to see 2 patients for whom my services had been specifically requested. They both have large uterine fibroids and ovarian cysts, but it was unclear to me why I was needed. It seems that Dr. Jallah, an excellent Ob-Gyn who had trained at Jefferson in Philadelphia, and who was one of our stalwart friends here, decided she had had enough and retired! Then it also seems that these two women were brought to JFK at the urging of Auntie Jenny, and she was the one who requested that I be involved in their surgery. So I spoke with the Liberian Ob-Gyn who is there, and I think we agreed that I would assist him on Thursday. Should be interesting! We then went to clinic and saw the usual diverse array of patients including a 4 year old with a large abdominal cyst which appears to be coming from her pelvis (shades of Harriett)(we will operate on her soon); a 60 year old woman with advanced breast cancer; a 62 year old man with a melanoma on his heel and large inguinal nodes; and then a bunch of strange complaints that we hope will respond to ibuprofen! We went to check on the 12 year old boy after his laparotomy, and found him in pain. The nurses said that they hadn't given him anything because I had not written post-op orders; I showed them where I had indeed written orders, but they explained that I should not write them on the "Physician Order" sheet, but rather post-op orders are supposed to be written on the back of the written op note sheet. While it defies any logic to me, I have learned my lesson and will write them where directed in the future! After coming home for a shower, we went to the house of an aunt of Jonathan's wife. She is stationed here while working for the UN. She prepared us a lovely dinner which was most enjoyable. She lives in an apartment complex off Tubman Boulevard; the complex has a generator to provide power, and the noise brought back memories of the Bungalow! I have to say that the current accommodations are quite nice, and I don't miss the noise of the generator; I do however miss the proximity to the hospital. Being able to walk to and from the hospital when we wanted to was a big advantage to the Bungalow; here we need a driver to take us to and fro, and while they are very gracious and willing, it is still less convenient.