Tuesday March 12

An interesting day today, from many perspectives. On each trip I seem to have a day when my frustrations reach their peak; today was it for this trip. We made our usual rounds, and found that all of our patients were doing well, but the rounds were somewhat hectic and disorganized. We then went to the OR to discover that Presillar didn't know we had planned to do any cases today, because neither she nor Anthony had received a list. We gave them the list, and then it turned out that the Chinese ophthalmologist needed to use our room for general anesthesia for a child. We convinced them to let us start in the Ortho room, so Nathan and I did a cholecystectomy in there. Of interest, that was the first cholecystectomy I have done in Liberia. It was frustrating was that we didnt start till 10:30 or 11:00, and nothing moved easily throughout the day. Next case was a splenectomy for me and John, and a colostomy decommissioning for Santiago and Nathan. The spleen was HUGE, weighing 4.2 kg, ans extending from LUQ to pelvis and across the midline. It was really quite fun to do, mixed with the normal level of anxiety about bleeding, and boosted by John's quite understandable enthusiasm ! The frustration was that circulating nurse was out of the room more than in it, and that created numerous delays. For reasons that were unclear, we then had to wait about 2 hours to do the final case, which was another colostomy decommissioning in a young boy. Santiago and John did that fairly quickly, and then we all went to Sajj for dinner and to watch a football match on the TV there. Interspersed with cases during the day were several patients brought to the OR area from the OPD Clinic by the intern for me to evaluate, such as a woman with a large fungating skin cancer on her left flank, and another woman with a large breast cancer which is potentially treatable. They clearly both need surgery, but I have no idea how we will fit them in as we move into our final days. I spoke to Mary, our angel who somehow manages to solve all of our problems, and I know she will take care of things. I find it frustrating that there are so many in need of services, and yet sometimes it is so difficult to arrange to provide those services. That frustrates me, and then the delays in the OR, the lack of efficiency, and a host of other factors push me above my tolerance. As I mentioned, this happens just about every trip, and by tomorrow I will have settled into the final stage of the process, which is accepting that we can't change everything, and we can only do what we can do.