Monday September 2

     After a restful night disturbed only by torrential rains at 3 am, we came to the hospital at 8:30 am to see what was in store for the day. We were greeted very joyfully in the OR, and it was wonderful to see so many familiar faces. The first case scheduled was a 48 year old man with obvious abdominal carcinomatosis who has been losing weight and having difficulty eating. I couldn't understand why anyone would expect us to operate on him since he was obviously inoperable. He did have a Virchow's node, so after consulting with Dr Moses and Dr. Konneh, we decided we would biopsy the node on the unlikely chance that the process going on was lymphoma rather than gastric cancer. If its lymphoma, it is at least potentially treatable. When we went down to the surgical ward to talk to those doctors before we did the case, we were again greeted with outstretched arms and lots of smiles by the doctors and nurses. I am astonished by the warmth of feeling and outright joy expressed by everyone from the Administrator to the elevator operator when I come back here; it is rather intoxicating, and very gratifying.
     The second case was a neonate 2 weeks old with an imperforate anus scheduled for examination and dilation if there was an opening to dilate. We spoke with the pediatric resident Dr Shankar, who noted that the baby had a congenital diaphragmatic hernia(CDH) also; it is quite common for babies with one anomaly to have others. He had a blind end sinus about 1.5 cm in length. As he is he is unable to eat, so after some discussion we decided that we will do a colostomy on him tomorrow. Then he can eat, and gain weight, and be nutritionally prepared to have the CDH repaired. Because of the CDH, and hypoplasia of his left lung as a result, he is at significantly higher risk for anesthesia, but it appears that we have no choice. That is a common dilemma we find ourselves in over here: choosing between two suboptimal alternatives .
      The third case was an inguinal hernia done by John and Diego. The fourth was an ileostomy decommissioning by Jonathan and Diego, and at the same time John and I did an emergency laparotomy on a 40 year old man. He had presented with a typhoid perforation 10 days ago, and had a small bowel resection and primary anastomosis. A couple of days ago he started leaking intestinal content from one of his drain sites, and today he was looking toxic, so John and I operated on him this afternoon. He had several more perforations, so we did another resection and brought out ostomies. The fifth case was a 15 year old with perforated appendicitis who came into the ED this morning after 2 days of abdominal pain. It seems like most patients with abdominal pain like to stay home for a least a week or two, so it was good that he came early. Jonathan and Diego did his surgery with Joanna, a 3rd year surgical resident at MGH who spending a month at JFK as part of her Paul Farmer Global Surgery research fellowship.
    As we were walking out of the hospital to come back to the bungalow for dinner, we saw Dr. McDonald and had a pleasant chat. Apparently I would be making a house call after dinner to look at a painful swelling on the hand of a VIP. Definitely not my field of expertise, but when asked for an opinion, it would be rude to refuse. It turned out to be a ganglion cyst, and I will aspirate it tomorrow evening after work.
     When we returned to the bungalow this evening, not only was the a/c repaired and working in my room, but we have running water also. On top of that, for the first time, we have hot water at he house ! Yes, I know, it isn't that bad taking a shower with ambient temperature water, but its nice to have it hot.