Friday March 14

Friday March 14

         We began our day with breakfast at the President's house. There was a large group of people at the breakfast which was held in the palava hut and around the pool. Besides us, there was a large group of church people from Anchorage Alaska including Aunt Jenny's son Dr. Estrada Bernard. He is a neurosurgeon in Anchorage, but on this trip they were all working at Todee Mission School doing building projects. There were also a number of other friends joining the group. As usual, the President was extremely gracious, referring to me as "family"; at the end she asked when I would be back, and I told her that I would "see you in September". She laughed and said " I like the sound of that !"
         We left there and went to the hospital to work, except for Santiago. He went with Muna to get a passport photo so he can have a JFK ID like I have, and then he went downtown to be interviewed on the radio by Adelaide, an old friend of the President who was at the breakfast and who has a regular radio show. Unfortunately we didn't get to hear it, but when he came back he said it was a blast ! In the meantime we did a baby hernia, which went well with no problems, and in the other room Rakesh did an adult hernia with Moses.
          The next patient was a 16 year old boy with a month history of fever, weight loss, and loss of appetite, and a tender mass in his left abdomen. He had an ultrasound, and then went to Tepita for a CT scan which showed massive splenomegaly with a large area of possible necrosis in his spleen, and questionable "nodules" in his abdomen. He was seen by Dr. Venee Tubman, a native Liberian who is a hematologist/oncologist at Children's Hospital in Boston who was here until last week; she is a friend of the family as is Dr. Yvonne Butler, an OB-Gyn from Baylor who has been here for 2 years on a grant from Chevron. The diagnosis was uncertain, and I eventually decided that open surgery with splenectomy and biopsy of the nodules would be the quickest way to find out what was going on. When we opened his abdomen, what we found was shocking and frightening. His massive spleen was covered with omentum contained large nodules of tumor deposits; then spleen was also adherent to his stomach, making removal impossible. I asked Santiago to scrub in to feel it and confirm my feeling that this was unresectable, and he agreed. So we biopsied the nodes and called it a day. For me, like for many surgeons, unresectability is akin to being defeated; we don't take it easily. But in this case I was worried that if we even started dissecting, we would get into bleeding that would force us into a very bad situation, and the very real chance that he would not survive. Venee thinks this might well be Burkitt's lymphoma, which is treatable with chemotherapy, so I think we made the right decision. We will get the results of the biopsies next week when we are back in Waterbury.
       Before we started the surgery on that boy, I was asked to see the son of one of the employees here. This 27 year old male had 3 days of left testicle pain, and on examination is was very hard and tender. I was pretty certain he had a torsion, but after 3 days it was most likely infarcted and would need to be removed. Mary was able to expedite his admission and paperwork, so that we brought him to the OR next where my suspicions were confirmed. We removed his left testicle, repaired his hernia on the right, and fixed his right testicle to avoid to possibility of him developing a torsion on that side.
      The last case was a 7 year old boy with constipation and "anal stenosis" whom Santiago had seen. They did a barium enema and he has a huge rectum, so he thinks he has Hirshsprung's disease. He did a rectal biopsy, and we shall see what that shows.
      In the evening we went to a ceremony celebrating the first 6 months of school for nurses and physician assistants. It was a long ceremony with many, many speakers; we had been recognized as special guests, and at one point they asked if I would like to say a few words. Unfortunately, or perhaps fortunately, I developed a coughing fit, so I pointed to Santiago sitting next to me to make the comments which he did very well. Once he was finished speaking, my coughing miraculously ceased... He let me know that I will pay for that !
       As usual, it is a sprint to the finish as we end our 2 weeks here. We weren't able to get to Buchanan to see Dr. Kerkula, which was unfortunate, but I told him we would try again in September. We have a couple of cases to do tomorrow morning, and that should be it.