Friday March 7

Friday March 7

I like the way we are adapting and organizing. We try to leave from the apartments at 7:45, and Albert has been very good about being here waiting for us to go in the van. We have breakfast in the dorm; Yuk and Rakesh have already rounded, so they are able to give us updates on all the patients. The sad news this morning was that the young girl with the burns died overnight; it is not clear what the cause was, but I have to say that I was not surprised given her overall condition. All of our other patients are doing well. Then we walked over to the hospital to start our work day, announcing with some fanfare to the OR staff that we have arrived and are ready to begin working. The initiation of activity sometimes requires more prodding than should be necessary, but I have to remember that this is Liberia!! Philomina Thuruthumaly, our anesthesiologist, has been fantastic about getting things going, and also figuring out ways to maximize our ability to use the resources we have available. We currently have only one anesthesia machine available; John Wasik is working on getting a second one up and running but it hasn't happened yet. So we are limited to one room for general anesthesia, but we can use spinal and/ or local with sedation on other patients in the other room; Philomina has been fantastic about suggesting ways to do that.
      Our first case today was a one year old boy with a large right inguinal hernia; his father works at JFK. Yuk and I took care of it; as usual there were moments of intense anxiety with going into and coming out of anesthesia, but it went well. It was kind of weird having the father in the room while we operated; I will talk to Percillar about whether that is a custom here. While we did that case, Santiago and Rakesh did an adult hernia in the other room
      Next was a 19 year old male with an abdominal mass. Apparently he had appendicitis, and was operated on at another hospital where the surgeon found an unidentifiable mass and closed him up after doing the appendectomy. He then referred him to JFK for further evaluation. He turned out to have a large retro peritoneal mass involving the base of the small bowel mesentery. There was no adenopathy and no evidence of spread. It was clearly not resectable, so we took a biopsy of it and closed. With luck it might be a desmoid tumor.        
       Our 4th case was an adult hydrocele which Yuk and I took care of.
       Later in the afternoon we went to their first "Mortality" conference, which is different from what I had expected. It seems like this is an attempt to introduce more accountability in the departments at JFK; I'm not sure the system they have developed is optimal, but it is a start.
        After changing we went for dinner at Sajj at the invitation of Tony, the owner, whom I had met at Aunt Jenny's the other night. In fact, I had met him several years ago when I and others were invited to lunch at his house next to Sajj after we had repaired his brother's hernia. Anyway, he came and joined us with a hookah as we ate, and then assured us that our meals were on the house. It was very kind of him, and we had a delightful meal.