My cold seems to be better ( perhaps because of the Indian food last night), and so I slept well. We had a lot of cases on our schedule today; as usual we didn't do all of them for a variety of reasons, but we still had a good day. We started out with a 1 year old boy who had a moderately large hernia. All seemed to be going well until midway through the operation when he coughed and bucked a little, and his airway was lost. There was a scramble at the head of the table as Philomina, Mr.Hne, and others tried to get it back; in the meantime the tone of the pulse oximeter was low and worrisome. To explain: the pulse oximeter measures the oxygen saturation in the blood using a fingertip probe with a light. Normal oxygen saturation is in the 95-98% range and with such a reading the oximeter we have emits a high pitched beep; when the saturation starts to fall, the tone becomes lower pitched. One of the things about working on small children is that their saturation can fall much more quickly than an adult's would. Fortunately, we have some excellent pulse oximeters obtained from Lifebox (www.lifebox.org) which are produced at a low cost to make them available in minimal/low resource settings. I had heard about Lifebox in a talk by Dr, Atul Gawande at the American College of Surgeons meeting, and with help ( thank you Darryle and Jon) I was able to obtain several for use at JFK.
Returning to today, they were able to mask and then eventually intubate the baby, and we finished the operation as quickly as we could. It then took several hours for the baby to wake up, and for us to feel that he could safely breathe on his own. Throughout those several hours, we sat and watched him in the OR, and listened to the tone of the pulse oximeter as it went up and down. Eventually he did wake up, and he is fine, but it was a difficult experience for all of us particularly at the beginning when they were struggling to oxygenate him. Philomina did a fantastic job staying cool and figuring out solutions, and we were all very grateful she was there.
While we were in one room dealing with that, Santiago and Rakesh did a couple of hernias, and a breast mass excision. Santiago was momentarily indisposed during the breast mass excision, so Yuk went in to help. By that time we were ready to start the next case in the other room, so Santiago came in to help me with a splenectomy. The patient is in her mid 40s, and had a huge, uncomfortable spleen which was probably enlarged by repeated bouts of malaria. Sometimes when a spleen gets big, it starts eating up platelets, and that is a reason for removal; her platelet count was 40 thousand, with normal being 150-300 thousand. When the platelet count goes under 50 thousand, there is an increased risk of bleeding; ideally we would have liked to give her platelets during surgery, but that capacity does no exist here. I reassured Philomina that we could do it with minimal blood loss, and we did. As always, it's fun and good to operate with Santiago.
The last case of the day was a young girl with Crohn's disease whom Jonathan Laryea met at Phebe Hospital on a previous visit to Liberia, and then he and Santiago have been seeing her each trip and bringing her medicine. Her Crohn's has progressed, and so she was admitted yesterday so that Santiago could examine her under anesthesia today. based on the exam, they will play around with some different medicines and hope for the best.
We have only 2 days left for operations on this trip, and as usual it is very hectic coming to the end. Time to go to sleep and rest for another busy day tomorrow.
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