Thursday March 6

Thursday March 6

Everyone is doing well after yesterday's marathon, so that was welcome news this morning. One of my constant worries is that we will arrive at the hospital in the morning to learn of some disaster overnight with one of our patients. But today the disaster happened during the day: I mentioned previously a 4 year old girl with a recurrent chest wall tumor that I thought might be a sarcoma. We talked with Venee Tubman, a hematologist-oncologist at Children's Hospital in Boston, whom we have met here previously several times; she thought it might be some sort of lymphangiomatous process, and I thought she might be right. Venee is going back to Boston on Saturday, and we decided to get a biopsy of the mass, so that we might know what it is before we leave, and perhaps we could do something like debulk it. So we brought her to the OR, and Philomina gave her some Ketamine so we could examine her. The mass was huge covering her entire left chest and extending over her shoulder to her back. It was predominantly jelly-like, and I was able to remove a large piece for biopsy just using my fingers to squeeze it off. It was one of the most bizarre things I have ever seen.
      Unfortunately a hour or two later, Yuk was called to the Pedi floor because the girl was unresponsive. She didn't bleed, she tolerated the Ketamine with apparent ease, and everything seemed to go smoothly as far as we were concerned. But she faded away, and died soon after Yuk got there. I have no explanation for it, but I can't help thinking it was probably a blessing for her.
       After that Santiago spent several hours doing an abdomino-perineal resection on a patient with rectal cancer whom we have seen here several times in the past. In fact, we saw her at the end of our trip in September, and she decided she wanted to wait till Santiago came back in March for the surgery she knew she needed to have. She is a Jehovah's Witness, and thus refused to allow any blood transfusions; the operation can be bloody under the best of circumstances, so doing an APR on a Jehovah's Witness in Liberia is a huge challenge. Those of you who know Santiago know he was up to the challenge, and it seemed to all work out very well.
      While he was doing that, Yuk and I excised a breast mass from the mother of one of the nursing supervisors. I think it is benign, but we won't know until the pathologists at Waterbury Hospital check it when we get back. A couple of interesting points: the daughter was in the OR taking photos with her cell phone ( I was too astonished to comment on the appropriateness of it), and after a short stay in recovery, the patient went home! I believe that is the first surgery at JFK where a patient received more than local anesthesia and then did not stay overnight. Yes, One Day Surgery is coming to JFK!
       We then did a couple of minor cases, and finished up with a mastectomy on a 37 year old woman. She first noticed changes in her nipple more than a year ago, but delayed seeking treatment. She had obviously involved lymph nodes which we removed with the breast, so I think the long term prognosis for her is not good unless she can get access to chemotherapy. Unfortunately it is not readily available, and what is available is costly, so not many people receive it.
        We are so lucky to have John Wasik with us on this trip. He is a biomedical engineer who is able to figure out al sorts of problems and fix them. He has been fixing all sorts of machines at JFK, and it is great to be able to call on him when we have a problem, just as we do in the OR at Waterbury !! He has also been finding all kinds of equipment stored away; today he found a suction machine and got it working ! Many others in the hospital want him to come work on their problems, but for the time being we are keeping him in the OR. Today I was asked if John was teaching the Liberians how to fix things like he does; my answer was that what he possesses cannot be taught. He has the knack, the smarts, the skills to see solutions that others can't see.
        After making some rounds we went to the dorm for dinner, and then back to the apartments for an early night.