We had quite a good and productive day today, despite starting later then usual. Percillar and others were delayed because they had to get their cars registered as a new law is taking effect requiring that; until now, registration has not been required apparently ! We started with a young man we were asked to see in the ED yesterday who presented with a history of a month of vomiting. It was described as projectile, but bilious, and that didn't make much sense since typically projectile vomiting is not bilious. They had done a barium swallow and follow-through which showed barium in his colon while some was still in his stomach, indicating that there was no obstruction. But the doctors were convinced he had something serious going on that required surgical correction, so I agreed to operate on him to find out what was going on. It came as no great surprise to me that today we found nothing wrong. Perhaps he has gastritis or perhaps it is psychological; in any case I wish I had listened more to that little voice inside telling me that the story didn't add up. The problem is that I have been fooled a few times in Liberia by that little voice, so sometimes I don't listen to it. In this case the patient had an "unnecessary" operation, but it did prove to everyone that there was no serious internal pathology so I guess maybe it was worth it.
Rakesh and I then did a little girl with a large umbilical hernia. Apparently her mother had tried to make it go away by tying it off with a string around the base; all that did was to cause an ulcer on the overlying skin. The was bowel in the hernia, so I guess the little girl was lucky that the damage from home treatment wasn't worse.
We then went over to the Maternity Hospital to operate on 2 women at the request of Dr Butler; both of them had burst incisions following C-sections. One of then had burst about a week ago and had small bowel exposed; we were able to close the fascia and hopefully they will do well, though I think they are both at high risk for developing a hernia.
While we were doing that, Santiago and Yuk were doing a 60 year old man who had presented with an acute bowel obstruction. He turned out to have a sigmoid volvulus which they resected and did a primary anastomosis.
The final case of the day with one of the men with a malignant melanoma on his heel and big nodes in his groin. We doubled teamed him, with Santiago and Rakesh doing his foot which Yuk and I did his groin. Since the only OR light was a single portable one, I was glad to have a headlamp ! I how we have provided some palliation for the man so that he can walk around without the mass on his heal, but unfortunately his prognosis is rather grim.
Right now we are limited to one OR because there is only one working anesthesia machine, so while we were operating, John Wasik was trying to fix one of the anesthesia machines that isn't working. He thinks he is making good progress, and hopes to have it up and running in the next day or two; having a second machine, and thus a second room available will allow us to be much more productive, and given the amount of work ahead, that will be a very good thing!
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