Tuesday September 13

     I am annoyed to see that my postings for yesterday and today have disappeared into the vapors, for reasons that are beyond my level of understanding. This is particularly unfortunate because I thought yesterday's blog was quite good ! Oh well, so it goes....
     The major case yesterday was the 9 day old girl from the Neonatal ICU who had an intestinal obstruction.  For surgeons, the most worrisome part of an operation on a small child is the anesthetic management, mostly because there is not a lot of leeway. Kids can crash quickly, and babies even quicker. This child weighed 2.1 kg (4.8 lbs), which is quite small  for an operation under the best of conditions. The problem was that if we did not try, she would not have survived. The anesthetists were unable to intubate her despite repeated attempts, so eventually they decided the surgery would be done under Ketamine sedation. Deirdre and Jonathan did the surgery, and a wonderful job they did ! It turned out that the baby had a jejunal atresia, in which a segment of the bowel is block due to some maloccurence during development. In her case they found a large dilated proximal small bowel, and then a transition, and then collapsed distal small bowel. They worked their magic by taking out the blockage in the transition zone, and then sewing her intestine back together. It was really quite an impressive piece of work, and I was very proud of them !
      While they finished that, I did a minor surgery and then we did a few smaller operations like hernias. When we thought we were done and heading out, Dr Macdonald asked us to stop in the Medical ICU to see 3 people with GI bleeds. Two were middle-aged men with a reason to have a bleeding ulcer; the third was a young woman ( variously reported as 16 or 19) who had had several episodes of significant bleeding in the past few years. All of the patients were stable, and did not require urgent intervention.  They will undergo endoscopy in the morning if the equipment is working.
      During the day we received word that Madame President had invited us for dinner that night, so we went back to the apartment to get ready for that. At her house we joined the other guests including 3 members of the Peace Corps who are in Monrovia for the year: Gary, an ED doctor, Kevin, a family practice doctor from the University of Vermont who is working at the medical school, and Nicole, a nurse midwife from NYC. Also attending were Dr. McDonald, Prof. Njoh the head of internal medicine at JFK, Masmina, Adelaide Gardner, and Ophelia and Carney Johnson. After drinks around the pool, the 4 of us, the 3 Peace Corps volunteers, Dr. McDonald, and Prof. Njoh had dinner with the President in the palava hut. As usual, it was fascinating to hear her talking about her work, would she still want to take on the job knowing what she knows now after 11 years (yes !), and a variety of other insights. I think it is particularly wonderful to have young residents like Deirdre and Daniel sit, listen, and converse with a Head of State. It's one more thing that will make this trip a memory they will savor forever.