Wednesday September 7

       Today was an excellent day for a lot of reasons. We accomplished a lot, mostly because so many people helped out in the effort. When you consider that for the past several months, the OR team has only been doing occasional emergency cases in the Maternity Hospital, doing 6 cases with us today on Day 2 of our visit was really quite remarkable and commendable!
        The cases were a 5 cm lipoma over the clavicle under local anesthesia, excision of a recurrent cyst of the thyroid isthmus, a large inguinal hernia in a 3 yr old, decommissioning of a loop ileostomy, excision of a huge parotid tumor, a colonoscopy, and decommissioning of an end sigmoid colostomy. The huge parotid tumor was done by me and Daniel. The 40 year old patient first noticed it several years ago, and I guess finally it became big enough and was leaking so he decided to seek medical attention. I have certainly never seen anything quite like it ! I wasn't at all sure we would be able to remove it, but it was somewhat mobile and that gave us hope. For those who don't know, the important thing about surgery on the parotid gland is that the facial nerve goes through it, dividing it into a superficial and a deep lobe. The facial nerve inner ages the muscles of the face, so damage to the nerve during parotid surgery can cause quite noticeable effects like drooping of one side of the mouth, especially obvious when smiling, or inability to close the eye. In the case,d the tumor was in the superficial lobe ( as it usually is), and postoperative lay the patient had near normal muscular activity in his face. I suspect when we see him tomorrow, and he has had a chance to look in a mirror and see that the alien living on his left cheek is gone, he will be smiling broadly !
         Another gratifying aspect today was the presence of postgraduate trainees in the OR with us all day. It turns out that they have made a written schedule for the 2 weeks we are here assigning PGY-1 and PGY-3 residents to our cases. This is a big change, and a wonderful one, and I'm pleased that it is happening. Sometimes it's easy to forget that our main purpose here is to teach Liberian surgeons how to do the surgery. In the heat of battle against a parotid tumor, the level of concentration is intense and it's easy to tune out everyone around you; I tried to stop every once in a while to explain my thought process, or my strategy, or point out anatomy. Tomorrow we will have some hernias to do, and I look forward to working one-on-one with the Liberian residents to teach them my approach to hernia repairs in Liberia.
        As you can imagine, surgery is a team sport requiring efforts from anesthesia, nurses, techs, and cleaners as well as surgeons. I can't say enough good things about the way everyone at JFK has stepped up to help us. They have stepped up in the past, but I think this is different in view of the major problems existing in the hospital over the past several months from the leaky roof. I'm truly grateful  for their work on our behalf.
        Back to the apartment for dinner and conversation, and then to bed.
        An interesting note on global trade : the bottled water we have here in the apartment, bought in a local grocery store, is Poland Spring, the taste of Maine !!