Monday March 27

      For a day that we didn't think would be busy...we were wrong !! We went to Grand Rounds to hear a talk on Graves' disease, which was presented very well and directed by a new endocrinologist at JFK. After the talk Santiago and I spoke with him about a protocol for the work-up of patients with multinodular goiter, an entity which we have seen with frequency on this trip.
      We then went to the OT where Santiago and Konneh operated on a young man who came in last night with a perforation, probably gastric. Apparently they felt he was too ill from sepsis to be operated on last night, so they kept him for this morning. He was clearly on death's door the he was brought to the OT, and then we went thru the door early in the operation dying on the table. My view of this is that it was good for them to realize that he needed resuscitation before surgery last night, but they didn't realize that the window of opportunity in these patients is quite narrow. After rapid vigorous fluid resuscitation, he needed to come to the OR right away not several hours later; then he might have had a chance. But the way it was handled doomed his surgery and outcome for the start.
        Aaron and I did a 1 year old boy wth a large hernia, and we did a couple of local anesthesia cases.Between cases Mrs Cooper had me come down to the Admitting Office to see some patients. On was a girl in her 30s who has a huge ulcerating breast cancer. If she has a mastectomy, she will need a skin graft to cover the wound on her chest. I had already seen a man who says he has been waiting for 2 years to have a skin graft placed on his ankle; I admitted him so the girl with the breast cancer will have to wait as we can only do one skin graft a day. She is scheduled to see Prof. Golokai in clinic tomorrow, so he can deal with it.
       We finished around 5:30, then went back to the hotel to change for dinner. Theresa and Alex Cummings met us and Masmina and her brother at the Mamba Point Hotel for a delicious sushi dinner. I still can't get over the fact that there are 2 really good sushi restaurants in Monrovia!! We had a wonderful time with them talking about all sorts of things including the upcoming race for President. Alex is one of the 20+ declared candidates !!
        Santiago and I talked earlier in the day about feeling the way we always feel at the end of these visits: anxious to get home to see friends and family, but always leaving with a sense that there is so much left undone. We work hard, and do a lot, but there is always the wish that we could have done more.