Thursday March 23

        Today was a great day ! I felt like we accomplished a lot today in terms of the number of surgeries but equally importantly the amount of teaching. We had medical students as well as residents around us all day, and it was a lot of fun. We started out as always in morning report where the residents tell the faculty about admissions and events overnight. A major event was the death of a young man who had presented to the hospital about 2 weeks ago with a small bowel perforation from trauma. He was operated on, and seemed to be getting better, but then took a turn for the worse earlier this week. Santiago took him back to the OR and re-explored his abdomen; he found some leakage from the repaired perforation and reclosed it. He had a rocky postoperative course and then developed kidney failure followed by death last night. We will be discussing the case at length tomorrow in Morbidity and Mortality Conference, but we started the discussion today trying to understand what we could learn from the case so that the result might be different for the next case that presents in the same way. Some of the discussion today revolved around the difficulty of making a complex diagnosis in this resource-poor environment where lab tests and sophisticated X-rays are not available. Under such circumstances, close attention to detail and using ones brain are really the only things we can do to sort out the complexities. I'm sure the discussion tomorrow will be very interesting.
       We had several surgery cancellations and no-shows today, but we managed to keep a fairly full schedule in the OT with a bunch of small cases, some scopes, and a thyroid goiter. Tomorrow we will have a full day with more cases scheduled than we can possibly do including 4 thyroids, but we will do the best we can. We have less than a week left on this trip, and as usual, there will be several patients we planned to operate on but won't have time to do them. I think we have done pretty well in prioritizing cases, and doing the ones that were most important because of the need for a tissue diagnosis or the value of doing the surgery as a teaching exercise. As I said at the beginning of this entry, I really enjoyed today because I was able to teach medical students some basics, and then see some consults with the residents and share my thought processes. They seemed to think it was valuable !