Friday September 8

Friday September 8

      Another very busy but productive day at JFK: we did a total of 9 cases- 7 elective and 2 emergencies. The elective cases included the usual couple of large African hernias as well as a pediatric hernia, a screening colonoscopy, a cholecystectomy, and the excision of a plunging ranula. You might be asking yourself “What in the heck is a plunging ranula?” And you would be in good company because we had no idea either. A 15 year old boy came to see us complaining of a bulging mass inside his mouth, and a mass in his neck.  On examination, they seemed to be connected. An ultrasound showed that it was a cystic structure filled with clear fluid, so I aspirated it partially with a needle, and indeed it looked like saliva. With help from Google, Sandeep was able to identify is as a plunging ranula, and we were all able to read articles on how to best remove it. It is a salivary gland cyst, and the best treatment involves removing the cyst along with the sublingual salivary gland, taking care not to injure the lingual nerve. The approach is thru the floor of the mouth. So this morning Sandeep and Jonathan excised it! We are general surgeons, and so we do what general surgeons do: find surgical solutions to problems when possible ! Sometimes the problem is outside of our normal range of practice, like with this boy, but there is no oral or maxillofacial or ENT surgeon here, and it is unlikely that there will be one in the foreseeable future. Under such circumstances, how can we refuse?

       I saw a very sad case this afternoon: a woman I had operated on in March came to see me. She is 35 years old, and was diagnosed with locally advanced breast cancer a little over a year ago. She was advised to go to Ghana for neoadjuvant chemo-radiation, since neither chemotherapy nor radiotherapy is available in Liberia. She went to Ghana and received 2 rounds of chemo, but it was very expensive and she could feel the cancer growing despite the chemo. So she came back to Liberia and begged me to operate to try to decrease the pain she was feeling from the weight of the increasing breast mass. I did a palliative mastectomy, explaining to her that I was not able to remove all of the cancer. Pathology showed it was a very aggressive cancer that was not hormone-responsive. Today, less than 6 months later, the cancer has grown back significantly, and we have nothing to offer her. Her parents have died and she has no siblings; she is alone in the world. It was an exceptionally difficult conversation to have with her as I tried to find something to hold out to her as hope, but I came up empty.

     I felt better after going to visit Varney and his mother. He is the boy who has an esophageal stricture who had his stricture dilated the other day in retrograde fashion thru a gastrostomy. He was able to eat yesterday, albeit small amounts, but its the first food he has kept down in a long time. He hasn't smiled for me yet, but I'm determined to get a photo of him smiing before we leave.