Friday March 16

      Today was a great day ! I suspect it might be difficult for non-medical and non-surgical readers to understand what follows, but give it a try. To me this represents the ultimate experience of our profession. J. is 10 years old, and had a large abdominal mass filling her abdominal cavity; she looked like she was full-term pregnant. It seems to have happened slowly over the past several years, according to her aunt who is her caretaker. She stopped going to school because she was so embarrassed by her protruding belly. It was not causing her pain, and she was able to eat and run around like a normal 10 year old. She was seen at Redemption Hospital, and then referred to us by Dr. Carol Humphrey, and American Peace Corps physician who is working there. They did an ultrasound at Redemption which showed the mass was cystic, and extended from her pelvis to her liver. After she was admitted here, one of the superb surgical residents, Dr. Ayon Cassell, repeated the ultrasound; he thought the cyst was arising from the right kidney, so I asked Professor Edet Ikpi if he would join us for the surgery. Professor Ikpi is a Nigerian urologist who is here on sabbatical to run the Postgraduate Surgical Training program and be Head of Surgery at JFK Hospital; he is a wonderful, enthusiastic, smart guy who has made this particular trip quite wonderfully memorable.
      We scheduled J. for Friday morning. Like Harriet several years ago, I approached this surgery with some trepidation, because she is a child, and we really didn't know what we were going to encounter. One of my favorite themes with the US residents who come with us to Liberia is that we have to learn to deal with diagnostic uncertainty here. In the US, it is very rare that a surgeon carries out an abdominal operation and doesn't know what he is going to find because all of the patients get CT scans and MRIs pre-op; obviously here it is different, and challenging, and fun when it works out.
        Professor Ikpi, Dr. Konneh, Sandeep, and I explored her abdomen, and discovered fairly early that Cassell was right, and this huge cyst was arising fro her right kidney. In fact, it had pretty much destroyed her kidney so that there was just a nubbin of what looked like kidney left. Sometimes operations move along like a beautiful symphony or a well- choreographed and danced ballet; this was one of those occasions. I intended to step aside and let Dr. Konneh  work with Prof. Ikpi, but I was having so much fun I just couldn't until Prof and I had the mass removed intact. It weighed 10 pounds !
         Later on I went to see J in the Recovery Room. She had mucus and said the it hurt to cough, so I pressed on her abdomen while encouraging her to cough the junk up, and she did. Then she took my hand and held it, and smiled at me. I melted 😊
         As we finished the operation, Professor Ikpi said:" This is what JFK is for !" and he is right on target. JFK needs to develop itself as a referral center known for tackling tough problems with excellent clinical surgery and medicine. I see the beginnings of that on this trip, and I have a good feeling about the future here.
         After that Gbozee and Sandeep and David did a fellow with a complex enter-cutaneous fistula following a typhoid perforation. I would go in occasionally to see how they were doing, and they called me in once or twice to see something, but I did my best to let them make the clinical/surgical decisions. I think it worked out well.
         I didn't write this last night because I was feeling superstitious that talking about J would jinx usvlol. I'm happy to say that she is looking good today, and smiled when she held my hand, again.