Tuesday March 13

       This is probably going to be short because the day was very long! I think we did 10 cases today; that wasn't our intent starting out, but between elective cases and emergencies it turned out that way. And in between cases we were screening potential patients, since the word went out yesterday that we were here and we would screening patients for surgery at no charge. For those patients who do have surgery, obviously there is no charge for our services, but they are generally required to pay a hospital fee and a fee for drugs used. In circumstances where a patient really needs the surgery done urgently but they don't have the ability to pay for it, we are usually able to work something out. I suspect that we could nearly fill our OR schedule for the two weeks with the patients we saw yesterday and today, but we won't; instead we will be somewhat selective.
       Several aspects of today stand out: first, in each case a Liberian resident was part of the surgical team either as surgeon or first assistant, emphasizing the importance of teaching in what we are doing. Second, Professor Ikpi is an amazing and wonderful addition to the postgraduate program. He is engaged and enthusiastic, and even said to a group of us toward the end of a long day "This is so much fun!"
      The last case we did today demonstrated some of the difficulties of doing surgery here. The patient is a mid-70s years old woman who came to the Emergency Room complaining of 3 days of abdominal pain. She has diabetes, hypertension, and congestive heart failure, for which she is on multiple medications. She had a tender abdomen, and was groaning in pain more than one might expect from the exam of her abdomen. The point of telling my non-medical readers about this background is that this is high stakes: there are some pretty disastrous potential causes for her pain where waiting would probably be fatal, but on the other hand she has co-morbid conditions (diabetes, hypertension, and congestive heart failure) which make her a high risk for surgery. Under the circumstances, one would like to be more sure what was going on in her abdomen, in the hopes that surgery could be avoided because she would get better without it. But we don't have a CT scan or other means to develop that certainty; the only way to know what was going on was to operate and take a look. So we did, and discovered that she probably would have gotten better without an operation, but I still think we made the right decision to operate. Her breathing was labored as she woke up from anesthesia, and the anesthesiologist wanted to keep monitoring her in the OR room till she was breathing better. Dr Gbozee and I and Sandeep did the surgery; after 2 hours in the OR waiting for her the breathe better, we Sandeep, David, and I) decided that we needed to get some sleep so we left her in the capable hands of Dr. Gbozee and the anesthesiologist, who felt it would be another couple of hours before he would want her to go back to the ward. I felt guilty leaving her, but we have another bust day planned for tomorrow, and I need some sleep. We had some pizza and beer back at the hotel, and then off to bed.