Wednesday March 21

     We are approaching the end of this visit, and as usual things get hectic. We had several patients brought up to our " consulting room" outside the OR who were disappointed to learn that we couldn't do their surgery tomorrow. Most of them were invited to return in September when we will be back, and I hope they show up.
      The first disruption to our day's schedule was the addition of an emergency who came in to the ED yesterday afternoon. We saw him around 5 pm, and I felt he needed more hydration with IV fluids before any surgery, expecting that he would be operated on by the on-call team later in the evening. For whatever reason, he wasn't, so we did his surgery as the first case of the day. He turned out to have a perforated gastric ulcer, with spillage of over a liter of bile into his abdominal cavity. In keeping with our new role, I decided to let Gbozee lead the team with Albertha Clark and Mike Quaye assisting him. I was in and out of the room, kibitzing, pimping, and really enjoying my role as teacher. I particularly wanted Gbozee to make decisions about operative strategy, and he did; I think as a team they worked well, and for me it was another milestone in this Liberian experience.
       At some point in the morning I was told that Varney was here, and I couldn't believe it ! Varney is the 4 year old boy with an esophageal stricture from lye ingestion whom we saw in September; through an interesting combination of skills, Jonathan Laryea was able to dilate his esophagus so that he was eating Cream of Wheat before we left. We told his mother that he would need serial dilations, but she didn't bring him back to JFK till today. He is not able to eat much, but apparently gets something down because he looks reasonably nourished. He isn't swallowing well, so we admitted him for endoscopy and possible dilation tomorrow.
       The big item on the schedule was a 5 year old girl with multiple anomalies including urinary and intestinal; she seems to have no outlet to her bladder, and her rectum ends blindly, and she has a mass on her low spinal cord. She also probably has other abnormalities including heart. But her abdomen is distended with no way for poop and pee to get out, so that was what we were planning to take care of. Unfortunately it got late n the day, and we decided eventually that it would be better to wait till tomorrow.
       The final two cases were hernias, so we have Sandeep and Seville doing the repair in one room, and Cassel and David in the other, and I was going back and forth offering advice. I like this change in our way of doing things, and so does everyone else I think.
        We were done around 7 and called the car service. This was a new driver (for us), and as we were traveling the short distance to the hotel, he was telling me that he has a hydrocele that he wants to get removed. (A hydrocele is fluid around the testicle in the scrotum, and they can get quite big). He has had it for 20 years, but heard we were in town so he wondered if we could do it tomorrow. I explained that we had a full day already, and it was our last day of operating, so it would have to wait till September. He was unhappy, and tried one more attempt at convincing me when we pulled up to the hotel by pulling down his ants to show me !! We all thought it was pretty funny and amazing, but it didn't change my plan to make him wait till September.