Sunday September 9 and Monday September 10

        Sunday was a day of rest. I got up around 9, had breakfast, and then went back for a nap! Dan and Michael wanted to go to Kendeja, the RLJ beach resort, but there was a football match (Liberia vs. DRC) yesterday afternoon, and that precluded driving past the stadium. It's difficult to explain driving here: traffic rules and stoplights appear to be thought of as advisory rather than mandatory, and when there is a big event like the football match, the traffic is real bad. So instead they walked around locally, and I understand Mike went swimming. Anyway, around 2 we went to a birthday party at Mrs. Cooper's house. She runs the Admitting Office, and it was her husband's 78th birthday! t was great fun to be there as guests at a family celebration and to see some Liberian friends once again. Then we came back and I conked out early.

      Monday was a very busy day in which it felt like we struggled to get 7 cases done. The struggles were not personnel, but the system. The power went out a number of times today; that is tolerable when operating on an adult, but it makes for scary moments when operating on a child, as we  were at the end of the day. The last 3 cases were all 5 years old, and two of them were twins. The twins (Peter and Paul) each had a large right inguinal hernia; I didn't think a child could have a huge inguino-scrotal hernia like the adults, but I was proved wrong. They both did well, but it was scary when the power went out and the anesthesia machine was therefore out also.

      In the afternoon our patient Francis came to dee us. He is the 21 year old with a schwannoma involving his left axilla and left arm. Schwannomas arise from the Schwann cells which create the myelin sheath around nerves; 98% of schwannomas are benign. One of my main concerns is that Francis is in the 2% with a malignant schwannoma causing the pain and other nerve symptoms. So I thought it would be prudent to get a chest x-ray to look for evidence of metastatic disease. unfortunately, he told us later in the afternoon that JFK Radiology had not film to print the image. He went to anther healthcare facility and was told that the only technician who could do a chest X-ray was out sick. We were planning to operate on Francis tomorrow, but due to the delay caused by no X-ray, we plan to attempt his surgery on Wednesday instead.                                                                                                         

     When he came back, he said he wanted to ask us a question. He told us that his mother had died when he was young, and she never had anything like his tumor. And that he knew he wasn't born with it. So, he asked, had he done something wrong in his life to get it? We tried to reassure him that he hadn't, but the whole situation is clearly a difficult process for him to grasp. His situation is one of the most challenging and difficult clinical problems I have seen in Liberia. We don't actually know if this is malignant or not, and we won't know till after we get back to the USA and the pathologists have looked at his tissue specimens. Despite not knowing if it is cancer or not, we may have to amputate his arm in an attempt to palliate his pain. We have talked to a number of people here and elsewhere about him, and no one has a good answer as to how we decide whether to cut off his arm. He is willing to go thru anything to get rid of the pain; I hope we can do that for him.

       Another big day in the OR tomorrow, even with putting Francis off till Wednesday. We have 17 cases scheduled; completing all of them seems like an impossible task at this point, but we will try.