Thursday September 6

       This was quite an amazing and busy day! There have been times in the past when doing 5 OR cases in a day seemed like a big accomplishment; today the general surgery team did 18 operations ! Some were big, and some were small, but nonetheless it was quite an accomplishment by the OT staff in particular. The cases included 2 mastectomies, several hernias, several colonoscopies, an endoscopic esophageal dilation for a child who swallowed lye, and the final case was a large lipoma on the shoulder which Dan Slack and I attempted under local anesthesia, but it was too big and too painful so he was given some sedation.
       One of the cases we had scheduled to do today was on a patient who sadly passed away yesterday. His name was Anthony Hne, and he was a nurse anesthetist at JFK for several of the first years I came here. He was excellent, knowledgeable, and caring, and I know we all miss him. He was admitted to the hospital last week, and asked his son to get in contact with me, which he did. I saw Mr. Hne downstairs on the ward the other day, and I knew his time was quite limited. We were going to attempt a small operation to make him more comfortable, but he took a turn for the worse yesterday morning.
       The two mastectomies are representative of the frustrations that are part of surgical and healthcare decision making here. One patient, whom Dr. Cassell and I operated on, is 40 years old and had a large breast cancer which had spread to her lymph nodes. We don't know if it had spread yet to other areas such as liver and lungs because at this time sophisticated x-ray imaging is not available here. Though they are saying that a CT scan will be running at JFK early in the new year. In any case, chemotherapy is for the most part available only to Liberians who have enough money to travel to Ghana or elsewhere for treatment. Hopefully as healthcare delivery in Liberia improves, that will change, and more cancer treatment will be available here in Liberia. The second patient, operated on by Dr. Gbozee and Dr. Slack, is a 50 year old with a relatively small cancer (2.5 cm) in a large breast. She would have been a good candidate for tumor excision followed by radiation therapy to the remaining breast to significantly reduce the risk of recurrence, but radiation is not available in Liberia. She does not have adequate resources to go to Ghana for radiation, so she chose mastectomy; I have every reason to believe she will do well.
       We got back to our hotel around 7:30pm. After a quick shower and dinner, I ready for sleep so we can do it all again tomorrow !