Thursday March 21

    Today was our last full day of operating at JFK for this trip, and what a day it was ! We had 3 thyroid operations scheduled for today: the first one was a 26 year old female who had a very hard and nodular gland which to my mind increased the possibility of cancer. My sense was that successful treatment might require a total thyroidectomy, but that would require thyroid hormone replacement for life after surgery, and that medication is not readily available here. I decided that we shouldn't do her surgery without at least more information such as an ultrasound. The cancellation put her into tears, and made me feel bad for having done it, but I think I was right in terms of her safety and the best treatment.
     Shortly after that, Santiago told me that there was a patient with Ludwig's angina downstairs.  This is a condition in which swelling in the submental space(under the chin) compresses the trachea and causes difficulty with breathing; it creates an emergent need for a tracheostomy. So everyone went into action, and quite rapidly the critically ill patient was in the OT. Santiago and I successfully did her trach under local anesthesia, and felt good about that. Unfortunately I heard tonight that she passed away this afternoon.
      We then spent the day doing a variety of cases, trying to get as much as possible done as soon as possible so that we could come back to the hotel and get ready for a celebratory dinner. Of course that was dangerous thinking, because when you do that something always happens. In our case today, around 5 pm a young woman was brought to the ED after her husband bit off about 1/3 of her lower lip. I would have no idea how to repair that, but fortunately we had Rob Kimmel Sr available and ready. I thought it would take a long time, but the Kimmel duo did it in short time and produced an amazing result.
     We got back to the hotel, showered, and bot ready for our annual dinner on the rooftop of our Hotel hosted by Shinny, the owner. It was a lovely gathering of about 20 people, and the Minister of Health Dr. Wilhemina Jallah even stopped by to offer her thanks. It was a lot of fun, and a fitting celebratory end to this trip