Friday September 20 and Saturday September 21

Friday September 20 and Saturday September 21

Friday was another long day: we arrived at JFK at 8:15am, and left at 9:30pm having done 14 cases. That was quite an achievement in itself, but considering we only had one room to operate in for the morning, then 2 rooms in the afternoon, and finally 3 rooms after 5pm it was quite an accomplishment ! Major kudos to Ama, Adeola. and the entire OR and PACU staff for working with us to get all of our scheduled cases done as well as some add-ons. The reason our rooms were limited was because local surgeons needed to some urgent cases, and there was no staff to open up others rooms. I’m pleased that there is increasing surgical activity by Liberian surgeons; i think that is an indication of progress. At the same time it was frustrating to have our scheduled cases delayed, but I was able to get over my frustration fairly quickly. Late in the afternoon we still had 6 cases to do; the option of cancelling those patients for today was offered, but we decided to push ahead and get them done rather than disappoint the patients by rescheduling for another day.

     One concern/time limitation/concern was that the hotel restaurant typically closes around 9:30pm. While i was doing our last case of the day, Jonathan spoke to Adil at the hotel, who told him we didn’t need to worry, and they would feed us whenever we got back to the hotel. That turned out to be 9:45pm, and then we had a lovely dinner ! 

      After our long day yesterday, we slept in an extra 30 min and came to the hospital at 8:30 today ! We had 12 cases scheduled, but had to do some switching around because of emergencies and ended up doing 10 cases in total. The scheduled cases included thyroids, hernia as, endoscopy, and a variety of lumps and bumps. The emergencies included a 22 year old man who had an intestinal perforation repaired a week ago, but postoperatively he was going downhill. On exploration we found he had a hole in his repaired colon; working with one of the Liberian residents, I  removed the damaged part of his colon and gave him a temporary ostomy. He is likely to have a stormy course after this operation.

       The other emergency was a young boy with abdominal pain. We were asked to see him this morning, and his examination was quite concerning for appendicitis or some other infection. Ideally he would get a CT scan to help nail down the diagnosis, but they cost money, and his mother said she couldn’t afford it. On clinical grounds we thought appendicitis was likely enough to recommend surgery, and his mother consented. At operation we found that he had mesenteric adenitis which is swelling of the lymph nodes near the appendix; this was the most common cause for a “negative appendix” early in my surgical career before CT scans were common. I don’t feel badly about putting him thru an operation to obtain this diagnosis; it was the right thing to do under the circumstances, and he will do well.

        Jonathan and Thu Ha are doing an endoscopy and putting in a gastrostomy( feeding tube directly into the stomach) for a 2 year old who drank lye and has an esophageal stricture. I have written about this as a public health problem here and in other countries in sub-Saharan Africa. It is a terrible and deathly childhood problem in search of a solution; in the meantime we do what we can to try to keep them nourished and alive.

         It’s just 9pm now. As soon as they are done we will call our van driver to take us back to our hotel so we can have dinner and go to bed. Tomorrow we have the day off !