We are challenged here by knowing the best way to treat a certain condition and then trying to figure out how to provide the best treatment we can with limited resources. Sometimes its just simple things: in the case of each of the 2 young women with large breast masses, I spent time thinking about where I would place the incision to be least obvious cosmetically while providing adequate access to remove the tumor. In the end, my decision was largely based on the fact that there was one minimally mobile OR light, and that would have made it difficult to work deeply under a skin flap for instance. Lights and available tools are just 2 of the practical considerations that go into decision making in this setting. I think that these challenges are one of the main reasons I enjoy coming to Liberia.
This trip has been a whirlwind and quite busy; the result for me is that the days and the cases blur together. I have been writing this blog every 2 days because I am tired at the end of each day, but I think for the next week I will go back to blogging every day if I can. Friday was another busy day of a variety of hernias (umbilical, inguinal, and femoral) as well as some other miscellaneous cases. Nothing too exciting, and yet each case brought its own set of challenges which had to be overcome.
We had expected to work a half day yesterday, but it didn't work out that way as we did 13 cases ending around 8pm. Some were scheduled, and several were emergencies that had to be done. The JFK Administration announced on Monday that the only charge for surgery by the HEARTT team (us) would be any JFK drugs or supplies used; there would be no charge for registration, surgery, or hospital stay less than a week. I think this has stimulated many patients to finally get their hernia repaired etc. So with 15 patients on the schedule, we felt obligated to push on to get as many of them done as possible. One patient had been in the hospital since Wednesday awaiting her surgery, but was put off to the next day twice. Yesterday she came up to the Surgical Suite and announced that she wasn't going to leave until her surgery was done. After examining her, I told her that her problem would be best taken care of by a plastic surgeon, and I might have one coming on our March trip if she wanted to wait; she said that she wanted me to do it, and so I did !
The final case of the day yesterday was a patient who came to the ED yesterday seriously ill with an acute abdomen. Jonathan brought him to surgery and found his abdomen was full of pus, but no visceral perforation could be identified. He went into the OR in critical condition, and came out still critical and requiring medication to maintain his blood pressure. He was brought to the new JFK ICU to recover. I was pessimistic about his chances of survival, but the word this morning was that he had survived the night and was off the ventilator. Here's hoping he continues to do well.
As we were leaving, I stopped in on the 3rd floor medical ward to see a Facebook friend. Gwendolyn Remmie, a longtime JFK nurse. 11 years ago she took care of a 5 year old girl I had operated on, and did a wonderful job; we have been friends ever since. We greeted each other with big hugs, and had a wonderful short reunion.
Today we had the day off, and enjoyed doing nothing but resting and having a team lunch on the rooftop terrace of this hotel. We had hoped to go to Libassa, the eco-resort we enjoyed in April, but there were difficulties with transportation. Just like the challenges in surgery, there are challenges in most things here. from the main paved road, to get to Libassa you need to travel a couple of miles on a dirt road. During rainy season, the dirt road is impassible without 4 wheel drive, so we were out of luck. Having a rest day was very nice though !
You are doing such valuable work. May the Lord bless you and keep your hands steady.
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