Thursday March 9 and Friday March 10

 Thursday was a limited day in that we had 5 patients scheduled but only 2 of them were admitted the previous day. No one seemed to know why they weren’t admitted; the likely reason was financial. JFK has once again announced that surgery while we are here will be at minimal cost, and that is a big attractant. The two cases we did were a thyroidectomy for goiter done by Dr Mabanza and Gaspar and one of the Liberian residents, and a colostomy decommissioning done by Paul and myself. The thyroid presented itself as something of a watershed moment for me. The thyroid is very vascular, and requires meticulous dissection and lighting a lot of small blood vessels. It also requires careful dissection of the recurrent laryngeal nerve which inner area the vocal cords; injury to this nerve can cause voice changes or worse. I decided that changes in my vision due to glaucoma in my left eye create more risk to the patient than I am willing to take, and therefore I won’t be doing any more thyroid surgery. Dr Mabanza was very understanding and did the case successfully with Gaspar. It pained me to accept this diminution in my skills, and made me feel older, but I know it was the right thing to do. Paul and I did the colostomy decommissioning with no trouble.

Friday was a busier day. Dr Mabanza and Paul did another thyroid while Gaspar and I removed a giant juvenile fibroadenoma from the breast of a 19 year old girl. Gaspar and I then replied a hernia in a 15 year old boy. After that Paul and I repaired a large incisional hernia in a large woman which was quite a struggle but in the end we were successful. Dr Joshi did a TAPP block on her do she woke up with no pain, which was awesome! While we were doing that, a 30 year old male was brought up from the floor for an exploratory laparotomy. He had been in a high speed car crash the day before, and had developed an acute abdomen. Gaspar joined to Liberian team in surgery, and they found that he had almost completely transected an area of small bowel. He also had a non-expanding retroperitoneal hematoma. They repaired his small bowel and had finished closing his abdomen when he became unstable and then precipitously crashed and coded. Resuscitation efforts failed and he was pronounced dead. It takes a lot of force to transect small bowel, and it was likely that the small bowel was crushed by the bottom of the steering wheel crushing bowel against the spinal column. That type of deceleration injury often causes injury to the thoracic aorta, and my best guess is that was the cause of his demise. We will never know since his parents took the body for immediate burial, which is a common practice here. Everyone involved was quite distraught as expected.