Day 3

I woke up early this morning, as we had planned for Dewall to pick me up at 8:30 so we could start our OR cases at 9. He arrived at 8:30, but said that we couldn’t leave yet as Adaman was next door visiting his mother. Robert called me at 8:45 to say that they had already moved our patients up to the OR suite so we could start at 9 as planned; this was a totally unexpected display of efficiency!! Then at 9 AM, Adaman came walking down and said there was a change of plan, and that we had been invited for breakfast with his mother. So I had to call Robert to tell him that we would be delayed since I would be having breakfast with the President; this was perhaps the best excuse I have ever heard for a surgeon being late for his first case ! Anyway, before breakfast Adaman took me across the street to meet the Mayor of Monrovia, Mary Brough, who is a firecracker ! She is doing a lot to try to clean up the city; one of the things she told me was “the time for awareness has passed…now it is time for enforcement !” She gave us some Tshirts as we left…she is a very cool woman !

We then went for breakfast with Madam President. Her house is quite unassuming, aside from the pillbox and the armed UN soldiers and Liberian Army guys milling around. We all sat at the table, and rose when she entered, and then had a nice breakfast. She is quiet and appears very contemplative; she asked interesting questions, and added her perspective. She is in her early 70s, and was carrying 3 cell phones : a Blackberry, a small one, and one other I couldn’t identify. Also at breakfast was Uncle Jerry, and Aunt Jennie, two of her most trusted colleagues.

Then we went to the hospital. Robert and Colleen did a 5 year old girl (Blessing is her name) with a left inguinal hernia, followed by a 19 year old man with a right inguinal hernia, both of which went well. Then we planned to do Saah Two, a 62 year old man with a large mass on his posterior neck which we think is a hemangioma, and which spontaneously at least partially thrombosed. Unfortunately anesthesia could not intubate him, so we cancelled the case. We could possibly do a tracheostomy, and then resect the mass, but I thought it made sense to think about it and plan it rather than starting that at 2:30 in the afternoon. I could imagine us getting into serious bleeding as the light started to fade, and that would have been a regrettable moment.

Apparently overnight a 4 year old boy came in with an intestinal perforation, probably due to typhoid. One of the surgical trainees took him to the OR and repaired it, but in the Recovery Room his abdomen became very distended and he was having difficulty breathing. They couldn’t get the surgeon to come back; apparently they bagged him for a while, but then got tired and stopped. The boy died. Robert was quite upset that no one called him or us to help; we will see if there is anything we can do to change that. But since we are here for only 2 weeks, it is hard to introduce any systematic changes. I was thinking about M&M, so at least maybe someone would learn something through the deaths. But I don’t think they are ready for personal accountability yet. Death is handled more easily than expected, in part because it is just a fact of life. Infant mortality is high; the average lifespan is in the 40s; and 80% of the population is under 25.

Since yesterday was a National Holiday (Decoration Day, aka Memorial Day), things were slow so we joined the others at a resort about 20 minutes drive from Monrovia on the sea. It was developed by Robert Johnson, owner of Jet Magazine and others, and is really quite a nice spot. We had some beers, and food, and then came back to town. Then Georgette (pediatrician from Portugal, Senora, Jonis, James and I went to Sam’s Barbecue for another beer before calling Dewall to bring us home for the night.