Day 6

It’s Saturday, but we are back in the OR trying to take care of our backlog of cases. First was a young girl (18 or 19) with a giant juvenile fibroadenoma measuring about 15 cm across in her left breast and several smaller 2-3 cm fiboadenomas in her right breast. Colleen and I did it and it came out quite well, I think. It occurred to me during her surgery that we generally consider excessive blood loss to often be due to poor surgical technique, but I don’t think the surgeons here have the same perspective. At the same time we did that, Robert and one of the interns did an appendectomy for acute appendicitis.

Our next case was a mastectomy for inflammatory breast cancer. I regretted having ever had bad thoughts about the way they tolerate blood loss. It was a very bloody mess !! In the end it came out alright, but during the case I remembered how much I dislike a lot of bleeding and poor lights ! It became a matter of survival surgery: hoping that we could get through the operation, accomplish our objectives, and have a viable patient at the end. We succeeded in doing that, and in fact after a while the bleeding calmed down, and we actually ended up with a decent result. I doubt that we have changed her prognosis significantly, but we have hopefully made her short term outlook a little brighter.

Then we did an incarcerated inguinal hernia under spinal. For the first time some of the surgical house staff came in to watch, and it was good that they were interested. They asked good questions, and made some good comments. Then we made rounds to sort out what we ar doing on Monday. Although it is a public holiday, apparently it is a working holiday, and after some discussion with the anesthesia staff, we have been given permission to do cases. So we will do another mastectomy for a fungating breast cancer, and incisional hernia repair, and an ileostomy decommissioning. As people are learning that we are here, there are all sorts of patients being referred for possible surgery, so that is a good thing…for us anyway !

Then there was another hernia, but that turned out to be a hydrocele, so we were done for the day. We went to the Administration Building to meet Adaman, Senora, Jonis, and Steve along with Dr. McDonald. While they finished up there meeting, we spent some time chatting with a delightful woman whose name I will get…but she was a Professor of Dentistry/Maxillo-facial in Philadelphia before she retired and moved to Liberia. Her family is from Togo originally I believe. Anyway, there are NO dentists in Liberia, so she is setting up programs at JFK and elsewhere, and is much busier in her retirement than she ever expected! She was delightful to talk to, and had so many interesting ideas.

Tonight we came back here for dinner and beers, and had a good time once again. Tomorrow is Sunday, so we will have a day of rest…though we have some plans scheduled. Adaman came back from a visit after dinner to say that any of us who are interested are invited to attend church with The President tomorrow. We have to be ready when the convoy departs at 9:30; I’m going ! And then tomorrow night she has invited all of the HEARTT participants to her house at 5 PM.