Monday march 12

Monday March 12

     I guess the meeting last Friday did have some impact, as the OR had our first patient on the table and close to being put to sleep at 8:35 AM. Unfortunately, being Monday,we had Grand Rounds so we couldn't start till 10:30...but it was good to see that they were primed and ready to go. Our patients were all doing well, with 2 exceptions: the woman who had the amputation on Friday passed away last night, and the 4 yo girl with the large abdominal cyst developed malaria over the weekend. She is getting appropriate treatment, and hopefully we can do her surgery on Friday.
     Grand Rounds was a presentation on sepsis by 3 of the HEARTT ER residents: Noah from Brown, and Sewena and Jenny from Yale. They gave a very good presentation, and there was lively discussion afterwards about the role of steroids and of lasix.
      With our first case cancelled, we moved to the thyroid: a multinodular goiter that Konneh had been asking me to do with him since we arrived. We did a subtotal thyroidectomy, and to my surprise it wasn't bad at all. In fact, afterwards I told Konneh that I would do more thyroids on my next visit. After that Diego and I did a guy with a hepatic abscess. We did ultrasound pre-op and could see that is was superficial; our plans to do intra-operative ultrasound were thwarted by battery failure in the litlle handheld ultrasound. As it turned out, when we got inside his abdomen, we found his liver was stuck to the chest wall medially, and in bluntly taking down that adhesion, we found the abscess and drained it, leaving a foley in it. While we were doing thyroid, Santiago and John did a bilateral orchiectomy for prostate cancer, and then Santiago, Ainhoa, and John started on Victoria. She is the young woman about 30 who was given a lye enema for reasons unclear, and who developed serious complications as a result. She had previous surgery which included a colostomy, but the full extent was unknowable. Santiago examined her under anesthesia last week, and thought he could offer her a way out of her ostomy. The good news is that after about five hours of surgery, she is back together with a diverting ileostomy, and there is the hope that the ostomy will be decommissioned in 4-6 months.
     After they finished we went to the dorm for our daily Internet fix, and then home. The four of us had dinner, and then sat around talking about surgery, and our education, and life history. It was a chance to get to ow one another better, and was very enjoyable.