I am finding that 2 of the most common words that run through my mind are "if only." If only I spoke Amharic, If only they could afford a CT scan, If only she had come to the hospital one week earlier, If only we could have operated sooner. But we do the best we can...

In addition to head injuries due to stick fighting the other common problem is little kids getting big things stuck in their throat. I am sure this is pretty common back home too, but we sure see some interesting objects here.

Today began a little unfortunately. Our first case of the morning was to be a child with a large brain mass that we thought was infection - most likely TB. The pediatricians thought the diagnosis was also TB, and so they felt the patient did not need an operation - medicines only will suffice. Now, I grant you that my experience with children and TB is limited, but it sure seemed like the child needed an operation. We are to discuss the case at the pediatrics grand rounds tomorrow. I'll let you know how that goes.

The second case of the day was our young woman - 30s - who came to the hospital with progressive weakness of her legs and was now paraplegic. Her x-rays (left) showed this large thoracic (upper back) mass which had mashed her spinal cord. Dr. Mersha and I were able to remove the whole thing. In surgery, it looked like a meningioma (benign mass). Hopefully she'll get a little better.

Our second case was a 10 month baby with hydrocephalus (build up of spinal fluid). The family could not afford a CT, so the baby had an ultrasound showing the hydrocephalus, but not much more than that. So we took the baby for surgery and placed an internal drainage tube. Hopefully the family can afford a CT to see why the baby has this problem.

So the day began as any other. Bucket shower. Nescafe. You know the drill. Then to the OR. We had two cases planned for today. A young man with a large right sided brain mass (the CT is backwards - left is right and right is left). He was in bad shape and needed an operation. Yesterday we had arranged to have two units of blood prepared for the operation. Here, in order for a patient to have blood ready for an operation, a relative or friend must donate the number of units that we are requesting. So this was done. However, this was done at the downtown Red Cross. So the blood was available there, but had not made it to our hospital. Hence the anesthesiologist would not put our patient to sleep. OK. So maybe we get delayed by a couple of hours. We can in any event do our next case in the meantime.

You thought I was kidding about the stick injury business. This unfortunate guy was banged with a stick. At an outside hospital, one week ago, they had decided to attempt to repair the fracture. However, as the fracture was over a major blood conduit, they encountered (in their words) torrential bleeding. At this point, they stuffed as much gauze as they could in the wound and told him to come here. Fortunately, he made it, although it took him a week to get here. When we saw him, he had a large open wound on his head, with a large wad of gauze stuck into it. In any case, the operation went well, and he is fine.

Back to the main story, while we are preparing this man with the gauze in his head, another anesthesiologist indicates to me that there is no ventilator, should the patient need to be on a respirator after the operation. Now the man is very lethargic, and this is a possibility. The three ventilators in the SICU are being used. The medical ICU has one, but they will not relinquish it for a neurosurgery patient. After much begging they agree to let our patient use the ventilator.

By now, it is 1PM. I find out that the anesthesiologist leaves at 2PM, and if we can finish the craniotomy in an hour we can proceed. Needless to say, we did not proceed. So after seeing my great disappointment, we have agreed to do the case first thing in the morning. Hopefully our guy will make it until then. Equally importantly, hopefully a ventilator will be available then.

I forgot to update you on our child with the brain mass we felt warranted an operation. The pediatricians have decided to treat the child for three weeks for TB. At the end of this time, if the child is no better, they will ask for our assistance.