Wedneday October 22

"You're list is moving but you're staying in this room". Doesn't always happen but when the unexpected occurs we just get on with it. And so we did today. Having been happily prepared for a max fax list with 3 smallish cases there was an emergency to do on a patient with Ludwigs angina - nothing to do with his heart. This is a condition that often occurs as a result of a dental abscess. It causes serious swelling in the neck which can impair breathing. In this situation the patient was intubated and the infection sorted out by drainage and antibiotics. because this had to be operated on first and the other OR room was free they received the emergency and their surgeon came into the OR room I was working in.

Dr Gary Parker is very well known for the surgery he performs and today's was no exception for him. A 14 year old boy with a very large posterior cleft palate who had received no previous treatment had his palate closed or rather covered over since at 14 the palate is hard and cannot be closed like it can in a new born child. What was even more remarkable was that his older sister had the same problem, although her cleft palate was not as large and she was the next patient!. these patients actually require speech therapy as they have learned to speak by raising the base of their tongue to occlude the cleft. Consonants are particularly difficult. When most of us speak we lower the base of our tongue. While they will never have brilliant speech they will be able to make themselves understood for more easily.

This filled the day which had started at 5.00am out on the dock, walking briskly. So far this week I have walked ten and a half miles to Benin. As a team we are moving slowly towards the goal. Plans for Benin are well inhand for the ship and in fact we are now being asked to make sure certain things ae done ready for the ships departure. and yet we are as busy in the OR and on the ward as ever, still patients come but we now only have a months operating tme left. it is always saddening when patients have to be turned away but we are limited and sometimes the surgery required by the patient is simply something we can't do.