Surgery was busy today. The word is out that the trip is almost over so many people are coming at the last minute, hoping to get their surgery done.  For tomorrow we have a mandibular tumor, a giant ventral hernia, a submandibular mass, a cecal cancer,  2 pediatric hernias and a recurrent ovarian tumor in a 21 year-old female. More will becoming,  as well. Tomorrow is the last day of operating so we plan to finish all comers, even if we stay up all night. We have done 122 surgeries.

Sister Mary Joseph Nodule
The clinic was also busy. One old man came with an umbilical tumor, a Sister Mary Joseph Nodule. The tumor was fungating and bleeding so we resected it-not expecting a cure but a slight improvement in the quality of life for the patients final days. He has carcinomatosis from an unknown source.

A patient from two years back also came today. She is 40 years old. In 2009, she came in with a rectal cancer. I performed an abdominoperineal resection which involves removal of the anus and formation of a colostomy. She was wealthy enough to get chemo and radiation after surgery and is doing quite well now. She was wearing a standard appearing colostomy appliance, which surprised me. She was able to purchase it in the market for 350 Naira, about $2.33. She uses a bag about every 5 days so she will spend about $150 /year on ostomy appliances-not much unless your monthly salary is $100!

It is 845 PM. We just got called for an obstructed hernia so we are returning to the hospital. Don't wait up.