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2/12/07 (Monday)

Greg and I are sharing a room and we both slept very well last night.  Greg brought a little mosquito tent that sets up like a pup tent.  It just lies on the mattress and he crawls in and zips it shut.  It has a padded floor as well.  This works well to keep the strangers and critters from visiting during the night.


Lord, today is a big day in the operating room.  We begin our schedule for the week and I pray that we can and will sense Your presence in that room all week.  I pray for the patients, for their health, their protection, their safety, and their healing.  I pray for Jane and Greg and myself for endurance and wisdom.  I pray for Your hands to encircle ours like a glove and that You would guide us step by step.  I pray for our anesthesiologist for her wisdom and willingness to be part of our team.  Most of all, Lord, I pray we can glorify You today.  Amen. 

Our first patient, Aura Solis, is a 47 year-old with a large goiter primarily involving the right lobe.  This will likely take 3 hours to complete.  Greg and Jane will do this surgery together. The surgery went well taking 3 ½ hours to complete.  They took out an 8 cm cystic mass from the right side.  Jane plans to send this for pathology.    

Our second patient, Mayte Ramirez, age 39, was evaluated by Jane before I arrived.  She is scheduled for a hysterectomy with possible removal of left ovary and tube.  She has had a previous myomectomy and presents with prolonged and heavy menses.  An ultrasound showed a mass in the uterine cavity, possibly a polyp or development of an intracavitary fibroid.  She complained of pain and tenderness on the left side and her ovary was tender on exam.  At her surgery we found multiple pelvic adhesions with the left ovary bound down to the back wall of the uterus.  We had to free all this up in order to take out the uterus and the left ovary.  Her surgery went along well. 

Our third patient, Maria Santacruz, age 46, has stress urinary incontinence and abnormal uterine bleeding.  She has some tenderness on the left side of the uterus and a large cystourethrocoele, which is the cause of her urinary incontinence.  We are planning a hysterectomy and removal of the left ovary as well as a Burch urethropexy to pull up her bladder and correct the incontinence.  If needed, we will do a vaginal repair to correct any remaining relaxation after the Burch.  This surgery involved a hysterectomy and removal of the left ovary.  She had a large corpus luteum cyst on the right side.  After the hysterectomy we then did a Burch urethropexy with good support of the bladder and urethra obtained with two sutures placed on each side of the bladder neck connecting to Cooper’s ligament.  This gave good support without needing to do any vaginal surgery.  Her anatomy was restored and she should have normal bladder function without incontinence. 

After the third patient we stopped for lunch and had a quick break.  It is now 4:25 PM and we are getting ready to start our fourth surgery.  We have two to go and hopefully we can be done by 7 to 8 PM.   

Our fourth patient, Danny Quinonez, age 39, presented with a 15-year history of left pelvic and left abdominal pain.  She had normal bowel and bladder function but had daily pain on the left side.  On exam we found a painful mass in the left mid abdomen somewhat lateral to the umbilicus.  The uterus was separate from the mass and was also tender.  We are approaching this with an exploratory laparotomy to evaluate and remove the mass.  We may also do a hysterectomy depending on the operative findings.  After her anesthetic was administered we did an exam under anesthesia.  There was something in the left abdomen that seemed separate from the uterus and ovary.  After opening the abdomen we found absolutely nothing in the way of a mass.  This lady has a deformity of her left leg and this causes some contortion of her posture.  Her left psoas muscle was much bigger than the one on the right and I wonder if this is the mass we were feeling.  It seemed to correlate to what we felt through the abdomen.  We did find she had had some pelvic infection in the past as she had some minor adhesions around the uterus.  We cleared these adhesions but did nothing else.  I hope this helps her pain but I doubt if it will.  At least we ruled out some very serious problems and she didn’t have to lose part of her bowel or other organs.  Her entire small and large intestine was normal. 

Our fifth patient, Ana Loida Tapuyo, age 46, came to us yesterday from the rivers.  She is a Chachi Indian and has a history of carcinoma-in-situ on a pap smear.  She has had 4 pregnancies.  Jane and Greg evaluated her yesterday and added her on the schedule as a hysterectomy.  We plan an exam under anesthesia to see if this can be done vaginally.  After her spinal was administered we did an exam under anesthesia.  The uterus was a little enlarged and did not appear to be easily removed vaginally.  Thus, we went ahead with an abdominal hysterectomy and removed the uterus and ovaries.  She had very little blood loss and should recover very well.

Today, a lady came in with papers indicating she was having surgery.  Jane had forgotten about her as she had seen her before I came and told her we would do a hysterectomy on her today.  So we added her to the schedule for tomorrow.  The anesthesiologist wants to leave at 4 PM tomorrow and we only had three cases for her.  We told her we wanted to start at 6 AM instead of 8 so we can get done by 4 PM.  She was not very happy about coming in early but agreed to do so.  That means we will be getting up by 5 to be ready to start surgery at 6.  Most likely Greg and I will start surgery and then Jane may break away to make rounds.   

Father, today has been a good day serving You.  We were able to help five women with surgery and You protected them and cared for them.  I sensed the peace that is there when You are there with us.  We didn’t run into any problems that would distract us from You.  Thank You, Lord, for Your endless grace and unfailing love.  Amen. 

We finished about 7:30 and will soon be eating our dinner.  Then we will head to bed as we need to set our alarms for early in the morning. 


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