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2/13/07 (Tuesday)

Our day started at 5 or so because we wanted to get an early start on our surgery load.  We have 4 big cases today and it will likely take all day to complete these.  Our anesthesiologist made it clear to Jane she would not work past 4 PM today.  She is only tuned in to her needs, not anyone else’s.  Her cell phone keeps ringing while in the OR and she runs out of the room to talk for several minutes.  Yesterday, I had my laptop sitting just outside the door of the OR to make notes on this journal throughout the day.  She was reading a large textbook of medicine and was writing notes.  She asked me if she could use my laptop to write the notes and save them on a diskette she had with her.  I allowed her to do this and then during the next case she spent most of the time outside the operating room working on her notes.  I then moved the laptop in and set it up right next to the anesthesia machine.  I told Jane that if she is going to work on her notes, she would do it at the head of the table so we know she is there and at least partially tuned in to what is going on.  If the machine alarm sounds because of low oxygen or some other problem, she would be there to respond.  So we spent the rest of the day with her dutifully logging notes from her reading and studying and sitting next to the patient on the operating room table.  Actually, it worked quite well and she stayed with us all day.  Today, I plan to do the same thing.

The anesthesiologist came about 5:30.  Surprise!  We told her we wanted to start at 6 hoping she would be here by 7.  Yesterday she arrived a little after our start time and this put us behind a little.  While working on some email before heading over to the OR, in she drove.  That means she will be ready to roll at 6.  So I need to shut this down and head over to the clinic building.

Father, thank You for the good night’s sleep.  In spite of the early hour, I feel rested.  I pray, Lord, for Your presence in an extra measure today, especially during this first operation.  Lord, this young lady appears to have ovarian cancer.  Please Lord help us to help this lady.  Perform a miracle and take the cancer away.  Make this mass something benign and easy to manage.  Lord, we depend totally on You for all our wisdom and strength.  Thank You for your incredible grace and mercy.  Amen.

Fabiola Quintero, age 32, presents with a large complex pelvic mass and an elevated CA-125.  The ultrasound strongly suggests an ovarian tumor, possibly malignant.  She had not missed any menses and workup revealed an elevated CA-125 and the very suspicious ultrasound.  A couple weeks ago her blood count was 8 but today her blood count is normal at 13.  She also has symptomatic gall stones.  Our plan is to explore the pelvis and treat accordingly.  If this is benign Jane would like to take her gall bladder while we are there.  We entered the abdomen and found the large mass to be an ectopic pregnancy from the left tube that had bled into the pelvis and then clotted off.  The left tube had the pregnancy still in it with the bleeding coming out the end of the tube.  We took out all the old blood clots and then removed the left tube and ovary.  This was not cancer!  Once Greg and I had the pelvic part done we closed the incision and then Jane made an incision over the gall bladder and she then took out the gall bladder.  Greg assisted and I passed instruments for her.  We took several pictures of this ectopic pregnancy.  We are very glad for this patient to have a non-malignant problem.

 

Esperanza Valencia, age 38, has a lot of problematic bleeding and on exam has an enlarged and tender uterus.  Our working diagnosis is adenomyosis.  We are planning a simple hysterectomy.  She came in today and didn’t have the money for the procedure.  She does laundry for a living and makes about $30 per month.  The hysterectomy would cost her about 5 month’s wages.  She went out to various friends and family to see if she could borrow enough to get the surgery done.  She came back having raised $80.  Because of that effort, Jane is willing to go ahead with the surgery so she will be our fourth case for the day.  This surgery was especially difficult.  This lady is overweight somewhat and had a deep pelvis making the usual technique of hysterectomy much more of a challenge.  Jane and I did the surgery and we had to struggle to put in some of the deep sutures.  However, with God’s grace we were able to accomplish this surgery without major bleeding or any complications.  Our anesthesiologist left us when the clock was at 4 in spite of us still in surgery.  Fortunately, we were closing the abdominal wall and only had the skin to put together.  It is frustrating to me to have physicians showing minimal concern on the condition of their patients.  This lady seems to think primarily of herself and doesn’t really be concerned about the patient who is under her care.

Gina Churta, age 34, presents with a large fibroid uterus, almost 20 weeks size.  She had been in to see Jane recently complaining of heavy menses and pelvic pain.  Jane noted on exam that she had “mioma grande.”  She has had 3 previous C-sections.   We found the uterus to be quite large from fibroids but no other problems.  Her hysterectomy went well except for the patient sneezing periodically throughout the case.  When she would sneeze all of her intestines would shove out the incision and block our vision.  We had to be careful placing sutures, especially when she was sniffling some, which usually preceded a sneeze, because sudden movement of the bowel would probably cause a bowel injury from the needle.

Lidia Soliz, age 46, came in yesterday with her papers for a hysterectomy.  Jane had seen her previously for evaluation of menorrhagia and performed a D&C removing a polyp.  This, however, did not control her bleeding.  She was also hypertensive.  She has been medicated for the hypertension and this is better controlled.  She has had an ultrasound that showed fibroids.  Jane had recommended a hysterectomy.  At surgery we found uterine fibroids.  Her hysterectomy went along well with no major problems.  It was a little difficult because she was heavy and exposure was compromised somewhat.  Prior to the surgery Greg felt a little ill.  He went over to the house to lay down for awhile so Jane and I did this surgery without his help.

Our lunch consisted of the usual cooked rice with plantain and this time the meat was choncha – clams.  The lowest rung of the economic ladder in this area is occupied by the conchera, the people who dig clams for a living.  They will work the entire day and may get one bag of 100 clams for which they will be paid about $1.00.  These people live at poverty level and usually spend their lifetime doing this type of work.  To purchase the clams to fix for food, one bag of 100 costs $3.00.  The meat is extracted from the shells and then cooked in a soup mixture and put on rice.  The clam meat we had today had a unique flavor and were a little chewy.  After lunch we will do our last hysterectomy before the anesthesiologist leaves.  Jane has two others to do under local anesthesia.

Jeferson Martinez, age 13, had a thorn penetrate his palm a few weeks ago.  It has been a continual sore area and is draining pus.  Jane plans to open it and search for a foreign body.  Supposedly the thorn was removed when the incident occurred; however, the area has not healed.  Jane said she was able to pull out a thorn that was about 2 cm long.

Jacinto Suarez, age 46, was stabbed in the abdomen about 6 months or so ago.  The weapon was a glass mirror and he received three wounds.  He had the wounds repaired; however, he has one area of persistent sharpness and feels he has a piece of glass remaining under the skin.  Jane plans to explore this area to see if she can find a foreign body.  These situations are not easy in that the foreign body may be very hard to see, especially if it is glass. 

Jane is doing the two local anesthesia cases herself.  She said she did not find any glass on the second patient.

Greg and I were quite tired from being on our feet all day.  Greg became quite dehydrated and came over to the house and slept for awhile and drank a lot of water.  He came back feeling much better.  We both took Jane’s offer to head over to the house and relax while she finished up with the two local explorations. 

I called Phyl on the satellite phone and talked with her a few minutes.  She told me that
Fort Wayne was to get 11 to 16 inches of snow today and they are having blizzard conditions.  This makes the heat and humidity not sound so bad right now.

Father, thank You for a good day.  We had several surgeries and thankfully the young lady with what we thought was ovarian cancer will not have to deal with that dreadful disease.  She was in Your loving hands I can tell because she survived a ruptured ectopic pregnancy when she could have bled to death.  Thank You for giving us the strength and ability to deal with the difficult surgeries today.  Our last surgery was especially difficult, yet You enabled Jane and me to effectively do that case without any problems.  Father, thank You for watching over us and guiding us.  Thank You for protecting our patients.  Thank You for your unfailing love.  I pray for healing for the patients.  Please touch them, Dear Father, and bring rapid recovery.  Thank You for blessing this day.  Amen.

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