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2/14/07 (Wednesday)

Up at 5:30 to get ready for surgery.  The anesthesiologist arrived shortly after 6 to start our long day of 5 hysterectomies.  I had a good sleep once again, possibly of being very tired from standing all day sweating all the time.  I signed on to email before heading over to the operating room and received an email from Phyl telling me about her night in the emergency room with her mother.   

Father, I pray for Phyl and Mom right now.  Please be with Mom and help her.  I don’t know what the problem is other than a severe headache and tremors in the legs.  Help her please and also comfort and help Phyl with the care she will give to her mother.  Lord, I pray also for our day here.  We have several more surgeries scheduled and it will be a long, hot, sweaty day.  I pray for our strength and endurance and most of all for wisdom to make the right decisions and give the right treatment.  Thank You, Lord, for the opportunity to serve You here.  Amen. 

Olimpia Nazareno, age 46, with pelvic pain and bleeding.  Jane examined here before I arrived and found uterine enlargement and fibroids.  She scheduled her for a hysterectomy.  At surgery we found multiple fibroids.  In fact, she had a Snoopy Dog uterus – fibroids that made the uterus look like Snoopy in the comic strip Peanuts.  Greg and I did the hysterectomy with Jane passing instruments.  The surgery went quickly and there was little blood loss. 

Our next patient was to be Enriqueta, the lady with cervical cancer we had examined when I was here in September last year.  She has since been treated at the cancer hospital in Quito and we had thought we would be doing a hysterectomy on her here.  She has had radiation therapy and chemotherapy.  We have been unable to find her and Jane wasn’t sure she would show up for an exam and possible surgery.  This morning we received word she was in Quito at the cancer hospital.  I hope she does well with her cancer treatment.  Jane mentioned that efforts were underway to contact one of our patients scheduled for tomorrow and bring her in today.  This will lighten our load tomorrow.  That will be helpful.  We had a breakfast break after the first surgery.  Breakfast was potatoes with some sort of gravy, bologna that was fried and cheese.  I did not eat the cheese in that it is very salty.  I have had it before and I did not find it too tasty.   

Carmen Valencia, age 44, has had 11 pregnancies with 10 living children.  She has had menstrually-related pain that has been progressive in nature as well as increased flow.  When Jane and I examined her the other day her uterus was quite tender and enlarged about twice to three times normal size.  I suspect she has adenomyosis.  We are planning a hysterectomy.  Jane and I did the hysterectomy while Greg passed instruments.  This was one of the toughest surgeries of the week for me.  The uterus was large and the pelvic dimensions were narrow and what space was left was taken up by fat pads.  We struggled just to get exposure for the brief moments when one could place a clamp on vessels and ligaments and cut and place sutures.  I was really tired at the end of the case and decided to break and let Greg and Jane close the abdomen while I sat on the floor and rested.  I was wearing a Gortex surgical gown which is water repellant.  It is so good at repelling any moisture from the outside that it also becomes a sauna on the inside.  I think some of my tiredness was from all the sweating and needing to replenish fluids.  This is the same thing that happened to Greg yesterday.  So, I sat on the floor and drank two glasses of Diet Coke.  Our temperature in the room is about 80 and the humidity is 50% with the air conditioning running full blast.  It is 10:30 and we are now done with two of our cases.  We have two more on the schedule and possibly one will be added.  Some of the patients coming for tomorrow are traveling a long distance to get here.  They will arrive today and stay over night in the alberge.  Possibly we could do one of those cases today instead of tomorrow.   It is 11:00 and our next two patients have yet to arrive.  Our first case for tomorrow is already here so we will move her up in the schedule and do her surgery next.  

Jaqueline Medina, age 37, has 5 children and comes from the rivers.  Jane had seen her before I arrived.  This lady has had problematic bleeding and pain.  Jane felt her uterus was enlarged and a hysterectomy was indicated.  Our plan is a simple hysterectomy.  Greg and I did the hysterectomy.  This one went better than the last and we finished in about an hour.  She had an enlarged, boggy uterus that probably contains adenomyosis. 

We are now going to break for lunch and then work through the next two cases before the end of the day.  I am really tired today.  I think I am behind on fluids like Greg was yesterday.  Hopefully, lunch will help.  It just seems like I am sweating much more today than yesterday even though the room temperature and humidity is about the same.  All this sweating and heat is catching up with me. 

Angela Quintero, age 42, has had a one year history of left lower quadrant and left pelvic pain.  She has had 14 pregnancies with 10 living children.  She has a very tender uterus on exam with some tenderness to motion of the uterus as well.  Her left ovary was normal on exam.  I suspect her left-sided pain is originating in the uterus and radiating to the left.  We are planning a hysterectomy and will evaluate the left ovary and remove it if it shows disease.  Her pain pattern suggests chronic pelvic inflammatory disease.  However, this lady failed to show up for her surgery.  The staff had attempted to contact her to no avail.     

Bernardita Pinargote, age 47, has had 6 pregnancies with 6 living children.  She has a history of uterine fibroids and feels a mass in her lower abdomen.  When Jane and I examined her we found a grossly enlarged uterus that is quite irregular in shape.  Her uterine size was similar to the size of a 4-month pregnancy.  Jane had examined her in October of last year and found fibroids but they have expanded significantly since that exam. Our plan is to remove the uterus.  The ovaries were very difficult to feel on exam.  Hopefully, we can leave at least one ovary for her to continue hormone function.  She had an ultrasound recently that demonstrated multiple fibroids but the ovaries appeared to be normal.  At surgery we found a very large uterus with multiple fibroids.  She even had involvement in the broad ligaments.  Because of the changes we needed to remove the ovaries along with the uterus.  Her surgery went quite well with minimal blood loss.  We took some pictures of the fibroids because of the size and unusual presentation.  We are back to the house at 3:30 PM having finished for the day.  Because the one patient failed to show, we get a little break and can rest our legs some.  I have not felt well today but after lunch and drinking a lot more, I feel much better now.  I hope to get some rest and enjoy a quiet evening of reading.  Father, thank You for a productive day and a day where Your protection encircled us.  You provided for us in so many ways and we can only say, “Thank You.”  Our patients went through their surgeries without problems.  Even the surgery that was so difficult You provided enough endurance and wisdom to successfully accomplish what needed to be done.  Thank You, Lord, for Your incredible grace and mercy.  Thank You for always loving with an unfailing love and providing just what we need.  Amen.We had a good afternoon just hanging out in the house reading and relaxing.  A cool shower felt wonderful.  Greg went with Jane to take the Angelita and Maria Luisa home and he was able to see downtown San Lorenzo.  He said it looked very much like some of the neighborhoods we visited in the Dominican Republic and especially was very similar to what he saw in Haiti.  Nancy brought in our dinner and it consisted of rice, potatoes and liver.  I haven’t had liver for many years and it will hopefully be several more years before I have it again.  It tasted like liver and I think it was okay.  I just have never been a liver lover.   

We plan to start early again tomorrow.  We have 5 surgeries tomorrow and they should take most of the day.  By starting early we can be done in the late afternoon and this is much more workable for Angelita and Maria Luisa as they need to go home to their families.  Tomorrow we have a hysterectomy, tubal ligation with a Burch urethropexy, a gall bladder, multiple myomectomy and an exploratory laparotomy to remove a pelvic mass.  It is time now to read a little more and then head to bed for a good night’s sleep. 

Lord, thank You again for this day.  You have chosen to walk through this place and have me tag along.  I get the privilege of being Your hands and feet here.  I get to use the skills You have imparted into me to serve the people here and help deliver Your healing power.  I get to privilege of being allowed to distribute some of Your unfailing love to these people.  Thank You, Lord, for the opportunity You have given me to come here and help Jane and be part of this ministry.  I pray for the recovering patients, Lord.  Touch them and give them Your healing power.  I pray for protection from any problems and complications.  I pray also for their comfort.  Thank You, Lord.  Amen.


1. Donald W. Seely - February 15, 2007

Hi Marv,
We have been enjoying your blogs and are amazed that you find the time to write them with such a packed schedule. This is amazing work that you and Jane are doing and I know that the Lord is there with you.
Our men’s prayer group is meeting and praying for you. We meet again tomorrow at Starbucks at 6:00 a.m. and will be praying for you and Jane and the team.
We are also praying for Jim Maley and the family. Jim will undergo a tracheotomy tonight at 6:00 p.m. and it is risky with his broken neck. But, he needs to come off of the vent. Several of us from the church will be there ahead of time to pray. Bill Culp will perform the procedure and we are praying for him too.
We hope that the biting critters will leave you alone for awhile.
Stay safe!

Don Seely

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