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2/16/07 (Friday)

We are up again with the roosters, dogs and trucks.  They seem to know when 5 AM occurs because that’s when it starts.  Last night in the middle of the night I was awakened by what sounded like three gun shots just on the other side of the wall next to our house.  Some dogs barked but nothing else.  I wondered what happened and was glad there is a 12-foot security wall between the house and whatever was taking place on the other side.  I don’t think they were firecrackers.  They sounded very much like gun shots.  I asked Jane about the noises and she heard them as well.  She said they were gun shots.  We never heard anything else so we don’t know what happened otherwise. 

I have been communicating via email with Phyl about her mother.  Her mother is in the hospital and undergoing a workup.  It appears she is having seizure-like episodes and they are trying to evaluate this.  Phyl’s calendar has been cleared of her plans to be able to help her mother.  This adds a lot of stress for Phyl, especially since I am not there to help. 

Today, I will be calling Fort Wayne to WBCL Radio studios for a one-hour program on our
Resource Center at
Dupont Hospital.  I will be on the air for an hour as we discuss our lifestyle management program with Dr. Neil Gordon fromSavannah, GA, Bobbie, the nurse who works with me, and the hostess, Char.  Char will be calling form New York and Neil from Savannah.  I  will be calling fromEcuador.  Bobbie will be in the studio.  This should be an interesting  program.  I will be connecting with my satellite phone I rented for this trip. 

Father, Thank You for the good night’s sleep and this new day.  Thank You for the opportunity You have given us to live and work for You today.  I pray for Your presence in this operating room and for Your protection and healing touch for the patients.  Please give Greg, Jane, Angelita, Maria Luisa, the anesthesiologist and me the strength, endurance and wisdom needed to meet the demands of today.  Thank You, Lord, for bringing us here to serve You.  To You all the praise and glory is directed!  Amen! 

We started our surgery day about 6:30 AM.  Gladys Delgado, age 47, complains of chronic pelvic pain mostly on the left side.  She has been on antibiotic, dicloxicillin, with no help or relief.  On exam she was quite tender in the left lower abdomen with deep palpation.  On pelvic exam there was a very tender mass in the left side.  Palpation of this reproduced her pain.  She has had a hysterectomy in the past but both ovaries remain.  I feel her pain is likely coming from the left ovary.  Our plan is to do an exploratory laparotomy and remove both ovaries and excise the left pelvic mass.  I suspect the left ovary is part of this mass.  At surgery we found a lot of adhesions involving both ovaries.  The left ovary was encased in large intestine as well as other adhesions.  This required some delicate dissection to free up the bowel and take down the adhesions.  We then removed both ovaries.  The mass of adhesions, bowel and left ovary is what comprised the left pelvic mass I felt when we examined her in the clinic.  The surgery should result in relief of the pain.  The anesthesiologist put in a spinal and it didn’t work.  Consequently, she then inserted another spinal and this had some effect but not enough.  We were able to open the abdomen but then she started to feel pain and became nauseated.  The anesthesiologist did not want to do anything more; however, it became apparent that we were not going to be able to complete the surgery without better anesthesia.  At this the anesthesiologist responded to our hints and urges to give the patient a general anesthetic so we could complete the surgery.  Once the lady was asleep, the surgery went along just fine.  

During the first case the lady who went home yesterday and did not come back called to see if she could come in and have her surgery today.   After the first surgery I went back to the house and picked up my satellite phone.  I then called Fort Wayne to WBCL studios and was able to connect with a clear signal.  I had to stand outside in the grass away from the buildings to get a strong signal.  It was very cloudy and I was concerned I might not be able to use the phone.  Our back up plan was for Loita to drive me to the nearest phone cabin where I could call from there.  However, the signal was good and I stood outside the clinic building in the grass the hour I was on the air with the other panelists for the radio program.  It sprinkled some while I was standing there and there was a rooster who kept coming around and putting his 2-cents worth into the conversation now and again.  Fort Wayne is snowed in right now and very cold so the listeners probably wondered what was going on hearing a rooster crowing in the background.  Our radio interview was about programs at our Resource Center at Dupont Hospital.  Today we featured our lifestyle management program with Dr. Neil Gordon from Savannah, GA.  We had a good discussion about the importance of lifestyle management in lowering cardiac risk factors and improving health.   

I asked Jane if the lady from yesterday was coming in today and she said she didn’t think so.  So we have just two more cases to finish our week of surgery.  Dionicia Avila, age 45, presented to Jane in January with pelvic pain and bleeding.  She has had 6 pregnancies and was wanting relief of the pain, especially the menstrually-related pain.  Jane found on exam an enlarged uterus and evidence of fibroids.  She also questioned the presence of adenomyosis.  She scheduled her for surgery when Greg and I were here.  I came in from my satellite phone call and Jane and Greg were midway through the hysterectomy on this lady.  The uterus was enlarged with multiple fibroids.  The surgery went very well and this lady should have considerable relief of her symptoms. 

Near the end of this surgery the lady from yesterday made contact with the clinic and stated she was on her way to have her surgery done.  Our next patient had not shown up for her surgery so we plan to add yesterday’s surgery on to our schedule.  We will do her next. Ana Rivadeneria, age 34, has had 4 pregnancies was scheduled for a tubal ligation and a Burch urethropexy.  She has a prolapse of the vagina.  On exam I found an urethrocoele which will often be part of the prolapse and can lead to incontinence.  Fortunately, she does not have incontinence at this time.  She is late for her period so we asked her to do a serum pregnancy test.  If this is negative, we will proceed with the tubal ligation and also do a Burch urethropexy to correct the urethrocoele.   

Maria Cedeno. Age 41, has had problems with continual vaginal bleeding and anemia secondary to the blood loss.  She had a hemoglobin of 8.9 in January.  He has had a known fibroid of the uterus and an ultrasound confirms the presence of a large fibroid in the uterus.  Her exam revealed a very large uterus that extends up to the navel and was about the size of a 20-week pregnancy.  Our plan is an abdominal hysterectomy.  This will stop her bleeding and allow her anemia to correct to normal. However, she failed to show up for her scheduled surgery.  Several attempts to contact her were unsuccessful.  She was not answering her cell phone.  Of all the people needing surgery, she was first in line.  Her uterus is huge and she bleeds heavily resulting in significant anemia.  Because she didn’t show up, the anesthesiologist left.   

This finishes our week of surgery.  Total number of cases was 24 major surgeries and 2 minor surgeries.  We saw about 50 people in the clinic before the surgery week.   

Lord, thank You for a good week of work here in San Lorenzo.  We were able to help 26 people with surgery that could make their life much better.  In the process we prayed with each person before surgery.  Lord, it is such a joy to serve You.  You brought us here and empowered us to reach out in Your name to the people who came to see us.  You especially have empowered Jane to continue Your work here along with Maria Luisa, Angelita, Jorge and Gonzalo.  Thank You for pulling this team together and allowing Greg and I the opportunity to participate with them in Your service.  Thank You Lord!  Amen. 

This afternoon will be a time to unwind and take a load off our feet.  Greg has been troubled with back spasms and I fully understand.  I get the same spasms in my back when I am standing bent over the operating table for long periods of time.  The main treatment is to lay down or at least not be standing and supporting your posture in a somewhat fixed position.  Our power went out at the start of our last procedure and we are now on generator.  The diesel generator sits right next to the front part of the house and is very loud.  It fills this place with a loud roar to the point you can’t hear yourself talk or think.  I hope that doesn’t go on all afternoon.  It will make relaxing and possibly taking a nap more difficult.  Unfortunately, the generator ran to almost 6 PM when the power came back on.  It was a very noisy afternoon.  I tried to take a nap but that was useless.  About 4:30 the entire clinic crew came into the house and celebrated Loita’s birthday, which is tomorrow.  We had some ice cream cake.  That was a fun treat.  Jane then took the team home and they said their good-bye’s to Greg and me.  Greg heads out tomorrow and Jane and I will likely be here unto Monday.  

While Jane was gone Gonzalo came and asked me to check on a patient.  The lady was our last patient and she has developed a small hematoma in her incision.  I redressed it and put some pressure on it.  Once Jane returns we will examine it again.  I suspect some pressure will take care of the situation.  After Jane returned we ate dinner and then went over to check on this hematoma.  The hematoma had enlarged significantly and needed evacuation.  We took her back to the operating room to open the incision, evacuate the hematoma and control the bleeding.  Since we had no anesthesia, Jane gave her some versed and some fentanyl IV and the lady promptly went to sleep.  Jane and I opened the incision and removed about 300 cc of clots.  In one area of the subcutaneous fat was a small bleeder.  That was controlled with a couple stitches and the incision was dry.  Then we irrigated the incision liberally and closed it again with our usual closure.  The lady by then was responding to us and following orders but was not complaining of any pain.  I feel much better about this having stopped the bleeding and controlled the hematoma.  Now I think we can sleep better tonight. 

Tomorrow we will be taking Greg to Esmeraldas to travel back to Quito.  Usually, Damarys would come from Quito to pick him up or if we were available we would drive him back.  However, Damarys does not have access to a car tomorrow.  So Jane and Damarys have worked out a travel plan for Greg.  We will take him to Esmeraldas to the airport there and he will catch a flight to Quito.  Damarys will meet Greg at Quito and make sure he is taken to his hotel and by way of taxi will show him around Quito.  Greg wants to do a little shopping so Damarys will help him with this.  I have not been to Esmeraldas so I am interested in seeing some new sights as we travel that direction tomorrow. 

Father, thank You for protecting this lady from a serious hemorrhage.  Thank You for making me uneasy about it so that I would not ignore the problem or overlook it.  Thank You for Your guidance and help that has been with us throughout the week.  Lord, I pray for the patients tonight.  I pray for their comfort and their healing.  I pray that we will have safe travel tomorrow and that Greg will have safety in the air tomorrow and on Sunday.  Thank You again for bringing him here to work with us.  Lord, I pray for my family tonight.  Be with Phyl and give her comfort and rest.  I pray for my children and their families.  Thank You for blessing Phyl and I with our children and the joy they have been to us.  Thank You for our grandchildren and how much they lift our hearts and fill us with joy.  Lord, I pray for Phyl’s mother tonight.  Please protect her and help the doctors caring for her to understand the problem and develop appropriate management.  Thank You, Father, for this great week!  Amen.


1. Joy Seward - March 17, 2007

Dr. Marv, thank you for the story and pictures. I can just imagine being there, and what it must be like. I loved the times God reminded you to double check a patient, Is’nt He faithful? What a work out you had, and under less then comfortable conditions, It must have been Very hot in the OR room and under all the gowns you use, Wow! I’ve loved you sharing your experiences there with us. Praying for you all Joy and walt.
PS. Let me know how Phyliss’s mother is doing, thanks.

2. Joy Seward - March 17, 2007

Dr. Marv, thank you for the story and pictures. I can just imagine being there, and what it must be like. I loved the times God reminded you to double check a patient, Is’nt He faithful? What a work out you had, and under less then comfortable conditions, It must have been Very hot in the OR room and under all the gowns you use, Wow! I’ve loved you sharing your experiences there with us. Praying for you all Joy and walt.
PS. Let me know how Phyliss’s mother is doing, thanks.

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