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1/24/05 (Monday)

6:00 AM.  A really good sleep was an immense help.  This was probably because exhaustion was the contributing factor.  The wall being up on our side of the building acts as a nice sound barrier.  The pigs and chickens are less noisy or at least I can’t hear them.

Our surgery schedule starts today.  We have 24 scheduled so far: 13 abdominal hysterectomies, 3 vaginal hysterectomies with repairs, 2 anterior repairs, 1 myomectomy, 1 conization, 1 exam under anesthesia, 2 sigmoidoscopies, 1 D&C, and an exploratory laparotomy.  We have room for a couple thyroid patients if they show up.

11:00 PM.  What a day!  We started with an anal ulcer that required biopsy and sigmoidoscopy.  Then we had 3 abdominal hysterectomies, all for fibroids.  The first lady’s fibroids weight 1.5 kilograms.  The hysterectomies all went very smooth.  The last case was an exploratory laparotomy for a lady with a very painful mass in her right lower quadrant.  This exploration involved lysis of adhesions and vioal! the mass disappeared.  The cecum and small bowel all stuck together must have been the mass.  We found nothing else.  Hopefully, this will take care of her pain.

Multiple fibroids distorting the uterus

Multiple fibroids distorting the uterus

We had a problem with John, the visiting physician who is here to work with the family physician in the clinic.  John tried to take over the post-op patients.  He was checking them frequently and wanting to treat with pain control.  He spent the whole day with our post-op patients, hovering over them instead of seeing patients in the medicine clinic.  He kept interrupting Jane in the OR about his findings and recommendations.  He complained that he was a board certified family physician and surgeon and he was not allowed to exercise his clinical judgment.  Jane was quite frustrated with this and she ultimately had to remind John that he was here to work in the medical clinic and that she would care for the post-op patients.  This kind of tension is not needed here, or anywhere for that matter.

I went with Jane to take Angelita, Maria Luisa and Jorge home.  Gonzalo road with us.  These 4 have so much fun together.  Spanish was spoken a mile a minute accompanied by frequent outbursts of laughter.  I understood none of it, of course, but I enjoyed watching them have a lot of fun.  They even sang some songs.

The Ecuadorian customs are so polite.  A greeting is always with a handshake and a kiss on the cheek.  When saying good-bye, it is the same.  I am enjoying all the kisses!

Before going to bed I got to send an email to Phyl.  I also sent to my partner, Matt Sprunger, to see if another partner, Cortney Schwartz would consider coming to work with Jane in late May. 

Thank You, Lord, for Your loving protection and support as we did surgery today.  You wrapped Your hands around ours and guided us.  You held the patients in those very same hands and loved them and protected them.  Thank You for Your unfailing love!  Amen.

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