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1/27/05 (Thursday)

6:45 AM.  Up and awake from the cold shower.  Our day today is lighter with only 3 cases.  Our first surgery had to be cancelled because the lady’s hemoglobin (blood count) is only 7 and she is severely hypertensive.  That combination with anesthesia and surgery spells stroke and possibly death.  She has no money.  To go to Quito to be treated would cost her 4 to 5 thousand dollars.  We have no blood bank or other resources here.  She has large fibroids and is bleeding all the time.  There is no hormone available expect for estrogen, no depoprovera or lupron.  This poor lady has nowhere to turn for help.

Lord, if she could just touch the hem of your robe!  Would You make that possible for her?  Please go beyond us and heal here.  Lord, I pray for our day today.  Give us wisdom and skill to do the right things.  Please help those wyou are recovering and heal them.  Thank You for the opportunity to be Your instruments of healing.  Amen.

7:30 PM.  Today we had only 4 surgeries so we finished earlier.  We did an abdominal hysterectomy and 2 vaginal hysterectomies.  The second one had total prolapse requiring a sacrospinous fixation.  This case was a challenge because of the distorted anatomy.  The left ureter came down into the vaginal eversion making it very susceptible to injury.  I wasn’t sure how I would expose the sacrospinous ligament without the proper retractors.  However, I was able to get a good view using a long Pedersen vaginal speculum and was able to anchor two sutures under direct vision.  That surgery was quite tiring but it felt good to me to see this poor woman’s anatomy restored.

We had an add-on today – a lady we saw earlier with a positive pregnancy test and an ultrasound that didn’t show a pregnancy.  She came in again today having a lot of right pelvic pain and another ultrasound showing a complex right ovarian mass.  She was also having a lot of right lower quadrant pain.  We decided to operate to make sure she did or didn’t have an ectopic pregnancy.  At laparotomy we found a 5 cm unruptured ectopic pregnancy in the right tube.  This was removed without difficulty.  This lady could have bled to death from this!  Thank You, Lord, for giving us clarity and direction and saving this lady.  We are Your instruments to serve You through serving others.

Large unruptured tubal pregancy sitting above the white ovary

Large unruptured tubal pregancy sitting above the white ovary

9:00 PM.  Jane and I are done with evening rounds and I finished some email.  Now it is time for bed.

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