6/26/04 (Saturday)

6:50 AM. The roosters, dogs and pigs have all told me it is morning. There are a couple fruit and vegetable vendors who drive by slowly harking their good over a loud speaker. Usually they come by a little later. One guy decided to get an early start on business so he already was my back-up alarm to tell me to get up.

This is our final day in surgery. We have 6 short cases – most of which will be under local anesthesia. I have a D&C to do also. The rest are moles, hernias, toenails. Jane and I plan to stay till Monday so we can have all the patients discharged and home. We have several who will go home this morning and a couple who will probably go home tomorrow.

Sheila’s care has a major engine problem. When she arrived her engine shut down as she was turning into the drive to the clinic. She coasted to the house and stopped. A local mechanic looked at the engine and repaired the condenser and points and plugs and got it running. However, he detected a noise and diagnosed a broken piston ring. He told her she has big trouble with the engine and would have even bigger trouble if she attempted to drive back to Quito. The last place she would want to stop would be along the highway. She has a cell phone but would not have a connection and would be stranded. She will have to have the car towed to Quito. She was planning on leaving today as she has guests arriving tonight. Needless to say, Sheila is quite frustrated with the whole mess.

Lord, I pray for Sheila and this situation with her car. Give her patience and wisdom and help her get her car back to Quito. Father, I pray for today. Please be with our patients who are recovering from surgery and those who will be having surgery today. Guide our thoughts and hands as Jane and I work together to help these people. Lord, comfort little Jose and his parents. Please heal his nose and make it whole. Thank You, Lord, for this week of surgery, for keeping a watchful eye and healing hand on the patients and for giving Jane, Sheila and me the incredible opportunity to serve You here in San Lorenzo. Bless Jorge, Maruka, and the caretaker of the clinic. They help so much and are great team players. Thank You, Lord, for who you are and for the unending, unfailing love You extend to each one of us and each one we serve. Thank You, Lord! Amen.

12:00 AM. It has been a very long day. We had six short cases scheduled; however, we had two other surgeries come in and an exam under anesthesia. One lady was sent from the local hospital for treatment. She was given malaria medicine by her husband and then aborted. There is some doubt she had malaria. Some times the malaria medicine used here is utilized to terminate a pregnancy, not to treat malaria. At any rate, the lady went to the local hospital 2 days ago bleeding badly. The doctors there observed her and did not go ahead with a D&C because they did not have an anesthesiologist. She then became infected, anemic and sick. Suddenly, they transferred her to us. We did the D&C and are giving her IV antibiotics to treat her sepsis.

Then this very cute and bubbly little girl came in with her mother. The girl has had a persistent vaginal discharge and the mother was told the girl has gonorrhea and would likely be sterile. I decided we needed to do an exam under anesthesia since she was only 4 years old. Her exam was okay and we got some specimens to take to Quito for testing. She was so cute. Her name was Janela.

Janela

As the day wore one we had 3 children for surgeries. We decided to do them first since they hadn’t eaten. One lady who had eaten her share of most anything and who was scheduled for a hemorrhoidectomy complained because the little kids were going first. Jane told her we wanted to do the children because they hadn’t eaten for several hours and they were hungry. The lady replied, “But I’m starving too!” Our anesthesologist told the lady that she should be a calendar girl because she was so big! We all got a good laugh over that comment…behind her back of course.

Our patient who had a thyroidectomy didn’t want to go home today, even though she was 2 days post-op and doing very well. Sheila told me she really liked it here because the bed was a real bed with sheets. She said this was probably very luxurious compared to what she most likely lived in at home. She said this lady probably did not even had a bed at home but slept on the floor or ground.

Four of our patients

Jane said part way through the day that it would be the icing on the cake if we got a penetrating injury case. She then said we need to do an appendectomy and a c-section. They were joking at the time. About 6 PM a man came in with a wire driven deep in his thigh. He had been in a hospital in Esmeraldes, the capital city of the province and the doctors referred him to us. They had attempted to remove the wire. Thus, our penetrating injury went to the OR for a couple hours of exploration of the thigh. We couldn’t find the wire. It was a frustrating case. When we were finished and were finally eating our supper, two ladies came to the window asking for help for a 19 year old pregnant girl who was told she needed a c-section. We checked her and determined she was not in labor yet and told them we couldn’t do the c-section. Boy, did the memories come back when I checked this lady to see if she was dilating! I haven’t practiced obstetrics since 1985. Now we are waiting on the appendix!

This afternoon the little boy, Jose, came in to have his nose repair evaluated. The section we sewed on was pinker and looked viable. It had turned totally black and we thought it would likely slough. Jane was very pleased. We plan to see him again tomorrow.

All total we did 28 cases this week. What a challenge! The surgeries we had were all unique and presented specific difficulties and challenges requiring extra care and adaptation to get the job done right. We did some very big cases – things one would not even imagine in this little clinic with such limited facilities and support. Only God would be able to do this. He deserves all the credit.

I have really enjoyed watching Jane work. If I could describe her technique, her touch, her approach to the patient, it would be “gentle.” Jane’s skills are superb. She knows what need to be done. Her methods are always gentle. In surgery she dissects with care leaving tissue whole and uninjured and having very little bleeding. Other surgeons I have worked with would be faster possibly but would be sloppy and destructive leaving behind bleeding, bruised, distorted tissue which makes the healing process more difficult, painful and prolonged with scarring and adhesions a common result. Not so with Jane. Her touch is gentle, respectful of the tissue, accurate and precise. When she closes the incision the tissue is replaced back together with precision and care. Her patients have much less pain post-op because of her gentleness.

When Jane talks with patients it’s like this person was the only one for the day. She smiles, talks with compassion and concern, answers all questions, explains in detail always showing extreme respect for the individual person – respect for a person whom God loves. Jane is gentle. When Jane touches she is gentle. Removing a dressing she peels the tape off very gently causing minimal pain and apologizing the whole time for making any pain or discomfort. She palpates with gentleness. Her whole touch is soft and gentle yet forceful enough to be able to accurately feel the dep mass or organ. She is gentle. When it comes to making a quick decision, such as involved with a trauma case or a sudden situation where one must move fast, Jane is quick, accurate, wastes no time and remains on top of the situation. Yet her every move, her every touch is gentle.

I admire her so much. She is everything one would want in a physician/surgeon. She certainly is what I would want if I were the patient. If I needed surgery I certainly would want Jane to do it. Jane prays with each patient. That, too, is displaying gentleness. Jane exemplifies Christ the physician as she works here in San Lorenzo being His hands of healing to these hurting people.