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10/11/08 (Saturday)

5:30 AM.  I awoke before the alarm was to ring so I got up and really woke up when I stepped into the shower.  We have no water heater here so there is just one handle to turn and one temperature of the water.  Thus, when the first splash hits the back and I am finished inhaling, I am thoroughly awake.  Funny how cold water on my back makes me stand on my tiptoes and breathe only one direction – in.  This must be some sort of reflex because it happens every time, even when I know it will happen and I try to suppress it.


Jane and I discussed Maria again last evening.  I told her about waking yesterday to the compelling thought to pray for her.  I prayed for her several times yesterday and even this morning.  Jane said both Maria and her husband are Christians.  Maria has had this lymphedema condition all her life.  Her husband married her and saw her initially as a ticket to an easy life.  Instead of working at a job, he would take Maria places and put her on display.  He then collected money as a beggar would by playing on the sympathy of passers-by.  The money was solely to live on, not to pay for help.  Then when Christ entered the picture in their lives and Maria started receiving care here at the clinic, her husband now has gotten a job and plans to support her in this fashion.  I remember seeing a young man with grotesque deformities of his legs begging in the street in Santo Domingo, Dominican Republic.  He would come up to the gringos, point at his legs and hold his hand out for money.  One of the Dominican workers with our mission project stated that helping these people by providing the care needed to restore them to full health and function essentially “ruins” their life as they see it.  Their living is made by exploiting the problem.  If the problem is resolved, the opportunity to earn a living by begging goes away.  Then one has to find work, get an education, etc, to earn a living.  Healing someone brings on a complete life change at times.  And it may be more of a price to pay than to stay as you are and live in the rut you are in.


Lord, Thank You for the restful night and the new day.  Thank You for the time I have to talk with You and the ability to learn to know You through Your Word.  Thank You for allowing me to walk with You today.  I pray for today, Lord.  I pray for wisdom to make the right decisions.  I pray for stamina.  I pray also for Maria and her husband.  Hold them closely, Lord.  Teach them what they need to know.  Give them hope.  Thank You, Lord, for Phyllis.  Please wrap Your arms of love around her.  Thank You, Lord.  Amen.


7:20 AM.  Breakfast was majada (pronounced mahada), a hot dish of smashed plantain and eggs.  The last time I had this was in Zapallo Grande when Jane told me to be careful how I pronounced the word.  If I changed it to majado I would be telling people I had cow manure for breakfast.  Also, there is the word, mojada, which means wet.  So, if is stuttered and said I had majado mojada, I would be saying I had wet cow manure!  And people think English is a tough language?  I think I will just stick to “it was hot and it tasted good.”  We did have fresh Mora juice to drink.  Mora is a fruit that has a color inbetween a raspberry and blackberry and looks much like these fruits.  It has a unique flavor.  Here the fruit is blended into a smoothie texture and is delicious.  I have to say Mora has become one of my all time favorites in fruit.


At breakfast it was my turn to pray.  I asked Jane if she wanted to translate for me and she said, “No, God speaks any language.  Just say Amen loud so they know you are done.”  So I prayed and emphasized the Amen part.  Our patients are arriving and we will soon start our day in the clinic.


Reading further in Matthew I focused this morning on chapter 23.  Jesus uses some strong words as He puts His finger in the chests of the religious leaders and calls them to task about their leadership as God’s representatives to the people.  He tells them they are fakes; they say one thing and do another.  Because of this practice they have kept the Word of God from the people they are to serve.  He points out their pride and desire to look good in front of people.  He tells them how wrong they are and that they have put their personal interests above God’s.  He points out their inconsistency in their witness.  As I read this chapter I kept seeing myself in the mirror.  How often have I done the same thing – not practiced what I preached?  The more I study God’s Word, the more I see and understand how important authenticity is to God.  He wants followers who are sold out, committed to Him – always – in spite of how difficult that would be.  And I have learned that when you follow that path and life becomes very difficult, that is when God steps in and acts on my faith.  To really see the miraculous works of God I have to take myself out of the picture and depend on Him only.  My walk with God is one of being completely attached and dependent on Him every step of the way.


8:30 AM.  The patients who arrived earlier were here to ask some questions.  The one lady is scheduled for surgery on Thursday and she is fearful because of a previous bad experience.  The problem then was an obstetrical situation where she needed a c-section and the anesthesiologist had difficulty getting a spinal anesthetic to take.  He then put her to sleep.  In the process the baby died and this became a horrible experience for her.  Now, facing another surgery, she is very anxious.  She experienced Jane’s compassion and reassurance.  Jane talked with her for about 30 minutes.  It is so important to remember the human side of medicine.  As a physician, delivering care easily becomes a task list that quickly represents more time than I have available.  Jane described it well.  A surgeon’s view often is that of a hammer and everything that comes in looks like a nail.  It is easy and very tempting to start swinging and hitting because that’s what hammers do to nails.  It is important to understand each nail represents a person who has certain issues, stresses, fears, pressures that shape his or her perspective on that moment.  A surgery becomes a major event, a disruption of plans, a resurrector of past buried fears and pain, a cause of intense anxiety and even dread.  To the surgeon the problem is a task waiting to be checked off, a nail waiting to be hammered.  To the patient the problem can be viewed as the most terrifying, life-threatening moment ever experienced.  This is where compassion is essential and why it is valued deeply by the recipient of health care.  Compassion has probably saved more doctors from malpractice suits than anything else when something goes wrong.  The reverse is true as well.  The lack of compassion has probably generated more malpractice suits than anything else.  Frequently, when I was involved in reviewing a case acting on behalf of an attorney or insurance company or participating in a malpractice panel, I found at the very root the lack of compassion.  It was the doctor’s callous attitude that triggered the process.


Compassion means so much to God.  Christ was a man of compassion.  He railed against the religious leaders because of their lack of compassion.  I believe the core values of any health care worker should include compassion.  It is an essential part of the acts of serving, helping and healing. 


Compassion can become your enemy, so to speak.  It can rob you of your objectivity and paralyze you as you attempt to serve and help.  It is very hard to care for a relative or close friend because the love and close relationship can overwhelm good judgment in providing the right care.  There must be a balance.  But, one must never forget the essential ingredient in serving God and serving others – compassion.


3:00 PM.  One lady came for a colposcopy.  Jane had three women scheduled this morning for colposcopy and possible cervical biopsy because they all had abnormal pap smears.  She also had another lady scheduled to come for evaluation of post-menopausal bleeding and needed an endometrial biopsy.  Only one of the four showed up.  Fortunately, this lady’s exam was normal and we did not have to do any biopsy.  I recommended to Jane to repeat her pap again in 3 to 4 months.  Her pap was minimally abnormal and frequently in this situation the condition that precipitated the abnormality clears and the pap returns to normal.  One eleven year old girl came in for a steroid injection of a keloid scar on her ear lobe.  This girl looked much more mature, closer to age 19 than 11.  The keloid development is a common problem here with the black-skinned Ecuadorians.  Any scar becomes a thick, disfiguring keloid.  The women especially struggle with this because the culture almost demands wearing earrings.  When a woman has her ears pierced for the earrings, all too frequently the site turns into an ugly keloid.  Then the keloid will enlarge into a large, bulbous mass that occupies the earlobe and becomes an unsightly problem.  Sometimes, injecting steroid into the keloid will cause it to reduce some.  It is difficult to manage these because removing the keloid requires an incision which induces another scar and keloid to form.


A man came in to have a lipoma removed from his neck.  This was a small fatty tumor that sat right over the thyroid and was just under the skin.  He would grab it between his fingers and thumb and pull it out from his neck.  A little local anesthesia and a small incision and Jane took out the lipoma without any problem.  Jane closed the incision in her usual fashion with a hidden subcuticular stitch.  This is a preferred closure because it requires no follow up to remove stitches and will heal with a minimal scar if any at all.  Sometimes, in the black skin, the incision becomes almost invisible, especially if the incision line is in a skin fold.  Jane said the people here come in asking for the “laser” surgery she does that doesn’t leave a scar.  Her skin closures look so good and are hardly noticeable and the people here have the rumor going around that Jane does the surgeries with a laser or uses some kind of magic.  Incision closures by other physicians in the area are generally done with large sutures leaving wide scars and the railroad track pattern.  These scars frequently develop into keloids. 


We moved some equipment into the new operating room and even did the colposcopy exam there using the operating room table for better exposure.  I used the candy cane stirrups and they worked wonderfully.  This positioning will really help this week with all the vaginal surgeries we have scheduled.  I had brought with me some light bulbs for the operating room light and Jane and I replaced three bulbs.  This light has 5 bulbs and only two functioned.  When we had all five working, the amount of light was just wonderful.  Before, we struggled at times with the dimmer light making it difficult to see deep in the pelvis.  Now, we should be able to see much better.  Her new OR has room for two tables and this would allow her to have two surgeries going on simultaneously if the situation arose.  The equipment is all stored in cabinets behind glass doors and these cabinets can be stocked from the other side to allow someone working in the sterilization room to stock the shelves without having to come into the OR.  The entire set up is a huge step forward for Jane to be able to provide the quality surgical care she does here.


Esther fixed a huge lunch of fried pork chops, delicious mashed potatoes with lots of butter, green beans and carrots mixed with garlic and then had another fruit drink that was quite tasty.  This fruit is a small firm fruit like a nectarine without a thick rind.  It made a juice that was brown in color but tasted really good.  Again, the juice is made in a blender so the fruit pulp is all in the juice as well.  We all ate much more than we should have and had to take a siesta for an hour or two just to recover.  I then helped Jane see another patient who came in with a bleeding problem.  We did her exam and gave her the prescription she needed and she was on her way.  Now the agenda is to relax and enjoy the rest of the day.


Father, the day has been slow and I have enjoyed that.  Thank You for constantly providing all we need.  Your unfailing love is so reassuring.  Father, I pray for my family right now.  I pray for Phyllis and my children and their children.  Thank You for blessing me so richly.  I pray also for Jane and her team.  She has a team of very dedicated people who are all her for one purpose, to serve You through serving the people of San Lorenzo.  Thank You for them, Father.  Please bless them in a special way today.  I pray also for Maria.  She is continually in my thoughts and I pray for her.  Please bless her and heal her, Lord.  Also, I pray for the people we will be operating on this next week.  Prepare their hearts Lord and comfort them.  Guard them and protect them as they undergo surgery and recover.  Instill Your healing power in them, Lord.  Thank You, Father.  Amen.


Jane told me the church I attended with her before is now meeting in her ministry building.  Apparently, the building the church occupied downtown is being torn down and the church needed a new home.  They have for now moved into the ministry building and hold services on Friday evenings and on Sunday morning.  We will go tomorrow morning and will not have to walk far at all to get to church.  The service starts at 8:30. 


Father, this has been a good day and I praise You for all Your blessings.  Thank You for allowing us to see the patients and develop a schedule to do the surgeries that are needed.  I pray for Your hands to wrap around our hands this next week and for Your wisdom and guidance to prevail.  Please assure the patients that You will be there with them throughout and allow us to share Your grace and mercy with them.  Thank You, Lord for Your unfailing love.  That degree of love is so precious to me.  Thank You for loving me, especially when I deserve none of it.  I praise Your name tonight, Lord.  Amen!


1. Rich and Susie Goodwin - October 12, 2008


Phyl emailed us that you are back in Ecuador. May the Lord bless you with good health and an effective ministry. May He give you wisdom and guide you in your surgery this coming week. We’ll be praying for you and Phyl during the next 2 weeks.

Blessings and Peace

2. Tom Beckner - October 15, 2008

Your story about the fellow in the Dominican Republic reminds me of Christ’s question to the man at the pool at Bethesda. He asked what seemed on the surface to be a silly question–“Do you wish to get well.” The fellow had to make that decision–one that meant he no longer had folks catering to his deficiency. He decided to accept the gift of God and pay the price of being self-sufficient. What a blessing that Maria’s husband has acceoted that notion–and what a change in her life to begin experiencing a healing process instead of being an object/novelty for others to exploit!

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