10/17/08 (Friday)
5:30 AM. It was a short night. Last evening Jane checked on our post-op patients and the last patient of the day was bleeding from her incision. This is not unusual to see some ooze; however, this was more watery and more abundant. The first thought is that the incision is separating and the fluid is coming from inside the abdomen. We talked about this and felt we needed to explore the incision to make sure the closure was intact. The last thing we need is to have the incision totally open up with the patient somewhere else than the operating room. So we took her back to the operating room and opened the incision only to find one small vessel that had been previously cauterized now bleeding. Once that was controlled, we found nothing else. The closure of the fascia was intact and we could not understand where all this watery fluid was coming from. We inspected the entire area carefully and found it all to be intact with no failure of the sutures that had been previously placed. So we closed the incision and took her back to the recovery unit. At least we feel better now about the situation and won’t have to worry about her incision opening up. Then I was able to get in bed at 11:30 PM. So, when rise and shine time came at 5:00, I really didn’t want to rise nor shine. However, the cold shower changed my attitude very quickly.
Jane and I will start rounds shortly as we have several people to see. We need to take out several catheters and hopefully all the patients will have normal bladder function. Then they will be heading home. Our 80-year-old lady from Wednesday looked really good yesterday. With all the surgery to correct her anatomy, her bladder may take awhile to function properly. The first step to learn this is to try the catheter out today and see how she does. I really hate to send people home with a catheter in place unless I know they will be able to take care of it appropriately. One lady went home yesterday morning but returned because she could not urinate even though she did here before leaving. We had to anchor a Foley catheter and leave it for a couple days. She caught on quickly on how to manage it and only lives a few kilometers from the clinic. We will have her remove it on Sunday and to call us afterward to report how her bladder is working. If there is any question, we can see her then to determine what to do.
Father, we start another new day You have given us. Lord, You provide so much to us. The air we breathe, the sights we see around us, the food we eat, the day to day experiences of life are all from You, Lord. Thank You for making Yourself visible to me right now. Especially Lord, I see You in the healing processes when I have the privilege to monitor the recovery from surgery. Lord, this process is incredible and it is all from You. Thank You, Lord, for all the provisions You deliver faithfully to us. I am humbled and ashamed that I don’t acknowledge Your faithfulness in my life more often. Father, I pray for our patients. Please attend those in the Albergue as they recover from their surgeries. Protect them from infection and complications, Lord. Touch them with Your healing touch and especially, Lord, make them aware of Your incredible unfailing love. Lord, I am overwhelmed by that love. Thank You, Lord, for how You wrapped Your hands around our hands to guide us in the operating room. Thank You, Lord, for preparing the hearts of those patients who accepted You as Lord and Savior of their lives. Lord, we have witnessed physical and spiritual healing. This in such a joy for me. Lord, I pray for our day today. Guide us again in the operating room and protect the patients coming in. Lord, today we tend to children, precious ones who have a special place in Your heart as they do ours. Please protect them, Father. Thank You, Father, for allowing me to come here to San Lorenzo to serve You. Thank You for the privilege to have another day to live for You, to serve You through serving others. Thank You, Father! Amen.
Today, Mark will leave after breakfast to head back to Quito and on to Shell. He is taking Damarys, Loida and Esther with him to give them a way back to Quito. That way Jane can keep her car here and then someone will not have to travel from Quito to pick us up on Monday. In the middle of the night, about 3:30, I was awakened by someone knocking on my window. In the dark I could see two heads at my window and then some masculine voices in Spanish. They then left. What I learned this morning was these were two men who were with a couple patients and they had some questions about the patients. Loida awoke at this time as she was at the next window and directed the men around the building to Jane’s window.
7:45 AM. Mark, Damarys, Loida and Esther are getting ready to leave for Quito. We said our good-byes and once we return to Quito we will see Damarys again. I pray for a safe trip for them. Jane and I will soon start our day in the operating room. Prior to starting our surgeries, one of the family members of a couple of our patients wanted us to check her. She has been having some stress incontinence and she wanted evaluated. We brought her in to the pre-op area and examined her. She has some changes but I feel Kegel exercises would be helpful at this stage. Jane explained these to her and she will do the exercises for a few months. Someday she will probably need surgical repair to gain better bladder control.
Our surgery schedule for the day:
The first patient is a 4-year-old boy with phimosis and needs a circumcision. I did not scrub in on this surgery as Jane only needed one assistant and Angelita filled this role. This allowed me a little time to sit and pass some time. Although, with the short night, I had to fight off the strong temptation to close my eyes and take a quick nap. I didn’t want to fall off the stool and make a big scene in the OR.
The second and third patients were sisters with an umbilical hernias. They live in Lita and when we stopped there on the way to San Lorenzo, Jane talked to the mother and examined the girls. They were scheduled for surgery today. Damarys called from Lita on their way to Quito and learned that the mother had had an accident with an injury. Therefore, she would not be bringing her daughters to San Lorenzo for the hernia surgeries at this time. So our schedule jumped forward to our fourth scheduled surgery for the day.
The fourth patient is a 60-year-old man with a left inguinal hernia. We saw him last week in the clinic. He will be given a spinal anesthetic. I assisted Jane with this surgery. She did a very nice dissection of the left inguinal canal and repaired the hernia covering the defect with surgical mesh.
The fifth patient is a 58-year-old man with a left inguinal hernia. This hernia dissection was almost like the previous one with the same anatomy. Both even had a lipoma in the hernia as well.
The sixth patient is a 21-year-old girl with an umbilical hernia. This patient cancelled her surgery. Thus, we are breaking for lunch and Vivianna is leaving to return home. Our last two patients are scheduled with local anesthesia. Nancy fixed lunch for us and served us fried fish over rice. Several of our patients went home today leaving only a few that will stay overnight. It is likely we will send them all home tomorrow, or at least on Sunday.
The seventh patient is a 19 year-old girl with a left breast mass. Jane feels this is a fibroadenoma. She did obtain an ultrasound of the breast to confirm the mass and the interpretation also was a fibroadenoma. Under local anesthesia, Jane dissected the fibroadenoma out and it was larger than it felt on initial exam. The mass was the size of my thumb to the first knuckle. There was very little bleeding.
The eighth patient is 31 and has a left Bartholin cyst that is not infected but causes her some pain, especially when sitting. We plan to open this to drain it and marsupialize it to keep it from recurring. This procedure involves stitching the cyst lining to the skin edge so the cyst heals open. This will keep it from redeveloping. Jane opened the cystic gland and marsupialized the cyst lining out to the mucosa without difficulty. This should heal open so the cyst will not recur.
Our surgeries are finished. We did 22 surgeries all together. This is a little less than previous times I have been here. Interestingly, the patient problems were different compared to previous trips. Several of our patients went home today, even the 80 year-old lady who was so frail. Her catheter came out and she had normal bladder function right away. I expected her to have some problems because we changed her anatomy so significantly compared to what she had been used to. At times even putting the bladder back to its normal position will result in urinary difficulties initially until the bladder is retrained.
Today, my legs became more swollen and they hurt most of the day in spite of naproxen and Excedrin. At lunch Maria came in and sat beside me. I was ashamed of my concern about my swollen legs when I realized that Maria has way more of a problem than I have. Also, she must live with her condition continually whereas mine is merely temporary. I have nothing to complain about. I went with Jane to take Maria Luisa, Angelita and Maria home. Again, I see the homes and the living conditions that are normal for this area and I wonder why I even bother to complain when my comfortable home is too hot or too cold or some other inconvenience is present. If for no other reason, it is good that I become exposed to a different world, a different culture, different living conditions so I appreciate all the more the blessings God has bestowed on me.
Lord, thank You for a good week. We were able to help many people and even watched several people learn to know You for the first time. It was extra special to see and even be part of the harvest of souls into Your kingdom. Thank You, Lord, for leading these people to You. Thank You for the team here. They remain ever vigilant for an opportunity to share the Good News about You and the price You paid so that we all can live forever in Your presence. Thank You, Lord, for the example they give me. Thank You, so much! Lord, I am ashamed of myself for dwelling on my swollen legs when I see Maria and the life-long problem she must deal with. Please bless her, Lord. Please heal her, Lord. Her attitude is so good. She radiates joy and hope and I believe that is because she depends on You. Lord, she teaches me so much. Please bless her. Lord, also bless in a special way Maria Luisa, Angelita, Jorge, Gonzalo and Nancy. Likewise, bless Damarys, Loida, and Esther. They are so supportive of the ministry here. Especially, Lord, bless Jane. She is giving her heart to this community and to serving You through serving the people here in San Lorenzo. Thank You for her. She is such an inspiration to me. Lord, please bless my family. I love them so and am so proud of them. Bless Phyllis, please. I love her so much and I thank You for bringing us together. Thank You, Lord, for this past week of surgery. Thank You for the opportunity to come here and serve You. I praise You! Amen.
8:00 PM. A knock at the window and I heard a voice talking to me in Spanish. Jane was over in the albergue tending to a couple post-op patients and I was sitting in the house working on this blog. The person talking was a neighbor, Beatriz, on whom I had operated in 2004. She had a very bad invasive cancer of the cervix and we did a hysterectomy just to keep her from bleeding to death. I did somewhat of a radical hysterectomy but in no way adequately treated her surgically for invasive cancer of the cervix. However, every year I come back I see her across the street and she remains healthy. Earlier this week I mentioned to Jane that I would love to examine her again just to see the result of our surgery, now 4 1/2 years later. Tonight, that opportunity came. She was having severe pain in her lower abdomen. The pain began rather quickly earlier today and it was associated with urinary symptoms suggestive of a kidney infection. We took her to the clinic and examined her. She has a mass in her left pelvis, most likely ovary, that is very tender. I wonder if she either ovulated and bled into the ovary or possibly twisted the ovary. She also was very tender over the left kidney and she had findings suggestive of a kidney infection or possibly a kidney stone. We gave her an antibiotic and pain pills and asked her to obtain an ultrasound in the morning and then come back to see us. Unfortunately, if she needs surgery, we have no way of doing that here now that our anesthesiologist is gone. Her exam did bring me great relief in that I saw absolutely no evidence of any cancer. To me she is probably cured of her cervical cancer. I told Jane that she is a miracle before our eyes. She should not have been cured with just the surgery we did on her in 2004. Yet, here she is almost 5 years out with what appears to be a complete cure. Thank You, Lord, for this great encouragement and for performing a miracle before our very eyes. Please be with Beatriz tonight and ease her pain. Lord, please help us as we work with her tomorrow. Give us wisdom to know what to do. Please comfort her tonight. Thank You, Lord. Amen.
Medical Missions 
I prayed this morning for your physical stamina.