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10/18/08 (Saturday)

9:00 AM.  Rounds are done, breakfast is over and now we have the day to do whatever.  Last night was interrupted by a serious thunderstorm.  I was awakened in the middle of the night by this very loud clap of thunder.  For a moment I wasn’t sure if there was an explosion nearby or something like that.  The noise was very loud and kept going for a few seconds before quitting.  I kept wondering what happened and thought about thunder.  However, in the previous trips when it rained I noticed that rarely was there any wind involved and I had never seen thunder and lightning.  That isn’t to say it never happens here but so far I have not witnessed it like one would back home.  I asked Jane about thunderstorms and she said rarely one will go through.  Well, last night one went through.  This thunder was really loud.  Once I was awake I realized it was raining.  Then a little while later there was this very bright flash of lightning followed in a few seconds by another thunderous boom.  Following that there were a few more episodes of thunder and lightning.  The rain was coming down fairly hard and it continued through the night.  This morning everything was wet and there were big puddles of water everywhere.  I recall Jane stating this is the dry season when rain is infrequent.  The past week we have had rain on several occasions, usually at night.  A couple days were gray and cloudy all day looking like rain would soon happen.  This has kept the temperature cooler but the humidity obviously is up. 


Jane and I planned to meet at 7 to start rounds and then would eat breakfast afterward.  As we were gathering up our equipment, we noticed one of our patients walking out of the clinic and climbing into a taxi.  She was going home and we had not had the opportunity to see her yet.  We talked to her yesterday and told her she could go home then but later she decided she wanted to stay the night.  So, she left this morning before we had a chance to see her and send her on her way.  I jokingly asked Jane if this was a case of leaving AMA (against medical advice).  Our rounds went quickly.  Everyone else went home except one man who had a hernia repair yesterday.  He asked if he could stay overnight and go tomorrow because he came from a long distance.  We asked him where he lived and he said in the province of Bolivar.  Jane said that is a long distance from San Lorenzo.  I looked on the map I have and Bolivar is quite a distance south of Quito.  Quito is a 5 hour trip via car from San Lorenzo and would be a lot longer taking a bus.  Then traveling on to Bolivar would probably be another very long journey by bus from Quito.  Jane asked him how he learned about her clinic and why he came from that great of a distance to have this surgery.  He said he had been working in San Lorenzo for awhile and that is how he learned about the clinic.  Therefore, when he needed surgery, he made the effort to travel to receive treatment from Jane.  His wife is here with him so they are the only ones staying for the night.  I watched his wife out doing laundry at the cement sink out in the yard and hanging up her clothes.  Jane said she would like to get a map of Ecuador and frame it for on the wall and then put pins on the locations from where patients come to receive care at the clinic.  She commonly sees patients from Esmeraldas, the capital of the province of Esmeraldas.  This province is the northern corner of the country where San Lorenzo is.  Esmeraldas is a several hour trip by bus from San Lorenzo.  We also have seen people from Guayaquil, a large city located way south, even further south than the province of Bolivar.  I think it would be interesting to visually see on a map the locations from where the patients come to the clinic.  I suspect Jane’s outreach is far wider than what one would expect.  The travel for most of the people here is by public transportation, mainly bus.  This type of travel takes a long time, several hours, because of the frequent starts and stops along the way.  I can’t imagine the time and trouble people deal with just to receive care at Jane’s clinic.  I remember on previous time I have been here seeing people traveling by bus several hours to come to see us just to ask a medical question.  One evening we had a lady come from Ibarra, traveled by bus several hours arriving late in the evening just to ask a question about menopause.  She did not need treatment.  She only wanted to obtain some information.  Once I answered her question she thanked us and went out to the front of the clinic and boarded the next bus heading back to Ibarra. 


Jane and I had a good conversation during breakfast about evaluating opportunity wisely.  We look at the changes life brings and some are opportunities and some are threats.  How we approach these is very important in setting the course for the future.  I look at my own life and the magic age of 65 just around the corner, thinking about retirement, and wondering just how am I going to approach this stage.  I want to remain healthy, I want to do some of the things I have thought about for years but never had the opportunity, I want to continue being productive and I want to make a difference in other people’s lives.  How do I balance all of those?  There are some choices that seem to work against each other.  It seems the adage “you can’t have your cake and eat it too” comes into play.  The same concept occurs when you look at an organization and its strategic planning.  Opportunities are there along with threats.  How does the organization respond to these?  And one can look at ministry like Jane’s clinic.  What opportunities are here to explore and what threats are always lurking waiting to trip up and even destroy progress?  How much growth should Jane plan on and how quickly?  I can see where building things too quickly may look really good on the surface but have we just build a house of cards that could easily come tumbling down with one small tremor?  We didn’t answer any of these questions in our conversation but it did get us to thinking.  This is probably a good exercise for everyone to do personally as each day comes along, or each year, or as major life events appear on the horizon.  As I face the change brought on by retirement, I need to look at the whole picture and determine just what will be my response to this life event.  I need to have a plan and I need to think through this plan very carefully.  The decisions I make cannot be reversed easily.  I also won’t have the time to make up a loss because of a mistake in judgment.  Phyllis has told me repeatedly that when I retire I am not welcome to go to the grocery with her every time she goes.  She said she sees other men retire and then become totally bored because they have nothing to do.  They then follow their wives around all day and literally drive them nuts.  I likewise saw this in my practice.  I had patients come in for regular exams with their husband in tow.  Then, in the privacy of the exam room when the husband was out in the waiting room, the patient would unload on me how the husband is bored and has nothing to do and how this is creating major stress inside the home for her.  I certainly don’t want to do that.  When I stopped active practice I had a patient tell me that I wasn’t retired, I was remantled.  She had been reading Scripture about Elijah and Elisha and how Elijah had taken his mantle and put it across the shoulders of Elisha as a symbol of releasing Elisha to his own ministry as a prophet of God.  Elisha, through this act of placing the mantle on his shoulder, was at a major life event.  His life was forever changed at that moment.  His mentor would soon be gone.  He was now on his own continuing the work God had called him to do.  I see retirement being very similar.  This is a time of life when the mantle is changed and I now have a new direction, a new plan, a new occupation, a new ministry.  It is not just sitting and soaking and having basically nothing to do.


I have been thinking about Beatriz frequently and praying for her.  Jane and I prayed for her this morning.  We are wondering what is happening to her pain.  She was going to board the bus and travel to Borbon, about a 2 hour trip, to get an ultrasound today.  There is a local doctor who performs ultrasounds here in San Lorenzo.  He does a good job; however, he does not work weekends and thus this resource is not available for Beatriz.  To get the test she must travel to Borbon.  That will be at least a couple hours by bus over bumpy road just to get the ultrasound and then return with that study so we can see her again.  All this travel while still having severe left pelvic pain!  Just the act of walking is very painful for her.  I can’t imagine what discomfort she will experience riding the bus.  Yet, this is life here.  This is reality here.  The people put up with these “inconveniences” because this is all they have and know.  They live with pain daily and deal with it.  They tolerate pain very well.  We had one lady who went home today, the one we had to take back to the OR to explore her incision, and she told us she used only one pain pill since surgery.  Just one!  And she was comfortable.  Obviously, getting up from bed was painful for her but only temporary.  Once up she walked without problems and seemed to get along fine.  She said the pain was only “piquito”, very small, and not a bother.  This pain was not enough to require a pain pill.  I think of the people in the US and how giving just one pain tablet post op would be considered malpractice.  The difference in the attitudes toward life’s difficulties is remarkable. 


Father, thank You for the rain last night and the refreshment You bring to Your world with the rain.  Thank You for the restful night and the refreshment that brings to us.  Lord, especially, thank You for the healing power You instill in the patients.  To see them up and about so quickly and leaving our clinic just one day to two days post-op is remarkable.  Lord, I pray for Beatriz.  Please cup her in Your hands and hold her close.  Help her, Lord.  Whatever is causing the pain, take that away, Lord.  I don’t know what we can do here for her except to pray for her.  Please, Lord, touch her and heal her.  Thank You, Father.  Amen.


12:45 PM.  Our morning has slipped by without doing much.  I took some laundry over to the clinic building to wash before packing for my trip home.  The washer was full of wet sheets and drapes and the dryer was also stuffed very full of wet sheets and drapes.  There were two large laundry tubs on the floor both full of wet sheets and drapes.  So, before I do my laundry, Jane and I are working on drying the sheets and drapes as they will mildew if not.  Likewise, Jane would like to take them back with her to Quito so they can be folded, packed and sterilized.  So we have been making trips back to the laundry room about every hour to switch out the stuff in the dryer.  Eventually, I will get to my clothes. 


I got a chance to walk next door to a Porta phone cabin and call home.  I talked with Phyllis for about 9 minutes and it was good to hear her voice.  We had a good conversation.  She told me about what was happening in Fort Wayne and also told me about Shelly and Darcy dealing with sick kids.  It seems every time they get together to let the cousins have fun playing with each other, the kids all get sick.  This time is no different.    I then called my daughters Shelly and Darcy in Charleston because they are together this weekend and all the kids are getting sick.  Darcy’s daughter has a fever and a very stiff and sore neck.  Shelly urged Darcy to talk with the pediatrician about Abby.  Abby was then seen in the emergency room and strep was diagnosed.  Shelly said now all the kids will likely come down with strep.  Shelly was worried about something more intense such as an abcess in a tonsil or meningitis.  The cost to call home was a little under 50 cents per minute.  It is cheaper in town but the convenience of walking next door is worth the extra charge. 


3:45 PM.  We have been working over in the operating room taking inventory so Jane can replenish her supplies.  She has everything listed in an Excel spreadsheet on her computer so doing the inventory is well organized.  With two of us counting, the process went along smoothly.  During this time we were doing laundry.  Periodically, the circuit breaker to the washer would trip and if we didn’t check it regularly, the laundry would still be sitting in a washer full of water.  We have been drying the sheets and still have several loads to do.  Jane said with them sitting there wet they are about a half hour away from mildew.  We will continue drying them and folding them so she can take them back to Quito for final folding and sterilization. 


We have not heard from Beatriz today.  This concerns me as to how she is doing.  I suspect she either has not returned from Borbon with her ultrasound or she is feeling enough better to not check in with us.  We have not seen her out at all today.  Father, please protect her and take away her pain.  Thank You, Lord.


6:30 PM.  Jane fixed some boiled chicken for dinner and it was quite tasty.  She also fried some plantain, which was very good.  We plan to have some popcorn later.  We went over to check on the laundry and the circuit had tripped again with the clothes in the washer not spun and the dryer still running but cold.  As we studied the circuit breaker box, I realized that the electrician had wired the laundry room running the 220 volt line for the dryer and the 110 volt line for the washer off the same circuit breaker.  Jane said the circuit breaker trips a lot when the ladies are doing the laundry.  What I believe is happening is the dryer and the washer pull too much current for the 110 breaker.  Thus it flips off leaving the washer dead and the heating element to the dryer cold.  The dryer motor must be running off the other line coming in to make the other half of the 220 volt line.  I don’t know why the electrician would have wired these two together in the same circuit.  I would think the 220 line to the dryer should be a completely separate circuit than the 110 line to the washer.  With the 220 line in the operating room floor that wasn’t properly grounded and now finding this, we wonder just how much the electrician knew about wiring.  Now we have the dryer running without the washer on so my second load of laundry should be getting dry sometime soon. 


Tonight, Jane has some questions she wants to review with me about the clinic building.  Alex, the man who comes from Quito and works for HCJB, is her handy man who comes periodically to fix things and help install plumbing, electrical equipment, and other things.  Alex wrote Jane some questions on email for her to answer so he can get a better idea of what he needs to bring with him next time.  Jane wants me to review this list and help her answer the questions.  Then it will be time for bed.  Tomorrow is church at 8:30 and also we have one patient to see and release in the morning.  Then the rest of the day will be a lot like today, just talking and reading.


Father, thank You for the restful day.  I pray for Beatriz and hope that she is better.  She has not returned to see us and we don’t see her across the street.  Please comfort her and help her.  Thank You for Your unfailing love that You shower on us continually.  Lord, we many times don’t pay attention to that or even acknowledge it, yet You faithfully provide unending love to us.  Lord, forgive us when we fail You in this way.  Forgive us when we purposely sin against You.  Lord, forgive us for forgetting to honor and glorify You.  Father, Your mercy and grace are overwhelming.  Thank You for continually providing everything we need every minute of the day.  Father, I pray for a good rest tonight.  Thank You, Lord.  Amen.



1. Tom Beckner - October 23, 2008

I loved your mantle illustration! I can also identify with your retirement musings, and I see this adjustment falling in the “opportunities” category. God has wonderful ways for us to serve in this new part of life’s journey if we allow Him to lead.

Have a blessed day!

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