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9/19/06 (Tuesday)

Tuesday, September 19, 2006 

6:15 AM.  The night was a little short having only about 6 hours of sleep.  I awakened several times in the night because of outside noises and just thinking about today.  The lady with the vaginal prolapse is on my mind trying to figure out what would be the best approach to fixing this.  I don’t want to place her at extra risk, especially from blood loss.  Fixing it from below has the potential of more blood loss.  Going above gives me the ability to know where other structures are, such as ureters.  It will be difficult and complex either way.  I want to sign on to check my email this morning before we head over to the OR to see if any of my partners responded.   

Lord, I pray this morning for an extra measure of your counsel and grace to manage today.  Our surgery schedule is heavy and could be difficult.  We have some tough choices to make today.  I need Your insight and wisdom to know what to do, Lord.  I know You are here with us and are in the OR with us, even standing behind us with Your hand on each of our shoulders as You help us through each case.  Lord, I don’t know what I would do without You.  However, the afternoon cases, the radical hysterectomy and the vaginal prolapse, weigh heavy on me right now.  I pray for these ladies for Your protection and mercy and grace and I pray for Your guidance and protection for Jane and me.  Thank You, Lord, for giving me the comfort and peace that You give just by being here.  We commit this day to You, Lord.  Your Name be praised forever!!  Amen. 

2:40 PM.  Our first three cases went smoothly.  I brought my computer over to the OR so I could check my email to see if any advice came from my partners.  I signed on and received no email from them.  I still feel at peace about approaching this prolapse from above instead of attempting a major vaginal reconstruction.   

Our anesthesiologist has been covering the local hospital in San Lorenzo while working with us.  We didn’t know this.  Today she received several phone calls and then after our third case ran out to do an appendectomy at the local hospital.  We are now left high and dry without an anesthesiologist for who knows how long.  She promised us she would return in about 20 minutes.  It has been over an hour and she has not shown up.  We have two big cases this afternoon, each could take 3 hours.  If we don’t get started soon, we will be here quite late tonight.  Tomorrow, we will have Paul to work with us for the rest of the week.  That will make both Jane and I more comfortable.  Jane is not happy about the situation we are in right now.  It is frustrating.  I thought about how this problem could easily exile us from God right now.  Jane and I talked about it and we both realized that we have to keep our focus on Him and Him only and not let these frustrations exile us from Him.  It just seems we have to learn the hard way on this. 

Another patient showed up to the clinic today having made a 12 hour bus trip to get here for surgery.  Jane and I examined her and she too has a prolapse but not near what the other patient has.  This could be fixed with a vaginal hysterectomy.  So, we put her on for Thursday afternoon.  That will give us 31 cases total.   

Our first big case in the afternoon was a lady with cancer of the cervix.  Jane examined her before and felt she had local disease in the cervix which would be treatable with surgery primarily.  Our anesthesiologist put in a spinal and then left again for the local hospital.  We started the surgery with no one at the head of the table.  Once into the abdomen we found the cancer had spread further than the cervix.  This was encountered after we had the uterus mostly out.  Then we ran into some very troublesome bleeding that took a lot of work to get under control.  I was very worried that we could get into deep trouble and have no way of managing it.  Fortunately, we were able to get the uterus out but we had to leave behind some obvious cancer.  This lady will need to pursue further treatment at the cancer hospital.  Jane said she would refer her to them for radiation treatment.  The big problem here is that medical care is on a cash basis.  If you have the cash, you can get treatment.  No cash, no treatment, regardless of your problem.  This lady is quite poor and likely will not be able to afford treatment.  Jane said she may be able to make arrangements through HCJB to get this lady the treatment she needs.  Otherwise, she will slowly die of her cancer.   

Our anesthesiologist returned after a couple hours while we were still doing the cancer surgery.  This was quite a stressful time because she left us stranded and also the spinal was wearing off and we had no anesthesia to give her.  We did give her some versed to help her relax and just kept working because of the troublesome bleeding.  Jane and I both felt very uncomfortable with this situation.  Jane was angry with the anesthesiologist because she was supposed to be committed to us and she was also working on the side at the local hospital.   

Because we finished with our big cancer case so late in the day I recommended we not start our next case which I felt would take us three hours.  We will do that surgery as our first case tomorrow.  Then we received a lady with acute appendicitis from the local hospital.  She had a ruptured appendix and was quite ill.  She had been in the hospital for a few days for observation and had a classic presentation of appendicitis.  Yet, nothing was done for her.  The surgeon opened her up today and felt she needed a colostomy and just closed her and sent her to us.  We opened her up and found a hot appendix that had ruptured and obvious peritonitis.  After removing the appendix we irrigated the abdomen with three IV bags of saline.  Jane used a phrase that she said she learned from her residency in dealing with contaminated situations from infection, dirt, etc.  That phrase was, “Dilution is the solution to pollution.”  That is so correct.  The liberal irrigation will literally wash out a lot of the infection and leave the belly much cleaner so that antibiotics will work more effectively.  We finished this case about 10:00 PM.  I am really tired and now will be heading to bed for some good sleep. 

Lord, it was a trying day.  There were several events that threatened to exile us from You today.  Some of the time, especially during the surgery on the lady with cancer, that it would have been very easy to forget You were there with us and we become exiled from You.  Jane and I even had to stop and remind ourselves to keep focused on You.  Thank You, Lord, for guiding us through the day.  Please wrap Your loving arms around each of our patients, especially the lady with cancer.  Protect her and heal her, Lord.  The need here is so great and I feel so small in providing for that need.  Yet, You empower us to facilitate healing for Your people.  Thank You, Lord, for the opportunity and even the problems.  I praise Your name tonight!  Amen. 


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