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9/20/06 (Wednesday)

Wednesday, September 20, 2006 

I was up a little before 6 this morning.  Because I had a few minutes before heading out for rounds, I sat down with my Bible and opened it to Psalms.  The page fell open to Psalms 147 so I read this slowly, out loud.  This Psalm meant so much to me right now.  I could understand what the writer was stating because God has delivered us and performed some mighty works right here in San Lorenzo.  This was the beginning of my day… 

Praise the Lord!  For it is good to sing praises to our God; for it is pleasant and praise is becoming.  The Lord builds up Jerusalem; He gathers the outcasts of Israel.  He heals the brokenhearted and binds up their wounds.  He counts the number of the stars; He gives names to all of them.  Great is our Lord, and abundant in strength; His understanding is infinite.  The Lord supports the afflicted; He brings down the wicked to the ground. 

Sing to the Lord with thanksgiving; sing praises to our God on the lyre.  Who covers the heavens with clouds, who provides rain for the earth, who makes grass to grow on the mountains.  He gives to the beast its food, and to the young ravens which cry.  He does not delight in the strength of the horse; he does not take pleasure in the legs of a man.  The Lord favors those who fear Him, those who wait for His lovingkindness. 

Praise the Lord, Jerusalem!  Praise your God, O Zion!  For He has strengthened the bars of your gates; He has blessed your sons within you.  He makes peace in your borders; He satisfies you with the finest of wheat.  He sends forth His command to the earth; His word runs very swiftly.  He gives snow like woo; he scatters frost like ashes.  He casts forth his ice as fragments; who can stand before His cold?  He sends forth His word and melts them; He causes His wind to blow and the waters to flow.  He declares His words to Jacob, His statutes and his ordinances to Israel.  He has not dealt thus with any nation; and for His ordinances, they have not known them.  Praise the Lord!  Psalm 147. 

Our day started at 7:00 AM as Jane and I went to the albergue to see our post-op patients.  We have 10 people recovering from surgery.  Monday’s patients are all going home today so we will fill those beds with today’s patients.  Everyone is doing well, especially the lady with cancer and the lady with the ruptured appendix.  I was worried about them both because of bleeding and really bad peritonitis.  However, the lady with cancer complained only of being hungry.  She is a very large lady and I suppose she doesn’t go hungry very often.  When we finished with surgery, which was under a spinal, she said she was hungry as we were moving her from the OR table to the cart.  Today, she was very serious about her hunger.  The lady with the ruptured appendix looked great today.  She was alert, not having any fever and was not in much pain.  God is taking care of them as usual. 

We have one lady with a large cancer of the cervix scheduled for surgery for Thursday.  Jane and I have talked about this lady and we both wonder if it is wise to attempt surgery here.  I am concerned about getting into more tumor than we feel on exam and then not giving her the best treatment.  She really needs radiation therapy.  Her husband came in this morning and we talked with him about his wife’s problem.  He seemed to grasp it all and wanted to head to Quito tomorrow to get started on the treatment.  Jane talked with Loita and she is making arrangements for them to travel on Sunday and to show up on Monday to her office to get the right paperwork and then they will go to the cancer hospital to be seen.  This takes one very difficult case off our schedule on Thursday and gave us room to move a patient scheduled for today into tomorrow. 

Our first patient today was this little Chachi Indian who has the total vaginal eversion.  She came here by herself and has no family with her.  She has no money and we have been giving her some food.  She just lays there with no smile or expression at all on her face.  That seems to be the way all these Indian women are.  Their expressions are so flat.  It is like they were born to never smile or show any emotion.  Her surgery took us 3 ½ hours to complete.  It was a complex situation but very interesting as we worked through the anatomy and tried to restore it to its original state.  The end result was very good in my estimation.  I think this lady will truly enjoy life without having her insides hanging out all the time.  This is one of the joys of doing this surgery, especially for people like those here.  The impact you have on their lives is immense.  Plus, it gives us an opportunity to witness to them and share the love of God with them.

Our second patient had a fibroid that was in a very unusual place.  It had gotten so big that it pinched off her bladder necessitating the use of a catheter for the past 3 months while she was waiting on me coming to do her surgery.  We had to struggle to extract this mass from the pelvis but we got it done.  Tomorrow, we plan to take out her catheter and hopefully she can urinate on her own.  That will make her life so much better.  Here the living conditions are not nearly as clean as I am used to at home.  There is always dirt everywhere.  People usually walk around barefoot and they generally have no running water to keep themselves clean.  Most of the time they bathe in the river where they also wash clothes and dump sewage.  When you have those living conditions and then add something that needs to stay clean and hopefully sterile, the likelihood of serious infection is high.  This patient had her catheter put in somewhere else and it had been in for at least a month since the last time it was changed.  The catheter was almost black from dirt and stains. 

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Paul is putting in the spinal anesthetic.  

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Hysterectomy in progress.

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The removed uterus.  The body of the uterus is the small part on top.  The cervix was the size of a softball or larger.  It should be smaller than the body of the uterus.

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The cervix completely filled my hand.

The remainder of our day involved three more hysterectomies.  By the time we were finished it was 9:30 PM.  This makes a long time to stand in one position most of the day.  I have some muscles in the middle of my back that start to spasm after standing and leaning over a little all the time.  Tomorrow, our day has 5 big cases once again.  Jane looked at the schedule and realized we are about half way through it at this point.  It is hard to concentrate all your surgery into one short time but it has to be done when anesthesia is available.  Consequently, we work like crazy when the anesthesiologist is here. 

I am able to take my computer into the OR so I can sign on once in awhile to check email.  That makes it fun to check in now and again and get messages from home and family.  I have been able to consult with my former partners on a couple cases.  This makes it nice to get a quick opinion on a medical situation that needs more clarity.   

Lord, Thank You for today.  You were with us throughout the day and we felt it.  Our cases presented us with some challenges but we were able to stay focused on You and not get distracted or exiled from You.  Thank You for caring for our patients and bringing healing to their bodies.  Thank You for allowing us to use the skills You gave us to serve people and help point them to You.  Lord, it is indeed a privilege to be Your servant and to participate in Your love for people everywhere.  Here in San Lorenzo or even in the villages on the rivers these people are one You love and even gave Your life for.  Thank You, Lord, for allowing me to walk with You here in San Lorenzo.  Thank You for Jane and her heart to serve You here full time.  Thank You for Maria Louisa, Angelita, Jorge, Gonzalo, Nancy as they work with Jane and reach out in love to those who walk through the door of the clinic.  Thank You for bringing Paul here to work with us this week.  Lord, Thank You for the miracles You continue to perform as people are healed and events occur that defy explanation.  Lord, Thank You for Your precious Word and how it speaks so clearly to me.  Thank You, Lord Jesus!  Amen.

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