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9/21/06 (Thursday)

Thursday, September 21, 2006 

The day started again at 6:00 AM.  My night was short only about 5 ½ hours sleep.  These long days and short nights are a challenge to the old bod to keep up.  I don’t know how Jane does this all the time.  She is up at night tending to patients and doesn’t get near the sleep I do.  Fortunately, this pace is only for a week now and then and not all the time.  She has to group her surgeries because anesthesia is not always available.  Thus, she will fill a week’s schedule when she has an anesthesiologist who can come and work with her for the week.   

Our surgeries today involve more hysterectomies and a gall bladder.  Hopefully our day will be a little easier.  Our first case is a lady with cervical cancer on biopsy but she has no visible or palpable disease.  She may have early invasive disease and could be cured of her cancer with just surgery.  Jane will save the uterus for pathology evaluation in Quito to determine if further treatment is needed.  This lady is a little heavy but not like the ones we had earlier this week. 

Lord, I pray for today.  I pray for Your strength to support us physically as we face another long day.  I pray for Your wisdom to make the right decisions and do the right procedures.  I pray for Your knowledge that will give us the ability to recognize and manage problems appropriately.  I pray for Your overwhelming grace to empower us and envelop us as we work here and reach out in Your name to the patients.  Lord, You called me here as You have called Jane.  We are here to serve You and touch people’s lives for You.  I pray for Maria Louisa, Angelita, Jorge, Gonzalo and Nancy as they make up the team that keeps this place in operation.  Please wrap Your loving arms around each of these people and bless them in a special way today.  I also pray for Paul as he works with us providing anesthesia.  Thank You for bringing him here.  Please work in his heart and draw him close to You.  I pray also for Jane as she is pulled so many directions all the time trying to direct the clinic and provide the services.  Thank You for her heart and commitment to the people here and to You.  Please bless her today, Lord.  I pray also for me, Lord.  Give me strength and keep me alert as we work today.  Help me to stand for the day without back spasms.  Lord, keep Jane and I focused and always aware of the exile opportunities that cross our paths.  Satan would be pleased if we falter and fail in this ministry for You.  Please keep him at bay and put a hedge of protection around the clinic walls today.  Thank You, Lord, for your unfailing love.  In Jesus precious name, I pray.   Amen. 

Rounding on our post-op patients involved sending some home and checking in on the others.  The lady with the large cervical fibroid was doing well and we took out her catheter.  She was able to urinate on her own.  She was so excited.  This meant she could now go back to work and support herself.  She worked as a clam digger, a lowly job of harvesting clams from the waters in the mangrove swamps.  This meant she would wade in water all day digging for clams.  If she had a good day she could harvest a large bag of clams for which she would get paid $1.  With the catheter in she was unable to work because the catheter would be dragging in the water.  Getting the catheter out meant a big change for the better for her.  Jane said this lady got trapped by loan sharks.  The need was there for daily living expenses so she turned to a local lender for help.  The lender gave her some money but charged her $4 per day interest.  The lady was doing everything she could to pay the daily interest.  She came to Jane about this and mentioned that since she had the catheter in her ability to make money was gone.  Jane loaned her $30 to pay off her debt and get away from the loan shark and the lady has been paying Jane back little by little.  The successful surgery was huge for her because she now can continue working and can support herself.  

Breakfast came for Jane, Paul and me before our first case.  It was a combination called majado, crumbled baked plantain covered with fried eggs.  It actually tasted pretty good.  Jane said for me to be careful in telling people here what we ate.  The food dish is called majado.  If the word is spelled majada, it means cow manure.  So, if I didn’t carefully pronounce the word and said I had majada for breakfast, I would get some very peculiar stares and probably generate some laughs.  I told Jane I would stick to English and not make a mistake like that.   

2:30 PM.  Our first two cases were for early cervical cancer.  The tumor is probably Stage 1a with no visible lesion but invasive cancer on biopsy.  Both ladies were fairly heavy.  We were able to get their surgeries accomplished without difficulty although it took us from a little after 7 to 1:30 to complete the task.  We stopped for lunch and are now ready to start the rest of the day.  We have another hysterectomy and hernia repair, a gallbladder and a vaginal hysterectomy.  I hope we are finished in good time tonight so we can have a little more time to catch some sleep.   

Jane and I talked with our lady from Tuesday who had more invasive cervical cancer than we thought.  We gave her the diagnosis.  She just shrugged and said, “Okay.”  Jane said here in Ecuador, especially San Lorenzo, there are people who won’t walk on the same side of the street as you if you have cancer.  The cancer victims are treated as outcasts, probably like lepers were treated.  The tough part about the cancer is there is not much treatment available to most people.  Only those who can pay for it will get treatment.  Then the treatment may not be the caliber we are used to in the States.  At least in the States everyone has a chance at medical care even if they can’t afford it at all.  Insurance and welfare will pick up the tab.  Here in Ecuador, money is what determines whether you receive treatment or not.  If you are poor, count on suffering and dieing of your disease for treatment is likely out of your range of affordability. 

10:30 PM.  We are still in the OR getting ready to start our last case.  This lady is getting her gall bladder removed.  Our cases today all took much more time than expected.  The first two were hysterectomies for early cervical cancer.  Those surgeries went well although then took more time because of the extra dissection.  The third case was a lady with a large fibroid and heavy bleeding and an incisional hernia.  We thought this would be a faster case but upon entering the abdomen we ran into extensive adhesions.  It took at least an hour just taking down adhesions so we could find the uterus.  Then we found the uterus to be stuck with adhesions and it was a struggle getting it out.  This case took us 3 hours at least.  Following that was a vaginal hysterectomy that required vaginal reconstruction.  That took a little longer.  Here it is 10:30 PM and we are just now getting ready to do the gall bladder.  We will hopefully be done by midnight.  This day has been much longer than we both anticipated.  This morning we felt we could be done by late afternoon and could have the evening more free to relax a little.  That hope went right out the window!


The large mass is the uterus covered with adhesions. 

12:30 AM.  Finally done for the day!  What a day at that!  This was possibly our hardest day so far.  All the cases had some element of surprise with more complexity than expected.  I am glad to lie down for a few hours and get some sleep.  My feet are all swollen from standing all day.  Hopefully, that will go down through the night. 

Lord, it has been a very tough day.  Yet You were with us through it all.  You protected us from distraction and answered my prayer regarding that.  You protected our patients.  You gave Jane and me the right wisdom and insight to do the right things for our patients.  You helped us through the tough surgeries and gave us strength to carry on in spite of the long hours.  Thank You, Lord, for a great day serving You.  Amen.



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