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9/25/06 (Monday)

Monday, September 25, 2006 

5:45 AM.  My internal clock just keeps on ticking in spite of my intentions to sleep in a little.  It is amazing.  I wake up about this time every morning regardless of how much sleep I had.  Sleeping in is unusual anymore.  Earlier I was awakened by the loss of our power.  My fan went off and suddenly the room was very quiet.  The low constant noise of the fan running was absent.  The silence woke me up.  I then fell back to sleep but didn’t sleep well.  Then I started thinking about Maryuri and the problems with internal bleeding and the possibility of a retained lap sponge.  Jane and I have gone over her surgery multiple times talking through all the steps we took in removing the fibroids and the use and placement of lap sponges.  In this situation, neither of us remembers putting a sponge inside the abdomen because we could bring the uterus out of the abdomen and expose it totally.  I wrapped a couple sponges around the base of the uterus to trap any bleeding from the myomectomy so the blood would not go into the abdominal cavity.  Those sponges we remember removing.  However, the nagging reality is we were possibly one sponge short on the final count.  There is still the possibility that we only had 9 sponges to start with.  Here we cannot totally count on the correct number of sponges per pack.  Yet, we have to assume that we started with 10 and retrieved only 9.  We have not told Maryuri yet about this because we explored her belly when we closed and then reopened the incision before we were completely done to re-explore the belly.  Both of us explored the belly and could not find the sponge.  We did not want to introduce the idea and create a lot of confusion and misunderstanding on the part of Maryuri and the family.  Maryuri appears to be an educated woman and I feel if approached correctly would understand.  She has done so well post-op that we feel there is no sponge in the abdomen.  Having a foreign body there, especially a sponge, would interfere with bowel function return and would cause other problems that we would have seen by now.  Her post-op progress has been such that we feel the belly is okay.  Yet, I am persistently nagged by the uncertainty of where that missing sponge is.  If there is one in the abdomen, she would have continual pain and could even develop more problems, such as infection and abcess as well as bowel obstruction.  Essentially, she would get sicker instead of better.  I feel God has been speaking to me this morning about being honest with Maryuri.  There is this persistent pressure to be honest with her and tell her that we are concerned about a missing sponge.  If she were under my care I would be seeing her weekly for a while and looking for signs and symptoms that would suggest a problem and then re-explore the belly if needed.  Maryuri’s condition was such that returning to the OR would have been very risky.  I feel this could be more easily done in a few weeks instead of now since she is doing so well.  If she recovers but has persistent pain in one area, I would explore.  The difficulty here is there is no x-ray that would give guidance.  Even if an x-ray was available and even if we saw a sponge on the film, I would probably wait until Maryuri recovers more before taking her back to surgery.   

Lord, thank You for awakening me and prodding me with what needs to be done with Maryuri.  We need to explain to her the situation and the possibilities involved.  We need to not come across appearing like we are trying to cover something up.  Integrity is on the line here and I don’t want to give that away.  Lord, please help us as we try to explain this to Maryuri.  Give her an understanding spirit so she can be a partner in her care.  Thank You, Lord. 

6:00 AM.  The power just came on!  Now I can see and get up and get ready for the day.  I had turned on the computer because the screen gave enough light to be able to see to go to the bathroom and sit on my bed and work on today’s thoughts.  Now it is time to get ready for the day. 

I talked with Jane about my concerns with the missing sponge.  She agreed that integrity is utmost importance but she also didn’t want to introduce a new problem.  After discussing this we felt it best to follow up with Maryuri in a week when Jane returns to San Lorenzo and see if she is having problems.  Jane would then get an x-ray or if she is having more pain would then consider taking her back to surgery to explore the abdomen.   

We then went to the albergue and saw all the patients.  Maryuri was doing great and she was soon on her way home.  She will return in one week to see Jane and continue the follow up.  Jane explained to her that she had internal bleeding and the chance for infection is higher than normal thus requiring close monitoring.  Jane told her to come back or call if any problems develop.  The other patients were doing very well and were ready to go home.  The Chachi Indian wasn’t moving well and preferred to remain laying on the hard bed.  We encouraged her to get up and move around.  She wants to stay another day before heading back to Borbon and on to her village.  The husband later saw us packing the car and he came over to see if we would take him and his wife to Borbon.  Jane told him we weren’t going that direction.  Corina looked better this morning.  She was still running a fast heart beat and her blood pressure was in the 110/70 range.  She was still breathing somewhat fast.  Her urine output was better and she could sit up without dizziness.  The family was happy she was making some progress.  We likewise felt she was making progress but still could not find a reason for the tachycardia and tachypnea.  We planned to keep her through the day and let her go home in the morning if she was still doing okay.   


Before we left I gathered all the team for a group photo.  The Chachi Indian in the yellow shirt was standing in the area and when he saw we were taking a picture, he came over and jumped right in.  He did not understand what was going on and he wanted his picture taken.  Everyone was laughing so much about this but he just stood as proud as can be.    

We then packed the car and headed out to go to Otavalo for some shopping on our way to Quito.  About an hour or so on the road and suddenly the car started making a loud grinding/squealing noise.  We stopped the car and shut off the engine and looked under the hood.  I saw nothing amiss.  Jane was praying like crazy because this stretch of the road is somewhat dangerous.  There is no cell phone coverage and we were totally alone on the road.  Jane said you could trust no one out here.  We then started the car and it seemed to run okay.  We started out again only to have the noise occur again and louder.  We stopped and shut off the engine and I looked again under the hood.  I asked Jane to start the car so I could see where the noise was coming from.  When she started it the fan belt flew off.  There we were with no fan belt and out in the middle of nowhere.  Jane said there was a rest stop not too far ahead and she knew the lady who lived there.  We decided to run the car a little and see if we could at least get to the rest stop.  We moved ahead slowly running on the battery and watching the temperature gauge.  Around the next turn we saw the first sign for the rest stop.  It was about a half kilometer ahead.  We moved on up and pulled in.   

At the rest stop Jane explained the situation to the lady and she got her husband to come and look at the car.  He found the one pulley wheel holding the fan belt had lost its bearings and was immobile.  This was likely the cause of the grinding noise.  The fan belt has been worn though as the wheel did not turn.  He took the pulley off and put it in a sack along with the fan belt and recommended we grab a bus and go to Ibarra and get another pulley and fan belt.  We would then bring the bus back to his place and he would put the belt and pulley back on and we would be on our way.  Ibarra was 2 to 3 hours away plus Jane said she had no idea where to go there to get the parts we needed.   

Jane felt we could take the bus to Lita, a small community about 20 km up the road.  Cell phones worked there and Jane could call Damarys to see what she could do.  Usually, when Jane travels this road she text messages her location to Damarys so Damarys can keep up with her progress.  She said Damarys would already be worried because we were an hour or so beyond our time we should have been in Lita.  When we arrived in Lita Jane’s cell phone signaled a text message and it was from Damarys indicating she was worried about us because Jane had not checked in.  Jane called her and told her about the situation and Damarys and Loita were immediately on their way to pick us up.  Loita was going to get her husband’s pickup truck which is a quad cab and could hold the four of us plus all our luggage and packs of drapes in the bed.  They were on their way and it would take about 3 hours or so to get to Lita.   Jane said we will just have a very casual lunch at one restaurant and spend an hour or so and then stroll through town to the other end where we will sit in another restaurant and have something to eat there.  We had lunch which consisted of a large bowl of soup and a full plate of chicken, beans and rice.  It was pretty good.  We made it stretch out for an hour and a half as we sat and talked and killed time.  Then we walked through Lita and found a phone cabin.  Jane then called home to her parents and told them what was happening.  I then called Phyl and told her.   

While we were walking Jane received a distressing call from the clinic.  She had just phoned the clinic and talked with Angelita and explained our situation to her.  Maria Luisa called back a few minutes later to report that Corina had an episode of vomiting a massive amount of blood and then collapsed and died.  The general medical doctor was there and intubated her and did CPR but she did not respond.  When we were in making rounds on her we had her sitting up and one daughter took our picture with Corina with her cell phone.  Now we learn that she suddenly died.  Jane was just sick about this as the family will blame the surgery for her death.  We figured from the vomiting of blood that she may have had a stress ulcer that bled.  She may also have had some cardiac event that made her have a fast pulse and breathing fast.  We had asked her this morning if she felt short of breath and she said she was comfortable and did not feel any distress at all.  The doctor then called Jane and explained the situation in more detail and he recommended getting an autopsy so the cause of death could be determined.  He felt this would help the family understand the problem better and would see that the surgery was not related to this.  Her surgery was one of the easiest we had all week.  This news really saddened us.  Jane said this was the second death in the history of the clinic.  The other death occurred several years ago when an older person had cataract surgery.   

Lord, I don’t understand this tragedy.  Why did it have to occur?  Yet, I know and believe that You are in charge.  Jane tells me Corina was a Christian and I am glad about that.  She is now in Your arms and enjoying the bliss of being in heaven with You.  Lord, I pray for the family.  They saw their mother die and probably feel it was unnecessary.  I don’t understand what happened to bring on this death.  Yet, Your timing is always perfect even when we may not grasp that.  Lord, please come close to the family and encourage them and comfort them at this time.  They are hurting and need Your peace and hope.  Lord, please be with Jane and the clinic crew.  This death will affect them all.  Please encourage them as well.  Thank You, Lord, for Corina and her trust in you.  Thank You.  Amen. 

We walked on to the other end of town and sat down at another restaurant.  Again, we ordered lunch because it would be impolite to not do that.  I told Jane it had been a long time since I spent all afternoon eating.  It seemed like a progressive dinner.  We spent another hour or so there and then Damarys and Loita arrived.  We then went back to the rest stop and unloaded the car and loaded the pickup truck.  It was raining a little and Jane did have a piece of plastic in the car so we could cover the luggage and drape packs.  It was now 5:00 PM and we headed out to Quito.   

The family at the rest stop was very nice.  They had Jane park the car off to the side and they said they would make sure it stays safe.  I told Jane they were angels in disguise.  We had our car problem right near their place when it could have been way out where we would have been very vulnerable.  We have our parts we need to replace.  Jane will get them in Quito and then return with Damarys on Wednesday.  The man will install them and Jane can be on her way back to Quito.  Our day of shopping in Otavalo did not occur.  God had other plans for us and all we could do was trust Him in this.   

10:00 PM.  We are finally in Quito.  I am staying in the HCJB Guest House and this is very comfortable.  Jane, Damarys and Loita are taking me to Otavalo tomorrow for some shopping.  That will be a fun time.  We were planning on going to the Nunnerys to see hummingbirds and talk with them about Barbara’s ultrasound.  When Jane talked with them Tony had said if we didn’t make it on Tuesday, they would understand.  Jane said she will visit them soon.  She said she may be able to get the ultrasound from the clinic here.  I told her to try to take some pictures of the scan and email them to me and I’ll send back my thoughts so she can share them with Tony and Barbara.   

Father, today was a day of unexpected happenings.  First, the car breaks down in an area that was not safe.  Jane was heartsick and worried.  Yet, You provided for us.  Why did the fan belt break close to the rest stop?  I feel You were in charge of that detail.  We could have been farther away and been very vulnerable.  Father, thank You for taking care of us today.  Thank You for the family at the rest stop and how generous they were.  Thank You for them keeping Jane’s car safe and secure for her.  They truly were angels sent by You to care for us.  Father, then we are heartsick over the death of Corina.  This happened when we were unable to be there to help care for her.  Death is so hard to understand with our finite minds.  Yet, I firmly believe You were in charge of that detail as well.  Corina is now with You…forever.  I pray for her family for they are now experiencing the pain of grief and loss.  Please encourage them and love them in a special way tonight.  Father, thank You for Damarys and Loita who left their desks and came to our aid right away.  They, too, are angels in disguise.  Thank You for them and I ask you to bless them in a special way.  Lord, I pray for Jane.  She has such a heart for the people she serves and to have a complication that takes a life is very difficult to bear.  Please uphold her and comfort her.  She is so special to me and I know she is special to You as well.  Thank You for her and how You have equipped and empowered her for the work You have called her to do in San Lorenzo.  Father, I pray for a good night’s sleep tonight.  Thank You for this day.  It was interesting to say the least.  Yet, I felt no fear and no worry for I knew You were with us at all times.  Thank You, Lord! Amen.



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