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11-7-2011 (Monday)

6:30 AM.  We start our morning with breakfast and devotions at 7:00 and then will begin our first surgery about 8:00.  I didn’t sleep as well as I did the night before but do feel rested.  Of course, the cold shower takes away any grogginess and stupor that sleep brings regardless of the quality.  Our surgeries today include two hysterectomies and a laparoscopic cholecystectomy.  The two women for hysterectomy have been on my mind all night.  Both have cervical cancer in an early stage and should be given more radical surgery than what we can do.  I am concerned about this because we cannot give the full treatment that these problems require to achieve the best results.  Yet, referring them to a cancer hospital may not give them any treatment at all if the patients can’t afford the treatment.  This is a time when my faith is stretched because I can only do so much on my own and I must depend on God to fill in the gaps. 

I remember in 2004 Beatriz came in bleeding heavily and had a large cervical cancer that was bleeding.  She was in a very grave risk of bleeding to death.  We performed a hysterectomy to mainly control the hemorrhage knowing this was substandard treatment for this cancer.  However, the combination of surgery and prayer and faith produced a complete cure.  Beatriz came in to the clinic in 2009 and I was able to examine her after not seeing her for 5 years.  She was cancer free and in good health.  My faith was stretched to the limit and God filled in the gap and cured Beatriz.  And then He let me see His handiwork 5 years later when by our standards Beatriz would have been declared cured of her cancer.  God had actually cured her on the table in 2004 but I did not know that at the time and I must admit would have doubted that then.  I don’t doubt it now.  It is interesting that when we want to increase our faith in God He gives us something that causes us to stretch to the breaking point.  Only then do we exercise complete faith in Him.  Today, I am again turning to this level of faith as we operate on two women with cervical cancer knowing we are not giving what would be considered full treatment.  I must add, the full treatment definition does not have God in it at all.  Therein lies the difference.

Father, I bring to You this morning the two women who are coming in for hysterectomies to treat their cervical cancer.  Lord, I am uneasy about these surgeries because I am not capable of doing what my training says I need to do.  However, I do know and firmly believe that You are present at the table, scrubbed in, and ready to assist us.  Lord, that gives me great comfort and courage to proceed.  I pray, Lord, for wisdom for Jane and me to do the surgery and avoid complications.  I pray especially for these women, for safety, for comfort, and for healing.  Lord, they face such difficult circumstances just in living here and I can’t imagine the difficulty of dealing with a slow killer as cervical cancer.  Please heal them, Father.  Pull them close to Your chest, cradle them in Your loving arms, and bring healing.  Lord, I pray for today.  What lies before us is not impossible with You and that gives me confidence to move forward.  Thank You, Lord, for Your unfailing love, mercy and grace.  I pray for our patients in the name of Jesus.  Amen.

Looking at the four discipleship criteria already mentioned, another one comes to mind that seems to summarize these four.  Being a disciple of Christ means making Him Lord of my life.  Do I practice the Lordship of Christ?  Is He truly Lord over all of my life?  Do I have Him at the very top of my priority list?  Are the first thoughts of the day about Him?  Do I consult Him frequently throughout the day?  Is He my Lord?

I look at my relationship with Christ as one of walking with Him along life’s path each day.  We are walking together, shoulder to shoulder, encountering together whatever challenges that come before us along the path.  We converse with one another and I continually learn from Him.  Yet, He is the one determining the direction and the pace of our walk together.  He is the leader and I am the follower.  He determines how we deal with the challenge before us.  If the path gets rugged He just grabs my hand and helps me deal with it.  At times He carries me across an especially difficult area.  By walking with Him in this relationship I keep Christ first and foremost in my life.  He is Lord.  How could there be any other relationship if one wants to be His disciple?  The meaning of disciple makes the one to whom you are a disciple the one in charge, the lord.  Thus, being Christ’s disciple involves making Him Lord of your life.  He will have it no other way.  If I wander  from His side and investigate and involve myself in something else, I have just abandoned His Lordship for something or someone else.   If I do the same to my wife is that not being unfaithful?  Yet, it seems we can do this to Christ and not have any guilt or shame attached to it.  But, Jesus does not see it that way.  He wishes to be Lord and always be Lord.  He will not call us to be His disciples if we cannot make Him Lord of our lives.

This walk with Christ, this fellowship, brings all sorts of benefits.  One is I share experiences with Him.  The disciples who walked with Jesus over the lands of Judea , Samaria and Galilee shared every day with Him.  They saw Him do wondrous things, multiple types of miracles, demonstrating His power as the Son of God.  Imagine what that must have been like to be the first on the scene and watch Jesus do His work!  That had to be incredible just to witness it firsthand.  Through these experiences Jesus also taught them about the Kingdom of God.  It seemed like the disciples were a little thick-headed at times and it took repetition to get the principle into their brains.  I have to admit, I am the same way.  I need the repetition to really incorporate what Jesus is teaching me.  I can learn something intellectually easily but to make it a practice of my daily life is another matter that requires more and more training. 

As I learned to do gynecologic surgery it took lots and lots of repetition and practice to be able to acquire the skill needed.  Reading about it was one thing but actually taking what was stored in my mind and push it out through my fingers was another.  The same principle is needed in taking the truths of the Scripture and making them a part of every day.  The world is controlled by Satan and his goal is to destroy any allegiance to Christ.  We know the end of the book and we know Satan stands defeated already.  However, that doesn’t stop his lies to us and his ability to pull us off course.  He can’t take away our salvation but he can make us miserable as we try to be a disciple of Christ.  It takes for me repeated study of Scripture and repeated exploration of the person and ministry of Christ to undo the influence of my sinful nature and keep me on the right path walking next to Christ.

8:30 AM.  We are ready for surgery but are waiting on the patient.  Jane charges small fees for the surgeries she performs here.  The fees are what keep the clinic in operation plus it teaches responsibility to the patient.  I learned in the Dominican Republic on my mission trips there that people need to pay something for the service they obtain.  Giving free care, although that is an option, does not work well in a situation like this.  The word spreads quickly and a line will form at the front door with people asking for the same free care.  These people will usually have the cash on hand to pay for that service but will sometimes even deceive to get free care.  The first patient appears to be trying to scam the clinic.  Yesterday she agreed to the amount of the surgery and then today comes in with a story that she doesn’t have any money.  Then she said she could pay half and the other half was at home.  She was hoping to get her surgery done for less as the other half would likely never be paid.  The clinic personnel running the front desk is quite aware of these attempts to deceive the clinic.  They sent this patient back home to get the other half before we would proceed with surgery.  It sounds a little cold-hearted but that is the way this culture operates.  If you give something for nothing, everyone soon shows up demanding the same favor.  So we wait to see if this patient returns to the clinic to get her surgery. 

We finally started on the first surgery after the patient returned with the rest of the cash.  She had already been given a discount and then tried to get by with less.  Her surgery was difficult in that the uterus was huge, about the size of a six month pregnancy.  The cervix was involved with cancer but it had not extended beyond the outer margin of the cervix.  Thankfully, there was no evidence of spread beyond the cervix and we were able to remove the entire cancer.  It took some careful dissection, especially on the left side to dissect out the ureter to make sure we didn’t capture it while suturing on the vaginal wall.  I have to thank God for guiding us through this surgery.  It was difficult to say the least.

Father, thank You for helping us through this tough surgery.  Because of Your presence and Your guidance we were able to accomplish the surgery and do the best we can for this patient.  Thank You, Lord!! Amen.

After the first surgery I followed orders and took a rest in the bed the team had set up for me in the instrument room next to the OR.  Because of my recent surgery and recovery, the women working for Jane wanted to make sure I got plenty of rest.  So they set up this comfortable bed and when it was time for me to break scrub I was told to go lay down.  So I did!  And it was wonderful to get the feet up and take a snooze. 

After lunch we did the second patient with cervical cancer.  This surgery was easier and there was no evidence of cancer extending outside the cervix.  This will give a good result for the patient.  Thank You, Lord, for again walking us through this surgery and protecting the patient. 

The third surgery for the day is a laparoscopic cholecystectomy and Jane is doing this with Damarys and Angelita.  I will not be scrubbing on this surgery and plan to go back to my room to rest for awhile.  I got involved helping Steve work on the big sterilizer.  He was trying to figure out how to put a little spring in its right position so it will lock the door when the sterilizer is on and running.  What he needed were some special tools.  We looked at the situation and eventually I found some gyn surgical instruments that had a specific curve which fit nicely where the spring needed to be placed.  With some maneuvering we were able to get the job done and Steve was a very happy man.  This may be the step needed to finally get this big sterilizer to work for Jane.  Now I will head to my room to lay down for awhile and maybe get a nap.

7:45 PM.  I slept for about an hour and feel much better.  Soon we will go for dinner and then call it a day.  The Internet has been very sporadic today and this has been a problem for Steve as he needs to access information related to the sterilizer and also talk with a biomedical engineer in Tennessee via Skype to get some directions on fixing some of the equipment.  As Steve, Dr. Chang and I were sitting waiting on Jane the power just went out and the clinic is now on generator.  Sometimes the power outage is short, other times it can go for hours.  Fortunately, all the surgeries are done. 

Father, this has been a long day with some difficult surgeries.  However, they went smoothly because You were there with us.  Thank You for Your guidance and assurance.  Thank You for bringing us here to share Your love with the people here.  Thank You for the opportunity to walk with You and be Your disciple and be part of Your work.  Thank You, Lord.  I pray for the patients we operated on today.  I pray for healing and comfort.  Keep them safe, Lord.  Especially, I pray for the two women with cervical cancer.  Please protect them from any further development of this dreaded disease.  Lord, thank You for allowing me to be Your instrument to bring care and healing to these people.  I pray for the team here at Clinica San Lorenzo.  Give us all a good rest and sleep tonight so we can be fresh tomorrow.  Tomorrow is another big day in surgery with some difficult problems.  Lord, we depend on You always.  Amen.


1. Steve Johnson - November 7, 2011

Marv, wonderful updates – thanks! – Steve J.

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