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11-8-2011 (Tuesday)

6:30 AM.  I slept 9 hours straight!  The power was out when I went to bed and we were running on generator.  In the middle of the night I awoke only to realize the generator was off and my fan was still running.  At that point I rolled over and promptly fell to sleep again awakening about 5 minutes before the alarm was to go off at 6:00.  The 9 hours sleep was wonderful and I feel good this morning.  Thank You, Lord, for the good sleep!

Today we have more difficult cases in front of us.  One is a woman who Jane operated on in May finding a huge fibroid uterus that was impacted in the pelvis and she could not get at the blood supply to try to remove it.  She stopped and called me to talk about it.  I advised Lupron, a medication that shuts down the pituitary-ovary system and puts the patient into menopause with estrogen deficiency.  This is useful for fibroids since estrogen stimulates fibroid growth.  Lupron is sometimes used to shrink fibroids before surgery and it is given for 3 months ahead of time.  Jane was able to arrange Lupron for this woman and gave it to her in August.  When we saw her on Sunday Jane said the fibroid mass was significantly smaller.  It still was huge with the mass extending up above the navel and still filling the pelvis.  One significant change is the mass is movable now when it wasn’t before.  This surgery is our first one today.  We follow with two other challenges that will likely take us most of the day to complete. 

Father, You provided what we needed yesterday to successfully care for the patients.  And I know You will provide what we need today as well.  Lord, I so enjoy working and serving for You because I get to experience these provisions when You work along with me.  When we step out in faith You answer just like You promise in Your Word.  Thank You, Lord!  Today, Lord, we have some challenges that You have given us.  Please wrap Your hands around our hands and let us wear You like gloves as we do the surgery.  Guide our thoughts and help us to stay focused with clear thinking to be able to understand the complexity of the anatomy and to do the surgeries correctly to achieve the intended result.  Our goal, Lord, is to help these patients with their suffering and misery.  Also, our goal is to represent You, Lord, to these people and share Your love with them.  Thank You, Lord, for being here with us.  I can definitely feel Your presence and it gives me great comfort.  Thank You, Lord!  Amen.

I reviewed the surgery schedule with Jane and learned that the one with the large fibroid is on for tomorrow instead of today.  Another 24 hours of praying for her certainly won’t hurt!  Our surgeries today are more vaginal in approach.  We have an older lady, age 76, who walks with a walker and has prolapse that is giving her trouble.  She is not a good surgical risk and Dr. Chang evaluated her on Sunday and decided she could receive a spinal for anesthesia.  We will do a vaginal hysterectomy and repairs to correct her problem.  The second patient is younger, age 50, having had many babies and now has complete eversion of the vagina.  The uterus hangs out in this everted vaginal sac which also includes her bladder and colon.  The goal of this surgery is to restore the anatomy to as near normal as possible.  One can have a plan but you have to be flexible and work with the anatomy presented to you so each situation is always a little bit different.  Our third patient has a prolapsed bladder and stress incontinence.  We will be doing the appropriate repair to again restore the anatomy so she can have normal bladder function and not leak urine all the time.

Father, I pray for Your help today as always.  Give us wisdom and clarity as to what to do with these surgical challenges before us.  You are here with us and we depend so much on You.  Lord, it is a joy to experience Your presence with us.  At times I even feel Your hand on my shoulder as You direct my thoughts and give me instructions on what to do.  Thank You, Lord.  Please keep our patients safe and secure.  Amen.

We gathered for breakfast and our morning devotions were from Hebrews 5:13 to 6:3.  The topic was achieving spiritual maturity.  We have a choice in our walk with Christ – feeding only on milk and remaining a child in our faith or growing and feeding on meat and becoming more mature in our faith.  This fits into the discipleship theme completely.  How can one be a disciple and still be only on milk?  Then we sang in Spanish the great hymn Great Is Thy Faithfulness and this expresses my joy of walking with Christ.  In this hymn are the words, “All I have needed thy hand hath provided” and that is so true, especially working here in San Lorenzo. 

In his book, The Divine Conspiracy, Dallas Willard describes what it means to be a disciple of Christ.  He refers to this as life on the rock.  Matthew 7:24-25 describes this life: “Therefore everyone who hears these words of mine and puts them into practice is like a wise man who built his house on the rock.  The rain came down, the streams rose, and the winds blew and beat against the house; yet it did not fall, because it had its foundation on the rock.”  Being a disciple of Christ is as Willard puts it living my life as Jesus would if He were me.  Jesus lived His life solidly on the rock, a firm foundation that did not give way to any pressure that came upon it.  When I walk with Him, follow Him as His disciple, I experience life on the rock.  The pressures of life do not prevail.  I am able to stand my ground because of living on the rock.  Are you living on the rock of Christ?  If the storms of life come against you, will you be like the wise man that Jesus talked about?  If not, what should you do about that to avoid disaster?

The more I study Christ, the more I bring Him into my life.  I become more Christ-like in my reactions and responses to the travails and challenges of life.  I learn to represent Christ in all aspects of life.  I learn to respond like He would and share His love with others.  A song written by Roger Bennett, the pianist for the Cathedrals, had these very poignant words framed as a question: When the world looks at me what do they see?  What does the world see in me, in you?  Do they see Christ?  Do my words and actions demonstrate Christ who lives in me?  As His disciple I would expect me to radiate Christ in all directions into all aspects of life.  I expect this because this is the standard that Jesus set when He described what being a disciple involved.  When the world looks at you (me), do they see Jesus?  Think on that question.  Let it bounce around in your head and wrestle with it.  It is likely the most important question you will face in your walk with Christ.

Our first surgery went very well.  We all were concerned about this patient’s general health condition making her a poor surgical risk.  However, the surgery went along quite well under a spinal anesthetic.  I was able to complete the vaginal hysterectomy and anterior and posterior repairs and an enterocoele repair in about an hour and a half.  The patient sailed through the surgery quite well and had no problems breathing or other difficulties.  Thank You, Lord, for being here with us and helping us with this surgery.  The potential for complications and difficult surgery was definitely there but You made it all very easy.  Thank You, Lord, for Your mercy, grace and unfailing love!

3:45 PM.  We finished our second surgery a little after 3 PM.  This case was very complex and took a lot of time just trying to figure out the anatomy and how we would restore the pelvis to normal.  This patient had a complete vaginal eversion with the uterus hanging out as well.  The anatomy in this situation is all distorted and it is quite the challenge to determine what needs to be done to correct everything.  Our surgery took over 3 hours.  Father, thank You for giving us the guidance we needed to do this woman’s surgery.  You definitely kept us on the right track and I am so appreciative.  Thank You, Lord!

During the surgery Jane had her mother and father singing to us.  On her computer she had a file of her mother and father singing hymns and we had the privilege of listening to these grand songs of praise all through our surgery.  I found myself humming along or even singing with Don and Dixie Weaver.  This great music in the back ground gave us a sense of peace while we worked.

While we were doing the surgery a relative of Maria Luisa came in to be evaluated.  She is about 5 months pregnant and had what appears to be ruptured membranes.  She had a gush of water a day or so ago and was told her baby would die and she should go ahead with an evacuation of the uterus.  However, an ultrasound shows a live baby with a good fetal heart but minimal amniotic fluid.  I checked her and there was no leakage and no cervical dilitation.  We talked with her and will watch her for now. 

5:45 PM  We finished our last surgery for the day.  This patient had stress incontinence and needed a bladder repair.  I had Jane do the surgery with me assisting.  We are now done for the evening, although Jane just told me a patient was coming in with some heavy bleeding and she wanted me to be here to help check her.  So I am waiting on my bed in the instrument room.

8:45 PM  We just finished dinner and I have been lucky to be able to get online for more than a minute or two without the service being interrupted.  The past couple days the Internet has been very sporadic making online email and blog updating difficult.  Soon I will be heading to bed.  I normally don’t go to bed until 10:30 to 11 each night but here I have been laying down about 9 to read some and the next thing I know it is morning.  Each night I have slept 9 hours at least.  That has been really good for me.  I feel rested and have more energy to deal with the stresses of the operating room during the day.  Tomorrow is another big day in the operating room with some more tough surgeries waiting.  I have never seen such difficult situations as I have here.  These types of problems were very unusual back home.  I think we see them here because people don’t get routine care and many problems keep developing until they are out of hand.  At home we pick them up much earlier and interrupt them before they get too serious.

Father, this has been a good day of work in Your behalf.  Thank You for allowing us to serve You through serving the people here.  Thank You for Your participation in the operating room and empowering and equipping us to do the surgery successfully.  Lord, it is such a joy to be Your instruments used to bring You glory and honor.  Thank You for this opportunity.  Father, please cover the patients with Your grace, mercy and healing power.  Give them peace and comfort.  Let them know You are there with them, watching over them, caring for them.  Thank You, Lord, for the people I am privileged to work with here.  They all love You and desire to serve You.  It is such a joy to be part of this team effort.  Thank You, Lord.  Please give us all a good night’s rest.  In Your precious name I pray.  Amen.

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