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11-9-2011 (Wednesday)

6:20 AM.  Another night of solid sleep!  Thank You, Lord!  It’s Wednesday already!  We have three days left of surgery with some challenges ahead of us surgically.  I awoke thinking about the patients we will be working with today.    The patient with the large fibroid that I thought was on the schedule for yesterday will be one major challenge for us today.  Her uterus is still very large and in this situation getting to the blood supply can be quite difficult.  On each side of the uterus where the blood supply comes in are other vital structures such as the ureters from the kidneys to the bladder running very close and also the large vessels to the legs.  In a routine hysterectomy one must be careful to avoid damaging the ureters especially.  In a situation like this patient the caution is even more important since there will be little room to dissect out the blood supply and not run into the ureter.  We also have another patient with cervical cancer.  This situation appears to be an early cancer development as her exam is completely normal with no obvious evidence of any changes. 

As I lay there in bed for a few minutes I prayed for our day and for our patients.  I think about the challenges that missionary physicians face compared to what I experienced in practicing medicine in the States.  There we had all the resources we needed at our fingertips.  If I needed an expert consult, I could get one, sometimes immediately.  If I needed various x-ray or lab studies, I could get them.  If the patient couldn’t pay, that didn’t matter.  Treatment was given and we dealt with those details later.  However, on the mission field such as here in San Lorenzo there are none of these resources.  If we want an x-ray or ultrasound, the patient has to travel someplace to get it and then it may not give you much information.  Plus the patient must pay up front to even get the test.  If there is no money, there is no test.  Most of the time we make our clinical decisions on history and physical exam alone.  We have to judge what the problem is and determine what to do based almost entirely on what we hear and what we feel and see.  It makes one feel very vulnerable yet it is where God would like us to be because we become totally dependent upon Him.  I have found these situations push me more in my faith and force me to lean even harder on Him.  It is in these situations that we get the awesome privilege of watching God fill in the gaps and do the miraculous. 

Father, we have another big day in surgery with people who have placed their lives in our hands.  I don’t take that responsibility lightly, Lord.  In fact it is quite scary at times.  However, Lord, I have You and that makes all the difference.  You fill me with what I need and together we get the job done.  Thank You, Lord for allowing me to be an instrument of Yours to bring healing and health to the people we see here in San Lorenzo.  Father, I pray for Your presence and Your power today.  Thank You, Lord!  Amen.

8:00 AM.  We had breakfast and devotions and then started preparations for our first surgery.  We have three hysterectomies today.  The first one is the patient with the large fibroid that is impacted in the pelvis and had been on Lupron for the past 3 months.  The fibroid has shrunk considerably.  The second surgery is a hysterectomy and a Burch urethropexy to correct stress incontinence.  The third patient has cervical cancer and we will be doing a hysterectomy on her. 

How do I learn more about Christ so as a disciple I can be more like Him?  He is my teacher and has invited me to join Him in His kingdom work.  Becoming more Christlike is not an instant change.  It takes effort on my part to learn about Him as a person and about His mission here on earth.  The more I learn about Him, the more I take in His qualities and incorporate them into my personality.  This is where various disciplines come into play. 

One discipline that is so important in learning about Christ and what He wants of me is to shut out the world around me and make myself available to listen to Him.  This means I take time out of my day to go to a place of quiet where I can be in solitude.  This means not having a lot of noise around me that would interrupt my thoughts and distract me.  Solitude becomes an important practice to just listen to God speaking to me.  It is not me talking with Him.  It is listening to Him. 

Sometimes the solitude gives me the quiet time to just focus on God and then thoughts will come to mind that carry me further or even lead me to Scripture to dig deeper into what God wants me to know.  Then there are times when solitude is combined with study where through reading God’s Word I then get an understanding that I did not have before.  Suddenly, the passage of Scripture seems to leap off the page as it opens my mind into some principle or truth about God that I hadn’t realized before. 

I remember one time my pastor was in the middle of a sermon and was reading from a passage of Scripture.  Suddenly he stopped and was quiet for a moment and then said to the congregation, “I have read this section of Scripture so many times but suddenly it spoke to me like I had never read it before.”  He had suddenly acquired a new understanding of what these words meant and it changed his line of thought and the sermon.  He stood there amazed.  But this is how God works in our lives at times.  When we are in the midst of dwelling on His Word and studying all the while practicing solitude, suddenly a thought or realization occurs that sheds incredible light on what we are reading.  Suddenly, you get it.  Everything seems to click into place and now the light goes on. 

To reach these levels of understanding one must put aside all the other distractions and busyness of the day and practice solitude.  Frequently, this is in conjunction with study.  What I do and you can do at this time is to focus completely on what God is teaching us.  As I think back about the times I had these revelations they were at times of solitude and study when I made myself available to listen to God. 

10:30 AM.  We finished the first surgery.  It was very difficult needless to say.  Jane said the fibroid mass had decreased at least 50% in size yet it was still solidly impacted in the pelvis.  I don’t know how this patient had bowel and bladder function with this mass taking up so much space within the confines of a bony pelvis.  With God’s help we were able to extract the mass intact and then took the uterus with it.  This fibroid came off the back side of the cervix and then buried itself beneath the peritoneum making it very difficult to get around to deliver it out of the abdomen.  The ureters were right next to it on both sides and we had to carefully isolate them and keep them out of the way.  Jane did most of the surgery with me talking her through it.  She did a great dissection and got the mass out in one piece.  She was very happy we were able to help this patient.  Thank You, Lord, for helping us with this surgery.  It was quite difficult and without You guiding us it would have been impossible.  Yet, You were there with us and guided us throughout the procedure.  Thank You for allowing us to be Your hands to touch this patient and bring healing to her. 

1:00 PM  We finished the second surgery and now are going to break for lunch.  The second surgery went well with a routine hysterectomy and then a urethropexy to reposition the urethra to manage the patient’s stress incontinence.  This should give her a good result.

3:15 PM  Our third surgery is over.  This patient had an early cervical cancer with no visible lesions on the cervix.  The uterus was tiny.  Jane did the hysterectomy with me assisting.  We are now done for the day.  Tomorrow we had three patients scheduled for myomectomies.  This is to remove large fibroids without taking the uterus.  The second patient, however, came down with acute malaria so she is cancelled.  So we only have two surgeries to do tomorrow. 

Thank You, Lord, for a good day in the operating room.  The first patient was a real challenge but we were able to accomplish this tough surgery because You were there with us guiding us the whole way.  Thank You for Your presence and Your giving us the ability to serve these people in Your name.  Lord, You are so gracious and loving.  Thank You!  Amen.

6:30 PM.  I got a good nap in and then was able to get online and talk with my wife, Phyllis, on Skype.  The connection was solid enough to support a conversation and that was great.  Soon it will be time for dinner and before I know it time for bed. 

Father, this has been a great day working with You here at Clinica San Lorenzo.  Thank You for the opportunity.  Thank You for being there with us throughout the surgeries.  Your presence was definitely palpable and You made tough surgeries look easy.  Thank You, Lord.  I pray for our patients, Lord.  Please watch over them and cover them with Your healing power.  Give them the assurance that You are there with them.  Thank You, Lord.  Thank You, Father, for allowing me to speak with Phyllis.  I love her so much and I thank You for bringing us together 45 years ago.  Please be with her while I am gone and give her comfort and safety. 

Father, I pray for a good night’s sleep for all of us.  I pray also for the patients coming tomorrow for surgery.  Please prepare their hearts and prepare us to be able to give them the best care possible.  Lord, they will give us some special challenges but I rest in the fact that You will be there at the table with us.  That gives me great comfort, Lord.  Thank You, Father.  Amen.


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