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7/23/2012 (Monday)

6:30 am.  I awoke again about 5 minutes before the alarm on the clock.  I slept through the night and feel well rested this morning.  I am now shower fresh having expanded my lungs sufficiently by running cold water down my back.  While enjoying this shower I thought about a comment Jane said to me last evening after she had treated Nancy.  She said she had told Nancy to take a shower here at the clinic before going home.  Part of the reason was to wash off the dried blood and debris from the abscess.  Also the main reason was that Nancy has no shower at home.  She, Gonzalo and the children all bathe out of a bucket.  The method of bathing is dipping into the bucket and pouring water over themselves.  This is their state-of-the-art shower that is their life.  And I felt like complaining about the cold water!  At home I have a very nice shower, warm, clean water, plenty of room to move around, everything I need within my reach.  I even had a fan to take the humidity away.  And I want to complain???  I was humbled at the thought that some people don’t have water accessible.  They have to go to the river to dip up a large bucket to use for that day for their bathing, cleaning, cooking and drinking.  I have so much to be thankful for and yet I find myself frustrated at some little inconvenience. 

Father, I confess that I am self-centered and want all the conveniences of life and get frustrated when the shower is cold or something is in my way delaying me in my pursuit of whatever I am doing.  I look at the inconvenience instead of looking at all that You have given me to even be in that position.  I confess that, Lord.  Please forgive me.  Thank You.

We will be meeting in a few minutes for breakfast and then devotions.  The entire team gathers for the meal and devotions.  This gives a chance for Angelita, Maria Luisa, Gonzalo, and Carmen to have good nourishment to start the day.  This also pulls the team together to align our focus on what we are here for and what we have before us.  Then we turn our hearts and minds to God in prayer to guide us through the day.  It is an example that we should do more often in our families and our workplace.  Too often we rush here and there and charge into an assignment without pausing and recognizing the Source of our energy, wisdom, and the very breath of life that we breathe. 

8:00 am.  We finished breakfast of delicious, hot empanadas.  Loida was our cook this morning and she has the reputation of a master chef from previous times I have been here.  She can create some delicious meals and I have had the privilege of enjoying them.   We also had some fruit–mango, pineapple (which is white here), apple and a delicious fruit called pitajaya.  Now I am sufficiently nurtured and ready to convert all this good food into energy to carry me well into the day.  We probably will not stop for lunch until 2 or so and then will have dinner after the day is over. 

Empanadas, hot and ready to eat, courtesy of Loida.

Loida turning one over.

Damarys getting ready to pour our fruit drink

Passing the empanadas.

9:00 am.  Our first surgery is done.  The patient was the one who had 21 babies.  She had a cystocoele that repaired very nicely.  Jane did the entire procedure while I assisted.  It was like the Shake N Bake commercials…”And I haalped”  The repair should give her a good result.  Our second surgery is a lady with endometrial hyperplasia that has changed from simple, which is benign, to atypical, which means it is moving toward malignancy.  This is now a precursor to endometrial cancer and hysterectomy is indicated.  She is 65 years old and in good physical health otherwise.

12:20 pm.  The second surgery is finished.  Jane performed a complete hysterectomy with Elizabeth and me assisting.  The surgery went very well with minimal blood loss.  The patient had a spinal for anesthesia.  Our next patient is having a laparoscopic cholecystectomy (gallbladder removal) and a D&C.  This patient has gall stones that are giving her problems and also some postmenopausal bleeding.  The D&C is to obtain tissue to evaluate the cause of the bleeding. 

3:20 pm.  After the second surgery we took a lunch break and enjoyed a good meal of baked chicken and rice.  Ecuadorians have the biggest meal at mid-day making it a little difficult to keep moving in the afternoon when a nap would feel much better.  After the lunch we then did the laparoscopic cholecystectomy.  Jane did the surgery rather quickly and before we knew it the gallbladder was out of the body.  After this we repositioned the patient so I could do a D&C to evaluate the postmenopausal bleeding she was having.  Our next patient is the young lady with the vesico-vaginal fistula.

5:00 pm.  We are finished with our first day of surgery!  Jane performed the fistula repair very nicely.  She was able to dissect out the fistula, remove it from the bladder wall and close the bladder and then vaginal mucosa.  We tested the closure with methylene blue solution in the bladder and then putting pressure on the bladder and no leak occurred.  The patient will wear a catheter for two weeks at least to allow the area to heal completely before taking the catheter out.  I feel this will be a very successful surgery for this patient and she will now be dry for the first time in three years.

Father, You have been here all day with us, standing beside us, guiding our thoughts, wrapping Your hands around our hands and helping us do the right surgeries for these people.  Thank You, Lord, for how You provide so much for us.  We lean on You for these surgeries.  They would not be possible without Your presence.  Thank You for a great day of surgery being able to help four women and make a significant difference in their lives.  To You and only You go all the praise.  Thank You, Lord!

7:45 pm.  After our day in surgery I went back to my room and rested with my feet up for awhile.  It felt good to not be standing the whole time.  The Jody came to my door to tell me we were gathering for dinner.  Carmen cooked us a meal and it was delicious.  Every meal seems like a home run.  They all are very tasty.  Tonight Carmen served us beef that had been cut into small chunks and cooked in a broth with onions and other spices.  It was tender and very good.  With this we had what looked like potato cakes but made from the yucca plant.  This was called llapingacho and the yucca was mashed into round patties about 4 inches by 3 inches and about an inch thick.  Inside the patty was some cheese and then they were fried.  They had a unique flavor and were delicious.  The yucca is similar in taste and texture to potato but different as well. 

Tomorrow will be another long day in surgery.  We have three abdominal hysterectomies that will take a couple hours each and then a big surgery dealing with an older lady with total vaginal prolapse.  Her situation will take longer in that the entire anatomy needs to be restored to the normal positions.  That can be a real challenge when everything is stretched and distorted so much in situations like this.  I suspect we may be finishing our day tomorrow later than we did today. 

Lord, I pray for another good night’s sleep.  The rest is so essential to have the energy to work in the operating room all day.  Thank You for providing that to me.  I pray for the patients we operated on today.  Thank You for guiding us through those procedures and protecting the patients.  I pray for the ones we will see tomorrow.  Again, Lord, we depend so much on Your wisdom and Your guidance.  Please be with us.  Thank You, Lord.

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