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7/24/2012 (Tuesday)

5:30 am.  Today the alarm got me up.  I had awakened somewhat but was laying there half asleep thinking about today’s surgeries, especially the lady with the total prolapse.  In the middle of that mental rehearsal the alarm rang and I had to get up to greet the day.  Jane will be meeting me at 6:15 to go to the albergue to make rounds on yesterday’s patients.  We will complete rounds by 7:00 so we can meet with the rest of the team for breakfast and devotions.  I have a dull headache this morning and hope it moves on before surgeries start. 

6:00 am.  Jane should soon be ready.  I completed my deep breathing exercises in the shower and haven’t gotten any better at tolerating the cold water.  I have learned to just push myself into the cold water and get it over with.  That makes the shower quicker but still it is associated with a lot of prolonged inhales.  It is an interesting reflex – cold water on the back with an immediate prolonged inhale.  At least my lungs are fully expanded every morning. 

Father, Thank You for the restful night.  You have given me good rest each night here.  There have been no noises of the night that keep me awake and no interruptions.  Thank You for that, Lord.  I pray for the patients we will soon see who are recovering from surgery from yesterday.  Lord, touch them with Your healing hand and protect them from complications, especially infection.  Lord, bring complete healing to them.  Father, I pray also for the patients we will see today.  I pray for wisdom and guidance for Jane and me to do the right surgery.  Help us sort through the complexities of each situation.  Lord, I am especially concerned about the lady with total prolapse.  Help us decide what needs to be done to help her.  Lord, we want to do the right procedure on all of these patients and not cause any harm or set them up for problems down the road.  Please guide our thoughts and our hands today.  Thank You, Father.  To You I give all the praise.

6:15 am.  Jane and I went to the albergue to check on yesterday’s patients.  The four surgical patients were doing quite well.  These people get along with minimal pain control.  They have pain pills at their bedside but actually use minimal amounts to manage their pain.  I am impressed with the way these people handle their pain.  They ambulate quickly and start eating solid food rather quickly.  Many times by the second day they are ready to go home.  And that usually means going some distance by various means of travel that isn’t always a smooth, comfortable ride.

7:00 am.  We met for breakfast and devotions.  Loida fixed pancakes and sausages with mora juice for our drink.  Mora is such a delicious fruit and it makes a wonderful drink.  The mora berries are put in the blender and whipped into a smoothie.  We then had devotions focusing on Psalm 77.  I found this pertinent because of what I have been studying on my own and also I was concerned about the surgeries today, especially the older lady with the total prolapse.  This psalm told me to remember what God has done for me and not get worried about the challenge in front of me. 

Jane leading us in devotions

Psalm 77: 1-15   

I cried out to God for help; I cried out to God to hear me.  When I was in distress, I sought the Lord: at night I stretched out untiring hands and my soul refused to be comforted.  I remembered you, O God, and I groaned; I mused, and my spirit grew faint.  You kept my eyes from closing; I was too troubled to speak.  I thought about the former days, the years of long ago; I remembered my songs in the night, my heart mused and my spirit inquired:  “Will the Lord reject forever?  Will he never show his favor again?  Has his unfailing love vanished forever?  Has his promise failed for all time?  Has God forgotten to be merciful?  Has he in anger withheld his compassion?”  Then I thought, “To this I will appeal: the years of the right hand of the Most High.”  I will remember the deeds of the Lord; yes, I will remember your miracles of long ago.  I will meditate on all your works and consider all your mighty deeds.  Your ways, O God, are holy.  What god is so great as our God?  You are the God who performs miracles; you display your power among the peoples.  With your mighty arm you redeemed your people, the descendants of Jacob and Joseph.

Damarys talking with Loida, on left, Dalia our anesthesiologist in center, and Carmen on right.

11:00 am. We finished the first surgery.  This was the older lady with complete vaginal prolapse.  We performed a vaginal hysterectomy and closure of a large enterocoele and anterior and posterior repair.  The result was a well supported and correctly positioned bladder and the vagina now back in its normal position and securely anchored there.  I am pleased with this result.  Even when the surgery corrects the defects, the problem is this tissue continues to remain stretchy and in time the patient may redevelop a prolapse.  My hope is this would not occur.  I was worried about this lady and how I could help her with surgery.  I spent time last night praying for her and praying for wisdom from God to know what to do.  The psalm we read together this morning reminded me to remember, to recall what God has done for me in the past and this reassured me that He will certainly be faithful in taking care of my immediate concerns today.  And He did!  He gave me the confidence and the knowledge to do this surgery. 

Thank You, Lord, for rescuing me from my doubt and fear and giving me the confidence to move forward and serve this lady in Your name.  You equipped Jane and me to do this surgery.  Thank You, Lord, for the surgical result we obtained with Your help.  Lord, Your love is unfailing.  You are always there  and are always helping and supporting me.  Thank You, Lord.

1:00 pm.  The second surgery is finished.  This patient had an abdominal hysterectomy for problematic bleeding and pain.  Jane suspects a condition called adenomyosis.  The surgery went smoothly.  With Elizabeth helping with exposure Jane was able to efficiently perform this surgery.  We are now taking a break for lunch and I am looking forward to getting off my feet for a while.  With Elizabeth helping, I broke scrub when it came time to close the incision and let Elizabeth assist Jane.  I went to the bed in the instrument room and lay down to put my feet up.  The next thing I knew I was awakening after a 30 minute nap.  This was very refreshing as I was quite tired from standing all morning. 

Our lunch was calamari over rice, fried plantain and salad with lemon juice added to it.  It was delicious.  We had orange juice to drink.  Carmen fixed the meal for us.  After lunch we started our third surgery for the day.  The patient was actually number 4 on the schedule.  The other patient failed to show up today.  So, after we finish this surgery, we will be done for the day.

4:00 pm.  We are finished for the day.  The surgeries went well with no complications.  I am especially happy that the surgery for the total prolapse went as well as it did.   I thank God for watching over us and giving us the ability to render this level of care for these patients.

Elizabeth scrubbed in with us on all the surgeries today.  She is learning a lot about surgery and medicine.  Jody also is getting good experience in the OR.  They are great help for us and for the crew in that the work they have to do is shared by two extra persons.

Eliazbeth and Jane working together.

5:15 pm.  I came to my room and got another 30 minute nap.  I am especially tired today and the naps felt really good.  We will be eating dinner in another hour or so and I am enjoying the time just resting and reading.

7:30 pm.  We just finished dinner of spaghetti.  Then we sat around the table and talked for some time.  I am enjoying learning to know the various people.  Jane was telling me today that Dalia, our anesthesiologist, is currently the president of the anesthesia society of Ecuador plus she teaches nursing students at a university in Esmeraldas.  She is busy.  While we have been operating, she sat at a table next to us grading test papers from her students.  She told us today that two weeks ago her husband, a cab driver in Esmeraldas, was almost killed by a robber.  This man got in his cab and then jumped him from behind using a knife and tried to slit his throat.  The knife was dull and didn’t cut deep enough to get into any blood vessels.  Seeing this did not kill him the robber then stabbed him in the back several times causing one lung to collapse and the loss of a lot of blood.  Her husband survived the attack and she didn’t say if the attacker had been captured.  Most likely he wasn’t.  Jane said she really likes to work with Dalia because she is so conscientious.  She will almost always come when Jane calls and takes good care of the patients.  Dalia is trying to learn English so she was asking us the English words for various things in the OR.  I told her I am trying to learn Spanish and I find it just as difficult as she is experiencing learning English. 

After the dishes were taken care of several of the team settled in for a hot and heavy game of Ticket to Ride.  Loida loves this game and gets it out every night.  It is a fun board game.

Ticket to Ride.  Left to right: Owen, Damarys, Elizabeth, Jane, Loida

While here there is no news from around the world.  One can feel really isolated.  When I go online I do get some quick headlines on my Yahoo home page but if I don’t see that there is no word about what is happening elsewhere.  I remember a few years ago when Jane and I went by canoe to a river village to work there for the week we were very isolated.  Jane said, “World War III could break out and we would not know it.”  Here in San Lorenzo we do not listen to radio or watch television and most evenings are spent playing games or reading or doing chores that need done.  I will have some catching up on world events when I return home.

9:30 pm.  Time to turn in for the night.  I will need to get up early to make rounds with Jane in the morning.  We will meet again at 6:15 and will have 7 patients to see and evaluate.  Most likely the ones from Monday will be going home tomorrow.  They all were recovering well today.  The lady who had the laparoscopic gallbladder removal might have gone home today but was having some nausea this morning.  I don’t think she went home today because of that.  Our lady with the vesico-vaginal fistula was doing great and feeling great.  She will probably go home tomorrow and will have to wear her catheter for at least 2 weeks before it can come out.  She lives on the rivers somewhere so her trip home is not just across town but to the place where she would board a canoe and then on to her village.  When Jane and I went to the river village we had to travel to Borbon, about an hour or so by car, and then board the canoe and travel 3 ½ hours up river to the village.  Jane was teaching her how to manage the catheter bag this morning and I am sure we will be reviewing that with her tomorrow. 

Father, this has been a good day in surgery.  I was worried about the lady with the complete vaginal prolapse.  My worry was because of my lack of self confidence, Lord.  I was relying on my own abilities instead of trusting fully in You.  I confess that, Lord.  You answered my prayers and guided my thoughts and hands as I was able to do this surgery empowered and assisted by You.  Thank You, Lord.  This lady’s life has been changed and You receive all the praise and honor for that.  Lord, thank You for the opportunity to serve You here.  You supply all my needs and I confess that I don’t remember all the many benefits that come from You.  Lord, thank You.

I pray for the team: Jane, Dalia, Loida, Damarys, Angelita, Maria Luisa, Elizabeth, Jody, Karl, Owen, Gonzalo, and Carmen.  Father, bless each one of them in a special way tonight.  Thank You for them.  You have pulled us all together to do Your work here and it is a privilege to be part of this effort.  Lord, I pray for our patients who are recovering.  Thank You for Your hand of healing that is upon them right now.  I pray also for the patients we will see tomorrow.  Please guide us tomorrow as You have the past two days, Lord.  Thank You for how You help us.  Father, thank You so much.  Amen.


1. Audrey Hindle - July 25, 2012

Thanks for reminding us that it is not us but you Lord that blesses us
so we can bless others.

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