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7/25/2012 (Wednesday)

6:00 am.  I awoke at 5:30 and now am showered, shampooed and shivered.  Again, I tried to control the inhale reflex but to no avail.  It is automatic and totally out of my control.  I will be meeting Jane in a few minutes to make rounds on the post-op patients.  We will then meet as a team at 7:00 for breakfast and devotions to start our day of surgery.  We have three surgeries on the schedule today.  The first surgery is a thyroidectomy and this will take some time.  It needs to be approached with meticulous surgical technique to avoid bleeding and nerve damage , especially to the nerve that goes to the vocal cords and lies directly in contact with the thyroid.  That surgery will take most of the morning.  Following that are two gynecological surgeries that should not take much time each.

Father, today is another day in surgery to serve You through serving the people who come seeking care.  Thank You for this opportunity.  Lord, the day might be long because of the thyroid surgery.  Those can take a long time but hopefully it will go well and we can be done with surgery earlier than usual.  I ask for Your guidance in surgery today, Lord.  Especially, be with Jane and give her clarity of thought and wisdom in dealing with the large thyroid.  Help her to do the surgery correctly and give us both stamina in case the surgery takes a long time.  Lord, please be with the patients today, both the ones coming in for surgery but also the ones recovering.  Thank You, Lord, for Your unfailing love and constant presence with us.   

8:00 am.  We have had breakfast and devotions.  Today was a mix of various types of fruit and toast sandwiches with cheese.  I enjoyed both the fruit and the cheese.  We are now in the OR getting ready for our first surgery.

4:00 pm.  We just finished the thyroidectomy.  It started about 9 and we have been standing in one spot for 7 hours plus.  The thyroid was very strange with a large mass on the one side and an irregular, calcified mass on the other with lots of adhesions requiring meticulous dissection to get it out.  My legs and feet are very tired and ache.  In the middle of the case Gonzalo called in stating the patient that had the vaginal reconstructive surgery yesterday was bleeding.  We had him bring her over to the recovery room and I broke scrub to check her.  She was oozing from one area on the vaginal cuff.  I put in a pack to put pressure on it and then checked her while Jane was closing the skin.  The pack is dry and there is no more bleeding.  We plan to observe her at this point.  There are two more surgeries yet to do.  It will be a long day for sure!

4:45 pm.  We just finished lunch.  Carmen made lasagna and it was tasty.  This was the first time she ever made this dish and we applauded her for making a good meal.  She then told us that she made a double recipe so we will have lasagna tonight for dinner as well.  She said if we didn’t have it for dinner then we would have it for breakfast tomorrow morning.  She served an avocado salad that was very good as well.  It felt good to get off my feet for a little while.  We will soon start our second surgery.  This one should be a short surgery.  The patient has had an area of sharp tenderness in the vagina under the bladder.  We could reproduce the pain on exam but did not see anything there.  She had had a mesh insertion in a surgery to correct her stress incontinence.  She had been in last November to see me for stress incontinence and wanted us to put in a mesh then.  We said we didn’t have any mesh and would not do it.  She went to some other physician in February and had this done.  Now she is having a lot of vaginal pain and wants us to remove the mesh.  We are not planning on taking the mesh out in that we are uncertain as to how it was inserted.  She is continent and we don’t want to create a new problem for her.  We plan to open the vagina at the spot where she hurts to see if there is something there we can do to manage the pain.  I am not sure what we may find.

6:10 pm.  We finished the second surgery.  We thought there was a mesh erosion, however, when we were able to examine under anesthesia there was no evidence of such.  There was one area that was very tender on exam in the clinic and Jane excised this area and performed a short anterior repair.  I am not certain as to the source of her tenderness.  I hope excising the area will help.  Our next surgery is a laparotomy to remove the right ovary.  She underwent a hysterectomy six years ago under the care of another physician and then two years later underwent a laparotomy to remove a retained sponge.  She has had right pelvic pain since the hysterectomy and her exam in the clinic revealed a tender mass adherent to the right vaginal apex.  I suspect her ovary is adherent to the right vaginal area.  Our plan is to explore the area with laparotomy and remove the right ovary.

8:00 pm.  We finished with the last surgery.  We found adhesions and a large right ovarian cyst stuck down in the pelvis on the right.  We took the ovary out and I suspect this will help this lady’s pain.  I am glad to have the opportunity to get off my feet.  My legs are swollen and the feet hurt.  I plan to lie down and maybe even stay there for the rest of the night.  What a long day of surgery! 

I went to my room and was able to go online on Skype to talk to Phyllis.  It is great to be able to talk with her every day.  At times the connection isn’t the best and the calls are dropped mid sentence.  Yet, we are able to hear each other and to talk for a little while. 

Father, this has been a very long day.  However, You were with us throughout and gave us the strength needed to meet the challenges.  Lord, thank You for guiding Jane through the difficult thyroidectomy surgery.  That was very difficult and took a long time to complete.  However, the surgery was successful and the patient will no longer have the large mass in her neck.  Thank You, Lord.  Thank You also for the help You gave us with the other two surgeries.  Lord, Your presence was with us throughout and that is so encouraging.  Thank You, Lord, for Your unfailing love and grace.  I pray for our patients, Lord.  Please keep them safe and bring healing to them.  I pray also for a good night’s rest so we can be ready to do the work You have called us to do tomorrow.  Thank You, Lord.  Amen.

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