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7/13/09 (Monday)

Monday, July 13, 2009

6:45 AM.  I got up about an hour ago after a decent night’s sleep.  Even with the fan on I still lay there and sweat the whole night.  Yet, I sleep okay in spite of the sweating and the discomfort of the heat and humidity.  That must mean I am more tired than usual.  Once I fall to sleep, the noises of the night don’t even penetrate my thick skull.  We are meeting in about 15 minutes for devotions and breakfast and then will start our first surgery at 8 AM. Today will be a long day with 4 cases.  Our first surgery is a subtotal gastrectomy to treat a gastric carcinoma that presented as an ulcer.  The lady is small framed and thin which will make the overall surgery easier.  Jane anticipates this will take us at least 4 hours to complete.  Following that surgery is a tuboplasty and then a myomectomy.  The last case is a man with an incarcerated inguinal hernia.  We will spend the morning doing the gastrectomy and the remainder of the day doing the other three cases. 

Father, it is a new day for us, a new day You brought into being.  May this day be one of glory and honor to You.  Lord, I pray for each of us today as we work together as a team to bring safe and effective care to our patients who are trusting us with their lives.  The surgeries have the potential of being difficult and time consuming.  Give us endurance and patience as well as wisdom and the necessary skill to complete the surgeries without any difficulties.  We place our trust in You, Lord. 

Father, I pray for the four patients we will operate on today.  Please wrap Your arms of love and protection around them and hold them close to You.  Please give them peace and the assurance that You are there with them and will go through the surgery and recovery at their side the whole time.  Please wrap Your hands around our hands and Your thoughts around our thoughts to not only equip us and help us but also to protect the patients.  Lord, we are completely dependent on You.  Thank You for the incredible privilege of being able to come here and be Your instruments of healing to these people.  This is a huge honor for me and I want to turn that honor back to You Lord.  Father, to You and You only goes all the honor and praise.  Thank You, Lord.  Amen.

7:50 AM.  We met for breakfast and devotions.  The juice this morning was a puree of a fruit called the tree tomato.  It is a red fruit that is somewhat tart but has a unique sweetness to it as well.  We had pancakes and orange gelatin that in this warm climate struggles to set up into something that would even stay on your spoon.  It was an experience trying to eat this partially solidified gelatin without it totally sliding off the spoon and into your lap.  Once breakfast was complete we went to the OR to prepare for our first patient. 

Our first patient, S.Q. is 44 and in good health.  She has a gastric carcinoma.  This was diagnosed by biopsy of a gastric ulcer.  The ulcer is small and Jane is planning a subtotal gastrectomy to treat this.  Upon evaluation the ulcer and tumor complex was 2 to 3 cm and there were some enlarged nodes along the gastric margin.  Jane did a gastric resection and then moves some small bowel to connect to the remaining segment of the stomach.  We started at 8:00 AM and finished at 4:00 PM.  After standing in one position for 8 hours my back is very tired and my legs are swollen up to my knees.  This would be tolerable if we didn’t have anything else to do today.  Unfortunately, we have three more cases and could likely take 5 to 6 more hours to complete our day’s schedule.

5:00 PM.  We just finished lunch of rice, cold vegetable medley and fried liver.  Now it is time to start the second half of our day.  Our second patient, M.L. did not show up for surgery today.  I told Jane if she decides to come in, we will add her to the schedule tomorrow.  By the time we are done with the other two cases, it will be rather late anyway.  So, we moved on to our third surgery. Our third patient, R.C. is 28 and has never been able to conceive.  She has a large fibroid in her uterus that is distorting the uterus significantly.  Our plan is to remove the fibroid via a myomectomy procedure and hopefully restore her uterus to more normal so she can eventually conceive.  At surgery we found a large fibroid in the upper uterus plus several small superficial ones.  We did a multiple myomectomy with Steven scrubbed in as the second assistant.  He then helped me close the incision after Jane broke scrub.  Hopefully, this lady will have a better chance at pregnancy now that the uterus is not distorted by the large fibroid. 

7:50 PM.  We are getting ready for our last surgery of the day.  This patient, J.T. is 72 and has an incarcerated inguinal hernia.  He has been waiting for this surgical repair for a couple weeks.  The patient had dealt with this large hernia for a few days before coming in to see Jane.  The hernia is a large fixed mass in his left groin.  Jane said the mass was quite tender.  Even after a spinal anesthetic, the mass could not be moved well or reduced.  Most likely there is trapped bowel in this hernia mass.  Jane found the mass to contain what appeared to be necrotic tissue and possibly a loop of bowel.  She then entered the abdomen and found the mass to involve the terminal ileum necessitating a bowel resection including the cecum.  What started out to be a “routine” hernia repair turned into a 4 plus hour surgery involving dissection of the left inguinal canal, removal of the large mass, and a bowel resection.  The terminal ileum and cecum where the appendix is located, on the right side, was what was part of this left sided hernia. 

12:00 Midnight.  We have been on our feet since 8:00 AM.  Today has been almost a total day of bowel surgery.  My fibroid surgery only comprised about an hour and a half of all the surgery time.  The rest of the time was working with bowel, doing resections, removing masses that were quite difficult because of all the distortion of the anatomy.  We are all very tired and ready to head straight to bed.  Fortunately, tomorrow we have only three cases scheduled, all hysterectomies.  Our surgery time should be more like 6 hours or so and we should be able to get more of a chance to get some much needed rest in the afternoon. 

Last evening an older gentleman came to the gate and talked with Loida.  He wanted to see the doctor who was visiting so he could have his prostate checked.  Loida talked with him about the visiting doctor was a gynecologist and did not take care of prostate problems.  She then told him this was the fourth time she has had this conversation with him in the past few days.  He either is persistent in wanting to see me or is struggling remembering details from one minute to the next.  Loida sent him on his way and I wonder if he will be back again before the week is over.

Father, it has been a very long day.  Little did we realize how much work we would be doing today, especially in relation to the two patients who had bowel surgery.  Yet, You brought them to us and equipped us to provide the healing care needed for their conditions.  Father, Your presence with us continually provides immense peace.  You fill us with hope and cover us with Your grace.  Thank You, Lord for protecting our patients and us.  Physical fatigue can be dangerous in the operating room.  We all are tired but still are energized to complete the work You have asked us to do.  Thank You, Lord.  I pray for each of us a good rest tonight.  I pray especially for our patients as they recover.  Please rest Your healing hand upon them and cover them with Your grace and love.  Thank You, Father.  Amen.


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