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7/14/09 (Tuesday)

Tuesday, July 14, 2009

7:45 AM.  Our day begins with us getting started an hour later since last night was so late.  I did sleep well in spite of the short night.  Even though I didn’t go to bed until 12:30 AM, I still awoke about 6 as if an alarm went off.  It seems the older I get, the more my internal clock resists any change.  For the past 30 plus years I have had to get up early because of work demands.  Now when I can sleep in a little, I still awaken at the earlier times.  Our day begins again with meeting as a team to enjoy some breakfast and then some devotions.  We hope to start our surgeries about 9:00 instead of 8:00.  We have three hysterectomies scheduled today with nothing else.  Hopefully there won’t be any surprises, especially bowel related situations, that will take up a lot of time in the OR.  I hope to get some rest this afternoon after our surgeries.

Father, thank You for the restful night.  I slept well in spite of the noises outside and the heat and humidity.  Thank you for Your presence with us yesterday.  I neglected to thank You for the rain we had overnight that left us with plenty of water for yesterday.  Lord, Your provisions are always just what we need.  Thank You for honoring us in this way.  Thank You for the privilege of being here to serve the people of San Lorenzo and to be Your hands and Your voice to them.  This is an awesome privilege and an awesome responsibility that I don’t take lightly.  And in the process we have the privilege of watching You perform miracles of healing and even working things out that are too complex for us to understand.  Lord, Your protection is all around us and we take that for granted a lot of the time.  Thank You for protecting us, equipping us, empowering us, honoring us, and most of all, loving us with unconditional love.  Lord, it is indeed a privilege to serve You.

Father, I pray for our patients today.  Please guard their hearts and their bodies as we do surgery to help them physically and promote healing.  Please guide us through the surgeries.  Again, I ask for Your hands to cover ours and Your thoughts to cover ours.  Help us to minister to these people and love them as only You would love them.  Father, forgive them and us of any thought, word or act that would offend You and bring dishonor to You.  Lord, the devil would like nothing better than for us to fail in our serving You and bring disgrace to You.  Please enclose us with a hedge of protection that will keep him away from us and this ministry.  Thank You, Lord.

Father, I pray for my family today.  Please give each of my children and their children, my wife, Phyllis, and my brother and sister and their families an extra measure of Your love and grace today.  Tomorrow is Dad’s funeral.  I would like to be there but I know he would rather me be here continuing the work You have placed before me.  Please comfort my brother and sister and my Dad’s sisters and family who will be coming to mourn his passing.  Lord, I feel assured that Dad is in Your presence at this time and he is far better off than any of us.  Thank You for his life and his desire to have a loving relationship with You.

Father, I commit this day to you.  I ask only for Your blessing and grace upon us today.  Thank You, Lord. Amen.

Our first patient, G.Q. is 44 and has large fibroids.  She also has a large lipoma on her right arm.  Jane had seen her before I came and already put her on the surgery schedule for a hysterectomy.  The uterus is large and distorted and she is having pelvic pain that radiates down the legs.  She is anxious to be rid of the pain and discomfort.  She also has a large lipoma on her right arm and Jane plans to remove that as well.  At surgery we found a large uterus from fibroids and also evidence of a previous pelvic infection with residual adhesions.  We did a total abdominal hysterectomy and then Jane removed the lipoma before the patient was awakened.  She underwent a spinal with some effect but it was spotty.  This necessitated switching to general anesthesia.  Her surgery went well with no problems otherwise.

11:50 AM.  We are finished with our first surgery and the aroma of lunch is in the hallway.  I suspect we will break for lunch and then proceed with the other two hysterectomies for the afternoon.  However, I learned that Nancy was cooking our lunch and it would not be ready for an hour or so.  So we will proceed with our second surgery and then break for lunch.

Our second patient, M.Z. is 46 and has a very large myomatous uterus.  The uterine margin extends about 3 cm above the umbilicus or navel.  This mass was quite soft when I examined her the other day.  In fact I was concerned about a possible pregnancy.  The ultrasound showed a large solid mass interpreted as a myoma.  When she lay on her back the mass was very apparent and extended up above the umbilicus.  Once we opened the abdomen we encountered a strange cystic feeling soft mass that filled the pelvis and extended up into the abdomen.  This mass was adherent to the back wall of the uterus, which was small and more normal in appearance.  Both ovaries were normal as well.  This mass was retroperitoneal but it dissected out easily.  The right ureter was compressed by the mass and was dilated some but otherwise not involved.  After a lot of careful dissection we were able to remove the mass and uterus as one unit.  Once it was off the table, Jane took pictures of it and then opened it revealing it to be a strange combination of solid and cystic tissue.  The mass did not appear to be malignant but Jane is going to obtain a pathologic evaluation of it just to be sure.  This was one of the most unusual pelvic tumors I have ever seen.  I am very curious as to what it is and if it is malignant.

One nice touch during this surgery was listening to Jane’s mother singing old hymns.  Apparently, during a visit here her mother and father made a recording of multiple old hymns.  Damarys had contacted a pianist in Quito and they met with him and made the recording.  It was neat to hear all the hymns we remember singing over and over in church when we were growing up.  The younger generation today does not even know these hymns.  I will contact Don and Dixie Weaver to thank them for their concert of praise that gave Jane and me the peace and wisdom to work through the difficult surgery.

It is now 2:30 PM and we are stopping for lunch.   Nancy fixed us fried chicken over rice and covered with some lettuce, tomatoes, and onions.  We had lemon juice to drink.  It was much like orange juice but a little more tart.  It could have been Tang for all I know.  It was refreshing and that was what counted. 

3:30 PM.  Our third patient, who is 49 and weighs about 285.  She has very large fibroids, even bigger than the mass found in our last patient.  This lady was very thin making the surgery much easier.  With someone very heavy, the surgery can be considerably more difficult and risky.  We are planning a hysterectomy.  She did see a cardiologist for her hypertension before surgery and he cleared her for surgery.  Paul, the anesthesiologist could not get in a spinal anesthetic because this lady was large enough that the spinal needle would not reach the area needed.  So she underwent a general anesthesia which in retrospect was the right move.  Her uterus was huge and packed in the pelvis making it very difficult to see to get to the main blood supply.  This lady was anemic to begin with so we didn’t want to encounter any aggressive bleeding during the surgery.  Once we got the uterus out it had to be placed in a bucket because it was so big.  I suspect it weighed close to ten pounds. 

6:30 PM.  Our surgery day is complete and we are now at the house just hanging out.  It feels good to get off my feet.  My legs are very swollen from standing all day.  The food here is more salty and I believe that contributes to the edema as well.  The swelling doesn’t go down totally even laying down for the night.  By the end of the week I might not see my ankles at all. 

Father, thank You for working with us in surgery.  I felt Your presence with us, especially when the surgery was very difficult and panic could easily take over.  However, I had this secure confidence that You were there with Your hands on our hands helping us do the surgeries properly.  The right decisions were made and You gave the strength and clarity of mind to manage the obstacles that were in front of us.  I felt total peace and I know that was because You were there. Thank You, Lord, for a great day of surgery.  These people received the healing they needed because You were with us answering their and our prayers.  I give You all the praise!  Amen.

The past two days the men have been here working on the well.  They have now fixed the burned out motor in the new well and the well is fully operational.  We now have abundant water.  Interestingly, since the well was being fixed, the rain has stopped.  We have learned that the city is short on water and the local hospital in town does not have any water.  Angelita and Maria Luisa state they have intermittent water at their homes.  Here the two wells are working fine now and we still have a good supply of rain water.  The new well is deep enough the water is very good quality.  Jane said that water is drinkable without being treated.  However, the water gets mixed with the old well that is much shallower and thus the water needs filtered to be safe to drink.  The cost to fix the well was $4800.  Jane had to pull funds from another project in order to pay for the well.  Now we are praying for funds to come in to cover the well expenses. 

8:45 PM.  We just finished our supper which was a soup that was somewhat creamy filled with beans, vegetables, corn and poured over rice.  It was quite tasty.  Soon I will be heading to bed to get some good sleep and time off my feet to help the swelling. 

Father, thank You for a great day.  You were with us throughout the day and we felt it.  You provide so much for us day after day.  Lord, each new day is because of You.  You make Yourself visible to me over and over through Your creation around me, through the wonderful ways You work in my life, and through Your unfailing love.  Thank You, Father.  I pray for a good night’s sleep and a good day tomorrow as we again use the skills and wisdom You have given us to reach out to the people who come to us for care.  Thank You for the opportunity to serve You here in San Lorenzo.  Amen.

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