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7/16/09 (Thursday)

Thursday, July 16, 2009

6:00 AM.  Another sweaty night but still slept fairly well.  I am up early to make rounds with Jane.  The traffic is moving on the road with lots of trucks and busses going by.  There is a speed bump on the road outside the clinic and this causes all the traffic to slow way down to go over it.  The busses and trucks must downshift, apply the brakes, and then start up again.  Of course, that is not the quietest process.  The roosters are telling everyone that morning is here as well.  Plus, there is only so long this old body will tolerate laying in one position on a rather firm mattress.

I was thinking more about the relationship God desires with each of us.  My thoughts took me to the Gospels and the accounts of Jesus calling the disciples.  As he walked along he picked out specific people and said simply, “Come, follow Me.”  In the Gospel of Mark, the response by Peter, James, John, Andrew, and others was recorded as immediate.  They immediately left their nets, their occupation, their livelihood and followed Christ.  Jesus was saying to them, “I want a relationship with you, a relationship founded on love and trust.”  I was drawn to the word, trust.  This is an essential component of any relationship and especially in the relationship God desires with me, with you.  He asks us to trust Him.  That is an easy word to speak but it is harder to act out, especially when the path Jesus takes me on is treacherous and scary.  He asks me to follow Him and many times holds out His hand so He can help me navigate the danger ahead.  Yet, when it comes to truly trusting Him, it sometimes is hard when everything within my senses says no.  That’s when I must depend on my relationship with Him.  That relationship must be founded on trust, complete trust.  It must be the same level of trust Job had in God when Job was in the midst of intense suffering.  At the time Job’s wife was urging him to curse God and die, Job said, “Though He slay me, still I will trust in Him.”  Job had that relationship and when you read the first two chapters of the book of Job, you see God so confident of that relationship that He gave permission to Satan to go after Job. 

I think about the surgeries we have been able to do this week.  Some were quite risky and even in a hospital with all the equipment and support services, these surgeries are still risky.  Here there are no support services, no labs, no blood bank, no x-ray, no ICU.  To take care of these people requires trust, a lot of trust.  It is God who enables and who heals.  It is God who shelters His people with His grace and His love.  It is God who fulfills the relationship built on trust.  We have to have trust in God to be able to do what we do here.  I see Jane working in the mindset of complete trust and that speaks to me loudly.  Why do I complain when my life is going a little rough when I see the people here living every day in much worse circumstances than I have even experienced?  Where is my trust?  When God taps me on the shoulder and says, “Come, follow Me,” what is my response?  Should I even hesitate and think it over or should I be like Peter, James, John, Andrew and immediately leave what I am doing to follow Him? 

Relationship requires trust.  That message comes through loud and clear.  And God honors that trust evidenced by the miracles He performs in my life and work all the time.  Watching Him heal these people who are seriously ill is amazing.  These situations have all the potential of serious infection and complications yet the patients move through this challenge protected by God.  These are the trust builders for me.  Watching God do this in a person’s life on behalf of Jane and her team trusting Him and praying for His protection and guidance to function as His instruments is simply amazing.  I know then that God will answer my prayers and I trust Him for His hand to grab mine and allow me to walk with Him through the tough times.  Trust…is this part of your relationship with God?

Lord Jesus, I trust You as a partner as we walk along life’s path together.  You invited me to join You and walk with You.  You are the decision maker for the path and my role is to trust You.  I walk along side of You and we face life’s challenges together.  That gives me peace and comfort even though the path is dark and treacherous.  I may feel lost, but You are not lost.  In fact, You are never lost.  Understanding that fact brings immense peace to my heart.  Lord, why do I worry?  Is that a lack of trust in You?  I confess that sin to You and ask You to fill me with Your peace and strengthen my faith.  Thank You, Lord, for taking me through challenges in the past to build my trust.  Thank You, Lord, for bringing me here to San Lorenzo again to build my trust in You.  Thank You, Lord, for the sheer pleasure of watching You perform miracles before my eyes and allowing me to participate in those healing miracles to build my trust.  Thank You, Lord!!

Lord, I pray for today.  I pray for the patients we will operate on today.  Please protect them and cover them with Your grace and mercy.  Please protect us.  Keep us healthy.  Guide our hands and thoughts.  Stand by us as we stand at the operating table and work for You.  Thank You, Lord, for this privilege of being Your instruments of healing and love to our patients.  Thank You, Lord.  Amen.

Jane and I rounded on all the post-op patients finding them all doing well.  The little old man with the incarcerated hernia is doing well.  He is draining from his inguinal incision where the necrotic tissue was and Jane has been irrigating the incision area.  He continues to tolerate all this without using pain pills.  The lady with the gastric resection is steadily improving.  She is taking liquids well and has been up and about some.  The other patients are all getting along well and several are going home today.  The lady with the vesicovaginal fistula repair told us this morning that she urinated around the catheter a couple times during the night.  Each time she expelled a large amount of urine.  This causes us to shudder in that the last thing we would want on a bladder with a fresh incision is to be distended and stretched.  Again, I have to just trust God to help these people heal.  After rounds we met together with the others for devotions and breakfast.

3:00 PM.  I am taking a break from our first case of the day.  This lady has a very large parotid tumor and we started about 8:30 AM.  It took most of this time just to trace the facial nerve which runs through the middle of the parotid gland.  My legs began to hurt enough I had to get off of my feet for a short while.  I have pitting edema all the way up to my knees and my feet ache.  With nothing to eat or drink the whole time and all my extra fluid running into my legs and feet, I began to get lightheaded and needed to rest a little.  After about a half hour’s rest, I feel much better.  Jane is still working on the tumor and it appears she will remove the top half and then send the patient to a head and neck surgeon to remove the bottom half since the facial nerve is so involved.  We still have four more surgeries to do after Jane finishes this procedure.  It is time for lunch.

5:00 PM.  We are now ready for the second surgery.  C.P. is 56 and has given birth to 12 children.  She has a large vaginal bulge with defecation and her exam reveals a large rectocoele.  We are planning a posterior vaginal repair.  At surgery the rectocoele was reduced easily with a posterior repair. 

6:00 PM.  The third surgery: N.A. is 36 and has had a previous tubal ligation.  She has a new husband and now wants to have the tubal sterilization reversed so she can conceive again.  A hysterosalpingogram revealed the one tube to fill with dye out to the end of the tube and the other tube fills only to the mid portion.  Our plan is to look with a laparotomy and then see if at least the one tube can be opened with a cuff tuboplasty.  Depending on the other tube status we may be able to rejoin that tube as well.  At surgery the right tube was not amenable to correcting.  There was too much tube missing.  On the left side about 5 cm of tube remained beyond the ligation.  I was able to open this tube and rejoin the ends to allow it to function again. 

The fourth surgery: J.P. is 40 and is wearing a copper-T IUD that needs removed.  When we saw her in the clinic the string is not visible.  We are planning to do a D&C to remove the IUD.  At surgery the IUD was easily removed.  I taught Jane on using a special endometrial biopsy curette to remove the IUD.  This can easily be used in an office setting and avoid the need for anesthesia and surgery.

The fifth surgery:  C.V. is 60 had has a large endometrial polyp that has prolapsed through the cervix.  We plan to do a D&C to remove the polyp.  However, she failed to appear for the surgery.  Her husband has a large gastric carcinoma and was one of the gastrectomy patients; however, he refused to have the surgery and was not accepting the idea he had cancer.  The wife had agreed to surgery and went forward with scheduling for today. 

8:30 PM.  We have completed our work for the day and are back at the house preparing to eat our supper.  It looks like a chicken soup on rice.  Then we will be heading to bed.

Father, thank You for the good day in surgery.  The first patient took much longer than expected and we could not take out the entire tumor for fear of leaving her with a facial paralysis.  Thank You for giving Jane the wisdom and discernment on just how far to go with the surgery on this lady.  Lord, I pray for the patient and that she will follow through with the rest of the surgery.  I pray also for the other patients who underwent surgery today and for our recovering patients in the albergue.  Thank You for watching over them and healing them.  Lord, I pray for our sleep tonight.  I am especially tired at this time and really need the rest.  I pray for all of us to have a good night’s sleep.  Thank You, Father.  Amen.

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