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7/17/09 (Friday)

Friday, July 17, 2009

8:00 AM.  I awoke about 5:30 and then got up and showered to be ready to round on the patients with Jane.  All our patients are getting along fine.  The little old man with the incarcerated hernia is progressing nicely.  He incisions are clean and he still is not using much pain medicine.  The lady with the gastric resection likewise is progressing along well.  She still has the NG tube in and claims this is what is keeping her alive.  Initially, when she awoke from anesthesia, she had an Oxygen cannula in her nose along with the NG tube.  Someone told her the tube is keeping her alive.  Since then the oxygen cannula has been removed she is convinced that the NG tube, which is draining her stomach, is actually keeping her alive by allowing something life supporting from the outside to get inside.  Jane has tried to tell her the NG tube is draining her stomach where the surgery was performed.  She still isn’t convinced of that yet.  Jane isn’t sure she will be able to remove the NG tube without the lady becoming very anxious about not having her life-giving tube anymore.  Most of our other patients are going home today.  The lady with the fistula is doing very well and she will go home tomorrow mainly because she comes from a village several kilometers away and does not have transportation today. 

Father, it is a new day for us and You provided a nice rain overnight to fill our cistern again.  Thank You for that.  Thank You for the good sleep last night.  Today, Lord, we have several surgeries and will need Your hands around our hands again like You have provided daily for us.  Thank You, Lord, for Your support of our work here.  We dedicate this work to You, Lord.  You reach out through us to touch the people we see.  You love them with an unfailing love and allow us the privilege of being conduits of that love.  Thank You, Lord!  Amen.

We have six surgeries scheduled for today.  Most are short cases.  Hopefully, things will run smoothly and we will be able to finish in good time later this afternoon.

Our first surgery, J.M. is 68 and has a hernia in the midline of the abdomen above his navel.  He had been having pain there and thought he had a lipoma.  Jane diagnosed the hernia.  Steven scrubbed as first assistant and was able to help with the hernia repair.

The second surgery:  M.C. is 25 and has never been pregnant.  She has a small myoma on the uterus and has been advised by others to have this removed to be able to conceive.  I found a small myoma, 11 mm in diameter, on the surface of the uterus and I doubt if this is a major factor in her ability to conceive.  She really wants it removed.  Her grandmother and other family members have been insisting she have a hysterectomy.  The problem is there are “doctors” in the area who would do just that without giving any thought to what a hysterectomy would mean in the life of this young lady.  We will do a small laparotomy, remove the fibroid and assess the tubes to make sure no other problems exist.  At surgery we found not only the one 11 mm fibroid but seven other smaller ones, all superficial.  One was developing at the left corner of the uterus and would likely interfere with the left tube function as it got bigger.  We did a multiple myomectomy without any difficulty.  I feel bad for this young lady having fibroids with the potential of developing more in the future.  Hopefully, she will not get into trouble with them in the coming years so when she is wanting to conceive, she will be able to.

The third surgery:  E.G. is 28 and is in for a tubal ligation and removal of the Norplant contraceptive system.  She is wearing one implant and was told it would be good for three years.  The normal use of Norplant is to insert all 5 implants and they are good for 5 years.  It appears someone is treating multiple patients with only one system.  Her surgery went quickly and Jane removed the Norplant under local anesthesia.

The fourth surgery:  E.V. is 39 and has had one previous pregnancy.  She wants to conceive and has been unable to do so since her last pregnancy.  That pregnancy was delivered by C-section and the baby died at age 8 months.  Jane had obtained a hysterosalpingogram which revealed both tubes to be open with possible hydrosalpinx at the ends of each tube.  This most likely is a result of infection, possibly at the time of the C-section.  We will look and do a bilateral cuff tuboplasty to open the tubes.  At surgery we found some adhesions of the sigmoid colon mesentery to the surface of the uterus.  The tubes were open and normal except for dense scarring at the junction of the tube with the uterus.  This looked like a crush injury from a clamp place there most likely at the time of the C-section.  To fix this problem would mean removing the corner of the uterus and the scarred section and reimplant the tube on each side.  This would be a major undertaking and may not really improve her chances of pregnancy.  Unfortunately, there was nothing we could really do to help her.  I did remove a couple small fibroids on the surface of the uterus.

The fifth surgery: M.G. is 36 and is in for a tubal ligation.  However, she failed to show for the surgery.

The final surgery: A.M. is 50 and post hysterectomy by a few years.  She has had some vaginal bleeding post intercourse and on exam has a small polyp on the lateral vaginal wall that bleeds easily.  We plan to remove this polyp under local anesthesia and sedation.  With a little local anesthesia and some sedation, we were able to quickly remove the polyp and suture the site to control bleeding. 

3:00 PM.  Our surgery week is done!  We finished in good time and this will give us some time to rest a little and pack for travel tomorrow.  We had lunch and a good time just sitting and talking and saying good-bye to Paul and Loida who are leaving for Quito.  We also said good-bye to Angelita, Maria Luisa and Piedad who are heading home for the day.  We will be packing and heading out with Jane and Damarys tomorrow morning for our return to Quito.

6:00 PM.  We have returned to the house and I have organized all my clothes and packed for the trip back.  My luggage I brought fits inside the one suitcase that carried the bovie unit.  I will be able to travel back with one suitcase and one carry-on.  That will make traveling back a little easier.  Tonight will be an evening of rest and relaxation and hopefully some good sleep.  Jane is planning on travelling back with us tomorrow to Quito and then will return to San Lorenzo on Sunday.  She will have some patients still here recovering and will need to come back to help care for the lady with the gastric resection and the man with the incarcerated hernia.  Both are recovering okay but need to be watched closely.  Jane does not want to leave them totally in the hands of Gonzalo. 

Outside the police set up a roadblock right in front of the clinic.  They are stopping all traffic coming into the city and checking every car.  Several are standing there with assault rifles drawn.  We wonder what is happening and hopefully we won’t be caught in the crossfire.  Nyletta said this is better than the COPS program on television.  We are watching everything live. 

8:20 PM.  We ate our dinner that Nancy fixed for us.  The Ecuadorian meal always has rice with it and generally beans or lentils.  Tonight, we had fried pork, rice and lentils.  Then Jane, Damarys, Steven, Nyletta and I sat and talked for awhile.  Jane and Damarys said there is a rumor that there is going to be a strike tomorrow.  Jane said it is just a rumor but she and Damarys take these rumors very seriously.  Usually, a strike means some group decides to block the highway and won’t let any traffic through.  They may make you stay at the place of the strike or you have to turn around and return to San Lorenzo.  If that occurs and we have to return, we will probably miss our flights on Sunday.  We are hoping the rumor is just that…a rumor.  I am sure we will all feel better when we make it to Ibarra and Otavalo as we will be beyond the strike zone.  This is something else to pray about and to just trust God. 

Father, thank You for our great week of surgery.  We have had some challenging surgeries that demanded every skill and thought from us.  And You so bountifully provided everything we needed to accomplish the physical healing You intended.  You could have just touched them and healed them but You choose to work through Your created beings to accomplish this most of the time.  It is such a privilege to be one of Your instruments of healing, Father.  Thank You for that. 

Father, I pray for the patients and their processes of healing from the surgeries.  Thank You for protecting them and keeping them safe.  Thank You for helping them avoid serious complications.  Thank You, Father for loving them do deeply and profoundly that You would send Your Son to be the sacrificial Lamb to allow these people, and us, the opportunity to stand before You forgiven, accepted and welcomed into Your presence.  Father, what a glorious reality for each of us!  Thank You for that.

Father, I pray for a good night’s sleep tonight and we all obtain the rest we need.  I also pray for safety on the road tomorrow.  Lord, keep the strike rumor a rumor.  Please intervene and allow the people here to travel.  Please guide us through this area so we can arrive safely in Quito and be able to complete our travel back home.  Father, I trust in You and walk with You through all of this.  Thank You, Lord, for the peace You give me, a peace that truly passes all understanding.  Just being at Your side facing the situation together brings me incredible peace.  Thank You for that.

Father, please provide the same peace for Phyllis and my family.  Thank You for allowing me the privilege of being a husband to Phyllis and for sharing our lives together.  I love her so much and I know You do to.  I pray for her at this time. 

Thank You, Father, for Your rich blessing You have given to Jane and her team here at the clinic.  Thank You for the witness they have in this community and the help they give to those in need.  It is such a privilege for me to be able to participate in that ministry, even for the week or two that I can come.  Thank You for that, Father. 

Father, to You and You only goes all the praise.  Amen.

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