9-13-2010 (Monday)
I awoke this morning after a good sleep and feel rested. Today is the beginning of our surgery week with some of the more difficult surgeries of the week. We will have our work cut out for us for sure. We gathered together at 7 for devotions and then had breakfast. The clinic staff use Our Daily Bread as their topic guide for devotions. Today’s study was from Romans 5:1-5 “Therefore, since we have been justified through faith, we have peace with God through our Lord Jesus Christ, through whom we have gained access by faith into this grace in which we now stand. And we rejoice in the hope of the glory of God. Not only so, but we also rejoice in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not disappoint us, because God has poured out his love into our hearts by the Holy Spirit, whom he has given us.” (NIV) We talked about the tough times of life and how God uses these to strengthen us, stretch our faith, and give us hope. Damarys talked about her children who are going to school in Quito while she is here for the week. She said it is very hard for her to let them take a taxi to school each day and she is not there to take care of them. I talked about a comment made by Dr. David Jeremiah when he was pastor of my church in Fort Wayne. He talked about growing up in a greenhouse. The greenhouse is good but eventually you have to move the plants outside to be buffeted by the wind and the harshness of weather because only then do the plants become strong.
Father, today is the start of the surgery week. We have a lot of work ahead of us but I am confident because You will be with us throughout. Lord, I pray for Jane and me for wisdom and skill to accomplish what we need to do. I pray also for Angelita, Maria Luisa, Damarys, and Loida as they are here supporting us and making sure we have all the supplies for the surgeries. I pray also for Nancy who is cooking for us and keeping us nourished. I thank You for Viviana for providing our anesthesia for us. Please surround her with Your love and wisdom also. Lord, I especially pray for the patients we will see today. Please cover them with Your protective hands and assure them You are there with them throughout the surgeries. Thank You, Lord, for Your unfailing love. Amen.
The first surgery, R.H., age 38, has huge fibroids extending all the way up to the right rib margin. On palpation of her abdomen she has a very large mass that fills the belly and extends deep into the pelvis. When we opened the abdomen the mass was a conglomeration of several fibroids that all mixed together distorting the anatomy considerably and occupying a large portion of the space in the abdomen. This surgery went along well but was very difficult, especially because of the distortion of the anatomy. The blood vessels were not in their usual places and were enlarged greatly to feed this mass. We had to be methodic and careful and identify the anatomy as we went along. Eventually, we were able to remove the mass and the uterus as one entity. We suspect this entire mass weighed more than 10 pounds. God was with us throughout covering us with His hands. That was the only way we could have accomplished this surgery.
The second surgery, A.P., age 42, also had large fibroids. She has been bleeding heavily and had become significantly anemic. Jane gave her some iron at higher doses and she responded by building up her blood count to a safer range. Frequently, when a problem occurs with the uterus, such as fibroids, and heaving bleeding occurs, the bleeding many times does not stop. The result is loss of a lot of iron and then iron deficiency anemia. The bone marrow is running at its maximum to replace the blood cells that were lost but can’t because the raw material, iron, is not there. So, when one takes iron replacement the bone marrow responds quickly and the blood count can quickly respond. This lady had a uterus that was the size of a 5 month pregnancy. This was not nearly as big as the first patient and seemed a lot easier as well. She went through the surgery very well.
After the second surgery it was 2:30 PM and we stopped for lunch. The first surgery took almost 3 plus hours to complete. Nancy fixed us a delicious lunch. She prepared some fresh squid in coconut sauce, which was mainly coconut milk. This was served hot over hot rice. She then took the white coconut meat and chopped it very fine, mixed it with sugar and we had that as a treat. It was like eating granola but very different flavor. The squid was very tender and tasted like scallops. I never liked squid because the only times I have tried to eat it the meat was very rubbery and difficult to chew. This time it was not like that at all.
After lunch we started our third surgery. This lady, W.B., age 52, also had fibroids and a lot of pelvic pain and bleeding. She, too, had a uterus that was the size of a 5 month pregnancy. She had a large fibroid on the cervix which is something I rarely saw in my practice. I took care of a lot of women with fibroids but rarely saw involvement of the cervix. However, here in Ecuador it seems we see cervical involvement all the time. The problem this gives is it makes the surgery much more difficult. The blood supply to the uterus and the ureters that drain from the kidney to the bladder are in the area close to the cervix. When the anatomy is distorted by a mass, such as a fibroid, the vessels and ureter are frequently more difficult to work around and avoid injuring. The first patient had a huge cervical fibroid. This lady it was much smaller but still gave a challenge getting it out without causing any injury to the ureters.
By 5 PM we were ready to start our last surgery. A.C., age 20, is a healthy young man with a right inguinal hernia. Jane anticipated this surgery would not take too long; however, once we were in the middle of the procedure Jane found changes that are more usually seen in much older men. This added time to the surgery and we finally finished about 7:30 PM.
After cleaning up the OR and getting everything ready for tomorrow, Jane took Angelita and Maria Luisa and Gonzolo home. We then had our dinner, which consisted of lentils over rice. Dinner here in Ecuador is the lighter meal with lunch being the biggest. Actually, this would be a better way of eating for Americans. We burn the calories that we just consumed first before taking calories out of storage (fat). We eat our biggest, most calorie-laden meal in the evening and then do very little to burn those calories. Thus, the body chunks them into storage and we then wonder why we all gain weight. We actually should eat more of our food in the day time when we then are more active in burning off the calories. The lentils over rice was good. I didn’t eat too much because I don’t sleep well when my belly is full of food.
9:50 PM. I am back from our dinner and getting ready to call it a day. My legs are tired from standing all day and the feet are swollen. I am looking forward to laying down and getting some rest. We have a full day tomorrow and standing all day leaning over an operating room table results in leg and back pain. Sometimes you have to stand in one position for a long stretch of time. The back muscles complain by going into spasm and that makes the case even more interesting and challenging.
Father, thank You for a good day. We feel we accomplished a lot for these people we cared for. I am sure the women will find life much easier without all the bleeding and pain. Thank You for giving me the skills needed to help people in this way. Lord, thank You for being with us in the OR. We sensed Your presence and this gave me incredible peace even in the face of very difficult surgery. Lord, I pray for the patients we cared for today. Please give them rest tonight and relief from their post-op pain. Help them recover and heal, Lord. Cradle them in Your loving and healing arms, please. I pray for Jane, Viviana, Damarys, Loida, Angelita, Maria Luisa, Gonzolo and Nancy. Thank You for each of them and the help each one brings to make this clinic function. Especially, I am grateful to You for bringing me here to help serve You through serving the people of San Lorenzo. Thank You, Lord. Amen.
Medical Missions 
God bless, and more prayers are going your way!
Continued prayers for strength and wisdom
I pray blessings on the work–may the surgeries provide healing for many years.
I loved Pastor Jeremiah’s greenhouse analogy, too!
Tom Beckner