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9-14-2010 (Tuesday)

It’s morning already!  I didn’t sleep as well as I hoped last night.  Since I am planning to meet Jane at 6:30 to round on the post-op patients, I set the alarm to get up earlier.  Frequently I will have this happen.  When I know I need to get up at a certain time, I am constantly awakening to look at the clock.  I started looked at 3 or so and every now and then would awaken and look at the clock.  The next 3 hours of sleep was not good sleep, lots of tossing and turning and wondering what time it was.  Over all I did rest in the supine position but didn’t sleep as well.  Of course, by 5 AM the trucks and buses start rolling and needing to slow down for the speed bump.  This makes the last hour or so of sleep even less sound. 

Father, I didn’t sleep as well last night and I need the energy and the wakefulness to function well today.  Please energize me with Your spirit and Your presence today, Lord.  Again, cover us with Your wisdom and Your unfailing love and especially care for the post-op patients and those we will operate on today.  Thank You, Lord, for the walk we will have together today.  Amen.

I met Jane about 6:30 and we rounded on the post-op patients.  Everyone was doing great.  We took out the foley catheters and the IVs and they were getting up to walk about and taking food.  The first lady from yesterday with the huge fibroids and difficult surgery looked comfortable and was not complaining of any significant pain.  We were very pleased with how all the patients were doing.

I was thinking about our devotions yesterday and how difficulties work to our good by stretching us and making us rely more on God and less on ourselves.  Yesterday, our surgeries were demanding and did stretch us significantly.  However, God showed massive strength in the midst of our weakness and we saw some of that strength this morning as we visited our post-op patients.  Thank You, Father, for Your healing power and the tender care You give to our patients.  You guide us and have us use ourselves to deliver Your love and Your grace to these people.  Then You wow us with healing beyond comprehension.  Lord, the praise and glory goes only to You.  Thank You!!  Amen.

We started our day with devotions from Deuteronomy 6:4-9.  “Hear, O Israel:  The Lord our God, the Lord is one.  Love the Lord your God with all your heart and with all your soul and with all your strength.  These commandments that I give you today are to be upon your hearts.  Impress them on your children.  Talk about them when you sit at home and when you walk along the road, when you lie down and when you get up.  Ties them as symbols on your hands and bind them on your foreheads.  Write them on the doorframes of your houses and on your gates.” (NIV)  When you read these verses that Moses spoke to the nation of Israel, he was telling them to make God part of every facet of their lives.  How do we do this?  To me it comes with knowing God.  The more we know Him, the more we incorporate Him into our day.  He becomes central in our thoughts.  He becomes ever present in our minds and hearts.  We practice walking with Him every step along life’s path.  We then live out this relationship in front of our families, our friends, our co-workers, and our world.  We finished the devotion time with singing To God Be The Glory.  That is exactly what we should sing.  We are to bring God all the glory.

During our breakfast Sandra’s husband came in for a visit.  He brought the little baby along for all of us to see.  He said Sandra was going to come but wasn’t feeling that good so he came by himself.  He told me he and Sandra want to come before I leave to thank me for delivering their baby.  We took some pictures of the baby and him.  I am so happy the baby is healthy and doing very well.  Praise God!!

Our first patient, S.P., age 53, has gall stones and is in for a laparoscopy cholecystectomy.  Because of donations from a surgery center in Fort Wayne, Jane now has laparoscopy available here.  She received the scopes, instruments and monitors so she can have full laparoscopic offerings here.  This was the second laparoscopic surgery Jane has performed here.  This patient was on the heavy side and I was concerned how things would go.  However, Jane make it look simple and easy.  In no time at all the gallbladder was removed and there were no complications or even any times when things became tense.  I had another walk down memory lane with this surgery since I did a lot of laparoscopic surgery when I was in practice and even trained one of Jane’s partners with the basics of laparoscopy before he went to get general surgical training on this instrument.  I was thrilled to see this service available here in San Lorenzo. 

Our second patient, L.C., age 72, was a robust gentleman who didn’t have an ounce of fat on his body.  He was muscular and to me looked younger than his age.  He had a huge hydrocoele, a fluid collection in the scrotum.  This sometimes is associated with an inguinal hernia.  As he entered the OR Damarys asked him to read and sign the consent form for the surgery.  He looked it over but was hesitant to sign it explaining that his hands shake so bad and he wasn’t sure he could control them to sign the paper.  Actually, he was quite embarrassed by this condition.  Damarys reassured him that this was okay and he then signed the paper.  Jane and I talked about this.  It seemed like an intentional tremor and not something you see with Parkinson’s Disease.  This poor man was really restricted on what he could do because of the tremors.  He was very muscular and looked like he has been working hard all his life.  Yet, as age advances and one loses functions it is understandable that a lot of mourning of these losses takes place.  I began to wonder what I will do when functions I have taken for granted start to disappear.  Will I want to continue doing surgery, something that gives me tremendous pleasure and satisfaction?  I remember a colleague going through this transition.  He developed Alzheimer’s Disease and this took him out of the OR and eventually out of his practice.  Had he not had this problem he most likely would have kept working as his practice was so important to him and was a major part of his life.  It is like taking the keys away from someone because driving should not be done anymore.  There are situations where an elderly person just should not be driving anymore.  However, to that person taking the keys away is stripping them of part, an important part, of their identity.  For this patient the surgery went well and we fixed the hydrocoele.  He will be feeling much better by having this mass removed from between his legs.  I am sure it bothered him as he walked and sat.  Yet, I felt sorry for him because of his tremor.

Our third patient, I.G., age 39, I saw in the clinic last week.  She had been told she needed a hysterectomy because of a large fibroid; however, she was desperate to keep her uterus.  She said she wanted to have another child.  When I examined her then I felt we could possibly remove the fibroid without sacrificing the uterus.  This is called a myomectomy procedure.  The fibroid is a hard tumor mass that is almost always benign and grows in the walk of the uterus.  Fibroids cause trouble because they distort the uterus resulting in problems with bleeding, pain and at times infertility.  During pregnancy fibroids tend to enlarge a lot and take up valuable room needed for a growing baby and can lead to pregnancy loss.  Removal of the fibroid can cause a lot of damage to the uterus.  Thus, sometimes it is a very difficult decision on what to do.  Sometimes the hysterectomy is easier and less risk.  However, in this lady’s situation the fibroids were very superficial and I felt we had a good chance of saving the uterus for her.  Today she arrived and was upset because she wasn’t first in line for surgery.  Somehow she felt she was promised to be the first case of the day.  Jane never told her this and we don’t know how she got this idea.  When she saw others going to surgery before her, she created a scene.  She was actually fourth in line today but we moved her up to third just to give Loida a break at the front desk.  Apparently, this lady was giving Loida a lot of grief.  I am amazed how some people can be so inwardly focused and don’t see the needs of others around them.  This lady thought only of herself and the inconvenience she was having to endure because she was not at the front of the line.  When we operated on her we found a large fibroid, bigger than the uterus, sitting in a web of tissue next to the uterus.  It was connected to the uterus only at one small spot where it obtained its blood supply.  This large fibroid came out easily without causing any damage at all to the uterine wall.  She also had a small one on the surface of the uterus and this also came out with minimal effort.  We were very pleased to have a successful myomectomy procedure that leaves the uterus intact with no scars that could give trouble with a subsequent pregnancy.

At this point we took a break for lunch.  Nancy again fixed a nice warm meal.  It is more like dinner to me.  One problem that occurs after a meal like this is the sleepiness that seems to bother you for a couple hours.  I don’t like that after effect when I am doing surgery. 

After lunch we operated on our fourth patient.  L.Q., age 44, came in for a hysterectomy because of large fibroids.  This surgery schedule is sounding like a broken record!  Everyone who walks through the door has large fibroids!  She was having difficulty with bleeding and a lot of pain.  Her uterus was the size of a 4 ½ month pregnancy.  At surgery we found the fibroid uterus as expected but also found a large blackish cyst on her right ovary.  The cyst was a dermoid cyst.  Dermoid cysts are generally benign tumors of the ovary and are comprised of mature cells from various parts of the body.  What is usually found is skin and hair, teeth, bone and cartilage.  This cyst was filled with black hair and also a piece of bone. 

At the completion of our schedule I came back to my room and took an hour nap.  I was really tired from standing all day and didn’t feel all that good.  After sleeping for an hour I got up for dinner and felt much better.  After dinner Damarys, Loida, Viviana, Jane and I played a board game.  Now it is time for bed as Jane and I will round on our post-op patients tomorrow morning starting at 6:15.  Tomorrow has another full day in the OR with some possibly longer cases. 

Father, today went a little quicker and I thank You for that.  What could have been some really difficult situations went very smooth and easy.  Thank You for giving us a break when physically I was wearing down quickly and getting really tired.  I pray for the patients we cared for today.  Please hold them close to You and heal them.  Lord, I also pray for the older man with the tremors.  Please settle his hands so he can use them.  Help him, Lord.  Thank You for another good day of serving You.  Amen.


1. Lou Ann - September 15, 2010

Lord, Renewed energy and strength for Dr. E and the team…Thank you for caring so deeply for everyone he has seen. Amen

2. Tom Beckner - September 15, 2010

Praise God for another successful day for your team!

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