9-16-2010 (Thursday)

I didn’t sleep well because my mind was going over the surgeries for the day and I’ll have to admit I was worried deeply about how we would care for the two people with big problems. Lord, I am worried about A.G. with cervical cancer and A.C.C. with the huge vaginal prolapse. Yet, You tell me not to worry or fret. God, You have all the capability to handle these issues without me or anyone. Yet, You choose to work through people like Jane and me. Lord, help me balance my wisdom and eagerness with Your wisdom and healing power. Wrap Your hands around mine, Lord, and literally guide my hands, eyes and thoughts. Keep me focused, Lord, and especially cover me with the calm that comes from complete confidence in You. Please don’t let my own self-confidence become cockiness. Help me Lord. I am leaning on You completely. Thank You, Lord. Amen.

Our devotions this morning were based in Ephesians 4:25-32. Therefore each of you must put off falsehood and speak truthfully to his neighbor, for we are all members of one body. “In your anger do not sin.” Do not let the sun go down while you are still angry, and do not give the devil a foothold. He who has been stealing must steal no longer, but must work, doing something useful with his own hands, that he may have something to share with those in need. Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen. And do not grieve the Holy Spirit of God, with whom you are sealed for the day of redemption. Get rid of all bitterness, rage and anger, brawling and slander, along with evry form of malice. Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you.(NIV) Here Paul talks about knowing Christ. Our behavior, mind and body, should honor Him. The more we know Him, the more we will follow these commands that Paul gave us. We are to avoid distractions that take us away from knowing God and honoring Him. Father, right now worry is distracting me from trusting You fully. Lord, lift that burden from my shoulders and give me peace. Thank You, Lord. Amen.

Our first patient, D.M., age 85, has a significant prolapse. She must wear a rag stuffed up inside to keep things in and allow her bladder to work. This is a difficult inconvenience for her. Her BP was 190/105 and that bothered us. Her chest is congested with rattles in both lungs. She also has considerable swelling of the feet and ankles. This lady is not well and probably some of this is age related with generalized deterioration of her heart. I wondered if she could be in early heart failure. Viviana was not comfortable giving her an anesthetic and did not want to proceed with this surgery at this time. Thus, we cancelled the surgery. The lady was disappointed but understood. Her family wanted to know when I am returning to San Lorenzo so she can have her surgery then. My heart says to operate and relieve her of her problem but my mind says it’s wise to hold off.

Our next patient, A.G., age 55, has cancer of the cervix. She is bleeding from the cancer and on exam the cancer felt mobile and the possibility was there of maybe being able to remove it. However, when we got in the abdomen we found more cancer, especially off to the left. The cancer extended to the pelvic side wall and involved the ureter. She also had enlarged nodes in the pelvis but not further up. Jane and I talked about what might happen if we got a biopsy and did nothing more. She said this lady could not afford any radiation treatment and would not return to the cancer hospital. She said she would likely just die of her disease. We felt if we could possibly get around the tumor it might give her some chance plus it would be a positive path report for the cancer hospital. Our goal was to convince her to return with a proven diagnosis and receive radiation therapy. As we thought and prayed about this situation we decided to attempt removal. The surgery was very difficult and we could not remove all the cancer. We did get the uterus and cervix out but left cancer on the left pelvic side wall. At least she has a chance with radiation therapy. I felt really bad about this situation in that she has a very poor prognosis. Her ureter is obstructed on the left and that will leave her with just one functioning kidney. We did not have the capability of bypassing the ureter into the bladder. It is so hard to end a difficult procedure knowing you did not accomplish the goal you had and you are leaving the patient with an incomplete treatment. This is especially hard for me because of the economics of health care in this country. This lady will likely go home and die and not receive any of the care that she could receive in the USA even if she couldn’t pay for it. Lord, please wrap Your arms of love around this lady and touch her with Your healing touch. Please draw her close and care for her, Lord. We have done all we can do and that isn’t enough. Yet, I know You are here and You have plans for her. Thank You, Lord. Amen.

Our third patient, A.C.C., age 47, is the Chachi Indian with the terrible prolapse. I noticed when she was on the OR table talking with Damarys and Angelita, her teeth were in horrible shape. With one daughter being a dentist, I notice teeth more than I used to. It appears this lady never brushed her teeth and likely has never seen a dentist. Several of the teeth were replaced by large black cavities. I wonder if she is in pain from all that dental disease. I can’t imagine how hard life must be for these people. I asked Jane what this lady might do every day. She said she probably lives by herself in a small house or shack and maybe has a small garden to provide food. She probably goes to the river every day to get water for drinking and cooking and probably has to carry this water back to the house. Also, she very likely does her laundry in the river. She is from a village further up the river from Zapallo Grande. As I studied the prolapse and tried to understand the changes that led to this remembering the type of repair I did in 2006, I was able to discern that my repair was still intact. Her tissues must be very stretchy and over some time everything just enlongated and allowed the prolapse to occur again. I felt good that my work before held but also now entertained the possibility that whatever I do today will likely fail as well. She is very thin and has no shoes. Her feet are calloused and dirty. She appears to be chronically undernourished. She lives by herself and every morning must answer the question, “Will I survive today?” We have no concept of life on the rivers in Ecuador, isolated from the world and living from day to day. As I studied the prolapse I was praying the entire time asking God to give me directions and tell me what to do. Then it happened. A plan formulated in my mind and I knew what I must do to accomplish a good repair and possibly one that will not fail again. This involved essentially removing the vagina which we had talked with her about before. The surgery took about 2 hours and in the end the large prolapse was gone and she had a secure repair. Thank You, Lord, for guiding me and supervising this surgery.

At this point in the day I was completely spent, physically and emotionally. My back was hurting with multiple spasms and I wasn’t feeling good. In fact, it seemed I might be running a slight fever. I told Jane how tired I was so Viviana had me lay down on the OR table and shut the lights out and I got a 30-minute power nap. That felt really good and the spasms eased a lot. O

ur last patient on the schedule for today, G.S., age 62, needs a simple bladder repair. She has a small prolapse compared to the lady we just treated. I did her surgery in about an hour and got a good repair.

At this point Jane asked me to assist her on a colposcopy exam. The patient was a young lady with some mild changes on a recent pap smear. Her exam was unremarkable with no spots or lesions noted under magnification with the colposcope. I recommended to Jane that she wait for 3 months and then redo the pap smear. The time will allow a very early spot to define itself better so a directed biopsy could be obtain or it will confirm what we see today in that there is nothing going on. Sometimes these early changes will appear and then disappear on their own. At this point all Jane needs to do is monitor this lady more frequently and biopsy if indicated.

We have been invited by Sandra and her husband to come to a place here in San Lorenzo for fruit salad. They want to treat us as a thank you for delivering their baby. It is now 7:30 PM and Jane said the fruit salad place is closed. So we are going for ice cream. Then we will come back for dinner. I told Jane this is a good plan for I’ve heard it said, “Eat dessert first, life is uncertain.”

I wonder if I am getting sick. Today I have felt overly tired, actually exhausted. I also felt hot most of the afternoon. Now I ache all over. I suspect I am getting some virus. I took some Tylenol and now feel a little better. Tonight I plan to crash and sleep the night away. I talked to Jane about it and got a thermometer from her to see if I am running a fever. Tomorrow our surgery schedule is light with several small cases. I need to be there for a couple but otherwise Jane can do the rest herself. I took my temperature and it was elevated to 37.6 with 37 being the same as 98.6. So I am running a low grade fever. Now I am wondering what is going on with me. Father, thank You for covering us with Your grace and mercy. You helped us when we were at the end of ourselves, Lord. Thank You for continually being there for us. Help me, Lord, as I don’t feel well. Help me get the rest I need. Thank You, Lord.

The power just went out and now the generator is on to provide power to the clinic building. The house and albergue is not covered by this generator. The clinic staff were transporting our last post-op patient to her bed when the power went out. I was able to feel my way to my room and get my flashlights. I went out and used the lights to help transport the patient to her bed. Now I am writing this by flashlight. How long the outage will last no one knows.

Eventually, the power came back on. We went to the ice cream party and Sandra’s husband told us how thankful they are that we provided the care for them and delivered their baby. At this point the baby has no name as they are trying to come up with a name that reflects us. I know Marvilita was one possibility. He said they are taking the first initials of everyone and seeing if these letters would spell a name for the baby.

9:15 pm. I talked with Phyllis briefly on Skype and am now heading to bed. I took more Tylenol and am looking forward to a good rest. Father, please give me a good rest tonight and help me, Lord. I don’t feel well and now is not the time to get sick. Please cover me with Your grace, Lord. Thank You, Lord. Amen.