9-17-2010 (Friday)
I slept well except for awakening a couple times, one with shaking chills and the other after Tylenol with drenching sweat. My temperature continues to be low grade and now I have continual pain in my right upper abdomen. When I take a deep breath and palpate under the ribs I can feel my liver and it is tender. Now I am wondering if I have some viral infection that is affecting the liver. I hope I am not getting hepatitis.
Father, please help me stay healthy, especially here in Ecuador. I need to be sharp for our surgeries today. I pray for Your healing touch on me. Lord, I pray for our patients today. I pray for those recovering from surgery that their recovery will go well and they will not have any complications. Also, Lord, I pray for the ones who will have surgery today. Please protect them and guide us as we deliver care to them. Give us the wisdom to do the right thing for them. Lord, I pray for our two big surgeries from yesterday. I pray they are recovering okay and not having much pain. Please protect them from serious complications. Especially, Lord, I pray for healing for the lady with cervical cancer. Lord, I pray for my family. Thank you for them. Please be with them today as they have their own responsibilities to tend to. Thank You, Lord. Amen.
I met Jane about 6:30 and we rounded on the post-op patients. The lady with cancer was looking good this morning. She hasn’t taken any pain meds all night and sat up in bed without much difficulty. The Chachi Indian likewise was doing well with minimal drainage and not requiring much for pain control. I am amazed at how little these people use in the way of pain control. Usually, they will take on Vicodin maybe a couple times a day, if that much, and get along just fine. The man who had the gallbladder and common bile duct exploration has yet to take anything for pain. The other patients were all doing well and several were going home today. Most of these patients go home by their second day and walk out to the car without difficulty. Knowing they go home to a small house with minimal furniture and other comforts, I must admire them for their courage and stamina.
Our devotions this morning were from 2 Corinthians 10:1-11. Again, this scripture spoke to knowing God. Paul was talking about recognizing and taking down arguments that would pull you away from your walk with the Lord. He talked about thoughts that would distract you and emotions like anger that would pull you away from your relationship with God. He said we are to make every thought obedient to Christ. One statement in the devotional was, “Faith was never intended to be a substitute for intelligence.” We need to study the Word and know God as much as possible. Then our faith will grow from there. Just going on blind faith without some intelligence and knowledge makes you vulnerable to every wind of disagreement and false teaching. I remember Pastor David Jeremiah stating in one of his sermons, “If you find God seems distant to you, ask yourself, ‘Who moved?’” That is so true. If we don’t have good knowledge of God, we won’t even know if we have moved away from Him. I am amazed at the devotions this week and how they all aligned with my personal mission to know God better.
Our first patient was the fourth on the schedule but she was the only one who appeared so far this morning. She had several genital warts on the external genital region and around the anus. We removed them and cauterized the bases. This is the third time Jane has treated this lady. Frequently, these are difficult to treat. They are from a virus and it is very hard to rid the skin of the virus. You can get them under control and eventually they will reappear.
The second patient, M.M., age 60, is in for a vasectomy. I was surprised at his age and wanting to not father any more children. He really looked more like someone in their early 40s not 60. He was thin and very muscular. Jane was going to do this while I took a break from the action. I don’t feel all that healthy right now and I am enjoying the time to sit. My energy is down and my liver hurts, especially with each breath. Also, the low grade fever persists.
Our third patient, A.J., age 64, is one I operated on in 2004. At that time we did a hysterectomy and a Burch urethropexy for incontinence. That has worked fine for her since then. Recently, she developed a vaginal bulge and on exam had a breakdown in the supportive tissue overlying the rectum allowing the rectum to bulge into the vaginal space. This problem is an easy fix. She came in this morning concerned that she would go all day without food. Now, one look at her and you realize she hasn’t missed a meal in a long time. This morning she ate a huge breakfast to last all day. The anesthesiologist did not want to give her a spinal or a general anesthetic because of her quite full stomach. She said we would need to wait at least 8 hours. She did say she could give her a caudal block and I could supplement with local anesthesia if needed so we tried that approach. Actually, that worked very well without even needing any local anesthesia. I got her repair done easily and she was out in time for lunch.
We had 7 patients on the schedule for today with three being tuboplasties to reattach the tubes to allow pregnancy. Two of these patients cancelled and the third never did show up. We tried to call her but her cell phone was off and we never got in touch with her. So my surgeries were complete and I was planning to leave and go lay down to get some rest. Jane had a couple lipomas to remove under local anesthesia and also had a patient for a sigmoidoscopy. She continued to finish these cases while I left to my room for a nap.
I slept for 2 hours! That was wonderful. I awoke feeling much better. My chills and fever seem to have quieted down and actually I feel a little better overall. I am hoping this short viral illness will just go away and I won’t be bothered by it, especially on Monday when I fly back home.
About 5 pm Jane came by to tell me she was taking Maria Luisa and Angelita home. I went along with her so I could say good-bye to them. They are really dear people who love the Lord and love the work they do at the clinic. We came back and I learned that Damarys and Loida left for Quito while I was sleeping. Gonzolo and Nancy left then so Jane and I are here by ourselves. We will send home the rest of our patients in the morning and plan to travel to Quito on Sunday morning.
Before I came to my room for my nap I went to check on the Chachi lady in the albergue. Gonzolo called to tell Jane that this lady could not urinate. She had her catheter out this morning and now couldn’t go. Frequently, a bladder repair takes a few days of catheter drainage before the swelling goes down and urinary function is back to normal. This can even be longer when you drastically change the position of the bladder like we did in this lady. I put the catheter back in and talked with Jane about leaving it in for a couple weeks or so before taking it out. Sending this lady back to her home on the river give me concern in that she has no idea about caring for the catheter. I suggested to Jane that she have the lady return to the clinic in a couple weeks and try the catheter out and keep her overnight to make sure she can urinate normally. Jane felt this would be a good approach and we will talk with the lady and her friend about this in the morning.
Our surgery week is over and we accomplished a lot of surgery. It was a demanding week with standing all day and then on top of that I became ill. I am glad we are done and now it is time to relax a little before travelling home. Tonight, Jane and I are going to work on a list of equipment she would need to consider before starting obstetrics care. Then I hope to get a good night’s sleep.
Jane and I had dinner and then we talked about various things. I am creating a list of things she needs to consider if she is planning on providing obstetric care at the clinic. We then went to the albergue to check on the post-op patients. All four of them will go home in the morning. Jane and I plan to talk with the lady with cancer. She does not know yet what we found and what is left. She lives on the river also and I suspect she will not have any more care for this. We are going to urge her to follow-up at the cancer hospital for radiation therapy if she wants any chance of surviving this horrible disease. It is now time to go to bed and get a good sleep.
Father, thank You for a great week of surgery here in San Lorenzo. With Your equipping us with wisdom, skill, and stamina we were able to bring You glory through serving these people. I pray for all our patients as they recover. I especially pray for the lady with cancer and the Chachi lady. Please watch over them and help them heal. Thank You, Lord, for helping me to feel better. I praise Your name tonight! Thank You. Amen
Medical Missions 
So glad that you are doing better. It has been a big week. Rest , have a safe trip back . The ministry you all are doing is so great.
Kent