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6-20-2014 (Friday)

One of the frustrations I had in my practice was the “wisdom” of the protocols, guidelines, and the insurance companies that dictated how my patient should be treated.  There was no effort to personalize the treatment or to even understand the patient’s situation.  At times I had to confront the powers that wanted to rule over my doctor-patient relationship in order to provide the best, most personal, most compassionate care for my patient.  This involved taking a stand on behalf of my patient and fighting the battle in an effort to treat her with what she really needed.  With the approach of government provided healthcare, we will see even more of these situations.  How can one be Jesus when the power and protocol is against you?

I am reminded of a passage in Matthew 8:1-4.  Jesus had just finished the Sermon on the Mount talking to a multitude of people, possibly thousands.  He was coming down the mountain with a large group of people surrounding Him.  The scripture reads as follows: 1When he came down from the mountainside, large crowds followed him.  2A man with leprosy came and knelt before him and said, “Lord, if you are willing, you can make me clean.”  3Jesus reached out his hand and touched the man.  “I am willing,” he said.  “Be clean!”  Immediately he was cured of his leprosy.  4Then Jesus said to him, “See that you don’t tell anyone.  But go, show yourself to the priest and offer the gift Moses commanded, as a testimony to them.” (NIV)

Look at the situation here.  Jesus was surrounded by a large group of people.  Imagine this large group of people moving along trying to get as close to Jesus as possible.  Then a leper approaches.  This is remarkable in that lepers were outcasts and were not to come close to people.  They had to announce that they were unclean and had to keep a distance from anyone.  Yet, this man, driven by his faith in Jesus, didn’t follow the rules and approached Jesus boldly.  Imagine the crowd separating and pushing away from this man as much as possible.  Imagine a safe zone spontaneously developing to keep away from this leprous man.  The people in the crowd knew the protocol and they could not get close lest they be defiled and become outcasts themselves.

But notice Jesus’ response.  Jesus didn’t back away or keep himself from this man.  He allowed this man to approach him and then He reached out His hand and touched him!  Can you hear the collective gasp of the crowd standing there?  The people would have been agast watching this intentional defilement.  But Jesus didn’t care.  He gave no thought to the rules but paid full attention to the heart of the man.  He saw this man’s faith and filled with compassion reached out risking His own defilement and rejection to offer healing.  Jesus’ compassion overruled any protocol.  He confronted the “laws” and protocol in order to recognize the person and heal the broken. His love for man drove Him to ignore man-made rules and regulations that isolated the broken (leper) and did not allow any compassion and healing.

Sometimes being Jesus to someone takes courage and boldness to confront the system in order to reach out and touch.  Confronting the system for a physician sometimes brings you in conflict with the guidelines describing what is considered the “best” care by those who write the rules.  You may even risk being charged with malpractice and could even jeopardize your privileges at a hospital.  You could even lose your license to practice.  As we face the government mandates on delivery of healthcare, we see the respect for the conscience of the provider being set aside.  This is especially troubling for me and other pro-life physicians who will be required to provide abortions even though they find this to be in direct opposition to their beliefs.  Being Jesus can be costly.  Jesus gives us the example in this incident.  He put compassion and love for the individual ahead of any protocol and rules.  He looked at the heart and saw the value of the person.  He teaches us to do the same.

I think about the barriers that are developing here in Ecuador for Jane and her ministry.  The government of Ecuador would love to take over Jane’s clinic.  Barriers are being erected to make it more difficult for her.  It would be easy to just give in and not struggle with the fight to keep up the ministry.  Yet, Jane and her team see the importance of being Jesus to the people who walk through the front gate seeking care.  Jane sees the importance of bringing healing to the body and the heart.  She puts this above protocol and barriers that those opposed to this ministry put in front of her.  Being Jesus can be costly and a struggle.  But if we walk with Him, He assures us He will never leave us nor forsake us.  He knows the struggle we face and will fill in the gaps as needed.  He wants us to lean on Him and walk with Him.  That is what is taking place here in San Lorenzo.

Father, the morning is upon us.  Dawn has broken through the darkness and the city is alive once again with traffic coming and going, trucks and buses, mopeds and walkers.  I wonder where everyone is going and what their purposes are.  Sometimes to me, Lord, it appears to have no purpose, just random movement.  Yet, Lord, You created this world and we are privileged to be part of it living within Your marvelous creation.  Thank You for that.  Thank You, Lord, for bringing us here to serve You through serving the people.  Thank You for putting in our hearts the opportunity to follow You and have a personal relationship with You.  Thank You for inviting us to walk with You.  Sometimes, Lord, that walk is not easy.  The path is difficult and treacherous.  Sometimes, that path leads us to confrontation with those who would like to interrupt and oppose Your plan.  Lord, give us wisdom to deal with the path before us and the constant desire to lean on You for strength and guidance.  Thank You, Lord, for Your incredible friendship.  Yes, Lord, it is awesome that I can call You my friend for that is what You want to be.  We are like the leper, Lord, defiled, unclean, needing healing.  And You show us Your heart.  You cross the line, put away the protocol, and reach down and touch us bringing healing.  And, Lord, You give us to opportunity to do the same to others as You reach through us to touch others and bring healing and hope.  What an opportunity!  Thank You for allowing us to walk with You.  Amen.

Up by 6 am and sitting here in our kitchen area of the house drinking a cup of coffee and thinking about the day all the while the traffic goes by.  Howard asked a pertinent question, “Why does everyone feel the need to honk their horns all the time?”  I wonder that too.  It seems, as Howard stated a couple days ago, there are two things to push on the car or moped…the horn button and the accelerator.  That describes it well.  Horns honk and engines roar and there appears to be a shortage of mufflers in this area.

Today is Phyllis’s birthday!!  I would really like to be with her to celebrate this day with her but this time I will have to just share my birthday wishes with her via email and in this journal.  HAPPY BIRTHDAY, PHYLLIS!!!!  (I won’t make the mistake of stating her age, especially in front of the “cloud” of witnesses who might be reading this.)

Our day today is one of preparation.  Angelita and Gonzalo are cleaning the operating rooms and sterilizing the floors and walls to make them as clean as possible.  Carmen is cleaning the albergue (post -op ward) here the patients will go after leaving the recovery room.  Jane is doing some final paperwork for each of the surgeries, getting the consent forms ready and all the medical records ready so all information and forms are available.  Howard and Jordan are laying tile.  Me?  I asked Jane what I could do and she said my job is to stay out of trouble, out of the way and get rested up for tomorrow we will hit the ground running and it will be a seven day run.  So, I will be spending time reading and praying and filling in where I need to fill in if an extra pair of hands or legs are needed.


Jane gave me a copy of the surgery schedule.  We start tomorrow and it will be a busy week for us.  We have 32 surgeries on the schedule and two waiting in case something is cancelled.  Our surgery schedule:



L.E. Abdominal hysterectomy, Burch urethropexy and Anterior repair for total prolapse.

C.M. Laparoscopic cholecystectomy (gall bladder)

R.B. Left inguinal hernia repair

E.P. Unbilical hernia repair

N.Q. Excision of left breast mass



D.Z. Burch urethropexy, sacrospinus fixation, anterior, posterior repairs for total prolapse

V.C. Laparoscopic cholecystectomy

J.C. Left inguinal hernia repair

I.P. Umbilical hernia, excision of warts

M.P. Excision of right breast mass



D.M . Laparoscopic cholecystectomy

E.C. Hysterectomy

M.R. Myomectomy



L.T. Vaginal hysterectomy, repair of incisional hernia at appendectomy site

M.C. Hysterectomy

M.B. Hysterectomy, Burch urethropexy

S.B. Umbilical hernia, excision of peri-umbilical mass



E.M. Hysterectomy

M.C. Hysterectomy

M.B. Hysterectomy

I.J. Hysterectomy



W.Q. Hernia repair

E.P. Anterior vaginal repair

F.P. Tuboplasty

A.R. Left inguinal hernia repair

E.B. Tubal ligation

P.B. Left inguinal hernia repair



R.T. Umbilical hernia repair

E.V. Umbilical hernia repair

E.A. Excision of right breast mass

G.G. Excision of urethral mass

W.P. Right inguinal hernia repair

Howard and Jordan finished the tile work and tomorrow will start applying grout.  The floor looks really nice.  We then went out to eat to the place we had dinner two nights ago, the place where Jordan was served “the best meal ever.”  While there Ecuador won the soccer game at the World Cup and the town erupted in celebration.  Within minutes a long parade of motorcycles loaded with people, pick-up trucks loaded with people, and even bigger trucks loaded with people went streaming by honking horns and yelling.  This parade went past us and then came back.  After we finished eating we drove downtown and even got mixed into the parade for a short distance.  The celebration will likely go on most of the night.  Jane said we got to experience some San Lorenzo culture tonight.

Before we left for dinner the sun was setting in the west and the color in the sky was really beautiful.  Above us some clouds were reflecting the color and then a rainbow appeared in the clouds.  God put His signature on our day today.

Sunset over San Lorenzo

Sunset over San Lorenzo


Rainbow in the clouds

Rainbow in the clouds

Upon returning to the clinic we will prepare to go to bed and hopefully be able to sleep through the horns and traffic.  Our surgeries start in the morning and we will meet for breakfast and devotions at 7 am.

Father, thank You for this day.  Thank You for empowering Howard and Jordan in completing the tile work.  Thank You for helping us get things ready for our surgeries tomorrow.  Lord, I pray for a good night’s rest, for wisdom needed to do the surgeries, and especially for the patients who will be coming in tomorrow and the days that follow.  Please protect them and bring quick healing.  Thank You, Lord, for allowing us to be here and be Your hands we we work serving You.  Thank You, Lord.  Amen.




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