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6-26-2014 (Thursday)

6:30 am.  The night was short as my internal clock woke me up at the usual time.  Of course, the external clock was right on time — trucks and buses, horns honking, engines accelerating, dogs barking — the hustle and bustle of San Lorenzo.  Interestingly, as I lay in bed awakening to the noises I realized I have not heard one rooster this week.  Usually they were in abundance in the neighborhood.  They would start about 4 am and carry on with their noise well into the day.  This trip has had the absence of roosters.  I don’t know why it took a week for me to realize this but I’m not complaining.

Our day today involves several small surgeries, hernias, tubal ligation and one patient who wants a tubal reversal.  I plan to look at the status of the tubes to see if a reversal is possible.  The concern is the amount of tube that would be functional once the reanastamosis is complete.  If the tube is too short even if it is open pregnancy will not likely happen.

We met for breakfast.  Carmen is fixing bolon, a ball of plantain with pork embedded in it and then fried.  She also made fresh tamarillo (tree tomato) juice and cut up a watermelon.  The bolon was very tasty as was the tree tomato juice and watermelon.






Table is set for breakfast

Table is set for breakfast

Our devotions came from Luke 6:27-36. 27But to you who are listening I say: Love your enemies, do good to those who hate you, 28bless those who curse you, pray for those who mistreat you.  29If somone slaps you on one cheek, turn to them the other also.  If someone takes your coat, do not withhold your shirt from them.  30Give to everyone who asks you, and if anyone takes what belongs to you, do not demand it back.  31Do to others as you would have them do to you.

32If you love those who love you, what credit is that to you?  Even sinners love those who love them.  33And if you do good to those who are good to you, what credit is that to you?  Even sinners do that.  34And if you lend to those from whom you expect repayment, what credit is that to you?  Even sinners lend to sinners, expecting to be repaid in full.  35But love your enemies, do good to them, and lend to them without expecting to get anything back.  Then your reward will be great, and you will be children of the Most High, because he is kind to the ungrateful and wicked.  36Be merciful, just as your Father is merciful. (NIV)

This passage of Scripture is difficult to read when you have the intention to be Jesus to someone today.  It’s easy to be Jesus by showing compassion and loving and serving others.  However, what about the person who is out to harm you or steal from you?  How am I to be Jesus to that individual?  The words of Jesus stop me short because I have to admit I would find it difficult to turn the other cheek and give my shirt as well as my coat to someone trying to harm me or steal from me.

Jane carries a stick in her car to defend herself when someone tries to break in and steal her purse.  That has happened before where she was stopped at a stoplight and suddenly an arm comes through the window or even breaks the window and grabs the purse on the seat next to her.  She drives with the stick in one hand so she can smack the hand and arm of the one trying to steal from her.  Yet, this passage raised the question from her if she should really carry the stick.  It is easy to say I would pray for that person but would I really when that person was attacking me?  In the heat of the moment would I have the sense of mind to pray instead of defend and fight back?  Tough questions.  But I see from this passage that this is what being Jesus to someone involves.

Father, these words of Jesus are difficult to read because I am a sinner and I behave like sinners.  The world does not understand turning the other cheek or giving my shirt also.  The world does not understand forgiveness and the words Jesus uttered on the cross about forgiving those who were putting him to death.  Lord, help me to grasp these words and make them part of me, make them so much a part of me that my first response is to love my enemies and to pray for them instead of fighting back.  Father, this is difficult but so necessary if I am truly wanting to be Jesus to those I meet each day.  Thank You for Your timing as this devotion was what I needed at this time.  Thank You, Father.  

I pray for our day today, Lord.  Our schedule, though shorter surgeries, is still full and I am tired from a very late night last night.  Lord, I pray for energy, stamina and strength not only for me but for the rest of the team as they also had a very late night last night.  Help us all, Lord.  Wrap Your arms around us and hold us.  Lord, I pray for the patients.  Help us to be Jesus to them today.  Thank You, Father.  Amen.

Our first surgery is an anterior repair on E.P.  She is 67 and has had the development of a troublesome bulge of tissue from the vagina.  Her exam shows a prominent cystocoele without any prolapse of the uterus or urethra.  She has normal bladder function.  We advised an anterior repair to correct the bulge.  Father, please be with us as we do this surgery.  I know You are here and I shouldn’t even ask.  Yet, I pray for Your presence at this time.  Guide our thoughts and hands Lord.  And grant E.P. your peace, the peace that passes all understanding.  Thank You, Lord.  The surgery went very well with minimal blood loss.  She had good fascial tissue that we were able to use to rebuild the bladder floor effectively reducing the cystocoele and giving good bladder support.  Thank You, Father.

A lady, A.P., came in to the clinic complaining of a lot of abdominal pain.  She brought an ultrasound that shows a 10 cm cyst involving the right ovary.  Jane will have her come to the pre-op area so we can examine her to determine what should be done, especially today.  This young lady is 24 and about a week fron an expected menstrual period.  This morning she experienced sudden pain in the right lower quadrant of her abdomen.  She is almost writhing in pain and has a very tender mass in the right lower abdomen that would likely correspond to the cyst seen on ultrasound.  I wonder if she has a twisted ovarian cyst with the onset of the pain like she describes.  Jane will start and IV and give her some pain medication and we will work her in for an exploratory surgery right away.  Father, this young lady is in a tremendous amount of pain.  Please comfort her, Lord.  Help Jane and I as we open the abdomen to see what the problem is and give us the wisdom to correct the problem.  Thank You, Lord, for being here with us.  You give us so much reassurance.  Thank You, Lord.  We opened her abdomen and found a very large left ovarian cyst that had twisted on its ligament shutting off its blood supply.  The cyst was dark purple to black and when we untwisted the vasculature to the ovary there was no color change.  The adjacent tube was also dark but it rapidly pinked up once circulation was restored.  It was evident we could not save the ovary and thus removed it.  The right ovary was normal.  Blood loss was less than 10 cc.  Thank You, Lord, for bringing this young woman to us and allowing us to be Jesus to her by actually administering Your healing touch to her.  Lord, You give us the incredible privilege to participate in healing and even miracles.  Thank You, Father, for Your unending grace.  


Large hemorrhagic cyst of left ovary

Large hemorrhagic cyst of left ovary

Twisted cyst of left ovary with infarction of ovary

Twisted cyst of left ovary with infarction of ovary

Our next surgery is for a possible tubal reanastomosis.  F.P. is age 34 and has had 5 previous pregnancies and a tubal ligation at the time of a cesarean section.  She is newly married and now wants to conceive again.  She came in requesting consideration for a tubal reversal.  She told Jane her new husband does not know she had a tubal ligation.  He has never fathered a child and if he found out she was infertile, it might destroy the marriage.  She was wanting to undergo the tubal reversal to have a baby for him.  This procedure involves removing the closed area of the tube and rejoining the healthy portions of the tube.  The risk is a higher chance of ectopic pregnancy and the determining factor in this is if there is enough tube to work with.  Our plan is a small incision to look at the tubes to determine if we can even proceed with the reanastomosis.  Father, guide us please as we evaluate this situation.  Give us wisdom on what we should do.  Lord, if the procedure can be done, please guide our hands and help us rejoin these delicate tubes.  Thank You, Lord.  Once we made a small incision and pulled the tubes into view it was evident that we could proceed with a reanastomosis procedure.  So this was accomplished without difficulty.  Thank You, Lord, for guiding us through this.  Please walk with F.P. and protect her as she heals.  Lord, I pray the tubes won’t scar and will heal together into functional tubes.  Thank You, Lord.

Our next patient, E.B., is in for a tubal ligation.  Jane had seen her before I came and scheduled this while we had anesthesia.  Father, please cover E.B. with Your grace and comfort.  Guide us as we do this surgery.  Lord, it is an easy surgery to do but still we need Your presence and help.  Thank You, Father.  We were able to quickly do the tubal without incident.  It is strange, the previous surgery I am trying to restore tubal function and this time I am trying to destroy tubal function.  Thank You, Father, for protecting E.B. and helping us with this surgery.  Please cover her with Your healing power.

Our last surgery is on P.B., age 77, with a recurrent left inguinal hernia.  Jane saw him earlier this month finding a hernia at the site where he had a previous repair 5 to 6 years ago.  Lord, please watch over this man and help Him heal from the surgery.  Please guide Jane on repairing this recurrent hernia.  Give her the wisdom and skill needed to fix this problem.  Thank You, Lord.  This man had a rather complex hernia.  Laying on the OR table this hernia was the size of a man’s fist.  Jane reduced it before making an incision and you could feel the hole in the fascia through which the hernia moved.  Once she got into the inguinal area the hernia sac was found to have colon in it and the colon would freely slide in and out of the opening through the abdominal wall.  This took some time dissecting out the sac and understanding the anatomy of the hernia.  This man had had a previous hernia repair and there was some mesh involved as well; however, Jane could not fully detect what had been done.  It appeared that the previous repair did not close the opening but only put mesh over it.  The hernia sac was under the mesh.  Jane finished with the hernia repair.

Father, Thank You for a good day.  We have gotten a lot accomplished and even had an emergency that we were able to work with You to manage.  Thank You, Lord for bringing us here and equipping and empowering us to do Your work.  Lord, it is indeed a privilege to serve You.  Thank You!  Amen.

6:15 pm.  My legs had become really swollen today from standing all the time, mostly in one area.  They were aching and feeling tight.  Since the surgeries were complete, I went to the house and took a nap.  The rest helped a lot and my legs, though swollen, feel much better.  Soon we will be having dinner and then we will play another game of Ticket to Ride.

Tomorrow is our last day of surgery with some hernia repairs, excision of a breast mass and biopsy of the urethra.  Then we will be packing to return to Quito on Saturday.

Howard said Jordan installed tile today on the walls.  He supervised while Jordan did the cutting and the installation.  They will continue to work tomorrow.  This is great progress and experience for Jordan.

10:00 pm.  We just finished a round of Ticket to Ride.  Damarys won and Jordan was only a couple points behind her.  It is time to head to bed.  We have one more day of surgery and Howard and Jordan have wall tile to install tomorrow.

Father, I pray for a good night’s sleep for all of us, including the patients.  Thank You for how You worked through us today and how You cared for the people who came to see us for surgery.  Thank You for bringing the young lady with the twisted ovarian cyst to us so we could be Your hands and bring healing to her.  Thank You, Lord, for using us in Your service.  Thank You, Lord.  Amen.




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