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Day 8 – March 13, 2019

Last night around 9 pm, the time I am heading to bed, the neighbors on the other side of the wall around the clinic that is only about 20 feet from my window, turned on their sound system and were blasting music.  It was very loud and continuous for about 2 hours.  Even when I took out my hearing aids I could still hear it loud enough that there was no chance of sleeping.  So, I got some reading finished that I wanted to do.  

After a night of several awakenings for a variety of reasons, I awoke about 15 minutes before the alarm was set to ring and got up and got ready for the day.  Another ice cold shower done very quickly and then I am fresh and ready, still shivering but ready!  

We met for devotions and breakfast.  Devotions centered around Acts 26:9-15 where Saul, later named Paul, recalled the details of his life leading up to his encounter with Jesus on the Damascus Road.  Saul had made it his mission to destroy any and all elements of this new religion called The Way.  He was out to destroy Jesus.  As he and his companions were on the road he encountered the very One he was out to destroy and this encounter changed his life instantly.  I try to imagine what that was like.  Saul had his sights set for Damascus and to rid that city of the Christians.  Then out of the blue this very bright light surrounded them and blinded them.  Then Jesus spoke to Saul and asked him why he was persecuting Him.  Can you imagine what your thoughts would have been had you been there?  

In the devotional we read today there was a scene described about two passengers on a commuter train.  The one passenger treated another very rudely because this passenger was in the way or moving too slow.  At any rate, a few rude comments were made as this one hurried or inconvenienced passenger verbally assaulted the other.  A little while later this rude passenger shows up at the office where he was headed for an important job interview.  As he stepped into the office, he met the last person he wanted to meet that day.  His interviewer was the other passenger he verbally assaulted on the train.  The story doesn’t state if the passenger got the job but I suspect we can guess what the result of the interview was.  The surprise was probably somewhat like the surprise Saul experienced.  But, with Saul, it was a life changer.  I wonder if the rude passenger’s life was changed from his experience.  

In the movie, Woodlawn, a true story about football, another story that runs through the movie is the evangelization of the entire football team and coach.  Often through the movie the line spoken was, “This is what happens when God shows up.”  Saul learned what happened when God showed up in his life.  What has happened in your life, in my life, when God showed up?  For me, the greatest adventure I have ever experienced has been the opportunity to walk with Jesus.  I go where He goes.  I learn to know Him so well that I think His thoughts and see the path before us through His eyes.  I did nothing to deserve this opportunity.  Actually, it was an invitation from the Lord Himself.  He asked me to walk with Him and He asks you to do the same.  How will you respond to His invitation?  Believe me, walking with Christ is the greatest privilege you will ever have.

Today, we have just one surgery but it will be long and difficult.  The patient is a man who has complete gastric outlet obstruction, possibly from scarring from severe peptic ulcer disease.  The obstruction is complete not allowing any food or fluid to pass from the stomach into the digestive system.  He has lost a lot of weight and if something is not done to help him he will probably die.  We are operating on him to assess the obstruction and try to fix it or even resect that portion of the stomach where it attaches to the small intestine and hook up the two again so he can eat and drink and get nutrition.  This is not a gynecologic procedure!  I am going to scrub in to be a pair of hands helping Jane.  

Father, I pray for our surgery today and especially for our patient.  Please protect him and guide us with Your hands around our hands to help him and correct the obstruction.  You love that man as much as You love each of us.  He is made in Your image and You died on the cross for him just like You did for us.  Rather, I ask for Your presence to fill the room and surround us with peace as You give us wisdom and the skills needed to help this man.  Thank You, Father, for Your unending, unfailing, unconditional love!  

The surgery is done and our prayers were answered.  We were concerned as to why this man was totally obstructed.  Once inside the abdomen we encountered a lot of adhesions around the area of the lower end of the stomach and duodenum.  After freeing up this area the stomach and duodenum appeared totally normal with no swelling or constriction or tumor mass palpable or visible.  At this point we wondered if the pyloric area of the stomach had been twisted or kinked by the adhesions as it was not nearly as smooth and visible when we first saw it as it was after freeing it up.  Jane then got the gastroscope and did a gastroscopy to visualize the pylorus and duodenum as we didn’t want to do anything to it if it weren’t necessary.  Passing the scope all the way into a good portion of the duodenum showed everything open and normal.  The obstruction must have been external to the stomach and probably from the adhesions possibly twisting or kinking the lower end of the stomach.  Jane then took the gallbladder as it was full of stones.  We then closed the abdomen.  We had prayed that we would find an answer and not need to interfere with the stomach and small intestine.  God certainly answered that prayer.  

We ended up with two more cases this afternoon.  A woman came in having delivered about 6 days ago requesting a tubal ligation.  She came ready for surgery so we brought her to the OR and did her sterilization.  Then another patient came in for a wound infection.  She had surgery about two weeks ago and today spilled “pus” from her incision.  Our anesthesiologist suggested we do the wound exploration under sedation.  We took her to the OR and then were able to do a thorough exam of the incision.  The infection was likely a seroma.  Jane packed the incision with antiseptic gauze and will keep her for a couple days to make sure the incision cleans up.  

When we went into the recovery room after the tubal ligation surgery, the man on whom we operated for a pyloric obstruction was producing bile from the stomach tube Jane placed at the end of the surgery.  He had not shown any biliary changes before but now bile is present in the stomach.  This is a very good sign that the pyloric area is open.  One would wonder how an obstruction could occur in this area to totally block off the flow of food from the stomach to the small intestine.  Generally, this would have been from a tumor or constriction of the pyloric area but we didn’t find anything of that sort.  What we encountered were multiple adhesions that had to be cleared out before we could even expose the area.  Once the adhesions were cleared the stomach and duodenum appeared normal with no evidence of obstruction.  To see the bile flowing is such a good confirmation that what we did corrected the problem without needing to do anything to the stomach or duodenum.  

Our surgery day is complete.  Now to get off my feet for awhile before gathering for dinner.  I have occasional times when I can get online to read some of the news from the States.  Today the FAA grounded all the Boeing 737 Max 8 and 9 planes because of two recent crashes of these planes in other countries.  My trip to Quito from Miami was on the 737 Max 8 plane and according to my trip itinerary the return trip next Monday will be on that same plane.  Now that the planes are grounded, I assume American will continue the same flights but with a different plane.  I also assume American may contact the passengers affected by this grounding to let them know if flights are changed.  I hope my flight isn’t cancelled and then have to make other arrangements to return to the States.

Tomorrow we have one patient who has been bleeding rather heavily and has a blood count of only 7.  There is no blood bank but there are people in town who will donate blood for our patients.  The process is to bring them in and collect a pint of blood and then give that to the person who needs is.  There are two people who have the same blood type as this patient so tomorrow morning the transfusions will begin and then we will do the needed hysterectomy to stop her bleeding.  We have two other surgeries tomorrow as well.  

Father, this has been a good day.  You blessed us amazingly when we saw before our eyes Your answer to our prayers for that man with the obstruction of his stomach.  It was a thrill to see his system working again right after surgery.  Thank You, Lord for that.  I pray for the patients we operated on today and also for the one coming tomorrow to receive much needed blood.  I pray also for Jane and the team here.  They do such good work and influence so many lives as they represent You and share Your love.  Thank You, Father for Your unending grace.  Amen.

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