Thursday, May 05, 2016

The beauty of the vaginal hysterectomy

Yesterday we operated on 3 women with heavy menses. Our procedure was billed as a "simple" hysterectomy, but in fact was not "simple" at all. Our team consists of a gynecology attending, a urogynecology attending, a urogyn fellow, and a senior resident- a full gynecology force. We all insist , and believe that vaginal surgery is the best for the patient. We were determined to deliver fibroid and large uterus through tight vaginal openings with little exposure. Our first case the 2 attendings competed for the scalpel until one stepped back. There was instruction on entering posteriorly, clamping pedicles, and how and when to morcellate fibroids. After a long struggle fibroids and the uterus were delivered and the vault properly suspended. That was the first case.

With every case the movements became more coordinated, the case smoother, and Stephanie, our senoir resident, bolder. The most amazing part was that Stephanie's skill improved exponentionally throughout the day! By the last case she had morphed from a stay-in-the-back-quiet-Asian-girl to an I'm-an-amazing-vaginal-surgeon-don't-get-in-my-way. She was clamping faster than we could cut suture, directing us lowly assistants with direct clear orders, and morcelating fibroids with little effort. She had grown from a senoir resident with moderate confidence in the vagina to a master-vaginal-surgeon-in-training. With these cases, our patients were changed, we were changed, and we had all grown better.








Monday, May 02, 2016

Has it really only been two days?!

Wow.  So last night, a blog was simply not in the cards-- we started trying to see patients around 9:30 after hitting market for about an hour, and finally succeeded in seeing our first patient close to 10:30!  Between setting up the clinic for the day and waiting for them to bring us the charts of the patients that were waiting, it was just (as usual) not as quick as hoped!

We chugged through 23 patients during the day, with Stephanie leaving me alone for a couple of hours to go scrub with Tom on a hernia repair upstairs in the OR-- but then receiving a HUGE boost of speed and energy when Dr Sylvia Botros and Dr. Shilpa Iyer finally made it to Chichicastenango!!  Don't worry; we let them go to the apartment and put their suitcases down before we put them to work ;-)

We finally got out of clinic at around 10:30 last night-- which was 11:30 for Sylvia and Shilpa!  We had sent Stephanie and Shilpa to grab dinner at a local restaurant, so we got back to the apartment, stuffed our faces, and pretty much crashed.

Yesterday was a long day not only physically, but emotionally as well~  Always some highs and some lows, but truly challenging perhaps even more than usual...  Here are some highlights:

  • 10 surgeries scheduled-- 3 of which are combined cases with Tom, the general surgeon!
  • We actually managed to get through pretty much all of the non-Urogyn cases right before our Urogyn helped arrive-- Thanks God-- Nice planning! ;-)
  • Patients were referred in from 8 different missionaries (including myself, of course)
  • Patients ranged 21 to 81 years old
It was fun to watch Stephanie's skills as a Doctor of Osteopathic Medicine (DO) be put to good use on some hip pain patients-- plus it gave me a chance to snap some quick pictures.

Please pray especially for a young unmarried patient with a very large fibroid in her uterus-- kind of a tough spot since the surgery to remove it can be a little dangerous for my taste to do down here, so we would like to wait and see if she needs it for fertility... Also especially for a sweet 76 year old mother with cervical cancer-- her daughter, a Christian believer, brought her in last night and we biopsied her mass but the outcome is fairly certain.  She is not a believer, and when her daughter came in again alone today-- to get her pap smear!!!-- we talked a lot about that and the opportunities that might arise in the next few months.  Also, we were able to set her up with some follow-up care with Dr. Paul and Dr. Lindsey from Agape in Action.  They have a clinic near them that meets this Friday.

Today's surgeries (we scheduled two more from the 8 clinic patients this morning!) went very well-- we got out of the OR around 8:30 tonight, so it was at least better than yesterday.  Tom did a laparoscopic gallbladder when the anesthesiologist finally arrived at "8:30" (closer to 10:30), then we were off to the races-- 

Please also especially pray for Concepcion, the 81 year old that we operated on late this evening to help with prolapse.  She truly has no family support, and almost backed out of her surgery this morning because she was worried about who could help her during her recovery time.  We talked with her fairly extensively, and the man who brought her in-- she washes clothes and "works" some for his family, but they are pretty poor themselves.  None of them are in the church, so we were really grasping at straws to find some church to help support them!  Please pray that something actually comes through; this lady could really use a local church to wrap its arms around her right now.  Her surgery was a small procedure so she should recover quickly, but it's still tough to put her through it...

Some pics-- finally got a chance to steal them from Stephanie's phone!  Our waiting room line the first day...


The storage room where we had to unpack all of our equipment-- but I forget what a great blessing it is to have all of this waiting when I get here each time!


A panoramic of the L-shaped clinic room...


And another one of Steph really trying out her panoramic skills on the hospital courtyard on the second floor-- the OR is on the right, with the nursing station and one patient ward straight ahead, the men's and women's wards further to the left, and on the far left is a small maternity ward.  The downstairs is all the outpatient clinics.


 

Saturday, April 30, 2016

Heidi's Heart-- Warning: RAW, emotional, and probably not well-suited for those just looking for a nice update on our week ;-)

So here's what's really on my heart right now-- and my biggest prayer request for the week-- Right now, Matt and I do not know what my employment will be after June 17th of this year.  We DO know that I will no longer be at GSK, and that I do NOT currently have anything else lined up.  Several applications out, lots of personal contacts made on my behalf, but not even a call for an interview. To make a long story short, though (NOT my forte!), we have really prayerfully considered and struggled through issues of trust vs stewardship of resources and thus continued spending vs saving, and have come to rest at this as our current plan:

I will not be traveling to Guatemala for any more quarterly trips until I have secured further employment.

Those who know me at all know that it breaks my heart to write that!  I think it's the first time I've actually verbalized it, even, "out loud".  Emotions are overwhelming as I face the very real prospect that maybe my continued presence here is not what God has planned for me right now.  My heart really wants to scream and cry out, "No!  That can't be true!  Can it?!?!"-- But the answer is, "Of course it can!"  We know that all things work together for our good-- and more importantly, to HIS glory.  But that doesn't mean all things work together to what we think is good for us at any given time (i.e., to give us the worldly desires of our sinful hearts instantaneously).

So there's that.  I need to also make it clear that I believe with all of my heart that God is getting ready to do something amazing that will bring glory to Him in both Cary and Guatemala-- and I yearn to be a part of it by continuing in the way that I have been!  But I am trying very hard to accept that His ways are not my ways (thankfully!), and that He ultimately has a much better plan than anything we could even dream or imagine~

So Matt and I are praying for wisdom, peace, and-- obviously-- provision.  We are asking specifically and boldly for a job with IBM Watson Health, which at least on paper sounds like a dream job for me at this point.  So far all of the advice I've gotten has pretty much told me I don't have much of a chance at all at it-- which, I figure, is the kind of space where God has plenty of room to work ;-)

We are excited to see what the future will hold.  But we are also quite frightened and getting further and further outside of our comfort zone by the (seemingly daily) unexpected expenses piling up as contracted work comes quickly to a close.  There is a real struggle we are facing (and I'm pretty sure The Enemy is loving it!) as we see God calling us away from an idol of self-reliance and more fully in to reliance on Him and a fuller understanding of the nothingness there is without Him.

But then The Devil's in the details-- isn't he always?  He just loves a nice Type A that he can continue to taunt and pester with those details and facts and figures to doubt and debate!  We find ourselves struggling fiercely with the issues of "where to draw the line" between trusting in His provision (and thus, say, continuing to spend on the mission field at the same levels as always...) versus being good stewards of what He has generously given us (and thus, say, going in to as much of a spending freeze as possible until a new income is secured)?  For years, we have felt strongly called to earn a substantial salary that we could use a good chunk of for missions.  Most of you know how very strongly we feel about avoiding consumer debt in order to maintain financial freedom for giving as well as freedom for following where God sends us and being able to help with needs that may come up.  Several long-term missionaries have become like family to us-- and we are acutely aware that they don't have retirement savings or health insurance or other things that sometimes come in handy if a body ever decides to break down at all.

Are we wrong about our calling?  Has it changed?  Is it just that (and if I'm honest, this is my greatest fear), this is all a big lie I've been telling myself and hiding behind to justify my really, really comfortable life?  How do we know when letting go is letting God, versus just being really financially irresponsible?  I can easily go without cable TV, eating out, my truly preferred-but-obnoxiously-expensive toilet paper brand, new clothes, a MacBook, etc.

But when we start talking about digging in to savings accounts-- and especially "long-term" savings accounts, we both get pretty uptight.  We are truly blessed to be "on the same page" with money issues in our marriage, and Matt has proven time and time again to be a very trustworthy leader of our family in this area.  How he has managed to hide so much money from me and keep me from spending it at the dollar store is truly impressive, y'all ;-)  But what we have in long-term savings is supposed to be just that-- SAVED.  Right?  But is this the rainy day we've been saving for, or just a little blip on the radar?  Is there a worse time to come, or will a job offer come through tomorrow?

Anyway, this was way too long about ten paragraphs ago, but to give you a quick idea of the questions we struggle with, here are some examples:

  • If unemployed, should we take an expensive family vacation?  (duh-- obviously no)
  • But what if there's one planned with the in-laws and cousins that will be relatively inexpensive and priceless in terms of family time, and definitely do-able schedule wise since you're not working?  (hmmm... that gets a little stickier quickly, right?!)
  • If unemployed, should you buy a new computer?  (seems easy enough, right? of course not!)
  • But wait-- when your contract at GSK ends, you won't actually have a computer anymore since you've been using theirs!  Don't you need a laptop to work on publishing a paper still and job searching in the meantime?  Should you buy a cheap $200 laptop to get you by until you can get something better later, or go ahead and buy a quality machine that will last a while?  And so on and so forth...
And ultimately, of course, if unemployed, do you continue to go on quarterly trips to Guatemala at well over $1,000 per trip?  That's the one that's the weightiest, of course, and I guess you could say we've kind of thrown out our fleece at this point...

So please pray FIRST for His will to be done, but we are boldly and specifically asking for the desires of OUR hearts as follows:
  1. A job for me (IBM Watson Health current first choice, but obviously a place that supports continued time in Guatemala high on priority list, as well as a place that seems sustainable long-term)
  2. Clear plans for my continued work here in Chichicastenango and/or Canilla-- for the foreseeable future!~
Join us in those prayers, please?  Thanks for listening~






Meet (2 of 4 of) the Team!

Well, the first post of the week is always entitled, "Meet the Team", but had to be edited slightly this time since only half the team is here so far-- :-(  Dr. Sylvia Botros, who some of you may remember from a May trip two years ago (urogynecologist extraordinaire from Chicago who taught me more in a week than I learned in four years of residency about urogyn?!) and the fellow (urogynecologist-in-training, post-residency) that she is traveling with got delayed until tomorrow! Boo-hiss, but not the end of the world.  With any luck, they'll be arriving in clinic just about the time Steph and I are exhausted and needing a little injection of new (albeit quite travel-weary) energy in the afternoon's flow of patients... That's usually about how it works!

Speaking of Steph, she's new to all of us-- Dr. Stephanie Marr is now the third resident I've had the privilege of hosting/precepting from the SEAHEC residency program in Wilmington, NC.  Total kudos and thanks to Todd Beste, their program director, and Skip Johnstone, who was with us on the last trip, for their continued support of this experience for their residents!  This is her first missions trip, and her first time outside the tourist areas of a developing country-- it's fun to see her enthusiasm for learning and taking in what she can about the culture and history and richness of differences.  All the pictures are hers, of course; I'm so used to all of this by now that it wouldn't dawn on me to photograph any of it.  That's why it's always so fun to see things newly through different eyes every. single. trip.  God never ceases to amaze me that way with His plans.

Tomorrow will be a long day for all of us, but I have a hard time even imagining how long it will feel for Sylvia and the other young doctor she is travelling with (I know, I really don't know her name yet!  Bad! Bad host!!!) -- their international flight out of Chicago is at 5am, with one connection, then a 3-ish hour drive once in Guatemala up to the hospital where we will be trying to put them straight to work in clinic... Can't wait to capitalize on their expertise, but seriously y'all-- PLEASE be praying for extra strength for them tomorrow?!

Also, I'll go ahead and throw out my biggest prayer request for the week right out in front-- Right now, Matt and I do not know what my employment will be after June 17th of this year.  We DO know that I will no longer be at GSK, and that I do NOT currently have anything else lined up.  Several applications out, lots of personal contacts made on my behalf, but not even a call for an interview.  Those of you who are long-time readers, close friends, or partners with us in the Gospel, please read tonight's second post as well-- "Heidi's Heart", but those just looking for an update and to keep it relatively light, DO feel free to skip it!  It's quite heavy and personal...

I'll try to grab some pictures off of Steph's phone to post tomorrow, and get one of the team if I remember.  Dr. Tom Hoak, the North American general surgeon who was down here long-term with his family from 2005 to around 2013 and is now about 6 weeks here and 6 back in the US, just popped his head in to let us know we are fixing a two year-old with an inguinal hernia in the morning-- hopefully early enough to not make us too late starting clinic, but doubtful ;-)

So yep-- pray for that kid and his family, too!  Hard to imagine taking one of my kids in for surgery, so that's just another item on my very long list of things to be truly grateful for this evening!


Saturday, February 06, 2016

Heading home!

Wow, here we are again... another week down and on the way home!  It's amazing how quickly these weeks fly by... but usually not until after I'm really, really ready to see my family again so it all works out nicely.  We actually got here to the airport quite early for our flight (nearly four hours early, to be exact) since Duane had some errands to do before noon here in The City after flying us in.  Nick and Amanda were total rock stars on the bumpiest flight I have ever experienced in the Cessna 182 this morning, thankfully.

We are now sitting down to a nice lunch and enjoying free WiFi before heading to the gate.  We have about 4 hours in Miami and then get "home" to RDU just after midnight... Can't even begin to tell you how nice it is to live 10 minutes from the airport instead of two hours now!  Please pray for good weather for Nick and Amanda so they can get back to Wilmington safely.

Had a great couple of days in Canilla as usual-- It was so, so good to get my arms back around Katie Ficker after her horrific pregancy and surgery experience in December!  My arms could have wrapped around what's left of her (she's so tiny as she continues to recover from blood loss and bed rest) probably more than once and never let go if I had my choice.  Thanks to all of you who helped pray her back to health recently.  For those of you new to the story, feel free to check her out at https://theaaronfickers.wordpress.com/ -- but fair warning, don't start reading the most recent post if you need your mascara to still be in place for the next few minutes.  It's a heartbreaker...

It's amazing to see the new hospital under ROOF now... God has been so faithful throughout the expensive building process, and the workers-- under the leadership of Duane and his oldest son Ryan-- have done an amazing job.  It's mind-blowing to think of what will soon be happening there and the blessing that it will be to such a large and underserved area.  Until the completion of the hospital, the nearest one is about an hour away-- but the nearest one more-or-less guaranteed to be able to do a C-section is nearly two hours away!  Plus, they are both "free" government hospitals where Mayan patients especially are not treated very kindly most of the time.

As I post pictures of the new construction, I realize that I haven't really posted much of the hospital in Chichi-- the Good Samaritan Hospital-- where we worked this week!  I love the open-air design and courtyards there, which have been incorporated in to the designs for Adonai's hospital also.  So here are some shots of both...

Rooftop view from Adonai Hospital-- ready for the concrete roof/floor pour soon!


Walking around, touring the grounds-- note to the right where the roof is finished over much of the outpatient area!  We are standing in the (future) courtyard...


The view out the back of the hospital-- yep, cows and all!  It's a beautiful valley, though...


And the rooftop view over the side of the hospital, from atop the future ORs... Cloudy but beautiful day...

The clinic (prenatal area) in Canilla-- soon to move to the outpatient area of the hospital


And another one I can't get to turn the right way!  GRRRrrrrr... But this is the beautiful courtyard area inside the "Buen Samaritano" or Good Samaritan Hospital in Chichicastenango... the bottom floor is outpatient, and the upper floor is inpatient.  Love the open air feel!


The Emergency Room is also pretty open, though...


And the view from the rooftop is a little more urban in this location!



 We hope you've enjoyed following along this week, and thank you for your support and prayers-- Back the first week of May if you want to check in again!


Thursday, February 04, 2016

Wrapping up at the hospital

Well, no major disasters yesterday, but we did manage to spend nearly five hours seeing about eight patients... and four of those were post-op patients from last trip who looked great!  One other was a young couple struggling with infertility who brought some lab results back for us to review and to discuss next steps.

My "favorite" patient (I know I'm not supposed to have those...) was the daughter of Anastacia, the patient who I operated on in August and who made me the personalized bag that I so cherish...



Her daughter is 23 weeks pregnant and was here for prenatal care.  The more surprising thing, though, was that Anastacia herself was carrying a 2 month old baby with her... and said it was hers and not a grandbaby as I had assumed... Being fairly certain I had removed her uterus about six months ago (and then checking my records to confirm that before asking...), I was a bit baffled!  Turns out, of course, that this baby was not hers "by blood", but she had taken the baby in because the father had died and the mother had no means of supporting her.  So this beautiful little girl gets a new chance at life through adoption... just like we do when we are adopted in to God's family as His children.

Last night we had the third of four of us sort of get the "rest of the way" sick-- Amanda went to bed around 3 or 4 o'clock and hasn't really gotten up yet!  Thankfully Nick is here and has already had the virus that he shared with her, so I'm keeping away the best I can!  Turns out he has gotten to play not only Physical Therapist and surgeon (!) this week, but nurse as well... Probably not exactly as he had planned.

Yesterday we sent our first two surgical patients home, and we will hopefully send one more home today.  The one that we had to operate on abdominally has been predictably a little slower to bounce back (score another one for minimally invasive surgery!) and will probably be tomorrow or so and left under Tom Hoak's awesome care from here.

Today we will likely still see a few patients in clinic although we packed up all our supplies last night since we hadn't planned to, then hang out in market for a bit if Amanda's feeling up to it.  Then we will fly out to Canilla, Guatemala, to check in with our dear friends the Fickers there!  Seeing them is always a highlight of my trip.  Apparently the hospital they are building there is under ROOF now, which is just amazing.  Can't wait to see it!

Gotta share a few pics before I sign off this morning-- Dr. Johnstone with the granddaughter and namesake of our first patient, Rodas... (how many doctors does it take to figure out how to not display this sideways?!?!?  Apparently, more than one at least...)


And me trying to get the whole family to participate in a photo with Rodas... There is actually a good shot of this crowd floating around somewhere, but I'll have to find it on someone else's phone later it seems!


God bless you all and keep praying for these patients please!!


 

Tuesday, February 02, 2016

More people to love on and pray for!

Sorry we didn't get around to blogging last night; I got home from Tom's last case in the OR around 11, and after our two long cases for the day and a few clinic patients it just wasn't meant to be... ("it" being ANYthing other than crawling in to a nice, warm bed, that is!)

So we now have four gynecologic surgery patients in the hospital and four members of our surgical team-- and it is both a blessing and a curse to report that the patients are now officially less sick than WE are! Nick is feeling better from his cold, but he passed the cold part on to Amanda and the GI symptom part on to Skip, it seems!  No idea how I'm managing to avoid it so far, but you better believe I'm knocking on every wooden surface within reach when I say that ;-)

Both yesterday's and today's surgeries were awesome-- Despite the fact that poor Amanda was stuck operating between two dueling attendings who were literally making a sport out of disagreeing with each other!  I'm not sure I've ever laughed so hard in the OR before, and keeping it light definitely was great.  I learned a ton from Dr. Skip Johnstone with his vast experience in vaginal surgery, and he at least learned about how much he can do with WAY fewer and lower quality instruments than he is used to.

In all seriousness, though, we have done four awesome surgeries and both Amanda and I have gained valuable surgical experience.  More importantly, though, four women now have bodies that are in much better shape now gynecologically-speaking and should feel much more comfortable.  There are simply no words for the joy of realizing the privilege it is to serve these women in this way.

One of our patients, Rodas, can't speak much Spanish (only her native Mayan language), but each time I visit with her, she takes my hand and simply stares into my eyes smiling as if she will never let go.  She says more in those eyes than the largest dictionary ever could.  I deserve absolutely none of her gratitude or praise, and can only feebly attempt in Spanish words to redirect it to my God to whom it belongs... but it is still a sweet gift that He has chosen to give me just as a loving parent does with his or her children.  What a blessing.

All four are doing quite well and the first two will likely go home tomorrow.  It is amazing and humbling to know that despite the dirt floors and tired old pads-as-mattresses or cots or maybe even straw mats they are going home to sleep on, they would still rather be at home with their families instead of on a soft bed in the hospital with their pain controlled and their meals cooked for them.  Can you imagine getting on a public bus or in the back of a pick-up truck to go home from the hospital after your surgery?  And then getting out and walking anywhere from 10 to 45 minutes or so to get from the road to your house?  These ladies are tough as nails, my friends.  There is so much we could learn from them!

I do covet your prayers especially, though, as I post about once a year or so, for guidance and vision for the mission here in Chichi or in Guatemala altogether.  This week has been very slow patient-wise, and that always makes me worry-- why are the patients not coming?  Did something happen that I don't know about that tarnished the reputation of my surgeries or the hospital?  Is God just trying to tell me I'm not needed here that much anymore?  Or is He just getting ready to send something CRAZY in the door tomorrow that He knows we will need all day to deal with?!?

Patients in clinic-- though few in number-- have definitely kept us busy and on our toes!  As usual, I'm glad that many specific patients that have come in came in specifically this week when I have the specific expertise on the team that I do.  Dr. Johnstone's strong background and experience in urogynecology has been invaluable for both Amanda AND I this week in clinic~  not to even mention the patients!

Tomorrow we only have clinic patients and Tom's surgical patients scheduled so it "should" be a little more low-key of a day.  We will try to let you know tomorrow night, but I somehow kind of doubt it... Let's just say I've spent enough time here to know better! ;-)

My very favorite picture from today is this one-- Not many people in the world have a picture of themselves with their spouse in the OR, scrubbed in for a case and praying over the patient before starting.  Photo cred to Skip, who I encouraged to "play heathen" during the prayer in order to snap the shot.





Also, the "obligatory", traditional "uterus selfie" from yesterday-- thanks to Erin for taking a break from PT student duties for a bit down at ASELSI to join in our OR phone also!


Also, our last patient from today, who we will most likely do a hysterectomy for in May (long story, but she is just not ready yet for this trip...).  SHE asked at the end of the consult if she could get a picture with US on her phone-- so of course we said only if we could take one with ours, too!  Another Guatemalan "first" for me this week.  She and her husband are adorable and were so much fun, even after waiting over eight hours to be seen by us today!  Again, puts things in to perspective some and very humbling.


God bless you all tonight or whenever you are reading this, and remember, "IT'S ALL GOOD"-- according to both God in The Bible (Genesis) and my favorite catch-phrase and Spare Change song!!


Sunday, January 31, 2016

Clinic Rocks.

After a pretty good night's sleep, it was off to the races in clinic today!  At first I was a little concerned when we "only" had 12 patients, but by the end of the day we were thankful and could see that once again, God sent us just as much as we could handle...


Out of those twelve, we scheduled four surgeries, have four coming back later in the week to review various labs or other studies, admitted one for overnight management of her diabetes (yes, it was THAT bad...), and have at least one that Skip is going to "have" to come back to further care for!!  Although ideally we would see only surgical patients for scheduling this early in the week, it was really a nice mix today--


Please pray for two young couples who have both been married for 10 years with no children~  They are both, of course, heartbroken over it.  One couple will come back with some labs to review later this week and can hopefully be helped with some hormonal treatments.  The other lady, though, will actually be having surgery on Tuesday which may take away any chance of fertility (for you medicalese-speakers, she has at least one large hydrosalpinx and we're hoping it's not bilateral...)


Also pray for our four surgeries that are scheduled:  three "vag-a-thons", which is the affectionate term we use for vaginal surgery that will take several hours for prolapse, plus the young lady with the tube problem and infertility.  Also pray that some more patients will find us if they need help during the week!


Of course, the lady we admitted for diabetes control could use some prayer help as well!  Her name is Manuela, and she really needs some good help with her diabetes... We are very hopeful, since Paul and Lindsey with Agape in Action have a clinic in their town this Tuesday and every month!  So we will get her started on insulin and then send her to them for continued care afterwards. 


Last but not least, pray for health for our team-- Nick has a pretty bad cold coming on that we hope to not all catch.  Everyone today was a bit dehydrated with various symptoms but we're working on it and improving.  No one passed out, so that's good, right?  Great attitudes and patience and clinical skill, though, were abundant and I really don't see that changing with this team.  We were able to catch a couple of pictures today, which I will try to post when we get back to the apartment.  (We're at a restaurant for dinner now... It's only 9 pm after all...)


More to follow...