Monday, October 15, 2018

Humble Pie


So every now and then, I make the grave mistake of starting to think that I kind of have some stuff together.  I start becoming confident in my surgical skills, or my parenting tactics (ha!), or sometimes even in just my ability to be a “good person”.  Those are the times that God, in his grace, steps in to humble me before I really manage to get out of control!

This week—and especially today—was clearly one of those times.  I’ve been going along nicely for a while now, without really getting in to anything scary or nerve-wracking or starting to feel like something I couldn’t handle in the OR.  I’ve also been going along nicely for a while without encountering any really major surgical complications in my patients.  Do you know where this is going yet?

So this week, I got to take not just one but TWO former patients back to the operating room for repair of a surgical complication—one from earlier this year and one from three years ago!  I’ll spare you the details since you aren’t all gynecologists, but suffice it to say that neither of their conditions was at all pleasant to think about living with.

Dr. Hoak was ready, willing, and ABLE—as always!—to help us repair a fistula, and I thank God that he and I were finally down here at the same time (I haven’t seen him in about a year!) when this lady came in so I didn’t have to put her off until further help could be found.  Her surgery took us several hours yesterday, but she looked great this morning.  She is in for quite a long recovery, but we are hopeful that she will be feeling much better soon.

Today we took another lady back, who had a repeat of “things falling out” after we did a hysterectomy and fixed those things three years ago!  This is a known risk of the surgery, but heartbreaking when it happens.  I’m very hopeful that she will feel much better now after her re-operation today (colpocleiesis for you gyn-curious folks—if you don’t know what that is, suffice it to say you do NOT want to Google it!)

Our second case today was a very sweet and very bright young lady who wanted to wait until today to operate because she has University classes on Saturday.  We knew her case was going to be challenging, but neither Lee Ann nor I has ever encountered the amount of bleeding that we did on starting the case as a vaginal surgery.  Every single clamp we placed after the first few seemed to only make the bleeding worse, when anatomically they “should” have stopped it easily!  

It wasn’t long until I asked the nurses to start asking the family to gather up some blood donors for the patient as it looked like we were headed towards the need for transfusion.  I’ve always felt I had a bit of a safety net since I’m a universal donor in case of emergency, and after a few minutes I asked them to actually send someone in to use my foot to collect a unit of blood from me while I operated with my hands!  

THIS was when I finally learned that today, apparently, there is no one available in the hospital lab who can perform the studies needed for a transfusion.  Umm, this would have been good information to have before we were in the process of losing what turned out to be about two-thirds of her blood volume!  Thank GOD Dr. Iris Gamez, a REALLY good anesthesiologist, was here today and on top of it!

It was clear by now we needed to open up the abdomen emergently to get the bleeding stopped, which we did quickly—but the damage was definitely done.  Dr. Gamez struggled with meds and fluid for several hours before someone arrived at the lab that could make a transfusion happen. Her family members stepped up like I have never seen a family here step up before, and long-story-short, she has now received two of three total bags that she will end up receiving. 

There is nothing quite as humbling, confidence-shaking, and exhausting as realizing how close you came to actually killing a patient by operating on them.  May we never forget to properly respect the privilege granted to us of operating on another human being.  It is indescribable how cool it is to know you can cut things open, fix them, sew them back up, and cure a patient’s problem. But let us not forget that with great privilege comes great responsibility, and let us continue to pray for Ester’s recovery.

The hospital we work at here, the “Good Samaritan” hospital, is truly a place that I believe is blessed by God’s hand.  For all the faults and missing equipment, and for all the grievous errors or breaches of “sterile” technique, we have almost inexplicably good outcomes.  I believe with all my heart, and have for many years, that it is only a result of God’s grace being poured out due to the people working here with true hearts for the patients and in obedience to The Lord.  

So tonight we will go to bed exhausted—physically, mentally, and emotionally—but resting assured in God’s love and provision for us as we bumble along in this world trying to make the most of it.  

Friday, October 12, 2018

Grace Upon Grace


Tonight we want everyone at home to know one thing for certain:  no matter how hard we might try to come down here to be a blessing to the people here, we always end up being the ones that are more blessed!  I’ve always loved the (true) saying, “you can’t out-give God”.  And even when we have given 13 and ½ hours at the hospital today between four major surgical cases and 15 more clinic patients, the saying holds true.

Today we were blessed by the smiles and tears of relief and gratitude of several family members when we were able to tell them that their loved one’s surgery went smoothly and they would be out of the OR in a few minutes. 

Today we were blessed by a hospital staff that worked right alongside us without (much) grumbling or complaining, despite the fact that they work three or four times as hard during the weeks we are here than when we are not, and they don’t get paid extra.

Today we were blessed by a patient that brought us apples as a gift—out of gratitude for us “taking care of her so well”—Friends, I am not exaggerating when I say we did almost nothing for this patient, and she waited from probably around 7:30 am until 4:15 pm before we could even see her!!!!!  We explained that a problem she thought she was having was actually normal and gave her a small tube of cream for some itching.  I truly hope and pray that what she felt, though, was God’s love working through us to bless her.  (God knows we were tired enough to have very little left of ourselves to give her at that point!)

Today we were blessed—as we always are!—by the hot lunch that the hospital cook provides us.  She is simply amazing, and it’s embarrassing how well we eat here while on a “mission” trip!

And today we were blessed, most of all, by each other’s company and laughs and silliness and energy keeping each other going.  Do you know I have NEVER had any personality issues with any small team I have brought down here, despite 10 years of travel with folks that often didn’t know each other, sometimes didn’t even know ME, and have always stayed in quite tight quarters?  Never.  That’s nothing short of divine intervention, friends, and I am so grateful for it!

We do need to ask for some extra special prayers, though, for our new friend Ofelia.  We diagnosed her with a bad cervical cancer tumor today (biopsy results pending but it was pretty obvious).  It is not operable, and her only treatment option is to get very expensive radiation therapy down in Guatemala City several hours from here.  She is basically the single mother of a nine year-old little girl, as her husband left for The States about six years ago and rarely sends money anymore (he has a new family there now).  Her little girl’s name is Yesica. 

I lost my mother when I was nine. That’s no way to grow up.  Please pray for divine intervention as well as for the father to step up and pitch in!  I’m really worried about how advanced her tumor is.
I’ll really try to post some pictures so as not to end on a low note here, but no promises—internet is spotty 😉

God bless you all, and good night!

Thursday, October 11, 2018

Day One in Clinic!


Enough with the clinic already!

Wow.  Like seriously—enough!  We had 36 patients show up (25 is really, really hard to get through in a day…) and ended up sending a few in the afternoon home to come back tomorrow. We saw 28, and of those we scheduled an unprecedented 12 surgeries for the next 3 days!  I have never, ever filled up all of the possible surgeries we could do on the first day—AND we sent two others home to come back for surgery in February because we simply don’t have time to operate on them!  It’s good to be needed and wanted, but we were begging for mercy by the end…

The team rocked it out, of course—there’s a LOT that goes in to bringing a patient in, getting a history from scratch, writing it up in Spanish, doing a full physical exam (insert gynecologist-with-a-stethoscope joke here…), determining the plan, counseling the patient, often doing an ultrasound, getting the urine dipped or urine pregnancy test, vital signs, and finger stick—not to mention surgical consent and financial counseling about the costs—on each patient all in the same small room! 

Here are some of the “stats” for the day—

·       We’ve already said 28 patients, 14 surgeries

·       One lady whose chief complaint (at age 52) was that her back hurts when she chops firewood!  God bless her.  Wasn’t really sure how to fix that one…

·       One patient that had 11 babies—today’s record

·       Four pathology specimens sent from clinic today (biopsies and such)

·       Only two or three calls to Dr. Hoak for help 😉  He’s the general surgeon here that I thank God for daily

·       One fistula—if you don’t know what that is, you don’t want to.  Or according to Dr. Nikki, “just know that urine in the vagina is no good; poop in the vagina is even worse”… Sorry for that.  I told you it was Nikki…

·       One case of depression, unfortunately—pretty severe, unfortunately.  Please pray she can find a good Church and friends for support

The rest of the stories will have to wait for when we get home… sorry; we are tired.

Will try to post some pics if Nikki can send me some from her phone; wish us luck!

MEET THE TEAM-- Finally!

Good morning from Guatemala!  Hoping that I will have some time to get some internet coverage (it’s pay-as-you-go physical, plug-in modem here mostly—remember those?!)  so I can get this posted today.  Wanted to get everyone up to speed and on the same page… so it’s time to

“MEET THE TEAM”!

Long-time readers will know that is literally the title of the first post of every week here, so let’s go…
I’ll start with introducing myself better to the new folks:  I’m Heidi Bell, an OB/Gyn from North Carolina (currently in the Cary area) with a bit of a winding road of a career history--  It goes like this:
  • ·         Studied medicine at ECU (where you’ll see I met most of the others on the trip later)
  • ·         OB/Gyn residency in Houston, Texas—where God was clearly preparing me for His work in Guatemala by teaching me Spanish through my patients
  • ·         Met my amazing husband Matt while in Houston, and he and I felt called together to move to Guatemala after my residency training
  • ·         Spent an unforgettable and life-changing two years living here in Guatemala with the support of a group called Agape in Action from the Houston area—you can read more about them here:  agapeinaction.org
  • ·         Returned to the US to take a faculty position at ECU in 2008 where I stayed until 2014
  • ·         Have been amazingly blessed and privileged that God has been faithful to provide for and continue to keep going this current mission set-up, which consists of 3-4 times yearly, one week trips down to do a few different things:

o   Perform affordable gynecologic care and surgery for the indigent population
o   Be the hands and feet (and yes, scalpel!) of Christ for these people in any way that I can
o   Strive to encourage the long-term missionaries here in the area with whom I have become very close over the years and been blessed to know—especially the Ficker Family who you can read more about here:  adonaiinternationalministries.org and docsforhope.org
o   Bring different small (2-5 people usually) teams with me each time who hopefully go away with a renewed sense of how “the rest of the world” lives and hearts renewed by The Gospel as well.

And that was way too much about me!  But I should also mention this can only be accomplished with the support and patience of my family (including in-laws, a husband, two kids, and a goofball Boxer dog) at home as well as my church family in Cary.  Life is truly better than I deserve, friends.
I’m joined this time by three ladies who I look forward to getting to know better—I’m continually blown away at how many people “sign up” for this trip sight unseen and with very little detail about what they are getting in to!  Serious cool-cat-easygoing-hero status here, y’all~

So Lee Ann Garner is an OB/Gyn working in the Wilmington, NC, area currently.  I met her at ECU when she was a medical student there, and one of her current partners, Julia Posey, came down with me a few years ago as a resident.  You might recognize the city of Wilmington from recent news, where Hurricane Florence hit.  Her kids (10, 8, and 4 if I remember the ages correctly) are STILL not back in school there!  What an amazing sacrifice to show up for the trip anyway, right?  Let’s pray that she and her family will be truly blessed this week!

Dr. Nikki Parson was an OB/Gyn resident while I was on faculty at ECU, and we’ve been talking about getting her down here for years now.  She works in Charlotte now, and I absolutely LOVE that she brought along her “right-hand (female) man” from her office for the experience.  Crystal Yarborough has worked with Nikki in her office since she started there out of residency, a little over 3 years ago now as a Certified Medical Assistant.  Theirs is clearly a special and close relationship, and it has been awesome meeting her!  Nikki has two beautiful boys in 6th and 7th grades at home with another clearly amazing husband of the group.

It is Crystal’s first time leaving the country, so maybe some extra-special prayers for her this week?  She has been an awesome trooper so far, especially since she has two kids (16 and 9!) at home and clearly is very involved and beloved in her community.  Poor thing was up at 5:30 this morning with well-wishers calling to check on her (not quite realizing that we are two hours behind NC here… 😉)

So today will be a bit of time in market and then a LOT of time in clinic seeing patients and hopefully setting up lots of surgeries for the coming days.  Pray for patience, wisdom, and perhaps a bit of efficiency as we dive in to usually 20-30 patients.  But above all, pray that we can truly be a light and just a tiny reflection of God’s love for them—it’s pretty hard to feel in a world that can feel rather bleak at times.

Everyone hug your families hard and appreciate them today!  We are running off of your prayers and love from afar… so thank you for that.

Saturday, June 23, 2018

Sabado!


Sorry for the lapse last night—we were pretty tired! Three full major OR cases yesterday, and we finished up around 7pm or so… then grabbed supper and definitely headed for bed.  The three cases went really well and smoothly, but were quite time-consuming. 

Today, we went to round on our patients—they are all doing fairly well, although we are a little worried about sweet Rafaela—she seems to have lost more blood than we feel like we saw at the time of surgery, and we are watching her closely in case of a hidden (retroperitoneal) bleed.  Tonight she still looked quite stable, but please send up a little prayer for her expedited healing.  I’ll probably end up giving her a bag of my blood in the morning—thankfully, God has blessed me with O negative blood that the Red Cross won’t accept because of my frequent Guatemalan travels!

Then down in clinic we only had two patients—our sweet little 31 week preeclamptic lady (who is, unfortunately, looking more and more preeclamptic…) and a little teenager worried about her cycles.  Yesterday was a little more interesting at least—our last patient of the day (who waited from 8am to after 4pm to see us!) had a complaint of headaches and feeling “sweet” around her mouth!  Being gynecologists and all, we did our best to treat her ailments on the opposite end of her body from where we specialize!   Not sure we took care fully of the “feeling sweet around her mouth”, though?!?!

Today’s surgeries also went smoothly, and were really quite a lot of fun.  We had an older lady with a prolapse, then a younger lady with a more challenging uterus to remove vaginally.  I may or may not have stolen the second one from Kathryn a little 😉  They looked good this evening, so hopefully they will look great tomorrow and be ready for discharge before we leave on Monday.

Today was also Naomi’s birthday, so of course we had to go overboard for that!  We had the hospital staff help us surprise her with a cake and a piñata for a nice traditional Guatemalan celebration!  I thought it was pretty nice of us not to wake her up at 3am with firecrackers outside of her window, which is another quite traditional Guatemalan way of celebrating…

Here’s some pictures to try to keep things interesting…
Naomi being tortured by us trying to bust the piñata... (don't worry; we all go our turns!!)


A couple of views of the central marketplace in Chichi from a balcony where we enjoyed a hot chocolate this afternoon...


 
And an amazing photo Kathryn took in the restaurant where we went for a little night on the town tonight!  It was truly lovely...

Thursday, June 21, 2018

Day One


So as promised, we had a long day in clinic today—we only saw a total of 24 patients (that won’t sound like much to full-time docs at home!), but you have to keep in mind that most are brand-new patients and we are doing a full history and physical, our own urine testing, vitals, glucose testing, decision-making, often ultrasound, counseling, and dispensing of medicines!  It can take a while—especially when you are working in a second (Spanish) or even third (the Mayan Quiche language)!

The morning actually started with a brief devotional service that the hospital staff do every morning, which is beautiful.  Today, another Doctor and the Medical Director for the hospital preached/spoke briefly on Isaiah 40:29-31.  There could not have been a more perfect passage for us today!

29 He gives strength to the weary
    and increases the power of the weak.
30 Even youths grow tired and weary,
    and young men stumble and fall;
31 but those who hope in the Lord
    will renew their strength.
They will soar on wings like eagles;
    they will run and not grow weary,
    they will walk and not be faint.

We definitely needed that before diving in—we went to the hospital around 8 this morning and didn’t finish until around 7 tonight, with about 1 15 minute lunch break.  Eeesh, right?  The worst part was that, of the 24 patients, we only scheduled THREE for surgery so far!  Usually by now we have scheduled at least 6 or 8, so we will see what the next days bring… 

Our favorite story from clinic—and our biggest prayer request!—is a patient who came in after being treated/followed by me for a little over a year now for infertility—She was sporting a suspiciously pregnant-looking belly, and totally joked with us when she saw the expectant/questioning look on my face that she “has been drinking a lot of beer”!!!  LOL—She, of course, is totally PREGNANT with a little BOY (which she just found out today)!!!  So. Very. Exciting!  However, I’m pretty worried that she likely has preeclampsia at about 31 weeks, so please be in prayer that she can stay healthy enough not to deliver too prematurely or run into bigger problems here!  We will see her again on Saturday…

I can’t really top that, and there really weren’t that many other good stories from today.  We did have a mother-daughter pair who both are convinced they have vaginal infections because they itch all the way from near their vaginas all the way down their legs—Pretty sure it’s just dry skin/eczema, ladies.  Why do the lady parts get blamed for everything?!

We did get a few pictures today to share, so here you go—I’m otherwise signing off for BED now, after a nice team dinner that we could treat our fantastic nursing help to this evening!

Actually, it may just be this group shot until I can download Kathryn’s pictures a little later:

From left to right: Mica, Kathryn, Heidi, Naomi, Alicia
AAaaaaaaactually, the internet is kinda acting up, so it may not be any pictures tonight!  I'll try to upload again in the morning... sorry!

Wednesday, June 20, 2018

Meet the Team!


So anyone that has read this blog in the last, well, EVER knows that I always try to do a quick “meet the team” post on the day of arrival. We are super-exhausted so this won’t be much, but here ya go for now:
 

Well, there’s me—Heidi Bell.  OB/GYN, although my current full-time job is in pharmaceutical research after burning out pretty hard in a busy academic practice in 2014.  My husband Matt and I had the amazing privilege of living down here in Guatemala and serving as medical missionaries full-time with the support of a group called Agape in Action out of Texas from 2006-08—the first two years out of my residency! That was intense, of course, but amazing—and I’ve had the extended privilege of traveling back down for a week every 3-4 months SINCE returning in 2008.  That means God has been faithful to PROVIDE for these trips for TEN YEARS now, y’all!  It’s been an amazing road.
 

I’m here with Dr. Kathryn Pool, who is a private practice OB/GYN in Columbus, Ohio.  We literally met for the first time today—this amazing woman responded to a post that I put out on a facebook group we are in together saying that I needed help for the June trip!  Came down here, sight unseen, trusting a person she had never met—and on top of that, shopped and scavenged tirelessly for a suitcase full of things that will be a huge blessing down here both in the OR and the homes of some missionary friends. 
 

Kathryn is here without her three teenaged daughters and husband, so please pray extra hard for everyone in her family this week!  My kids are up at “Camp Grandma and Grandpa” in Michigan for the week, so no worries there; they will probably notice we aren’t around by maybe next Monday or so… 
 

We are also sharing an apartment we typically stay in (owned by the hospital) with a young nurse named Naomi, from near Chicago in the US.  We will get to know her better over the next few days, but I’m afraid we are not great company right this minute!
 

Today started around 3 am for both of us, after very little sleep for either of us last night and a very long travel day—so we are pretty likely going to be in bed by 8pm local time and will hopefully crash long and hard!  Tomorrow will be a long day of a different sort, in the clinic—wish us luck!
 

We will also be joined tomorrow by two young nurses from Canilla, a smaller village we will visit later in the week where my missionary friends the Fickers live and work.  They will be furthering their OR training here at the hospital as we try to get the ORs up and running more regularly at the newly-built hospital out there—so pray that we don’t teach them bad habits!
 

Thanks for reading and for your prayers this week~ 

 
PS, You can read more about all of these missions at:



www.DocsForHope.org (partners in the hospital-building)

 

Heidi and Kathryn