Surgery, etc.

Today was a morning off and then surgery in the afternoon. So we got up and made some banana pancakes (yes, the mission field is all about the suffering) and enjoyed a nice morning here at the house. We fielded a few questions from the construction crew, but it was mostly "tranquilo".

After lunch, Heidi picked up our friend Toby and headed to Chichicastenango for one of two scheduled cases.

Yes, this is one of the frustrating parts of mission work. The woman we discussed in a previous blog who needed a biopsy of a mass in her breast had her husband call us last night to tell us that they couldn't come. The issue, at least the one they gave, was that they couldn't afford the trip.

Remember that the hospital is a non-profit. That means that they have to break even. So there is a cost associated with each surgery and that cost averages out around $700-$1000 per surgery. Clearly, our patients can only dream of having this much money. So we take what they can afford to pay us and we have a fund that covers the rest. The average patient contribution is between $13-$50. Sometimes it's a bit more but we normally encourage patients to try to come up with at least $10. It's not THAT far out of the realm of possibility for most (though we have operated for free before when the patient's family circumstances warrant).

This patient, who is married, and thus better off than many, said she could only come up with $13. You may remember that she has a suspicious breast mass and her daughter's name is Heidi. Dr. Heidi's mom died of breast cancer when she was about the same age as the patient's daughter, so this one hits a little close to home. So, we agreed to operate for $13. However, she said that she couldn't afford the trip to Chichi, so Heidi offered to reimburse her for the trip when she got to the hospital (we don't just hand out cash - that's a really bad idea).

So back to last night. The husband claims that they can't afford the trip. They can't come up with the $7 for the two of them to travel to Chichi. Heidi asked if they were still planning to pay $13 for the surgery. Yes, they have that much, but they don't have $7 more. Heidi reminded them that she will reimburse them for the bus fare, meaning that they could just use $7 of the $13 they had set aside for the surgery, since they'll be getting it back when they arrive in Chichi (not to mention that it's all going to the same place).

Obviously, there's a reason other than cost that they don't want the surgery. It's frustrating, but you can't force people to get operated on. People have a right to make their own health decisions, even when they're probably not the best ones. All we can do is make every effort to try to help.

Now, to today. The patient who DID show up was a woman who had come in originally about a year ago and was scheduled for surgery with one of the teams who came last summer. She didn't show up and we had no contact with her until about two weeks ago. She called two weeks ago basically stating that after a year, she now felt that her situation was emergent and wanted Heidi to see her right away. We weren't in town for a few days and she was a little annoyed with us for asking her to wait a week until we were back.

In any case, she was scheduled for her vaginal hysterectomy and anterior repair today.

If you've ever had surgery, your surgeon probably explained to you ahead of time that there are possibly complications that accompany each case. In the case of a vaginal hysterectomy, the hope is that you wake up from anesthesia with the uterus removed and no external scar. Recovery time is VERY short and life is wonderful. Occasionally, however, things don't go exactly as planned. Every now and then, a surgeon will have to make an abdominal incision to clean up a mess that couldn't be accessed vaginally. These things are all explained to the patient and the family ahead of time (assuming you have a good surgeon, which this patient did).

Well, there's a reason for that.

After three hours of working vaginally to remove the uterus and try to stop some bleeding that was coming from a place that couldn't really be seen, the very difficult decision was made to open the patient's abdomen. (Keep in mind that Heidi is operating with NO backup surgeon, NO blood bank, and many fewer tools that most American surgeons are used to.)

She had to re-scrub before making the abdominal incision. So she took a minute to explain to the 20+ members of the patient's family who had come in that one of the possible complications they had discussed earlier had come to pass and that they would be a bit longer. She was able to locate the bleeding, stop it, and close the patient with about a 600cc blood loss. That's quite a bit for a vaginal surgery, but nowhere near the danger zone. God was watching out for the patient and her surgeon tonight. This is why we ask for prayer coverage on all of Heidi's surgeries.

Meanwhile, back at the house, work has been continuing on the addition. We forgot pictures yesterday, but here are a few from today.

The first is of some of David and Juan's handiwork (plumbing and drain work). The next two are some shots of the site. And the last one is of a very helpful little boy.

Oh, and while Heidi was gone, one of our patients from Chicabracan showed up. She had had a molar pregnancy about 6 weeks ago and came to the hospital here for her D&C (where they scrape the tumor from the inside of the uterus). A series of blood tests are needed to make sure that the body no longer believes that it's pregnant. The test costs about $20. We offered to pay for that test, since without that offer, the patient wouldn't get the test and we wouldn't know whether the hospital had gotten all of the tumor out or not. It's simply not worth dying for lack of a $20 test or two.

Well, her test results came back a little higher than we had hoped, so we asked her to come to our clinic in her village this Monday and we'll discuss her options with her then. Please pray for her that her body will overcome this little setback and she'll be okay.

Tomorrow is clinic at ASELSI and Heidi will run back to the hospital to check on her patient from today.