Thursday, May 20, 2010

Back Home Again

Just a quick "wrap-up" note to let everyone know that we made it back home safely late on Saturday night-- Many thanks to Tom for driving Pat and Monica and Duane Ficker for flying me down to the airport Saturday on time and safely! I was so glad to be able to make it out to the Fickers on Friday to visit with them; please pray that they will continue to receive the support and guidance from God that they have faithfully relied on for more than 10 years now!

It is always good to be home, but it is also always sad to leave again... It is such an amazing thing to always have a return date already scheduled, though! All of our patients have done well so far post-operatively, and they will all follow up with Tom within the next few weeks. He will also be able to follow up on the pathology results from some of the surgeries we did, which is such a blessing! Please continue to pray that especially Nohemi's pathology comes back benign.

We are also praying very hard now for another surgeon that can accompany me on my next trip to Guatemala in August-- Dr. Tom Hoak will be in the U.S. during that time to get his daughter off to college. I am not sure that operating by myself with no back-up or anyone to bounce thoughts and ideas off of prayerfully will be the right thing to do-- Please pray for both guidance in this area if no one steps forward or for someone to step forward that can come help! We know He has a plan, and just pray that we are mindful of it at all times.

I pray that someday each of you reading this will have the opportunity to be blessed even nearly as each of us participating in these surgical trips has. I will write more when our August trip gets closer, or if we hear something back on pathology reports soon.

Thank you all for your continuing support and prayers!

Thursday, May 13, 2010

Some Fun Before We Go...

Oh, how nice it was to get everybody out of the Operating Room and all of the scheduled patients seen before noon today! Monica was nice enough to help Tom with a hernia repair surgery he had scheduled which gave me time to finish up the consult patients and be ready for our second case. She was a young lady with a breast mass that is almost definitely not cancer-- we were able to remove it under just local anesthesia, which she appreciated since she would like to be back at work as a teacher tomorrow!

All of patients-- thanks be to God!-- looked pretty good this morning when we rounded, and slightly better even this afternoon before we left the hospital. I will check on them again this evening, and hopefully send them all home tomorrow and not have to leave Tom stuck rounding on anyone.

We then treated ourselves to a nice buffet lunch together, which really was a treat considering how little time Pat, Monica, and I have had together all three of us at all! We picked up a few last minute "needs" in the market and this afternoon are mostly cleaning up and planning for tomorrow.

We are still praying for negative pathology reports (i.e., telling us it's not cancer) on Nohemi, Maria, and another Maria especially, so please keep those especially in your prayers.

We still don't have a straight story on the lady that came in "just for an ultrasound" and we found the postmenopausal ovarian mass, but we are fairly certain she does NOT know Christ (although she considers herself Catholic, her neighbors consider her also to be a "witch"-- and unfortunately the Catholic Church down here has suffered from so much syncretism that those two are not mutually exclusive anymore!) We also found out that her son actually owns one of our favorite restaurants in town, so we did ask her to kindly pay her whole bill and not just the tiny bit she claimed to be able to pay before she left. This she did, to her credit, without grumbling-- I guess she knew she was essentially "busted".

It is always frustrating to know that would certainly not have been the first time we were taken advantage of by people who really do have the money to pay for their services, but the "Serenity Prayer" has been the only thing that has ever helped me come to grips with that in my years here...

"God, grant me the serenity to accept the things I can not change, the courage to change the things I can, and the Wisdom to know the difference..."

I hope that my Grannie is looking down and smiling on me quoting those words I first learned from her needlepoint sampler that still hangs in her old apartment, as I struggle to truly rely on God's sovereignty even in our human need for his unending Grace at every level.


Oh-- and the pics are mostly just for fun today... One is a "paycheck" from one of the patients, that brought us these beautiful plums from their tree (one of my all-time favorite Guatemalan treats!), one is of Pat feeding the Parrots at the restaurant (tortillas, of course! What else would a Guatemalan Parrot eat?!), and then there's the beautiful view out the back window of the resaturant (Try to imagine if that were a real waterfall and not just a "waterfall of trash" as one of our students once dubbed it ;-), and the other is just some of the patients waiting around to get well! Thanks be to God that they are indeed well on their way...

Wednesday, May 12, 2010

Operating and More...

Well, last night we were too exhausted after a pretty grueling day in the OR to write anything, so here's a quick catch up... Yesterday was one of those days when we just couldn't get anything to go right-- From not being able to start our first OR case until nearly noon to having to stop and change the tube in the bladder out because the first one wasn't working to running in to more bleeding than we wanted to calling Tom because I panicked and thought I had cut in to the intestines to... well, you get the picture. The ladies who work in the OR thought it was a spiritual attack brought on by the fact that our patient practices some witchcraft, and I'm not at all sure I don't believe them!

Thanks to all of you who have been praying so faithfully for us, today was a million times better and one of the best days I've ever had down here! The patients from yesterday looked fantastic this morning, the one from Monday went home, there were only three consults waiting for us, and four good surgeries scheduled. For the first time this week, we actually got all the scheduled cases done today! Tomorrow should be a relatively light day in theory, so maybe we'll have time to catch up on odds and ends (and shopping, of course!) that have eluded us earlier in the week. There are several of the nurses at the hospital that want to talk to us about something or other so we can finally see them tomorrow maybe.

Today we have a few fun pictures to share also... One is of Monica receiving a random but much needed shoulder rub from a young girl who came with her mother for her consult today! Never mind that they had been waiting by that time a good five or six hours to even see us and we had relatively little to offer for their non-gynecologic problems-- The girl saw that we looked tired and took over trying to help US out, which is just another example of the spirit of the Guatemalan people we are so privileged to serve.

Warning: pictures that follow are not for those who really don't like gross stuff...

There are also some pictures of a great big uterus that Tom and I took out at the end of the day, which was actually a lot of fun considering how smoothly the surgery went. Also pics of Tom and I operating (Monica was nice enough to be operating the camera for this one) Monica got to be a little more involved on the cases today since they were going more smoothly, which was a blast for me (and hopefully for her, too!) to get to have her open up and close up her first surgery!

Thank you all for your continuing prayers-- We really felt them today in the operating room and in the Hospital in general and are feeling refreshed even after such a long day by being reminded once again how great our God is.

Monday, May 10, 2010

First OR Day-- So far, so good!

Well, more or less good anyway... Always a few set-backs, but nothing that we won't be able to work out. Today started off less stressful-ly than I was prepared for, which was good and bad in a way-- only 8 total patients came for consults with us, when we were expecting more like 15 or so from what we were told of how many were turned away yesterday! I'm worried that people didn't bother returning, even though I tried very hard to explain to people in the waiting room in one long "speech" about how we would see everyone that showed up even if it was today or Tuesday... But we just have to continue to trust that God sent those that needed us and do our best to help those that come.

We scheduled three more surgeries today out of clinic, which we were able to mostly get done before we got started in the OR. Then Monica and Tom went up and did a prostate surgery (slightly outside the scope of most general OB/Gyns...) while I finished up clinic, which made starting our vaginal case much less stressful with no one waiting on us. The case-- a vaginal hysterectomy with anterior repair, culdoplasty, and perineorrhapy for a complete prolapse for you gynecologic types-- or what we often affectionately refer to as a "vag-a-thon" for the others!-- went quite well overall but was very challenging. We will pray that she recovers well and doesn't have her problems recur in the future-- her name is Maria.

Our third case today was supposed to be the lady we blogged about yesterday with the ovarian mass and no complaints, but her labwork showed that her hemoglobin (measure of anemia) was at about half the level it should be (7.3) and we needed to get some blood donated for her before we could safely start! The husband's blood type was not compatible with hers and they only have one son in the area whose blood type they don't know, so it was looking a little iffy for a while. Then the family members of the first lady we operated on offered to "donate" theirs for her (for a fee, of course... I stayed out of those negotiations!) and we thought we were back in business.

Then we got set back again by the laid-back culture of Latin America-- It turns out that the lab tech, who is of course the only one in the hospital who knows how to crossmatch the whole blood and test for HIV and Hepatitis before transfusing it, decided to stay "a few extra hours" in her home town a few hours away this weekend and wouldn't make it back until tonight. She is usually back around 3 or so on Monday, but not so much today... So to make a long story short, we managed to send the men up to another private lab in town with some blood storage bags we found in the lab here, where they donated and brought the blood back. It is now waiting in a refrigerator overnight until it can be screened and prepared tomorrow and this lady can finally get her surgery! Of course we already have a pretty full load for tomorrow, so we'll see how we end up getting through it all. Somehow we will manage with God's help; we always do.

At least we got to take advantage of our early evening by a nice dinner out with some other local missionaries-- thanks to Roy, Erna, Sally, and Ervin for such a great time with old and new friends!

Will let you all know what tomorrow has in store...

Pictures today are of Monica and Tom operating on a prostate, then the "obligatory" first uterus picture of me and Monica after her first hysterectomy that she scrubbed in on! There's also one of the upcoming women for surgery with her husband in the courtyard of the Hospital, which is looking a little better every time I come down. What a lovely place to be called to work...

Sunday, May 09, 2010

Long Clinic Day

First of all, a quick HAPPY MOTHER'S DAY to all of my favorite Moms out there... Hope you got a little more pampering than we did today! ;-)

Today was a great day, but quite long-- started out to market around 8 or so after going to bed around 8 last night, so at least we started out well-rested! Monica got to experience the market for the first time, and Pat was there to faithfully help shepherd her through and give her the personal shopping experience that only Pat can... Then we hopped up to Church at the Hotel, which was another great service as always. Then it was off to the races when we arrived to a "standing room only" waiting room at the hospital!

We saw a little over 20 patients today, which won't sound like many to some of you but it took us almost 8 hours... We write up pretty full histories and physical exams on them all and try to make sure they all leave feeling like it was worth their while to wait the 8 hours to see us, which is sometimes more challenging than others of course! Either way, it was more than I've ever seen in a day at this clinic by at least 25%, and we turned many away to come back tomorrow. So there's no telling what tomorrow will bring, but God will provide for whatever He sends our way...

So speaking of what He is sending, our most interesting patient of the day was the 9th one we saw-- she was the first patient we saw that literally had no complaints-- she just wanted an ultrasound to make sure everything was OK "before I get any complaints from anything". She literally repeated and harped on the fact that she had no complaints until Monica learned that word quite well in Spanish! So we figured this one would at least be quick and easy and we could give her what she wanted as we walked over to the ultrasound room. It got less quick and easy when we diagnosed an ovarian mass the size of a small orange (she is post-menopausal so this is particularly concerning) and set her up for surgery tomorrow! I am now quite suspicious after reviewing some blood work that she may have ovarian cancer. If she does, though, it will be picked up early and maybe even cured without further treatment. Those of you who know anything about ovarian cancer know that this is rarely the case, so praise God for sending her today! I do not think she knows Christ personally yet, so please pray that we can really use this opportunity to minister to her and lead her to Him.

Please also pray for a young lady-- in her 40's, I think-- who has inoperable cervical cancer and likely only a few months or so to live. There is nothing I can do for her but hug her, pray with her, cry with her and her husband, and give her some pain medication. As a physician, those are some of the hardest times. As a Christian, though, it was a huge relief to know that she knows The Lord and is planning to spend eternity with Him in His kingdom. We will see her there someday and it will be a joyful reunion.

If any of our old regular readers remember the young lady that we tried so hard to help with her breast cancer a few years back (Maria was diagnosed while both pregnant and breastfeeding-- no-showed her mastectomy, tried some "faith healers" and such then finally did go to The City to get treatment but way too late...), we saw her family in the market today and they seem to be doing well. The first picture is a picture that I took of her husband's cell phone-- He has her picture as his home screen, which I thought was a beautiful reminder of her this Mother's Day. I get to see one of her daughters and her husband almost every time I come down, which is a great privilege in my travels here to have such continuity with a family.

We also scheduled several vaginal hysterectomies for prolapse, and a bladder evaluation (cystoscopy) for a lady with no prolapse but lots of bladder complaints and blood in her urine that is unexplained. I'll save some of the other clinic details for tomorrow or the next day; I guess y'all get the gist of it by now... the other pictures are some of the ladies we will be operating on this week, and the last one is just for fun, showing the "glamorous" side of gynecology which Monica snapped when I had stepped out to wash some speculums!

I did have at least three patients today that I had given appointments to come back and see me myself, which is always exciting-- one post-op from February and two other follow-ups for an abnormal pap smear and fibroid uterus. It is always wonderful to start those relationships and be able to provide continuing care, even when you're only here every three months! What a privilege, and what a wonderful way for God to prove just once again how good He is...

Saturday, May 08, 2010

Quick Update Before BED!

Just a quick note to those of you out there reading that we are here safely for the night.


Tomorrow will be another long but exciting day, so we are pretty much tuckered out and ready to turn in, but I thought I'd post a quick photo of Monica and Pat (they asked me to remind everyone that this is around 5:00 a.m., after getting up to travel starting at 2 a.m.-- they weren't exactly thrilled with me for taking it, but I think they are beautiful! ;-)

Monica is on the left, and Pat is on the right... just to put "faces with names" for those of you praying with us this week... Good night!

Ready for Take-Off!

Just a quick update now from RDU airport, where we have arrived safe and sound, with all luggage checked through and no issues so far! To introduce you to the "team" for the week, it's me (Heidi, OB/Gyn), Pat Peabody (a CRNA or Nurse Anesthetist who will be running anesthesia for us and saving us TONS of time and money-- this is her third trip down to Guatemala with us and she has become quite the tour guide!), and Monica Horne, one of the Certified Nurse Midwives on ECU's Faculty with me-- her first trip out of the country ever so please pray for a good experience for her especially! I am excited to have her helping me out in both the clinic and the operating room this week, and you never know what God will send us in the way of babies needing to be delivered since I'm bringing an expert with me... It really does tend to work that way.

Please pray for safe travels and some rest for us today-- we all got up before 2 a.m. to get here to the airport! Also pray, as always, for the patients that need to be seen to show up and that each patient walks away with what they need or what God wanted them to have from us this trip...

Thanks and God bless you all! We are boarding now so I'll try to update again probably tomorrow night after a full day of Church and clinic...