Wednesday, August 10, 2011

OR Day Three

The last two days have been long but productive ones! Yesterday we took out a 13 and 1/2 pound uterus (the second biggest that Tom and I can remember taking out together) and went to the hospital thinking that was the only case we had scheduled... those of you who know how things go down here are probably snickering at that since you know it didn't stay that way!

So Tom had two patients waiting for him in the ER when he got to work in the morning, and promptly diagnosed one as very sick from her gallstones and the other with a likely colon cancer. We operated on the lady's gallbladder, then did a sigmoidoscopy to confirm the tumor diagnosis before operating on him today.

This morning Tom started with the colon tumor with Maryann while I did what I had hoped would be a "quick little LEEP" procedure in the clinic downstairs. I was so glad that Keith Nelson had just done his Grand Rounds on the use of electrosurgery, since I actually had some idea how to use the machine that we had available. Having NO idea what to set the power at, I hopped down to the butcher shop to buy some meat to experiment with before getting started. Then we spent an hour or so troubleshooting why only one setting would work, and the last experiment I did was with both the meat and the grounding pad on my calf while I cut the meat with the Bovie. (I called Keith at his clinic before trying this just to make sure I wasn't missing anything in my understanding of electrosurgery!)

By then there was a patient in the Emergency Room that they asked me to see-- a 36 year old with 5 living children (although she has given birth to 8...) with vaginal bleeding and saying she is 3 months pregnant. I spent the next 5 minutes or so diagnosing her with about an 18-week sized Molar pregnancy, and the next hour or so trying to explain this to her and her family and talk her in to a hysterectomy. (For the GYN types out there, I'm not really excited about trying a D and C on that with nothing but wall suction, pitocin, and methergine-- Remember I have no blood bank here...)

Unfortunately, so far Marta has refused surgery-- she insists that she feels her baby moving inside of her, and wants to wait out her nine months and see what happens. I am heartbroken over this, but she is supposed to come back in the morning to get the results of some labs so I am hoping for maybe a change of heart overnight. I am afraid she will bleed to death from this if we don't take care of it soon.

The rest of our cases went well today, except for the colon cancer tumor turned out to be inoperable (It was too stuck down to some very important veins for even Tom to be able to safely remove). Tomorrow we have several more lined up, and I will be praying tonight over Marta's case as we might do her hysterectomy. Please join me in that!

(I tried to post a picture of the electrosurgery machine but I can't get my phone to send it to me... sorry!)

Monday, August 08, 2011

OR Day One

Whew! Long but good day today... started out with trying to go down to the hospital at about 7:30 to get organized for the day, only to turn back around and come back to the hotel when there was no one to open the locked hospital doors for me! So I tried again-- more successfully-- around eight.

Mom and Micah hung out at the hotel most of the day, but did get to come say hi to us in the OR a little later. We were hoping to grab lunch or something together but our timing was off-- Micah had just fallen asleep every time I called when I got out of the OR!

I was happy to see a lady in line this morning with a card from Leslie Ficker's clinic in San Andres-- she had a large abdominal mass that they found yesterday, so I saw her early, admitted her, and operated this afternoon! Turned out it was just a large fibroid uterus, thankfully. We'll send it to the pathologist but I'm fairly certain it is benign.

The first two cases were the ones scheduled from yesterday-- a tubal ligation ("tubes tied", for elective sterilization) who went home this afternoon, and another abdominal hysterectomy for a quite large uterus-- think about 4-5 months pregnant size. Please pray that Valbina's pathology report comes back benign; I am a little more worried about hers...

Sorry I didn't take any pictures today to share-- I'll try to get Mom on that task for tomorrow! But seeing 2 to 4 patients AND pumping after talking with the family, writing the op note, and doing orders in between each case I somehow didn't find the time. The other 13 patients I saw today are mostly non-surgical, except for one lady who will come back in November for surgery since we are afraid we'll be busy all day tomorrow with one very large abdominal mass. Wednesday is pretty fully scheduled with Tom's cases that had piled up already last week! He has another full day Thursday.

Don and Maryann McLeod, who are graciously providing anesthesia as well as some OR nursing expertise for us last week and this week out of Atlanta, leave Friday. It is always so nice to meet other people who have developed a heart for Guatemala over the years in so many different ways.

I actually had a pretty warm shower back at the hotel tonight, and now I'm praying that Micah, Mom/Mary Jean, and my two inpatients get a good night's sleep tonight!

Sunday, August 07, 2011

Back in Guatemala Again This Week!

So yesterday we left the house at 3:30 a.m. and arrived at our hotel in Chichicastenango around 7 p.m. or so-- talk about a long travel day! But we do it every three months so I'm not sure why I'm always so surprised...

Anyway, "we" is me, Micah (now four months old), and my mother-in-law Mary Jean Bell, who is just sweet and crazy enough to come down here with me mostly to help out with Micah. I am so grateful for the company-- not to mention the help! What a blessing.

This morning we got up after variable amounts of sleep (Micah and I actually did much better than Mom... she's not nearly as used to the noise around here as I am!), hit the market for a little while, then went to Church where Pastor Don preached another one of his really good messages. Seeing so many old and new friends up at the Church here is one of my favorite parts of the whole week. I can't believe how blessed I have been to know so many amazing people who have dedicated so much of their lives to serving our Lord.

After Church, we grabbed a quick PB and J here at the hotel and then I was off to the races in clinic! I never have any idea what to expect there-- sometimes we've worked until after 9:00 p.m. seeing patients. Today there were only 14 or 15 that signed up, and I totally "struck out" with scheduling surgeries (only scheduled 2). I really got to see quite a few patients that simply needed reassurance that they did NOT need surgeries that had been recommended. These women were by far the happiest of the day as they left with a weight seemingly lifted from their shoulders.

A few other patients I was actually able to diagnose and help with creams or other medicines or just advice or education. So it was really a great clinic day although the patient-to-scheduled-surgery ratio was a little higher than most surgeons like it!

Please pray for our patients scheduled for tomorrow-- Elvia and Valbina. Also feel free to thank God for making it through customs once again without any hassles! I was able to bring in quite a few (like, at least 20) laparoscopic instruments for Tom to use-- they X-rayed all of our bags but didn't seem to have a problem with anything.

Here's some random shots from travel and our day today... just to add a little color to this post! Will try to keep you updated tomorrow. Thank you all again for reading and praying with us.