Friday, February 07, 2014

Pictures of Silvia and Brian Tómas!

Praying for Silvia and Brian Tómas before surgery…

Mitzi ready to step in to action!

One of our first pictures of little Brian...

… And Brian bonding with Daddy while we finish up with Mommy!!!

Friday Morning After a Short Thursday Night

Well yesterday started out slow, but everyone who has ever been in obstetrics knows never to utter those words out loud!  We mostly wandered in and out of market, helped Tom with all of his cases (he had four lined up), and worked at organizing and cleaning up the clinic from the week.  (This included cleaning all the speculums that we had used-- thanks Tia, Elliott, Mitzi, and Sarah for taking care of this while I was still in the OR!  Yippee!)

Anyway, right around lunchtime we were literally walking out of the clinic room to pack up the stuff for another few months in the storeroom when a young lady I recognized came in and asked for a consult.  The ladies up front sent her to ask me since I had told her we were closed as we were packing up and had had no one show up by 11:30 that morning.  

Silvia is a young girl that we had done a LEEP on a few years ago for some pre-cancerous cervical cancer cells, and she is now term pregnant!  It is her second baby, and she had a C-section with her first one for a "sideways" baby, which is all she knew.  I figured it was a quick prenatal care visit and nice continuity of care to encourage her to come back postpartum in a few months for a another follow-up pap, so I had her come on in.

Sometimes the Lord really does guide us when we let Him.  Sometimes we just get lucky.  I'll never know for sure, but I have my suspicions.  On questioning Silvia, she had some pretty concerning symptoms of preeclampsia for several days now, and her blood pressures were consistently high.  Even though the protein in her urine wasn't very high, the team agreed that the best management for her given her other resources for follow-up was to go ahead and get her delivered, so I did my first C-section ever here at this hospital in Guatemala!  (Just to clarify, definitely NOT my first C-section, and not even my first C-section in Guatemala… don't worry, dear readers!)

Her surgery went well, and her baby, Brian Tómas (Yes, the accent is on the first syllable; weird for that name around here…) was born at 9:03 last night.  Please continue to pray for their family.  We went down and  checked on them around midnight because we are a little paranoid about the education of the nurses about checking for bleeding or infant exams, etc… and I'll tell you, it was INDISPENSABLE having an L and D nurse there that felt comfortable really examining the baby for us!  Babies make me nervous, especially when they come out a little too "tranquil" or quiet for my taste, but Brian had perked up considerably and was breathing a little easier by the time we checked back in so all here could sleep much more peacefully!

We will get pictures up soon of the happy family, but for now here are some of Sarah's from the last few days… The rest are on Elliott's camera that I have to get from him this morning…

I love this shot that Sarah surreptitiously took during the worship service the other morning!

Sarah's first tortilla, with the hospital's beloved cook, "Chiky" (That's her nickname; I've never known what it is short for)

Tom and Elliott operating, with Angelica looking on and acting as scrub nurse

The OR "Pharmacy"or Pyxis...

And the OR "Charge keeping/reporting system" for each case… for this case we used 15 sponges, 60mL thimerosal, 1 5mL syringe, 1 3mL syringe, 2 liters normal saline, 2 liters LR, and 5 "peanuts" for dissection!

Thursday, February 06, 2014

Quick Post Before Rounds

One of the things I love about this hospital is that there is a small worship service every morning at 8 am.  We are trying hard to make it there again this morning, and considering we don't have any gyn cases to do ourselves and just Tom's to help with, it should be easy to round on our patients and then see the clinic patients after the service.  I'm going to try to pop a few pictures up before we head down, but I haven't collected all the pictures that people have taken yet the past day or two so nothing is really "hot off the presses"…

The first one is just because I feel like Mitzi has been so gracious about taking pictures in the OR that she has been conspicuously absent in most of them!

Here is a panoramic shot from someone's iPhone from the roof of the hospital…

and the front door to the hospital itself!

Ah, the belated pictures from the birthday party Sunday night!  Happy birthday again, Tia and Beth!!

(They DID, between the two of them, manage to blow out all five candles!!)

Two beautiful ladies!!  Sarah and Beth, fooling around with the flowers from their "limonada con soda" (carbonated lemonade) in the restaurant Sunday night

I hope you guys at home have as great a day as we are planning to have!!!!  Love and prayers to everyone...

Wednesday, February 05, 2014

Day Three of Creative Blog Titles

So today started off a little slowly since we all stayed up until nearly midnight talking, giggling, sharing testimonies, sharing stories of cool things that God has done in our lives and the lives of others we know, and getting to know each other better!  So once we finally made it down to the hospital it was already 8:00 and we went straight up to round on the ladies from yesterday.  They both looked quite a bit better after a good night's rest (they don't get woken up nearly as often by the nursing or loud hospital noises here as they do at home).  They should be able to go home tomorrow to continue recovering and being taken care of by quite loving families.

Marta was our surgical patient today, and we did a really great abdominal hysterectomy.  The really fun part was that our entire team participated (with the slight exception of little Eli).  Tia got started with Elliott while Sarah and I finished with the patient down in clinic (see the story below).  Then Sarah and I went up to help.  When I got up there, we did our pre-operative prayer (that's pretty much what we do in place of the "time-out" here), and I think my very favorite part of the day was when the patient started praying with us!  (Almost all of our surgeries here are done under local or regional anesthetics instead of with the patient asleep since it is much safer and easier to control).

Mitzi was also scrubbed in with us, so we made sure she got to help us take the uterus out at after we made the skin incision.  She was then gracious enough to scrub out and go relieve Beth from caring for Eli and believe it or not, we got her scrubbed in to the surgery!  Sarah was also gracious enough to scrub out and walk her through the process of scrubbing in (that's just the kind of team I'm working with this week, folks!) after the major parts of the hysterectomy were completed by her and Elliott. Tia did a great and very patient job teaching the two medical students through the hysterectomy, and then Beth got the very rare privilege of being scrubbed in to a surgery with her husband.  Also a great photo op, of course!  Then we started to be in danger of our anesthesia wearing off, so Tia and I got to operate very quickly through the last few steps.  I can't deny that it was good to actually have an excuse to get my hands dirty for a second, too ;-)

Our second patient in clinic this morning (who we also took in just before they were upstairs trying to get Marta's anesthesia going for her case… of course!) was a particularly sad one and the one that needs the most prayer.  Josefa is a 76 year old woman who came in with some of her adult grandchildren looking very sickly.  She is in a Catholic church and says she knows and has accepted Christ.  This is important, and something that I really hope she is right about since she has a large cervical cancer tumor  that is inoperable.  She really is already quite sick from it, and we don't suspect she has much longer here on this earth.  While Tia and Elliott went up to get started in the OR, Sarah and I had the privilege of talking, praying-- and inevitably crying-- with her and her family before they left with our well wishes, promises to pray more, and pain medication.  Those are the harder days on the job, but God is still in them giving us chances to glorify Him!

Time for some photo ops:

This is me (Heidi) letting the family know that the surgery went well for their family member.  I have the removed uterus in my hand to show them, kind of like asking to see the old parts from the car mechanic in the U.S.!

Tia and Elliott doing a vaginal case, with Beth looking on and me doing my best to supervise!

One of our favorites from the week… taken from the doorway of the OR, where little Eli is watching Daddy operate!!  What a gift to treasure in coming years, right?!

Elliott practicing his best "disapproving attending look" for years to come!! (Or maybe just waiting for someone to help him get his glasses back up his nose; I'll never tell…)

Sarah and Elliott doing their first abdominal hysterectomy!  Under excellent supervision, of course… 

Beth and Elliott operating together for the first and only time to date!  I couldn't resist throwing them in there to take this picture to treasure either.  Don't worry, you can see Tia still supervising from the right and I'm standing really just behind Elliott where you can't see me.  And we had them cut a suture.  Literally.  Cut this string here.  But it was still cool!  And safe.

Monday, February 03, 2014

Day Two, and Our OR Debut!

So we are all sitting around having some pizza now, reviewing our day.  So far we've got:

It was long.
We learned a lot.
Surgeries went well!
We really need prayer for a young lady that we saw this morning-- see below.
Tia is "a little brown girl, but has a lot of blond moments".  According to her.  A direct quote.
Beth accomplished her goal of going in to the OR today-- no loss of consciousness or anything!
Both Elliott and Sarah first-assisted vaginal cases.
Tia did two vag-a-thons-- pretty much by herself.  Which was one of her goals this week!
Heidi was pretty much bored in the OR today because Tia was operating-- which was pretty much one of her goals this week!

Mitzi led some awesome devotions this morning, really focusing us on why we are here.
Eli played basketball with the other kids in the hospital courtyard with a 50 cent ball and a makeshift hoop made of a plastic bag, some wire, and an IV pole!  (Beth, by the way, is the best. mom. ever.)

So anyway, speaking of why we are here… Please help us pray for our second (of only two-- also pray for that, as I'm not sure why things have been so slow down here; even for Tom!) patient of the day, Maria Imelda.  She came in with her husband with a complaint that went somewhere along the lines of, "my head hurts, my eyes burn, my arms hurt, my hands burn, my feet hurt, and oh how my back aches, and… well, you get the point!"  One of those "positive review of systems" type people for those of you medical types who know what I mean, or a "macarena" patient for those of you who know what I mean by THAT!  So I ask her if she has any gynecologic problems, and she sweetly says that she just heard there was a team here that was supposed to help women with their problems so she came.

OK, now what?  So I ask some more detailed history as the team starts doing a very thorough physical exam, and try to pinpoint the problem.  The husband can't really tell me what the worst problem is.  It's more of a, "If it's not her eyes, it's her head; if it's not her head, it's her hands; if it's not her hands…", etc… Then I got around to what I really wanted to know.  Are you in a Church?  They are.  An Evangelical church.  Have they accepted Christ?  The husband has; the wife hasn't yet.  Go figure.  I look at the husband and tell him I think we've found the problem.  He nods and kind of grins in conspiratorial agreement.

Maria Imelda comes off the table, and we get to have a great teaching moment with Tia and Elliott.  We were all in a hurry to get up to the OR (We had heard that the spinal anesthetic was already put in, so it was REALLY urgent that we get up there and not waste time, but isn't that always the way?!) about "positive review of systems patients".  There are three things we always have to consider, and I am embarrassed by how many times I have failed to do so with so many patients in the past and at home.  Abuse didn't seem to be the issue.  Neither did depression in this case, but we discussed both of these concerns before bringing up the real problem.

Maria Imelda lacks the peace of knowing Christ.  So we talked about that-- while Tia and Elliott went up to prep the patient, I had the privilege of helping share the gospel with her, which her husband helped with.  We prayed together, and she cried very emotionally.  I really think that some seeds were planted, and we need to pray they landed on fertile ground.  I love my job.

Day One… Finally!

Well, now it is the morning of day two, and the internet finally seems to be working for a few moments again.  Hopefully long enough for me to get this written!  Last night I posted the pictures from the restaurant after gathering them from everyone's cameras and various smart devices.  (I know, I know… "first world problems!" We won't even get started about my scare with my iPad not working yesterday-- again, don't worry, honey! It's resolved now.)

I can really sum up the trip so far by saying how amazingly blessed I am, once again, to be here with another amazing team.  As we sat at breakfast before clinic yesterday sharing some goals for the week, I was amazed at how so many members of the team had already come so far in overcoming (perceived) obstacles to be here!  We were able to brainstorm ideas to make sure that every team member got the most out of the clinic experience which warmed my academic heart-- but most importantly, to be sure that each PATIENT got the most out of clinic, which was even more heartwarming to my believer's and missionary's heart.  What a great group.  I can't wait to see some great things come especially from these young medical students in the future!

Today we will start with a combined short case with Tom Hoak, the general surgeon who lives and works here full-time with his wife Jana.  Suffice it to say for our less gynecologically-minded readers that it is a more urologic problem that we can hopefully help her with today without too much detail to turn people off.  We will then follow up with two vaginal surgeries.  Those are the ones that we affectionately refer to as "vag-a-thons" for the length and number of procedures involved for prolapse of the uterus after having a lot of children with usually poor nutrition and older age.  They should be a great surgical experience for Tia, and hopefully life-changing procedures for Santa and Amalia, the two patients.

We will also be seeing patients again in the clinic today, so we will see what else God sends us!  It will be a busy day, but we will make it a good one.  Please pray that our surgeries go well and that we all continue to work well together.   Most of all, please pray that the people here will see God's love for them through us, and not just North American wealth or "stuff" or language or privilege or pity.

Also remember to pray for Ana Perez, the lady in the middle in the picture yesterday.  She came in sent from Tom because he saw her a few weeks ago and found a significant uterine prolapse.  When she came to see us, though, her main (and really only…) complaint was a headache.  In reviewing his notes, that was her complaint then, too!  He talked to her about the prolapse and kind of assumed she wanted it fixed so sent her to us (a valid assumption, really, if you know anything about this condition)  In talking to her about it, though, the only reason she wanted surgery was because she thought it would help with her headaches!  After long discussions (amongst ourselves and then with her and The Lord), we sent her away with Tylenol, two large bottles of water that Elliott went to the store to get, and instructions about treating headaches and getting a general doctor to see her if they don't go away.

Sometimes "first do no harm" is kind of hard.  It kind of looks like turning people away that need your help.  But operating on a uterus isn't going to fix a headache, so please keep praying for Ana with us.

Sunday, February 02, 2014

Pictures Only… Still more to follow!

Hey Matt!  Tia says she's ready to try out for the Integrity band…

Sarah and Tia trying on some traditional local dress...

Beth concentrating on market purchases while Eli (tied on her back in true Guatemalan style!) tries to squirm around to see what's happening!

And, of course, the most important picture of the day… the lady in the middle is the one we need to be praying for-- that her headaches would resolve and that she would be feeling better soon!  Her daughter-in-law on the left has a lot of trust in us because we operated on her mother in the past, which is always a plus.  Thank you all again for all of your support and prayers.

Today: The Quick/Abbreviated Version

OKAY, I've been asked to make sure I get a blog post up, but have very little time, so here's the down-and-dirty, and I'll try to do the more fun, expanded version after we wind down/after supper later!

  • We got here safely-- finally!  But dog tired last night
  • Today rocked, but we're dog tired again
  • Saw 11 patients
  • Scheduled five surgeries, but only four of them are gynecologic (one's a hernia for Tom; long story)
  • Everyone (except Heidi-- don't worry, honey!) rotated in and out of market and got some shopping done
  • Finally got internet service established (both the modems I had from prior trips, it turned out, were broken) after an hour at the store this afternoon
  • Now headed to dinner and to celebrate both TIA and BETH, who both have birthdays today, believe it or not!!!  
  • Then headed back to maybe catch the end of the Super Bowl with Jana and Tom if it's still going
  • Then planning to crash. Hard. Again.
I'll write more later and get some pictures posted, I hope!  Thank you all for your prayers and love...

Saturday, February 01, 2014

Meet the New Team!

Well, after six months (the longest I have been away from Guatemala in many years now!), I am back on the way-- with another fantastic team in tow!  For the new readers, "I" usually refers to Heidi Bell, an OB/GYN currently living in Greenville, NC and working with the ECU/Brody School of Medicine.  My husband Matt and I lived in Guatemala and did full-time medical mission work for two years from 2006-08, and since then I've been blessed to be back every three months to continue some gynecology consults and surgeries there almost without interruption.  I love taking people down to my old stomping grounds and introducing them to the country and people that God has placed so heavily on my heart, and am thrilled about the group he has sent with me this time:

There's Mitzi Sherron, an L and D nurse from our department who I've known from church since before she was a nurse-- much less an L and D nurse working with me!  She's got such a heart for people and is a very hard worker.  Please pray for her and her husband Jake, one of our Church Deacons, who have never been apart from each other for a week since they met as freshmen in college!

Tia Robertson is a fourth year resident in our OB/GYN program who is in progress of accepting a job in Lincolnton, NC, for after graduation.  She, too, has been going to Integrity Church with us since I strong-armed her in to it as an intern four years ago (she tells the story differently, of course…), and is a joy to be around.  She is the fifth of six children in her family from Georgia and also a very hard worker.  I know she is going to fall in love with our patients on site (She has been known to form strong bonds with patients that some of her colleagues would rather not have dealt with at all right here at home even), and it will be a fun process to watch.  She'll also be a nice help in the OR, of course!

Elliott Overman is a fourth year medical student with us at ECU, who has chosen to go in to OB/GYN!  We are so excited that he brought his wife Beth, who nannies for another physician family in town while she watches their own two-year old Eli who they also brought along!  They have a huge heart for missions and really have a vision for their family and an ongoing involvement with missions as a family.  I know from experience the kind of dedication it takes to travel with a two-year old, so I applaud their enthusiasm and cannot wait to see Beth and Eli interact with all of the waiting kids and women at the hospital.  Elliott should have a pretty good experience in the OR, also, assuming that God sends us some surgical patients this week!

Sarah Kim is meeting us down in Guatemala today (although we met up with her in Raleigh this morning to organize some luggage before flying briefly)-- she is a fourth year student at Carolina that we met through Kim Newton (think back to February a year ago, the other fourth year student from Carolina and Ed Newton's daughter…)  She has chosen to pursue General Surgery as a career and also has a heart and plan for lifelong involvement in missions, so it will be  a joy to see this play out in her week.  Don't think for a minute that it's not always in the back of my mind that people like Elliott and Sarah may come and replace us someday (sooner than we want to think about!) when we are old and decrepit-- or even when we just get lazy…

We'll try to get some better group shots to post soon (we left home this morning before 2 a.m., so it's a looooooooooonnnng travel day and we're not all looking or feeling our photogenic best, but here's a sneak peek for now…

 Why any members of Tia's family are even up this early to talk on the phone is still a mystery, but isn't her smile infectious?

You'll have to trust us that Mitzi's is, too… She's catching a quick nap behind the scarf that she's supposed to be knitting!

My attempts at the Elliott family are fairly incompatible with my slow Droid camera; sorry!  Two-year old: 3, Camera: 0, yet again!  What a beautiful family, though.

Somehow at four a.m. it slipped my mind to go ahead and get a picture of Sarah, so I'll work on that later!  We'll try to do better tomorrow, dear readers.  For now, take care and thanks for the prayers!