Off to a Great Start in the OR!

 So today we got off to a great start in the OR and saw about 9 more patients in clinic.  We didn’t schedule any new cases for the rest of the week, unfortunately, but got some time to focus more on Izabela’s case for planning the rest of the week.   We also had an awesome surprise visitor from Canillá—Victoria has been down for a while now from Charleston and is such a delight to be around!  It is a joy to watch her serve the Guatemalan people, and she was a huge help translating today and just a great part of the team.  We put her to work in the OR today (she is currently hoping to start medical school this fall) as you can see…

We managed to get a team picture (all of us except our photographer, Hale, that is) also somewhere in the craziness…

Sylvia got us off to a great start with her teaching and operative skill on two ladies that have stress incontinence, and both are doing very well tonight.  One went home, actually—she is the hospital director’s wife who definitely has the resources to give us a call if she has any issues overnight.  The other lady, Tomasa, should go home tomorrow. 

We also spent quite a bit of time this morning AGAIN trying to track down our fistula patient who didn’t show up for her surgery this morning!  We were so disappointed, but managed to find out that she was concerned about how much she would have to pay for the surgery (despite us asking for “only what she could afford to offer”; something obviously got lost in translation!).  We got in touch with a couple of people that knew her and they managed to get her in by about 1:00, so she got her surgery after all!

Talk about a win-win situation—Cruz (the patient) got a life-changing surgery (she basically just leaks urine all of the time, which should improve drastically at this point!), and I got to see Sylvia do the repair surgery, which was quite a highlight of the week for me already.  Tomorrow we are doing a prolapse repair which will be another great learning experience for me from Hale and Sylvia, as well as providing a great outcome for the patient! 

Update on Izabela:  at this point, we are not at all sure that she has a gynecologic cancer, but we did take some fluid (like, more than half a liter)  off of her abdomen this morning and sent some to the lab for a little bit more information (an SAAG if there are any Internists who happen to be reading!)—Unfortunately the fluid had recollected by early this afternoon, which was a strong signal to us that it would be dangerous to operate without ICU and better lab support.  Also, we asked the opinion of Dr. Iris Gamez, the anesthesiologist who I really respect here, and she had great insight and reasoning as to why we should not open her abdomen to operate this week.  At this point, we feel pretty clear that we are not going to operate on her to try to remove a tumor—especially without knowing if or where she has one!  Tomorrow I think we will take her and do a biopsy inside of her uterus to at least try to start figuring out if she has cancer in the uterus.

The other lady we were praying for guidance on with the cervical tumor, Esmirna, actually did not show up for the X-ray that we wanted to do to help plan for surgery.  This was surprising to us, but a pretty clear message as to whether or not we should operate! 

The other pictures are from inside the hospital courtyard, looking up at the patient wards and some of the patient families,  and a view from inside our clinic room—thanks to Dr. Hoak for the loan of his clinic for the week!  Sorry it looks like an explosion just happened in a mattress factory in there; we promise we’ll clean it all up and put it back in the bodega before we leave! ;-)