Thursday, May 05, 2016

The beauty of the vaginal hysterectomy

Yesterday we operated on 3 women with heavy menses. Our procedure was billed as a "simple" hysterectomy, but in fact was not "simple" at all. Our team consists of a gynecology attending, a urogynecology attending, a urogyn fellow, and a senior resident- a full gynecology force. We all insist , and believe that vaginal surgery is the best for the patient. We were determined to deliver fibroid and large uterus through tight vaginal openings with little exposure. Our first case the 2 attendings competed for the scalpel until one stepped back. There was instruction on entering posteriorly, clamping pedicles, and how and when to morcellate fibroids. After a long struggle fibroids and the uterus were delivered and the vault properly suspended. That was the first case.

With every case the movements became more coordinated, the case smoother, and Stephanie, our senoir resident, bolder. The most amazing part was that Stephanie's skill improved exponentionally throughout the day! By the last case she had morphed from a stay-in-the-back-quiet-Asian-girl to an I'm-an-amazing-vaginal-surgeon-don't-get-in-my-way. She was clamping faster than we could cut suture, directing us lowly assistants with direct clear orders, and morcelating fibroids with little effort. She had grown from a senoir resident with moderate confidence in the vagina to a master-vaginal-surgeon-in-training. With these cases, our patients were changed, we were changed, and we had all grown better.

Monday, May 02, 2016

Has it really only been two days?!

Wow.  So last night, a blog was simply not in the cards-- we started trying to see patients around 9:30 after hitting market for about an hour, and finally succeeded in seeing our first patient close to 10:30!  Between setting up the clinic for the day and waiting for them to bring us the charts of the patients that were waiting, it was just (as usual) not as quick as hoped!

We chugged through 23 patients during the day, with Stephanie leaving me alone for a couple of hours to go scrub with Tom on a hernia repair upstairs in the OR-- but then receiving a HUGE boost of speed and energy when Dr Sylvia Botros and Dr. Shilpa Iyer finally made it to Chichicastenango!!  Don't worry; we let them go to the apartment and put their suitcases down before we put them to work ;-)

We finally got out of clinic at around 10:30 last night-- which was 11:30 for Sylvia and Shilpa!  We had sent Stephanie and Shilpa to grab dinner at a local restaurant, so we got back to the apartment, stuffed our faces, and pretty much crashed.

Yesterday was a long day not only physically, but emotionally as well~  Always some highs and some lows, but truly challenging perhaps even more than usual...  Here are some highlights:

  • 10 surgeries scheduled-- 3 of which are combined cases with Tom, the general surgeon!
  • We actually managed to get through pretty much all of the non-Urogyn cases right before our Urogyn helped arrive-- Thanks God-- Nice planning! ;-)
  • Patients were referred in from 8 different missionaries (including myself, of course)
  • Patients ranged 21 to 81 years old
It was fun to watch Stephanie's skills as a Doctor of Osteopathic Medicine (DO) be put to good use on some hip pain patients-- plus it gave me a chance to snap some quick pictures.

Please pray especially for a young unmarried patient with a very large fibroid in her uterus-- kind of a tough spot since the surgery to remove it can be a little dangerous for my taste to do down here, so we would like to wait and see if she needs it for fertility... Also especially for a sweet 76 year old mother with cervical cancer-- her daughter, a Christian believer, brought her in last night and we biopsied her mass but the outcome is fairly certain.  She is not a believer, and when her daughter came in again alone today-- to get her pap smear!!!-- we talked a lot about that and the opportunities that might arise in the next few months.  Also, we were able to set her up with some follow-up care with Dr. Paul and Dr. Lindsey from Agape in Action.  They have a clinic near them that meets this Friday.

Today's surgeries (we scheduled two more from the 8 clinic patients this morning!) went very well-- we got out of the OR around 8:30 tonight, so it was at least better than yesterday.  Tom did a laparoscopic gallbladder when the anesthesiologist finally arrived at "8:30" (closer to 10:30), then we were off to the races-- 

Please also especially pray for Concepcion, the 81 year old that we operated on late this evening to help with prolapse.  She truly has no family support, and almost backed out of her surgery this morning because she was worried about who could help her during her recovery time.  We talked with her fairly extensively, and the man who brought her in-- she washes clothes and "works" some for his family, but they are pretty poor themselves.  None of them are in the church, so we were really grasping at straws to find some church to help support them!  Please pray that something actually comes through; this lady could really use a local church to wrap its arms around her right now.  Her surgery was a small procedure so she should recover quickly, but it's still tough to put her through it...

Some pics-- finally got a chance to steal them from Stephanie's phone!  Our waiting room line the first day...

The storage room where we had to unpack all of our equipment-- but I forget what a great blessing it is to have all of this waiting when I get here each time!

A panoramic of the L-shaped clinic room...

And another one of Steph really trying out her panoramic skills on the hospital courtyard on the second floor-- the OR is on the right, with the nursing station and one patient ward straight ahead, the men's and women's wards further to the left, and on the far left is a small maternity ward.  The downstairs is all the outpatient clinics.