Day Two in the OR

So Day Two in the OR, Day Three in the clinic today, and all is still well.  We are thankful that both Chris and I continue with good health and good energy levels, as there is still plenty of work to be done!  All four of our operative patients from yesterday looked great today, including the one that we lost nearly a liter of blood on.  We were thankful that she started out with a great hemoglobin, so today she was still doing well and it doesn’t look like she will need a blood transfusion.

That is a particularly good thing, since both Chris and I gave a bag of blood each to a lady who DOES need probably at least four bags!  We are giving three of them tonight BEFORE her surgery tomorrow, to remove the uterus that is causing her to bleed to these levels!  She saw the local gynecologist who works at the hospital a little over a month ago for the same problem.  Her hemoglobin was just as low then, but he recommended that she wait and see us since she could not afford to pay him to operate on her.  Sigh. 

I understand that everyone is not a missionary, and that everyone has bills to pay.  But he could have at least sent her to the government hospital to try to get her surgery sooner at a hemoglobin that low!  Or had her get blood donated and transfused in the meantime!  That would not have cost him anything but a little bit more time to explain and write an order.  But some folks just aren’t interested.

On a brighter note, we sent two ladies home today looking great on post-op day one, which was definitely a plus since we don’t have many more beds here!  Tom has some anesthesiology friends from back home that got in this afternoon, so we are planning to run two ORs tomorrow and we are filled up with cases in both—it’s a lot of patients and not a lot of hospital!  We will continue to pray that everyone does well and can go home on time or early this week.

Clinic has remained interesting.  Today we added yet another abdominal hysterectomy on for tomorrow, for a grand total of five of those this week.  We’ve seen the usual variety of belly aches, cysts, and a scattered pregnancy or two—plus a lady today who has pain only when she worries about things (yep, you guessed it—diagnosis is depression/anxiety), a lady who cried with relief when we told her the lump she has in her breast that she waited 14 months to seek care for is almost definitely NOT breast cancer (but we will definitely take care of it with Tom’s help!), and a lady whose prolapsed lady parts we fixed back in July but who now says her feet swell when she tries to walk very far—only since the surgery, of course.  What do you say to that—“sorry we fixed your vagina, but broke your feet?”

Anyway, tomorrow will be another long day in the OR with three major abdominal cases and a minor procedure to do, plus some return patients in clinic or referrals.   Hopefully we will get out to Canillá on Thursday. 

We will leave you with some pictures that we had to have the circulating nurse take in the OR, plus one of Chris braving the HUGE needle used for blood donation here in the ER!

Brief Clinic Summary

So we just finished clinic at around 8 this evening, which quite frankly is a minor miracle since we saw 28 patients in just under 11 hours!  Told you Chris and I make a great (and experienced!) team ;-)  We are now exhausted, however, so here’s a quick summary:

First some stats:

·      28 patients

·      9 surgeries scheduled

·      ZERO “vag-a-thons” (so weird)

·      FOUR abdominal surgeries (pretty sure that’s more than I’ve EVER done in one week)

·      Only three that had fully non-gynecologic issues (although in fairness, one was told by both one doctor and one lay “midwife” that her uterus might be the cause of her back pain and leg falling asleep!)

·      A full FIVE patients who were told that they needed surgery by Guatemalan surgeons but had absolutely NO indication for surgery that would have ever been operated on in the US. 

This last problem is a perpetual one and one that makes me crazy.  It’s also a very time-consuming one in clinic, as it takes a very long time to explain to a patient why they do not need a surgery that “everyone” tells them they do.  They feel they are being turned away from what “everyone” recommends to them as a great opportunity to get their surgery from us.  Occasionally it’s a judgment call where it is at least not INadvisable to operate, but unfortunately it’s often something where we would have flunked our oral boards if we had tried to defend the surgical management to our mentors back in the day! 

It’s just so frustrating and saddening and maddening what these patients are up against sometimes.  The tiny little drops in the bucket we make of help while here seem so insignificant, but we continue to trust in God’s plan and goodness, and in the power of prayer and The Gospel to affect real change.

Now back to the lighter side—I did, as always, have a few more “firsts” again today, and here they are:

·      Had to get a patient’s husband on speakerphone during the surgical consent because he has been in the US for the last ten years.  At least he is still involved and sending money!

·      Had a patient’s husband ask if there was anything he did “wrong” during sex that caused her fibroids—such a sweet and concerned guy…

·      Had to wait for one patient to finish her call on her cell phone so we could pray for her.

I'll end with a couple of pics that Chris snuck in during clinic.  One is me giving my pre-clinic shpiel about "please be patient; we won't turn anyone away, and no one needs to be fasting, and Jesus loves you".  One is a super-sweet grandma that we couldn't resist taking a photo of.  Pray that she gets a large mass in her chest taken care of so that we can take care of an uncomfortable gynecologic problem for her in February.

Meet the Team

Well, my first blog post of the week is always called “Meet the Team”, although this week it will be pretty short since any regular readers already know us all!  What a great joy and privilege to get to work alongside Dr. Chris(tina) Schwering (née DeLuca) this week again—I can’t believe it’s been 8 years since she first came down here as a resident with me!  Since then she has married, adopted his child as her own and seen her graduate from college, birthed a child who will soon start kindergarten, fostered two babies, become Chief of Staff at her hospital, and clearly is just freakin’ Wonder Woman! 

Her husband Tony is basically running IT support for the hospital out in Canillá, so he will fly out early Monday morning with a full lock and security/badge system to install for them this week while we operate.  Truth be told, I’m pretty sure he’s the one who keeps the Wonder Woman suit and plane clean, available, and running on time, but don’t tell him I know ;-)

I’m still “me”, Heidi Bell—the same OB/GYN who has had the amazing privilege of not only living here in the Department of Quiché in Guatemala from 2006 to 2008 with my own amazing husband, Matt, but also spending a week every three months here for nearly 10 years now since then!  God has been so faithful to keep this ministry going.  I learn something new every trip, and He clearly still has a lot more to teach me.  Also, I tend to be a slow learner on the more important life lessons, so I’m pretty sure I’ll still be coming for a while.  At least I hope so.

We arrived today with  probably close to 400 pounds worth of supplies for two hospitals (the one we are operating at here in Chichicastenango, plus the one our dear friends the Fickers (adonaiinternationalministries.org) and Docs for Hope (docsforhope.org) are building out in Canillá, plus gifts and treats for as many of the “boots on the ground” missionaries as possible.  Since I left my clinical medicine job a couple of years ago, my ministry here has really morphed into a lot less bringing of medical supplies and a lot more just ministering (through physical/tangible gift-giving from the US) to those who serve here.

It’s amazing how often these missionaries are neglected even by visiting friends or groups from their home churches!  Folks who have wonderful intentions, of course, of serving the Guatemalan people when they come down.  But when asked if they could bring down a book or other supply needed for the nursing school or other project or even just a personal need, it’s “our luggage space is really tight with all the supplies we are bringing for the VBS children” and such.  Again, total good intentions.  But after a while as a missionary, you just stop even asking, and you pray for someone to come along and ask YOU what they can bring YOU.

Enter folks like Chris, Tony, and I.  And all of you who have helped or donated to help us meet needs or wants or even provide little luxuries here and there over the years!  And don’t get me wrong—There’s lot of other needs that we are missing or neglecting to meet this one; this just happens to be the one that God has laid on MY heart and very specifically equipped Matt and I to provide for.  We cherish it.

Tomorrow will begin clinic and if recent history is any indicator, it will be a super long day—so now I’m going to bed.  Hopefully I’ll get my modem charged up with some money on the account tomorrow so I can actually post this to blogger since I am just typing it up in Word tonight… If you are reading this anytime before Sunday night, that plan worked, likely meaning that I sent Tony to a store with some cash and a note that says in Spanish, “please charge account number xxxxxxxx with these 50 questzales”!  And that the shop owner could read ;-)

You gotta love this place!  I know I do.

From The Airport

So Im typing this from my phone as I never did get the internet to work on my computer this week (for once I can't blame Microsoft, though-- even though I should have brought my Mac!!)  It might be shorter than usual, but let's face it-- that's probably a good thing.  I'm a rambler.  At least I have self-awareness.

I think a list of ongoing prayer requests from the week might be a nice way of summing up the kind of week we have had in the most efficient way, actually, so here goes:

• For Francisca, Basilia, Tomasa, Juana, Josefa Toño, Juliana, Isabel, Manuela, and Josefa Chach-- continued recovery and healing I. Their homes after discharge post-op, and most of all that their old outcomes would be a dim reflection of God's glory and live for them here on earth.

• For Rosa, our dear friend known by the Ficker family for years now--  words can't describe how lame saying call heart is or how sick her sweet body is. She has the worst asthma I have ever seen. She has now developed diabetes from all of the prednisone she has been dependent on for so long now. She has gynecology problems from all of the coughing she has done over the years. She has unstable angina. She is only 40 years old.  She has lost a child due to the horrible healthcare here in Guatemala.  it seems so very unfair and so very sad.   We will continue to treat the problems that we can, but for those that we can't, we will continue to offer prayer and fasting. I will be in fasting for her every Monday until at least October when I go back down to Guatemala. Who will join me?  This is the only woma this is the only person I know of who is Latin who has married a Mayan person. Her husband is a pastor who translates at our clinics for us and they both have beautiful hearts for the Lord!  We selfishly want to keep her with us for a long time, so will remain in prayer for her and covet your prayers too!

• For guidance for the nursing class I taught Friday night-- that they don't go out and try to do anything crazy and outside their realm of practice after we went over breech deliveries and shoulder dystocias!

• For the fertility of so many young women that Kelly and I diagnosed with PCOS in Canillá this weekend-- it's just as devastating a diagnosis here if not even more so as they tend to be left by husbands with no means of providing for themselves.

• For safe transition to flying the new larger plane that the Fickers have acquired for their ministry. (A PC-6 or Pilatus Porter for those of you interested)

• For safe and productive decisions in the opening of inpatient and surgical services in the hospital-- especially for sterile technique and instrument provision in the OR, post-operative nursing care, and paperwork keeping-- as well as as caregivers making wise decisions about staying within their scope of practice but providing what they can for patients and finding that balance)

• For me to remember not to try this AeroMexico flight itinerary again!

• For us all to remain grateful for the resources God has given us, and generous with the same... 

May God bless you all to His service, and tune your hearts to sing His praise!!!!

Pictures!

 OR Selfie!  Suzy's got serious skills... Heidi and Kelly are scrubbed in with Everaldo here.

The whole team finally in a shot together without our face masks on (we got this at the end of our last case today--)  From left to right, Micaela, Suzy, Kelly, Alma (Guatemalan scrub nurse and an institution at the Good Samaritan hospital where we work; she has been there over 30 years!), Heidi, and Everaldo

A few of our patients waiting to see us on the first day, while listening to me tell them they will all be seen if they wait patiently and they do NOT have to be fasting, followed by a word of prayer... (I like to think they are all deep in concentration, but they are more likely just wondering about my weird Spanish and accent!)

Suzy checking in on a post-op patient.  Cool Mickey Mouse sheets, huh?

The hospital courtyard-- I'll never be able to prove it scientifically, but I swear this place is good for healing!!

Suzy checking in on another patient~  she's rocking out the heart and lung exams for us since, let's face it-- we're gynecologists ;-)  She's a pediatrician so she actually pays attention to these things.

Kelly with a sweet, sweet patient that we operated on yesterday.  

Nice overview of the OR with Heidi and Kelly doing a rare open abdominal case and Suzy showing off her camera skills again.

And yes, that is Suzy (the pediatrician!) operating!  Turns out, pediatricians are darn good at suturing, of course ;-)

Kelly with "Ever" and "Mica"

 Told you we've been "paid" in peaches... by about eight different patients at least!

Unless you are a surgeon it's difficult to understand, but where we are operating is actually directly behind me here and directly to Kelly's left (i.e., the pelvis, of course)-- Seriously, difficulty level 11.5 out of 10.  I was pretty much struggling just to drive the camera while Kelly rocked this thing OUT like she'd been doing it all her life!

Just a taste of the colorful Guatemalan life

Rounds tend to be a little laid-back-- kinda more like a family conversation in the living room!  Only with three or four different families.  That didn't know each other until they all got put in the same hospital room.  And are all helping each other recover now.  Such a thing of beauty in so many ways.

A better one of Suzy and Kelly in the OR

And with that, my friends, it's LIGHTS OUT for me!  Good night.

I Need a Hammer; Can I Borrow Your Shoe?

Yep, true story.  Real quote.  (Technically, specifically asked for Suzy's Dansko, since I happen to know they make good hammers...)

Sometimes mission work is all about improvisation and learning to work within the resources available.  Such as when you are in the OR and one of the nurses kind of gets the stirrup holder stuck and you need a hammer~  you use a shoe.  Then when you put the patient's feet up and find out they are size of your eight year old kid's feet~ you end up taping the feet in to the stirrups.  And when they tell you that they can't move the TV screen away from just over the patient's right shoulder during the laparoscopy because the tubing won't reach, you do ovarian drilling upside-down and backwards (like a BOSS, Dr. HOLDER!!!!)

Other events of the last two or three days? Let's see...

I may or may not have ordered a round of shots for patients this morning just before discharge-- but don't worry, they were milk of magnesium "shots".

I gave a bag of my own blood to a patient, but much more surprisingly and exciting than that was the fact that her husband actually volunteered to give the first bag!  Blood donation is just NOT a thing here that people understand or do.  It's been a horrible frustration for many years.   We basically usually end up buying a bag from someone, so I think today I may have started a "matching donations" program?!

We watched a parade from an OR stretcher through a window, which was all fun and games until we realized the wheels on the stretcher weren't locked in position and wondered how we were safely getting down...

We had the clinic curtain fall down on two different heads (mine and the lab tech's)

Oh-- speaking of the lab tech, for the first time ever, the only blood I had on my scrubs during a week here was my own!  She probably should have taped the needle in while collecting the bag of blood, in retrospect...

We've done 9 major cases, all significantly life-changing for these women.  We've been more than reimbursed by their smiles, the gratitude in their eyes, and the gazillions of bags of peaches they have gifted us with.

We've gotten to know two really cool new graduates from the nursing school that the Fickers opened a couple of years ago, and benefited from their help.  We hope they've benefited from some teaching from us as well, since they will soon be opening up the ORs in Canilla!!!

We (meaning me...) locked ourselves out of our clinic room, which is nothing new since I typically do that at least once a trip and when I call for Felipe, the sweet young man who cleans the hospital, he always knows I need him to climb in the window again~  Usually when I have him do that I find the keys on the desk inside and not actually in my pocket, though ;-)

Tonight, we finally have gotten to sit down to a nice dinner together here in town to reflect on our week together~ and what a week it has been.  I'm reminiscing on just how many crazy, wonderful, horrible, beautiful, sad, ugly, and all-in-God's-perfect-planning-and-timing memories and stories I have~  and it is such a joy to now share some of them with Suzy and Kelly.

I'll try to post some pics in a bit...