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...

Wow

Wow.

“Whirlwind” doesn’t even begin to describe the last two days.  Dr. Kelly Holder (a former resident of “mine”, now all grown up and rocking out her career), Dr. Suzy Schulte (a pediatrician I’ve known since my Houston residency days that married Matt’s best friend) and I arrived safely here in Guatemala late Saturday evening.  Luckily, we rested fairly well that night.

Sunday, there were nearly 40 patients waiting to see us!  The ladies at the hospital had started a list they were turning away after the first 20, but we vetoed that plan when we caught wind of it (which in retrospect may not have been the brightest idea—we were there until nearly midnight seeing over thirty!)  It was a little frustrating that we only scheduled nine of them for surgery of the bunch, but at least we can help those nine and were able to reassure quite a few others. 

I know 30 doesn’t sound like a lot, but you have to remember that many of these patients need translation from Spanish to Quiche language, are all new to us, and are often very poor historians so it takes a while to get to the real chief complaint—here’s an example:

How can we help?

My feet burn.

OK, anything else (hoping the gynecologic complaint will be next)

Really bad—like, super bad.  I can’t sleep at night.  And all the way up my legs.

OK, anything else (same hope)

Both sides!

OK, we are here for gynecology problems. Do you have anything wrong with your uterus?

Well, “they” say it’s my uterus causing my feet to burn.  They really hurt bad (rubbing feet) And my arms. They really hurt, too!  And, oh how my uterus hurts my arms and head too!

OK, how do “they” say it’s causing these problems?

Well, they say I need surgery because of my tumors…

[5-10 more minutes of this non-sense generally passes before an ultrasound is generally presented diagnosing fibroids that are either (1) tiny and don’t need to be operated on or (2) ginormous and should have been removed years ago but the patient couldn’t afford it.  There’s rarely an in-between somehow.]

Then you also have to remember that this visit is also the initial visit, the pre-op visit, the financial counseling visit, and the pre-op labs, so it’s hard to hurry much.

And then all of that has to be fully documented.  In—you guessed it—Spanish.

We thankfully had the help of two nurses from the freshly minted class of 2017 (?) in Canilla, Ever and Mica this week—they are here to try to learn some OR nursing skills but so far have probably given more than they have received, unfortunately.  They did scrub with us today and are hopefully gaining quickly in skills so we can get the OR up and running out in Canilla soon!  They are wicked smart and have great surgical instincts.

Today, we saw about 10 more patients in clinic in between three major and quite grueling surgeries.  Everyone did great and kept great attitudes (OK, except for maybe me…) up through around 11 pm again.  We. Are. Exhausted. 

I will try to post some pictures soon; I promise!

Wow.

“Whirlwind” doesn’t even begin to describe the last two days.  Dr. Kelly Holder (a former resident of “mine”, now all grown up and rocking out her career), Dr. Suzy Schulte (a pediatrician I’ve known since my Houston residency days that married Matt’s best friend) and I arrived safely here in Guatemala late Saturday evening.  Luckily, we rested fairly well that night.

Sunday, there were nearly 40 patients waiting to see us!  The ladies at the hospital had started a list they were turning away after the first 20, but we vetoed that plan when we caught wind of it (which in retrospect may not have been the brightest idea—we were there until nearly midnight seeing over thirty!)  It was a little frustrating that we only scheduled nine of them for surgery of the bunch, but at least we can help those nine and were able to reassure quite a few others. 

I know 30 doesn’t sound like a lot, but you have to remember that many of these patients need translation from Spanish to Quiche language, are all new to us, and are often very poor historians so it takes a while to get to the real chief complaint—here’s an example:

How can we help?

My feet burn.

OK, anything else (hoping the gynecologic complaint will be next)

Really bad—like, super bad.  I can’t sleep at night.  And all the way up my legs.

OK, anything else (same hope)

Both sides!

OK, we are here for gynecology problems. Do you have anything wrong with your uterus?

Well, “they” say it’s my uterus causing my feet to burn.  They really hurt bad (rubbing feet) And my arms. They really hurt, too!  And, oh how my uterus hurts my arms and head too!

OK, how do “they” say it’s causing these problems?

Well, they say I need surgery because of my tumors…

[5-10 more minutes of this non-sense generally passes before an ultrasound is generally presented diagnosing fibroids that are either (1) tiny and don’t need to be operated on or (2) ginormous and should have been removed years ago but the patient couldn’t afford it.  There’s rarely an in-between somehow.]

Then you also have to remember that this visit is also the initial visit, the pre-op visit, the financial counseling visit, and the pre-op labs, so it’s hard to hurry much.

And then all of that has to be fully documented.  In—you guessed it—Spanish.

We thankfully had the help of two nurses from the freshly minted class of 2017 (?) in Canilla, Ever and Mica this week—they are here to try to learn some OR nursing skills but so far have probably given more than they have received, unfortunately.  They did scrub with us today and are hopefully gaining quickly in skills so we can get the OR up and running out in Canilla soon!  They are wicked smart and have great surgical instincts.

Today, we saw about 10 more patients in clinic in between three major and quite grueling surgeries.  Everyone did great and kept great attitudes (OK, except for maybe me…) up through around 11 pm again.  We. Are. Exhausted. 

I will try to post some pictures soon; I promise!