Turning in my keys...

I don’t even know where to begin with this post.  I’ve talked directly to a few key players at the hospital, and word is slowly making its way around the hospital and around town that “Doctora Heydi” will likely not be coming back to Chichicastenango…

With Dr. Hoak’s deciding recently not to regularly return to Guatemala for general surgery care, and the upcoming retirement of the hospital administrator who has been so supportive of us for years, and the upcoming retirement of Alma our scrub nurse, and the likely departure of our beloved and trusted nurse Angelica who does much of our follow-up care after she finishes her professional nursing degree… PLUS the completion of the operative suites at the Hospital Adonai out in Canillá which I’ve been privileged to be a small part of from the time we were literally sketching it out on napkins about five years ago—well, long story short, after much prayerful consideration—I’m packing up my clinic here and literally moving it out to Canillá starting February of 2020! 

This is incredibly bittersweet—sweet, absolutely, in the sense that I will get to spend more time with my dear friends in the Ficker family (read more about them at adonaiinternationalministries.com, those of you who don’t know them!  They were a second family to Matt and I when we lived here in Guatemala and have mentored us in every possible way from the birth of our son to the rebirths of our souls…)   But certainly bitter in that I will no longer be visiting every few months with the amazing and generous and loving staff of the Good Samaritan Hospital here in Chichi.

I’m not even sure I realized how hard this would be, y’all!  And there will be rebuilding, and relearning, and re-teaching of the new staff at the new hospital, and it will all be in God’s perfect timing, we trust.  It will be wonderful and hard and everything that Chichi has always been and then some… Will you please continue to pray with me as we make the transition? 

Tomorrow I will turn in these keys for the last time—the ones with the ten year-old piece of tape on the back of the Lord’s Prayer keychain that says “Dr. Heidi Bell clinic”—the ones that I pray have opened doors not only for me to practice my craft, but also for patients to feel safe and cared for and—dare I say—loved with just a tiny foretaste of Jesus’s love for them—the ones that I have to ask to “borrow” for the week every. single. time I come down here, when they again open the door for me but don’t leave me the key for the week—the ones they have kept in a drawer for 11 years now, just waiting for me to come down in another three or four months and trusting that I would. 

I snapped this picture tonight when I looked at them and couldn’t hold back my tears.  Isn’t it funny how the littlest things can bring on such on onslaught of memories and emotions? 

So yes—tomorrow, I turn in my keys again for the last time here in this town.  And I look forward to seeing how God continues to open doors—with or without physical keys!—in other parts of His kingdom.

Keep Praying Please!

Ugh.  Today was a long day.  To those of you who were praying for us today, THANK YOU.  We could definitely feel it, and we definitely needed it! 

We started off OK in the OR, and fairly calm in the clinic—three patients we saw before starting our cases, which was nice.  Our first patient, Esmirna, did quite well in her long vaginal case and should have a great outcome and recover well.

The second surgery, which we thought would be the easiest (a “quick” abdominal hysterectomy), was a nightmare.  Literally.  You know those nightmares or horror movies that involve blood spraying across the room or being collected in bucketfuls?  Yep, that kind.  Lost probably at least 2 liters of blood (likely close to half of her blood volume) and clearly had a heck of a time getting the 12 cm fibroid out from under the uterus.  (For you medical/gyno folks, it was a 12 x 8 cm fibroid essentially growing retroperitoneally off the back of the cervix… huge, ginormous, bleeding mess!)

Again, thanks for those who got the word during the surgery to be praying for Dominga, and please keep it up overnight!  She looks fairly good right now, about 2 hours post-op, and we will go check on her again in another hour or so before any of us will be able to sleep. 

These cases always serve to remind us how much we have to respect the privilege of being surgeons.  I’m so thankful to be here this week with two other amazing gynecology surgeons.  It is definitely a privilege not to be taken lightly, and one I am honored to have.

Good night and sleep well, friends—we are exhausted and happy to have only one surgery scheduled tomorrow.

Getting Started in the OR

Today, as usual, was a whirlwind of operating, getting new folks oriented to the OR and hospital, and seeing patients in the clinic in between surgeries.  We saw an additional 11 patients and got our three scheduled surgeries done.  We were able to schedule two more patients for a current schedule of three major surgeries tomorrow and one on Sunday.  There were also a few clinic procedures we were able to get done.

Thankfully, all of the OR cases today went smoothly—please continue praying for Natalia, Maria, and Manuela in their continuing recoveries.  We will check on them again after our dinner and then hopefully crash for a good night’s sleep! 

Probably our cutest patient today was a little old lady—like, in every sense that phrase drums up in your heads!  She was 81, all kinds of stooped over and slow-moving, and cute as a button.  We ended up doing a quick biopsy on her that we are hoping will come back with good news.  But the cutest part was when Denise handed her a maxi pad since there might still be a little bit of bleeding—and she had no idea what to do with it!  I’m sure those types of things were not available when she was still needing them 😉

The quote of the day is probably when I told our scrub nurse that I knew it had been a long day, but falling asleep during the case really is not OK!  Sad but true story. 

Speaking of scrub nurses, though, those of you who know our sweet friend Alma, do please pray for her!  For those of you who don’t, she is the scrub nurse that has worked with me for 13 years now, and at the hospital for 36 years!  She’s not fast, super-great about sterile technique, or very safe with the needles and other sharp things on her table—but she will never, ever fail to show up when you need her!  And she will never fail to pray for the patients and truly care for them. 

She is working but didn’t scrub today, and really looks quite horribly ill.  The only thing she has been diagnosed with is severe gastritis despite many tests and seeing many doctors.  I actually asked the lab to draw a hemoglobin on her today because she looked so bad and was dizzy!  It came back OK, but definitely on the low side for women here at high altitude (we are at about 6900 feet).  Tom has looked at her as well, which makes me feel better.  But I really do worry about her. 

First Day in Clinic

So, it occurs to me now that the second post of the trip is almost always called, “Long Clinic Day” or something of the sort… and today is no exception, of course!  We started our day around 7 with the trip to the grocery store we missed out on last night.  Then we got fully started in clinic by about 9, finishing up tonight around 6:40.  Not the worst day I’ve had by far, but still pretty long!

We only saw a total of 24 patients, but we hear there are lots more coming tomorrow!  We also only scheduled 5 surgeries so far, which we hope increases also. Tomorrow we will begin with two big hysterectomy cases and a smaller biopsy case.

There were a lot of great patients in clinic to pray for today, though—my two favorites (I know I’m not supposed to have those… 😉) were on opposite ends of the spectrum—the first was a sweet lady that had been told she had very large fibroids and needed surgery.  When we told her that her fibroids were actually quite small, she was 100% convinced that God had worked a miracle and removed them.  She said they were all the way up to the top of her stomach, which I’ve definitely seen, but not today!  She literally wailed her gratitude out loud (very loud, actually) and was unbelievably relieved.  It is such a privilege to be able to give great news!

The other lady, sweet Maria… can you please pray for her with us?  She was diagnosed in June with endometrial (uterine) cancer, and has traveled all over the place looking for care.  Quiche sent her to Quetzaltenango, Quetzaltenango sent her to the cancer hospital in Guatemala City, the cancer hospital sent her back to Quetzaltenango and said she needed surgery, Quetzaltenango sent her back to The City for a CT scan, then scheduled her surgery.  Then postponed it.  TWICE already.  Once because they had too many patients scheduled or something, and once because the doctors were in some kind of meeting?  She is currently scheduled for December 2^nd.  I’ll be a little surprised if she lives that long, to be honest.  She appears to have quite a bit of cancer in her belly, and definitely has metastatic disease that we don’t know the extent of.

Unfortunately, she has more disease than we are capable of operating on as general OB/Gyns—we debated this long and hard, but eventually had to come down to “first, do no harm”—we would definitely rather leave the patient the same instead of worse!  Hard to turn them down, but they were so gracious and understanding—almost made it worse.  We prayed with them; they are in a good church and have faith that whatever happens is God’s plan.

The only thing we were able to offer her was a little bit of help for her anemia.  Y’all, her hemoglobin was 5!!!  Usually here in the mountains, 14 is even on the low side.  So since I’m O negative, I could at least offer her a bag of blood.  The lab technician was kind enough to come in to our clinic to collect the blood while we kept seeing patients, so that worked out nicely… At least she can have a little more energy for a bit.  We also gave her meds to try and control her bleeding and some iron to help build her back up.  These are the hard parts of medicine whether here or in the US, though. 

So please pray for sweet Maria.  She and her husband are so sweet and adorable in their tattered clothes but beautiful souls.  And pray for us as we face another very busy day tomorrow in the OR and seeing the 15 or so patients that got turned away this morning to come back tomorrow… fingers crossed for good rest tonight and some more surgeries to schedule tomorrow!

"Meet the Team"... again ;-)

Yup.  You guessed it—“Meet the Team” time!  Sorry I’m just not very original…

But I’m thrilled to have with me on this trip two other OB/GYN surgeons—what a blessing!  Many of you will remember Dr. Kathryn Pool, who is now on her THIRD trip down with me since last summer!  She hails from Columbus, Ohio where she practices full-time and raises three teenage and young adult girls with her Internist husband.  That’s a busy life to sneak away from for even a week and I’m so glad she did.  She could use some extra prayers this week for strength and some rest as she had to go to Australia less than two weeks ago to help her parents—her father fell ill on the first day of a planned 53 day cruise there!  Thankfully he is home and doing better now, but I can’t fathom that level of stress and jetlag…

Dr. Denise Tukenmez joined us here at the Guatemalan airport all the way from California!  She, like Kathryn last year, just “met” me online through a Facebook group for OB/Gyn Moms that we are all in.  I’m completely awed every time someone new just up and volunteers to come down sight unseen!  Her oldest daughter is currently starting out a year in Spain, and her youngest is missing her at home.  I’m so thankful for supportive families at home that make these trips possible.   She works at a county hospital in the Bay Area and has a lot of administrative duties.  It was a tough time for her to leave (they just went live on a new EMR system!), so please pray for her to have a great week as well.

Then there’s me, for those of you I haven’t met—I’m Heidi Bell, another OB/Gyn who lived here in Guatemala as a full-time missionary doctor from 2006-08.  I’ve had the privilege of coming back down three to four times a year for a week each time to grow a surgical practice here.  It’s been nothing short of amazing and miraculous how God has continued to sustain our efforts here over the years.  I could tell stories for days (and I have!), but for now I’ll just let you look forward to hearing the stories from this week for starters…

Unfortunately we (well, I) had some struggles with customs today for the first time in forever—but that means a late start getting up to where we are staying and possibly no time to get groceries tonight.  That makes for an even tougher start to a long day in clinic tomorrow.  Pray for supernatural strength and great attitudes please!  (I must admit I didn’t have the greatest attitude in customs today :-/)

Winding Down

Wow.  We are so very exhausted right now, but happily so after a very full OR schedule for 3 days—We are happy to report that we got out of the OR just before nine last night, and then we didn’t go to the hospital until 8 this morning.  We rounded on our eight patients, and discharged five of them who looked great.  We have prevailed upon the good graces of one of the local doctors to round for us tomorrow morning on the last three and hopefully send them home.  Please be praying for continued healing in their homes.

One of the coolest parts of this trip/mission is that we have so much more follow up and long-term relationship than most other “short-term” trips.  Our patients will come back in a couple of weeks to be seen by one of the nurses here who Dr. Hoak (the general surgeon from the US who has been working here since 2006) has pretty much trained up as a mid-level practitioner at this point—She will review their pathology reports, send me copies of them via email, and call me if there are any concerns or issues.  Very cool and reassuring.

Today we will take a small van up the road about 30 minutes to the town where I used to live, then catch a private plane out to  Canilla, a smaller town a little up north where my friends (basically family by now, though!) the Fickers live.  You can read more about what they do at www.adonaiinternationalministries.org, but they do amazing, amazing work—especially in the medical realm.  They have literally built a whole hospital!  Although we are still praying for staff for the hospital to come—especially OB, anesthesia, and peds.

Apparently as of 8 am there were already 15 patients waiting there to see us, so it looks like we will be busy this afternoon too!  It’s definitely nice to be able to provide occasional OB/GYN consults there, though, so they schedule them in the intervening 3-4 months.  Unfortunately quite a few infertility patients, and then a mix of other things.  We are grabbing a good breakfast before we go, just in case 😉

We will leave you with some pictures from around the hospital... enjoy!

The women's ward... and the overflow ward...

The beautiful courtyard!  By far the hospital's best feature...

And three of the hard-working nurses who take good care of the patients... bless them!

Tired Ladies...

Whew!  We are now at the end of two long days in the OR so far… yesterday we saw 11 more patients before the anesthetist arrived, and we scheduled one more for surgery on Sunday.  Unfortunately, we had to turn 2 more away that wanted surgery but we simply don’t have time to do this week.  It’s good to be “popular”, I guess?!

Yesterday we operated until somewhere after 10:30pm, which as you can imagine was exhausting.  That was three major cases after our anesthesia arrived, plus one minor procedure under local before we saw the other 11 patients.  The cases all went well-ish, although one was significantly more challenging than the others.  Thankfully, all the patients have looked good today and should go home tomorrow. 

Today started off with a great blessing—Some of you may remember that when Kathryn was last here with me in June, we saw a lady who was 32 weeks pregnant with preeclampsia.  This pregnancy was actually the result of infertility treatments (Clomid) that I had given her previously, so it was such fun to see her pregnant!  And then sooooooooo scary to have to send her to the national hospital when we left!  And then sooooooOOOOOooooo much scarier to follow along as we prayed for her quite premature infant who only weighed three pounds to gain weight and be discharged.  And then scary still as we prayed for him to stay healthy at home and really put on some weight.  I’ve been able to keep track of her with phone calls here and there, and we unfortunately missed each other on my last trip in October.

TODAY I GOT TO MEET HER SWEET BABY BOY, Tomas, for the first time!!!  And thus started our day.  It was an amazing blessing and many pictures were taken by both her AND us.  There were gifts that I had for the baby (tiny things) and a gift from her to me—a really nice tablecloth that is very typical of this area.  I can’t even describe how wonderful it was to see his sweet, chubby little cheeks. 

That was definitely the highlight, then began the hard work—four full and difficult but rewarding surgeries.  THANKS to all of you who were praying for Matea, the lady with the horrible prolapse (y’all do NOT want to see pictures, but I have them if you do 😉) and ulcerated skin that we needed to try to sew up—We are happy to report that her surgery seemed to go way better than expected, and we are super-hopeful that she will feel amazingly better and heal well.  Keep those prayers coming, though!

After that, there were two “vag-a-thons” and then a (thankfully relatively straightforward) abdominal hysterectomy.  To say we are tired now is an understatement, but we did manage to get home just after nine tonight so it feels early!  It’s been ramen for dinner the last two nights since everything around here closes by 8 or sometimes 9, but impressively this team’s attitudes and willingness to serve just keep being positive and amazing! 

Here are a few more OR pictures from today and yesterday, plus a cute one of Mili serving a pre-op patient with a new pair of cozy socks to protect her feet in the OR...

Tomorrow you can please pray for straight-up supernatural energy in the OR—we have 3 vag-a-thons plus another difficult vaginal surgery scheduled!  Why I did this to us, I am unsure.  I usually try to keep a rule of no more than two vag-a-thons daily.  But this is the most commonly needed surgery, so we are praying that as we are faithful to do what God has sent us to do, He in turn will provide some favor tomorrow in the OR.

Thanks, God bless, and GOOD NIGHT!

Group Pictures (Finally)

Selfie time!  Heidi, Mili, Kathryn

Dinner selfie time!  Mili, Heidi, Kathryn... and no, those are sadly NOT margaritas... but that probably IS this blog on my computer in the background ;-)

Pictures!

Getting ready to set up clinic!  The cool thing about this mission is that it has been ongoing for so long and has been so sustainable. This is the storeroom where we keep the clinic supplies on designated shelves when we are not here.  (Heidi pictured)

Three sweet sisters!  I love this picture and these ladies-- we are operating on the one on the right tomorrow...

Mother and daughter, operating on mom this week

Unflattering picture of me, but at least I look passionate?  I'm praying fervently for this lady, who we are doing surgery on this week-- We are really worried about the state of her tissue that we are operating on.  Please do pray with us for Matea's surgery!

Part of our clinic set-up this morning-- pretty state of the art exam lamp, right?  (#itworksfinethough)

Heidi and Kathryn giving a quick talk to the patients before starting clinic, asking for their patience to wait their turn on this long day, and letting them all know they will be seen eventually but can EAT in the meantime (they all tend to show up fasting!)  

From the second floor of the hospital-- I have always LOVED the open air here!  I swear it helps them heal to be out in the sun on their post-op days and not cooped up in a sterile hospital room!

Three of our nurses that will be worked HARD this week once we start admitting patients tomorrow... feel free to keep them in your prayers also.  They manage to keep great attitudes all day and all night long despite the tripled or quadrupled workloads while we are here.

Photo cred for ALL of these to Mili!  THANKS!  I'll try to upload one with her in it in a minute...

Meet the Team! (A day late... sorry!)

So these are out of order because, long story short, I posted this to the wrong blog this morning-- sorry!

Long-time readers know that the first post of the week is always “meet the team”…

FIRST-TIME or new readers, WELCOME to “meet the team” that invites you to join our journey this week—there are three of us traveling together this time, and I’m super-excited to once again be blessed with two other awesome attending physicians.

First I have to tell you who “I” am, though—briefly, my name is Heidi Bell, and after finishing residency in 2006 my husband Matt and I moved down here to Guatemala to serve as full-time medical missionaries for two years.  It was an amazing privilege then, and it’s been possibly even more of a privilege to be able to keep up a practice of sorts here in Guatemala by coming down for a week every three months on a regular schedule.  God has been super-faithful to provide for this mission through six years on faculty of a very busy medical school, contracted pharmaceutical work, unemployment for nearly a year, and now full-time work with a pharma company.  I mostly left clinical medicine in the US in 2014 for a better work-life balance, so now I live in Cary, NC, with my husband and two crazy-but-fun children- Isaac is 11 and Micah is 7.  Gotta give mad props, always, to my husband and especially my in-laws, who faithfully support this mission by driving down from Michigan nearly every time I come down here to help with the kids!

I’m traveling this time with Kathryn Pool, who some of you will remember from last June!  She and I met in a facebook group that we are both in—and she came down and met me in Guatemala sight unseen from Columbus, Ohio!  I was so impressed that she would do that once in a lifetime, so imagine how excited I was when she said she was coming back!  Mad props to her family, also, for supporting her in it.  Especially with 3 teenage girls!  Let’s be praying for Dad this week, right?!  Dr. Pool is in practice that is fairly heavy in obstetrics and light in gyn surgery, but you would never know it by her skill in the OR.  I can’t say enough about how excited I am to have her back down here!

The third member of our party should “complete us” quite nicely, I think— Dr. Milicent Triche and I graduated from residency together! We’ve been facebook friends for a while, and I have LOVED watching her three kids grow up—Ty is 14, Micah is 12, and Maya is 11.  They are awesome and active, so that’s another Dad to pray for and be thankful for this week!  Oh, if 2006 could see us now… SO cool to get to work again with a friend from residency.  And if anyone that knew us at LBJ’s ears are burning this week, we are definitely why.  Mili opened her own practice (!) in Houston, Full Circle OB/Gyn, in 2008 just two years out of residency, which never ceases to amaze me.  Can’t wait to hang out with her in the OR especially this week.

Our trip got off to a rough start when my flight to Atlanta this morning was delayed and I missed my connection to Guatemala.  These poor ladies have been major troopers all day hanging out in Guatemala City with mostly just medical Spanish skills.  In the market, it’s not really helpful to know how to ask someone about their vaginal bleeding or how well her baby is moving, so you can imagine the stress of waiting nearly eight hours for me!  We are now finally headed up to the mountains and Chichicastenango, but we will likely arrive to our beds after midnight tonight.  Please pray for supernatural rest and strength since we are scheduled for a long day of clinic tomorrow.

First Clinic Day

So today, as always, was a busy clinic day.  We ended up seeing 22 patients, but unfortunately have at least 10 more to see tomorrow between surgeries that showed up today but were turned away.  Clinic tends to run long because each patient gets a full history and physical (in Spanish), and surgical patients also get consent counseling, financial counseling, labwork (fingersticks plus urines), paperwork for admission, and instructions for the day of surgery.  It can take a while!

And today, we scheduled 11 of our 22 for surgery!  There were at least two more that have surgical issues but don’t quite want surgery yet.  Others were an assortment of “macarena” body aches and pains (when they start telling you their symptoms and pointing to where it hurts and it pretty much literally looks like they are starting the Macarena dance!), a lady who is unmarried and had an elective abortion 26 years ago with pain ever since (likely with a psychological component), a couple of abnormal cervical biopsies, one post-op from October that looked GREAT (thank goodness!), and one lady whose problems were really all due to her diabetes that is out of control.  (For you medical types, she had a Hemoglobin A1C of 12.4!)

Surgeries scheduled for the next few days include:

1 LEEP

1 Partial Colpocleiesis

6 vaginal hysterectomies with prolapse repairs (what I lovingly refer to as a “Vag-a-Thon”!)

2 abdominal hysterectomies

1 removal of a prolapsed fibroid—who has a hemoglobin of 7!!  She has been bleeding for 2 years straight, y’all… and we were sooooo happy to be able to diagnose the fibroid and not cervical cancer which had been suspected on a recent ultrasound!

Please pray especially for one of our vaginal repairs patients.  Her name is Aura, and she was in tears in clinic today asking for prayer for her and her husband, who she thinks is having an affair with another lady in their church!  He ended up showing up at the end of the appointment after we had explained and arranged everything with her—so of course we got to kind of start over with him!  And this is why many more than 20 just doesn’t work in the day.

We did manage to get some photos today of some of these special women, and a few from around the hospital.  I will share those in a separate blog post hopefully still tonight, but want to go ahead and upload this since the pictures take a bit longer!

Thanks for your prayers and well-wishes this week.  Let us know if there is anything you want to hear more about!