San Lucas Toliman: Thursday – Overcoming Challenges, Delivering Care

Our week is almost over. Despite a few adjustments along the way, the team continues to work cohesively and efficiently. By the end of today, 67 patients will have received treatment.

As usual, we began the day with morning rounds. In Pre-Op, starting IVs has been challenging. Many patients are dehydrated, and older patients often have smaller veins. Additionally, prolonged sun exposure has caused tougher skin, making access more difficult.

Dr. Arce’s first patient, Manuela, a 60-year-old female, is being treated for an abdominal hernia. Due to her previous surgeries, he anticipates needing to make an incision in the superior area. Manuela first developed a hernia 10 years ago, making this a recurrent incisional hernia that has already been repaired twice. Her case is more complex due to a recent history of pneumonia in January. She is unsure of the medications she takes, only noting that they “open up her lungs,” so extra precautions are being taken. She also has a history of heart disease and hypertension.

Another patient, Silvia, was originally scheduled for a total hysterectomy. However, today she will undergo a LEEP (Loop Electrosurgical Excision Procedure), which removes abnormal, precancerous cells from the cervix. Her hysterectomy was postponed due to her Hemoglobin A1C being over 11, whereas a normal level is 6 or lower. Surgery might still be considered if her A1C were around 9, but at her current level, the risk of infection is significantly increased and could be life-threatening. From the beginning, her case has been complex—her CT scan showed signs concerning for cancer, but her pathology results were normal. A cervical tissue sample will be sent for further pathology, and Dr. Tun will determine whether she can proceed with surgery when the team returns.

Loida, a 67-year-old patient, came in for two hernia repairs, but during surgery, doctors identified three hernias. She has a surgical history that includes a hysterectomy and gallbladder removal, both performed outside of Monseñor Gregorio Hospital.

Tomorrow will be a shorter day. Half of the team will be in the General OR, while the other half will focus on inventory and closing out the week.