Saturday, April 14, 2012

Appendicitis in Colombia

While preparing to come to Colombia, one of our big concerns was about the health care available to us. During our visit, our concerns were put to rest as we learned that we would receive comparable health care to what we were used to in the States. Throughout our time raising our support team, health care questions were common questions we received, right after whether or not it was safe to come here with the guerrilla warfare. We had several concerned ladies ask if we were bringing our infant daughter due to safety and health related concerns. We assured those we spoke with that we had looked into the health care here in Bogota and that we felt comfortable with the care we would receive.  This month, we learned more about the health care system here in Bogota as we utilized different aspect of the hospital care.

To hopefully answer many of the questions around this event, I will start from the beginning.

Monday afternoon, I (Marlayna) started feeling ill with an upset stomach. I thought it was food I had eaten for lunch was not agreeing with me. I left school early because I didn’t think I would make it through the rest of the day.  I made it home just in time to throw up three times in three hours with a remaining upset stomach.  At this point, I still wasn’t thinking anything about of. Tuesday afternoon,  I started to have more intense abdominal pain, starting on the right side and then spreading to the rest of the abdomen.  Now we were starting to wonder what illness I have: a parasite? A virus? Or just the flu?  I made it a point to get in touch with our school nurse the next day, Wednesday.  Wednesday the pain remained, about the same intensity, so she came to me at the apartment.  After basic triage, questions, and the rebound test to test for appendicitis (negative result), she thought I had a virus that was going around that has similar symptoms to appendicitis. The rebound test is when you push on the appendix area and when you release from the press, there should be greater pain than while pressing down.  She gave me some medication but also told me that if the pain increases and localizes to the right side to go to the hospital in the morning to get it checked out. 

As the evening progressed, the pain did localize but not intensify and the rebound test was still negative.  Steve started to do research and decided that we were going to the hospital in the morning no matter what. Period. No discussion. Because “there are too many things it can be that are fatal; we’re going.”

We found a sitter for the ‘morning’ for Elleazah and a helper at school to be our translator at the hospital. We arrived at the hospital at 8:15 and by 9:15 I had been through the hospital triage and was being seen by the first doctor. Again the rebound test was negative and I did not show all the normal signs of appendicitis. But, because I had such sharp pain on the right side he ordered for me to have a scan of my abdomen.  But, I was dehydrated and needed to be more hydrated for the test. So I spent the next 3 hours hooked to an IV getting fluids. At 12:15 I had the scan, which turned out to be like an ultrasound and the man said that it was in fact appendicitis. I was still in denial because I didn’t think I had all the symptoms for appendicitis and, furthermore,  I don’t remember the doctors using an ultrasound machine to diagnose my sister with appendicitis when she had it while in college.  Did they really diagnose me correctly? I didn’t want to have surgery unless necessary.  I asked  as many questions I could think of to make sure they were confident that it was appendicitis and not a virus or something else that would be a less invasive ‘fix.’

We were then in the phase called: waiting. The original doctor needed to be notified of the results and a surgeon needed to be contacted.  Nothing seemed to happen quickly. Steve updated our sitter of the situation and they were willing to keep her into the evening.  Our school nurse had called up to check on us and when she found out the news she let people know at the school to 1. Start praying for us, 2. Help us get the extra help we would need.  For example, one lady at school who had often asked to watch Elleazah, even overnight if needed, was notified of the situation and she was willing to alter her evening plans to watch Elleazah that night so Steve could stay with me as much as possible.  Another lady offered to make a meal and help around the apartment since my sister was scheduled to visit for spring break week.  Steve then made a trip home (about 20- 30 minutes by public transportation) to get Elleazah’s things ready for her first sleepover and get other things together we would need for the next couple days.

Steve was back at the hospital by 6 that evening.  I had just met my surgeon, a wonderful older man who spoke some English. He told me he was going to do a laparoscopic surgery, which is the method my sister had, so the news of a similar surgery was comforting. He even told me, reminded me, that “God is in control, He knows.” Oh how comforting it was to hear those words come from his mouth.

By 7:15 I was being moved to the surgical area of the hospital.  We waited for another half hour for the operation room to open and get prepped for me.  I went in shortly before 8pm. 

In the OR, the anesthesiologist told me that I was going to have local anesthesia, meaning I was going to be awake for the surgery (I actually preferred this)! I was thankful they had pretty good English. They gave me a shot in the back, similar to an epidural, though I don’t remember my epidural hurting so much when I received it for Elleazah… maybe because the induced contractions hurt SOOOOO much more than the epidural ‘prick.’ Anyway, the drug seemed a lot stronger than the epidural dosage and they continued to angle my body in different directions so gravity would pull the drug where I needed more numbing. For the most part, my feet were higher than my head so I would be numb up to my mid chest. Though I felt like my breathing was restricted, I could see my chest rising normally as I breathed normally. By 8:25 I was numb and they started the surgery. They put a sheet up so I couldn’t see all they were doing (bummer- though I might have been really freaked out seeing it all). But an anesthesiologist sat next to my head so I could tell him if I was uncomfortable. A clock was just behind him so I was counting the minutes until it was done!  The only things I felt was my belly button being tugged at as they were making the incision putting in the tools (maybe)  and then the pressure of them inflating my abdomen with air so he had space to work. The air added pressure to my upper chest, making it hurt to breath. When I told the anesthesiologist this, he gave me a shot of pain meds… great more medication. Well, the surgery lasted until 8:41 when I was all done getting my stitches.  They moved me out to the recovery room where I was supposed to be for a couple hours. Steve came in to visit after about 30 minutes after I asked 3 times to see him. When Steve came in he told me that the doctor had said that my appendix had broken and that he did his best to clean me out. I was going to be in the hospital for a minimum of 3-4 days due to the inflection.  At this point, I was so glad Steve  insisted  we go to the hospital to get it checked out.

The infection caused me to have a high fever the first 36 hours.  I was on antibiotics and pain medication, which I started to have trouble with (migraines and nausea) so they switched me to strong Tylenol. I was glad for this switch because I knew that was what I had after my knee surgery  11 years ago.

Once out of the recovery room (which wasn’t until the next afternoon due to the crowded hospital), I was moved to a regular room, which was similar to a room we were in while in the States after having Elleazah. The accommodations were very comparable.  The nurses were nice, talking slowly in Spanish and using words I knew. One nurse even tried to teach me some more vocabulary, which I appreciated.

Overall, we were very pleased with the care we received. The only negative would be the amount of time we waited to have the surgery after we found out it was in fact appendicitis. After all, we think my appendix broke sometime between the scan and the surgery. 

It was really neat to see God working out the details of those five days. Prayers were being answered and we are so thankful for our prayer warriors.

I think my parents were especially thankful my sister was coming to visit me. She was able to send them more detailed information about my condition faster than Steve. Though our plans for her visit changed due to my surgery, it was nice to see her and have her part of my recovery time.

Saturday, April 7, 2012

Holy week reflection

This past week has been Holy week here in Bogota. Many families from the city leave to go on vacation; many families that remain make their trips to Mass for their religious obligations. Church buildings that I thought were no longer in use are now rather busy with worshippers and people selling candles just outside the doors. It is sad to see many trying to earn their way into God’s good graces by being good and completing tasks. And yet, when reflecting on our own lives, it is not too difficult for us to find areas where we can be just like the Pharisees in doing good things with the wrong motives. What a refining processes we are in but we are thankful that it is through God’s grace we are saved and not from any of our own works that we gain favor with God. This past week, as a family, we have been reading through parts of the Gospels that make up Jesus' last week. How thankful we are for Christ’s sacrifice on the cross so that we may have a personal relationship with God.