Marie

I'm poised over the body, scalpel in hand. It's hard to believe that this will be the third major surgery on this poor woman in a month. I've been torn inside as to whether this is the right thing to do, but now as I stand ready to cut, I feel peace.

"Let's pray."

As Samedi prays in Nangjere I find images rapidly running through my mind:

Huge mass. Cut ureter. Tied femoral vessels. Sinking feeling realising what I've done. Meticulous suturing. 4 hour surgery. Feeling of failure. Swollen leg, but alive. Slow but sure recovery. Discharge. Return a week later with swollen belly. Ultrasound showing loculated fluid. Is it tumor or leaking urine. Abdominal surgery again. Belly full of yellow liquid. Every surface inflammed and stuck together. Jelly like substance on everything. Retention sutures. Two drains. Three weeks in the hospital with liters of fluid still coming out. Uncertainty. If it's the leaking ureter I should take out her kidney. If it's the tumor, why put her through another major operation. Today, there's pus coming out the drain. I can't wait longer.

I open my eyes and slice from the bottom of her last rib, across her side to in front of her pelvic bone. I use the electric cautery to slowy go through fat, fascia and the different muscle layers. I open the cavity over the kidney. I dissect out the fat. I slowly release the fine fibers attaching the kidney surface to the surronding tissues. I work my way deep in and around the top part taking off the adrenal gland. Then aroudn the bottom part and the back. Finally I find the huge renal artery and vein. I delicately strip off the fat till I can see it well. It's so deep. I'm trying to not shake in my nervousness. If I don't tie it off well, she could bleed out quick. I don't really have the right instruments. I finally get three clamps on the artery. I cut the artery and tie the part I'm leaving in two places and the part I'm taking out in one. The vein is huge and branches right under where I've cut the artery. I have to go deeper. Finally I clamp it and cut it. Then the ureter is clamped and cut. I pull out the kidney and then tie off the ureteral stump. Then I tie off the vein twice and release the clamp. Blood surges into the field. I clamp the stump quickly, put it under a little tension while Samedi suctions till I can see where it's bleeding and clamp that. I tie it off. I release it. No bleeding.

I close up and finally, Marie Guelia, goes home a week later completely healed. I know that what I have done I am incapable of having done. But that's the cool thing about working here, God puts me in situations where I know I can't do it, and then when I do, I can't help but give him the credit.

James