Written by Kim Grahl, M.D. 

It’s Friday night in Santa Cruz. The street jugglers have appeared again at the corner outside of our hotel. These lithe young acrobats dart out into the crosswalk to entertain drivers stopped at the red light, then weave a path between the lanes to accept gratuities just as the impatient drivers step on their accelerators. Somehow, the fearless pair of jugglers always finds their way safely back to the curb, catching their breath until the light turns and they repeat precisely the same perfectly timed sequence of moves over again. I admire their playfulness; I envy the way that they can repeat the exact same finely choreographed routine, and pull it off flawlessly, over and over again.

General Surgery Operation

Taking care of our patients isn’t like that. Surgery, especially on the complex cases served on a Solidarity Bridge mission trip, most definitely isn’t like that. Many of these patients have had multiple prior surgeries on their intestines. When the surgeons first look inside such a patient’s belly – which this week was generally through a laparoscopic camera inserted through an incision just a few centimeters wide – they do not generally find themselves navigating easily through the familiar landscape depicted in an anatomy textbook. More likely than not, getting to the places they must reach to complete the surgery is a time-consuming, arduous process of carefully winding their laparoscopic tools through a labyrinth of scar tissue, cutting and cauterizing, gently lifting loops of bowel this way and that in search of the destination. There is no map; Chagas’ disease has stretched out, constricted, or weakened segments of the digestive tract, and prior surgeries have both re-routed the intestines and inevitably left behind webs of scar tissue.

Such was the case with our dear Aurelia, whose tears of gratitude and serenity through prayer I wrote about in my first blog. The surgical team planned a colostomy reversal which, given all of the conditions mentioned above, would be a bit like trying to reconnect two ends of a severed, badly corroded sewer pipe in locations you have to guess at, and find by searching through a thick jungle at night. We prayed with Aurelia again on Tuesday morning, asking God to work through the surgeons to find a way.

They did not find a way. After hours of painstaking effort, they just could not identify two ends of tissue healthy enough to sew together. It was heartbreaking. As we started to gather our missioners together late in the evening for dinner, Jodi filled me in. We would have to explain to Aurelia in the morning how to adapt to living with a colostomy, a diversion of her bowels into a plastic bag attached to the right side of her abdomen, for the rest of her life. It was a conversation we’d hoped would not be needed.

Kim visits with Aurelia

Meanwhile, surgeon Magued Khouzam was attending a late afternoon Mass in the Cathedral, engaging in a conversation of a different sort.

He emerged with a plan. They would take Aurelia back to the OR again. He had come up with a way to create a temporary intestinal connection that, after months of healing and a bit of luck, might alter the anatomy and the health of her tissue so that yet another surgery could be tried, months down the line, to finalize the repair.

Our Bolivian colleagues discussed and approved the plan and rearranged the surgery schedule. This morning, I found myself once again at Aurelia’s bedside. This time, given her fresh incision sites, she had to remain flat in her bed to pray. Her faith in God and her warm gratitude to our team had not faltered.

This afternoon, somehow, the surgeons found a way. In fact, almost miraculously, they were able to complete the surgery as originally planned. Assuming her recovery over the days ahead goes well, she’ll soon find her own way back into the company of her three children and eleven grandchildren, far away from San Juan de Dios Hospital.

As I reflect on the jugglers, on Aurelia, and on all of the moments that nourished my soul over the past week, I am reminded of the words of poet Antonio Machado:

Caminante, son tus huellas el camino y nada más.
Caminante, no hay camino, se hace camino al andar.

Traveler, your footsteps make the path, and nothing more.
Traveler, there is no path. The path is made by walking.


Dr. Kim Grahl is a specialist in Internal Medicine. She is affiliated with NorthShore University HealthSystem in the Chicago suburbs. This is her first mission trip with Solidarity Bridge. She is serving as internist and chaplain. 

This mission trip is a part of our General Surgery Program. Throughout the year, our Bolivian partner surgeons perform gall bladder and hernia surgeries for impoverished patients identified through our Bolivian partner offices in Cochabamba and Santa Cruz. Mission trips give Solidarity Bridge the opportunity to deliver vital equipment and supplies and provide ongoing training. Our goal is to continue to advance skills in these procedures and expand competencies in these and other high-complexity surgeries such as megacolon and various oncological surgeries. 

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