An excerpt from Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between.
On the morning of the first day of surgery in Nicaragua, I paced. It was 8:10 a.m., and the cases were supposed to begin at 7:30 a.m. But as with most missions, the first day was already running behind, with last-minute changes to the operating schedule and other logistics being worked out. My first patient would be less than a year old, and two years had passed since I had cared for an infant that young.
My circulating room nurse was named Julie, and she waited with me at the front desk of the operating suite. Like most of the people on the mission trip, Julie had come from a different part of the country than I and didn’t know any of the other thirty-five members who had assembled for the week. We would be together all day, each day, and would be fast friends by the time Friday rolled around. On Saturday, we would depart, never to see each other again. The other surgical teams were milling around with us. We were lucky this year, because each crew had been assigned their own operating room, rather than having two surgeries done simultaneously, as I had with a prior mission.
We waited.
As we stood at the desk, I tried to mask my apprehension. It was bad enough to feel it—I didn’t want to show it. I rocked back and forth on my feet and opened my hands widely, fingers stretched apart, then clenched them in fists, as if that might calm me. No luck. “Damn it,” I murmured, “can’t we just get started and get the first little one done?”
Then, all at once, five young mothers holding infants in their arms arrived, led by a hospital nurse. They walked towards the desk together, slowly, cautiously, as if by staying as a group it would be somehow safer. Each patient’s name was read aloud, and the mother gently nudged towards the anesthesiologist to whom she would surrender her baby. They arrived wordlessly and stood before us.
The mother of my young patient looked like a child herself. Eighteen, maybe nineteen at the most, and short, all four feet something of her before me, eyes cast down. She held her son close in with her arms encircling him, seeming to protect him from those around her. Perhaps she was trying to hide his face, as well. I took the infant’s chart in my hands, a manila folder with a single piece of paper inside. I couldn’t read the writing, but a Post-it note on the outside told me all I really needed to know: “11 months, 8.2 kg. Combo.” So, a really young one scheduled for a combination cleft lip and cleft palate repair. I swallowed nervously. On the top right-hand corner was his name, Jose something, the place he had come from, and then his travel information. It read, “Two days. First day canoe, second day bus.” I reflected on when they made the arduous trip to the hospital the week prior, the mother had no assurance her son would even be chosen for surgery. But she did have hope, and that had been enough for her to make the long journey.
Julie took the folder from me. She spoke Jose’s full name, reading from a sheet of paper that listed the operating schedule for our room. The mother looked up; our eyes met. She half-smiled, warily, hopefully. I held out my arms, and she gently, reluctantly, gave her son to me. I cradled him in my arms. He was really small for his age, light as a feather. I guessed he was only in the lowest tenth percentile of weight, maybe from malnourishment from his facial defects, maybe from poverty, maybe from both. I pulled back the blanket that covered his face and saw the unmistakable features I would come to recognize in many of my patients that week: a kind of copper sheen to his skin, dark chocolate brown eyes, straight jet-black hair, and prominent cheekbones. Jose’s eyes peered up at me, seemingly curious about the Caucasian man who now held him. Below his cheekbones was a vicious curled gash in his upper lip, off to one side, which ripped all the way up to his nose. The skin was twisted and purplish, pulled tight and scarred white at the edges. It was split wide enough that you could see a gap in his pink upper gums as well, extending inside to the area where his palate was cleaved in two. He was beautiful. As Psalm 139 describes, fearfully and wonderfully made.
I held Jose gently in my arms and smiled at the mother. She looked back at me with dark eyes, wide. She reached up and put her hands on my shoulders. Quickly, she drew me in and pulled me down. She kissed me softly on my cheek, holding me there for a moment. As she withdrew, I saw her lips were quivering. A solitary tear ran down her cheek from one eye. Without a word, holding Jose close to my chest, I turned and strode to the OR.
David Alfery is a cardiac anesthesiologist and author of Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between.
