Haiti Day Two – Soul
June 2, 2017
The word for day two is soul. My first recollections of the word soul are from my very early years in parochial elementary school. We were taught one’s soul lives beyond life on earth into eternity. A soul is our compass for knowing right from wrong. A soul distinguishes us from all other creatures.
I hadn’t thought about the word or the concept of a soul in many decades, not until I stood before an operating table and saw the patient: a 20-year-old woman whose skin was pulled back exposing about 70 percent of the underlying muscles, tendons, bone, and teeth in her face and neck. For the first time in my life, I saw the inside of a human body.
The surgeons were about to perform a free flap surgery. In simplest terms, she had a tumor the size of an orange embedded in her jaw, and it was still growing. The only option to save her life was to remove her mandible, the lower jawbone, and replace it with the fibula, a bone in her lower left leg.
It’s a difficult, complicated, and challenging procedure even if performed at an academic medical center like Jefferson, equipped with the most advanced surgical and imaging equipment and staffed by a very experienced and deep OR team. We were far from Jefferson.
OR#1 at St. Luc Family Hospital in Port-au-Prince, Haiti, is sparse to say the least. It has no imaging equipment. The nurses assemble all of the instruments on just one table. It has no supply cabinets. The only monitor is used by the anesthesiologist. We brought most of the supplies needed for the surgery ourselves in six large suitcases.
Surgeons and nurses from Jefferson’s Department of Otolaryngology – Head and Neck Surgery, in partnership with Dr. Donald Weed of the University of Miami, have been coming to Haiti for two years to give a chance at a productive and happy life to people with no access to advanced medical care. At the same time, and as important, they have been training Dr. Patrick Marc Jean-Gilles, the top ENT surgeon in Haiti, so he in turn can train other Haitian physicians. Providing hope and knowledge, this was genesis of the CHANCE program.
My only previous OR experience was occasionally watching Grey’s Anatomy (just early years, of course). I was excited and extremely humbled when Dr. Curry invited me to bring scrubs so I could observe in the OR.
It was a transformative experience. There is both tension and a sense of calm in the OR. There is absolute, complete focus on the patient for every millisecond of what turned out to be about an eight-hour procedure. And there is smooth confidence in the surgical team, rooted in experience and skill. Jefferson nurses Jennifer Holzworth and Rachel Williams move effortlessly, easily, anticipating each movement to assist the surgeons. Watching the procedure was like attending the symphony or ballet: practice leads to performs leads to perfection leads to the sublime.
I scrub in. It’s like a sacred ritual for the physicians and nurses—deliberative, repetitive, purifying.
They are already about 4 hours into the surgery. Dr. Curry took a break and on the back of an empty bandage package he sketched out a diagram explaining how the bone removed from the patient’s leg will be mitered to take the shape of the jawbone. He told me that mitering the fibula was easier than installing crown molding in his dining room!
Dr. Luginbuhl then guided me to the operating table. The patient’s left leg is bent at the knee, and I can see the fibula has been removed. The incision, which spans the entire length of her calf, is still open. Surprisingly there was very little blood.
Now I am standing immediately to the right of the patient’s head. Drs. Curry and Jean-Gilles are working on her jaw and Dr. Weed has the fibula in his hands and is meticulously preparing it to become her jawbone. I am completely mesmerized.
A look of concern comes over Dr. Luginbuhl’s face. He leans in and says to me, “Are you queasy?”
I respond, “Not at all.”
He instructs me to put my hands on the patient as it is the safest place for them. I touch her and the word springs into my mind: soul.
In my role at Jefferson, I see people doing amazing things to help others. And I often reflect on what inspires such good. Literally looking inside a person, I did not see muscle or matter. I saw something more, something deeper. I saw beauty. I saw Drs. Curry, Jean-Gilles, Luginbuhl, and Weed, in perfect synchrony with Jennifer and Rachel, saving a life, a soul.
I saw hope.