My main concern, though, is her adjustment to being a patient. She’s terrified at the opening of a pack of gauze and hasn’t let me anywhere near her.
After reading the letter, Peter had no doubt that Mike Smith was so involved with her case that somehow or other, he would find the time in his schedule and be just the man they needed to fly to the U.S. with her—and then accompany her father back home a week later. It was clear that this girl compelled people’s help, but at this point he still didn’t have any first hand knowledge of her.
* * *
On June 10th, 2002, Homeland Security Director Tom Ridge spoke to a gathering inside the Ronald Reagan Building in Washington, D.C., explaining President Bush’s decision to create a powerful new Office of Homeland Security. This purpose of this office was revealed to be the coordinating of all stateside security efforts among the FBI, the CIA, and any other organization involved in assuring the continued survival of American society.
The need for such action came with one of the Western world’s great political revelations of the early twenty-first century—that the concept of “freedom” is interpreted very differently by cultures around the planet, and that we can’t rely on “freedom” as a coin of influence that will be respected by all the world’s other realms.
Consensus had finally been reached at the highest levels on the idea that the government’s most powerful bureaucratic reaction to the state of the human condition was to restructure government agencies and increase their range of power.
The situation begged for an answer to the question of whether or not there is anything of great value that America as a civilization can export to the rest of the shrinking globe, besides certain material goods and the threat of annihilation.
In short, the highly advanced state of governmental defensiveness itself implies that the American heart is not only real, but worth preserving. It is something that can be recognized by its effect upon events at home and abroad. It is not that the people who live in the United States are any different than others around the globe, but rather that the pallet of opportunity presented by a democratic society enables and encourages the development of natural human traits that have often been repressed elsewhere by entire civilizations.
The creation of the new federal super-bureau was a standing acknowledgement that any example of the American heart is something that is recognized and appreciated, anywhere else on the planet where individual human life is respected—but that there are still many places where individual human life is garbage.
June 10th was also the day that Zubaida and her father landed in Los Angeles with Mike Smith, plus the NGO representative and a translator who met them at their London stop and flew with them. Smith was glad that the public in the U.S. was far less inclined to stare at her; they made it through the airport without any nastiness. All were driven to the offices of the Grossman Burn Center of Sherman Oaks, in the San Fernando Valley northwest of downtown Los Angeles.
Peter Grossman felt that he must be just as excited as Mohammed Hasan when the two men met for the first time. When he introduced himself to Zubaida, he was heartened to see that although she could not turn her head, she raised her eyes and looked directly at him while he spoke. When he told her his name, she quietly repeated it and made the slight twitch of a smile, all that her face would allow.
His staff liked to avoid confusion in referring to Peter and his father, since simply saying “Dr. Grossman” wasn’t helpful. So to them, the two doctors had long since become “Dr. Richard” and “Dr. Peter,” around the office. Zubaida quickly picked up on it as began addressing him as Dr. Peter, too.
For his part, he found that the pixilated email photos that he had received months earlier hadn’t told the full story of the extent of Zubaida’s disfigurements. With the continued growth of scar tissue in the months since they were taken, she now looked much worse. Grossman was presented with a child of ten and a half years, nearly emaciated at sixty pounds, and so badly scarred about her neck and face that she was unable to close her mouth. Even so, when he introduced himself, she said “hello” in memorized English and stuck out her good arm to shake his hand. While her immediate appearance tended to indicate some sort of unformed intelligence, such a notion was immediately dispelled by her projection of the awareness of her surroundings and of her personality with regard to them. Underneath the inevitably hesitant demeanor of a child whose self-esteem has been continually assaulted over the course of an entire year, there was the conspicuous shine of a bright and lively awareness.
He and his staff found themselves confronted with a girl who was clearly self-conscious about her appearance, but who also made direct eye contact with everyone who dealt with her. When Peter brought in his key support to meet her, anesthesiologist Charles Neal and pediatrician Matt Young, she again stood up and walked across the room on her withered, sixty-pound frame to shake their hands in greeting.
Zubaida presented a striking study in internal conflicts to the whole staff. She was clearly frightened, almost vibrating with fear, and yet they could see with absolute clarity that she was determined to face everything that was happening, eye-to-eye. Throughout the coming many months, their impressions of her would match perfectly with those of the soldiers and doctors who dealt with her back in her homeland—this is a little spirit whose endurance and determination to live surpasses understanding.
While it was clear that Zubaida’s father doted on her, Mohammed Hasan also appeared thoroughly intimidated by the situation. Only his gaze remained strong. He stared around at everything as if his eyes were sponges. Peter and his staff repeated the basic overview of the procedures that Zubaida needed to have done, just as Mike Smith had already done with the pair back in Kabul. Hasan repeatedly indicated that he understood and was eager to get on with the process before his emergency visa expired. For Zubaida’s part, she alternated hovering at her father’s side and engaging in brief greetings with each of Peter’s staff while they took turns babbling about her in words she couldn’t fathom.
Through the interpreter, she repeatedly communicated her concern that the operation might turn out to be an experience on the order of her original, no-anesthesia procedures with the stripping of her burned skin. After repeated assurances about the power of anesthetics and the fact that she would sleep through everything, she began talking through her NGO interpreter about how she felt eager to get started. She had reached the acceptance stage and was at the point where it would be easier to stop talking about it and just get it done.
On Zubaida’s second day in California, she and her father got their first chance to sit down alone together somewhere quiet and talk over the bizarre situation. Just hearing each other’s impression coming from one another helped to keep it all from dissolving into an unbelievable dream. They found a place at a table in a quiet outdoor visiting area, and she felt herself beginning to settle down. The area was surrounded by a decorative wall, so that the enclosed space held a certain familiarity. Dense, opaque walls keep out strangers, keep you safe within them. The heated summer air was neither as hot nor as dry as her desert home, so the slight June breeze blowing around the area brought a feeling of comfort in the relative coolness of the whispering air. She couldn’t see the outside world other than to glimpse a few building tops over the surrounding walls. This American city smelled so much different than her village because of all of the vehicle fumes in the air and practically no animals anywhere to be seen, but in the past few short weeks Zubaida had also been though the cities of Herat, Kandahar, and Kabul, so she knew that the burned oil smell lingered in the air wherever there were a lot of cars and trucks.
This “Los Angeles” had a newer, almost hollow smell; something about it felt empty. Instead of reeking of ancient occupation beneath the charred fog of modern traffic, underneath the combustion fumes, Los Angeles smelled like nothing. There was no smell from its people at all, so that except for the fumes from the long lines of rumbling engine
s that rolled along the streets, it felt as if Los Angeles and everything in it had arrived there not long before she and her father did.
She was still in her relaxed little bubble when she saw a smiling woman walk toward her and her father, accompanied by one of the local interpreters. Zubaida studied the woman in fascination. She had seen other Western women who wear no coverings at all in public, no scarf of any kind. The thing that struck her was that this woman’s hair was a beautiful honey color, something she had never seen inside her home village. Even in the cities of Afghanistan, very few woman there had light hair to begin with, and even if they did, nearly all kept their heads covered anyway. Zubaida immediately saw that this American woman’s hair was a crowning glory that no woman would want to cover up. Zubaida would want to show it to the world, too, if it were hers. In the days before the burns, back when her appearance still mattered in a good way, Zubaida had always been proud of her thick and wavy dark hair. She tried not to stare at the woman, but she had to wonder what it was like to walk around with hair like that all day. Did people stare at her? Did the men ever throw things and tell her to cover herself up?
Speaking through the interpreter, the blonde woman introduced herself to Zubaida and her father as Rebecca Grossman, and said that they should call her Rebecca, and then explained that she was the wife of Zubaida’s doctor, the man who said that she should call him “Peter.” Zubaida walked over to her and shook her hand the way that you do with Americans and looked her straight in the eye because she already knew that you could do that in this place, and because she wanted Rebecca and everybody else to understand that she was inside of there. She was there behind that stiff armor of scar tissue and if they really could carve her face and body back out of the shapeless mass that was slowly consuming her, then she wanted this “Rebecca” to understand that she was someone worthy of their best effort. She didn’t know why she felt so worthy of such help anymore than she knew why she refused to let go of her life in spite of the high price in physical suffering. She just felt it.
Rebecca went away from the encounter, like many other people before her, distinctly impressed with the amount of charisma that could be generated by any person, and especially any child, who has been physically reduced to such a condition and emotionally assaulted as this waiflike girl had surely been. The father seemed to be a quiet and gentle man, but his eyes flashed with contained emotion. Rebecca had already heard about how quickly he could be provoked into ranting displays if he perceived his daughter’s needs to be unappreciated. Today, he had nothing but heartfelt gratitude for this opportunity. He spoke to her as a gentleman, even though he seldom looked at her and didn’t seem comfortable in her presence.
But Rebecca had come to the hospital feeling especially eager to meet Zubaida, since the original connection came through her brother Michael Gray because of his position in the State Department. She knew that he held that position because of his concern for refugees in that region, particularly the children. She wasn’t sure if what was driving her now was the same thing that connected her brother to his work, and she didn’t know what name to give the feeling that she carried into that meeting, but she came away with dual sensations of being both satisfied and thrilled.
It didn’t matter that she couldn’t define what was happening, the wonderful coincidence of having Michael and Peter and her there to attempt to “catch” this girl was made all the more valid to her the moment that she met Zubaida. It was electric, to look into the girl’s eyes and realize that this is the little soul who has defied death and endured unimaginable pain, frequently alone in her bed in a hovel in the desert, for an entire year. It was immediately apparent to her that one little girl’s hunger for life, supported by her father’s unfailing efforts, had reached out to Rebecca through a long chain of other concerned people. Moreover, it reached just about as far from Zubaida’s homeland as anyone can go without leaving the planet, in order to touch Rebecca and leave it to her to pass that touch along.
She also knew that this girl was about to embark on many months of surgeries, isolated here in the United States. Even after the many medical hurdles were overcome by Peter and his team, Rebecca was not at all sure that this frail child would find American society at large to be a compatible mix for a girl whose cultural background was not far removed from the Middle Ages.
For Zubaida, Peter’s blonde wife Rebecca proved to be a pleasant distraction. Her hair color would be a real item of conversation if Zubaida ever got back home again, and the gentle kindness that Rebecca showed gave her a warm feeling.
After she and her father were alone again, excitement and hope battled with fear, and with the kind of deep dread that settles in the pit of the stomach, but she reminded herself that she had already made the journey to this place and survived it, and so far, no monsters had appeared that equaled the Taliban enforcers back home. She and her father had come to this unbelievable place where they were well taken care of, and even though she had seen so little of this American city so far, she could smell the nothingness of it and knew that there was plenty of strangeness all around her. There was some consolation in the momentum that everything had taken on, since it was impossible to predict how things would turn out for them.
There was nothing left to do. She was about to find out whether the Others here in America would actually be able to work any of their famous Western “magic” on her or not.
* * *
Four days later, early on the morning of June 14th, Peter Grossman’s team prepped Zubaida for surgery at the Grossman Burn Center while her anxious father huddled with the interpreter in the nearby waiting room. She was admitted the day before so that she could acclimate to the place, under the fictitious name of “Sarah Lewis” to foil media reps and curiosity seekers who were already circling the situation.
By the time she had been in the hospital for a full day, she had already made it a point to meet all of the staff as well as the few other patients who were also being treated there. Peter and his whole staff were impressed by the usually high degree of adaptability that she displayed. Peter had often been struck by the chameleon-like quality that many children have while their developing brains are still flexible toward change; this young girl was a powerful example of it.
He came to the case prepared with a stellar team to assist him in the complex opening salvo of procedures, and consulted heavily with them before finalizing the day’s surgical plan. It was agreed that Peter’s father, surgeon Richard Grossman, would team up with Dr. Alexander Majidian to focus on freeing her frozen left arm. Surgeon Brian Evans would work with Peter on the first of many procedures to Zubaida’s face, neck and chest. Pediatrician Matt Young was there to handle the many pediatric and medical needs associated with extensive surgery on a weakened youngster, and Dr. Charles Neal had the daunting task of handling her anesthesia.
The first complication showed up right away—Dr. Neal was unable to get a breathing tube down her throat because of the acute downward angle that Zubaida’s head was trapped in by the scars. He even used a special camera in a fiber optic endoscope to guide the tube, but the degree of contraction was too severe. Zubaida was already sedated, but her airway remained unsupported. There was only a limited amount of time before the I.V. sedation would begin to suppress her respiratory drive. Without an inserted tube for breathing support, she would go into respiratory arrest. The upshot of her year-long journey in search of healing would be to die in the American hospital during the very first operation.
Since the body responds much more slowly to an injected drug than to an inhaled gas, it is dangerously easy to overdose a patient with an I.V. sedative before their physical reactions offer any indicators. On the other hand, too much caution about overdosing could lead to insufficient anesthesia and all its incumbent horrors.
That was the opening round.
The team went forward to race with the clock while the patient hovered under I.V. sedation. As soon as Dr. Neal had her
far enough under, Dr. Grossman made an incision around the chin line to cut through the bands of tightened scar tissue that bound the chin to the chest wall. He encountered layers of scar tissue half an inch thick, more like hide than skin.
The first of Zubaida’s amazing transformations was almost immediate; as soon as the incision was made around the entire jaw line, her head automatically tilted back into a normal supine position; much of the distortion to her face gave way. With her head in a normal position now, Charles Neal immediately slid the breathing tube down her airway and began a standard gas anesthesia, happy to switch to that far more accurate method of keeping her at the right level of sleep. With the patient’s airway secure, the first major hurdle and potential disaster slid by without incident. Dr. Peter felt better once the game was on.
Over the course of the next hour and a half, Dr. Peter saw a little girl emerge from under the monstrous mask that day. He performed two of the most dramatic and challenging surgeries on her at the beginning, the first to release her head and neck from where they were fused to chest, and the second to release her left arm from the binding of the scar tissue that fastened it to her torso.
At that point, one of the near-magical elements of modern medicine came into play. The large open wounds created by the release of the face and neck scars was carefully sprayed with Tisseel Fibrin Sealant, a complex formulation of “glue” created for human surgical needs which seals off tiny points of bleeding and allows a wound to stabilize before the skin grafts are applied. The high level of success in modern skin grating techniques is due in part to this miraculous substance, and it was especially important in Zubaida’s case because she had so little healthy skin available. Every single graft needed to take, and the sealant gave Dr. Peter a head start in that direction before applying the new layer of skin.
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