As usual when so many different points of view are involved, it was vitally important to determine the truth and nearly impossible to find it.
Chapter Six
Zubaida’s first surgery for the month of October was on Monday the 7th. At the same time that she was going under general anesthesia, the Associated Press released a text copy of the speech that President George W. Bush would be making later that day at the Cincinnati Museum Center in Cincinnati, Ohio. The speech contained every one of the justifications for a massive pre-emptive strike inside of Iraq which would later become the familiar hot buttons of national and international punditry. The repercussions of the speech would remain long after the date itself was forgotten.
Off into the distant future, worldwide debate continued to flare over how to best use military force in coping with the human condition.
* * *
Peter Grossman began the surgical session of October 7th with a series of multiple steroid injections throughout Zubaida’s face, neck, and both sides of her body, to help break down existing scar tissue and prevent it from thickening the way it had done in those first months after her burn.
There was a sizable, tight scar remaining under one side of Zubaida’s jaw that was still preventing full movement. When he cut the binding scar tissue away from her neck, the open wound that remained required sixty square centimeters of skin to seal it. The area would be temporarily covered with that special type of split-thickness graft called a homograft, made from processed cadaver skin. The Grossman’s clinic routinely carries quantities sufficient to completely graft a large male adult. But since these grafts can’t take life in the patient’s body, they are only good as temporary measures to allow the patient to recover some strength before enduring the process of donating their own skin. The same sixty square centimeters of homograft that the skin bank could easily supply from its stock would soon have to be replaced with an identically sized piece of living tissue from one of the few unscarred areas still left on her body.
The subtlety of the day’s work culminated in the work to her chin, underneath the vermilion border of the lip on both the left and right sides. He carefully traced the outlines of each lip, cutting away any binding scarification, then reconstructed the tissue using a “Z-plasty,” one of the powerfully effective tools of reconstructive surgery.
Since any cut leaves a straight scar whose stiffness will resist stretching from both sides, a Z-plasty allows that principal to cancel itself out by re-cutting the line of a scar into a relaxed “Z” shape. In this way the natural pull from the skin will be distributed all along the “Z,” allowing much more natural movement of the surrounding flesh. The depth, the angle and the size of the “Z” have everything to do with what that living surface will look like in six months, in a year, in ten years. Errors in such choices would be measured in millimeters.
This is the part of medicine that challenges Peter Grossman the most, the one that raises his pulse the highest. Whether he was working on the little girl whose life he had brought so far into his own, or on some total stranger who has just been pulled from the back of an ambulance, the surgeon leaves the body’s moment to moment, three-dimensional well being to his attendant colleagues while he occupies the fourth dimension of time in order to visualize every cut for its long term effect.
Everything went as hoped and expected that day, so Zubaida stayed at the hospital; she was scheduled to be back for the second round of this set of procedures in three days. It was much easier to assure that he dressings were maintained in a sealed and clean condition under constant care. Dr. Peter had noticed that since Zubaida’s last procedures, nearly two weeks before, she seemed to be filled with a nearly compulsive need to hum or sometimes sing out loud and even dance her body around despite her limited range of movement, so he made it a point to wrap her with extra thick gauze and asked the nurses to do whatever they could to keep her still so that the grafts stayed clean.
That afternoon, after Zubaida was awake enough for a conversation in the recovery room, he gave her the same caution about not wiggling around to music and stretching her new skin grafts, using simple words and gestures to make his point. Her gaze detached from his and fixed on some point far away while she murmured a generic “okay” that could have meant anything.
* * *
On October 10, 2002: Senator Bob Graham of Florida made a floor statement on the pending resolution to use massive military force against Iraq. He quoted Winston Churchill for his response to the Iraqi Resolution: “I close with the words spoken in one of the darkest periods of history of the Western World, in 1941, by Winston Churchill: ‘Never, never, never believe [that] any war will be smooth and easy, or that anyone who embarks on the strange voyage can measure the tides and hurricanes he will encounter. The statesman who yields to war fever must realize that once the signal is given, he is no longer the master of policy but the slave of unforeseeable and uncontrollable events.’” Senator Graham vehemently protested the Iraqi Resolution as not being a strong enough use of military force to gain control of the human condition.
* * *
On that same day, Zubaida went back under general anesthesia so that Peter Grossman and his team could replace the cadaver skin temporary grafts with an equal amount of full-thickness grafts from the inside of her thigh. There was enough unscarred skin there to get the needed sixty square centimeters of donor skin, but since the donor site’s skin would also have to be replaced, the surgical wound would be covered by a split-thickness graft from her own body, so that it could incorporate into her skin even though it would never stretch like the surrounding tissue. He swabbed the finalized surgical wounds with a mesh dressing impregnated with a solution called “Scarlet Red.”
Scarlet Red is a user-friendly name for a synthesized organic dye that Dr. Peter would be applying liberally on Zubaida’s donor graft sites. Scarlet Red has been in widespread use for over fifty years by the mainstream medical community as a topical antiseptic and for its known power to speed healing for many types of burns, even though no one is sure exactly how—or even why—the bright red organic dye works the way that it does.
Experiments on the thin red liquid have shown it to have the power to stimulate the proliferation of new cells in an injured area, and it has also been used to enhance the speed of wound healing. Since Scarlet Red shares most of its chemical makeup with more than half of the world’s commercial dyes, the understanding of why it should work when other colors don’t is a dissertation topic looking for a doctoral student.
Scarlet Red is also picky about where it spreads its power—a different kind of organic dye will have the same antiseptic and healing effect on a slightly different type of wound. Medical dictionaries can list the various shades of organic dye one after another, noting the particular types of injuries for which each one is prescribed, with no specific explanation as to how Scarlet Red or any of the other dyes work.
The concept of using of an organic dye as a wound-healing substance may go back much, much farther than the fifty years it has been recognized in mainstream medicine. And so it was in that bright red topical elixir that modern Western medical touched fingertips for a moment with the impoverished clinics of an ancient nomad culture—who also rub their patients’ wounds with ointments whose power they can’t explain.
* * *
The cultural laws mixed into Zubaida’s blood and impressed onto her view of the world were clear in telling her that adults around her represented the Law. Of course, that wasn’t supposed to hold true with the Others, but she was alone among them now and they seemed to be in charge of every aspect of her existence, so whether it was right or wrong, the adults around her also represented some sort of law. It was law because they had authority and she did not.
They explained things to her, so many things, over and over again, as if the words of their own laws had any meaning to her other than as the pronouncements that the adults made about what was to happen
to her next. Her hosts could communicate with her in a language that she could now understand fairly well, but which still sounded foreign to her ears. In the hospital or at her hosts’ home, most of what was said to her didn’t seem to mean anything much, whether it was perfectly translated or not. All the adults around her, all of the cold and impersonal adults around her, tried so hard to be friendly and only succeeded in looking like strangers trying hard to appear friendly. It was consoling sometimes, but other times sent a cold shiver of warning up her back.
She couldn’t really tell why the same sorts of actions might strike her as pleasant one time and make her skin crawl at another. It was as if she had two separate sets of nerve endings, which the world randomly selected every time any part of it touched her. Sometimes, when her skin felt crawly inside, she could jump and shout and run around until she burned enough nervous energy to smooth herself back out. But other times, her changeable nerves reacted to the world by overloading, burying her under more sensation and information than she could bear to take in. Then it didn’t matter to her if it was coming from her hosts in her language or from the Others in American words. It meant nothing to her. It was like listening to people gargling a mouthful of gravel.
When that happened, she liked to crawl under the kitchen table and curl up into a ball. She tried to pretend that she was in a little hole in a bank of cool sand and that she could pull the sand over her and disappear, safe from any further disturbance from the world and its sensations.
Sometimes that sent the people around her into various states of upset, which was good, since it allowed her to feel her willpower reaching out into the world and having some measure of effect, even though she generally felt invisible and unheard. At other times, she could hear adults talking about teaching her a lesson and not giving in to her manipulations. That was good too, because then they left her alone and safely curled up under the heavy table, in a state that was sort of like peace.
Other times, though, the adults seemed to need to provoke her. It felt as if they only existed to push her first one direction and then the next, with no clear reason to any of it. It was all just a series of instructions, explanation, orders. Doctors and nurses poked at her during her check-ups at the hospital, the host parents poked at her while they checked her dressings, and through it all the carefully translated words made it abundantly clear that these things were all for Zubaida’s benefit. She was beginning to lose track of what her “benefit” was even supposed to mean.
She understood as far as any ten year-old understands the idea of immediate sacrifice for a long term gain. But on deeper and more primal levels she shared the trait with most other humans of hating the feeling of being poked and prodded. The infuriating messages of helplessness that went along with every push and pull and poke and jab were far worse than whatever physical discomfort might be involved.
Sometimes when the adults were so sure that what they were doing was for her own good that they seemed to her as if they didn’t even realize she was a living thing. Then she had to stop them in their tracks—wake them up—make them see her. Make them listen to her. More than once, when their continual orders seemed specifically intended to drive her insane, she exploded and grabbed a kitchen knife, swearing that she would cut herself or anyone who came near her. It took that much to make them snap out of their adult trances and to actually see her as she was, standing in front of them. The pause never lasted for more than a few moments, but it was good to make them see her.
And as time went by and the host family tended to forget, she kept having to make them see her again.
* * *
The charitable Non-Government Organization that handled Zubaida’s case from Afghanistan to California was like any other NGO, in the sense that its interest in her remained strong even after arrangements for the trip and the surgery were completed. Throughout the month of October, however, the ordinary interest morphed into real concern. Peter and Rebecca began getting calls and emails from the NGO representatives with news of behavioral episodes involving Zubaida with her host family. The parents had grown worried about the unknown depth of Zubaida’s levels of emotional disturbance. Now their questions took on a real sense of immediate alarm.
How extreme might her behavior become? Were their own two children in danger?
The hosts wanted reassurance, but who could give them such a thing with confidence? Could the NGO who sponsored her, the hosts now wanted to know, offer any guarantee of Zubaida’s mental stability?
When that question came in, the NGO reps contacted Peter at the hospital and asked him what they should tell the family. Were the hosts in any danger? Could Peter and the NGO offer any guarantee at all that anyone was safe in this girl’s presence?
And it wasn’t her overt emotional scenes and melodramatic threats that upset them most; they could see through those manipulative sorts of behavior. Their greatest concern was over the increasing inability to get any cooperation out of her at all. It was as if Zubaida had somehow dismissed their credibility and was now detaching herself from them and from their authority, across the board.
When they challenged her solo foot trips, she explained that back in her village of Farah, she made it a habit to work off her considerable nervous energy with long walks through the ancient city walls. Even the strict local customs allowed such petty freedoms to a little girl. Now here in Los Angeles, Zubaida was firmly insisting that since there were no Taliban around to enforce their code of driving all girls inside the home after their tenth birthday, she intended to keep up her very Zubaida-ish habits of long walks filled with flights of imagination. The big problem was that she tended to disappear for these “long walks” at odd hours forgetting to leave any indication where she was going or when she would return.
However, the hosts knew her customs well enough to understand that such disrespect for household rules would never be tolerated inside of her own home, thus the implied message of contempt was difficult to miss. They complained of their utter inability to gain any cooperation from her about it at all. In fact, once Zubaida saw how much this sort of thing rattled them, she appeared to step up the behavior.
What were they supposed to do?
Peter was baffled by the situation and wondered how he was supposed to be able to solve their dilemma. Most of Zubaida’s time with him was on a medical patient basis; these other issues just never came up at the hospital. There Zubaida seemed to clearly understand that maximum cooperation was her most reliable route to a comfortable process and the best possible outcome. Even though the nursing staff maintained a family atmosphere among the patients on the ward, and despite the fact that Zubaida fondly referred to Helen San Marco, one of the older nurses, as “Grandma,” there were really no family-type confrontations there. Sometimes Zubaida would try to negotiate for a little more recovery time before her next procedure, but other than that—and her tendency to wiggle and dance whether or not she needed to be still and let her stitches heal—she had never presented him with such irrational behavior.
Still the calls and emails continued. Her behavior, according to the host family, was eroding so rapidly that they no longer felt safe in the house with her. They wanted to be replaced—they demanded to be replaced—and they wanted Zubaida out of their home as quickly as possible.
Peter’s heart sank the moment that he heard that. This was the nightmare scenario that he hoped to sneak past, because he already knew that the charitable NGO had never followed through on securing a back-up family—their own stockpile of obligations siphoned away enough of their work time that nobody ever got around to it.
He urged everyone to find some sort of compromise. The surgical process with Zubaida was nowhere near completion. Her original treatment plan already compacted three years’ worth of surgery into a single year, so there was just no acceptable way to speed that timeline up any more. It would only deny her fragile body the already limited recovery time that she was getting now.
/> He made sure that everybody involved in the decision-making process understood that if Zubaida had to return to her village at this stage, much of her current progress would eventually be lost while her body continued to grow and the unresolved scars pulled harder and harder against the rest of her. Both her appearance and her mobility would be heavily affected if essential work on her chest and torso was left undone.
But no matter who he dealt with at the NGO, the same answer came back—they had already done everything that they could to secure housing and care for her. How could they ask another host family, even if they found an acceptable one, to take on a child that the original host family was afraid of? Aside from the moral issues, who could begin to unravel the legal implications of such a thing, if indeed a second home was established but the situation there turned out even worse? What if it involved violent harm?
Who would answer for it, among all of them: the soldiers who first encountered her, the medics and doctors who cared for her, the State Department, the NGO, the Sherman Oaks Hospital, the Grossman Burn Center, or even Peter Grossman, himself—the doctor who first insisted that the Burn Center take this case on in spite of its many risks—who would answer for such a disaster, if it happened?
Who would have the power to fix that one?
* * *
The ancient and instinctive animal drive to avoid torment is imprinted on the very cells of the bones and the blood. Nothing that lives and moves will tolerate poking and prodding, especially on an unrelenting basis, without, at the very least, moving out of the way. Or, if sufficiently provoked to anger, it will strike out like a deadly predator. Civilizations teach various methods of learning to delay that response within human company, and of tolerating a certain amount of poking and prodding as an inevitable consequence of life in the community. But the veneer of civility is known to be thin. Poke anybody a few too many times, and even the most bland personality will erupt in anger. Further provoked, they will rise to the level of rage where violence not only becomes possible but is likely, even guaranteed.
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