The Unlikely Smile Maker

As I finished surgery on a beautiful ten year old girl from a local orphanage with a secondary cleft lip deformity, I did not realize how this tiny little Philippino girl was about to humanize me and my entire team involved in her care.  When I met her the day before with her caretaker from the orphanage, it was obvious that she had a beautiful disposition.  But like a technician, I came to the Philippines to perform cleft lip and palate surgeries to restore form and function, not get emotionally attached.

This girl was just one of many on a long list of patients in the middle of a busy week.  My responsibilty was to create a smile only on her face, but little did I know, this little orphaned girl’s simple innocent actions the next day would be responsible for creating smiles on an entire team of doctors, nurses, surgical technicians and countless others with whom she came in contact.  I have heard many times that I am a miracle worker, that our team is miraculous in what we are doing.  This could not be further from the truth as this little girl was about to teach me.   

I glanced over at the table next to me and saw my colleagues Scott Mosser, MD, a San Francisco based plastic surgeon and Raquel Redtfelt, MD, an ENT surgeon from Arizona working on another girl roughly the same age.  This is a typical scene on our medical missions to the Philippines, two operating beds in one operating room.   We were working to correct a cleft lip, a congenital deformity where the structures of the lip do not completely form leaving a defect in the face.  Over the past few years, Scott and I have done hundreds of cleft lips surgeries as part of Destination Hope, a non-profit organization started and maintained by him. 

This year Scott assembled the best of best from the US, who traveled to the small town of Tarlac City in northern Philippines from January 20-24, 2014.  Aside from us three surgeons, our plastic surgery team comprised of Drs. Vernon Huang and Susan Wong, two amazing anesthesiologists from the Bay Area in Northern California.  Also included were Dr. Lawrence Lipana, a meticulous compassionate pediatric resident doctor from Southern California, Tania Di Re, Elizabeth DeGuzman, Alberto Enriquez, and Juyon Yi, amazingly gifted and most kind-hearted OR nurses from Northern California.  I took a moment to appreciate this fine collection of like-minded professionals dedicated to their craft and dedicated to help those with less.  Soon thereafter, I noticed Scott and Raquel finished surgery on their little girl. 

Both the girls had no problems after surgery.  The three of us were pleased with the outcome of the surgeries on these girls.  They did well during their immediate recovery phase and were admitted to the hospital for overnight observation.  The following morning we made rounds to check on the patients that we operated on the day before.  This is a routine mundane, but necessary, part of what we do as surgeons.  This involves an entire entourage of doctors, nurses and all ancillary staff, including translators, who go from room to room, patient to patient, to make sure they are recovering. 

Our two older girls from the previous day, though strangers to each other, were placed in the same ward in adjacent beds.  As we approached their beds, I saw that they were already interacting with each other as if they knew each other.  They did after all share a common problem, which connected them beyond any ordinary bond.  In general our patients are babies ; these two girls were older.  They were able to appreciate the events that brought them to this point in their random lives.  This was a meeting point for these two strangers, who shared a common bond that they could not have imagined the day before.  These two strangers were about to touch me and my entire team in a profound way.     

As I watched the two children interact, I felt the sudden urge welling up that no surgeon likes ; I was struggling to hold back my tears.  Surgeons don’t get emotional, we are technicians who put things together without getting emotionally invested.  These two kids were old enough to realize the monumental change that had just occured.  I handed each girl a hand-held mirror so they could see the change for themselves.  Where there once was a shapeless hole in the middle of their face, now there is tissue and structure.  Where once they looked like outcasts, monsters, now there is a normal looking face staring back from the mirror.  Where once there was no smile, now there is a gorgeous warm infectious smile.  They now looked like all their friends.  Perhaps now they can leave their home to wander outside, perhaps now people will no longer stare, perhaps now they can live a normal existence. 

The two girls smiled at each other staring into the hand held mirror exchanging small sheepish glances with each other and with the rest of the strangers standing around them.  Then the two girls turned the mirror simultaneously towards each other’s faces to show the other her new face.  They were gleaming in excitement, as I felt emotions welling up again.  I glanced at my entire team and noticed they were all smiling in admiration and appreciation.  I reminded myself, surgeons don’t get emotional. 

With this simple gesture, these girls succeeded in creating smiles in all those standing near them.  It was a pivotal moment, the jolting realization that for this moment I was not a surgeon, I was a fellow human being sharing in the private joy of these two little girls and their care takers.  I was part of that great moment for this orphan, who I just met yesterday, but will not forget for the rest of my life.  She reconfirmed for me why I do this every year.  In a moment of clarity, behind my concealed tears, I realized something even greater.  This little orphaned girl from a remote village in the Philippines was the miracle, she was the teacher, she was the technician who knew how to create smiles better than any surgeon.  She was our unlikely smile maker.