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So close yet so far…

Despite the many reconstructive surgical missions that I have been on, I always dread the haunting feelings the patient and I experience when I am unable to help. This by far is the hardest situation that I and other Plasticos Team members experience. I am not referring to patients with problems requiring the talents of different surgical disciplines or even cases I can do with specialty equipment or intensive facilities back at home. What I am referring to are children with devastating deformities/injuries that we not only can take care of but can also teach the local surgeons how to perform the same after we have left. . After all, this is the mission of Plasticos Foundation. These are children that because of time limitations are left when our trip is finished. Even worse are children unable to have surgery because of other issues of fate.  An example of this happened just this morning.

Ly Math is a 3-year-old engaging boy with the weight of the world upon him or so it seems. Actually, he looks like there is a weight pulling his right lower eyelid, cheek, jaw line and neck onto his chest. In reality, a mosquito net used to prevent Malaria and Dengue Fever (rampant in this area) caught on fire from an oil lantern and burned his skin off. The healing wound contracted pulling forcefully down his facial tissues via thick deforming scar tissue. Behind this deformity is an attractive boy with playful eyes though somewhat apprehensive because of his appearance. His right eyelid is pulled down so a tear always lingers but does not fall. He is unable to look up to see his mom’s face without arching his back Food and liquids come out of the corner of his mouth that is pulled down when eating.. Quite simply, it is impossible for Ly to be just a little boy who runs and plays with other children. That is the way life is supposed to be, isn’t it?

Because of the complexity of his deformity, this could not be corrected by local surgeons. One day his mother listened to the radio announcement in her village a month prior to our arrival  Last week, Mother and son started their arduous journey to see us. This was the lucky miracle they had prayed for! Or so they thought.  Of the many children we screened for surgery this boy would have the most dramatic improvement with immediate correction of this debilitating injury. It was also a great chance to demonstrate some advanced surgical techniques to the dexterous and bright Cambodian surgeons we are working with. He was scheduled for surgery first thing Wednesday morning. All of our team were excited to be a part of his cure.  Despite his young age and attendant fear of surgery by strange doctors and nurses speaking a foreign tongue, you could tell he wanted this more than anything. Anything to be free from the restrictive bonds of deformity preventing him from being like any other boy.

Ly Math, on the day of surgery with a 103 F temperature.

Ly was admitted the night prior to surgery – Our team arrived bright and early the next morning ready to erase his inequity of fate only to find out that he had a temperature of over 103 F temperature previous night. The hospital pediatricians tentatively diagnosed  Influenza Virus (Flu) but could not rule out Dengue fever. The bottom line is that this fever- whatever the source- made it too dangerous to operate on him. We observed  him for another day but alas more of the same. Painfully, the doctors and nurses of Plasticos and the Ankor Watt Childrens hospital shared in the devastating news to his Mom and Ly. In short, the wings of ours and this little boys desires were cut by the harsh shears of reality. We did our best to tell them not to give up hope and that we would return one day; that they should listen to the radio for a similar announcement. It is hard to imagine how cruel fate can be and what must be going through their minds. How would I have coped if this was my son?

I shall never forget his face. With luck our paths will meet more auspiciously next time. He deserves better.

So does the baby on a bed in the hallway with a cleft lip who developed pneumonia at just the wrong time, and the little girl with contracted burn fingers who developed a skin abscess the day prior to surgery and so on………

Larry Nichter, MD- Team Leader/Plastic Surgeon


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