Geoff, a plastic surgeon from Fort Wayne, is explaining to a Vietnamese surgeon and Mike, a fourth-year medical student from New Jersey, what he will do to the 5-year-old in front of him. The child’s head is tipped back, eyes taped shut, fine black hair spread out, dirty feet and hands relaxed. The Dingman, a sort of metal mouth rack, has stretched him open like a gaping cavern. I look down inside him from above to see a natural wonder. The split lip leads to a winding path through the gums and down into a serpentine chasm banked by pink bony ridges, descending to a murky red pool in the child’s throat.
My expectations for this volunteer medical mission had been vague, as were my reasons for going. The fervor that compelled me toward this adventure, however, was clear. It wasn’t about altruism. It was a quest.
Two years earlier, after I’d had a mastectomy, a plastic surgeon fabricated an apparently normal body part to fill my sudden emptiness. The first time we met, he had just returned from his yearly Operation Smile mission to China, where he renovated children’s damaged faces. He still wore the aura of his recent experience; I was in a zone of heightened sensibility, on alert and grasping for comfort. What he radiated came from somewhere beyond the usual, and I linked it with where he had just come from.
Because of him, when a local Op Smile clinic was held in Nashville, I helped. The children who came for treatment had somehow slipped through the health-care cracks; their anomalies ranged from webbed fingers, disfiguring port-wine stains and burn scars, to hemangiomas and cleft lips. I was fascinated, not by their alienating differences, but by their course of transfiguration in this newly discovered wonder-world of compensation and resurrection. Without medical training, I could handle logistics, oil the wheels. I held children, sat with their parents through the surgeries; I was a voyeur, but with an urgency. My surgeon let me watch his cleft cases in the operating room, standing on a stool behind him, my hand on his shoulder for balance. I felt the intricate movements of his hands work their way up his arm to where I was holding on. Peering down, I saw him lift those children’s sentences of abnormality and felt a fleeting but palpable rush. I had tasted the certainty of possibility.
That was what I wanted more of—to be close to the power of transformation and healing. I signed up for a two-week project in the place that so many of my generation had desperately tried to avoid, or had gone to, only to return permanently altered. Vietnam, a history hole filled with the ghosts of unfinished business, fraught with still-festering sores and old, tender bruises, shimmered with alluring, metaphoric possibilities.
I tried to pack light. Forget the French dictionary, someone told me. “No one will speak that colonial language now.” The mission coordinator said to bring scrubs for the OR and modest gifts for my Vietnamese counterparts, whoever they would be. “Bring a fanny pack for your passport, tickets and money, and never take it off.” My baggage was full of good intentions, 200 frog finger puppets, some trepidation, a little heavy on the mea culpa. Of course, I wasn’t fully prepared.
Reconnaissance
The advance team, 15 of the crew of 36, met at the L.A. airport. It was like a group blind date; we would recognize each other by the smile pins we were supposed to wear. I didn’t put mine on. What if it wasn’t cool? There were seasoned hands on that flight: surgeons who had been doing this for years, nurses who had taken their two-week vacations and done Kenya, Nicaragua, Romania, Colombia. I was a groupie to their band of common experience. I had no idea what my role would be, but I wanted to be needed.
And I wanted to know these strangers in some essential way. Then, I hoped, I would know a mighty source. If I could capture their experience in words, I would own it. I kept a journal.
Hong Kong to Ho Chi Minh City. Across the aisle is Susan, from L.A., plastic surgery team leader. Her husband, David, a helicopter-door gunner in ‘69, will help with medical records. This is his first time back to Vietnam; they are holding hands. Valerie has done volunteer anesthesiology in Ecuador. Fred, 73, retired from private practice 10 years ago and does eight volunteer medical trips a year with his wife, Pat, an OR nurse. Jackie, a pediatric intensivist and one of the 30-somethings in the group, has done her homework and shares my sense of incongruity about our destination.
Vietnam, now a frontier tourist destination, is beautiful and flowering, says my Lonely Planet guide. It tells me where to buy the best baguette and to visit the Chu Chi tunnels. Beware of vendors hawking alleged MIA remains. Don’t drink the water. Don’t climb inside bomb craters. Have a drink at Apocalypse Now. Tet is a time to celebrate. VC and DMZ have changed to BR and NGO.
Our translators are the Viet Kieu, those phantasmal boat people, now citizens of other worlds, sailing back through the sky. All of them are fragments, scattered years ago from secret harbors. Some of them remember last year’s mission when immigration officers in Hanoi harassed them, called them traitors, kept them dangling for days. Still, they are coming back.
Next to me, Diep is checking and rechecking her visa. Her father was a South Vietnamese army captain, and her mother worked for the CIA. Their ID cards said they were fishermen when they put out to sea. We have been talking about ghosts, those who died for the wrong reasons, against their karma, without proper rituals. Faceless, nameless hoverers, unattached to any place, she says. Ngoc, a row behind, is a bio-medical technician from Orlando who served in the South Vietnamese navy until the day he saw his port city blown up from the ship he was on, which kept going, leaving his wife and children behind. He tells me that the airplane we are now on is his time machine, taking him back to reconnect with his people. More than translation, there will be interpretation.
Can Tho, population 150,000, sits on the lip of a river capillary in the heart of the Mekong Delta. To get there we ride Highway 1, blazing with heat and crawling with life. It is a six-hour bus ride, with two ferry crossings, from what is still called Saigon by almost everyone. My tourist map shows points of interest: pagodas, battle sites, resorts. My own markings on it show where friends have fought and bled and killed. We wait in the sweltering street for our bus to be loaded onto a ferry, engulfed by a tumult of exotic daily activities, children swarming, pushing fly-encrusted snacks in baskets at us. Alice, a recovery-room nurse, 55, blond, dainty and parched, says, “Isn’t this wonderful? Do you realize how lucky we are to be here?” It’s a far cry, that’s for sure.
The hotel is owned by the army. It is grim, with tube lights and heavy cooking smells in the steamy halls. But it has toilet paper and hot water. My roommate, post-op nurse Marja, unloads her gear: antibacterial hand cleaner, biological odor eliminator, 40 bottles of Children’s Tylenol, hairdryer and a scented candle. She tells me the children will love the frog finger puppets. It is 12 hours later than it is in Nashville. Inside my mosquito net, I cannot sleep. It isn’t Marja’s snoring or the splutter of the diesel-powered fishing boats in the canal outside the window, but the din inside my head.
Triage
At 6 a.m. we eat noodle soup with lime and chili while Khai Nguyen, our logistics coordinator from headquarters in Virginia, gives instructions. He hands out copies of the screening-location layout and tells us about Typhoon Linda. Two days ago most of the Delta was flooded, and the provinces targeted for this mission were hit the hardest. We don’t know how many children will make it. Next, he gives cultural instructions: Don’t touch the tops of the children’s heads where their spirits live; don’t show anger toward anyone because you will lose face and they will be embarrassed for you.
At 7 a.m. we troop off the bus at a low-slung, crumbling compound wearing our smile buttons, stethoscopes, fanny packs, khakis and Reeboks. We are a team—strong, equipped and totally alien.
We are met by a throbbing crowd of faces, most of them terrible mistakes. Children with no roofs inside their mouths, tongues coming from places where nostrils should be, tusk-like teeth protruding from slabs of gum at the bottom of a nose that didn’t happen, vestiges of bifurcated lips. Mesmerized by the profusion of deformity, I am useless.
A friend who heard that I was going to Vietnam to help plastic surgeons repair children’s facial disfigurations and burn injuries had said, “Oh, from the war.” She’d had a momentary time warp. Those children would, of course, be more than 25 years old now. These children are only the latest ravaged casualties of nature and accident.
Amanda, 25, the child-life specialist from Charleston, is armed with stuffed animals. She expects these barely clothed children to share. They have traveled for hours or days to get here, on foot or by bus, their houses inundated by the typhoon. They share. I am assigned to crowd control, which means keeping it at bay, letting in five at a time to be chosen or rejected for surgery. I use my hands to make futile pushing-away gestures at the surging tide of desperation.
Lucy, clinical coordinator and Navy captain, processed Haitian refugees on the high sea. She says it was the best time of her life. Now she volunteers 75 percent of her time. She pulls tables and chairs into a pattern, musters the local hospital personnel and a translator. Those from the farthest provinces are seen first. Histories and vitals are taken. Surgeons make their evaluations and send the children on through dental, anesthesiology, speech pathology, pediatrics and photos. Photos. I can collate forms and put them in the charts, fill in the date. I can hostess, welcome and guide the mangled flow with directional body language, and look into their eyes.
They are manifestations of heaven and earth. A mother wears wide, black peasant pants and a boxy shirt, holds a conical straw hat, her feet bare. Her 12-year-old daughter wears a black T-shirt that says “Versace Jeans Couture.” Jackie is worried about her asthma. I am worried about the rest of her life if she is rejected. Susan and Fred are excited about another girl—the syndromic 16-year-old with lustrous, long black hair, monstrous eye and facial clefts, a tangled mouth. I am having a hard time looking at her and struggling with aversion that I don’t want to admit. Her bombed-out communication center, fully exposed, is the aftermath of a capricious rampage. Abandoned, reclusive, estranged, her name is Hai, and she can be fixed.
The surgeons can see just by looking, how to release spirits trapped deep in prisons of distortion, how to repair the shattered gates. Rejected: the boy so anemic his nails were blue, the feverish babies, the asthmatics. Marja does the body weight; Susan does the fate weight.
Larry, the orthodontist, examines a tall, gaunt woman. Her top front teeth, at right angles to her exposed gums, protrude between the two sides of her split upper lip, which is open to the base of her nose. Susan and I watch her as she crosses the room, a graceful specter, blank-eyed, vacant or fear filled. Susan says, “In one hour her whole life can be changed. I want to do it.” I look at the chart: Age, 47.
“It’s coming so late in life for her,” I say, thinking of loneliness.
“Who is that man with her?” Susan asks Ngoc.
“Her brother,” he says. “Her husband couldn’t come. He had to stay with their five children at home far away.” Susan laughs at our assumptions, at our limited understanding. “It was a love marriage,” Ngoc says. “But because of poverty she had to go out in public to work. She was always taunted, but the family strength supported her.”
“Still,” Susan says, “her whole life will be changed.”
By afternoon, 120 surgeries are scheduled. There would have been more but for the typhoon.
R&R
The cargo—5,000 pounds of donated technical equipment; every suture, glove, tube, instrument and IV bag needed for the surgeries; all the anesthesia and medications—is held up in customs. Hospital setup is on hold. Don’t they want us to do this? All those waiting faces, and we have the morning off. Khai, who is only 25, negotiates with the intractable customs officials. His Vietnamese is fluent, though he grew up in Canada. His job description includes cultural acrobatics, mostly balancing. His memory holds his own family in a small, crowded fishing dinghy, adrift and storm tossed, 16 years ago. He arranges a boat trip down the Mekong River for the team to fill the time.
The banks of the Mekong are clotted with habitation and green, lush growth. We are fighting dehydration and exhaustion and starting to get acquainted. I catch Jackie’s eye, knowing she, too, is seeing in black and white: boys who are not there, chest deep, guns raised, wading next to us. I ask Fred about cross-cultural surgery. Is operating on an Asian face different than on a Western one? “Different emphasis on the same thing,” he says. “The objective is always symmetry and harmony.”
Susan leans forward and holds me with her eyes. “Symmetry, Melissa, not perfection,” she says. “We try to make the part commensurate with the whole.”
“They need what we have to give them,” Fred says, “but differently than we need.” I’m not sure what he means. Perhaps, I think, the proportions are different.
We’re sipping on straws stuck into the navels of coconuts, sucking on the milk. Pat is telling a story about a project she and Fred were on in the Amazon rain forest. Fred had just finished a boy’s lip under local anesthesia, and the boy asked to see his face. No one had a mirror so Pat found a shiny metal trash-can lid and moved it around in front of him till he got a glimpse. Everyone listening to this nods, having heard all the parts she didn’t tell. Someone else tells about local nurses in Kenya emptying the suctioning equipment out the back door of the OR into the dirt road. Then it’s on to legendary stories of love affairs between teammates that bloomed in the desert, or the jungle, and how they’d only meet on missions. Moving along to Remember Whens, more mutual references, risks taken, crises survived or not. Together, at different times and places. I am adrift in this boat, an audience apart, rapt.
Briefing
Today the team will make presentations to their Vietnamese counterparts at the educational symposium. The hospital classroom is full of surgeons, nurses, anesthesiologists and dentists. The director of the hospital, middle aged, ruddy and rumpled, welcomes us. Ngoc translates and sweats in his white shirt and tie and the 100-degree heat. Overhead fans stir the melting pot. I sit between two Vietnamese women about my age, our shoulders crowded against each other. We smile awkwardly across a vast divide. John, anesthesiology team leader, talks about safety and the problems of using Western medical techniques in countries where resources are less developed. “In the U.S. the doctor looks at the monitor. Here, we must look at the patient.”
The women next to me don’t speak any English. I take a chance and ask in French, “What is your work?” Lights go on, and French words come out as heavily accented with Vietnamese as mine were with American English. I can almost understand. A few more tries and I know that one is the head nurse and the other a dentist. They ask if I have children, and about what work I will do this week. I try to explain; they smile and nod at me. We dig with primitive tools. Susan shows surgery slides and talks about the psychological effect of disfigurement and the inability to communicate. I smile at these women across a smaller void than before.
Reinforcements
Bravado is in the air. The rest of the team, 21 more, arrived last night. Tonight we have a mandatory group dinner for merging purposes. A bonded team is a better team, according to past experience. John observes, “These are mostly people who are used to being in charge, and now they have to work together.” Susan’s job is to make controlling their egos seem like fun. There is hilarity and cold Tiger Beer flowing with the platters of rice and shrimp and presentation of the selves.
Carl, a newly arrived plastic surgeon, loudly announces, “I do this for two reasons only: to do challenging plastic surgery and to drink.” His cosmetic practice is lucrative, he adds. “Only 10 percent of what I’ll do here will be for good-guy points,” he says, putting his arms around the nurses on either side of him. So far, I’ve had “to make a difference” and “pay back” thrown at me as tidbits when I’ve probed some depths, searching for clues to what makes these people tick, but I can’t swallow those sound-bites whole.
I walk back to the hotel after dinner through the dark streets of Can Tho with Court, another plastic surgeon, 48 years old, from New York. We talk about a niche we both came from having to do with straw-bottomed Chianti bottles and war protesting. When I say that the empty bottle was always used as a candleholder and that protesting had been a rite of passage, we connect. Children follow us calling, “Hello, hello, hello,” and want to hold our hands. Court says, “The war ripped our generation apart, literally. I was in medical school when my best friend was killed here. I’ve been coming back on medical missions for years, trying to heal those wounds.”
Staging
The cargo was delivered at midnight. Khai, John and Dr. Thong, the Vietnamese head anesthesiologist, carried it to the third floor of the old barren hospital. This morning we are stockpiling supplies by area. Tomorrow is surgery. Anesthesiology unpacks machines, tubes, masks. John, a lanky circulating hawk, tests every function. Here, he says, is what not to do to a child, as he shakes a doll in another anesthesiologist’s face. “Would that calm you down?”
A flood in the storeroom soaks the cardboard boxes of IV bags. I move and re-sort them. The post-op area has no cupboards for a pharmacy, so we make some from large cartons and tape. Larry gives toothbrushes to the families who have been cooking and sleeping in the narrow halls, sharing two bathrooms. They have no place else to go. Amanda, her orange hair aflame in the sun, is on the roof with dusky children, blowing bubbles and showing them how to anesthetize themselves with gas masks. The ID bracelets are missing. Recovery needs a fan; there’s no air conditioning in there. We pack in cartons of Vietnamese mineral water aptly named La Vie.
Pat and I are doing the ritual checking of the major and minor cleft palate sets: metal boxes of slender, stainless instruments with names like Mosquito Clamp, Two Prong Rake, the Freer Elevator. Carefully, they are swaddled in cloth and sterilized in an autoclave we hope is working. My own instruments, pen and notebook, are cached in a bag in Larry’s makeshift lab, where he is setting up to make prosthesis palates, like retainers, for the surgically ineligible.
Children are piled at the barred windows, peering in at us. The stage is set. We pass John’s readiness inspection and slip away through the waiting patient families while Hong, the barefoot, pregnant orderly, does a final sterilization.
At dinner Khai says, “Be on the bus at 7 tomorrow morning. We cut at 7:30.”
Surgery Day One
The hospital is still, the people quiescent, expectant. A little girl meets me on the stairs and presses something into my hand, smiling with her eyes and part of her mouth. It is rice, wrapped in a banana leaf, bound with string.
Diep and Lucy locate the first patients, line them up with their families on a bench in the hallway, and write names, weights, ages and procedures on their white hospital pajamas. They have been given soap to bathe with, but most of them haven’t; there are only two bathrooms and a trickle of water. Diep translates, goes over what will happen, says they shouldn’t be afraid. If they are, they don’t show it. The five anesthesiologists, their faces still uncovered, come to get the children. Valerie talks to her first patient through Diep as they walk, holding hands, into the OR. A young mother kissing her baby’s cleft lip looks up to Craig, who plays with him for a minute before taking him from her reluctant arms. Down the hall, the next on the schedule wait silently.
On the table, Valerie shows her child how to hold the mask to her own face, holds her in her arms and murmurs in her ear as she melts. Consciousness controllers and guardians by trade, the anesthesiologists hold these lives in limbo. “In these little bodies,” Valerie says, “things can go bad real fast.”
At 7:45 the five tables are filled with sleeping cases. There are two double-table rooms and a single. “This is a brutal surgery,” Geoff says, almost apologetically. He will move the lining of the 5-year-old’s mouth from where it has mistakenly migrated to the sides of the roof, to where it should be. “We plow it up from the bone with a crude tool. All but one of the vessels that cross over out of the bone into the tissue are severed. Everything at the margin has the capacity to bleed.” But fusion of the two released sides will mean internal symmetry. It will mean normal eating, breathing and, maybe, speaking. In the bony corners and at the frontal tip of the roof there will be no stitches holding the repaired tissue in place, only threadlike anchors. And, Geoff says, in two days it will have adhered and healed through self-regeneration.
By 8 our blue scrubs are sweat soaked. The ORs have window air conditioners that clatter in counterpoint to the grinding noise of ancient suction machines and Sting on the tape player. One cauterizing unit for two tables means that Kate, the circulating nurse, has to hook it up and unhook it as it is needed for each patient. She hopes they won’t need it at the same time.
Now, Valerie and Craig carry their drugged children, with nurses holding the IV bags aloft like victory flags, to recovery. They stay, watching, while Alice and Lisa do vitals, wipe off the blood, check the breathing. At this way station, hovering consciousness is monitored by sight and touch. Lisa is holding a baby with one arm and the baby’s IV bag with the other hand. “Melissa, get me some tape. This needle is coming out.” I don’t know where the tape is. When I find it, I can’t rip a piece off. That’s all she needs, a piece of torn tape. My fingers are swollen from the heat and won’t manipulate. I don’t have the right angle on the rip. Lisa is looking at me, sweat beads on her lip. “OK, hold the bag, I’ll get it,” she says.
Alice is partly lying on top of a thrashing child, trying to hold the thermometer in his armpit. She asks me to help her. I don’t know what to do, but she shows me how to hold his arm, where to put my body weight. I think What if this were my child, and he begins to calm. Alice’s face is close to mine. As we release our grip, she says, “These trips are how I mainline to what is meaningful to me about what I do; I can go directly to the art part of nursing. No monitoring crutches between me and the patient, just basic skills, hands-on care and feeling.”
Jackie is a sentinel in her baseball cap, her starched white coat brilliant against her glistening, dark-brown skin, a bright toy attached to her stethoscope. She stalks trouble in recovery: vomiting, fever, bleeding palates. Geoff comes in between surgeries to look at his 5-year-old, who is seeping ceaselessly. The tannic acid in a wet tea bag is supposed to constrict vessels, and one has been pressed inside the child’s mouth, the string and Lipton label trailing from his swollen lips. Geoff takes it out and puts his finger inside with a wad of Surgicel, putting pressure on the palate “until I feel it seat,” he says. “Sometimes you have to safeguard your surgery.” Mike, who assisted on this child, slides his finger in over Geoff’s, and they wait together until Mike has the feel of the pressure and can take over. Twenty minutes later, when I bring some charts, he still stands there, bent over, concentrating.
“This one’s ready for post-op. David, can you get him?” David, the door gunner, puts down his camcorder and turns around. When was the last time he carried a Vietnamese child? This is a large one, and he’s not sure where to put his hands. A Vietnamese nurse shows him how to pick the boy up while she untangles the tubes. I open the door and am met by a surge of expressionless parents, wanting their children. What can David be thinking? He moves in a dreamer’s slow motion down the hall to post-op, his face flooded with radiance, the child’s father following at a distance.
There, each straw-mat-covered bed holds two recovering children and two parents sharing space meant for one. Neatly folded into their tight spaces, water bottles, food vessels and cooking utensils arranged around them, they exude distress. No translators are here now to explain that the long black threads corning from their children’s mouths, taped to their cheeks, are tongue stitches for emergency airway clearance. That the moaning and lethargy are normal. That the swelling will get worse before it gets better. I am standing in the middle of the throng, holding a small yellow basin filled with cotton swabs, waiting for someone to need one. Jackie is in here assessing and catches me in her sweep. “How are you doing?” she asks, as if I am her patient.
“I’m not doing anything,” I say, with a minor but discernible tremor.
As if I am her child, she puts her arm around me and says, “Every touch, every word, every look is doing.” And she leaves me standing here.
Marja says that when the children were put on pre-op “nothing by mouth” orders, the parents stopped eating and drinking, as well. Now they are exhausted and dehydrated, fanning their fragile children, whose identities have been tampered with. She asks me to find a translator so she can talk to the parents; she cannot decipher their blank faces. “In Kenya they were into jubilation at this point,” she says. Here, only their pleading eyes speak. Thanh, a post-op nurse from Virginia, spent four nights alone, at age 17, on a small boat crammed with 63 strangers. When it beached on a wild island near Malaysia, everyone foraged, everyone shared. She tells us that the parents are suffering because their children are suffering.
An old woman beckons to me and points at the black stitches in her sleeping child’s lip. I squat next to the bed and touch the child’s forehead, as if I have a right. The skin is smooth and cool. When I look up I see that the woman is waiting for me and that the expression on my face is mirrored in hers; she smiles back at me, toothlessly.
Thanh tells me that this woman is the child’s neighbor. Her grandmother, with whom she has lived since her parents abandoned her, is blind and couldn’t make the five-hour bus trip, the two days walking. “There is a word in Vietnamese, tôt, that means good person, someone who has the capacity for caring, for doing good,” Thanh tells me.
“Ask her why she did this for the child,” I say.
But Thanh shakes her head and says, “If you claim your good deeds, then they don’t count. The act in itself is enough.”
Later, Mike comes into the lunchroom, ebullient. The bleeder had fallen asleep biting down on his finger. “He felt comfortable with me taking care of him—that’s the greatest feeling—and when I took my finger out and looked inside with a flashlight, it was pink and clean and gorgeous.”
Retreat
The local staff will take the all-night shift. We are on the hotel roof in the moonlight drinking Tiger Beer and tightening the invisible thread holding us together. Carl has ordered in dinner for everyone. Six people in cycle cabs deliver and serve us the fragrant, eight-course meal. The child-size plastic chairs we have brought up from the hotel’s waterfront café are tight fits. When we stand up to form a loose circle, they are stuck to us.
Twenty-five surgeries today. Some of us have showered; some are just coming in. Valerie is spent and upset. “It was a really good day, but my last case was a 3-year-old who started calm but at the last minute went ballistic with fear.” No slack for her, no margins. Her mission is to mitigate pain, and fear is pain.
Geoff, who is tall and broad, is cramped in the little chair. His cases today were one lip, three palates and a combo. “I forgot how exhausting the palates are,” he says. “You have to hunch, crane, contort. I’m completely steamrollered.” Last year Geoff did this in China.
“Why do you really do this?” I ask between bites, expecting the standard gloss.
“Everyone is born with a gift that must be recognized and shared,” he says, lighting up. “Whatever it is.” Whatever? Everyone? He has obviously thought about this before; I want to hear more, but he looks so tired.
Craig, young, blond and single, says, “My friends think I’m crazy to give up two weeks’ salary and work in these conditions. But this is what I went into medicine for—pure experience. I don’t have to worry about billing, mergers or being sued. Just have to do my best and take care, and I make an impact on someone’s life.”
Geoff continues, “Working on the human life ups the ante. There is connection through the recipient of our service at the time of their need, and we need to be connected.”
Court turns to me and lays his hand on the side of my face. “You have beautiful bone structure.” I freeze. “Fat in the right places,” he says as he moves his long fingers across my cheek. Beneath my skin lies a skeletal cage of bird-bones, crushable. “Well preserved for your age.”
“I exercise,” I say, suddenly fragile and exposed.
“Nothing to do with it; it’s genetic.” So, roll of the dice, luck of the draw. I long to press my forehead into his palm; instead, I move away. His gesture, deeply personal and impersonal, is not what I expected. This isn’t supposed to be about me. Or is it?
I corner John before he goes to bed. Every morning before breakfast, when he jogs along the canals, people washing their clothes and preparing their breakfasts wave and greet him. He’s drinking La Vie and rubbing his eyes, but he leans toward me with attention. “I had a savage childhood,” he says, unwrapping himself like a gift. “Raised in a boys’ home, an orphanage. I guess I do this to reconcile my life, to reinforce to myself that I’m capable of good. Having a good heart means having the capacity for caring. I do good for others so I’ll feel good about myself.”
Fred is a toucher. He and Pat stop to say good night on their way to bed. “Keep asking those questions,” he says, putting his arm around me. He is white haired, rugged and very handsome. How did he know what I’ve been asking? I haven’t gotten to him yet. “We’re all part of the survival mechanism, aren’t we?” he says. “When we do good work as an expression of our inner being, we help the cosmic wheel to turn. The Bhagavad Gita says that work is sacred and pure when it is done with no desire for reward. What we’re doing here provides necessary goods and services, but it also helps to liberate us from our ego-centricity.” He and Pat both hug me and go to bed.
Small pockets of intimacy are forming in the shadows as the dinner is cleared away. Legs propped in one another’s laps, backrubs in a circle, low-voiced confessions of divorce, psychoanalysts, disappearing fathers, alcoholic mothers, fractured childhoods, parental pride, marriage advice, successes, dreams. Confidences. Family photos are passed around, offerings of clues to another self. The darker it becomes, the closer we come together. Grown-ups at a slumber party trade visceral revelations in the dark.
Marja, Dominique and Jackie arrange to take turns checking in all night at the hospital, just to make sure.
Surgery Day Two
Dr. Thong bows to me at the post-op door. “Bonjour, Madame.” The Vietnamese nurses ripple in to get the room ready for morning rounds. They brush against me, trailing their arms around my shoulders and one another’s, like fresh breezes. The head nurse gives me a piece of paper with her name on it. She is Xuan, which means spring in Vietnamese. I tell her mine, honeybee, in Greek. Somehow, through these words, we are related. She tells me in heavily accented French that the ward was quiet all night. This morning the children are sitting up, drinking, eating soup. They are ready to go home. Mike’s bleeder has a fever and has to stay. His mother and father are on the bed with him, nesting. Thanh tells me, “That child’s mother wants to talk to you.”
“The water was waist high in our house when we left,” she tells me through Thanh as I settle in beside them. “Without the typhoon it would have taken us only 12 hours to get here. We are rice farmers. Our ancestors did not have this face problem. We were sad when he was born like that.” I know about the clefted babies preserved in bottles at the War Remnants Museum in Saigon and the sign on them that says: “The Result of Agent Orange.”
“Why do you believe this happened to your child?” I ask.
“The fault is in my past life. I did something very bad.”
“And why do you think that he has been fixed, now?”
“Because in this life, I have been very good. And I am lucky.” She leans toward me and puts her hand on mine. “I wish that you could come to my house. I wish that we could talk together, about many things. I can never repay what you have done.” I wish I had done the surgery, but I am her conduit to the team. And I am the one sitting here, holding hands with her. I would give anything to go home with her, to sit by her cooking fire, to see the neighbors come acknowledge the lifting of her shame. To see this seemingly random redemption through to the end.
For two hours Court has been rearranging Hai’s face and teaching new techniques to visiting surgeons from Saigon. I could be helping Amanda with the toys and games or sorting folders with Diep. But I can’t seem to leave the foot of this table. Valerie tells how Hai ran into the OR, pulled the mask to her face and inhaled with all her might. Now her slender feet are turned up and outward; her flat stomach moves almost imperceptibly with breath. Valerie’s eyes move in a steady pattern between her, the minimal machines and gauges, the tubes and wires. She doesn’t mention that Hai had asked to keep her bra on, dingy cotton, now loose over her small, sleeping breasts.
A crowd gathers around her head, each American with a Vietnamese counterpart. Two anesthesiologists, two surgeons, two nurses. Pat offers to make room for me if I don’t touch anything. I can hardly breathe behind my mask; the paper shower cap holds the sweat in place. I move in closer, close enough to see that Hai has been dismantled. Like small red flags, splayed, the flaps of her face are inside out. Court is tailoring without a pattern and explaining his decisions as he makes them. Long silences are cut by bursts of words heavy with exertion. Fred comes over from the other table in the room to look, but I cannot anymore. I feel a scream coming on, my mind groping in panic for the hand brake. Ever the one trying to put together things gone asunder, what can I do in the face of this total deconstruction? Still, I cannot leave the foot of the table.
“That’s it,” Court says and steps back. Now I can see what he has done. “In the U.S. it would be better,” he says. “We would have taken a flap from her back to fill out her cheeks, and the lip needs a touch-up later. But this is pretty good.” In fact, even with black railroad-track stitches running the lengths of her cheeks and around her mouth, even with her eyes temporarily sewn shut, she is almost beautiful. Court pulls off his mask and cap. He is flushed and bathed in sweat as he tells Mike, “It doesn’t get better than that. The essence of plastic surgery is creativity. You can’t find a textbook that tells you how to do that operation; there’s no recipe. You have your concepts of tissue movement, so you put them together with a plan for a specific patient. Then, things change as you do it. Things you don’t expect come up. This goes beyond technicianship, and when you get a good result it is absolutely thrilling. It’s why I do plastic surgery.” Unconsciously, he is stroking Hai’s arm with his bare, ungloved hand.
Amanda has collected all the handmade dolls without faces that were sent in the cargo and given out this morning. Ladies at auxiliary meetings somewhere in the States made them, chatting over tea and cookies about how much fun it would be for the little Vietnamese children to draw on the faces. “These are a big mistake here,” Amanda says. “When these people see no faces, they see ghosts.” No face, no identity.
We draw on the faces and return them to the children.
Bump Day
There is a square in the center of the town, and in its early-morning gardens the people gather like dew to perform Tai Chi. A conductorless ensemble, each is his own instrument. Ngoc, merged in their daily midst, flowing in their current, is dawn dancing for the restoration of consonance.
I am going to interview the hospital director. Juliette, born Quang Tri, who married an American civil engineer in 1970, will translate. While we wait for Dr. Huan to emerge from his afternoon nap on the cot behind a screen in his office, she says, “All these years I could not communicate with my people. Now I can help them. Doing good deeds during my life means that my children and grandchildren will be blessed in future lives.”
Dr. Huan’s many Vietnamese words go into Juliette and come out of her in condensed English. He grew up near Da Nang and studied medicine in Hanoi. He is 50 years old; we are of the same generation. Suddenly, he looks at me directly and says, in French, “During the American War, I worked with a medical team in the jungle.” Now there is no filter; we are eye to penetrating eye. He says, “I was with the National Liberation.”
Juliette, close to me, breathes, “VC.” The hairs on my arms stand at attention; blood presses behind my eardrums.
He and his superiors have always had the same aim, he says: unification, which has allowed his country to receive help from worldwide humanitarian organizations. He is happy to have us in Can Tho because of the skills we bring and the numbers we help. But, he says, “Most important is the friendship. This does not depend on who gives what, or how much, but on the person who brings good things.” Is he for real?
I write in my notes: “I am in the Mekong Delta speaking French with the Viet Cong.” In case I wake up, I want a record.
Record keeping is, in fact, now part of my job description. Khai has asked me to keep a daily journal for him to use in writing his final report. As resident errand-runner and odd-jobber, I circulate through the whole project freely, like a roving camera, observing and documenting. Of course, the mental pictures I take and develop are filtered through the lens of myself.
The 47-year-old woman whose life Susan wanted to change is on her table. We figure that she would have been 20 when David was here before, when Dr. Huan was in the jungle. Larry has extracted her front teeth. Susan says, “You know, during the war, American surgeons would pull cleft kids out of the paddies and fix them when things were slow.” Like fishing, I think, as Susan ties off her knots on this belated catch.
I don’t remember these four teen-age girls, perched together on a bed in post-op, warily watching me dip a cotton swab in peroxide solution. They don’t know that I am not a nurse or that when I clean their wounds, it will not hurt. So close to them I feel their body heat, so lightly I pass the swab across the scabs. The way their black hair falls in their faces, I want to smooth it back. They have been here for a week, being processed, living meagerly. Now, I want to touch them, but they are ready to leave with their new faces, their turgid lips tied up with stitches.
There are monks in the halls, bare armed, shaven headed, saffron robed. Silent. They wait for Valerie. Last night she went to their pagoda with Amanda, Craig and Dominique for services and chanting. They singled her out to read an X-ray, the inside of one of the monks, shadows and light of a foreign land better understood by this gentle foreigner. That they came, trusting, bestows blessing. When they are gone, the scent of incense lingers where they were.
It is 9:15 at night, and two tables are still working, one of them Fred’s. When the power fails he is deep into an operation. Suddenly, it is dark and silent. Pat reaches up and switches on the headlight strapped to his head. Fred has been around the block; he doesn’t waver for a second.
Surgery as Metaphor
There is a congregation around Susan’s table, all masked. She and Court, the protester, have been sharing technique; he is going to watch her next case. Dr. Thong, South Vietnamese, is intubating the 6-month-old baby asleep in front of us. Ngoc, Viet Kieu, checks the electrical connections. David, veteran, is videotaping from a height at the foot of the table. The Viet Cong director stands behind Susan at the head. This gathering is a remarkable confluence. Susan says, “Plastic surgery puts the missing pieces into a puzzle.”
She draws a coded map along the crest of the cleft lip. Now she follows the trail of blue dots with a knife and then with a scissors. “You have to take it all apart,” she says, “so you can put it back together the way it should be.” Beyond skin, she goes down to the deepest levels, revealing infantile, raw meat. She snips tiny scraps of tissue from either side, placing the moist rubies on the sterile blue sheets. “This buildup of scar-like tissue is characteristic of the cleft condition and has to be removed, for release and mobility. I take it out, make fresh surfaces, and now, start stitching. First, the underlying muscle. Then, the part that shows.”
A simple thing, this fissure fusion, but not easy. Susan tugs gently on the baby’s skin with suture in one hand and tiny tweezers in the other, aligning, pressing it together like a little pie crust. His nose and mouth are now symmetrical, unified by this collective karma correction. Just then, the thread pulls up tight, and in an infinitesimal moment of suspended time, there is closure.
Surgery Day Five
The director is in when I go calling, alone. “Monsieur,”I say, “La vie est très compliquée,”as I hand him the modest gift I have brought for my unknown counterpart. Suddenly, I have no words in any language. If he looks in my eyes, he will see unexpected tears. “C’était une expérience très unique, pour moi. Merci,” I say. He does look into my eyes, bows and smiles.
John flits from table to table, dancing down the hall to Reggae music between the operating rooms. He is celebrating the success of the project’s safety standards on this last day of surgery. Xuan and I share family photos and exchange addresses. In recovery, Lisa and Alice change the dressing on a skin graft. They ask me to make sure the 14-year-old boy who has just been brought in doesn’t fall out of bed.
He is agitated. There are no translators nearby. Semi-awake, his free arm is up in the air waving around; he moans. I stand next to him; he tries to tell me something. Wide-eyed, he reaches toward me. I take his dry, rough hand in mine, and he pulls me to him so that I am leaning over him, my hand now under his, on his chest. He holds me. His breathing slows; he is peaceful, and so am I. He takes the mirror I give him and looks at himself for a long time. I can’t tell him that the swelling is temporary, that the stitches will disappear. He can’t tell me anything, but he has tears in his eyes. He gives a thumbs-up and falls asleep smiling, his hand still gripping mine. Engulfed, I am awash.
Jackie watches me from a corner, her brimming eyes beaming into mine. She, too, has been carried away in this rush; we have lost ourselves together at the point of convergence. Here it is, the last day, and I am just getting started. If only I could plunge like this and stay immersed indefinitely.
Rounds
A few patients remain to be discharged. All the parents want their children looked at and are anxious to leave. I take dictated notes from Geoff who, with Mike and Thanh, are responsible for this last day of post-op. Patient No. 124, large clot extracted from both lateral troughs, no active bleeding, institute rinses; No. 113, nasal airway collapse in this syndromic infant, possible apnea, repair looks excellent, hold one additional day to evaluate airway; No. 079, lip repair, no infection, adequate oral intake, home today with instructions. Thanh translates between Geoff, the parents and the Vietnamese staff and portions out liquid Tylenol into zipper-lock bags for the families to take with them.
I have been watching Mike as he looks inside mouths with his pen-light to check the palates. On the end of the tiny flashlight is a green frog finger puppet. “Look at this,” he says to me. He shines the beam inside the child’s mouth, which is covered with a thick, white coating. “That’s fibrin, a protein. It’s the body’s way of sealing itself off when there’s injury. The protective fibrous network it forms helps the body to heal.” What I see is divine fabric, a second skin on every surface. When it is gone, only the scar of the reconstructed central fusion line will remain. This self-healing is, to me, a cause for celebration. Mike gives the child the frog, which, it turns out, symbolizes wisdom and kindness in Vietnam.
No. 082, Hai. It is time to cut the stitches holding her eyelids shut. Geoff asks me to put soaking, wet cotton pads on them to loosen the dried crust before he starts. For days she has been locked inside her head alone, with the windows shuttered. Now she begins to tremble.
I hold Hai’s hands as Geoff snips the eyelid threads. With each snip she flinches and tries to fend him off. When he has finished she struggles to open her swollen eyes to the coaxing of the Vietnamese nurses who have gathered. The first reflection she has of herself, as she squints against the light, is in their eager faces. Then, she sees herself in the small pocket mirror one of them offers. Her young uncle, who has been taking care of her, squats on the end of her cot. He tells us that she has lived with him for 10 years, since her parents abandoned her. She takes care of his children, who love her, does the cooking and cleaning, and never leaves the house. Why has he accepted her? I ask. “Because she is my niece; it’s only normal.” And he begins to weep.
Hai has been made symmetrical, harmonious, pleasing on the outside. But this kind of deliverance has another side, another kind of aftermath. Her internal armor, her fortifications, her mask are still in place. The fibrous network holding her together is her own self’s ability to regenerate. This is beyond appearance. It will be months before these external scars fade and she moves on. Now, she doesn’t know who she is. No wonder she is crying.
I should have known this. Geoff, whose plastic surgery practice is 80 percent reconstructive and 20 percent cosmetic, knows about parents who need days to re-bond with children whose anomalies have been corrected and about patients who face identity complications after a nose job. He doesn’t even have the language with which to speak to this teen-ager in his simple, clear way She won’t open her eyes again. Tears stream from their corners. The bundle of clothes under her head is soaked. I look up at Geoff’s unreadable face. I want him to be in charge here, but he is not. He has not relinquished control; he never had it.
My thoughts veer away, touching my reconstructed right breast, an understudy for deformity, hidden beneath my clothes. I remember the follow-up to my surgery, which involved refinement of shape and creation of an artificial nipple. I had opted for local anesthesia because I wanted to be there, I thought, to experience part of my own restoration. But this was a ruse. After all, not long ago my surgeon had had his hands deep under my skin, burrowing in fleshly manipulation. This time I was trying to get inside him as he crafted an intimate anatomical body part from a harvested graft. I strained to see, from my restricted position, through his glasses. In profile, I saw his eyes, amber, translucent, steady, but not what they saw. I had wanted more than to be done to, but my conscious presence had been a delusion of superintendence.
Geoff, standing here over Hai’s bed, is a finely honed instrument, a corporeal strategist in this battle, having done here in Vietnam what he does well and what gives him satisfaction in Fort Wayne. No more, no less. The real power, I am beginning to see, must be intrinsically the patient’s. As for control, no one seems to have it.
When the parents were evaluated, days that seem like eons ago, John talked to me about the fluid dynamic that changes with each mission and determines who gets treated and in what order. A combination of variables falls into place: who the surgeons are, what they are strong in, how many patients show up, what capacity the hospital and local staff have for extended care, how healthy the patient is on the day of the screening. He hadn’t mentioned typhoons, good neighbors, uncles, decision-making VC directors. And what about the pull of the homeland, war wounds, inarticulated desire, past lives, grace.
What an orchestration to arrive at this crescendo. I have been asking why when I should have been asking how we all got here: via serendipity and consequential choices made at every crossroad. Here I sit with this survivor, both of us working on second chances that came without guarantees. In fact, all of us, by whichever circuitous, biographical route we took to get here, are hanging by a common thread. So what alchemic incantation can we conjure up to make it strong? Solve et Coagula: dissolve and reconstitute, transformation through breakdown, chaos at the critical juncture between changing states. Then, together, we can use the gold to spin a web in time and space, to catch each other, if we are lucky.
Hai is discharged. I cannot bear to watch her leave.
Disengagement
The hospital has been emptied again, the cargo packed up, shipped off. We left behind whatever supplies we could, and something else. On our way out the door we were stopped by a woman carrying a small child with a bilateral cleft lip. Her own face was frozen in panic. She had come too late. The child was dirty and exhausted; they had been traveling for three days. Dr. Thong, who was seeing us off, went to find the Vietnamese surgeons who had worked with us. He returned to say that the surgery would be done when anesthesia equipment could be borrowed. The surgeons had learned new techniques and were ready for this child.
I have photos in my camera of Xuan and me at the farewell banquet, our arms around each other, smiling into the distance. We took turns serving each other from the communal bowls, turning our chopsticks over and using the clean ends to choose choice morsels for each other, lotus root salad and morning glory stems. Neither of us would eat till the other had been served.
There were speeches after dinner. Ngoc translated as the governor of the province thanked us. “You have demonstrated in actions the words of the U.S. ambassador, who has said that the U.S. wants to build a bridge of friendship between our countries.”
Khai, holding the microphone, told the story his mother told him as a child in Vietnam, the one that carried the warning: Be careful, or the monsoon winds will carry you away. “It wasn’t the wind that carried me away from Vietnam; it was the war,” he said to this conflated group. “I was a child of circumstance, just as the children we helped here are. For me, this was more than a humanitarian mission. It was a journey of self-discovery, of finding who I am and why I am the way I am.” Alice and I looked at each other across the table, on guard for Khai, who had thrown off his camouflage.
On departure morning the team gathered at the waterfront for photos, in groups of specialty: surgeons, nurses, anesthesiologists. Finally I knew where I belonged: support staff, along with child-life, speech pathology and translators. Of course. Support.
At the Saigon airport I looked at the departure board: NhaTrang, Pleiku, Hanoi. As if those were normal destinations. Stretched to my limit of absorption and inextricably entwined, I left Vietnam and came down from the supramundane.
Correspondents
Back in the world, I long to continue conversations within our mutual context and aim missives at my teammates’ fading, receding forms. There is a flurry of communication: season’s greetings, photos, lasting impressions. Between the lines I write to stay in touch are deeper meanings, tying things together in myself. Before, I had only tasted the potential of this experience. Now I have gorged myself. Why am I still hungry?
Geoff writes to me, “My life changes directions with these trips. I return valuing material things less and human spirit more. My family and community become higher priorities. I experience a more fundamental self.”
I write back, “How can we know so much about each other while knowing almost nothing about the details of each other’s lives? What kind of car do you drive? When is your birthday? Does it even matter?” He sends me his journal of our trip. Our common experience, I see, is a Roshamon—changing, depending on the angle it is seen from. So much for capturing and owning.
On the phone, Court says, “This trip was really good for me; it was purely humanitarian. I saw, finally, that the war is over. My political motivations are jetsam now. Maybe it’s time for me to move on.”
“It’s difficult to explain to my wife about the intensity of emotions on that trip,” Carl e-mails. “Simplicity, beauty and love all intermeshed with passion, honesty and trust. I’m less comfortable doing a cleft palate than a facelift, but I was more calm there than back here. It’s especially about the trust in each other that we had there.” Is this the same guy?
Amanda tells me that she crossed boundaries she hadn’t known existed. “I went through their eyes, into their culture, into their lives. They touched me. We touched each other.” Her voice drops to a whisper. “It was like being in love.”
Fred writes in a surprisingly feathery penmanship, “If work is an expression of love, it does not ask why, for love has no why. My definition of love is quite simple: Love is the Experience of Connectedness.” Who wouldn’t want more of that?
I didn’t know, beforehand, what healing hinged on this multi-faceted expression of work. When people ask me now about my recent “adventure,” I sometimes say, obscurely, “Well, you only live once. Maybe.” But the truth is that one high led to another, one longing to another. This affair is of the mind and the heart, anointed with balm, suffused with addictive elixir, full to overflowing. It seeps through its encapsulating membrane and spreads in rivulets, transforming my internal landscape. I went to Vietnam, was blown away, consumed, and returned permanently altered.