When I was 15, I moved with my parents and two younger brothers to Kenya. My father, a plastic surgeon, took a year’s leave of absence from his position as Chief of Plastic Surgery at UC Irvine to serve as a Flying Doctor in East Africa. Having heard stories about surgery all my life, I finally got to see my father in action as he repaired cleft lips, treated burns, and removed tumors. I saw my father transformed lives through plastic surgery. I was hooked.
One of the first cases I saw wasn’t big or dramatic or transformative, yet I remember the details so clearly that the recounting of them became part of the fabric of my bedtime stories when my children were young. It was a minor case–just some stitches. That’s all.
A Small Plastic Surgical Case
Two months after we’d arrived in Kenya, one of the other Flying Doctors, a general practitioner named Anne Spoerry, invited our family to spend the weekend at her farm north of Nairobi. I’d never known a woman like her, and I counted the days until our visit.
Anne was French, but her masculine attire and short gray hair showed no sartorial trace of Paris. Having survived a Nazi concentration camp and swayed European expats to accept a female bush doctor, she dressed instead for a life of breaking barriers.
In her 40s she learned to fly to be able to deliver basic health care and vaccinations to remote villages across East Africa. She also set up a small clinic near her farm for the benefit of her employees and their families. On top of that, she was a gracious host.
Early Saturday afternoon, while we were enjoying lunch on the veranda, an African man came running up a dusty path to speak with Anne in rapid Swahili. When he finished, Anne looked up at my father and announced in a British accent with hints of her French origins, “Dave, I’m afraid your services are needed. There’s a 10-year-old boy with a panga gash to his forehead. Far better he receive a proper closure from you than anything I could do for him.”
Then she turned to me. “Heather, since you’re interested in medicine, you’ll want to come along, I suppose.”
A “panga” was a large knife resembling a machete. Designed to whack weeds and wood, pangas were also used as weapons. The newspapers were rife with reports of injuries and deaths from attacks by “panga gangs.”
Anne led my father and me to the clinic, where the boy waited by the entrance, eyes cast down, the blood on his forehead still wet and shiny. After greeting him in Swahili, Anne put her arm around his shoulder, unlocked the door, and guided him inside. My father and I followed her past the small reception to a treatment room, where she motioned her patient toward a blue vinyl exam chair. The boy climbed up and took a seat, his feet in their rubber tire shoes dangling high above the floor.
As Anne gathered supplies, my father opened them on a small metal table, while I shifted my position around the room’s perimeter, feeling self-consciously useless and trying to stay out of the way. When I found a safe spot, I noticed that the boy was staring at the doctors, so I felt safe in staring at him.
His skin was deep brown, like coffee straight from the pot with no milk, and his hair was so short it had no height, like a layer of black matte paint. Fresh blood dappled the boy’s dirty white shirt and fraying gray shorts, letting the memory of today soak red and brown into what was clearly his only clothing.
I moved closer to look at his wound. In the middle of the yawning scarlet gash in the center of his forehead, I noticed a sliver of white. Brilliant white, like ivory. Or like bone. As I realized I was staring at the boy’s skull, a wave of nausea washed over me, and I looked away, breathing deeply, until the queasiness passed.
I noticed the boy’s eyes dart toward the threatening instruments on the sterile table. My father must have noticed, too, as he said, “Habari? Mzuri?” Are you feeling OK?
Built like Abraham Lincoln, my dad might have been physically intimidating, except for his warm green eyes, his gentle voice, and his kind smile.
“Ndiyo. Mzuri.” The boy responded softly, saying he was fine.
“Come take a look, Heather,” my father said, looking my way.
I smiled at the boy, trying not to look as useless as I felt.
“See that shiny layer on the bone?”
“Mmm hmm.” I felt light-headed and sweaty again.
“That’s called the ‘periosteum.’ It’s a thin layer that lines the bone. Fortunately the panga missed it, so all I have to do is suture the soft tissue.”
In the background I heard several cabinet doors slamming in rapid succession. “Dave,” Ann said. “I have no local anesthesia. Not even ice.”
No anesthesia? I stared at the wound edges smiling back at me like ruby lips.
“The boy will do fine, though, Dave. Mark my words.” Anne spoke with the conviction of someone who knew.
“Tayari,” My father said, touching the boy’s forehead gently. “Ready.”
He picked up a large, curved needle five times the size of the delicate needles I’d seen him use before. The back end of the needle pulled a 12-inch length of thick, black nylon thread. Thick like a horse’s tail hair. Placing the needle in the jaws of needle holder, and grabbing a pair of tweezers in his left hand, my father paused to say, “Sasa kali.” Expect some pain.
Grabbing one wound edge with his tweezers, he plunged the needle into the skin.
The boy didn’t flinch.
Dark skin is thicker than white skin, so a large needle that is pushed and pivoted artfully to puncture white skin must be forced even harder to puncture black skin. I was fascinated as much by the force my dad applied to the needle as by the boy’s stillness. He was a statue.
After pulling the nylon through, my father approached the opposing side, puncturing the skin’s underside, aiming the needle tip upward. Again he pushed and pivoted until the silvery glint of the needle emerged and he pulled the suture through, tied the knot, and cut the suture. The first stitch was done.
Only the tears welling up in boy’s eyes and his quickened breathing indicated that he felt every poke, push, and pull. He withstood eight punctures to complete four stitches and never moved.
Then it was over. My father washed the blood off the boy’s forehead and patted it dry.
“All done,” he told the boy in English, smiling.
The boy didn’t answer. Even after my father helped him out of the chair and Anne arranged for him to return in a few days, he said nothing, not even good-bye. But as I stood outside, I saw his face break into a smile as he ran down the dirt road to flaunt his stitches to his mates. A half minute later, the bravest patient I’d ever known disappeared around a bend.
It was a small case on a small boy, but it was big to me.