Karaikal, India: Friday, January 23

Mr. Pakirasamy from the tiny Tamil village of Annakuppy stood in the white-tiled corridor of the Vinayaka Hospital watching his five-year-old daughter being led away into the OR where Dr. Mel Spira was waiting to fix up her incomplete cleft palate. Pakirasamy was the first of the long line of patients to register yesterday. It had been a long process to this point. Now it was all happening.

But it wasn’t happening fast enough to suit Medical Director Angelo Capozzi. Clad in blue scrubs, the surgeon was grousing to Mission Director Paul Fisher, “We’re moving in third gear here. We’ve got to get moving!” He headed back into the OR with a forward leaning stride, balanced on the balls of his feet like the former college athlete he is.

Fisher shrugged. “Angelo believes that the way you come out of the gate sets the tone for the whole mission,” Fisher said. He and Capozzi have worked together with Rotaplast over many years and he knew his colleague well. Fisher said Capozzi was anxious to actually do what he’d come to this small town in south India to do: “Get his hands on some knives and get to work.” With a fond smile, he added, “Angelo went to Notre Dame. Does that explain anything?”

The day had not started well. Breakfast at the Paris International Hotel, Karaikal’s most exclusive residence, now that the Rotaplast team has taken over nearly every single room, was delivered at 6:20 am. The team was supposed to be eating at 6:00 and heading off to the Vinayaka Hospital at 6:30. That was the plan.

Nevertheless, the first patient came out of OR at 9:45 am, lip slightly puffy, but otherwise perfectly angelic. Ursula Blasej stroked the girl’s arm, comforting the child. Paula Filari, head of recovery room said, “Give her oxygen, but let’s just do a blow-by.” So Ursula positioned the mask just to the side of girl’s face, the oxygen wafted by.

“Kids don’t things on their faces,” explained Paula, a recovery room nurse at St. Francis Hospital in San Francisco. “So we do it this way.”

In the OR 3, Capozzi occupied himself with instructing interns while nine-year-old Sivassamkari had her incomplete cleft lip repaired by another surgeon. It was Capozzi’s rotation day and tomorrow he would get his hands on some of those knives.

In OR 2 surgeon Mel Spira worked on 8-year-old Kemalu’s cleft lip. Tom Javelona was running anesthesia. In OR 3, Roland was busy with three-year-old Bagylakshmi’s cleft lip repair.

Back in Recovery, the first parents came in to see their daughter. They looked frightened, stunned, and awed by what had happened to their child. Standing by, Dr. Bob Demuth said, “We’ve got all these gimmicks and masks…” He compared it to hospital practice in the US, saying American parents are generally not allowed in the recovery rooms immediately after surgery. “They are very demanding. In our society we tend not handle adversity as easily as they do in places like this.”

Soon both parents were cracking smiles. “I am very happy,” the father affirmed through a Tamil doctor. Dad happens to also have a cleft lip that he has tried to conceal beneath a bushy black moustache. The Tamil doctor said the man was emboldened now to have his own lip repaired, something the hospital will probably do after the Rotaplast team departs.

One of the OR team came in with Kemalu in his arms, announcing, “I’ve got a cute one!” Paula and Ursula rushed over to give her attention. By now, all four beds in the recovery room were occupied by tiny figures, some groggy, others whimpering, some giving full-throat cry to the pain that comes after the anesthesia wears off.

Pakirasamy rushed over to greet the surgeon. Spira offered his hand, the girl’s father made a ritual sign and, instead of shaking Spira’s hand, he kissed it. He said he was happy and that he had the greatest respect for doctors. The Tamil translator said the man used the word “deivanu” – the doctors were gods.

It made me think of how my own son was born with the umbilical cord wrapped around his neck. The obstetrician performed an emergency C-section on my wife and yanked him out, a blue lifeless form. I watched helplessly as the anesthesiologist blew him up like a balloon; suddenly he was pink and wriggling, and let out a yelp, the kind of wonderful noise that my sixteen-year-old boy continues to this day. I think I wanted to kiss the doctors’ hands, too.

At the end of the first day of surgery the schedule for the rest of the mission has been compiled by volunteers Louise Capozzi and Lydia Tal. It’s good to see that nearly all of the kids that Wayne and I have visited in their homes or gotten to know during the screening process have been slated for surgery. This includes Shy Girl, the 22-year old from the Poovam, on the road going outside of town.

We’d seen the first registered patient go through the cycle today. Turns out Shy Girl was the very last patient to register. Surgeon Ron Gemberling recommended her for lip and nose revision as well as visit to the orthodontist, and that will happen on Thursday. No decision is in yet on the boy with the bad burns from kerosene stove explosion. It all depends on some special equipment being available in Chennai.

For now I am sitting on the terrace of the Paris International Hotel watching the setting sun turn the sky a tangerine color over K-town, listening to rush hour madness on Main Street below. Cacophony would be too kind a word for it. I’m thinking what I’d like right now is a steak dinner, medium – or a swordfish platter with a fine California chardonnay. But whatever the Paris chef puts on the table tonight will gladden my heart, as long as it’s not served late. I’m sure Dr. Capozzi feels the same way.

Rex Weiner
Wayne Schoenfeld