A Most Special Patient

A few months ago a patient came in for a consultation. After I’d spent the allotted appointment time discussing her concerns, she pulled out three pages of “ask-your-plastic-surgeon” questions she’d found from a Google search. She began reading. I had other patients waiting, so I tried politely, but ineptly, to have her continue with my staff, when she posed a question that nearly took my breath away.

“Would you do surgery on a member of your family?” I pondered the strangeness of the question as I answered, “No, I wouldn’t do major surgery.” “Why not?” she asked, her eyes wide and her brows raised. Her expression indicated I’d given the wrong answer. I paused for a moment as I suddenly heard my little girl’s screams; saw blood flow down her face; felt the terror of not knowing how badly she was injured as I scooped her up in my arms.

The Patient

A warm, July Saturday 20 years before had beckoned my 19-month-old daughter and me outside. Toddling along the sidewalk, shrieking with laughter, my little Siena dodged left, then right, to escape my reach. Still on the run, she tore down our neighbor’s steep driveway in a fit of giggles. I bounded after her trying to grab her overalls, but I didn’t reach her in time.

She landed on her face, slamming into the aggregate cement, her body flipping over her head like a Slinky. My first thought was her neck–Would she be paralyzed? After first rejoicing when she moved her limbs, I stared in horror as her screams bubbled through the blood pouring from her nose and her mouth. I scooped her up and ran home, yelling for help in between sobs. My husband, Paco, opened the front door, and we ran straight to the bathroom to rinse off the blood.

We were happy to see Siena’s few teeth glistening white and whole. As I ran my fingers along her bones, I felt no step-offs and elicited no additional screams. Next I looked at the source of the bleeding. In addition to abrasions, she had a deep, curved, jagged cut shaped like a 48-font capital C. It spanned her upper lip, from just beneath her nose toward her beautiful Cupid’s bow. She would need sutures. At her age, she would lie as still as popping corn, and sharp instruments on a moving target risked serious injury. She would need general anesthesia.

I cried right along with my crying girl. I was relieved she wasn’t paralyzed, and her bones and teeth were whole, but I cried because I’d been too slow to catch her; I cried because she needed surgery; and I cried that her perfect baby face would be scarred forever. As Paco mopped up the bloody bathroom floor, he looked up and said slowly, “If you stop crying, Siena will stop, too.” I slowed my breathing and controlled my tears, and soon Siena was sucking her thumb, nestling her head into my shoulder. “She wasn’t going to be a model anyway,” I said, trying to put the scar into perspective.

The Plastic Surgeon

Because my husband and I are both plastic surgeons, the situation was both easier and more complicated, depending on one’s point of view. As a general policy, we don’t treat our family. But after we discussed whom to call, my husband decided he could suture the wound himself. “Really? You’ll be comfortable doing it?” I asked. “Sure. I’ll be fine.” After a minute, I said, “I’d be fine, too.” “Then you do it–because if it isn’t perfect, you’ll blame me forever,” and he gave me a knowing smile. I smiled back, silently admitting he was right.

The Surgery

Two hours later, Siena was in the operating room. Not wanting to make the anesthesiologist nervous, I stepped outside while he put my baby to sleep. When I walked into the O.R. again, I was jolted by my daughter’s eerie stillness. No sleeping patient had ever affected me like that. As calm as I was, and I was finally calm, I was acutely aware that I was operating on my daughter. I was operating on my daughter! That meant I didn’t have to double glove! No risk of HIV or Hepatitis C! I was about to tell the scrub tech to forget the second pair of gloves, when I stopped.

No, I would do everything the way I always did. I had to. If I strayed from my routine, I’d make a mistake. For the next hour, I had to forget that the girl on the table was my daughter. She was my patient. Once the sterile drapes were in place, exposing little more than the jagged wound, I could forget I was my patient’s mother. Cutting away the frayed, beveled edges with a scalpel, I reminded myself that one slip of the blade would add another scar. But that cautionary warning played in my head with every patient. When the edges were sharp and clean, I spread my scissors beneath the skin to disperse the tension over a wide area when I closed. Tension could lead to thick, wide scars. Then I matched the wound edges and placed several fine, black stitches. After I applied antibiotic ointment, I was done.

Siena with stitches

The Mother

That night I lay next to my injured angel and fell asleep. After midnight I awoke with a start, shaken by the realization that my daughter’s face was scarred forever. My surgeon’s voice said, “It’s small; it won’t be noticeable.” But I was my patient’s mother. When she was in kindergarten, when she graduated from college, when she got married, when she retired, she would have that scar. Forever.

“Would You Do Plastic Surgery on a Member of Your Family?”

As I sat in the exam room facing my patient with the three pages of printed questions, I told her what it was like to put stitches in my daughter. Just stitches. Nothing more. If my daughter had had a cleft lip rather than a cut one, I would have found a good plastic surgeon for her, one who wasn’t family.

Siena on the runway in Harvard’s Identities Fashion Show (photo courtesy of Caroline Silber)

The Daughter

These many years later Siena’s scar is visible only in a certain light. Rather than horrifying me, it conjures up memories of how much I loved that bouncing toddler who flew herself headlong into life, drinking it up with gusto, much as she does today. And as for modeling? The scar never held her back.

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