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EXTENDING COMMUNITY THROUGH COLLABORATION

Sharing smiles

Kelly J. Gonzales

by Kelly J. Gonzales

She went to Venezuela to serve as a pre-op and post-op nurse with Operation Smile, a humanitarian agency that provides craniofacial surgeries for children all over the world, but in helping to heal a little girl she found healing for herself.

“Mira, mi hija. ¡Hija, mira quien está!” said the mother, pointing at me. “Look, my daughter, look who it is!”

As the 8-year-old girl responded and turned her attention toward me, her eyes told me she was sedated. Was this the same little girl I had assessed this morning? Then, she had been all smiles as we colored together and waited for her turn for surgery. Her eyes had lit up when I allowed her to play with my penlight and stethoscope, and the wide-eyed surprise and beaming smile she had flashed upon hearing her own heartbeat were priceless.

Although her eyes were now having difficulty focusing, a look of recognition swept across her countenance. A smile appeared briefly on part of her face, including her eyes, but stopped short of her traumatized mouth and lips. That part of her face found no reason to smile.

As tears welled up in her eyes and her face crumpled in sadness, my stomach did flip-flops. I quickly moved close to her, knelt down next to her bed and held her left hand with both of mine.

As I squeezed her hand, I wondered how “dirty” mine were. Sanitation had been a concern all week. Only yesterday had we begun washing our hands with soap, and that’s because I had brought in a bar of soap from our hotel.

“¿Por qué estás llorando?” I asked. “Why are you crying?”

The little girl began to sob harder, and I smelled her breath. I could only imagine how bad my breath smelled. Despite the heat and high humidity, I hadn’t had any water to drink in hours. My mouth tasted horrible and felt like the Sahara Desert. I pitied this poor girl if she could smell my breath.

For a moment, my mind went back in time. Ask anyone with a cleft lip or palate about the taste in their mouth after surgery and they all describe the same thing—old blood. Having experienced cleft-palate surgery myself, I knew what that was like. For some time following my surgery, I would awaken from sleep aware of the distinct metallic taste of blood in my mouth. That I indeed tasted blood would be verified for me an hour later when I would vomit more of the blood I had swallowed, despite the use of suction during surgery.

Again, I looked at her. Our eyes locked, and I forgot everything around me—her family at the bedside, the five other patients and their family members, all in that tiny room—and I no longer heard their rapid-fire Spanish conversations.

As I looked at the little girl, my thoughts transcended language barriers. I knew why she was crying. I felt the confusion, anger and betrayal in her heart. She was wondering, “Why do I feel so bad right now?” It was partly the anesthesia. She was also wondering: “Why me? Why is this happening to me?” I couldn’t help her there, because I had often wondered the same thing.

She was angry because no one had told her she was going to feel this way! Not once had the doctors or nurses mentioned that this surgery would involve pain. Until a couple of hours ago, everything had been fun and games. Her parents were thrilled that she had the opportunity to have this surgery. Everyone promised, “This will make you beautiful!” But it’s hard to feel beautiful when you can’t smile and there’s a cobweb of Dermabond and stitches in your mouth. I saw this with my eyes and felt it in my heart.

In the background, I heard again the conversations in Spanish. How interesting this hospital was. At my hospital in the United States, the sound of monitors drowned out most conversation. Here, we had no monitors. Here, there were open windows with sounds of the outside coming in. A car horn blared far off in the distance. The sky began to darken, and I prayed that a storm would come with rain and winds to get rid of the humidity.

As I looked at this beautiful girl, her eyes still penetrating me, her tears began to dry and I sensed a calmness slowly coming over her. I was aware that she could see into my soul just as I saw into hers.

I wondered if she could see the pain I had felt many years ago when I went through the same surgery. I wondered if she could see that I was there to care for her. I wondered if she would ever know that while I helped her heal, she helped me heal. But I could not risk losing my composure. I had to be a nurse first, and a person with cleft lip and palate second.

I assured her the worst was over. In a few hours, she would feel better. Tomorrow, she would feel even better than before.

Could she smile for me? She shook her head no. Did she think she could smile later for me? She didn’t think so. Would she try smiling tomorrow? She said she would try.

I gave her hand a squeeze; brushed her beautiful, long dark hair off her face; and wiped her tears with a piece of gauze. After assuring her I would check on her later, I quickly left the room.

I headed toward our makeshift “terrace” but stopped abruptly, escaped into a vacant room and began to sob. With tears streaming down my face and the little girl’s face remaining a picture in my mind, I relived my own experiences.

For the rest of the afternoon, my patient slept. I checked on her and offered encouragement to her parents while trying to complete a seemingly endless “to do” list. Finally, the sun set on the horizon. I paused by our terrace to steal a quiet moment and take advantage of a gentle breeze. It was getting dark enough now to turn on lights in the hallways and in the patients’ rooms. I looked down the hall and smiled as I saw more than a dozen patients ambulating, a good sign.

My patient was walking to the bathroom with her mother, and I stopped to talk to her. Stray hairs had escaped her beautifully braided pigtails. Her cheeks tried to smile, but her mouth remained unforgiving. Later, after bidding her family good night, I checked on my sleeping beauty one last time before leaving.

The next morning, after asking to spend time with the post-op patients instead of going to pre-op, I raced to my patient’s room, hoping to see a smile. She was dressed, and I removed her tongue stitch. She still refused to smile as we posed for a picture, but she looked fantastic and I detected a glimmer in her eye. I think she was teasing me.

Eventually, I saw my patient and her family in line, awaiting their discharge instructions. She was all smiles! My heart soared. I knew I would never forget her, or her smile. RNL

—Kelly J. Gonzales, RN, MSN, is an instructor at Creighton University School of Nursing in Omaha, Nebraska.