Memory

Every Wednesday night the ship has a medical in-service night where surgeons or program directors give lectures on specific topics such as maxillofacial surgery, orthopedic surgery, VVF, plastic surgery, the ponsetti method for clubfeet and many more.  These nights are some of my favorite nights on board.  I find it truly amazing that after operating for hours on their feet, these amazing individuals continue to stand up and teach us the intricacies of their work so I, in turn, can be a better nurse.

Dr. Gary Parker who has served the last 30 years as a MaxFax surgeon on board

Last week Dr. Gary Parker spoke about Mandibular tumors, a popular surgery performed here onboard.  We have already had a handful of patient's this field service with mandibular tumors that I have been lucky enough to take care of.

Most mandibular tumors we operate on are Ameloblastoma's.  Ameloblastoma's are rare, benign tumors that originate from the enamel, or outside portion of the teeth.  They are typically slow growing tumors that rarely become malignant.  In developing countries, these tumors are removed when they are found and never progress to these extremes.  While not malignant, these tumors become deadly when left untreated.  If you are lucky, the tumor only grows in an outwards progression, away from the inner mouth and airway.  If the tumor grows in a posterior or superior direction the individual is faced with the possibility of either starving or suffocating to death.

Our respiratory drive is one of the strongest reflexes in the human body.  When threatened, it becomes an all encompassing drive that causes every thought to be dominated by finding that next breath of air.   Imagine when you were held underwater as a child in a swimming pool.  The tightening of your chest.  The panic of possibly being unable to resurface.  Every cell in your body fighting to find an oxygen molecule.  The slow suffocation.  All while being hidden away from society because of your appearance.  The isolation...  I cannot imagine a more heartbreaking way to leave this world.

Dr. Gary has spoke of previous patient's in the past who show up at our gangway, bent over, gasping for breath and using every accessory muscle in their bodies to pull in oxygen.  In some of those dire situations, emergency surgery was performed to simply give them a tracheotomy (or an airway through the neck) to immediately save their lives in order to prepare them for surgery at a later date to remove the mass.  

Just last week, I asked one of my favorite patients Julien about how he was feeling.  Half drooling from the excess skin left in place, he smiled at me and said simply "I cannot wait to be able to smile again.  And to someday get married".  Isn't that amazing?  Both of those desires are desires to give love and to receive love.  That's all this man has wanted in his life.  The simplicity is beautiful and echoes the true desires of the human heart.  

Julien (yellow hat) in line at the screening center

As always, when I finish his dressing change he stares at himself  for a long time in the mirror.  The picture isn't quite perfect yet.  He will come back at a later date to have more surgery to fill the titanium plate in his jaw with a bone graft and remove whatever excess skin is left.  Before I leave him to stare into the abyss of his reflection I always ask him "Julien, what do I always tell you after your dressing changes?"  His eyes light up, he smiles and says "My skin has memory".  I smile and say "that's right."  Just as a pregnant woman's skin retracts after giving birth, so will the excess skin stretched by years of tumor growth.  I never walk away without reminding him of this. Your skin has a memory.  

Although I'm not quite so sure he cares about the outward appearance anymore.

He is simply glad to be free.  

Compassion is not a relationship between the healer and the wounded.  It is a relationship between equals.  Only when we know our own darkness well, can we be present in the darkness of others.  Compassion becomes real when we recognize our shared humanity.