For a long while, I sat there and watched the flow of families. I kept my eyes on the fathers mostly. I gauged their reactions to this most domestic of activities, hoping to see a flicker of doubt, something in the eyes that might comfort me. But I didn’t.
I’m not sure how long I stayed like that. Not more than ten minutes, I suppose. An old favorite by James Taylor came on the radio. It brought me back. I smiled, started up the car, and made my way toward the hospital.
An hour later, I was scrubbing up to perform surgery on an eight-year-old boy with—to use terminology familiar to both layman and professional—a facial smash. Zia Leroux, my medical partner, was there.
I’m not sure why I first chose to be a plastic surgeon. It was neither the siren song of easy dollars nor the ideal of helping my fellowman. I had wanted to be a surgeon pretty much from the get-go, but I saw myself more in the vascular or cardiac fields. Life’s turns come in funny ways though. During my second year of residency, the cardiac surgeon who ran our rotation was—what’s the phrase?—a total prick. On the other hand, the doctor in charge of the cosmetic surgery, Liam Reese, was incredible. Dr. Reese had that enviable have-it-all feel to him, that combination of good looks, calm confidence, and internal warmth that naturally drew people. You wanted to please him. You wanted to be like him.
Dr. Reese became my mentor. He showed how reconstructive surgery was creative, a Humpty-Dumpty process that forced you to find new ways to put back together what had been destroyed. The bones in the face and skull are the most complex stretch of skeletal landscape in the human body. We who repair them are artists. We are jazz musicians. If you talk to orthopedic or thoracic surgeons, they can be pretty specific about their procedures. Our work—reconstruction—is never exactly the same. We improvise. Dr. Reese taught me that. He appealed to my inner techno-weenie with talk of microsurgery and bone grafts and synthetic skin. I remember visiting him in Scarsdale. His wife was long legged and beautiful. His daughter was school valedictorian. His son was captain of the basketball team and the nicest kid I’ve ever met. At the age of forty-nine Dr. Reese was killed in a car crash on Route 684 heading to Connecticut. Somebody might find something poignant in that, but that person wouldn’t be me.
When I was finishing up residency, I landed a one-year fellowship to train in oral surgery overseas. I didn’t apply to be a do-gooder; I applied because it sounded pretty cool. This trip would be, I hoped, my version of backpacking through Europe. It was not. Things went wrong right away. We got caught up in a civil war in Sierra Leone. I handled wounds so horrible, so unfathomable, that it was hard to believe the human mind could conjure up the necessary cruelty to inflict them. But even in the midst of this destruction, I felt a strange exhilaration. I don’t try to figure out why. Like I said before, this stuff gets me jazzed. Maybe part of it was the satisfaction of helping people truly in need. Or maybe I was drawn to this work the same way some are drawn to extreme sports, who need the risk of death to feel whole.
When I came back, Zia and I set up One World, and we were on our way. I love what I do. Perhaps our work is like an extreme sport, but it also has a very—pardon the pun—human face. I like that. I love my patients and yet I love the calculating distance, the necessary coldness, of what I do. I care about my patients so much, but then they are gone—intense love mixed with fleeting commitment.
Today’s patient presented us with a rather complicated challenge. My patron saint—the patron saint of many in reconstructive surgery—is the French researcher René LeFort. LeFort tossed cadavers off a tavern roof onto their skulls to see the natural pattern of fracture lines in the face. I bet this impressed the ladies. Today we name certain fractures for him—more specifically, LeFort type I, LeFort type II, LeFort type III. Zia and I checked the films again. The Water view gave us the best look, but the Caldwell and lateral backed it up.
Simply put, the fracture line on this eight-year-old was a LeFort type III, causing a complete separation of the facial bones and the cranium. I could pretty much rip off the boy’s face like a mask if I wanted to.
“Car accident?” I asked.
Zia nodded. “Father was drunk.”
“Don’t tell me. He’s fine, right?”
“He even remembered to put on his own seat belt.”
“But not his son’s.”
“Too much trouble. What with him being tired from raising a glass so many times.”
Zia and I started our life’s journey in two very different places. Like the Stories’ classic seventies song “Brother Louie,” Zia is black as the night while I am whiter than white (my skin tone, as described by Zia: “underwater fish belly”). I was born at Beth Israel Hospital in Newark and grew up on the suburban streets of Kasselton, New Jersey. Zia was born in a mud hut in a village outside of Port-au-Prince, Haiti. Sometime during the reign of Papa Doc, her parents became political prisoners. No one knows too many details. Her father was executed. Her mother, when released, was damaged goods. She grabbed her daughter and escaped on what might liberally be dubbed a raft. Three passengers died on the journey. Zia and her mother survived. They made their way to the Bronx where they took up residence in the basement of a beauty parlor. The two spent their days quietly sweeping hair. The hair, it seemed to Zia, was inescapable. It was on her clothes, clinging to her skin, in her throat, in her lungs. She lived forever with that feeling that a stray strand was in her mouth and she couldn’t quite pull it out. To this day, when Zia gets nervous, her fingers play with her tongue, as though trying to pluck out a memento of her past.
When the surgery was over, Zia and I collapsed onto a bench. Zia untied her surgical mask and let it fall to her chest.
“Piece of cake,” she said.
“Amen,” I agreed. “How did your date go last night?”
“It sucked,” she said. “And I don’t mean that literally.”
“Sorry.”
“Men are such scum.”
“Don’t I know it.”
“I’m getting so desperate,” she said, “I’m thinking of sleeping with you again.”
“Gasp,” I said. “Woman, have you no standards?”
Her smile was blinding, the bright white against the dark skin. She was a shade under six feet tall with smooth muscles and cheekbones so high and sharp you feared they might pierce her skin. “When are you going to start dating?” she asked.