The unmarried woman with the wide congenital unilateral cleft lip was among the many patients in the line awaiting exam and advice regarding whether surgery was appropriate for them. Contrary to the traditional parachute trip model, Interplast trips included a succession of visits to ensure patient care. The first, was a visit to assess the cases (sometimes this work was done by the local professionals or volunteers); the second, was the actual surgical work, and the third was a follow up clinic.
Olga Riselda Elizalde was an older mature woman who was 72 years of age. The interesting aspect of this case was not only that she constituted the oldest cleft lip I had ever interviewed for surgery in clinic, but that she was a case where my communication skills would be tested. Maybe she didn’t want her cleft fixed.
We are instructed by the experienced ones in plastic surgery that you must not assume that the “chief complaint” or the problem is the obvious one on their body but rather to ask the patient a general question. For example, if the patient has protruding ears and we say “how long have you had those Dumbo ears?” and the patient had come for a nasal deformity for rhinoplasty, we would have produced a defect in the patient’s mind. An expert in body appearance, a plastic surgeon doctor, had criticized their appendages. Therefore always ask “what can I do for you; what bothers you?”
I asked this lady, “what bothers you today my dear.” The answer was not “this defect in my upper lip,” but rather was just as to my advisors had advised. She answered “I have never known a man in my life.”
My answer to her was “we do not have guarantees, but perhaps we can help. We will see.”
We explained the whole deal to her and the possible problems and complications, including the possibility of infection from the hospital itself. I performed the surgery on her under local anesthesia with an anesthesiologist guarding her for pain or restlessness. In fact, I was so wary of infection from the hospital itself because it was significantly greater than in a younger whipper snapper, that I sent her home by bus, (Pope Francis style). The sutures were removed by my professional brother Luis Bueso Arias himself. No complication occurred.
Six weeks later I was in clinic reviewing all of our previous work and here she was with her repaired cleft lip. “Como le ha ido?” I asked “how did it go for you.” The answer was “con exito” or “with success. On the way home on the bus I had three offers from men asking for a date.”
WOW – the lessons learned from my mentor friends who were more highly experienced paid off in spades. I did not insult her by referring to her ugliness post-surgery. The entire episode was conducted on a superficial plane, that of being “airy and light”. In this case, the patient, in a way, treated the doctor.
Olga treated me to a delightful experience; she treated me to experiencing a story which I could tell my grandchildren and tell my surgical friends who were visiting firemen coming to visit me at Stanford. I would be able to ask how many 72-year-old cleft lips have you operated on, “o you of the greatest experience, o you who knows it all.”
This experience represents the heart of interplast trips; you see every single person in contact with this story benefited a great deal. “I want to do this the rest of my life” is a phrase that I have heard 28 times. “This is fun, not work”.
Many People, Many Passports 