On Fatima and her mother's final afternoon in Israel, the volunteer staff came together to express to them how much they have come to mean to us in the past five weeks. A party was laid upstairs, of homemade cookies and brownies and tea. Before sitting to the tables, Jonathan said a prayer of thanksgiving in Arabic.
A gift basket was made, with books and clothes and a handcrafted doll.
After these were given, an open moment was had for members of the community to share a parting word, reflection, or blessing with either of the two ladies. Several people spoke. Jonathan translated. Fatima's mother was affected with a deep gratitude, and thanked God and the team of Shevet Achim repeatedly. Fatima squirmed and smiled on her lap.
In the courtyard downstairs last goodbyes and prayers were said,
after which it was in the van and out the gate for an evening drive across Israel's eastern border to Jordan. From Amman this weekend, Fatima and her mother will fly home to northern Iraq, to a family that has been missing them.
As they go to meet one family, they are leaving another, ours. These are not just words we are obliged to write: Fatima and her mother were loved here. For myself, having shadowed Fatimas heart surgery - standing five hours a mere three feet away from her open chest cavity and broken heart - she seemed a miracle. I am, we are, extremely thankful she is now well. Her story in Israel finishes today, but the hope is that Shevet Achim and Gods love would be understood as a beginning.
Today our beloved Fatima officially concluded her term of treatment at Israeli hospital with an echo that brought the declaration 'mushkilania!'(Kurdish for 'no problem!').
This news was much to the relief and joy of Fatimas mother who had been nervously praying to herself before and during this last echo.
Both mother and daughter seem to have grown significantly stronger on this journey to Fatima's health: Fatima cried at every station in the hospital during her first visit, but today during the echo she let out only a few small whimpers and finally one solid, resolved sigh as she kept a fixed gaze on the screen displaying her heart. Her mother eagerly looked at the screen as well in between prayers; I told her repeatedly that everything was okay, and she received each assurance as if one had never been said previously.
"I couldn't recognize her! She is not blue anymore!" were the excited words of Dr. Tamir as he passed through the hall after the echo was finished.
The joy and excitement did not cease between the two of them for the rest of the day. Melodic giggles and cheers flowed from a brightly grinning, curly-haired kissing machine (Fatima) while her mother repeated "Khalas" (finished) to herself every so often, with the hope of home lingering in her voice. Throughout the day as Fatima marched down the hospital halls with her confident arms swinging with each stride like over-wound pendulums, I found myself craving to hear Fatima's sweet laugh, and curiously her mother's laugh as well.
The pair will be beginning their journey home tomorrow afternoon, and will be greatly missed.
Thumbs-up was the word of the day. Fatimas heart echo revealed a beautiful surgery healing nicely. Dr. Alona saw no reason to detain her from returning home. The stitches were removed, and another follow-up echo was scheduled for a week from now. After this scheduled echo, all subsequent medical care will take place in her home country.
Fatima and her mother have much to look forward to in the coming week, and we will be celebrating with them as preparations are made for their return to their family in northern Iraq.
To look at this child, you would not know that just six days ago she lay silent in an operating room, machines pumping her blood and breathing for her while a team of surgeons repaired and sculpted the inner chambers of her little heart.
All medical things were completed by afternoon, and Fatima and her mother returned to Jerusalem to a reunion with friends at the Shevet Achim house.
April 15, 2011
Twenty-four hours after open heart surgery Fatima is making good progress in recovery. The artificial respiration tube has been removed from her lungs, and she is awake in the ICU, breathing with an oxygen enrichment mask and connected to a few drip lines. While I was with her today the nurse came by and checked on the level of fluid drainage from her chest. A plastic tube is draining plasma and other post-surgical runoff into a sack connected to the side of her bed. The nurse was pleased with all readings.
Fatimas mother was very glad of the company today, and seems encouraged that her daughter is awake and alert. When we entered the ICU, she started smiling crazily and waving, just beaming everywhere. Weve become friends through this. I popped my sim card out of my phone, and helped her place an international call to her husband in Iraq. As for Fatima herself, she is in discomfort. She is weepy and fussy, and seems claustrophobic in her own body. From a medical perspective, her healing is excellent. But it's just flat no fun recovering from surgery, any way you cut it.
The girl who around Shevet Achim has gained a happy-go-lucky, always ready for a joke reputation is very subdued in her hospital bed today. When she is awake, she winces, and is on the edge of teardrops even if you touch her springy brown hair. Most of the time, though, she sleeps. One looks at her slack frame there on the hospital bed, lost in a drug-induced slumber, and knows that the body within is rapidly healing itself, reassembling magically on the matrix of DNA code. Her mother is by her side constantly, smiling, feeding her chocolate wavers and spoon-feeding her Kool-Aid when the nurses arent looking. Feeling like she is helping her daughter get well seems a relief to her, the relief of being needed. She talks to Fatimas father in Iraq, and although a residual element of uncertainty, even displacement, remains in her eyes, more and more can one see in her expression the calm reign of gratitude and love for her little one.
Donna leaned around the front seat of the van this morning to ask me in the back: So, Ryan, if you could shadow Fatimas heart surgery today, would you? I did not hesitate. Yes. And then I forgot entirely her question. It was a distractingly beautiful dawn, the orange sun making his customary morning circuit over the hills of central Israel.
I opened my Bible, looking for my center. I found the Acts of the Apostles another dawn it seems, one that beautifully distracted many with its message. Peter speaks there, quoting David, My flesh also will dwell in hope. The words call to mind for me the holism of the Christian vision of salvation, a promise for the corporeal and incorporeal, and I tell myself to meditate more on this verse in its appropriate venue: a hospital.
We arrived to a sleeping girl and anxious mother. And not any too soon. Within minutes the nurse came to collect Fatima and to set in motion the medical processes of open heart surgery. We walked with her as a group to the underground surgical unit, on the other end of the hospital and down one level. Fatimah continued to be agitated and weepy, and her mother seemed like she was trying to emotionally hold it together for her daughter. Only one pre-surgical smile was documented:
Donna came into the room suddenly; I hadnt realized she had been away. Okay, Ryan. I just got permission. Youre going into the operating theater. I did not know what strings she pulled, or why, and I did not ask. I simply found the closet with the surgical scrubs, pulled on a set, and tried to cloak all the ecstatic celebratory jazzercising going on inside with dignified external aplomb.
So, I witnessed open heart surgery today, performed on a little person I consider my friend, who giggles and leaps off the staircase into my arms in a way that makes me feel nervous and trusted at the same time. I am going to try to use this blog to explain the medical science I observed today during Fatimas surgery, to give you a different perspective on Shevet Achim's involvement with sick children.
Fatimas condition is called Tetralogy of Fallot. Tetra, from the Greek word meaning four. It is a common genetic heart defect which expresses itself in four compensatory malformations. That is to say, one defects necessitates another, times four. From what I could gather, however, Fatimas heart only had three problems. It took fifteen professional people six and a half hours today to solve them. It reminded one of a football team, with specialized clusters of individuals (punt team, offense, defense, etc.) and the lead surgeon Dr. Sasson, like a quarterback, calling plays and running the show.
The first forty-five minutes in the operating theater were used to prepare Fatimas body for operation. They began to cool her body, slowing her biological functions. Three intravenous drips were inserted, in the hand, pelvis, and neck. The anesthesiologist expanded her throat with a thick metal hook instrument, inserting a tube into the cavity and down into her lungs. The chest, neck, and hips were daubed and sterilized with orange iodine. Two nurses prepared a fleet of scissors and scalpels in the corner, laying their gleam out on tables like news models at a Mercedes dealership.
Preparation complete, the operating theater truly became theater-like: perimeter lights went low, thirteen high-intensity bulbs illumined Fatimas body from different angles, and the surgeon assumed the table.
The first task was to cover her body with sheets, leaving the zone of operation exposed. Then a razor-scalpel punctured the surface skin along her sternum, below which is the organ of the heart. After the scalpel, a short utensil with a burning tip descended along the same line of incision, presumably to etch a small furrow to guide the electric saw which would break through the cartilage of the sternum. Grey smoke curled upwards into the harsh lights, filling the room with the smell of burning. The electric saw then made quick and powerful work of Fatimas sternum, and before I realized what had been accomplished, she was open. Ive seen saws like this before when I worked a couple summers of construction in Montana. They are designed to penetrate resistant material, but leave soft material undamaged. This technology is what allowed doctors, I believe, to penetrate her sternum without great concern of damaging what lies below the sternum.
To describe to you what it is like when a childs chest is opened in this way, (if I can avoid the accusation of likening the awesome to the chincy), it reminds one of opening a baked potato: after you pierce a straight center line with your fork, the tender flesh simply melts open and away
I was invited by the surgeon, to my disbelief and delight, to stand next to him for the duration of the procedure. I stood on a stool just above Fatimas covered head, and looked down on his hands working in the exposed red rectangle of my friend. Cloth, thread, and pincing scissors positioned the heart muscle for clear access.
Most of the hearts volume, as we conceive of a plump fist-sized organ in the chest, is blood. Remove the blood, and the heart becomes deflated, reminding one of a thick relaxed balloon. The surgical team spent much time this morning transferring her normal heart and lung functions to the workings of a large machine with four whirling cylinder and an oxygenation chamber. This is the machine (somewhat less streamlined and aesthetic than the heart organ, would you say?):
Afterwards, her pulse flat-lined, the balloon deflated and was eerily still, and doctors could begin structural repair.
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Fatima's day began with a very short celebration of her sixth birthday. The birthday girl was greeted by about 10 Shevet staff members in pointy hat at 8:30 AM as she was preparing to leave for the hospital for her surgery. She didn't seem to understand why someone had put a princess crown on her head and why she was being asked to open gifts when she had more serious issues on her mind. It didn't take long for her to just break down in tears as her anxiety continued to build.
Within a half hour we were on our way to the hospital. As she gave her new Barbie and princess shoes a more thorough inspection, she was calm and reserved on the ride. In between admission procedures the anxiety was relieved by looking at magazine pictures and pictures of her and her friends on my camera. Even the help of a passing clown wasn't enough to distract Fatima from the fear of that which (in her six year old mind) loomed bigger than her ability to handle - the fear of pain.
After the blood work was completed, Dr. Tamir brought Fatima and two other children with heart defects into a room full of students wearing white lab coats and stethoscopes. He was teaching the students the different sounds the heart makes when it functions with different defects. For Fatima, that was just more attention than she wanted to be subjected to. To relieve the uncomfortable attention, bubbles provide a good distraction...
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Fatimas surgery is scheduled for first thing tomorrow morning. Her mother speaks Arabic, which gives her the ability to be encouraged by the support and kindness of the Gaza mothers who are in the hospital with their own children.
Nobody can understand better what another mother is feeling while their child is having a very serious operation than another mother who has experienced it - except the Lord. May we each pray for His compassion and grace to fill the hearts of both Fatima and her mother, both tonight and tomorrow.
She laughed and clapped her hands as each wave approached her, swirling around her ankles and splashing upward. Thoughts of hospital visits and surgery seemed as far away as the distant horizon.
When I wrapped my arms around her petite frame to lift her above the waves, I felt her small heart beating quickly. Like waking up from a dream, I suddenly remembered why Fatima is here and was struck with the reality of her frail health counterpoised by her carefree spirit. It was beautiful to watch her revel in sand castles without a trace of worry. The only thing on Fatima's mind was this newly discovered world that evoked pure joy.
Despite our efforts to keep her dry, the waves eventually soaked the bottom half of Fatima's jeans, much to her mother's dismay. Being warm and dry ranks high on the list of priorities for Kurdish mothers. Thus, Fatima was bundled back up in her fluffy orange coat as we sat down to enjoy a scrumptious picnic.
Even so, while sitting in her mother's lap, I caught her gazing contentedly on the scenery around her. It was evident that everyone shared with her in feeling peaceful and refreshed on this special occasion. It is truly a gift to live side by side with Fatima and her mother in this season, loving them and building memories together as a family. I pray that they will continue to experience the deep deep love of their Creator whose thoughts toward them outnumber the sand on the seashore.
Fatima is small in stature for a girl who is almost six years old. But what she lacks in height, she more than makes up for in personality. Her charisma added joy to our day as we traveled to Wolfson Hospital for her first echocardiogram in Israel. She colored happily with her friend Hawraz until Dr. Merav was ready to examine her.
Fatima's condition, Tetralogy of Fallot (TOF), is complex because it affects four different areas of her heart. Although Fatima does not seem critically ill, she does exhibit some classic symptoms of TOF, including mild cyanosis (blue-tinted skin) and clubbing (rounded fingertips/nails). Both of these symptoms reflect a lack of oxygenated blood, which in time will become deadly if not surgically repaired.
As Fatima lay anxiously on the examining table, she let out several whimpers. What happened next was beautiful to witness. I watched with admiration as Dr. Merav sang softly to Fatima in Hebrew throughout the entire echo. She blended the profiency of an experienced doctor and the tenderness of a mother so seamlessly. That's her on the left, with the grey shirt.
Once completed, I returned to the nurse's station for final details, quite pleased with how smooth the day was progressing. Suddenly, Fatima's mother rushed back in from the cafeteria, where she had gone to eat lunch, carrying her daughter in her arms. Initially, it was believed that Fatima had complained of chest pain while eating lunch. Everyone sprung into action as Dr. Beni did a thorough assessment including drawing blood for lab work.
This brought frightened tears and screams from Fatima and deep concern from her mother. Thankfully, Dr. Beni was able to speak with her mother in Arabic and clarify that it was not chest pain but nausea that aroused alert at the lunch table.
After waiting a couple hours for the lab work to return, we were relieved to hear that the results were within normal limits. Fatima's playful spirit returned immediately, as if nothing out of the ordinary had happened. It's amazing to watch how quickly children rebound after seemingly traumatic events! Her soft smile in the car seat, followed by peaceful slumber on the way home assured me that all was well.
I pray that Fatima's courage and joy will continue to flourish as she takes one step closer to life-saving surgery.