by Cap Lesesne
We got out of the car. “Your quarters are through here,” said Ali, and I followed him across the sun-bleached square, inside the castle, and down many stone steps. Suddenly, we were outside again, and I was looking out on the most spectacular beach I had ever seen. Its beauty took my breath away. Its serenity would have, too, but every fifteen feet stood another sentry with a gun, from one of the country’s three armed services.
“Dr. Lesesne?” Ali said, waving me on. “Your room is in the basement.”
I was led down a dungeonlike passageway and then, to my shock, to a cramped, damp room. After all the top-notch travel and amenities, I was a little stunned.
“I can’t believe you’re putting me here,” I said in a tone more confrontational than I’d meant. It had been a long day.
“The room does not please you?” he said.
“Honestly? It might be better for Your Majesty if I stayed at a hotel.”
Ali bowed his head. “That is fine.”
Ten minutes later, as I entered the downtown Hyatt Regency flanked by Ali and another bodyguard, two gorgeous, familiar-looking native women, dressed in Chanel, passed us. One of them turned.
“Dr. Lesesne?” she said. “What are you doing here?”
Quickly noting my companions, she put two and two together, smiled, and walked on.
Thank you, I thought.
My security guys looked at me funny. “I did not believe you knew anybody here,” said Ali.
“Dumb luck,” I said. They were sisters I’d performed lipo on a month before, in New York.
Up in my hotel room, I was convinced the place was bugged. After all, these guys left nothing to chance. But it was a magical moment. I set down my bag, opened the window, and reveled in the present. I scanned the view of the minarets of the mosques, of the small houses and the people walking below. At that instant, in the hot, dusty twilight, the imams started their call for evening prayers. The air was filled with a scent of flowers, animals, and the sweet fruit in the stalls below.
I gazed out the window for a long time. I reflected on how, when I was training to be a surgeon, never did I imagine that I would find myself in such a place or such a moment. Yet here I was, experiencing exactly the kind of life I’d dreamed of as a young boy. Only I’d made it here not as an international lawyer but as a doctor.
I was a long, long way from Grosse Pointe.
I walked back to the bed, lay down, and drifted off into a wonderful, secure sleep.
An hour later, the telephone rang. Ali was calling from the lobby.
“Doctor, come down. We’re ready to go.”
Outside the hotel, yet another black car awaited me. This one was flanked by two men, both with handguns. I was whisked to yet another oceanside vacation estate, this one owned by my new friend Ali. A wedding was going on. The country’s entire cabinet was there, along with regional dignitaries. Many of the women wore Western dress, but some, their hands painted in oil, danced in traditional folk dress. I watched the scene, fascinated.
Ali turned to me. “Is there anything you would like to do while you are here?”
“I’d like to see the most beautiful mosques,” I said.
Everyone within earshot turned. Ali and the rest smiled at me, but perplexed smiles.
“Why?” asked Ali. “You’re an American. You’re not Muslim.”
“I’ve seen pictures and so many of them are breathtaking. I’m interested in mosques.”
Again they smiled, perplexed. “I belong to a group in New York called Friends of Islamic Art,” I said.
“A political group?” one asked.
“The Metropolitan Museum of Art,” I said.
Their smiles lit up the room.
Finally, I could let go a little bit. I allowed myself to drink several different wines, but just a few sips of each. I had no idea what tomorrow would bring.
Early the next morning there was a knock on my door. I was driven to the castle, where, finally, I got to do what I’d been summoned for. The queen, the wife of the army chief, and Ali’s wife, along with all their several ladies-in-waiting, got dermabrasion, collagen, and Botox. No one demanded anything taxing. (No anesthesia was required.) Everything went smoothly.
Now all I had to do was wait two or three days while Her Majesty recovered.
The results, I knew, had better be good.
In the days waiting for the ladies to heal, I was escorted to visit the mosques – their glittering domes, the white walls and minarets, the phenomenal views they offered of desert and sea. I explored the surrounding countryside and ate every single meal under the watchful eyes of Ali, the chief of police, and numerous bodyguards. It’s hard to imagine warmer, more gracious hosts. It’s hard to imagine that – God forbid something went awry with one of the royal procedures – they would actually have killed me.
Finally, after checking in with Her Majesty and her ladies once more, it was agreed by all that, yes, the work was more than satisfactory.
Maybe we would meet next time in New York.
“Inshallah,” I said, their customary good-bye. If God wills it.
My passport and wallet were returned. I was flown first-class to New York. Months later, I received an invitation to the wedding of one of the royal daughters.
Since then, I have occasionally wondered why I wasn’t more worried about the possibility – highly unlikely, of course, but within the realm – that something might go wrong.
But I never gave it a second thought.
Professionally, at least, I was as sure of myself as I could be.
Reconstruction
Lisa Gaylord, my OR nurse at the time, and I were driving to my Westchester office when traffic just stopped. We couldn’t see what was happening, so I pulled my car onto the shoulder, stepped out, and walked toward the commotion.
There had been a head-on collision a minute before.
In one car, an older man was unconscious and cut up, but he did not appear critically hurt. Two bystanders lifted him from his car and laid him on the road with his legs up, so he wouldn’t go into shock. Shortly, he regained consciousness.
From the second car came the stink of burning rubber. The driver was slumped against the steering wheel. A volunteer fireman and I pulled him out.
The man, who looked about thirty, had no pulse. No respiration. He bled from the mouth. He was turning blue.
Brain damage begins within three minutes of total oxygen deprivation.
Lisa started giving him CPR and we got a heartbeat. But still no breathing. I tried to get air into him via mouth-to-mouth, but I couldn’t form a seal. The man was turning bluer.
I would have to do a tracheotomy.
The only remotely surgical-like instrument Lisa and I had between us was a penknife. I cut into his swollen neck – or more accurately, I sawed into it, so dull was the knife blade – and cut down to the trachea, hoping I didn’t hit his carotid artery; if I did, and if he really wasn’t dead already, then he’d absolutely be dead. With my finger, I swept the muscles away, feeling the cartilage of his trachea against my index finger. I could now see it was the trachea. I cut out an H-shaped hole but still couldn’t form a seal to breathe into it for resuscitation.
Fortunately, a police officer had arrived with an oxygen tank and, at least as important, tubing.
I cut a beveled edge at one end of the tube, slid that end into the trach hole, and we turned on the oxygen.
Seconds later, the man turned pink.
It’s exhilarating to save a life, especially when you’ve witnessed so many lives that weren’t savable.
I thought I was starting to get a sense of who I was, first and last – namely, that my destiny was to help others, which I loved doing more than anything, but perhaps at the price of my own domestic and romantic fulfillment.
That was okay. But, as a plastic surgeon, I bristled a little at the notion that what I did most of the time with my medical training was somehow less valuable than what I might be doin
g with it. It’s the question that every plastic surgeon gets, and frequently.
“So, doing breastlifts and nosejobs and face-lifts and tummy tucks is probably satisfying, but they don’t compare to what it feels like doing a facial reconstruction or helping a burn victim – right?”
Wrong.
I am not an ogre. I am not suggesting that doing facial reconstructive surgery, or helping to alleviate the effects of a childhood disease like cleft lip, or doing a skin graft on someone who’s been in a fire, is not hugely gratifying. I am blessed and humbled that I have the ability to do this.
But all of it is equally gratifying, at least for me. And probably for most of my colleagues, too.
I became a plastic surgeon because I saw what it could do to change people’s lives, to propel them to greater things. Simple as that. Yes, some changes and life results are bigger than others, but it can be presumptuous to decide whose life is more profoundly affected by one surgery or another. Doing a nosejob on someone who has always labored under the impression that she is ugly; removing saddlebags from a woman who has never walked past another human being, male or female, without obsessing that she is being looked at mockingly; enlarging the breasts of a woman who has never felt womanly; or removing jowly skin to restore a jawline to a man who believes his colleagues think he’s over the hill … doing all that, so these people can feel more attractive, confident, desirable, better equipped to attract a man or a woman, or interview for a job, or just walk their dog on the beach … that’s huge! Sure, you can argue it; you can say that it’s all just elective surgery, after all; you can say that what’s inside the person is still inside the person and you can’t fundamentally change that. Having done thousands of elective surgeries that “merely” tweak and fix things on faces and bodies, I can tell you that what gets changed on the outside can alter the inside, despite what skeptics may think.
A provocative survey was recently done whose results I implicitly believe. A born optimist, the survey said, generally fights through tough times to retain his or her natural optimism, while a born pessimist, no matter the prosperity, eventually finds his or her way back to a pessimistic outlook. The study’s most quotable example: An optimist who suffers an accident that leaves him quadriplegic will likely, after the shock and adjustment, eventually become an upbeat paraplegic, whereas a sourpuss who wins the lottery, after the thrill and adjustment, eventually becomes a grumpy millionaire. That doesn’t work in all cases, of course, and there are many permutations and nuances to it. But I believe there’s something inherently true about it.
Still, that doesn’t mean that significant, life-altering transformations can’t happen, because they do. I see it all the time, day after day, year after year, and it’s my privilege to be part of and witness to them. For example, a fifty-year-old woman comes to me for Botox injections once every five months and now spends so much more time outdoors and socializing than she spends in her home, where she would often grow depressed and self-obsessed. Another example: the thirty-six-year-old who hasn’t owned a bikini since she was a little girl, and who comes to me for a breast augmentation so she can wear one (she brings with her the three she’s considering) on her upcoming trip to Mexico with her new boyfriend. Will they live happily ever after? Who knows? Will she feel sexier around him? You bet. However deep-seated our basic natures are, I can say, from years of doing this, that when body anxiety is removed by fixing the exterior, it’s as if a new person – a person with a new interior – can finally emerge. And focus on other things, things beyond the body.
Here’s the irony: So many of the patients I see come to me not because they’re vain – the common perception – but because they don’t want to be thinking about their body and face! They want to be consumed by the world outside, not the world that begins and ends with their skin.
That’s why I became a surgeon. To watch people become more alive. To make them happier.
Everything I’ve said in the last page or so is as true, potentially, of someone who feels wrinkled, old, and unattractive as it is of someone whose face has been mangled by a car accident. Our goal as plastic surgeons is to make people happy. Period. So if I can make a woman whose husband walked out on her look terrific and feel confident about her appearance … she’s probably experiencing at least as big a jolt in her life as someone who had me revise a scar from a childhood operation.
The vice president at Blythedale Children’s Hospital in Westchester – the mother of a patient of mine – approached me about starting a reconstructive program for children with severe deformities and malformations. I was immediately excited by the idea. Over the next week, I started to jot down notes about requirements for the program. I was unsure about how the endeavor would be funded until one night when I was seated at a New York restaurant, eagerly describing to my date the possibilities for the program. A diner seated behind me overheard our conversation. She leaned over, introduced herself as Ann Colley, and said, “I apologize for interrupting, but I think I know someone who can help you out.”
Ann Colley is an angel.
The next day, a woman introducing herself only as Janet telephoned my office. “I work for a gentleman who is very successful on Wall Street,” said Janet. “He’s a religious and thankful man. He has four healthy children, and he wants to give something back to society. But he only wants to donate to charities where the money goes completely to the children. And he wants it to be anonymous.”
Janet, as his representative, came to inspect the hospital. Within ten minutes, she asked to leave, with tears in her eyes. Blythedale is a unique place that makes you realize just how lucky you are to have your health.
An hour after reaching her office, Janet called back, pledging millions of dollars on behalf of the mystery benefactor.
“My boss was so impressed,” she said, “I’m sure that his friends would also like to help to fund this endeavor.”
There were never forms to fill out. Just a single telephone call.
There really is a God.
To date, we have been frugal with the money, and these generous benefactors have helped many people regain the use of their arms, their legs, their lives. We’ve worked on many children who have suffered terribly disfiguring conditions, but a couple of them stand out. Ronnie Lugo, who didn’t have a home and was living on the street, was thirteen years old when he had acid thrown in his face. It horribly scarred him, restricted his jaw movement, and cost him sight in his left eye. I reconstructed his eyelid with a series of flaps and skin grafts. The New York Times became interested in Blythedale and ran a story describing our program. An ophthalmologist at Columbia University read the story and called me up.
“Dr. Lesesne?” he said. “I read about your boy in the New York Times. I have a new procedure that I think can restore his eyesight.”
Ronnie had his surgery a month later and went from wanting to kill himself to wanting to be a child psychologist.
Another case was at once satisfying and hugely disappointing – but the disappointment had nothing to do with the limits of medicine or surgery. Kevin, a two-year-old boy, had suffered burns on 40 percent of his body. He was so scarred, he wasn’t growing and he couldn’t walk. He could not stretch out his knees because of his flexion/contraction scars. I did multiple skin grafts, scar releases, and Z-plasties – a technique that reverses the direction of a scar to allow skin around it to grow again. Kevin started to walk again. He started to grow again. He started to play baseball again.
A couple of years later, another boy was brought into our clinic who had been similarly profoundly burned. Naturally, the boy and his family were distraught, and I thought it would help their psyches tremendously if the family of Kevin, who was doing spectacularly well now, would talk to these people and offer words of encouragement and show them there were reasons for hope. I called Kevin’s father and told him what I needed.
“No,” he said.
“No?” I said.
“That part of Kevin
’s life is over. We want nothing to do with burn victims or anything that reminds us of burn victims. That part of our life is over.”
The second boy, fortunately, also had a relatively successful surgical outcome.
But while I understand that some people want to put the past behind them, I will never forgive Kevin’s father for not talking to another family going through the distress that his family had, when they had been fortunate enough to make it to the other side of their despair. To this day, when I think about that phone call, I can almost feel my blood boil.
Even though the vast majority of my practice was in-office cosmetic surgery, every so often I would find myself doing a surgery that was almost surreal.
Edward came to see me at his sister’s recommendation (she’d had a rhinoplasty years before). He had a small lump on his left eyebrow that he wanted me to examine and possibly remove. The moment I dissected around it, I was concerned. The lump had a gray, gritty consistency. From its appearance, a sarcoma was highly probable.
The biopsy results came back positive for cancer – specifically, “spindle-cell” sarcoma, something very rare that I’d only heard of, never seen. I had to research it on Medline, an online search engine for doctors. The cancer grows along the sheath of the nerve. It’s highly malignant.
I discussed the situation with Edward, gently telling him the bad news, the treatment, the future. I told him that this could be bad, lethal. He was amazingly calm about it; his family was not. A CT scan revealed that the cancer had tunneled above his eye and traveled to the roof of the orbit, the bony wall around the eye. I suggested we remove the cancer immediately.
After a tedious dissection of Edward’s face, I kept finding more cancer.
And more.
And more.
