Travel

Aug 12:Each day, I meet new children for preop evaluation, brought by smiling family members huddled at bedside in the Pingliang People’s Hospital. In the faces of the parents, I see a combination of fear, concern and hope.

Although I anticipate the answer, speaking with them through an interpreter, I ask what they want me to do for their child. Rather than reply verbally through the interpreter, the answer is almost always made by pointing to the obvious cleft of the lip, or by opening the child’s mouth to point to the gaping opening of the roof of the mouth, a cleft palate.

It is so easy to feel a bond with the patients. Even though we do not speak the same language, the instinctual parental sense of attraction and desire to protect and nurture is irresistible. This seems common among my fellow American teammates who continually comment “how cute” the children are and the nurses are quick to want to hold the babies and play with them. These seem unusual, even extraordinary and unexpected reactions to a child with such an obvious facial deformity.

Later, I notice those same feelings manifest in how the crew is playful and caring for the baby as we bring the baby into the operating room and prepare to begin the surgery. My mind shifts to focus on the steps of preparation, administration of anesthesia and the technicalities of the reconstructive procedure. With cleft lip surgery, the challenge is in the planning. I wear magnifying lenses as I measure and mark with needle and ink the relevant anatomic points that are crucial to the precision of the ensuing incisions and surgical rearrangements of the repair. It is a unique sort of puzzle: finding the hidden pieces and moving them to complete the aesthetic solution.

An hour passes without my notice, my consciousness engulfed in the conceptual and technical challenge before me. Finally, we place the last stitch and pull back the drapes.

Then, I see the cute little baby, again.

Only now, without deformity the cute baby can be seen by every one.

Aug 8: Some background on Pingliang, (平涼) located in central China: the most famous landmark is Kongtong Mountain (崆峒山), the cradle of Taoism.

Pingliang is almost exactly in the middle of the map of China, right.

I had a chance to visit Kongtong Mountain, which is a short taxi ride from our accommodations in Pinliang. It is interesting to note that traffic regulations are quite different here. It appears that the lines in the road are merely “suggestions.” Cars do not hesitate to drive on the “wrong side” of the road, if it is convenient for the driver. This adds interest and excitement to the trip, like watching a national tournament of vehicular “chicken.”

The landscape is terraced for agriculture, and sandstone rock faces are perforated with thousands of man-made caves, used for centuries as dwellings, now mostly for storage – typically of grain and other agri-products grown here. The Chinese consider the area “desolate and dry,” but it feels humid to a Coloradoan. Things do grow here, but it is hardly lush, as the sandstone and conglomerate soil is not very fertile. This accounts for this being a poor province, since agriculture is the main industry here.

The road curves to the left and we are abruptly in a more verdant landscape bordering a remarkably green lake above which is the steeply rising 2200 meter Kongtong Mountain. The immediate impulse is to get to the top of this natural tower that dominates the Gansu plateau.

The sharply ascending cable car ride over the lake is accompanied by rapidly clicking camera shutters. I join in taking pictures, knowing these photos fail to capture the beauty and feelings I am experiencing today, but I hope the photographs can serve to remind me even a little about how it feels to be in this place.

Even before the cable car arrives at its station, we see many temples perched on the mountain’s tiers of rocky projections. I have a moment of recognition that I am actually in one of those exotic places I have seen in ancient works of Chinese art; I feel I recognize the dragon- and gargoyle-adorned, pointy-roofed temples at the edges of thousand-foot precipices from some movie or travelogue. Only now, I am actually here, they are real, and not just an exotic image or artist’s creative machination.

After a bit of walking over the rocky landscape among great centuries-old temples, I have broken away from the group distracted by the fortune-tellers, souvenir booths and beer garden of the Tourist Center. The thousand stairs that very steeply rise to the next peek beckon and intimidate, but the view through the trees to the temple looming above is irresistible. The irregular stone steps are very tall and dotted with pilgrims pausing to rest and scan the panorama. Intermittently, a small path directs me to ancient Tao alters like “Temple of the Clouds,” each on its own particular perch, with its unique view.

My senses are further filled by incense, intermittent prayer gongs, and the chanting of robed monks.

High up in “Heaven City,” I happen to meet up with one of our crew; Barry is a bright Anesthesiologist from Beijing. He is cheerful and physically very fit. He is surprised to see me at this remote altitude, smiles and asks, “Should we go to the top?” By now, “the top” seems illusory, unreachable, like a mirage; as soon as I think I have gotten there, I see another temple through the trees above. Of course and without hesitation, I answer, “Yes!”

Some stairs are cut into the mountain with a temple carved around them. The views, altitude, and climbing steep narrow rocky paths on precipices with drops measured in hundreds of meters can all be described as “breath-taking.” One of the most thrilling is the narrow cable-suspended, “Bridge to Heaven,” the only tenuously thin attachment traversing to an isolated, needle like tall spire rising many hundreds of meters from the valley and crowned with its own small temple.

Barry and I reach the very top of Kongtong. The top temple is heralded by an archway before which Barry immediately poses, instructing me to photograph him being certain to clearly include the three Chinese characters painted on the arch which frames the temple behind. I comply. Barry takes the camera to ascertain adequacy of my photo-documentation. Sure that we are standing at an ancient and sacred spot, paramount in significance to the lore and history of Taoism, I ask Barry what the sacred calligraphy means. He points to the words and interprets for me: “This is the top.”

I just returned from the American Society of Plastic Surgeons Meeting in Seattle, Washington. The ASPS is the world’s largest organization of board certified plastic surgeons, so it’s meeting draws experts from around the world.

Attending the meeting is a bit of a manic state: it is truly a three ring circus, with 2 to three major auditoria presenting scientific and clinical papers and symposia, side by side with exhibits and courses.
I have learned to go prepared with specific agendas and plan my time to hear the talks and see the exhibits on my list. At the same time, I know (and hope for) the unexpected will catch my attention, and present a new learning opportunity. That really is the essence of these conventions: the opportunity to learn from experts and colleagues, exchange ideas, and see what advances are on the horizon.

New techniques and technology may sound intriguing in our journals and other media: we plastic surgeons are bombarded with new devices, lotions, potions, and evolving techniques. The ASPS is a great venue for closer scrutiny and separating hype from substance.
One area of attention is fat grafting for augmenting contours, adding volume to the face, breasts and buttocks. Although there is a great deal of interest (and many presentations, courses, and specialized devices), we still are learning, and have a way to go before the techniques are consistent and reliable.