The Boy With the Blue Sweater

David C. Kim, MD, FACS

I am often asked if there is one memorable patient or operative case that has impacted my career. Indeed there is: The the boy with the blue sweater.

Several years ago, two days prior to departing from a surgical mission in Bhutan, I decided to walk from the hospital to my hotel rather than traveling on the Surgicorps team bus. I wanted to enjoy the views of the Himalayan mountains since our days were relegated to the hospital and hotel. On an isolated road, I passed a boy wearing a blue sweater who appeared 17 or 18 years old. I immediately noticed he had an extremely wide cleft lip, so wide his front teeth were exposed and his nose deformed. Clinically, his situation was rather unusual, not only because of the extent of his deformity, but also due to the rarity of an untreated cleft lip at his age. Cleft lips and palates are typically repaired during infancy. I was shocked by his condition. He passed so quickly, stopping him wasn’t even a thought.

Continuing my trek to the hotel, I rationalized my hesitation by convincing myself that I didn’t know the language and didn’t want to offend him by addressing his condition. That night I regretted my inaction. I questioned why I wasn’t more proactive. I agonized, imagining him enduring the deformity through his childhood and teenage years, its impact personally and socially as a young man. During my travels abroad, I learned that some societies marginalize and ostracize people with deformities, especially disfiguring ones.

The next day I walked the same route, desperately and selfishly hoping I might see him. But no such luck. Miraculously on the final day at the hospital, he showed up by himself—still wearing the blue sweater. Unfortunately, my team and I had already packed our supplies and were ready to leave the hospital. The team graciously agreed to unpack and assist me with the surgery. Because we had exhausted our anesthesia supplies, I operated on his lip using only local anesthesia. He didn’t flinch and tolerated the procedure without any emotion. I wondered how he even knew to present to the hospital, why he was by himself, and if his stoicism was from years of hardship. In the end, it didn’t matter. After the surgery, I gave him a mirror. He smiled, and I cried.

I have had the honor of participating in 40 international surgical missions. They serve as continual reinforcement of providing medical care in its simplest form to people who are in dire situations. Where I have traveled, there are no overseeing agencies dictating care, no

secondary gains to manage, and no impending threats of liability. Even with the best of intentions, there are patients that we just cannot help. Sometimes their conditions are too extensive to treat. My team and I transport surgical equipment and supplies, but hospital resources and support are scarce or non-existent. And sometimes we just do not have enough time or staff to handle the droves of patients. But by just listening, understanding, and sometimes holding their hands, patients appreciate our intentions, even if we cannot help. Being a father myself, I cannot fathom how desperate parents can be so gracious with our inability to provide care.

I still believe medicine is one of the noblest professions known to humankind. Each of us is graced with the opportunity to help others who do not have access to the care and resources they need. I encourage you to nurture, embrace, and extend your talents without hesitation. While this notion was instilled in me by my parents, mentors, and family, I learned this lesson from the boy with the blue sweater. +

David C. Kim, MD, FACS is Chief of Plastic Surgery at St. Vincent Hospital and Reliant Medical Group.