The Perfect Hands Doctor

The doctor's office had a rectangular shape with three pale-yellow painted walls and a vibrant-burgundy one. By the door, to the left, was a computer sitting on a shelf, and next to it a counter with a tiny sink. The examination bed was against the corner, opposite to the door. There was only one painting, a colorful one, which had the big task of uplifting the visitors’ spirit while waiting for the doctor; in this case the visitors were Natacha, Valeria and I visiting Shriners Hospital for Children the first time in the cold month of March. The abstract painting, which resembled a puzzle with each piece of different color, was falling short in its purpose, but fortunately that changed when Dr. Dan A. Zlotolow, MD came in to the office.

Dr. Zlotolow  a hand surgeon of about 50 years old, with salt and pepper curly hair brought the energy the room was missing. His assistant, a tall man in his early thirties, joined him.

Dr. Zlotolow was eager to teach us as much as possible about Valeria’s case, for example he mentioned that in cases when a baby is born without thumbs, or mirror hands, he also has mirror forearms. That means that instead of having one radius and one ulna bone, he has the same bone duplicated. The elbow is not designed for that, so the baby has problems rotating the forearm. We turned to see Valeria, and she was throwing away big Lego pieces like a pitcher, so clearly her forearm bones were fine.

Then Dr. Alburger—the foot surgeon—entered the room; I felt honored to be in front of those two brilliant doctors, and seeing them discussing logistics like when the surgery could take place. Dr. Zlotolow said he could operate when Valeria turns a year and a half old. Dr. Alburger said he could operate right away.

"Are you saying you're so important you don't want to operate with me?" asked Dr. Zlotolow to Dr. Alburger who seemed not to enjoy the joke.

"That's what he meant right?" said Dr. Zlotolow talking to me.

"Yeah, that he meant." I responded, smiling.

Dr. Alburger left the room without smiling though, and I was just hoping I didn’t offend the man who was going to open the flesh of my precious daughter.

Dr. Zlotolow explained that waiting for the surgery was necessary because babies lack firm muscles in their hands when they’re less than 18 months old; their muscles are like spider webs, not strong enough for the stitches.

“Be patient,” said Dr. Zlotolow, "to operate her hands, I need you to give me a hand."

We smiled at this play of words; though Dr. Zlotolow s assistant didn't. I guessed he had heard the joke way too many times.

Dr. Alburger did his part in May with great results on Valeria’s feet—he was even smiley and supportive in the following visits. The postoperative period was extremely difficult though. In January is Dr. Zlotolow s turn to do his part; I know the postoperative period won’t be easy since Valeria uses her hands a lot, but having gone through the previous experience, we’re ready to stand up to anything.

Valeria taking Greta for a ride

Valeria's Progress

If part of my feet’s bones were cut off, I'd be crying to my mom that I'd never walk again, but Valeria, like most babies, is resilient, and completely unaware that she went through surgeries.

Her progress was moving quicker than I anticipated.

Since she accidentally removed the casts off her feet, only a week after the surgery, she's tried to stand up. Silly me, I didn't ask that Friday when we went to see the doctor whether we could allow Valeria to stand up if she tried, and I paid for that.

In my mind she was in pain, so she would never try it; in her mind she was finally free of those casts, so she would only crawl, jump, and walk. I emailed the doctor asking my concern, but it was the weekend, so he didn't reply until Monday.

Loly, my mother-in-law, Natacha and I ended up exhausted trying to hold her and distract her from wanting to lean on her feet. We listened constantly the Gummy Bear song and Mickey's Hot Dog song, let her play with all the cel phones and remote controls of the house, and took turns, carrying her back and forth in our small NY size apartment. Finally on Monday, Dr. Alburger responded, "it's ok for her to stand up; it's a good sign."

Since then, the floor has been her kingdom.

Three weeks later, we went back to Philly to Shriners Hospital for Children to remove the bandages and get the final discharge. Dr. Alburger showed up to his office with his assistant, and holding a brand new package with scissors and bandages in his hand. He sat in front of Valeria, who started crying, and began unrolling the bandages until the feet appeared in front of us.

They had the right amount of fingers, and almost had the right shape. They were still swollen, and, because of the bandages, the top parts were almost live skin. Dr. Alburger used the scissor to remove the stitches from each edge, but the rest of the stitches were inside Valeria’s skin; her body was going to absorb them. The shapes of the feet were 90% as expected, but the x-rays were 100% perfect.

Seeing the before-surgery and after-surgery x-rays was extremely comforting, and gave me a moment of peace. I told Natacha, “after all this, we need a good vacation.”

I now see Valeria’s feet, and I’m amazed by their new look; it’s gladly unexpected after being used to seeing the old foot, the mirror foot.

We prepared for months for this moment, and were joyful that we took the right action. We had been very patient though; especially when we wanted to do something since that moment in the ultrasound room, over a year ago, when Valeria was growing in Natacha’s womb, and the ultrasound technician was telling us that everything was normal with the baby. Suddenly she stopped smiling, printed some images, and left the room. She came back with a doctor, a matured woman, who sat in front of us, and told us, “your baby has an extra digit.”

Valeria's brand new feet work perfectly fine

Casts Slipped Off Valeria's Feet

“Gino, this is urgent; one of Valeria's casts slipped off,” said Natacha on the phone, reaching me at work at about 6 pm. “I’ve talked to the hospital, and they’re calling the doctor; just be prepared for anything,” she added.

I was afraid this would happen. Just 6 days prior, when Valeria was being discharged from the hospital, her surgeon, Dr. Alburger, had prevented us, “Casts sometimes come off, so try to keep Valeria’s feet up.”

Dr. Alburger and Valeria, the day after her surgery 

Another doctor from the hospital—Shriners Hospital for Children in Philadelphia—returned the call since Dr. Alburger was in surgery. He directed Natacha on how to put on a temporary bandage, and recommended we be at the hospital the day after.

Valeria wasn’t in pain, on the contrary; she was smiling like she hadn’t done it in days; she must have felt relieved without the cast.

When I got home from work at about midnight, Loly and Natacha were trying to distract Valeria, and preventing her from moving. I noticed the top of the other cast, which was still on, was by the ankle; that seemed odd; it originally was right below the knee. Valeria was anxious for someone to carry her, and Loly did; Valeria started swinging her legs, and that’s when I heard a big bang on the wooden floor. The other cast had slipped off too.

Seeing her foot was shocking; I couldn’t believe this was really happening; I felt like I was a spectator watching the scene from a movie. The cut from the surgery was from her ankle to her toe, and still healing; it was swollen, and bruised. This was the extremity treated of mirror foot; so basically, it was the foot that had been cut off in two to get rid of the mirrored half.

Valeria wasn’t in pain for this foot either, but Natacha started crying, and couldn’t bear to see the foot. I was breathing heavily. Fortunately, Loly was able to calm us down.

Moments later; once we were able to put ourselves together—Natacha gained her strength back, and was able to see the injury without feeling affected—we put a sock on the foot, taped it, and decided to leave to Philadelphia right away; that way we would stay in a hotel close to the hospital, and be at the door at 7:30 am when the hospital staff arrived.

I went for the rental car, came back for the family, and we all left Brooklyn at about 1 am. Valeria slept all the way to Philadelphia; on the way there, nobody said a single word; nobody put the radio; nobody asked to stop for a bathroom break; nobody wanted to wake up Valeria.

At about 3:30 am, we got to Philly. Valeria kept sleeping in the hotel and for the whole night; something she hadn’t done since before the surgery.

The morning after, arriving at the hospital was a relief, and being finally in front of Dr. Alburger even more. He examined Valeria’s feet, and said, “she’s healing well; there’s no sign of infection; I need to see her in two weeks to remove the stitches.” He didn’t put another cast on the feet, but covered them with bandages. When he called to make his voice report before leaving the office, he said, “Valeria Ginocchio, she had surgery 7 days ago; casts came off; she’s healing well; mom did a good job covering the feet.”

Finally at Shriner Hospital for Children waiting to see the doctor

We left the hospital, feeling much alleviated after a frantic night. We then went to Geno’s to eat their famous Philly Cheese Steaks. Sitting in the sun, Natacha, Loly and I were able to join Valeria in smiling.

Valeria's casts

Valeria the Champ

 

Valeria the Champ after conquering the surgery at Rocky Steps, Philadelphia

Help from Cuba

In early 2012, I called the United States Interest Section in Havana—AKA the consulate, but because of the embargo, it has a different name—to make an appointment for Loly, Natacha's mother who lives in Cuba, for a visa to the US. The soonest one available was for November 2016.

Loly wanted to be in New York when Valeria was born, but she had to miss it, and she wanted to help during Valeria's surgery, which Natacha and I really needed, but having the surgeries in Cuba proofed rather complicated.

In the meantime, we continued looking for the right doctor in the US, and found Shriners Hospital for Children in Philadelphia; they were amazing, and quick to set up a date for the surgery.

We mentioned to Loly that we were happy with the physicians we had found, and that the surgery was within a few weeks, that would be in May 2013. She mentioned that she had heard visas’ appointments had been sped up; we should try calling again the US Interest Section. And I did without any hope.

When I phoned, they asked me for Loly’s info, and then they said, “we have an opening for April 16th, 2013.”

I thought, “2013? That’s in how many years? Wait! That’s in two weeks!”

“Will you take it or not?” the operator at the Interest Section asked.

I was still in shock, so it took me a few seconds to react, but I said, “Yes, we take it”.

In less than fourteen days, Natacha and I had to gather the documents to proof that we could financially invite her, and Loly had to gather all the documents to proof that she had strong ties to go back Cuba. The main tie was that she’s the only taking care of Nancy, her 87 years-old mom.

On April 16th, only 35 people out of 700 got visas to the US; one of them was Loly.

She didn’t have a phone, but a relative of hers emailed me with the results after the appointment. I called Natacha, who was anxiously waiting for the news, on video chat. She started jumping with joy when she heard the news, and hung me up right away; “Bye”, she said, “I have to tell the family.”

After getting her visa, Loly went back to Bayamo, packed her things up, arranged who was going to take care of Nancy for the three months she was going to be away, and flew to Miami. All within three days.

She spent a short time there visiting her relatives, and finally made it to New York last night; Valeria was resistant to be carried by Loly for a while, but after a few grandmother tricks, Valeria ceded.

Natacha and I finally got the help from Cuba that we needed, and right on time. We’re ready to drive in a few hours to Philadelphia for the surgery of the mirror foot.

To Do List Before Heading to Philly

1- Pick up the car - check
2- Make hotel reservations - check
3- Make sure Valeria sits comfortably in her car seat - check
4- Picking up the mother-in-law at La Guardia Airport - Not check but almost

We're Having Surgery in May

The lobby at Shriners Hospital was quiet, and it was just Natacha, Valeria, and I waiting there in the chill month of March. On the wall, there was a long horizontal painting of joyful kids in crutches and wheel chairs arriving to the finish line helped by men wearing fez, the red mason hat, which looks like a bucket upside down; it might look a bit funny, but the task that the masonry do is extremely serious; it raises money for the Shriner’s Hospital for Children like this one in Philadelphia, which we were visiting for the first time.

Part of the painting in the lobby of Shriners Hospital for Children in Philadelphia

After filling out forms, we went to the doctors waiting area. We sat in front of a teenage girl, who had prosthetic legs. She was missing her left forearm, and her right arm was almost complete, except that she only had two fingers in her hand. All this didn’t stop her from texting on her cel phone super fast.  When she and her mother stood up to leave; the elevator door, which was about twenty feet away, opened, and the girl ran to hold it for her mom, “Come’on mom!” she said. I was so glad to see that she was just a typical hyperactive teenager.

A few minutes later we were called into the doctor’s office. There was a patient’s bed cover with paper, which Valeria prompted to rip apart; I threw away the mess before the doctor came in, rolled over more paper on the bed, but hurricane Valeria was quick to rip everything apart again, and that was when Dr. Alburger, the foot surgeon, came in. In his early sixties, with silver hair, and a gentle voice, Dr. Alburger didn’t mind the mess. “She’s very strong; she kicks hard”, he said, examining her legs. “Do you have the X-Rays?” he asked. I gave him the CD, which his assistant took away to open up. I also gave him the X-Rays plaques we had brought from Cuba, old school, but effective; he put it against the light box, and saw what Valeria had.

He mentioned the mirror foot, how he was going to operate, and then he added, “On the right foot, I’ll do the surgery on the inside part, so the scar is not visible.” That comment was unexpected because I was more concern on the functionality of the foot, rather than the esthetics, but he was concerned about all the angles, which hinted we were in good hands.

“We can go into surgery anytime; talk to my assistant to set up a day.” He said.

“But we thought we had to wait until she’s a year old.” I mentioned.

“We can do it anytime.” He responded.

After he left, his assistant told us May was opened. She also said, “the surgery will take from 3 to 4 hours. She will stay over night with one of the parents, and will have a cast for 3 or 4 weeks.”

We were happy after meeting Dr. Alburger, and astonished to have the surgery soon. Shriners Hospital had been great, and we still had to meet the hand surgeon.

Valeria is unaware of the harm she has caused to the extraordinary people of Shriners Hospital for Children

Valeria Ripping Apart Shriners Hospital of Philadelphia

Natacha watches Valeria rip Shiners Hospital of Philadelphia apart; don't tell the doctors