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Saying "No"
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Saying "No" There comes a time on every mission where one of the doctors has the difficult job of saying "no". "No," as in: "No, we won't be able to operate on your child this trip."
Sunday afternoon, that task fell on Dr. Joe Mazza. His job was to tell the parents of Rocio, who was screened and scheduled for a cleft palate repair and a pharyngeal flap, that due to their daughter's mouth size, it was not safe to perform the operation. "Basically because the child wasn't able to open it's mouth wide enough, it would make it too difficult to do surgery," explained Operation Rainbow volunteer surgeon Joe Mazza. " If we had a problem with the airway it would make it nearly impossible to do something about it." Mazza made the decision after the child was asleep from the anesthesia. Click to see the video. Operation Rainbow has established protocols and guidelines which are developed in cooperation with the volunteer surgeons and the local health care workers. When one of the surgeons or the anesthesiologist feels the time is not right for a particular patient, or the type of surgery is not appropriate for the mission, they can elect not to perform the surgery. "I was thinking of the 'what ifs'?. What if: we struggled to do surgery we did the surgery, and post operatively the child had swelling and difficulty breathing. The we would have a lot of difficulty getting an airway -- putting a breathing tube back in the child and that could be disastrous." So we said "no". It hurt us to say no, it hurts us when we have to turn away a child, but it's definitely in the child's best interests not to operate. So we'll come back in a couple of years when the child gets bigger and the jaw grows and the mouth opens more." This is Mazza's fourth mission and he knows there is a point in every mission when the team has to say "no". "Usually toward the end of the mission, as word gets out, more children come and we don't have the time. That gets to be the hardest part," Mazza explained. "What makes this unique is that in this hospital, the child is going to be followed with an obturator by the orthodontic department. She'll have a temporary palate while she grows until her mouth opens wider," explained Operation Rainbow Program Director Sue Ellen Ruggles. According to Ruggles, Rocio's mother's reaction was both concerned and stoic. "If there hadn't been any other hope, we would have seen another reaction. That's why having the established orthodontic department is so important and is a tremendous benefit to the children here," Ruggles said. Angel del Campo one of the local coordinators assisted with the translation of the situation between Dr. Mazza and the mother. "You have to have some skills to talk to the parents and thank God I have some. It has to be how you talk. If you don't use the right words, it can be a shock." For Angel, the case struck a familiar tone. A relative recently was scheduled for surgery, but it had to be delayed. "It's the same as with my brand new nephew. We were expecting the treatment -- but it will be better for the surgeons and better for the kids." But after four missions, Mazza still says saying "no" is the hardest part.
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