Wednesday, Aug. 4, 2010
Haiti's Desperate Needs, Brought Home
Back from a medical mission, an oral surgeon couldn't forget what he'd seen. He was determined to see one case through.
By Michael Vitez, Inquirer Staff Writer
One in an occasional series.
All his professional life, Steve Moriconi, an oral surgeon with a private practice in Jenkintown, had wanted to do a medical mission, and the Haitian earthquake was the catalyst for him. He spent a week in Haiti in April.
In the little town of Gressier, Moriconi, also director of the dental residency program at Abington Memorial Hospital, found a tumor ballooning in the jaw of a 31-year-old woman and took a tissue sample.
But, of course, there was no working lab in the earthquake-ravaged area, so he smuggled the tissue home in his suitcase and sent it to a lab at Temple University. The woman, Adeline Joachim, had a fast-growing cyst that was not cancerous but was already deforming her jaw and would soon break it, leading to an infection. In Haiti, that could be fatal.
Moriconi had treated the woman for only a few moments in his dental chair, and he had no idea how much she had already suffered from the earthquake.
But back at home, he was haunted by the knowledge that without help, Joachim, in Haiti, would surely suffer and even die. He was so moved by what he saw there, and aware of how little effort it would really require of him to make a difference, that he concluded, "We have to try to bring her here. There's nothing else to be done."
At 6 p.m. July 24, he met her at Philadelphia International Airport.
He wasn't sure he'd recognize her, but thought he did, and the fact that airport security escorted her to baggage claim was a dead giveaway.
He clapped as she approached, then threw out his hands and said, "You made it!"
She hugged him, and then kissed him on the cheek.
"Thank you," she said, two of only a few English words that she knew.
'I have seen what I could be'
At 57, Moriconi is in what he calls "the latter part of my practice career," and while he often does pro bono work at Abington's dental clinic for local patients, an unsettling question had been gnawing at him: Was he really fulfilling the oath all health-care practitioners take to alleviate human suffering wherever and whenever they can?
"So often in our professional lives we lose track of that," he said a few days before Joachim arrived. "I know I had. Especially when I read each year the glowing, optimistic, altruistic essays of our student applicants."
His best friend since college, whom he met during a semester abroad in Switzerland, was a Haitian named Carl Blanchet. His family had fled the oppressive Duvalier regime and settled in the Philadelphia area. Moriconi's own parents were living abroad, and Blanchet's family became his family. So the earthquake in Haiti, even though he'd never been there and knew nobody who had died, took on a special resonance with him. And he immediately put in motion a plan to spend a week there, working in a clinic.
It took until April to pull it together. In Haiti, he spent the first two days in Port-au-Prince, and the rest in a clinic in Gressier, where he did 25 surgeries in three days. He had brought tools, medications, and bandages in three suitcases to Haiti, and left behind 150 dental instruments at the Gressier clinic.
He was most impressed that week by his translator, Joel Vixama, 20, who had just started medical school in the neighboring Dominican Republic but dropped out after the earthquake to come home and help his family. Vixama was working as a translator for $20 a day, a huge sum for most Haitians, and Moriconi took a liking to him the first day and requested him all week.
Vixama stood at Moriconi's shoulder for many of the surgeries. Moriconi was blown away by something the young man said, which still chokes him up when repeating it: "I have seen what I could be."
"Here is a young man who has taught himself English, taught himself Spanish, started medical school, wants to better himself, has a family that is as supportive as can be, but they're Haitian peasants, and he's trying to rise above all this," Moriconi said.
On the last day, heading to the airport, Moriconi told the young man, "Go back to school, I will take care of it."
"It came down to about $350 a month it's costing him" for medical school, Moriconi explained. "And for me, that's a drop in the bucket. So let's leave a drop in the bucket. It's five years. 'You go back and I'll support you.' He started to cry. He didn't expect that to happen, and I didn't expect to say it, either. It just came out. I said, you've got to do this. You can't go back to your tent across the street, and your parents' tent 20 minutes from here, and expect that this is really ever going to happen for you. You go back, you become a physician in Haiti, and you take care of your people."
First-class Treatment, Free
So Vixama returned to medical school, grateful as one can be to Moriconi, whom he e-mails almost daily. On May 10: "Well, i went to school this morning and everything was perfect. thanks for making it happen my friend. i'm finally in med school. my dream start being true for sure."
Moriconi came back to Philadelphia more deeply affected than he could have imagined, and also with a lung infection from breathing the diesel fuel, dust from the rubble, and smoke from the ubiquitous fires in Haiti.
Moriconi sent Joachim's tissue to the lab, and as soon as he got the results – odontogenic keratocyst, as he suspected, a noncancerous but rapidly growing tumor – he realized there were no oral surgeons in Haiti. The clock was ticking.
There was no reason in the world he couldn't help this woman, no reason other than his own inertia, and he wasn't about to let that stop him.
He would donate his services. He asked hospital executives if Abington would donate the use of an operating room, medicine, staff time, and inpatient care after the surgery. Their answer was simple. Yes, absolutely.
Abington, like all hospitals receiving tax-exempt status, is required by law to provide the equivalent of at least 5 percent of its revenue in community benefits, according to Ronald Fabrizio, the controller. Abington does this in part by providing care through its walk-in, dental, and maternity clinics on a sliding scale, based on what patients can afford, right down to free.
In the fiscal year that ended June 30, Abington provided free care worth $9 million – 17 percent more than the year before.
In applying for a medical visa for Joachim, Moriconi estimated the cost of her care to be $75,000.
Robbin Tatlock, a hygienist in Abington's dental clinic for 26 years, had just won a $1,000 travel agency voucher in a raffle for employees who had contributed early to the hospital's annual-giving campaign. When she heard about Moriconi's effort to bring Joachim to Philly, she offered up her voucher to pay the airfare.
"How could I not?" Tatlock said. "I have privileges living in America. I have a paycheck. I can travel some other time. This lady may never have an opportunity like this again."
Within 24 hours, the flight was arranged. Joachim would fly first-class.
A Hand to Hold
Joachim spent her first night in Jenkintown getting acquainted with Moriconi and his wife, Kristina, who had been studying Creole, the language of Haiti.
Several times Kristina Moriconi asked, "Eskew vle dlo?" "Would you like a glass of water?"
A daughter was off to camp, so Joachim would have a bathroom to herself. Kristina had spent the day cleaning it.
They were also joined at the airport and most of the week by Judes Isidore, 47, who moved from Haiti to America 10 years ago and is an electrician living in Philadelphia. He worked for two years in the maintenance department at Abington and still does translation when the hospital has Haitian patients.
Kristina Moriconi anticipated her role during Joachim's two-week stay would largely be that of supporting her husband – driving Joachim to medical appointments, shopping, whatever was necessary.
The next morning, Kristina, 44, a former graphic artist who is studying and teaching writing, took Joachim to Willow Grove Park. She bought her an iPod, and at home downloaded a playlist of Haitian music she'd been collecting for weeks. At the mall they also bought Joachim an outfit at Macy's – jeans, top, and shoes, and clothes for her 10-year-old son, Rivaldo, back in Gressier. Kristina said many people had donated money to help, including her cousin, a hedge-fund manager.
On Monday, the day before surgery, Kristina, along with the translator, took Joachim to several medical appointments – for a physical, a full set of films by Steve, and a cleaning at Abington's dental clinic.
Joachim kept the iPod going the entire day – one earbud in, the other out so she could interact with doctors. She was often anxious, as when Steve showed her the three-dimensional X-rays of her enormous tumor – a black sprawling mass in her jaw. She had never been on an airplane, never been out of Haiti, never been to a shopping mall, never had an IV, never given a medical history, never had so much fuss made over her, and Kristina constantly held her hand.
"Someone held my hand once when I was scared," she said.
Dead in Her Arms
On Monday evening, they feasted on a last meal before surgery Tuesday morning.
Steve Moriconi cooked tilapia in a spicy sauce, Haitian chicken salad with beets, even a Haitian sweet potato bread.
"How many patients have their surgeon cook for them the night before and then do the surgery?" said his wife.
As Steve was chopping and cutting, spicing and tasting, preparing the meal, Joachim, through the translator, shared her story. She is a cook at a school that her son attends. This was evident when she, reflexively, standing in the kitchen, picked up the fresh sage, smelled it approvingly, and then began dicing. Steve had to stop her. No, he was cooking.
Joachim, a single mother, recounted how she was in her home, stirring a pot, when the earthquake struck on Jan. 12. Rivaldo was outside, studying at a table. Joachim had a 10-month-old, Donloy, still crawling on the floor of their two-room concrete home. Joachim felt the ground begin to shake. She quickly turned to pick up her baby, who was trying to crawl out the doorway. Just as Joachim was about to reach him, the earth shook and, like a giant wave, threw her back inside the house.
Her son outside, seeing this, started to rush toward his little brother, but Joachim screamed at him to stop. It all happened so fast. The wall of the house collapsed on Donloy as mother and brother helplessly watched.
The infant was still alive, and Joachim held him to her chest and ran to the small hospital in Gressier, but it had collapsed into rubble. As she stood there, desperate, hysterical, helpless, Donloy died in her arms. An estimated 150,000 buildings collapsed that day in a country with no construction codes. Thousands of Haitians are homeless, and many, like Joachim, now live in "tents" of corrugated metal.
Joachim was sure after seeing Steve Moriconi in April that she was going to die as well, that Rivaldo would become an orphan as well as an only child. But then the Haitian dentist who runs the Gressier dental clinic told Joachim that she would be going to America to have surgery, that the American who took her tissue sample had set this all in motion.
"I couldn't believe it," Joachim explained through the translator, sipping water in the Moriconi kitchen, with its granite countertops, which everyone knew without saying was larger than the tent where she lived with her son. "I still can't find the right words," she said. "It's like a miracle."
All sat down to a marvelous meal. Steve made a toast: "Tomorrow you will do very well and wake up in no pain."
Paying It Forward
Kristina drove Joachim to the hospital at 6:30 a.m.
Prepped for surgery with an IV in her arm, she lay on a gurney, with a parade of medical professionals coming in and out of her room in the pre-op area. Luis Mercader, an anesthesiologist donating his services, took her medical history once again and explained she might wake up with a sore throat from the breathing tube down her throat for mechanical ventilation during surgery.
Tears welled in Joachim's eyes.
As Joachim was wheeled into the operating room, Kristina told her, "I'll be waiting for you. I'll be right here."
Joachim raised her head off the pillow and whispered in Kristina's ear, in English, "I love you."
Kristina's own eyes welled with tears.
"I don't even get this emotional over my own children."
Kristina went out into the waiting area, and began pacing.
"I never get this way."
But there was a reason.
On July 16, 1986, Kristina was 19, a student at Beaver College (now Arcadia University), driving on Fitzwatertown Road near Old York Road in Upper Moreland about 5 p.m. when she was hit by a drunk driver.
Her car was so badly crushed, it took rescue workers two hours to cut her out. Her knee was so deeply embedded in the dashboard that it went with her in the ambulance.
As Kristina lay trapped in the car drifting in and out of consciousness, she looked in the rearview mirror, and all she could see was blood. She couldn't speak because she was trying to hold her teeth in her mouth. As she lay there, a woman, a stranger, held her hand the entire time and comforted her.
At 3 a.m., Steve Moriconi got a call from a friend, the surgeon working to save Kristina's life, asking him to come and fix her jaw. Steve was married, with a family. He walked into the operating room and saw she was so badly injured that he asked whether she was going to make it. "We're getting there," the surgeon told him, so Steve fixed the jaw and stitched and sutured and remembers thinking, "What a tragedy, what a beautiful girl, and her face is totally wrecked."
Kristina remained in the hospital for months, and he saw her on follow-up visits there and in his Jenkintown office. In years following, after she married, he did surgery on her husband and mother.
In 1993, Steve Moriconi separated from his wife, and in 1995, they divorced. In 1997, he saw Kristina at a road race to benefit Abington Memorial. (He runs, she walks with her bad knee.) She had separated from her husband.
Six months after that, he was at Abington, writing notes after seeing a trauma patient, and Kristina walked out of the next room, where her aunt was recovering after surgery for a brain aneurysm.
They got to talking, and he asked her out for a drink, and three years later, in 2000, they married.
For 24 years, Kristina has wanted to find, and thank, the woman who held her hand that day of the accident.
She now explains why she's so emotional. After all these years she is able to "pay it forward," to do for another what someone once did for her.
"Now I'm the person holding someone's hand," she said.
Under the Knife
Operating Room 11 looked like something out of a movie – overhead lights, patient unconscious and intubated, machines all around.
Steve Moriconi first removed teeth on either side of the cyst. They'd been compromised, and they came out effortlessly.
Then he removed the bone and tissue around the tumor. Once he reached it, the tumor was loose, almost like a yolk inside a hard-boiled egg. He got tweezers and fished it out.
He was pleased it was in one piece and firm, an indication that he'd gotten the whole thing.
Then he deadened the area with a chemical akin to formaldehyde. Because the tumor sends out shoots into surrounding bone, he wanted to make sure any shoots would be killed so the tumor wouldn't recur.
In removing the tumor, he hit an artery, and bleeding was bad. He was grateful that he was in an operating room with a blood supply and specialists available if necessary.
Once he cauterized the bleeding, he filled the cavernous hole with a packing tape coated in antibiotics and pain relievers that would encourage healing and diminish pain.
Then he sliced a meaty wedge from the tumor and sent it off to pathology. "I'm not 100 percent certain it is what they say it is," he said.
And after an hour, he was finished.
He threw his bloody scrubs into a can for hospital waste and went out to report to his wife, who was pacing. "I can't sit still anymore," she said.
Back to Haiti
Waking up after surgery, Joachim was in a lot of pain. By Wednesday she was feeling much better. Pastor Samuel Pierre brought her a Bible in Creole, and they prayed some more.
Kristina Moriconi went to the gift shop and bought Joachim pink pajamas.
On Friday, feeling much better, Joachim left the hospital and Kristina brought her to a nail salon for manicure and pedicure.
Meanwhile, Steve Moriconi got his lab results back. The sample he sent originally was only from the surface. This second slice was from the core - and it revealed the tumor was an ameloblastoma, a type that has a much higher tendency to come back.
He explained his concerns to Vixama, the young medical student in the Dominican Republic. Had he known it was ameloblastoma all along, the prudent course "would have meant cutting out half of her jaw, placing a graft from her hip, and using a reconstruction bone plate," Steve e-mailed. "I think to do that now, with her returning to a tent and bad water and unsanitary conditions, would be a bad idea. So, I will accept the surgery I did and hope that the tumor will not come back."
Kristina also e-mailed Vixama: "You have helped us to see a light that had gone dim in our daily lives. So, thank you for that. I keep you in my prayers every day."
On Saturday, Kristina took Joachim to camping and sporting-goods stores to buy a tarp, air mattresses, and a solar lamp for her tent. The Moriconis took her to Pierre's Haitian church Sunday morning, and then to an afternoon cookout with Steve's old Haitian roommate in Downingtown, where she and Blanchet talked for hours in Creole and traded recipes.
Joachim, who returns home on Saturday, says she's grateful for everything she's received, and Kristina hasn't stopped doing everything she can, knowing that Joachim is going back to her life in a corrugated tin tent, in a struggling land.
They will meet again when the Moriconis go to Haiti in March, he to work in the same clinic, she to teach English at a school for a week.
What they've done, Steve Moriconi said, is just a drop in a bucket.
But he added, "Even a drop in a bucket multiplied many times could fill it, and further overflow it, eventually leading to a river and then an ocean. ..."