ever seen. She had gorgeous eyes, a gappy grin and soft black hair that fell in crazy layers around her face.
She was a happy little thing, chatting away merrily to everyone in her native tongue and had a giggle that was wickedly infectious. She had taken a particular liking to blonde-haired Katya and in the two days she’d been at the clinic Ten-ti had drawn at least a dozen pictures of her favourite nurse.
Katya had taken Ten-ti down to the garden with her that morning and the little girl had crawled into Katya’s lap and laid her head against Katya’s chest and waved and smiled at everyone who had come past as if to say, look at me, look how important I am.
The foundation had found Ten-ti at an orphanage. She had been abandoned at the age of one by her family when her condition had shown no signs of improving. It was hard to believe that the little girl was so happy. When Katya thought about how abandoned Ten-ti must have felt, it broke her heart.
At least she wasn’t going to give her baby a chance to get attached.
Katya looked down at the defect now as Ben made his first incision. The haemangioma was impressive. The vascular benign tumour protruded from Ten-ti’s skull over her temple. It was quite large, about the size of a grapefruit, and its typical bright red colour was marred in the centre by a large, ugly, grey-black patch where it was badly ulcerated.
It looked like something out of a science fiction magazine. Like a maniacal cartoonist had dreamt it up — a beautiful child with a mushroom-like growth protruding from her head. A soft spongy mushroom.
The nuns that ran the orphanage had been told that it would gradually get smaller and disappear, as the majority of hemangiomas did, but Ten-ti’s had shown no such propensity. At the age of four there were no signs of the tumour involuting and the ulceration, with its associated bleeding and pain, had made her a perfect candidate for surgery.
The actual excision of the haemangioma was relatively easy and Katya watched as Ben expertly sliced and slowly divided the tumour from the scalp. She handed him a metal kidney dish as he performed his last slice and he dropped the spongy mass into the metal receptacle.
Katya stared at it. On Ten-ti’s head it had looked huge. A nasty, poisonous-looking, disfiguring mass that had isolated her and flawed her features. And now, after four years of marring her life, causing her to be abandoned, it lay there, looking incongruous.
Impotent.
Katya turned slightly and placed the kidney dish on her trolley, draped with sterile towels and returned her attention to the procedure. There was now a sizeable area on Ten-ti’s head, about six centimetres across, where there was no skin to cover the skull.
‘Closure device,’ said Ben.
She had already anticipated his needs and he held out his hand at the precise time she was handing him the instrument. The transfer was seamless. No pauses or fumbling, just smooth and flawless. Textbook. A well-oiled team.
Katya had never seen these devices until now. There hadn’t been much call for them in the MedSurg environment. Ben used them quite a bit and she’d even seen him use them under local anaesthetic at the bedside. They looked a bit like a fancy can-opener to her but the results were fantastic.
Ten-ti’s wound was too wide for normal closure. The wound edges were too far away from each other to sew together and would normally require a skin graft. But this tricky little device was designed to stretch the skin so the margins could be brought together and then safely sutured or stapled. It worked by applying a controlled amount of tension evenly along the wound margins and exploiting the elastic properties of skin while minimising its tendency to recoil.
Ten-ti’s head had been shaved around the tumour site to allow easy visualisation of the wound edges and Ben now applied the device to them. When he was satisfied with the placement he locked the device in place and started to turn the tension knob, beginning the stretching process. After twenty minutes Ben was satisfied with the approximation of the edges of the wound and he sutured it closed, using the conventional method.
‘There,’ he said, turning to Katya. ‘She’ll be as pretty as a picture.’
Katya couldn’t wait to see Ten-ti’s reaction when she woke up and realised that the disfiguring growth, which had bled and caused her so much