THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Tuesday, January 3, 1995 TAG: 9412310094
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: By DEBRA GORDON, STAFF WRITER
LENGTH: Long : 239 lines
EARRINGS.
Pierced earrings.
Gold, maybe, with tiny diamonds. Or pink, with dangling Barneys.
That's what 6-year-old Anna Morgan dreams of.
One problem. Anna was born without ears. Just the smoothness of her toffee-colored skin disappearing into her curly black hair.
And so Anna asked her doctors for the one thing she truly wanted for Christmas.
Ears.
It's nine days before Christmas, and the Morgan apartment in Hampton is scrubbed clean, the colored lights on the tree luminous in the deepening afternoon gloom.
The phone never stops ringing. It's a television reporter who wants to do a story on Anna. It's her aunt in Georgia to check on the details of the surgery. It's a friend who wants to spend the night.
Anna is wired, babbling non-stop in her thick, hoarse voice, a result both of her hearing deficiency and a malformation of her jaw.
``Want to see my room? Want to see my picture? I can ride a bike. I'm getting a bike for Christmas. Look, I got straight A's in school.''
She needs to burn off some of that energy. Maybe go over to the community center and shoot some hoops, her favorite after-school activity.
But it's much more exciting today in the small apartment, where a table of Christmas goodies and a visitor she can charm are waiting.
``Can you believe when she was born they told me she'd never walk or talk?'' asks her mother, Jean Morgan. Jean, 41 and a single mother, was expecting a perfect baby when Anna was born four weeks early.
Her ``perfect'' child had no ears, no tailbone, a misshapen jaw and face, and severe gastric problems, necessitating surgery.
She had a disease Jean would come to know well over the years: Goldenhar Syndrome, a series of birth defects primarily affecting the face, jaw and vertebrae.
For nearly a year, Jean remained in denial about her daughter's problems. She wouldn't let anyone talk about Anna's deformities; wouldn't admit to them herself.
She asked Anna's plastic surgeon if she could give her daughter her own ears. ``My life is over,'' she said. ``I don't need them.''
And she never took her baby out of the house without a hat on. Winter, summer - didn't matter. Anna always wore a hat. Always with little flaps to cover her missing ears.
Until one hot summer day, about a year after Anna was born, when Jean walked into the social workers' office at the Children's Hospital of The King's Daughters for an appointment.
She'd become friendly with the office manager, Jayr Ellis. He gave her money for food and gas, listened to her talk, held Anna.
On this day, as he watched the baby sweating under her ever-present cap, he confronted Jean, saying: ``Jean, it's hot outside. Why is she wearing a hat?''
``I don't want people staring at her.''
``Jean, she's going to get her courage from you. And if you can't deal with it, she can't deal with it.''
Jean took the hat off Anna and stuffed it into the diaper bag. That was the last time she tried to hide Anna's deformities.
Gradually, as Anna's independent, sunny personality developed, Jean learned to look beyond the missing ears, to see the uniqueness in her rambunctious daughter.
When Anna was 2, Jean entered her in a baby beauty contest. ``Cause she's so pretty,'' she'd explain to people who asked her why. ``Because she looks like a little china doll.''
The little girl with the thick, sooty eyelashes didn't win, but the experience went a long way toward helping both mother and daughter cope with Anna's disabilities.
It was a statement, a ``coming out'' of sorts, that even though she didn't look like other little girls, Anna could still do things other little girls did.
Like hear.
Initially, doctors told Jean her daughter had no hearing. But one day, when Anna was 18 months old, the physical therapist clapped her hands hard on Anna's left side.
Nothing.
Then she clapped on the right side.
Anna blinked.
She clapped again, and Anna moved her head.
That's how they discovered she had some hearing on her right side. To intensify the vibrations against whatever existed of her middle and inner ear, Anna began wearing a one-sided headset on her right side.
Throughout Anna's struggles, Jean, too, has grown. She's taken control of her life, getting her GED and entering Thomas Nelson Community College. She hopes to become a physical therapist, to work with children like Anna.
Her goals are simple: to get off welfare, to provide more things for her and Anna, to show Anna the value of hard work.
Her daughter is her biggest cheerleader. Anna makes sure a visitor knows that Jean is on the student council, that she made all A's this semester.
But when the talk turns to her ears, Anna quiets.
It feels bad to have no ears, Anna admits, her deep, liquid brown eyes grave. ``It just feels different.''
At school, the kids ask her why she doesn't have ears. Why she has to wear that funny one-sided headset over the place where her right ear should be.
And Anna answers them the way her mother taught her: ``Because I'm one of God's little angels, and one day I'm going to have ears.''
And now that day has come.
Barney is dressed in miniature surgical scrubs and a mask. He's getting ready for surgery, just like Anna, who, on this still-dark morning six days before Christmas, clutches the stuffed purple dinosaur in her arms.
She's scared. So scared she's lost her ability to hear and just stares open-mouthed at the friends and relatives who shout encouragement.
She clings to her mother, who is trying bravely to control her own tears. Jean has perfect faith in Anna's doctor, plastic surgeon Ivor Kaplan, but she's also scared about the length of the surgery. Four hours her baby will be under. Four hours.
``I want Dr. Kaplan,'' Anna croaks. ``Where's Dr. Kaplan?. He's the only one who can make my ears.''
Finally, it's time to go. A nurse comes to take Anna to the operating room. But because this is no ordinary hospital, they don't go the ordinary way.
Instead, Anna climbs into a small blue car, puts Barney in the seat next to her, and, with the nurse pushing, ``drives'' her way down the hall to the operating room.
Once there, she's surrounded by a gaggle of nurses, who fuss over her braided hair and multicolored rubber bands. They give Anna a plastic anesthesia mask and ask her to hold it over Barney.
Then they put a similar one over her face, and the sweet watermelon scent of the gas drifts up her nose.
The nurses sing the Barney theme song: ``I love you, you love me. We're a hap-py fam-i-ly.'' Before they reach the next verse, Anna is limp.
They lay her down on the table, whisk Barney away and begin prepping her for the surgery.
By the time we are 3 years old, our ears have grown to 85 percent of the size they'll be when we're adults. By age 10, they're the size they'll be for life.
So when doctors make new ears for children, they like to do it around age 6 - right before the kids start school. Because with school comes the taunting of other children and the possible loss of self-esteem.
Little girls, Kaplan says, just want to be able to wear earrings. Sometimes he even brings earrings into the operating room and pierces their ears before they come out of surgery.
But he won't be able to do that with Anna.
Today's is just the first of several surgeries she'll need before she can toss her head and feel the jangle of earrings against her neck.
Subsequent operations will lift the ear away from her head and create a lobe. In about three months, if all goes well, she'll go through it all over again - on her left side.
But none of it will help her hear better. What it will do, says Kaplan, is provide a site for the ear doctors to work around if they go in later and build an external ear canal.
In ear reconstruction, unlike hip replacement or breast enlargement, there are no plastic, man-made devices to use. Because the layer of skin covering the ear is so thin, man-made devices would show through if the skin gets nicked or cut.
So while Kaplan works on her head, plastic surgery resident Richard Raszewski will remove three pieces of cartilage from Anna's rib cage. Later, Kaplan will painstakingly carve and wire them into a facsimile of an ear.
This combination of creativity and science, of art and skill, makes ear reconstruction one of the toughest surgeries to do.
Anna's surgery is complicated by the fact that she has hair growing on her face where her ears should be. And nothing, says Kaplan, is worse than making a new ear and having hair grow on it.
Ordinarily, he would simply open a slit between the skin of her face and her skull and slip the new ear in, much like stuffing an envelope.
But in Anna's case, he has to carefully slice a tissue-thin layer of the covering of the skull itself - called the fascia - into a flap he can then fold over the ear. This provides the blood-rich base on which a skin graft, to be taken from her inner arm, can grow.
The operation is even more difficult because Anna has nothing - not even a tiny nub of ear - to guide Kaplan.
``This is the worst kind of ear reconstruction,'' he says. ``We're starting from ground zero.''
To direct him, he has made a template from the ear of another 6-year-old patient, cutting it out of clear blue X-ray film.
He also relies on ancient anatomical studies of ear placement conducted by the Renaissance artist Michelangelo, who showed that the ear is usually one ear's length from the side of the eye, in a line from the eyebrow to the bottom of the nose.
Kaplan, following this rule, places another piece of X-ray film over Anna's skull, and, measuring from the base of her nose, draws an outline of an ear.
Two hours after the surgery has begun, it is time for the second, most difficult stage of the three-part procedure.
Anna lies still on the table, a wet gauze covering the bloody flap on the right side of her head. Raszewski is still closing the crescent-shaped incision over her ribs.
In a stainless steel tray are three white pieces of cartilage, each about 3 or 4 inches long, that Raszewski took from her rib cage. They'll grow back, says Kaplan. ``It's amazing how many parts of our body we don't really need,'' he says.
He slips on his magnifying glasses, places a clean blue towel over the bottom of a metal basin, and carefully lays the three pieces of soft bone on top, preparing to carve.
When he was a resident, Kaplan learned to carve ears by practicing on soap. Camay soap.
But there is no time - nor any extra cartilage - to practice with today. It must be done right the first time.
Kaplan uses a simple woodworker's tool, an X-acto knife bought at a hobby shop, to mold the soft, flexible cartilage.
He holds the template over one piece and uses tweezers to bend it into a curve. Then he picks up a tiny needle threaded with stainless steel wire and begins sewing the pieces together.
It doesn't have to be perfect, this ear. Instead, Kaplan uses illusion and shadow to create the perception of an ear, a base on which the skin will mold itself.
Watching him work, you can't help but reach up and touch your own ear. Feeling its ridges and bumps, its height and depths. And you know, as he carefully scrapes flecks of cartilage from what will be the outer ridge of Anna's ear, that you will never again view your ear in the same mundane way. From this day on, your ear is a sculpture, a piece of art.
When he is finished, the operating room erupts with applause. It is an ear. Even without skin, without a lobe, it is definitely an ear.
Kaplan moves back to his spot at the right side of Anna's head. He slips the ear into the pocket of skin he had created just above her cheekbone - later he will cut it out to form the lobe - and carefully, moving very slowly, lifts the tissue-thin flap of fascia down over the ear.
It stops with about an eighth of an inch still showing.
Too short.
He eases the ear out, hands it to a nurse and carefully lengthens the pocket over Anna's cheekbone.
Then he tries again, and this time the flap of tissue folds over. He inserts a suction tube, turns on the suction and with a whoosh the fascia is sucked down onto the ear, and all the ridges and shadows are revealed.
Using a device that looks like an oversized cheese slicer, he carves a wafer-thin, 2-inch square piece of skin from the inside of Anna's arm - the best color match - and drapes it over the fascia. The skin graft will bind to the fascia tissue, using its blood supply to grow and eventually covering the entire ear.
And then, using a curved needle no larger than Anna's pinky fingernail, Kaplan, the Santa Claus of the operating room, begins stitching together Anna Morgan's Christmas present. MEMO: Anna Morgan was released from the hospital three days after her
surgery and spent Christmas at home with her family. She saw Kaplan on
Dec. 27 in his office, where he unwrapped her bandages. Most of the ear
was doing fine, a bright, healthy pink. But some of the flap and skin
graft had died.
She was scheduled to go back into the operating room Dec. 30 for
additional surgery. ILLUSTRATION: Color photos by Lawrence Jackson, Staff
Anna Morgan...
by CNB