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A Crown for Kathrina: A Long Day of Surgery (Part 4)

12.28.05

“In a way there’s an advantage with her only being 4. She doesn’t quite understand. If she were 8 she’d really understand much more of what she’s getting into. So there’s maybe a little less fear,” said Kathrina’s mom, Tamara.

In the few remaining minutes before their daughter’s surgery, Tamara and Paul get their final instructions.

“And if they need us at any point in the middle, they just page us,” said Tamara.

Now it’s time to take the long walk down the hallway. Their time together here ends all too soon.

“Saying goodbye was really hard, really hard. More because I know she didn’t want to say goodbye. She wants me to stay right with her. So that’s hard,” said Tamara.

After one last kiss and some final words of encouragement, the realization of what’s about to happen finally hits Kathrina. It is the first time, we see her cry.

“Be brave. Doctor is going to get you a crown. Get the crown on you’re going to be able to breathe better,” said Paul.

“Mommy … mommy will be with you as soon as you wake up, OK.”

“You keep it short and sweet, because if I drag it out it only frightens her more,” said Tamara.

In the operating room at 8:16 a.m., Kathrina is put under anesthesia. A blue plastic film is draped over her eyes protects her corneas. The intense color makes her look even more the porcelain doll.

Before he begins, Dr. Richard Hopper, Clinical Surgical Director of the Craniofacial Program at Seattle’s Children’s Hospital, checks the model again. He will refer to it several times during surgery.

“The model was very helpful. It will let me visualize 3-dimensionally exactly where my chisel was going to be placed, where the breaks needed to be and how things would separate,” he said.

This is a difficult and rare surgery where anything could go wrong. If there is uncontrolled bleeding in the brain, she dies. One wrong tap of the chisel and her facial bones would shatter.

Then there are the shunts under Kathrina’s eyes, put there during a previous surgery. Puncture them and she loses her vision completely.

“While she’s asleep, we can feel her nose and you can see she has no nasal support. There’s no bone protecting her eyes from the top,” said Dr. Hopper.

Dr. Hopper will be working very close to Kathrina’s brain.

Another goal will be to elevate Kathrina’s cheekbones and forehead to protect her eyes, and build a nose to help her breathe.

Dr. Hopper plans to make the nose by using a piece of her rib.

“At Kathrina’s age, she can actually grow ribs back, where adults can’t do that so it’s really not going to be a problem to take that and use it for the nose. But I’m not going to make this cut and harvest the bone until I’m sure I can use it. If we run into any problems before the rib grafting I want to make sure we don’t have the rib wasted,” said Dr. Potter.

A surgery like this typically takes about eight hours. In a more challenging case like Kathrina’s, 10 hours, but even that prediction will prove overly optimistic.

“The first thing on my mind was getting ready for that first challenge which was being able to peel Kathrina’s forehead down without causing any damage to her brain,” said Dr. Potter

It’s a long and arduous process, made even more so by scar tissue from a previous surgery, when Kathrina was only an infant.

“You just have to anticipate and be ready for anything,” said Dr. Potter. “It’s a tough dissection as we knew ahead of time. She’s had a number of procedures, that’s what makes it difficult.”

The clock ticks and hours pass while the Goodwins wait.

“I’m pretty good at waiting around, killing time … just try not to think about it too much,” said Tamara.

“It just makes you shiver a little bit. And recognizing its 11 hours of surgery, its a long day for her and what she’s going to go through,” said Paul.

More than three-and-a-half hours later, the first stage of the operation is complete. Dr Hopper has finished the delicate task of exposing Kathrina’s skull.

“Everyone always asks where’s the drama? Where’s the excitement? Everything we try to do is to avoid the drama and the excitement. If that happens, we’re ready for it, but the best way to deal with something suddenly going wrong is to just calm yourself down, take a step backwards and then take care of the problem,” said Dr. Potter.

Next, Dr. Hopper rebuilds Kathrina’s cheekbones. Set extra low, they’re difficult to reach.

“Once you make the breaks, and you’ve sure you’ve made all the right breaks you have to slowly tease the face loose,” said Dr. Potter

At this point, Dr. Hopper sees there is enough bone to anchor Kathrina’s new nose, which he now builds from one of her ribs.

“It’s been made into a tomahawk so that this becomes the root of the nose and this becomes the tip of the nose. so it’s almost like you’re looking at somebody’s nose in profile. You look at it like that,” he said.

Finally, almost 11 hours into the surgery, Dr. Hopper is ready to attach the distraction device: Kathrina’s crown.

“Everything went extremely well … a little bit longer than expected. We’ve built up Kathrina’s forehead and protected her eyes. We’ve broken her facial bones off of her skull and attached this distracter and that allows us to move her cheekbones forward. We also started to build her a nose. This is a bone graft from her ribs. before the operation I could push right down and flatten her nose and now she has a nose that has support,” he said.

“All of the goals were achieved. We’re very happy with the results so far and I look forward to talking with her parents.”

It’s been 12 hours of surgery. Now, just after 8 p.m., Kathrina is wheeled out of the OR and down the hall into the recovery room. She’ll be sedated for the next three days.

Everything went well, even better than expected.

Still, Dr. Hopper isn’t ready to call the operation a success.

“Things can still turn bad very quickly. So I never let myself breath a sigh of relief until the device is off and she’s back to normal.

She can get a bad infection, she can get an infection to the point that I’d have to remove the device. Her face wouldn’t heal. And we’d lose everything that we’ve gained,” he said.

« Part 3: Preparing for Surgery | » Part 5: Kathrina Goes Home