Restoring the face of a 4-year-old boy deformed by a gunshot wound is a situation most people only expect to encounter in medical dramas like Grey's Anatomy. For Craig Birgfeld '94, it turned out to be one of the most rewarding experiences of being a craniofacial specialist.
In May 2007, Birgfeld donated his time to the 12-hour reconstruction of 4-year-old Muhammed "Hamoody" Hussein's face at the Children's Hospital and Regional Medical Center in Seattle. Birgfeld, who in addition to being a surgeon is an assistant professor at the University of Washington, worked alongside University of Washington Professor and Chief of Craniofacial and Plastic Surgery Joseph Gruss to perform the surgery.
"Dr. Gruss, my mentor, has a vast experience in reconstructing facial trauma," says Birgfeld. For Hamoody's case, expertise in the realm of facial reconstruction was essential.Hamoody received the gunshot wound in 2005 in his native Iraq, after Sunni insurgents ambushed his family, who is Shiite. He was brought from Iraq to Seattle in 2006 by the Everett chapter of the national nonprofit Healing the Children. Hamoody had already gone through a year of having doctors in the United States assess the extent of his facial injuries before the case was finally handed over to Gruss, an expert in facial gunshot wound repair. Although earlier attempts were made by surgeons to repair Hamoody, none had truly aided in the reconstruction of his face.
"When we saw Hamoody, it was still clear that a large hole had been blown right in the middle of his face, displacing his nose and cheeks outward like a crater," explains Birgfeld. "The bony framework was in disarray and his facial components were in the wrong place."
What followed was a difficult reconstruction. "While I have performed thousands of surgeries in my residency, none of them were the same as Hamoody's," recalls Birgfeld. "Hamoody's reconstruction borrowed techniques from treating birth defects, clefts and trauma patients."
According to an article in the Seattle Times, the gun was likely fired at Hamoody at close range. The gunshot shattered both Hamoody's nose and an eye socket and displaced much of his soft facial tissue. The prolonged blockage of Hamoody's nasal passage had also caused him severe sleep apnea and sinus damage.
"We had to re-create his nasal airways, as they had been filled up with bony fragments from the initial injury," says Birgfeld. "We drilled out these airways and lined them with local tissue so he would again be able to breathe through his nose, which he had been unable to do since the injury."
In turn, Birgfeld and Gruss rebuilt many of Hamoody's facial structures, including his nose, from part of his ribs. "We shaped the rib like a tomahawk so that it would provide support for his nasal cartilage and skin," explains Birgfeld. The doctors also used a 4-inch piece of Hamoody's rib to replace the missing eye socket. Birgfeld remembers that cameramen who were covering the surgery had to sit down at times because their cameras became too heavy during the intense, 12-hour process.
Although Hamoody's case proved to be unique for Birgfeld in terms of its technical challenges, it was not his first pro bono case. According to Birgfeld, the necessity for doctors to donate their time to patients happens more often than one likes to imagine. "In the field of craniofacial surgery, this can be a fairly large part of the practice and this is right here in the United States," he says.
"In Seattle, we treat patients from five states in the Northwest including Alaska and quite a few of these people do not have insurance. For the most part, the care we give them is uncompensated." According to Birgfeld, the same can often be true on an international scale. "When you look outside the U.S. to third-world countries, the medical need is astounding," he says.
Hamoody's case is an example of the individual acts of kindness that allow doctors like Birgfeld to provide treatment to those who need it most. "Hamoody's story is particularly touching given the tragedies he has gone through and the lengths people have gone to in order to get him the medical care he needs," says Birgfeld.
As a craniofacial surgeon, Birgfeld feels privileged to be operating on children. "We are always taught in medical school that children are not little adults," he explains. "They tend to be healthier and bounce back faster, but at the same time, it seems the risks are greater in children as they have a whole lifetime ahead of them." For Birgfeld, the benefits of working with children always outweigh the risks. "It's extremely rewarding," he adds. "They're just kids who like to laugh and play and pull my tie and draw pictures like any other kid. It makes going to work fun."
Birgfeld believes his academic experience as an undergraduate at William and Mary contributed invaluably to his ability to take on difficult cases such as Hamoody's later on in life. "After 15 years of schooling and training, I can safely say that nothing was harder than getting a good grade at William and Mary," he says. "I met and worked with many people from other 'top tier' schools where grade inflation was the norm and I can say that the grades given at W&M are earned."
As for Hamoody, more surgery will be needed in order to complete his facial reconstruction. "These complex reconstructions often require multiple stages, which means a few trips to the O.R. for the patient," Birgfeld explains. Although uncertain of what lies ahead for Hamoody, Birgfeld hopes to work on any future operations that he may undergo in the United States.
"He is an amazing little boy," explains Birgfeld. "There are many times I finish my day and can't believe how lucky I am to get paid for doing something I love so much."
