9 ‘o clock AM. It is a beautiful day at the Angkor Children’s hospital. The blazing sun bakes my skin, sticky from the engulfing, inescapable humidity.  Step into the screening room.  Ahhhh – “the refuge,” as Paul calls it – at 86 degrees Fahrenheit.  On the other side of the double doors stand 60 children and their mothers in the heat of the outside sun.  Some have traveled far to come to the hospital. For many, the cost of getting here is more than the average weekly wage; a couple hours in the sun is nothing.  Eyes look through the glass windows in the double doors – mothers with happy faces, children with curiosity.  These children have been pre-selected by the hospital for our team.

Jessie and I set up our laptop and patient charting station.  On the other side of our desk is Paul (our pediatrician), and in front of him are Dr. Nichter and Dr. Vann Thy (Assistant Chief of Surgery at the hospital), and to the right Chris (our anesthesiologist). We all set up our arbitrary “stations.”  And then the screening process begins.

Children walk in, sometimes not knowing what to expect.  Some are hesitant; some little ones – not understanding what is happening – cry; most children have serious, somber expressions, as if seeing a doctor confirms there is something wrong with them.

Fast forward a couple hours.  A shirtless quiet 3-year-old boy with a buzzed haircut holding his mother’s hand steps into the screening room.  His name is Ly Math.  His mother motions for him to sit in the chair facing Drs. Nichter and Vann Thy.  He obeys, then turns around and looks at her, hiding half his face behind the backside of the chair.  Dr. Nichter asks to turn him around so that he can begin examining him.  From the left, Ly looks like a soft, impressionable, innocent little child.  His right side is stretched and immovable, drastically limiting facial mobility.  A brief flash in a fire at 1 year old, changed his life forever.  The bottom of his chin is attached to his  shoulder, making it impossible to turn his head.  Should he have to see something on his side, he’ll have to turn his entire body.  The bottom right corner of his mouth is pulled down and is permanently open (probably limiting chewing capability).  The bottom of right eye –stretched so that the white of his eye made more visible.  Facial mobility in the right side of his face affects facial mobility on the left.  Therefore, Ly looks stoic — hard to read.  Yet his physical responses give clues to his thoughts.  He listens to Dr. Nichter talk – his eyes searching and curious.

On to Paul, who has a wonderful — almost fatherly way — with kids.   Paul checks to see if he has any allergies, is on any medication, what his past surgical history is like and so on.  He is a go.  Cleared for surgery.

I then walk him over to Jessie, who takes his pre op photo. I motion him to the space in front of the camera.  At the sight of the huge, wide lens, he stops.  His hesitation, a window into his thoughts.  He looks up at his mom and she gives him a reassuring look.  He walks to his place, and I am surprised by how small he is.  Perplexed, I can’t tell what he’s thinking.   His face says nothing.  But something about him seems older than his age. He’s holding something back…such restraint, control, acute awareness for a young boy. I smile at him, hoping to convey that he will be fine, that everything will be all right.

Then, suddenly, a teardrop lands on his right cheek and runs down his chest.

And another one.

And another one.

Each time, heavier; each one, bigger.   His scarred right lower lid is stretched down, creating no space for tears to pool up, so they fall out of his eyes.  Yet no words or bodily movements that would indicate that anything is wrong.  He stands there, in front of the camera, tears rolling down his face and chest.  I can no longer force a smile and I feel my throat swell, my face warm and my eyes water.  After pictures are taken, his mom holds his hand and walks out of the screening area.  I walk back to my desk and Paul asks me if I heard what Ly asked him.  I didn’t.  The boy asked if he was going to die, because that is what he thinks happens to people in the hospital.  At 3 years old, Ly has experienced more than is bearable.

Ly Math

Linda Nguyen- Trip Coordinator