On the agency side, business continued to take off. Our software client asked us to handle their global advertising, including twenty-nine countries. We opened a second office in Paris. Before long I was flying back and forth to Europe each month. My lifestyle shifted into high gear along with the agency’s soaring revenues. These were the go-go ’90s, a time of crazy excess in New York. Like a lot of my high-rolling friends back then, I was invested in new tech startups and seeing insane, instant returns. I bought a McMansion in the Hamptons. I was backstage at the Metropolitan Opera House sipping Champagne with Pavarotti, riding in a helicopter with Tom Brokaw to a special dinner with the governor of New York on Long Island, and flying to Utah with my friend Ann Ziff and Carly Simon in a private jet to see the Bulls play in the NBA finals.
It was as if I was living in two completely separate worlds. My work with the school’s program grounded me in a side of New York that was invisible to my wealthy friends. But at the same time, I’ll admit, I was living happily and spending lavishly. Looking back, there’s every chance I would have continued on my path of excess—while keeping my charity work quietly in the background—if it weren’t for another serendipitous event that occurred in the spring of 1993.
It was lunchtime, and I was sitting at my desk on Madison Avenue, eating a sandwich and flipping through People magazine. All of a sudden, I saw something that made me pause: an article about a charity called Operation Smile. That’s weird, I thought. Our NYC school program is called Operation Smile! But this article was about a charity based in Virginia. Even stranger: this organization was also offering free reconstructive surgeries to kids. I read on and learned that this project was much broader in scope than ours: they sent teams of volunteer plastic surgeons from the United States on two-week missions all over the developing world to help children receive the surgeries they needed.
We had already been discussing taking our schools program nationwide, but it had never occurred to me to think beyond America. This was a whole new dimension and I was intrigued. I wrote to the organization’s founders and told them I was sorry that I had inadvertently taken their name for our program! I explained our success with the schools program and wondered if they were interested in exploring common ground or opportunities to collaborate. I got a very nice note in return, so not long after, I got on a plane down to Virginia to meet them.
From the moment I arrived at the other Operation Smile’s offices, I could tell that this organization was the real deal. As we walked along the hallways, I saw framed articles and photographs, accolades, and recommendations from everyone from Mother Teresa to Ronald Reagan. In one room the size of a small warehouse there were crates and boxes stacked high, ready to be packed up for the next mission. That day I learned that while my program was helping a few hundred children in New York, this Operation Smile was helping thousands of children all across the developing world.
I was really attracted to the size, scope, and scale of Operation Smile. Compared to what we were doing in New York it felt like the big leagues. We hit it off and over dinner, we started talking about joining forces. A few months later, I agreed to merge my school program into their charity and in exchange I would join their board of directors. The idea was this would give me the resources to scale my program up nationally to tens of thousands of schools while I learned about providing surgeries in developing countries.
Not long after I came onboard, Operation Smile’s management, feeling that it would help me understand the organization’s work if I spent some time in the field, suggested that I accompany a team on a mission to rural China. I agreed. I figured I’d go, take a few photos, make a few notes, and then come back and continue on with my life, slightly better informed of Operation Smile’s work in other parts of the world. I had no idea how that trip would alter the course of my life.
When I took that trip to China in 1994, I considered myself a pretty cosmopolitan guy. I was well traveled—or so I thought. I had been to Europe and the Caribbean. I knew all the best places to drink Champagne in Paris. But nothing in my life had prepared me for what I was about to experience as a volunteer on my first medical mission, to Jiangsu Province in China.
It had taken twenty-four hours of nonstop travel to get from New York City to Hong Kong, and after being confined in the cabin so long, I was looking forward to stretching my legs and breathing some fresh air—until I stepped off the plane, where a wall of heat and humidity hit me, as intense as a steam bath. I collected my luggage and joined the rest of the medical team, including the founders of the charity and some of their program staff, and together we boarded a crowded subway train. Next, we transferred to a small van to complete the last leg of the journey.
By now I was exhausted, so I closed my eyes and tried to drowse in my seat, only to be jerked awake about an hour later as our driver swerved dramatically to avoid something in the road. Out of the window, I could see a car accident, bodies strewn in our wake—a gruesome sight, and enough to keep me awake for the rest of our eight-hour drive along the uneven dirt roads of rural China. Outside, sloping green hills and marshy rice paddies seemed to stretch on and on. Night fell, and the lurching of our van over the rough terrain became increasingly jarring. Finally, around 2 A.M., we arrived at our destination: a small town outside Nanjing, in the northern part of Jiangsu Province.
Until now, my world travel had been an extension of my bubble of comfort and privilege in New York. Sure, I read the newspapers, but I never spent much time considering what life was actually like for people living in the developing world. Now, stepping out of the van, I was confronted by a place I didn’t recognize or understand. All I could see was a cluster of small tin shacks. Did people still live in shacks in 1994? The smell of wood smoke from open fires was thick in the air. There were hardly any streetlights, and only the occasional lantern punctuated the darkness. Chickens pecked for food in the road. The whole place felt disturbing and unfamiliar.
After leaving our luggage at our ramshackle hostel, we were taken to a nearby hole-in-the-wall for something to eat. I forced down a little food and then went back to my room, where I collapsed into bed around 4 A.M. Two hours later, the alarm rang. It was time to get up so we could drive to the hospital, where the team was already preparing for the day.
The sun had barely risen, but as we pulled up to the hospital compound, crowds of patients were already gathering outside a small cinderblock building where the mission was being staged. The line spilled out of the door and stretched around the building. Everywhere I looked, there were children, babies, toddlers, teenagers, all of them with some kind of defect or deformity: kids with terrible untreated burns searing their skin, babies with vivid tumors across their faces or huge disfiguring birthmarks. This was unlike anything I had ever seen in my life.
With our translator at my side, I picked my way through the crowd and toward the main building, and then up a series of crumbling concrete steps. Inside I found myself in a dark hallway lit by a single bulb. To Western eyes, this place looked more like a prison than a hospital, but in fact—as the translator explained—it was the only medical establishment in a hundred-mile radius.
With the help of our translator, I began to learn a little more about the families waiting in line. Each one of these children had come here with a parent or grandparent. Although the vast numbers of children in need made me catch my breath, it was the look in the eyes of the adults that affected me most. The parents stared at me with a mix of desperation and hope—desperation that this had happened to their child and hope that maybe these American doctors could finally do something about it.
“How did you hear about these surgeries?” I asked.
By word of mouth, radio ads, wall writing, billboards, they told me. These mothers, fathers, and grandparents were mostly peasants—rice farmers who earned daily wages that were barely enough to keep their families alive. They would never have been able to afford surgery for their children without this program. I shook every parent and grandparent’s hand, trying my best to communicate how much empathy I felt for them, even without the benefit of a common language. As we clasped hands, I could feel the skin of their palms, as calloused and rough as sandpaper.
I met a father and his nine-year-old daughter who had come from over 120 kilometers away. Through my interpreter, I asked the father if he could tell me his occupation. He said, “Peasant.” He explained that he made the equivalent of fifty cents a day tending the fields and that he could live a hundred years and never be able to afford the surgery his daughter needed. When this father heard there was a chance his child could be treated free of charge, he left his work, gathered together some meager belongings, and began the long journey to the hospital with his daughter. Without money to pay for transport, they walked much of the way, hitching rides whenever they could. The journey had taken them several days.
The man’s daughter was called Li Yin Kan, which roughly translates into English as “Beautiful Cloud.” In my memory of her, she will always be Beautiful Cloud because she was beautiful, with bright eyes and shiny black hair. But Beautiful Cloud also had a severe cleft dividing her upper lip. It looked as if someone—or something—had torn the flesh from that area of her face, dividing it in two.
INSERT PHOTO: BeautifulCloudBefore
In those days, I knew very little about clefts. I certainly hadn’t ever seen anyone with an unrepaired cleft before. In the West, any baby born with a cleft has it repaired in the first few months of life, leaving only a small scar behind. It would be unthinkable for a child in America to walk around with a birth defect as visible as Beautiful Cloud’s—the surgery is so simple, inexpensive, and readily available. But as I was about to learn, in rural China in 1994, when access to surgery was so scarce, unrepaired clefts were a very common sight. This was the number one birth defect in China and in most developing countries around the world.
Beautiful Cloud’s father told us about how hard it was for his daughter to live with her cleft. The other children in the village teased her viciously. His daughter was so miserable she had stopped going to school, and instead stayed home in virtual hiding, helping her mother with chores. The other villages gave the house a wide berth, believing the family must be cursed. Clefts are particularly tough on girls, the translator explained, as so much of a girl’s value in the developing world is measured by her ability to marry. If a girl with a cleft can’t marry, she becomes an economic burden on her family. Without surgery, there was little hope of Beautiful Cloud being able to lead a normal, independent life.
When I looked at Beautiful Cloud, I felt such a pang for her. Many birth defects can be hidden, but there was no hiding for this little girl. Her cleft was written across her face.
I asked the father if I could accompany his daughter into the operating room while she had her surgery, and he gave his consent. Father and daughter said goodbye to each other—I wasn’t sure which of them looked more terrified. Beautiful Cloud bravely took the hand of one of the nurses, who led her away to be prepped for surgery. I scrubbed in—making sure my hands were meticulously clean and putting on a hospital gown over my clothing—and when the little girl was ready, I walked with her into the OR.
All around us, gleaming machines were humming and beeping. The surgeon and his staff were waiting in their gowns and masks. I helped the little girl up onto the table, doing my best to reassure her with smiles and hand motions that she was going to be just fine. The anesthesiologist then handed me a mask and I showed Beautiful Cloud how to place it over her mouth. She did as she was told and within seconds she was asleep.
The surgeon began his work, sketching the procedure onto Beautiful Cloud’s face with a marker, outlining the areas of her lip where he was going to make his incisions. Then he made the first cut, pushing his scalpel deep into her upper lip. As he worked, the surgeon told me that he was going to “undo” the pieces of the cleft so he could then put them together correctly. All of the tissue that he needed to complete this task existed in her lip; he just had to carefully disassemble the sections and then piece them together, like a jigsaw puzzle.
I nodded, trying not to wince as the surgeon made multiple incisions in the little girl’s lip. Then he handed me a pair of clamps and asked me if I’d like to hold back a flap of tissue so that he could work on further separating the pieces. I told him I’d do my best.
The minute I took hold of the clamp, however, I felt an immediate rush of intense nausea. It was 100 degrees in the OR, I wearing my suit under my scrubs, and I was already dripping in sweat. Add to this that I’d had about four hours of sleep in the past thirty-six hours and that I’ve never been good with the sight of blood. Clearly, I wasn’t going to be able to help the surgeon with his work! I quickly handed the clamp to the nearest nurse and made my excuses. Outside, I sat on a bench and tried to compose myself. The room was spinning and I was drenched in cold sweat. I put my head between my legs and took deep breaths.
After about fifteen minutes I managed to collect myself enough to go back into the OR. By now, the surgeon had aligned the pieces of Beautiful Cloud’s mouth and was sewing the sections together with deft stitches that began at her nose and traveled down to the underside of her upper lip. I didn’t want to feel queasy again, so this time, I kept my head up and watched the clock. Before I knew it, the surgery was over. The entire procedure had taken about forty-five minutes.
Beautiful Cloud’s lip was swollen and covered with stitches, but it didn’t take an expert to see that the surgery had been a success. The terrible gash in her lip was gone completely.
Beautiful Cloud was still under her anesthesia, oblivious to what had just taken place. The surgeon asked me to carry her to the post-op ward, so I picked the little girl up from the table, limp and light as a feather in my arms.
Beautiful Cloud’s father joined me outside, following me into the post-op ward. Carefully, I put his daughter onto a cot and we both sat down at her side. As I smiled at her father, it was like meeting a different man. The fear and anxiety had vanished from his features altogether and he was beaming. Together we waited on the edge of our seats for Beautiful Cloud to wake up.
About twenty minutes later, the little girl finally opened her eyes and sat up. I couldn’t wait for her to see her new features! A nurse went to get a mirror, and then handed it to Beautiful Cloud.
We all held our breath.
Beautiful Cloud’s hands trembled as she slowly raised the mirror so she could see the results of her surgery. I waited for her to shout for joy, to jump around, or to do a little victory dance. Instead, she was silent, staring at her reflection. I was beginning to think something must be very wrong, and then I saw it: a single tear rolling slowly down her cheek. This was followed by another, and then another, and then nine years’ worth of pent-up tears. Back then, I considered myself a pretty hard-bitten guy, but like everyone in the room that day, I felt tears springing in my eyes too.
Watching this little girl see her new future for the first time was one of the most powerful things I had ever known. Even with the swelling and the stiches, Beautiful Cloud’s face was completely transformed. It was like witnessing a medical miracle.
Ultimately, that surgery didn’t just change a little girl’s life. It changed mine, too.
Good Reads: Before and After by Brian F. Mullaney, Co-Founder of Smile Train and WonderWork.
