MARWA NAIM CAME INTO MY LIFE nearly four years ago. She was a 12-year-old Iraqi girl who had suffered a horrible tragedy: A mortar round fired during an assault in Baghdad killed her mother, and the fragment of another shell took away Marwa’s nose and the thumb of her left hand. A relief agency called me to ask if I would be willing to reconstruct her nose. I said yes, and the wheels of the process to bring Marwa to Los Angeles and UCLA began to turn.
Her long journey started with a clandestine, night-time trip to Jordan, hundreds of miles from her ruined home, and then a flight to Los Angeles, where she arrived at 1 o’clock on a Sunday morning. What would I encounter when I first met her, I wondered. What would she be like, this too young, too innocent child, so far from her home, her language, her culture, facing an unknown future? Would she be terrified? Distraught? Suspicious? Angry?
She was none of those things. The child I met was, simply, Marwa, a bashful 12-year-old with unmistakable dignity and intelligence, and a distinctive wry smile that suggested, as she looked at me, “I’m OK, but you don’t look so good.”
It was remarkable that from the very beginning, Marwa did not seem to be disturbed or shy or embarrassed about her injury. If she was, she did a magnificent job covering it up. I remember hearing a report shortly after we had cut a flap from her forehead that had been turned 180 degrees to form her new nose that she went riding a bicycle along the beach in Santa Monica. The pedicle – the piece of skin that connected the flap to her forehead – was still attached! It surely was not attractive, even to her surgeon, but to my astonishment, Marwa did not seem to be the least bit bothered.
Sure, her self-confidence understandably would crumble on the day of each surgery, but as we went along, I could see that she recognized her face would be restored, and I like to think she trusted I would take care of her even though she did not fully understand what I was about to do. Then came the moment when the attachment was divided, and, for the first time, something that looked like a nose was there. Her smile, which was truly beautiful, appeared more often, and her spirit seemed to soar.
So did mine. In the final operation, I placed cartilage from her ear under the forehead to sharpen the projection of the tip of the nose. When she came to have the sutures removed four days later, I asked Marwa how she liked her new nose. She smiled broadly as she looked in the mirror and shook her head up and down. It was a very happy occasion, but there was also, for me, some sadness. I realized at that moment that my job was done and Marwa would be leaving.
For Marwa, the idea of returning home was filled with uncertainty. “Who knows the future?” she would say, through her interpreter and marvelous friend, Teresa Moussa, an international patient liaison at UCLA. Her feelings were clearly mixed – torn between a place that had welcomed her and many new friends who, over the four months she was with us, had grown to love her and her sense of loyalty and obligation to her family.
I didn’t go to the airport to see her off when she left; it would have been too difficult, both of us crying. But from the day she left, I believed somehow I would see her again. I’ve spent many nights worrying about her. I’d watch the news and see some of the terrible things happening in Iraq and wonder, “Where is she? Is Marwa OK?”
And Marwa did return. This July, she was able to come back for some further revisions of her nose. It was a joyful reunion, but also marked with sadness. Marwa told me how insurgents had fire-bombed her house in Baghdad because she had come to the United States for treatment, and that she was not allowed to return to school because she had spent so much time away. Yet, despite the ongoing hardships in her life, she is still Marwa – a beautiful young woman, now 15 years old, who is determined to endure and let her spirit shine.
I knew that she wanted to stay, but Marwa returned to Iraq in September. Much more verbal now, she would tell me how she needed to take care of her father and the rest of her family at home.
I am sure that is what she is doing now. And I also know she is thinking about those who cared for her, and who still care about her. It was a privilege for us to help her, but what Marwa may not know is that she has given us more than we have given her.
Dr. Timothy A. Miller is chief of the UCLA Division of Plastic and Reconstructive Surgery.