Eduardo and Jose were brothers, big brother and kid brother. They’re not really related, but they’re from the same town southeast of Navojoa, Mexico, and they both had cleft lips. Eduardo was twelve. His little friend was just eight. Eduardo had the look of a scrappy little guy who’d fought more than once when taunted about his gaping smile. He remembered when Jose was born, because everyone teased him now that he had a “brother”. As they grew up together, he became Jose’s protector, shielding him somewhat from the pain that children inflict on others when they’re different. Maybe he liked having a friend, when he had so few others, or maybe he truly believed that they were brothers. They were inseparable.

I noticed them first in clinic. We leave from California for Navojoa at 5 AM so that we can see patients on the day we arrive and decide who will receive surgery. As we rush around setting up, the patients sit quietly in the clinic waiting to be seen. Eduardo and Jose stood in a corner, Eduardo with his arm around his brother, Jose holding tight to Eduardo’s hand. Each time I’d walk out to call for another patient, the brothers would move closer to the door, Eduardo inching in, Jose pulling back. We simply don’t have enough time to operate on everyone that needs surgery; so many patients are turned away and asked to return next year for surgery. The parents and the children know this, so as the day wears on they know that fewer and fewer “slots” are left.

When Eduardo’s name was called, he practically ran into the examining room. Jose was not so certain, and as Eduardo pulled him into the room, he began to cry. Eduardo stopped and whispered to Jose, consoling, telling him that this was a great day. He said, “Mira, Mira…” (Watch, watch…) as he opened his mouth widely to be examined. This was a big day for Eduardo, the day his lip would be fixed, and the day he would stop being different. But even as he stood to be examined, his eyes and thoughts were on his brother. With his chin up and his mouth open, he reached for Jose, and pulled him closer, his arm on his shoulder.

Jose’s exam was next. Eduardo bent down, whispered softly into his ear, and then stood up. Jose looked up at his brother; then stood at attention and opened his mouth. We finished the exam, made notes in the chart, and then began discussing the surgery schedule between ourselves (surgeons, anesthesiologists, and nurses), charting the fate of frightened children. We were trying to manipulate the schedule to make sure that both Eduardo and Jose would be able to have surgery. Vincent, the Mexican resident physician who works with us in Navojoa, looked over my shoulder to help. In Spanish, I asked him if we would be able to get a second operating room on Saturday, explaining that the schedule was filling up. We spoke back and forth and he said he would go and check with the hospital director. He then left.

I enjoy the children we work with on Interplast trips, so I turned to Edurardo and asked him where he was from. We spoke for a few moments, then Eduardo was quiet. Finally he turned to me and said, “Doctor, si ho hay bastante tiempo por Jose y yo, entonces por favor, primero mi hermano.” (Doctor, if there is not enough time for both Jose and me, then please, my brother first.)

On Interplast trips we frequently operate twelve to fourteen hours a day. It is not unusual to do one or two cases the day we arrive, after twenty four hours of travel. On the last day, it is not unusual to operate until we leave for the airport to return to the States. We make a game of numbers, but that merely covers the urgency we all feel. Our trips frequently represent the only chance a child will have to correct the mistakes of nature. Every trip has it s successes, but the failures are the children we are unable to operate on. So that’s why we go back, year after year.

There was time for both Eduardo and Jose. Eduardo went into the men’s ward, Jose the pediatric. The afternoon following their surgeries, Eduardo had found Jose and the were sitting quietly in the courtyard of the hospital. Jose waved as we approached, the looked at Eduardo for approval.

We left the next day for San Francisco, feeling a sense of satisfaction. On this trip everyone who needed surgery received it. We’ll be back next year, and more patients will be waiting. I look forward to it.