Helping one girl face the future with hope

Miller walked in.

"Oh, my God," she said in English. She had heard people say that when they were frightened.

"I have something for you," Miller said. It was a flower: a tall, thin orchid with tender white petals. He asked an interpreter to translate.

"This is going to go well," he said. "There's nothing to worry about."

"Thank you," she said, again in English. And she smiled.

By 8 a.m. they were in surgery. She was anesthetized. Miller applied orange gel to her face. Then he marked off portions of skin with black ink.

At 8:05, he laid a scalpel into the flesh in the middle of her forehead. Delicately, he cut a U-shaped flap of skin. He left the bottom end of the flap attached between her thick eyebrows. He lifted the top end and examined both sides. It was brown on the outside, bloody and fatty on the inside.

A nurse suctioned the blood.

"Double hook, please," Miller said, calmly. "Moist cloths, please."

Gently, he draped the flap of skin against her cheek. He closed the opening it had left on her forehead.

Then he made a second incision, this time around the ugly black scar in the pit where her nose used to be. He cut out the scar and peeled back the skin on both sides. From my vantage point at Marwa's feet, even I could see that there simply was not enough cartilage left to use as the foundation for a new nose.

Miller directed his fellow doctors to her right ear. Deftly, they cut inside. They took out small, white chunks of cartilage. With this cartilage, Miller and another doctor began to build a new nose. For a moment, they looked like artists. Delicately, they molded the chunks and then sewed the structure together.

Miller stepped back. The cartilage looked like a miniature flagpole, a few centimeters tall. Then he took the flap of skin, its bottom still attached between her eyebrows, and twisted it to turn the brown side out and the bloody side in. Finally, he stretched it down, over the top of the cartilage flagpole.

It was a nose.

But not a very beautiful nose. It looked like a swollen, twisted, bloodied clump.

To keep everything in place, Miller inserted a thin, 3-inch metal rod through the clump. It stuck out on both sides. In Marwa's nostrils, he placed small yellow tubes to keep the passages open. The tubes jutted out from her face.

"This is a hard one," he said, stepping back again. He wasn't sure that her nose would ever look normal. And he worried about the forehead hair growing from it. He knew, though, that he would revisit this nose.