Today, January 25, marks the start of a new beginning for Kayeng. Though from Kayeng’s perspective, it was far from pleasant. Today is the first day of five intense days of examinations. There were a team of surgeons and pediatricians conferring to understand the details of bomb’s impact on Kayeng’s face and facial functions and to help them develop a strategy on how to approach Kayeng’s surgery.

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Up until now, Kayeng was only familiar with the comforting voices of his parents, grandparents, aunts and uncles. It was only they whom Kayeng would allow to touch, carry and care for him. Beginning today, many caring Bumrungrad nurses and doctors welcomed and cajoled Kayeng with kind sweet words, and prodded him with their hands and sophisticated equipment in preparation for his operation. He was scared. The many unfamiliar voices were in Thai, Lao and English. He was used to being spoken to in Hmong, the only language he knows. More than once did his Dad Vakoung translate Kayeng’s cries, “Only Daddy can touch me!” or “I miss my Mommy”. Out of discomfort and fear, Kayeng would thrash with his hands swinging to protect his comfort zone. At the end of each day, he would collapse and fall asleep from exhaustion.

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When he woke up, he was again happy, peppy and asking his Dad where his new Fisher Price toys that played “Old McDonald Had a Farm”, “Skip to My Lou My Darling”, and other familiar American children’s tunes.

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Bumrungrad Opened Its Doors (and Doctors) for Kayeng

But, it wasn’t for long before Kayeng had to put up his defenses again. Each new day meant 2-4 more examinations. The many doctors involved included an occuloplastic specialist, multiple pediatricians, a pediatric ophthalmologist, a maxillofacial specialist, an ENT specialist, a plastic surgeon, a neurosurgeon, an anesthesiologist, a radiologist, as well as the Bumrungrad’s Deputy Managing Director, who volunteered Bumrungrad’s facilities and resources. Dr. Nattawut is the driving force behind recruiting the hospital to find a donor to cover the hospital’s expenses and the doctors, who are volunteering their services for Kayeng.

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Plastic surgeon Dr. Somboon examined Kayeng on Friday. He shared his findings with the hospital’s committee of plastic surgeons. Many doctors had their assistants take temperatures, pulse and blood pressures, which didn’t please Kayeng. The pediatricians met Kayeng daily, because of the unplanned RSV/cold he had brought with him from home. This meant additional nurse visits for nebulizer, shots and suctioning of phlegm from his bronchis.

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Findings

– During the explosion, two pieces of shrapnel penetrated from right nose bridge through right orbital floor, and fractured the right orbital roof, which is part of the brain’s encasement (my words). A large piece of shrapnel is lodged against the brain cavity, necessitating the presence of a neurosurgeon in event removing the shrapnel causes brain fluid leakage. A smaller piece of shrapnel punctured the left eye, causing it to shrivel up over the past year and becoming useless.

– An ultrasound examination and a VEP (Visual Evoked Potential) corroborated the CT scan that the right eye is also useless. The VEP test confirmed Kayeng is blind in both eyes.

– Kayeng’s difficult breathing is caused by hurling shrapnel, destroying portions of the right nasal cavity and right nostril. Some teeth buds were destroyed, so he will be missing teeth on the right side.

After conferring with his dream team, Dr. Nattawut outlined a proposed sequence of surgical steps. Remove the shrapnel and the eyes. Reconstruct the right nostril air passage. Reconstruct the orbital floor. Reconstruct his maxillofacial (cheek) bone. Reconstruct his nostril, lips and other facial details. The operation is estimated to last seven hours (and likely longer).

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Unfortunately, Kayeng had caught the RSV virus (i.e., bad cold), so the operation was delayed. Attention focused taking care of his cold and cough. Kayeng has recovered. Doctors will examine Kayeng on Sunday, February 3 to establish an operation date.

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