Last day of work, and I am aching head to toe. My first patient is a 14 year old with a severe nasal deformity from an old fracture. The left side was completely blocked. The child stated that it began to twist at age 10 without explanation, but he also has stitches over his right eye that he does not want to talk about. He knelt in the operating room and prayed at length for his doctors. Carlos is a senior resident in plastic surgery, with 8 years prior experience as a professor in general surgery and an excellent technician. However, two months before graduation, he had never seen spreader grafts used in an open septorhinoplasty. Almost all of his prior rhinoplasties were cosmetic and most of the reconstructions were performed with rib cartilage. Not owning a headlight, he really did not have an opportunity to examine and operate on the septum.

Across the hall, Paul Juengel was performing an external ethmoidectomy on a 3 year old girl with rhadomyosarcoma of the right tear duct and sinus. This aggressive cancer had invaded the eye socket, and had been temporarily suppressed with a course of chemotherapy. Ray Komray was teaching the residents how to drill out chronic ear infections, a skill they had no hope of learning until a prior team arranged the donation of two surgical microscopes. I followed my first case with another rhinoplasty in a woman with a telescoped nasal deformity from prior trauma. Team leader Chris Perry continued his week of rhinoplasties, finishing with a very difficult rib graft reconstruction in a woman with prior nasal cancer.