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Jewel

I was not born into a religiously observant family and was not raised that way. Becoming ba’al tschuva isn’t only about observance it represents a level of faith, hope and belief in a Creator who only wants what is good and is inherently merciful. My story is not unique but my job is. As a pediatric surgeon I don’t just treat the child, my job often affords me the opportunity to be intimately involved with my patients and their families. It is a privilege but it is also a trial. I can see the hand of God and his chesed but I also question Gods existence and his mercy. My blog tells stories that, to me, really show the hand of God. I guess it’s up to all of us to decide how to interpret them.

Jewel was probably a delightful and rambunctious 2-year-old girl. I couldn’t know because when I met her she was completely unconscious and mechanically ventilated in the pediatric intensive care unit.   She lay motionless while the doctors and nurses were frantically trying to stabilize her. She had undergone CPR for a cardiac arrest shortly after her arrival and though she recovered a pulse, her blood pressure was dangerously low.  We didn’t know what had happened to her. Her mother said she collapsed suddenly, “out of the blue”, and mom then called an ambulance.

The intensive care doctors called us because Jewel’s abdomen was distended and they thought there could be a problem. She was too unstable to undergo a CT scan so we decided to perform a bedside paracentesis in the ICU.  We inserted a small catheter into her abdomen, irrigated it with saline and the answer was immediately obvious. “Enteric contents” or food was in her abdomen and floated out of the catheter; She had a hole somewhere in her intestines. We spoke with the mother and prepared Jewel for an emergency operation.

Jewel’s duodenum, the first part of her small intestine, was badly bruised and much of it had been torn from its blood supply resulting in part of it dying and perforating.  This was obviously caused by blunt force trauma. Most likely someone had hit or punched her. It also wasn’t new. Judging by the condition of the duodenum and the bruises around it, this had happened at least 24 hours ago.

This was a big problem. A hole anywhere else in the small intestine is treated by resecting the dead bowel and sewing the two remaining ends back together. The duodenum is unique in that it is attached to the pancreas and shares a blood supply with it. It’s virtually impossible to remove part of the duodenum so we tried something unusual. We placed a long tube through the abdominal wall, past the stomach and across the duodenum. The hope was that the tube would drain the contents of the duodenum and stent it so that it could heal. If the duodenum recovered it wouldn’t be quick so we also placed a separate tube further down in the small intestines through which we could feed Jewel while she was recovering.   No one in the operating room was terribly optimistic but we didn’t see any other options and hoped for the best.

The duodenum started to leak about 4 days after the operation but that wasn’t a surprise. We continued to treat her with antibiotics and monitor her progress. She had an echocardiogram to evaluate her heart function and to our surprise the left ventricle had a small aneurysm. Whoever beat Jewel hit her with such force, and so many times, they injured her heart in addition to her intestines.

Jewel spent a month in intensive care. Her recovery was slow but steady. One month after her operation she was out of the ICU and recovering quite well. To everyone’s surprise her duodenum stopped leaking and healed completely. In fact, by the time she was discharged she was able to take all her nutrition by mouth. Jewels mother, and her boyfriend, were arrested and charged with assault.  Jewel was put into the custody of her paternal grandmother and the family moved to North Carolina shortly after she was discharged. I never saw Jewel again but I did testify at her mothers’ trial a few months later. I thought of her often and have a picture me holding her on my lap about a week before she went home. I kept it on my office desk for many years.  I could only hope for the best for this little child who thankfully didn’t seem to remember what had happened to her.

Patients like this pass through our lives often and we never know what will happen to them. Sometimes I think we don’t want to. I will never know what God’s plan for Jewel was or why she had to endure such hardship so early on. Being almost beaten to death at the age of two by your mother is no way to start your life.   Everyone, including me, was grateful at the miraculous recovery she made but if I am being honest, thinking about what this little girl went through makes you loose faith in humanity and, maybe, God.

About 6 months ago a secretary in my clinic gave me an envelope with a return address that had the name “Jewel” on it. My hands were shaking so much I had trouble tearing it open. Inside was a handwritten note. A hand written note-who writes those anymore?!

To: The surgeon who led the surgeries that saved my life

From: The 2 year old girl you helped give a second chance

Hello Dr Arkovitz:

My name is Jewel Johnson. I am the 2 year old abuse victim whose life you saved back in August 2005. Without you there would not be a me right now. Thanks to you I am now 18 years old! There’s no amount of money or words that could thank you enough! What you and your team did for me. I could never stop thanking you guys. I now have my medical records and seeing everything you did for me and you don’t even know me! I just can’t thank you enough. I just want you to know you are a wonderful human being and I am beyond grateful.

Jewel J.

When she turned 18, Jewel contacted the hospital where she was treated and requested her medical records. She saw her operative report and found me on Google. She graduated high school a year early and is getting a bachelors degree in criminal justice, hoping to work with victims of human trafficking. She is beautiful and healthy and leading a very productive life with her grandmother. She doesn’t remember what happened to her but she knows she was the victim of abuse at the hands of her mother and hasn’t seen her since. She’s a very happy person with a great outlook on life, with dreams and hopes for her future. She sees what happened to her as part of her past, not part of her future.

About the Author
Marc Arkovitz is a pediatric surgeon practicing in Westchester, New York and an associate professor of surgery and pediatrics with more than 20 years experience working in both Israel and the US.
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