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26 t m c » p u l s e | d e c 2 0 1 7 /ja n 2 0 1 8 "Ilhan's oxygen saturation levels would never be allowed here in the U.S. without surgery or intervention or something like that," Breinholt said, after the exam. "If you look at her fingers"—he walked across the room to where Ilhan was curled, once again, in her mother's lap, and lifted one of her fin- gers—"her nail beds look kind of swollen, a little bulbous. That's called clubbing. That's the product of prolonged cyanosis— or prolonged blueness. Some of that will recede after she's repaired. Her color will be vastly different after surgery. Even though she is very dark-complected, I can tell she's cyanotic. Africans can be missed for this diagnosis." In the coming days, though, the oxygen levels in Ilhan's blood would only get worse. On top of that, a hurricane was heading toward Texas. The best solution On Friday, Aug. 25, Hurricane Harvey slammed into the Texas Gulf Coast. When the wind and water reached Houston, the Texas Medical Center found itself in the midst of an epic flood. Although hospitals remained open, access to the medical center was diffi- cult. Many surgeries and routine treatments had to be rescheduled. Jorge Salazar, M.D., started his new job at the Texas Medical Center on Sept. 1. "It was such a whirlwind," said Salazar, the new co-director of the Children's Heart Center at Children's Memorial Hermann Hospital, and professor and chief of the division of pedi- atric cardiovascular surgery at UTHealth's McGovern Medical School. "I came from Boston to Houston to lead this program at Memorial Hermann. We were in Houston, living in a hotel, when the hurricane hit." Ilhan, who had been admitted to the hos- pital a few days earlier, was one of Salazar's first patients. "She had been waiting for surgery because of the hurricane," Salazar said. "Her surgery had been planned for earlier. When I met her, her oxygen levels were under 50 percent, dropping to 40 percent. … Oxygen levels that are half of normal, of course, affect the brain and the rest of the body." So many babies and children needed care that Salazar and a team of doctors worked around the clock, sometimes performing two or three major operations a day. One surgery can last as long as six hours. "We weren't doing elective operations at that point, and Ilhan was one of the kids that needed urgent care," he said. "We decided to operate on the weekend." On Sunday, Sept. 3, Salazar and his team were able to fully repair Ilhan's heart and to keep her pulmonary valve. "Sometimes the best solution is the simple one," Salazar explained. "When you do the repair, the crux of the issue is whether or not you can spare the pulmonary valve. The more we can respect the normal anatomy and function of her own heart, the better and the more durable the repair. Everything we do is about maximizing the benefits long term and minimizing the risk." A dozen hard-boiled eggs Four days after surgery, Ilhan sat up in bed in the hospital, eyes glued to "Family Guy" on television. Her once-blue lips were now pinkish-brown, and her skin had a healthier hue. She smiled when a stream of visitors arrived, but remained quiet. Maryan, in a bright pink hijab, sat off to the side of her daughter. Speaking through an interpreter on a video remote interpreting Above: John Brienholt III, M.D., carries Ilhan to the examination table. Left: Brienholt examines Illhan's fingers. Jorge Salazar, M.D., started working at the Texas Medical Center on Sept. 1.