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t m c ยป p u l s e | d e c 2 0 1 7 /ja n 2 0 1 8 27 27 machine, she answered questions about the surgery. Were you afraid? "Of course I was afraid, but I prayed to God that everything was going to be okay." Are you anxious to return to Africa? "Yes, because all my other children are back home in Africa. Can you describe your life there? "The situation at home is horrible. It is very hot. But I don't have any other choice but to go back." Can you describe your home? "My house is made out of mud. Two rooms. About as big as this hospital room." Have you seen a change in Ilhan since the surgery? "She's able to breathe better. She is doing much better overall. Before the surgery, she was able to walk, but she would get tired after one or two steps. Since the surgery she has been able to walk without getting tired and walk a lot longer distance than before." All told, Ilhan spent more than a week in the hospital. Since she and her mother were stringent about what they would and would not eat, meals became a challenge. Becky Sam, RN, pediatric cardiovascular nurse coor- dinator at the hospital, ended up making food for Ilhan and storing it in a mini fridge at the hospital. Whether it was pasta with meat sauce or a dozen hard-boiled eggs, the meals and snacks lived in a large container labeled "Ilhan's Food." By the time Ilhan left the hospital, the oxygen level in her blood was 100 percent. Salazar said she was a patient he will never forget. "I have seven children," the surgeon said. "I take that same instinct of what I want for my own children and give that to the chil- dren I care for. It is impossible to imagine the stress and displacement Ilhan and her mother must have felt coming to such a different culture. I remember that her mother was so grateful. She was at her daughter's bedside 24/7." Bittersweet Breinholt kept a close eye on Ilhan after surgery. Soon after discharge, she developed a fever and was readmitted to the hospital. It turned out that the fever was related to an ear infection, nothing more. Ilhan was sent back to Warfa's home with a new antibiotic. Breinholt, who has four children of his own, has cared for several HeartGift-Houston patients and taken more than 20 trips with different organizations to help children and families in underserved communities. "We're people they've never seen before and they can't communicate with us like they'd like to," Breinholt said. "These fami- lies are concerned, but they don't ask a lot of questions. Many come from an environment where the prospect of losing a child is not as overwhelming as it might be for us. They tend to be understanding of those risks." Caring for children like Ilhan, who will return home and likely never see Breinholt or Salazar again, is bittersweet for both doctors. "You have to set a different type of expectation," Breinholt said. "How we look at it is: This is her only shot. They try to select cases where one surgery is going to be all the patient needs. This one was life-saving. Because we've done this, Ilhan has a very high likelihood to get married, to have children, a family. She'll have a long and fruitful life." The prognosis for children like Ilhan has gotten markedly better over the past few decades, Salazar said. "One percent of all babies born have a heart defect," he said. "It's really, really common. And it wasn't that long ago that we didn't have great solutions. Unfortunately, the vast majority would die before receiving care, especially outside the U.S. But over the last 15 years we have witnessed a transformation in the cases we can care for. More than 98 per- cent of the children who come to experienced centers like ours have excellent outcomes." For Ilhan, this was the opportunity of a lifetime, a surgical fix that will hopefully stick for decades to come. There will be no six- month or one-year checkups, though. That's not her reality. (continued) Ilhan smiles from her bed at Children's Memorial Hermann Hospital a few days after surgery.