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Dr. Harold Gewirtz: Americares


In appreciation, of your support during the February 1989 Armenian Patient Airlift AmeriCares gratefully acknowledges Harold S. Gewirtz M.D. for helping to make this relief effort possible.

Blazing a Trail of Love

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Dr. Harold Gewirtz: True Brotherhood

“When there's a disaster the true brotherhood comes out. People want to dispel the pain and suffering”

The story of how one small girl from halfway around the world affected the lives of people here:

Blazing a trail of love

Imagine that a decade ago or so a young Armenian woman arrives here to visit old friends.

There is the familiar impish gleam in her eyes, the warm smile playing round her lips and a tiny scar over her right eyebrow.

The mark, on the grown face of Lillit Oynoyian would be a small reminder of the three days she spent buried beneath the rubble of the earthquake that leveled her home and claimed 55.000 lives.

But it would be tribute, as well, to the medical care and emotional support that the 9-year-old received during her recent two-month stay in Connecticut.

Frightened and alone, with her parents still in Armenia and her 12-year-old brother dead, she arrived Feb. 5 with 14 other earthquake victims. They were airlifted from Soviet Armenia by AmeriCare Inc., a New Canaan-based relief agency which sent doctors and supplies to the devastated area within days of the earthquake.

On April 7 Lillit returned to her parents, and to the capital of Yerevan, some distance from her destroyed village of Leninagan.

Her new pink camera was filled with images of her extended Armenian-American family. Her suitcase was stuffed with clothes and souvenirs and her curious, alert mind was replete with tales to share with her family.

“No one can give back the friendship she shared with her brother. But she'll go back with another brotherhood. She`ll always have it,” said Pauline Leylegian of Stamford, who with her husband George, were among the many who gave their time and their love.

Perhaps as important, she allowed others to get to know her Members of the Armenian-American community, the staff at Stamford Hospital and those she met on the street have anecdotes to tell.

“Everyone's going to miss this one,” said Edna Keleshian of Greenwich. “She has brought such joy to the Armenians in this community. She's very warm very aware. She's almost like she`s 9 going on 90. She's more aware of life, not just intelligent, but so tuned in.”

She came to have the bald spots on her scalp repaired, and a damaged portion above her eyebrow restored. Her doctor, Stamford plastic surgeon Harold Gewirtz, had chosen a procedure to stretch the scalp and cover the patches.

Although Lillit approached the operation with bravado, for two days afterward she was miserable, calling for her mother.

She had definite eating habits, according to her hosts. She loved tomatoes and brought bananas home to her mother to taste. She accepted all offers for ice cream and tasted a hot dog and hot chocolate, but refused spaghetti sauce.

Somewhat reserved about whom she would allow to hug and kiss her, she withheld nothing from those she trusted.

One of her more important connections was with Dr. Marina Sisakian, a 25-year-old Armenian who is here being fitted with an artificial limb to replace the right arm she lost in the earthquake.

When Lillit was told April 4 that she was free to leave the next day, she refused.

“Tomorrow I promised I would to go the hospital for Marina to console her and give her courage,” she told Arman Guroian, who was one of her hosts.

“It's like we adopted a child,” the Stanford man said, “You get attached to her. She's not your general, run-of-the-mill 9-year-old.”

For six weeks, no one mentioned that her brother had died in the earthquake, Guroian said. Lillit had told how the two of them talked continuously for the three days they were trapped, saying that they would either make it together, or not at all.

Then, just before she left, she confided in Guroian that no one needed to be so discreet because she had overheard a discussion about his death.

“I know you kept it a secret,” she said. “I understand.”

But they will remember as well, a consummate ham, who loved to mug for the camera, primp with makeup and nail polish, and laugh more often than not.

She announced, with her usual authority, that she intended to be a doctor, and was curious about the hospital's medical equipment.

She even selected simple white tennis shoes on a shopping trip because they resembled shoes worn by hospital staff, said Guroian.

Her presence in the community also allowed others to reach out, sometimes in very small ways, said Leylegian who was among the people who spent hours with Lillit on shopping sprees of walks on the beach.

She said the little girl with the big brown eyes and white bandage on her head had touched people.

Perhaps the most moving incident, Leylegian said, was a woman at Cove Island beach gathering shells with her grandchildren. She approached Lillit, apologized for not having anything more, and offered her shells, which Lillit took.

Another woman, standing behind them in line at a department store, shyly offered a folded dollar bill and asked that it be spent on candy for Lillit. Restaurants offered her lunch, or ice cream “on the house,” and the manager of Woolworth´s on Greenwich Avenue in Greenwich gave Lillit a 20 percent discount on anything she bought.

“When there’s a disaster, the true brotherhood comes out,” Leylegian said. “People want to help; they want to dispel the pain and suffering. They want to give what they can.”

Lillit Road to Recovery

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Dr. Harold Gewirtz: Armenian Earthquake

In February 1989, Lillit Oynoyian arrived at Stamford Hospital with a teddy bear, a framed photograph of her parents and gaping head wounds she received in the Armenian earthquake.

Last week, to the delight of the friends she made here, the little girl returned for a month-long visit and brought pictures of her new baby sister and fading scars that minor surgery will all but erase.

“She`s gorgeous!” exclaimed harry Keleshian of Stamford, one of several Armenian-Americans who opened their homes to Lillit 18 months ago.

“She's gotten bigger and much more grown up, but she's still as vocal and expressive as when she came here after the earthquake,” Keleshian said of Lillit. “She's just a bubbly little thing.”

Since she arrived nine days ago, 10-year-old Lillit has shown the same bravery and resilience that so impressed her doctors, her Armenian hosts and many in the community during her first visit.

Friday morning, she was already recovering from two hours of surgery to remove scar tissue from her head and eyelid less than 24 hours before.

Lillit who is staying with Armen and Grace Goroian of Stamford, ate a big breakfast, watched a videotape she brought from home and mentioned that Armen`s don would be arriving on a train from Maryland that afternoon.

“I think we`ll be able to go greet him,” she said.

Lillit return to America was arranged through Medical Outreach to Armenians, a group Keleshian helped found in response to the December 1988 earthquake that killed 55.000 Armenians and leveled entire towns.

Although New Canaan-based AmeriCares flew about 100 Armenians to the United States for medical care in the months after the quake, Lillit is the only one to return for additional surgery so far, Keleshian said.

“There has been some special attention given to Lillit,” he said, “in part because of her bubbly enthusiasm, and because she is a young girl and the corrective surgery will enhance her life”

Dr. Harold S. Gewirtz said Friday that while the surgery he did last year repaired 90 percent of the damage to Lilli’s scalp, Thursday`s operation “got us another 8 or 9 percent of the way there.”

When he first met Lillit, Gewirtz said, “She was missing most of the top of her head.” The plastic surgeon performed two operations, one to insert tiny balloons under her scalp to gradually stretch the healthy skin, and another two months later using the stretched skin to replace the damaged areas.

Thursday's surgery was easy by comparison. He said. Once again, Gewirtz donated his services and Stamford Hospital donated its operating room.

Gewirtz removed a bald strip of scar tissue from the top of Lilli’s head, lifted the flaps together and closed the incision. He also aligned Lilli’s left eyebrow by moving some of the hair-covered skin down and replacing it with scar tissue he had removed.

Although Lillit learned Wednesday afternoon that Gewirtz could operate on her the next morning, she was not afraid. In fact, when he told her might have to take skin from her and graft it onto her forehead, she broke out in peals of laughter.

“That idea strikes her as funny,” Armen Goroian said.

As it has all along, Lilli’s outlook amazes those who know what she has been through.

When the earthquake struck, the nine-story building that housed her family's apartment in Leninagan collapsed “like a deck of cards,” Goroian said. Lillit and her 12-year-old brother, Armand, were trapped beneath the building`s rubble for three days before rescue workers found them.

Goroian said that on a visit to Armenia last fall, he met Lilli’s family and learned what caused her head injuries.

“When they found her, she was pinned by the reinforcing rods they use in cement,” Goroian said, “One end of a rod was embedded in her forehead and the other end in a cement block. The rescue workers couldn't get her out…so they got a hacksaw and had to cut the reinforcing rod to release her.”

Lillit and her brother, who had encouraged one another by talking constantly for three days, were taken to different hospitals. Doctors could not save Armand, who had been crushed from the waist down. “He arrived at the hospital too late,” Goroian said.

On her first visit to Stamford, Lilli’s hosts avoided mentioning her brother. But when Goroian visited Armenia, she took him to Armand`s grave. This time, she brought him pictures of herself holding her new little sister, whose name, Armanoush, is the feminine version of Armand.

Keleshian and Goroian said Lillit is healing more quickly than her country. Although Armenia is in the process of separating from the Soviet Union, the rebuilding is slow.

Lilli’s family is living in her uncle's house while waiting for the government to provide a new three-bedroom apartment. They still have no hot water or heating oil.

Still, during Gordian’s visit, Lili's father got a friend to come over with a video camera and film a dinner party to welcome him with music, dancing and many toasts.

They also showed him a tape of Lillit being interviewed on Armenian television on her return from America. Although she had refused to kiss Goroian goodbye at the airport, he was the only person she mentioned when asked her who she met in America.

“Mr. Armen,” she said, “was a 64-year-old man with a lot of humor”

On Oct.21, Armen Goroian will receive another compliment from Lillit: He'll become her godfather.

Because of the religious oppression in Armenia, Lillit was never baptized as a baby, said the Rev. Karekin Kasparian, pastor of St. James Armenian Church in Harrison, N.Y. After getting to know Lillit on her last visit, Kasparian began corresponding with her father, who asked him to baptize her in his church.

“This is a very significant thing,” Kasparian said. “Not just that she is getting baptized, but the fact that our parish has sort of adopted her as our child.”

Many people who meet Lillit seem to feel that way. For that reason, Gewirtz said that even after Lillit goes home at the end of the month, he expects he may see her again.

“She’s a very interesting girl,” he said. “After the first operation, I didn't think we’d be doing any more. And somehow she found her way back to America.”

“She may be 98 percent improved now, but it’s not going to look like nothing happened to her,” he added. “If she wants to find her way back here in two years and take care of the other 2 percent, we can talk about it.”

New Surgery Saves Finger

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Dr. Harold Gewirtz: New Surgery saves finger just in time

A 60-year-old woman who severed part of her right thumb in a household accident is the first person to undergo reattachment surgery in Stamford or Greenwich.

Greenwich physician reverses most of injury.

Three years ago, Anna Carella returned from a trip to her native Italy with a new tomato slicing machine.

The machine would be a big help in August when she would start cutting her way through five bushels of tomatoes to make sauce.

But tradition dies slowly, and she continued using knives to slice her tomatoes as she had since 1958 when she, her husband and three children came to Stamford from Italy.

When the 60- year -old woman used the machine for the first time in August, she felt its steel blade snap through her right thumb.

She had forgotten to unplug it as she was leaning it. When the blade popped back, Carella saw 1 ½-inches of her thumb dangling by a thin tendon.

Had the accident occurred much sooner, she might have suffered a permanent loss. The surgeon who reattached the thumb, Dr. Howard Gewirtz, moved to Greenwich about a month before the accident.

“The first surgeon who saw her in the emergency room recommended amputation,” Gewirtz said last week in his Stamford office. “He's a perfectly competent surgeon, and, in most cases that's what would have happened. She would have lost her thumb.”

Gewirtz a plastic surgeon and microsurgeon, reattached it in a four-hour operation at St. Joseph hospital.

The procedure was the first such operation to be done in either Stamford or Greenwich, according to the chiefs of surgery for the three hospitals in both communities. Local residents who had lost limbs before were sent to Yale-New Haven Hospital, which has been doing microsurgery since 1978.

Gewirtz said Corella’s operation should be classified as a “partial reattachment, since she had part of her finger still attached to a tendon.”

The reattachment of severed limbs gained its greatest fame in 1979 when a team of microsurgeons at New York University Hospital reattached the severed right hand of Renee Katz, a promising violin student who had been pushed in front of a subway.

The surgery team, under the direction of Dr. William Shaw, was dubbed “The Miracle Team” by the New York media.

Gewirtz had spent two years on Shaw`s miracle team before moving to Greenwich in July.

The trick to reattachment surgery, Gewirtz said, “is to suture a vein or an artery in such a way so that blood can flow through them. Veins are not like pieces of pipe: they`re floppy and flimsy, hard to hold on to.

Mrs. Carella had wrapped the thumb in a wet dishcloth, and the hospital subsequently covered it with ice. Half an hour later, Gewirtz was in the operating room, with an anesthesiologist, the chief resident and two nurses.

“She had just eaten before she came,” Gewirtz said of Carella, “so we didn't want to put her to sleep. She could choke on her food that way.”

Gewirtz and the anesthesiologist then performed an “axillary block” in which they shot a drug into her armpit and numbed her arm.

With the arm numb and bleeding controlled, Gewirtz put on a pair of glasses called surgical loops, which look as though tiny telescopes are set inside the lenses.

“They magnify everything four power” Gewirtz said, “and through them I could see that one of the tendons was cut and one was intact. I also saw both the bone and the neurovascular bundle- which is the nerve and the artery – were all cut. I had to repair them all”

To do that, he had to do both microsurgery and microsurgery. Microsurgery is done to bones and tendons and does not generally require the aide of microscopes. microsurgery is detailed surgery on veins, arteries and nerves. It usually requires the use of a huge microscope and tools- tweezers, scissors and clamps – that are at least four times as small as ordinary surgeons` tools.

“The first thing we did was to put 1 ½-inch-long Steel pins – wires, really, about 1/35,000th of an inch wide – into her bones. Then wen sewed the tendons together. Basically, that's the microsurgery.

“Then we started the microsurgery. First, we rolled in a huge microscope, that has a 20-300 power magnification. Then I began sewing. You have to sew each artery and vein in a circular fashion, so that you don't close off the blood supply.”

For sewing, Gewirtz uses a minuscule clamp and a thread so fine that it's nearly invisible.

“After that, we checked to see if her finger was alive. We just pressed on her fingernail to see if it blanched and then refilled. It did. That meant the finger was alive.”

Throughout the whole process Gewirtz did something that, he explained, sometimes surprises” his patients – he photographed what he was doing.

Most plastic surgeons use photography, he said, and reattachments really are one part of plastic – or reconstructive – surgery.

He said photos are references. “Plastic surgery is a visual practice and it's important to see how far we progress.

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Harold Gewirtz, M.D.

Stamford Plastic Surgery

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Stamford, CT  06902

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