An Expatriate's Last Day in American Samoa

oday is my last day in American Samoa.  It's like many I spent during the three months I served as a surgeon in the aftermath of the September 29, 2009 tsunami.

Like the remote American island itself, the day offered the contrast of glorious success and heartbreaking loss.

American Samoa is a hybrid nation.  It flies the U.S. flag.  It has given a higher percentage per capita of its sons and daughters in service to our nation's freedom than any state in the union.

Yet the 76-square-mile Pacific territory is deeply influenced by its 3,000-year-old Polynesian traditions.

Men are as likely to wear a wrap-around "lava lava" skirt as they are to wear combat fatigues.  Both are considered appropriate uniforms.

My last day in American Samoa saw the celebration of a medical miracle.  My surgical mentor, Dr. Herbert Gladen, came to the island from Fresno, California when I asked for his help.  Today he performed a complex surgical repair of a genetic defect that was crippling a seven-year-old child.

The family of the boy had no resources for specialty care off island, so the child's parents resigned themselves to their son's inevitable early death after dozens of hospitalizations for lung infections.

But Dr. Gladen changed their perspective today with the operation no other surgeon within 4,000 miles could do.

The little boy proudly showed me his bandage before I left the island.

Today was also a time to grieve.  The limits of modern medicine were reached, but not in the third world setting of American Samoa-and not from a lack of resources.

This morning, back in my beloved central California, my friend Anne died.

Years ago, when she was almost 70, Anne decided to join a fundraising effort to find a cure for leukemia and lymphoma.  Despite limited athletic experience (sewing her granddaughters' Halloween costumes was her favorite activity), she began walking marathons.

She then started training others and recruiting more volunteers and donors for the organization.

Anne became iconic in the cancer fundraising community, a fiery lady of a certain age who wouldn't tolerate bad grammar-and wouldn't take "no" for an answer when her cause was involved.

I even recall a recent Thanksgiving Day when Anne managed to convince a certain reluctant Turkey Trotter (me) to face the cold morning and join her and her legion of friends for a 5K race to help the Leukemia and Lymphoma Society.

Anne was as relentless as she was energetic.

About 18 months ago, after years of good health, Anne learned that she was ill-with leukemia.  She took the diagnosis in stride, declaring it maddening but slightly amusing that she'd raised so much money to support leukemia research, it was understandable that leukemia would one day retaliate.

True to form, Anne stubbornly kept to her training pace during her many hospitalizations.  Sponsored by Leukemia and Lymphoma Society friends, she did laps around the nursing station and thus continued fundraising even while an i.v. dripped into her arm.

Anne's grueling months of treatment were chronicled generously by her daughter in an online journal called "CaringBridge."  Along with Anne's many friends around the nation, I read of her chemotherapy regimen, her remission, her complications.  Her recurrence. 

I knew when her white blood count was too low to allow visits from the littlest grandchild and when she felt well enough to attend family dinners.  From thousands of miles away, I learned when she had to be cared for at a top academic medical center in San Francisco and when she took her glorious first steps back home.

A seven-year-old boy on a remote American outpost took his first unrestricted deep breath today.  A beautiful lady in Fresno, California took her last.

It's been a bittersweet last day for a surgeon sent to help in the aftermath of a disaster.  From the devastating loss suffered by the island came today's miraculous opportunity for healing.

And the joy of returning home is tempered by the knowledge that there will be one fewer competitor in the next Thanksgiving Day race.

Dr. Linda Halderman is a General Surgeon who serves as a policy adviser to California State Senator Sam Aanestad.  She also provides trauma and emergency services in rural communities and on American Samoa after the September 29, 2009 tsunami that devastated the South Pacific.
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