CLAUDIU IONESCU
talking to
President, Shrine Club Romania
Acad. Prof. Dr. Dan Mircea Enescu is the managing director of the Grigore Alexandrescu Children’s Clinical Emergency Hospital. He laid the foundation for plastic surgery for children in Romania, being the first plastic surgeon for children. He is a member of the Discipline Committee of the College of Doctors, founder and secretary of the Romanian Academic Society of Plastic Surgery – Reconstructive Microsurgery, founder of the National Foundation for Reconstructive Microsurgery, founder and president or the Romanian Society for Pediatric Burns, founder of the Association of Plastic Surgeons of Romania, a member of the European Burns Association (EBA), of the Academy of Science in New York and of the EBOPRAS Accreditation Committee (European Board of Plastic Reconstructive and Aestethic Surgery), vice-president of the Romanian Academy of Medical Sciences etc. The clinic he is running at the Grigore Alexandrescu Hospital is one of the 17 clinics accredited in Europe that can conduct trainings with any other clinic in the world. Professor Dan Enescu became a Shriner in 2012, having been initiated in Germany.
What attracted you to the SHRINE?
First of all, the fact that it is a society that has as purpose the treatment and saving of children suffering from burns, children with spinal deformations, children with cranio-cerebral malformations, children with a cleft lip or palate, that is to say, exactly what I do for a living. Practically speaking, I just went to the place that fit me best, whether it deals with fundraising for children suffering from such problems or with the greatest specialists in plastic surgery for children: professor David Herndon of Galveston, Texas, or professor Robert Sheridan of Boston. I have to say, every paper, book or presentation at a Congress starts with quotes from professor Herndon. For me, he is a model, as is also professor Sheridan. They treat children’s burns at the highest level. They have the most complex teams and the best results. Theirs are the only places where they save 100%; there are children with 100% of their surface burnt! In Boston, professor Sheridan precocious excisions, that is tosay, he removes the burnt surface, for example 100% of the surface of the body, he removes it and puts it aside in 24 hours. I remove the skin and replace it with another! Afterward, he treats it. A treatment there costs about $1,000,000, according to statements may some ten years ago! From this sum, the personnel received 55%.
We are certainly very far away from that! Is working with children different to working for adults in your field?
It is completely different! You know, there are sculptors who prefer marble and others who prefer clay… Well, the adult human being has one kind of material and the child another; you will ask, what is the difference. The difference is its metabolic state, or to be more specific anabolism, which is 100% in the case of the child – that is what we are working with, almost 100%. What is anabolism? It means that whatever you put it grows; the child is growing… For example, the five-day-old child (in the Bucur hospital, one caught its hand in the incubator), who had over 20% of the surface of the body carbonized; I was asked, “What do you see when you look at him?” I said: “I see an eighteen-year-old!” Because we really had to make a projection into the future; I knew exactly what I had to do: an excision, such that I would reach healthy tissue and so could preserve the respective functionality and imagine what it would look like when he grows up. It takes some imagination and a lot of experience. You can only achieve this kind of vision if sufficiently many children have passed through your hands. I really had cases, in the beginning of my professional experience, where kids came to see me with small skin defects; I closed them quickly, with all sorts of creams, and then one year later, on their check-up, they showed monstrous scars! I realized that it is something entirely different, working on a growing organism. It is an entirely different philosophy, another conception. The formulas are different. The mode of action is different. The team must be used to another sort of pathology. Working on burnt children is counted the most difficult in the world. Consider that we are working with an organism that has almost 100% water and 100% anabolism and can go into catabolism in a matter of a few hours. Interior liquids are lost. The skin is the membrane that separates the internal organism from the exterior. It protects mechanically, against microbes, achieves perspiration… it serves many functions, it is also the biggest immunity system, it is the biggest organ in the organism: it weighs 4kg for an adult. We know the evolution, for example, we take a look and we know exactly that between the first day and the third, certain things can happen, between the seventh and the tenth, others, and inside, we know how cells work, we know what happens to them, how we can compensate. Meanwhile, this child behaves as if things are normal. Meanwhile, we have to work with the parents, too, so that they understand what is happening to their child. The family connection is important, you have to explain so that they understand, because they need to help. The best nurses are the family of each, especially the mother. The children suffering from such an accident grow more mature every day, in a couple of days they become old men! After 4-5 days of hospital stay, a five-year-old comes and asks: Am I dying, doc? He begins to reach the essence, the life, the death, the grave, important things… Or he arises from his bed, with all those perfusions, saying: Do something, give me something to take! I want to live! When a child says that to you, that’s a moment when you do not know yourself anymore, it is like an impulse from another world, and you must choose what is best for that child at that moment. It’s between you, the child and God. You are condemned to perfection. God is, God lives and works through us. I am proud to feel this connection to Him, that He is making use of me. I count myself a chosen man and the fact that I have been made to do what I am doing, that I have come here, that was a specific command.
No detail can be neglected. Nothing is merely detail in this sickness! Everything is important, essential and decisive. And the price is life! The life of that child and your conscience! The burn is considered the greatest medical-surgical urgency in the world. There is nothing more complicated. That is why few do it, it is very difficult, you do more work inside your head than looking at the child; it can be lively, playful, but in fact it might be post-convulsive shock. The burnt surface, which might 40, 50, 60, 70%, he loses pounds and pounds of liquid, which it cannot perceive at the time, but which we have to replace!
Think about it, you do not see the results immediately. Most diseases are suddenly over, you do the operation and the patient goes away. In our case, you have to wait. When the patient leaves the hospital, that’s just the beginning! He is leaving with scars that will develop, scars whose development you have to stop, make them disappear by the time he turns 18 or at least make them less significant, so that the patient can integrate in society. A normal human being is needed, not a marginalized one. I tell all my patients: if God gave us one life, you have a bonus, he gave you two! To come out with your life when 80% of the surface of your body is burnt is fabulous, it is a miracle! So do something with your lives! And what is there to do except become normal people, maybe even more than normal people, because this bonus is not given to everyone, so you must be more than others. You have to get to the point where you have your own job, your family.
What case comes to your mind just now?
A girl that came in with 80% of the surface of her body burnt and who left home after almost four months; she had a difficult evolution and I managed to fully reconstruct it. After a couple of years, the family appeared at my door and I did not know what happened… I thought there was something the matter with the scars I left after my operations. No! She told me she wanted breasts… That she was alright, but that she suffered from a complex because she did not have breasts. Therefore, I gave her silicone implants and now she is very happy. I wanted to say that only then did I consider that I ended the case. It is like a kind of commando. In that moment, when you are facing the case, you only do what you have to do and when you have to do it, not necessarily because it is written in a book. We cannot keep our calm and say we did what we did because we read it somewhere and here is the bibliography. I am interested in the results: that does not mean only the health of the human being, but the future of a child. I have to have the vision of what is happening in that moment and then project that years into the future, when the child will grow up. The serious and permanent work across the years does not allow the formation of fissures in the foundation you are building, fissures that become obvious always in the case of special moments. Then do you see whether you have laid a healthy foundation or not, in the difficult moments. That is the moment of truth. If everything is laid out properly, the stone on stone and without gaps, then that will show. The reaction will be correct and the results according. If you skip a step or do not put something where it is needed, automatically the result will be disastrous and you can destroy, in a second, the entire construction.
How do you have time for medicine properly speaking, being a member of so many medical forums, teaching at the university, managing a hospital?
Medicine is my life! The rest is transient, it simply gets done! I work very much. I have written treatises, books, articles, I have tried to teach students and interns. I have tried to pass on to them those things which one cannot learn except from someone who has been through a lot. It is important, in the way you have children, a family, so also in the hospital you need successors. It is important to know that something will endure after you are gone, that it is not all over when you are. I smile now, remembering the beginnings, when all sorts of delegations were coming from America or elsewhere, asking me: What are you doing? How are you making do? I answered: I am the best plastic surgeon for children. They asked: How do you know? I answered: I am the only one so I am certainly the best!
My specialty comes with the temptation to work in the private sphere, making very easy money. Rather than working with children suffering from severe burns, where it is a matter of life and death, who have scars, and do it in very bad conditions you can cross the street, play with a laser and win serious money and not have any problems. I found it very difficult to assemble a team because I had to find people who were similarly dedicated! Happily, I managed it. I have a team I enjoy, of whom I am proud and who work with their souls and for love. Love of what you are doing is what holds everything together. All the knowledge is worth nothing unless you pass it on with love. Children immediately sense that excess energy that gives value to the things you are doing. We also educate here; there are children who never read a book before coming to us, even though some are as old as twelve, 13 or 14. They did not even know that there are such things as books and, leaving, they could not believe they had reached another world, having been taught to read, educated, making up for all those years they had lost. We try to make those we treat into normal people. The job is one thing, the work, but we also try to reach their souls as well, because in that moment, you change them entirely. Our motto is: „To everyone we try to pass on that whatever happened to them happened on the surface, but inside they are the same!” Love is sensed. In consultation, children reach out to you with their hands, I see them go away from their parents, coming to me… I think that the moment these children no longer reach out with their hands, this job is no longer be the job for me, because I am not good enough!
Who do you owe most?
Nothing of all that I have done would have been possible without my wife, Mihaela, with whom I have been together day and night and built these things. Out of an 125 year old hospital we have made a new one, we have made a new team, we have created a new conception, I could say that we have revolutionized in our country the way in which burns are treated and we would have had more things to do together, but my angel passed on to the angels… That is how it was meant to be! I am now trying to continue because she sent me this command, to finish what we started together!
