Finally, a new face for young Hamoody

On the day Muhammed "Hamoody" Hussein was to get his new face, he begged for a fast ride in a wheelchair, shot a toy cannon down the hall and professed his adoration for the hospital receptionist.

"I love you!" the blind Iraqi boy told hospital admissions clerk Paula Royal. "Are you sure?" she asked. "What shall I call you?"

"Bob."

Eight hours of surgery and many unexpected difficulties later, Hamoody is now in critical condition in the intensive-care unit, having taken the first step toward a new life on Friday.

What was destroyed by a gunshot in May 2005 when his family, who are Shiites, were ambushed by Sunni insurgents, was partially restored by the skilled hands of Drs. Joseph Gruss and Craig Birgfeld — who donated their time — at Children's Hospital & Regional Medical Center.

It was a yearlong wait for the big day to arrive.

Last May, Hamoody was brought from Iraq to the Seattle area by the Everett chapter of the national nonprofit Healing the Children, which matches children in need of medical care unavailable where they live with doctors and hospitals willing to donate it. He was placed in the Snohomish home of Randy Smith and Julie Robinett Smith, and doctors at Swedish Medical Center planned to donate their services. But once doctors began to examine him last summer, they found that not only could they not restore his sight as they initially had hoped, but that Hamoody had severe sleep apnea and badly damaged sinuses from having been shot in the face during the attack — an attack that killed his uncle and critically wounded his mother.

The shooting left him blind, shattered an eye socket and his nose and displaced much of the soft tissue, leaving the boy disfigured. Another uncle drove Hamoody to Iran for surgery, but what was done there only complicated things, local doctors say.

The past year has been full of tests as doctors tried to determine the full extent of Hamoody's injuries. Eventually, Gruss, an expert in repairing facial gunshot wounds, took over the case, but even he was surprised on Friday at the extent of the damage he found once the surgery began.

Start from scratch

Gruss had assumed Hamoody, 4, was able to get some air through his sinuses. What he found was that the airway was entirely blocked, and it took hours and sorting through many delicate layers of tissue before he could determine that the nasal passage was blocked with misplaced bone.

"When you have a person who is missing so much of their face, you have to re-create the defect and start from scratch," Gruss said. All of the prior surgery in Iran had to be undone and surplus scar tissue removed.

As the doctors worked, they removed small bits of shot, leading Gruss to believe a shotgun had been used instead of an assault rifle, as previously believed.

"With a high-velocity rifle, you don't see that," he said. "Shotguns don't do as much damage as you get farther away." He theorizes that Hamoody, who was 2 at the time, was shot at close range.

Correcting apnea critical

During surgery, ultrasound equipment occasionally picked up the sound of Hamoody's heartbeat and it echoed in the white-tiled room like marching feet. The heart monitor kept a steady beep-beep-beep, and doctors worked in halos of bright light.

The small boy was draped in teal cloth, his thick, curly, dark hair braided to keep it out of the way. Correcting the sleep apnea was critical, said Gruss, who sported a surgical cap printed with happy faces. Children whose sleep apnea is not corrected end up with developmental disabilities from oxygen-deprivation brain damage, Gruss said.

Hamoody's blockage was so severe, "I've never seen anything like it before," Gruss said. "No wonder the little guy couldn't breathe.

"With this type of stuff, we're not often sure what we're going to do," he said. "A lot of it I didn't expect. It didn't show up on the X-ray."

More surgery still ahead

After the blockage was fixed, Hamoody, in effect, got a reverse face-lift, in which skin was pulled toward the center of his face to fill in the recessed parts the shot had blown away.

Gruss took a 4-inch piece of Hamoody's rib, split it in half, bent it with a special tool and placed it where the missing eye socket would be.

"A very beautiful structure — the eye socket," he said, as the rib sprang into place and he fastened it with titanium screws.

"I love rib," Birgfeld said, admiring the work. Another part of rib became the bridge of Hamoody's nose.

When the stitching was over, and Hamoody was reunited with his Mariner Moose and rolled into intensive care, the Smiths were looking anxious, the surgery having taken twice as long as they'd expected.

Hamoody will need at least one more surgery, Gruss said. But the boy can now breathe. "He'll be so excited," Julie Robinett Smith said. "He's wanted to be able to breathe through his nose." That will change his voice, too, she said.

And it will bring him closer to the day when he is to return to Iraq and the father and mother and extended family who telephone to talk to him.

After a year, he no longer remembers them, or his native language. As for the Smiths, Hamoody has no less a place in their hearts than their own two daughters. And they spent the day at the hospital waiting and praying.

When Randy Smith saw Hamoody after the surgery, "I was grinning from ear to ear," he said.

The wait "was nerve-wracking," Julie said. "But we knew he was in God's hands."

Saturday, Hamoody was groggy but out of bed, sitting in Julie's lap and clutching a new water gun.

Nancy Bartley: nbartley@seattletimes.com or 206-464-8522

Thomas James Hurst: thurst@seattletimes.com or 206-464-3894