More than technique, plastic surgery is a relationship, one that Batra works hard to develop. When his cellphone rings with the opening chords of Led Zeppelin's "Kashmir," he knows it could just as likely be a patient as the office or a friend. He would have it no other way.
"Well, Dr. Batra, this is going to be a long night," he said. "When we are done, he is going to be a canoe."
Batra knew how surgeons deal with the stresses of their careers by distancing themselves from their patients, making light of death, morbidity and deformity, and how plastic surgeons often fall prey to professional narcissism.
Striking a balance between emotion and objectivity isn't easy, especially in matters as sensitive as appearance, and in Ana's case, he found it nearly impossible. He felt sympathy for her. He found himself hoping that by changing her appearance, he could change her life, and one day she would find a job, walk down the street without drawing stares, meet someone who could love her.
When he asked Halls if he thought they were making a difference in her life, Halls told him it didn't matter. The only thing that mattered was whether they were doing their jobs as surgeons. You cannot change the nature of a tiger, he said.
Batra was accustomed to patients who appreciated his work, and he had hoped for the same reaction from Ana. He had a difficult time reading her one-word answers and seeming indifference.
But how could a few hours under a surgeon's blade undo a lifetime of experience?
Neurofibromatosis had determined the course of Ana's life, and there could be no underestimating the stigma she felt living with the disorder, even if she denied it. The tumors had been a mask, locking her inside herself, and even as they slowly disappeared, unlearning that mask would take time.
Spring blurred into summer. Ana couldn't stop worrying about the next operation. Long weekends in San Diego with a girlfriend and carne asada barbecues on Fiesta Island helped. Phone calls with a boyfriend she'd met on the Internet distracted her. There was a friend's quinceañera in September, and on the occasional Saturday or Sunday when it got really hot, she went fishing.
A local lake was as good a getaway as any. Edged by a few eucalyptus trees, the open water drew an afternoon breeze, just enough to take the edge off 100-degree temperatures.
In the shade, Ismael enjoyed a beer. Margarita read astrology magazines. Family stopped by. They grilled corn, served napoles and made soft tacos with beef, white onion, tomatoes and cilantro. Sometimes they caught a catfish, and there was even cell service.
"Como se curó," her aunt said of Ana. She is cured.
As the lavender twilight spilled over the lake, cottonwood tufts drifting across the sky, barbecue lifting into the air, the fluorescent corridors and antiseptic smells of Scripps seemed far away, and Ana let herself relax, seemingly content for an afternoon of forgetfulness, even as Batra and Halls began to recast their plan for the third surgery.
They had been concerned about Ana's recurring headaches, caused by her double vision and the misalignment of her eyes. Initially they had planned to cut and shift the facial bones around her nose and forehead to elevate the orbit of her left eye, but they realized it didn't need to be that complicated.
They presented their opinion to the other doctors at a dinner meeting at Ruth's Chris Steakhouse in Del Mar. Over calamari and shrimp appetizers, they opened a laptop and studied Ana's CT scans.
"It's a volume problem, excess volume in the orbit," Batra said.
The tumors hadn't misaligned the orbit; they had expanded it, allowing the left eye to settle lower than the right.