Earlier this year, a 6-year-old girl was shot and badly wounded during a firefight between U.S. and Afghan forces and the Taliban. Her father, a Taliban fighter, her mother and some siblings were all killed in the gun battle.
Dr. Chance Henderson, a Texas-born orthopedic surgeon, was there when the girl, whom NPR is calling Ameera, was brought to the hospital at the Bagram Airfield outside Kabul.
"I remember her quite vividly there on that stretcher, and how tiny she looked," he says.
Back in May, NPR reported that it was unclear whether Henderson — who has a daughter close to Ameera's age — and his medical team would be able to save Ameera's severely wounded left leg.
The stakes were high, Henderson explained at the time, because the girl's "outlook on a life as a single amputee that does not have a family is much different than it would be for us in the States. Her future would be grim, and probably her lifespan would be short."
This week, there's good news. Henderson says he succeeded in saving Ameera's leg via a procedure called a cross-leg flap. It involved temporarily attaching her two legs and directing blood flow from the healthy right leg to the left.
"We just take the skin from one leg, the other leg and flap it down kind of all the way to the muscle, and use that muscle and subcutaneous fat to sew to the other leg, to cover that defect, and allow the bone to get her blood supply to it, take away infection and let it heal," Henderson explains. "The nurses were calling it a mermaid flap."
Ameera's legs were stabilized with a bar "so she didn't pull them apart as she was waking up or in normal day-to-day life," Henderson says. "And so she was sewn together, as well as bars and pins holding her legs together."
The flap was divided after four weeks, the operation a success. Since then, the team has worked with Ameera to strengthen her legs, with the help of a custom-made walker.
"She's a little stiff and we have a therapist here that's been working with her to help her walk," Henderson says. "But she's doing quite well."
Ameera is doing so well that she is getting ready to go home soon. It's a bittersweet transition for Henderson and his team.
"She has been here from the first week of this deployment, when we first got here in early April, and so I don't think there's a person at the hospital that hasn't spent hours with her," he says.
Nurses, therapists and physicians have all gotten to know the girl. They've played with her and done what they could to make her feel more comfortable.
"And so she's very near and dear to all of our hearts," says Henderson.
So much so, in fact, that in the beginning, several of them had thought they might adopt her.
"The first night we met her, we all thought, that's it, you know, we've got to save this little girl," Henderson says. "Immediately when we heard that she had lost her family, of course that's what everybody's thinking. We were excited to find she did have other family members, but I think there's a law, a federal law, against military members adopting. And we asked the question and were told no. And I think some of us asked twice and were told no twice, which is a strong no in the military."
Henderson expects Ameera to be discharged "very soon." She'll go into the care of her family, though it's unclear which relatives will look after her. To protect her security, the location where she'll be living isn't being made public. Henderson worries that her time in a U.S. hospital may elicit threats.
The most important thing from Henderson's perspective is for her to lead as normal a life from now on as possible.
"I really want her to be able to run and walk and do all of the normal things that a kid can do almost when she leaves here, just purely because I think follow-up will be difficult, given that she may be far away from here," he says. "I want her to be 100 percent."
When Ameera leaves, he says, "It's going to be a tough day." In the time she has spent at the hospital, she's picked up a little English: "She says 'hi' and 'bye' and 'thank you' — and she's certainly learned how to say 'no' quite clearly," says Henderson.
For him and his team, "bye" will be the hardest thing to hear. But Ameera, he knows, "will smile, she'll be excited."
KELLY MCEVERS, HOST:
We're going to check in now on a little girl in Afghanistan. In April, she was shot and badly wounded in the leg in a firefight between U.S. and Afghan forces and the Taliban. Orthopedic surgeon Chance Henderson was there when she showed up at an American military hospital at Bagram Airfield.
CHANCE HENDERSON: I remember her quite vividly there on that stretcher and how tiny she looked.
MCEVERS: We're not using the girl's name for safety reasons. Her father, a member of the Taliban, was killed in the firefight. So were her mother and some siblings. We first brought you her story in May when it was unclear whether doctors would be able to save her wounded leg.
This week, we got back in touch with Dr. Henderson, and he told us how he managed to save the girl's leg using a procedure called a cross-leg flap.
HENDERSON: We just take the skin from that one leg - the other leg, flap it around kind of all the way down to the muscle and use that muscle and subcutaneous fat to sew to the other leg to cover that defect and allow the bone to get her blood supply to it, take away infection and let it heal.
MCEVERS: So basically, the two legs were sewn together.
HENDERSON: Correct, yeah. The nurses were calling it a mermaid flap. And so we just used that device and put a bar across to the other leg to help stabilize that flap so she didn't pull them apart while she was waking up or in normal day-to-day life. And so she was sewn together as well as bars and pins holding her legs together.
MCEVERS: So, I guess, I would imagine that she didn't stay that way, right? Were the two legs eventually separated once the bad leg was able to heal?
HENDERSON: You are correct. Yeah, we divided that flap at four weeks from when we placed it there. And eventually, it gets blood supply from the wounded leg. And so you can then divide it. And that has been successful. That wound is covered now. And now we're just kind of dealing with the sequela of having your legs together for four weeks. So she's a little stiff.
And we have a therapist here that's been working with her to help her walk. But she's doing quite well.
MCEVERS: How soon will she be good enough to be released?
HENDERSON: Very soon. It kind of depends on her therapy. I really want her to be able to run and walk and do all the normal things that a kid can do almost when she leaves here just purely because I think follow-up will be difficult given that she may be far away from here. And she'll go back with her community where she came from.
And, you know, she may come back for follow-up. We certainly are happy to have her come back. We've requested that. But, you know, it's difficult for them to travel that distance to get here. So I want her to be 100 percent. And that may be maybe a week or two from now.
MCEVERS: Wow. Her father was a Taliban fighter, and he was killed together with her mother and some of her siblings. Do you know who she's going back to?
HENDERSON: All I know is immediate family. You know, her family has been here to help care for her, basically be by her side the entire time she's been here. But I am not 100 percent sure from there. I think back with her immediate family, and I'm not sure who that will be.
MCEVERS: Wow. I know that many people in the hospital were, you know, so interested in her and her getting better and some were even talking about wanting to, you know, bring her back here to the U.S. Was that ever a discussion in your family?
HENDERSON: Absolutely, man. We were going to try to figure out how to sneak her out of here. No, I'm kidding. But we have, I mean, the first night we met her, we all thought, you know, that's it. You know, we've got to save this little girl. And immediately, when we heard that she had lost her family, of course, that's what everybody's thinking. We were excited to find she did have other family members.
But I think there's a federal law against military members adopting. And she has family. And I'm sure that's where she wants to go. But all of our hearts, I think, were in the right place. And we asked the question and were told no. And I think some of us asked twice and were told no twice, which is a strong no in the military.
We learned to say yes, sir - but absolutely.
MCEVERS: Is it going to be hard to say goodbye?
HENDERSON: I think it'll be tough. I think - and the people that see her the most are the therapist and the nurses. They spend every waking hour with her. They wheel her around the hospital. She's learned how to play some video games. And, you know, she watches "Frozen." And, I mean, they've taught her some English words. And she says hi and bye and thank you.
And she's certainly learned how to say no quite clearly.
HENDERSON: But she - yeah, she's a sweet like every other 6-year-old girl. And I think we're all going to have a hard time. And she has been here from the first week of this deployment when we first got here in early April.
MCEVERS: Oh, wow.
HENDERSON: And so I don't think there's a person in the hospital that hasn't spent hours with her. And so she's very near and dear to all of our hearts. It's going to be a tough day.
MCEVERS: You talked about wanting her to be released sort of fully functional. Explain why that's so important, I guess, in Afghanistan. You know, if she were to go back disabled, how would that be difficult for her?
HENDERSON: The family members that were here with her, at the time it was an uncle, was very clear that it would be exceedingly difficult for her to have any kind of quality of life with one leg or an amputation, any kind of physical disability just based on the difficulty of where they live and the terrain but also for being accepted by others.
And then someday in the future, having a family and having a husband would be difficult for her 'cause she doesn't have a dowry, at this point. And her folks, you know, are gone, like you mentioned earlier. So I think, you know, it's quite clear that it would be just difficult for her to have any kind of a quality of life.
MCEVERS: Do you think she'll be in any danger going back having spent so much time in an American hospital?
HENDERSON: Yeah, that's my fear. Yeah, I'm very concerned. That is absolutely my concern.
MCEVERS: I want to ask Dr. Henderson more questions but then this happens.
HENDERSON: You're on speaker just a second. We have an incoming rocket right now.
MCEVERS: OK, all right. Stay safe.
HENDERSON: Bye, thank you. We'll give you a buzz back.
MCEVERS: That was U.S. Air Force Lieutenant Colonel Chance Henderson. By the way, everyone is OK. This happens a lot at Bagram Airfield in Afghanistan. You can see our earlier story about the girl and watch her steps toward recovery at npr.org. Transcript provided by NPR, Copyright NPR.