One way to look at the Karen Vazquez story is that she's an 8-year-old Cuban girl who faced death but lives happily today because of good-hearted Marylanders -- a hospital, four doctors, a social worker, a minister, three charities and many new Hispanic friends.
Another way is that the American medical system saved her after the Cuban medical system tried and didn't.
Still another is that Karen, an evangelical Christian, is the beneficiary of Sinai Hospital's practice of tsedakah (pronounced sedaka), acts of righteousness in daily life as dictated by the Torah and Jewish law.
In any case, Karen and her parents, Lino and Laly Vazquez, are eager to praise God, George Washington and Maryland.
The story starts in October 1994 when Karen was a healthy second-grader who got straight A's in school and danced at the national theater in Havana. Her parents ran a tropical fish business. Mr. Vazquez, a marine biologist, also taught Russian.
Karen's health began to change. Her face became puffy, her abdomen grew, she tired easily, she lost some hair. She was not in physical pain, but other children made fun of her when her face took on the shape of a full moon.
The normally happy child often retreated in tears to her mother's arms. School became a nightmare.
The family doctor dismissed the parents' worries, saying Karen's heaviness was normal growth. Unconvinced, her parents took Karen to another doctor. Tests began. Karen was taken from one doctor to another, to six Cuban hospitals in all.
Some doctors suspected Karen had Cushing's syndrome, a metabolic disorder caused by too much cortisol, a naturally occurring steroid that regulates blood pressure, inflammations and other functions. If a growth on the pituitary gland is the cause, that's Cushing's disease, rare and potentially fatal. Cuba had little experience in treatment.
Karen's condition deteriorated. She could hardly walk. She entered a hospital March 27 and would not leave hospital care for months.
"We thought Karen would die," Mr. Vazquez said. "In the spring of 1995, we started to write letters."
Saving Karen's life became the family's obsession. They sold most possessions to pay for medicine and for travel to doctors. The father wrote to the Cuban government, President Fidel Castro's brother Raul, the Red Cross, other doctors, other hospitals. Letters went unanswered or responses were discouraging.
"I started researching the medical problem," Mr. Vazquez said. "I wrote to doctors who had written papers on Cushing's, asking for help to save our dear daughter."
One such letter went to a Baltimore doctor. He asked for help from a friend, Dr. Annabelle Rodriguez, a Sinai endocrinologist who speaks Spanish.
Dr. Rodriguez said, "Let's see." She met with Nancy Swartz, the Sinai pediatric oncology social worker and with Paul Umansky, community relations director. Institutions don't assume such cases lightly, needs are so great.
Two years earlier, Sinai took on another critically ill foreign patient, a Russian girl with leukemia. She eventually died.
Sinai Hospital administrators, who approved $7.5 million last year in uncompensated charity care mostly in the Baltimore area, agreed to take on Karen free of charge. Dr. Rodriguez told the Vazquezes the good news by telephone and letter.
dTC Dr. Karen M. Armour, a Sinai pediatric endocrinologist, received pictures of the bloated Karen and with others concluded that the little girl probably had Cushing's syndrome. Many tests were needed.
Ms. Swartz called two Baltimore nonprofit agencies, the Ronald McDonald House and Roads to Recovery Inc., on whose boards she served. The McDonald house, 635 West Lexington St., lodges families of critically ill children during treatment. Roads to Recovery is a nonprofit agency run from a Wilkens Avenue living room by Mike and Della Polk, who lost their 9-year-old son, Christopher, to leukemia in 1990 and set up the charity for transportation expenses in similar cases.
The groups agreed to pay for the Vazquezes to fly and stay here.
Dr. Rodriguez contacted the U.S. Interest Office in Havana to begin preparations to request permission for the trip. The Vazquezes applied for visas, which eventually were approved.
'She didn't improve'
Meanwhile, Karen's doctors in Cuba apparently decided she did have Cushing's disease. Her condition worsened. A resident in general surgery rather than a neurosurgeon operated on Karen June 27 in a Havana hospital, the parents said.
"The hospital told us Karen was cured," Mr. Vazquez said. "But she didn't improve. She stayed in intensive care in July, August and September." She was too sick to travel.
In late September, Cuban doctors corrected the electrolyte imbalance that was keeping Karen from traveling, Dr. Rodriguez said. Having few possessions left, the family sold their air conditioner to buy clothes for the trip to Baltimore.
The family arrived in Baltimore the weekend of the pope's Oct. 8 visit. The doctors had only a Cuban medical summary. At Sinai much of the fall, Karen underwent more tests. Cushing's disease was confirmed, requiring surgery. The Baltimore doctors said the Cubans did as much as they could; their surgery did not make things worse.
Many Maryland Hispanics and others welcomed Karen and her family. They included two staffers fluent in Spanish, Diana Melendez, a nurse, and Emma Modeer, a radiology technician.
The Rev. Segundo Mir, of the First Hispanic Church of Laurel, and his congregation welcomed them at Christmas. Rae Miller, a Sinai volunteer for 38 years, became a friend.
The Make-a-Wish Foundation paid for a family trip to Walt Disney World in Florida after an inquiry by Julia Duncan, another Sinai staffer.
Tumor was benign
On Jan. 18, the Sinai doctors operated on Karen. Dr. Martin A. Goins III, the chief ear, nose and throat specialist, entered under the lip and proceeded into the sinus passage to a bony cavity at the brain holding the pituitary gland. Dr. John Ragheb, a pediatric neurosurgeon, removed the tumor, determined later to be benign.
The operation was a success.
"We are very pleased with her progress," Dr. Armour said. "We have taken her off various medications, blood pressure and potassium supplements. She's off thyroid supplements, but we're not sure she can stay off.
"Karen is a very brave little girl," the doctor added. "She's made a tremendous rebound. She's so warm and fuzzy. She corrects my Spanish. The parents deserve so much praise. They fought tremendous odds to get a cure for their child."
Many of Karen's symptoms have eased. Her bloated face is waning. More hair is growing; she walks and runs, plays computer games and loves to throw snowballs at her mother. She says "computers" when asked what she'll do when she grows up and "fine" when asked how she feels. Her smile and laugh accentuate the point.
The Vazquezes' visas expire in early April. An extension is being sought to allow Sinai doctors to monitor Karen's progress longer. The family hopes to live in this country eventually.
Meanwhile, her father, the marine biologist, volunteers at the National Aquarium and is learning English free, courtesy of Baltimore City College.
Hospital and doctors' fees would come to about $70,000, if the family were charged.
The Vazquezes' thanks are pouring forth. Karen says "thanks." Her mother thanks "God and Sinai and all the Marylanders."
Her father also thanks George Washington for starting "a great nation under God's protection."
He urged Americans to remember what Washington said: "Stay united, be Americans."