She gave them hope that Nadia would one day be well.
Mapping a surgical path
While Nadia and her parents were settling in, the liver center's senior staff met to discuss her case.
They had two options: Put the child on the waiting list for a new liver and prepare her for a transplant, or perform a Kasai, which might allow her bile to drain and give her liver time to recover.
Both courses carried some risk. Though rarely, children still die waiting for a transplant. And Kasais are major operations with inherent dangers.
Several doctors argued that a Kasai was unlikely to succeed given Nadia's age and the advanced state of her disease. Better to spare her surgery now and prepare her for a transplant.
Rand, medical director of CHOP's liver transplant program, and others argued for trying a Kasai.
The risk of the operation in the hands of CHOP's experienced surgeons was minimal. If it didn't work - Kasai procedures are unsuccessful in 40 percent of patients - Nadia would go on the transplant waiting list.
Either way, Nadia would get a feeding tube and extra vitamins to help her gain weight, size and strength in preparation for a transplant. Rand would give Nadia's parents the special vitamins she kept stashed for patients in a cabinet over her desk.
"There was the possibility that this could work well for her," said David A. Piccoli, director of the liver center and chief of the division of gastroenterology and nutrition at CHOP. But, he said, the prognosis was not as bright as it would be if Nadia were younger and her liver not as severely damaged.
In medicine, experience counts. Two surgeons at CHOP perform all the Kasai procedures. Each does four or five a year, more than most surgeons do in three years. And as with many complex operations, the more Kasais a hospital and a surgeon perform, the better the outcomes.
In the early afternoon on May 2, eight days after she arrived at CHOP, Nadia was taken from her room on 8 South to the fourth floor, for surgery.
Joe and Allison went with her. They stayed by her side until the anesthesia took effect and she was wheeled into the operating room.
At 2:30 p.m., surgeon Michael Nance made a small incision on the right side of Nadia's abdomen an inch or so under her rib cage.
Wearing magnifying glasses to help him see the tiny vessels, Nance located the remnant of Nadia's gallbladder and injected some dye to check for bile flow.
The dye didn't move.
Nance next traced the bile ducts from the gallbladder up to the liver and down to the connection with the intestines. He widened the incision, releasing fluid that had built up in Nadia's abdomen.
The surgeon could see Nadia's liver was in bad shape. It looked dark green, its surface bumpy - clear signs of cirrhosis.
After a second injection of dye - this time directly into the ducts to double-check for any flow - Nance removed the girl's damaged gallbladder and bile ducts.
That tissue was preserved for testing and research.
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