ANN ARBOR, Mich. — Surgery has replaced her charred skin and time is repairing broken bones, but for the 4-year-old girl who alone survived the crash of Northwest Airlines Flight 225 there will be deeper injuries more resistant to healing.
While her doctors say that the girl, Cecilia Chichan, is recovering well from serious physical injuries, experts say the trauma is all but certain to inflict profound emotional wounds that will linger long after her body is whole again.
For now, she lies in a hospital bed here surrounded by evidence of a nation’s good wishes; boxes and letters and hand-made cards engraved in crayon and a Cabbage Patch doll sits not far from a parcel from Minnesota that reads: “To the 4-Year-Old Girl Victim of the Northwest Airline Crash.”
Under sedation, she drifts in and out of consciousness, asking if she is in the middle of a dream and wondering where her mother is.
So far, the team of doctors, social workers and psychologists have put off confronting the first of the horrible things they must tell her as they begin helping her understand what happened: that her parents and 6-year-old brother died in the crash that also killed 154 others. “It has not been decided who will tell her or how and when it will be done,” said Catherine Cureton, a spokesman for the University of Michigan Medical Center.
Leading child psychologists say she is at great risk for depression now and in later life. Her case is particularly complex because, all at once, she has suffered a plane crash, burns and a painful treatment, and the loss of her immediate family. Any one of these traumas would present psychological difficulties; coming simultaneously compounds the risks.
Being the sole survivor of a disaster leaves its own psychological imprint, experts say, including feelings of guilt.
Physically, she has made tremendous progress, her doctors say. After undergoing four hours of skin graft surgery, she was moved to the intensive care unit of the University of Michigan Burn Center where she was listed in serious but stable condition.
“We’re increasingly optimistic,” said Dr. Theo Polley, the pediatric surgeon overseeing her case. “Things look good.”
The child’s psychological status is uncertain, however.
For a 4-year-old, the reality of the death of a parent doesn’t strike immediately,” said Dr. Lee Salk, a professor of psychology, psychiatry and pediatrics at the New York Hospital-Cornell Medical Center. “It begins to take on greater meaning as she begins to miss them and notice they aren’t there.”
For a young child, the grief of losing one’s parents can arouse deep anxieties about separations of any kind. A child at that age will have strong memories of her parents, and bereavement is likely to include intense memories and withdrawal into resentment and anger.
Experts caution that the girl’s recovery will depend on many factors, including her own emotional makeup and the circumstances in which he is reared.
“It is possible she will come through being more resilient than most, able to cope with tragedy, on the one hand, or extremely vulnerable to life’s difficulties on the other,” said Mardi Horowitz, a psychiatrist at the University of California Medical Center in San Francisco, who runs a clinic for victims of psychological trauma.
How she develops over the coming years will depend on the love and understanding she receives from whoever takes care of her, the experts say. The more loving and dependable those substitute parents are, the fewer psychological problems she is likely to have later in life.
The child’s relatives say they are uncertain who will rear her, but there are many aunts and uncles and two sets of grandparents who may be able to do so. About 10 relatives have flown to Detroit to be by her side. The family is a close one, said David Cichan, one of Cecilia’s uncles. “I’ve got the phone bills to prove it,” he said.
Children in such situations should be told the truth about what happened, although they may have to be told in small doses, the experts say. “You should let the child pace how much you tell her and when,” Horowitz said. “Begin with the obvious: you’re in the hospital, you were injured in a plane crash, we’re going to stay with you while you get better.
“Only when she asks where her Mommy and Daddy are would you then tell her that they were in the crash, too, and they’re not alive — that’s easier to take than, ‘They’re dead,”‘ Horowitz said. “Let her indicate by her questions when she’s ready for each bit of the bad news.”
One of the special dangers in such cases is guilt, the experts say. “Kids at this age experience such horrible events as a punishment for something they’ve done and feel guilty aabout it,” Eth said.
The Cichan family — Michael, 32, an assistant professor of botany at Arizona State University, Paula, 33, a nurse, David, 6 and Cecilia — were heading home to Tempe, Ariz., last Sunday after a vacation in Philadelphia, where the family visited both sets of grandparents. The four caught Northwest Airlines flight 255, en route to Phoenix after a short layover in Detroit.
At 8:46 p.m., the MD-80 took off, staggered to an altitude of only 48 feet and then plunged to a busy freeway, killing 157 people, including three motorists on the ground.
The girl’s survival has created an entire mythology. Officials at first found the idea so preposterous that they announced that the girl must have been a passenger in one of the cars crushed and burned in the crash.
For days, she remained unidentified until her grandfather, Anthony Cichan, 59, flew in from Philadelphia and confirmed her identity by her purple nail polish and chipped front tooth. And relatives like to say that it was her mother who, in a final gesture of love, saved Cecilia by clutching her in her arms when the plane crashed.
As clean-up crews and federal investigators remove the last chunks of charred shrapnel from the ground near Detroit Metropolitan Airport, Cecilia lies in a tiny space cleared among the gifts of balloons and stuffed animals.
Paradoxically, the psychiatrists said that the huge outpouring of support for the child could itself hinder her emotional recovery. Salk said her celebrity could distract her from the introspection she needs to move toward recovery. There are 9,800 letters from around the country, personal checks ranging from $1 to $2,000 and so many new parcels, the hospital aides can barely keep track.
The aides are keeping a catalogue of every balloon and stuffed animal that makes the room look more like a toy store. “It’s a celebration of life,” said therapist Toni Leeds. “It’s like the prodigal son coming home.”
