Mirjam (pronounced Miriam) Peraj is a nature lover.
Every morning she would open the windows in her fifth-floor apartment in Shkodra, Albania, to bring a little bit of the outdoors inside.
But for 10 years, most of her days were spent inside her apartment.
A botched operation when she was 7 years old had worsened a degenerative hip problem, and despite seeing other doctors, she was barely able to walk. She was in such pain it was hard to sit in a chair and she could not bend over to put on her shoes.
Her apartment building had no elevator, so she could go outdoors only on the two or three times each year when relatives would carry her down the stairs, to visit her mother’s home.
But she remained optimistic that someday, things would get better.
“Life is long, so I never gave up hope,” Peraj said.
More than 5,000 miles away, in a classroom in the business school at University of Tennessee at Chattanooga, hope would find a way.
Erlanger orthopedic surgeon Dr. Paul Apyan calls himself a businessman who became a doctor, and he was fascinated by the changes occurring in health care. After completing more than 6,000 knee and hip operations, he decided he needed an MBA degree, so he enrolled at UTC.
The professor for his information technology class?
“We’re in the class in November, and he asks me, ‘Do you think you could help my sister-in-law?'” Apyan said in an interview last week. “So I go up to his office, and he pulled out this X-ray that has been through the mill.”
His sister, professor Beni Asllani explained, had hip problems, was scarcely able to walk and mostly was confined to her one-bedroom apartment.
“My brain starts to engage — what will you have to do to make this happen?” Apyan said.
The surgery would not be easy. Both of Peraj’s hips would need to be replaced in one operation. It was surgery Apyan had performed before, but not often.
And there were the logistical problems — could she get a visa to enter the U.S. for the months it would take to do the surgery and recover? And how would she pay for the surgery, with no health insurance?
Apyan agreed to donate his fees. But while Erlanger officials were sympathetic, the hospital could not offer the procedure for free. After some negotiation, Erlanger came up with a discounted fee, and Asllani wrote the check.
Now Apyan needed to see his patient.
This time it was Asllani, a professor at UTC since 2002, who offered a deal. If Apyan and his wife came to Albania, he would provide a guided tour of the region.
Apyan is an inveterate world traveler. He did some of his medical training in Germany, Switzerland, England, and Canada, so he didn’t hesitate to accept.
Albania is a small country, tucked northwest of Greece about 45 miles across the Adriatic Sea from the “heel” of Italy’s “boot.”
Originally part of several Roman provinces, it won its independence in 1912 after the collapse of the Ottoman Empire. The Italians invaded under Mussolini, and then the Nazis took over during World War II, spurring a furious resistance movement under Communist leader Enver Hoxha. Hoxha won and established a brutal dictatorship that lasted until 1991.
While Albania is now on friendly terms with the West, it is still struggling to improve basic services.
The hospital in Shkodra had modern imaging equipment, but the walls were crumbling, Apyan said.
There was no way he could perform the operation in Albania. “That was not an option,” he said. “She needed to be here in our controlled environment, where I have all of the things available.”
So Peraj needed a visa. The U.S. Embassy had already turned her down once, but this time Apyan wrote a letter explaining his plan. The embassy issued a one-year visa, and Peraj was on her way to Chattanooga.
Was she worried about getting on a plane for a place she knew little about, trusting her future to a doctor she hardly knew? “Not really,” she said in an interview last week at Erlanger. “I had no other option. Given the condition I was in, it was the least thing to worry about.”
Apyan has a regular team of assistants he works with on hip and knee surgeries. He refers to them as his pit crew, trained to work together as smoothly as the pit crew at the Indianapolis 500.
Susan Higley is the physical therapist on the team. “When we first got Peraj in the hospital, it took two strong guys to pick her up and sit her on the side of the bed,” she said, “because of her pain and weakness.”
The team also had to negotiate cultural differences between Chattanooga and Albania. “Albania is largely Muslim,” Apyan said, “and the women there are very modest, so I had to be sure to be respectful.”
Peraj’s sister Lirie, Asllani’s wife, worked as the translator. “I would have to say, ‘I’m going to try to move her leg,’ and ask her sister to tell her,” Apyan said. “I didn’t want to upset anyone.”
The surgery was set for October. Peraj was wheeled into the operating room and given anesthetics. She was placed on her side while Apyan replaced one hip, then turned to replace the other. Apyan takes pride in his speed and efficiency as a surgeon, but the operation still took some three hours.
Peraj was in the hospital for four days recovering before going home to her sister and brother-in-law’s house in Hixson, only about a mile from where Apyan lives.
Physical therapist Higley worked with her regularly. “Everything was a milestone,” Higley said. “It was a big deal when she got home and could actually get out of bed on her own, or go up and down a few steps. Then it got to where she can go up a full flight of stairs.”
Even Apyan is impressed. “She has not walked well for 50 years, so how much normal function she would regain, I wasn’t sure,” he said.
Peraj’s family is overjoyed. “I was just expecting for her to be pain-free,” Asllani said, “and when I see her sitting like this and walking ” His voice trails off as he shakes his head.
But no one is more pleased than Peraj. “I’m very, very happy, thanks to Dr. Apyan and his wonderful staff,” she said, with her brother-in-law translating. “I was hoping that this happy day would sometime come, but I had no idea how it would come. And now it is here.”
There is still work to do. Her muscles need to be strengthened, Apyan said, and she needs to improve her balance. He is optimistic she will be able to walk without a cane.
But the doctor is clearly pleased. “This has been the closest to a perfect thing in my life,” he said. “This is why you go to medical school.”
For the next few weeks, Peraj plans to travel with her sister and brother-in-law — a trip to Destin, Fla., and perhaps a visit to Gatlinburg, before returning to Albania in June. Apyan already has accepted an invitation to visit later in the year.
And what will Peraj do when she returns home?
She has a brother, and once or twice a year, he would put her sitting side-saddle on the back of his bicycle and drive her around a nearby lake. Now Peraj wants to try riding a bicycle on her own.
And where will she go? “I will just go out to see things,” she said, with a smile in her eyes. “Because I have missed a lot in my life.”(Cortezi: Steve Johnson)