The next morning, Hermide called Wilner and left the phone with Janel. When she came back to retrieve the phone, Wilner told her that Janel had agreed to go to treatment. After Hermide hung up, Janel said to Hermide, “I want to go to treatment today.”
But then he refused to get out of bed.
Hermide called me.
I was with a patient and silenced my phone so I could call her back when I finished, but she kept calling. I excused myself apologetically and stepped out of the clinic room into the hallway to take the call. I took a deep breath before I answered—the constant disruptions were beginning to wear on me. I was in awe of Hermide’s patience and persistence, and I wanted to be helpful, but I didn’t really know what I could do—and Janel was not my only patient to take care of.
“I give up,” Hermide said and sighed. “We need to get his mother here. Maybe he’ll listen to her?”
I told her I would talk with Michelle and Anne to come up with a solution.
Despite our best efforts to get Janel his treatment, it was becoming clear that our strategies to do so were failing. Now what? His mom didn’t have a birth certificate, so waiting for a passport and visa for her could take months, as it did for Janel. Should we send him back to Haiti for a few months to recover and then have him come back with his mom when she finally got a passport?
The radiation oncologist thought the sporadic doses of radiation Janel had received over the prior two weeks would contribute to the overall limit he could tolerate before risking toxicity but probably wouldn’t contribute much to controlling his tumor if there was a months-long delay before he got further radiation. In other words, if we took a break, the treatment he had received so far would be wasted and couldn’t be repeated.
It seemed as though we had to go with our last resort: to hospitalize Janel for the next month so he could receive his full treatment course. Most of the challenges had been at Hermide’s, so hopefully everything would go more smoothly if we admitted him to the hospital.
I stepped back into my clinic room, apologized to the patient, and finished the appointment. Despite having fallen way behind, before I called in the next patient, I dashed off emails to Janel’s oncology team and to Anne and Michelle about the possibility of admitting Janel to the hospital. Then I kept on seeing patients, and after each one, I checked my email and found a dozen messages flying back and forth discussing what to do next.
“Who will pay if we admit him?” asked one of the oncologists.
“If this is medically necessary for him, then it’s part of his care, which the hospital committed to,” I replied.
In a separate email chain, Michelle wrote, “I like the idea of admitting him!”
“The hospital administration didn’t budget for this—they are not going to be happy with us,” I lamented in my reply.
“They can afford it!” she quipped back.
“Agreed, but will they ever want to help us again with another case after this one?” I asked. “This is becoming a disaster!”
We all agreed our only choice was to hospitalize Janel, but this still didn’t resolve the question of whether he really wanted to be treated. Anne called Wilner and explained the situation. He again expressed that he was embarrassed about how Janel was behaving and was sure that it was the disease causing him to behave this way. Wilner reiterated that Janel and his family would want us to do everything we could to try to make him disease-free for the future, and he fully supported admitting Janel to the hospital if that was what he needed. Wilner’s only concern about hospitalizing Janel was whether the hospital staff would be as patient and kind with Janel as Hermide and the women who lived with her had been. We assured him they would.
Finally, after an exchange of more than forty emails over several hours, we had made a decision and arranged the logistics. Janel would come into the hospital the next day to complete the rest of his six-week course of chemotherapy and radiation therapy.
We were all relieved. A rest for Hermide and the women who helped her take care of Janel. A safer plan to ensure the continuity of Janel’s treatment schedule for the oncology staff. A break for Anne, Michelle, and me, from what had been a nearly full-time job of interfacing with Hermide, the oncology staff, and each other to try to make things work in parallel with our full-time jobs in the hospital. And most important, Janel would get the treatment he needed for his tumor in what seemed to be a more comfortable environment for him.
By the time all of this had been sorted out and I had finished seeing all of my patients and writing my clinic notes, it was late in the evening. As I walked home through the cold winter night, I went through my mental checklist for what I needed to pack and take care of before I left for Haiti the next morning for one of my regularly scheduled trips. After weeks of chaos—not to mention the bitter cold of Boston’s winter—escaping to Haiti felt like a welcome reprieve.
10
My flight to Haiti was delayed, landing at the same time as flights of several other airlines. The customs hall clearly wasn’t prepared for this. I waited in line for almost two hours in the crowded, humid room. If it got much later, I would have to spend the night in Port-au-Prince and travel to Mirebalais the next morning, since navigating the mountain roads at night is dangerous. But so is Port-au-Prince. I was getting anxious.
Finally I made it to the front of the line. I approached the window and gave the customs agent my passport.
“What are you doing in Haiti?” she asked in thickly accented English, thumbing through my passport without looking up.
“Mwen doktè. M travay Zanmi Lasante,” I answered. (“I’m a doctor. I work for Partners In Health.”)
She continued looking through my passport, not impressed in the least with my credentials or my Creole.
“And what type of doctor?” she asked in English.
“Newolog,” I said. (“Neurologist.”)
“Ki sa ki yon newolog?” she asked with continued lack of interest. (“And what’s a neurologist?”) She started entering information into her computer.
I took a moment to think of how to say what I wanted to say in Creole. “Newolog se doktè pou pwoblem nan tèt,” I finally said, tapping my finger against my temple and smiling. (“A neurologist is a doctor for problems in the head.”)
Now she looked at me, her face suddenly brightening. “Se doktè tèt ou ye?!” she asked excitedly, breaking from her previously serious official-border-agent demeanor. (“So you’re a head doctor?!”)
“Doktè tèt, wi,” I replied. (“A head doctor, yes.”) I smiled again, amused by the literal translation, “Doctor Head.”
She smiled too. “Eske ou ka we boul m gen nan tèt mwen?” she asked. (“Could you have a look at this bump in my head?”) She leaned forward and pulled apart some strands of hair just before they entered her tight ponytail. She took my index finger and guided it to a small, soft bump on her scalp. “Kisa m gen la?” she asked, furrowing her brow in concern. (“What do I have there?”) She moved my finger back and forth over the bump. It felt like a pimple or a bug bite, but I wasn’t sure.
“Sorry, I’m not the kind of doctor you need. I’m a doctor for what’s inside the head,” I told her.