Two hours later, we received a text message from the young physician:
The airline crew is a little nervous . . . Any medical information I need to be aware of other than what you’ve passed on?
I couldn’t help but wonder who was more nervous, the airline crew or the doctor traveling with Janel. I certainly would have been nervous if I had been asked to travel with a patient I didn’t know and couldn’t communicate with, especially one who was so neurologically impaired and could have a seizure on the plane. In fact, I would have been nervous to travel with Janel, and I had probably spent more time with him than with any patient I’d ever taken care of. While I was thinking about this, Michelle replied, conveying her usual confidence and optimism that everything would work out just fine:
They are often nervous ;) Just flash your doctor badge and I think they will calm down. His cognitive issues may be what’s making them worry, but he really should be fine. He was admitted for 6 weeks and the only real event was a possible seizure, but he is on medication for that, so it should not be a problem!
A few minutes later, he replied:
OK, thanks! I think they’re OK: after speaking with six different crew members, they are OK, and in any case, the airplane is now pushing back from the gate, so we’re good.
To everyone’s relief, Janel slept through the entire flight and was transported uneventfully to the rehab ward at HUM. Just over five months after Janel had left Haiti for the first time in his life, he was finally home.
* * *
Our first report from the rehab team at HUM was that Janel preferred lying in bed and sleeping all day, engaging only intermittently in physical therapy. But the rehab team was persistent, Janel slowly acclimated to the ward, and Janel’s mother came to HUM and stayed with him, encouraging him to participate more with his physical therapists. After a few weeks, the rehab team reported to us that he was able to walk the length of the ward and back with minimal support. He was eating on his own and indicating with gestures to the rehab staff when he needed help to get to the bathroom instead of just wetting the bed as he had done when he first arrived.
By the end of six weeks of rehab, Martineau wrote to me how impressed he was with Janel’s progress:
Janel walked over 300 feet with hardly any assistance. He can eat on his own with only a small residual tremor. He spoke to me in full sentences. I think we’ve made great strides. We must continue to accompany him.
It was starting to look like Janel might turn out to be a big save after all. I was glad we had pushed to get him maximal treatment rather than giving up prematurely.
We had hoped Janel’s mother would be able to return to Boston with him, but due to ongoing political chaos in Haiti, Martineau no longer had a personal contact in the immigration office. Despite his best efforts, he was still a long way away from getting her a passport through the normal process. It could take months. Janel would have to return to Boston alone.
Unfortunately, there weren’t any PIH staff members traveling between Haiti and Boston around this time to accompany him. I was going back to Haiti the following week to continue my work with Martineau and the HUM medical residents, and so I offered to have Janel fly back with me at the end of my trip. But this would have been too late to make the appointments already scheduled for him at Brigham to resume his treatment. I was disappointed I wouldn’t get the chance to see him doing so well in Haiti, but I also felt guiltily relieved that I wouldn’t have the somewhat frightening responsibility of flying back with him.
Anne suggested we thank Hermide by paying for a trip to Haiti for her to visit family and friends, then fly back to Boston with Janel. Hermide was happy to do this, and we booked her trip for the following weekend. As it turned out, I left for Haiti on the very same day they were returning to Boston. Looking down on the clouds from 30,000 feet, I thought about the odd coincidence: I was flying from my home in Boston to work in rural Haiti while Janel was flying from his home in rural Haiti to my workplace in Boston, both of us flying to lòt bò a—the other side.
12
Late June in Haiti is sweltering. Although June falls during the rainy season, it only rains for about an hour or two each evening. The temperature peaks in the high 90s by midday, the air becoming progressively more humid and heavy until it explodes into a brief but torrential evening downpour. The storm cools things off a bit outside, but the concrete staff house seems to retain the heat from the day. The rains just make it more humid.
As I walked to the hospital in the early morning, my shoes got sucked into the thick, sticky mud from the previous night’s rains. Jerking them out made a loud kissing noise, my feet sometimes slipping out of my shoes. I remembered from my visit during the prior year’s rainy season that by noon, when I walked back to the staff house for a quick lunch of rice and beans, the dirt road would be dusty and chalky, baked from just a few hours of summer Caribbean sun. Then the nightly rains would turn the route into sludge again, and the process would repeat. Haiti, land of extremes, I thought.
My morning ritual in Haiti has always been to get to the hospital about an hour before beginning my work there so I can catch up on the previous day’s emails, since the staff house doesn’t have internet. I had come to appreciate the internet-free period from sunset to sunrise, which allowed me to either focus more fully on whatever work I had brought with me or get lost in a novel until I sweated myself to sleep under my mosquito net. But I tried to keep up with my Boston life as much as I could while I was in Haiti by responding to emails from 7 to 8 a.m., during the lunch hour, and then at the end of the day before going back to the staff house.
When I arrived at HUM, it was still early, and the cleaning staff was sweeping the hospital floors, humming hymns as they worked. They looked at me as I approached and then down at my mud-caked feet. I scraped the soles of my shoes against the concrete walkway to the entrance to remove some of the mud and then wiped them off on a patch of damp grass.
I made my way up the stairs to the administrative area, found an empty office, flipped on the ceiling fan, sat down, and waited for my phone to connect to the hospital Wi-Fi. I always felt my pulse quicken as I connected to the internet each morning in Haiti, wondering what I might have missed in the last twelve hours at work, at home, in the news. Fortunately, there was usually nothing major.
This morning, as my inbox convulsed with each spurt of new emails, I saw a message from Anne fly by with the subject “Janel” and scrolled down against the incoming tide to open it. The email had been sent just before midnight:
Hermide and Janel were on the way home from the airport and are now headed to Brigham after Janel had a seizure. Hermide called me soon after they left the airport with concern that he was having some shaking, but it resolved while we were on the phone and we agreed she should continue home. She called again just now to say that he had a big seizure, describing tonic/clonic movements of his arms and legs lasting 2 minutes. Sorry for the news.
Thank goodness this hadn’t happened in the air, I thought as I toggled to my phone app for the Brigham medical record system. I imagined the plane making an emergency landing in some small rural airport and taking Janel to the nearest local emergency room. What would they have made of such a complicated patient? I could see the staff’s eyes widening as Hermide explained that he’d had several neurosurgeries, radiation, and chemotherapy for a rare brain tumor, that he had a shunt, and that they were flying back from Haiti to Boston for more treatment. And if he had a seizure on an airplane, would everyone have insisted on another air ambulance flight to get him back to Boston—and where would we have come up with another $33,000 to support that? Maybe we would have had to drive down to pick up Janel and Hermide and drive them back. It was concerning that he’d had a seizure, but at least it had happened after the plane had landed in Boston.