“Oo oo! Doktè! Doktè!” she nearly sang, her voice high-pitched and lilting. She hugged me close to her and moved her head from over one of my shoulders to over the other, back and forth several times. She continued to hug me, rocking us back and forth. “Oo! Bondye ap beni w! Apre Bondye se doktè! Oo-eee!” she cried out. (“Oo! God bless you! After God is the doctor! Oo-eee!”)
I glanced over her shoulder at Janel. He looked the same as when I had last seen him in Boston a few months prior. Mute, motionless, staring blankly ahead. He still looked terrible. I was confused by his mother’s effusiveness.
“Kouman Janel ye?” I asked her tentatively. (“How is Janel?”)
“Li la!” she exclaimed joyfully, releasing me and taking hold of my hands, still smiling broadly. (“He’s here!”) “Li byen, grace à Dye! Janel! Salye doktè!” (“He’s good, thanks to God! Janel! Say hi to the doctor!”)
There was no reaction from Janel.
This was byen (good)? She motioned excitedly for me to sit down in the chair she had been sitting on. I tried to encourage her to sit there, but she insisted. I was touched by her greeting but struggled to make sense of how she could be so happy with him still looking so bad.
Then I thought of the first thing she had said: Li la—He’s here.
In Haiti, saying “Mwen la” (“I’m here”) is a common response when people are asked, “How are you?” Although “I’m here” may sound like the bare minimum of how one can be, it’s actually a more positive response than some of the other frequent answers to the question, like “M pa pi mal” (“I’m not too bad”) or “N’ap kenbe” (“We’re holding on”), not to mention “N’ap lite” (“We’re struggling”) or “N’ap boule” (“We’re burning”). A colleague of mine in Haiti says they all essentially mean “I’m okay,” but I’ve always been struck by the literal translations.
Li la—he’s here. Janel was here, he was alive. Maybe that already exceeded his mother’s expectations—in a place like Haiti, where so many people die of much more mundane and trivial causes than brain tumors, mere survival could be a gift. I remembered how months earlier I had agonized over whether Janel and his mother truly understood the risks of brain surgery in Boston, but they had been willing to do anything that had a chance of helping him. Though I’d felt defeated about how poorly Janel had done after all of modern medicine’s attempts to save him, his mother was thrilled just to have him alive. What had seemed a tragic disappointment to me appeared to be a triumphant victory for her.
Deeply moved by Janel’s mother’s gratitude in spite of the outcome, I thought about how success and failure in medicine are never as sharply defined as we may think. That night, I wrote to one of my oncology colleagues:
Not a spectacular outcome by any means from our perspective, but his mom was so happy and grateful for him being cared for. I suppose it’s all relative in a place where so many people just seem to die for no reason. It really put the whole thing in perspective for me.
She replied:
I guess it’s not a huge victory, but in my neuro-oncology world, he’s alive and home and well overall, which is about as good as you could hope for.
* * *
Midway through my week at HUM, I got an email from our local PIH/ ZL administrative colleague who had been trying to help Enel with his passport. She wrote:
Morning Aaron and Anne, I prayed last night—harder than usual—LOL and this morning, I was able to “find” Enel. He’s in Port de Paix. I asked him to come asap. We spoke of having someone else travel with Davidson if he can’t and he’s ok with that. He’s hoping to arrive in Mirebalais on Saturday so we can make a plan.
That weekend, while I was eating some rice and beans and reading an article on my phone in the staff house dining room by myself, I saw a man walk by the entrance to the house out of the corner of my eye. Could it have been Enel? He was supposed to come to Mirebalais at some point over the weekend. I didn’t get a good look at him, and lots of people who stay or work in the house are constantly coming and going. A little boy ran after the man. I guess not, I thought. If it had been Enel, he would have been carrying his son since Davidson couldn’t move. I went back to my lunch and article.
The man came into the dining room doorway and looked at me.
“Doktè Aaron?” he asked.
“Monsieur Enel?” I asked him.
We smiled and shook hands.
The little boy I had seen ran up behind him, grabbed onto his leg, peered curiously around it, and then flashed a big smile.
“Se frè Davidson?” I asked, smiling down at the little boy. (“Is this Davidson’s brother?”) He looked a lot like Davidson. But he didn’t have the same cherubic cheeks I remembered from when I’d met him six months prior. And he could move.
“No, li se Davidson,” Enel replied calmly. (“No, that’s Davidson.”)
My smile faded abruptly. I must have misunderstood the Creole. Davidson was bedbound and immobile, and this little boy had already scampered off while I tried to make sense of what Enel had just said.
“Li se Davidson?” I asked, eyebrows raised nearly to my hairline. (“That’s Davidson?”)
“Wi,” Enel replied nonchalantly. (“Yes.”)
“Li ka mache?!” I asked, bewildered. (“He can walk?!”)
“Wi, li ka mache kounyea,” Enel said casually and smiled softly. (“Yes, he can walk now.”) He didn’t seem fazed by my shocked confusion. I invited him to sit with me at the dining room table. Someone had brought a pizza from Port-au-Prince, and I cut him a slice. I sat down across from him at the table.
Davidson ran into the room, hopped up onto a chair at the table next to his dad, bent his legs under him, sat down on his feet, and looked eagerly at the pizza.
“Kouman li ka mache?” I asked Enel, unable to take my eyes off Davidson. (“How can he walk?”)
“A few months ago he started to crawl,” he said, cutting a piece of pizza for Davidson and putting it on his plate. “Then he started to walk.” He took a bite of his slice of pizza, chewed it, and swallowed. “And now he can even run.”
I was astonished. How could this be the same boy who just a few months ago was completely paralyzed from the neck down, crying in pain when we touched his neck?
“I didn’t recognize him,” I said.
“Yes,” Enel explained, “since he became active again, he lost some weight.”
I kept staring at Davidson. “Before he starts eating, can I examine him?” I asked.
Enel asked Davidson to put down his slice of pizza. He did so calmly, and I walked around the table to where he sat. I put my hands under his armpits, lifted him up, and sat him on the dining room table.
I tested his strength by having him pull and push my hands with his arms and legs—completely normal. I jiggled his arms and legs to test his tone—all were loose, the spasticity gone. I stiffened my first two fingers and tapped his elbows and knees with them—his reflexes had all gone back to normal. When I scratched the soles of his feet, his toes curled down—the normal response, no more Babinski sign. I lifted him from the table to the floor and asked him to hop on one leg, which he did easily. I bent down, reached around him, and gently put my hands on the back of his neck to see if it was still stiff. He initially pulled away, but with his dad’s encouragement he cooperated. His neck was more flexible than before, but there was a hint of slight stiffness at the extremes of movement, and he winced a little. But he didn’t cry this time.