“That’s expensive!” I said. “How were you able to pay for it?”
“A pastor doesn’t make so much money,” he said, shaking his head and frowning. “Fortunately we had some insurance through the church. But we paid all of our own money, and so much of our family’s money too. We had to ask everyone we knew for money.”
I stared at him, horrified by the tragic story. I thought I should clarify that all of his care in Boston would be free in case there was any doubt. If he wasn’t even aware that this surgery would be big enough to leave a scar, perhaps he hadn’t understood that this would be nothing like his experience in Cuba. I explained that they wouldn’t pay a cent of their own money, and if they needed anything, they shouldn’t hesitate to ask Anne or me.
“Le ciel prend note!” Pasteur exclaimed, pointing his index finger upward. (“Heaven is taking note!”) “I called my family in Haiti last night and said, ‘They paid for our flights, they picked us up at the airport, they gave us food.’ God bless Boston!” His voice was taking on a preaching melody and rhythm, each phrase more animated than the last. “It doesn’t matter how you get to heaven, if it’s by way of Haiti or by way of Boston! In the glory of God, amen!!” He raised his hands as if addressing his congregation.
“Amen,” I said without thinking. I’m not a religious person and couldn’t remember the last time I’d been in a synagogue, church, or temple aside from tourist sites when traveling. But Pasteur’s slow, melodic incantations were inspiring.
“You kept coming back to HUM, and I kept telling you, ‘I’m still trying,’” I said as we stood up to walk to his MRI appointment. “Others might have given up, but you didn’t. And here you are.”
“Louange à Dieu,” he said softly. (“Praise God.”)
Michelle was working at Brigham and stopped by to meet Pasteur and Dorotie in the waiting room after Pasteur’s MRI while I went to look at the scan with the neuroradiologist. I had seen his enormous tumor on the CT scan he’d had at HUM, but the detail afforded by the MRI made the mass even more striking.
Several inches behind the eyes, just below the center of the brain, lies the sella turcica—literally “Turkish saddle” in Latin. In this saddle sits the pea-size pituitary gland, the endocrine command center that provides hormonal control of the thyroid, adrenal glands, and reproductive system. The optic chiasm passes just above it, transmitting the sense of sight from the eyes to the brain. Blood pulses past on either side through the carotid arteries, whose branches supply the majority of the brain’s oxygen and nutrients.
Arising from Pasteur’s pituitary was a fist-size tumor expanding irregularly outward in all directions, enveloping the optic chiasm above it, encasing one of the carotid arteries beside it, and indenting the adjacent brain, deforming its normal contours.
I took some pictures on my phone and sent them to Ian. We had waited over two years to see the true shape and extent of Pasteur’s tumor in full detail beyond what we could see on his CT scan. I smiled when I saw Ian’s characteristically short, surgical reply, reminiscent of our correspondence about Janel:
Wow, that’s huge.
I came back from the radiology reading room to find Michelle beaming from ear to ear as Pasteur appeared to preach to her. “Se doktè ki swenye, mais se Bondye ki geri!” he was proclaiming as I arrived. (“It’s the doctor who heals, but it is God who cures!”)
“I’m loving this!” Michelle said as we walked with them outside into the afternoon sun.
“When we arrived, did you notice I was wearing a bright green shirt?” Pasteur asked us in Creole. “And my wife was wearing green too. Green is the color of hope! And this building is green!” he said, touching the wall of the hospital building we’d just emerged from.
Michelle and I hadn’t heard about the significance of colors in Haiti and asked him about them.
“You don’t know about the colors?!” he asked. “Red is victory, white is purity, yellow is treason, black is death. We wore green! Bright green! Hope!” He tapped against the green wall of the hospital again. “Lespwa!” (“Hope!”)
Michelle and I couldn’t stop beaming. I imagined we were both thinking the same thing: from the villages of Haiti to the medical metropolis of Boston. Our daily workplace on this hot, humid summer day transformed by Pasteur’s words, creating the feeling that we might as well be chatting under a mango tree in Mirebalais.
“They are heavenly!!” Michelle texted me as I led Pasteur back inside for his next appointment. “Got my dose of church for the day!”
“Amen,” I replied.
* * *
“Sometimes I think things that aren’t real. Is that caused by the tumor?” Pasteur said as we sat in one of the neurosurgery clinic rooms waiting for Ian.
“Can you give me an example?” I asked him, not sure I had understood.
“There are things you can say to people and things you can’t . . .” he said.
Before he could clarify, Ian entered, and Pasteur and I stood to greet him. Ian firmly and briskly shook hands with Pasteur and me and then sat down next to us in front of a large computer screen that took up nearly the entire surface of a small desk.
“I can translate,” I said.
Ian nodded once without looking away from the computer screen, where he opened Pasteur’s chart and began scrolling through his MRI images.
He turned to look at me. “How long did we estimate for length of stay in the hospital?” he asked, slightly under his breath.
“A week or something like that,” I replied.
He looked at me a moment longer and then turned back to the computer screen and continued reviewing the MRI.
He turned back to me, expressionless. “This is a huge case,” he said without breaking eye contact or blinking. He held my eyes with his for a few moments, blinked once, and then turned back to the computer. “Right up against the hypothalamus,” he muttered to himself. The hypothalamus sits above the pituitary and controls it, serving as a command center for countless vital bodily functions.
Ian turned toward Pasteur and oriented him to the scans. “These are your eyes, this is your nose,” he said. “And this is the tumor.” He traced the tumor’s irregular contour with the cursor’s white arrow for Pasteur on the computer screen.
Pasteur looked at the black-and-white image for a moment and then looked at Ian. “Will there be a laser?” he asked.
“No,” Ian said, looking at Pasteur. “No laser.”
“Will I have a scar?” he asked, opening his shirt to show his keloids to Ian.
“Yes,” Ian said. “There will be a scar.”
They maintained an intense eye contact.
“It’s a big surgery,” Ian said soberly, directly to him. I translated.
Pasteur didn’t react.
I explained to Ian that we’d been through all of this earlier in the day. I didn’t want him to think I’d brought a patient to him without explaining how big a surgery this was going to be. I wondered why Pasteur was asking Ian all of the same questions he had already asked me. Were he and I not understanding each other? Was he just curious to confirm with Ian what I had told him? Or maybe it was all just overwhelming and he was trying to keep track of everything, as would be the case for any patient about to undergo brain surgery.