I was clearly more worried about all of this than Pasteur was. For him, a woman in the congregation could have her tumor cured by a miracle, and three men could be thrown into a fire and come out unscathed. It just required faith.
* * *
I walked through the preoperative area at Brigham along rows of gurneys separated by tan checkered curtains. When I found Pasteur’s bed, he was already dressed in a blue-and-white checkered hospital gown. A nurse was placing an IV in his left arm. Dorotie was standing at his bedside in an orange T-shirt and denim skirt, and Anne and Joseph stood on either side of her. I said hi to Anne and then greeted Pasteur, Joseph, and Dorotie, asking, “Kouman ou ye?” (“How are you?”) to each in turn.
“Avek Jezi,” Pasteur replied softly but firmly. (“With Jesus.”)
“Anfom,” said Joseph calmly. (“Fine.”)
When I turned to Dorotie, she looked away and began softly sobbing.
Joseph smiled at her and said, “Don’t do that, don’t do that. Everything will be okay.”
Anne put her arm around Dorotie’s shoulders and led her outside the small curtained-off area.
Joseph and I lingered next to Pasteur’s bed but didn’t speak.
The anesthesia team arrived to put an arterial line in Pasteur’s wrist under sterile conditions and sent Joseph and me outside the curtain. We found Anne standing in front of Dorotie, holding both of her hands, speaking softly to her as she sobbed. Anne let go of Dorotie’s hands and told us she needed to leave to get to the wards to start her workday. She turned back to Dorotie, hugged her, then tenderly put her palms on Dorotie’s cheeks before turning to go.
The anesthesia team finished their procedure, and we stepped back inside the curtain.
Ian’s assisting neurosurgery resident came, made brief small talk with Pasteur, and then drew an X over his right eyebrow with a purple marker—standard practice to make sure the team operated on the correct side. I thought back to the confusing moment when Janel had scrawled an X on the signature line of his consent form. Things were certainly going much more smoothly with Pasteur so far. So far.
Pasteur looked at me, bent his arm, and made a fist in front of his chest. “Viktwa!” he said. (“Victory!”)
“Rouge!” I responded and smiled, remembering he’d taught me that red was the color for victory in some Haitian tradition I still didn’t really understand.
He smiled back. “Rouge! Viktwa!” he said again, making the same gesture with his fist.
Then we stood in silence around him. Through an opening in the curtain, I saw the patients on gurneys being rolled past one by one like floats in some strange parade, disappearing behind white double doors marked by a red stop sign reading:
RESTRICTED ACCESS
STAFF ONLY
Ian emerged from these double doors and came into the curtained area, appearing laser-focused as always. He greeted everyone with a wave and a brief smile. “I’ll see you in back,” he told Pasteur. Then he turned and stepped out of the curtained area and I followed him.
“This is going to be a long case,” he said to me calmly and quietly in his deep voice. “There are two main aspects of this operation that are dangerous: vascular injury and capsular bleeding.”
Vascular injury I understood: the carotid artery was encased by the tumor. If the artery was irritated or damaged during the surgery, this could lead to a stroke. I wasn’t familiar with his second concern. “Capsular bleeding?” I asked.
“You’ve got to stay inside the tumor capsule,” he said matter-offactly, looking to the right of me, then back at me. “Otherwise you risk major bleeding.”
I nodded, trying to imagine him mentally preparing to stay inside the several-centimeter space of the tumor capsule for the next ten or more hours.
“I’m going to go in back and set up,” he said. “The nurse will text you with updates.” He turned and walked with his confident surgeon’s stride—slightly hunched upper back; long, quick steps—toward the white swinging doors with the red stop sign, pushed through them, and disappeared.
I stepped back inside the tan curtain.
“We’re going to go back now,” the nurse said to Dorotie and Joseph. “Time for hugs and kisses!” She smiled.
Dorotie stood frozen, looking anxiously at Pasteur.
“Go give him a kiss,” Joseph said to her and chuckled.
Dorotie hesitated. Then she leaned forward and timidly kissed his forehead the way a child might kiss her elderly grandfather goodbye after being forced to do so by her parents. She started sobbing again and walked outside the curtain, covering her face.
“Don’t do that, don’t do that,” Joseph gently scolded, following her.
“It’s okay,” I said, stepping out with them.
A clicking sound marked the unlocking of the wheels of Pasteur’s gurney. Then the curtain opened and the nurse wheeled him toward us.
The nurse stopped in front of us, and I shook his hand. “W nan bon men,” I said. (“You’re in good hands.”)
“Men Jezi!” he said with quiet passion. (“The hands of Jesus!”) A single tear sprang from his bulging right eye and trickled slowly down his cheek. As the nurse pushed his gurney past us, he raised his fist in front of his chest again, and Joseph and I did the same.
As soon as he was out of sight, Dorotie burst out crying more forcefully. Joseph put his arm around her as we walked out.
I left them to go to my clinic, already late, wondering how I was going to focus on the patients I would see that day knowing that Pasteur was under the knife, remembering how terrible Janel had looked after his first surgery.
As I saw my patients in the neurology clinic, I got updates on my pager throughout the day that the operation was “going okay.”
Then, for several hours, I heard nothing.
Four p.m. passed.
Five p.m. passed.
I paged Ian’s assistant and asked if she had any updates.
“The status in the electronic operative record is ‘Closing,’” she said, “so they must be almost done.”
I couldn’t take the suspense and called the operating room myself. The operating room nurse who answered said that the surgery was finished and they were about to try to wake the patient up.
I waited for a text from Ian.
Finally, at 5:30 p.m., one arrived.
Ian: All done, waiting for wake up.
Me: Thanks. How’d it go?
Ian: It went well. Very tough case—tumor is so extensive. There are capsular remnants and tumor in sella and around carotid but I think we accomplished the goal. Main risk now is bleeding.
Me: I will update his family. When do you think OK to tell them to come see him? 1–1.5 hours?
Ian: I think. His right eye will be swollen. He will maybe not be wide awake.
Me: Got it and will relay.
About ten minutes later:
Ian: Slow to wake up so getting CT, but not too unusual.
Me: Got it. Thanks.
About five minutes later:
Ian: CT is fine. He may stay intubated overnight.
I called Joseph to let him know the surgery was over and all had gone well, but Pasteur was still asleep and on the breathing machine. I asked him if Dorotie wanted to come see him.
“No, no, she doesn’t want to see him tonight,” he said. “We will come tomorrow.”