by Tracy Kidder
The boy was gesturing at Carole’s black purse. He wanted to see what was in it. Carole opened it and held it toward him. He poked his fingers around inside, then waved dismissively at it, as if to say, Nothing interesting in there.
Carole leaned over him and spoke softly in Creole. “Pa pè”—“Don’t be afraid,” she said, and tears began to roll down John’s cheeks, pearly in the dim light of the Children’s Pavilion.
The two doctors and Ti Fifi moved away from the bed to confer. “The most reassuring thing to me right now is he’s totally a kid,” said Carole. She went on, “His spleen and liver are not enlarged. The only thing is his congestion.”
“I think the congestion will be better with him sitting up,” Serena said. She was thinking about trying to get him on the plane tomorrow. Maybe she could cover his neck with a blanket. The image didn’t work, though. “I don’t think we can take him on a commercial airline. I don’t think they’d let him on board. So why don’t we just figure out how we take him on another plane? Carole, do we or do we not take him tomorrow on a commercial plane?”
“The one thing that’s going to kill him are these secretions,” said Carole. “I think it would be irresponsible, as a physician, to take him. Without suction. On a plane.”
Serena went over the situation. The chief pediatric oncologist at Mass General had told her that John had a reasonable chance if the cancer had not metastasized into his bones, and there was no way of telling, here in Cange, if that had happened. “He has to have his fighting chance,” Serena said.
Ti Fifi said, “Maybe we can get a helicopter to Port-au-Prince and then a medevac flight.” She looked thoughtful. “I don’t know what a medevac flight will cost.”
“Maybe twenty thousand dollars,” said Carole.
“Let’s just pay it,” said Serena. “Now I’m like, big deal, what’s twenty thousand? What if he died on the plane? I can see the story. Harvard doctors from PIH totally irresponsible. Jim would kill me. I shouldn’t have left this little boy here a month ago. I feel very responsible. Next time I’ll be quicker.”
“We didn’t even have a diagnosis a month ago,” said Carole.
“I’m just bummed because I should have brought him back a month ago,” said Serena. “We dicked around waiting for a diagnosis.”
Carole looked down. The plastic bag with Farmer’s new shebunkins was sitting on the floor. “Shit! I brought them all this way, they’re not going to die now.”
They took a break and walked across the gwo wout la with flashlights to Farmer’s ti kay and turned on the lights to his fish pond. Carole looked down into the plastic bag and said, “That’s Jean Claude and Yolande. I’ll miss you, too, kids, but you gotta go ahead and make some friends.” She dumped them in the pond, and we bent over and watched the fish swim off among the others.
At dawn Serena and Ti Fifi headed back to Port-au-Prince, to look for a medevac and a helicopter. It was a long day.
When the truck reached the paved road at the foot of Morne Kabrit, Alix, Zanmi Lasante’s driver, accelerated to seventy miles an hour and went into the city scattering chickens and dwarf goats. He pulled out into oncoming traffic to pass camions and tap-taps, making a third lane on the road, which had only two, and sometimes making a fourth as he pulled out to pass vehicles that had themselves pulled out to pass. Carole had said there was a special beep that drivers made on their horns in Port-au-Prince to announce, “I’m coming around this corner in the wrong lane,” and the saying in her girlhood was that if you made that beep and then heard another like it coming from the other direction, you prayed you would die in the collision so as not to be sent to the Central Hospital.
I told myself that, if I were a Haitian, I’d compete wildly to get a leg up on anything I could, and probably be an anarchic driver, too. And then I thought that here were Serena and Ti Fifi trying to save a boy’s life, while Alix, sweetly smiling at the wheel, was putting dozens of other lives in jeopardy, just now those of two boys sharing a bicycle, the truck’s side mirror nearly brushing their shoulders. When we got stuck in the traffic near the airport, I felt relieved, for a while.
We were in and out of traffic jams all day, traveling to Ti Fifi’s family’s house in the city, where there was a computer hooked up to the Internet, then to the airport, then to the office of a friend of Ti Fifi’s who had a fax machine, then back to the airport, then back to her place. There was lots of time to see the sights by the sides of the city roads. The brightly painted wooden booths selling lottery tickets, the proprietors’ hopes preying on hope—“Bank Lotto, New York.” The rubble by the sides of the streets—old tires, trash, ragged chunks of concrete, skeletons of trucks and cars stripped as clean as bones in a desert. Men sitting with shotguns on their knees outside every gas station. Dying men and women begging. People on crutches, people with the stumps of their legs inserted in what looked like ice cream containers. Up ahead in traffic, I saw a camion with a legend painted on its rear window which seemed to sum up Serena and Ti Fifi’s problem for today. “Oh Morne Kabrit!” it read.
A medevac flight from Port-au-Prince to Boston was fairly easy to arrange. It entailed only several phone calls and one traffic jam. But the price was $18,540. Serena was ready to pay it and raise the money later, but Ti Fifi wanted Farmer’s approval. Serena had sent him this e-mail: “John’s condition is growing more tenuous. He is curious, sweet as can be, interactive with us and they would not have let him on the plane. And yet weak weak weak and I fear would not survive the trip to the airport and they would not have let him on the plane. Polo, I know this sounds crazy but he still has his fighting chance. This could still be a localized tumor with abscess tipping him over and increased mass size. I will take responsibility to pay for this flight. We are proceeding with plan while we wait to hear from you.”
But Farmer seemed worried about the expense, and perhaps the precedent, of a medevac flight. He’d written back, “Serena, honey, please consider other possibilities.”
This message left Ti Fifi looking worried, which was unusual. Sitting by her computer, she said, “Usually Paul would say, ‘I trust you. Go ahead.’ He would never say don’t do it. But if he wanted us to do it, he would say so.”
“So in the context of Polo, this is a no,” said Serena.
“It’s close,” said Ti Fifi. “There’s other consequences to this. What are we going to do if another kid like this comes to us? It’s not a onetime thing. We’re not going to close the hospital after this. It’s really tricky. The staff will be asking why did they spend this money. Paul’s worried about it.”
“I’m looking at only one child,” Serena said.
“That’s the thing,” said Ti Fifi. “There are so many kids waiting for heart surgery, and the staff is asking for more money. A medevac flight is not something you do in Haiti.” Softly, as if to herself, she added, “I am sure that people will say, If your child is sick go to Cange and they will fly him to Boston. In the central plateau, this is going to be an event.”
“I have an idea!” said Serena. “Just have me pay for it, and tell everyone in Cange that I did.” She added, “The fact that he has free care at the other end makes it excruciating.”
“We should get all the arrangements and the cost, and ask Paul,” said Ti Fifi. “Because I know this guy.”
Serena seemed on the verge of tears. Ti Fifi got up and hugged her. Ti Fifi, whose head barely reached the level of Serena’s shoulders, reaching up, Serena bending her knees to receive the hug. Ti Fifi laughed softly, saying, “More and more patients. Every day something. A crisis. Like John. This is nothing. Every day, every minute you have cases like this. Someone’s sick, someone’s in danger.”
Then Ti Fifi got on the computer and wrote Farmer, “You have to say yes or no.”
I imagined him receiving this message, restive in a Bavarian castle. His reply came fairly quickly. He wrote, of the cost of the medevac, “Well, it could be worse.” Also: “I’ll be there within twenty-four ho
urs, but would not try to second-guess all of you there. Getting him on a plane is the only way to save his life, so I’m for it.” He closed, “In any case, his hope is in leaving Haiti, by one way or another—like many other Haitians, alas.”
But there was still the matter of getting John down Highway 3 to Port-au-Prince. “He will die on the road,” one of Zanmi Lasante’s Haitian doctors had said last night. This seemed far from unlikely to me. Ti Fifi had searched through the airport for someone with a helicopter, but there appeared to be none in Haiti, at least none available to her—and she was very well-connected. Perhaps a small plane would do—but no landing strip existed anywhere near Cange. So John would have to be taken down the road, over its boulders and giant potholes, across the streams. Ti Fifi didn’t like the prospect. “I’m not giving up,” she said to Serena. “But what is best for John?”
“He will be in his mother’s lap in the truck,” said Serena. “Ti Fifi, I know he looks very weak, but I think it’s criminal not to try.”
“Okay,” said Ti Fifi.
“The reason I feel so strongly about it is I talked to Paul about this.”
“Paul is not here,” said Ti Fifi. She sighed, then smiled. “There’s no point arguing. It’s the same, you know, circle.”
“If only we’d brought manual suction,” said Serena. This now looked like the insuperable problem. Without a suctioning device, John might well asphyxiate on the trip to Port-au-Prince, and the only suctioning devices in Cange were electrical. None would work in the truck.
Ti Fifi wondered if they could hire an ambulance with its own device. She worked her contacts and found a publicly owned ambulance that would have done the job for free, if it hadn’t been broken down and in the shop. Ti Fifi shook her head and smiled at this news. “Only God, only God can help us,” she said. Then she got on the phone again and located a private ambulance company.
It was on John Brown Avenue, an outfit called Sam’s Service Ambulance. The company owned one vehicle. It was shiny but old—a Kennedy, a recycled American model from around the 1970s, and it didn’t have four-wheel drive.
Nevertheless, Ralph, the proprietor, was willing to try the road to Cange. He was a fit-looking, muscular fellow. He’d served in the U.S. Army for ten years and had come back to Haiti to build a little business—hoping, he said, to do his part to help his native country. But while Haiti had plenty of need for ambulances, there weren’t many people who could pay for one, and he’d grown discouraged. Why not, he seemed to feel, give this job a try?
He and four of his men got dressed for the journey. They put on T-shirts that read “Sam’s Service Ambulance” and white hard hats, and climbed into their vehicle. Then they turned on their siren and led the way out of Port-au-Prince at high speed, calling back, “Follow us!” through the loudspeaker mounted on their roof.
The ambulance broke down for the first time about halfway up Morne Kabrit. It was dark and pouring rain by then. Sitting in the Zanmi Lasante truck, parked on the edge of the cliff, we watched one of Ralph’s men pour quart after quart of oil into the ambulance’s engine. The headlights of both vehicles angled sharply upward. I noticed the rainwater. It was running with the volume of a small brook down the so-called road, a dry riverbed no more, and I wondered what would happen if the rain didn’t stop. And what about the zenglendo, the bandits who were said to prey on broken-down travelers? Ti Fifi was a very calm person, and even she had said she didn’t like to be out on the gwo wout la after dark, because of the zenglendo. But Farmer had said that Haitians don’t like being out in the rain, and maybe this generalization applied to zenglendo, too.
We sat inside the truck waiting for about half an hour. No ambulance meant no suction device. For the lack of a simple manually operated tool, all the work would be spoiled and the boy’s life forfeit. I was immersed in these thoughts when Serena said, “Well, guys, we did it. He’s flying out tomorrow.”
I said, “Serena, that isn’t clear yet.”
“But you gotta rejoice a little along the way,” she said. Then she started in on worries that seemed remarkably premature. “We have to have the ambulance get to Port-au-Prince right when the plane arrives tomorrow. So that John gets to Mass General before five P.M. if possible, because …”
I muttered, I’m ashamed to say, that Sam’s Service Ambulance wasn’t going to make it up Morne Kabrit, never mind to Cange, and Serena began to cry. Then, just as I’d begun to apologize, Ti Fifi’s cell phone rang. It was Ralph calling from a few yards away.
“They’re still going to try?” Serena asked.
“I guess so,” said Ti Fifi.
“Oh, I love them!” said Serena.
Ti Fifi chuckled. “God is good.”
But about two-thirds of the way to the summit, the ambulance stopped again. In the stage set that our headlights made, you could see steam pouring out from under the hood. A couple of Ralph’s men came outside in their hard hats and ponchos and rolled a large rock behind one of the ambulance’s wheels. Ti Fifi’s cell phone rang again.
“They have tried,” Ti Fifi said to Serena. “But now they are low on oil again, and they don’t have any more.”
“But maybe they’ll loan us their suction,” said Serena.
“If they will, we will have to pay them something,” said Ti Fifi.
“Pay them lots,” said Serena.
After a little palaver, Ralph said, “No problem.” Serena was cheerful again. She and Ti Fifi got out and climbed into the back of the ambulance to watch the men work. Inside the Zanmi Lasante truck, Patrice, one of the hospital workers, shook his head. “I think Serena, she never gives up.”
A female version of Farmer in this respect, I thought. But I didn’t see what good it would do to transfer the suction device. It was electrical. It would take better mechanics than these guys to hook it up to Zanmi Lasante’s truck, in the middle of the night, during a rainstorm on the slopes of Morne Kabrit.
Hours—it seemed like hours—went by. The rain had let up. I stood outside and listened to Ralph and his men at work. There was a lot of banging and scraping. It sounded as if they were tearing the whole ambulance apart. I poked my head inside the back door and heard Ralph say to Ti Fifi, “You should have me run transportation for your hospital, and I’m tellin’ you, no problems.”
I thought, Yeah, sure, as you mangle your broken-down ambulance. It is so easy, at least for me, to mistake a person’s material resources for his interior ones.
I stood at the edge of the cliff and gazed at the lights of Port-au-Prince far below. More time went by, and then I saw Serena’s hand appear out of the back of the ambulance with the thumb turned upward, and moments later Ralph was carrying the suction device to the truck. He had mounted it on a board and wired it to a plug that would fit the socket of the truck’s cigarette lighter. He leaned into the cab, inserted the plug, and the machine began whirring. Serena clapped her hands.
Then Ti Fifi said we should go back to Port-au-Prince for the night and get another truck, because there would be no room for Serena and me and Patrice inside this one tomorrow, and Serena said, “No. We can’t do that. It would mean another day’s delay.” She and I would ride to the airport tomorrow in the open bed of the truck. “That’s what Paul would say. Get your ass in the back.”
The streams that cross Highway 3 were swollen. They looked like rapids in the headlights, and Alix actually paused at the first one, then plunged the truck in. For a moment our lights were shining through water, and then we were across. Later Serena would tell me that she had been very frightened. “What if I die?” she said she had thought, when the headlights went underwater. “I can’t die,” she had answered herself. “I have so much life left.” And then, as the truck had struggled up onto dry land, shuddering like a beast shaking off water, she’d said to herself, “Okay, remember that. If it’s your life, it’s always the most important thing.”
The party made an early start for Port-au-Prince the next morning. As usual, ther
e was a crowd of patients in the courtyard. They watched solemnly as Dr. Hugo Jerome carried John in his arms out to the truck. He kissed the boy, then placed him in the backseat beside his mother and Carole. Dr. J, as I called him, was one doctor who, I believed, would never leave Cange for a better posting—one time in my presence he’d raised a glass of Haitian rum and said to Farmer, “You are the best Haitian I know.”
Alix rose to the occasion. He drove very slowly over the craters of Highway 3, and the long stretches of lumpy, fissured bedrock, and the steep inclines where the dirt track was just piles of boulders. Inside the truck Carole and John’s mother ministered to the boy. He suffered, every bump a sharp pain. “Imagine your worst sore throat times a thousand,” Carole said. But the suction device never quit, and John arrived safely at the airport, and safely in Boston, perhaps the first Haitian peasant ever to have traveled in a Learjet. At Logan an ambulance came onto the tarmac and picked us all up. I rode in front with the driver. He told me, “It’s gonna get real rough.”
“How so?”
“The roads. There’s a lot of bad road between here and Mass General.”
This should have been comic, but I couldn’t begin to explain that to the driver, and for some reason I couldn’t name, this made me sad.
The little jet had landed once, in Wilmington, North Carolina, so we could all clear customs. The agent had asked Serena the perfunctory question, “Did you bring anything back from Haiti?” Then the agent had added, “Not that you’d get anything there anyhow, except disease.”