Global Doc: Long day

Author: Dr. Vincent DeGennaro Jr. ’02

The only thing on my schedule today was to go to the bank to send an international wire transfer. I never made it there. Before I could, the day would turn bizarre and then surreal in the mountains high above Port-au-Prince.

Three familiar patients caught me for unexpected visits in the parking lot of the hospital — a not uncommon occurrence.

One was a patient with breast cancer who had had an X-ray of her spine and hips, looking for metastases to her bones. She was a humble woman from the countryside six hours away and had been in the treatment program for nearly eight months. The mass on her chest wall had stopped oozing and had shrunk considerably since starting oral chemotherapy pills, but two days earlier she had come to the clinic complaining of back and hip pain and had now returned for the results. I had no good news for her. The cancer had invaded and partially collapsed one of her spinal vertebrae, rendering it unstable. Even on the long bus ride home, the bone could finish cracking through and sever her spinal cord, spending her few remaining months as a paraplegic. I offered her medications to reduce the pain and explained the situation. She nodded in comprehension, but the subtle smile never left her face.

The next patient was a 14-year-old boy with a bone tumor in the thigh that had forced the surgeons to amputate the leg. Prior to sending him to the Dominican Republic for radiation therapy, we performed a CAT scan to check that the cancer had not spread to his lungs. His mother returned to collect the results of the test, and unfortunately, more bad news. We spent the visit the day before talking about the process of getting a passport and visa. Now we focused on the inevitable end.

I delivered the news to those two with calculated indifference, a scientist explaining the mechanism of metastatic cancer, but Daniel broke my heart. I’d cared for Daniel’s throat cancer for nearly two years. I’d stood in line with him outside the Dominican embassy, all but forcing my way in the gates. We had spent thousands of dollars on his care, but he had been only 14 years old when we started, so we estimated it was a wise investment. During his care, he and his mother had slept on a mattress on the floor of our cancer ward since they had no family in the capital.

He had complained of difficulty swallowing, so at his last visit we did a CAT scan. It revealed an aggressive recurrence of the tumor only two months after he had finished radiation therapy. I’d known for a few weeks that there was nothing more we could do for him, but today was the day when he found out.

“Map mouri!” he wailed as he crouched down towards the asphalt. I’m dying. I hadn’t directly said those words, but he inferred correctly when I offered to only treat his symptoms and not his cancer that there was nothing more we could do. I sat in the office stunned for half an hour, unable to muster the energy to go to the bank. The wire transfer would have to wait.

Then an ambulance rolled in transporting a patient that only spoke Spanish. He was tied down to the gurney, a clear sign that somebody thought he was psychotic or dangerous or both. I asked him questions to test his orientation and noticed his accent was from Spain. He had no idea what year it was or how he arrived at the hospital. He knew that he was in Haiti but couldn’t explain why his passport had no stamps in it. He rambled about corrupt policemen, forced imprisonment and drugs for psychiatric illness that he had refused to take. Frustrated by the questions, he struggled against the restraints and finally started smashing his head on the headboard of the gurney, forcing the staff to medicate him. I discussed the case with the Spanish embassy to resolve how somebody from Spain could have traveled to Haiti without a single stamp in his passport. Later in the day, he calmed enough to participate in a discussion on the phone with the embassy. Apparently, he’d spent time in a Dominican jail for what sounded like a traffic accident. The Spanish embassy in the Dominican Republic had reissued him a passport and he crossed the border into Haiti illegally since he was not permitted to leave the country. His plan was to fly directly from Haiti to Spain, escaping the short-arm of Dominican justice. I released his restraints and instructed him to treat the nurses well or the large men outside would come back to tie him up, and he agreed. He spent the night in the ER before being discharged on his own recognizance and with an ongoing diplomatic headache for his embassy.

After leaving work, I had plans to attend a fashion show and party in the mountains to fundraise for the hospital. I tried to leave behind the memories of Daniel and psychotic Spaniards. After two hours sitting in Port-au-Prince traffic, we arrived at the venue — an old monastery whose ceiling had collapsed, leaving only the outer walls and a clear view of the night stars. The same event last year raised nearly $10,000 for the hospital and we had reason to believe this year would be an even greater success. At $70 a ticket plus the cost of drinks and VIP tables, the event was guaranteed to be a success.

The prime minister, who had been forced to resign as a result of typical Haitian political maneuvering only days earlier, was sitting in the VIP section. I spoke to him and offered condolences on the absurd situation that forced him out of office. My friend, who hadn’t eaten since rushing out of a nearly six hour surgery, was busy scarfing down the appetizers on the prime minister’s table. The security and waiters were less than thrilled with his antics, but the prime minister simply offered him more.

Then the fashion show commenced, rivaling any on the runways of New York or Paris. A parade of stunning models strutted down the runway to display the season’s latest fashions. After, an internationally-renown Haitian DJ played dance tracks until 3 a.m. I danced and schmoozed, pretending to not be thinking about Daniel, sitting on a bus or at home without electricity or running water. The upper class crowd at the party danced on tables and the runway before slowly filtering out, returning to their mansions just down the hill.

We quietly wound our way down the mountains and back into the city. The traffic was gone as most of the population had been in bed for hours, making it easier to crisscross the city to drop everyone off.

Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit Project Medishare. See his An American Doctor in Haiti blogs.