A Small Thing

My name is Nick Cardinas. I used to play around. Had a Corvette, stayed out all night, drank more than my share, loved fast women. Then I spent a summer with my uncle Charlie, a surgeon. The first week we saw a man in the emergency room who was bleeding to death from a damaged liver after an automobile accident. My uncle took him to the operating room and stopped the bleeding with stitches and metal clips—saved the guy's life. Charlie studied and worked long hours, he cared about each patient. His life inspired me to become a doctor. I gradually learned to control myself, casting aside the behavior I had enjoyed, replacing it with endless studying in medical school, becoming what you might call a solitary library monk, memorizing chemicals, bacteria, diseases, and body parts. Hours were spent reading some damn pharmacology book, preparing for the next test, then I'd forget it all while dissecting a cadaver all weekend, memorizing for an anatomy examination given by some nearsighted professor making me look stupid by pointing out obscure functions of tiny oblique eye muscles, the object of his life-long research. I smelled like formalin and had nightmares of forgetting to prepare for the next day's examination. Then came surgical residency. Never sleeping, taking care of critically ill patients for days on end, performing minor surgery, but mostly watching adroit moves of famous surgeons in the operating rooms. My body was turning to soft putty from lack of exercise. Dreams of being like my uncle became lost in medical minutia. I was sick of drawing blood at 5 a.m., of suturing minor wounds instead of performing major surgery.

I developed a fine hand tremor, and, because I sometimes felt unsteady, began using elevators instead of risking falls on stairs. What was wrong with me? Was it just stress, chronic sleep loss, or an early stage of some neurological disease? Worried, but not wanting to tell anyone, maybe not even thinking straight, I quit the training program, and shacked up with Vera, a tough operating room nurse, who didn't take my complaints seriously.

"Oh that tickles," she would say, as my shaking hands caressed her back. She was lanky, low fat, and looked great in scrubs with her long legs. A fanatic exerciser, who said she needed the conditioning to stand long hours in the operating room telling surgeons what to do when they got into trouble. I had watched her in the operating rooms, heard her say things like:

"Doctor, why do it that way? Isn't it easier to tie off the blood supply first?" Or "I've never seen anyone try that before," then staring down icy glances. High-cheeked and full-lipped, never at a loss for words, her taut voice always ready in an argument. She was the type of woman you had to push against to save your manliness. Like a parasite I clung to her, hoping to steal some of her plucky energy. I should have been uncomfortable with my lack of assertiveness, but the secluded study of medicine and long hours observing surgery had robbed me of social adroitness, even my psychic well-being. I was tired and leaned against Vera, a sturdy post.

*****

I decided to visit Haiti again after being thrown out five years before while marching in Port au Prince with a human rights group. The energy and endurance of the Haitians fascinated me then.  Now that I was a doctor, perhaps I could help them and also share their zest for life.

I packed a few things in a small bag, picked up Vera, who said she was also ready for a short vacation, and might enjoy working in a hospital there for a few days. We flew to Haiti and checked in together for a week at the Hotel Oloffson, a spooky, run-down Gothic hotel I'd read about in one of Graham Greene's novels.

I must have still been on some undesirable list. Two tough looking Macoutes, real goons, led me into a small room near the Oloffson reception desk, "Why are you here again?" The tall one asked, standing there, pistol pointed in my direction, his dark glasses only partly covering a frown. The second thug kicked my chair after whacking me on the head.

"Look, I was a kid then," I said. "But now, I'm a doctor, a surgeon. Vera and I want to work in a hospital here for a few days."

"You are a master bull-shitter," the tall one said, whacking me again. "We know you're still in training, but the woman you are with is an operating room nurse, someone useful, without her, we'd take you to the goddamn airport tonight and put you on the first flight the hell out of here."

"No, no," I said, "I've had years of surgical training." The taller Macoute laughed. "Well, Mr. Surgeon, we'll let you two stay here tonight, but tomorrow morning we're going to haul your sorry asses out to a country hospital near St. Mark for the rest of your stay, so you can see what practicing Haitian medicine is really like. After that, assuming no more screwups, we'll personally see that you get on a plane to Miami." The short stocky one smiled.

"Have a nice stay," he added. "If there's anything we can do to make your vacation more enjoyable, don't hesitate to ask."

The hotel floors squeaked, tap water flowed only part time, nothing unbottled was safe to drink, marijuana smoke infused the faded balconies, flowing like a rising tide over fragile wooden fratwork, lapping against menacing Vodou statues in dark corners of the bar. The Tonton Macoutes sat lazily around the corners of a balcony talking with visitors, their penetrating eyes hidden behind sun glasses, pistols strapped to their sides.

Vera and I spent the afternoon tangling sweaty sheets in our third-floor room, radio tuned to Rara bands, drinking rum and Haitian beer, lying out by the pool afterward. I bought her a long coral necklace from the hotel gift shop. She seemed to be having such a good time that I didn't tell her about getting kicked around and threatened by the Macoutes. I think she thought the ride into the countryside the next day was sort of a private tour I had arranged through friends made during my previous visit to Port au Prince. She waved at the Macoutes whenever we walked past.

"Why don't they wave back, Darling? Maybe they can't see with those glasses."

After dinner, a group of Haitian dancers and singers performed on an old wooden stage near the decaying Gothic veranda. Slapping the Conga drums, shaking castanets, flowing red gowns, sweating, barefoot, stomping their feet. Large chalices of smoldering marijuana swung from either side of the stage, sending sweet smoke flowing across the audience. We became jovial as hell. I put my arms around Vera; she squeezed my soft waist tightly and licked my neck. "This is a fucking great place," she said, bouncing up from her chair, pulling me into a shag line led by the dancers, out into the street in front of the hotel. I followed just behind Vera, arms wrapped around, clinging to her breasts, laughing, stomping to the beat, sweating, and shouting. The Tonton Macoutes watched for a while, then escorted us back to our room.

"Be ready to start the ride into our lovely countryside at eight this morning," the tall one said.

*****

Sharing a seat, Vera and I hung on to each other as the top-heavy Haitian bus rattled its way along the potholed road to St. Mark. Passengers clung to the roof, crowded the seats, and shared the floor with crated chickens, pigs, and a few scrawny goats. A black Jesus reaching down from heaven adorned the bus front. A large, ecstatic female nude hung just below a fringed rear window above the dangling exhaust pipe. Passengers' shouts and laughter helped push away the heat, dust, and animal smells as the bus bounced along the old road. Shouting so she could hear me, I finally told Vera about being slapped around by the goons, that this was not a sightseeing trip, and instead, we were being sent to work in a small country hospital. Frowning, wide-eyed, lips pursed, she grasped the seatback and turned toward me.

"My God, why didn't you tell me sooner? We could be surfing or just resting on a peaceful beach, not stuck in this forsaken worn-out police state. You just needed to stand up to them at the hotel. We should have just left the country yesterday."

"I thought we'd be welcomed now that I am a doctor," I said, looking down at the bus floor. "Then it suddenly was too late. I should have resisted, you're right, we should have just gone back to the airport. Sorry."

She stared past me out the dirt-smeared window. "Well, it's too damn late now."

The Macoutes' jeep followed closely behind, finally pulling the bus over near St. Mark. "Okay, we're here," one of them said, pointing to several tin-roofed buildings hiding behind banana and mango trees, the surrounding bare earth crumbled to dust by a herd of scavenging goats. Vera and I dragged our bags past the goat herd to one of the faded white-washed mud buildings. Disturbed wild roosters squawked loudly from a tall-limbed Mapou tree, announcing our arrival. A tired, wrinkled woman dressed in white introduced herself as Sister Emmanuel. Hunched, and short statured, she looked up at us.

"Oh, we're so glad to have you both," she said, resting against a cane held firmly in her right hand. "I prayed for help and God sent you—a doctor and a nurse both!" The Macoutes didn't tell Sister that I wasn't really a surgeon, neither did I. A long line of patients, some sitting on the ground, some standing using small tree limbs for crutches, others, too ill to stand and being carried, waited near the open clinic door.

The floor of the examining room was sticky. There were two worn chairs and a stained metal examining table. "Here is our doctor," Sister said, pointing to an exhausted-looking man, Doctor Hugon, whose wrinkled, dirt-smeared coat caught fresh ashes from a smoking cigar stub held firmly between his lips. We watched as he gently pushed aside worried family members and crouched over a young child with a twisted arm. Then Sister showed us a tiny room with two cots and a washbasin in a nearby thatched-roofed building, its mud walls faintly white–washed. "You can both sleep here," she said, pointing out the two widely separated beds. "The latrine and a barrel of rain water are just outside the door." She turned, and walked slowly away, her shuffling feet tracing the dirt floor.

"Why didn't you tell them you were still in surgical training?" Vera asked. "What if something happens? I mean what if there's a real emergency?"

I don't know why I didn't. Maybe I just wasn't used to correcting or explaining after all the medical school seclusion. Anyway, I let it drift. We helped at the clinic the next few days. Just minor problems.  Small burns from cooking fires, infections, a few rashes from poisonous vines. Minor illnesses. The last night, lying there under our mosquito net, cots shoved together, both of us naked except for her coral necklace, Vera turned to me.

"You need to get your butt back home and finish your surgical training," she answered. Laughing softly, I caressed her; she explored with her tongue, then, kneeling, moaned softly as she took me inside her body, the necklace sliding softly between us.

Yellow candlelight highlighted Sister's wrinkled face as she stood at our bedside. It was 3 a.m. "Please come to the examination room as soon as you can," she said. Vera and I pulled on our limp, dusty clothing, slipped on our sandals, and hurried to the clinic.

The patient was lying on the examination table, rolling, tossing, shouting, as she held her enormous, rounded belly.

"This is Madame Toutant," Sister said. "She's been in labor for five hours," gently touching the patient's forehead.  "I tried to turn the baby's head. I used both hands to pull the head left and right, but I can't get it down for delivery. You try, Doctor. Please!"

"Where is Dr. Hugon?" Vera asked.

"Oh, his family lives in Port au Prince. He goes to see them whenever other doctors arrive.  Slips away even for a few days. He'll return Monday."

I'm thinking, what the hell? How did I get into this mess?

Vera looked over and gave me a nudge. "You try it, Doctor," she said. I could have choked her for saying that but realized I had set this up myself by not telling the truth.

"Grab the head and push it down," she added.

I carefully put my hands on the woman's belly. The baby was moving around. I thought I had the head between my hands. I pulled it over and down. The woman screamed. I jumped back.

Sister sadly looked at us. "Oh dear, I think we'll have to do a Caesarian Section." A jolt of lightning struck deep in my gut as I tried to remember the only Caesarian I'd ever seen.  In a high amphitheater I had looked down, amazed how the surgeon deftly took command, how he quickly cut through the abdominal wall tissues, sliced into the uterus, the sudden gush of bloody fluid as the baby was delivered. Palms sweating, I had looked away.

Sorting through the shelves of a rusty cabinet, Sister continued. "We have a few things here. Suction, Xylocaine, flashlights, and our little autoclave gives us several sterile instruments. We have a few sutures and skin clips. Dr. Hugon has a coagulation machine he uses to stop bleeding, but we've never tried to do a major operation." She looked up at me. "It's the baby's and mother's only chance though."  

"Tell them you're not a real surgeon, tell them now, damnit!" Vera whispered anxiously. Trying to appear calm, I grasped her hand firmly.

"We have to try to save them." I took my hand away from hers and walked across the room to Sister. "The woman and baby will die without surgery," I said. Vera, frowning, said nothing.

She and Sister seated the moaning patient in a nearby chair and cleaned the small table in the examination room. I looked at Dr. Hugon's bottles in the nearby cabinet. One was labeled Xylocaine. I had never given an anesthetic, but had inserted a long needle between several vertebrae into the spinal canal to obtain a spinal fluid sample a few months ago. This woman was slender, almost malnourished. I could count her vertebrae easily as Sister held her forward in the chair.

"Ou ap santi li fret." (It's going to be cold), Sister warned. I washed the patient's back with alcohol. Piki. Piki, I said, and pushed a needle between  two lower vertebrae without getting any spinal fluid. The second time, clear liquid came through the needle, and I inserted a syringe full of Xylocaine into the spinal canal and around nerves to her abdomen and legs. Sister pricked the woman's legs with a pin.

"Pa santi anyen?"(Is it numb?)

"Wi."

A higher pin stick on her abdomen. "Pa santi anyen?"

"Wi.Wi."

The two Macoutes then entered the clinic, sleepy-eyed, strapping on their pistol belts as they leaned against a wall nearest the door.

The patient was on the table. I washed her with alcohol and applied sterile drapes. "You stand at my right side," I said to Vera. She looked surprised at the command but moved into position. The surgeons I had watched in school had more assistants. I looked at the tall Macoute.  

"What's your name?" I said.

"Louissaine."

"Well Louie, put on those gloves and stand at the other side of the table so you can hold these retractors. And leave your sunglasses and gun on your chair." He jumped up angrily.

I stared at him. "Hurry up, we don't have much time!" Vera kicked me under the table, but Louie did what I told him.

I looked at his partner. "You, Robert or whatever your name is—you help Sister hold the flashlights."  He looked pissed too, but got up from his chair and stood beside Sister at the patient's head.

"Knife!"

Vera slapped it into my right hand. I made a long vertical cut through the abdominal skin, using the coagulator to stop bleeding. I could hear instructions from those years in training and, in my mind, could picture those gruff surgeon's moves I had watched in an amphitheater a few months ago. Stay exactly in the midline, the Linea Alba. Go straight in, deeper. Stay away from the rectus muscles. I opened the final layer and entered the abdominal cavity.

"Hold the light steady," I said while moving one of Louie's retractors. "Keep the light inside her abdomen." There it was, the dark maroon uterus, the baby moving inside. Outside the clinic, drums began playing a soft hand beaten rhythm. A Vodou witch doctor entered the room, the feathers dangling on his hat cast threatening shadows until he stood quietly in a corner. Sister stood expectantly with a clean towel, smiling at me as if she had confidence.

"Vera, get the sponges and suction ready," I said. "This is where we have to move quickly."

"Yes, Doctor."

Sweat dripped into the wound but my tremor was gone, it had just disappeared. Then hesitating, I couldn't remember what direction was best to cut open the uterus. A vertical or transverse incision in the uterus? I couldn't remember which was better. Vera leaned toward me, whispering: "Horizontal incisions heal more strongly." Sister was ready and the drums were louder. The witch doctor stood like a statue in the corner. I made a long cut. Blood and watery fluid gushed out of the abdomen, soaking sponges, filling the suction, spilling on the floor. I saw black hair and grabbed it. Out came the baby's head, then a shoulder, I pulled gently as the uterus contracted; the baby slid out. I clamped the umbilical cord, cut it, and handed the baby quickly to Sister. After removing the placenta and holding the contracting uterus firmly, the bleeding stopped. The baby girl cried loudly as I finished the operation. Sister lovingly wrapped the baby before giving the infant to Madame Toutant, whose bright smile lit the darkened room.

"Such a small thing. She's God's gift to us." Sister said.

The stars began to fade. The Vodou doctor sat beside a small fire outside the clinic door, beating a goatskin drum rapidly and blowing magic dust high into the air. At dawn, he sacrificed two white doves to keep evil away from the new baby. We drank clarion with the Macoutes in the early morning light. Held their hands, even embraced them. Vera kissed everyone. I was exhausted.

Dr. Hugon returned from Port au Prince later in the morning. Thanking us before we left in the Macoutes' jeep, Sister gave a crucifix to Vera for good luck. Clasping my right hand in both of hers, she looked up at me: "God was with you," she said. "He will stay with you."

We made the afternoon Miami flight. The Macoutes escorted us to the airplane.

"Vera," they said. "Bring him back when he's a real surgeon."