Green Hills Literary Lantern




Primum Non Nocere




The Haitian sun had yet to clear the deforested mountains as Dr. Etienne walked alongside a grassy pasture inside the nursing school compound. Except for the concrete wall topped with razor wire surrounding the outside perimeter, it was a scene of pastoral tranquility complete with grazing farm animals, lurking cats, and a rawboned rooster. Dew dampened the toes of his tattered running shoes and darkened the bottoms of his scrub pants. He recalled the sense of displacement he’d felt as a homesick child when his mother dropped him off at Camp Abe Lincoln back in Iowa. No hunger, no thirst, no tears—just a hollowness in his gut and a tightness in his chest.


Small goats were staked out at intervals across the green lawn with thick white ropes tied loosely around their necks. One had entangled its hind leg and bleated out for relief. The doctor ambled over to the distraught animal and laid a gentle hand on the goat’s rump.


“Shhh, just calm down,” he said. “How did you manage this?”


“Blaaaah,” answered the goat.


With a stiff tug on the collar, he created enough slack to slip the twisted knot down the goat’s leg and over its cloven hoof. The rope immediately straightened, and the goat went to work nibbling the fresh grass in its newly widened radius.


It was Dr. Etienne’s fifth trip to Léogâne, Haiti—and it wouldn’t be his last. No amount of money could buy the spiritual rewards and psychological benefits he received from these annual excursions. Ominous State Department warnings, potential hurricanes brewing in the Atlantic basin, political unrest, and infectious disease outbreaks might delay his travel arrangements, but eventually, he’d be back with his team of medical missionaries. As long as the people needed his help and welcomed his efforts, he would return.


Bonjou, Doc,” Father Jon said from the porch of the guest house. “Did you sleep well?”


“I always sleep well down here, Father,” he answered, “until that damned rooster wakes me up at dawn.”


“He’s more reliable than an alarm clock. Are you walking to the hospital today?”


“I know, I know. I’ll be careful.”


“No, you really don’t know. Desperate people do desperate things.” The priest ran a handkerchief over the sweaty sheen that glistened on his bald white head. He’d been in Haiti for over thirty years and had witnessed the best and worst of humanity. When the 2010 earthquake struck, he was standing on a sixth-floor balcony in a Port-au-Prince hotel and survived the avalanche of crashing concrete as the building collapsed beneath his feet, pancaking many unfortunate victims. “There’s a looming gas crisis, the gourde is crashing…”


“Just another day in paradise.” Dr. Etienne wondered how uncomfortable it would be to wear black pants, a black short-sleeved shirt, and a tight white collar in this tropical heat. No, he’d never trade his loose cotton scrubs for the vestments of the Church—not even for divine protection.


“At least take Roberson with you.”


“He can’t babysit me all the time.”


“That’s his job, Doc.”


That was true. Roberson knew everyone and everyone knew him—Léogâne was his town. He spoke Haitian Creole, French, English, but more importantly, he knew the language of the street. His black-ink tattoos, chiseled muscles, sideways baseball cap, and gold chains made quite an impression. A beaded necklace attached to a large silver cross completed the ensemble. With his ready smile, nimble mind, and entrepreneurial spirit, Roberson was no mere hustler; he was a force of nature, and this was his world. There was safety in his shadow.


“I won’t stray from the narrow path.”


“You can’t save the world if you’re dead, Pilgrim.”


“I suspect Roberson has my back, even when he’s not by my side.”


Dr. Etienne waved good-bye and continued along the dirt road toward the ten-foot sheet metal gate at the entrance. A uniformed sentry stepped out of a tiny guardhouse and slung an old shotgun over his shoulder before sliding open the blue-painted barrier.


Mesi,” Dr. Etienne said as he squeezed through the opening.


The guard tipped his hat and slammed the gate shut, leaving Dr. Etienne in the midst of chaos: motorcycles carrying up to five people zipped around him dodging large potholes filled with cloudy white water; pickup trucks and brightly colored tap tap taxis loaded with people bounced and splashed through puddles; vendors lined the streets in front of dilapidated cement structures with corrugated metal roofs, selling papayas, bananas, and fruits he could not name. And people were everywhere.


Gravel dust and smoke from charcoal cooking fires burned his eyes, leaving everything hazy. Car horns beep-beeped polite warnings to pedestrians and other vehicles. Untethered goats searched for clumps of grass, and street dogs nosed through piles of garbage. Flattened plastic bottles and other debris littered the streets. Dr. Etienne thought of all the simple things he took for granted back home: sidewalks, garbage pickup, a reliable electric grid, running water, plumbing. He wondered how all these people could survive without basic necessities.


Yet, the people were dressed in clean, bright clothes, and many carried cell phones. For the most part, they seemed friendly and affable. He passed by women carrying large bundles on their heads, and men pulling handcarts filled with empty water canisters. Armed only with a smile, he noticed a few wary stares and curious glances, but no one impeded his progress. His pale skin did make him feel self-conscious. No doubt, he stood out like a white flag on a battlefield.


One block shy of Hôpital Sainte-Croix, he peered within an abandoned structure and noticed a thin dog with a curly tail basking in a patch of sunlight, surrounded by concrete rubble and exposed rebar. He clicked his tongue, and the dog opened her almond-colored eyes. Her prick ears and wrinkled brow gave her a thoughtful, intelligent look. He’d seen her before and had tried offering treats to gain her trust without success. Typical Basenji trait, he thought, very standoffish and independent.


Prior to his trip, he had to put down his own aged Basenji, and he had not fully recovered from the loss. It remained an open wound. Somehow, saving this particular street dog had become an obsession. He dreamed of getting her all cleaned up, vaccinated, and shipped home—but first, he had to catch her.


“Why you keep bothering that dog?”


“Jesus! You scared me.” Dr. Etienne turned to Roberson and slapped hands. “Were you following me?”


“You know I have to keep track of my flock.” He stared down at the iPhone in his hand, scrolling with his thumb. His Beats headphones encircled his neck. “They’re putting the spinal in your first patient.”


“How many do we have today?”


“Sixteen if they all show up.”


It always surprised Dr. Etienne when patients who had been waiting years for surgical repair of their massive hydroceles would miss their chance to be cured. He couldn’t imagine walking around with a ball sack the size and weight of a bowling ball. While the plastic surgeons got all the publicity for cleft palate repairs, the urologic surgeons operated in relative obscurity. Nobody posts before and after pictures of a beautifully reconstructed scrotum.


“Fear and superstition.” Dr. Etienne removed a folded napkin from his back pocket and tossed a slice of hard-boiled egg into the ruins. The dog sniffed the air but refused to accept the food.


“You’re wasting your time, Doc. That dog will only bring you misery.”


“She’ll come around.”


They started walking up the street toward the whitewashed hospital that had survived earthquakes, floods, and epidemics. It stood three stories tall and was the only Episcopal charity hospital in the world. A crowd of people loitered around the front entrance waiting patiently for a chance to see a health-care provider.


“If you want a girl with fewer fleas and less filth, I know a place in Pétion-Ville.”


“I don’t think Father Jon would approve of that.” Nevertheless, Dr. Etienne smiled at the offer.


“A man can’t live on bread alone.” Roberson returned the smile and nudged Dr. Etienne with an elbow. “But if you have enough dough, the world can be yours.”


“I don’t want the world,” Dr. Etienne said. “I just want that dog.”


They made their way to the back entrance of the hospital next to the morgue. A funeral home was conveniently located directly across the street. Roberson rapped his knuckles on the gate and shouted something in Creole. The guard swung open a solid metal gate and let them into a walled alcove where several decrepit minivans were randomly parked. A group of bored-looking young boys sat on the pea gravel with their backs against a small tree.


Dr. Etienne recognized the kids and had been told their parents worked at the hospital. With his broken French, he tried to offer them a reward of $20 if they could catch the elusive street dog. Roberson translated the request into Haitian Creole and kept mentioning the word fou whenever he pointed at the doctor.


“This is a crazy idea,” Roberson said. “No good will come from this.”


“Don’t be such a spoilsport. Look how excited they are.” Whether or not they succeeded, Dr. Etienne planned to give them the reward. The boys talked rapidly among themselves and seemed to come up with a plan of action. When the gate opened to let in another vehicle, they slipped through and disappeared down the street.


“Bon chans, mes amis,” Dr. Etienne shouted after them.



*  *  *



Entering an open breezeway in the side of the building, Dr. Etienne passed several patients and their families sitting on benches. He made a sharp right turn and pushed through two sets of swinging doors into the main OR. A humid wave of chlorine-scented air washed over him. It reminded him of swim practice in the poorly ventilated indoor pool in the basement of his high school gymnasium.


“It’s about time you showed up, Chief,” Dr. Dean said from behind his surgical mask. He vigorously scrubbed his hands at the lone scrub sink and peered over his reading glasses at his younger colleague. His blue eyes sparkled with impish delight. Dr. Dean was the ringleader of their little enterprise and had logged over forty trips. “You out chasing some tail?”


“That’s a fairly accurate description,” Dr. Etienne answered, “but not in the way you think.” He covered his hair with a bouffant hat, slipped on shoe covers, and tied a paper surgical mask twice behind his head with practiced dexterity.


“After the marathon we’ve got today, you’ll be too tired to dip your wick.” He backed his rotund body into Salle 1 with his wet hands held high, water dripping from his elbows. The door swung shut behind him.


Dr. Etienne picked up a used sponge and quickly scrubbed his hands and forearms. In the tepid heat of the windowless room, the cool water felt luxurious on his skin. He backed into Salle 2 just as the nurses were draping the patient. The other two members of his team, both ex-military, were sorting and counting supplies before scrubbing in themselves to assist.


Bonjou, tout le monde,” he said and stepped into the surgical gown held out by the scrub nurse. After he was gowned and gloved, he took his place at the table and prepped the skin of a cantaloupe-sized hydrocele with betadine and alcohol-soaked sponges. A small air conditioner droned on the wall behind him, cooling the exposed skin on the back of his neck.


“Knife,” he said and the nurse handed him the scalpel.


For the next ten hours, he bounced from case to case and room to room in a rapid succession of surgeries with hardly a minute to rest. There were no consents to sign, no pause for the cause, no families to mollify. There were no orders or prescriptions to write. He didn’t have to do any charting or dictating. His fingers never touched a computer. All the paperwork and administrative duties were delegated to underlings. Unlike back in the States, all he had to do was operate—and he was in heaven.


In the moments between cases, the surgeons guzzled bottled water in a concerted effort to stay hydrated. Lunch was brought to them in a wicker basket packed with plastic containers filled with grapes, papaya, and fried chicken legs. They ate right outside the operating rooms on a wooden bench in the sweltering room, while the next patient sat quietly beside them in a wheelchair, holding his one-liter bag of saline.


Dr. Etienne felt a bit guilty eating in front of someone who’d been NPO for eight hours, but he had to admire the efficiency of the system. It contrasted sharply with all the bureaucratic bullshit back home. In America, he spent more time tapping a keyboard and clicking a mouse than actually taking care of patients. He felt more like a data entry clerk than a surgeon. The Haitians accomplished so much with so little, while his own country squandered vast resources at an incredible expense—all in the name of “quality care.”


When the last scrotum had been wrapped up in Dr. Dean’s proprietary X-dressing, the weary team trundled into a minivan for the short, bumpy ride back to the Notre Dame Residence Filariose. The heels of Dr. Etienne’s feet ached, and he looked forward to a cold shower and a hot meal. Despite his enthusiasm, it had been a long, grueling day.


“I tried to warn you, Chief,” Dr. Dean said. He squirted bug juice in his palm and swabbed it on his arms, neck, and face.


“I’m just hitting my stride.” Dr. Etienne tried to stifle a yawn.


“Sure feels good, doesn’t it? Doing what we were trained to do.”


“Why do you think I keep coming back?”



*  *  *


That evening after dinner, Dr. Dean led the team up a narrow staircase and out onto the roof of the residence. The sun had already dipped behind the verdant mountains, and the smoke of cooking fires could be seen rising from the surrounding city. Music and the faraway cheers of people watching a soccer match wafted across the distance. It was peaceful and almost surreal.


Dr. Dean passed out cold bottles of Prestige beer and took a seat on a cement pillar. After a moment of silence, he raised his bottle of water and offered a toast. “We helped a lot of people today, thank you.”


“Did anyone happen to bring a bottle opener?” Dr. Etienne asked.


The ex-marine produced a pocketknife with a bottle opener attachment and popped off the bottle caps. “Ooh-rah!” he said and tipped back his beer. He had been stationed in Iraq and didn’t like to recollect the terrible things he’d witnessed. Though Haiti was no Shangri-La, it did not compare to the scorching sands of the Iraqi desert and the deadly threat of roadside IEDs.


“This is such a beautiful country,” Dr. Dean said, looking out over the countryside. “The people are resilient, but there is so much need. After the earthquake, this whole area below us was an international field hospital. Aid workers and tents were everywhere.”


Father Jon joined them on the roof under the darkening sky and accepted a beer. “Haiti is a modern-day story of Job,” he said. “And you are good Samaritans—at least for one week out of the year.”


“If you can leave this country with a dime left in your pocket, you don’t have a heart,” the retired Army colonel said. It was her tenth mission trip, and beneath her gruff exterior, she was a real softy. This time, she had brought school supplies, Matchbox cars, and a suitcase full of old clothes. The only things she’d be taking back would be a couple of souvenirs, a camera full of pictures, and the clothes on her back.


“But sometimes our desire to help backfires,” Father Jon said. He went on to explain how at one time the US government donated tons of sugar and rice, which undercut the Haitian farmers and put them out of business. The same thing happens when well-meaning charities donate massive amounts of free medicine and inadvertently bankrupt the local pharmacies. He told the story of how United Nations peacekeepers accidentally contaminated the water supply, which caused a cholera outbreak that killed 10,000 Haitians after the earthquake.


“I estimate we’ve performed over two thousand operations,” Dr. Dean said.


“And yet there are still two hundred and fifty thousand Haitians infected with filariasis who need your help,” Father Jon said. “Currently, we lack the infrastructure and the resources to systematically inoculate the population and destroy the larvae transmitted by the mosquito vector.”


“The shitty brown mosquito,” Dr. Etienne said.


Culex quinquefasciatus,” Father Jon corrected. He was a trained epidemiologist who specialized in rare tropical diseases, and lymphatic filariasis was his nemesis. “Haiti is one of the only places left in the Western Hemisphere that hasn’t eradicated endemic filariasis.”


“Did I ever tell you guys the parable of the starfish?” Dr. Dean asked. Everyone turned their heads and gave him their full attention. “Well, there was a huge storm that washed up millions of starfish onto the beach. They covered the sand as far as the eye could see, and were dying in the sun. A boy walked down to the shore and started tossing them, one by one, back into the ocean. After a while, his father joined him and asked what he was doing. ‘I’m saving the starfish,’ the boy said. ‘You can’t possibly save the starfish,’ the father said. ‘There are too many.’ The boy reached down, picked up a starfish, and tossed it into the ocean—‘I saved that one.’”


While everyone absorbed the moral, the sound of an approaching motorcycle disturbed the silence. Dr. Etienne looked over the edge of the roof and saw a single headlight illuminating the grounds in front of the residence. The horn beep-beeped and Roberson shouted, “Dr. Etienne! Anmwe! Prese prese!


“What’s the matter?” Dr. Etienne called down to him. It had grown quite dark, but his eyes had adjusted to the night.


“I’ve got your chen.” He lifted a small bundle in his arms that looked like a swaddled infant and carried it up the front steps.


Dr. Etienne descended the stairs two at a time and met Roberson in the dining room, standing in front of the iconic picture of Dr. Dean performing surgery during a power outage under a spotlight of flashlights held by the outstretched arms of his team. Roberson set the bundle on the table and unwrapped a filthy blanket to reveal the limp, beaten body of the street dog.


“I told you this was a bad idea.”


“What the hell happened?” Dr. Etienne stroked the bloodstained fur and noted she was still warm and breathing shallowly.


“You lit a fire under them boys,” Roberson said. “They spent all day chasing the poor dog. When they finally got her cornered, she went wild and bit one of the boys on the hand.”


“Is the kid all right?”


“Don’t worry about him. It was only his pride that got hurt.”


“How did she end up like this?”


The dog was covered in bleeding cuts and welts; her eyes were swollen shut, her ears torn, and her white-tipped tail drooped flaccid and uncurled. She was barely recognizable.


“They realized they couldn’t catch her alive, so they pelted her with rocks.”


“But, I didn’t mean…” A black pit opened up inside Dr. Etienne’s gut.


“Twenty dollars is a lot of money to those boys, and they didn’t want to disappoint you."


“Jesus, what have I done?” He flashed back to the moment the vet pushed the lethal injection into the IV of his old Basenji. “I can’t save her.” He felt for a femoral pulse––it was weak and thready. “She’s lost too much blood. There are too many injuries.”

“This is a Haitian dog, Doc.” Roberson placed a strong hand on his shoulder. “She will make it if you give her a chance.”




S.W. Gordon has a BA in English from the University of Iowa and an MFA in creative writing from Stetson University, as well as an MD. He is a practicing urologic surgeon in Florida, where he lives with his wife and daughter.