PASSING OF THE TORCH

Florida’s winter sun crept up the horizon to illuminate yet another day in paradise. Dr. Dean rolled out of bed, dressed quickly in green scrubs, and donned his long, white coat. Without waking his wife, he kissed her forehead and tiptoed through the sunbeams slanting across the hardwood floors. He’d slept poorly and his lower back ached, but he had a clinic full of patients, consults to see in the hospital, and a couple surgeries scheduled at the ambulatory surgery center.

“Time to make the donuts,” he whispered under his breath. Days had become weeks, weeks had become months, and months had degenerated into years—forty years, to be exact. But who was counting? Soon his son would complete his training at Notre Dame and join his thriving urological practice. Dr. Dean could hardly wait to relinquish the reins and offload his innumerable responsibilities. There would be plenty of time for a thoughtful and well-executed transition.

Halfway through his morning clinic, Dr. Dean was already an hour behind and patients were becoming antsy. He stared down through his bifocals at the computer screen, transfixed by the spinning blue circle, waiting for the next screen to load. The electronic medical record program was frozen again, and he was dead in the water. If only he could go back in time to paper charts and Dictaphones. Things were much more efficient back then. A doctor could delegate most of the administrative hassles and focus on taking care of patients, but those days were long gone.

“Can someone call IT and find out what’s going on?” Dr. Dean asked, fidgeting on the edge of his chair. Abruptly he stood up and rubbed his bald forehead.

“It’s been acting up all morning,” his medical assistant said. “They think the sync is down again.”

“Then call a plumber.” He turned away and started walking to the kitchen to refill his coffee cup.

“Did you sit in some catsup?” she asked, pointing at the back of Dr. Dean’s coat.

“Don’t think so.” He twisted his neck and pulled his coattail to the side. A crimson streak stained the part of the coat he’d been sitting on. “Is seventy too old to have one’s first period?”

“These days? I suppose anything is possible.” She grabbed his coffee cup. “I’ll top you off while you get cleaned up.”

When he got to the bathroom and undressed, Dr. Dean realized that blood had seeped out his rectum. Probably just a hemorrhoid, he thought. By the time he’d changed clothes and placed an ABD pad in his shorts, the computer issues had miraculously resolved, so he trudged through the rest of his day as if nothing untoward had happened.

Dr. Dean had always taken his health for granted. He didn’t have any major medical problems, and both his parents had lived to a ripe old age. Longevity was in his genes. Nevertheless, he called a GI colleague on his way home and told him about the episode of painless, bright-red blood per rectum. The gastroenterologist told him to swing by his office.

“This doesn’t feel right,” the GI doctor said while performing the digital rectal exam. “It’s rock hard.”

“I’m a little turned on too, Bubba. But let’s keep this professional.”

“All jokes aside, Dean,” he continued, “it feels malignant.”

“It’s just a thrombosed hemorrhoid,” Dr. Dean said. “Don’t be so grim.”

But the bad news kept coming, and no amount of humor could lessen the blow. A rectal biopsy confirmed adenocarcinoma, and a CT scan showed widespread metastasis to the liver and retroperitoneal lymph nodes. Even the mercurial Dr. Dean couldn’t laugh in the face of stage 4 rectal cancer. It was a death sentence.

***

A week later, while waiting to board the plane, Dr. Dean’s cell phone rang. He fished it out of his carry-on luggage and saw his partner’s name, Dr. Etienne, on the screen.

“Hey, Chief,” Dr. Dean said. “How’re they hanging?”

“Not good, Dean,” Dr. Etienne answered. “You promised to take me with you.”

“It’s too dangerous.”

“Apparently not for you.”

“That’s one of the advantages of having terminal cancer, you can take more chances with minimal repercussions.”

“Why Haiti? Why now? It doesn’t make any sense.”

“You of all people should understand. Remember how good it felt to operate all day without any administrative constraints? Remember how grateful the people were and how good it felt to help them? That’s an irreplaceable high.”

“You’ve made over forty trips and helped thousands of people.”

“I have to put my house in order while I still can.”

“You’ve done your part, Dean.”

“I start chemotherapy next week. This may be my last chance.” There was silence on the other end of the line for several seconds.

“You don’t deserve any of this bullshit. You don’t even smoke or drink.”

“I’ve smoked a few cigars in my time, but I had to give up booze.” He didn’t like the person he became when under the influence of alcohol and blamed it in part for destroying his first marriage. Drinking was not something he could do in moderation.

“I suppose you could have eaten better and exercised more. That might have kept you in shape.”

“Hey, last time I checked, round is a shape.”

“None of this is fair!”

“Whoever told you life was fair?” Dr. Dean welcomed philosophical and theological discussions. “My faith demands I help wherever I can, whenever I can, for as long as I can––it’s not optional.”

“It’s shit like this that makes me an atheist.”

“God has given me many things. I have lived a good life.”

“You earned everything you have through hard work and dedication.”

“Who blessed me with those abilities? Who made me the way I am?”

“Your wonderful parents and loving family.”

“Touché,” Dr. Dean said with a laugh. “But who made them?”

***

The flight from Daytona International Airport to Port-au-Prince, Haiti, only took ninety minutes. Dr. Dean used the time to update his contact list and organize his donor registry in a tattered black ledger book that contained outlines of the business protocols and budgetary concerns necessary to carry out his weeklong surgical mission trips. Hidden within the pages there were also surgical notes on performing complex reduction scrotoplasties, directions on how to apply his proprietary compression X-dressing, lists of required surgical supplies, and the names of all the various doctors, nurses, students, and volunteers who had accompanied him over the years. This time, however, he came alone.

As the plane circled for a landing, Dr. Dean glanced out the window at the azure waters contrasting sharply with the industrial wasteland and gray shacks of the surrounding city. A brownish haze hung over the distant horizon where green, treeless mountains met the cloudless sky. So much poverty, he thought, so many people in need. It was shocking that third world conditions could exist anywhere in the western hemisphere, let alone so close to the United States.

With his Notre Dame baseball hat protecting his bald head from the tropical sun, Dr. Dean descended the stairs onto the tarmac and took his first breath of Haitian air. He smiled at the familiar scent of wood smoke laced with ocean salt and a tinge of garbage. If only he could bottle the essence to remind him of the spiritual fulfillment he received caring for the people of Haiti. It restored his faith in himself and opened his heart to those in need.

After navigating his wheeled carry-on through customs, Dr. Dean searched the throngs of Black faces lining the un-air-conditioned airport corridors, politely declining offers of assistance and ignoring street vendors plying their wares. He knew Roberson would easily locate his solitary white face amidst the crowd and take him under his protective wing.

“Dr. Dean!” Roberson called out. “This way, my friend. It’s been too long.” He gave Dr. Dean’s hand a strong shake and took control of the carry-on. “Where is your entourage?”

“It’s just me this time,” he answered. “I know it was short notice, but thanks for helping me out.” They weaved their way through the crush of people and made their way to the parking lot.

“You’ve always been there for me, Dr. Dean,” Roberson said. “I will always be there for you.”

“Well, thank you, Roberson.” Dr. Dean knew Roberson depended on the extra income derived from helping various surgical and religious missions with transportation, entertainment, and security. His street smarts, local reputation, and translation skills made him an indispensable asset for any outsiders hoping to avoid misadventures while doing the Lord’s work in Haiti.

“If I’d have known you were coming alone, I’d have stuck you on the back of my motorcycle.” Roberson winked and flashed his trademark smile.

It was not uncommon to see complete families piled onto a single motorcycle on the streets of Haiti and not a helmet on anyone. Necessity always trumped safety. Roberson himself had suffered several broken bones and broad patches of road rash when his motorcycle clipped the bumper of a tap-tap taxi several years earlier. Dr. Dean had helped pay for the medical expenses to make sure the bones were set correctly and prevent any long-term disability.

“You know I have cancer,” Dr. Dean said, “but I’m not prepared to die today.”

“No worries, I have the hospital’s minivan and enough gas to get back to Léogâne.” He pointed to an old, white vehicle. “Unless you want to take a little detour?”

“What did you have in mind?”

“I know a place in Pétion-ville that’s not too far out of the way.” Roberson raised an eyebrow and shook his head affirmatively. “Very clean, very safe. I guarantee those girls will make you forget anything that ails you.”

“Tempting,” Dr. Dean said, “but that’s not the kind of salvation I need right now.”

“Those girls have families to feed and have to make a living too. You’d be doing them a favor.”

“Maybe next time,” Dr. Dean answered and quickly changed the topic. “So how’s your little girl?”

“Not so little anymore. She had her First Communion and wore the prettiest white dress, thanks to your blessings.”

“It was the least I could do for my goddaughter.”

They climbed into the minivan and began the thirty-mile drive down the coast to Léogâne. Due to traffic and poor road conditions, this part of the journey often took longer than the flight from Daytona. It was also the most dangerous. Kidnapping, robbery, assault, and even murder were all possible if you took a wrong turn or became a target of a local gang. Dr. Dean welcomed the threats; they made him feel alive and vital. He’d rather go out in a blaze of glory than the slow wasting away of metastatic cancer. Where was the dignity in such a prolonged and ugly death?

***

When they arrived at the nursing school compound in Léogâne, Roberson beeped the horn outside the solid, ten-foot metal fence. The uniformed guard swung open the gate, adjusted the rifle strap over his shoulder, and tipped his hat. Dr. Dean always welcomed the serene calm that existed behind the razor-wire-topped walls. It contrasted sharply with the congested, narrow streets of the city. Grazing goats were staked out at intervals, and chickens roamed freely over open green pastures between the sparse, one-story buildings. A rutted dirt road ran through the middle of the property and ended at another tall gate, behind which stood the stately three-story Residence Filariose that housed the good Samaritans who participated in the Notre Dame Haiti Program.

Jean-Luc sat at the base of the entryway stairs and rose to greet them. As always, he was immaculately dressed in white linen pants and a loose-fitting silk shirt. Jean-Luc was the local coordinator for the Notre Dame Haiti Program and had just completed the building of a new elementary school for over fifty Haitian children. Dr. Dean had helped extensively with the fundraising efforts and had thrown several gala parties at his home.

“Welcome back, my friend,” Jean-Luc said. “I hope the trip wasn’t too unpleasant?”

“Not at all,” Dr. Dean responded, “aside from having to take a piss for the past hour.”

“You weren’t the only one.” Jean-Luc pointed to a tree where Roberson was relieving himself.

“You know that’s illegal, right?” Dr. Dean shouted.

“What?” Roberson said, glancing over his shoulder.

“A grown man holding a little boy’s penis.” Dr. Dean delivered the punchline and scrambled up the steps to the first-floor bathroom before his bladder could get the final laugh.

After relieving himself Dr. Dean joined the others in the living room and settled down on one of the musty couches. Jean-Luc passed out chilled plastic water bottles and gave Dr. Dean the rundown of the week ahead. It was much the same as previous trips: meals at the nursing faculty building, van rides to and from the hospital, cold showers, mosquito nets, bug juice, and a daily surgical marathon.

“At some point you need to come tour the new school,” Jean-Luc said.

“Last time I was here, it was just a bunch of stakes in the ground,” Dr. Dean said. “I really didn’t think you’d be able to pull it off so soon.”

“It would not have been possible without all the help of you and your friends and colleagues. The Intervol donations overcame all the setbacks we faced.”

“I’m glad I could play my small part,” Dr. Dean said.

“And did Roberson tell you about his new job?” Jean-Luc asked.

“I am the school’s resource officer,” Roberson announced proudly. “They even gave me a uniform and a badge.”

“Congratulations, you humble bastard,” Dr. Dean said, slapping Roberson on the back. “The kids couldn’t be in safer hands.”

“He’ll be coming for my job next,” Jean-Luc said. “Never underestimate Mr. Roberson.”

***

The next morning Dr. Dean woke up to the sound of his cell phone alarm. Strange, he thought, what happened to that godforsaken rooster? He completed his morning routine and walked through the dewy grass over to the nursing faculty building. No one else was around but someone had left a continental breakfast on the counter. He drank a cup of coffee and ate a few pieces of papaya. Moments later he heard the beep of the minivan out front.

“Bonjou,” Roberson said. He was almost unrecognizable in his security uniform. “Did you sleep well?”

“Too well,” Dr. Dean said, climbing into the passenger’s seat. “I didn’t get my usual cockadoodledoo wake-up call.”

“Cat got that old rooster,” Roberson said. “Carried him right over the fence.”

“How do you know someone didn’t cook him?”

“Too thin for a stew chicken,” Roberson explained, “and I found bloody feathers in the barbed wire.”

“As much as I hated that noisy fucker,” Dr. Dean said, “I kinda miss him.”

“Another one will come along sooner or later.”

They made the short drive over to Hôpital Sainte-Croix and entered through the back gate into a small courtyard. The local surgeon had lined up several patients with large, cumbersome hydroceles. Dr. Dean swung through the preop holding area, where all the day’s patients and a few family members were huddled together on small cots. There was no expectation of privacy as he examined their massively swollen scrotums. He smiled warmly, patted several shoulders, and shook many outstretched hands. Roberson did all the talking in Haitian Creole and answered all the questions without even translating for Dr. Dean. It was not his first rodeo.

For the rest of the day, Dr. Dean performed surgery after surgery, flipping from one operating room into the other with only a few minutes between cases. The efficiency and economy of the Haitian people never ceased to amaze him. They did so much with little and let nothing go to waste. By comparison, the bloated bureaucratic nonsense of the American medical system was an extravagant embarrassment.

By the tenth and final case, the hems of Dr. Dean’s green scrubs were spattered with blood and wet with spilled hydrocele fluid. He’d been operating for over ten hours with only a brief lunch break to rehydrate and use the restroom. His feet were sore, his legs weary, his back stiff, his mouth dry, but his fingers were deft and his mind fully alive. It was the epiphany of exhaustion that he craved, knowing all his hard-earned knowledge and skills were being put to good use and not being wasted on meaningless paperwork, insurance authorizations, and regulatory hoop-jumping. The freedom and autonomy was as intoxicating as it was refreshing. He knew he would sleep well. Tomorrow would be yet another opportunity to reach for the brass ring.

***

Five grueling days later forty Haitian men had been drained of several gallons of debilitating scrotal fluid, and many had undergone complex reduction scrotoplasties. Once healed they would be able to return to a normal life, free of their embarrassing impediment. Dr. Dean now had to calculate the wages of all the support staff and dole out the money. He would split the costs with Intervol and his own personal savings, supplemented by donations from his friends and colleagues. The overhead costs were minuscule compared to his ambulatory surgery center and insignificant compared to the hospital’s, but the supplemental income was invaluable to the Haitian healthcare workers.

When he arrived back at the residence, Father Jon stood in the darkened hallway, staring at a large, framed photograph of Dr. Dean operating by the light of cell phone flashlights held aloft by many outstretched hands.

“I’ve always loved that picture,” Father Jon said. His white collar stood out against his black vestments. “Despite the power outage, you found a way to continue the work.”

“My team found a way,” Dr. Dean said. “I was sweating bullets waiting for the generator to kick in.”

“The inspiration you lit in them shines down upon you like a holy spotlight.” The priest turned and shook Dr. Dean’s hand. “I’m glad you came back.”

“I was afraid I might not get to see you.”

“I was attending a Tropical Disease Conference in Miami.”

“Were you one of the speakers?

“I was on the filariasis panel.”

“Not many priests with advanced degrees in tropical medicine.”

“Not in this hemisphere.”

Dr. Dean knew that Father Jon had dreamed of being sent to Africa but somehow ended up in Haiti, fighting to eradicate the last dark corner of endemic filariasis left on this side of the world. He had made it his life’s work. While Dr. Dean helped those already afflicted with the disease, Father Jon wanted to eradicate it at the source––once and for all.

“I have a small favor to ask of you,” Dr. Dean said. “I don’t know how much time I have left.”

“Nor do any of us. When the earthquake struck I felt the floor disintegrate beneath my feet and fell six stories into a pile of choking dust and rubble. I expected to die any second.”

“Then you know what it’s like to stand on the precipice.”

“What is it you need to get off your chest?”

“Forgive me, Father, for I have sinned,” Dr. Dean began the litany. “I cannot remember the last time I confessed…”

“And next you’ll be requesting the sacrament of extreme unction.”

“You’ve heard my diagnosis.” Dr. Dean managed a feeble smile.

“Then come, my son, join me in my heavenly confessional.” He led the way to the top floor, down a narrow hallway, and up a small, steep staircase to a metal door that opened onto the flat roof. Above them the stars sprinkled the sky, and a light breeze chilled the humid air. They sat back-to-back on one of the concrete support pillars that projected out of the building.

“I’m not ready to die,” Dr. Dean began. “There’s so much more I want to do with my life. I thought I’d have another decade at the very least.”

“You have led an exemplary life, Dean. Anyone would be proud of your accomplishments. You have done your part in God’s plan.”

“Then why am I not satisfied?” He held out his hands, palms up, and looked up at the night sky.

“Altruists are never satisfied. Delayed gratification becomes habitual self-denial. Oskar Schindler saved twelve hundred Jews during the Holocaust, spent his entire fortune to keep his factory workers alive, and still wished he’d done more.”

“If he’s your standard bearer, I’ve clearly failed.” He dropped his arms to his sides.

“Whoever saves one life saves the world.”

“But who will pick up the baton when I’m gone?”

“The world will go on with or without either of us. Haiti can use all the help it can get, but it doesn’t need more white saviors stealing its agency. Someone, perhaps one of Jean-Luc’s students, will complete our mission.”

“I would like that.”

“Go home, Dean. And be with the people who love you. Their world will never be the same without you.” Father Jon stood up and stretched his legs.

“So I have no penance?”

“Say ten Hail Marys and five Our Fathers.”

“Damn, that’s a lot.”

“Add a rosary for blasphemy.”

Dr. Dean put his hand over his mouth before he could utter another expletive.

“Until we meet again.” Father Jon looked up to the heavens, made the sign of the cross, and touched Dr. Dean’s forehead with his thumb. “May you go with the grace of God.”

***

That final morning Dr. Dean awoke to the familiar beep of the minivan. He reached for his cell phone, pressed the home button, and realized it was dead. An overnight power outage had prevented it from recharging and knocked out his alarm.

“Dr. Dean!” Roberson yelled from the entryway. “You’re going to miss your flight.”

Every joint and muscle ached as Dr. Dean rolled out of bed and threw back the mosquito net. His feet and calves remained swollen from the prolonged standing in the operating room. He dressed quickly in his travel clothes, brushed his teeth, and hurried down the stairs.

“Sorry, I overslept,” he said. “What time is it?”

“It’s time to go,” Roberson answered. He grabbed the carry-on, lugged it out to the minivan, and threw it in the back seat. “We can still make it if there are no demonstrations or accidents along the way.”

“Demonstrations?” Dr. Dean asked. He climbed into the passenger’s seat and plugged his phone into the car charger. Roberson had kept the engine running with the air conditioner on full blast.

“Port-au-Prince is a tinderbox. Prices are too high, not enough gas, too much crime.”

“Haiti can’t catch a break. As soon as things start to improve, along comes an earthquake, another hurricane, HIV, or cholera.”

“At least COVID stayed away.” Roberson waved to the security guard, who proceeded to open the gate.

“Not many obese, elderly diabetics in Haiti.”

“And none of us wore masks or got vaxxed.” Roberson turned onto a narrow road and weaved the van around potholes, dodging people on bicycles and braking for women carrying large baskets on their heads.

“Perhaps Haitians have natural immunity?”

“Perhaps the treatment was worse than the disease?”

“You’ve been spending too much time on social media, my friend.”

“How many shots did you get?”

“I was triple vaxxed.”

“And then you got cancer.”

“Correlation does not imply causation.”

“I will never get the jab.” Roberson pounded the steering wheel.

Dr. Dean knew it was fruitless to argue. Roberson had made up his mind. And the jury was still out on the efficacy and side-effect profile of the vaccines. The post-pandemic analysis was just beginning, and politics were already muddying the waters.

They drove on in silence and nothing impeded their progress. When they arrived outside the departure gates, Dr. Dean handed Roberson a bank envelope containing all his remaining cash and then placed his Notre Dame baseball cap on Roberson’s head.

“It looks better on you, Chief,” Dr. Dean said.

“Mesi, mesi, mesi,” Roberson repeated. He adjusted the hat to a roguish angle. There were tears wetting the corners of his eyes. “I will miss you.”

***

Two hours later Dr. Dean had navigated the long, serpentine line at the ticket counter and obtained his boarding pass. Sweat dripped down the sides of his face as he went through security and handed the guard his passport. On his way to the gate, the pain in his right calf had intensified, and he began to limp, favoring his left leg. He reached down and massaged the muscles of his lower leg.

Almost there, he thought, and then I can rest.

Arriving at the gate with minutes to spare, he discovered that his flight had been delayed several hours. He found a nearby café and bought a Coke Zero. As he sipped his drink with nothing to do, he thought about the upcoming battle when he got home: chemotherapy, radiation therapy, nausea, vomiting, anorexia. Well, he could afford to lose a few pounds. He’d already lost most of his hair thanks to male pattern baldness, so at least he wouldn’t suffer much from that indignity. But the loss of his large, bushy eyebrows was almost unimaginable. They were the hallmark feature of all the male members of his family. Whatever the cost, he was fully prepared to fight until the last breath. He had so much to live for and so much left to do.

On his way back to the gate, Dr. Dean wandered into a gift shop and bought a rosary with his credit card. The night before he’d fallen asleep long before he could complete his penance and had lost count of his progress. Since he had time to kill, he decided to go through the motions of his penance from the beginning. He closed his eyes and mumbled ten Hail Marys and five Our Fathers, counting each prayer on his fingers. It had been many years since he’d recited the rosary, and he wasn’t sure he would be able to remember all the steps, but when he kissed the cross, the words sprung to his lips from some deep spiritual well in the center of his chest.

“In the name of the Father, the Son, and the Holy Spirit…” he whispered to himself as he made the sign of the cross. The prayers flowed through his soul like a raft on a river as his fingers moved from bead to bead. While he prayed he contemplated the four sets of mysteries, relived the life of Jesus from the annunciation to the ascension, and considered the formation of Church dogma. All the teachings and wisdom of a lifetime came to the surface of his conscious mind.

By the time Dr. Dean finally boarded the plane, the sun had traversed far into the western horizon. He took a window seat on the right side of the aircraft just in front of the wing. No one sat next to him. He texted an update to his wife and put his cell phone on airplane mode. At last he could relax. Physically he was exhausted but spiritually he felt redeemed. Whatever the future had in store for him, he was prepared to meet it head-on.

Halfway through the flight, at the apogee of the ascent, Dr. Dean glanced out the window and became mesmerized by the dark shadow of the plane dancing on the white clouds below. It seemed to be pursuing the plane, waiting for the right moment to strike. And then, without warning, a large blood clot that had formed in the deep veins of his leg broke free and traveled up the femoral vein to the iliac veins, to the inferior vena cava, through the right atrium, down into the right ventricle, and finally settled as a saddle block at the junction of pulmonary arteries.

Without the ability of his lungs to oxygenate blood, Dr. Dean developed acute shortness of breath, pain on inspiration, and intense chest pain. His nimble mind rapidly put the pieces together and made the diagnosis: pulmonary embolism. The calf pain and swelling now made sense. He knew it could be rapidly fatal. In the moments he had left, he saw himself sitting at the piano bench teaching his grandchildren Christmas carols, imagined standing across the operating table assisting his son in surgery, and dreamed of all those exotic trips he would never take with his wife.

As the plane continued westward into the blinding sunset, Dr. Dean closed his eyes, his hand fell limp in his lap still cradling the crucifix, and his chin settled onto his silent chest. A serene smile remained forever fixed on his face. And a filament of smoke swirled above him before vanishing.