Ebstein's Anomaly

Marc--February, 2014
(Photo by John Carroll)

Daniel

Daniel
(Photo by John Carroll)

Daniel's Home Visit--- But Who is the Patient?--Update Three http://t.co/UYojO7xcqf
— John A. Carroll (@haitianhearts) March 5, 2014

Princess Buggie

Princess Buggie and Grandma--February 26, 2014
(Photo by John Carroll)

This sweet baby girl named Princess Buggie was born with holes in her heart and she needs surgery ASAP. If you have any leads on who would want to save this little but important life, let me know.

I have done a History and Physical and have an up to date echocardiogram. (Princess has an AV Canal.)

Thank you.

John A. Carroll, MD
haitianhearts@gmail.com
www.haitianhearts@gmail.com

Rotchina and OSF

 
Rotchina, January 2014 (Photo by John Carroll)


In August 2000 I brought a nine month old baby girl named Rotchina to OSF-Children's Hosptial of Illinois (CHOI) in Peoria. Rotchina suffered from severe pulmonary valve stenosis. This means that she was born with a very small pulmonary valve which was restricting blood flow to her lungs.

An echocardiogram performed at OSF-CHOI in 2000 revealed a huge pressure gradient (174 mm hg) across a tiny pulmonic valve. (A normal pulmonary valve would have no gradient.) This meant that their was a huge block at the pulmonary valve as blood was rushing from her right ventricle through the tiny pulmonic valve on its way to her lungs. And her right ventricle was too big because it had been doing so much work to pump the blood through the small pulmonary valve.

In the Catheterization Lab at OSF the pediatric cardiologist and his excellent team at CHOI inserted a catheter into a major blood vessel in Rotchina's thigh and threaded the catheter up to her tight pulmonic valve. When it was determined the catheter was in the correct position, the cardiologist inflated a balloon at the end of the catheter and popped open her abnormal pulmonary valve. The valve area increased immediately which allowed much more blood to flow to her lungs with each heart beat.

The procedure was successful and Rotchina was released from the hospital the same day and went back to her host family in the Peoria area.

Rotchina stayed with this wonderful family until she was medically cleared and then we took her back to Port-au-Prince to be reunited with her mother.

Rotchina is now 14 years old. She and her mother survived the Haitian earthquake in 2010 which destroyed most of Port-au-Prince.

Recently I have been hearing that Rotchina has not been doing well. I called the CHOI cardiologist who opened her valve when she was a baby and described Rotchina’s situation now.  He offered some thoughts but he sounded shaken to hear her name again. He wished me luck in finding care for Rotchina.

So I had another OSF cardiologist review a recent echocardiogram that Rotchina had in Haiti. The cardiologist noted that Rotchina now has severe pulmonary valve regurgitation which means that her pulmonic valve, which was tight when she was a baby, is now very leaky. And this cardiologist stated that she may need to have heart surgery to have a new pulmonary valve placed.

But how would I get this done at OSF which is where it should be done? For a decade OSF has denied all of my Haitian Hearts patients from ever returning to OSF. (The surgery that Rotchina may need is not done in Haiti.)

So over a month ago I asked another friend of mine and a long time friend of Keith Steffen, OSF-Saint Francis Medical Center's CEO, to call Keith and ask him to accept Rotchina back to OSF for a complete cardiac work up and surgery if needed.

I will spare you the morbid details but after weeks of faithful efforts by my friend with Keith Steffen and Margaret Gustafson, Executive Director of CHOI, OSF did not remove their embargo against Rotchina. It was a painful lesson for my friend and he saw up close and personal how OSF works for Haitians kids.

The other day in Haiti I examined both Daniel and Rotchina. She is now a tall 14 year old adolescent who is very pleasant and polite and she and her mother appeared fine. Her mother was carrying the original medical records from OSF-CHOI like they were treasured documents.

Rotchina’s mother states that Rotchina is a good student but does miss school due to health reasons. Her mother also reported that Rotchina is short of breath, has heart palpitations and chest pain. ( I hear these complaints almost everyday in Haiti. Sometimes they mean something significant and sometimes they don’t.)

Rotchina's physical exam revealed normal vital signs but she did have a loud murmur over her pulmonic area that sounded like her pulmonary valve is indeed leaky as the OSF cardiologist mentioned when we reviewed Rotchina’s echocardiogram in Peoria.

But as mentioned above, Rotchina is quite tall and I noticed she has long arms and skinny fingers. And she wears glasses. I asked myself if she has Marfan’s Syndrome.

Marfan’s is an inherited connective tissue disorder with many forms. Marfan’s can cause problems in multiple systems. Hearts can have leaky valves, arms can be long as can fingers, and there is high incidence of visual problems associated with Marfan’s.

Thus, Rotchina needs a work up, not only for her pulmonary valve to see if it needs to be replaced, but to determine if she has Marfan’s as well. If she becomes pregnant in the next few years and she DOES have Marfan’s, she could die in pregnancy. (Women with Marfan's can be high risk for rupturing their aorta during pregnancy and need to be monitored carefully.) But what do I tell Rotchina and her mother when she has NOT had a proper medical workup?

So Rotchina, like Daniel, is stuck in Haiti with nowhere to go. She needs to come to OSF so the physicians can work her up and treat as appropriate. The OSF Sisters first first mission value statement reads: "Personal worth and dignity of every person we serve regardless of race, color, religion and ability to pay." So I think this should cover Rotchina too.

"We are not likely to recognize the ravages of inequity because of our isolation from one another, but they are there." (Charles Blow, New York Times)


John A. Carroll, MD
www.haitianhearts.org

Dangerous Corporate Medicine in Peoria

(Daniel--January 2014, Photo by John Carroll)

Dangerous Corporate Medicine in Peoria

I am going to make a case that Peoria's OSF-Saint Francis Medical Center’s CEO Keith Steffen should be terminated from his position at OSF. In my opinion Keith should be removed by whoever in the huge OSF System has this responsibility. If it is the Sisters or one of the OSF Boards then they need to ‘throw him under the bus” on Glen Oak Avenue and be done with it. But I will also explain why this probably won’t happen. And at the end of this post I will have some personal requests and advice for Keith.

Peoria’s OSF-Saint Francis Medical Center has over six hundred beds. It is the fourth largest hospital in Illinois. The new Emergency Department and the new Children’s Hospital of Illinois were completed several years ago costing close to one-half billion dollars. It was Peoria’s largest building project ever. OSF has a medical staff of more than 800 physicians and is the second largest employer in Peoria. For the cost report period ending September 2011, OSF-Saint Francis Medical Center recorded $2.4 billion in gross charges and a net income of $52 million, according to American Hospital Directory.

This post is not a personal attack against Keith Steffen.  I am simply stating why I do not think Keith should be in charge at OSF. And after you have read this entire post, starting with an unfortunate young man named Daniel, determine if you think people’s lives anywhere should be in Keith Steffen’s hands. Ask yourself if you think Keith is following the founding Sisters philosophy of respect for life.

-----------

Daniel is a 33 year old Haitian man who I brought to OSF in 2000 when he was nineteen years old. He was part of the Haitian Hearts Program. Daniel had suffered from rheumatic fever which destroyed his mitral valve and put him in congestive heart failure as a teenager in Haiti.  After careful pre operative work up, Dr. Dale Geiss and his skilled cardiac team surgically replaced Daniel's diseased mitral valve with a tissue valve. Daniel recovered very well after surgery and even mowed his host family's yard in the Peoria area. And after he was medically cleared, Daniel returned to his family in Haiti. (Dr. Geiss performed all his medical care for Haitians free of charge. And Haitian Hearts donated over 1.1 million dollars to Children’s Hospital of Illinois for OSF's care of Haitian Hearts patients.)

A couple of days ago I visited Daniel in the slum where he lives in Port-au-Prince. The slum is named Drouillard and is filled with tens of thousands of other unfortunate souls. For the past five years Daniel  has lived here with his five brothers and sisters. They   share a tiny dark room on the second floor and look down on the confusing cement maze of corridors below. They have no running water and no electricity. And they have only one bed and Daniel gets it. The five others sleep on mats on the floor.

Daniel’s only sibling who has a job is a 36 year old sister who teaches at a nearby primary school. Her salary is meager at 80 US dollars per month and she supports all of the others with this income. The unemployment rate in Haiti is estimated to be 80 percent so Daniel and his siblings are not unusual.

During the last few months Daniel has become sick and can barely walk due to shortness of breath. He now props his head up on several cushions in order to sleep at night. He spends much of the day in bed in their room in Drouillard.

When I examined Daniel the other day another Haitian friend had to shine his cellphone flashlight on Daniel so I could see his eyes. He has a wise appearing face and his voice seemed strong. Daniel is the typical courageous Haitian warrior who continues to fight against incredible odds. However Daniel is very thin (one hundred pounds?) due to the catabolic stress that eats at him while his heart fails him. And while listening over his mitral valve I heard a raspy murmur indicating that it is dysfunctional and it is the culprit making Daniel very sick.

After my exam I asked Daniel if he had the strength to go downtown that day to have a formal echocardiogram. He said he would try and loaded his cachectic frame onto a filthy tap-tap amidst the dust and debris of Port-au-Prince.

The eighty dollar echocardiogram clearly showed that Daniel’s mitral valve area is scarred and tiny and allowing just a trickle of blood to enter his left ventricle. His ventricle is working well…it just doesn’t have enough blood to pump to the rest of his body.  And because the blood cannot be pumped forward efficiently it backs up into his lungs making it very hard for Daniel to breathe.

Over the past 14 years this tissue valve that was implanted at OSF has saved his life. But now this same valve is killing him.

The fact that the valve has scarred down is not uncommon . What is uncommon is that Daniel is being denied repeat surgery. Daniel needs to have his bioprosthetic tissue valve replaced with a plastic and metal valve that will last indefinitely. It is OSF’s responsibility to accept Daniel back to allow a willing Dr. Geiss to perform this surgery.

For the past decade Keith and OSF have refused all of my Haitian Hearts patients that were operated at OSF from ever returning to OSF. Three of my Haitian patients in their early 20’s have now died because they did not have repeat heart surgery. However we have had the good fortune of having some of our Haitian Hearts patients operated elsewhere during the last ten years and their lives were saved. However, other medical centers and contacts that could operate Daniel now believe that Daniel is OSF’s responsibility and have already rejected him.
 
So what do I tell Daniel? That the OSF Sisters don’t turn any one away except Haitian Hearts patients including him? That OSF does not care if he lives or dies? What should I say to him?

And how will Daniel die? He will die slowly over a few months. His activity will continue to decrease. He will become more short of breath and begin to cough up blood. Daniel won’t have the strength to eat and he will become moribund. He will suffer from air hunger and won’t be offered any morphine to take the edge off because he won’t be in any hospital in Haiti. (And most hospitals for poor people in Haiti have no morphine in the first place.) Some day his eyes will roll back and he will suffocate and die in front of his horrified brothers and sisters. And when it is done, his brothers will carry his body to a local morgue. And when they scrounge up enough money from their slum neighbors, his brothers and sisters will have pauper’s funeral for Daniel and bury him in the Drouillard Cemetery across the dusty street from their slum.

This scenario of course does NOT need to be the way it plays out for Daniel. OSF and Keith could change the outcome if they wanted. Daniel’s life could definitely be saved if they act now.

But this does not seem to be happening. During the last few weeks I have had a friend of mine and a friend of Daniel’s talk to Keith about removing OSF's embargo against Daniel so as to allow Daniel to come back to OSF to be operated.  Keith has not removed the OSF embargo against Daniel. I have been told to pursue other avenues for Daniel. But I have "pursued other anvenues" and they are leading nowhere for Daniel. He is not being accepted elsewhere. Sadly, Daniel is working on renewing his passport and calls me everyday here in Port-au-Prince. And when I see the call is from Daniel, I feel like vomiting.

How could the CEO of Peoria’s enormous Catholic medical center that says they turn no one away continue do this? I am still in total disbelief of this negligence even after seeing this happen for ten years. Sister Judith Ann, Chairperson of OSF Healthcare, typed me a letter last year and said that she puts her trust in the administrative team at OSF? Really?

So, dear reader, are you still with me?

This unfortunate scene that I described is typical of Corporate Medicine in Peoria and around the United States. Corporate Medicine is a new specialty but it is not primarily focused on the well being of the patient. It is focused on profit. In Peoria, Keith Steffen puts an interesting and unusual twist into the story with his weird antics and statements over the years, but other hospitals have bad administrators too. Non-caring administrators are ubiquitous. Corporate Medicine is one of the main reasons costs of health care have risen so much. We have too many administrators and too many of them are corrupt. They devalue the lives of people like Daniel. Our lives really mean nothing to them. People like Keith are divorced from direct involvement with patient care and don’t see the human side of medical care. Keith doesn't know Daniel and doesn't want to get to know him. Especially in Daniel’s slum.

What about the doctors who work for OSF? Can they be of some help? Probably not. Their paychecks are signed by OSF and they are always looking over their shoulder. They can be intimidated by administrators that visit their OSF offices. Keith told me that “fear amongst employees is a good thing”. Does that sound healthy to you?

And if Pope Francis walked into Keith’s office at OSF, do you think he would be pleased with OSF or Keith Steffen? The Pope would see Keith’s Bible on the nice table top but what would be missing would be the smell of sheep. Keith does not smell like a sheep because he is not working with the "common folk" enough. His feet are not dirty enough. He is not really doing what the Pope wants all of us to do.

Will anyone do anything about this? Probably not. The OSF Sisters bowed out years ago. The Peoria business and religious community will stick together and continue to give each other awards. And our priests will continue to give passionless and boring homilies at Mass to the anesthetized souls in front of them.

Keith and OSF are in a very bad spot here. It would be the right thing for OSF to get rid of Keith and reverse their discriminatory embargo against my Haitian patients. OSF needs to accept Daniel back. He is their patient.  But if they did this they would be indirectly admitting that they made a big mistake by neglecting young dying Haitians that they cared for previously by stopping them from returning to OSF. And OSF like other big corporations (think Catholic Church) don't usually admit to making mistakes without outside pressure.

Barring a miracle Daniel is done. And there will be other Daniels in the future and they may not be Haitian.

——————

So Daniel is one reason and a very important reason that I believe Keith Steffen should be terminated from OSF.

What I did not mention above and won’t describe in detail below are a few more reasons why I think Keith should be terminated from OSF. You see what YOU think after you read the paragraphs below:

A fifty-some year old man had a cardiac arrest and died at a Peoria restaurant after a Peoria Fire Fighter Paramedic stood and watched and was not allowed to insert a breathing tube. OSF has always been a strong supporter of Advanced Medical Transport.

The Psychiatric Unit at OSF-SFMC closed its doors. Isn’t mental illness a disease too?

Caterpillar's generous monetary donations worth tens of thousands of dollars earmarked for Haitian Hearts children were not credited to the Haitian Hearts children. The Peoria North Rotary Club President told me that Children's Hospital attempted to get their hands on Rotary’s twelve thousand dollar yearly donation to Haitian Hearts. This Rotary money was not meant for OSF.  I discovered thousands of other dollars that came to Haitian Hearts but was not turned over to us by OSF until enough pressure was put on Keith to write a check and pay us back.  And a physician’s huge donation that was earmarked for Haitian Hearts never made it to us but did make it to Children’s Hospital.

There was a delay in operating multiple sick Haitian children in Peoria to the dismay of their host families. One baby named Samuel even arrested and had to have outpatient CPR to revive him. I had to report the Children’s Hospital Executive Director for medical negligence of Haitian children to the OSF Pediatric Resource Center.

OSF’s spokesperson Chris Lofgren said Haitian Hearts would survive just fine after my departure from OSF in December 2001.  But Keith had been saying “behind the scenes” that he was going to stop all Haitian Hearts funding. And he did so in July 2002.

I won’t describe what Keith said to me in his office, what he said to my family in his office, what he said to OSF employees in his office, or what he said about the “devil” in his office to a friend of mine and how she wanted to get out of his office as quickly as possible. And I won’t describe what Keith said about Haitian children.

I won’t describe how OSF called the American Consulate in Port-au-Prince and how the Consulate officer cried in front of me thinking that this may hinder the sick Haitian child's visa application to come to Peoria for heart surgery.

I won’t describe how Keith stated that if I quit blogging against OSF, he may allow a Haitian OSF patient to come back to OSF. Can you imagine bartering a Haitian life for a blog post?

------------

Personal note to Keith--

I have tried to keep this as impersonal as possible. As you know, based on what you told me in your office, and what many people have told me, this post could have been much more descriptive.

Keith, why not just resign? The nuns have paid you well to do their dirty work. You are their Samoza. Go golf in Arizona or somewhere. Enjoy yourself. Life is short.

And if you decide to resign, please do some networking for Daniel before you leave. Reach out to the many hospital administrators that you must know across the United States and ask someone to accept Daniel. You don’t have to go into all the unethical reasons OSF won’t help him but you could save Daniel's life if you got him accepted somewhere else. I would transport him to and from Haiti as usual. Please give this some serious thought. Wouldn’t that be a satisfying way for you to end your career?

And one last thing, Keith.

Haitians were brought to Haiti from Africa hundreds of years ago to work as slaves. And when they dropped dead in the sugar cane field, they were replaced with more slaves. Ubuntu is an African philosophy that concerns itself with the essence of being human. It speaks about interconnectedness amongst humans. It says that you can’t exist as a human being in isolation. Ted Oswald, author of Because We Are: A Novel of Haiti, writes about Ubuntu: “…my humanity is tied up with your humanity. It says that if a part of the community is suffering, then I am suffering. Solidarity means if I am higher, I lower myself, so that you may be lifted up and we can stand together.”



John A. Carroll, MD
www.haitianhearts.org

Catholic Tribunal Courts Not Used Often Enough

Bishop Daniel Jenky of Peoria refused a Tribunal Court against OSF. He wanted to protect OSF like other bishops wanted to protect pedophile priests.

Bishop Jenky declined Tribunal Court...Pope Benedict Defrocked 400 Priests in 2 Years for Child Abuse http://t.co/X91S68DEWF via @TIMEWorld
— John A. Carroll (@haitianhearts) January 17, 2014

Haitian Child-Slave Becomes Miracle

(Photo by John Carroll--December, 2013)


During the last two decades I have had the opportunity to meet hundreds of people who have cared for Haitian Hearts children in their homes before and after the children have had heart surgery. These host families from all over the United States  have been wonderful.

In 2003 Haitian Hearts brought six Haitian children on the same flight from Port-au-Prince to the Tampa International Airport. All were sick and needed heart surgery soon. Three of the children would be operated at All Children’s in Saint Petersburg and the other three at St Joseph's Children's Hospital in Tampa.

In the large crowd of people at the airport who greeted us as we got off the plane were Yves and Micki Morency. The Morency’s were to be one of the children’s host parents in Saint Petersburg.

Micki’s incredible story of Louise (not her real name) is posted below. As Micki beautifully describes, Louise’s heart surgery is only one of the miracles experienced by her and witnessed by everyone involved in her care.

Micki has kindly allowed me to post her article on Dispatches from Haiti in the Peoria Journal Star. Thank you, Yves and Micki, for all you have done. Deye mon gen mon (Behind mountains there are mountains).

---------

A Miracle
by Micki Morency

I met Louise for the first time in October 2003, she was sixteen years old. My husband and I went to the airport in Tampa, Florida about 20 minutes north from St Petersburg   where we lived since 1986, with our two daughters. In 2003 they were nineteen and seventeen. The oldest was away in college and the youngest, a senior in high school was preparing to leave home soon. I needed to refill the nest.

I received a call from our local Children's Hospital that they were expecting three Haitian children to arrive the following week for heart surgery through Haitian Hearts of Peoria, Illinois. Would I be interested in hosting the oldest one, since none of them spoke English?

The social worker felt Louise would be happier with a Haitian family, since she was older.  And that is where the first miracle happened. Had she been placed with an American family, I believed that perhaps her story may not have been told today.

We brought Louise home from the airport around ten in the evening. During the trip home I tried to engage her in conversation, but I could barely elicit a response. I realized that she was shy and it would take time before she felt comfortable with us.

When we got home, she hesitated to enter the house. I took her hand and we walked through the door. I offered her a snack. While she was eating, I kept talking. I loved to meet people and learn their stories as I shared mine. As usual my husband sat at the kitchen counter observing, but not saying much. Finally I asked her age. She looked at me and thought for a couple of seconds and said, “My Aunt said I am nineteen years old.”

I thought it odd. The hospital said she was either fourteen or sixteen, but we figured we’d confirm that once she arrived. She looked no older than twelve, even though her facial expression told a different story. She looked weary and old. She was 4’8” and weighed 84 lbs. I asked to see her passport, she handed me a manila envelope with her documents.

Her birth certificate indicated she was sixteen years old, and I gently told her. She just stared at me with no sign of understanding. There was no reaction, and I immediately thought: how come she didn’t know her age? That was bizarre, for a teen coming from the capital.

It was late, so I took her upstairs to our guest room. She looked like she just entered a magic place. Her jaw dropped and her brown eyes with the thick and long lashes bulged. Louise stood on the threshold and I had to prod her into the room. She looked at the queen bed and asked me, “Where should I sleep?” I pointed to the bed. She looked confused.

I assisted her with all the gadgets in the bathroom. I turned down the bed, and tucked her in. I woke up in the middle of the night to check on her, and I was shocked to find her sleeping on the floor under the comforter. I decided to let her rest. I went back to my room, but could not sleep. I was confused about her behavior. However, slowly a picture was forming in my mind of what this child life might have been like in Haiti.

The next morning, I went in the room to help her get ready for her first pre-op appointment. I found her sitting on the floor with a very scared look on her face. As I helped her in the shower, I noticed the scars on her back. I asked her what happened, she said dispassionately, “They beat me all the time.” I froze. The anger would come later. After breakfast of oatmeal with lots of sugar we headed to the hospital.

“Louise, why did you sleep on the floor last night? I asked, while driving to the hospital.

“I never slept on a bed before, Auntie, and I didn’t want to get in trouble with the master of the house,” she replied.

I laughed. I realized she was talking about my husband. I had to explain to her that I was actually the “master” in the house, but more importantly that beds were made to be slept on, and I expected her to sleep on it.

When we got to the hospital, I was so excited to take the elevator with her, because I knew she’d never been on one.  As the door was closing I asked her to push the number three.

“Auntie, I don’t know numbers or letters. I can’t read or write,” she said flatly.

I just stood there with my mouth open. I didn’t know how long until someone got on and asked, “What floor?”

After meeting with the medical staff, I learned how serious her condition was, she was born with a hole in her heart, a condition called Tetralogy of Fallot. I explained to Louise as best as I could, because even in our native Creole, she looked at me as if I was speaking Chinese. I kept thinking: What hole did this kid crawl out of? What happened to her? How did she get here?

She had several medical tests that day. Through all the needle sticks she never uttered a word. I held and stroked her small hand with the bent knobby fingers   a side effect of her congenital heart disease. I told her that she will be able to walk more than ten steps without stopping. She’ll be running and jumping ropes, activities she had never been able to do.
   
With pre-op tests over, it was time to go shopping. We went to the mall and I asked her to choose every time I saw something she might like. The answer was always the same: “I don’t know, you pick, Auntie.” I insisted in her choosing at least the color. She loved red.
   
We went home with clothes, sandals, underwear, toiletries and I saw the hint of a first smile. She kept looking in the back of the car, furtively as if the bags might suddenly disappear. She was exhausted. When we got home I fed her and she took a nap on the bed.
   
After several hours, I went upstairs to check on her. I could hardly make out her outline under the huge comforter, but she had a smile on her face while she was sleeping. I had a hard time rousing her. When she finally awoke, she looked at me with fear in her eyes.
 
“I’m sorry, Auntie, I overslept. Please show me what you want me to do around the house,” she said, while trying to leap out of the bed.
   
“It’s ok honey. I only want you to rest and have fun before your surgery,” I replied.
   
“Thank you, Auntie. The bed felt good and comfortable.”
   
I reached over and gathered her in my arms and hugged her for a long time. When I let her go, she started crying.
   
“What’s wrong, honey,” I asked, alarmed that I had hurt her somehow.
   
“Nobody had ever touched me before, except to beat me,” she hiccupped.    
   
She lived under horrible conditions. She was the first to get up and the last to lie down. Even though she cooked the meals, she was not allowed to eat, until everyone had seconds, by then there was never enough left for her. Her mother, who lived in the countryside with seven other children, sent Louise to Port-au-prince when she was a sickly five-year old, to live with Annette, who promised to get her medical care. Annette needed a child-slave to take care of her household and her five children. Louise was one of the thousands of children that are used in Haiti as slaves. But, her mother did not know that.
     
Louise cooked, cleaned, washed clothes and went to market daily. Her day started at four in the morning, because she had to do everything slowly, otherwise she got chest pain. She was beaten frequently for being too slow. She was malnourished, she never saw a doctor and never went to school. She slept on a straw mat under the dining table, so the kids would not purposely step on her swollen hands. The rags she wore were held together with safety pins. Her beautiful long, thick black hair got so matted that Annette frequently chopped it off, rather than combed it.
   
The second miracle occurred when a neighbor heard about this American doctor who came to Haiti looking for children with cardiac diseases. She took Louise to see Dr. John Carroll, while Annette was out of the house. The third miracle was that medically she was not supposed to live this long with her heart defect, especially under these conditions. There will be many more miracles.
   
After her surgery we spent a lot of time together, Louise was afraid of everything, people, bugs, noises, being alone, so I took her everywhere. We bonded over the three- month period before she returned to Haiti.  I made financial arrangements for her to go live with Marie, someone I knew and trusted to take care of her, and that decision saved her life again.
     
Had she returned to live with Annette, I would not be sending money, knowing that she would not care for Louise. I would not have been allowed to contact Louise. It was during one of my weekly call to Louise and Marie, that I learned she was not feeling well. I immediately told her to take Louise to see a cardiologist. He confirmed that she was in congestive heart failure. The patch that was placed over the hole in her heart had come off, and her heart was pumping blood into her lung. That was six months after her return to Haiti.
   
With the assistance of the hospital and Dr. Carroll once more, we made the necessary arrangements to bring her back as soon as possible. I picked her up at the airport a week later and my own heart hurt. I had to use a wheelchair to transport her. I took her directly to the ER where she was immediately admitted. She was treated for two weeks prior to surgery, to increase her odds of survival.
   
The surgeon came out to talk to me before the operation.
   
“She is very sick, so this could go either way. Let’s pray for a miracle.” he said with such sorrow in his eyes.
   
“Doctor, I believe God brought Louise back here for a reason. He has a purpose for her. She’ll be fine,” I replied, trying hard to contain my need to scream.
   
“I pray that you’re right,” he said as he reached for my hand and squeezed it with so much compassion.
   
“I have two little girls at home. I’ll do my very best,” he added, his voice breaking.
   
I remembered sitting there praying, like I’ve never prayed before. Louise survived the operation and she thrived physically. However, she had a lot of physical and psychological scars to heal. When the surgeon told me that she could no longer live in Haiti, because of her heart, I opened mine and took her in.
   
Thus, began her journey in the United States. Louise was discharged on a very hot Florida summer day in July and I was so excited to bring her home. I was eager to start caring for her and to reconnect from where we left off.
   
She had a very high tolerance for pain from the long term abuse she suffered. She refused pain pills, even when I could see her wince when she breathed. Since Louise couldn’t read nor write, the only diversion I could provide was talk to her.
   
She loved when I talked about life in the US. I shared my personal experience, when I first came from Haiti. She marveled at my ability to speak this “funny language” and still speak Haitian Creole. I explained to her that I had to go to school and that one of the many great things about America, was that one could go to school at any age and become anything.
   
Her physical healing was very fast. I was amazed how she could run up and down the stairs, like a typical healthy seventeen year old. However, she would tell me that she was scared about the prospect of staying in America, because it all seemed so complicated. There was the refrigerator, the stove, the microwave, the blender, the toaster, the dishwasher, the television set, the remote control, the washer and dryer.
   
“What about them,” I asked, puzzled.
   
“I’m overwhelmed” she replied, “How will I ever learn how to operate these machines, when I can’t read.”
   
She started to cry. I walked over and took her in my arms and whispered “I’ll teach you.”
   
From that day, she followed me around the house, like my shadow. She might not have been able to read, but she soaked up information like a sponge. Within a couple of weeks, she could use the smaller appliances. Louise was happy and proud of every small achievement, and I lavished praises on her, for I was also very proud of her.
   
We were both eagerly awaiting her sixth-week post-op check up and clearance, so she could start school. That day finally came. Louise was ready to go to school. We went shopping for school clothes, supplies and a backpack. Her eyes lit up like a five year old getting ready for kindergarten, but in a way she was. She had never been to school before.
   
The next morning she was up and dressed early. She wore a pair of pink short and matching top that highlighted her light brown skin. Her hair styled in a pony tail made her look even younger than she was. She strapped the backpack on and a big smile on her round face that traveled to her wise eyes, she was ready to go. I tried to get her to eat breakfast, but she just wanted to head out the door.
   
When we got to the school, her demeanor changed. She stayed very close to me, and was looking curiously around her. I reached for her hand, and without a word, she visibly calmed down. After signing all the papers, I took her to her classroom and introduced her to her teacher. She was a very enthusiastic young lady and I explained Louise’s situation to her. She took Louise by the hand and in a very soothing voice, she welcomed her.
   
I left and sat in my car in the parking lot and cried, just like I did when I took my daughters to school for the first time. I couldn’t wait to pick her up to find out how her first day went. Well, she talked all the way home, telling me in minute details everything she did, saw, heard and touched.
   
We had a great routine. I took her to school in the morning, picked her up in the afternoon. We read, did homework, cooked dinner and ate together when my husband got home from work.  My daughters were away in college, but just like that I had another family again.
   
Louise was born with a hole in her heart, so the abundance of love and forgiveness it carries could overflow and bathe her in this wise and serene aura. It is joyful to be in her presence.
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(As 2013 comes to a close, Louise is a healthy and talented 26 year old young woman. jc)

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