THE BOY WITH NO NAME

We had already seen over thirty patients in the sweltering afternoon heat, and the long line of people continued down the dim hallway and into the stairwell. In the adjacent open ward, children, sometimes two or three per bed, were packed together with only small shifting channels between beds that widened and narrowed as nurses and families scraped by. My friend and colleague Dr. Ena Miller and I were seeing outpatients at the public hospital in Honduras. The neurosurgery clinic consisted of a tiny glass-walled room sandwiched between the pediatric ward and hallway that doubled as a nurse’s station. The clinic contained an examination table covered in torn brown vinyl and a dented gray metal desk with missing drawers and unhinged doors. The glass between the clinic, hall, and ward was only partly covered by thin, faded Winnie-the-Pooh curtains, and the door to the exam room would not close completely. A young mother caught her breath and clutched her newborn after my gentle wordless examination. The mother’s hair was pulled tight back, high-cheeked face and cupid’s bow mouth over rounded belly still swollen from her recent pregnancy and delivery; The infant lolled in red crocheted booties with satin ribbons dangling from toneless feet and legs, the curve of the ribbons followed the curve of the legs in a macabre echo. “Yes, the baby would need surgery to repair the sore on her back and another to drain the fluid from her head into her abdomen. No, she would not be able to walk,” Ena explained carefully. Crinkly carbon copies smelled sour as Ena wrote out a shunt prescription for the red-bootied baby. Though the window to the ward I watched a thin, somber woman standing firm beside her son’s crib, rhythmically squeezing the ambu bag that filled and refilled his limp little lungs. That woman had been standing just as she was now each time I had been on the ward, twice daily, for the past two weeks. As I entered the hallway to call for the next patient, a small, skinny boy I judged to be about eight years old darted past me and into the exam room. His rust-colored hair was short and crinkly, his scalp crisscrossed with scars. He clutched a green plastic bottle of Sprite. I recognized scars from craniotomies, and I recognized scars from other things. “Doctura, I have a terrible headache.” said the boy. “My head, it is hurting terribly, please Doctura, I think my shunt is not working, please admit me to the hospital.” The boy was well-known to Ena, who explained to me in English that he was about 18 years old and had hydrocephalus and a shunt. He had been coming to the hospital since he was an infant and required emergency surgery to remove a subdural hematoma sustained at the hands of an abusive father. He had many craniotomies through the years for similar injuries as well as multiple shunts and shunt revisions for post-hemorrhagic hydrocephalus. Ena and I examined the boy, and although the refill on his shunt valve was a little slow, we found no clear evidence of shunt malfunction. Ena reached toward the prescription pad to order an outpatient CT. The boy began again, pleading in earnest, eyeing me hopefully, and in English adding: “My father beats me. My father beats me on my head.” Switching back to Spanish he added, “I don’t want to go home. Please find me a place in the hospital today.” Ena explained she could not admit him with only a headache, and offered again to obtain a CT scan. The boy refused, backing sadly into the crowd and repeating “La Doctura, por favor, por favor.” “What is his name?” I asked, contemplating adoption and what my husband would say if I returned home with this boy in tow. “I don’t remember.” Ena said, sifting through a stack of files on the desk, looking for his record. She did not find one, so she asked a nurse to help. “He has no name.” the nurse replied. I tilted my head and Ena arched her brow. “He has no name.” she repeated. “His mother and then the boy use no name to hide him from his father. I do not think he has a name.” When a trauma patient arrives in a United States Healthcare Facility without identification, the patient is typically given a temporary name such as “John Doe.” The patient is further assigned an obviously incorrect date of birth, such as “January 32, 1826,” so that the patient can be registered and emergency labs, scans and procedures accomplished until the patient’s true identity and birth date can be determined. Sometimes victims of violence are also assigned temporary aliases by a hospital to offer some protection from those outside the hospital who would do them further harm. In Honduras, these conventions simply do not exist. I called for the next patient and a petite young nun with a salmon pink wimple and habit came, bearing an infant with a myelomeningocele, a saggital synostosis, and a sacral decubitus ulcer. The nun was from the local orphanage. This infant had been abandoned at the hospital a few months earlier by his family, and the nuns had taken him in. Although profoundly disabled, the infant was smiling and clean the nun tender and devoted. I remarked on the infant’s polish and Ena described the orphanage: how spotless and well organized it was, how there were hundreds of such children there, all pampered and protected by the pink-clad nuns. As Ena crafted a foam donut and instructed the nun on the care of the infant’s ulcer, I noticed the first boy again hovering nearby, still holding the bottle of sprite, watching and listening. We completed the infant’s visit, and the nun deftly picked up the baby to return to the orphanage. As she crossed the exam room threshold with the baby in her arms, she paused and gazed steadily at the boy with no name. She nodded once, and then motioned for him to accompany her. He did. They walked down the hallway together, light from the low sun glancing off the linoleum, briefly illuminating this strange new family with golden light.