"I joined the Navy not to serve Haiti but to serve the United States," he says. "It's an interesting irony that I can serve both in one mission."
The flight deck on the Comfort roars from sunup to sundown.
Helicopters lift off with personnel and supplies, returning with quake victims and possibly a family escort, if one survives. Patients arrive at the Comfort from landing zones on the mainland and from the Bataan and the Vinson, which have far more limited medical facilities.
Flight deck crewmembers set patients' litters on wheels and race them from the helicopters into elevators. Their doors open in the casualty reception center, or "Cas Rec" (kaz rek), the ship's massive emergency room. The floors are bright red. When the choppers arrive, the patients roll in.
Waiting to greet each stretcher is a small, stocky triage nurse with a military haircut, Lt. Cmdr. Daniel D'Aurora, also from Bethesda. A strip of adhesive tape across his back says "Casrec Bulldog." Alternately joking and barking orders, he waves patients into open bays, where waiting doctors treat open wounds, set simple bone fractures and insert IV lines.
Patients may be sent to the ICU, isolation rooms, pediatric wards or one of the ship's eight busy operating rooms.
"We're seeing infections that most people never see in their whole medical career," says Capt. Richard Sharpe, a surgeon who has served four combat tours in Afghanistan and Iraq. "It's just amazing to me that some of these people are alive."
Most of the patients in Cas Rec bays come wearing rags and bloody bandages. Many lie quiet, silenced by illness, pain, exhaustion, grief or incomprehension.
Dozens of children arrive alone, some silent with hollow eyes, others screaming in pain or crying out for their mothers.
"That kid over there was found under a house," says Cmdr. William Todd, a pediatric orthopedic surgeon, weary after 40 hours of surgery. "Many of them don't have families. I had a 12-year-old whose whole family was crushed. A little boy was sobbing on his gurney. I asked him what was wrong, and he said, 'I want to go home. I want to see my family.'
"He has no family. He has no home. It's all gone."
The surgeons aboard are gearing up to work around the clock, because so many patients are turning up with internal injuries, with massive fractures that must be reinforced with braces and pins, and with life-threatening infections.
The doctors so far have performed about 200 operations, more than 20 of them amputations on patients forced to choose between their limbs and their lives, says Cmdr. Timothy Donahue, the ship's chief surgeon.
"I had to amputate a guy's foot today," Donahue said Monday. "He's a policeman in Port-au-Prince. He's got four kids. He had gas gangrene. He said, 'How am I going to support my children?'
"If I don't (amputate)," Donahue told the patient, "you'll die today or tomorrow."
As the ship's leading ethicist, Etienne is drawn into surgical cases, too.
On Sunday night, a 23-year-old woman decided that rather than have a futile operation, she would die. She had been crushed by a falling pole when she lunged into the street to save a child. She asked doctors if she could die peacefully on the Comfort, with her mother, who lives in Port-au-Prince, by her side. Etienne arranged for her mother's flight.