Etienne's role on the hospital's ethics committee draws him into some of the most complex cases on board, cases that reflect the depth of Haiti's suffering. There were the young man with cerebral malaria and three patients with tetanus, which Etienne says he has never seen before. None is expected to survive.
The ship's obstetricians called on Etienne for advice on how to handle a near-term pregnant woman with a broken pelvis and thigh. Her internal bleeding was so severe it threatened to drain the ship's depleted blood bank — and cost both mother and baby their lives. Delivering her baby and repairing her wounds would require three operations. Etienne found that the consent form mentioned only two.
"Unless you get her consent for the third operation, it will be battery," he told the doctors. The consent form was revised, the mother survived and the obstetricians delivered the mission's first baby, a girl named Esther.
Lt. Cmdr. Susan Farrar, who helped deliver the baby, says the mother awoke from surgery worried that Esther might have been hurt by the earthquake.
"The first thing she asked me was, 'Did the baby have any injuries?' " Farrar says. "We told her the baby was perfect."
In a case that divided the medical staff, Etienne was called in to consult on an 11-month-old boy whose head is so swollen with hydrocephalus — a blockage that prevents spinal fluid from draining — that Etienne had to stick two paper tape measures together to gauge its circumference.
The boy's case provoked a furious debate among doctors, already stretched to the limits of exhaustion and resources. Should they perform brain surgery to put in a shunt and tubing that would let the fluid drain into his abdomen?
Or should they focus instead on patients injured in the earthquake and not roll the dice on what might be a temporary fix for a fatal condition?
"Personally, I would treat him. We have the shunts. We have the tubing," says Cmdr. Dennis Rivet, a neurosurgeon, noting that the operation is done with success in poor African countries.
"I would set him free with a blessing," counters Capt. Arne Anderson, a pediatrician. He notes that many shunts eventually fail.
He also says the Ministry of Health of Haiti had asked the Comfort not to provide medical care that can't be sustained in Haiti.
"He'll die," Rivet says.
"If you like the risks, and the risks are small, I'll support you," Anderson says.
The doctors agree to wait for a CT scan to decide. If the boy's brain shows no damage, surgery might become a reasonable option.
Etienne says the case offers a perfect reflection of the crossroads Haiti has reached. If the earthquake had not happened, he says, "the kid would never have left the house. The family would have hidden him away. Because the earthquake wrecked their house, the family can't hide him any longer."
The earthquake likewise exposed the depth of Haiti's problems, he says.
But there can be hope even in the most difficult circumstances, Etienne says. "I believe in God, and there is always a chance of a miracle," even in a case as dire as Brianville's.
Chaplain David Oravec offered a prayer of hope moments after Etienne had delivered his diagnosis. He also asked Brianville, "What do you do?"
"I used to sing," Brianville said.
"No matter what," Oravec said, "you'll still sing."