Osly St. Preux and his mother hopped on the back of a truck and rode for hours along rutted roads in northern Haiti before they finally arrived, barefoot, at the hospital run by nuns and often staffed by American volunteers.
When Osly, then 12, took off his shirt for a surgeon from Baltimore, the doctor couldn't believe what he was seeing. The tumor growing out of Osly's right armpit was enormous, a gnarled, bulbous mass larger than a grapefruit and getting bigger by the month.
Dr. Mojtaba Gashti knew almost immediately that he and his team, who every spring make a pilgrimage to Haiti to perform surgery, would not be able to save Osly - not there, in fairly primitive conditions in one of the poorest places on the planet.
The doctor looked into the boy's big brown eyes and saw his own young son, an American teenager who wanted for nothing. His heartstrings tugged, his head spinning with thoughts of how best to help, Gashti decided he had to bring Osly to the United States and make him well.
Gashti slogged through diplomatic red tape, lobbied his surgeon friends to donate their time and persuaded his hospital to approve the operation and help pay for it. And finally, last week Osly and his mother, Natalie Pierre, entered an airport for the first time, flew on an airplane for the first time, and made their way to Baltimore.
Tomorrow, Osly will have his sarcoma removed during a six-hour procedure at Union Memorial Hospital, where Gashti is chief of vascular surgery.
"We've seen so many people there - you can't bring everyone back," Gashti said. "Something about his smile and his face and his cap. ...
"Our hope is that it's not too late and we can resect it and cure it."
Gashti, 47, has been going to Haiti since 1994, when he was training at St. Barnabas Hospital in New York. One day in the on-call room, the Iranian-born Gashti got to talking with a junior resident, Dr. Renoir Eugene, who hails from Milot, a hamlet in the north of Haiti. They hatched a plan. What if they went to Eugene's homeland and put their new surgical skills to work on the needy villagers who can hardly afford food, let alone basic medical care?
The first trip happened that spring. The operating room at Hopital Sacre Coeur, just 12 beds at the time, had no air conditioning, no ventilation of any kind, flies buzzing all around. But they were able to do so much in those five days. Gashti has been returning ever since, taking a week's vacation, paying his own way, to work from early morning until late at night, doing as many as 67 surgeries in one trip.
"Ever since that first year, I tell everyone they need to go to Haiti once in their lifetime, like a hajj [pilgrimage], so when you come back you're grateful for every little thing you have," Gashti said.
"I don't come from a very rich family or a rich place. I know what poverty is," he continued. Haiti, though, ís "beyond poverty. It's not like people are poor. They just don't have anything. Poor means you have little. These people have nothing."
The first time Osly had ever seen a doctor was in 2005, at age 9, when he and his mother trekked to Milot the week that Gashti was there. Osly's case was simple - a small fluid-filled cyst under his right arm needed to be removed. It required only a local anesthetic.
Most surgeries Gashti does in Haiti are simple in the United States. But by the time patients in Haiti finally make it to the hospital to be seen, what could have been taken care of easily when it was small has grown so large that surgery is now quite problematic. Their goiter is so large they struggle to breathe. Their untreated hernias may require removal of the affected organ. Their infected appendix is ready to burst.
Last May, when Gashti returned to Haiti, Osly was back at the hospital. In the spot where the small cyst had been, the large ugly tumor had taken its place.
The tumor was painful. Osly couldn't put his arm down. He could barely fit into his shirt. Gashti saw right away that this tumor might kill the boy if it remained. At the very least, he would likely need his arm amputated.
The surgery couldn't be done in Haiti. It was far too complicated. Arteries, veins and nerves could all be involved. Osly would likely lose blood, and the hospital can't do transfusions. A skin graft, which he might need, was out of the question in this operating room, with its malfunctioning lights, shaky tables and shortage of antibiotics.
Gashti took 10 or 15 minutes to think. He looked at Osly. If this boy were Joshua, his now 15-year-old son, his wish would be that someone do everything possible to help. So he did something he had never done. Gashti had the Creole-speaking nurse tell Osly and his mother he wanted to bring them to the United States.
Osly's smile went from ear to ear. He grabbed the doctor's hand, shaking it with joy.
His mother was jubilant. "She said she woke up that morning and knew God was sending somebody to help Osly," Gashti recalled. "I thought maybe that someone was us."
Passports secured, fees paid, plane tickets purchased, the visas came through three weeks ago. Osly and his mother began their journey to Maryland, leaving behind the one-room home without electricity or running water that they share with five of Osly's seven siblings.
At the last minute, Gashti had to wire money - neither Osly, now 13, nor his mother owned shoes, something they would need in the United States. The only pair Osly could find are a bit too small, but he can't part with the brand-new, gleaming white sneakers he can call his own.
They departed for Fort Lauderdale, Fla., where Gashti had flown to meet them. Osly held tight to Gashti's coat as he rode in his first elevator. Gashti had to grab Pierre as she was nearly torn in two when she put one foot on an escalator but not the other.
Mother and son spent their first full day in the United States at the sprawling new Ellicott City home - with its high ceilings, flat-screen televisions and granite countertops - that Gashti shares with his wife, Leida, his 12-year-old daughter, Jasmin, and Joshua. This will be Osly and Pierre's home until Osly is well enough to return to Haiti.
Language is an obstacle. Neither speaks the other's tongue. The Gashtis have a Creole phrase book. Venezuelan-born Leida knows some rudimentary French. But most importantly they have Haitian-American friends who are a phone call away. That has helped in confusing moments.
Osly and Joshua seem to speak the common language of teenage boys. They both sit slack-jawed in front of a Sylvester Stallone action movie. They spend hours on the PlayStation 2.
Pierre, 48, communicates in her own way. She did something she had never done in her life, making snow angels and rolling down hills in the Gashtis' backyard.
On Wednesday, Osly went to Union Memorial so doctors could finally see inside the tumor. There is no diagnostic equipment at the Haitian hospital, no X-ray machines or CT scans.
Osly's tumor was also inspected by Dr. Vinay K. Gupta, chief of oncologic surgery at Union Memorial. When Gupta pulled away Osly's shirt - a soccer jersey borrowed from Jasmin - Pierre had to look away. It is too hard for her to see her baby this way, she said through an interpreter.
Gupta sensed her angst. "This will be very good for him," the doctor reassured her.
Osly was a bit of a celebrity at the hospital that day. People kept tracking him down with little gifts - a lacrosse jersey, a baseball cap, a notebook, a football and a little radio with earbuds. He greeted every present with a merci or a beaucoup. He hugged these strangers, trying to find a way to express his gratitude without shared words.
Wearing the cap and the earbuds, he looked very much like an American kid.
Marilyn Cook, a New Jersey nurse who has gone on several of Gashti's missions to Haiti, sat and watched Osly with a big smile.
There have been times in their travels when she has felt there was just too much need, too deep a hole to fill, that they could never do enough.
But, she said, "Dr. Gashti always says, 'little steps.' You can only do so much. You have to believe you're doing as much as you can."
Said Gashti: "We have made a lot of difference. We take care of them the same way we would take care of any patients in the United States and they know that. ...
"Any little thing we do there is something they didn't have or something nobody else was going to offer them."
And he has done so very much for this one boy and his family, arranging the trip, putting them up in his home, paying thousands of dollars out of his own pocket for a chance at a cure.
"She is thanking the doctor and God for blessing this child," the translator said, relaying Pierre's words.
"If not by the power of God, the doctor would not have found this child's case. This child could have lost this life."
Echoed Osly, "Thank everyone for giving me my life back."