As Mark Shrime stepped on to the world’s largest civilian floating hospital off the coast of Sierra Leone this month, it was only a matter of time before the case of a patient on the lengthy surgical list would make him lose sleep.
There is always one whose condition is more urgent than first thought, causing the head and neck surgeon who has served with Mercy Ships for 17 years to wrestle with doubts.
The feeling forces him to painstakingly prepare by poring over old text books, visualising again and again the plan for removing the tumour, and plotting an exit if the mass cannot be excised.
Shrime speaks to The National about the operation during his latest rotation aboard the Global Mercy. “I finished with him about nine minutes ago," he says. "It was hard but went well. He is a young gentleman, I want to say 23, something like that, with a very, very large neck tumour,” he says, cupping a hand under his chin.
“I booked him in the operating theatre for three hours and it took five. But everything came out like it was supposed to, and now we’ll just hope that his recovery is smooth.”
As he explains, the factors complicating cases differ. It might be that a growth is engulfing the structures between oesophagus and skin, enveloping the jugular vein, pushing the carotid artery back towards the spine, impeding the airway, encompassing crucial nerves, or replacing an entire jaw bone.
Lack of access to surgery
Common to all is a chronic lack of access to surgery that allows what Shrime, the international chief medical officer of the Christian charitable organisation, describes as an occupying force in the neck to expand unimpeded.
It seems inconceivable that barriers to surgical care cause more deaths in low and middle-income countries than HIV/Aids, malaria and tuberculosis combined, but Shrime says research proves this is so.
“Two thirds of the world’s population cannot access surgery when they need it. The reason the case I just came from was so difficult was because the poor guy had had that tumour growing for years, not because he wanted to but because he didn’t have a way to get surgery.
“That’s why the development work we do is so important, because people shouldn’t be waiting for a ship to come in to do their surgery. Their healthcare system should be able to take care of them.
“Surgery has often been viewed as this thing you get once you’ve figured out malnutrition and antenatal care and infectious disease, but I would never sign up to live in a country without access to surgery. None of us would. So why do we say that it’s a luxury for everyone else?”
Shrime speaks almost evangelically of learning to listen to his patients in sub-Saharan Africa, diagnosing and then treating their life-threatening tumours – as well as the underlying injustices that they represent.
First, though, came the transition from successful but reluctant physician in academic practice in Boston to global health advocate, which took two decades and is recounted in his part-memoir, part self-help guide, Solving for Why.
The book is full of anecdotes that led to and go beyond the moment he got off the “moving sidewalk” that was propelling him from graduation to a safe retirement. His advice, in a nutshell, is not to forgo doing what we love, what matters to us most, in favour of job security, cachet or financial recompense.
Path over purpose, he says, never pans out. “My why is giving people back their rightful seat at the table of humanity.
“Fundamentally, I am convinced that the closest we can get to our 'why' is getting outside of ourselves. Everyone’s 'why' is different. I have these skills and I want to do something with them for those who are impoverished or have been 'othered'.”
Born to Melkite Catholic parents in Beirut in 1974, his long journey to revelation perhaps began when he was a year old, just after the Lebanese civil war broke out. A gun was aimed at the head of Souad, his pregnant mother, and then at him at a militia checkpoint as his father, George, was forced from their car.
That his parents survived the incident and escaped the conflict to begin anew in Texas gave young Mark a strong sense that they had not done so for him to lead a mediocre existence. As with many eldest sons of immigrants to the US, Shrime says he had three career options: doctor, lawyer or failure.
In the end, daring to take the risk of failing magnificently as a contestant at the unlikely entertainment sport that is American Ninja Warrior eventually enabled him to find much-needed meaning in the truest Platonic sense as a medic.
Rise of the Ninja Surgeon
Having discovered the joys of rock climbing in his 30s, he was watching videos of athletes competing on the arduous obstacles when a fit of “hubris” made him apply, along with 75,000 other hopefuls, in 2016.
Which is how he eventually came to be limbering up at 4.30am one chilly spring day in Cincinnati, Ohio, for what was his third and, although he did not know it then, final attempt to qualify.
“I was one of the last people to run, meaning I had the entire night to just sit there and stew about how I had to be better than last time. Three strides in, I stepped off the course out of sheer anxiety response. It’s never happened to me before. That was the end of my Ninja Warrior competitive career.
“I went out on basically as low as you can get. American Ninja was very much part of my public persona. What am I going to keep from this? Who am I now? There has been a lot to learn.”
Freedom from failure
No other competitor did worse on the night, but Shrime credits the freedom from feeling such fear throughout the three seasons and trying anyway as the means for venturing to do the same professionally.
His childhood home was in a nondescript residential neighbourhood of Dallas, Texas, with two-storey strip malls, a bank, grocery shops and Tex-Mex restaurants, where 20 or so years later he would be robbed at gunpoint of $18 while getting out of his Volvo after work.
George, an engineer, and Souad imposed an “uneasy balance” on their three children, homeschooling at weekends in Arabic and French while insisting they fit in and speak English like the US newscaster Dan Rather.
Shrime grew up bookish and unathletic alongside his extroverted siblings, Maria, a former physical therapist and recent contestant on the reality TV series Survivor, and Ryan, an actor, writer, director and producer.
Yet, he, too, would overcome shyness to appear on stage and screen as a sought-after speaker at more than 160 events, including a TEDx Talk, if not on American Ninja Warrior.
“It’s just a weird thing. We’ve never talked about it as the three of us kids, but we all have an attitude like: ‘This might be a stupid decision, but what the heck.’ That serves us well sometimes and serves us very poorly sometimes.”
A deeper purpose
For a while, a long-haired Shrime practised guitar incessantly, dressed in black, and sent letters proffering his services to the pioneering Christian rock band Petra. “Their music had a deeper purpose that aligned to the things I believed in. I could proudly feel like I’m listening to music that I love and also worshipping at the same time.”
There were other ambitions, of being a missionary in the mould of the 19th-century British Baptist Hudson Taylor, or a philosopher or linguist, anything other than being a doctor. As with music, however, George refused to countenance any child of his studying a subject whose “only purpose was to perpetuate itself”.
Educated at the Cistercian Preparatory School by Hungarian monks, Shrime graduated valedictorian in a class of 28 that was all white but for two Asians and him. Despite being teased for taking cream cheese and olive sandwiches in packed lunches, the realisation that he was Other only dawned the day after the First Gulf War began, when a fellow student drove into the car park with a song intended as an offence to Arabs blaring from the speakers. “That was the first time really that I thought: ‘Oh, I am different. I am the diversity'.’’
Writing on the wall
At Princeton, with his degree in molecular biology drawing to a close, Shrime sent out applications to medical schools across the US but is not sure what made him begin taping one rejection letter after another to the dormitory wall.
“There may have been an ‘I actually can’t do this, nobody’s going to accept me, and look at the 23 rejection letters on my wall, here’s the proof’. Maybe the med schools sensed an unspoken hope that all 25 would reject me because then I could be free of this obligation.”
Alas, two, including the University of Texas Southwestern Medical Centre, didn’t. “I failed at failing,” he concedes, smiling.
A few weeks before graduating summa cum laude, he lost his "rock" when George died from non-Hodgkin's lymphoma at the age of 55. Shrime, who was spending the summer on research in college, never got to say goodbye.
“I’ve changed, my family has changed, the world has changed. What would he have thought about the way my career, my brother’s career, my sister’s career have gone? I like to think that he would have been proud, and that’s something both my parents were really good at. My mother carried that on for 28 years without her husband.”
Field of dreams
Shrime carried on with what he saw as filial duty. In the middle of an arduous five-year residency (ear, nose and throat) at the New York Presbyterian Hospital, which followed a year teaching organic chemistry in Singapore (one of many failed attempts to escape medicine) and four years of medical school, a friend invited him to an exhibition of photographs he had taken with Mercy Ships off the coast of Liberia in West Africa.
Deprived of sleep, he went nonetheless and still has vivid memories of “health renewed, sight regained, faces mended and justice restored”, all made possible by a surgeon with a knife. He signed up the next day.
In July 2008, after six months of travelling, Shrime boarded the Africa Mercy off Monrovia, descended the red staircase to the hospital deck, turned right and then left, and had an epiphany.
“There were all these patients with head and neck tumours – pre-op all the way to just about to be discharged – and it really was: ‘Oh, my god, this is what I had been training for 15 years to do, and I didn’t even know it.’”
So transformative was the experience that Shrime thinks had he been single at the time he would have gone home, packed up and returned immediately. Instead, he completed another fellowship (microvascular reconstructive surgery) at the University of Toronto, did two years full-time as an attending surgeon at Boston Medical Centre, and only then went to one day a week as he began a PhD at Harvard in health policy with a concentration, aptly enough, in decision science.
Long look before 'leap'
“One of the problems with me is that I’m not very brave. As much as I hated medicine in the US, it’s a stable career and stability is important.
“I’d like to tell you that it was this sort of mindful ‘OK, I’m scared and I’m going to leap off the moving sidewalk anyway.' There was some of that but also this, like, ‘I’m so done with what I’m at right now.’ It was a slow process.”
Shrime turned 50 in August, celebrating with friends at a Lebanese restaurant with the same kind of “birthday cake” – a raw meat and bulgur wheat dish called kibbeh nayeh with a candle stuck in it – as he did as a child. That he has managed to dedicate a third of those years in part or full to Mercy Ships, he says, is mind-blowing.
Asked whether he would have followed the advice to “keep your heart towards the poor” in a commencement speech at his Cistercian alma mater, had he been sitting listening to it in 1992 instead of at the podium imparting the words in 2019, he pauses.
“I think the answer might be 'no', because the things I was saying to that audience are what I wish somebody had told me, but I live with anxiety. I have fear. I don’t know that I would have been, like, ‘OK, throw it all to the wind. Go pursue this thing.’
“But the other half of your question – would I have found my 'why' – I get in a different version from students, residents and trainees: Do you regret going to med school, residency, fellowships when you hated it so much? I find it’s impossible to answer. The only reason I can do what I’m doing right now is because I did all that. Had I not, it would have been different but what sort of 'why' I would have found is really interesting.’’
These days, Shrime is based in New York City, where he focuses on research, strategic thinking, and longer-term investments to chip away at the five million missing healthcare providers on the African continent “who should be there”, or works in Africa.
Full circle
For six to 12 weeks each year, though, he is back aboard the Global Mercy or the Africa Mercy, which have come to feel like home among the close-knit communities who crew the hospital ships.
He talks about how much it means to be able to resume “the beautiful dance of the operating room” that those stays afford. “I mean, that was my 'why' 17 years ago, and it’s still there.
“You know, they say there’s a day that you pick up your child for the last time, and you don’t know it. There’s going to be a day when it’s my last time on Mercy Ships, either because I retire or stop doing surgery, and that’ll be sad,” he says, a sombre note creeping in. “That will be sad.”
