The water is icy. It’s freezing me to the bone. I can’t bail it out fast enough. I run from one end of the dinghy to the other, using every ounce of strength and agility I have, but it is no good. The boat is still full of water.

Then, before I know it, I’m overboard. It is the dead of night. I am only sixteen, and I’d thought I was invincible. It hits me that I am about to die.

On board the boat, almost everyone is asleep. We are forty miles from Lampedusa. If the others do not hear me right now, they’ll leave me behind, and that will be the end of me—they won’t even know I’m gone until they are back in port. This is not how I want to die, not at sixteen. I’m terrified.

Panic sets in and I start to shout at the top of my voice, kicking hard to stop the sea from dragging me under. The Mediterranean enables us fishermen to make a living, but at any time it can choose to abandon us, turning into a cruel and pitiless monster. “Patri!” I shriek, hysterical. “Patri!” The man at the rudder is my father. But he cannot hear me. This is it, I think to myself, but I keep screeching. Then something astonishing happens. My father turns, and notices me. He sees my flailing arms, hears my desperate, croaking voice, and turns the boat around to rescue me.

My father calls out to wake the others, and soon there is a flurry of activity on board the Kennedy. The waters are choppy and the seamen struggle to haul me out, but soon enough they manage to lift me to safety. I am cold and sick. As I vomit salt water, shivering and bawling like a small child, my father holds me tight and does his best to warm me up. The trawl is over. We return home empty-handed, but we have saved one life. Mine.

At home in our modest fisherman’s cottage, I refused to speak for days, even though I wasn’t a quiet boy. Not a single word escaped my lips. For the first time in my life, I had stared death in the face.

I did not know it then, but my whole life would be marked by a capricious sea that spits out living or dead bodies at will. Now it is my job to try and save the living, and I am the last person to touch the dead. Now, every time I go to the pier and see a man, woman, or child, frozen and sodden, eyes wide with fear, I think back to that night when I was sixteen. Sometimes the memory returns to haunt me, but in the three decades that have passed since then, I have accumulated other, more devastating nightmares.

*

Lampedusa is not an easy island to live on. It is a small piece of the earth’s crust that broke off from Africa and drifted toward Europe. As such, it is something of a symbolic gateway between the two continents. Its destiny and the fates of its people have been shaped by tectonic movements.

There is hardly anyone on the island who does not remember the shipwreck of October 3, 2013, which took 368 lives. The coffins of the dead were lined up in the hangar at the airport. They perished only yards away from the beach, safety, and the chance to start a new life. But fewer of us remember the shipwreck that happened only a few days later, on October 11. Just as many people drowned, but that disaster occurred further away, off the coast of Malta.

That day, a Maltese helicopter dropped off nine survivors on Lampedusa. The clinic looked like a field hospital in wartime. Some of the patients were lying in beds, while others sat in wheelchairs, draped in blankets, attached to drips. One man was the only person in a family of twenty-two to have survived. He was howling that he wanted to kill himself. We persuaded him to sit, and calmed him down.

A young Syrian man was hooked up to a drip. His face was blank. I tried to talk to him, but he would not respond. The woman sitting next to him was cradling a nine-month-old in her arms. She, too, was staring straight ahead, with glazed eyes. She was cradling her baby in a strange way, alternately clasping him to her and holding him away.

After an hour or so, the man decided to speak to me. He explained that the woman was his wife. When the boat was wrecked, they were thrown into the water along with eight hundred other passengers. He was an excellent swimmer and was carrying the nine-month-old at his breast. He held his wife’s hand with one hand, and clasped his three-year-old’s in the other. They started swimming side by side, treading water continuously and trying desperately to stay afloat. They waited for help, but none came. They were exhausted.

At a certain point, the man realized that he was running out of breath, while the waves were getting higher and the current stronger. Right then, suspended between life and death, he had to make a decision. If he just kept treading water, all four of them would drown. In the end, he opened his right hand, and let go of his son. He watched him disappear under the waves.

As he told me this, he could not stop weeping, and nor could I. I did not have it in me to hold myself together. I felt guilty, since a doctor is not supposed to let his patients see that he is overwhelmed, but I couldn’t remain impassive in the face of such grief. The man was tormented by the fact that, only a few moments later, the helicopters arrived. “If I had held out just a little bit longer, my son would be here with us. I will never forgive myself.”

Another woman had a two-year-old in her arms. The little girl was making a gurgling sound: “Drun drun.” The mother told me that her daughter was thirsty, but that she vomited each time she was given water. We had difficulty inserting a drip, but at last we succeeded. The woman said that her husband had stayed behind in Libya. They could not afford to pay the fare for all three of them at once, so they had decided that she and the child would go on ahead. They had not heard from him since.

Among the survivors was a university student who told us that a woman had gone into labor during the journey. As it happened, there were seven doctors on board, and they all assisted with the birth. Immediately afterward, the boat capsized. Perhaps, he said, it was because so many people jostled to see the newborn that the vessel keeled over.

The following morning, a guardia di finanza boat came to port in Lampedusa. Instead of survivors, it brought us twenty-one dead bodies, and these were lined up as usual in green body bags along Favaloro Pier. Before starting on the first autopsy, I spent some time looking at the victims and summoning up the courage to begin. Among them were four children, who looked as if they were asleep. Performing any postmortem is hard, but examining the corpse of a child is devastating. I went home even more despondent than I had been the day before. For a long time that shipwreck kept on delivering bodies.

The following week, I received a telephone call from a Syrian man who spoke excellent Italian. He had tracked me down after first calling all the other Bartolos on Lampedusa. He asked whether I had found his brother among either the victims or the survivors of the wreck. His brother had been on board with his wife and their four children. He was a doctor who ran his own clinic together with six colleagues. They had all escaped together from Syria to Libya, before boarding the same boat. Seven doctors, I thought—they must have been the ones the student had told me about.

Several days later, the man sent me photographs of his brother, the sister-in-law, and the children. I recognized his niece. She was one of the four little ones in those body bags. I called Porto Empedocle and Malta to see if any of the others had survived. The answer was always the same.

*

You never get used to seeing dead children, or women who died giving birth on a wrecked boat, their tiny babies still attached to them by the umbilical cord. You never get used to the indignity of having to cut off a finger or an ear from a corpse to be tested for DNA so that the victim might be given a name, an identity, and not merely a number. Every time I open a green body bag, it feels as if I am doing it for the first time.

People often assume that the chief obstacle for refugees is having to cross the sea. That is just the last hurdle. With the help of the interpreters who work at Lampedusa’s reception center, I have spent hours listening to their stories. The choice to leave behind home and country. Then the desert: they say that is a hell you cannot understand unless you have been there yourself. The heat is stifling. You are crammed onto a pickup truck, and if you so much as sit in the wrong place, you are thrown out and left to die. When the water runs out, you are reduced to drinking your own urine. Finally you arrive in Libya and think the nightmare is over, but it has only just begun: ill treatment, prison, torture. Only if you manage to survive all of this do you finally make it onto a boat. Only then, if you do not die on the open sea, do you arrive at your destination and begin to hope that your life can start all over again.

One day in June, I saw a group of young refugees at Guitgia, a pristine beach just out of town that is a favorite of families with children. The migrants had clustered on a rock, away from the holidaymakers.

I was amazed that they did not hate the sea for what it had done to them: holding them at its mercy for so many ghastly days and nights, swallowing up their friends, separating them from their countries. Then, of course, I remembered that it was also the sea that had saved them from certain death by war or famine.

*

Reaching the open seas, casting my lines, and waiting patiently: that is the only way of reconnecting with myself that I know.

A wheelhouse is all I have left of the Kennedy, the fishing boat that fed my family for forty years. My father maintained her lovingly until he died. He was already dying of cancer when he decided that his boat had to move with the times. So he had her renovated, put in new electrical equipment, and constructed a larger cabin.

The Kennedy was his home. On her, he had spent countless calm and tempestuous days, and innumerable nights. She was his world and he would never abandon her. He had made great sacrifices and taken serious risks to build and maintain this boat. It was everything to him.

We had to sell her after he died. When the fishermen from Anzio who had bought her came to Lampedusa and picked her up, I wept on the pier like a child.

It was on the Kennedy that I learned to be a seaman and a fisherman, and grew a strong stomach. There I had felt real hunger, and celebrated good catches. That was where I discovered the meaning of exhaustion, and of self-denial. And where my best moments with my father took place. He had wanted me to be tough and fearless.

Above all, on the Kennedy I had learned to love the sea. I developed an intrinsic need for it; I could not live without it.

For my father, too, the sea was everything. When his illness got the better of him, he stopped going out on the Kennedy and returned to our old Pilacchiera, which was smaller and easier to control. Since he could not do it alone anymore, he often asked me to go down to the pier with him and help him aboard. But he never asked me to accompany him out to sea—not that I would have been able to go anyway, since I was needed back at the clinic.

Invariably, he returned with the Pilacchiera full of fish. People called him obstinate, saying he should not be going out in his condition. I asked him why he kept fishing even though he barely had the strength for it. “Because it is the only weapon I have against this monster that is devouring me,” he said. “Because it is my life.”

And so I continued to help him. When he came back to port with his catch, his face was always white with salt. The water would splash onto his face and then dry in the burning sun, leaving behind a layer of salt like a mask. It was a mask that revealed the authenticity of his being instead of hiding it, a mask that permitted no falsehoods.

I see the same masks on the faces of the migrants who have spent days at sea, tossed by the waves. When I see them I think of my father. They are children of the same sea.

*

Adapted from Tears of Salt: A Doctor’s Story by Pietro Bartolo. © 2016 by Mondadori Libri S.p.A., Milano. English translation copyright © 2017 by Chenxin Jiang. Used with permission of the publisher, W.W. Norton & Company, Inc. All rights reserved.