HW 29- Reading and Noting Basic Materials

For this homework I have decided to structure my three "domains" by the triforce. For those of you who do not know what the triforce is, it is made up of the three elements of Power, Wisdom and Courage.

POWER:

When it comes to illness and dying (in mainstream U.S. and/or western civilization in general) the power is really in the hands of those who decide who gets medical care and who does not. As seen in Michael Moore's "Sicko", several (roughly 50) million people in the United States do not have medical coverage. Of those millions a vast majority suffer from not being able to receive proper care when it is needed most. There are examples of those who have sustained serious injury, developed advanced disease and still they are denied the treatment and care they require to continue to function. The main interest here is money. Insurance companies want to profit over the illnesses and deaths of patients, and doctors expect to be paid well for their treatment of said patients. Doctors pay a lot to be expertly trained with the highest tech equipment, and after the Great Depression medical bills started to become higher than a month's salary. (Sick, 6)

On the other hand, my father didn't have to pay AT ALL for his treatment during the time he was terminally ill. But in retrospect, making us pay would've added insult to injury. We were lied to and lost in the shuffle because of the insurance company's errors, and by the time they had "come to his rescue" it was FAR little WAY too late. In the end, insurance companies possess this power to deny sick people coverage, continually playing puppet master to the doctors and agents who are paid and professed to save lives, not a quick buck.

WISDOM:

When one becomes sick without the breath of death in their face, they have quite a few options. It takes the wisdom and judgement to be able to determine an individual's situation and immediate needs, which can be instrumental in one's fate. For example, when my brother stepped on a toothpick that got lodged up his foot a couple of months ago, it was clear he needed serious medical attention, so he and his friend traveled to the emergency room. If he were able to pull the entire toothpick out, however, he might have dealt with the situation differently. This is a clear example of turning to the allopathic side of the treatment spectrum. Can he completely trust the doctors? Maybe not, given that there's a possibility of serious repercussions (nerve damage) as a result of the doctors slicing his foot open. Now he somewhat regrets going directly to the emergency room, which in the end let him out no better than he started.

In MY case with my trip to the emergency room, wisdom might have saved my life- that is if I DID have appendicitis. When my lower abdominal area felt like it had been struck by a truck, I turned to homeopathic and holistic methods of making the pain disappear first. I tried to eat, drink tea, go to the bathroom, massage my belly and sleep. When none of this worked and I felt like vomiting my brains out I decided it was time to put my fate into the hands of the allopathic system. The irony of it all of course, was that not only did I NOT have a serious problem- but not even the acclaimed doctors and specialists could determine what struck me that fateful day. Everyone in the hospital had the utmost confidence in my having appendicitis, and they were all proven wrong. If I DID have it though, they said I would have been in grave danger judging by my pain and crohn's disease. When I interviewed my mom for an earlier HW, she said she thought the spirit and methods of holistic treatment were wonderful and sometimes even triumphant- but it would be foolish to shun allopathic ways completely. She must be right, because out of the three personal accounts of illness mentioned above, my father was the only one whose illness defeated them, and he was the only one who refused to see a doctor.

COURAGE:

Knowing that you have a terminal illness and are going to die is probably the hardest truth one can come to accept. It takes the utmost bravery to say to yourself, "this is it, I am going to die", and even moreso to continue to fight your mortal enemy: cancer. My father never acknowledged the fact or even possibility that he would die... out loud at least. He never collapsed or got depressed by his predicament, and continued to work on his art and support my brother and me as his sons. To the patient, this feeling must be head-spinning and crushing at the same time. One must ask themselves, "how will it feel to die? what does it mean to be dead?" For the family it is even more painful, watching your loved one, the one who cared for you since your very first waking moment to crumble before your eyes and to have no control over it.

My father was treated much differently in his time of illness, and he treated people differently as well. Much of the tension that had built up between my dad and my mom's side of the family had dissipated, and my family treated him with the greatest of respects for his level of courage and without any of the stigma that usually comes with illness. He continued to try and play tennis with us, and even placed 3rd in our annual mini-golf family tournament (out of us 20 other players!). When WE as a family decided that there was absolutely no chance of his recovery (in this case he had SO much courage he would never outwardly come to this conclusion), we decided to take him home for the last time and allow him to let go when the time came, surrounded by his artwork and the environment he flourished in. It wasn't as apparent to me at the time, but I now realize a lot of people do home hospice (to a lesser extent however, we never had doctors or any outsides come out save the buddhist monk). (...And a Time For Dying)

HW28 Comments!!!

From Aaron on HW27:

Sorry for commenting a little late! I forgot my password and had to enter a new one.
The quote "This has been a crushing blow to him. For someone who is extremely active, beyond the drum kit to the tennis courts and ping pong tables and swimming pools etc., to even think about the possibility of never having full use of you foot is astronomically depressing." stands out to me because it shows how hard life is for you and your family. It showed how your brother must have been strong facing against his disability. It also shows how much you care about your family and how you can even feel their pain. For you and your family to face this really shows how strong and close you guys are.

From Casey on HW27:

Evan,
I hope a solution is found for your brother's predicament! What a horrible situation...It's heart wrenching and horrifying how once humorous issues can quickly turn into future-hindering conflicts. I enjoyed your line, "Bangs on cans with conviction." The lyricism and alliteration made it stand out, and showed your brother's can-banging in a positive light.

From Eloise on HW27:

I believe this is great insight to an odd predicament. The harsh reality that health care is not the only solution, and many times with even all our medical knowladge simple maladies cause great harm. It is sad to hear this but he should be greatful that he at least has the opertunity to have someone tell him they don't know what to do verus... we dont know how to help you without you giving up some cash. I wish you would have exmplified with more lucidity and strength what the dominant social practices seen here are ? My favorite line was "t is extremely upsetting to him and everyone around him that the medical system has yet again continued to fail our family (in addition to the fact that they couldn't even identify MY problem when I went to the ER a short time ago)." I think it got to the center of the issues of how someones injury affected you and all around you. This could have been improved by expanding on a wider scale as aforementioned..

From Mom on HW27:

Well, having been a participant in the aftermath of this freak accident, spending the last couple of weeks accompanying Josh to specialists and through a battery of tests, I have seen, first-hand, the pluses and minuses of our medical system once again. However, I think you were a bit harsh in saying that it failed us again. Medicine is an art as well as a science and it is not always possible to correctly diagnose or treat our complex body systems. In fact, I felt that everyone bent over backwards to try to help.

I think the best part of your blog posting was your sympathy for your brother, your understanding of just what is at stake for his career and for him as an active person: "For someone who is extremely active, beyond the drum kit to the tennis courts and ping pong tables and swimming pools etc., to even think about the possibility of never having full use of your foot is astronomically depressing." I also thought it was a good connection (and sweet) that you thought to acknowledge that his relationship with dad was even closer than yours: "Keep in mind that he went through almost everything I did with my father, even moreso being that he was my brother's best friend and closest companion." That is a very honest and generous observation.

In the end, I am optimistic as you are that Josh will beat this, and I love how you showed him making proverbial lemonade out of lemons: "he... continues to write some kickass music in the meantime!" Happily, he has begun to tentatively walk in the last couple of days, powered by sheer will. In this determined way, you two are very much brothers, and very much the sons of your father (and mother).

Comment on Casey's HW27:

Casey,

Awesome post here. I see many parallels between your uncle and my father! They both thought they were invincible, did the most to avoid being in the hands of doctors and suffered for it. You are absolutely right about this 'invincibility complex' that we all share, and as for the best line, I have to agree with Eloise with

"I realized that such an attitude can be found in most people, whether revealed by an 11 year old boy jay walking, a high school freshman smoking cigarettes, a college student forgoing a condom, an obese middle aged woman watching television all day instead of going to the gym, or a diabetic man having a field day at Kentucky Fried Chicken."

Pretty much summed it all up there. We take death for granted and even laugh in its face often multiple times a day, little do we realize we will never truly obtain the "last laugh". Wonderful.

Keep it up!

Evan

p.s. I found one little typo you might want to edit... at least I think it's a typo? "Infects his life" at the end of the first P?

Comment on Eloise's HW27:

Eloise,

My goodness what a visual and grueling post to read! I am not sure if you meant to write it this way but being a filmmaker I could really, REALLY visualize your tale and even hear your tone in narration. One of the greatest lines to me was

"The melody to her environment is the constant beep, beep, beep, beep, beeeep beeeep beeeeep of the thermometer. When she can sleep she seems the most content, but the parallel world it sends her to seems quite unappealing as well. It's as if all the energy that usually pours outward upon others is battling within her trying to kill the bacteria."

To be honest if I were writing a screenplay it would go something exactly like this! Lines like this actually drove me to think about how I would frame such an image to do it justice. As always I would do a quick read through (especially for such a long post) to look for simple spelling and grammar errors. However in this case I found such grammar errors delightful because it made me hear the narrating voice so much better!

Evan

HW27- Visiting an Unwell Person

My visit to an "unwell person" was more of their visit to me. I am talking about my brother of course, a drummer who bangs on cans with conviction. However, he hasn't played drums for some weeks now, after he stepped on a toothpick, lodging it up the ball of his foot! At the time, he was up in his dorm room in Boston, hours away from us. After the fateful step, he attempted to pull out said toothpick. Unfortunately, while he got about half of it out, the other half snapped off inside his foot, making it virtually unreachable to bare hands. A friend of his escorted him to the Mass General (very good hospital btw) emergency room (keep in mind this was about 3 weeks before my own predicament in the ER) to have the toothpick removed. To him, this situation was painful and extremely unpleasant, yet at the same time hilarious (think of the sheer physics!!).

No doctor at Mass General could successfully remove the toothpick. They told him they could cut further, but they risk serious nerve damage. He told them not to (wouldn't want serious nerve damage to the foot of a drummer!), and they let him go with bandages, crutches, and most delicious of all, powerful antibiotics. This tasty combination made his life very unpleasant for some time, and after a short while he could no longer take the antibiotics. The doctors told him that there was simply nothing they could do about the toothpick, and because he seemed to avoid infection, was free to keep it encased in his foot (provided it didn't cause unnecessary pain and problems)

Well what do you know! Weeks later he could still feel the pain in his foot (so much that he could not so much as brush his foot on any surface), and this puzzled the doctors greatly. To fast-forward this for you, many tests were conducted and the riddle still has not been solved. Some specialists point to RSD, a nervous system disorder known to cause chronic burning of the affected nerve area. For privacy reasons I'm not going to go further than that, but if you don't know about RSD, look it up, and you will find that it is nothing to sneeze at. Other people have said that while he shows the signs of RSD, he is more likely to have the "psuedo" RSD, a fool's gold version of the real thing. As of this date (1/1/11) and countless tests, it is still unknown what that little piece of wood has done.

This has been a crushing blow to him. For someone who is extremely active, beyond the drum kit to the tennis courts and ping pong tables and swimming pools etc., to even think about the possibility of never having full use of you foot is astronomically depressing. Keep in mind that he went through almost everything I did with my father, even moreso being that he was my brother's best friend and closest companion. Right about now he feels pretty fed up with doctors, hospitals, and just about everything that has to do with illness and dying. He finds it particularly frustrating that so many well-educated specialists cannot solve a mystery solely caused by a tiny, obscure toothpick, and that this same small splinter of wood can single-handedly handicap him for the rest of his life. It is extremely upsetting to him and everyone around him that the medical system has yet again continued to fail our family (in addition to the fact that they couldn't even identify MY problem when I went to the ER a short time ago). Obviously my mom (the guest speaker) applies to the situation and continues to be my brother's best advocate, in a situation that is grimly familiar to that of my father's.

As for my brother's current attitude, he continues to be positive and fight with determination to beat whatever might be lurking against him. He has been making good progress in rehabilitating his footwork and continues to write some kickass music in the meantime! He knows his father would fight to the end against his enemy, and in those spirits he seems to be doing well!

HW26- Looking Back and Forward in Unit

Important Ideas / Insights:

-My own experiences in the emergency room lessened my hatred and personal intensity with illness and dying, most likely because I myself was in the 'hot seat' and was able to observe and infer from an 'ill person''s point of view. (source is obviously LIFE EXPERIENCE)

-I am now aware of more examples of determined people such as Dr. Paul Farmer, but I just cannot figure out how an inevitable problem such as illness and dying can be "solved". ("Mountains Beyond Mountains" by Tracy Kidder)

-Best idea I took from Mountains Beyond Mountains: "I have fought the long defeat and brought other people on to fight the long defeat, and I'm not going to stop because we keep losing. Now I actually think sometimes we may win. I don't dislike victory." ("Mountains Beyond Mountains" by Tracy Kidder)

-While I admired Michael Moore's spin on the world of healthcare and its problems, I couldn't help but think of it as no better than a cartoon after watching the realistic and self-explanatory "Near Death" by Frederick Wiseman. I think the main difference is that Moore felt like in order for people to understand he had to include witty commentary and flashy graphics, whereas Wiseman simply knew that in order to penetrate the audience most, all he needed to do was hit 'record'.

-We are always kidding ourselves about death. We all at one point (whether we like to admit it or not) believe we are invincible, that death is unreachable, and that we are meant for "another day". This is perfectly understandable. Unless us human beings are convincing enough to fool ourselves about an afterlife, no one has the ability to fathom what happens when the 'long defeat' simply becomes the 'defeat'.

Even though it was short-lived, I really found "Near Death" to be the strongest of the sources presented in the unit (to me... understand that I've heard and talk to my mom all the time about my dad) because it felt like a revisit to my own brutal experiences with death. It was so interesting to me to get a first-hand look at how the doctors and nurses approached these touchy situations, not only toward each other but toward the dying people. Of course "Sicko" was entertaining and informative, and I'd be sure to watch it again, but I feel like its more entertainment than substance compared to Wiseman's efforts. Also, I felt like Moore was the puppet master of his film, controlling all that we see and what sources we consult. Wiseman seemed like a passenger, giving us a grand tour of what REALLY matters in the end- the illness and the dying!

My questions that I think would be interesting to discuss in class over the last couple of weeks would be: If we know illness and dying are truly inevitable, how can we cope with it? I mean how can we be at peace with this horrifying fact? Is there any way to make dying less painful? Isn't illness and dying necessary? Isn't it true that if we ALL received wonderful care, that fewer would die and therefore the world would become over-populated (getting even MORE out of hand)? I think these are questions we've brushed around, but have never directly addressed in full-out intellectual discussion.

HW25- Sicko Response

Precis of movie (at least as much as we watched in class): America is a land of freedom and equal opportunity- until you take a good look at the greatest equalizer of them all: illness and dying. There are millions of Americans who cannot afford or qualify for Health Insurance, and as a result they unnecessarily suffer from mutilation, deformation and humiliation (excuse the alliteration!). As if this were not unfair enough, there are people in this land of opportunity who have Health Insurance and STILL cannot receive adequate care for their illness. Like many other "lovely" qualities of the US, Health Insurance is simply another victim to capitalism; the rich get the greatest care and they themselves are often in control of picking and choosing who gets covered and who doesn't. Why not follow suit like other successful countries' healthcare programs? Because Pat Buchanan is afraid of communism of course!

One piece of evidence that Moore used to bolster his argument that I found quite shocking was the 79 year-old man sweeping bathrooms at PathMark. This may not have been the grandest or strongest use of evidence he made, but it disturbed me nonetheless. The reason why he continues to work turning on 80 is because his employer supplies him with adequate health coverage, something he could in no way attain himself in retirement. Moore is relying on the sympathy of the audience to strengthen his argument that Health Insurance in the U.S. has become long astray to exclude such an elder, and it succeeds.

Although it's general, I was curious to see how much the number of people with health insurance has changed. This does seem to be the first and foremost of Moore's pieces of evidence, after all. Upon some research I found this number to be mostly unchanged. However, I did come across some interesting statistics regarding the reasons for those who do NOT have insurance. It is estimated that there are about 46 million people in the U.S. who do not have HI in total. However, it should be noted that at least 10 million from this sum are not officially U.S. citizens. I found it interesting that on July 22nd, Obama claimed that 14,000 people will lose insurance every day. I am not entirely sure where HE got his source, but coming from him I suppose most people (excluding how ever many people Rush Limbaugh counts as) will take his word for it. I also found out that over 18 million of the uninsured are younger than the age of 34, which I find to be disturbing. Why Moore omitted some of these pieces of information is beyond me, but maybe it was because these facts came from http://usgovinfo.about.com/od/medicarehealthinsurance/a/insurancestats.htm.

Overall I think "Sicko" is an entertaining and informative movie, but I do get a feeling afterward that I have just watched a cartoon. While Moore's witty and sometimes aggravating commentary keeps the "average Joe" type viewer following along, and as I look deeper into his arguments and overarching thesis I have a hard time considering the credibility of his film. After thinking about other movies having to do with illness and dying that actually take the viewer into the hospital scene to leave them with only their own thoughts and no narrator "Sicko" feels kind of like a Quentin Tarantino movie (something that is undoubtably fun to watch but on a grand scale somewhat irrelevant). I find myself agreeing with Moore and seeing him as "one on our team" but having gone through intense experiences of I&D I am skeptical about his decision on what to show the mainstream audience. He seems to be preoccupied arguing about money, not the moral of the doctors themselves. I will certainly be sure to watch "Sicko" again, maybe with a more critical eye know that I know about other films.

HW 24- End of Book

Tracy Kidder, Mountains Beyond Mountains

Random House, 2004

Precis of ENTIRE BOOK:

Dr. Paul Farmer is a headstrong doctor and philosopher who subscribes to a world that excludes no one. He makes great sacrifice (his absence from his family and friends, his lack of sleep) to love and serve the world. From the cracked roads of Haiti to the slums of Peru, from the gruesome prisons of Russia and beyond he devotes his life to the health and well-being of the world around him. He is not a man without flaws, but a genius who is determined to fight a long, inevitable defeat to the things which makes us all similar: illness and dying. He may lose patients beyond his control and his temper, but he never gives up and never fails to make a triumphant return to his ultimate mission: to revolutionize and transform our morals that have to do with illness and dying. Tracy Kidder tags along to follow the chronicles of Partners in Health, Farmer's flagship organization, and finds that there is much to be learned from him. Paul Farmer knows that one day he will die and TB and AIDS will continue, but at least for a while, he felt like he was winning a fight against death- not just for himself, but for the world around him.

Gems:

"Now his legs and arms were emaciated. You could see all the bones in them, and his knee and elbow joints looked outsize, with the flesh shrunk away." (P. 268) This stopped me dead in my tracks. This was very very hard to read because it did a wonderful job of recreating some twisted images from my own memory I'd rather have forgotten. The connection between John and my father may not be great, but after reading this quote I cursed on anyone who would dare to get in the way of his survival. All the more tragic was his loss of the battle...

"I have fought the long defeat and brought other people on to fight the long defeat, and I'm not going to stop because we keep losing. Now I actually think sometimes we may win. I don't dislike victory." I feel like this almost entirely explains how Farmer identifies himself and his obligations towards others. I really admire his optimism that he helps others believe they are winning the fight against the long defeat, but I also admire his realism in that he knows in the end, it is just a long DEFEAT.

"The woman who said to me years ago, Are you incapable of complexity? That was an epiphany for me. Are you going to punish people for thinking TB comes from sorcery? It's like the guy on our own team, a nice guy, who said he would help with a water project in a town here, but only if the people really showed they wanted it. What if that standard had been applied to me when I was a kid, before I knew that water could carry organisms that made people sick?" This quote really spoke to me. Many people in our culture look to religion and their own belief system to dig deep and do two things: blame sickness on the divine and use the same idols as a motivator to help. Everyone is pretty much on the same team when it comes to illness and dying (unless you're a serial killer!).

In the end the final third of this book was an intense journey. I felt like most of my questions were answered (mainly questions like "what makes this guy tick?" and "doesn't he realize his futility in the grand scheme of things?") and I felt a deep connection between one of the chapters (the one about John) and my own life experiences. I think Dr. Farmer is a rare breed- one who simply does not care about the glory or the money, but whose only mission is to help others believe that they can win the long fight against death, even if it is just for a glimpse of a moment. People just don't want to die, and Farmer takes each and every one of these people in as if they were his own family. He may have been reckless and at some times chaotic, but in the end he is really just an advocate for those who need it most- the dying! I have to wonder how he could possibly outdo himself and/or what will happen when he finally "faces the long defeat".

HW 23- Illness and Dying Book Part 2

Tracy Kidder, Mountains Beyond Mountains

Random House, 2004

Precis on chapters 12-14:

As Paul continued to make his trips between Boston and Cange, military rule was growing rapidly and Paul's girlfriend Ophelia became worried. Paul had become somewhat reckless, being rude to soldiers and smuggling thousands of dollars towards pacifist movements. It took the circumstance of gunpoint for Farmer to finally give in to the immense sacrifice (according to him of course) of saying "long live the Haitian army." After receiving a MacArthur grant in 1993, Paul retreated to Quebec to write his to-be successful and controversial book, "The Uses of Haiti" where he questioned the credibility of 'heroes' such as Woodrow Wilson and Mother Teresa. Finally, Farmer was formally banished from returning to Haiti (even bribery could not undo this) until October of 1994 when Aristide was reinstated. Paul returned to a different Haiti this time however, one that had been ravaged and virtually broken to shambles after the rule of the junta. Partners in Health had done quite the opposite, and only strengthened during this time. After obtaining a permanent HQ in Cambridge, it was now time for Paul to stretch his revolutionary arm to a new location.

Paul takes this new time to reflect on perhaps his biggest opponent: MDR, Multi-Drug Resistant TB. TB was one of the most common diseases Paul treated in Haiti, but MDR did not appear on the radar until the rule of the junta. Paul comes to realize that poverty is diseases' greatest boon, but super diseases such as MDR do not often appear in universally poor populations like in Haiti. This poverty creates a lack of basic human necessities: food, water, shelter that all help prevent deadly diseases. When a friend of Paul's falls victim to the frightening MDR in Peru, he takes this a sign as to where his efforts are needed most.

While still attending medical school, Paul had lived in the infamous Roxbury neighborhood of Boston. However, he was living in the hands of Father Jack, a priest who allowed Paul to stay at St. Mary of the Angels for the better part of his education. Long since after, Father Jack moved to the quaint slum of Carabayllo in Peru. Upon one of his visits back to Boston, Father Jack tells Paul that Carabayllo could use his help. Jim Kim, Paul's right hand man makes it clear that he wants to take charge of the Peru project and not long after helps to build a pharmacy next to Jack's church. Jim and Jack survey the medical scene in Carabayllo, and all seems fine until Father Jack becomes suddenly ill. He is diagnosed with TB, flown to Boston to be treated by Dokte Paul himself and treated with 4 of the 5 main TB drugs. Much to Paul's dread and dismay, Father Jack is of no saving and dies a month later. It turns out his friend had MDR, but not just any MDR, but a species impervious to all 5 TB drugs. Paul is broken.

BEST LINE (would post multiple gems but I found this particularly striking):

"Perhaps it is a universal tendency to view the deaths of strangers philosophically."- I found this quote to be very deep because in a sense I think we all disconnect ourselves from those who have died in order to view it in a strictly objective way. All the time we see people die on the news, and although these are strangers, we often take advantage of the news to widen our views on illness and dying. When a close family member becomes ill or dies, it becomes personal, not just to the sick or dead person, but it seems like the devil is out to screw you personally. We can't exactly take a step back to think about our loved ones' death in a philosophical way, whether it be because of pain or lack of memory (trauma often ends up as a blur in our memories).

Thoughts and Questions:

Up until now Paul seemed to me like a superhero. Maybe I was mislead but I felt like at the beginning of the book, if I was ever in danger, this guy was a definite trip to safety. Finally seeing one of his best friends die from a disease he could do nothing about was heartbreaking. Throughout these chapters one word has been ringing through my mind: bravery. The bravery Paul had to be so smug and disrespectful toward the junta, the bravery of Jim to lead PIH in Peru, the bravery of Father Jack to survey the sick people in his community. From the outcome of these events and my own personal experiences I know that bravery alone cannot save you, and in some cases, it's all about luck. Who's to say one day Paul wouldn't have run into a particularly pissed off soldier to find a cap in his head? What were the odds of neither Jim or Father Jack being in the pharmacy when it blew up? These are just thoughts that make me admire Paul and co. a lot more than I already did (which is pretty damn impressive!).