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!).

HW 21B Comments and more

Comment on Casey's HW21:

Casey,

It feels awfully weird commenting on this post, but I am very happy and touched by what you wrote. I felt you especially got who my father was, and I honestly would have thought you had known him prior to his illness by this sentence:

"Those who knew him remember him as an artist, a father, a neighborhood guardian, an involved community member, tenacious, stoic, a “fighter”. Although he was involved in various familial conflicts and was sometimes far from a peace-maker, the positive parts of his memory are particularly preserved."

Your last paragraph in its entirety spoke many truths to me, sometimes in ways I never even thought about myself (how pain represents the courage to feel). I wish I could write such a faithful and earnest tribute for you, but again part of me is glad you are not in my position. I sincerely appreciate your kind words, and as always I look forward to future posts,

Comment on Eloise's HW19:

Eloise,

"I think this exemplifies the INSANITY and abnormality of our society that the healing of the mind and human body IS predominantly INDUSTRIAL? "

You speak the truth! I think you hit the nail right on the head here and did a great job articulating your insights. However, like Casey, I too wonder what you mean by "TIME ENDS". Do you mean our sense of time, or time itself stops? I also agree with you that society (at least ours) is GROSSLY obsessed with eternal youth, which is a subject that hasn't really been touched on yet.

Spell check on Microsoft Word would not hurt, but again this is a minor suggestion.

Comment left on my HW 19 by Aaron:

I found the line where your mom was talking about the effect it had on her relationship with your father, "She said that IF there was any way that his illness and dying had any positive aspect (not really appropriate word choice but I honestly can't think of anything better to replace "positive", excuse me), it was in the effect it had on their marriage" to be very touching. It makes one think you never know what you have until it's too late. To know that your mother and father made a positive experience out of something so horribly dreadful gives me a better understanding of making the best of a bad situation. I can't even imagine what this whole process was like for you all. Sorry if this comment is not appropriate enough, but this very hard for me to write about. Thank you for allowing me to read this and I think you did a great job explaining your family experiences to illness and dying.

Comment left on my HW 21/Reflection by Mom:

I was quite struck by two things you said. First, I hadn't thought about your peers scrutinizing you for reactions to what I was saying. I suppose I thought about what they might be thinking when YOU spoke, but it never occurred to me that they would be looking at you for reactions as I spoke. I also never think of you as being particularly concerned with what others think of you because you always seems so sure of yourself, so it was interesting to me to hear you voice this. It made you a little more vulnerable in my eyes, not a bad thing. Secondly (and I suppose this is related), I never realized that you felt misunderstood by your peers (or cared). As close as we are, I guess we still have a lot we can learn about one another. In general, I wish to say that your postings have been very brave, and that I admire you and love you very much.

Mom

Comment on my Reflection by Casey:

Evan,
I did sometimes wonder what you were thinking in your mother's presentation, and why you sometimes smiled a bit. I think everyone does have an inherent desire to be heard...sometimes silence can be like shell, a burden. Perhaps you could have elaborated on the "deepest, most painful realms of my thoughts", because it would help the reader to understand your story further. I admire the way you continue to handle this episode with such grace.

Comment on my Reflection by Eloise:

I AM SO UPSET I MISSED THIS !!! HONESTLY THIS IS THE ONLY CLASS I WISH I COULD GOT TO SCHOOL FOR !!! GRRRRRR !!! you stated "search the deepest, most painful realms of my thoughts" I have been doing this alone recentley and I feel it has been helping me but it is hard, what were some of the questions asked?

Comment on my ER Reflection by Eloise:

I wish you would have reflected upon how this compares to the dominant social practice, why was your trip so anti-body? Does this show you that hospitals DO NOT CARE ABOUT THE PATIENT THEY CARE ABOUT THE $. I feel you on there not being one nurse/doctor, my uncles first MONTH in the hospital was the same !! It is ironic though how knowing that hostpitals are about the money, we still go. It is the ultimate money making trap, who dosent want to save there life if possible? I have to agree with you, I am sick @ home and it sucks!! but i do love the attention from my parents. I think this post and the one before it were great but need more reflection on how this connects to the bigger theme of our class ! The last one I get you just got home, I am even suprised you were able to bang out that much !!! But i was expecting more from this 1 !

HW 22- Illness and Dying Book Part 1

Tracy Kidder, Mountains Beyond Mountains

Random House, 2004

Precis of Chapters 5-6: Doctor Farmer had quite an adventurous and unusual upbringing. His father, known to many as "The Warden" because of his strict ways toward his children led a ship of six kids, Paul being the second youngest. Paul turned out to be very gifted in his intelligence, and even after having a considerably rowdy college life became the very successful doctor and writer he is today. He was able to flourish in an otherwise challenging environment, and eventually Paul came to realize that his true calling was not to simply heal others, but to transform the healing of the less fortunate in Haiti. His studies of Virchow and Haiti culminated in a 6,000 word article about Haitians laboring near the college campus, entitled "Haitians without a home."

Best Line(s):

"Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community."

"The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them."

Thoughts/Questions:

-"P.J." must have truly been gifted, I honestly cannot imagine such a brainy kid coming out of that upbringing otherwise.

-I was really surprised to hear that Paul tried all of this crazy stuff and failed to get straight A's (especially him) for his early college career. I would have thought he would have already been making great strides.

-It sounds to me like this is somebody who really cares about helping people. I hope this doesn't sound offensive, but I wouldn't go to Haiti if you paid me. Paul sounds like someone who is not afraid to get their hands dirty, and that his only satisfaction can come from healing and changing other's lives.

-This is not really related, but I wonder if this were a mandatory read in medical school, if there might be an ethical change on the "dominant" side of this social practice.

Reflection on Today's Presentation

When it comes to today's presentation, I couldn't help but feel uncomfortable sitting up there listening to my mom speak. I wasn't uncomfortable simply because I was sad or embarrassed (of course I was sad but not embarrassed), but because I wondered what people were seeing in me as I silently sat there. I occasionally shifted my eyes around the room to see of any of my peers were observing me. Did they think I was an emotionless robot? Did they admire me for my stability? Were they simply giving me pity? Were they searching for certain reactions at particular parts of my mom's speech? While I felt uncomfortable, I have to admit it felt great, amazing almost, to finally have my peers hear my story. Like I have mentioned on multiple occasions, I feel misunderstood by my peers, and I think that finally having them sit and listen (to my MOM for pete's sake) and nothing more was satisfying in the comforting sense that I know perhaps they now understand me a little bit more. Answering questions after lunch was not difficult at all, in fact it was almost a revelation for me, to question and search the deepest, most painful realms of my thoughts. It is not something I am often able to do, and I am very appreciative that my peers did not hesitate to ask such questions, in fact I commend them for their bravery: these are questions I am not even asked by from my own family. Whether this is out of respect or sympathy I do not know, but what I do know is that those who asked questions today and even those who did not genuinely cared, and I deeply thank them for that with all of my heart.

I am making one edit: I am quite surprised that hardly anyone has mentioned me in their posts. Not that I mean to sound self-centered, but if I were observing, one of the first things I would have asked myself was how I got through the entire thing, why I didn't crumble or currently show signs of being emotionally disturbed, or signs of any traumatizing past? I think part of the reason why is because (and I hope nobody takes this personally) my peers are uncomfortable characterizing me in their posts, for fear that I might read them and be offended in some way. If anyone honestly had any questions, musings or insights having specifically to do with me, let me say right now that by all means, please do. And if you are still uncomfortable putting it up for anyone to read, a personal message will do just fine. I am not, will not ever be offended by how you characterize me.

HW19- Family Perspectives on Illness and Dying

As everyone (in Andy's class) now knows, my mom and I have been through the most extreme of illness and dying situations in the last 10 days of my father's life. Because of this experience we share we are able to talk together on almost the same level about not only my father's illness and dying, but moral values and world views about illness, dying, denial and the medical systems of the world. When I interviewed my mom, I had a good feeling I knew exactly what she was going to say, and not just because I've heard the story, but because I played an active part in it.

The first question I asked her regarded the everlasting battle between allopathic and holistic medical beliefs and techniques. I myself see it necessary to meet in the middle and take the best from both sides, and my mom did not see it any different. While she is a firm believer in the spirit and attitude that comes with holistic methods, she thinks it would be foolish to completely shun the allopathic side of the spectrum. In the end, holistic ways may keep our minds and fortitude alive and well, but there is no denying that in most cases allopathic ways keep our bodies alive, which are essential. She also associated words such as "comfort" and "encouragement" with the holistic end of the spectrum, and words like "security" and "protection" towards allopathy. I found that these were particularly fitting, and made me see things with a different light. I find myself asking if my mom was willing to give up my father's"security" for his "comfort" in his last hours. But I also ask if she was in turn sacrificing his "protection", which probably doesn't apply here because at that point, what protection could the allopathic really offer?

Then I asked a question that I felt was slightly dangerous: if there was any way, ANY way to view the experience in a positive way, what was it? For me the answer to the question is that at the very least, and by this I mean THE VERY LEAST I know what true dying looks like as a filmmaker. But for my mom, whom the experience was the most emotionally intense, was there anything gained from the experience? Her answer was much like what she told everyone today: you learn that you have to be your best advocate, and that the experience, as horrifying and gruesome as it ended up being, brought their relationship together almost at its strongest. Rather than worry about things like taxes or finding work, the two could reconnect, and in addition to their relationship becoming more intimate, much of the tension between my father and my mom's side of the family subsided. She said that IF there was any way that his illness and dying had any positive aspect (not really appropriate word choice but I honestly can't think of anything better to replace "positive", excuse me), it was in the effect it had on their marriage.

In the end I know that my mom and I have this special connection that nobody else on the planet can have, and because of this we seem to be very in touch with each other's thinking. I knew exactly what she meant because I had gone through almost just as much as she did with my father's illness (by this I mean the latter stages). I have to wonder if anyone can ever understand it as much as we do, especially because we did it so differently from how anyone would have treated the situation. Unfortunately even the closest of other family members will never share this connection with us, however I do NOT think it is degrading or lacking of our relationship, just an experience that is missing. Hopefully most of my peers my mom talked to this morning will have gotten as close as possible to understand our story.

Illness at the Emergency Room Wednesday Night! (Insights)

The very first impressions that came to my mind entering and waiting in the Emergency Room (other than "OW THIS HURTS LIKE HELL WHERE'S MY ROOM") were that the hospital (not just the room closest to outside but the actual room I stayed in) were freezing. I didn't have a fever at the time, and although I understand there are machines that need to be in a certain climate to function I could not understand for the life of me why they could not turn up the thermostat.

I also have to wonder why my wait time was so short compared to other sick looking people who had obviously been waiting longer than me. Of course I did not waste a second considering this at the time, but I know I would NOT be happy if I was just sitting there watching people get called in after arriving 5 minutes ago.

I found it interesting that rather than assign me one nurse or doctor, there was a constant flux of different nurses and attendants that I did not know waking me up every half-hour. I also found it weird that no matter how many times I repeated myself, they continued to ask the same questions over and over again. Maybe my view is exaggerated because by 5:00am I just wanted some sleep, but it left me wondering why they couldn't assign me just one nurse who already knew the answers to their questions in addition to where my pain was. Other than this little annoyance I really had no issues with the staff, all who were very friendly and mentally and emotionally dedicated to my well-being.

With regards to the seemingly "magical" nap that I took, I still do not understand what it was that cured me almost instantly. I suppose it has something to do with lifting the mental and physical stress that was on my body before I simply called it quits and laid down. This also leads me to question whether or not the doctors had the greatest intuition- everyone, with great confidence thought that I had appendicitis, and in the end I didn't have that or even an intestinal blockage- just a bad virus. Of course I couldn't really blame them, I WAS showing all of the symptoms, and I myself was convinced I had it.

This WAS my first time ever in a hospital for serious illness, and I have to say the experience was bitter, sweet, and then bitter again. Of course the beginning was bitter because it felt like I had been impaled by a flagpole. After my nap however, I have to admit being "ill" and having people catering to my every whim was actually somewhat enjoyable. This somewhat contradicts what I said in HW17 about no aspect of illness being enjoyable, and in retrospect I was probably angry given the subject matter. If I said being able to watch TV, play games on my iPod and surf the web while I waited for people to give me pillows and blankets while complimenting me about my mood was not enjoyable in any aspect, I would probably dunk my head in the urinal they supplied me. This was swell for a while until the next morning, where I simply had enough. I felt fine, the CT scan confirmed my lack of a serious problem and I was itching to leave. I waited a seemingly endless amount of time for some paperwork to work its way to us so I could leave, and as I sat in my own sweaty pajamas with a huge IV in my arm I found myself listening for hopeful footsteps to approach my room. They wouldn't show up until hours later of course! What if there was another sick kid, who really NEEDED the room who didn't have one while I sat in here like a king?

The actual CT scan was to my surprise quite intriguing. I'll spare you, the lucky reader the less attractive details but it certainly helped one of my problems (if you can guess what that is, if not, I'll leave it at that!). Being immersed in the giant machine was kind of freaky, it felt like I was in some sort of sci-fi film and the laser was scanning alien bacteria in my stomach. The actual effect of the laser ring was a surprise to me. My entire body became really hot and I felt like I couldn't breath (not like I was anxious, but I actually felt like there was a restriction on my lung intake. Overall this was actually fun, and a huge relief afterwards (again, I will stay ambiguous here).

Finally I HAVE to say something about "lunch". It's not like I expected a filet mignon but mystery meat? With a thick coat of barbegoop on it? Uhhhh. Thanks? On the side were some seasoned potato wedges, which were not bad, and cooked carrots. I found it kind of strange that one slice of bread could come in its own package, and that they gave it to me plain and not toasted. Perhaps they were thinking I had some sort of dietary restrictions? In the end, a nice hot cup of tea kept me busy as I waited in the final moments.

Overall, my stay was an interesting experience and I am CERTAIN it will give me a fresh perspective on illness as we go into this unit. Would I do it again? Not necessarily, because in order for it to happen I would have to vomit a waterfall all over again! And besides, I was extremely lucky that I did not require an operation, which would've proved to be an entirely different, not so fortunate experience.

Illness at the Emergency Room Wednesday night! (Narrative only)

Although I realize this doesn't exactly fulfill the requirement to HW19 (which I will absolutely post separately in the near future) I thought this was worth writing about. This post is completely narrative. I will give my insights on the entire situation after they can properly sink in in another, separate post. If this post seems overly long, I apologize, but please understand that documenting specific details will help me write my impressions, observations, feelings and insights when the time comes.

At about 5:00 am on Wednesday morning my stomach was upsetting me. Now I will spare you the less attractive details, but it certainly was not pretty. However, I decided that something as intermittent as stomach aches were not worth missing school for, so I decided to go anyway. I had a fairly good and active day, my stomach aches subsided and a satisfying lunch.

Then it hit me.

Halfway through teaching my after school class I felt a sharp, stabbing pain in my lower right quadrant. I decided that it was probably best that I leave and get some rest (I did have a long day at internship ahead of me). When I got home I tried to lay down on my couch, but could not bring myself to peace. The pain was too much, and at about 6:00 I began considering if this wasn't simply part of my condition, but an entirely different monster. This felt like no ordinary stomach ache, so I asked my mom to look up the symptoms for appendicitis. Low and behold I had all of the symptoms and I made my mom call my pediatrician, a man who I trust very highly as a diagnostician. He thought it was wise that I head to the emergency room, and because I was already considering that myself I obeyed.

The minute I got into the car I vomited buckets worth of food onto the car floor. Personally I find throwing up to be my least favorite sensation of the body. I always feel like I am choking and cannot breath while puking my guts out at the same time. When I arrived at Mt. Sinai Hospital, there were many people waiting to be seen. However, it seemed that I was lucky, because I was called in not very long after I checked in. THEN came the true waiting. I sat in a chilly room on a plastic chair feeling the worst pain I had ever felt in my life, desperately looking around for a sign that I might soon me relieved and taken into a room. Eventually I WAS called into a room for examining where a lovely nurse pressed around my abdominal area. As soon as she finished doing so however, I heaved up more vomit, a seemingly impossible amount at that, and with the addition of the pain and hunger I now had I was simply defeated. They stuck me with an unusually long IV needle, which because I am usually comfortable with needles was not a challenge. They decided that a CT scan was necessary, and perhaps a serious operation to follow that up. After getting tired of waiting for the next step, a decided to try and take a nap again.

When I woke up the world had changed. I was suddenly warm, my thirst was satisfied and there was no stomach pain to speak of. I had not been operated on or even so much as touched since an hour before, and the pain that once put me in serious, unmatched fear was history. My brother called, oblivious to the entire situation and was very worried about my situation. A few friends of mine had also been checking up on me, and I thank them for that. My brother was nice enough to inform the world on his Facebook page, and for once I overlooked my worn out political statement to see what people were saying. At around 1:00am I was given about 1000mL of contrast to drink for my CT scan, which despite everyone's warnings I didn't find to be too disgusting. After another seemingly interminable amount of time I was wheel-chaired to the scan room, where a giant spinning laser tunnel took pictures of my intestinal track.

I didn't get the results of my scan until long after I was moved into my new room on another floor. There many nurses asked me strange questions and I didn't get to actual sleep until around 5:30am. Every so-often I would doze off but nearly every half hour a new nurse came around to ask me the same questions and check my vitals. Finally, the next morning I was met by my pediatrician (whom I had consulted earlier) and my GI doctor. It turned out that the results were surprisingly good, and not only did I NOT have appendicitis, but I didn't have a major blockage either. Because of this, I was finally allowed to eat again knowing that I would not be having an operation. The tray of food they gave me consisted of mystery meat (it somewhat resembled chicken), seasoned potatoes, diced pear, bread and butter and tea. At around 3:00pm I was finally dismissed from the hospital.

As soon as this all sinks in enough to thoroughly analyze it (and after a good amount of rest), I will post another entry strictly focusing on my impressions, observations, feelings, insights, etc.