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!).

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.