Death Be Not Proud

In John Gunther’s memoir Death Be Not Proud, one of the most interesting and illuminating elements of his account of his son’s life and illness, was his metaphysical depiction of his son’s mind, even while still viewed in conjunction with the physical brain that was combating the cancerous tumor. Gunther describes how his son’s mind operates on different levels of awareness: on the surface he appears unaware of the seriousness of his condition, elaborating at many points on the small size of the at times large tumor, but beneath, Gunther describes in an early passage, his mind, at a deeper level, is substantially aware of the seriousness of his plight. As the days proceed and his condition roller-coasters, a considerable part of the times he shields himself from the utter stress of directly confronting his enemy (death) using humor, a technique his father attributes to his Frances instilling a light-hearted and patient nature. In essence, Johnny’s mind is certainly conscious of his condition. What allows him to continue his fight, in both a physical and metaphysical sense, are his seemingly endless good cheer, humor, and unceasing will to live. His is a frightening, courageous journey. The narrative of his father is both philosophically challenging (almost demanding one to self-examine) and impossible to put out of one’s memory.

The Death of Ivan Ilych

In Tolstoy’s “The Death of Ivan Ilych”, the slow death of Ivan is of a particularly sorrowful nature. Though the slow realizations that color the later portion of the tale do much of the emotional torment, the peculiar status that Ivan finds himself occupying in his social circle as his unknown disease progresses is equally disturbing for Ivan. While perhaps not as profound as his self-reflections, the refusal of his colleagues and family, aware of his disease, to recognize his dying state, imbues the tale with a paradoxical twist that is as irksome to the reader as it seems infuriating to Ivan himself. With a refusal to treat Ivan as dying, his wife, doctor, and colleagues instead treat him like he is both already dead and completely healthy. It is as if one can only be live and completely healthy, or dead and out of the picture. The sick and the dying, Ivan realizes, are an inconvenience. His family, friends, and even physician construct different ways of stepping over the issue, completely conscious (at least in Ivan’s mind) of doing so, giving off the impression of “waiting him out.” The whole of society, it seems, is awaiting his death.

This complex and dark portrait of the dying patient, and his relation to the community, provides us with a startling way to examine and explore the issue of the dying patient in society. Feeling ignored and disconnected, Ivan is the embodiment of the patient who all-at-once feels misdiagnosed, ignored, and like a focal point for the false sympathy of others.

Intricacies of the Doctor-Patient Relationship

The week’s discussion focused on the doctor’s perspective on treating and attempting to relate to patients, and the difficulties in doing so. Such a topic is so ripe with complexity, and the essence of the relationship is difficult to capture and at the same time key to medicine, as Williams and Bulgakov’s narratives exemplify.

The stories below each delve into issues that serve to deepen the complexity of an already intricate and undeniably-meaningful relationship, that of the sufferer to the healer, and of the healer to the sufferer.

The first reads as a guide to doctors on dealing with patients who become friends:

What to do when patients become friends: embrace it or end it?

The next focuses on the idea that those patients who are likely to be hospitalized most should be targeted for more comprehensive, continuous care:

A stronger doctor-patient relationship for the costliest patients

Ernest Hemingway’s The Indian Camp – Suicide Rates and Prevention

One of the important medical issues raised by Hemingway’s ‘The Indian Camp’, is that of suicide. Nicks father’s inability to prevent the husband’s suicide resounds through the story’s close, haunting his discussion with his son as they walk back toward the lake.

Rates By Gender

One of the issues raised in class was that of a supposed higher rate of suicide among men, connected to the husband’s death in Hemingway’s story. While in general rates differ greatly depending on country, in the US the rate (as of 2005) per every 100,000 people was 17.7 males, 4.5 females. These statistics are apparently in keeping with the historical trend. Sadly, the search for a reason behind this apparent difference would require a study of an array of sociological, economic, and gender issues. Statistics for suicide attempts are less accessible, due to their very nature, and therefore it is difficult to confirm the idea raised in class that women attempt suicide more often, though this could very well be the case.

Care/Prevention

The issues of care and prevention are ones that are not stated anywhere in the story, but one can see their importance implied in the inattention that surrounds the death in the story – a brief remark is all that notes the man’s existence before his later suicide: smoking in the dark upper bunk. As noted in class, Nick notes a bad smell in the room – perhaps indicating the possibility of his foot being uncleaned and infected, and thus neglect.

Two Interesting Articles:

CDC Alters Guidance, Advises HIV Prevention Pill For At-Risk Heterosexuals

I think this news article ties together a lot of the things we talked about in class with the topics raised by the short writings on HIV/AIDS.The article states that the drug Truvada, which was originally intended to treat those who have already tested positive for AIDS, has since been recommended as a daily preventative measure for those at a high risk for HIV.

The link to the topics discussed in class lies in the fact, while the drug was, when originally released in 2004, intended only for AIDS patients, following a study of its effects, it was found to have an effect in preventing transmission among gay and bisexual men.

In an eerie paralleling of the early views of the AIDS epidemic, the possible utility of the drug was not fully realized until recently, when the scope of the drug’s prevention of transmission was expanded to include women and heterosexual men.Though “a quarter of new HIV cases each year are heterosexual”, not until this year has the CDC issued new guidance and “formally approved the sale of Truvada as a preventive measure for healthy people at high risk of getting HIV.”

This late move to recognize that HIV/AIDS is not a purely a “gay disease” is at least an encouraging sign that HIV/AIDS is becoming less stigmatized. While I think that most of us (perhaps naively) believe that the widespread ignorance and misinformation that characterized the early days of the epidemic is quickly vanishing, the late recognition of an important drug’s utility speaks to lingering associations that are still with us today.

—-

2 HIV Patients Now Virus Free

This other article focuses on the use of bone marrow transplants (bone marrow being the body’s source of immune cells that HIV infects) which apparently resulted in two HIV-positive patients also undergoing cancer treatment being found virus free.

These two cases are reminiscent of an earlier case, known as “The Berlin Patient”, in which a man underwent a bone marrow transplant from an individual with a genetic mutation which makes cells HIV-resistant. While not entirely a breakthrough, the apparent similarity of the cases represents a possible route for further HIV/AIDS research.

The Plague – Parts 2&3

Part 2

Looking back retrospectively from the end of the novel, it appears to me that the second part is where the characters’ various ideologies begin to be compromised or embraced by their reality: Rieux struggles to maintain distance at first, but is pushed by the plague’s reality into a radically detached view, only able to count the growing death toll and confirm cases and isolate their families. Paneloux’s faith is challenged by the boy’s death and he responds in a descent into an untenable all-or-nothing viewpoint.

Paneloux’s ideology cannot survive in the world of Camus’s plague, and he dies in utter contrast to his ideology: a “questionable case”, neither here nor there, and in his own perspective, neither saved nor damned. Paneloux’s death, with the exception of Tarrou’s final battle with the plague, is perhaps the novels most noteworthy death.

The rationality of Rieux, depicted as a positive, parallels the self-destructive irrationality of Paneloux’s form of faith. These two characters seem at odds, but find themselves working together in the days before Paneloux’s turn away from his friends in a way that makes me think Camus himself can be seen in the character of Paneloux. Though arguably one of the most negatively depicted of the major characters (other than Cottard), Paneloux in my view is the voice that represents Camus’ struggle with questions of faith versus reason.While he ultimately decides for the latter in  his fictional crisis, the ambiguous way in which the plague takes Paneloux shows not a dismissal of the idea, but a reflection of Camus’ sadness that faith, in addition to a number of other things, cannot save us in such times.

Just like Tarrou and his human ideals, Paneloux and his faith are incapable of defeating the plague. Camus’ death scenes for each of the characters in question makes clear that while Rieux and his crusade of reason are the clear victor, he is genuinely torn in his choice and quick to not discount either entirely: in the end Rieux himself descends into sentimentality, especially in the revelation that he goes on to compile the account of the plague.

Part 3

In retrospect, the revelation that Rieux is the narrator deeply affects this portion of the novel. Though short, it constructs a highly objective, de-personalized voice that drifts through the city’s changing atmosphere and growing turmoil. The fact of Rieux’s being the narrator is perhaps best recognized here, while in other Parts of the novel Rieux’s voice is the objective one and the narrator is more sentimental in his descriptions of the goings-on of the city.

The Plague – Part 1

What strikes me most about Camus’s writing is the way in which perspective, either the perspective of the unrevealed narrator or that of the various characters experiencing the Oran plague, comes across rather strongly. When exploring the perspective of the narrator, he appears almost omniscient to the various happenings across the city, and describes the city and the plague’s progression in vivid, sometimes personified terms. The doctor, Rieux, approaches the situation from an objective and at times callous perspective that those passages seem to share.

Camus seems to take care to evoke different atmospheres, different ways of experiencing the same situation, for each of the different characters whose narratives color the story. When the narrative is that of Rieux’s perspective, the human element is pushed to the outskirts, the surroundings and his thoughts and calculations take priority. Comparatively, Tarrou appears sensitive and interested in the goings-on of individuals while Dr. Rieux is merely fascinated by the plague itself, in an ongoing battle that we touched on in class. Whereas others seem concerned with survival, things lost, the future, Rieux’s reality is almost a metaphorical chess-game with the non-human force of the basilis: becoming less interested in his patients each day, more intrigued by what ravages their bodies as the plague begins to gain ground.