Mountains Beyond Mountains

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A young Haitian boy whose rare facial cancer necessitates his being flown out to Boston for extensive treatments. John’s long, agonizing journey from Haiti to Boston is the dramatic climax of the book, because it encapsulates the challenges—and, at times, the futility—of Paul Farmer’s medical ventures in the Third World. Although John receives the best healthcare possible, he eventually dies of his cancer, meaning that Farmer has spent tens of thousands of dollars on John’s failed treatment. Although his colleagues point to John’s death as proof that Farmer is too generous with his allocation of resources, Farmer insists that there is inherent value in trying to save as many lives as possible, even if the chances of saving a life are very small.

John Quotes in Mountains Beyond Mountains

The Mountains Beyond Mountains quotes below are all either spoken by John or refer to John . For each quote, you can also see the other characters and themes related to it (each theme is indicated by its own dot and icon, like this one:
Cost-Efficiency vs. the Value of Life Theme Icon
). Note: all page and citation info for the quotes below refers to the Random House edition of Mountains Beyond Mountains published in 2009.
Chapter 25 Quotes

“Well, this boy is a challenge. But I’ve cured sicker kids.” Serena laughed nervously. She said, “Well, now he’s in Man’s Greatest Hospital.” That was what Mass General people called the place, playing on its initials, MGH. Dr. Ezekowitz chuckled. “As soon as we start to believe that, we won’t be.” He turned to the young intern. “Isn’t that right? We can always do better, can’t we.”

Related Characters: Serena Koenig (speaker), Dr. Alan Ezekowitz (speaker), John
Related Symbols: John’s Treatment
Page Number: 276
Explanation and Analysis:

In the penultimate chapter of the book, Kidder focuses on a single patient of Farmer's—a patient whom, in Kidder's mind, sums up the strengths and weaknesses of Farmer's approach to medicine. The patient in question is John, a Haitian youth who's suffering from an extremely painful facial tumor. At great expense, Farmer's nonprofit rushes John to the Massachusetts General Hospital. There, a young intern chastises Serena Koenig—the woman responsible for making the call to bring John to Boston in the first place—for leaving John so malnourished.

By saying, "We can always do better," Dr. Ezekowitz is subtly chastising his intern for her rude comment. Essentially, Ezekowitz is admitting that no hospital is perfect, whether it's in Boston or Haiti. To judge a patient for being poorly cared for, as the intern has done, is to pretend that one's own hospital needs no improvements. Therefore, Ezekowitz's statement is optimistic: like Farmer, he believes that healthcare is always improving, grounded in doctors' sincere desire to help the sick. Ezekowitz's words are particularly inspiring since they follow Koenig's nerve-wracking, controversial decision to spend thousands of dollars to fly John to Boston for more care. Although the chances of curing John are extremely low, Ezekowitz seems to support Koenig's decision. No matter how much it costs, or how unlikely the possibility of a cure might be, doctors need to work together to help those in need, always doing a little bit better.

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“Can we not have him in a place where people are trained in palliation? Isn’t palliative care important? And a place where his mother can grieve in private instead of an open ward with flies all over her face?”

Related Characters: Serena Koenig (speaker), John
Related Symbols: John’s Treatment
Page Number: 277
Explanation and Analysis:

After John is transported to the hospital in Boston, he's treated for his facial cancer, but ultimately dies. Serena Koenig, the doctor who made the choice to fly John to Boston, is devastated by John's death. In part, she's saddened by the death of a patient. But more generally, she's beginning to question her decision to spend tens of thousands of dollars on flying John out of Haiti for a treatment that ultimately didn't change John's fate at all. Serena tries to rationalize her decision by arguing that even she didn't succeed in saving John's life, she at least improved his quality of life in the final hours.

Kidder doesn't offer his opinion on whether or not Serena did the right thing by choosing to fly John to Boston—he leaves it up to us to decide. John's treatment cost a lot of money, and therefore might detract from Farmer's ability to treat other patients in the future. And yet John was also a young boy who desperately needed better medical treatment—even if his treatment was expensive, Farmer would argue, it's not up to us to decide which lives are worth expensive treatments and which lives aren't. 

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John Character Timeline in Mountains Beyond Mountains

The timeline below shows where the character John appears in Mountains Beyond Mountains. The colored dots and icons indicate which themes are associated with that appearance.
Chapter 25
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In 2000, Kidder explains, PIH flies a Haitian child named John from Cange to Boston for treatment for a rare facial cancer, nasopharyngeal carcinoma. The process... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
While Farmer attends a Soros conference in Europe, Serena prepares to fly John out to Mass General for a full treatment for his cancer. Kidder sees John lying... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Serena decides to arrange for an ambulance to drive John to the airport, even though John’s condition is uncertain. She reasons that she can prevent... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
The driver of the ambulance decides to arrange for another truck to drive John to the airport. Serena and the other hospital technicians hook up John’s suction device to... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Kidder reports that John survives his medevac flight to Boston, helped by his suction device the entire time. When... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
The ambulance drives John to the pediatric wards of Mass General, and the team has John in bed very... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
The medical team at Mass General proceeds with treating John. They identify tumors in John’s nasal area and spine—extremely painful. Gradually, they realize that there’s... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
A few days later, John’s mother arrives on another flight. She’s able to see her son just before the end... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Kidder is unsure how he feels about John’s treatment. In a sense, he thinks of it as a lesson in the impossibility of... (full context)
Chapter 26
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
It is December, two months after John’s transportation to Boston. Kidder is in Boston, preparing to travel to Cange with Farmer for... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...house, Kidder tries to ask Farmer a question he’s been formulating for a while—ever since John’s death. He points out that Farmer can never treat every sick person on the planet—there... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Farmer discusses John’s death with Kidder. It’s certainly possible to question Serena’s decision to move John to Mass... (full context)