Mountains Beyond Mountains

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John’s Treatment Symbol Analysis

John’s Treatment Symbol Icon

While Mountains Beyond Mountains doesn’t have many symbols (it’s a work of non-fiction), Tracy Kidder acknowledges that the death of John—a young Haitian boy who’s rushed to Boston for emergency treatment—is a poignant symbol for the value (and perhaps, ultimate futility) of Dr. Paul Farmer’s life’s work. John suffers from a rare facial cancer that can’t be treated in Haiti, and as a result, Farmer’s nonprofit spends tens of thousands of dollars to fly John to better facilities in the United States. But in the end, John dies in Boston—the plane flight and extra care had no effect on the eventual outcome. John’s fate could be representative of the fate of Haiti itself: although Farmer devotes huge amounts of time and money to improving conditions in the country, nothing he does can change the fact that Haiti is an impoverished country, in which there will always be sick, suffering people. Even so, John and his treatment could also be considered a symbol of the ultimate value of Farmer’s project. Even if he can’t save John’s life, Farmer can improve John’s living conditions in his final moments—as a nurse puts it, letting John die in a place where there aren’t flies on his face. Even if Farmer doesn’t eliminate the root cause of his patients’ suffering, there’s value in reducing some of the suffering.

John’s Treatment Quotes in Mountains Beyond Mountains

The Mountains Beyond Mountains quotes below all refer to the symbol of John’s Treatment. 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. 

The next time I was in Cange, I asked Zanmi Lasante’s chief handyman, Ti Jean, what the people in the region were saying about the case. He told me that everyone talked about it. “And you know what they say? They say, ‘Look how much they care about us.’”

Related Characters: Tracy Kidder (speaker), Ti Jean (speaker)
Related Symbols: John’s Treatment
Page Number: 278
Explanation and Analysis:

In this scene, Kidder receives an important piece of evidence. One reason that Koenig's decision to fly John out of Haiti for additional treatments was so controversial was that, according to some doctors, flying Haitians out of the country for medical care would encourage others to ask for the same treatment—soon, every Haitian patient would be demanding an airplane. As this quotation makes clear, the Haitians don't demand that "special" treatment at all. On the contrary, they consider the airplane an incredible gesture for John, but don't ask for it again.

The quotation is important because it dispels some myths about the supposed "cycle of dependency." Some people argue that the efforts of humanitarians in Haiti are useless in the long run, because they encourage Haitians to rely on free medical services or aid from other countries—an unstable situation for any country. Farmer has always argued that arguments for the "cycle of dependency" border on racism: they offer dubious logic in order to support the old, prejudicial idea that people in third-world countries shouldn't receive the generosity of the United States. Whether or not one agrees with Farmer that dependency arguments are racist, this quotation certainly suggests that dependency arguments are wrong.

Chapter 26 Quotes

If you say, Well, I just think how much could have been done with twenty thousand dollars, you sound thoughtful, sensible, you know, reasonable, rational, someone you really want on your side. However, if you were to point out, But a young attending physician makes one hundred thousand dollars, not twenty, and that’s five times what it cost to try to save a boy’s life—that just makes you sound like an asshole. Same world, same numbers, same figures, same currency.

Related Characters: Doctor Paul Farmer (speaker)
Related Symbols: John’s Treatment
Page Number: 289
Explanation and Analysis:

Farmer offers Kidder one final explanation of why arguments for efficiency are immoral. There are some people (cynics, in Farmer's opinion) who would argue that John's treatment in Boston was a colossal waste of money, since it cost thousands and didn't save John's life. Kidder's point, however, is that these arguments place an unfair burden on the lives of third-world citizens. No first-world person would ever have to argue for why she "deserves" healthcare—the only relevant argument would be that doctors have a moral duty to help the sick. It's only when we bring up third-world people that the question of of cost-efficiency is brought up in the first place. Furthermore, Farmer argues, focusing on the cost-efficiency of treatment is the wrong issue. It would be better to focus on the ludicrous amounts of money spent on other, non-life-saving issues and professions, not the relatively small amounts of money that good doctors spend on sick patients in Haiti.

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John’s Treatment Symbol Timeline in Mountains Beyond Mountains

The timeline below shows where the symbol John’s Treatment 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
...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 of diagnosing John requires several trips... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...conference in Europe, Serena prepares to fly John out to Mass General for a full treatment for his cancer. Kidder sees John lying in bed, and is shocked by his appearance—his... (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... (full context)