Mountains Beyond Mountains

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Themes and Colors
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
LitCharts assigns a color and icon to each theme in Mountains Beyond Mountains, which you can use to track the themes throughout the work.
Saintliness Theme Icon

More than once in Mountains Beyond Mountains, people refer to Paul Farmer as a “saint.” Although Farmer always denies such a label, saying that he’d have to work much harder to become one, Tracy Kidder makes it clear that Farmer works harder (and comes closer to embodying sainthood) than anyone Kidder has ever met. Farmer barely sleeps, travels constantly to attend to his patients in Haiti, Russia, and Peru, gives hours of his time to advising other doctors on the best treatments, and, in spite of his immense prestige and lucrative fellowships, lives in a tiny apartment. Whether or not Farmer qualifies as a saint, his selflessness and generosity are worth considering more closely. Where did these qualities come from, and what does Farmer’s example—an example that’s almost impossible to follow—tell us about ourselves?

Whether Farmer intends it or not, his selfless devotion to other people often makes his friends and colleagues guiltily question their own lives and choices. This is especially clear when Kidder meets Farmer: Kidder is amazed by Farmer’s hard work and love for medicine, but he’s equally upset by his own inaction, which, relative to Farmer, looks like pure laziness. This sense of guilt is even more apparent in Ophelia Dahl, Farmer’s long-time friend and former lover. After many years of loving Farmer, Ophelia decided that she couldn’t live up to his lofty standards of right and wrong: she couldn’t entirely sacrifice her own happiness and wellbeing for others’ sake. Ophelia became so exasperated with Farmer’s saintliness that she’d secretly cheer whenever Farmer showed any negative affect or emotion, such as anger, fear, or frustration. Ultimately, Farmer’s life is something of a paradox. Although his good deeds have inspired thousands of doctors to follow his example and devote themselves to charity and nonprofit work, the handful of people who know him very well—Ophelia and, arguably, Kidder—find his example maddening as well as inspiring. As Ophelia admits, Farmer’s saintliness reminds her of her own selfishness and close-mindedness—in other words, he’s a deterrent to good deeds, as well as an inspiration for them.

Mountains Beyond Mountains also shows the limitations of a life spent traveling from country to country, curing disease. Farmer can be angry or stubborn at times, and more importantly, he neglects his wife, Didi, and his child, Catherine. As he willingly admits, he values the lives of his patients, most of whom are extremely poor, much more highly than those of his loved ones, whose cares and problems simply aren’t as important. Kidder suggests that Farmer’s unorthodox behavior may be the result of his own experiences as a child: Farmer’s father refused to show any love for him for fear that Farmer would become arrogant. Farmer is afraid of playing favorites with his own loved ones, just as his father was. As a result, he overcompensates by almost never seeing his own family. In this way, Farmer’s saintly life comes at a high cost. He embodies a form of love and compassion that few human beings could hope to imitate—and yet he’s uncomfortable with the one form of love and compassion that most humans do exemplify: love for one’s family.

Ultimately, Kidder doesn’t doubt that Farmer is a very, very good person, but Kidder never gives in to the temptation to canonize Farmer. Instead, he grapples with the definition of saintliness, and challenges Farmer’s neglect for his family even as he praises his life-saving work around the globe. The goal isn’t merely to lionize Farmer, but rather to show him in his subtle weaknesses as well as his enormous strengths. In this way, readers can decide for themselves which aspects of Farmer’s life to imitate and which to avoid.

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Saintliness Quotes in Mountains Beyond Mountains

Below you will find the important quotes in Mountains Beyond Mountains related to the theme of Saintliness.
Chapter 1 Quotes

The world is full of miserable places. One way of living comfortably is not to think about them or, when you do, to send money.

Related Characters: Tracy Kidder (speaker)
Page Number: 8
Explanation and Analysis:

At the beginning of the novel, Tracy Kidder (the author) offers some harsh truths about the state of the Western world. For most of the people who live in developed, first-world countries, the easiest course of action is to carry on with one's own personal problems and affairs, and ignore the millions of starving human beings around the world—people whose lives could be drastically changed for the better with just a fragment of the wealth or resources most Westerners enjoy daily.

In short, the rich countries of the world have to perform some complicated mental gymnastics to avoid becoming overcome with guilt at their own passivity: no moral, prosperous human being, Kidder insists, can think about the world's poverty and disease without guilt. Instead, most people either ignore the problem or do the bare minimum, and send some money now and then in the hopes that it will improve the problem slightly.

Against this backdrop of ignorance, passivity, and sheer laziness, Kidder introduces us to Doctor Paul Farmer—a man who refuses to play along with his peers in America. Instead of ignoring the world's problems, Farmer tries to use his intelligence and medical training to eliminate them altogether, one problem at a time.


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Chapter 2 Quotes

As Farmer was leaving the shelter, he heard Joe say to another resident, just loudly enough to make Farmer wonder if Joe meant for him to overhear, “That guy’s a fuckin’ saint.”

Related Characters: Tracy Kidder (speaker), Joe (speaker), Doctor Paul Farmer
Page Number: 16
Explanation and Analysis:

At several points in the book, characters will compare Paul Farmer to a saint. Here, Joe, a man who's been sent to a medical shelter in Boston, calls Farmer a saint for taking such good care of his patients, going far beyond the minimum requirements even for a doctor.

When Joe calls Farmer a saint, he means that Farmer devotes huge amounts of his time and energy to helping other people whom he's never met before. Yet throughout the book, Farmer insists that he's not a saint at all—on the contrary, he claims, he's just doing "his part" to help others. Farmer is so used to spending 20 hours a day caring for the sick that he considers himself just an average, decent human being—he's just doing what any intelligent, trained person should be doing to help alleviate the vast suffering in the world. One disturbing implication of Farmer's claim that he's not a saint is that we as readers—or anyone with education, wealth, time, or other resources—aren't doing remotely enough with our own gifts. It's easy for us to believe that Farmer is a saint because it absolves us of some of our own guilt at not doing more to help people in need—only a superhuman or saint could do what Farmer does. The troubling part is when we think that Farmer is just a normal human, doing what all normal people ought to do.

Chapter 3 Quotes

He made about $125,000 a year from Harvard and the Brigham, but he never saw his paychecks or the honoraria or royalties, both fairly small sums, that he received for his lectures and writings. The bookkeeper at PIH headquarters cashed the checks, paid his bills—and his mother’s mortgage—and put whatever was left in the treasury. One day in 1999, Farmer tried to use his credit card and was told he’d reached his limit.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer
Page Number: 23
Explanation and Analysis:

Kidder notes some irony here: although Farmer contributes more to society than almost anyone (he literally saves lives almost every day), he's not rewarded for his actions with money or property. Instead, Farmer sends most of his income to other people. He's learned to live so simply that he has no use for extra cash.

The fact that Farmer doesn't feel any need to spend money makes us wonder—what motivates his quest to help the sick? Does he get any pleasure from doing so, or does he see it as a duty? While Farmer clearly gets a sense of joy and comfort from knowing that he's important to other people, he's also so regimented and rigorous in his routine as a doctor that he seems to treat curing the sick as a basic obligation, not a joy. Strange as it might seem, Farmer doesn't really enjoy his work—"enjoy" is the wrong word. Rather, Farmer seems to treat charity as the cornerstone of a normal, moral life—a life that few people emulate, however.

Chapter 5 Quotes

By then Farmer had quit his fraternity. He wrote them that he couldn’t belong to an all-white organization. (“I received quite a frosty reply,” he would say, in a tone of voice that implied this still surprised him.) He’d come to admire his father’s distaste for putting on airs.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer
Page Number: 56
Explanation and Analysis:

In order to get a better understanding of Dr. Farmer, Kidder focuses on Farmer's past. Even in college, we're told, Farmer showed signs of being a remarkably forward-thinking, progressive person. Although it was the norm at the time for white fraternities to exclude black students, Farmer didn't hesitate to quit his fraternity when he realized that it was a racist organization.

Farmer's decision to quit his fraternity for its poor racial politics illustrates his refusal to play along with racist "groupthink," an instinct that continues throughout his career as a doctor. Again and again, Farmer ignores the "common wisdom" about charity in Haiti or South America—i.e., that there's no point in helping the Haitians or South Americans because it doesn't make financial sense. One reason Farmer ignores other people's advice about nonprofit work is that he sees this advice as an extension of American racism and indifference to people of other cultures—a form of racism he's been avoiding at least since his experience with his college fraternity. Just as his frat excluded blacks, the powerful charities of the U.S. have an unfortunate tendency to buy into the myth that white Americans will always be better than their neighbors to the south. Farmer finds this latent racism disgusting.

Chapter 7 Quotes

For a long time I thought I could live and work in Haiti, carving out a life with you, but now I understand that I can’t. And that’s simply not compatible with your life—the life you once told me you would like to lead even ten years ago.

Related Characters: Ophelia Dahl (speaker), Doctor Paul Farmer
Page Number: 66
Explanation and Analysis:

For many years as a young man, Dr. Farmer is romantically close with a fellow charity worker, Ophelia Dahl. But as he spends more and more time working with his patients, Farmer struggles to spend time with Ophelia. He makes it clear that he'll only be able to pursue a relationship with Ophelia if she can get used to a life of constant travel and work. In this quotation, Ophelia writes Farmer a letter in which she tells him that she can no longer pursue a relationship with him: she's just not ready for the life he wants to lead.

Ophelia's letter reminds us how difficult Farmer's life is—contrary to what he always claims. There are few people who could spend their entire lives traveling the world, meeting with hundreds of strangers a day, and devoting incredible amounts of time to dangerous or thankless tasks. Indeed, Ophelia's letter establishes the basic sacrifice that a "saint" like Farmer must make. Farmer must choose between his family—a small group of people with whom he's very close, such as Ophelia—and his profession—a life spent circling through a huge group of patients, none of whom he's very close with. While most people choose to give most of their love and attention to the small number of people in their immediate family, Farmer takes a different path. Ironically, in choosing a career that, on the surface, seems incredibly noble and loving, he shies away from love for a family—a basic form of love that almost every human being expresses.

Chapter 8 Quotes

He was already attracted to liberation theology. “A powerful rebuke to the hiding away of poverty,” he called it. “A rebuke that transcends scholarly analysis.” In Haiti, the essence of the doctrine came alive for him. Almost all the peasants he was meeting shared a belief that seemed like a distillation of liberation theology: “Everybody else hates us,” they’d tell him, “but God loves the poor more. And our cause is just.”

Related Characters: Doctor Paul Farmer (speaker), Tracy Kidder (speaker)
Page Number: 78
Explanation and Analysis:

In this passage, Farmer gives an eloquent explanation of liberation theology, the strain of Catholicism that defines his approach to charity work in Haiti. In many conventional interpretations of Christianity, poverty should be ignored altogether, because it's unimportant in the "grand scheme of things" (no point worrying about your paycheck on Earth when you're going to Heaven for eternity, anyway). Farmer disputes this interpretation, arguing that it's vitally important to focus on improving life on Earth, here and now. To allow the people of Haiti to live in poverty is, in essence, to support suffering and misery—an obvious violation of the spirit of Christianity. Armed with liberation theology, Farmer devotes huge amounts of his time to working with the poorest Haitians, recognizing that their need for medical attention is great.

Chapter 9 Quotes

On the way back they laughed about the incident, and yet of all the times she’d eaten things that she could hardly bear to look at, this one occasion when she failed the test stood out for her.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer , Ophelia Dahl
Page Number: 87
Explanation and Analysis:

In this passage, Ophelia Dahl describes an episode from her travels in Haiti when, accompanied by her lover, Farmer, she was offered a traditional Haitian dish. Ophelia politely refused the dish, not realizing that her politeness would be interpreted as rudeness. Farmer irritably corrected Ophelia, showing that he was far more familiar with Haitian culture than she. Ophelia continues to remember this episode for many years. In her mind, it proves that she'll never be an important part of Farmer's life; on the contrary, she'll always be less relevant than his patient care.

A further implication of the passage is that Ophelia feels like a outsider in Haiti because of her privileged life in the United States and England. Ophelia, the wealthy daughter of the famous author Roald Dahl, is occasionally uncomfortable in Haiti because she's reminded of how lucky she was to be born to wealthy, white, Western parents. Incidents like the one described in the passage push Ophelia further away from Farmer while also exacerbating her "white guilt."

One time when they were together in Boston, White said, “You know, Paul, sometimes I’d like to chuck it all and work as a missionary with you in Haiti.” Farmer thought for a while, then said, “In your particular case, that would be a sin.”

Related Characters: Tracy Kidder (speaker), Tom White (speaker)
Page Number: 95
Explanation and Analysis:

In this passage, one of Farmer's key allies, a man named Tom White, discusses the possibility of going to Haiti to be a one-on-one charity worker. White is a wealthy man who donates millions of dollars of his own money to ensure that Farmer can continue practicing medicine in Haiti. When Farmer says that White's decision to move to Haiti would be a sin, he's saying that White is far more valuable to the world as a donor to nonprofit work than he would be as a missionary on the ground.

Farmer's observation shows an awareness of the importance of strategy and resource allocation in nonprofit work: there are some people who work best as donors and some people who work best as one-on-one doctors. At the midpoint of his career, Farmer excels at the latter: while he thinks of the "big picture" as much as possible, he prefers the thrill of curing an individual patient's illness.

Chapter 15 Quotes

The motion of his mind toward root causes had always excited him. He loved the challenge of diagnosis and all its accoutrements—the stains on the microscopic slides, the beautiful morphologies of the creatures under the lens. But what he called “the eureka moment” had a bad aftertaste this time. Later he would tell me, “God, I’d hate to ever feel triumphant about something so rotten.”

Related Characters: Doctor Paul Farmer (speaker), Tracy Kidder (speaker)
Page Number: 140
Explanation and Analysis:

In this quotation, Farmer sheds some light on his own psychology: what motivates him to devote his entire life to medicine? And what goes through his mind when he works with a patient?

As Farmer explains, he feels a special thrill when he diagnoses a patient with a serious viral disease. But this thrill immediately causes Farmer guilt and shame—how could he possibly feel happy about a virus that causes human beings so much misery?

In general, the passage suggests that Farmer doesn't really think of his work as a doctor as pleasurable at all—what little pleasure he does feel on the job vanishes almost immediately, as Farmer takes in the gravity of the situation. Instead of practicing medicine for his own gratification, Farmer does it out of a more abstract sense of duty: his faith in liberation theology encourages him to devote himself to other people, whether he enjoys it or not, and he can never fully savor his more abstract, aesthetic appreciation of diagnoses without also considering the real-world, human cost of his work.

Farmer and Kim began collecting a number of official WHO statements. Some put the case more plainly: “In developing countries, people with multidrug-resistant tuberculosis usually die, because effective treatment is often impossible in poor countries.” For Farmer […] there was a larger principle involved. A TB epidemic, laced with MDR, had visited New York City in the late 1980s; it had been centered in prisons, homeless shelters, and public hospitals. When all the costs were totaled, various American agencies had spent about a billion dollars stanching the outbreak. Meanwhile, here in Peru, where the government made debt payments of more than a billion dollars every year to American banks and international lending institutions, experts in international TB control had deemed MDR too expensive to treat.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer , Jim Yong Kim
Page Number: 141
Explanation and Analysis:

This long passage illustrates the hypocrisy in the way the Western world studies and treats diseases. As Kidder describes it, there was an outbreak of tuberculosis in Boston and Peru almost at the same time. The U.S government provided huge sums of money to ensure that the people of Boston wouldn't suffer any more than they absolutely had to. And yet when the time came to treat tuberculosis in Peru, American medical officials—including some of the same people who'd supported TB treatments in Boston—insisted that TB was too expensive to treat in Peru.

The hypocrisy of the medical establishment is clear here. If the sick are American citizens, who share a culture and a heritage with the medical officials, then no sum of money is too high to treat them. It's only when the patients are strangers—people who speak a different language, or have a different skin color than the medical officials—that cost becomes a factor at all. As Farmer argues, even to ask the question, "Is this treatment worth it?" is to treat a patient as a second-class human being, something to be measured in terms of economic value rather than basic human dignity.

Chapter 21 Quotes

He distrusted all ideologies, including his own, at least a little. “It’s an ology, after all,” he had written to me about liberation theology. “And all ologies fail us at some point. At a point, I suspect, not very far from where the Haitian poor live out their dangerous lives.” Where might it fail? He told me, “If one pushes this ology to its logical conclusion, then God is to be found in the struggle against injustice.

Related Characters: Doctor Paul Farmer (speaker), Tracy Kidder (speaker)
Page Number: 195
Explanation and Analysis:

Farmer takes a moment to clarify his thoughts on politics and philosophy. Although he's passionate about his belief in liberation theology—the Catholic belief in the importance of solving the concrete, real-world problems of human beings—Farmer acknowledges that any system of beliefs is always flawed in some way. In other words, he concludes, there's no system of thought that can tell us what to do in all cases—there will always come a point, particularly in an impoverished place like Haiti, where humans have to use their instincts to decide on the "right" thing to do.

Farmer's observations about the failure of "ologies" are important, because they help clarify why he's so devoted to helping the sick through individual consultations. In part, Farmer refuses to settle into a comfortable administrative position (chair of a major nonprofit, president of a medical society, etc.) because he doesn't want "ology" to guide his decision-making processes. By meeting with the sick one-on-one, Farmer reminds himself that no abstract belief system can fully solve humans' problems—only hard work and a strong sense of duty can make the world healthier.

It still seemed to me that he took a stance all too conveniently impregnable. He embodied a preferential option for the poor. Therefore, any criticism of him amounted to an assault on the already downtrodden people he served. But I knew by now he wasn’t simply posing. I felt something about him that I’d later frame to myself this way: He said patients came first, prisoners second, and students third, but this didn’t leave out much of humanity. Every sick person seemed to be a potential patient of Farmer’s and every healthy person a potential student. In his mind, he was fighting all poverty all the time, an endeavor full of difficulties and inevitable failures.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer
Page Number: 210
Explanation and Analysis:

In this quotation, Kidder voices some of his frustration about Farmer and Farmer's attitude toward healthcare. Kidder can't help but suggest that Farmer is being a little disingenuous when he claims to be a kind of savior devoting his life to helping the poor and the sick. The problem with such a life, Kidder claims, is that it's immune from all criticism—Kidder can't disagree with Farmer without feeling that he's also somehow hurting the poor and sick people whom Farmer helps.

In part, Kidder's objections to Farmer sound like frustration with his own passivity—as Kidder himself acknowledges, he feels guilty whenever he's around Farmer, because Farmer could put any humanitarian to shame, let alone a wealthy writer like Kidder. At the same time, Kidder seems to have a valid point: Farmer isn't critical enough in his attitude toward patient care. By refusing to ever think of patient care as a matter of dollars and cents, Farmer is overly idealistic.

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.