Study Guide Mountains Beyond Mountains by Tracy Kidder

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The setting of this chapter is Boston’s Brigham and Women’s Hospital whose great works and fame make people feel stilled in its presence. Kidder is gathered with Dr. Farmer and his team in radiology where they are discussing the cases for the day. Dr. Farmer is now 40 years old and dresses, like the “big-shot” he is, in formal attire. He still spends most of his time in Haiti, but he is also a very important professor of both medicine and medical anthropology at Harvard Medical School as well as being an attending physician on Brigham’s senior staff. They are discussing a patient who has recently been treated for a parasite in the brain. Farmer elicits opinions of his staff about whether to continue treatment for infection. He listens carefully, but it is evident that he is in charge. He calls a female parasitologist, an old, close colleague, whom he calls “pumpkin.” He tells her they are going to treat the patient. This is part of a typical ordinary day for Farmer and his staff. They have dealt with six cases all of which are somewhat of a puzzle, until the last patient who they are concerned may have TB as a result of being HIV positive. They head upstairs to see the patient, and along the way, Kidder is impressed by Farmer’s demeanor: he speaks to everyone in a personal manner and stops at various places to do small office duties and help other physicians.

Kidder is further impressed by how Farmer deals with the patient, named Joe. Joe is a drug addict and often doesn’t take his medication or eat properly. Farmer curls right on the bed to the point that Kidder thinks he’s going to climb in with the man. He is very close and personal with the guy to show how much he cares. The patient tells him he want to have a home to go to where he can have a six-pack of beer a day and someone to make sure he eats and takes his medicine. On the outside, he is too distracted by finding drugs and a warm place to sleep to take care of himself. Farmer stares at Joe’s face intently as if he and his patient are the only ones in the world, and he promises Joe he will do everything he can to fulfill his wish. A few days later, on a message board outside the door of Brigham’s social work department is the message: “Joe OUT: cold, their drugs, ½ gal. vodka; IN: warm, our drugs, 6 pack Bud.” Beneath this message are the words, “Why do I know Paul Farmer wrote this?” A homeless shelter is found, but they forbid alcohol, understandably, which doesn’t deter Farmer from pleading his patient’s case.

On Christmas, when he is on duty, Farmer wraps a six pack of Bud as a present for Joe, and when they leave the patient, Kidder overhears him say, “That guy’s a fuckin’ saint.” When Kidder asks him how he reacts to these kinds of comments, the doctor says that he doesn’t mind that they say that, it’s just that he feels it’s inaccurate, and it makes him think he has to work harder to live up to the label. Kidder feels his own inner disturbance to this comment. It isn’t that the words seem immodest to him; it’s that he feels he’s in the presence of a very different person, whose ambitions he hasn’t yet begun to fathom.

Farmer finishes his service at Brigham and returns to Haiti on New Year’s Day. He sends Kidder a copy of his latest book, Infections and Inequalities, in which he makes connections between poverty and disease. In it, Farmer can hardly contain his anger at how the necessary drugs don’t make it to the patients. He isn’t at all like the teaching doctor at Brigham. He shouts on every page. Kidder e-mails him that he loves the book and is going to read his previous ones as well - his oeuvre (body of work). Farmer tells him that those books are not his oeuvre. To see his oeuvre, Kidder has to go to Haiti.



This chapter reinforces the type of doctor Farmer is. To Kidder, he is like a split personality: he is a calm, caring laid-back doctor who goes the extra mile for his patients. In his book, he is an angry physician, shouting out the needs of his patients and how the poor suffer more, because they’re poor and don’t have access to necessary care. Kidder seems intrigued and even somewhat disturbed about what he will see in Paul Farmer in the future.


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