quinta-feira, junho 23, 2016
I first met this patient at the ER - a type 1 diabetic in his early twenties, blind from diabetic retinopathy, pale from a hemoglobin under 7 g/dl, swollen from accumulated fluid, vomiting from a urea level above 300 mg/dl, with a sky high blood pressure. A classic case of end-stage renal disease caused by diabetic nephropathy, that for lack of timely treatment had reached an advanced stage we fortunately seldom see today. My first reaction was to feel angry: "how on Earth someone reaches this state nowadays?". Then I talked to him. He came from a lower-class family; his mother had just died a few days before, his father had left them long ago, and he lived with a younger brother. His mother was his caretaker, not a very efficient one, struggling with the depression that drove her to suicide, and his care had been haphazard, he didn't even know he had renal disease. He was combative and argumentative, he didn't want to start dialysis at first - such is the bad reputation this treatment has, even if it's so undeserved and mostly based on ignorance - but of course he yielded, and we started to treat him. He was discharged from the hospital after a few days, slimmed down to his normal weight and mostly asymptomatic.
He has been my patient since then, and a difficult patient. Being blind and living most of the time by himself - his younger brother, though affectionate and caring towards him, is away most of the time, and he stubbornly refuses his father's help, who is not that interested in him anyway - his medication is totally haphazard, not to speak of his diet, and he often comes to dialysis with a 4 or 5 kg weight gain, a glycemia above 300, and a blood pressure in its 200s/100s. No matter how many medication charts we'd send home, we always knew he took his pills or his insulin in a completely aleatory way, and of course his diet was appalling.
But then, even as we nag him, we cannot stop ourselves from liking him. He's a young man from a tough neighbourhood, and he always tries to play the ruffian - he even managed to get himself arrested once, for stealing at a convenience store, which puzzled me, with him being blind and at the time in a wheelchair - he is always combative and argumentative, and sticks small rolls of toilet paper in his ears during dialysis, which make him look like a funny young Yoda. He's terribly resilient, the only diabetic I know to survive a Fournier's gangrene. But even when I joke with him about his getting an ear piercing to look prettier I'm always worried, I'm always waiting for the day he will have a brain bleeding because of his uncontrolled blood pressure, a ravaging sepsis or a fatal hypoglycemia.
So yesterday I was really happy because, after the nth medication change (I always try to make it as simple as I can), his blood pressure was perfect. I heartily congratulated him, and he smiled a proud grin, saying: "yeah, it looks like you got it right this time!", and I somehow felt moved, felt like stroking his head and giving him a fatherly kiss - which of course I didn't. Like so many of my patients, I feel responsible for him, and every therapeutic success, how small or short-lived it may be, feels like a victory. I know this will be short-lived, I know he will die soon, from one of the many complications he is vulnerable to, and I feel angry about my helplessness to help him, as to help so many other of my patients. This kid is old enough to be my son, I would like to protect him, to care for him,but there is so little I can do.
domingo, junho 19, 2016
I had heard very flattering critics of Angela Carter's books, but had never read anything by her. I watched Neil Jordan's movie The Company of Wolves years ago, thought it was nice but didn't move me much. I was surprised and impressed by this book. The writing is absolutely stunning, like a colourful tapestry embroidered with jewels,and the tales are exquisitely rendered, reminding me of Bruno Bettelheim's The Uses of Enchantment, a book I loved when I read it, many years ago. Angela Carter's writing is strong, beautiful and erotic, and a joy to read.
This was the second book I read in Swedish. I watched the series by Bille August before, so I knew the story, which made it easier to read and also made me picture the characters as the actors looked like in the movie. Beautiful story, and beautiful writing; there were many words I didn't understand and had to look up, but I was happy to understand enough to be able to read it pleasantly. I think my next Swedish book will be Lanterna Magica, since I'm now acquainted with Bergman's writing.
quarta-feira, maio 25, 2016
I loved my recent trip to Naples and Pompeii. Arriving in Rome, at the Termini train station, when one presses the button "English" on the ticket vending machines, there pops up a message: "beware of pickpockets!", which reminds me how my wife was mugged as soon as we arrived in Rome, the first time I've been there, many ears ago. Familiar territory, then. The train to Naples takes only about an hour.
The city centre in Naples is very different from most European cities, usually gentrified and made up for tourists. Not here - the city centre is dirty, chaotic, lived in, and it feels like a refreshing place, no "boutique" hotels or "gourmet" places, but crowds of local people going about their business, cars and motorbikes driving everywhere, tourist shops amid local shops, food stalls where local people queue to eat, etc. And then there are lots of churches, among them the beautiful Duomo and San Domenico, and the small museum of the Capella Sansevero with the veiled Christ. The old Scapanapoli is a feast for the eyes, and it's always nice to eat an icecream or a babá au rum.
On the second day I walked along the corniche, from the Castelnuovo until the Donanna palace, along the beautiful bay. It looks like a different world from the sleazy city centre, with the stately buildings and the gorgeous views over the sea and the Vesuvius. The funicolare takes us to the Vomero neighbourhood, to castel Sant'Elmo, from where we can enjoy superb views over the city and the bay. The affluent neighbourhoods of Mergellina and Posillipo seemed miles away from the hectic centre, a sign of the city's diversity.
The Archeological Museum has a stunning collection, even if it's somewhat haphazardly shown. Great statues, amazing paintings and mosaics from Pompeii, not much information and a sad cafeteria with vending machines - couldn't they have set up a café?
Then a visit to Pompeii - I always wanted to go there, ever since reading about Winckelman's diggings when I was a child. The city is just amazing, one can really feel how this was a real city, extremely modern in many ways - the speed bumps, the night reflectors, the baths, the food stalls - and the decorated villas are just stunning. I could spend whole days there, exploring the streets, the villas and their beautiful frescoes, the theatres, shops, etc. The setting is beautiful, with the hills and the volcano in the background. The casts of the people killed and buried by the eruption are impressive and moving. One wonders how a big city would look like in the heyday of Roman times, from this small sample...How would have been Rome, Athens, Ephesus, Alexandria?
Back to Naples, we decided not to go to the Amalfi coast, beautiful as it must be, but rather enjoy a last day in the city. We visited the Capodimonte Museum - amazing collection of Renaissance painting, and very well displayed for a change - and then walked down from the museum to the city centre - popular narrow streets, with corny altars in every corner, lines of drying clothes, busy small shops. Toured the busy narrow streets of the centre and the Spagnioli quarter again, ate more ice creams and babas. It felt really good relaxing around this lively city, watching the scenic vistas over the bay and the Vesuvius, drinking strong espressos and eating tasting pizzas. Naples is a wonderful town, and it really made me look forward to know more of Southern Italy, and Sicily... Another time.
I knew about Matti Friedman, as about so many other people and stuff, on Facebook, through a good Israeli friend. She praised me his book The Aleppo Codex, which made me read it, and I liked it very much; I have since been reading his articles, always sensible, intelligent and articulate, so I was looking forward to reading his new book, that was published early this month. So, my expectations were high, and I was not in the least disappointed, actually it's even better than I expected. It's a very well written story, moving, engaging and thought provoking. Through its characters, ordinary - even if I dislike to use this word, because each one comes out as a unique and interesting individual - young men who find themselves right after high school in the middle of a dangerous, bloody and seemingly pointless low level war, one gets a clear and poignant picture of the violence and senselessness of war, and how meaningless and wasteful it all seems. Young boys die, huge human potential is lost, the status quo goes on; the similarities to other conflicts, other lives equally wasted is often evoked along the narrative's several allusions to the trenches of WWI and the sad and beautiful poetry of boys like Owen or Brooke. This doesn't mean these young men, the author included, were pacifists, they were all conscious of the need to protect a vulnerable country surrounded by enemies and willing to risk their lives to do it, even if they were probably not aware of what it really entailed, as young men usually aren't, with the youth's belief in its own invulnerability.
One of the things I liked most about the book is how it balances an articulate and sharp view of the historical and general context and a humane and insightful description of the individual people involved. He captures excellently the mood of the soldiers, the families, as of the country after the war, affectionately but never condescendingly. His analysis of the conflict and its consequences is lucid and realistic. Another thing I liked much was how he shows how our convictions, expectations and perspectives change with the events along the years, and how our appraisals are far from static, and what we believe to have been "always like this" actually changes a lot is as little a couple of decades - a good lesson lots of people should understand to think twice before embracing radical beliefs or making bombastic and too staunch statements.
The last part is particularly impressive, one really gets an eerie feeling of unreality and one turns the pages as in a thriller, almost as if one was there oneself, besides the narrator, driving on a simultaneously familiar and alien land, meeting these nice individuals that yet are the enemy. And again one is reminded that, in spite of all that divides us, we are all pretty much the same.
All in all, a great book, and I highly recommend it.