Winter Journal, by Paul Auster

I always liked Paul Auster's books, ever since I read Leviathan many years ago. Some are better than others, and I wouldn't say he's one the best novelists I read, especially since I tend to forget his books not long after reading them, and to confuse the several plots. But he's still a very good writer, a great story-teller, and I feel especially identified with the way he looks at life, his recurrent themes of chance and serendipity and simultaneous strangeness and familiarity of life. So, I was curious to read his latest memoir. I liked it very much; it's a nostalgic reminiscence of his life and family and places where he has lived, sometimes sweet, sometimes sad, in some points somewhat repetitive, and with several very good stories masterly told as usual. His writing is excellent as usual, even if the choice of the second person becomes sometimes a little tiresome. Something also appeals to me: he's not an astounding writer (meaning the kind whose books change literature or the world) and he hasn't lived a particularly remarkable life, had never influence in politics, society or mores. So it's just an intelligent, sensitive and cultivated man reflecting and reminiscing on his life; somehow I like to think that if ever was to do the same, I would do it that way.

Dancing Arabs, by Sayed Kashua

A nice book by an Arab Israeli author, about the tribulations of a young Arab growing up in Israel, caught between the two cultures of his land, desperately trying to become like a Jew, since he thinks it's the only way to better his life and self-esteem. Through a series of small chapters, very well written in a dry and ironic humor, one gets the sense of the plight of the poor Arab citizens, their difficult situation and the many obstacles they have to surmount until they can become full citizens of Israel. Besides the problems of poverty, lack of education and being an ethnic minority, and the consequent sense of inadequacy and frustration, common to many other disadvantaged minorities in many countries, there's above all a problem of troubled identity, due to the particular history and politics of the region, the sense of being betrayed by the other Arabs that have kept them in an intolerable situation for decades and don't do anything to really help them. There are no answers or solutions in the book, only questions and a vivid portrayal of the situation, through characters sometimes endearing, sometimes despicable, not always likeable, but eminently believable.

Professional joys...

"Hey, doctor, how are you?"; I turned around, and there he was, a young man, smiling at me, Simon. And I was so happy to see him, a young man looking good. I remember the first time I saw him, a 17-year-old boy, so lost and desperate, not understanding what was happening to him, asking from some kind of reassurance. He landed in the hospital Nephrology clinic, sent from another hospital, where they had nonchalantly told him he had to start dialysis and hinted he should be a drug addict, since he was HCV positive. He was angry, he had never used drugs and he didn't understand what was happening to him. It turned out he had a congenital disease, that had caused him to have hearing impairment and severe low platelet counts since childhood, reason why he had received multiple blood transfusions as a child (and caught the hepatitis C virus), and progressive renal failure, that had been overlooked then and had just been detected in the near end-stage phase. And that's where I met him, this dirty-blond kid dressed in black, in a grungy urban-depressive look. He went by himself to the hospital, and it was extremely delicate to explain him about his condition, the imminence of dialysis, etc. He didn't seem to understand, didn't want to understand, and, even if it's relatively common to have to explain this kind of situation to people who never knew they had any kidney problem (it's very frequently undiagnosed until the end-stage), it was particularly hard to tell it to this fragile, upset and lonely kid. I asked him in the end to bring his parents to the next appointment.

But he came back alone; his condition was getting worse, we had to make some treatment decisions, and he was not even of legal age. I pressed him, asking about his parents, finally he told me his mother was severely bi-polar and his father was deaf and aloof and he couldn't count on them. There was an older twenty-something brother though, and I urged him to bring him with him as soon as possible.

Then, what I feared happened: he turned up an afternoon severely uremic in need of immediate dialysis. His brother was with him then, totally bewildered, he hadn't told him anything until then. I was glad it was me the nephrologist on duty, at least I was familiar with the situation and the boy seemed to trust me. I tried to comfort him and the brother as best I could, and silently thanked I was experienced enough - one doesn't put a dialysis catheter in a patient with 9000 platelets with a relaxed mood... Fortunately, everything went smoothly, and in a few days he was feeling much better. His father showed up, and things became calmer. He then opted for peritoneal dialysis, and didn't see much of him for a couple of years, since I was not in that department.

By chance, it was again when I was on duty that a kidney turned up; I was glad to call Simon and to assist him after the procedure. It was successful and, as I was working then at the transplantation unit, I saw him very often for a few years. By then I knew him pretty well, and it was a pleasure to watch him grow. He played the drums in a rock and roll band - he gave me the link to their musics, which were an extremely noisy kind of punk rock, and I joked they were like that because he was half-deaf - then he studied computers and started to work. From a depressed and mixed-up kid he turned into a self-assured young man and, being so used to care for old people, he's one of the patients for whom I always had this kind of paternal feelings.

A few years ago I left the transplantation team, so now I only see him if by chance we meet when he goes to the hospital for blood tests or appointments. I'm glad his transplanted kidney is working well 11 years later, he's now about 30 and leading a full productive life. I really feel professionally and personally fulfilled when I meet him, and just hope he keeps being well and I won't have to put him on dialysis again.

The Yellow Wind, by David Grossman

As usual when I visit a country with whose literature I’m not familiar, I go to bookstores and search for books by national authors that can help me to get into the national mood and preferably enjoying good reading at the same time. And I’m very unfamiliar with Israeli literature, of which I only know Amos Oz, from several essays and the beautiful A Tale of Love and Darkness. So I perused the shelves of a couple of bookstores in Jerusalem, and bought three books, two by Jewish Israelis and one by an Arab Israeli.

The Yellow Wind, by David Grossman, is an impressive and disturbing account of the author’s dealings with people in the Occupied Territories in the late ‘80s, but probably it still applies to the present day. I had my opinion about the Israeli-Palestinian question before, and it hasn’t changed much after going to Israel or reading this book. But it’s always interesting and enlightening to read from different sources and to see some of the places one reads about.

I don’t feel like I have the right to take too strongly sides in complex questions that don’t concern me directly and about which my knowledge is always second or third-hand, and the Israeli-Palestinian problem is certainly one of those. But I have my opinions nonetheless. I think that, historically, and today, the main responsibility for not reaching a reasonable solution lies with the Arabs – from the unspeakably vain and conceited Al-Husseini, mufti of Jerusalem, who maybe bears the greatest responsibility for the present situation, to the murderous and foolish Arafat and the terrorist Islamic organization Fatah, and a series of ambitious Islamic leaders, who undermined and lost a succession of opportunities through the years. Their intolerance never allowed for a reasonable solution, they keep denying to recognize the State of Israel, they were the ones who started all the wars, and they never did anything to improve the situation and lives of the Palestinian refugees, preferring to kindle their misery and hatred, which they use to their own political purposes. There is no “right to return”; especially after wars who were started by them – what about the millions of displaced persons after World War II? Should they have demanded the right to return to their former homelands? To think that millions were displaced, and the last refugee camps were closed in the early ‘50s, and the Palestinians keep living in camps 40 years after 1967… War is awful, but obviously the effects of their war are purposefully prolonged, and that’s unforgivable.

But I also stand here […] as a human being, rising up against this education in blind hatred, and against such tremendous energy being expended for the preservation of malice, instead of being spent in an effort to get out of this barrenness, this ugliness in which this kindergarten lies, these little children who are so good at hating me.

But I cannot condone either the prolonged Israeli occupation of the Territories, and certainly not the policy of the settlements. Israel is a democratic and admirable country, and it’s being corrupted by its behavior as an occupying power. In my opinion, they should annex whatever land they deem indispensable for their security and let go of the rest. I cannot believe it would be more difficult to defend the country, and their moral standing would be much better, and I believe they would actually be a model for the region, since I’m sure that Israeli Arabs live better than Arabs in any other country of the Middle East. I sincerely hope the younger Israeli generation will steer away from Jewish religious intolerant bigots and support the reasonable and morally right conduct – to end the occupation. I know it won’t be easy, no less for the absence of any credible and reasonable Arab Palestinian organization to deal with, but one of the things this book shows is we’re dealing with people, and human beings are much the same everywhere, and we must struggle for the basic rights of everyone to happiness and well-being.

… and that in any case I cannot be responsible for what was done before I was born, and that on the contrary, since today we see the results of earlier wars, we must take care not to bring about further injustice.

The pregnancy that wasn't

It’s not her in the photo, but it could well be. She’s also from Guinea-Bissao, a petite very black woman, usually quiet and seldom smiling, when she does her very white teeth and suddenly bright eyes lighten her face. I’ve known her, and been her doctor, for a little over 10 years now. As many others, she had just arrived from Guinea, evacuated to Lisbon due to needing dialysis, unavailable in her country. That meant she had to leave home and family (she had a little daughter) overnight, to live in Lisbon, where she had to make a living, since the agreements between Guinea and Portugal cover just the medical treatments, and the patients have no support whatsoever from their government. It’s the plight of several people from former Portuguese African colonies – Cape Vert, Guinea-Bissao, São Tomé, Angola – who need dialysis to survive and so have to make a living in our country.

So, this girl, who was 26 at the time, found some work as cleaning woman and eventually built herself a new life, with a new partner, sending money home to her old mother and her daughter, who later emigrated herself to France. I always liked this woman; she was never very compliant with therapy, she was always stubborn and sometimes silly, but she was hard-working, she never complained, and she cared about her family. Once, when I complained about the amount of anti-hypertensive medication she kept asking for, she told me: “My mother takes Norvax… I send it to her”. – By the way, that’s not the only time I faced this situation, I remember a man from Guinea who sent his HIV medications to his wife because she wrote him she was ill.

She had lots of problems – hepatitis C, an abortion, a renal carcinoma – but she kept on working and looked always the same. And then, recently, she told me she had missed her period. Women with end-stage renal disease rarely become pregnant, but I have seen a few cases, so I ordered a pregnancy test, and it was positive. I was worried – the chances of a successful pregnancy on dialysis are thin, and this particular patient had a lot of risk factors besides her renal disease – hypertension, hepatitis C, previous miscarriage… I asked her if she wanted the baby, hoping she wouldn’t, but she said she did. Probably because it would be a child by her new partner, I don’t know. So, I changed her treatment plan, changed her medication, sent her to the Obstetrics high-risk clinic. I’ve had a couple of successful pregnancies on dialysis, but I had a bad feeling about this one, too many problems, and I feared it would all end in her losing the baby and getting worse in the way. But I complied to her wishes, and we would try.

Then the obstetric ultrasound was inconclusive, and so was the confirmation blood test, they thought she might have an ectopic pregnancy, then an ovarian tumor, then finally she bled again and it had all been false positives. I must say I was relieved by it – I knew it wouldn’t end well, and it was good she wasn’t pregnant after all.

I don’t know if she felt sorry for not being pregnant. She just looks the same, I talked to her and resumed her usual medication. I’m glad she was spared an almost certainly unsuccessful pregnancy, but I don’t know if she understands it, I don’t know how she feels. She just looks the same.