Home > Our Malady :Lessons in Liberty from a Hospital Diary(2)

Our Malady :Lessons in Liberty from a Hospital Diary(2)
Author: Timothy Snyder

 

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   The rage was pure me, my wish to be a sound not an echo, to compose not decompose. It was not against anything, except the entire universe and its laws of unlife. For a night or two I could shine in my own light.

       Yet, slowly and softly, a second mood impinged, one that sustained me in a different way: a feeling that life was only truly life insofar as it was not only about me. Like the rage, this mood visited me when I was alone, when I could do little for myself, when my whole sense of motion came from visions in my mind. In this mood I felt myself to be in a cluster of something with other people, tumbling through time. When I tried to draw the feeling in my journal, I came up with an uneven, floating conveyance. It looked a bit like a raft.

   A raft can be built over time from bits and pieces. I was a part of a raft, and others were, too; we were floating and jostling together in the same water, sometimes effortlessly, sometimes against the rocks. If my plank fell into the deep, the raft might lose its way or capsize. Some planks of the raft were further from mine, and some were closer. I recited to myself the ways my children’s lives were bound to my own. What mattered was not that I was distinct, but that I was theirs: their father. Every bit of their existence involved the expectation of my presence. They had never not touched me. Their planks had always been bound to mine.

   I imagined what would change without me, beginning with the daily details that mark the mental calendar of a parent: soccer practice, math homework, reading out loud. I recognized with pain that my vision of my son without me, of my daughter without me, were just as real as my previous life with them. I watched their future unfold without me, in my mind’s eye, and then I reeled it back.

       This floating recognition that my life was not my own, this gentle empathy, escorted me away from death. This sense that life was shared began with my children but extended outwards, an uneven collection of timber making up the raft. I was splashing and tugging forward with everyone I knew and loved, and all would be affected if I fell away now. In this mood I was not raging, but floating along, remembering, contemplating, empathizing.

   The rage helped me see myself, helped my body and mind take on distinct form after a shock. The empathy placed me among others. In this mood, it was not so important that I was special. It was important that I was inside other people, in their memories and expectations, a support in the shape of their lives, a buoy during difficult passages. Since my life was not just my own, then my death was not just my own. When I reached that point, I began to rage again. This could not happen.

       The empathy, though altogether different from the rage, worked together with it. Each mood revealed a truth, an element of me. Neither was enough; I needed both. I needed the torch and the raft, the fire and the water, the solitude and the solidarity, to get well, to be free. And what is true for me, I suspect, is true for others.

 

 

INTRODUCTION


   Our Malady


   Had I died, my death would have been all too typical, a passing into sad statistics. Far too many Americans needlessly departed life in the early months of 2020. Far too many Americans are too close to death every month, every moment. Although we have been promised ever longer lives, life expectancy in our country has flatlined, with no meaningful change in half a decade. In some recent years the life expectancy of Americans has declined.

   The beginning of life in this country is frightening and uncertain. Care of expectant mothers is wildly uneven and grossly inadequate. Black women often die in childbirth, and so do their babies. The mortality rate of babies borne by African American women is higher than in Albania, Kazakhstan, China, and about seventy other countries. America as a whole does worse than Belarus, the most Soviet of the post-Soviet states; and Bosnia, an awkward creation of the Yugoslav civil wars—not to mention forty other countries. Young adulthood has lost its charm. Unless something changes, millennials will live shorter lives while spending more money on health care than Gen-X parents or boomer grandparents. The prime of life is not what it once was. Middle-aged white men are committing suicide and drugging themselves to death in astonishing numbers. Middle-aged white women in the South are dying before their time.

       Our system of commercial medicine, dominated by private insurance, regional groups of private hospitals, and other powerful interests, looks more and more like a numbers racket. We would like to think we have health care that incidentally involves some wealth transfer; what we actually have is wealth transfer that incidentally involves some health care. If birth is not safe, and is less safe for some than for others, then something is wrong. If more money is extracted from young adults for health care, but they are less well than older generations, something is wrong. If the people who used to believe in the country are killing themselves, something is wrong. The purpose of medicine is not to squeeze maximum profits from sick bodies during short lives, but to enable health and freedom during long ones.

       Our malady is particular to America. We die younger than people in twenty-three European countries; we die younger than people in Asia (Japan, South Korea, Hong Kong, Singapore, Israel, Lebanon); we die younger than people in our own hemisphere (Barbados, Costa Rica, Chile); we die younger than people in other countries with histories of British settlement (Canada, Australia, New Zealand). Other places keep passing us in the longevity charts. In 1980, when I was ten, Americans lived on average about a year less than inhabitants of countries of comparable wealth. By 2020, when I was fifty, the difference in life expectancy had grown to four years. It is not that other countries have more knowledge or better doctors. It is that they have better systems.

   The gap between the United States and other countries grew in 2020, since no democracy mishandled the coronavirus pandemic as we have done. People in Japan and Germany, in South Korea and Austria, and indeed in all rich democracies, were at less risk than we were, because their governments treated them better, and because they had better access to information and care. It was already far too easy to die in this country before the novel coronavirus arrived in the United States. Our botching of a pandemic is the latest symptom of our malady, of a politics that deals out pain and death rather than security and health, profit for a few rather than prosperity for the many.

       The new coronavirus ought to have been taken seriously from the time of my hospitalization, which is when it was documented. In January 2020 we should have acquired a test for the novel coronavirus, tracked the new disease down, and limited its reach. This could easily have been done. Far poorer countries did it. Americans infected with the coronavirus should all have had access to hospital beds and ventilators, and the doctors and nurses who treated them should have had enough masks and gowns. A virus is not human, but it is a measure of humanity. We have not measured up well. A hundred and fifty thousand Americans are dead for no reason at all.

   Our malady makes pollution deaths, opioid deaths, prison deaths, suicides, newborn deaths, and now mass graves for the elderly all too familiar. Our malady goes deeper than any statistic, deeper even than a pandemic. There are reasons why we are living shorter, unhappier lives. There are reasons why a president thought he could keep Americans ignorant during a pandemic, and exploit our confusion and pain. Our malady leaves us isolated, uncertain where to turn when we hurt.

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