Our malady Lessons in liberty from a hospital diary

Timothy Snyder

Book - 2020

"From the author of On Tyranny comes an urgent diagnosis of an American malady: our heartless system of commercial medicine and our politics of pain. On December 29, 2019, historian Timothy Snyder fell gravely ill. Unable to stand, barely able to think, he waited for hours in an emergency room before being correctly diagnosed and rushed into surgery. Over the next few days, as he clung to life and the first light of a new year came through his window, he found himself reflecting on the fragility of health, not recognized in America as a human right, but without which all rights and freedoms have no meaning. And he had no idea how much worse things could get. Now, American hospitals, long understaffed and undersupplied, are buckling und...er waves of coronavirus patients. The federal government has responded with willful ignorance, misinformation, and profiteering. Even with public life at a standstill, thousands of Americans continue to die, needlessly, every single day. In this eye-opening cri de coeur, Snyder traces the societal forces that led us here and outlines the lessons we must learn to survive. In examining some of the darkest moments of recent history and of his own life, Snyder finds glimmers of hope, and principles that could lead us out of our current malaise. Only by enshrining healthcare as a human right, elevating the authority of doctors and medical knowledge, and planning for our children's future can we create an America where everyone is truly free"--

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Subjects
Published
New York : Crown [2020]
Language
English
Main Author
Timothy Snyder (author)
Edition
First edition
Item Description
"A Crown Trade Paperback original" -- title page verso.
Physical Description
179 pages ; 16 cm
Bibliography
Includes bibliographical references.
ISBN
9780593238899
  • Prologue: Solitude and Solidarity
  • Introduction: Our Malady
  • Lesson 1. Health care is a human right.
  • Lesson 2. Renewal begins with children.
  • Lesson 3. The truth will set us free.
  • Lesson 4. Doctors should be in charge.
  • Conclusion: Our Recovery
  • Epilogue: Rage and Empathy.
Review by Booklist Review

Snyder, a Yale historian and author, landed in the emergency room with tingling hands and feet and a baseball-sized abscess in his liver from an overlooked burst appendix. His own near-death experience causes him to reflect on the "flawed" U.S. medical system and how ill-equipped it is to handle the pandemic. It's not his usual area of expertise, but he gives a broad overview of how the government mishandled its response to COVID-19. No fan of the president, Snyder writes, "Trump made it clear that resources purchased with taxpayers' money would be distributed according to governors' loyalty to him." The current failures show "how far our democracy has declined." He also chillingly observes that Trump's behavior follows the traditional authoritarian pattern of denying reality, claiming magical immunity, harassing reporters, and cultivating fear. Critics may take issue with whether a historian without a medical background is best qualified to argue for a single-payer healthcare policy, but he makes a compelling case for fixing a system that is so expensive that nearly half of Americans avoid medical treatment because they cannot afford it.

From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review

Historian Snyder (The Road to Unfreedom) frames this searing critique of the American health-care system around his own recent medical emergency. After a series of medical mistakes related to an appendectomy, Snyder nearly died before undergoing surgery for a severe liver infection in December 2019. Doctors treating the appendicitis had seen a lesion in his liver but did nothing to treat it; a different set of doctors botched a spinal tap and missed clear indications of a liver problem in Snyder's medical records. These were not isolated mistakes, according to Snyder, but symptoms of a systemic failure in which doctors and nurses are not given enough time to meet with patients and truly assess their needs, and are encouraged to prescribe medication rather than get to the root of the problem. Snyder also contrasts his wife's medical care during pregnancies in Vienna and the U.S., and sketches the Trump administration's inadequate response to the Covid-19 pandemic. According to Snyder, the present state of health care violates America's founding principles: "Freedom is impossible when we are too ill to conceive of happiness and too weak to pursue it." Though he doesn't offer much in the way of specific solutions, Snyder draws valuable context and insight out of his harrowing personal experience. The result is a troubling portrait of a system in which the patient is the last priority. (Sept.)

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Review by Library Journal Review

The malady discussed here is one that Snyder (history, Yale Univ.; On Tyranny) says permeates our society. From the end of 2019 until March 2020, the author found himself intimately involved with the U.S. health care system when his appendix burst following a missed diagnosis, leading to an overlooked abscessed liver and septicemia; it brought him to the brink of death. Once able, he began journaling his experiences, feelings, and conclusions about how we care for one another. He emerged from his personal battle directly into the new world of COVID-19. With this lens, the author describes what he sees as clear evidence of disparity in health care accessibility in the United States, in which the highest spending in the world produces poor results compared with other developed countries. He argues for health care as a human right, and asserts it is not recognized as such in this country. Advocating for a universal system with medical professionals rather than insurance companies in charge, he believes, would allow patients more freedom in their health care choices. VERDICT Snyder writes with passion and clarity, using personal observations, historical references, and case studies to raise the call for reforming the current health care system; stating that without changes, true freedom remains elusive for many.--Richard Maxwell, Porter Adventist Hosp. Lib., Denver

(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review

The award-winning Yale historian launches a broadside against the American health care system. "The day that had just begun, December 29, 2019, could have been my last." So writes Snyder about his hospitalization and subsequent poor treatment over the next few months, experiences that left him enraged at the state of health care in America. "In five hospitals over three months," the author found himself with a front-row seat to the beginnings of the coronavirus pandemic. He took detailed notes during his time as a patient, and he clearly shows a health care system far more interested in profits than health, a system that follows the dictates of computers and algorithms rather than any one-to-one relationship between doctor and patient. Snyder delivers a scathing critique of this "grotesque" and "ludicrous" system as well as a government response to the pandemic that he dismisses as "magical thinking." Indeed, the Trump administration's "unwillingness to test did not mean that we were healthy, only that we were ignorant," and the "focus on a foreign source of 'fault' meant that no one here was to blame. When no one bears responsibility, no one has to do anything." The author meticulously documents the health problems he suffered--among many others, a burst appendix, tremors, and "an abscess the size of a baseball in my liver"--seemingly all of which were ignored or misdiagnosed by doctors. Snyder compares the impersonalized, economy-driven care he received in American hospitals with the far more nurturing treatment he and his wife had experienced during a childbirth in Austria, a procedure that was both "intimate and inexpensive." Ultimately, writes the author, "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." An impassioned indictment of a broken system and its enablers and necessary reading as the pandemic intensifies. Copyright (c) Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

Prologue Solitude and Solidarity When I was admitted to the emergency room at midnight, I used the word malaise to describe my condition to the doctor. My head ached, my hands and feet tingled, I was coughing, and I could barely move. Every so often I was seized by tremors. The day that had just begun, December 29th, 2019, could have been my last. I had an abscess the size of a baseball in my liver, and the infection had spilled into my blood. I did not know this at the time, but I knew that something was deeply wrong. Malaise, of course, means weakness and weariness, a sense that nothing works and nothing can be done. Malaise is what we feel when we have a malady. Malaise and malady are good old words, from French and Latin, used in English for hundreds of years; in American Revolutionary times they meant both illness and tyranny. After the Boston Massacre, a letter from prominent Bostonians called for an end to "the national and colonial malady." The Founding Fathers wrote of malaise and malady when discussing their own health and that of the republic they founded. This book is about a malady--not my own, though mine helped me to see it, but our common American one: "our public malady," to borrow James Madison's phrase. Our malady is physical illness and the political evil that surrounds it. We are ill in a way that costs us freedom, and unfree in a way that costs us health. Our politics are too much about the curse of pain and too little about the blessings of liberty. When I got sick at the end of last year, freedom was on my mind. As a historian, I had spent twenty years writing about the atrocities of the twentieth century, such as ethnic cleansing, the Nazi Holocaust, and Soviet terror. Recently I have been thinking and speaking about how history defends against tyranny in the present and safeguards freedom for the future. The last time I was able to stand before an audience, I was giving a lecture about how America could become a free country. I hurt that evening, but I did my job, and then I went to the hospital. What followed has helped me to think more deeply about freedom, and about America. When I stood before the lectern in Munich on December 3rd, 2019, I had appendicitis. That condition was overlooked by German doctors. My appendix burst, and my liver became infected. This was neglected by American doctors. That is how I ended up in an emergency room in New Haven, Connecticut, on December 29th, bacteria racing through my bloodstream, still thinking about freedom. In five hospitals over three months, between December 2019 and March 2020, I took notes and made sketches. It was easy to grasp that freedom and health were connected when my will could not move my body, or when my body was attached to bags and tubes. *** When I look at the pages of my hospital journals, stained by saline, alcohol, and blood, I see that the New Haven sections, from the last days of the year, concern the powerful emotions that rescued me when I was near death. An intense rage and a gentle empathy sustained me, and provoked me to think anew about liberty. The first words I wrote in New Haven were "only rage lonely rage." I have felt nothing cleaner and more intense than rage amidst deathly illness. It came to me in the hospital at night, giving me a torch that ignited amidst kinds of darkness I hadn't before known. On December 29th, after seventeen hours in the emergency room, I had an operation on my liver. Lying on my back in a hospital bed in the early morning hours of December 30th, tubes in my arms and chest, I couldn't ball my fists, but I imagined that I was balling my fists. I couldn't raise my body from my bed on my forearms, but I had a vision of myself doing so. I was one more patient in one more hospital ward, one more set of failing organs, one more vessel of infected blood. But I didn't feel that way. I felt like an immobilized, infuriated me. The rage was beautifully pure, undefiled by an object. I was not angry at God; this was not His fault. I was not angry at the doctors and the nurses, imperfect people in an imperfect world. I was not angry at the pedestrians moving freely about the city beyond my chamber of twisted sheets and tubes, nor at the deliverymen slamming their doors, nor at the truckers blowing their horns. I was not angry at the bacteria celebrating the bounty of my blood. My rage was directed against nothing. I raged against a world where I was not. I raged therefore I was. The rage cast a light that revealed an outline of me. "The shadow of the solitary is the unique," I wrote, rather obscurely, in my diary. My neurons were just starting to fire. The next day, December 31st, my mind began to recover from the sepsis and the sedation. I could think for more than a few seconds at a time. My first extended thought was about uniqueness. No one had ever moved through life as I had, making just the same choices. No one was spending New Year's Eve in exactly the same predicament with just the same emotions. I wanted my rage to lead me out of my bed, and into another year. In my mind's eye I saw my dead body, its decomposition. The predictability of rot was horrible. It is the same for everyone who has ever lived. What I wanted was unpredictability, my own unpredictability, and my own contact with the unpredictability of others. For a few nights, my rage was my life. It was here, it was now, and I wanted more of the here and more of the now. In my bed I craved a few more weeks, and a few more weeks after that, when I wouldn't know what would happen to my body, wouldn't know what would play out in my mind--but would know that the person feeling and thinking was me. Death would extinguish my sense of how things could and should be, of the possible and beautiful. It was against that nothing, "that particular nothing," as I wrote in my diary, that I raged. The rage was with me for only a few minutes at a time, bringing warmth as well as light. My body usually felt cold, despite my fever. In my hospital bed on New Year's Eve I wanted the sun to come up, and I wanted it in the room. I wanted it on my skin. After three days of trembling, I needed more than my own warmth, which escaped through the thin sheets that kept twisting around the tubes in my chest and arm. The winter sunrise in New England through a thick window isn't much; I was living in symbols and desires. I didn't want the torch in my mind to be a lonely light. And it was not. People came to visit me. My wife opened the shade, and the wan New Year entered. When other visitors began to arrive, I guessed how they would react at bedside to a helpless me, but I didn't know. I remembered that some of the old friends visiting me think that patients who are visited get better treatment. They are surely right: health is a matter of being together, in that way and a hundred others. A visit helps us to be alone. Being together in solidarity permits a return to solitude in tranquility. Just by appearing, my friends set off memories, chains of association back into our past. I remembered a moment when one friend had shared that pragmatic view of why patients should be visited: years before, when it was I who was at her bedside, when it was she who was ill, and pregnant, in the same hospital where I myself now lay. I thought about her children, then about mine. Another mood was coalescing: a gentle empathy. Excerpted from Our Malady: Lessons in Liberty from a Hospital Diary by Timothy Snyder All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.