It was hard to stay angry at Farmer, especially then, as he sat there in his rumpled black suit, waiting out another airport delay in a barren little restaurant, worrying that his admiration for Cuba might be used against his cause and end up harming his patients in the central plateau. I wasn’t sure we really had much of an argument over Cuba. Years of bad publicity heaped on the country’s government had certainly colored my view of the place but, more than that, had made me wary of coming to conclusions. No question but that Cuba had pulled off something difficult and, in the view from Haiti, enviable—first-rate public health, equitably distributed, in spite of severely limited resources. I just wondered what price in political freedom its people paid for that achievement. But I understood that Farmer would frame the question differently, and ask what price most people would be willing to pay for freedom from illness and premature death. For me, Cuba posed a rather abstract question. For Farmer, it represented hope, proof that a poor country could achieve good public health. “If I could turn Haiti into Cuba, I’d do it in a minute,” he had said rather heatedly a while ago. I’d have agreed, if I hadn’t felt that the heat was directed at me.
We lingered in the restaurant. I asked him what his hopes for Haiti were.
“I don’t have any that are based on analysis or numbers or hard-headed interpretation of the best available data,” he said. “But I have hopes for Haiti.” These lay partly outside Haiti. “Some people would say things will get so bad that Haitians will revolt. But you can’t revolt when you’re coughing out your lungs or starving. Someone’s going to have to revolt on the Haitians’ behalf, including people from the wealthy classes.” He added, “But that would be regarded as a total joke by the left.”
He turned and gazed out the window. A large sign was affixed to an airplane hangar across the tarmac. It read PATRIA ES HUMANIDAD. An internationalist assertion—the only real nation is humanity.
“I think that’s so lovely,” Farmer said.
“I don’t know,” I said. “It seems like a slogan to me.”
He looked away. “I guess you’re right.”
I felt as though I’d punched him. Among a coward’s weapons, cynicism is the nastiest of all. “No, it is lovely,” I muttered. “If it’s really meant.”
We got to Miami so late, and he had so much shopping to do, and so many e-mails had accumulated in his account—about a thousand in all, at least two dozen of which concerned patients and required immediate answers—that we almost missed our night flight to Paris. They closed the gate behind us, and Farmer declared our timing “perfect.” But the plane was full, and there was no room left for our briefcases. I felt as if I wedged myself into my seat, and Farmer’s legs were longer than mine.
For the last day and a half, I’d been suffering from diarrhea. Not from the Cuban water, probably from too many mojitos. I had resolved not to tell Farmer and remained determined not to, right up until I told him.
We had taken off. He’d ingested a sleeping pill, a fast-acting benzodiazepine, and his eyelids were fluttering. They opened right up, however, when I made my complaint. He looked over at me, his face utterly serious. “From now on,” he said, “I want a full report on all of your bowel movements.”
I felt greatly reassured, much better already in fact, and the last remnants of my anger at Farmer seeped away.
It still seemed to me that he took a stance all too conveniently impregnable. He embodied a preferential option for the poor. Therefore, any criticism of him amounted to an assault on the already downtrodden people he served. But I knew by now he wasn’t simply posing. I felt something about him that I’d later frame to myself this way: He said patients came first, prisoners second, and students third, but this didn’t leave out much of humanity. Every sick person seemed to be a potential patient of Farmer’s and every healthy person a potential student. In his mind, he was fighting all poverty all the time, an endeavor full of difficulties and inevitable failures. For him, the reward was inward clarity, and the price perpetual anger or, at best, discomfort with the world, not always on the surface but always there. Sensing this, I’d begun to be relieved of the shallower discomforts I sometimes felt in his company, that I’d felt keenly back in the airport in Cuba. Farmer wasn’t put on earth to make anyone feel comfortable, except for those lucky enough to be his patients, and for the moment I had become one of those.
CHAPTER 22
Farmer had loved Paris as a boy from Jenkins Creek on his college semester abroad, and he’d felt great anticipation when he’d taken his wife, Didi, there. It was her first trip ever away from Haiti. Wasn’t this the loveliest city in the world? he’d asked her. But the sights of its gorgeous parks and buildings had moved her differently: “Knowing that this splendor came from the suffering of my ancestors.” Didi was studying that subject now in Paris, in the archives of the French slave masters, in the detailed records they had kept of their commerce in West Africans. Since then, some of the city’s charm had worn off for Farmer.
The sleeping pills that he brought to get us through the flights have left my memories of our stop in Paris all wrapped up in gauze. I recall an early morning, Farmer gazing out the windows of the cab, reentering the first world by staring at the cardboard box–like high-rises of the periphery, where, he said, many of the indigent of Paris had been relocated. As we entered the city proper, that great dove-colored epicurean city, he murmured something about how much could be done in Haiti if only he could get his hands on the money that the first world spent on pet grooming.
The cab let us off in the Marais district, a place of narrow streets and sidewalks, of bistros, diminutive hotels, and shops. The Farmer family residence was an apartment of three small rooms, borrowed from one of his oldest friends from Duke. Didi—tall and stately—met us at the door with an enormous smile. I remember thinking that Didi probably was the most beautiful woman from Cange. And I remember Farmer in his black suit, dancing with his daughter, holding her to his chest, swaying from side to side in a loopy, long-limbed waltz. And the little girl’s dark eyes, which her face hadn’t yet grown into, fixed in serious rapture on some invisible object on the ceiling. Later, Farmer sat on the sofa and watched Catherine play with her stuffed animals. Didi called to him from the kitchen. When did he leave for Moscow?
Tomorrow morning, Farmer said.
From the kitchen came the sound of something dropping and a deep-throated exclamation.
I looked over at Farmer. He was clasping his knees with his elbows and covering his mouth with both hands. I remember thinking, despite my enveloping haze, I’d remember this. It was the first time I’d seen him at a loss for words or action.
Ironic, I suppose, that just when his organization’s endeavors had ceased to be global in theory and had become global in fact, a child had entered his life. Lately, he received a fair amount of criticism from friends for not spending more time with his family, and there were some who, when they spoke about this matter out of his earshot, seemed oddly animated. Their voices would rise, or they would smile conspiratorially. “Can you imagine what it’s like being married to him?” I wonder if this was a species of moral envy. Jim Kim said, “Paul has a gift for making people feel guilty.” Farmer counseled others to take vacations while taking none himself. He didn’t disapprove of others having luxuries, so long as they gave something to the causes of the poor. He demanded a great deal from protégés and colleagues, and he always forgave them when they didn’t measure up. And so I think it was a relief, for some, to find what looked like a chink in his moral armor.
In Haiti, we’d had a conversation about his daughter. A month after she was born, a woman had come to Zanmi Lasante suffering from eclampsia. It is a disease of pregnancy, of mysterious origin, found preponderantly among poor women. It leads to protein in the urine, hypertension, seizures, and sometimes death, for both mother and child. The treatment is magnesium sulfate and delivery of the child. The clinic was very busy. Farmer was rushing around trying to get the tr
eatment started. He was saying to the staff, “Come on, get off your butts. Get an IV in, I want to induce her now.” The baby was alive. He could hear the heartbeat.
He remembered, “The mother was seizing. I said, ‘Hurry!’ Everything was going okay. Then the baby was born, and it was dead. A full-term, beautiful baby, and I started to weep. I had to excuse myself and go outside. I wondered, What’s going on? Then I realized I was crying because of Catherine.” He had imagined her in the place of the stillborn child. “So you love your own child more than these kids,” he said to himself.
He went on: “I thought I was the king of empathy for these poor kids, but if I was the king of empathy, why this big shift because of my daughter? It was a failure of empathy, the inability to love other children as much as yours. The thing is, everybody understands that, encourages that, praises you for it. But the hard thing is the other.”
I thought about this for a while, attempting to frame my question delicately. Finally, I just tried to disassociate myself from it: “Some people would say, Where do you get off thinking you’re different from everyone and can love the children of others as much as your own. What would you say to that?”
“Look,” he replied. “All the great religious traditions of the world say, Love thy neighbor as thyself. My answer is, I’m sorry, I can’t, but I’m gonna keep on trying, comma.”
I imagine that many people would like to construct a life like Farmer’s, to wake up knowing what they ought to do and feeling that they were doing it. But I can’t think that many would willingly take on the difficulties, giving up their comforts and time with family. It wasn’t as if this stopover in Paris represented all there was to his domestic life. He and Didi and Catherine spent the summers together in Cange, and no doubt those periods would lengthen once Didi finished her studies. But his days and nights looked hard and in some ways lonesome. He was carrying a pair of photographs on this light month for travel. One was of Catherine, and at each stop he’d show it off to friends like any proud parent, but then sometimes he’d show the other, a photo of a Haitian child of about the same age, except in the throes of kwashiorkor. At first, this seemed perverse to me. But the other, starving child wasn’t an abstraction, like the pictures of starving children on TV. She was Farmer’s patient, and I think in his mind she stood for all the others, including tuberculous prisoners in Russia, for whom he was leaving his daughter tomorrow on the morning flight to Moscow. I don’t think anyone who knew how much Farmer craved connections among all parts of his life could have looked at him at that moment on the couch in Paris, all folded up as if trying to hide, and not felt some sympathy for his predicament.
The moment passed. Farmer was stopping in Paris mainly for Catherine’s second birthday party. The event was a success, and Catherine clapped her hands at her present—a mechanical bird on a wire that flew around the small living room. He’d bought it in the Miami airport. It was one of the reasons we’d almost missed the plane to Paris. Among the guests, there were a couple of members of the French family for whom Farmer had worked as an au pair, almost twenty years ago, during his student year abroad. These days they did some fund-raising for PIH. There were also Haitian friends at the party, in France long enough that they no longer passed what Farmer called “the fat test”—that is, they looked well-fed—but Haiti was almost all they talked about. There was a family friend from Burkina Faso, who told me he was homesick, and I was reminded of something Farmer had said, that PIH headquarters wasn’t Boston or even Haiti but wherever PIH-ers happened to be. He had built a web of acquaintance as large as any major politician’s. The difference was that not many people in his web remained mere acquaintances for long, and not many would have found it easy simply to slip away, even if they wanted to. For Farmer, the worst kind of exile wouldn’t be geographical. It would be something like excommunication.
Before he went to bed, he phoned his mother in Florida, to ask her to give him a wake-up call at 7:00 A.M. here in Paris. Didi shook her head. “We have an alarm clock,” she said to me, but she was smiling.
I counted time zones. His mother would have to be up at 1:00 A.M. to make the call. I wondered if she minded, but she told me some months later, “I just think it’s so cool that at forty he still does that. I’d miss it if he didn’t.”
We got to the airport early, for once, and went to a café for breakfast. “Okay,” Farmer said, when we found a table, “time to get to work.” He pulled out his most recent bwat list. Only about two-thirds of the little boxes had been checked. “This is shameful.” He stared at the sheets of paper. “All these bwats were supposed to be done before we left Cuba.”
Among them was a dual bwat, one that consisted of two chores; if he completed either, he’d get to check the box. The dual bwat commanded him either to buy new underwear or to finish a letter. “I didn’t get the underwear, so …” This was a letter he had started during a hike we’d taken back in Haiti. He pulled the unfinished page from his briefcase. It had a grease stain on it, from some article of the fifth food group he’d eaten on the hike. “It seems fitting to write you as I sit in the middle of the Haitian countryside,” the letter began. He bent over it, writing on.
“Is this bwat transfer or bwat cheating?” I asked.
“Depends on whether or not you have an H of G for the endeavor,” he said, without looking up.
“An H of G” was short for “a hermeneutic of generosity,” which he had defined once for me in an e-mail: “I have a hermeneutic of generosity for you because I know you’re a good guy. Therefore I will interpret what you say and do in a favorable light. Seems like I’m the one who should hope for as much from you.” I have counted scores of terms like that one in his lexicon, which was also the lexicon of PIH. Jim and Ophelia had invented some, and some came from the Brigham, but most were Farmer’s, or his family’s.
One time his brother Jeff, the wrestler, sent him a card in which he misspelled the word “Haitians.” He spelled it “Hatians.” So in PIH lingo, Haitians were “Hat-eans” or simply “Hats,” and their country was “Hatland.” The French were “Fran-chayze,” their tongue “Franchayze language,” and Russians were “Rooskies.” A “chatterjee” was a person of East Indian descent—there were a few in PIH—who talked a lot. Farmer referred to himself as “white trash”—he had an old photo to prove it, his extended family at a picnic around a couch outdoors. The man who railed about the plight of impoverished women everywhere would in private, poking fun, employ terms like “chicks.” “I don’t care about any of that stuff,” he told me once. “Just the one thing.” Impolite terms, used intramurally, were meant as philosophical rebukes to the misplaced preoccupations of those who believed in “identity politics,” in the idea that all members of an oppressed minority were equally oppressed, which all too conveniently obscured the fact that there were real differences in the “shaftedness,” also sometimes called the “degrees of hose-edness,” that people of the same race or gender suffered. “All suffering isn’t equal” was an article of the PIH faith, generated in reaction to the many times when they had tried to raise money and instead had been offered lectures about the universality of suffering, or simply lines like “The rich have problems, too.” (Farmer once taught a course at Harvard called Varieties of Human Suffering.)
“When people get around Paul, they start talking like Paul,” his old friend from medical school the writer Ethan Canin said. “He’s such a word gymnast.” There was an obvious utility in the brevity of terms like “H of G,” for a mind moving fast, and for people trying to keep up. When, for instance, “TBMI” (transnational bureaucrats managing inequality) produced clever arguments (also known as “well-formed stool”) against treating MDR or AIDS, one could simply say, “Love, ID,” and be completely understood. Everyone in PIH knew that “DQ” stood for “Drama Queen,” and a DQ proposal meant an emotional appeal. (“We could use a DQ quote here, and a generic inequality-of-outcomes over here,” I once heard Farmer say to a young assistant
working with him on a speech.) “Geek flowers” was the completed research that PIH-ers presented to Farmer or Kim, and “scholbutt” was short for “scholarly buttressing,” which meant that every statement of fact Farmer made in a paper had to be verified as coming from some authoritative source. (“He’s neurotic about having it all perfect,” said a medical student who did a lot of scholbutt for Farmer. “Not because he’s anal but because when you’re doing these things for the poor, amidst arguments that it’s not cost-effective to treat them, you have to be perfect or you’ll be picked apart.”)
“Lugar” was luggage. “Koutoums” meant “customs.” To commit “a seven-three” was to use seven words where three would do, and a “ninety-nine one hundred” was quitting on a nearly completed job. (“Nothing pisses me off like a ninety-nine one hundred,” Farmer would say.) PIH-ers often said “Thank you” to people who had done something for a third party, for anyone who belonged to the multitudinous group known variously as “the indigent sick,” “the shafted,” and “the poor,” the last being the term of choice in PIH because, as Farmer would say, it was the term that most Haitians used to describe themselves.
You could hang around the inner circle of PIH for a long time without understanding what the rules were and feeling excluded, and the more left out you felt, the more you suspected you were being told you weren’t as good as they were, even as you suspected that your irritation proved it. To me, the inner circle of PIH seemed like a club, or even like a family, which was deeply opposed to the concept of insiders and outsiders, and yet equipped with its own special bylaws and language. Say that to Farmer and he’d reply, “If so, it’s surely the most inclusive damn club in the world, being full of people with AIDS, WL’s galore, tons of students, church ladies, lots of patients, and it’s a club that grows and never shrinks.” And Farmer had a way of creating a club that consisted just of him and you.