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  1. University of Arkansas for Medical Sciences
  2. Medicine and Meaning
  3. Author: UAMS Online
  4. Page 16

UAMS Online

Epic Haikus

Epic, open, please!
Numerous charts to complete.
Will you ever load?


Physician builders,
Trained to improve Epic work.
We need more of you.

Alvin F. Stewart, M.D., is the Epic Anesthesia Operational Lead and Epic Physician Builder. He is also an Assistant Professor in the Department of Anesthesiology at UAMS.

Filed Under: all, Poetry

I, Atlas

Beautiful life so often forsaken
Let sounds of the night gently awaken
The burning desire to live

Caught up in the rhythm with no rhyme or reason
I keep running in place with each passing season
To proceed I first must forgive

Forgive myself for not reaching the unattainable
Forgive the world for being so unchangeable
And I must let myself just be

Be merely human. Be free

Tyler Estes is a third-year M.D./M.P.H. student at UAMS.

Filed Under: all, Poetry

Riding the Waves of Discovery

Ocean waves
(Image credit: Getty Images/iStockphoto)

By Paulette Mehta

He wanted to be scooped up in the ocean wave of new discoveries and to ride the wave for as long as he could. Anything, anything to have a chance.

I met Mr. Lemming for the first time in the I.C.U. He had been flown in from Bentonville, a bustling, small town that was home of the national headquarters of Wal-mart in Northwest Arkansas. He had come to the Emergency Room for confusion and blurred vision. Work-up in the local hospital showed that his white blood cell count was more than 15 times normal making his blood thick and possibly causing it to stagnate in his arteries and veins. His referring doctor thought he was having a stroke and sent him to our hospital immediately. Since he had fought bravely in the Vietnam war, had been honorably discharged, and had acquired several conditions presumably because of his service, he was eligible for free medical care in the V.A. system. He was therefore flown to our V.A., the largest such facility in Arkansas.

When I came down to meet him in the I.C.U., I realized that our resident team was giving him blood, antibiotics, and fluids and they were consulting me, the hematologist, to help them figure out why the white blood cell count was so high and what needed to be done.

I took the team aside to find out and asked: “what’s going on?”

The resident answered: “He’s had a diagnosis of chronic myeloid leukemia for 10 years, off and on, and now it’s out of control.”

“When did it start?” I asked.

“This episode started about ten days ago with confusion and headaches. He thought it was from working too hard in the yard in this heat,” referring to the heat wave radiating through the state. The temperature had been over 100 degrees Fahrenheit for the past week, part of the normal Arkansas summer.

“But it kept getting worse and his wife insisted he come. She seems to be in charge. She’s right there in the waiting room if you want to talk to her,” pointing to a tall, thin, 60 -ish year old woman wearing a tailored, plaid dress.

As I entered the waiting room, I saw her sitting alone in a far corner reading The Arkansas Democrat-Gazette with a copy of the New Yorker on the seat beside her.

“Can we talk?” I asked her as I entered the waiting room and escorted her to the conference room. As we walked into the conference room, I asked her permission to take notes.

She started: “Many years ago, he had leukemia, it was low grade, indolent as you doctors say. There was no effective treatment and they told us to go home and let nature take its course. That was in the 1970’s. He was only 22, way too young to let go, but then again, the other young people and even children with cancer were also dying in those days. He was about to go under, to sink under the pressure of his disease; but he was a fighter.”

“Then what happened?” I asked.

“He said no, he was going to fight this disease in whatever way he could. He’d go anyplace, do anything, give himself to science to get a chance. He told me he wanted the chance to live, to swim not sink, to go over the waves not under. More importantly, he wanted his life to mean something, to be used towards research that could help somewhere somehow. He’s a good man.”

“So, what happened then?” I asked.

“He called every place in the country to see if someone could treat him, if there was something somewhere that could help. They were doing a trial at the National Institutes of Health in Washington DC to see if chemotherapy could help and he wanted to go there. We had to get the money to afford the trip, but I worked two jobs, so he could make it there, and they didn’t charge him for the medicines.”

“Then what?”

“Someone offered us a chance. They didn’t know if it would work and how long it would work but we could try it. It would be a clinical trial, they would use him like a guinea pig. He was so excited –he wanted to be a guinea pig. He wanted to be scooped up in the ocean wave of new discoveries and to ride the wave for as long as he could. Anything, anything to have a chance.

“The treatment turned out to be chemotherapy which they were using for patients with acute leukemia. He didn’t have acute leukemia, but they were trying it. In low doses. I forgot the names. They were low dose and they made things better for a while, well for about two years. But they made him sick with nausea, vomiting, diarrhea, rashes, and..oh..of course he went bald. He hated it but said it was worth it to be alive. He would ride any wave, any new development, as long as he could live.”

*

The alarm went off and I went racing into my patient’s room. A whole group of people were hunched over my patient’s bed, compressing his chest, in and out, pumping, pushing, priming. Finally, they stopped, his heart had returned. “Sepsis” the resident murmured to me, “he’s going under; even if he survives he doesn’t have a chance to overcome this storm, let’s get palliative care involved.”

Later in the evening, I went back to be with his wife. “He’s OKfor now. Leave the records with me. I can read about the rest. We can talk later. Stay with him and hold his hand. He’ll know you’re there. I’ll be back tomorrow.”

*

I came home with a briefcase filled with paperwork. My husband peered at me and said “another all-nighter? You’re an attending now, give up being an intern! ” I wanted to, but I couldn’t. Who was this man in my I.C.U. and why was he holding on so tight?

“What’s for dinner anyway?” my husband called out to me.

“Whatever you cook or whatever you call out for,” I answered. “OK, it’s pizza tonight, again, the fourth time this week.”

*

The wife had gotten all the details right. He had been diagnosed with chronic myeloid leukemia, in chronic phase and he had been treated with low dose cytosine arabinoside. His blood counts had partially normalized but were still too high. His liver, spleen and lymph nodes were enlarged but had receded with treatment.

Then two years later he relapsed despite still taking the chemotherapy. His treating physician suggested hospice, but he refused. He knew the storm was returning but he wasn’t ready to drown under the waves. He wanted to surf the waves again and ride over, not under, them. He had weathered the last storm, could he do it again? He had resisted calls to give up, to go to palliative care, to go to hospice, or to “let nature take its course.” He would resist again. But what would he do?

His wife called every cancer doctor in the city and no one had a better treatment. That’s when she called the research nurse at M.D. Anderson again and begged for another trial. Did they have anything, anything at all which could help? Was there a wave of discovery he could ride again?

“Why, yes, we do have trials and we could discuss options with you,” the research nurse had responded. “We’re experimenting with interferon and some patients have already done well with it.” Interferon was a drug that stimulated the immune system, and the immune system in some people could fight the leukemia. But the inflammatory response was very robust, and most people developed high fever, chills, shakes and felt sick for the whole day. The drug was given by self-injection into the abdomen three times a week. Most of the time my patient felt really sick on it. He had however gone into complete remission for eight months. He rode this wave very successfully as he had ridden the past one. He was riding high over the wave, not under.

Until he wasn’t.

*

That was when he relapsed, again. The disease was literally stalking him. The waves were about to take him under again. What should he do? After two types of different treatments, there was very little likelihood that cancer would respond to still another treatment. Therefore, his treating doctors had suggested, again, to consider palliative re and hospice support for comfort care only.

That’s when he and his wife wondered if another type of treatment should be considered. That’s also when they started calling around again, to the same places they had called earlier. Maybe just maybe something had changed. She wanted him to stay above water, to float over the waves for as long as he could.

Some of the cancer doctors from M.D. Anderson had moved upstate from Texas into Arkansas and had developed a stem cell transplant program at the University of Arkansas for Medical Sciences (UAMS) hospital. It was quickly becoming the biggest stem cell transplant center in the world focusing mostly on treating patients with multiple myeloma. But the program accepted any patient needing a stem cell transplant, regardless of diagnosis. The team had a well-greased machine and was led by a giant in the field who had assembled an amazing group of doctors from around the world.

The wife hesitated to call at first. Would they accept him? Would they give him a chance? Would they do a transplant event though his heart wasn’t working well anymore? What would the charge? Could they afford it? But most importantly could her husband stand it? Would he drown in the recurrence of his disease or stay afloat with this new discovery again?

“Come as soon as you can,” the voice on the phone told her when she finally got the courage to call. “We can take care of him. We can take care of anyone.” This would be another wave of discovery. He could again ride the waves and get some more time.

She continued talking to me: “He was in relapse when he showed up in the stem cell transplant clinic. His counts were sky high with a white blood cell count ten times normal, and with low red blood cells and platelets. They gave him treatment and he started to improve.

“Transplant had just developed as a possibility for chronic myeloid leukemia. Would it work? Would he survive it? He had trembled while thinking of it, but his wife said it could save his life and he should ride the wave of this new discovery now. She wasn’t ready to be a widow. He wasn’t ready to die. He didn’t want to drown. He wanted to ride this wave for as long as it would possibly hold him.

The wife continued, “I had shouted at him: ‘If you can’t do it for yourself, do it for me! Hold on and ride this wave for as long as it lasts! Do it for me!’

“He agreed, for me.”

“Months later after he finally went into remission with the chemotherapy, he underwent transplant and it worked like a charm. All of the blood counts normalized quickly. He felt better. He could get around better. His mood improved. Our marriage was better.”

*

“Thanks, you’ve been a great historian, let’s get together tomorrow and talk more,” I said, knowing I needed to move on and finish my day’s work. This evening my husband and I had committed to going to a potluck dinner and I needed to make chicken curry for the evening meal. We were part of a potluck group that met weekly on Wednesdays and we never missed a date. It was our home away from home with people who knew us better than any of our colleagues or even our families all so far away.

After the potluck, I kicked off my shoes, put on my PJ’s and continued reading.

The stem cells he received were from a matched unrelated donor, nicknamed a “MUD transplant” for the acronym. The donor was unrelated to him, matched perfectly with him, and would save his life. He would never know the identity of this kind stranger who had donated so many stem cells out of the goodness of his heart to someone he didn’t know and never would know. The cells from the other person “homed” to his bone marrow and fully engrafted after 30 days, as expected.

Then something strange happened. The stem cells from the donor—that is, the graft—turned against him in a condition known as graft-versus-host. First the donor stem cells (graft) invaded the skin, then liver, then the intestines. There was intense inflammation, pain, fevers, rashes, bruising, bleeding. The blood counts dropped. It was controlled with steroids, very potent anti-inflammatory drugs. The storm was raging again, and he was fighting above the waves, or at least he was afloat. Or at least alive.

Gradually the acute graft-versus-host disease abated, but later a chronic form erupted. The chronic form of graft-versus-host disease involved mostly the joints causing stiff painful arthritis. It also involved the esophagus and stomach making it hard to swallow and to tolerate eating.

In effect, he had traded one disease for another, leukemia for graft-versus-host disease. It was a good trade: he had traded his leukemia for chronic graft-versus-host; the former was fatal, the latter was not.

*

Now here he was with us in the V.A. hospital and in the I.C.U. The graft versus-host-disease had resolved, but the leukemia had come back. Perhaps the graft-versus-host-disease had been treated too well, preventing the donor cells from fighting his normal but also his leukemia cells. He was very sick with active rampant disease. The storm had become a tsunami, the water was devastating, the waves overwhelming. He would never get out of the I.C.U.until his leukemia abated. And if it didn’t abate, he would die.

But there was still no effective chemotherapy and another stem cell transplant was out of the question while he was so sick. I couldn’t figure out anything to do to get him to ride another wave of discovery. I did not imagine he could ride over this wave, rather I saw him sinking deeper and deeper to the bottom of the ocean. His time had come, I thought.

*

That’s when one of the medicals students asked me: “why can’t we try STI 1571? It worked in other patients with this disease and some of those patients are still alive. I read about it in an abstract that was presenting a few months ago at the American Society of Hematology.”

“Really?” I asked, not admitting that I didn’t know anything about it.

The drug was so new that it didn’t have a name yet. But people were talking about it. A young doctor at Oregon State Hospital had figured out that this safe, oral, daily drug could stop the oncogene driving this disease and cure the leukemia. Initial trials were unbelievable with 90% of patients achieving a complete response within 4-6 weeks, even if they had previously not 6responded to other treatments. Later when it proved itself indeed to be a miracle drug, it was approved by the FDA under the name “Gleevec” and became the gold standard for initial treatment for all patients with chronic myeloid leukemia, eliminating the need for most hematopoietic stem cell transplants to control this disease.

But this was before FDA approval and I wondered how I would get it. It didn’t have a name. It was not FDA approved. It was not sold over the internet.

My medical student interrupted my thoughts with her comment: “I’ll call the company and see if we can get it by compassionate use. I’ll beg them for the drug, I’ll explain that this man needs it, that he can’t live without it, that it means the world to him, his wife, and….to us.”

Then she continued, “I already spoke to his wife, she’s the next of kin, and she said yes, she was so afraid he was finally drowning but this new drug could save him from the waves that would otherwise overwhelm him. He could ride this wave too, a new wave of discovery which he could surf for as long as it took him. She would make sure that he agreed, if not for himself than for her. She needed him.”

“Let’s get it,” I said, awed at his luck in riding so many waves of discovery, each of which kept him alive one wave at a time.

Paulette Mehta, M.D. M.P.H., is a professor in the Department of Internal Medicine Division of Hematology/Oncology at UAMS.

Filed Under: all, Fiction

Waiting

Dry shampoo
Babywipe showers
Cafeteria food
Courtesy coffee
Valet parking
Cold comforts
Cold rooms
Cold faces
Well-wishers
Absent friends
Days become
Weeks become
A month
Without answers

Author information

Filed Under: Uncategorized

A Mother

A mother in the NICU
waiting room thinks aloud,
If God were listening
If God were
If God
If
And looks to where clear sky and ground meet,
and tries not to contemplate the gravity of anything
on the other side of the window.

Christopher Fettes is a Program Coordinator and Instructor in Environmental and Occupational Health in the UAMS College of Public Health.

Filed Under: all, Poetry

Musings

I do not understand love, as mightily as I strive, it is at once real and tangible, yet dimensionless, for like space and time can not be measured, nor truly comprehended, it can only be known.

We talk of showing our love yet it is invisible, and cannot be seen, we demonstrate our love through our acts, but they can not be described,
it may be offered but can not be owned,
love can only be felt.

Love is not shared, it is freely given, it is not a barter to be traded, nor bargained
it does not cause joy or gladness, nor pain nor sorrow,
love is joy, sorrow its absence, love is love,
nothing more.

We search our lives for love, but it is not found, for it lies not without but within us,
for it is self, the most difficult of all things to know, ourselves,
given freely, love asks for nothing,
but to be accepted.

I do not understand love as mightily as I strive,
it stretches our emotional fibers past their limits,
it takes joy beyond pains threshold, then pain to joy, it is wondrous,
tho never understood.

Mark Weatherton is an Emeritus Professor in the UAMS College of Health Professions.

Filed Under: all, Poetry

River

Year after year flowing through halls
A healing river of humanity
Quickly it comes
So soon it goes
Carrying with it all it knows
Out to the state and world
It flows and flows
A warm stream
Healing for the suffering

Laura Stanley is an Assistant Research Professor in the Department of Neurobiology and Developmental Sciences.

Filed Under: all, Poetry

Love in the Time of Cholera

Photo of Gabriel Garcia Marquez
(Image credit: © Pablo Corral Vega)

Gabriel Garcia Marquez

“An Appreciation of Love, Aging, and Cholera”

By Richard Ault

The Man ….

Gabriel Garcia Marquez, perhaps the most honored and well-known Latin American novelist of the modern age was born in Aracataca, Colombia, in 1927.  These origins identify him in Colombia as a “Costeño,” a native of the Caribbean coastal region of the country known for its color, vibrancy, and the rhythm of its music and language, contrary to the dreary, wet, mountainous interior where the capital city of Bogota is located.  His Costeño origins will loom large in his life, his journalism, and his fiction.  To Americans the most accessible entry to “Costeño” culture is Cartagena, a coastal city frequented by American cruise lines.  

Marquez lived a childhood filled with considerable instability.  His father was an itinerant pharmacist/homeopathic quack, and while his family still remained partially intact despite the instability he was raised frequently by his maternal grandparents in Aracataca, and moved occasionally to Barranquilla, the other primary Costeño city.  These locations are significant because most critics identify the unnamed city at the center of our story as an amalgam of Cartagena and Barranquilla.  In my opinion, the most important influence on young Gabriel was his grandfather, Gabriel Eligio Garcia, a man greatly respected in the Costeño region for his refusal to remain silent about political atrocities during Colombia’s seemingly endless civil war, in particular the massacre of perhaps as many as 3000 banana workers by thugs employed by the infamous United Fruit Company. These atrocities occurred the year after Gabriel’s birth.  Indeed, his first novel, Leaf Storm, is a searing reimagination of these events.

After his secondary school graduation in 1947, Gabriel’s higher education took an uncertain path.  He spent two years studying law at the National University in Bogota, largely to please his father.  He transferred to the University of Cartagena in 1950 after the National University closed during a period of particularly intense political violence which is, after fùtbol, Colombia’s national pastime.  His dedication to his legal studies was essentially non-existent and there is no record he ever attended a class in Cartagena.  He gravitated to journalism at this time, and it is the profession that supported him, more or less, until the publication of One Hundred Years of Solitude led to fame and some fortune.

Unsurprisingly, Gabriel Garcia Marquez was an outstanding journalist, pioneering what was, in effect, investigative journalism and, probably years before the term was even coined America.  Similarly, Gabriel’s role as a journalist in Colombia presented a precarious way for him to make a living because of the instability of many of the country’s newspapers and magazines, to say nothing of having to navigate through the dizzying array of loyalties and betrayals in the seemingly never-ending “La Violencia” which gripped Colombia for much of the 20th century.  Ultimately “La Violencia” morphed into the Narco-terrorism of Escobar, Ochoa, and Lederer.  Luckily for Gabriel, by the time the Narcos came to prominence he had made his fortune and spent very little time in Colombia.  Otherwise, it is likely that Pablo Escobar would have had him assassinated for dangling a participle.

Before we move to more literary concerns, we must speak a little about Gabriel’s politics.  It will come as no surprise to anyone that he was a leftist and an undying admirer of Cuban dictator, Fidel Castro.  Of course, we must place the leftist politics of almost all Latin American intellectuals into proper context.  The sad reality is that without a democracy-promoting middle class, given the unholy alliance among the great landowners, the Church, the Military, and whatever western capitalists were relevant in a country (United Fruit, Anaconda Copper, Royal Dutch Shell, etc.) on the right, and the Socialists and Communists on the left, the choice was easy.  And it was made easier still by the power and bumptiousness of the Great Gringolandia to the north. When Castro came along and thumbed his nose at the Yanquis, it was true love for Gabriel, a love that never wavered even after Castro revealed himself to be the murderous thug that he was.  Gabriel’s later political journalism was marked by pirouettes and tight-rope walking worthy of a Wallenda to justify “La Revolución.”

And His Literature …

Throughout much of his professional life Gabriel (or Gabo to his friends) lived an almost hand-to-mouth existence, supported, such as it was, by his journalism.  Despite the fact that he had been publishing fiction regularly since Leaf Storm in 1955 (it took him seven years to find a publisher) he saw very little material success until the publication of One Hundred Years of Solitude in 1967.  This magnificent book ultimately sold over 30 million copies, led directly to the award of the Nobel Prize for Literature, and secured his financial future.

Of course, you can’t get far into a discussion of Gabo without coming to terms with the concept of magical realism.  There are about as many definitions of this term as there are critics writing about it, though they all revolve around magical, fantastical, or supernatural themes and events woven into realistic or even mundane circumstances.  As another essayist noted it is literature that suspends the physical laws of time, space, life, and death in otherwise realistic circumstances.  For reasons that I am not capable of understanding magical realism has bloomed spectacularly in Latin American literature and Gabo is only one of many practitioners.  The best I can do to understand magical realism is to propose two possible contributing factors to the phenomenon – First,  the undeniable music in the Spanish language; second, the rampant despair and poverty in so much of Latin America which might promote a desire to escape the crushing reality.   

Though critics may not consider Gabo the foremost magical realist, the broader world certainly does, all attributed to One Hundred Years of Solitude.  This soaring multi-generational tale of the Buendia family and the Costeño town of Macondo is a breathtaking book. Yet this is, after all, a contribution to a medical literary journal, and I think I can better justify “El Amor en Los Tiempos del Cólera,” as at least tangentially appropriate to this journal’s themes.

I must admit that my absolute love for this book may be a bit unhinged.  In my reading life, very few books have affected me as much as Cholera, and I have pondered why this is.  I was particularly concerned when my wife, who is not an unsophisticated reader, was profoundly unimpressed with this book.  I have thus decided that perhaps only men can be true romantics, and in my opinion the absolute best audience for this book is seasoned men who have experienced love and loss.  So, yes possibly, I’m a bit biased. Perhaps it’s just good enough to say that I am a sucker for great characters, and I have never met a more compelling set in my five-plus decades as a reader.  Florentino Ariza, Fermina Daza, and Dr. Juvenal Urbino came vividly alive to me, and even the lesser characters – Aunt Escholastica, Lorenzo Daza, Transito Ariza, Jeremiah de Saint-Amour, and even that unnamed, malevolent Parrot provide a delicious richness that makes this book, for me, a transformational joy.

While in One Hundred Years, the magic is knitted deeply into the characters and the narrative at literally every point in the novel, Cholera, like several other Marquez books, wears its magic lightly. The book does have its moments – the preternaturally linguistic parrot; Fermina’s dreadful growing doll; the whistling scrotal hernia, the 622 serious assignations in 51 years, 9 months and 4 days (certainly magical for most of us), and my personal favorite:  Florentino’s utter inability to compose a simple business letter, despite his immense talent writing love missives for himself and strangers as well in the “Arcade of the Scribes.” The magic in Cholera is an accompaniment to a story of love, obsession, and a bittersweet tale of aging.

And Now to “Cholera”

While to most it is the Feast of the Pentecost, for us it turns out that it is, in fact, “La Dia de los Muertos” as we meet Dr. Urbino, attending to the pre-arranged suicide of his friend, Jeremiah de Saint-Amour, who has died, according to Dr. Urbino, of  “Gerontophobia.”  And before this busy day ends the machinations of a malign parrot lead to the death of Dr. Urbino himself. In a few pages we see death at both ends of a bizarre spectrum – one a tightly planned, prepared, and intellectually justified exercise in self-destruction, and the other due to capricious and thoughtless chance, though clearly leavened by a dose of arrogance.  At the end of these opening pages only Dr. l Urbino’s wife, the regal Fermina Daza remains.  And just as memorable at 72, “Her clear almond eyes and her inborn haughtiness were all that were left to her from her wedding portrait, but what she had been deprived of by age she more than made up for in character and diligence.”  She is, we quickly see, a woman of substance who could only stir strong feelings in men.  But at this point little do we know how deep these feelings are in the heart of Florentino Ariza, our soon-to-be met protagonist.

A few pages further on, we discover that Fermina Daza and Florentino Ariza were the victims of an erstwhile love torn apart by cruelty, class envy, and, perhaps in that time, inevitability.  This drama launched them on two separate, but intertwined, paths.

Fermina Daza, of course, becomes the wife of Dr. Urbino, and he was the catch of the century in our Costèno city.  He is a classically trained physician, a man of culture and refinement, and at least outwardly, a gentleman of the highest character.  Above all, he is a man of the future.  Throughout his distinguished medical career he advocates for modern medical practice, and in the seemingly unending battle against cholera, he is at least the savior of the city, if not the country. The marriage of Dr. Juvenal Urbino and Fermina Daza, though outwardly perfect in every way, is not without its challenges.  Both are strong-willed which inevitably leads to small tensions and strains, though in the case of Dr. Urbino his stubbornness is multiplied by more than a whiff of childishness.  He also succumbs to a dalliance with Barbara Lynch, Doctor of Theology, and this arrangement almost, but not quite, destroys his marriage. Despite these travails, Dr. Urbino and Fermina lead a successful and fulfilling life, and his last words to her are, I think, fitting – “You will never know how much I loved you.” That is a great exit line! 

If one were worried that Fermina Daza’s widowhood would be empty and forlorn, leading to inevitable decline, one would not have taken the measure of Florentino Ariza, whom we shall now meet in depth. Just as Dr. Juvenal Urbino is a man of the future Florentino Ariza is indisputably a man of the past. He is the bastard son of Don Pius V Loayza and the remarkable Transito Ariza.  Don Pius V discreetly provides for his son, but Florentino Ariza also benefits from his mother who owns a small notions shop, and also makes a very good living as a shylock to distinguished families who have fallen on hard times and cannot bear to borrow within their social circle.  Don Pius V Loayza further insures a position for Florentino Ariza at The River Company of the Caribbean, where he is mentored professionally by his uncle, Don Leo XII Loayza, and carnally by Lotario (interesting name choice)  Thugut, that rarest of all things, a randy German.

Despite having the material advantages to adopt the accoutrements of his times, Florentino remains sartorially a creature of the past – Formless home tailored black suits, high celluloid collars, hats of no style.  And above all, he wears a perpetually mournful visage.  A notable highlight of the adaptation of the book is Javier Bardem’s spot-on presentation of Florentino Ariza’s doleful passage through life in spite of the mediocre film depiction.  

After Florentino Ariza and Fermina Daza’s chaste youthful love affair is dashed by Fermina’s social climbing and thoroughly unpleasant farther, Lorenzo Daza, Florentino  vows perpetual fidelity to his lost love, and goes on to violate it in the most spectacular way, though always keeping Fermina in his heart, if not in other organs.  This is where the book becomes confounding.  Less sophisticated readers will deem Cholera a love story, but this is unsatisfying, indicating a most superficial reading that is, frankly, troubling to me. The novelist, I think, plays with us a bit here and provides Florentino with clearly romantic traits.  He is both a poet and a lover of poetry; he serenades his beloved (of the moment) with his violin; and that sweet, sad face – what women wouldn’t fall for it!  Indeed, as Florentino begins to stray from his vows to Fermina, we at first view his conquests as almost comical.  It’s as if comedy legend Stan Laurel were a secret Casanova.  But, after his assignations with the Widow Nazaret, Auscenia Santander, and the woman from the insane asylum, events take a dark turn.  We discover that Florentino Ariza, under the tutelage of Lotario Thugut, supplements his consequential assignations by “hunting little birds.”  Now, to me, the term “hunting” is jarring and evocative of 20thcentury psycho-sexual killers more than our slightly absurd hero, and this more or less ruins the notion of a love story for me.

As we begin to doubt Florentino , events go from sinister to deadly.  First, a thoughtless branding of Olimpia Zuleta’s belly leads to her gruesome murder at the hands of her enraged husband.  Then, as Florentino Ariza’s 51 year, 9 month, and 4 days of combined vigil and bacchanal is approaching its end, things get downright creepy as America Vicuna enters our story.  She is a fourteen year old blood relative of Florentino Ariza, though the exact degree of consanguinity is never established.   Inevitably, she enters Florentino Ariza’s bed, making him a serious competitor to Lolita’s Humbert Humbert as the worst legal guardian ever!

It is in the midst of his dalliance with America Vicuna that Florentino Ariza learns that Dr. Juvenal Urbino has met the parrot with his name on it, and Fermina Daza is now free.  Without a thought for America Vicuna and with cosmically awful timing, he bursts into the funeral to declare his undying and eternal love to the newly minted widow.  She, in turn, with natural imperiousness, rejects him in no uncertain terms.   But, of course, our story does not end here.  As she settles into her widowhood Fermina begins to ponder the fact that she has lost her identity as anything other than Mrs.  Juvenal Urbino, and that she now possesses perfect freedom to live the rest of her life as she pleases. Once again our story turns to romance, even if it is dimmed by the ravages of age.  Step by step, Fermina Daza and Florentino Ariza are on a path leading inevitably to the luxurious cabin on the riverboat “New Fidelity.”  “New Fidelity!” Really!

As our story comes to its floating climax there is still much to ponder.  Shortly into the voyage, Florentino  receives the fateful news that America Vicuna is dead by her own hand, and he internally vows that all he can do is stay alive and “not allow himself the anguish of that memory.”  Is this an act of great self-control, or does it reveal him as nothing more than a monster?  The river voyage provides us with a close-up look of love accommodating the realities of old age.  The last pages are replete with images and events that shape the future for the aging Florentino and Fermina including the hostility of her children, her loss of hearing, and her lament, “I smell like an old woman!”  And, as the couple’s long-delayed passion is consummated   “… he dared to explore her withered neck with his fingertips, her bosom armored in metal stays, her hips with their decaying bones, the thighs with their aging veins.” Finally, there is their inexpert love-making, perhaps also qualifying as magical realism given the practice Florentino Ariza has had.

In the end, then, we are left only with cholera.  Its imagery pervades the book. Dr. Juvenal Urbino has been a tireless combatant against the disease, promoting modern treatment, and more importantly, modern sanitation.  His effort partially defeats the disease, particularly among the urban upper classes.  The poor, however, continue to suffer as they remain living in squalor.  The young Florentino Ariza, after his dismissal by Fermina Daza suffers from acute love sickness, the symptoms off which mimic those of cholera. However, in perhaps the most magical of moment in the book, the dread disease provides our lovers with an unlikely path to their future.  After the “New Fidelity” encounters a massive epidemic upriver and has raised the yellow plague flag to speed its return to the city, Florentino orders the Captain to turn around and speed back to the plague zone.  Incensed, the Captain asks, “And how long do you think we can keep up this goddam coming and going?” 

Florentino had kept his answer ready for 53 years, 7 months, and 11 days and nights:

“Forever,” he said.


Richard Ault, MHSA, is an Assistant Professor in the Department of Health Policy and Management of the Fay W. Boozman College of Public Health.

Filed Under: all, Non-fiction

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