Mountains Beyond Mountains: Chapter 25 Summary & Analysis

Farmer has always found the flight from Haiti to Boston strange, Kidder reports. When he arrives in Boston he sees well-dressed people complaining about the most superficial of problems—a far cry from the poverty and suffering of Haiti.

In 2000, Kidder explains, PIH flies a Haitian child named John from Cange to Boston for treatment for a rare facial cancer, nasopharyngeal carcinoma. The process of diagnosing John requires several trips to and from Haiti, over the course of several weeks. Farmer’s assistant, Serena Koenig, arranges an emergency medical visa for John, so that he can exit and enter Haiti without a problem. Farmer thought that he could conduct most of John’s treatment in Haiti, with Serena’s help and with shipments of treatment drugs from Boston. In the end, however, Serena decides that it is better to conduct the surgery in Boston, not Haiti. Preparing for the treatment costs nearly 100,000 dollars, but with much difficulty, Serena is able to convince Mass General to waive its fee. In order to do this, she’s forced to make up family information for John. Although John’s parents have checked him into Zanmi Lasante, and visit him periodically, Serena is forced to invent names for John’s parents while filling out paperwork (since she doesn’t know their real names, and doesn’t want to wait for their next visit).

While Farmer attends a Soros conference in Europe, Serena prepares to fly John out to Mass General for a full treatment for his cancer. Kidder sees John lying in bed, and is shocked by his appearance—his limbs are terrifyingly thin and emaciated, and he makes a sickly gurgling sound when he breathes. Serena prepares for an ambulance to drive John from Zanmi Lasante to the airport—a form of transportation that, along with the medevac flight from Port-au-Prince to Boston, costs more than 18,000 dollars. In the days leading up to the car ride and flight, John’s condition deteriorates, so that it’s unclear if he’ll be able to survive a long flight to Boston. Serena is unsure whether or not she should proceed with her plan. She emails Farmer asking for advice, and Farmer replies, very promptly, that he’ll be in Boston in 24 hours, but that he thinks Serena should “consider other possibilities” in the meantime. Serena interprets this to mean that news of the flight will set an expensive precedent for future Haitian patients: everyone will want to be flown to the U.S.

Serena decides to arrange for an ambulance to drive John to the airport, even though John’s condition is uncertain. She reasons that she can prevent the flight from becoming a precedent for Haitian patients by saying that she paid for it herself. The ambulance service is extremely unreliable, and on the road to the airport, the ambulance breaks down. John needs a “suction device” to ensure that he can breathe properly during the car and plane rides. Without this device, his facial tumors would suffocate him.

The driver of the ambulance decides to arrange for another truck to drive John to the airport. Serena and the other hospital technicians hook up John’s suction device to the truck’s battery, and they drive off toward the airport. John is in great pain during this ride, not least because the road is extremely rocky and bumpy. After hours of driving, during which the car stops several times, John, Serena, and Kidder make it to the airport.

Kidder reports that John survives his medevac flight to Boston, helped by his suction device the entire time. When the group lands in Boston, the ambulance driver tells Kidder, “There’s a lot of bad road between here and Mass General,” a statement that, Kidder later realizes, is hilariously funny, considering what John has just been through.

The ambulance drives John to the pediatric wards of Mass General, and the team has John in bed very quickly. Farmer, who’s agreed to meet Serena in Boston, tells Serena that she did the right thing by bringing John to Boson. A medical intern at Mass General criticizes Serena because John is so malnourished. Dr. Alan Ezekowitz, the head of pediatrics, subtly chastises this intern by saying, “This boy is a challenge. But I’ve cured sicker kids,” and adding, “We can always do better, can’t we?”

The medical team at Mass General proceeds with treating John. They identify tumors in John’s nasal area and spine—extremely painful. Gradually, they realize that there’s nothing they can do to save John’s life: he’s going to die. Serena nods, and whispers, “He’s getting excellent care.” She explains that there was value in bringing John to Boston, even if his life couldn’t be saved: he got excellent care, and he will at least be able to die in a room where his mother can grieve without “flies all over her face.”

A few days later, John’s mother arrives on another flight. She’s able to see her son just before the end of his life. Shortly after John’s death, Farmer offers her a job at Zanmi Lasante, which she accepts. Months after the incident, the Haitians aren’t mobbing Zanmi Lasante with demands for transportation to the U.S.—on the contrary, Farmer’s assistant Ti Jean reports that the Haitians merely say, “Look how much they care about us.” Moreover, Mass General waives medical fees for several other Haitian children in the months after John’s death, and Serena is able to arrange for them to be flown up to Boston. Thus, John’s death in Boston could be said to have a silver lining.

Kidder is unsure how he feels about John’s treatment. In a sense, he thinks of it as a lesson in the impossibility of Farmer’s project—a symbol of its futility.