TB, Airborne
Traveling XDR class.

Now the truth can be told: if I were the other night intern, I would have been taking care of the phthisic traveler a few days ago. Even though I didn't have the pleasure of putting on a mask and going into his room in Bellevue (sorry, "a New York hospital," as the first Times article coyly put it), I feel compelled to provide some information about a question we're all wondering about: how easy is it to get tuberculosis on an airplane?

You can't do that experiment. (Though it would be fun!) What does the literature say? Google Scholar gave me links to two articles. One of them talks about TB transmission from an infected crew member to his colleagues. The other, by Kenyon et al., is titled "Transmission of Multidrug-Resistant Mycobacterium tuberculosis during a Long Airplane Flight." We read in the abstract: "In April 1994, a passenger with infectious multidrug-resistant tuberculosis traveled on commercial-airline flights from Honolulu to Chicago and from Chicago to Baltimore and returned one month later. We sought to determine whether she had infected any of her contacts on this extensive trip."

In brief, their findings were as follows:

1. The researchers managed to get in touch with 802 fellow passengers, or about ninety percent of the people on the airplanes the woman traveled on -- a commendable effort.

2. Of these passengers, twenty-nine tested positive on the "TB skin test." Twenty-two of these had previous risk factors for tuberculosis, which means it's impossible to tell in this case (since the passengers weren't followed beforehand) whether their skin tests were positive before they ever took that flight.

3. Of the seven without previous risk factors for TB, six were on the longest flight the passenger took (a nine-hour jaunt from Chicago to Honolulu). They all sat in the same section, and four of them sat within two rows of the passenger.

The authors conclude, "The transmission of [the TB organism] that we describe aboard a commercial aircraft involved a highly infectious passenger, a long flight, and close proximity of contacts to the index patient."

How does this article relate to the now-famous globe-trotting lawyer? The kicker here is that the woman in the article was "highly infectious". To wit:
The index patient was a 32-year-old Korean woman, who according to relatives was taking no antituberculous medication but had previously been treated for tuberculosis — twice as an adolescent in Korea and once within the past two years in Japan — with unknown medication. She arrived in Honolulu in April on a tourist visa and was reportedly coughing and lethargic while staying with friends (Household 1) for five days. She then flew from Honolulu to Chicago and from Chicago to Baltimore, where she remained with friends (Household 2) for one month. Members of Household 2 reported a worsening of her symptoms, including progressive cough, lethargy, shortness of breath, fever, night sweats, and the eventual onset of scant hemoptysis. In May she returned to Honolulu, flying from Baltimore to Chicago and from Chicago to Honolulu. Eight days after returning to Household 1, she had an acute episode of hemoptysis, described as consisting of approximately 1 liter of bright red blood. Hospital evaluation revealed extensive pulmonary disease (Figure 1), and her sputum was highly positive (3+) for acid-fast bacilli and was culture-positive for M. tuberculosis. The patient died of pulmonary hemorrhage and respiratory failure five days after being hospitalized.

She died of TB shortly after the flights in question, and was highly infectious when she flew. Contrast this with the patient in this week's story, who has so-called "active" tuberculosis (the organism is in his blood) but does not appear to be either symptomatically ill or highly infectious (the amount of TB-causing organism in his sputum is low).

Was quarantining the passenger in this most recent case (or, rather, attempting to quarantine him) the right thing to do? Probably, since he is infected with so-called XDR (extremely drug resistant) TB, which is associated with a higher mortality rate. It's best to be on the same side, even though it's probably unlikely that anyone he traveled with got infected.

(However, I'll take the opportunity to mention that many organizations (schools and the like) use the TB skin test indiscriminately, without assessing their members' risk factors for TB, their infectiousness if they do test positive, and the resultant small likelihood of transmission even if they are infectious.)


When I pray for certain sick people

it's not that I don't want other sick people to get better. Of course I'd like all sick people to get better.

So why not pray for all of them?

There are time constraints.

If you had infinite time, and knew everyone's name, would you include the names of all the sick in your prayers?

All the sick I know (of) personally. The farther away a sick person is from my personal knowledge, the less strength my prayers have. The less I really want them to get better. Or: the less often I think about them. It's a complicated relationship, if I were to think about it more precisely: not just the strength of wanting, not just the frequency of wanting, but the intensity with which the person's condition occupies my attention. The difference between home and another place.

Ideally, you would wish with equal strength for everyone to get better.

I think so.

You recite traditional Jewish prayers, which ask for the sick to be healed "among the other sick of Israel." Do you generally include non-Jews in this prayer?

Not generally. I don't know if that's because I know fewer non-Jews than Jews, because I tend to actively seek out (names of) Jews to pray for, or because I find it more congenial to include Jewish names in a Jewish prayer.

"More congenial" is a pretty term for racial exclusion.

Why don't we pray for the entire world? Why do we stick to our people, to our mythic ancestors, to our Jewish God? Because there's a power to specificity. If there were a strong prayer, embedded in a particular poetic idiom, which embodied a wish for the cure of the entire world, at once, without regard to any divisions at all . . . I can't imagine such a prayer because each prayer has its own preconceptions. Everyone wishes from somewhere, has their own family to yearn from. There is no universal person.

Why not write that prayer? Why not be that person?

There are cultural constraints.


An Intern's Lexicon
Version 1.0
Descriptive only. Not prescriptive, endorsed, or reflective of these terms' actual scholarly or humanistic meanings.

A-stick (v.) to draw blood through puncturing the radial artery.

Baseline: at baseline (adj.) Describing a usual or healthy state before arrival in the hospital or before some insult or incident. "His baseline mental status is poor."

Code: 1. (v.t.) To attempt to resuscitate a patient. (n.) An attempted resuscitation. 2. (v.i.) To undergo an attempted resuscitation. 3. (v.i.) To die after an unsuccessful attempted resuscitation. 4. full code (adj.): Someone who is to be resuscitated in case of cardiopulmonary arrest. Opposite of DNR.

Cute: (adj.) Possessed of some attractive or positive attribute. Used of older patients. "That patient of mine in the step-down is so cute! He sits there with his blanket, reads the paper, and asks me how I am when I pre-round on him in the morning."

Dispo: (Short for "disposition.") (n.) Plans for discharge, or a patient's destination upon being discharge. "She's hanging out, waiting for dispo."

DNR: Short for Do Not Resuscitate.

Fail: (v.) (paradoxical reverse construction) To be unsuccessfully treated by a medication. "That gomer failed Vanc[omycin], so we put him on Imi[penem]."

Female: (n.) Woman.

Fix: (often jocular) (v.) To treat, especially acutely. "Your list is so small!" "I fixed everybody."

Gome: Short for "get out of my emergency room." Originally used in House of God, now generally used. n. An older, chronically ill, demented patient. -- Gomey (adj.)

Hang out: (v.) To stay in the hospital while no longer acutely ill. "Anything going on with Mr. Smith?" "He's just hanging out."

Ins-and-outs: Measurements of intake and output on the part of the patient.

Jeopardy: (n.) A backup system whereby certain residents are called in when others become sick or otherwise unavailable.

Male: (n.) Man.

Mental status: (n.) Cognition.

Psych issue: (n.) Psychiatric, psychological, or emotional complication. More generally, any expression of feeling.

Resp (v.) : Short for "respire." To breathe at a certain rate. "The patient is resping at 36."

With it: (adj.) Able to converse; interactive. "He was with it when he came into the hospital


Say It In Chabon
Or: Der yidisher polislayt-unyon.

The newest, baroquest Jewish novel is one I won't be reading -- not because I am opposed to it on principle but because my complexes will get in the way of any purely literary experience. To explain we have to turn the clock back to 1997 (or sometime before), when Michael Chabon happened upon the sublime little volume Say it In Yiddish, a book that provides practical phrases for the traveler to Yiddish-land. The notion of a country whose inhabitants might use Yiddish in daily life captivated Chabon with its otherwordliness, and -- so inspired -- he wrote a whimsical essay for the Library of Congress magazine Civilization about such a land (with, it bears mentioning, the requisite Ben Katchor illustrations for a Yiddish reverie).

Thus ensued a kerfluffle in the tiny on-line Yiddish world, or, more precisely, a flame war (which I took part in) on the Yiddish e-mail list Mendele, most neatly summarized by Chabon's response to his critics (thanks to Leizer Burko of yiddishland.googlegroups.com for digging this up):

Date: Sun, 29 Jun 1997 10:05:37 -0700 (PDT)
From: Michael Chabon <mchabon@earthlink.com>
Subject: Weinreich's phrasebook

I am hesitant to wade into this fray, but the recent assertion by Mr. Mordkhe Shaechter [7.025] that "the author of that article has already apologized to B. Weinreich" compels me to step in. I have been following the recent exchanges over my article in Civilization ever since an interested party began forwarding them to me last week. They can, as far as I can tell, be divided among those who got it, those who most decidedly did not, and those, like Mr. Turkel [7.024], who feel qualified to comment without having read the article at all. Since I can neither speak nor read Yiddish in any but the most rudimentary fashion, I don't know what Mr. Adam Whiteman had to say.

People who get the piece recognize, first of all, that a book which explicitly advertises itself, on the cover, in capital letters, as a PHRASEBOOK FOR TRAVELLERS, naturally, logically, and commercially implies the existence of a country to be travelled to. A country. An entire nation. Not a neighborhood like Crown Heights. Not the annual meeting of a Yiddish language society or a Folksbeine. No one takes a Chinese phrasebook for travellers to Chinatown or a Chinese New Year's Parade. Even if someone might, such certainly would not be the imagined market for a series of traveller's phrasebooks.

This inherent implication is the central pillar of my ruminative essay (not a book review, not an analysis of the current state of Yiddish). There is a phrase given in the book, with Yiddish translation: Where can I get the boat/ferry to --------? My essay simply tries to imagine different ways to fill in that blank (that is, to imagine a place where one takes a ferry either to or from a country whose principal language is Yiddish). _Now._ Post 1958, when the book was published. Not in the twenties during some shortlived Soviet republic. Not in Israel shortly after its founding. But now, when the book, with its series of useful phrases for visits to auto mechanics and airline ticket offices, is still apparently very much in print. Where, in 1997, could you go that it would behoove you to know how to say, in Yiddish, "Which way to the casino?"

The second thing people who get the piece recognize, I think, is that however many people are still reading, speaking, and enjoying Yiddish, and however many young people are taking up the study of the language--however vital is the spirit of Yiddish revival--something has been lost. Something immense and profound. I don't know anything about Mendele and its ways. Perhaps this statement will bring the wrath of the entire subscribership down upon me. But I believe it. If this causes some of you to pity me, or shake your heads, or even wish, with Mr. Turkel, to excoriate me, so be it. There is no nation to take the Weinreichs' little phrasebook to; for every other language in the series, such a country exists. That difference saddens me.

In the course of a recent, and personally frustrating correspondence with Ms. Beatrice Weinreich, I did express my apologies to her--but not, as Mr. Schaechter seems to imply, for what I wrote. I stand foursquare behind every single word of that essay, without apology. What I regret is the hurt feelings and grief that my words evidently brought to a woman whose work I respect. It was a harsh blow to her to discover that someone thought her phrasebook was, among many other things, and in the saddest way, funny. (I gather from this list that I am not entirely alone in thinking so.) I have tried to explain to Ms. Weinreich that she, like some members of this list, had misinterpreted both the spirit and the letter of my essay. I love Yiddish. I love being Jewish. I love language and humor. All of these inspired my writing. The desire to hurt, offend, or insult Yiddish scholars and lovers of Yiddish did not make up even one atom of my motivation. My only desire was to report faithfully how the book made me feel, and the fancies it conjured in my imagination.

In her initial letter, and in her subsequent, generally unmollified reply to my reply, Ms. Weinreich argued, as have some members of this list, first of all, that the book could be useful for trips to Crown Heights or Williamsburg, for example; and second, that it might come in handy in Israel, or perhaps would have come in handy in Israel at an earlier time in the book's life. My principal rejoinder to these arguments has already been made: a phrasebook for travellers implies a country whose principal language is that of the phrasebook. Sure, there are, or could be, exceptions to this. There could be a phrasebook for travellers in Romany, say, that might be useful under certain conditions, or one in Latin that might at some time have come in handy in the Vatican. With regard to Israel, and the argument that there were or are many Yiddish speakers there who, as Ms. Weinreich attempted to convince me, felt or feel at sea in a land of Hebrew, I fail to understand how they would have benefited from an English-Yiddish phrasebook. Yiddish-Hebrew, perhaps. As for the English speaking traveller, if I had been going to Israel in 1959, say, I doubt I would have chosen an English-Yiddish phrasebook to be my companion.

AIl this is, however, completely beside my point. I wasn't interested in writing about whether this book was, or could be, useful; it is evident to anyone not blinded by sentiment or passion that such a book is, in a practical sense, all but useless. What interested me was imagining another world in which a Yiddish phrasebook for travellers would have an obvious referent, one with the official passports, customs agents, airlines, and ferry companies that play such a prominent (and, to me, poignant) role in the phrase book. The more I thought about, and imagined this country, the sadder I felt at its absence, a sadness which --for me, the only person I ever claimed to be speaking for--no amount of extinct Soviet republics, Chasidic neighborhoods, and Yiddish preservation and renewal societies will ever completely abate.

I'm sorry if this angers, hurts or irritates some people, or everyone who reads this post. I'm sorrier still for anyone who can't see the humor--the heartbreaking, wistful, uproarious humor--in the book. But I don't regret a word of what I wrote. On the contrary, Mr. Schaechter.

Michael Chabon

And from such an exchange, it turns out, came the impetus for The Yiddish Policemen's Union.

Ten years after the mini-dispute, I, like Bina Weinreich, remain unmollified. I see the humor of the book (which has acquired near-classic camp status in some circles), and I appreciate the whimsy of Chabon's take, but ("blinded by passion or sentiment," perhaps) can't overlook his mistake: the assumption (so American-Jewish! so confidently ignorant!) that only languages with a country have a useful function, that only official state languages have any business arrogating to themselves any practicality (except for the two non-state languages of Romany and Church Latin [!]). That's an ignorance that even a brilliant prose style can't wash away, and whimsy can't cover up.

Here I am, still blinded in Yiddishland.