Consumed In The City: Observing Tuberculosis At Century'S End

Introduction: TB and Sociology

Introduction TB and Sociology The man was 54 years old, short and slight of build, a heavy smoker, and a habitual drinker. One day in early winter, while working in the detached garage outside his small home, he slipped and smashed his chest against the side of the car. When the pain in his chest did not go away, he went to the doctor. He was told that he had a tumor, that it was most likely cancer, and that he needed surgery. It was almost Christmas, so they told him to wait until after the holidays. The impending event hung over the family. The surgery was scheduled at a large private hospital in downtown Chicago, twenty miles from his working-class neighborhood , on the far South Side. The last time he was hospitalized was for an emergency appendectomy more than twenty years earlier. Following the surgery, he was placed in a postoperative recovery room with another patient. Then, suddenly, he was moved to an isolation room. Nobody explained why. His son’s fiancé was a nursing student and had rotations in another hospital on the North Side. She was the first to visit him after the room change. In her presence he cried, not knowing what was happening to him. He didn’t understand why he had been shut away in a room by himself, or why people were walking in and out with masks on. He was confused, alienated, and afraid. When they cut him open they found something in his lung, but it wasn’t cancer after all. It was an old colony of disease which he had contracted when young, a disease that had killed many thousands, a disease which had once been considered incurable. It was tuberculosis, or TB, and for many it was a disease of the past, a disease of tenements and factories, of crowded ships and sweatshops. Like others who suffered from TB in the days before antibiotics, the man had recovered his health after a stay in a residential sanatorium. His immune system had contained the deadly bacteria, encasing them in thick scar tissue. But age and stress can weaken these internal defenses, and he now had “consumption” once again. This was the reason why he had been suddenly switched from an open bed to an isolation room. It was a standard precaution in possible cases of infectious TB, one that is still followed to this day. Unfortunately, no one had bothered to explain. The large modern hospital, with its multi1 tude of personnel and procedures, was overwhelming to this simple and mild-mannered man. If not for the familiar presence of the student nurse, who investigated and explained the situation to him, he might have remained in the dark, unsure of his own fate, scared and alone. The year was 1962. The man was my grandfather. The young nursing student was my mother, and she related this story to me in the mid-1990s. At the time I was a health worker specializing in tuberculosis control, working for a large public hospital in downtown Chicago. I recount the tale here for several reasons, not only to show my own family’s connection to the long and tragic history of this disease, but also to demonstrate that the issues discussed in the following pages are nothing new: the alienating experience of the hospital, the fear of a deadly diagnosis, the cultural distance between the neighborhood and the medical institution, the impact of poverty, addiction, and social class, and the persistent problem of compliance. I did not know my grandfather—he died when I was only four years old—but after many years of working with TB patients in the field, his story seemed familiar enough. My own involvement with the disease began when I was in my twenties . In 1992, I was one of many individuals hired by the city of New York to aid in the struggle against a resurgent wave of urban tuberculosis. I was a field-worker, and my duties included interviewing patients with active, infectious TB, tracking “delinquent” tuberculosis patients, returning them to clinical care, and threatening “noncompliant” patients with involuntary detention, or quarantine. In late 1993, I accepted a job working with tuberculosis patients back in Chicago, the city where I was born. From November 1993 until July 2000, I went out every day to meet TB patients and to watch them swallow their pills, ensuring their successful treatment and thereby limiting the spread of the...