It can either come by laugh or cough. It can rush in like a wave or slither in like a boa. Sometimes, it is simply invisible — a disregarded scourge. Waiting and lingering through the air in microscopic droplets, it waits for an instant of weakness. Other times, it is not so gracious to wait for a lapse in security. Activating an army of rod-shaped microbes, it sends your central system into chaos. Identified “130 years ago”, tuberculosis is still ravaging through the world on an uncontrolled rampage — debilitating anyone without discrimination [3]. A seemingly dated disease that is more associated with “developing third world countries” than it is with the American dream has eclipsed Zika in number of casualties [2]. Although treatable, it is often ignored or mistreated to the point where a resistance strain develops. With no more options after developed resistance, a death sentence is submitted. However, this is only the beginning of the end for Marciano. In Boyle’s “The Fugitive”, Marciano gives insight into the emotional and physical troubles of escaping the clutches of tuberculosis. Boyle uses tone, imagery, and diction in this short story to voice his opinion on the troubles and failures of the American healthcare system.

Mycobacterium tuberculosis, TB, is caused by bacteria spread from person to person through the air. It typically affects the lungs but can also cause other problems.

Marciano is the embodiment of every person that the healthcare system has failed. Boyle uses him to depict the unseen and unreported distresses that many endure at the feet of the healthcare industry. This is demonstrated by the lack of empathy that Marciano receives at his treatment clinic. The simple gesture of reassurance cannot even be offer. He is only given a mask to loosely cover up the coughs erupting from his lungs. Although the mask is used for the protection of society and himself, Marciano “feels like he had a target painted on his back — or his face” [1]. The mask symbolizes a failed effort to quiet the voices of the ill. Boyle’s tone subsequently is critical towards the government and its plan of action for society’s overall health. Boyle uses this work to express that the U.S. system is simply an inefficient hybrid in which the government foots the the bills and directs private spending through the “tax preference for employer-provided insurance” [3]. Money is an asset and resource that Marciano does not have, and without it he feels “there was nobody he could turn to” [1].

Using imagery, Boyle describes the challenges that come about when inadequate education is given regarding diseases such as TB. If Marciano was informed of the true importance of finishing his round of antibiotics, his chances of reinfection with another stronger strain of TB would be lowered. It is important to stress the danger if he fails to do so. However, it is obvious when he “started selling the pills” that he was oblivious to the dire consequences that awaited him [1]. To Marciano, the clinic was a place where he was peered at with “angry, hateful eyes” [1]. It lacked a sense of security — and instead made him feel as if he was being backed into a corner. He only “came back here to their contempt and their antiseptic smells and their masks and their dictates and their ultimatums” after the disease “shake him like a rat in a cage” , and he “spat up blood” [1]. This illustrates that only on the verge of death was Marciano willingly to seek help. He was scared and unwilling to go back to place that was cold and disheartening. Boyle uses this to create some stir some sympathy and emotion within the audience to take action and declare a want for change. Marciano goes on to describe the debilitating effect of his medication on his physical and mental state. He explains the pills made him “itch, as if there were something under his skin clawing its way out” a pain that many cannot imagine [1]. It is yet another exhibition of Marciano’s effort to combat TB.

The short story goes on to depict Marciano’s life as he leaves the clinic. It takes the audience beyond the threshold of what we can imagine. His point of view depicts all the insecurities one feels when they are isolated. Marciano is an American citizen who doesn’t speak English hence the presence of translator Rosa Hinojosa. Hinojosa symbolizes the frail human emotions Marciano feels. He wishes only to love her and kiss her pillowy lips. This stresses his humanity and how his urges are the same as the those who are not ill.

Finally, the diction that Boyle uses is her way of emphasizing the impact of the clinic and its demands on Marciano. In the story, he is “rehearsing in his head the phrase he was going to give the bartender — “Please, a beer” — which made use of his favorite word in English, and the word wasn’t “please” [1]. The use of the word beer explains how he uses alcohol to confide his doubts and worries. He wants to lose some inhibition — to not be able to remember he is living through a mask. This excursion from reality is used against him as another case of tuberculosis is reported and traced back to him. Furthermore, his job is progressively getting more difficult. He tries ignoring the symptoms that make his head spin, but “felt weak all of a sudden, weak and sick, and here came the cough, right on cue” [1]. It displays that his battle with tuberculosis is an intense and energy costly. Perhaps in his mind, the medicine is not helping him getting better but making his life harder. His once eager demeanor is lost and replace with a lucid and slow worker which is such an obvious contrast to his former self that his partner, Rudy, comments, “Late night again?” [1]. Marciano can only response the nod of his head. It displays a sense of emotion that the audience can connect with. It is a pity that can be shared and felt with all readers. There a definite moment in which he felt betrayed. “He was scared. He was angry” after gulping down Corona beer to hide the impending cough that sat in his throat [1].

In conclusion, Boyle’s use of imagery, tone, diction acts as a catalyst to forward her criticism on the healthcare system in American. He uses Marciano to explain the point of view of the sick that no one hears about. Little is heard about the multi-antibiotic resistance strains of tuberculosis that are roaming amongst us without truly education the people through mass media. As of 2012, Johnson and Johnson are the final stages of creating a “approval for SIRTURO™ as part of combination therapy to treat adults with pulmonary multi-drug resistant tuberculosis” [2]. This is the point that has taken more than a century to come through. All that is left to do is to encourage the education of the public on infectious diseases that can be prevented and cured. All in all, his short story “The Fugitive” is his response and critique to the current health system established.

Bedaquiline is the active substance in a TB drug which is also sometimes known by the trade name of Sirturo. Bedaquiline works by blocking an enzyme inside the Mycobacterium tuberculosis bacteria called ATP synthase.

Works Cited

Boyle, T. Coraghessan. “The Fugitive.” The New Yorker. N.p., 27 June 2016. Web. 12 Sept. 2016.

Johnson “News.” FDA Grants Accelerated Approval for SIRTURO™ (bedaquiline) as Part of

Combination Therapy to Treat Adults with Pulmonary Multi-Drug Resistant Tuberculosis. N.p., n.d. Web. 12 Sept. 2016.

Cervantes, Jorge. ScienceDaily. ScienceDaily, n.d. Web. 12 Sept. 2016.