Resumo A novela “A morte de Ivan Ilitch” (1886), de Liev Tolstói (1828-1910), fornece-nos valiosos subsídios para pensarmos o significado de doença de longa duração. Fundamentando-se nessa obra literária, o presente artigo analisa as múltiplas dimensões do processo de adoecimento. Parte do princípio de que a doença não é uma totalidade formada a priori, mas um trajeto de associações entre o doente, o médico, a família, os amigos e cuidadores. Agir, ser afetado, pensar e sentir são fenômenos que caminham juntos no desenvolvimento dessas associações. A análise sobre o adoecimento de Ivan Ilitch está dividida nos seguintes itens: (a) a doença como alteridade e incompreensibilidade (estranhamento do corpo e estágios pelos quais o corpo é gradualmente objetificado); (b) a doença como trajetos em um campo de práticas que envolve aquisição de habilidades e uma “educação da atenção”; (c) cuidados à saúde como um conjunto de técnicas, objetos, discursos e práticas que em situações concretas são agregados ou associados ao longo de trajetos que envolvem a busca pela manutenção da saúde. Doença de longa duração é, portanto, uma forma de imersão do doente em redes de relações que passam a fazer parte de sua vida cotidiana.

Abstract The short story “The Death of Ivan Ilyich” (1886), Leo Tolstoy (1828-1910) provides key elements for a reflection on the meaning of long-term illness. Based on Tolstoy's short story the present paper analyzes the multiple dimensions of the process of illness. It starts with the argument that illness is not an a priori totality, but a trajectory of associations between the sick person, the doctor, family members, friends and caregivers. Acting, being affected, thinking and feeling all come together in the development of these associations. The analysis of the Ivan Ilyich's illness will consider the following points: (a) illness as otherness and incomprehensibility (growing unfamiliarity with one's body and the stages by which the body is gradually objectified); (b) illness as trajectories in an field of practices that involves the development of skills and the “education of attention”; (c) modes of health care as a set of techniques, objects and discourses that are put together or associated throughout trajectories concerned with the establishment of health. Long-term illness is therefore a mode of immersion of the sick person in networks of relations that come to be a part of her everyday life.

Resumo A novela “A morte de Ivan Ilitch” (1886), de Liev Tolstói (1828-1910), fornece-nos valiosos subsídios para pensarmos o significado de doença de longa duração. Fundamentando-se nessa obra literária, o presente artigo analisa as múltiplas dimensões do processo de adoecimento. Parte do princípio de que a doença não é uma totalidade formada a priori, mas um trajeto de associações entre o doente, o médico, a família, os amigos e cuidadores. Agir, ser afetado, pensar e sentir são fenômenos que caminham juntos no desenvolvimento dessas associações. A análise sobre o adoecimento de Ivan Ilitch está dividida nos seguintes itens: (a) a doença como alteridade e incompreensibilidade (estranhamento do corpo e estágios pelos quais o corpo é gradualmente objetificado); (b) a doença como trajetos em um campo de práticas que envolve aquisição de habilidades e uma “educação da atenção”; (c) cuidados à saúde como um conjunto de técnicas, objetos, discursos e práticas que em situações concretas são agregados ou associados ao longo de trajetos que envolvem a busca pela manutenção da saúde. Doença de longa duração é, portanto, uma forma de imersão do doente em redes de relações que passam a fazer parte de sua vida cotidiana.

Abstract The short story “The Death of Ivan Ilyich” (1886), Leo Tolstoy (1828-1910) provides key elements for a reflection on the meaning of long-term illness. Based on Tolstoy's short story the present paper analyzes the multiple dimensions of the process of illness. It starts with the argument that illness is not an a priori totality, but a trajectory of associations between the sick person, the doctor, family members, friends and caregivers. Acting, being affected, thinking and feeling all come together in the development of these associations. The analysis of the Ivan Ilyich's illness will consider the following points: (a) illness as otherness and incomprehensibility (growing unfamiliarity with one's body and the stages by which the body is gradually objectified); (b) illness as trajectories in an field of practices that involves the development of skills and the “education of attention”; (c) modes of health care as a set of techniques, objects and discourses that are put together or associated throughout trajectories concerned with the establishment of health. Long-term illness is therefore a mode of immersion of the sick person in networks of relations that come to be a part of her everyday life.

ABSTRACT Most breast cancers originate in the ductal epithelium and are referred to as invasive ductal carcinoma. In this study we report on the clinical procedures adopted to diagnose myiasis in association with infiltrating metastatic breast carcinoma in a female patient. A 41 years old woman came to the Federal Hospital of Andaraí complaining of intense itching, warmth, redness and hardening of the breast, which had acquired the aspect of an orange peel. A lesion in the left breast was cavitated, dimpled, had fetid odor, and had fibrotic and infected air nodules filled with exudate and Dipteran larvae. The tissue was cleaned and 33 larvae were extracted. The patient was hospitalized and received Ivermectin. Eighteen of the larvae extracted from the patient were placed in 70% alcohol, and twelve were placed in a container with sterile wood shavings under controlled conditions until they metamorphosed into adults. The taxonomic identification of the flies revealed that the culprit was Cochliomyia hominivorax. A histopathological exam conducted three months earlier had revealed infiltrating ductal carcinoma. Two months after the myiasis treatment, the breast tissue had healed. The patient had waited ten days from the onset of the myiasis to seek treatment, and that delay interfered negatively in the prognosis of both the neoplasm and the myiasis. This study is relevant to public health in view of the strong social impact of myiasis.