Claude Piantadosi of Duke was direct on this point: severe emaciation, the visually dramatic condition that people associate with starvation, is characteristic of end-stage starvation. A person who is still alive and ambulatory and coherent, as Alvarenga was on arrival, is, by definition, not in end-stage starvation. The expectation that a 14-month survival should look like end-stage starvation reflects a confusion between the visual markers of imminent death and the markers of extended but non-fatal deprivation.
## The El Salvador He Returned To
El Salvador in February 2014 was a country with significant problems: gang violence, economic pressure, emigration. It was also a country that, in the first weeks of that February, had produced the most extraordinary survival story in the recent memory of anyone paying attention to such things. The Salvadoran government was attentive to Alvarenga’s return. The media coverage in El Salvador was significant.
He arrived on February 10, 2014, flying into San Salvador from Majuro. His parents — Jose Ricardo Orellana and Maria Julia Alvarenga — were there. His daughter, who had grown up without him present, was there. After eight years in which his family had believed him dead or lost, the man was back.
The reunion photographs that circulated in the media showed a man who was simultaneously the center of enormous attention and clearly overwhelmed by it. From 438 days of absolute solitude to an airport arrival in front of cameras and reporters and family members and officials is a transition that has no preparation and no gradual acclimation. He had gone from the quietest environment on earth — the open Pacific, with no human voice, no engine noise, no electronic signal — to one of the loudest possible.