On the Bottom of a Paper Bag

I suppose I had noticed the names and dates at various times when I bought a deli sandwich or a cup of coffee or some totally evil pastry that came in one of those small paper bags.  A quick glance at the bottom of the bag at the name Maribel or Raymond or Mary, Lucita or Juan or sometimes a first initial and last name like L. Vu.  And a date. While I had noticed the names I hadn’t thought too much about them until I went to an exhibit at Mass MoCA with my friend Pat, after driving through the autumn New England countryside from Saratoga to North Adams.

Mass MoCA, the Massachusetts Museum of Contemporary Art, Mass MoCAis housed in an enormous old brick manufacturing building, with huge galleries, including room after room of Sol Lewitt’s wall drawings of bold strips of color and myriads of intersecting pencil lines.  The collection of paper bags by artist Mary Lum was part of an exhibit called The Workers that chronicled the connection of the people who operated the machines with the products and process, the banality and pride of manufacturing. The Mass MoCA blog states:  “Tinker Tailor Soldier Sailor features an assemblage of hand-torn paper bag fragments which the artist has been collecting for nearly two decades. Each of the pieces – torn from a multitude of bag bottoms — is stamped  with the name of the individual who made the bag or oversaw its production and quality on the assembly line.   A detail easy to miss, each name reminds us of the human element behind industrialized production and the objects we use on a daily basis.”  Mary Lum stated that the piece was about “the idea that a human being is taking responsibility for the acts of a machine, and the double purpose of being named, pride and quality control.”

(To read more about the exhibit: Mass MoCA The Workers May 29, 2011 to April 14, 2012  http://blog.massmoca.org/2011/08/03/artist-spotlight-on-mary-lum/)

The exhibit was a reminder of how powerful our names are.  We sign checks, our tax returns, and all manner of legal documents that commit us, connect us, bind us and sometimes separate us.   We sign our names on little notes to loved ones, birthday wishes and post cards from faraway places; we sign our passports.  And for those of us in health care, our names verify notes in patient files, prescriptions, care plans.  When I was in the pre-op room before my ankle surgery on February 7, 2013, my surgeon, according to surgical protocols, initialed my right leg.  Tragic surgical errors of operating on the wrong person, at the wrong site, with the wrong procedure have resulted in the need for checklists of the process of identification and accountability to assure safety and quality of care.  On the website of the American Academy of Orthopedic Surgeons, the list is as follows:

Pre-operative verification process

  • Hospitals should identify the methodology of pre-procedure verification and site marking based on their own circumstances. Verification of the correct person, procedure and site should occur with the patient awake and aware, if possible:
  • At the time of surgery/procedure is scheduled.
  • At the time of pre-admission and testing
  • At the time of admission or entry into the facility.
  • Anytime the responsibility for care of the patient is transferred to another caregiver.
  • Before the patient leaves the preoperative area or enters the procedure/surgical room.

http://www3.aaos.org/member/safety/guidelines.cfm

An article in the Chicago Sun Times noted that: “Even seemingly minor mistakes such as using an unapproved pen to mark the site, resulting in the ink being washed away before surgery, can open the door for a wrong-site error,” Joint Commission President Dr. Mark R. Chassin said.  Chicago Sun Times July 4, 2011

The surgical site can be marked with a line where the incision will be made, or with “yes,” with an X, or with the surgeon’s initials.  So my surgeon, Adam Becker, MD, of Englewood Orthopedics, marked my right leg with his initials, I am happy to say.  This might just be the protocol of Englewood Hospital, but to me it meant he was not only marking the site so there was no doubt about which ankle needed the incision, titanium plate and six screws, he was taking ownership of that ankle.  The procedure, the responsibility, the accountability and the quality of my ankle repair belonged to him.  I must say about a month after the surgery, after the massive wrappings and ace bandages which were transmogrified into a bright blue hard cast were all removed and the stitches came out and I was able to (finally!!!!) take a bath, I was a little sad to see the Sharpied AB on my skin float away into the warm water and bubbles.  My ankle was back to being my sole possession and responsibility although I will always appreciate Dr. Becker’s kindness, skill and his accountability.

Accountability is what it is all about in health care now linking the reduction in costs, with the increase in quality outcomes and patient satisfaction.  The triple mantra of right price, right place, right services, supports the structures of Accountable Care Organizations, under the Affordable Care Act.  Believe me, everyone out there providing health care wants to be an Accountable Care Organization because that’s where the government money is going.  Being Accountable is lucrative and the big health care providers and insurance companies are all grappling with the cost/quality/satisfaction matrix.  There’s a great website http://www.accountablecarefacts.org/facts/ that brings together all of the research and expertise that accountability in health care is generating in policy and practice.  Important information for all of us care providers and patients.

And yet in this grand shift of corporate health accountability I think the change will be in the commitment of individuals to their own responsibility and pride in a job well done, of individual caring within a structure of accountability…kind of like people putting their names on paper bags.  Atul Gawande, MD, my second favorite surgeon, has focused on this in his Checklist Manifesto:  How to Get Things Right  http://blog.ej4.com/wp-content/uploads/2012/06/The-Checklist-Manifesto.pdf   In the environment of massive knowledge and expertise he maintains that true accountability and quality is in the commitment of each individual checking off their box on the check list.  I did this, I am responsible for this, I care about this, I am committed to the best of this, I check this off and put my name on it.  I own it.  This is my paper bag, my ankle, my responsibility and pride, my own name, my humanity.

At another museum, The Hirshhorn  on the Mall in Washington, DC, which I visited last  November with my friend Heller An and her daughter Karen, there was an exhibit of the work of Ai Weiwei, the brilliant Chinese artist, philosopher, political dissident  and human right activist.  There were his amazing Circle of Animals Zodiac Heads around the reflection pool, the back pack sculpture representing the 5385 students who died in the 2008 Sichuan earthquake, and the bold black on white statements like, “When was the last time you laughed?” And on one wall the testimony to each person’s accountability, rights, pride, commitment to quality, to their individual spirit and value, in health care and all care, caregiver or care recipient, individual human caring, kindness and virtue:

A name is the first and final marker of individual rights, one fixed part of the ever-changing human world.  A name is the most basic characteristic of our human rights:  no matter how poor or rich, all living people have a name, and it is endowed with good wishes, the expectant blessings of kindness and virtue.   Ai Weiwei

lewitt and me

Karel Rose Amaranth

Beautiful to the Bone

The fine black line that diagonaled through the bright white shaft against the dark background was the reason we were looking at this picture.  It was cause for concern, for necessary interventions, for my fear.  And yet my attention was also drawn to the lower area of this study in black and white where delicate lines and sensual little spheres connected, designed like an intricate and elegant piece of jewelry.   These were the bones of my right ankle and foot.

I soon came to have a great appreciation for my ankles, the right one in particular.  I have of course enjoyed them and they have held me up in ever so many of my endeavors:  running on my pier out into the Hudson River; climbing along a precipice in the foothills of the Himalayas; standing in Proud Warrior; kicking away the blue and green and aqua of oceans and rivers and swimming pools; holding me steady as I bounced a baby (mine or anyone’s else’s I could get my hands on;)  dancing and leaping into a silly pirouette; rocking forward on a tennis serve, sloshing through the Mumbai Monsoon; supporting me as I sauté-ed and fried and roasted and peeled and mashed and whipped in my kitchen.

But I never learned to really appreciate my ankles until my right foot slipped from a wet stair onto a wet tiled floor and slid sharply (much too sharply) to the left on a wet San Diego morning.  Snap.  Alas, the ominous black diagonal line running through my lovely fibula poised above the delicate bones of my foot.  Despite the diagnosis, the picture of my ankle and foot was quite beautiful.  Perhaps if I ever decided to take online dating seriously I would post, instead of the requisite head shot, this foot shot with the caption, “Not just another pretty face.”

So while I have certainly enjoyed the structure and support of my bones, I haven’t really thought about them all that much, as is probably true of most of us.  Sure, I am pretty compulsive about getting my calcium; cheese is after all one of the great pleasures of life.  And then there is all of that low fat yogurt:  plain, Greek, frozen, and in smoothies.  Ice cream.  Zero Percent Over the Moon Milk (with Oreos, of course.)  Pizza with fresh mozzarella and anchovies.    I haven’t exactly indulged in all of these calcium rich foods for purely medicinal purposes.  I do also love all those green leafies: broccoli, Brussells sprouts (an odd early acquired taste during my childhood,)  spinach (preferably creamed. ) I have done exceedingly well on my bone density tests with very little advance study.

Now I think about my bones all the time; now that the thin black line has resulted in my right ankle being permanently adorned with some titanium.

I have also been thinking about why we don’t typically think too much about our bones.  In fact bones actually get kind of a bad rap.  Halloween: scary skeletons.  One annually adorns my front door kept company by the Jack O’Lanterns.  Pirate ships:  Skull and Cross Bones.  The dangling marionette of bones in a medical lab in a science fiction thriller.  Malicious King Richard found under a parking lot.  Creepy, but bones intact.  The pejorative terms:  bag of bones, bad to the bone,  bare bones and bone head.

I looked through a few magazines to do some research on the fashion value of bones.  More seemed age appropriate for me.  Here are the survey results of attention to body parts  beautiful as depicted in advertisements:

Skin:  18

Hair: 8

Eye lashes: 4

Lips:  3

Nails (fingers and toes):  2

Bones:  0 (except for a minor mention among heart, joints, muscles, digestive tract, immune system in an ad for Shiff vitamins.  Not very glamorous. )

Of course there were lots of ads for beautiful clothes, and shoes (I long to wear two matching shoes; high heels are yet a dream for the future…although mostly I would love to be wearing my tennis sneakers on the courts.)

Where would those clear unwrinkled skins, exotic eye lashes, lavish hair styles, luscious lips, and sassy finger and toe nails be without the beautiful bones holding everything up.

I was thinking that maybe to attain beautiful bones it just doesn’t take a lot of chemical research (certainly not like what it takes to have those exotic eye lashes.)

Here’s what the NIH has to say:

Get enough calcium and vitamin D in your diet at every age.

Be physically active.

Reduce hazards in your home that could increase your risk of falling and breaking bones.

Talk with your doctor about medicines you are taking that could weaken bones, like medicine for thyroid problems or arthritis. Also talk about ways to take medicines that are safe for bones. Discuss ways to protect bones while treating other problems.

Maintain a healthy weight. Being underweight raises the risk of fracture and bone loss.  (hmmmm here’s something those fashion models might need to know.)

Don’t smoke. Smoking can reduce bone mass and increase your risks for a broken bone.

Limit alcohol use. Heavy alcohol use reduces bone mass and increases your risk for broken bones.

Surgeon General’s Report on Bones

http://www.niams.nih.gov/Health_Info/Bone/SGR/surgeon_generals_report.asp

I thought it was interesting that it didn’t say anything about don’t do crazy stuff like skiing, playing tennis, skate boarding, bike riding,  bungie jumping, mountain climbing, running Marathons. Take it from me, done a lot of those things and never broke a bone.

Most of these recommendations are pretty easy for us here in the United States, but may be more difficult in developing countries.  In some countries dairy products are either expensive, difficult to acquire or in places like India and Nepal not a dietary desire.  When I was planning my trip to Nepal, I asked the Director at the US Embassy what he might like for me to bring him from home.  He didn’t hesitate for a nano second:  “Cheese.  Please bring me cheese. “ And it was true there was no cheese in Nepal.  There are other ways of getting calcium.  It is in those green leafy vegetables, nuts, herbs, soy and seeds (including, yes, Amaranth!!!!!)  But 4 cups a day of that zero fat milk will give you 100% vitamin D, 120% of your calcium, at only 360 calories.

So get your exercise, don’t smoke or drink too much, definitely don’t be underweight, be careful at home, and get your calcium and vitamin D.

But here is something a little tricky and it’s about the vitamin D.  Would you ever think that being out in the sun without sunscreen and eating sausages would be good for you.  Seems a little counter intuitive.  And yet one of the most important ways we get our vitamin D is why it is called the “sunshine vitamin.”   Yes, we get it from sunshine.  It’s also in some things we might find kind of odd:  Cod Liver Oil (ick!:) Fish (yum;) Fortified Cereals (think Cocoa Krispies;) Oysters (sexy;) Fortified Soy (meh!) Eggs (: ) Mushrooms (exotic;) Fortified Dairy (there’s that milk again:) and!!!!!! Salami, Ham, Sausage (get down and make yourself a good hoagie!)

As we know, sunshine is much maligned and for some good reasons like skin cancer.  But we do need some.  An editorial in the Indian Journal of Medical Research by Sarath Gopalan and Prema Ramachanandran (March, 2008) states:

Adequate exposure to sunlight can provide

sufficient vitamin D to children and adults. It is therefore

imperative that nutrition and health education to

improve exposure to sun gets due attention. These

efforts will also result in increase in physical activity

(play in schools and walks for adults) which will reduce

risk of overnutrition and associated risk of non

communicable diseases and improve muscle and bone

health.

The article also notes that the preference for light skin in Indian and Asian cultures can keep people particularly women out of the sun, increasing the possibility of vitamin D deficiency.

If you want to read the whole (very interesting) article here’s the link: http://icmr.nic.in/ijmr/2008/march/editorial.pdf

So these are just some ideas about bone health.  Mostly, we all need to think about our bones more, love them, honor them, respect them.  I have been assured that my right ankle will once again be strong.  I will walk (without crutches,) swim, run, dance, balance, pick up and cradle babies, wrestle with my grandchildren.  I will climb mountains again.

And for this I have many people to thank:  My daughter Kierra who rescued me from Newark Airport and the hospital and nurtured, fed me and kept me smiling; my daughter Alex who will stay with me next week and get me off to my new job, I am sure with her typical sweetness; my grandchildren Nico and Sonoma who love me even in a cast; daughter Kristin who has cheered from the sidelines; Lauren who was able to make me laugh even when I was about to be wheeled into the hospital for surgery; Julie who kept me calm and brought me sushi the night before; Pat who is adopting me for (hopefully) almost the last of my days on crutches; Deb, Purna, Carol, Rochelle, Dan, Jon, Terry who have kept me company; Enrique who is always an Epic; and San Diego Steve who was there.

I am thankful to the health professionals at Englewood Medical Center and Englewood Orthopedics who are the finest and kindest I have ever known in any health facilities; Dr. Perlman who put me to sleep (and made sure I woke up;) and Dr. Adam Becker of Englewood Orthopedics who expertly put my lovely fibula back together (and called me “Princess” when I was wearing a shower cap, hospital gown and my glasses.  Sometimes it’s the little things that get us through.)

To all of the above, who have truly healed me, bones and soul, and to all of you, I raise a glass of Zero Percent Over the Moon Milk in a toast:

“To Our Beautiful Bones.”

http://www.youtube.com/watch?v=o4K-SPnZJOU

shoes

Empty Chairs and Empty Tables

I have been looking forward to the release on Christmas Day of Les Miserables, the movie.  I loved the play and all those revivals of accumulated casts typically televised on PBS for fund raising events, with Colm Wilkinson in the lead.  For years I listened to the CD in my car, usually singing along, plaintively vocalizing the sad song of Fontine, or the righteous ballad of Javert, or belting out “Can you hear the people sing, singing the songs of angry men….,” harkening back to the passion of my old college Viet Nam War protests.

So on New Years night, I decided it was an auspicious moment to take myself to the movies and just allow myself to wallow in the music and the drama, the protests and love and tragedies, the Les Miz Experience.  I was in total swoony love with Hugh Jackman as Jean Valjean.  I was worried about Russell Crowe who looked terrified every time he had to sing.  Amanda Seyfried was a little annoying with her high pitched squeaky voice.  And Anne Hathaway sang her heartwrenching song in a performance that The New Yorker movie review noted she would probably parody herself in on Saturday Night Live.  But I overrode these little criticisms, and was completely engaged in the lavish sets and costumes and, of course, the music.  When Eddie Redmayne sang the beautiful “Empty Chairs and Empty Tables” I was totally entranced.

So entranced was I during his passionate rendition of the song Marius sings after his friends have died in the battle on the barricade, that I didn’t realize until the elderly man sitting next to me handed me a handkerchief (a real cloth handkerchief, not a tissue) that I was quietly sobbing.  For me, the singer was not an idealistic university student during the French Revolution, he was a little boy in an elementary school in Connecticut.  “There’s a grief that can’t be spoken, there’s a pain goes on and on, empty chairs and empty tables, now my friends are gone.”  Empty desks, empty cubbies, empty playground swings and empty monkey bars.

I have found during the past few weeks since December 14, 2012, that the grief has not been spoken; it is too tragic, too horrible and too frightening.   We had all talked ad infinitum about Super Storm Sandy, the deaths, destruction, unpreparedness, power outages, Global Warming, subways under water, boats in the streets.   But in various social settings, in conversations with friends or colleagues, I found no one wanted to bring up the deaths in Connecticut.  I talked to my daughters, desperate to assure them how much I loved them, wanting to be sure I could console them.  Our ritual “I love you”s at the end of every phone call, xoxoxo’s at the end of every email took on deeper meanings as I thought of the last goodbyes of so many parents and their children.  But most of my grief was silent, unspoken.

I wanted to call my friend and colleague Teri Covington, Director of the National Center for  Child Death Review.  We had worked together on the review of child deaths in Nevada, a public health initiative to analyze each death and the circumstances, to make recommendations, to prevent future deaths, to “Keeping Kids Alive” as the Center’s tag line reads.  But what was the analysis of these child deaths?  It was all too simple:  innocent children, a violently disturbed young man, semi automatic fire arms.

“Oh, my friends, my friends don’t ask me what your sacrifice was for.

Empty chairs and empty tables.”

I didn’t call.  I quietly grieved.

On the website, grief.com, sponsored by Elizabeth Kubler-Ross, the phrase Public Grief is used and explained.   It is that pervasive grief that impacts an entire population:  the aftermath of 9/11, the massacres in Rwanda, the killings at Columbine, the shootings and deaths in a movie theater in Colorado, Gabrielle Giffords shot and members of her staff and constituency dead.  Through the media or direct contact with those affected, we are all affected.  Public grief is like any other public health epidemic, it ravages our bodies and emotions, impacts on our abilities to function, disrupts sleep and eating, it causes literal heartbreak.  But there is no typical arc of a disease outbreak.   And, there is no vaccine to prevent the damage, or surgery to correct, or medicine to treat.  The outcomes are as varied as each individual’s fingerprints.  Some will be energized to enact changes in laws or policies.  Some will sink into deep depression.  Some will reach out to the victims with love and tokens and memorials.  Some will find an artistic expression.  Some will provide counseling; some will receive it.  Some will advocate for teachers and school personnel to have guns.  Some will seem unaffected and will suffer emotional pain in years to come.  Some will advocate for the mentally ill and the disabled so that these do not become labels of fear or mistrust.  Some will grieve and join together with others and heal.  Some will quietly privately grieve. The pain goes on and on in a myriad of ways.

But I wonder what is grief? One definition is:  grief is a profound emotional process with very real biological symptoms that can endure for months.  But there is disagreement as to whether or not it is a “disease.”  The argument continues in regard to grief’s inclusion in the 2013 DSM:

Is grief a disease? That is one of the crucial questions psychologists are asking as the American Psychiatric Association revamps its Diagnostic and Statistical Manual of Mental Disorders (DSM), used by millions of mental health professionals to diagnose patients, for a fifth edition due out in 2013.

A group of psychiatrists have spearheaded a movement to include ongoing grief as a disorder, to be labeled “complicated” or “prolonged grief.” Others have proposed, separately, that a mourner can be labeled clinically depressed only two weeks after the loss of a loved one. The problem with both potential changes is that more people’s grief will be diagnosed as abnormal or extreme, in a culture that already leads mourners to feel they need to just “get over it”. (slate.com)

The psychiatrists and psychologists can argue on, but I don’t know, is grief a disease? An epidemic? A private emotional struggle?  I am not sure this research helped me at all to know what grief is, I only know how it feels.  But I do know what grief is not.  It is not despair.  It is not revenge.  It is not blame.  It is not a justification for violence.

I don’t know how it is that someone who suffered such a great loss could also give all of us a great gift.  It is as though the person with the most extreme pain is also the person able to provide a healing process for the rest of the population.  Robbie Parker, Emilie Parker’s father, was able to speak of grief, his grief, his family’s grief, the grief we all feel.  He spoke of his daughter’s beauty and generosity of spirit. He spoke of kindness, humility and compassion, and the inspiration for us to love each other.  He gave us a very public message from his own heart to help all of us begin to heal from our public grief and our own private broken hearts.  And as I think of his words I am reminded of a card I keep on my desk that says:

“…I swear I will not dishonor my soul with hatred, but offer myself humbly as a guardian of nature, as a healer of misery, as a messenger of wonder, as an architect of peace….”*

The chairs and tables will remain empty forever.  All we can do as we grieve is to try to be architects building a kinder, more compassionate, more loving world around them.

And to never forget to tell our children how much we love them.

P491guardians

 

 

*from a poem by Diane Ackerman; cards and posters produced by and available from Syracuse Cultural Workers, Box 6367, Syracuse, NY   13217

 

 

A Beautiful Day in the Neighborhood

“When I say it’s you I like, I’m talking about that part of you that knows that life is far more than anything you can ever see or hear or touch. That deep part of you that allows you to stand for those things without which humankind cannot survive. Love that conquers hate, peace that rises triumphant over war, and justice that proves more powerful than greed.”

It was not a beautiful day in the neighborhood.  The river swelled with rain, the high tide and the pull of the full moon which was obscured by the storm clouds. The wind blew houses apart, ripped out electrical wires, knocked down trees and set violent waves into motion.  On the streets of my little village, the storm left hundreds of people along the river and creek with water and mud in their basements, their living rooms, bedrooms and kitchens.  Some homes were missing entire walls. Docks were washed away.  Boats were in the streets and crushed into houses.  Without electricity the village was dark and people we had always welcomed as tourists became voyeurs to the devastation and some sadly came back under the cover of the darkness to take advantage of exposed boats and homes that still contained valuables.  We had a curfew in our little village.

As the days went on and communication was slowly restored we all became more and more aware of the assault on our larger neighborhood, other towns and villages where our family and friends live. Jersey City where two of my daughters live, Hoboken, the Jersey Shore with shocking pictures of homes washed out to sea and the roller coaster mangled and submerged.  Staten Island devastated; a woman walking around rubble where her house once was.  Battery Park under water and much of Manhattan at a standstill: a New York Moment became a long continuum of slow dark nights and days of daunting challenges of finding food, drinking water, housing and comfort.  There were deaths from falling trees, isolation, flooding.

Here in our little village we gathered last Thursday morning at the Village Hall for instructions, information and opportunities to help each other.  Our Mayor Chris Sanders said, “We didn’t lose anything of value; we lost stuff.  No one died.  We can replace the stuff but we can’t replace a life.”  “Life is far more than anything you can see or hear or touch.”  He didn’t say that, but it was the message in his message.

And the villagers joined together to help with the stuff.  Crews bulldozing the streets, neighbors helping neighbors pump water and clean sludge out of their homes, the Fire House serving as a temporary shelter.  I was fortunate.  I got to help just by doing something I love, cooking big pots of soup for people staying at the Fire House and the volunteers.  I also had the opportunity to just listen to some people who just needed to talk.   It was hard to listen knowing that I couldn’t fix anything that these women needed help with. I didn’t have answers, but I think there were people like Judy and Jackie and Helen and Sue who just needed someone to listen to their questions.  Like, “Can I ever go back to my house on the river?”  I thought of Atul Gawande’s book Better citing one of the five ways to change the world as listening.   I just tried to quiet myself down and truly listen.

There were all the public health issues of contaminated water and requirements of boiling drinking water, of wearing protective clothing in water that contained sewage and chemicals.  Concerns about food spoilage and gastrointestinal infections.   And the importance of safeguarding against stepping into water that had electrical wires concealed beneath the surface.  Although not too many homes in our village have garages I reminded people to not sit in a closed garage running their car to charge their cell phones.

In the midst of this I received an email from my daughter Kierra who had gotten information from my grandchildren’s Montessori School about what to tell kids about all the damage and devastation.  So often in the crisis and busyness of trying to cope and clean up and take care of and rebuild we forget that kids can’t understand what happened not just to them, but to others in the big neighborhood.  The email referenced a quote for parents, really any grown ups,to help children during a crisis in their own home, in the village, in the big neighborhood.

“When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.”  Fred Rogers

Those of us who are of a certain age and our children remember watching Mr. Rogers’ Neighborhood which was on PBS for more than 30 years from 1968 to 2001.  It was in fact always a beautiful day in the neighborhood as Mr. Rogers slipped into his zip-up sweater and sneakers.  Although Mr. Rogers’ Neighborhood was a little cardboard town, he gave kids and all of us who watched the understanding of the big neighborhood and our responsibilities for each other.  He helped us all understand, “That deep part of you that allows you to stand for those things without which humankind cannot survive. Love that conquers hate, peace that rises triumphant over war, and justice that proves more powerful than greed.”   And helpers that put the neighborhood back together after a superstorm that devastated homes and businesses and people’s lives.

As I look at the newspapers and the TV reports, at the online pictures of the damage left by the violent winds and surging water, I keep looking for the helpers and I keep reminding everyone I know, big and little that there are always helpers.  I don’t mean this in any way to be flippant.  The damage is real in real neighborhoods, not the little 1960’s cardboard TV set.  Precious irreplaceable lives have been lost and it will take a long time and immeasurable resources to fix and repair and replace the stuff.   But the messages that Mr. Rogers left for us are real, too, and I believe that these messages help us as helpers and as those who need so very much to be helped.

The Marathoners ran to Staten Island with rakes and shovels and bottled water. My friend Linda Burnside in Winnipeg ran her own fund raising  “Run Anyway.”  On the news last night there was the report of a man from Texas who drove to Long Island with supplies and food.  There was a fund raising concert last Friday night with Sting and Springsteen and Christina Aguilera supporting the Red Cross.   Senator Kirsten Gillibrand and Congresswoman Nita Lowey came to our village.  The Salvation Army was here in Piermont, so were our DPW, Fire Fighters, Women’s Auxiliary, Police Force and our inspiring Mayor Chris Sanders.   The helpers are everywhere on this beautiful day in the neighborhood.  They are us.

(And by the way, “I have always wanted to have a neighbor just like you, I have always wanted to live in a neighborhood with you.”)

http://video.pbs.org/video/1415187976/

► 1:28

http://www.youtube.com/watch?v=OFzXaFbxDcM

Fred Rogers > Quotes

“Anyone who does anything to help a child in his life is a hero to me. ”

“Love isn’t a state of perfect caring. It is an active noun like struggle. To love someone is to strive to accept that person exactly the way he or she is, right here and now.”

“If you could only sense how important you are to the lives of those you meet; how important you can be to the people you may never even dream of. There is something of yourself that you leave at every meeting with another person.”

“Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone.”

“Forgiveness is a strange thing. It can sometimes be easier to forgive our enemies than our friends. It can be hardest of all to forgive people we love. Like all of life’s important coping skills, the ability to forgive and the capacity to let go of resentments most likely take root very early in our lives.”

“When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.”

“We live in a world in which we need to share responsibility. It’s easy to say “It’s not my child, not my community, not my world, not my problem.” Then there are those who see the need and respond. I consider those people my heroes.”

“You rarely have time for everything you want in this life, so you need to make choices. And hopefully your choices can come from a deep sense of who you are. ”

“Often when you think you’re at the end of something, you’re at the beginning of something else.”

“Mutual caring relationships require kindness and patience, tolerance, optimism, joy in the other’s achievements, confidence in oneself, and the ability to give without undue thought of gain.”

“Love and trust, in the space between what’s said and what’s heard in our life, can make all the difference in the world. ”

“The greatest gift you ever give is your honest self.”

“In times of stress, the best thing we can do for each other is to listen with our ears and our hearts and to be assured that our questions are just as important as our answers.”

“Whether we’re a preschooler or a young teen, a graduating college senior or a retired person, we human beings all want to know that we’re acceptable, that our being alive somehow makes a difference in the lives of others.”

“Who we are in the present includes who we were in the past.”

“I hope you’re proud of yourself for the times you’ve said “yes,” when all it meant was extra work for you and was seemingly helpful only to someone else.”

“The thing I remember best about successful people I’ve met all through the years is their obvious delight in what they’re doing and it seems to have very little to do with worldly success. They just love what they’re doing, and they love it in front of others.”

“We need to help people to discover the true meaning of love. Love is generally confused with dependence. Those of us who have grown in true love know that we can love only in proportion to our capacity for independence.”

“The child is in me still and sometimes not so still.”

“Discovering the truth about ourselves is a lifetime’s work, but it’s worth the effort.”

“It’s very dramatic when two people come together to work something out. It’s easy to take a gun and annihilate your opposition, but what is really exciting to me is to see people with differing views come together and finally respect each other.”

“The connections we make in the course of a life–maybe that’s what heaven is.”

“Little by little we human beings are confronted with situations that give us more and more clues that we are not perfect. ”

“It’s not the honors and the prizes and the fancy outsides of life which ultimately nourish our souls. It’s the knowing that we can be trusted, that we never have to fear the truth, that the bedrock of our very being is good stuff.”

“I’m proud of you for the times you came in second, or third, or fourth, but what you did was the best you have ever done”

“When we treat children’s play as seriously as it deserves, we are helping them feel the joy that’s to be found in the creative spirit. It’s the things we play with and the people who help us play that make a great difference in our lives.”

“In the external scheme of things, shining moments are as brief as the twinkling of an eye, yet such twinklings are what eternity is made of — moments when we human beings can say “I love you,” “I’m proud of you,” “I forgive you,” “I’m grateful for you.” That’s what eternity is made of: invisible imperishable good stuff.”

“At the center of the Universe is a loving heart that continues to beat and that wants the best for every person. Anything that we can do to help foster the intellect and spirit and emotional growth of our fellow human beings, that is our job. Those of us who have this particular vision us to continue against all odds. Life is for service.”

“Whatever we choose to imagine can be as private as we want it to be. Nobody knows what you’re thinking or feeling unless you share it.”

“The world needs a sense of worth, and it will achieve it only by its people feeling that they are worthwhile.”

“What’s been important in my understanding of myself and others is the fact that each one of us is so much more than any one thing. A sick child is much more than his or her sickness.
A person with a disability is much, much more than a handicap. A pediatrician is more than a medical doctor. You’re MUCH more than your job description or your age or your income or your output.”

“Peace means far more than the opposite of war.”

“Knowing that we can be loved exactly as we are gives us all the best opportunity for growing into the healthiest of people.”

“There is no normal life that is free of pain. It’s the very wrestling with our problems that can be the impetus for our growth.”

“There are three ways to ultimate success:
The first way is to be kind.
The second way is to be kind.
The third way is to be kind.”

“I don’t think anyone can grow unless he’s loved exactly as he is now, appreciated for what he is rather than what he will be.” “Try your best to make goodness attractive. That’s one of the toughest assignments you’ll ever be given.”

“How great it is when we come to know that times of disappointment can be followed by joy; that guilt over falling short of our ideals can be replaced by pride in doing all that we can; and that anger can be channeled into creative achievements… and into dreams that we can make come true.”

“A young apprentice applied to a master carpenter for a job. The older man asked him, “Do you know your trade?” “Yes, sir!” the young man replied proudly. “Have you ever made a mistake?” the older man inquired. “No, sir!” the young man answered, feeling certain he would get the job. “Then there’s no way I’m going to hire you,” said the master carpenter, “because when you make one, you won’t know how to fix it.”

“I believe that appreciation is a holy thing–that when we look for what’s best in a person we happen to be with at the moment, we’re doing what God does all the time. So in loving and appreciating our neighbor, we’re participating in something sacred.”

“There was a story going around about the Special Olympics. For the hundred-yard dash, there were nine contestants, all of them so-called physically or mentally disabled. All nine of them assembled at the starting line and, at the sound of the gun, they took off. But one little boy didn’t get very far. He stumbled and fell and hurt his knee and began to cry. The other eight children heard the boy crying. They slowed down, turned around, and ran back to him–every one of them ran back to him. The little boy got up, and he and the rest of the runners linked their arms together and joyfully walked to the finish line.
They all finished the race at the same time. and when they did, everyone in the stadium stood up and clapped and whistled and cheered for a long, long time. And you know why? Because deep down we know that what matters in this life is more than winning for ourselves. What really matters is helping others win, too, even if it means slowing down and changing our course now and then.”

“It’s really easy to fall into the trap of believing that what we do is more important than what we are. Of course, it’s the opposite that’s true: What we are ultimately determines what we do!”

“It’s a beautiful day in this neighborhood,
A beautiful day for a neighbor.
Would you be mine?
Could you be mine?…

It’s a neighborly day in this beauty wood,
A neighborly day for a beauty.
Would you be mine?
Could you be mine?…

I’ve always wanted to have a neighbor just like you.
I’ve always wanted to live in a neighborhood with you.

So, let’s make the most of this beautiful day.
Since we’re together we might as well say:
Would you be mine?
Could you be mine?
Won’t you be my neighbor?

Won’t you please,
Won’t you please?
Please won’t you be my neighbor?”

Healing: knit one, purl one, knit one, purl one

I have a scar on my right cheek.  It’s this little crescent shape that I have thought of  as a moon or a smile.  I have had it for as long as I can remember because it is from a sharp piece of metal on a doll stroller I got for Christmas when I was about a year and a half old.  (Yes, toys back then before the proliferation of plastics were made of materials like metal.)  I apparently fell and tumbled into the stroller and the little sharp edge near a wheel sliced into my cheek.  Apparently there was much crying, probably more my parents  than me.  My cheek bled, healed and formed my little moon-shaped scar.

I have a few other scars that I am fond of because they bring back memories of my past.  There is one on the inside of my left knee from a buckle on a flipper a friend, Jim Winkler, was wearing when we were swimming at West Meadow Beach and he kicked past me.  All I felt was a little stab and then the blood rose to the surface… my blood.  Fortunately this was Long Island Sound, not the warm Pacific so a shark feeding frenzy did not ensue.

I have a scar on my right knee from a biking accident a few years ago when I was riding from Piermont toward Nyack and hit some gravel.   I got home and realized I didn’t have a Band-aid  anywhere in my house.  I was sitting out in my yard sopping up the blood with towel when my neighbor Dan  (who you have met before in these blogs) came out of his house.  “Dan,” I said in a particularly plaintive voice, “do you happen to have a Band-aid.”  Actually he had quite the Band-aid.  The kind that is akin to the body wraps now used for battle wounds.  A tight plastic seal impregnated with antiseptic.  The wound is sealed up and mends like magic.  That knee boo boo makes me think of a warm beginning of summer day and a good neighbor.

I have a scar on the top of my right foot where a very fashionable shoe bored a hole in my skin while I was walking from meeting to meeting in New York City on a hot summer day.  (Hint always have a pair of flip flops or sneakers hidden somewhere in your briefcase for these dangerous situations.)  The bloody wound transformed into a lovely silvery oval that I think looks quite sparkly as it peeks through the lacings of elegant sandals.

And there is a quite newly acquired scar on the back of my left hand.  This summer as my friend Julie and I were launching her lovely little sail boat, a West Wight Potter, the boat glided too close to the dock.  In some deranged super hero moment I thought sticking my hand between the dock and the bow would prevent damage to both; of course it was my hand that was painfully sandwiched and immediately blew up like an inflated surgical glove and oozed scarlet.  Julie handily took control of the boat and I dashed up to the boat house and stole (yes, I did not pay for, I totally ripped off) a big bag of ice and buried my hand in it.  I have a pretty high pain threshold so as long as I don’t have to actually look at my own gushing blood and other physical damage, I can be quite functional.  I joined Julie on the boat, we navigated out of the Nyack Boat Club basin, past the moorings and channel markers and sailed the Hudson.  It was beautiful.  Really there is nothing like sailing, especially with a good friend.  From time to time I pulled my hand out of the bag of ice and over the next couple of hours the swelling decreased, my hand, somewhat blue, was in fact totally functional and the bleeding slowed and the blood began to congeal.  The scar now looks like a little butterfly, perhaps a Monarch gliding over the Hudson River enjoying the summer breezes before setting off for Mexico.

It’s kind of a miraculous thing the way our bodies heal.  Miraculous, mystical, magical.  And what is amazing is that this healing is real, it’s scientific, it’s physiological.  Look up healing on the internet and you will get a barrage of spiritual healing, healing stones, healing scriptures, sexual healing, healing your heart, healing hands, the one simple thing to do every morning to heal your prostate, aroma therapy healing, Kundalini healing.  Everybody’s into some kind of healing which is a good thing.   But I love the plain ordinary physical putting little pieces of your body back together healing.  Here’s the process, it’s about three steps of somewhat complicated bio chemistry.

!.  The inflammatory stage (like ouch!!!!) immediately after  the injury.  Clotting takes place to stop the blood loss and various factors are released into the cells to protect from infection.

2.  The proliferation stage.  This is more complicated because this is where the mending takes place.  Collagen starts to form, and new capillaries are produced.  The wound edges are pulled together and then the cells start reproducing to regrow the loss of flesh.  Amazing that they know how to do this.

3.  The remodeling stage.  Collagen fills in the gaps and a scar forms.  This is also known as cicatrisation….scar tissue is cicatrix which I have always thought is a pretty cool word.

I have been a knitter for a long time.  Friends and family have gotten scarves and sweaters.  A sweater vest with Reindeer.  Last year for Christmas I knit everyone in my family a scarf in their favorite color.  I love knitting because you can take this long yarn which really is pretty useless and turn it into something useful, something that will keep someone warm, something comforting.  And I like that repetitive knit, knit, knit, maybe a knit, purl, knit, purl seed stitch.  It’s meditative.  And I think it is like healing.

When I was about 15, I had a very intellectual boyfriend named Richard McDonough.  For my birthday he gave me a book of John Updike poems called Telephone Poles and Other Poems.   I had that book up until about 5 years ago when getting divorced, moving, packing and the various painful activities involved therein, many of my books including that little volume of poetry disappeared.  I think the birthday card that Richard gave me was still in the book.  Sad.  But of course the wonders of the internet are that one can track almost anything down.  No, not the exact book that was mine, but another copy.  I clicked on the “Buy With One Click” button on Amazon and a few days later there in my mail box was Telephone Poles, its worn cover like a dear old friend.  The price on the jacket flap is $4.00 and the back sports a photo of a very young John Updike on a beach.   As I perused the poems, “The Great Scarf of Birds,”  “Winter Ocean,” “Wash,” the words and syntax brought back feelings and memories of long, long ago, a time when I had far fewer scars for better or for worse.

I came across a poem I had always particularly loved, “Seven Stanzas at Easter.”  Updike writing of the Resurrection wrote:

If the cells’ dissolution did not reverse,

molecules reknit, the amino acids rekindle,

the Church will fall.

The healing miracle was very physical.  It was like knitting.

When I get hurt, I like to think of healing as my cells, my molecules, my amino acids miraculously knitting themselves together, cozy, homey and very domestic like a winter evening in front of a fireplace, making something physical, warm, comforting.

By Any Other Name: A Life Well Lived

The devastating epidemic that claimed the lives of 100,000,000 people globally and at least 600,000 in the United States caused the death of her young father, the family support and breadwinner when she was only 3 years old.  She was sent to live with her grandparents. Her sister died when she was about 5, from what was thought to be a heart condition, although diagnostics were limited then.  Children often died and the cause was a sad guess. The separation from her mother and two other sisters was emotionally difficult for her, but under the financial circumstances in the family and nationally, her mother knew it was her best opportunity.  Her grandparents had a small grocery store so no matter how limited their income was there was always nutritious food, for her, her family and the local community, her grandparents often taking a parrot, a zither, a paper IOU as payment from neighbors for their groceries.

She was told at some point in her adolescence that she might not be able to have children, and yet she married  and had three daughters.  She had a heart attack.  There was a diagnosis of breast cancer, a breast removed, chemotherapy.  A broken hip.  A thyroid condition.  Upper respiratory infections.  The long slow decline of Alzheimers.

My mother, Rose, died last week at the age of 96.  Despite the health and financial challenges, she thrived for most of those 96 years.  Last August my youngest daughter, Alex, and I visited her at the nursing home she lived in for about 5 years.  She was bright and happy to see us although at some point during the last few years I had realized that she might not really remember my name or which one of the daughters I was.  But she was all smiles and hugs that day, and she loved that we were there with her.  She particularly loved the granddaughters.  Once about 4 years ago, she was rushed to the hospital barely conscious.  My daughter Kierra and I met my sister in the emergency room and standing at her bedside we all believed that my mother was about to die.  Concerned that she might, even in that state, be thirsty, Kierra dripped some juice from a straw onto her lips.  She licked her lips and as the juice ran into her mouth she swallowed.  Her eyelids fluttered open and she smiled at Kierra.  “What are you all doing here, Sweetheart?” she asked.

Fortunate to have had her for so long and to have been able to spend her last two days of life with her, I am still grieving, but I also can’t help but wonder what it was that contributed to her long life.  My father died in 2001 at the age of 86 from a heart attack.  Most of my parents’ friends have died.

When I think about the generally accepted contributors to health, exercise, good nutrition, and keeping mentally active, I wonder how these affected my mother’s life.  She was always active gardening, cleaning, taking us kids to the beach, helping at the church, but she never went to a gym, never ran, never wore spandex.  Even at the beach she wasn’t a swimmer.  She and my father though would take walks around the neighborhood, holding hands.  And nutrition, well, she was an amazing cook and in the summer months was always gathering fresh fruits and veggies and then canning and freezing them to get us through the winter with those summer vitamins.  But, there was lots of meat (red and otherwise) in our diets:  Sunday roast beef, pork and dumplings and sauerkraut, fried chicken, bacon and eggs for breakfasts.  I remember that when I was in elementary school, the other little girls had these darling little sandwiches made of cream cheese, and peanut butter and jelly, maybe tuna salad, cute sandwiches with the crusts cut off.  I however, would remove from my lunch box, big hunks of homemade bread with a fried veal cutlet or slabs of leftover Sunday roast beef.  And by the way cutting off crust was considered totally wasteful and my parents subscribed to the philosophy that  eating “crusts makes you pretty.”  And of course there were not only the sandwiches…..my lunch box consistently contained a big slice of homemade lemon cake (with frosting) or apple strudel or a poppy seed pastry or chocolate chip cookies.  Well into my parents’ late 80’s, my mother was known as the “Cookie Lady” in their neighborhood because rather than giving kids’ candy bars for Halloween, she baked cookies that she and my father put in little baggies with ribbons to give out to the costumed callers.  They were renowned at their church for making literally hundreds of donuts (fried in hot oil of course!) for the Fastnacht celebrations every year the night before Ash Wednesday.  For all of this, neither of my parents were ever overweight, nor are or were any of their off-spring.

So exercise and nutrition in my mother’s life were not exactly by the public health book.  Keeping mentally active was.  When I was in high school, my mother, who was a very good student in high school but never went to (as if it would ever even have been thought of) college, became the assistant for a well-known sociologist in Stony Brook.  She took over his academic life as a gentle whirlwind, organizing his books, redeeming royalty checks that were long expired, editing his manuscripts, negotiating with publishers and handling all of his correspondence and travel plans.  Long after Dr. Nelson died in his sleep on a train in Italy, my mother continued to read academic articles and edited my sister’s doctoral dissertation and my masters thesis.  But that wasn’t all.  She sewed.  No, she didn’t just sew, she was the mastermind of three daughters’ and her own wardrobes.  Months before Easter Sunday, we would all make a pilgrimage to various fabric stores where we would study pattern books for the latest fashions, hunt through bolts and bolts of fabrics, and ferret out the best notions:  little fabric frogs, buttons, lacey trims.  And then over weeks my mother would work her magic with pins and those thin paper patterns and hours and hours at the sewing machine.  And those, long  “hold still!!!!” sessions of her pinning up the hems and adjusting waistlines, shoulder seams and zippers.  She knit us sweaters and scarves and  crocheted a dress for me that I still have.  She made millions of little craft items and baby sweaters and booties, and cloth dolls for church fairs.  When the grandchildren she adored came to visit she taught them how to make little Christmas mice, pot holders and seashell jewelry.  She always had the best craft supplies. My daughter Kristin loved those little Grandma mice.

So what else?  Certainly the literature supports the association of a long stable relationship with health.  Rose and Charlie were together in a loving mutually supportive marriage for almost 70 years.  My mother had a very strong network of family support, neighbors and church members:  a social support being a strong indicator of health.  My father worked for Grumman Aircraft and so we all had good healthcare benefits:  I actually remember as a child when my parents thought I might have polio, the doctor coming to our house with his little black bag.

And then there was my parents’ consumption of coffee, the health benefits now well documented.  From the Harvard Review: In 2011, researchers reported findings that coffee drinking is associated with a lower risk of depression among women, a lower risk of lethal prostate cancer among men, and a lower risk of stroke among men and women. Go back a little further, and you’ll come across reports of possible (it’s not a done deal) protective effects against everything from Parkinson’s disease to diabetes to some types of cancer http://www.health.harvard.edu/press_releases/coffee_health_benefits

And this in the Daily Beast:  A new study suggests that drinking coffee significantly reduces our skin-cancer risk. There’s a raft of other research that’s piling up evidence that regular cups of joe—six-ounce servings packed with antioxidants, polyphenols, and other health-boosting chemicals—can prevent everything from diabetes to depression to cirrhosis of the liver to stroke. (Intracranial aneurysms, not so much.) Scared of superbugs? Pour yourself another cup. http://www.thedailybeast.com/articles/2011/10/28/coffee-health-benefits-how-coffee-might-save-your-life.html

My parents didn’t know any of this and perhaps all the coffee health benefits were outweighed by my mother’s yummy buttery pastries and cookies and cakes that went along with the caffeine and antioxidants, but I do believe that the two of them sharing coffee at breakfast, the mid morning coffee, coffee with lunch, the mid afternoon coffee break, coffee after dinner and the late evening coffee (usually accompanied by ice cream,) contributed to my mother’s long and happy life.  Maybe it was the conversations they had while they were drinking coffee or the plans they would make or the hand holding that went along with the coffee.

My mother was not a public health professional, she wasn’t a nurse or a doctor although I do truly believe that she saved my life several times when I was a child by making me yum yum, a combination of hot milk, honey and butter, in the middle of the night.  She wasn’t a great philanthropist with a foundation that put her name on some medical center building or library, and she wasn’t the author of any great books.  Her long loving life is however a testimony to a life well-lived and perhaps the greatest lesson we can learn about our own health and improving the quality of life in the world:  Love the people around you.  Be passionate about everything you do, especially those the small acts of kindness.  Make the world more beautiful in your own unique way.  Love children, grow roses, knit a scarf, bake cookies, smile at strangers, hold a hand, share a cup of coffee, change the world.


Rose’s Czech Peach Dumplings

This recipe makes 8 dumplings

In a glass measure, pour 1/2 cup milk. Add 2 large eggs and whisk together to blend.

In a large mixing bowl, measure 2 cups all purpose flour, 1 teaspoon baking powder and 1/4 teaspoon salt. Stir to mix. Make a well in the center of the dry ingredients and pour in the milk and egg mixture. Use a wooden spoon to mix well. Dough will begin to get stiff. If it is very sticky, add a little more flour. The dough should not be sticky, but should still be soft enough to roll into a sheet.

Divide the dough into 2 pieces. Roll out one piece at a time into a thin sheet and cut (with scissors) into 4 square pieces. Place a half of a peeled, pitted peach on each piece of dough, and add a small piece of butter, sprinkle with cinnamon and sugar.  Fold in the corners of the dough to cover the peach half.  Be sure the peach is sealed well in the dough. Repeat with the other piece of dough.  Sprinkle some flour on a clean surface. Set the peach dumplings on the flour and cover loosely with a clean kitchen towel. Bring a large covered pot of water to a boil.  When water is boiling hard, gently drop the dumplings into the pot. Put the cover on the pot. Set the timer for 20 minutes. Do not take the cover off the pot until the timer rings. Transfer each dumpling to a large dinner plate. Prepare to eat by cutting into small pieces. Pour melted butter over the dumpling. Sprinkle with more sugar and cinnamon. Eat. Enjoy!!!

50 Shades of Designer Bags

My children could tell you just how nerdy I am since they have experienced my crazy obsession with their school projects (“Oh, no, not foam core again, Mommy!”) and my over-preparedness for classes I have taken (at least half the text book read and HIGHLIGHTED before the semester started).  My  friends, fortunately for me, welcomed me back after I had spent months in the cocoon of writing my MPH thesis. My reading material tends to be the daily New York Times, The New Yorker and the American Journal of Public Health. (I actually have a once a week date night with The New Yorker; I have found it some mornings stuck to my face.)  I have been known (or hopefully unknown) to steal copies of Journal of the American Medical Association from my doctor’s office.  The most recent book I read is Classified Woman by Sibel Edmunds.  Although I do have to confess to having read……no actually I am going to take the 5th on the 50 Shades books.   When I fly I do totally indulge in something like Vogue or Glamour, but that is in response to my suppressed fear of flying and is for purely medicinal purposes.  So when 4 times a year The New York Times has a fashion supplement I feel completely justified in wallowing through those pages of luscious, colorful, crazy expensive designer clothes and accessories because after all, it’s The New York Times.  The Fall 2012 issue arrived last weekend.  I continue to wallow.

It seems that darling little designer clutch bags are very much in style for the Fall.  There’s a page of them in yummy colors and another section called Grab Bags:  Know when to hold ‘em and when to fold ‘em, with no apparent apologies to Kenny Rogers.   Somehow I did not fashion forecast well when I bought that big red Prada knock off in Hong Kong for $15.  These little bags are of course very pricey.  They are designed by Celine ($2,100,) Phillip Lim ($625,) Victoria Beckham ($650,) Marc Jacobs ($550,) and Coach (only $148,) among others.  My guess is they are just big enough for a credit card, a lipstick, a cell phone and a couple of condoms…maybe a box of Tic Tacs.   Just the basics for survival at some soignée soirée.

Of course I know what little bags can carry and the impact on health outcomes they can have because I spent about two years of my life studying the contents of little bags about 6” by 4”.  These darling little bags, not so pricey, not so pretty, carry things like a razor blade, string, a piece of soap, a sheet of black plastic: not really contents for a fun evening out, but pretty useful if you are going to have a baby at home in a rural region of Nepal or India or Uganda or Ghana or Rwanda or Afghanistan. At least 350,000 women a year die in childbirth internationally.   One of the leading causes of death is infection which can result from unsanitary delivery conditions.  So these little bags of useful items, called birthing kits, have been developed by several organizations including Zonta International, the World Health Organization and UNICEF. More than a million of these kits are distributed annually, especially in developing countries where maternal deaths are the highest in the world.

The kits have been designed by medical providers and organizations.   They are standardized and able to be mass produced, inexpensive and extremely compact.  Dr. Joy O’Hazy who works with Doctors Without Borders and Zonta told me that, “While quantifiable data is difficult to acquire what we have received is a large amount of anecdotal evidence from our partners about reduced infections and deaths in places like Kenya and Afghanistan.”  (Joy by the way is an amazing person and I have been fortunate to be able to stay in touch with her since completing my thesis.  “Hello, Joy!!!!”)

So here’s the thing I just can’t stop wondering about.  We know that birthing kits save lives, but to save lives they not only have to be available, they have to be used.  If rather than having a pretty little clutch bag, the only thing you could carry your evening supplies for a party in was a plain plastic baggie would want to do that or would you just leave your stuff home? Do you want someone to pick out that plastic bag for you or would you want to shop for something you like or you feel expresses who you are?  Do these seem like silly questions in relation to clean birthing supplies?  I don’t think so.

Social design is based on the understanding that for products to be effective they must include user end participation in the design, i.e., if you are going to design something ask the people who are going to use it to be involved with the design of that product.  How do I know this? I have a brilliant neighbor named Dan Formosa, Ph.D., who is one of the founders of Smart Design, and he told me about social design and he helped me with my thesis.  So I know this is true.  For birthing kits to be truly effective in saving the lives of women and babies, the design of the kits has to include the women who will use them.  They need to be social designer bags.  Not mass produced but in at least 50 shades.   The bags that women use in Uganda need to be Ugandan.  The bags that women use in Afghanistan need to be Afghan.  The bags that women use in Nepal need to be Nepali.  Not only is this social design, it is beautiful design.  All of these countries have wonderful traditional designs, colorful crafts, amazing creativity.

So here’s the challenge for designers.  Design beautiful, inexpensive, small birthing kits that can be distributed and used and can save lives.  You can include women from their countries, you can use some of the proceeds from your $600 pouches, you can engage the design community in saving women’s lives.  You can make preventing maternal mortality sexy and cool.  That’s what designers do.

Here are some direct challenges:

Hey, Prabal Gurung, do it for Nepalese women.

Mimi Plange, for women in Ghana.

Georgio Armani, Louis Vuitton, Channel, Estee Lauder, Gucci, Calvin Klein, Hermes, Prada, Marc Jacobs, Tod’s, Salvatore Ferragamo,  Celine, MaxMara, Michael Kors, Balenciaga, Missioni, Chloe………pick a country and get to know the women there.  And design with them.

And Kenneth Cole, how about some really cool compelling billboards.  You are so very clever.

Perhaps Tyler Brule, the editor of the hip international travel, design, political magazine Monocle would take on the coordination.

So I guess it is just my inherent nerdiness that got me from those darling little clutch bags to preventing maternal deaths.  Or maybe it was the women I met in Nepal and India and Brazil and my friend David in Uganda and Joy O’Hazy , who constantly inspire me and make me think, actually believe, that “it only seems impossible until it is done.”

PS…Hey, Prada, so sorry about buying the knock off.  I promise never to do it again.

There is No Finish Line

 Who could not be absolutely in love with Gabby Douglas? With Alex Raisman, Jordyn Wieber, McKayla Maroney, and Kyla Ross…the Fab Five who won our hearts and medals at the Olympics?  Along with so many athletes we are watching intently, cheering for, sighing for, disappointed with and celebrating with, they are paragons of health, of beauty, of achievement, of competitiveness, of winning.  Even when they fall short (literally off of a balance beam) we know they are at the Olympics because they are the best in the world.

As I watch night after night in my bed, my bedroom being the only place I have a television (very small) and air conditioner (very noisy), I find myself wondering what it is that these young women and the other athletes at the Olympics have that has made them the great athletes they are.  Is it exceptional physical abilities, a drive and commitment to their sport, parents who devoted themselves and their children to rigorous training, some unknown Higgs Boson-like God particle that they were born with? (http://news.nationalgeographic.com/news/2012/07/120704-god-particle-higgs-boson-new-cern-science/)

I did a little very non-scientific research on “what makes athletes great?”  Here are a couple of results.  The first is from a New York Times blog for junior high students. This is an answer from a 13 year old:

 Okay a lot of things make athlete storng and those things can be by eatting good and also by trying there best.but most importantly is when they never give up  http://learning.blogs.nytimes.com/2010/02/08/what-makes-an-athlete-great/

This one is from an article in Shape magazine from a couple of days ago:

In my opinion, it’s not just the amount of medals you win or how many events you compete in. There is definitely a lot more to being an Olympian than that. I believe athletes like Wilma Rudolph and Jesse Owens epitomize what it means to be an exceptional athlete. Rudolph was born prematurely and spent the bulk of her childhood in bed. She suffered from double pneumonia, scarlet fever, and later she contacted polio. After losing the use of her left leg, she was fitted with metal leg braces when she was only six. However, years of treatment and determination to be a “normal kid” worked, and Rudolph was out of her leg braces at age nine. She went on to become a basketball star before taking the track and field world by storm and ultimately went on to win three golds and one bronze at the 1960 Olympics in Rome. From there, she became the fastest woman in the world and the first American woman to win three gold medals in one Olympics.  http://www.shape.com/blogs/london-2012-summer-olympics/what-makes-olympic-athlete-great

Never giving up and overcoming difficulties seem to be favored ingredients, and certainly we have seen that night after night.  Gabby Douglas actually did fall off the balance beam and got back on; she didn’t win a medal in that competition and she knew she wouldn’t win, but she got back on that narrow strip of hard wood and jumped and tumbled and vaulted off.

Two things were going on in my head as I was watching event after event and pondering the question of what makes these athletes great: they were perhaps more subliminal than rational thoughts.  One was the often-played snippet from the Phillip Phillips song, Home.

Just know you’re not alone, Cause I’m going to make this place your home

And there they were accompanied by the song: the women’s gymnastics team, the audience cheering, the parents, the coaches.  The Karolyis and Liang Chow literally going to the mats and challenging Alex Raisman’s score to secure her bronze medal on the beam. Win or a fall, you are not alone.

The other had nothing to do with the Olympics.  It was an article in the Sunday New York Times Magazine section from July 29 that I kept getting distracted from and kept being pulled back to.  The picture on the first page of the article, titled Hope in the Wreckage, was of two women who could not look less like Olympic athletes.  Claudia Cox, a visiting nurse is pictured kneeling on one knee at the bed of a women dying of bone cancer at home.  “Just know you’re not alone,” the lyrics seeped into my head.  But it wasn’t just the photo. Claudia Cox works in Jackson, Mississippi a place with some of the worst health outcomes in the country.  Sixty-nine percent of adult Mississippians are obese or overweight: at least 25% of the state’s households do not have access to healthy foods, adequate grocery stores being up to 30 miles away.  The article notes that many of these families buy their groceries at gas station convenience stores. Mississippi has the highest teen birth rate and Human Rights Watch calls the state “the epicenter of the H.I.V. epidemic in the United States.”  Tragic human wreckage indeed. So where was the Hope?  The Hope is Claudia Cox working for an organization called HealthConnect which was founded by Dr. Aaron Shirley and Mohammad Shahbazi, a professor at Jackson State University, based on the community outreach and very personal home care in a program in Iran. The Iranians founded “health houses,” local huts that contain exam rooms and sleeping quarters for community health workers in rural areas to reach the population living in more than 60,000 villages outside the urban areas of Iran.  The community health workers who are all from the villages themselves, “advise on nutrition and family planning, take blood pressure, keep track of who needs prenatal care, provide immunizations and monitor environmental conditions like water quality.”  The services of the health houses lowered rural infant mortality by 75% and substantially lowered the birth rate, two benchmarks of overall improvements in the health of a population.  Dr. Shirley, impressed with the positive impact on health outcomes in Iran, adopted many of the same services, mostly local community members/health workers establishing close personal relationships with patients, encouraging them, counseling them, advocating for them. In one year the services of HealthConnect cut the rate of admissions to Central Mississippi Medical Center by 15%. http://www.nytimes.com/interactive/2012/07/27/magazine/mississippi-health-care.html#

I have seen these same health strategies and relationships in the home visiting programs in Costa Rica, in Resource Mother projects in Norfolk, Virginia, in the MIRA project in Nepal.  Community health workers, peer educators, home visitors teaching, supporting and advocating which all comes down to what the best coaches do for the best athletes.

The positive differences in any of our lives are often the results of coaching.  I will never play tennis at the Olympics, I am not even seeded and I don’t play at an exclusive club, but I do have a coach.  Bill is the best; he knows just how to keep me improving and “playing up,” without my getting frustrated (although he occasionally slams one past me just to keep me humble.)  He is also a person who has been there most weekends through many of my life’s changes over the past 7 years.  I missed the opening ceremonies for the Olympics because I was out with two of my other coaches, my yoga buddies Lauren and Julie who have also coached me as friends and guides.  My daughters Kristin, Kierra and Alex keep me balanced and let me fall and are there to get me back up or just sit on the floor with me for a while.  Carol has been coaching me since I was 5. Heller An who is a triathaloner knows good coaching.  I am fortunate to have many wonderful coaches.

Sure we all have our gifts, we all have our challenges, our abilities and disabilities, and some very exceptional people to dazzle and inspire us in Olympic events.  They show us what can be.  So does Claudia Cox.  So do each of us when we refuse to give up, when we open ourselves to being coached and when we assure others that “you are not alone.”

Home Phillip Phillips

or

http://www.youtube.com/watch?v=7dfTURAhrTY

Hold on, to me as we go

As we roll down this unfamiliar road

And although this wave is stringing us along

Just know you’re not alone

Cause I’m going to make this place your home

Settle down, it’ll all be clear

Don’t pay no mind to the demons

They fill you with fear

The trouble it might drag you down

If you get lost, you can always be found

Just know you’re not alone

Cause I’m going to make this place your home

Settle down, it’ll all be clear

Don’t pay no mind to the demons

They fill you with fear

The trouble it might drag you down

If you get lost, you can always be found

Just know you’re not alone

Cause I’m going to make this place your home

I heart H20

 Summer of 2012

It has been hot.  Temps have risen to those dreaded triple digits in New York, in Chicago, and places where the corn should be as high as an elephant’s eye, but is now dried up and inedible.  Even here in my little village of Piermont on the Hudson where there are usually lovely river breezes, my grass is scorched and the petunias I planted along my driveway have wilted beyond any vegetal recognition.  Writing at my computer or commuting into New York for meetings in the heat I have been reminded of an experience I had in the heat of last summer when I traveled into the Bronx every day.  The following was written late last summer with my love for water and my eternal love for the Bronx.

Summer 2011

I love water.  I drink it out of faucets, coolers, fountains, my backyard hose and as snowflakes on my tongue.  I love to be in it in rivers, streams, oceans, pools, my pond, stomping in mud puddles in my Wellies. I love to be on it in sailboats, kayaks, canoes, ferries, big truck inner tubes.  And really I just love to look at it and listen to it.  To me water just looks and feels and sounds like life itself: the trickle of a waterfall just melting after a winter freeze or the crashing of a wave.

This summer in New York was a hot one.  And so perhaps we all became a little more aware of water than we usually are.  People complained about the humidity while gulping from plastic bottles of Poland Spring or Deer Park or Jennifer Aniston’s Smart Water.  Leaving work via the streets of the Bronx I would have to close my sun roof and nudge through the powerful spray of an open hydrant and the children and adults soaking up the blast of cold water.  Concerned about kids and their parents coming to our child center who had traveled on subways and buses and hot sidewalks I ordered cases of bottled water and asked all staff to make sure everybody got water to drink when they arrived, while they were at the center and bottles to go.  And yes I worried about the plastic getting warm and releasing toxins and taking eons of time to degrade but it was a matter of situation ethics.  Gotta get water into every man, woman and child.

Some time in late July an email popped up on my computer screen from an organization called End Water Poverty http://www.endwaterpoverty.org/  It contained a message requesting donations which seemed quite compelling with a statement, “Our ambition is massive.”  Massive ambition indeed and massively needed for there in the opening paragraph was the statistic that to this day causes me to have to catch my breath every time I find myself taking those bottles, and cups and sips of water for granted:  every day 4,000 children die from drinking dirty water.  That is 1,460,000 children a year, a massive number of very special, lovely individual children who die because there is no clean water for them to drink.

Water.org with the leadership of Matt Damon cites these statistics:

780 million people lack access to an improved water source; approximately one in nine people.

3.41 million people die from water, sanitation and hygiene-related causes each year.8

The water and sanitation crisis claims more lives through disease than any war claims through guns.

People living informal settlements (i.e. slums) often pay 5-10 times more per liter of water than wealthy people living in the same city.

An American taking a five-minute shower uses more water than the average person in a developing country slum uses for an entire day.

Take a look at their website; they have a very beautiful video (with very beautiful Matt Damon.) at http://water.org/

The heat has somewhat subsided although midday it can still get oppressive on the sidewalks of the Bronx.  Yesterday I had to run back and forth a few times between  the medical center and my advocacy center.  I had patients and budget issues and the next meeting to go to on my mind, but most prominent in my consciousness was the aching in my sweaty wet feet as they rebelled against the cute kitten heels and pointed toes of the shoes I was wearing.  “Ah, when I get home I’ll dangle my feet in my pond,” I was thinking as I looked up and saw, through the shimmering heat waves, what seemed to be an aparition in the desert approaching me.  She was tall and elegant swathed in red and orange, the scarf of white wrapped over her dark brown face.  It wasn’t until she was about 10 feet away from me that I could see that she looked exhausted, beads of water on her forehead, streams running down her face, her eyelids lowered.  She reached out to me and I realized that we were both fortunate enough to be next to the front steps of a house under the shade of a gingko tree.  Her name was Ann and she was on her way to the bus stop on Bainbridge and 210th Street.  I asked her if she would like to come into my office for a while but she said she had to get to the bus and home to her apartment where her grandchildren would be arriving after school.  As we shared a grandmother moment, I remembered that I had stuck a bottle of water in my briefcase and I pulled it out and offered it to her.  She tipped her beautiful head back, closed her eyes, took a drink and smiled and then I remembered a line from The Little Prince:  “This water was indeed a different thing from ordinary nourishment. It was good for the heart, like a present.”

The gift to me from Ann was a moment of rest under a gingko tree when I could slip off those shoes, two women sharing our love of our families, her smile and a reminder that we all need water to sustain us and keep us massively ambitious.

Summer 2012

No matter where I am, I will always send my love to the Bronx

(photo credits: Jon Cary: 104 in Chicago. Lois Pearlman: Snow in the Bronx.)

When Sunny Gets Blue: Sex on the Beach, Mosquitoes and Karen Silkwood

There are lots of songs about being blue, in fact of course a whole genre of music is called The Blues.  “I Guess That’s Why They Call It the Blues,” “Blue Moon,” “Blue Christmas,” “Blue Velvet,” “Blue Hotel,” “Don’t It Make My Brown Eyes Blue,” “Love Is Blue,” “Tangled Up In Blue,” and “Mood Indigo.”  Blue in a song usually connotes sadness, but of course “When Sunny Gets Blue” took on a whole other connotation after Klaus von Bulow allegedly poisoned his wife Sunny putting her into an irreversible coma.   Sometimes being blue is literal and dangerous.  But enough about me; I can write about that in a future blog post sometime.

Blue has lately been making quite a fashion statement in nail polish colors:  Blue Blowout, Navy Narcissist, Blue Freeze, Poolside Passion, Blue Rhapsody, Beach Bum Blue, and Sex on the Beach (honestly, I don’t think Sex on the Beach is blue, but I did think it would get your attention.)  Sometimes at the nail salon I simply marvel at the names of nail polish colors and wonder who gets paid to make them up.  What an amazing job that must be.  I usually go with something like Gucci Mucci Pucci, Tennis Corset,  Angel Food or Negligee, but I am pretty conservative about my nail polish colors, only an occasional foray into something like Fishnet Stockings, Berry Naughty, Affair in Red Square, Skimpy Bikini or Clutch Me If You Can.

I love getting my nails done: the soaking, the filing, the hand massage and the little back rub as my nails dry.  Oh my God! And then there are pedicures…..And you know what?  I love the women who do my nails at the little shop I have gone to for years in Closter, New Jersey called Lux Nails.  As they file and massage and polish we have gotten to know each other.  We talk about our relationships.  The holidays.  Vacations.  We talk about our kids.  I have met their daughters and they have met mine.  I have had my nails done for celebrations, professional events and sometimes when I have been sad and blue, because the women bonding in the salon is very comforting.

So in no way is the following information meant to discourage anyone from enjoying their mani/pedis or abandoning their favorite salon friends.  I do think we all need to get some information about the products that are used in our nail salons.  I got some at a very interesting information at a forum I attended sponsored by NYCOSH (New York Committee for Occupational Safety and Health) called Beauty at What Cost?  Hazards Associated with Exposure to Beauty Care Products on June 20, 2012.

Here is the issue in brief: there are some really hazardous chemicals in those lovely nail polish colors and the other products used in nail salons.  In addition to various other chemicals, there is what is referred to as the toxic trio:  toluene, formaldehyde and dibutyl phthalate which are all quite prominent in nail polish,polish removers and artificial nail products.  They cause breathing difficulty with asthma-like symptoms, headaches, dizziness and have been associated with cancer and kidney disease.  All of these of course should be totally avoided during pregnancy.

For those of us who go to have our nails done once a week, every two weeks, whenever we want to feel good, the effects are most likely a non-factor in our health (but ask your obstetrician if you are pregnant.)   For the women who work in salons, our dear friends with whom we chat and sometimes share our deepest secrets, the health effects can be dangerous, deadly.

There are safety precautions that can be taken:  ventilation is really important.  Your salon should have good exhaust fans, windows, vents to remove the chemicals from the air.   Chemicals should be labeled.  And long sleeves can keep chemicals from getting into exposed skin.  With harsh chemicals gloves should be worn.  Here’s what it says in a Health Hazards brochure from OSHA:  Most work in nail salons will not require respiratory protection:  good ventilation and good work practices should keep exposure to gases, vapors, and particulates to a minimum.

So next time you have your nails done, you might just want to look around the salon.  You don’t have to be the Salon Police and you certainly don’t want to hassle the workers.  You might just want to make some suggestions or ask a few questions.  You can get the Safety and Health Topics at http://www.osha.gov/SLTC/nailsalons/chemicalhazards.html

Don’t we just love the women who so caringly do our nails, massage our hands and talk to us even when we are blue?

As women we all deserve to be beautiful and healthy.  All of us should be able to enjoy Safe Sex On the Beach.

 

Mood Indigo:  Duke Ellington   http://www.youtube.com/watch?v=GohBkHaHap8

 

Or you might like the Harlem Ramblers http://www.youtube.com/watch?v=Akd7F_w0als&feature=related

 

And here are the lyrics by Ella Fitzgerald:

You ain’t been blue, no, no, no

You ain’t been blue till you’ve had that mood indigo

That feelin’ goes stealin’ down to my shoes

While I sit and sigh, “Go ‘long blues”

Always get that mood indigo

Since my baby said goodbye

In the evenin’ when lights are low

I’m so lonesome I could cry

‘Cause there’s nobody who cares about me

I’m just a soul who’s bluer than blue can be

When I get that mood indigo

I could lay me down and die

You ain’t been blue, no, no, no, no, no

You ain’t been blue till you’ve had that mood indigo

That feelin’ goes stealin’ down to my shoes

While I sit and sigh, “Go ‘long blues”

 

Mosquitoes and Karen Silkwood coming soon to a computer near you in my future blog posts. 

Stay Tuned!

 

 

 

 

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