Nothing Rhymes with Orange

“Have you ever worn orange?” he asked.

I was thinking of this question as I stirred my Golden Milk, the recipe having been provided by a perky little blond Paleo infomercialist on Facebook guaranteeing the concoction of coconut milk, coconut oil, cinnamon, ginger, black pepper and most importantly turmeric, as the panacea for just about everything including a reduction in inflammation which she claims is the root of all unhealthy evil. I had smacked my knee on something a few weeks ago so I was counting on Golden Milk to reduce the swelling and pain so I could get back out on the tennis courts. As I stirred I realized the milk in fact was not golden, but the infusion of turmeric powder, “the traditional ayurvedic anti-inflammatory superherb, nature’s most important antioxident rich spice sustainably grown and harvested,” had rendered the milk a lovely orange.

“Have you ever worn orange?” he asked.

Orange is not my color. I lean into the other end of the spectrum to the blues, bluish greens, purples, occasionally Alizarin crimson. I have some pinks and greens, and as a New Yorker, black, although since my encounter at a conference in Tampere, Finland, with a group of young Finnish women who identified me as being from New York by my black outfits (easy to pack and not worry about matching various items of clothing) I have tried to go dark on black.

But stirring my Orange Milk, it did occur to me that there was an infusion of orange in my life. Right there on the counter was a bowl of Blood Oranges from Trader Joe’s, sporting their ordinary orange rinds but when sliced oozing with scarlet juice. I have a Starbuck’s Hong Kong mug…orange. I recently attended a fund raising lunch for the YWCA and there on the chair is their signature orange scarf; they call it persimmon. I have two Orange cats, Oslo and Hudson, and though Gracie is a Tortie she has beautiful orange stripes on her right hip. Orange is the color of the Saffron robes of the Tibetan monks I met hiking in Nepal.

I have a book called, “Little Glimpses of Good; finding hope in every today.” I actually have two copies of it, since after my mother died I retrieved from the nursing home the copy I had bought for her. I also gave a copy to my daughter Alex. There’s a page that says, “Once there was a sad orange; it was sad because it didn’t rhyme with anything.” Of course since this is a book about hope, the orange realizes, “I’m juicy and sweet and full of vitamins and sunshine and orangey flavor.” So the orange is happy. The book ends with, “Even in the darkest nights of the soul, there is morning in you, more light than you can guess. You are about to dawn.” There is a simple drawing of a bright orange sun.

“Have you ever worn orange?” he asked.

It was a rhetorical question, and asked somewhat mockingly, because the questioner, a member of my men’s prison group, assumed that in fact I had never worn orange, not the orange of inmate garb, styled similarly to operating room scrubs, but bright orange with DOC, Department of Corrections, lettered in black. He knew in advance that my answer was “No.”

The men’s group meets every other Tuesday at the jail, in a huge meeting area surrounded by two stories of cells around the perimeter. There are between 30 and 40 members of the group who sit in a big circle, all in matching orange, although the footwear varies from running shoes to slippers and canvas slip ons. Recently one of the members had a cast on his left foot.
The group is part of an overall program called RSVP, Resolve to Stop the Violence, which incorporates the manalive curriculum. manalive was developed in California by Hamish Sinclair and focuses on techniques for men to stop being violent and stay out of jail by examining their ides of what it means to be a man. The RSVP program, a violence prevention program founded in 1997 by the San Francisco Sheriff’s Department includes manalive strategies with the core principles of restorative justice: crime is an offense against the community; victims have a right to be heard; formerly incarcerated individuals can learn how to avoid violence with opportunities and the responsibility of repairing harm they have done. To learn more about manalive and RSVP you can go to http://www.no2violence.com/about-us/

The Tuesday groups, facilitated by my colleague Mark and myself, are victim impact sessions. The format is a morning session that is a presentation by a person who has been a victim of a crime: the man whose daughter was brutally murdered, the woman raped by her ex-husband, a woman who was the victim of child sex abuse, a man who was shot on a street in his home neighborhood, a woman whose clergyman husband beat her, a woman whose brother was robbed and shot to death as he delivered food to earn extra money for Christmas presents. Each of these people has courageously volunteered to come to the jail and tell the story of their victimization, the impact of the crime on themselves and their families, their pain, anger, despair, challenges of the justice system, and often their faith and resilience. In the afternoon session, Mark and I facilitate a conversation with the group members, typically beginning by asking the group what they heard, what did the speaker say, and we try to focus the conversation on the speaker. Sometimes there are questions. “Why was she/he there?” “Why didn’t she just leave?” “Could she have escaped?” “Didn’t he want to kill the perpetrator?” “ Had he committed a crime and was killed in retaliation?” But there is also an outpouring of concern, of sadness, of empathy, of awe that this person who had suffered so much would come to talk to them. Then there are the disclosures of a member of their family murdered, of a mother abused by her boyfriend, of being a child helpless in a violent neighborhood. During one session, one of the members said, “Can I give the community some feedback?” (Required “conscious language.”) “Yes, you may,” the community responded. “I am so touched by the speaker’s ability to bear her grief for her daughter’s death and commit herself to helping others that I want to write a song about her.” Others in the group talked about writing songs and poems and autobiographies, dedications to their families and documents of their experiences. As a community we decided to have a performance of readings and songs. We had practices and a dress rehearsal (everyone except me wore orange.) Two days before Thanksgiving there in that cell block, with the chairs arranged auditorium style, we held the Celebration of Gratitude, songs and readings by the Men in Orange, attended by a few staff from my organization and wardens and correctional officers from the jail. My contribution was an explanation of the word Namaste which I usually say at the end of our discussions: the light within me honors the light within you. I had gotten permission to bring in cookies and mini cheese cakes, X-rayed the day before, and the jail provided coffee.

Mark joined me in January, and he has been inspirationally creative. The weeks that volunteer speakers are not available, he has been developing discussion topics and created a survey so that group members could express their thoughts, ideas, reactions and attitudes about the group process. Through the review of the survey and discussion with the group we realized that these men had so rarely ever been asked their opinions about anything. One of the questions was, “I am more motivated to make changes in my life.” Eighteen percent answered agree and 73% answered strongly agree. To the question, “I am less likely to use violence to solve problems,” 26% respnded agree and 38% responded strongly agree. To the statement, “The program staff cares about me,” 28% responded agree and 28% responded strongly agree.

Mark had another great idea, to give the members an opportunity to respond to the ACE survey.
The ACE, Adverse Childhood Experiences study was developed by Dr. Robert Anda of the Centers for Disease Control and Dr. Vincent Felitti from Kaiser Permanente.
This is what the CDC website says about ACE’s:

Childhood experiences, both positive and negative, have a tremendous impact on future violence, victimization and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue. Much of the foundational research in this area has been referred to as Adverse Childhood Experiences (ACEs).
Adverse Childhood Experiences have been linked to
• risky health behaviors,
• chronic health conditions,
• low life potential, and
• early death.
As the number of ACEs increases, so does the risk for these outcomes.
The wide-ranging health and social consequences of ACEs underscore the importance of preventing them before they happen. CDC promotes lifelong health and well-being through Essentials for Childhood – Assuring safe, stable, nurturing relationships and environments for all children. Essentials for Childhood can have a positive impact on a broad range of health problems and on the development of skills that will help children reach their full potential.
The full study can be found at the CDC website
https://www.cdc.gov/violenceprevention/acestudy/index.html

Mark and I wondered about the Adverse Childhood Experiences of the men in our group. We wondered if they had ever wondered. We wondered if they would want to wonder, if they would want to answer the questions, if they could be honest with themselves, if that honesty would be too painful. Both Mark and I felt some trepidation as we handed out the survey. We passed around little orange golf pencils. The men started to look over the questions. Mark explained that the survey and answers were for them alone, we would not be collecting the surveys or sharing their answers with anyone.

There are 10 questions in the survey we provided for the group.

RSVP – ACE Study Survey 5/15/17
Instructions: Answer questions 1-10 and tally up all YES responses.
1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
YES or NO
2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
YES or NO
3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
YES or NO
4. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
YES or NO
5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
YES or NO
6. Were your parents ever separated or divorced?
YES or NO
7. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
YES or NO
8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
YES or NO
9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
YES or NO
10. Did a household member go to prison? YES or NO
Now add up your “Yes” answers: _ This is your ACE Score __________________________

Visually scanning the sea of orange in the room I assessed the reactions as the group members read through and answered the questions: there was deep concentration, there was laughter, there was annoyance, even some looks of disgust, a hand holding a pencil above the paper just hovering, the paper slipped in to a notebook questions unanswered.

I was once asked by a group member if I felt safe when I asked the community if I could walk across the circle to distribute a poem to be read. I was somewhat caught off guard. There in that big cavernous room, surrounded by jail cells, the only woman in a room of men, most of them wearing orange, some of them wearing the blue of correctional officers, in that huge building encircled by rolls and rolls of razor wire, it really had never occurred to me to feel unsafe. But there were times that I felt nervous, and this was one of them. I wasn’t frightened but I was, as Mark and I had discussed prior to this session, worried about what the reaction would be from the community. The questions obviously delved deep into their personal lives, into experiences and memories that could be painful, angering, upsetting. Were we opening a Pandora’s Box with contents far beyond anything we could respond to or contain in the brief time we had with the community? I felt safe, but really I was nervous.

The main group reaction was curiousity. The basic question was why would we have them answer these questions, what did it matter, they couldn’t do anything about their childhoods now. I had to dig into my public health brain for an answer I hoped would make some sense. i explained that if a person has high blood pressure they need to know so they can take care of themselves. If they don’t know they could make some bad health choices or mistakes that could damage them, even kill them. So the same could be said of understanding events and experiences that took place in your childhood that could be damaging; if you don’t know, you can’t make choices to protect yourself, good choices to not be violent, the choice to get help. “What kind of help is there?” And then Mark filled in with information about trauma focused therapy.

On our way out that day, as we traversed the electronic doorways that separated incarceration from freedom, one of the RSVP staff told us that a previous community member had been released the week before. “We just found out he OD’ed. He died a few days after his release. It really shook me up.” He told us the name, but we never use names; we are not supposed to know the identities, crimes or sentences of any of the members. “I’m sure you remember him. Tall, bald, he participated a lot in the group.” I tried to stretch my memory back to previous sessions, and review the circle of faces, the discussions, the comments, to search for a member with that description. At home that night, I continued my visual memory search. Was it him? No, he was there last week. Him? No. Him? Not bald. Him? He had asked about the murderer of the young woman. Him? He had talked about his father’s death just before Christmas. Him? He read a rap poem about freedom. Him? He said he worried about his daughters while he was inside and unable to protect them. Him? He would return my Namaste with his hands in prayer and a bow of his head. Him? I so wanted to remember the face, the responses in groups, his voice. I wanted to know who was released and died. I did not want to know.

For our next group session, Mark and I decided to propose another performance. Most of the current community members were different men from the ones who had participated in the Celebration of Gratitude; this group seemed hesitant. Maybe reading some other people’s essays and poems would be a good introduction and encouragement for them to write and read their own. We also thought this would be an opportunity for them to give voice to victims who could not speak to them, those who wrote victim impact statements. Mark and I researched the internet for victim impact statements, poems about victimization, readings about resilience and hope. As with the ACE study questions, we were unsure about how this would be received. Would the members not want to read, would they feel uncomfortable/resistant to being the voice of a victim, would they be angry that we were asking them to be the presenters?

At the beginning of each group session either Mark or I introduce ourselves and the reason we are there. From week to week some members change: new members arrive, some previous members were released, some sentenced to serve the rest of their time, possibly a long time, in State Correctional facilities, Sing Sing, Coxsackie, Clinton, Attica. “Good morning gentlemen. My name is Karel and this is Mark. We are here from Victims’ Services to provide the victim impact sessions as part of your RSVP program.”

Our fears were unfounded. As soon as we asked if anyone wanted to read, there were several volunteers. The first reader began slowly with,
My name is Priscilla D. the grieving mother of the late murdered Allison June B.

The voice of the next reader halted as he came to the last sentence of an essay by a child abuse victim.
This man has destroyed my peace of mind, caused irreparable damage to myself and my famiiy, and ruined countless people’s lives.

Then one of the men asked, “Can I give the community some feedback?”
“Yes you may.” 
“Please can we read about other crimes and not child abuse? Some of us have kids and it’s too hard to have to listen to kids being hurt and dying. It’s making me feel very uncomfortable.” Mark and I thanked him for sharing that and we skipped ahead in the readings to a poem,
The Invitation by Oriah Mountain Dreamer.

A deep masculine voice across the room read:

It doesn’t interest me what you do for a living
I want to know what you ache for
and if you dare to dream of meeting your heart’s longings.

And so the group went on, one reading after another, the men giving voices to people they would never know.

A soft voice with a Spanish accent emphasized Brene Brown’s rhyme of song and strong:

Showing up is our power
Story is our way home. Truth is our song.
We are the brave and broken hearted
We are rising strong.

The last reading was a poem by Ahmed Badr called A Thank-You Letter From the Bomb That Entered My Home 11 Years Ago. I had heard it read on NPR’s All Things Considered and found Ahmed’s email and sent him a message requesting the text. He is 19 now, founder and Executive Director of Narratio ( https://narratio.org )that publishes poems and essays by young writers. He was 8 years old when a bomb hit his home in Baghdad, This was a different kind of victimization for our group to discuss. When I explained what the poem was about the room was quiet, the men looked a little confused, but there was a hand up, raised above the orange sleeve, volunteering to read.

I knew I was gonna change your life.
I knew that as soon as I entered your old home in Baghdad,
Ahmed proclaims through the voice of a bomb, now read by the voice of a man in orange in a county jail cell block. When he reached the end of the poem, the man who gave the bomb a voice, thanked me for bringing the poem. Another man said, “That poem is about how even something as terrible as a bomb can bring about good. The bomb is thanking Ahmed for doing something so good with his life even after such a terrible thing happened to him when he was just a child.  Ahmed is a very brave person.”

During the readings, especially the poems, I found that the orange in the room faded, there were just the individual faces and voices of men, reading about pain and hurt and loss, resilience and hope.

Mark and I left the jail that day, walking across the broad lawn between the prison builidng and the razor wire fences, pleased that the group had responded so well. We don’t know yet if they will want to do a performance. We don’t know who will be in the group in two weeks when the brother of a young athlete who was gunned down in his car will be our guest speaker. We don’t know when members of the group will leave and go home or go to an upstate facility for many years. But whenever we have a positive group discussion and participation we are hopeful that for perhaps one important moment, for one important decision, for one member of our community, there will be a recollection of a victim who spoke to them, there will be a feelilng of empathy, there will be the remembrance of someone who cared, there will be a good choice. We hope.

 

 

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Skin In The Game

Grandma

 

Basal Cell Carcinoma: Abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis. BCCs almost never spread (metastasize) beyond the original site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. More than 4 million cases of BCC are diagnosed annually in the United States. It is the most frequently occurring form of cancer.

 

And I was one of the 4 million for 2016. Driven entirely by vanity I made an appointment with a dermatologist to get the 411 on Botox, fillers, etc for the 11 lines in my forehead which I have been cleverly covering with my bangs until they get too long and swept to the side. After the litany of suggested injections, paralysis of forehead muscles, silicone and $1,000 plus for each of the 4 to 5 visits a year, I decided to stick with the bangs and get them trimmed more often. But as long as I was there almost naked on an exam table I asked her to give me a check up on a few darks spots scattered here and there. She looked at my various heres and theres (and inbetweens) and declared me to be fine until she saw a little bump under my left eye and said, “We have to take a look at this,” and she directed a beam of light onto my upper cheek. As I was thinking “oh that little bump…it’s been there for about 8 years and no one has said anything about it, just a little annoying when I put on my make-up so of course it’s nothing….” I felt the sting of a hypodermic needle in my face. I thought wtf…but said nicely (after all she had a needle in my face) “umm I thought you were just looking. “   Alas looking to her meant numbing, slicing and putting a piece of my flesh under a microscope. About a week later I got the call. “That’s a basal cell carcinoma. Better call Moe.” Huh?

 

Moe is not Moe, but MOHS. MOHS, also known as chemosurgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer. During the surgery, after each removal of tissue, and while the patient waits, the tissue is examined for cancer cells. That informs the decision for any needed additional tissue removal. So I did not call Moe but I did call Dr. Yehuda Eliezri in Pomona, New York, and scheduled an appointment. I was advised that the procedure would only take a few minutes but then I would have to wait two hours for the results. If all was good, i.e., they had been able to remove the cancer cells plus 1 millimeter all around, I could be stitched up and go home. If however, the cancer cells went beyond the millimeter, there would be more tissue removal, more cutting. Dr. Eliezri, a very charming man, reviewed this with me, was very gentle with the anesthetic needle and truly only took about 2 minutes to cut and patch me up with a gauze pad. Then I waited in a waiting room filled with people with gauze pads taped to their cheeks, noses, chins, necks, arms, a couple of legs, 1 foot. We looked like inhabitants of the land of the boo boo people. During my 2 hours, there were people who were called back into the clinic rooms and would emerge stitched up, with heavily packed bandages and they would head out to their cars with a wife or husband. Others however, came back to the waiting room with gauze and another 2 hours to wait. Disconcertingly, one woman came out quietly sobbing. Then I was called. As soon as I got into the hallway with the nurse she said, “You’re good to go…just some stitches;” on the exam room door I entered was my paperwork with Neg written in yellow highlighter. I had passed some rooms with the word Pos in red. I have always loved yellow highlighters.

 

So I am home for a few days, changing my bandages which have morphed from big pieces of gauze to little strips of Telfa to now Disney Princess Band aids. I clean the incision with peroxide, dab with Vaseline and apply an ice pack every couple of hours. I also gaze in the mirror at the crescent line hash tagged with little black stitches that Dr. Eliezri so carefully placed as he kept saying, “I am bringing the edges together perfectly, no puckering, no folding,” “perfect,” “perfect.” The bruising has faded to drupelets of pale raspberries clustered on my cheek and in fact the scar does look quite perfect as a nice line under my left eye where there used to be a pearly bump. In 2 days the stitches will come out.

 

So I have added one more landmark to my scardom which I use to track a certain personal history. The one on my right lower cheek that I have brought from babyhood as an 18 month old cut on the metal edge of a toy doll stroller. The line on my left inner knee from a swimming fin buckle that jabbed me in the fortunately sharkless waters of Long Island Sound. And my favorite, until now, my ankle scar covering the titanium screws and plate that reunited the shattered pieces of my fibula.

 

My skin. It may seem ironic but this new scar reminds me of how lucky I have been (and now how careful I have to be) to have skin that has been broken, sliced, banged, burned, wrinkled and crinkled. And this, this one perfect scar is the only remnant of real damage. When we were kids no one used sunscreen, I don’t even remember there being such a thing as sunscreen. I grew up on Long Island where my childhood summers were daily beach outings to the rocky West Meadow Beach in Old Field to swim in the Sound and at least once a week a big packed lunch and sojourn with my friends Carol and Jim (and eventually Richard) Winkler and our mothers to the sandy south shore ocean beaches. We burned and peeled and tanned, and it was all just part of the wonderfulness of summer at the beach. As a teenager, along with my girlfriends, I slathered myself with baby oil, sometimes with the daring additive of a few drops of iodine; now I am slathering with sunscreen.

 

And so yes, I have been lucky and I think genetically blessed. I have always given my paternal Czech grandmother Emilie Zapotocka credit for my creamy usually tanned skin and blue eyes. I remember her face as light brown, like suede, not wrinkled but with soft folds, around her blue eyes and smile, under a big braid of silver hair. My favorite picture of her is her standing in her garden in Queens, New York, surrounded by roses. But my other memories are of her making dumplings in the kitchen (a talent inherited by her daughter-in law, my mother,) cursing in Czech when she got a bad hand at cards, and her head thrown back with laughter at the Woodbox, a luncheonette in Stony Brook where she, my parents and I were eating after showing her the property they were buying to build our new house. In response to my query about a plastic tomato on the table she held it up, and gave it a squeeze which covered my 5 year old face with ketchup. My parents who had stepped away from the table looked at my red drenched face horrified until they realized that I had only been the victim of a condiment and my grandmother’s humor. She always claimed she had no idea that the tomato would spew forth upon my face. She was an interesting woman who lived with my Aunt Millie and Uncle Larry in Queens, but clearly she was the owner of the house. My grandfather had died when I was a baby, but she had a “man friend” named Mr. Hruska. One of my earliest childhood memories is being in her garden wrapped up in an old canvas hammock like a cocoon with little twinkles of light coming though the woof and warp of threads on my face, and my grandmother and Mr. Hruska singing and swinging me gently.   I am sure it was quite scandalous, but we children didn’t know anything, except that she moved to Florida and Mr. Hruska moved there too. It was on one her trips back up north Christmas of 1959, that the car my uncle was driving with my aunt Millie and grandmother in the back seat, was struck by a drunk driver running a red light and the car spun on the ice so the back doors opened. Both my aunt and grandmother died, in the world before seatbelts that would have held them against the centrifugal force and saved their lives.

 

I was 11 when my grandmother of the soft brown skin and blue eyes died, the Czech curse words and her dumpling making lost with her, and almost lost was much of her history. When we were children not only did we not know about the Hruska affair, but we didn’t really know about my grandmother’s emigration from what was then Czechoslovakia. We assumed that she and my grandfather came here together, settling in Westfield, Massachusetts , right near where my youngest daughter Alex went to school at U. Mass, on a farm where my father, the youngest child and only boy, and his 3 older sisters were born. But several years ago, my sister Barbara, the historian, began piecing together some other information. In 2005, 4 years after my father died, when I joined Barbara in Prague while she was there on a sabbatical, we met with my father’s cousin, Jarmilla, who filled in some of the family history, including my grandmother’s departure from Svaty Jakub, a little village east of Kutna Hora, which is the beautiful Czech city with the Cathedral of Saint Barbara, for whom my sister is named. The story is like a puzzle with lots of missing pieces but a strong central portrait of a very courageous, maybe impetuous, daring, risk-taking young women. My grandmother, by some accounts, 14 years old and by some 19 in 1904, left her home having, unbeknownst to her family sold her dowry collection of quilts and other household items, risking all of her possessions and money, and traveled to Bremen, Germany. From there she took a boat to New York. That seems to be the basic story. The rest is assorted puzzle pieces some which easily fit together and others that don’t, but the one fact that seems clear is that my grandmother was a teenage runaway, leaving her family, her home, her village, and her church to travel to New York, possibly alone, possibly with a girl friend, possibly with my grandfather, possibly pregnant, definitely leaving behind her a reputation for being the family bad girl. There was some information that indicated that she had been betrothed to a much older wealthy farmer whose wife had died. She may have met my grandfather and left with him, but she may have not met him until she arrived in Bremen; nothing really connects them in Svaty Jakub, since he was from much further east, although he was a traveling veterinarian. Or she and a girl friend may have just decided to try their luck in the new world. But, for independence, for love, for luck, for some mysterious reason of the heart, run away she did in pre World War I Czechoslovakia somehow traveling about 500 miles from her village to Bremen to New York where she, carrying a baby, was met, according to the Ellis Island records, by my grandfather, Ptyr Ripl.   I try to imagine what it must have been like for her to step out of her house into the night and set out on such a daring journey, what plans she may have had, what hopes, what fears, what courage. She was so brave, following her heart.

 

There is something else we do know about my grandmother Emilie. Whatever her motivation for leaving, she and my grandfather were successful on their farm, and able to go back to Czechoslovakia by boat to visit her family in 1920 when my father was 5. According to Jarmilla, this was my grandmother’s way of saying, “See I was right to run away.” And, she was right. While the Czech family endured World War I, the depression and World War II, the genocide and devastation of Nazism, and then the repression of Communism, Emilie and Peter’s family was in New York, where they moved and opened a grocery store on the upper eastside; none of us were ever hungry, threatened, deported, arrested, sent to concentration camps. We lived in the land of the free, home of the brave. My grandmother had a beautiful rose garden, she cursed in Czech, she made dumplings, she gave me my creamy skin and blue eyes, and I think she would like to know that I traveled to Prague, Kutna Hora and Svaty Jakub; I went to Nepal alone; I got off a plane in Entebbe, Uganda in the middle of the night by myself; I slogged through the monsoon in Mumbai; I lived for a week at a clinic in Burundi and swam in Lake Tanganyika.   In addition to her skin, now bearing this lucky scar, I believe she slipped me a little trinket of DNA that said, “Be brave and follow your heart.” It is a genetic message from Emilie that I have passed on to my children, to be continued by my children’s children and my children’s children’s children.

Thank you to gentle Dr. Eliezri and his kind and attentive staff.

Please Wear Sunscreen

Photo above:  Emilie Ripel with her husband, Peter Ripel and their nephew Willie Ripel in Piermont, New York, where Willie was the original owner of the Piermont Community Market.

 

 

SNOW is just a four-letter word

waffles
      Those four letters that in fact convey the emotions and impact of other popular four letter words, have finally fallen upon those of us who live in the Northeast US. The “atmospheric water vapor frozen into ice crystals and falling in light white flakes or lying on the ground as a white layer,” has inspired many reactions from jubilation to panic. Of course it is in English that snow has four letters. In French snow is les neiges (as in “ou sont les neiges d’antan?”) In Spanish the word is nieve. In Swahili it is theluji. And even if there is only a percentage of the mythical thousands of Inuit words for snow there are purportedly at least 50 ranging from tlapa: powder snow; tlation: small flaked snow; kriplyana: blue snow in the morning; penstla: the idea of snow; taleni: snow angels. I have to say I got a little skeptical myself about the thousands of words when I encountered luantla: snow rolled into a reefer and smoked by wild Inuit youth. (I will leave to you to decide if that is a real word.)

  As the hour of the descent of crystals upon us approached I couldn’t help but wonder about the health effects of snow. I thought about heart attacks of shovelers, car accidents, freezing cold and slip sliding away. There are many inherent dangers in the white flakes falling and lying on the ground. News reports have confirmed several deaths just in New York from this storm: “Two more people have died in New York City Saturday during the mammoth blizzard that tore through the tri-state, bringing the total to five deaths in the area. Gov. Andrew Cuomo confirmed the deaths during a press conference Sunday morning. The five suffered heart attacks while they were shoveling the snow. ‘If you are old like me you want to think twice before you go out there and start shoveling,’” the governor said. (Ummm, old?… Andrew Cuomo is 58.) And emergency departments at hospitals are adrift in people with back injuries. For Andy Cuomo and the rest of you, here are some safe shoveling techniques: Pick the right snow shovel, warm up thoroughly, pace yourself and keep your feet on the ground, i.e., don’t slip. If conditions are really slippery don’t do it. Stop and rest when you need to. Most importantly, lift ergonomically. Whenever possible, push the snow to one side rather than lifting it. When lifting the snow shovel is necessary, make sure to use ergonomic lifting techniques:

  • Always face towards the object you intend to lift – have your shoulders and hips both squarely facing it.
  • Bend at the hips, not the low back, and push the chest out, pointing forward. Then, bend your knees and lift with your leg muscles, keeping your back straight.
  • Keep your loads light and do not lift an object that is too heavy for you.
  • If you must lift a shovel full, grip the shovel with one hand as close to the blade as comfortably possible and the other hand on the handle (handle and arm length will vary the technique).
  • Avoid twisting the back to move the snow to its new location – always pivot your whole body to face the new direction.
  • Keep the heaviest part of the object close to your body at your center of gravity – do not extend your arms to throw the snow.

Walk to the new location to deposit the item rather than reaching or tossing. http://www.spine-health.com/wellness/ergonomics/snow-shoveling-techniques-prevent-low-back-injuries And if you can’t get to the gym, the Huffington Post has these exercises for a healthy work out, just you, your shovel and the snow: http://www.huffingtonpost.com/2015/01/26/shoveling-snow-workout-gifs_n_6548946.html

To prevent car accidents, Mayor Bill deBlasio just said “stay off the roads!” and called a state of emergency in New York City. But as we know some of us have to travel and some people just need to get out. The Daily News offered these safe driving tips.

Don’t get cocky In a severe storm, signs can blow down, traffic lights might be out, or tree limbs could fall. Just because you know the road doesn’t mean you know exactly what’s around the next bend.

All-wheel-drive doesn’t help you Many people assume that having AWD is Mother Nature’s ‘Get out of Jail Free’ card. It’s not, buddy; you still have to brake like the rest of us mere mortals.

SUVs are not immune to snow Sport-utilities and crossovers can do many things, but defying the laws of physics isn’t one of them.

ABS is your friend go ahead, HIT THE BRAKES! Now, did you feel a pulse from the pedal, or hear a ‘thunkathunkathunka’-like sound? That’s good, because you should. My advice is to find an empty parking lot and mash the pedal, to get used to the sound and feel. It’s okay, ABS is here to help, even if it sounds and feels strange.

Turn down the tunes I know you love that new Taylor Swift *song, but turn it off if you’re driving on a mix of snow and ice, you might want to listen to…your tires? (my comment on this: but when you are not driving in snow, listen to Ryan Adam’s cover of 1989…brilliant!)

Steer into a slide – yes, it works Let’s say you turn right, and suddenly the back of your car starts to slide left…so turn in the DIRECTION OF THOSE REAR WHEELS. A slide means your tires have given up; they’ve basically walked out on the job because you’ve asked too much from them.

Get in touch with your inner Boy Scout Pack some extra gear if you’re going to be doing a lot of winter driving. A portable cell phone charger, flash-light, bottled water and snack bars, maybe a road flare or glow-stick…all are good things to have in case you get stuck somewhere

Invest in some snow tires You don’t go jogging in high heels, so why would you drive your car or truck on the wrong kind of wheels?

Be smooth baby, real smooth Don’t punch the gas. Don’t jam on the brakes. Don’t twirl the steering wheel. Keep things slow, smooth, and steady.

 (These are just some highlights. If you want to read the whole article go to :   http://www.nydailynews.com/autos/street-smarts/10-winter-driving-safety-tips-battle-blizzard-article-1.2503544

So we know that snowstorms can be dangerous, but there are also benefits to snow and cold. Agriculturally, one major benefit for our food sources of a good snow cover is that snow functions as an excellent insulator of the soil. Without snow, very cold temperatures can freeze the soil deeper and deeper. This could lead to damage of root systems of trees and shrubs. The insulation effect of snow also helps protect perennials, bulbs, ground covers, and strawberry plantings from alternating freezing and thawing cycles. Without snow, milder temperatures and the sun could warm the soil surface, leading to damage from soil heaving, which can break roots and dry out plant parts. Snow also helps conserve soil moisture over the winter. Snow and freezing temperatures also kill many surface bacteria and viruses, that begin to thrive and happily mutate when the weather is just damp and above freezing.  

Going into some deep biology for those of you who enjoy a little ontogeny recapitulates phylogeny with your cocoa, read on….

The process works like this: Cold air activates a receptor in the worms known as the TRPA1 channel, which is found in nerve and fat cells. This initiates a chain of biochemical signals that ultimately activates a gene known as DAF-16/FOXO, which has been associated with longevity in worms. Since mammals share much of the same genetic programs, it raises the possibility that exposure to cold could also affect longevity in humans. (Environmental Temperature Differentially Modulates C. elegans Longevity through a Thermosensitive TRP Channel.” DOI: dx.doi.org/10.1016/j.celrep.2015.04.066 ) So get cold, live longer.  

(A quick segue from worms to yummy food)  

One of the benefits of a snowstorm is the opportunity for some guilty pleasure eating. Everyone knows to stock up on healthy foods before a storm. I live alone and yet, Friday morning I went to my local Stop and Shop and bought a roasting chicken, high protein Naked smoothies, a bag of potatoes, onions, carrots, spring salad mix, a package of grass fed beef (why? Because meat just seemed appropriate in a snowstorm.) But I also bought everything I needed to make waffles, including blueberries and maple syrup. In addition to extra calories for shoveling (justifying the maple syrup) my psyche required comfort foods. Comfort foods are one of the great joys of snowstorms

So on to snowstorm mental health. There is the stress of all that snow is going to interfere with our daily routines. Will we be able to get to work? Will the power go out and I’ll lose my internet connection? Will the kids have a snow day? Check out this ad for Channel 7 Eye Witness News produced by PromoHouse: http://www.promohouse.tv/project/snow-day/   There is also the emotional stress of not having snow days. In this great video Snow rhymes with and is a substitution for the famous Adele “Hello.” https://www.youtube.com/watch?v=YnIRfvFLiWQ

But the key to staying emotionally well during a snowstorm is simple: accept what you can’t change. An article in Psychology Today (January 23, 2016) states: In his poem, The Snowfall Is So Silent, Miguel de Unamuno intuitively pinpoints the primary scientific reason that snow can create a sense of serenity. He writes, “The snowfall is so silent, so slow, bit by bit, with delicacy it settles down on the earth and covers over the fields. The silent snow comes down white and weightless; snowfall makes no noise, falls as forgetting falls, flake after flake.” There is research indicating that positive mental health and stress reduction are supported by three things: exercise, mindfulness and nature. http://time.com/4063368/stress-relief-meditation/                                    

A snowstorm can give us all three if we just let it. Shoveling snow, walking in the snow, skiing (if you are so inclined) give us the exercise. The silence of snowfall gives us the quiet of our environment and our minds. And the snow in the air, drifting from the sky falling around us and enveloping us surrounds us with the natural phenomenon of the crystallized vapor.  Tytti Pasanen, from the University of Tampere, Finland, observed in her research studies on stress that “spending time on wooded trails or in other natural outdoor environments—any place away from man-built stuff like streets or buildings—appears to trigger an immediate drop in stress.” Magically, even in the middle of a city, the noise of cars, subways and buses is hushed, lights are dimmed by the airborne crystals, the buildings and roads and even piles of garbage soften and disappear. My friend Elise just called me from New York City and she told me that the streets are empty of cars due to the state of emergency, and people are walking down the streets and avenues, happy and relaxed in the quiet and peace of the nature of snow.

On Saturday, as the snow started in the morning and descended all day and into the night, I went out three times and shoveled my walkway and twenty-five steps up to the street and my driveway. The snow was fluffy and it was delightful to be out in my little terraced yard with views of the Hudson River. I have learned to truly love shoveling snow. Having worked at a hospital for 11 years where there are no snow days, I decided that I could either be angry about having to shovel my driveway, take a shower and drive very carefully to the Bronx, or I could love it. As we learned from Viktor Frankl, in the end (and along the way) the only thing we have complete control over is our own attitude. And so I embraced my shovel, the cold on my face, the spray of flakes as they flew through the air, and the ache of my muscles. When I went out to shovel Saturday afternoon, I actually lay on my back and watched the millions of fluffy crystals dance down onto my face, a few caught in my eyelashes. At night the flakes reflected the lights like tiny mirrors in the darkness. And today as I finished off the last 7 or 8 inches under the brilliant blue sky, I heard the honking of geese against the quiet of the snow. I looked up and marveled at their chevron across the blue. On another day of noisy rushing and busy thoughts, I might have missed them. But in the midst of the exercise and nature I also had the perfect moment of mindfulness, of inner peace and joy, like the revelation in Mary Oliver’s poem, The Wild Geese.* 

Meanwhile the wild geese, high in the clean blue air,

Are heading home again.

Whoever you are, no matter how lonely,

The world offers itself to your imagination,

Calls to you like the wild geese, harsh and exciting –

Over and over announcing your place

In the family of things  

 

This was a gift of the snow, the quiet snow.

 

*shared with our class at Yoga House by our generous and kind teacher, Eileen McCabe

Like Two 747’s Crashing Every Day: the worst airline accident in history


Before you read this post, would you please take a quick 10 question survey at

https://www.surveymonkey.com/r/XWC9HK6

Thank you.

What are the three leading causes of death in the United States? Most people quickly identify heart disease and cancer, which in fact respectively account for about 750,000 and 550,000 deaths annually. The third leading cause of death is usually a guess: Alzheimer’s? Diabetes? Obesity? Traffic accidents? Airline crashes? With at least 440,000 deaths a year almost no one guesses the correct answer: medical errors. The practice of medicine, including diagnosis, treatment and surgeries, is the cause of deaths that approximate the number of fatalities of two full capacity 747’s crashing every day. If on one day there was such a loss of life due to airline crashes there would be massive investigations and media comparable to the March 1977 crash in Tenerife considered the worst airline accident in history: the search for black boxes, analysis of the weather, integrity of the equipment, the qualifications and behaviors of the pilots, and the airline’s quality assurance procedures. If two 747’s crashed on two consecutive days, there would be implications of terrorism, accusations of conspiracy. If two 747’s crashed on three consecutive days, the impact and reaction are unfathomable, but one could only guess that mass panic would set in nationally and internationally. Yet 1,200 Americans, twice the number of the casualties at Tenerife, die day after day, 365 days a year with the resulting death toll being that of the annual wiping out of the populations of major US cities: Atlanta one year, Sacramento the next, Miami the next, year after year. These tragic losses are not just numbers. They are our grandparents, mothers, fathers, siblings, our children and our friends. They are the victims of wrong site surgeries, the aorta sliced instead of the renal artery, over-medication due to a misplaced decimal point, a misdiagnosis of a hypokalemia leading to cardiac failure, a hospital acquired infection from inadequate cleanliness of supplies, equipment and hands, or a sponge left inside the surgical site.

How this is happening without public knowledge, panic and outrage is a simple question of multiple determinants. There are explanations when required, which is seldom. Hospitals are complex environments. To Err is Human, as the 1999 Institute of Medicine report citing the underestimate of 98,000 deaths a year was titled. In 2013, John T. James, PhD, a NASA toxicologist who’s own son was the patient who died from misdiagnosed hypokalemia, published his robust study based on findings using four different research tools, in the Journal of Patient Safety. His study results more than quadrupled the IOM number to 440,000 deaths a year. To err may be human, but in truth, all too often decisions for care are dictated by financial initiatives to benefit the hospital rather than the best care of a patient; hospital error reporting that is voluntary ; hospital quality assurance that is actually cover up ”risk management”; the autonomy of doctors who are never evaluated, tested or required to upgrade training and cannot admit that they have made a mistake. Atul Gawande, MD, in his book Complications stated, “There is a saying about surgeons, meant as a reproof: sometimes wrong; never in doubt.” Government, regulatory agencies and patient advocacy organizations have pressed for changes in reporting, hospital policies and procedures, and checklists ironically based on those used in the airline industry, but the number of deaths has not decreased, the needle on the scale of improvement hasn’t budged.

The Veterans Administration hospital scandal in June 2014, exposed the deaths of at least 40 veterans who died due to medical errors including delays in their diagnosis and treatment. But months and even years before the exposure, when lives could have been saved, employees in the hospitals had been raising concerns and reporting dangerous practices, inadequate care, and fraud. These whistleblowers were intimidated, threatened, harassed, transferred, put on administrative leave without pay and fired. Not unusual treatment for whistleblowers as recent high profile cases have been broadcast in the news.   The VA is now hustling to correct care deficiencies and provide remedies to the whistleblowers, but not enough to restore lives and repair permanent damage.

The Veterans hospital deaths as tragic as they are, are the tip of the iceberg of the 1,200 a day medical error deaths. Patients are dying in private hospitals, public hospitals, community hospitals and super-sized academic medical centers. Within these facilities whistleblowers have attempted to report and correct wrongdoing and system flaws that lead to the daily death count as well as almost 4 million errors a year that leave patients disabled, damaged and compromised. Like the whistleblowers in the VA hospitals these health care employees, nurses, lab staff, managers, and some doctors themselves, have lost their jobs, their health insurance, their retirement benefits, their professions, and ability to find other employment. Dr. Marty Makary states in his book, Unaccountable, which documents his experiences of patients suffering from medical errors, “if I was labeled as a whistleblower, my career would be shot.” Telling the truth in health care is risky business.

There is a long history of retaliation against those who have spoken out against the medical status quo that puts patients at risk. In 2008, Dr. James was presented with the Semmelweis Award, named for Dr. Ignatz Semmelweis, considered now the father of patient safety.   The observational case control study conducted by Semmelweis in the mid 1800’s indicated that women and babies in hospital maternity wards were dying because doctors were not washing their hands after examining cadavers and then delivering babies. With a maternal and infant mortality rate of over 18% in hospitals where doctors delivered babies in comparison to a 2% mortality rate for deliveries at home with midwives or even poor women whose babies were delivered in tenements, Semmelweis wrote a treatise, The Etiology, Concept and Prophylaxis of Childbed Fever, on the imperative for doctors to wash their hands between patients. The medical community was outraged that he would state that doctors’ lack of clean hands was killing women and babies. Semmelweis was declared mentally unfit, and confined to an institution where 14 days after his admission he was mysteriously found dead, presumably beaten to death by guards. His work was not recognized as valid until two decades later after Pasteur and Lister presented evidence of germ theory. In 1965, to mark the 100th anniversary of his death, Semmelweis was honored with his image on an Austrian postage stamp. Doctors in the United States today are still less than 50% compliant in hand washing.

Despite current legislation in healthcare law, shooting the messenger is still the general practice in medicine. Retaliation is often couched in legal defense of protecting patient confidentiality, and hospitals misuse HIPAA as a way to attack whistleblowers. But more effective to deter whistleblowing, hospitals maintain cultures of don’t talk or else.   Special Counsel Carolyn Lerner of the Office of Special Counsel, a whistleblower protection agency, has stated that 125 VA hospital employees have filed retaliation cases. Three of the whistleblowers she has represented are Dr. Katherine Mitchell, Paula Pedene and Damian Reese. Mitchell reported understaffing and inadequate training of staff in the emergency department at the Phoenix hospital and was removed from her position as the co-director of the emergency care. Pedene, formerly the hospital chief spokesperson, was re-assigned to a job in a windowless basement office after she reported financial mismanagement in Phoenix. Reese complained about the data manipulation that covered up delays in care; he was given a negative performance review. Lerner stated in a PBS report, (September 29, 2014,) “Dr. Mitchell, Ms. Pedene and Mr. Reese followed their consciences and reported wrongdoing, and their efforts have improved care and accountability at the VA,”

The recent British National Health Service report on whistleblowing, Freedom to Speak Up? (February 2015,) by Sir Robert Francis QC, documented the retaliation that was mounted against staff in hospitals for reporting systemic problems, incompetence and medical errors that impacted patient safety. The report includes recommendations for a shift in culture to not only protect but value whistleblowers, and zero tolerance for retaliation.

Like whistleblowers in other fields, most healthcare whistleblowers say they would do it again even knowing what the consequences would be. Why would they engage in such high-risk behavior? A 2011 National Business Ethics report states that most whistleblowers are very committed to their workplace and they have been successful performers. An article by Vicki D. Lachman, Whistleblowers: Trouble Makers or Virtuous Nurses? (MEDSURG Nursing, April 2008,) bases whistleblowing in healthcare as driven by the ethics of the duty to tell the truth, the standards of professionalism (nursing Code of Ethics,) virtue, and that inexplicable courage that causes an individual to jump into harm’s way to safe the life of another. She also states that, “They (whistleblowers) are above average performers committed to the organization with a strong belief in moral principles.” Lachman however notes the potential retaliation:  “The list of negative consequences to whistleblowers seems endless: broken promises to fix the problem, disillusionment, isolation, humiliation, formation of an “anti-you” group, loss of job, questioning of the whistleblower’s mental health, vindictive tactics to make the individual’s work more difficult and/or insignificant, assassination of character, formal reprimand, and difficult court proceedings.”

The victimization of patients and the victimization of people on the inside of healthcare trying to save lives cannot be ignored. These tragedies are deserving of a hard look at where the bodies are buried, who is causing these deaths, and what needs to be done to protect whistleblowers so that when we access medical care we are not inadvertently boarding a plane destined to crash and burn.

 

 

Glory to the Newborn

Madonna

I have been thinking a lot lately about the birth of Jesus. There is of course an obvious reason for this: the recent Christmas season with the full-on gift buying, festive food and drink consumption, decorated trees, store windows of lavish jewels and designer attire in snow filled glass enclosures, and perpetual email blasts of seductive sales and free shipping from the Amazon and the Beyond of Beds and Baths, as well as every other online shopping site.   In the air were the strains of Silver Bells and Sleigh Bells and Joy to the World, a Silent Night Away in a Manger with Herald Angels Singing, “Hark!” And scattered here and there were Nativity scenes on billboards, in front of churches, along my daughters’ street in Jersey City, a lovely one in front of their neighbors’ house. I have two Nativities: one from Ireland, the figures of Mary, Joseph and the baby accompanied by a sheep and a cow simply carved in stone, and one from Brazil, each of the collection of shepherds, wise men, cactuses, cows, sheep, lambs, camels, as well as the Holy Family and an Angel crafted by hand out of clay and painted in bright colors. In all of these crèches and scenes, the baby Jesus is swaddled in a little bed, sometimes of actual straw, sometimes he is sleeping, sometimes reaching up to touch Mary, a lamb or Heaven. And this is what got me really thinking about the birth of Jesus, the actual birth of Jesus.

 

I think everyone pretty much knows the story of Christmas, even non-Christians since it is proclaimed, preached, advertised, and I am sure tweeted just about every place. My sister Rosemary lovingly sends the account of the story by the Apostle Luke ever year with her Christmas card in some very creative way.  Here it is:

Luke 2:1-20 New International Version: The Birth of Jesus 

In those days Caesar Augustus issued a decree that a census should be taken of the entire Roman world. (This was the first census that took place while Quirinius was governor of Syria.) And everyone went to their own town to register.  So Joseph also went up from the town of Nazareth in Galilee to Judea, to Bethlehem the town of David, because he belonged to the house and line of David. He went there to register with Mary, who was pledged to be married to him and was expecting a child. While they were there, the time came for the baby to be born, and she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger, because there was no guest room available for them.

 

All of the accounts are pretty similar. Mary and Joseph in the manger, baby Jesus is born, shepherds show up and a few days later following a star, the wise men come for a visit bringing gifts. But there is a gap in this story and in that gap is the birth of Jesus, yes, Mary in labor and giving birth.

 

Now I am not faulting the authors of the New Testament, Matthew, Mark, Luke and John. They were men, writing for men, so it makes sense that there would not be a detailed description of Mary’s labor and delivery, not to mention what was probably unmentionable at the time and perhaps even now, that Mary was a woman, with a woman’s anatomy, and she ached just like a woman, she gave birth just like a woman, to paraphrase Bob Dylan.

 

Since I couldn’t find a specific account of the birth of Jesus, just based on common knowledge and my own experience of child birth, there are only two ways that babies are born. And since there is no documentation that Mary had a C-section, there is only one way that Jesus left Mary’s body, was then swaddled and placed in that bed of straw. In “Hark the Herald Angels Sing” there is the line, “Off-spring of the Virgin’s Womb.” Womb is about as graphic as anyone gets about Mary’s lady parts.

 

Now I don’t want to get into a theological debate here, because this really isn’t about theology it’s about childbirth in Israel in first century AD. There is apparently a belief that Jesus without opening, tearing, or causing any pain, simply passed through Mary’s uterus and landed in that bed of straw all neatly dressed and tidy. I have to say that this falls into the same category as Athena as an adult woman fully clothed in armor springing from the head of Jove or the golden haired voluptuous Venus floating onto a beach in a big clam shell. This may be the way male Greco-Roman gods gave birth, but that is not quite the stuff of Humanity.

 

To back me up on this there is an account in this article from Our Redeemer Lutheran Church in Lexington, Kentucky:

There is absolutely nothing in this text or any other text that speaks of Christ’s birth that suggests that His birth was anything but normal. Mary would have gone into labor, would have encountered the pains of childbirth; Jesus would have born naturally as all children at this time. Any accounts that speak of Jesus passing miraculously through the walls of the uterus must be dismissed as pious superstition that detracts from the reality of our Lord’s incarnation and human nature.

(I was raised a Lutheran so I’m going with it.)

There may be great disagreement about how and by whom Jesus was conceived and certainly much disagreement about his death/resurrection, but his birth is pretty straightforward.

So I did some research on childbirth in Israel in the time of Jesus. This is from a site called Childbirth in the Bible:

 

Hebrew women gave birth in their own tents or houses. During labor they were surrounded by other women: a midwife, their relatives and friends, and female servants of the family. They would certainly have seen other women give birth, so they knew what to expect and what to do.

Hebrew women gave birth in a squatting position, above a hole hollowed out of the ground. On either side of the hole were bricks or stones for the woman to stand on. She was supported at her back and under her arms by other women, either midwives or family members. As soon as the baby was born its umbilical cord was cut, then it was washed and wrapped in long bands of cloth (swaddling bands) which held the limbs of the baby firmly, though not tightly.

It was obvious to the ancient Israelites that the central task of women, one that could not be taken over by anyone else, was childbirth. It was also obvious that women suffered in the process of giving birth. The explanation for this, according to Genesis, was that the original balance of creation had been disturbed: in an ideal world (that is, the Garden of Eden) birth would not bring suffering.

(Before I go on, I can’t help myself from commenting on the issue of labor pain having to do with anything in Genesis. Human birth is painful because unlike our quadruped friends, i.e., cats, dogs, sheep, cows horses, whose unborn babies hang slinglike in the hammock of a uterus suspended between four posts/their four legs, our human babies hang between two legs in a uterus that has to be kept tightly closed until the appropriate time of birth, or they would just be pulled out by gravity at anytime and would not survive; the human race would not have made it past Adam and Eve. Opening up and pushing against those tight muscles that have held the baby in for 9 months is painful. I learned this in an undergraduate anthropology class taught by a wonderful professor and anthropologist named Dr. Margaret Wheeler at Stony Brook University, and since have personally experienced this three times with the births of each of my big, beautiful, brainy daughters.)

 

So back to Israel: first of all kudos to the women and midwives delivering babies at home who knew that the best position for birthing was squatting and not lying on one’s back in stirrups, which became the “modern way” to give birth about 200 years ago as dictated by predominantly male doctors in hospitals.

 

Here’s an excerpt from an article on evidence based positions for childbirth:

Researchers hypothesize that pushing in an upright position is beneficial for multiple reasons. In an upright position, gravity can assist in bringing the baby down and out. Also, when a woman is upright, there is less risk of compressing the mother’s aorta and thus a better oxygen supply to the baby. Upright positioning also helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. Finally, X-ray evidence has shown that the actual dimensions of the pelvic outlet become wider in the squatting and kneeling/hands-knees positions (Gupta et al. 2012). However, despite these proposed benefits of pushing in an upright position, most women in the U.S. give birth either lying on their backs (57%) or in a semi-sitting/lying position with the head of the bed raised up (35%). A small minority of women give birth in alternative positions such as side lying (4%), squatting or sitting (3%), or hands-knees position (1%) (Declercq, Sakala et al. 2007). It is thought that most women are encouraged to push in a lying or semi-sitting positions because it is more convenient for the doctor. October 2, 2012 by Rebecca Dekker, PhD, RN, APRN
© Copyright Evidence Based Birth.  http://evidencebasedbirth.com/what-is-the-evidence-for-pushing-positions/

Put succinctly by Hannah Dahlen, Professor of Midwifery at University of Western Sydney:

So, what began as a change in birth positions for the convenience of men has been shown scientifically to be an inconvenience for women and babies. It’s time for Australian women to stand and deliver once again.   (This is an excellent article. You can read it at http://theconversation.com/stand-and-deliver-upright-births-best-for-mum-and-bub-13095 )

The writings of the Roman doctor, Soranus of Ephesus (which I have visited and is now in Turkey), who in first century AD wrote a four volume treatise on Gynecology, may have reflected practices in Israel, that it was common for midwives and women to have supplies available to assist in labor and delivery:

For normal labour one must prepare beforehand: olive oil, warm water, warm fomentations, soft sea sponges, pieces of wool, strips of cloth, a pillow, things to smell, a midwife’s stool or chair, two beds and a proper room:

  • oil for injection and lubrication
  • warm water in order that the parts may be cleansed
  • warm fomentations for alleviation of the pains
  • sea sponges for gently washing the body
  • pieces of wool in order that the woman’s parts be covered
  • bandages the so new born may be swaddled
  • a pillow in front of the woman, on which the baby is placed till the afterbirth has been taken care of
  • good things to smell, such as penny royal, a clod of earth, barley groats, as well as an apple and a quince … to revive the labouring woman.’
  • (Soranus, Gynaecology, What Must One Prepare for Labour?)
  • Except for mentioning a clean blade, these could be items in a birthing kit.

But although these Israeli women had the advantage of upright deliveries, midwives, and supplies to ease pain and promote healing, the lack of prenatal care and healthy nutrition due to extreme poverty resulted in deaths of 25% to 30% mothers and babies. Mary and Joseph were poor as depicted in the Christmas story having to stay in the “manger” or the lower level of a private home where the animals were kept. The young 15 year old Mary must have been healthy, with a pelvis large enough accommodate a safe birth, and the survival of herself and her baby. The straw and flooring, and the blade used to cut the umbilical cord must have been clean enough so that neither of them contracted a life threatening infection.   One way or the other, survival of mother and baby was a miracle.

There is a video produced by National Geographic that aired on June 11, 2012 called Mysteries of the Bible: The Birth of Jesus that you may want to watch: http://channel.nationalgeographic.com/channel/episodes/birth-of-jesus

So why does any of this matter? What difference does it make how the baby Jesus, adored as a Savior by many and by many more honored as a child who grew into a great man and teacher, was born 2000 years ago? It matters because every baby has the right to be born safely, to be adored and to grow into someone to be honored for their gifts. It is my hope that Mary during the birth of Jesus was surrounded by shepherds, women who knew how to give the best care to a woman during labor and “shepherd” the baby through all of the stages of birth: contractions, crowning and delivery; that wise people brought the supplies needed to reduce pain and promote healing: olive oil, soft clean sponges, a pillow, things to smell, a birthing stool, a clean blade; that the animals gave off heat from their bodies to keep mother and baby warm; and that after Jesus was born, Mary was held and comforted by the women around her and by Joseph, and she was able to rest and adore her baby. This is the beautiful story we have missed in the Gospels and the Nativities. The birth of Jesus.

 

My hope is also that we continue to commit ourselves to the safe and loving birth of every baby, especially babies and their mothers at risk, who need the shepherds of midwives and community health workers, trained birth attendants and doctors. Who need wise people to provide the clean supplies of birthing kits and birthing places in their homes or clinics or hospitals where mothers can rest, and heal and adore their babies.

Glory to the Newborns and their Madonnas.

Peace on Earth

Nepali Madonna

Mother and Child, photo by Karel Amaranth, Kathmandu, Nepal, December 2010

top of post:  Madonna and Child, painting by David Saintus, Haiti, December 2008

A White Woman of a Certain Age Driving a Volvo

My hands gripped the steering wheel, my eyes focused on the dark roadway ahead, I concentrated on the exact pressure my foot needed to exert to maintain my speed at the 35 mile an hour limit. My heart was pounding and I had to consciously breathe in and out, steady and slow. It was close to midnight on my way home from a friend’s house in northern New Jersey. As I had driven along the Harrington Park side of the reservoir, a car had pulled out from a side street behind me. The driver had been following me, about two car lengths behind my car, for approximately 5 miles. Yes, clearly I was being followed for what reason I didn’t know, especially since the car was police patrol car, and the driver was a police officer.

It had been an evening of pre-Christmas fun with my tennis buddies. We met in Bergenfield, New Jersey at my friends’ house at 5:00 PM, and two designated drivers drove us to Heidelberg restaurant on the upper eastside for totally gluttonous indulgence of schweine haxe, veal chops, and sauerbraten (good but never to compare with my mother’s.) Big 16 ounce glasses of weissbier. Then a decision to skip the strudel and drive down to Rocco’s in the West Village for cannoli, tiramisu, cheesecake, espressos and cappuccinos. We went back uptown for a lovely drive past the Rockefeller Center Christmas tree. Truly a night of friendship, laughter, over eating, and holiday cheer. Back in Bergenfield we all kissed and hugged, and wished each other “Merry Christmas!”

And so I began my drive home, a trip of 13 miles northeast, to Piermont, New York. I was listening to late night NPR, enjoying the thoughts of the friends I had been with, thinking about Christmas plans, singing along with “The Messiah.” When the police car pulled out of the side street, I was certainly a little more aware of my driving, checked the speed limit sign on the side of the road and held a steady 25 mph, which I must say is very slow, but why take a chance? I continued to sing along, but with a little less gusto on the “And he shall glorify!”

At the first main intersection, Livingston Street and Broadway I could have gone straight but decided to make a right turn and head east to Piermont Road. I pulled into the right lane and waited for the light to turn green, since it is a no right on red light. The police car pulled up next to me in the left lane indicating that he (yes, I could see that it was a male cop at the wheel,) would be going straight up Livingston. When the light changed I made my right and suddenly the police car pulled out of the left lane and followed me. I do believe making a right turn out of a left lane is against the law, but hey, he’s a cop. But then I realized, he was really following me. Driving along Livingston I became very aware of my driving, really aware. But then I noticed we were approaching a police station. Oh silly me, he’s just going back to the station. No, on past the station he continued to follow me, maintaining that just about two car lengths between my taillights and his headlights. At the intersection of Broadway and Piermont Road, I moved into the left lane to turn north; the speed limit changed to 35 MPH. Carefully looking both ways at the stop sign I made the left, and then out of the right lane, he turned left too, just about two car lengths behind me.

And this is when my hands started really gripping the steering wheel, I had stopped singing, and had pushed the volume button off, I was aware, very aware of my driving, my speed, the way I rounded each curve, exactly where I was in relation to the center line, the side line, and very aware that there were no other cars. Yes, it was after midnight on a Sunday night, but there were no other cars either in the oncoming lane or behind me, just the steady headlights two car lengths behind me.

I felt scared, trapped, pursued, and mostly I felt like I was being set up. This cop was just waiting for me to slightly veer over a line, to roll through a stop sign, accelerate just beyond the speed limit. I watched the headlights in my rear view mirror and envisioned that at any moment the blue and red strobe would kick on. And then I thought about the beer I drank. Sixteen cold golden ounces between about 6:00 PM and 8:00 PM, intermingled with sauerbraten, potato dumplings, red cabbage, lots of brown bread, and then the Rocco’s tiramisu and cappuccino. Never had I felt the least bit impaired beyond a slight buzz during dinner and that was more than 4 hours ago, and yet I had no idea of what my blood alcohol might be. Never being a careless drinker and driver, never having even gotten a speeding ticket, I had never calculated any of this.

So I could feel a panic setting in as I drove along quiet, dark, lovely wooded Piermont Road. Clearly, I was getting the pump of adrenalin associated with a stressful situation. The internal chemical reaction that has been with us since the dawn of human time to protect us with the fight or flight response.

Adrenalin: A hormone secreted by the adrenal medulla upon stimulation of the central nervous system in response to stress, as anger or fear, acting to increase heart rate, blood pressure, cardiac output, and carbohydrate metabolism. Fosters protective actions of fight or flight.

Yes, I was definitely getting an adrenalin rush.

Fight or Flight: Involving or relating to an involuntary response to stress in which the hormone adrenaline is secreted into the blood stream in readiness for physical action, such as fighting or running away.

Here are the specifics of how this works and the behaviors it causes from a site called Changing Minds:

When we perceive a significant threat to us, then our bodies get ready either for a fight to the death or a desperate flight from certain defeat by a clearly superior adversary.

Physical changes

Fight or flight effects include:

  • Our senses sharpening. Pupils dilate (open out) so we can see more clearly, even in darkness. Our hairs stand on end, making us more sensitive to our environment (and also making us appear larger, hopefully intimidating our opponent).
  • The cardio-vascular system leaping into action, with the heart pump rate going from one up to five gallons per minutes and our arteries constricting to maximize pressure around the system whilst the veins open out to ease return of blood to the heart.
  • The respiratory system joining in as the lungs, throat and nostrils open up and breathing speeding up to get more air in the system so the increased blood flow can be re-oxygenated. The blood carries oxygen to the muscles, allowing them to work harder. Deeper breathing also helps us to scream more loudly!
  • Fat from fatty cells and glucose from the liver being metabolized to create instant energy.
  • Blood vessels to the kidney and digestive system being constricted, effectively shutting down systems that are not essential. A part of this effect is reduction of saliva in the mouth. The bowels and bladder may also open out to reduce the need for other internal actions (this might also dissuade our attackers!).
  • Blood vessels to the skin being constricted reducing any potential blood loss. Sweat glands also open, providing an external cooling liquid to our over-worked system. (this makes the skin look pale and clammy).
  • Endorphins, which are the body’s natural pain killers, are released (when you are fighting, you do not want be bothered with pain–-that can be put off until later.)
  • The natural judgment system is also turned down and more primitive responses take over–this is a time for action rather than deep thought.

Modern effects

Unfortunately, we are historically too close to the original value of this primitive response for our systems to have evolved to a more appropriate use of it, and many of life’s stresses trigger this response. The surprises and shocks of modern living leave us in a permanent state of arousal that takes its toll on our bodies, as described by Hans Selye’s General Adaptation Syndrome.

Freezing

A third alternative response which often comes before fight or flight is freezing. This is often used by prey as they seek not to be noticed by predators and is typified by the rabbit paralyzed by the headlights of an oncoming car.

Humans also will pause at signs of danger. By freezing, you also cut down on noise and visual change and so may hear or see things around you more clearly.

Freezing gives you time to assess the situation and, if necessary you may then take further action, including fighting or backing away.

And…

Shielding

Another automatic, unthinking reaction when faced with a sudden threat is to go into a ‘shield’ mode, for example cowering down and protecting the head by throwing arms over it. Turning away to use the back as a shield is also common.

When with a child or another person, the protection instinct may cause you to throw your body around them, pulling them in and literally becoming a ‘human shield’.

Sacrifice

Beyond shielding or perhaps as an extension of it, we will even sacrifice ourselves to help others, for example where a soldier ‘takes the bullet’ for a colleague.

When people are praised for being heroes, a common response is to say that they ‘didn’t think about it’. In other words, it was an automatic reaction to help others, even at the potential cost of one’s own life. This willingness to sacrifice is an essential element of humanity and society, even if we never have to take this action.

If you get wound up yourself, stop. Get out. Use any excuse to go somewhere and calm down.

 

Flight or fight to the death. That’s what our medulla has been programmed for in our survival and the survival of those we love and care for, even complete strangers.

But let me take you back from primitive humanity to that night in my car as my heart started pounding, my hands were getting sweaty on the wheel and I had to work hard to keep my breath steady. And my sudden realization: If the red and blue lights began to strobe behind me and I had to pull over, fight or flight were the last things I would ever want to do when confronted by a police officer. Even “getting out, using any excuse to go somewhere and calm down” was not going to work. The response that has protected us as humans since prehistory was exactly what not to do. Read any of the recent news reports. Michael Brown, Eric Gardner, compelling statistics of police violence specifically targeted against black men. Fight or Flight in these circumstances is deadly.

I am a white woman of a certain age, driving a Volvo, adhering to the speed limit, with an extremely clean driving record. Why was I chosen to be followed? What was my profile? What is anyone’s “profile”?

This is not a rant against police. My own Piermont cops came to my aid when I was locked out of my house and on another occasion carried me from my driveway down 20 steps after my ankle surgery. I have worked with many police officers and detectives in victims’ services, and they are dedicated to risking their own lives to protect others. I also know that when stressed, their fight kicks in; fleeing is not an option.

Marc H. Morial, President and CEO of the National Urban League wrote in the Huffington Post:

That is why we march — because Eric Garner, Michael Brown, Akai Gurley, Tamir Rice, John Crawford and others did not deserve to die; because Marlene Pinnock did not deserve to be viciously beaten and Levar Jones did not deserve to be shot for complying with a trooper’s request; because the excessive use of force — deadly force — by law enforcement against unarmed African Americans has no place in the land of the free and the home of the brave; because police should not fear the communities they have sworn to protect and communities should not fear those who serve to protect them; and because we — as a nation — must and can be better.

I never did have to contend with my fight or flight response that night. About 6 miles after the patrol car started following me, as I drove at 35 miles an hour on Piermont Road and I passed the big green “Welcome to New York, the Empire State” sign, the headlights suddenly disappeared as the officer at the wheel pulled a U-turn and drove back south. My heart rate calmed as I rounded the bend into Piermont and drove up my steep windy road home. But still I wondered why I had been followed. I continue to wonder about how we can all do better. I can’t pretend I know what it is like to be routinely profiled, followed, questioned, threatened, but I do know what a state of constant fight or flight does to a person’s nervous system, to the nervous system of a community, to a nation; a permanent state of arousal that takes its toll on our bodies, minds, hearts and souls, and costs lives when fight or flight is a death sentence. It’s in the research, it’s in the news every day. We must and can do better.

For me this was an isolated incident, but then I am a white woman of a certain age, driving a Volvo, adhering to the speed limit, with an extremely clean driving record.

 

 

 

 

On the Road in Uganda


on the road

I arrived at Entebbe Airport on Saturday night June 7, 2014 after about 26 hours of flights and stopovers. Was picked up by David and Joseph and immediately taken to a party at the home of Dr. Sarah Nkonge to celebrate the work we had been doing together, the Rotary of Makindye and me. Thus began my journey in Africa. The following is from a few days later when we traveled to the Lwengo District.

 

I didn’t sleep much last night and got through some of the toss and turn hours by reviewing my suitcase contents…why did I pack Catwalk Sleek hair spray?  Maybe for my visit to the King of Tororo…but more about that another time.  We left Kampala for a 3 hour drive out to Lwengo; of course it takes well over an hour just to get out of Kampala, the city of no public transportation or beltways so all roads lead to massive “jams.”  Our driver Joseph is amazing (the best, except maybe for Mahindra who drove me from Kathmandu to Hetauda for 8 hours over hairpin turns up very steep, narrow mountain roads with no guard rails.)  Sarah, David and a reporter from a local TV station and I all loaded in the four wheel drive Ford.  Sometimes beautiful landscape of rolling green mountains and then the villages of rusted tin sheeting and concrete blocks, the ubiquitous charcoal smell and piles of mostly plastic garbage, rotting foods and road kill.  A strange occasional battered phone booth, odd because almost everyone seems to have a flip phone and there are ads for “mobile money” everywhere. Always the sad lost discarded flip flops.  Traffic of cars, mini buses, bicycles, motorcycles piled with people, bananas, mountains of plastic containers; on one, a man and a women; on another, a man, a woman, a baby and a goat; on one several boxes of condoms that spilled out in a trail along the side of the road precipitating, among those in our car, several hilarious adaptations of and responses to, “why did the chicken cross the road?” which during all drives was prominent as many chickens actually crossed the road right in front of our wheels. Women walking with massive bundles of sticks, huge plastic jugs of water or gasoline, and bowls of cassavas on their heads, and babies scarfed onto their backs, the little baby feet peeking out on both sides of his or her mother’s breasts. Children playing in the gravel alongside the roadway and a few elderly people crawling.  All this takes place at dizzying speeds in a dangerous dance of near misses, and every moment that someone isn’t killed is a miracle, proving that Uganda is actually overflowing with miracles.

 

We arrived at a Girls School, a collection of large low buildings and toward the back of the “campus” was a large barn with a dirt floor and about 50 women and their children waiting for our presentation and distribution of the birthing kits.  The women are beautiful and the children adorable.  They were all obviously dressed in their best colorful clothes, some very worn but still bright and bespangled with sequins, decorated with embroidery.  The clinic director introduced me in Luganda, one of the several languages in Uganda that vary from district to district. She said I was bringing the kits from Australia, short cut for I am from the United States and I got the kits donated from the Birthing Kit Foundation in Australia.  I told them I was so pleased and honored to be there, that I had been all around the world but they were the most beautiful women and then I went through the contents of the kits.  The little piece of soap, a pair of latex gloves, black plastic sheet for the birth area, 4 cord ties, and the one clean wrapped razor blade  “Please don’t use this for anything but cutting the umbilical cord,” I pleaded, knowing that some research had indicated that the blades were sometimes used prior to the birth for any number of household tasks like cleaning fish.

womens group 2

I marveled that the babies and children actually looked quite well and healthy and were very playful and engaging.  When I commented to a few of the mothers later they told me that it is the healthiest babies that survive, the ones that are “right sized;” the others that are too small die at birth or shortly thereafter, the ones that are too big die with their mothers since they often can’t be delivered at a hospital that can perform C sections.  Other children that aren’t really strong die in the first year of malnutrition, malaria, dehydration or accidents…so it is the healthiest, most resilient that are with them.  Tragic Darwinism.

 

The women so were appreciative of the kits, but said they needed more than one pair of gloves, because they sometimes tear, and more pads for the bleeding after birth.  I said I would try.  Someone delivered bottles of soda. Fantas all around.

 

Then we went over to the Girls’ School to distribute sanitary pads and soap during the student lunch break, which I was told would be chips and soda.  There were about 50 girls in red uniforms.  This was outside on a hill and the breezy atmosphere was an opportunity to have a good time with them.  The girls all spoke English, so I could speak with them without a translator. I talked to them about staying in school, staying strong and being sisters.  Having babies when they were really ready and in a good relationship.  I found myself saying the same things I had said to kids in the Bronx:  Your body is your own. If someone hurts or touches you, tell an adult you trust.  I had an almost imperceptible heart pang thinking of my work at the Child Advocacy Center in the past.  They sang a song for me and we all danced and I taught them to kick like the Rockettes. Then we gave out the sanitary pads and soap which was like giving out party favors on someone’s birthday.

 girls kicking

The women had talked to me about how bad a local clinic was and that was why they would rather have their babies at home, so before we drove back to Kampala I asked to visit the clinic.  We drove to the clinic and on first sight I could see why.  It was literally a hole in the wall shack attached to other shacks.  The crumbling concrete steps alone spoke volumes about how difficult it would be to give birth there.  The clinic director showed me around and said she had been trying to get more support from the Ugandan government so she could improve the facility. She also has to charge 15,000 Ugandan Shillings for a delivery, the equivalent of about $6 US, and some women just can’t afford to pay. There was a small room of deteriorating concrete for the exams, the labor room with a damaged table and stirrups, and a room with 4 little beds side by side for recovery.  The women can stay for 6 hours after the birth to recover before they have to leave. I asked if (since there was a long drive back to Kampala) I could use the bathroom and was shown a rocky path to a shack beyond a stubbly field.  Let’s just say it was much more rocky than path.  The toilet inside the shack was a squat hole. Now I have used many squat toilets and they can be quite nice, tiled, clean and you get a good stretch workout in your quads while peeing. This one was covered with excrement and urine and dirt and full of insects.  Mosquitoes and flies and any number of unidentified winged things buzzed around my head. A caterpillar that could have morphed into an exotic butterfly or something that would rip my leg off humped past my foot as I stepped onto the two bricks on either side of the hole.  I did a quick flashback of all the meds I had taken: Hep A, Hep B, Polio booster, Yellow Fever, Typhoid capsules with live bacteria, Cipro in my bag and antibacterial wipes at the ready.  The women who gave birth there and the staff who delivered the babies did not quite have these advantages.

 

The four hour ride back to Kampala was quiet.  I perused a local newspaper:  Article “Uganda Fails to Achieve the Millennium Goals and Reduce Maternal Mortality.”  17 women and 106 babies die every day during childbirth.  That is a maternal mortality rate of 370 per 100,000. Most “economically developed” countries have a rate of between 5 and 10 per 100,000. The United States has a rate of 26 per 100,000 which has been increasing.

 

As the Ugandan landscape sped by my window, I needed a little “normal” and slipped in my earbuds, turned on my Ipod and slid the power bar.  It was on Shuffle, which i call Random.  Paul Simon’s most tender, sad, wrenching lyrics:  In a phone booth in some local bar and grill, rehearsing what I’ll say my coin returns.  How the heart approaches what it yearns.

 

 

 baby

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