It Takes a Village (one person, THE MAYOR, and NYS DEC)

06 Sep 2021 Leave a comment

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , ,

MPH on the Pier

As the pandemic raged and then retreated, then returned with Deadly Delta weaponry, I watched the numbers, social distanced, wore my masks, and thankfully extended my arm in the CVS in Valatie, New York, twice to receive the Moderna vaccine. I worked from home, covered for my direct reports when they took COVID leaves, checked in with and carefully visited my beloved family. And as a Public Health professional (New York Medical College, class of 2010, MPH, Maternal Child Health) I sought to have some even small involvement in the fight contacting my Alma Mater for any volunteer activities, supplying hand soap and bleach wipes for my colleagues in my workplace, and putting up signs in restrooms with the CDC hand washing Happy Birthday twice protocol. ( https://youtu.be/F_rkjjCkxGo ) I had a contest with my staff challenging them to come up with other songs or rituals to accomplish the required soaping time (“Staying Alive,” “I Will Survive,” “The Final Countdown,” and “Can’t Stop the Feeling.”)

News, reports, statistics, graphs, and trends were constants: I had dreams about Anthony Fauci. One escape that was available was the Piermont Pier, an extension of land mass protruding for a mile into the Hudson River, the conduit for WW II troops embarking on ships to Europe, including the shores of France. The Pier had actually been closed for several months at the height of the pandemic, the local government fearful that even walkers, joggers, bikers wearing masks outdoors might be spreading the virus. On weekends the treelined promontory would fill with visitors, bus loads from neighboring towns, camps, and residents of New York City. An article in the local Patch on August 22, 2020, referred to our lovely Pier as a “social distancing nightmare;” shortly thereafter the police barriers went up across the entrance. We Piermonters were allowed access with permits and I could once again find refuge from the Corona.

One early spring day 2021, as I was running (electronic speed sign actually registered me at 4 MPH) I was encouraged by the signs of new life. My husband and I had just gotten our second shots, shops and restaurants in our little village were opening with tables and chairs on the sidewalks extending into the streets, I was dazzled by actual faces in Stop and Shop. On the Pier new sprouts were coming from the base of last year’s dead marsh grasses, the waterbirds, egrets and herons wading into the shallows eyeing little flashes of their breakfast beneath the surface, the loons and ducks and Canada Geese floating on the undulating waves surrounding me. (“Oh, Canada,” if only your border were open or I could fly in on the feathered wings of Mary Oliver’s Wild Geese “high in the clean blue air, heading home again,”
( http://www.phys.unm.edu/~tw/fas/yits/archive/oliver_wildgeese.html )
This one slice of life seemed to have finally returned to normal. I breathed the estuarial fog directly into my maskless nostrils.

But there was one disturbing detail that entered into my experience. Amidst the other hopeful new growth; there were a few glossy leaflets emerging from the muddy earth against the trunks of trees that gave me an almost undetectable twinge of fear. I tried to avert my eyes, refocus on a red red robin that was bob bob bobbin along the path, but too late. I knew what was insidiously hovering just below the surface of the soil on the southside of the pier. I knew those lovely green trifoliate leaves with the glimmer of red: POISON IVY.

Toxicodendron radicans, commonly known as eastern poison ivy, is an allergenic Eastern North American plant in the genus Toxicodendron. It is well-known for causing urushiol-induced contact dermatitis, an itchy, irritating, and sometimes painful rash in most people who touch it. The rash is caused by urushiol, a clear liquid compound in the plant’s sap.

Even for those of us for whom the danger of urushiol is known for causing the painful rash, there were places on the Pier where it was almost unavoidable. I recalled the previous summer when vines of poison ivy dangled above the roadway, so that a cyclist or runner might literally run head first into the leaves, or someone retrieving a ball or hat blown into the marsh grass would stick their hands directly into the low growing vines, or a dog would wander into the treed (and previously pee-d) areas to use a trunk for doggy business and rub against leaves, then to be petted by it’s devoted owner.

But as I had often experienced, there were many visitors to the Pier who did not know that the pretty shiny red and green leaves were dangerous. I met a couple walking on the Pier who were picking the leaves to add to a bouquet of Queen Anne’s Lace and Cornflowers. I asked them please to take the leaves out and go wash with soap and water asap. But why? These leaves are so beautiful! There was a group of children playing tag with a stump covered with ivy vines as home base. I talked to their parents. They thought I was a little crazy for interfering with their children’s fun. And, the death-defying gentleman who stepped off the path and into the almost private space among the vines to relieve himself. I struggled ethically with this existential predicament, but did not converse with him about his exposure and possible exposure to urushiol.

These and many other experiences seemed to define me as a kind of nutty nature cop. Really, I didn’t want to intrude in anyone’s botanical aesthetics, or fun or “relief,” but the thought of people so unaware of the dangers of poison ivy was terrifying. Yes, to some people there is a nasty rash and itch, a contact dermatitis, which can last two to three weeks, and can be treated at home:

The most important action is to thoroughly wash the affected area with soap and water as quickly as possible. Also make sure your hands, including under your nails, are cleaned of any sap. This will prevent the oil from spreading and from contaminating other parts of your body. Pat your skin dry gently; do not rub as this can irritate the skin. Wash your clothing and any tools or equipment you handled that may have been in contact with the plants.
Once your skin has been cleaned, you may find relief from the itching by trying these remedies:
• Cold compresses: Soak a clean washcloth with clean, cold water and wring it as dry as possible. Place the cloth on the rash for about 15 to 30 minutes. This can be repeated several times a day.
• Oatmeal baths: Add oatmeal or oatmeal bath treatment to a running bath and soak in the tub for about a half hour.
• Topical lotions and creams: Over-the-counter products, such as calamine lotion and hydrocortisone creams (applied lightly) can help reduce itching and swelling.
• Over-the-counter antihistamine medications, such as Benadryl
It is very important not to scratch the rash or pop any blisters, as this can cause an opening for infection.
Oh yeah……That’s the tough part; when your skin is crazy itching, not to scratch!!!!! Just think about when you have a regular little itch that is in some hard to navigate area of your body’s geography. Then think about whole continents of itching. DON’T SCRATCH!!!!!
But for some people it’s beyond the redness and itching and submerging in an ocean of calamine lotion. Poison ivy can cause severe reactions to people who are allergic to the sap and can experience the following, requiring medical treatment.
• Severe swelling
• Swelling of the lips and tongue
• Shortness of breath or difficulty breathing
Even those who aren’t allergic to poison ivy, may need to see a doctor if they develop complications or have a severe poison ivy reaction, such as:
• The rash covers the face (lips, eyes, mouth) or genitals.
• The rash covers more than a quarter of the body’s surface.
• Breathed in smoke from burning poison ivy.
• Treatment at home does not relieve the rash or itch.
Scratching poison ivy rash or blisters can cause breaks in the skin that can become infected. If any signs or symptoms of an infection develop, a doctor should be seen as soon as possible especially it there is Increasing pain around the wound and fever.
Perhaps my vigilance about poison ivy is a flashback to my childhood. Shortly after my parents bought a piece of beautiful wooded property where they were to have our family home built in Stony Brook, New York, my parents, two older sisters and I, spent a day raking and clearing leaves and vines, which my father piled up and yes, he built a fire. We thought this was great fun, and as we cooked hot dogs and toasted marshmallows, we threw more and more leaves into the fire. The more and more leaves included some red and green glossy trifoliates. For the next couple of weeks we itched and tried not to scratch, bathed in oatmeal and smeared on the calamine. We went to the doctor, but miraculously none of us had breathed in enough of the smoke to damage our lungs. So even if the fear of poison ivy isn’t actually embedded into my DNA, it is certainly etched into my early childhood psyche.
So there I was on the Pier, early spring 2021. I foresaw a summer of warning people, interfering with fun, ethically challenged by some very personal behaviors in a public place. What to do? And then it occurred to me: this was a Public Health issue. Yes, a serious threat not just to individuals, but to a whole population of Pier visitors. It was time for government intervention.
As a governmental agency, here’s what the United States’ Center for Disease Control has to say:

Public health is the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world.

 

The government of Piermont consists of a Mayor, Trustees, Planning Board, Building Department, governmental employees like the Village Clerk, the Department of Public Works staff, Parks and Recreation, of course the Fire Department, and our Piermont Police Department (who have come to my rescue in various situations like when during the first week I lived in my house in Piermont, I locked myself out of my bedroom and they had a clever way of unlocking it, and when I was brought home by my daughter after my ankle surgery, they carried me down the 20 steps to my house.) I considered the level of governmental involvement the poison ivy invasion required and went with the Office of the Mayor.

The Mayor of Piermont is Bruce Tucker, is a retired businessman (former CEO of a multi-million dollar textile company) and a Democrat. I looked on the Piermont website and got this little bio and his email address:

Bruce Tucker has been Mayor of Piermont since 2018. He has been an active member of the Piermont community for the last 27 years. Prior to becoming Mayor, Bruce served as a board member at the Piermont Community Playgroup, the Dennis P. McHugh Piermont Library, the Piermont Historical Society, and the Rockland Center for the Arts, additionally serving as Treasurer for the latter three groups. Bruce is also a member of the Piermont Democratic Committee, and a former Alternate on the Village of Piermont Zoning Board

Mayor Tucker (as he signs his emails to me) is up for re-election, so I thought maybe he would want a crusade to stake his campaign to…..poison ivy on the Pier.

I sent a nice email, identifying myself as a Public Health professional by adding the MPH to my signature, and expressed my concern for the residents and visitors to our lovely little village

Good afternoon Mayor Tucker,
My husband and I live I Piermont and we said a quick hello to you after the parade on Memorial Day. I am very concerned about the poison ivy on the Pier. It is rampant, enveloping trees, hanging over the road and so well established it is bearing berries. Although many of us know to stay away, I have concerns about visitors especially children who may touch, rub against it, even possibly pick the leaves, eat the berries. I realize that removing the PI from the Pier would be very difficult and we certainly don’t want to use chemicals that would undoubtedly end up in our river. I am wondering if we can post some warning signs at the entrance to the Pier, and along the way, and if there are places where it can at least be cut back without risking the safety of our DPW staff.

Please let me know if there would be some way that (short of ripping it out with my bare hands) I could assist.
Thank you.
Best wishes,
Karel R. Amaranth, MPH, MA

Hi Karel,

Thank you for your email. Unfortunately, the New York State Department of Environmental Conservation owns the south side of the Pier, so we are not allowed to touch it. I did make them aware of the situation – this was their reply:

Thanks for passing this on. But the DEC does not normally eradicate a native species like that. Is the poison Ivy encroaching on the road? I am not sure it would ever be possible to eradicate Poison Ivy… and I would imagine it would require an herbicide.

As you point out, we certainly don’t want to use chemicals that would undoubtedly end up in our river.

Perhaps an email to the D.E.C. from a concerned resident as yourself may prompt them to take action. You can email Heather Gierloff at:
heather.gierloff@dec.ny.gov

In the meantime, I will speak to Tom at the D.P.W. to see about posting warning signs.

Thank you,
Bruce Tucker, Mayor
Village of Piermont, NY 10968
478 Piermont Ave.
Piermont, NY 10968
(845) 359-1258 x304
btucker@piermont-ny.gov

Native species??????? Wtf????? We are talking about poison ivy here, not the Western Underground Orchid, Pitcher Plant or Jellyfish Tree. But ok….I’ll contact Heather Gierloff. Public Health knows no governmental barriers, and in fact I was pretty excited about moving up from the government of Piermont to the State of New York Department of Environmental Conservation. (Note: In my email below I get right to being a Public Health professional!)

Dear Ms. Gierloff:
I am a resident of Piermont and I certainly enjoy our beautiful Pier. For the past few summers I have been concerned about the rampant and encroaching poison ivy. It envelops many of the trees on the south side of the Pier and is hanging over the road; some of the ivy is so strong that it is producing berries. As we all know, contact with poison ivy does not just produce itchy skin, it can be deadly, entering the respiratory system. I am deeply concerned about visitors to our Pier who may not know how dangerous this plant is: children who may rub up against the trees, adults who may pick the leaves and possibly think the berries are edible. Recently on a walk I had to ask a couple to please not gather the leaves which they were picking along with some other flowers and plants.

As a Public Health professional, I certainly understand that we do not want to endanger our river and river life with herbicides or chemicals to remove the poison ivy, but i am asking the Department of Environmental Conservation to find a way to control it, cut it back or use organic solutions (I use vinegar and salt on my own property.) I have contacted the Mayor of Piermont also requesting signage at the entrance to the pier and at certain points along the way to inform visitors about the dangers of poison ivy and how to identify it.
I would very much appreciate your response and attention to this danger to ensure safety for residents of Piermont and our visitors.
Best wishes,
Karel R. Amaranth, MPH, MA

Ms. Gierloff responded:

Karel,

Thank you for reaching out about the Poison Ivy issue.
I will be meeting with Bruce Tucker next week to look at the area and discuss options.

Have a good day
Heather

Heather Gierloff
she/her/hers
Regional Marine Habitat Manager, DEC Regions 3 and 4
Manager, Hudson River National Estuarine Research Reserve

New York State Department of Environmental Conservation
Norrie Point Environmental Center, 256 Norrie Point Way, P.O. Box 315, Staatsburg, NY 12580
P: (845) 889-4745 x118 | heather.gierloff@dec.ny.gov
http://www.dec.ny.gov | | |

I didn’t exactly get to have a passionate 1854 John Snow at the London water well moment, in fact I wasn’t even invited to the meeting between Mayor Tucker and Heather. It was kind of anti-climactic; I was probably working at my office or home feeding the cats or weeding the garden or something relatively mundane when The Meeting took place and strategies impacting on the health and well-being of the residents of Piermont and our guests were being determined by powerful governmental officials.

But a week or so later, as I resumed my runs on the Pier, I noticed some brown, dry curled vines dangling from trees as I approached the Pier Road from the parking lot. And there, right there at the entrance to the Pier was a sign saying, CAUTION Poison Ivy and a labeled drawing of the three-leaf design. There were more signs arranged along the road, more dead and dying vines, as I later found out, doused with a solution of salt, vinegar and dish soap. I stopped and gazed out at the Hudson River and when I turned to continue my run, a woman approaching me said, “Well, they finally did something about the poison ivy.” I smiled and continued to run.

 

Grateful for our beautiful Pier

Can we Stick to the Message of Safe Sleep and Prevent Infant Deaths?

12 Aug 2021 Leave a comment

by privatelifeinpublichealth in Uncategorized Tags:

Unintentional suffocation is the leading cause of injury and death among infants < 1 year old in the United States with 82% being attributable to accidental suffocation and strangulation in bed.  Understanding the circumstances surrounding these deaths may inform prevention strategies. 

Pediatrics; May 2019

Understanding the circumstances of infant and child deaths has been prominent in my work as the executive director of a Child Advocacy Center, the director of a victims services organization and as a public health consultant.  Over the past 15 years, I have served on a national expert Child Fatality Review Team, a member of a local county team, an advisor to the New York City Council as they developed legislation requiring child death reviews which was signed into law by Mayor Michael Bloomberg, and as a consultant for a developing Fetal/Infant Mortality Review Team.  The mission of all of these initiatives has been to understand the circumstances of infant and child deaths to prevent future deaths.  Reviews are often excruciatingly detailed including the brief lives and relationships, and tragic losses of lives; the understanding never ceases to be heartbreaking.

Reviews I have participated in over the years have included babies who had died from suffocation while in the care of family members, neighbors, friends of the parents.   I have often found myself wide awake late into the night and early morning hours struggling with how these tragic deaths could be prevented.  The American Academy of Pediatrics, the CDC, state departments of health, hospitals and health care providers provide information and training for parents.  The A, B, C’s of Safe Sleep has been promoted in videos, brochures, and on bus stop kiosks.  New parents receive information in hospitals after the birth of their baby; perhaps not the most teachable moment as parents celebrate their baby’s birth, but also adjust to many life changes.  These forms of Safe Sleep education have had varying degrees of success.  But how does this education reach other people who will care for babies?  Grandparents, aunts, uncles, cousins, babysitters, neighbors, friends?  There have been cases of babies placed on a soft sofa, a babies in a bed with another child, babies who died with their faces against a teddy bear or other soft toy.  

In the early morning hours of a recent sleepless night, I came downstairs to my computer and started researching articles and statistics and mostly just thinking about how we as public health professionals could provide education for anyone who would ever care for a baby.  It seemed overwhelming.  At some point I realized that general information, public service announcements, social media, those bus kiosks might not be the answer.  I had the thought that parents needed a tool to educate, remind, inform caregivers and as I glanced around my own desk, my own office and in various places in my house I realized how I remind myself and provide information to others:  sticky notes.  I had several on my desk about bills to pay and other “to do”s, on my refrigerator as a reminder that I was low on milk, and one on the front door to remind visitors to not let the cats out.  Sticky notes with Safe Sleep information could be stuck on a refrigerator, on a wall near where the baby would be sleeping, on a diaper bag.  I had a pang of embarrassment that I was thinking about a tool for parents to protect their babies by using something so simplistic as sticky notes to share Safe Sleep information, but I pushed through that and went to an online print service and bullet pointed the basics, organized the information on a 3×4 sticky note and placed the order.  When they arrived I shared them with several public health colleagues.  Good idea, too small.  I increased the size to 4×6 and organized the information in the A, B, C’s of Safe Sleep and sent it off to Stik2it.com where David, the company president not only cleaned up my format removing extraneous punctuation, but gave me a discount on printing.

Besides the basics of Safe Sleep parents leaving their baby will want to assure that the baby is not exposed to second hand smoke, that there is a fire exit, that there are no drugs, weapons, or other dangers in the home.  The Safe Sleep stickies cannot protect against all dangers.  Certainly from my participation in infant death reviews too many and too tragic, I know that saving lives can be complex and requires large scale interventions, medical science and technology, but I also know that saving lives can be accomplished by simple behavioral changes: wearing a seat belt, wearing a mask, throwing away that pack of cigarettes, applying sunscreen, washing our hands for 20 seconds singing Happy First Birthday twice to all babies.  Hopefully a caregiver having a sticky note with the A, B, C’s reminding them to put a baby to sleep alone, on their back and in a crib or firm surface can save lives.  

The bottom of the message on the sticky note states:  

My baby will grow to be a happy, healthy child with your love and kindness.

If you want to reach me or have questions, please call me at_____________________

Gratefully,_________________________________

If you would like a sample of the Safe Sleep Sticky you may contact me at 

Karel R. Amaranth, MPH, MA

Amaranth Advocates for Public Health

karel.amaranth@gmail.com

Nothing Rhymes with Orange

18 Jun 2017 Leave a comment

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , , , , , , , , , , , ,

“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.

 

 

Skin In The Game

30 Jun 2016 2 Comments

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , , , , , , , , , ,

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

25 Jan 2016 Leave a comment

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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

Glory to the Newborn

13 Jan 2015 Leave a comment

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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

19 Dec 2014 1 Comment

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , , , , ,

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

26 Jun 2014 Leave a comment

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , , , , , , , , ,


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

You Gotta Learn How to Fall

21 Apr 2014 2 Comments

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , , ,

 

Jeremy Abbott

The 2014 Winter Olympics ended two months ago, but this post was delayed by some circumstances beyond my control; let it suffice to say that I was temporarily “censored” on the subject of falling.  Now, however I think this post actually is even more meaningful for me, and I hope still relevant for you.  Thank you for joining in….please do skate along.  KA

 

Another Winter Olympics has come and gone with all of the

pyrotechnics, international attention (and international tension,)

competition, national pride and defeats, and personal achievements and

disappointments.  The performances were dazzling, daring and in some

cases downright dangerous.  Put a sharp blade or skinny ski on ice and

packed snow, or icy slush, at dizzying speeds and there is bound to be

calamity.  We witnessed the crashes of Andorra’s Joan Verdue Sanchez

in the Giant Slalom, Germany’s Johannes Rydzek in the Nordic Combined,

Chile’s Stephanie Joffrey and China’s Chao Wu in the Freestyle Ski

Event.  Our Americans Kelly Clark and Shawn White slammed into the

Half Pipe.  Germany’s Monique Angermueller skidded off the Speed

Skating track at 30 MPH. Each of these individuals landed and had to

pry themselves out of the snow or off the ice surface, possibly to try

again, possibly not, their dreams of Olympic metal dashed or at least delayed.

 

 

Then there were the Figure Skaters.  Our Jeremy Abbott who literally

hit the wall so hard it seemed he might have to be picked up and

carried off.  Japan’s Yusuru Hanaju, who did win the gold, hit the ice

hard in his short program. Beautiful intense young Russian Yulia

Lipniskaya fell in both of her programs slamming down from her

magnificent jumps.  Mao Asada of Japan, repeatedly fell; so sad to see

such a champion hit the ice again and again.  And our jewel box

princess perfect Gracie Gold, with a name destined for Olympic skill

and artistry, landed hard.

 

 

What is both amazing and baffling about the figure skaters unlike

their colleagues on the slopes and tracks is that they get right back

up, with grace, without missing a beat to the music, without a wince,

perhaps a nano second of disappointment flooding across their faces,

to be quickly transitioned to eyes focused with determination, perhaps

even a smile lifting their lips.  And they skate on, beautifully.

Only Jeremy Abbott crunched against the wall took a full 20 seconds to

return to his feet to glide and spin on.  Of them all only Eugeni

Plushenko, landing hard in the warm up, decided to call it quits, but

vowed that even if it took 10 more surgeries he would be back to skate

 

 

I wonder how these athletes, artists, competitors, champions, recover

so quickly.  How to rise from a clumsy and undoubtedly painful fall

onto that hard cold ice in their beautiful, somewhat skimpy, delicate

costumes.  It seems this would be difficult to bounce back from in the

privacy of one’s own home, alone on a private rink, but they have

fallen in front of literally millions of people.  Once, wearing a

dress, I slipped off an unbalanced chair at a Bat Mitzvah surrounded

by about 20 people. I was mortified.

 

 

So this makes me think about resilience.  What is it and where does it

come from?  Something fashioned into an individual’s DNA or is it

learned?  Is it practiced and practiced and practiced like a double

salchow into a triple toe loop?  Is resilience a learned confidence

that you can fall, and get back up?

 

 

I took ice skating lessons two years ago and the first thing I was

taught was how to fall.  My coach taught me a procedure similar to

this one I found on the internet:

 

 

Time Required: Practicing falling over and over again is the only way

 

 

to learn how to fall safely.

 

 

Here’s How:

 

 

Practice falling on the ice without skates on.

 

 

Next practice falling on the ice with skates on.

 

 

Practice falling on the ice from a standstill.

 

 

Practice falling on the ice while moving slowly.

 

 

Practice falling on the ice while moving a bit faster.

 

 

Practice falling on the ice over and over again.

 

 

Tips:

 

 

Wear gloves or wrist guards. Knee and elbow pads will also protect a

 

 

skater from getting hurt if a fall occurs.

 

 

Don’t allow your hands and arms to swing around or to get out of

 

 

control while you skate.

 

 

Put your hands on your waist or out a bit in front of you when you

 

 

ice skate, but don’t use your hands to help break a fall.

 

 

The only way to get over the fear of falling on the ice is to fall, so

 

 

practice falling on purpose over and over again.

 

 

If you anticipate that you are about to fall, bend your knees and

 

 

squat into a dip position.

 

 

What You Need

 

 

Gloves or wrist guards

 

 

Ice skates

 

 

Warm clothing

 

 

Knee pads and elbow pads are optional

 

 

I skated on a rink at a mall with a gazillion kids skating, falling,

sliding fearlessly around and around, zipping past my carefully

calculated glides and squats.

 

 

There is a massive amount of information about resilience in books,

journal articles, and on the internet.  There is a useful brochure

called The Road to Resilience from the American Psychological

Association http://www.apa.org/helpcenter/road-resilience.aspx   I

found an article about resilience by a clinician, Michael Ungar I

actually met at a conference in Belfast, Northern Ireland.   He is the co-director of the Resilience

Project http://www.resilienceproject.org/research-and-evaluation/biographies/90-michael-ungar

 

Michael Ungar relates the Olympic experience to the development of

resilience in children in his article Olympic Gold Medalists and

Raising Resilient Kids.

http://www.psychologytoday.com/blog/nurturing-resilience/201307/olympic-gold-medalists-and-raising-resilient-kids

In addition to getting control over one’s thoughts, having a positive

personality and having strong social supports, he cites the following

as a major contributor to resilience:

 

1) The advantages of setbacks. As odd as it sounds, most of the

study’s participants said that while serendipity (being in the right

place at the right time) sometimes helped them get a chance to show

what they could do, it was life’s challenges that provided them with

the motivation to push a little harder. Without some setback, most

would not have reached their full potential. The experience of failure

brings with it opportunity: the chance to say with certainty whether

one wants to give everything one has to achieving one’s goal.

Sometimes, those personal challenges were as simple as a bad

performance or being denied a spot at a qualifying competition.  But

personal milestones also played a factor. The loss of a parent, a

divorce, a personal injury all caused these athletes to pause and

reconsider their commitment to success.

 

What does this tell us about raising resilient kids? Don’t shelter

them from every challenge. Let them fail! (or fall!)

 

 

And the support network:  one of the major advertisers and supporters

of the Olympics, Proctor and Gamble sponsored the “Thank you, Moms”

spots and the Family Support Center in the Olympic Village.

www.google.com/search?q=proctor+and+Gamble+thank+you+Mom&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a&channel=sb

 

For teaching us that falling only makes us stronger. For giving us the

encouragement to try again. Thank you …

 

 

And what does this tell us adults who stumble, fall, sometimes totally

crash, whether in a relationship, our professions, our dreamed of

aspirations.  We can’t always foresee the event in advance enough to

squat and avoid falling.  We slip and slide and land sometimes with

painful results, damage, a massive set back.  It will certainly help

to have our loved ones and advocates on the sidelines cheering us on.

We may need to be physically or emotionally picked up.  But most

importantly we need to know that we can skate on, with confidence,

with good thoughts of ourselves and others, and then, we move on with grace.

 

 

You got to learn how to fall
Before you learn to fly
And mama, mama, it ain’t no lie
Before you learn to fly
Learn how to fall

You got to drift in the breeze
Before you set your sails
Oh, it’s an occupation where the wind prevails
Before you set your sails
Drift in the breeze

Oh, and it’s the same old story
Ever since the world began
Everybody got the runs for glory
Nobody stop and scrutinize the plan
Nobody stop and scrutinize the plan
Nobody stop and scrutinize the plan

You got to learn how to fall
Before you learn to fly
The tank towns, they tell no lies
Before you learn to fly
Learn how to fall

 

Dr. Kildare’s Strange Case: Sex, Drugs and …….

17 Mar 2014 Leave a comment

by privatelifeinpublichealth in Uncategorized Tags: , , , , , , , , , , , , ,

Dr. Kildare's Strange Case (1940) Poster

Well, of course there is no Rock and Roll.  The movie, Dr. Kildare’s Strange Case, which I recently watched at an alumni seminar at New York Medical College, was released in 1940.  Songs on the radio were Glen Miller’s In the Mood, Bing Crosby’s Only Forever, Cliff Edwards playing When You Wish Upon a Star on the ukulele, and Coleman Hawkins’ Body and Soul.

The sex is only the vaguely implied in the rivalry between James Kildare and the surgeon Gregory Lane who are competing for the body and soul of, or at least dinner with, nurse Mary Lamont.  Mary however has her heart set on a nice house with a white picket fence and will give herself to the doc with the bucks to get her there.

It’s the drugs that are the stars of this film.  But before getting into the pharma particulars here’s a brief synopsis of the cast and plot:

Cast

Lew Ayres as Dr. James Kildare

Lionel Barrymore as Dr. Leonard Gillespie

Laraine Day as Nurse Mary Lamont

Shepperd Strudwick as Dr. Gregory ‘Greg’ Lane

Dr. James Kildare gets competition for the heart of nurse Mary Lamont, when a brain surgeon, Dr. Gregory Lane, enters the scene at the hospital. James has not proposed to Mary yet because of his bad financial standing.

One day James is offered a well paid job at the Messenger Institute, but he rejects the offer to continue working with his inspiring mentor, Dr. Leonard Gillespie. Mary gives up all her hope of marrying James.

James and Lane are put together on a case where a man has had his skull fractured, and Lane, who has been quite unfortunate recently and failed to rescue the lives of his patients, wants James to perform the surgery instead. James manages to persuade Lane to perform the surgery anyway, and when the man wakes up again he shows clear signs of insanity and mental illness. Lane’s reputation as a surgeon is damaged again.

James is convinced that the man was mentally ill even before the accident which had fractured his skull, and risk his whole career by trying to prove this by injecting the man with insulin as treatment for the insanity. He succeeds, and restores both his and Lane’s reputations.

After the patient is sane again, James reconciles him with his wife from whom he was separated five years ago. Seeing the couple reunited makes James propose to Mary even though he cannot afford a wedding, and she accepts his proposal.  THE END

So insulin is the drug of choice here, curing the patient of insanity, reconciling him with his wife,  saving Dr. Lane’s reputation….. and Dr. Kildare gets the girl.  Pretty powerful stuff that insulin.

Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks.[1] It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s.

To keep the plot moving along, the process in “Strange Case” takes a few hours through the night during which Kildare and Lamont lock themselves into the patient’s room, administer the insulin and wait while the patient (who by the way could not provide informed consent because he was insane) becomes comatose and goes through various violent convulsions and regressions.  Alas, as the sun rises, he regains sanity, tells Kildare his name and his wife is found and brought in for the happy reunion.  Ah, medicine in movieland.  (Interesting sidebar:  Lew Ayres died in 1996 at the age of 88 of complications from a coma.)

(Here is the NYT April 12, 1940 movie reviewhttp://www.nytimes.com/movie/review?res=9C01E1D81F3CEE3ABC4A52DFB266838B659EDE )

Aside from the administering of an experimental drug without consent from the patient or next of kin, and with the presenting goal of saving Dr. Lane’s reputation, there are various other practices at this 1940 hospital that boggle our current health care brains.  Clearly HIPAA was not even a dim light on the horizon.  The doctors, nurses, the switchboard operator, and the ambulance driver all chat about the patients and their diagnosis/treatments.  No one seems to wash their hands except directly before surgery and it’s a perfunctory splash.

There is also the use of another experimental drug in a bizarre little subplot.  Joe, the ambulance driver fancies Sally the switchboard operator, but he like Dr. Kildare does not have the money to wine and dine Sally into romance and he knows that a certain fellow from Philadelphia has been taking her to nice restaurants and thereby winning her heart.  Predicament indeed for Joe which he shares with the bar tender, Mike Ryan, and Dr. Kildare at Sullivan’s Hospital Cafe.  They arrive at a plan for Joe to ask Sally out for a lovely lavish dinner, but bring her to Sullivan’s bar first for a drink.  Mike will give her a “special drink” that will cause her legs to be paralyzed, (yes paralyzed!) so she can’t go to dinner and Joe in fact can be the hero taking her home in this embarrassing state.  The three men all agree that this will get Joe the date and perhaps much more.  This certainly seems like the precursor to a date rape drug.  In the film it is presented as so very clever with our sweet idealistic Dr. Kildare as a co-conspirator.

And then there is the ubiquitous smoking of cigarettes.  Dr. Leonard Gillespie, Kildare’s mentor in medical research, is constantly lighting up to imbibe his steady dose of nicotine.  Gillespie, as played by Lionel Barrymore, is in a wheelchair and there is an implied serious health issue that has caused his disability.  In fact, Lionel Barrymore himself often used a wheelchair off the set. By the time the Kildare movies were made, he had broken his hip twice and then arthritis set in.  There is a “suggestion” that Barrymore’s arthritis was the result of his contracting syphilis in 1925.  The character of Dr. Gillespie adopted the same disability so that Barrymore could play the part, a switch on current Hollywood casting in which often the part of a character who is disabled is played by an actor who is not.  (Think of the film The Sessions, or of Lieutenant Dan Taylor in Forrest Gump who was a double amputee, but Gary Sinese was not.) The staff at the hospital, especially Superintendant Molly Byrd, are committed to keeping him healthy.  In one scene as Dr. Kildare and Dr. Gillespie share lunch, Nurse Byrd enters and actually says, “Drink your milk or no cigarettes!”  Dr. Gillespie, does an “Ick!!!” but gulps down the bottle of (undoubtedly whole) milk so he can retrieve his cigarettes from the matriarchal nurse.  Despite these efforts the real life Lionel Barrymore died of a heart attack.

It’s hard to know what the author of Dr. Kildare’s Strange Case had in mind.  Max Brand, born Frederick Faust, was a successful screenwriter who also wrote Westerns and loved mythology.   Perhaps in addition to the medical introduction of experimental drugs, he was portraying a world where men were men and gods were gods and magic potions to seduce women were de riguer.  And the smoking…well everyone did it.  Brand, himself had a heart attack and suffered from chronic heart disease until his death at the age of 52 from shrapnel in World War II.

Mingled within the issues of drugs and romance in the “Strange Case” is another vital difference between the world of Dr. Kildare and our current medical practice, and it’s death, the separation of Body and Soul.  When Dr. Lane fails the sheet is drawn over the patient’s face and death declared when the heart stops as per the 1816 determination of death by a French physician.  Prior to heart function as the definition of life, it was breath.  When a person ceased to breathe, as when the daughter of King Lear, Cordelia does not fog the mirror held to her lips by her grieving father.  Death could be determined by anyone who could hold a mirror or put their ear to a chest and hear, or not hear, a heart beat.  But 20 some odd years after Dr. Kildare, in 1968, Dr. Henry Beecher declared a new definition of death, the cessation of the brain to function, and this required the use of sophisticated medical equipment and the declaration of death by a doctor.  And, lingering questions about the blur between life and death.  There was a fascinating Radio Lab session called Afterlife on March 8, 2014, that I listened to on my drive up to DIA: Beacon on a sunny early spring day when all was poised for rebirth with the appearance of snowdrops and crocuses.  You can listen to it here:

https://www.wnyc.org/radio/#/ondemand/91681

I wish I could have had the Doctors Kildare, Lane and Gillespie, and Nurse Mary Lamont, the writer Max Brand on that drive to Beacon with me.  I would love to hear their reactions to the complex medical, spiritual, philosophical questions raised in the 11 vignettes of life and death, body and soul.  But of course I would not have let them smoke in my car.

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