Sunday, September 30, 2012

27. Home Care: The High-Tech Component

In a previous post (#25) on home care, I mentioned how the wonders of modern technology can speed up healing.  And so they can, at a cost, as Bob and I have learned.  Here follows our tale of woe.

Let’s start with the outlandish hoist that was delivered to our apartment and, when not in use, had to be stored in a hallway, blocking it completely.  It was meant to lift the patient -- rather like a load of freight being transferred from a dock to the hold of an oceangoing vessel -- from his bed to a wheelchair.  With apprehension, I imagined Bob traveling in midair.  But when it turned out that the contraption couldn't be placed properly beside the bed, it had to be sent back.  I was not sorry to see the bulky thing go.

Next, the VAC, the latest in high-tech wound healing, a complicated therapy that boasts of treating six million wounds worldwide, but that I never did manage to wrap my mind around.  It creates a vacuum in a tightly sealed wound, then drains the wound through a tube connected to a vacuum pump, causing the wound edges to contract, but that's about as much as I ever grasped.  But Marge, the young nurse who was coming to us at the time, insisted that I learn how to detach the canister attached to the pump as the canister filled up with an unsightly black guck that somehow resulted from what was going on in the wound.  I protested that I wasn't cut out to be a nurse, and that I wanted nothing to do with that heinous black guck, but she overrode my protestations.

As it happened, I never had to change the canister, but the worst crisis we ever faced came one night at 4 a.m., when my clumsiness disturbed the delicate mechanism of the VAC and unsealed the wound.  Desperate, I phoned the Visiting Nurses and, to my astonishment, reached a Florence Nightingale who understood the problem and advised me to apply a simple wet-and-dry to the wound: gauze moistened with saline, covered with dry gauze to secure it.  When I phoned the VAC supplier, they too had someone on night duty and she gave me exactly the same advice.  So I did as instructed and then, at
a decent hour in the morning, informed the Visiting Nurses that a nurse should come to reinstall the VAC.  All of which confirms what I have always stated with emphasis, that I am not, never have been, and never will become a nurse.  I'm too ignorant, too clumsy, too stupid.

The VAC was a prima donna demanding constant attention, so I was not unhappy when our doctor opined that it had done its job and discontinued the treatment.  But that wasn't the end of high tech, ah no!  Next came the Clinitron bed, which would also speed up the healing of the wound.  Getting it wasn't easy, since Medicare objected to the high cost involved, but our doctor worked his wiles and got it.  "It's better than the bed you have," said Marge, an ardent advocate of the Clinitron.  "With this bed, it's like floating in a boat on the sea.  With the Clinitron, it's like floating in the sea itself.  My patients love it!"  And so, to arrange the transfer, I got in touch with the Clinitron folks and those who had supplied the current bed.  "We don't coordinate with them!" announced the Clinitron spokesman.  "You've got to!" I yelled into the phone.  "If one bed is removed, the other has to replace it at once.  Is the patient supposed to lie on the floor?"  Finally the two outfits coordinated, and a date was set for the transfer.

Naively, I thought it would be a simple matter of taking out one bed and substituting another.  So when the great day came, the home care aid and I got Bob into a wheelchair and took him to another room, where he insisted on facing the room where the action was, so he could watch it step by step.  The
first bed was duly removed; no problem.  Then began the installation of the Clinitron.  Did I say "installation"?  Our apartment became a construction site.  Something that looked like a bed frame was trudged laboriously up the stairs (four flights, remember?), but it proved more of a foundation.  Next, as the three of us watched from a distance in amazement, two workers with large buckets starting dumping what looked like sand into the base or foundation.  This was the installation of a bed?  Bucket after bucket was dumped, then they raked the sand to make it level and evenly distributed.  Then, at last, what looked like a bed frame and mattress -- cushions, really -- were installed on top of all that sand, the whole business was plugged in, and the bed was pronounced ready for its occupant.  So the occupant was also installed.

"I don't like it!" Bob immediately announced.  "It pulses."

Sure enough, it did: the mattress was constantly pulsating, as if some vibrant little creature were inside it.  Air pressure made the sand -- beads, in Clinitron lingo -- dance.  And it whined.  The old bed had produced a gentle purr of a whine, but this one emitted the high-pitched whine of an enraged monster.

"You'll get used to it," I insisted, more out of hope than conviction.

"I won't!"

So began the adventure of the Clinitron bed, another prima donna, even more temperamental and demanding than the VAC.   It pulsed, it whined.  It drew lots of power, sending our electricity bill soaring.  And once, when the bed and the air-conditioner had been on nonstop for several days, our power failed.  To restore it, I had to go down to the basement and move a slew of empty cartons that the bakery (the famous Magnolia) had dumped there, so as to reach our circuit breaker and flip a switch.  "Turn the bed off for an hour every day," suggested Marge; "don't run it nonstop all the time."  Good advice, but when the bed was turned off, the cushions deflated and Bob announced that he was lying on boards: the worst possible outcome for wound healing.  As for the soaring electricity bills, Marge urged me to knock on my neighbors' doors --  every neighbor in the building -- to ask them about their bills, so we could compare them to ours.  "Marge, I announced, "I'm not going to do it!"  And I didn't.

But if the temperature in the room got above 86 degrees -- and it often did, since heat rises, and we are on the top floor -- the bed would shut itself off.  Then all you could do was wait a half hour and turn it on again, until it shut itself off yet again.  So it went for weeks; at night, anticipating a shutdown robbed me of sleep.  Meanwhile Bob hated the pulsing, and we both detested the noise.  The Saint George who delivered us from this monster was, once again, the doctor, who decided that the bed had done enough in accelerating the healing, and too much in fueling our anxiety.  So the bed was dismantled -- another lengthy process -- and removed from our apartment, replaced by another semi-electric bed with an air-filled mattress.  Farewell to the dancing beads.

So ended our adventures with high-tech healing: the little monster, the VAC, and the big monster, the Clinitron bed.  The doctor assures us that they helped in the healing, but we are quite content now without them, attending to a much shrunken wound that has yet to completely close, thus assuring us
of continued Medicare coverage.  (Three cheers for the shrunken wound!)

Another complaint about the prima donnas: unlike the doctor and nurses, they didn’t tell us interesting stories.  They just sat there and did their thing.

Thought for the day:  Hope is the fuel of life.

                                                        © 2012   Clifford Browder

Sunday, September 23, 2012

26. Foreign Visitors and What They Thought of Us: Charles Dickens

          When Charles Dickens came to America in 1842, he was already a successful novelist renowned on both sides of the Atlantic and known by the pseudonym of Boz, under which he had published his first work, Sketches by Boz.  Young and cleanshaven, with wavy long hair, he had just turned thirty, and came here with his wife to have a look at this vibrant new democracy, so he could judge it for himself.  Landing in Boston in January, he was quickly acclaimed, to the point where ladies desperate for a memento tried to cut off pieces of his coat .

          If this occurred in well-mannered Boston,
you can imagine the welcome that awaited him
when, in February, he came on to rough-and-tumble New York.  Crowds followed him in the streets, Tiffany's sold copies of his bust, and a barber was said to have sold scraps of his hair to fans eager, like the ladies of Boston, for a souvenir.  On a somewhat more refined level, the literati also courted him, including Evening Post editor William Cullen Bryant and the aging Washington Irving.  Climaxing his reception here was the Boz Ball of February 14, 1842, held in his honor at the Park Theatre and attended by some three thousand Gothamites willing to pay five dollars a head to have a closer look at the celebrity, not to mention a grand march followed by dances alternating with tableaux vivants illustrating his published works.  This grandiose affair was catered by none other than Thomas Downing (see post #20), who among other goodies provided 50,000 oysters (his specialty) and 300 quarts of ice cream.

          When he could escape from the horde of well-wishers, the young novelist marveled at the rushing traffic of Broadway and the rainbow silks and satins, fluttering ribbons, and pink stockings of the women -- probably working-class Bowery Gals, since respectable middle-class women shunned gaudy colors as emblematic of ladies of the evening, with whom the city was amply supplied.  Likewise on Broadway he took great delight in observing the numerous hogs that roamed about freely, let out by day by their owners to scavenge whatever food they could in the muck and mire of the streets -- a spectacle that visitors to the city never failed to comment on.  With a novelist's eye for detail Dickens describes the porcine scavengers as ugly brutes with brown backs like the lids of old horsehair trunks and covered with unwholesome black blotches.  Yet for all that he gives one of them a distinct personality, describing it as a "free-and-easy, careless, indifferent kind of pig ... a republican pig, going wherever he pleases ... a great philosopher, and seldom moved," though vagrant dogs have deprived him of a bit of tail and ear.  Clearly, in those days the city's rich street life encompassed more than humans and their vehicles.

          But Dickens had a great propensity for poking

about in low places where he could sniff out the seamy underside of things, and for this purpose roving hogs were not enough.  As a result he ventured into neighborhoods where Mrs. Trollope's dainty foot had never trod.  (Remember Mrs. Vinegar?  See post #24.)  Approaching what he described as a "dismal-fronted pile of bastard Egyptian," he entered the massive squat structure known as the Tombs, which housed both the courts of justice and a prison where those awaiting trial were confined.  There he was shown the four levels of the prison's interior, with black furnace-like doors opening into small cells lit only by light from a chink high in the wall.  That prisoners could be detained there for months pending trial, and get little or no exercise, appalled him.  Still more appalling for Dickens, ever sensitive to the plight of children victimized by society, was the detention of a boy of ten or twelve being held as a witness against his father, who was charged with murdering his wife, the boy's mother.  (What would Dickens say today of the justice system of our more enlightened age, with its massive incarceration, ample use of solitary confinement, and children often being tried as adults and sentenced accordingly?)

          But Dickens's appetite for the horrors of society was as yet by no means quenched.  Guided by two of New York's Finest, he entered the Five Points, the city's most notorious slum, named for the intersection of five streets but a few short blocks from Broadway and City Hall: a district rendered unhealthy by the inadequate landfill of what had once been the Collect Pond, a freshwater pond providing summer picnic sites and winter skating, until fouled by industrial waste.  (Yes, it happened even back then.)  In this swampy area long since abandoned by respectables, poverty and crime and violence were rife, and prudent visitors went only with a police escort.  There Dickens found filthy narrow lanes, coarse and bloated faces peering from doorways, patched and broken windows, and countless liquor groceries frequented by seamen, their antics watched by the painted eyes of George Washington, Queen Victoria, and the American Eagle posted on the walls.  What Dickens doesn't mention, in his American Notes for General Circulation, published later that year after his return to England, were the whores, both black and white, who were surely calling down from upstairs windows and beckoning to drunken sailors lurching about in the street.

The Five Points, 1827
Note the hog in the lower left corner, and the well-dressed gentleman in the lower left center, whose presence proves that slumming in the Five Points began long before Dickens, who is sometimes credited with launching it with his vivid description in American Notes.  A painting by George Catlin that was later reproduced as a print.

          Entering a shabby building and mounting its tottering stairs in the dark, he is shown a "wolfish den" where a Negro lad lights a match that reveals great mounds of dusty rags on the floor.  When the boy manages to obtain a flaring taper that better lights the room, the rags bestir themselves and rise up slowly, becoming a legion of sleepy black women whose bright eyes glisten with surprise and fear at this intrusion of two officers known to them only too well, and the stranger they are attending.  For the city's worst slum was of course the refuge and receptacle of all those unwelcome elsewhere in the city.

          Dickens doesn't identify any of the tenements he visited as the Old Brewery, though his descriptions match the Brewery perfectly.  Known as the worst slum's worst tenement, this dilapidated structure was located near the Five Points intersection and across from Paradise Square, a shabby triangle littered with loose bricks and rubble, corncobs, splintered barrel staves, manure, and dead rats.  Housed in the Brewery's shabby rooms were drunks and harlots, conglomerations of the almost homeless poor, real and fake crippled beggars, and thieves who with their loot disappeared into a maze of dark passageways where the police often feared to follow.  Rumors abounded of nightly killings there, of tunnels and hidden rooms, of buried treasures and buried bodies, in witness of which a dark, narrow lane beside the structure was known as Murderers' Alley.  Perhaps this was the stuff of legend, but when the Methodist mission ladies, having already with great courage ventured into its labyrinth of dark hallways and reached out to its inhabitants, finally bought the place in 1852 and tore it down to replace it with their mission, several skeletons were found on the site.  If Dickens didn't visit the Old Brewery, he should have.

Dickens and a friend watch the dancers
(an engraving from American Notes)
          Dickens also glimpsed underground chambers where Five Points residents could dance and gamble.  Invited into one of them run by a mulatto woman wearing on her head a handkerchief of many colors, and her blue-jacketed husband with a thick gold ring on his finger, he watches several black couples dance to the music of a fiddle and tambourine.  The whole shindig achieves a glorious climax when a young black man brings his partner onto the floor and with great abandon leaps and spins and shuffles, winning thunderous applause from the others until, as the dance ends, he leaps up on the bar to call for a drink.  If there were any whites dancing with blacks Dickens doesn't say, but couples of mixed race -- a rarity at the time
-- were not uncommon in the Five Points, where so many written and unwritten laws were broken.  One suspects that Dickens was again engaged in a bit of self-censoring, lest mention of mixed-race couples prove unsettling for his genteel middle-class readers back home.

          In spite of this joyous spectacle, Dickens concluded regarding the Five Points that "all that is loathsome, drooping, and decayed is here."  If he wanted to view the worst that the city could offer, he had richly succeeded.

          Or had he?  In quest of still more horrors, the novelist also visited what must have been the lunatic asylum on Blackwell's (now Roosevelt) Island in the East River, where he encountered a packed mass of cowering idiots with long disheveled hair, gibbering maniacs who laughed hideously, and others with fierce, wild faces who chewed their nails compulsively.  This at last was enough; when invited to view the violent inmates under closer restraint, he declined and by his own admission fled.   In time he left the city to tour other parts of America, coming back briefly in June for his return to England.

        What Mrs. Dickens was doing during her husband's forays into the city's nether depths, our novelist doesn't say.  Certainly she wasn't looking after their five children, since they had left them back in England.  Respectable women were not supposed to prowl about the city alone in those days, so one hopes she found some suitable companions and was busy improving her mind.

          Dickens had other and better impressions of New York -- excellent hospitals and schools, theaters, lecture rooms, elegant homes -- but his American Notes give ample space to the scenes of degradation, and echo Mrs. Trollope's depiction of men with coarse table manners who invariably chewed and spat.  Bu whereas his sharp-eyed and sharp-tongued predecessor had actually welcomed the amenities of slaveholding Virginia, where slaves provided well-heated rooms and ready refreshments in the inns (she liked to be comfy), he was profoundly disillusioned by the spectacle of slavery in the South, which he saw as a huge blemish on the face of American democracy.  He also severely criticized the nation's sharp business practices and greed, arousing much resentment in America.  And even while in New York his expressed complaints about the numerous pirated editions of his works in America, from which he of course derived no royalties, somewhat diminished the enthusiasm of his reception in the city, which, with its many publishing houses, was in this regard conspicuously guilty.  Many New Yorkers felt that, given the warmth of their reception of the novelist, he was being petty and selfish in wanting to earn a little money from his works.

          Mrs. Trollope never redeemed herself in the eyes of Americans, but with Dickens it was a different story.  Returning late in his life for a series of farewell readings, he arrived in Boston in November 1867, now properly whiskered as befitted a distinguished mid-Victorian gentleman, and toured all the large cities of the East, including of course New York.  Reading his works to paying audiences, he drew enormous crowds and earned the tidy sum of nineteen thousand British pounds.  In a farewell speech in New York shortly before his departure, he declared that he had found "gigantic changes" for the better in America and promised never again to defame the country in speech or print.  But the tour had been exhausting, and he returned with shattered health to England, where he never really recovered and died two and a half years later, in 1870.

          Thought for the day:  Greed ravages, but money soothes.

          A hopefully relevant aside:  Last Monday, September 17, was the one-year anniversary of Occupy Wall Street, which I have mentioned in vignettes #1, #4, and #5.  So what has this one year accomplished?  To my mind, precious little.  Yes, they have made our disparity in wealth a subject of conversation with their talk of the 1% versus the 99% (it's so comfy, knowing you're one of the 99%!), but their refusal to organize and put forth leaders has deprived them of any meaningful political influence.  This contrasts sadly with the Tea Party crowd, who have significantly altered the political landscape.  I regret the Occupiers' seeming futility but see no sign of their changing their ways.  This is my opinion only; I welcome other points of view.  (Since writing the preceding, I have learned that the Occupiers celebrated their anniversary with scattered demonstrations throughout the Wall Street area, and that some 180 of them were arrested.  Such shenanigans inconvenience commuters and give the police overtime at taxpayers' expense, but do they really effect change?  I doubt it.)

                                                                        © 2012  Clifford Browder


Sunday, September 16, 2012

25. Home Care: The Human Component

It wasn't Ann's favorite visit, the six-flight walk-up in the East Village, a shabby apartment with strange smells and no ventilation, but the elderly woman was diabetic and needed an injection of insulin every day, and as a Visiting Nurse she went wherever they assigned her.  Her patient was a Russian lady with little English, small, shrunken, but round, always wearing a nightgown fastened with a clasp, barefoot, with no bra, so that her ample breasts sagged down to her navel.  To communicate they used sign language and gestures, though the woman could manage a few words of English.  Also present, invariably, was a small dog, always silent, with matted yellowish hair, and cancer sores around its rear end: massive, cratered lumps draining smelly pus.  Ann thought the poor creature should be put out of its misery, but it was the old woman's only friend, rubbing against the woman's leg with affection.  Ann's work there was done quickly and she was glad to leave. 

As the visits multiplied, the woman referred at times to her son, but no son was ever present, though a door to another room was always shut.  Often, as she attended to the woman, Ann would hear the creaking of a door being slowly opened, and she had the eerie feeling that someone was watching her.  But when she finished and said good-bye to the woman, there was no one else there.

Finally, one day while Ann was preparing the injection, the mysterious door opened slightly and a man's head protruded.  He watched her, then slowly came out into the room.  Tall and fiftyish, with a dead look in his eyes, the man was wrapped from neck to toes in a sheet and nothing else: a living mummy.  Since this was obviously the son, Ann managed a faint greeting and asked him why he had wrapped himself in a sheet.

"Don't you see them?" he replied, gesturing toward the empty air around him.

"See what?"



"Yes, bubbles.  Bubbles everywhere.  Don't you see them?"

'Well, yes.  Yes, I guess so."

"In each bubble there is a tiny person.  If one of those bubbles touches my skin, it will burst, and that person will get inside my mind and tell me what to do.  I don't want that; the sheet protects me."

"Oh.  I see.  Yes, it protects you."

"I'm telling you this because I trust you.  I wouldn't tell just anyone."

"Of course not.  Thank you.  But I'll have to give your mother her injection, and then I'm off.  I have other patients to see."

Nervous and frightened, Ann did her business with the woman quickly, and got out.  The son was obviously delusional; she reported the incident, and a mobile crisis team sent a psychiatrist to interview the son, who refused to have anything to do with him and retreated back into his room.  When Ann went again to see the mother, the son remained in his room with the door tight shut; she never saw him again.  After that, Ann was reassigned to another area; her visits to the six-flight walk-up were over.  She heard that the woman had been hospitalized for further treatment, but what finally became of her, her son, and their dog she never knew.  This happened only too often in her work, but Ann, who was young and new to the game, wanted to help others, to heal them, no matter who they were or how they lived.  She knew already that her work would be full of surprises, and rarely the kind you enjoy.  But she stuck to it.

This is only one of many stories -- weird, sad, unsettling stories -- that my partner Bob and I have heard from the doctor, nurses, and therapists who have come to us.  When Bob returned from the hospital, he had a long list of vehement complaints: noisy talk from the hospital corridors, lights coming on in his room at five a.m., food he couldn't abide, an assertive woman therapist whom he referred to as the Gestapo.  And his bedsore wound, which was at a #2 stage when he went in, was at a #4 stage -- much larger -- when he came back.  We didn't need to be told that home care, if you can arrange it, is preferable by far.  So from then on our apartment -- only a four-flight walk-up -- has welcomed a doctor who actually prefers to make house calls, a series of Visiting Nurses, home care aides to see to Bob when I'm out or otherwise preoccupied, and for a limited time only, assorted therapists.

And what we haven't learned!  How a semi-electric hospital bed with an air-filled mattress relieves pressure on a bed wound.  How no two wounds are alike, and each heals at its own pace.  How protein is necessary for healing, so that the poor patient, in addition to meat and eggs, is urged to partake copiously of milkshakes and ice cream.  How saline solution cleans a wound, since almost nothing living can survive in it.  How vulnerable a patient can be: Ann has told us how, when she showed a male patient a photo of his wound, which he had never seen, he burst into tears.  How occasional delusions often accompany Parkinson's and other ailments and should not be cause for alarm.  How Medicare won't pay for treatment of incontinence or certain other conditions, but it will definitely pay for treatment of an open wound.  (Three cheers for the open wound!)  And how the wonders of modern technology can speed up healing.

The high-tech component of home care, and the contraptions it imposed on us, I shall tell about in a later post; here I want to focus on the human component.  The doctor, nurses, home care aides, and therapists have all been wonderfully helpful and supportive.  To be in the health care field, I find, requires diligence, patience, caring, and a sense of humor, and our team is amply supplied with them all.  When one sees patients in a hospital, at least the setting is predictable.  But if one sees them at home, one never knows at first what you may encounter.  Our doctor, nurses, and therapists have all have regaled us (if that is the word) with stories of their own adventures, as seen in Ann's account of the Russian lady and her sheet-wrapped son at the start of this post.  Here are some more:

Another nurse, let's call him Jim (all these names are fictional), was seeing a patient in an SRO (single room occupancy hotel) near Times Square.  The patient, being mentally unstable and prone to delusion, was on antipsychotic drugs.  One day Jim got a phone call from him reporting blood dripping down into his room from the ceiling.  Knowing his history, he informed a doctor, who agreed to go to the patient and adjust his medication.  When the doctor got there, he was stunned to see that blood was indeed dripping from the ceiling.  Further investigation revealed that a junkie in the room above had died while injecting heroin, and the syringe had fallen out, causing his blood to gush.

Speaking of SROs, our doctor has told how he was once treating an elderly woman in an SRO on the Lower East Side.  She lived alone in a tiny room, was from Buenos Aires, spoke little English.  What was memorable about her was her homemade clothing: she wore a miniskirt created out of plastic bags, and a bra made of the same.  She too was a bit dilusional.  Finally she refused to let him in, fearing he wanted to collect the rent.  As so often in these cases, he never knew what finally became of her.
An aside on SROs:  There are two to three hundred SROs in New York City, often occupying a large building that once housed a hotel.   These multiple-tenant buildings range in quality from decent
facilities offering low-cost housing for the elderly and ill, to squalid ones sheltering addicts, prostitutes, AIDS victims, and the newly homeless.  It's the squalid ones that the name "SRO" usually evokes, suggesting something akin to the Bowery flophouses of another day, albeit much bigger: tiny ill-furnished rooms rented by the week or the month; halls reeking of marijuana and urine; shared bathrooms and kitchens, the bathrooms caked in dirt and often without hot water; and the prevalence of drugs and violence.  Among the tenants these days might be those newly fallen from the ranks of the middle class, but hoping to wiggle back in.

An afterthought to the preceding aside:  Hey, it just occurred to me that I once lived in an SRO, though that name wasn't applied to it.  Years ago, a refugee from graduate school, I had a small room with a single window facing another building in the Golden Eagle Hotel in North Beach, San Francisco.  It cost all of five dollars a week, was reasonably clean and quiet, mostly occupied by old men on Social Security, with a sprinkling of beatniks and some unclassifiables like myself.  Through the one window came a woman's voice from another building, constantly scolding her young son: "Bad boy!  Bad boy!"  Poor kid.  And sometimes, in the bathroom, I would be covered with soap and about to shower, when the water was cut off.  Have you ever stood naked, covered with fast-drying soap, waiting and waiting and waiting for a shower head to gush?  A unique experience, typical of an SRO.  Well, it finally did.  Gush, I mean.  But so far as I could tell, I was the only tenant making use of the shower.  As for my neighbors, I rarely saw them, but a friendly maid showed me one room full of thriving green plants, and told how several alcoholics kept their doors locked, accumulating a mess that she would one day have to cope with.  Ah, these memories of my distant and adventurous youth!

One morning Ann came to us an hour late and explained what had delayed her.  Going to a client in the West Village, a man in his late fifties suffering from liver failure, she found the door shut and locked, got no answer when she knocked, but heard noises inside that alarmed her.  With no super on hand, and no neighbor with a key, what to do?  She phoned the police, but when they came and saw the situation, they informed her that they don't break down doors, that's the Fire Department's job.  So
New York's Finest summoned the Fire Department, six of whose stalwarts soon arrived in full regalia, equipped with axes and a battering ram.  When they began battering the door, a faint cry was heard from inside: "Help ... Help ..." The door was finally forced, and in the apartment Ann found her patient, who had fallen, lying barely conscious in a pool of blood.  There was blood all over the apartment, marking his path as he crawled from the bedroom to the bathroom to the living room.  Another phone call brought the medics, and soon the patient was being rushed by ambulance to a hospital for emergency transfusions.  Too late; he died.  And his older partner, himself already hospitalized, died the same week.  A tragedy?  Maybe, but maybe not.  Since her patient's name was not on the lease, after the partner's death he might have been evicted and ended up, alone, in an SRO.  Maybe a happy ending after all.

These stories are hard to top, but one told us by another nurse, Carla, probably does just that.  Going with a second nurse to see a woman in her eighties who lived alone in the Village, she found the door open, the apartment dark, and the usual foul smell of a place that hadn't been properly cleaned for months.  The woman kept birds that were uncaged, and as Carla groped her way in through the darkness, they kept zooming past, alarmingly close to her head.  That and the smell put her companion to flight, but Carla pressed ahead, found a light switch, flicked it on.  There, sprawled on the floor, was her patient.  Immediately Carla tried to resuscitate her, but couldn't; the woman was dead.  Nestled between her thighs was a vibrator.  "Maybe she died of happiness," said Carla.

Here now is an incident in a more cheerful vein.  A nurse once came to us who, observing Bob's somewhat muted speech and having heard that singing is effective voice therapy, invited Bob to sing.  Without hesitation he came forth with "Somewhere over the rainbow."  The nurse joined in, then a therapist who happened to be present, and finally I myself: three generations, all of whom knew the words.  A vibrant quartet, and a good time was had by all, though our Haitian aide looked on with a slightly baffled look. 

The stories of the nurses -- told briefly, almost as asides, as they perform their duties -- are sometimes hilarious, often weird, usually sad.  All around us in this vast city, tucked away in dingy apartments and tiny ill-lit rooms, are elderly people without friends, without means, without hope.  Maybe they'll let a nurse in, maybe not.  Often, whether out of budget concerns or habit or pride, they insist they can make it on their own, won't hire a home care aide, fall, recover with the help of a therapist, fall again, and still refuse to hire an aide.  We encounter them at the tail end of their lives, have no idea what they were like in their heyday, perhaps surrounded by friends and family, perhaps pursuing a meaningful career, perhaps happy and fulfilled.  Who of us know how we will end?  Which brings to mind those much-quoted words of John Donne:  "Send not to know for whom the bell tolls; it tolls for thee."

Thought for the day:  Healing occurs where there is silence.

                                               © 2012  Clifford Browder

Saturday, September 8, 2012

24. Foreign Visitors and What They Thought of Us: Mrs. Trollope

Foreign visitors have come to this country for a variety of reasons: to have a look at this raw new democracy and take stock of it (Alexis de Tocqueville, Charles Dickens); to make money (Sarah Bernhardt, Oscar Wilde, Dylan Thomas); to hunt buffalo (Grand Duke Alexis of Russia); to elicit good will (the Prince of Wales in 1860); to
find support for a failed revolution (the Hungarian revolutionary Louis Kossuth).  Most of them passed through New York, often to tumultuous acclaim.  No such acclaim greeted Frances Trollope, the mother of the future novelist, when she arrived in the city in the spring of
1831, and for good reason, but her visit would be long remembered.  What had brought her to the New World was an interest in a cooperative community in Tennessee, plus the prospect of launching a business venture that would redeem the family's dwindling fortunes in England; she was to go first, and her husband would follow later.  The cooperative community turned out to be a wretched and unhealthy place, and her business venture in Cincinnati proved disastrous, following which she decided to tour the cities of the Eastern seaboard, including of course New York.

        When the sharp-eyed English lady came here, she stayed five weeks and did the requisite visits, bustling her small, plump frame through the Collegiate Institute for Young Ladies and the Asylum for the Destitute.  Returning one day to her hotel, she complained to a waiter how a cabman had cheated her.
            “Did you agree with him first on the fare?”
            “Why no, I didn’t.”
            A smile.  “Then the Yankee has been too smart for you.”

            One can imagine her indignation.  Even here on fashionable Broadway, with its fancy shops, neat awnings, and superb trottoir (so welcome after her sojourn in the muck of the hinterland), she wasn’t safe.  It was the hundredth time the Americans had cheated her, the thousandth they had mocked her.  After three years in this untidy land she was sure she knew us only too well: the women dreary as homespun, discussing the latest sermon or dyspepsia pill while stitching pincushions for charity, so some pale young seminarian could go to Africa and die of a fever; the men great braggarts and boors who ate with their knives and nearly swallowed them, put their feet up on the table, chewed, schemed, spat.  Especially spat.  On the street, in restaurants, even in drawing rooms and church.

            For three years she had endured our jangle of barbarisms: “I reckon,” “I calculate,” “If that don’t beat creation!”  At the first jolting twang of our speech, she had tingled with fascinated horror, perked up her ears, scribbled notes.  For three years she had endured our presumption: “Your newspapers ben’t like ours, I reckon; we says and prints just what we likes!”  In those days we were an adolescent nation, and like any teenager worthy of his salt, we delighted in putting down our parent, Mother England, against whom we had already waged two wars.  While the portrait above conveys a sweet-smiling, demure young woman, one suspects that Mrs. Trollope, a ripened forty-eight when she came to us, was, with her preconceived notions and prejudices, her finery, and her shrill, piercing voice, just the sort of English biddy to elicit put-downs and insults from the Yanks.

            She had also observed our greed.  “You’re very rich, Nick,” she remarked to a ten-year-old seller of eggs, noting his pocket change.
            “’Twould be a bad job for I, were that all I’d got to show.”
            “Do you give the money to your mother?”
            “I expect not.”
            “What then do you do with it?”
            A glance from his ugly blue eyes:  “I takes care of it.”

            And had witnessed our strange backwoods religion: hellfire sermons inspiring orgies of repentance seasoned with screams of “Jesus!” and “Glory!” as defenseless young females swooned in the arms of ministers not loath to offer a mystic caress.  And at a camp meeting in the wilds of
Indiana, a ranting preacher exhorting a crowd of penitents, mostly women, who moaned and groaned under conviction of sin, then sprawled convulsively in a confusion of heads and legs, shrieking and screaming as they threw their limbs violently about and sobbed.  Which was not, one suspects, a concept of religion acceptable to a genteel English lady familiar with the decorum and restrained elegance of the Church of England.

            By the time she came to New York, Frances Trollope was not just repelled and scandalized,
but embittered by her experience of this new young nation, allegedly so replete with shimmering opportunities.  In Cincinnati, hoping to sell Jonathan fine imports from London and the Continent, but being woefully deficient in business acumen, she had erected a grandiose Bazaar that the locals, having fleeced her in its construction, promptly labeled “Trollope’s Folly” and declined to patronize.   Debt-ridden, her goods seized, she left.

            Longing in this rutted wilderness for the smooth lanes and tidy hedges of England, she might have gone home, but to round out her impressions and glean some hints of civility, she visited the cities of the East.  Alas, on either side of the Alleghenies (sublime mountains!) the Americans were mean and tricky and gloried in it: as Talleyrand had remarked to Napoleon, “Proud pigs.”  Yes, there were gentlemen, a few, but it was the rough, common article she chafed against.  She was tired of hearing slurs on “British tyranny” and her “paltry little place of an island,” and of being called “the English old woman,” while butcher boys were designated “gentlemen.”

            From New York she had hoped for more, but even here theaters were packed with slouchers and boors, and elegant ladies with infants performing the most maternal of offices.  Even here,
in close proximity to the avenues, she found smelly cattle yards and tanneries provoking memories
of the hog-butchering stink of Cincinnati.  Even here the men schemed, cheated, spat.

            Soon, her notes complete, she whom Americans obviously took for a quaint little English busybody would depart this strange democracy, so removed from the chivalry of life, and sail back over the ocean to where England lay waiting like a set jewel.  Back to clean linen, well-mannered inferiors, and lawns like green handkerchiefs.  But what would she do with those notes? 

            Long since already, an idea had probably flashed in her mind and snapped into place like a clasp:  A book!  Why of course, a book!  She would expose these sturdy sons of freedom, their manners and morals and pretensions of destiny.  The cheaters and spitters would hear from her as she chronicled every insult, every outrage on gossipy pages laced with blue venom.  Thin-skinned, they would cry her down from Maine to Georgia, but they would read her, and so would the world.  So was conceived Domestic Manners of the Americans, which, having departed this objectionable land, she wrote back home in genteel England with spite crackling from the nib of her pen.  It was published in London a year later, in 1832.

             Domestic Manners of the Americans  hit New York at the same time as the cholera, and with as much effect.  When people met on steamboats, on stages, or in the street, their first question was, “Have you read Mrs. Trollope?”  She was reviled in newspapers, mocked in cartoons, and labeled "Old Madam Vinegar," her likeness even exhibited in a traveling menagerie whose patrons were invited to abuse her.  But for years afterward, if someone put his feet up on the railing of a box in the theater, or otherwise misbehaved, the cry “A Trollope!  A Trollope!” rose immediately from the pit.  And when, years later, they asked Mark Twain, who had grown up in rural Missouri, if what she had written was true, he replied that, alas, it was only too true.

Thought for the day:  Behind the wall of noise, silence waits.

                                                        Copyright 2012  Clifford Browder

Saturday, September 1, 2012

23. Foraging: How to Live off the Land

                                                                      Ben Stephenson

In July Pelham Bay Park abounds in raspberries; ripe, they glisten in the sun, just begging to be picked.  One sunny morning many years ago -- quite innocently, I insist (why else so brazenly in the open?) -- I was doing just that, anticipating a meal embellished by their succulent sweetness, when three park rangers forsook their vehicle to rush over and inform me that picking anything in a city park was against park regulations.  "Leave them for the birds," said one of them, and I, a good citizen and by nature not an outlaw, agreed to do just that.  So my dream of succulent sweetness was squelched by dutiful compliance.

                                                                       Manfred Heyde
But later that day, as I was leaving the park, I saw that a park employee's power mower had just massacred a thick stand of chicory that I had marveled at on arriving in the park.  Chicory, a common roadside flower with sky-blue petals, is in no way a problem or threat to anyone; it simply displays its beauty, it exists.  It had appeared here voluntarily, a bounty for all, yet these fools had murdered
it.  Indignant at this act of callous and quite needless aggression, I vowed then and there to pick quantities of raspberries -- which I have never seen birds eating -- at every opportunity, a vow that proved remarkably easy to fulfill, since the minions of order are vehicle-bound, and city parks have many side paths where no vehicle can pass.  My vow was obviously shared by others, since every weekend the ripe raspberries of Pelham Bay Park had a way of vanishing; I learned to look for them toward the end of the week, so more would have time to ripen.  And so far the birds aren't starving.

For the hardy few:  I have recounted the joys and perils of picking wild raspberries in a poem (not rhymed) first published in the poetry review Heliotrope.  See "Wild Raspberries," no. 3, in the post "Poesy."

Wildman Devours Japanese Knotweed
I'm not the only one who forages in the city parks or the only one at odds with the authorities.  For thirty years "Wildman" Steve Brill, the "go-to guy for foraging," has led groups on tours of city parks, teaching them which wild plants have culinary and medicinal value and advocating better eating habits for all.  A carnivore turned vegetarian turned vegan, he has a profound knowledge of such matters and happily imparts it to anyone who cares to sign up for his scheduled tours.  I went with him twice, once in Central Park and once in Prospect Park in Brooklyn.  Bearded and bespectacled, he wears a pith helmet and carries a shovel and a backpack, and seasons his tours with humorous anecdotes, one of his favorites being how he was once arrested in Central Park.  Back in 1986 two undercover park rangers joined his group, taking careful photographs of his every act in the Park, including the consumption of a dandelion.  Armed with this fearful proof, they then called for backup.  Uniformed officers appeared, and Brill was handcuffed, hurried off in a police van, fingerprinted, and charged with criminal mischief.  "Parks Muzzle Weed Maven" announced the Daily News, while other papers reported that the culprit had been "nabbed in mid-bite."  As the story spread to media throughout the country that a man had been arrested for eating a dandelion in Central Park, waves
of mirth erupted, and the case risked being laughed out of court.  Meanwhile Brill observed that indiscriminate mowing of weeds and overpruning by park workers was causing considerable damage in the parks.  When he appeared for his arraignment, the unrepentant forager paused on the courthouse steps to serve a "five-borough salad," including dandelion, to reporters and passersby who in more than one way ate it up.  After that a compromise was reached with the Parks Department, the charges were dropped, and he actually worked for the department as a naturalist for several years, until the advent of a less plant-friendly administration ended the arrangement.

Since then the "go-to guy" has not been molested, except occasionally by a ranger new to the force who doesn't know Brill and the story of his prior arrest.  Park officials have a genuine concern about overforaging in the parks, but Brill knows these plants better than anyone, and insists that whatever he picks is never endangered; indeed, he's been foraging many of the same spots for years, and the plants have never failed to reappear.  So they leave him alone (the rangers, not the plants).  Which I heartily approve of; Steve Brill is an educator, not a criminal, and has revealed to hundreds the hidden treasures -- hidden in plain sight -- of the city's parks.  May he have many more years of happy foraging unmolested by the guardians of order, who even as they protect raspberries manage to massacre chicory, that most innocent and lovely of flowers.

My own foraging began before I knew Steve Brill, but has certainly been enhanced by his instruction.  To find  small plants in city parks I have learned to look wherever power mowers can't go: along fences, close to buildings and other structures, around the base of trees, and in any small depression in the ground.  In the spring I have myself picked dandelions, though I have never been arrested for doing so.  The trick is to harvest the tender leaves, which some see as resembling a lion's teeth (dent-de-lion = dandelion), before the showy yellow blossoms appear, since by that time the leaves are less tender.  Vacationing on Monhegan Island off midcoast Maine, I have supplemented my lettuce brought over from the mainland with quantities of dandelion leaves, thus avoiding the need to buy greens at the island stores, which have to import all their foodstuffs and therefore charge high prices.  For taste, there is nothing like freshly picked greens in a salad.  As for the other French name for dandelion, pissenlit, the less said the better.

                                                                          Evelyn Simak
Another food I love to forage is wild apples.  I have found them in Van Cortlandt and Pelham Bay Parks and the Staten Island Greenbelt, usually lying in quantities on soft grass .  Admittedly, they are on the puny side and often blemished, whereas the greenmarkets at the same time are offering some fifteen or twenty varieties of apple, much larger and with few or no blemishes, which tempts me away from the wild ones.  But the best apples by far that I have foraged are from a tree on Monhegan Island that I once stumbled upon while following a deer path.  In the fall this tree is laden with mostly flawless green apples with a tart taste that makes for good eating and superb baking.  My first harvest would be from the lower branches, following which I would return with an apple picker for at least two more harvests, resting on the ground from my labors while watching gulls and osprey and peregrine falcons soar overhead, before starting back with a net bag bulging with apples and so heavy I could barely get it from the woods to the cabin.  This tree grew in the middle of nowhere and I alone knew of it and how to get there.  But when, to eliminate ticks, the islanders voted to rid the island of deer, the deer path disappeared and I had to scramble over fallen spruce logs, around brambles, and up a hillside to reach my tree.  Each year it was more inaccessible, so finally I had to give it up and harvest trees in the village bearing acceptable but not superlative fruit.  My tree in the woods will probably never be harvested again; I dream of it in its solitary, laden, and resplendent glory.

                                                                           Renée Johnson
I have also foraged blackberries in city parks, and up in distant Harriman Park I used to slowly climb up Parker Cabin Mountain to the top (where neither Parker nor his cabin can be found) and lunched there, then went down a thrillingly steep descent to pick (quite legally) some of the myriad blueberries ripening there in August, preferring the big ones that grew on bushes at eye-level.  Then, going on to Lake Skenonto, I would have a small second lunch while enjoying the thrill of knowing I had reached the farthest point of the hike and
was now deep into the Park and far from civilization, with not another human being in sight, before starting back along another trail.  To my knowledge, no blueberries grow in New York City parks, though I have seen the plants on Long Island in the spring.

Other plants that I have foraged include an aromatic mint in Van Cortlandt Park that I have never been able to identify, since half its features suggest peppermint and half suggest spearmint.  Be that as it may, the leaves add a wonderful mint taste to cantaloupe, or to applesauce or apple crisp or apple pie -- in short, anything "apple-ish."  And for a peppery taste in salad I have used poor man's pepper or peppergrass, a common but easily overlooked mustard whose tiny oval pods are indeed peppery.
                                           Sue Sweeney
Another common edible is mugwort, or common wormwood (Artemisia vulgaris) -- not the inconspicuous flowers but the deeply lobed, pointed leaves, green above and silver-downy beneath, which, if used in moderation, add a slightly bitter but not unpleasant taste to a salad.  Aromatic, in late summer it grows in abundance in various spots in Pelham Bay Park, where I have found whole jungles of it crowding out other less hardy plants. What I love about mugwort and peppergrass and many other plants is that most people would dismiss them as "weeds," being totally unaware of their culinary and often medicinal values.

Footnote:  My favorite definition of a "weed": A weed is a plant whose value has yet to be discovered, or has been forgotten.

If we have many uses for plants, they have uses for us as well.  In late summer or early autumn just try walking through a field of tick trefoils, or simply brush past them on a path, and you will find your clothing thickly matted with hundreds of their small jointed pods, ridding yourself of which can take anywhere from twenty minutes to an hour.  They even cling to shoelaces.  No wonder these insidious plants of the pea family are also called sticktights.  Well, they've got to spread their seeds about somehow, and here you come, blithely unaware of the danger.  The same goes for beggar ticks and any plant with burs.  Happy autumn!  Nature's way. 

One summer when I was cycling on Nantucket and eager to explore the distant reaches of the heath, I vowed to find the "Hidden Forest" indicated on my map.  The name enticed me, and with great effort I did indeed discover it: a stand of scrub pine no different from numerous other stands on the island, but thickly carpeted with poison ivy.  In short, a Hidden Forest that would do well to stay hidden.

Poison ivy is one plant that everyone, and especially foragers, should know; fortunately,
it is readily identified by its consistent three-leaflet pattern.  No hike that I have ever taken, except in the most manicured of parks, is free from it.  I have seen it growing in wet soil and dry soil, in woods and swamps and fields, and on roadsides.  It can appear as an erect shrub or as a trailing or climbing vine, even twisting up tree trunks to appear at eye level or higher.  Every part of it is poisonous: leaves, stem, roots, flowers, fruit -- even the smoke, if it is burned.  Inescapable, yet avoidable.  Not to be eaten by humans, needless to say, but many birds love it for the small white berries.  I wish them well of it.

Another plant to avoid is stinging nettle, which, as I know from experience, lives up to its name.
And yet, it can be foraged.  I have seen it at Keith's organic produce stand in the Union Square Greenmarket.  One of the farmers told me that he drinks the tea as well, and has become immune to the plant, so that harvesting it causes him no trouble.  To relieve joint pain, he added, some people even lash themselves with it. The wonders of plants will never cease.

                            Heal-all                     H. Zell
That scientific names of plants have their use cannot be denied, but I have always preferred the traditional common names, the names that most people use, since they often give hints of the plant's uses in earlier times when supermarkets were unheard of and doctors were few and far between (fortunately, given their level of skills back then).  Knowledge of these herbal remedies sometimes came with the early settlers from Europe, and sometimes was acquired from the native peoples of America.  Boneset is a common white summer flower found in low, damp places whose name reminds us that the leaves were once wrapped around splints to help mend broken bones.  The dried leaves of fleabane were believed to repel fleas, and an extract from eyebright, a small plant with lobed white flowers, served to relieve redness and swelling of the eye.  On roadsides and lawns I have often seen heal-all or selfheal, a low or creeping plant of the mint family with violet flowers crowded among bracts in a terminal cluster.  True to its name, it has been used in poultices to help wounds heal; in a tea to treat sore throat, fever, wounds, internal bleeding, and diarrhea; and in China, where it has been known for over two thousand years, in an infusion to treat liver ailments.  From this one little flower, a host of healings.

                            Skunk cabbage leaves                   cmadler
Still other uses are suggested by the names of bedstraw, Mexican tea, and Indian tobacco,
all common in this area, and for vivid descriptiveness I would add arrow-leaved tearthumb (I have felt those prickles), bird-foot trefoil, lizard's tail, turtlehead, Jack-in-the-pulpit, cat's ear (with soft downy leaves), and shepherd's purse (the tiny heart-shaped pods suggest a shepherd's purse, though, knowing no shepherds, I haven't checked this out).  All of these are friends of mine from many a hike in this area.  But for candor in a name it's hard to equal skunk cabbage, spring's first wildflower here, which pokes up among dead leaves or even patches of snow in wet spots in woods, soon to be followed by broad green leaves that look perfect for a salad, until you sniff them and remember the name.  But I do protest the injustice embedded in the names of false dragonhead and false Solomon's seal (why false? they're just doing their thing), and the most foul and churlish allegation inherent in the name of bastard toadflax.
Poison hemlock
Once I get off on the names of wildflowers, I don't know where to stop.  For a name that's as baffling as it
is suggestive, how about cut-leaved water hore-
hound, a plant of the mint family found in wet soil throughout?  Suggestive in quite another way is poison hemlock, whose umbrella-like clusters of white flowers and finely cut, fernlike leaves I've often seen thriving near a huge sycamore tree in Van Cortlandt Park.  It of course brings the death of Socrates to mind, but anyone contemplating suicide who, having read Plato, thinks of following Socrates to a peaceful and noble end should be advised that, yes, the juice of
this plant is highly toxic, but the death it induces is anything but peaceful, being preceded by tremors, seizures, ascending paralysis, and coma.  Finally, to end on a more positive note, for sheer poetry I propose the names of Venus' looking glass, star of Bethlehem, Solomon's seal, and enchanter's nightshade, though admittedly this last, to look at, falls far short of its name.  Even so, think of the name itself: enchanter's nightshade -- what magic!

Thought for the day:  Be a friend of small grasses, rub the ridged bark of trees.

                                                                    © 2012  Clifford Browder