December: Voices, Memories, and Giving

December: Voices, Memories, and Giving

“It’s coming on Christmas.”

The voice may be tenor or soprano. The music may be folk, modern or classical. Whatever your choice, it now begins—Christmas music reemerges as we celebrate the season in sound. We hum, sing along. My husband and I move from Diana Krall and Bill Evans, to the Robert Shaw Choral, Vince Guaraldi’s Charlie Brown Christmas, James Taylor’s Christmas songs. Everywhere, there’s wonderful variety, music becoming the focus of family get-togethers, school celebrations and church events. Music is tradition. Music is memory.

REPETITION AND REMEMBRANCE or “GET UP ON YOUR FEET”

What song do you look forward to singing? Do you play old records or click on Spotify? Some of you might be part of a church choir—but with Covid, you might be forced to abandon practices. But you can always sing to your Christmas tree,  remember the songs that make you joyful for your beliefs.

Music captivated my younger brother in his teens, became his lifelong career and passion, so at Christmas, his Christmas Dreams collection is a favorite. He and my son will grab guitars, play, sing, fill the house with sounds of the season—and they’re always open to requests–grandchildren, cousins, everyone dancing. Be joyful, move your body—that’s all that’s required. Got a new move? Share it, for the holidays are always about health and new life, about blotting out the darkness that pervaded much of the world, about lighting candles, fires, and gathering people together to share food, drink and love. ( But honor your host regarding what you can bring to a celebration and do make sure you are vaccinated.)

DECEMBER: A TIME FOR EVERYONE 

The very existence of the Christmas season will always be connected to new life, the birth of Jesus Christ. It is also about memories, the cranberry bread you make every year. The lights you hang on shrubbery, trees and doorways to light up your surrounding world. The warm room, maybe a fireplace burning and always a hug or words of caring for those who come through your door. Just think: even though Australia and countries on the other side of the equator are unpacking their summer clothes—it’s still “coming on Christmas.”

And yet there are shadows that even a brightly lit world cannot dispel. Maybe this is your first Christmas without a parent, a spouse, your closest friend. This is a Christmas where your time will be spent visiting your son in rehab or remembering to take medication for a recently developed condition. Some of you will travel to rejoice with family and friends, or to mourn with them.  But we humans keep going, healthy, struggling, joyful or sorrowful, we keep on…

MORE VOICES…

Chris Erskine, in his column a few years back, reminded his daughter: “Everybody is someone.” That statement is always true, but during this season when emotions are heightened, memories can hang over one’s day like a dark cloud–instead of mistletoe. It’s best to remember to care for or smile at those you meet. And you could ask yourself, do I really need “another ornament” for the overloaded tree? I know I don’t, remembering that my mailbox has been full of organizations asking for help. Write that check, mail it today. 

So whatever your December brings you, I hope you will experience contentedness, the desire to reach out to others. After all, the season is only beginning, plenty of time to be grateful, to make Santa Claus come alive and for a child. Thanks for reading.

Artwork: thanks to Nancy Haley nancyhaleyfineart.com

This is an older post that has been edited.

THE STORY OF ONE PREGNANT PATIENT & THE APGAR SCORE

 

THE STORY OF ONE PREGNANT PATIENT & THE APGAR SCORE

Virginia Apgar

Writer and physician Atul Gawande, reminds us in his book, BETTER, that much of modern medicine did not just happen—it came to be through trial and error, through the deaths of others, the mistakes and triumphs that IS the history of medicine. In BETTER, a surgeon’s notes on performance, we meet Elizabeth Rourke in the chapter, THE SCORE.

OUR PREGNANT PATIENT

Rourke is forty-one weeks pregnant, having contractions. She’s an internist, on staff at Mass General. Her contractions are 7 minutes part. She reports this to her obstetrician at 8:30 am. She is told not to go to the hospital until her contractions are 5 minutes apart. Standard protocol. (this book was published in 2007). In medical school, Rourke has seen fifty births, delivered 4, and watched one in a hospital parking lot. It was winter, the baby was blue, crying. They covered the infant, raced back into the hospital. With that memory, Rourke finished packing her bag and her husband drives her to the hospital.

SOME HISTORY

Gawande then relates some history of pregnancy and birth that has been recorded. He writes of 21-year-old Princess Charlotte of Wales, in 1817, four days in labor, struggling to deliver a nine-pound boy in a sideways position, his head too large for her pelvis. When he finally emerges, he is stillborn. Charlotte dies six hours later from hemorrhagic shock. Gawande relates that her physician was reviled for not using forceps. In remorse for her death, he shot himself.

Gawande relates other statistical history of births—that in 1933, the New York Academy of Medicine published a shocking study of 2,041 maternal deaths in childbirth in New York City. At least two-thirds of those deaths investigators found to be preventable, that many physicians simply did not know what they were doing. They missed signs, symptoms, incorrectly used forceps and spread infection. Midwives did better.

UPDATE ON OUR PATIENT, ROURKE

Her pain has increased, thinks she must be 7-8 centimeters. She is at 2. Her labor has stalled. Then at 2:43 AM she is at four centimeters. It’s been twenty-two hours. They give Rourke an epidural. This is not a simple procedure. Gawande goes through the steps, explaining the risks, one being the mother’s heart rate dropping and the necessity for a bolus of fluid injections and ephedrine to increase and stabilize hers and the baby’s blood pressure. The baby’s heart rate is being monitored constantly, showing decelerations during contractions and then recovering. When necessary, Rourke (and thus the baby) are given extra oxygen by a nasal prong.

At 6 AM Rourke is a 4 centimeters. At 7:30 Dr. Alessandra Peccei comes on duty. Rourke is 6 centimeters dilated and 100% effaced. Baby is seven centimeters from crowning, head becoming visible at the opening to the vagina. As the hours progress, Dr. Peccei punctures the membrane of Rourke’s amniotic sac. Waters flow, contractions pick up, the baby does not move and the heart rate begins to drop. 120, 100, 80. When the doctor stimulates the baby’s scalp, the heart rate responds.  

SEGWAY to: VIRGINA APGAR, the APGAR SCORE

Virginia Apgar was a doctor working in New York, a doctor who had an idea, one that Gawande states is “ridiculously simple.” It transformed childbirth and the care of newborns. And as Gawande states, she was an unlikely revolutionary for obstetrics, had never delivered a baby, not as a doctor, not even as a mother. But she would often sit down with someone having trouble and say, “Tell Momma all about it.” She was a surgeon, but joined Columbia’s faculty as an anesthesiologist. She became the second woman in the country to be board certified in anesthesiology, helping the practice to have its own division, on equal footing with surgery. Gawande writes that Apgar was appalled by the care many newborns received.

“Babies who were born malformed or too small or just blue and not breathing well were listed as stillborn, placed out of sight, and left to die. They were believed to be too sick to live. Apgar believed otherwise. She had not authority….She was not an obstetrician.  She was a female in a male world. Gawande: “So she took a less direct but ultimately more powerful approach: she devised a score.”

The Apgar score—as it is now universally known, allowed nurses to rate the constitution of babies at birth on a scale from zero to ten. An infant got two points if it was pink all over, two for crying, two for taking good vigorous breaths, two for moving all four limbs, and two if the heart rate was over a hundred. Ten points meant a child born in perfect condition. Four points or less meant a blue, limp baby.  

RESULTS 

Throughout the world, virtually every child born in a hospital came to have an Apgar score at one minute after birth and then again at five minutes after birth. It became clear that a baby with a bad Apgar score at one minute could often be resuscitated, with doctors, nurses providing warmth, physical touch and oxygen, to help the baby gain an excellent score at five minutes.

The results: neo-natal units! The score also affected the management of childbirth. Spinal and epidural anesthesia were found to birth babies with better scores than general anesthesia.

Prenatal ultrasound became a regular process used to detect problems for delivery in advance.

Fetal heart monitors became standard. All these changes, these procedures have produced amazing results. Gawande writes: “In the US today, a full-term baby dies in just one childbirth out of 500, and a mother dies in less than one in 10,000.”

FINAL THOUGHTS    How did Dr. Apgar’s work make doctors BETTER?

The Apgar Score changed everything, being a practical way to calculate and give doctors an immediate feedback as to how effective their care had been.

The Score also changed the choices that doctors made concerning how to do better! They poured over the Apgar results, wanting to encourage results that would make every doctor, nurse, from the most experienced to the novice, a better practitioner.

And our patient, Elizabeth Rourke? She had almost 40 hours of labor and finally a Cesarean section. Katherine Anne was born at seven pounds, fifteen ounces, brown hair, blue-gray eyes, and soft purple welts where her head had been wedged sideway deep inside her mother’s pelvis. Her Apgars: 8 at one minutes, 9 at five minutes—nearly perfect.

MORE TO READ: Find more wonderful information about Health Care in Gawande’s books: BETTER: A Surgeon’s Notes on Performance, COMPLICATIONS: A Surgeon’s Notes on an Imperfect Science, BEING MORTAL: Medicine and What Matters in the End, THE CHECKLIST MANIFESTO: How to Get Things Right 

I’ve read them all.

 

Discussion, Review of Elizabeth Strout and OH WILLIAM!

In her latest novel, OH WILLIAM!–Lucy Barton, the main character and voice in the novel, tells us that when she learns William had been having an affair with her friend, “a tulip stem inside me snapped. It has stayed snapped, it never grew back.” 

 

 

 

 

 

 

Elizabeth Strout hated being a lawyer: “I couldn’t stand up for anybody, even when I believed in their case.” After six months, she left to do the adjunct professor thing in Manhattan, teaching literature—writing. Strout has admitted that there’s nothing romantic about being rejected, but she never gave up. “I often had only two hours every three days to work; I had to make the most of it.”

She succeeded, using her early life in Maine to create Amy and Isabel, Abide with Me and then Olive Kitteridge, her Pulitzer Prize winning collection of stories about a cantankerous wife, mother and former teacher. Example: Olive’s only child, Christopher, has just married Suzanne. Olive leaves the party, goes into the married couple’s bedroom…she crosses the pine floor, gleaming in the sunshine, and lies down on Christopher’s (and Suzanne’s) queen-size bed. …It pleases her to think of the piece of blueberry cake she managed to slip into her big leather handbag—how she can go home soon and eat it in peace, take off this panty girdle, get things back to normal.

…Then later, Olive sees the bride’s favorite pair of loafers. She takes one, smashing it into her purse with the blueberry cake. That’s Olive.

In Olive Again, 2019, Strout deals with Olive’s second marriage, her son’s divorce, her need to move to the Maple Tree Apartments. There she meets characters who have appeared in Strout’s work: Amy and Isabelle, The Burgess Boys. This expansion of the lives of former characters reinforces Strout’s oeuvre and the world she’s created. Toward the end of Olive Again….her mind twirling around, Olive suddenly remembered catching grasshoppers as a child, putting them in a jar with the top on, her father had said, ‘Let them out, Ollie, they’ll die.’

Her next, My Name Is Lucy Barton, allowed Strout to explore new artistic territory by creating Lucy, a writer with a background, a life experience worth exploring, exposing. Strout followed with a collection of stories, Anything Is Possible and now with Oh William! — Strout the writer, Lucy Barton her muse. 

In MY NAME IS LUCY BARTON, Lucy is hospitalized for complications from appendicitis. Away from her children and husband, she awakens to find her mother sitting in the hospital room. There is little positive history to connect these two, but the mother has traveled from Amgash, Illinois, a fictional small town Strout created where people cling to the land, seeking comfort in the narrowness of what they know. The mother’s arrival gives rise to Lucy’s childhood pain: her father locking Lucy in a truck with a snake; the tiny cold house; Lucy staying late at school where she could study, be warm, meet the gentle teacher who believes in Lucy, helps her escape Amgash, attend college where she begins to write about her life, where she meets and falls in love with William!

As she wrote the story collection, ANYTHING IS POSSIBLE, I envision Strout with piles of notes (her process, see previous post) while laboring over themes and visual details to create characters that might have walked the streets of poorer towns, maybe even those in her beloved Maine. In her story SISTER, Lucy has finally returned to Amgash to visit her sister and brother.

Lucy moved close to her sister, she rubbed her knee. “Oh, that’s disgusting. You are not icky, Vicky, you’re–”   “I am so icky, Lucy. Just look at me.” Tears keep coming from Vicky’s eyes. They rolled down over her mouth, with its lipstick.   “You know what?” Lucy said. She stopped rubbing Vicky’s knee and started patting it instead. “Cry away. Honey, just cry your eyes out, it’s okay. My God, do you remember how we were never supposed to cry?”

Strout left a thread in MY NAME IS LUCY BARTON, Lucy’s father, a WWII vet, won’t accept Lucy’s marriage to William, whose heritage is German. Now in OH WILLIAM! Strout explores that thread.

LUCY’S HISTORY…

Lucy married William, they lived in New York City, had two daughters, then later divorced. In Oh, WilliamLucy’s second husband, David, has recently died, her  daughters are grown. William has had women, but finds himself lonely. When he asks Lucy to go on a trip with him, help him search for a half-sister he has newly discovered on an ancestry website, Lucy questions her current role, but then agrees. The book is a trip of remembrance, of adaptation that all couples experience. Memories of their lives, their daughters lives past and present are shared. They talk about Catherine, William’s deceased mother, questioning how this step-sister might exist. The trip revives memories, Catherine putting William in a nursery school. “I’d cry every day at that place…Lucy, I would cry–the kids would circle around me at recess and they’d sing, ‘Crybaby, crybaby.'”
Lucy listens, silently questions how William will react if they actually find this woman, this half-sister.  

With MY NAME IS LUCY BARTON and now OH WILLIAM! Strout has mastered a clipped, direct style, scenes that flow into one another, revealing a character’s thoughts, ordinary, maybe even simple, but always revelatory….he was wearing the khakis that were too short and I had the same reaction I’d had when I first saw him wearing them at the airport the day before, but I was tired from my night and I did not feel it as strongly. 

so often I had the private image of William and me as Hansel and Gretel, two small kids lost in the woods looking for breadcrumbs that could lead us home. …that the only home I ever had was with William…I’m not sure why this is true, but it is. …being with Hansel–even if we were lost in the woods–made me feel safe.              I wrote in the margin, YES! Strout relates a character’s thoughts, questions, pains, and the questioning we all have about our closest relationships. 

I was in rural Maine and what had just come to me was an understanding, I think that is the only way I can put it, of these people in their houses, these houses we passed by. It was an odd thing, but it was real, for a few moments I felt this: that I understood where I was…that I loved the people we did not see who inhabited the few houses and who had their trucks in front of these houses. This is what I almost felt. This is what I felt. 

Again, we check in on our feelings as they flow through us, pinning them down as we question and then say YES.

Every reader comes to a novel with their own past, their own anxieties, beliefs and a view of the world. Getting lost in story can be pleasing, but it can also arouse questions. Reading Elizabeth Strout is a journey. It provides a look at the reality of lives, not always pleasant, not always redeeming. Her characters are flawed, as we all are. But people change and grow. Strout has penetrated those changes in her work. Maybe that is why she again finds her characters gathered on her table of messy notes, waving conjoling, encouraging her to write more about them. I hope she does.  

My INDEX TO AUTUMN

 

My INDEX TO AUTUMN

DEFINITION of INDEX: an alphabetical list of names, subjects, etc.,  typically found at the end of a book.

AFTERNOON: angle of light in; soccer games in; time to rake leaves, walk in;

APPLES: bobbing, drying, picking; for pies; green, red, yellow; teachers dislike for–truth revealed;

ARGUMENTS DURING: regarding football games on TV, leaf raking;

BABIES: record number conceived in; riding in strollers for walks;

BASKETS Of: apples, cinnamon bread, dried flowers, pumpkins;

BIRDS: departure of; feeding with break crumbs, pumpkin seeds;

BLANKETS: washing, adding to beds, especially in colder climates;

BOTTLES: contents of: cider, wines, window cleaner;

CANDY: see cavities;

CAVITIES: see candy, Halloween;

CHILDREN: arguments concerning leaf raking, trips to ER after football, soccer games;

CORN: husks; stalks in fields; sweet with butter;

CROPS: abundance of; ruined by rain/winds; varieties: cranberries, melons, pears, yams;

DYING: sunlight along the grass; light in the tops of the trees;

FOOTBALL: games, scores, tailgates; see also arguments about…

FROST: first; preparation for; harm to delicate plants not covered; see cultivars;

GRAPES: arbors of; jams, jellies; wreathes made from branches of;

GRASS: color of; reduced growth of; spreading roots;

GREEN: grass after rainfall; see photosynthesis;

HALLOWEEN: cornstalks; costumes; light on the night of; rain on the night of; scarecrows; tricks by children; See shaving cream, toilet paper;

HARVEST: moon;

HUSBAND: arguments about football games and raking leaves;

INDIAN SUMMER: stories, length of; discussion as to whether term is politically correct;

KILLING FROST: see frost;

LAWNS: covered with leaves; light from sun in late golden afternoons;

LEAVES: gold, plum, red, yellow;

MOON: harvest; full; lover’s moon; yellow; zenith hour;

PHOTOSYNTHESIS: cessation of in plants;

PUMPKINS: carving of; orange; size; transformation; See husband, children;

RAKE: varieties: bamboo, iron; plastic; verb: arguments pertaining to…

SLANT: of sunlight;

SQUIRRELS: everywhere; eat Indian corn off porches; bite into pumpkins;

SUNSETS: amazing…

TEENS: hanging in groups; homecoming; tricks on Halloween; football; testosterone;

TESTOSTERONE: see babies, teens; parenting;

WASHING: see windows;

WELCOME: see wreaths for doors;

WINDOWS: see washing;

WREATHS, on doors: corn husk, grape vine, soon to purchase evergreen; also, wreath of smiles. Autumn is the loveliest month.

Thanks for reading. This was written when my children were young. I save everything.

THANKS FOR THE GORGEOUS PHOTO FROM: Scattered Thoughts and Rogue Words  

Thoughts on Where We Are…Autumn

Thoughts on Where We Are...Autumn

Autumn is approaching…with winds and light rains, leaves beginning to fall, crops being harvested, trees becoming barren. Ah, the cycle. These weather patterns contrast with the drought and dryness in other parts of America and the world.  What does nature know that we do not about the length of our days? Why do some regions have bounty and others experience loss? Is there something we need to atone for?

Probably. But though despite the shadow fo global warming, I’m determined to enjoy autumn once again. I have a large planter of yellow and burnt ocher mums nestling by pumpkins on my front porch. My autumn welcome sign is hung and a wreath of yellow leaves blazes in in my living room. This is my time. For me autumn is always a beginning.

A CLEARER PICTURE 

When things fall back toward the earth, the outlines of garden and lawn, of walkway and road become more apparent. This precise definition creates a sense of order and organization. In fall there are memories of wild vines and riotous summer flower color. But now it’s best to be more satisfied with quieter denser things like clipped boxwood and evergreens, like bare tree trunks of grey and soft brown. The air is cool. The skies seem swept up too, presenting swathes of crystal color. Cold air outlines things so definitely, you can almost see each leaf and branch.

ORDER BRINGS TIME FOR CONTEMPLATION 

Definition and order soothes the soul. I lean toward putting things away in their proper place. I lean toward knowing that everything sleeps quietly waiting for a reawakening. This is a time to store energy, to store knowledge. It can be a time to read great books and contemplate, make decisions.

If you seek solace and quiet, this is your time. For as we move inside to do our living, placing things we love like a bright pumpkin or a sheaf of leaves on table surfaces, or brightening a room with a flowered pillow or candlelight, it can also become a time to move inward in our thinking–to meditate and determine more and more exactly who we are.

Autumn decorations can remind us of endings, yet good endings that are resolute and leave us feeling blessed, not sorrowful. Autumn is the time of atonement for the Jewish people and how appropriate to tidy up one’s soul as the earth is preparing for sleep and hibernation, as winter winds are soon to come and humans are stocking up on food energy and light energy, hoping they will provide the ability to survive.

ATONEMENT

But no matter what the season, we should atone for the hurts we have caused; we should try to mediate our expressions of anger. And certainly if we have hurt someone we need to ask for forgiveness, hoping that if someone has hurt us, we can find a way to forgive that person, lighten the loads we often carry. And of course, we must try to forgive ourselves.

SETTLING IN 

It’s a little early, but there will come a time as the days get shorter that we will want to settle back into our brains and examine who we are, where we are going, and how we might improve. Life cannot be lived like the riot of spring where nature blows her wad and lets everything grow and rush about. We enjoyed that fertility. But now it’s time to be more judicious in our use of harvest fruits; we need to carefully use and share our bounty.

Certainly in the spring, when life comes back, we have no fears of the future. But in the autumn, we need to count the jars in the cellar, the apples in the basket, the sins on the soul. We need to tidy our lives and draw within to discover how we will survive, how we will make it through the dark times of our life. And how we can help others through their darker, harder times.

FINAL THOUGHT 

In each of us is a light deep within. Sharing that light draws bounty, brings good things to us whether the world is hard-packed snow or dry desert. Autumn can provide a time for atonement. Winter and beyond can be full of the light of love as the grace of forgiving someone brings the warmth of reclaiming love. If you are feeling like all the days of your life are hard, cold winter, then it’s time to open up to those around you, to share the light within you. IT WILL BRING YOU HAPPINESS. As a wise woman once said to me: “Feeling sad today? Then go out and help someone else.” She was so right.

(this is a rewriting of an older post, but it always feels just right…)

What Should We Citizens Know About Our Place in Society?

What Should We Citizens Know About Our Place in Society?

Sometimes there are rewards when one goes into EVERNOTE and finds things. This was a response to a question that came in my email, but McSweeneys never responded. Oh well, dissed again…so I’ll share it with you…

 

 

 

Dear McSweeney’s, Here is my answer to: WHAT SHOULD THE CITIZENS OF THE US KNOW ABOUT YOU AND YOUR PLACE IN SOCIETY? 

It is always better to approach a fearful time with knowledge and understanding. We can downplay fear if every individual focuses on personal worth, yet believes in specific goals going forward.

Partisans who fight against a conqueror display a deep love and belief in the country they fight for. In this time of Coronavirus, our goals must be to save lives, but also to preserve positive elements of our culture.

STAY WELL; PRESERVE OUR CULTURE 

I value what the generations before me and my generation have brought to the foundation and advancement of our country. Turning against a particular group of people in a time of upheaval and fear is always misguided and can get out of control in the hands of overly frightened people. That’s called hysteria, and though we are not there yet, it would be so wrong to see older generations, people of color and newly arrived immigrants as sacrificial lambs. (rereading this maybe we are there now…at least in the minds of some.)

Now is a time for each of us, regardless of age, background and status to view life on a continuum.

GENERATIVITY: WHAT IS IT? DO I LIVE, BELIEVING IN THIS?  

Psychoanalyst Erik Erikson wrote about generativity, stating that in the middle years of adult life we come to realize: I am what survives me.

Though giving birth is the ultimate act of generativity, it is a parent’s follow-through, his and her commitment to nurturing and growing this person, that truly matters. People of all ages experience generativity by creating: a business, song, piece of sculpture, the resolution of a problem, a scientific theory, recipe, article, novel, hybrid-rose.

Generativity means creating the very future itself through teaching, volunteering, voting, forming and helping social institutions—and by currently working to save lives in hospitals, community centers, churches and health centers. In each of these actions resides a part of us and the good in us—because what we generate moves into the future and provides for those coming after.

I am what survives me.

YOUR KEYS TO A HEALTHY LONG LIFE…

Psychologists confirm, that people who want to generate and create, do experience feelings of well-being and low levels of depression. And it is always true that if you are feeling sad or lonely, the best cure is reaching out to help someone else. (In our age of communication, many of us can do this without worrying about exposure to the virus.) And yes, there is some ego or need for power in our acts of creation, but when we generate for future generations, we cover over the power with love.

TAKE THE TEST BELOW

Erikson reminds us that our acts of having children and building societies indicates our “belief in the species.” Even though we know that horrific things can happen on our planet, like this virus, daily we forge ahead believing in our own generative powers and the goodness that can still exist on our earth. Let’s not forget that in these contentious times, if there is to be sacrifice—it should be the giving of time and energy, or of funding hospitals and health centers. This is not a time to distain a generation who has brought our people through other traumas and still have energy, knowledge and hindsight to give to all generations.

P.S. Below is a self-test that each of you can take to see if you believe in generativity. The test if from the Loyola Generativity Scale (LGS).

Read the following six items and mark:

O if the statement never applies to you;

1 if the statement sometimes applies to you;

2 if the statement often applies to you;

3 if the statement always applies to you;

Then add up your score.  Men, women in their 30s, 40s and 50s usually score 11.  Younger adults and adults in their 60s and older usually score slightly lower.

___ I try to pass along knowledge I have gained through my experience.

____I have made and created things that have had an impact on other people.

____I have important skills that I try to teach others.

____If I were unable to have children of my own, I would adopt children.

____I have a responsibility to improve the neighborhood in which I live.

____I feel that my contribution will exist after I die.

Thanks to Dan P. McAdams for the inspiration from his article GENERATIVITY:The New Definition of Success

P.P.SMcSweeney’s is a nonprofit publishing company based in San Francisco. McSweeney’s exists to champion ambitious and inspired new writing, and to challenge conventional expectations about where it’s found, how it looks, and who participates.

Revisiting Thoughts on Liminal Space

After 9-11 life was totally altered, for all of us. As a writer, I sat and stared at my manuscript wondering if anyone would ever read a novel again. My husband had been traveling—not to New York, but to Connecticut. When he finally got home late on Friday, there was relief. But normality escaped us. It escaped everyone.

Then in those next few days, a friend offered me some insight. It came in the words of Father Richard Rohr, a Franciscan priest whose teaching is like that of the first St. Francis: empty yourself, be compassionate of others, especially those that are socially marginalized. Okay. How do I do that when I am angry and confused. 

TWENTY YEARS LATER 

And though time has passed, many of the same questions circle around us. So today, let me offer this…because the words that Father Rohr used to explain liminal space, will always be relevant and helpful when we find ourselves full of questions.

THE DEFINITION 

Liminal Space is:  a unique spiritual position where human beings hate to be… It is when you have left the tried and true, but have not yet been able to replace it with anything else… It is when you are between your old comfort zone and any possible new answer. If you are not trained in how to hold anxiety, how to live with ambiguity, how to entrust and wait, you will run…or do anything to flee this terrible cloud of unknowing. 
- Richard Rohr

HOW WE REACT: COVID 19 and LIMINAL SPACE 

Many of us once again feel this terrible cloud of unknowing. Some of us are angry that our lives have suddenly changed, that we are struggling with loss, death, an alteration in social habits like wearing a mask, avoiding closeness to strangers, having to prove we are vaccinated…the list is long.

Families have been pulled apart, because some refuse to be vaccinated. Why? There are many excuses, some of which I find hard to accept when my generation and the generations of my children began with a series of vaccinations to protect them from illnesses that were not only inconvenient (chicken pox) but could also lead to blindness and deafness in their future children, German measles (rubella), and sterility in males (mumps). So it makes no sense to risk death, damage to one’s lungs, having to be intubated etc etc when many of the refuse-nicks started out their lives being vaccinated. And all they have to do now is WEAR A MASK. 

SO ARE WE AGAIN LIVING IN LIMINAL SPACE?

Let’s look at that definition again. “You have left the tried and true, the familiar, but have not been able to replace it with anything else. Being under a terrible cloud of unknowing.”

SUGGESTIONS…

Having been a healthcare worker, the first thing I would suggest is to work against that vacuum, that feeling of unknowing. Examine questions–can we go out; will we be safe; will my children be safe and still get a good education; can I go back to work instead of working from home? will life ever be normal again? YES TO ALL THESE QUESTIONS. IF YOU ACCEPT THIS NEW REALITY AND GET VACCINATED–and during this interim time, WEAR A MASK.   

THOUGH LIMINAL SPACE IS ONGOING… we must accept it. The feelings that are part of liminal space are common to daily living. We are always waiting for something: a job, a pregnancy, a graduation, a diagnosis, an acceptance letter, even a death; or a yes from someone whose yes might change our lives, and until we get that yes, we feel like someone else is holding the rest of our lives in his or her hands. IT’S NOT EASY. Liminal space brings frustration, depression. We hate living under that cloud of unknowing.

Thus we must look for the good news. It was true post-9-11, that we saw, heard and felt the warmth, love, understanding and giving of many Americans who did whatever they could to help those who had lost someone. Later it was young men and women who joined our volunteer army, feeling that was the best way to give.

Certainly liminal space always challenges us. We are rarely free of the unknowing—because we are mortal and have no knowledge of the date of our demise. That’s a given. But it can be used to power our love of self (taking care of our bodies) and love of those we live and work with (getting vaccinated so that we don’t get sick and infect others.) For how much better to offer understanding, honesty and friendship on a daily basis—because who really knows what the next hour will bring.

You’ll find examples every day of folks who have conquered the awful questioning of liminal space: 

the cancer patient who goes into remission and dedicates her time to helping other patients; the teacher who takes extra time to work with the very student who upsets his classroom; the doctor or nurse who enters the clinic every day, even when Covid death stats are rising; the cop who does all he can to make certain-sure before using deadly force; the mother, father, neighbor, citizen who listens and evaluates any situation before making a judgment or rising to anger.

THE CITIZEN WHO FINALLY REALIZES THAT GETTING VACCINATED IS GOOD FOR HIM/HER BUT IS ALSO A WAY TO GIVE BACK TO THIS GREAT COUNTRY. 

After 9-11 Richard Rohr reminded us that both Christian and Muslim mystics preferred the language of darkness. That is: they were most at home in the realm of not-knowing. In such darkness, Rohr writes, things are more spacious and open to creative response. We are more open to letting in God or blessed, positive thoughts–just like the cancer patient who is grateful for every day and turns darkness into light.

This from the Persian mystic Hafiz:

Don’t surrender your loneliness so quickly.

Let it cut more deep.

Let it ferment and season you

As few human or even divine ingredients can.

Something missing in my heart tonight has made my eyes so soft.

My voice so tender, my need of God, absolutely clear.

In this time of questioning, where we find ourselves often divided, even from friends and loved ones who feel and think differently than we do, try to accept and live in the cloud of unknowing. Try to move a bit closer to the other side or try to find something they share with you. It can be very challenging and just downright hard. But remember, you are both in liminal space, not truly knowing all. And if you have time: watch the film The Hundred-Foot Journey which underlines that people and cultures that are vastly different can cross the threshold and come to a place were there is not only knowing, but sharing and love.

Truly, we have no choice but to live on the threshold, uncertain of which path to take. We exist in this liminal space, a new normal that we must accept and work with so the cloud of unknowing will be transformed into one of understanding.

Thanks always to Father Richard Rohr and the art of Charlie Bowater 

Mom Lessons: How to Lead a Good Life

Mom Lessons: How to Lead a Good Life

When my mother would gaze out at the late afternoon light, the golden afternoon she often called it, (a reference to a song lyric), she often become sad. “Why?” I once asked, and she explained that she would see the fathers coming home to their families, and those moments in the day, more than any of the others, reminded her–she was doing this all alone.

My mother was widowed at the age of 34, my father dying too young, leaving her with three children under the age of six, and the possibility that she would pull into herself, wish for a vastly different situation and let sorrow and anger fuel her life.

She did not. My mother taught us responsibility, loyalty. 

Her complete love for us became her focus, her sadness more and more remote. With creativity and love, she took on every challenge, big and small. When I look back on how she raised us, loved us—there was no better role model, ever. My mother became one of the first working mothers in our neighborhood, and like everything she did, she excelled.   

She taught us the rewards of a consistent, well-organized routine—today we would say she was multi-tasking.

To pay the mortgage and feed us, she worked at home, typing insurance policies in our dining room. At night, after dinner, she did what she called “processing” of the work she had completed during the day. She would sit at a card table in our living room, pull the copies she had typed apart, sort them into neat piles. This required paper clips, staplers, pens, glue and often her signature. While doing this, she could monitor our television watching, help us with our homework, even comment on the books we were reading.

My mother taught us that all you really need for entertainment is books, art and music.

As we grew, our living room vibrated with classical music, jazz, opera, musical comedies, The Beatles, The Beach Boys…my mother encouraging my older brother to read the Schwann catalogue and order recordings from the local record store; (in college he had his own classical music program on the university’s radio station); she encouraged my younger brother to learn how to play the guitar; (after college he moved to LA and within a year was on his way to a career in recording and promoting pop and contemporary music.)   

From the moment we all could sit still, my mother read to us, shared storybooks, later colorful art books with glossy photos. When we learned to read, there were weekly trips to the library where we checked out stacks of books, my mother modeling the importance of reading for knowledge as well as enjoyment.

And there were chores. Each of us had an assignment to keep our home clean and efficient. We made up songs, created lyrics to get through doing the dishes, though sometimes those lyrics were created to tease our youngest brother. We got in trouble for it.

Our mother taught us that when feeling sad, you might try singing.

Our mother had a beautiful voice and whenever we traveled she would sing while she drove–another way for us to learn popular music and how it just made you feel good. Crayons, paper and water colors were always available in our home to encourage creativity and to celebrate birthdays, holidays or just to say thank you.   Mom loved receiving the tree and house drawing that were my staple–and the I LOVE YOU message with X’s and O’s.

Our mother taught us responsibility, and that it was wise to save money. 

All of our lives, we were witnesses to good mothering—our mother, grandmother and our wonderful aunts. They challenged us, helped us look to our futures so that we might learn to dig in, contribute to the pace and satisfaction of our shared lives. We put up storm windows, mowed the lawn, raked leaves and planted a garden. I always cleaned the house. There were days when we fell back into kid-like behavior and Mom wasn’t all that happy: found us laughing at cartoons on a Saturday morning (two of us in college) while she came stomping up the back steps loaded with groceries. She got over it. She was human too.

Our mother was frugal, always driving used cars and buying her clothes on sale. She saved money for those things that brought true meaning into our lives. Thus we had a piano, and eventually a good turntable and speakers, as well as hundreds of books and framed watercolors on our walls.

Mom, through her example, taught us how to be kind and generous.

We learned that acceptance leads to happiness, contentment, though our mother certainly felt anger and disbelief when my father died suddenly, when she had to realize that she could make her life about us, about helping anyone else who was experiencing sorrow. She replaced her sorrow with gratitude, and whenever a friend or acquaintance was ill or had died, my mother was there to provide comfort. Our mother could give—but she could also receive.

Our mother taught use to accept gifts graciously. 

The doorbell would ring and there was Gen and her daughter with a box of hand-me-down clothing for me. There was also a friend who actually worked in a toy store and once a year he’d arrive with very expensive toys in three huge boxes—one for each of us. We were thrilled.

When you accept the generosity of others, the upside is giving back. Mom always had a bag or box or envelope for the people who cleaned for us or did repairs. Thank you were two words often heard in our home. We took them with us, bestowing them on others throughout our lives.

Other gifts…

Our mother inspired our desire to travel, to experience the world. She took us on a train trip from Chicago to California. She drove us to Washington DC and back, widening our vision and future goals. She sang as she drove, love songs reminiscent of my father’s courtship days—The Man I Love, Someone to Watch Over Me, Night and Day. I watched the land flow and listened to her beautiful voice, realizing that the songs brought back comfort and the powerful memories she cherished. I will always be grateful she shared them with us.

Our mother’s gift of freedom….

Our mother never married again. When she wasn’t busy caring for us and then for her grandchildren, she continued to work as a secretary in downtown Chicago. She always loved to travel—her last trip flying to Prague in her late eighties. Everyone who knew my mother received a gift from her—a note, a letter of encouragement or a series of prayers said with her worn rosary beads. Mom’s gifts were endless and enduring and I was gifted when she allowed me to hold her weary hands as she took her last breath.

Her final gift: she taught us that we could go on living without her.

 

Why Biden’s New Ruling Dates Back to 1990’s

Why Biden's New Ruling Dates Back to 1990's

Barbara Fassbinder, one of the first health care professionals to be infected with the AIDS virus while on the job, died on Tuesday at the University of Iowa Hospitals and Clinics in Iowa City. She was 40 and had lived in Monona, Iowa. Barbara Fassbinder died in 1994. 

BUT WHY TELL ME THIS?  Because this was the headline in an Iowa newspaper that hospital staff at all levels will never forget. It was a headline that became national news and changed hospital practice. 

Because soon after Ms. Fassbinder’s death (and others that followed, a patient of a dentist in Florida etc) radical changes were made as to how doctors, nurses, nurses aids, and people who cleaned OR’s and patient rooms–anyone working near blood and body fluids would practice their skills.

Below is an excerpt from an article that eventually appeared in the NY TIMES. 

In 1986, Mrs. Fassbinder was infected with H.I.V., the virus that causes AIDS, while helping treat a patient in the emergency room of Memorial Hospital in Prairie du Chien, Wis.

While pressing gauze on a needle puncture, the patient’s blood apparently mingled with her blood through small cuts on her hand from gardening, she said in 1990. The young man died, and an autopsy showed he had AIDS. But it was not until January 1987, when she tried to make a blood donation, that she discovered she had been infected.

She and her family kept the infection a secret until she decided to speak out in 1990. “My biggest fear was how the community would react to me and my kids and my husband,” she said at a news conference in Iowa City in which she told her story in the hope that it would warn other health-care workers. The 1,500 people of Monona, a farming community in northeastern Iowa, gave her family “nothing but support,” she said at the time.

Dr. Michael Osterholm, an AIDS expert and epidemiologist with the Minnesota Department of Health who became a friend of her family, said she “helped bridge the gap between the worlds of the health care provider and the AIDS patient in need of competent and compassionate care like no one else could.”

Mrs. Fassbinder traveled extensively, talking to people about AIDS and how to prevent infection by H.I.V.. She testified about AIDS before Congress, and in 1992 she was recognized by the Surgeon General and the Department of Health and Human Services for her work. A native of Marion, Ohio, she also served on the National Health Care Reform Committee set up by Hillary Rodham Clinton and was a member of the Iowa State Commission on AIDS, Dr. Osterholm said.

SO WE ALL KNOW ABOUT AIDS, WHY FOCUS ON THIS DEATH? 

MY ANSWER, OSHA, The Department of Labor’s Occupational Safety and Health Administration. It was Mrs. Fassbinder’s death and the subsequent deaths and illnesses of other healthcare workers that revolutionized the practice of dealing with blood and body fluids in hospitals.

All of this was done to protect doctors, nurses and anyone working in a hospital from contacting AIDS. The stringent regulations offered other benefits to hospital personnel who for years treated patients with bare hands and were exposed to bacteria and viruses, which they could then pass on to other patients and their families.

THE BIG RED OSHA bags became standard use in hospitals as a way to bind up materials that carried viruses and bacteria.

When you are admitted to a hospital today, you take it for granted that anyone entering your room will be using hand sanitizer. That’s not because of Covid. That’s because of Mrs. Fassbinder contacting AIDS.

MORE DETAILS ON THE LATEST NEWS CONCERNING OSHA  (NY TIMES)

The Biden Administration, in its efforts to combat Covid 19 has tasked the United States Department of Labor with writing a regulation that will force tens of millions more workers to get vaccinated—or to produce weekly negative test results. This move will test the agency’s legal power and could draw a legal challenge. 

The Labor Department will issue a regulation requiring companies with 100 or more employees to follow the above directives….Although the agency’s ability to meet legal thresholds necessary for such a forceful intervention into the private sector remains unclear, some in the business community who’ve been wrestling with how to increase their employee vaccination rates without controversy are indicating support for the move.

Some of you reading this post will have worked in healthcare. And you know and many people who have been hospitalized and even visited an ER, know that people who work in healthcare believe in and must comply with certain health requirements.
Currently those include inoculations for: Hepatitis B, Annual Flu, MMR (measles, mumps and rubella) Varicella, Tdap (tetanus, diphtheria, pertussis) and Meningococcal. And all healthcare workers should be screened for Tuberculosis. 
Copies of the OSHA Bloodborne Pathogens standard are available from the OSHA website.
Why Biden's New Ruling Dates Back to 1990's

Why Biden’s New Ruling Dates Back to 1990’s

A Woman’s Biology: Risk and Guilt

A Woman’s Biology: Risk and Guilt

Because of their ability to conceive a child, give birth, perpetuate the species, women have for centuries been honored, sometimes considered saintly, but often buried too soon to live a full and creative life. But precisely because of this biological endowment, this ability to help perpetuate the species, women have also been treated cruelly, taken for granted, sometimes considered evil witches with powers that require control and abuse.

As a former Labor and Delivery nurse, I was fascinated by a recent article that appeared in the New York Times. It’s a personal recounting by writer Leslie Jamison of her C-Section experience, and the research she did concerning this medical procedure. (Posting this after the unethical decisions being made in Texas, only underlines the importance of healthcare for women in any situation related to their reproductive rights.)

JAMISON, A PERSONAL HISTORY  

Jamison starts her piece by recalling the words she used to discuss the birth of her daughter. “When they got her out…”

Jamison writes: “…the day after my daughter’s birth, I found myself emphasizing how much I held her, how I never wanted to put her down. It was as if I felt the need to compensate narratively for that first hour, when I wasn’t able to hold her at all—to insist that we bonded just as much anyway. I found myself exaggerating the part about the not caring if I was numb before they cut me open, when in fact I did care. I told the doctors that I would actually love some more anesthesia in my epidural…as if I were trying to make up for other kinds of pain I didn’t experience – unwittingly obeying the cultural script that insisted on suffering and sacrifice as the primary measure of maternal love.”

Jamison states that even now, 3 years later, when women describe pushing out their babies or having 40 hours of labor, she feels a pang of guilt, a kind of shame, as if her own birth story “wasn’t one that merited pride or celebration, but was instead a kind of blemish, a beginning from which my daughter and I must recover.” She then provides a fascinating history of the Caesarian section. A few excerpts: French obstetrician Jean Louis Baudelocque wrote: “That operation is called Caesarean by which any way is opened for the child other than that destined for it bye nature.”

JULIUS CAESAR–AH, THAT’S WHERE WE GET THE NAME? 

There is an apocryphal story that Julius Caesar was born by cesarean, as his mother survived the birth and went on to bear more children—at a time when it was impossible to survive a C-section. She tells us that in 1925 Herbert Spencer, a professor of obstetrics at the University College London, speculates that it “was called Caesarean as being too grand to have been first performed on ordinary mortals.” He also calls it: “the greatest of all operations, in that it affects two lives.”

But Jamison knows and we know, that for most of history, the procedure saved only one life. The mother did not routinely survive, until the 20th century, because before then, the procedure was usually deployed as a last-ditch effort to save the child, the mother dying, bleeding out, or already dead.

MACBETH, A FORETELLING  

Historically and in literature, the C-section was often associated with the imperial, with the divinity. In Shakespeare’s Macbeth, the cesarean-born Macduff experiences a birth that is an answer to a riddle: The witches have promised “that none of women born shall harm Macbeth” but in Shakespeare’s creativity, Macduff is exempt from such a foretelling as he “was from his mother’s womb untimely ripped.”

Jamison, a modern woman looking back on the history of a procedure she has experienced, makes the comment that Macduff’s exceptional birth might grant him some singular power, but such a birth also relates monstrosity. “Untimely ripped doesn’t exactly summon the epidural and the blue tarp.” Jamison knows, she’s been there.

COLONIAL AMERICA 

Of course, the early history of the Caesarean, a little used and experimental procedure, did not insure life for either the infant or the mother. But neither did natural childbirth. The baby was often fortunate if he or she survived. But in the graveyards of Boston and other parts of the New England states, where our early settlers are buried, you can often find a series of graves for a family. First is the grave of the husband, his dates, which always extend his time of life. Then alongside him are his wives—sometimes two or three. No, he wasn’t a bigamist, but when the first wife died in childbirth or from puerperal fever (see below), he married again, and if that wife died, he married again—eventually not for sex or more children, but for someone to raise his progeny, feed and clothe them, tend his garden.

THE SHAME FACTOR 

Jamison also discusses how the advent of the C-section has been used by some to shame mothers. In his book, Childbirth Without Fear, Grantly Dick-Reed inferred that pain during delivery was a lesson women needed to learn. “Children will always mean hard work and will always demand self-control.” Easy for him to say when he’s standing by the delivery table and not lying on it. 

FINAL THOUGHTS  

Jamison’s article is pivotal and for her, she worked through the angst of her fears and regrets. But the end of the article speaks truth for all mothers, no matter how we have brought our children into this world. Jamison writes: Why do we want so much from our birth stories? It’s tempting to understand life in terms of pivotal moments, when it is actually composed of ongoing processes:not the single day of birth but the daily care that follows…diapers and midnight crying, playground tears and homework, tantrums…If we are lucky, birth is just the beginning. The labor isn’t done. It’s has only just begun. 

For more information on Puerperal fever that caused the deaths of post-partum women, go here https://boomerhighway.org/living-in-the-body-part-2/

Bridget Reyes / A Little Muse Photography