Let's hear it for the Faj!

About 25 years ago, I was sitting in a university classroom at the beginning of my training to become a physical therapist. There were under fifty students in the class and we were thrilled to embark on our professional paths. There was the typical fanfare of inspiration from the professors who boosted our sense of excitement. Yet there was one professor who quieted and humbled the room when he said, “You are all likely here because you want to help people. That is a noble goal and purpose. But I would like to remind you that your average sanitation worker will help thousands more lives than any of you ever could. Furthermore, sanitation workers are not awarded the respect that most of you will receive as physical therapists, nor would they classify their career choice as a helping profession.” This was back in the days when nobody brought laptops to class, only notebooks and writing utensils. The classroom fell silent after this statement; one could have heard a Bic pen fall to the floor.

I have treated many sanitation workers since then, for various injuries they sustain in their line of work. Many of them have strained backs from lifting garbage containers and twisting their spines to empty those bins into the back of the truck. Others develop tennis elbow, which is searing pain on the outside of the elbow, which renders grasping anything with one’s hand an exercise in pure torture. The reason that sanitation workers get tennis elbow is because of the repetitive motion of grabbing the handle of a garbage can and then turning the wrist to upend the can. Also, think of how many sanitation workers you’ve seen holding that slender metal pole on the side of the truck as they stand on the back of it when riding between houses. This necessity of the job would worsen the symptoms of tennis elbow.

There is one sanitation worker in particular who stands out in fond memory. His name was Fajri. I treated him in 2007 and he was a sanitation worker for the city of Newark, New Jersey. Fajri had sustained a very unique injury. He was removing garbage from a curb and there was a large, broken mirror in the rubble. This mirror sliced open Fajri’s right tricep muscle and he required surgery to mend the severed tissue. It was a few weeks after the surgery when I met him.
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​Fajri was of medium build, he had black skin and a well-shaped beard. He often came to the physical therapy clinic dressed in his uniform after a shift in high summer, dripping with sweat. Fajri was married with two kids. There was nothing striking about him, when I look back. But he had this remarkable presence, there was something special about the way he strode into a room which commanded attention.

After his injury, Fajri displayed tricep weakness, as well as numbness and tingling in some of his fingers. This made sense, because the radial nerve runs through the tricep muscle and supplies sensation to the hand. The physical therapy treatment involved strengthening Fajri’s shoulder, elbow and wrist, as well as doing soft tissue work along the scar where the surgeon had reattached his muscle after the mirror had cut it.

Fajri was progressing very well and the strength in his right arm returned. He was seen in the physical therapy gym, lifting weights and singing along to the radio. I often ate lunch with a Physician’s Assistant who also worked in this clinic. Her name was Heather and she had red curly hair. Heather didn’t seem to enjoy working in Newark, due to the rampant crime in the area. She was often sparing of words as she chomped on her spinach salad at noontime.

​Yes, Heather was sparing of words. Until we talked about Fajri.

“What is it about this guy that is so unusual?” I asked Heather.

“I agree with you that he is most unusual!” Heather exclaimed. “When I think of a garbage collector, I don’t usually think of a guy with such intention, such charisma. But when The Faj walks into this office, I can feel his powerful sense of duty.” It was from that moment forward that we began to refer to our patient as The Faj.

The Faj was doing beautifully after his injury and was back to working full-time. But he continued to report an irksome symptom. “My fingers are tingling all day long. I cannot stand it! Is there anything else we can try to make the tingling go away?” He begged. I spent a lot of time working on his right upper arm and stretching the nerves that ran into his hand. Despite this treatment, the tingling in The Faj’s right hand would not dissipate.

I became so frustrated by my patient’s lack of progress that my mind returned to the classes I took at the university. I remembered the professors who gave us difficult case studies so that we could problem-solve and help patients who were not responding to the traditional treatments. It was on one fine morning when The Faj came strolling into the clinic that it hit me. The nerves that lead into the hand originate in the neck! If I treated his neck instead of focusing on the tricep muscle, perhaps The Faj could get some relief from the tingling in his fingers.

He lay face-up on a treatment table and I worked on the vertebrae within his neck. We had the best conversations during those sessions. The Faj told me about the birth of his two sons, about how his mother had literally died of a broken heart when one of her children was killed in a drive-by shooting in Newark and how much he enjoyed collecting garbage and cleaning the streets of the city. In time, the tingling in his fingers subsided.

The Faj was amazed at his recovery. “How in the world did this happen? How exactly does you pulling on my neck stop the tingling in my fingers?”

“I was so overly focused on the mirror injury in your arm, that I neglected to see if you had an underlying neck problem. I was chasing after a red herring,” I replied.

The Faj had never heard the expression of a red herring. I told him that a red herring was a false trail, something misleading or distracting. He absolutely loved this turn of phrase and for his final sessions of physical therapy, he entered the clinic, rubbing his palms together with vigor and announced, “We are going fishing today, my lady!”

In thinking back on this story, the university training given long ago allowed me to help The Faj. But is also provided a very valuable lesson, as stated by that one professor who stunned a room full of enthusiastic new students. I would like to remind you that your average sanitation worker will help thousands more lives than any of you ever could.

Now, in the present state of the world as we humans are forced to confront the coronavirus, those professor’s words ring truer than ever before. Sanitation workers are not only up against the multiple musculoskeletal ailments which will befall them at some point in their careers. These days, sanitation workers are the people who are as close to the cells of COVID-19 as anyone can get. They work to remove garbage from our homes, jobs and streets. They work to protect us from the spread of this dreaded virus, all while placing themselves directly in harm’s way.

I am not sure if The Faj is now retired from his job, receiving his well-deserved pension. But I still imagine him in his uniform, proudly ridding the city of trash, leaving the streets clean and safe. I pray for his protection and the protection of all who perform this essential job during the outbreak of COVID-19. They are helping more individual people than MOST of us ever could. Let’s hear it for the sanitation workers! Let’s hear it for THE FAJ!