“Well, everyone can master a grief but he that has it.
Everyone knows how to overcome an injury
except the one who actually has one.”
I met Elaina over a clogged milk duct in her left breast. At the pelvic floor physical therapy clinic where I work, we often treat women who are nursing their babies when a painful, swollen lump emerges on the breast. Underneath the breasts of humans are mammary glands on the front chest wall which usher milk out through the nipple via a duct system (note the awesome illustration above). When one of these ducts gets clogged for any reason, the breast will become engorged, red, and painful and the infant will not be able to suckle as much milk from that particular breast.
The treatment for the predicament of a clogged milk duct is to massage from the outside perimeter of the breast towards the nipple. Simply put, this is akin to dismantling a damn in a river and opens a conduit for less restriction along the pathway of milk into the baby’s mouth. If you’ve never milked a cow or breastfed a child, you may not know that the milk that emerges comes out of separate pores in the nipple and resembles a shower spray in several different directions. When a milk duct is clogged, the milk may only squirt out in one specific direction, or not at all.
I sat in front of Elaina and began the treatment by working the skin along the outside of her left breast. For the first fifteen minutes, absolutely nothing happened, except that Elaina’s pain appeared to be worsening. Despite this, Elaina smiled and chatted. She told me all about how she has spent much of her life making money as a food server. Some people call them waitresses, but people in the business refer to themselves as ‘servers’.
At last, some milk came out of the left breast as I massaged the area. It came out in low pressure, just two errant streams that spurted a few inches into the air. Elaina explained to me that her milk had just ‘let down’ in both breasts. This is a reflex in the body which occurs after a few minutes of the baby sucking on the nipple that facilitates a surge of milk into the breasts. This ‘let down’ occurrence is a relaxation response of the body; some women feel it and delight in the sensation, while other women don’t notice it at all. Elaina said that she felt a warm tingling during the ‘let down’ and she pointed to her right breast so I could see what happened. A small droplet of milk had formed on her nonpainful nipple, a signal that she was ready to feed her baby.
Our physical therapy session continued, as Elaina told me that one of her favorite work experiences had been in 5-star restaurants, as opposed to less elegant eateries. I asked her why. “I think I love it because there is so much preparation and behind the scenes action that goes into 5-star dining. The napkins are perfectly pressed, as well as the uniforms of the staff. Courses are plated as if the white plate is a blank canvas with the chef as the artist. Each of the plates for the diners must be placed down upon the table simultaneously. But most of all, I love working in high-end restaurants because the communication between the workers is subtle. We communicate silently, with a nod or simple eye contact, and this is key to keep the flow going between the servers.” I had never known this about 5-star restaurants and was enthralled by Elaina’s words.
It was at this point that the hard and clogged duct finally loosened and milk began squirting all over the room. The milk covered the seafoam green sweater I was wearing in a sweet-smelling shower and the excess dribbled down Elaina’s belly. This was a very satisfying moment for both of us. Together, we mopped up the milk with towels and Elaina reported that she had substantially less pain. The clog had been opened.
It wasn’t until later that evening when I was driving home that I smelled that mother’s milk again. I lifted the sleeve of my seafoam sweater to my nose and inhaled deeply. I drove several miles in the dark and breathed in that heavenly scent. It was then that a clog within my own chest broke wide open, though it was not from a mammary gland. No, my heart began to hurt with great ferocity, as though its delicate lining, known as the pericardium, was detaching itself from the four-chambered organ which pumps blood throughout the body.
I had lost a dog just a few weeks earlier. The dog that died was the first I had ever owned as an adult. His name was Ruben and he had been my steadfast protector for over twelve years. Ruben was a stunning, 19-pound little guardian of my body and spirit. When I was forced to bring him to the vet to have him put down, I was bereft. But nobody knew that. I didn’t even really know how sad I was. I went through each day telling myself and everyone around me that I was fine. I was perfectly fine. People die, dogs die, and I had seen enough of that to be able to accept this reality of the world that I knew.
It wasn’t until I smelled the milk of Elaina on my sleeves that I realized how sorely I missed Ruben. The grief came heavily once I opened the door to its ghastly presence and it startled. I thought I had already surmounted this loss. But just as William Shakespeare said, “Everyone can master a grief but he that has it.” I wasn’t mastering this well. It was high time that I admitted it.
I shucked off the seafoam green sweater when I got home that evening, folded it and placed it on the top of my dresser. I got on my couch in pajamas and did the worst thing that anyone with depression and grief possibly can: I logged on to Social Media. I scrolled through images of my friends and family rejoicing in their lives, when suddenly, an ad for a pet adoption agency crossed my digital path. There was a picture of a small, spotted, black and white dog, a chihuahua mix. My pericardium was still pulling away from my heart with sadness, and yet there was something about this dog pictured before me. I filled out an online application for this spotted dog, knowing full well that she had probably already been adopted. Furthermore, anyone who has attempted pet adoption knows that this is typically a VERY long process. It is understandable that the people who run such organizations want the animals to be placed in good hands. But pet adoption agencies require such intense scrutiny of the humans and stop short only just before the endorsement from a Cardinal of the Catholic Church to adopt a dog. I am neither a Catholic, nor one who believed on that evening that anything would ever come out of this adoption application.
I didn’t want to wash that seafoam green sweater after it was covered in breast milk. But I realized that the smell of the milk had worn off the next morning. I put the sweater in an LG washing machine and watched as water covered it in swirls. I climbed up the stairs from the basement to hear my phone vibrating on the kitchen table. It was an unknown New York number. The woman who spoke into the phone ran a foster-adoption group for dogs. She was calling me merely twelve hours after I submitted the application for the spotted dog! She asked me a series of questions to judge my moral character and thankfully did not require a representative of the Catholic Church to deem me a good person. I met the little dog Maggie and brought her home less than a week later.
I recognized how much Elaina had endured with her clogged milk duct. She was trying to nurse her very first baby when this problem had come home to roost. She felt like she had failed her little son and that she could not give him the nourishment he deserved. Elaina had asked her friends about how to cope with her pain, she had searched online for solutions. But it was just as Shakespeare keenly observed: “Everyone knows how to overcome an injury except the one who actually has one.” It was Elaina alone who had to struggle with her clogged milk duct. And she was doing it so bravely.
Elaina is now considering a new vocation of becoming a lactation consultant. This will allow her to help other mothers who are having difficulties with breastfeeding. There are a lot of such mothers out there and I can think of no better person than Elaina to assist them along the way. Because she has known this injury. She understands this disappointment and pain. And because of Elaina and the smell of her mother’s milk on my sleeves, I was able to answer a call to new life.
This is the power of mother’s milk. Nursing a baby is very similar to serving food in a 5-star restaurant. There is a silent exchange between the suckling of the baby on the breast; this signals the brain to encourage the ‘let down’ of the breast milk, thereby providing full nourishment to the infant. It is the quietude between the mother and child which creates the best meals, a subtle swap of energy where words are unnecessary. My time with Elaina allowed me to quietly witness the wonder of breastfeeding. I relish in the idea of Elaina becoming a new kind of server.
As a lactation consultant, Elaina will provide authentic and luxuriant meals for her babies and countless others as she shows the world how to breastfeed with panache. I am certain that Elaina is already a very attentive and clever server; but now, she will become a server par excellence. Those beautiful mammary glands depicted in the illustration at the beginning of this story are flowery communicators of information. Much like servers in a 5-star restaurant, they rely on a glance, a nod, the gentle stimulation of the baby’s lips on the nipple to bring forth food. Only in this case, the uniforms of the servers will not be perfectly pressed. Instead, Elaina’s uniform will be drenched in milk. The other mothers will learn from her, they will allow their bodies to unwind without words. Their grieving and worries will be shed, and they will sit down to a stupendous dining experience at last.
Max weighed less than 10 pounds when he met his humans. He was merely a 4 week-old puppy back then. But because dogs do not understand their own age, weight or the passage of time, these things were not on his radar. Instead, Max paid attention to the home in which he was placed. There was carpeting underneath his tiny paws, a lively human woman who cooked things on a skillet and a few other humans whose feet he noticed as they walked by him. But there was one human who came to the house infrequently who really made Max stand up and pay attention. This human smelled of testosterone. He must be transitioning from a boy into a man, Max figured, because that hormone was potent in this human. He also gave off a scorching energy – this human had a raging fire underneath his skin. When Max leapt onto the lap of this particular human, the dog became suddenly aware of something breeding under the human’s left thigh. It was like a bunch of black fleas, clustered together on a bone. Max nestled himself onto the lap of the human, and felt scared, angry and emboldened to do something about the black spot on his human’s bone. Yes, Max decided: this one is MY human! Even if he rarely comes by, this is the person who I must protect.
Richie the human spent two years in a hospital for cancer. From age twelve to fourteen, Richie lived in a small room on a hospital bed, with another twin-sized bed for his mother to sleep upon. The osteosarcoma that tore through Richie’s young system destroyed his left femur bone. There was a brilliant physician, a young doctor who loved to throw cancer on the floor and stomp upon it, who took on Richie’s case. This doctor removed Richie’s left thigh bone and replaced it with a metal apparatus which resembled the same bone which had become rotten by cancer. But that wasn’t all: Richie needed cycles of chemotherapy which lasted the two years that he spent in the hospital.
Richie was only allowed to go home on occasional weekends. On his first weekend back from the hospital, he met the dog Max. Richie and Max bonded immediately. But what happened when the human came home from the hospital was that his body responded to the new environment with a raging fever (this was the scorching smell that the dog sensed without a thermometer). Richie usually left his home within 36 hours after arriving, leaving Max behind. Neither being had any choice in their circumstances then. So, they both waited to be reunited. They had their occasional weekends over the span of two years. But that did not weaken the bond between the dog and his human. Max paced and waited for Richie to return.
At the age of fourteen, Richie was released from the cancer hospital. Those dark fleas that had infested themselves in his bones were now gone. Richie had a brand new femur made of titanium. When Richie returned to his home, Max never left his side. Richie trained Max to stay close to him and not run away, as the human could not run after the dog with his new metal femur. The dog knew all of this, and never strayed away, no matter what other distractions were around. A few years later, Richie met a girl in school. Her name was Hillarie. Richie dated Hillarie for several months and figured it was time to introduce her to his family. But Richie’s relationship to his high school sweetheart came with a contingency: “I really like you, Hillarie. But I have this dog Max. He and I are very close. And if he doesn’t like you, I am not sure that this is going to work.”
It was a celebratory time, when this human couple knew a great passion of theirs would be realized, with the food truck. And the dog Max was elated. He loved his new human Hillarie (she bought him really good food and he really loved sleeping in bed between his two humans). But there came a day when Richie was grilling outside and Max was next to him, when something terrible happened. Richie tried to climb stairs to get more ingredients for food and he fell suddenly, as he grabbed for his left femur. Max felt great fear. Hillarie sat down on the steps and cried human tears. Loud sounds and flashing lights brought big men to lift Max’s human onto a metal thing with wheels and they took him away.
But then one day, Hillarie left the house. She came back home with Richie! He was walking with these long metal sticks. Max did not like these sticks. Not at all! But that did not stop him from jumping all over his human. Richie finally sat down on a chair. Max catapulted his tiny body up onto the chair and immediately sniffed his human’s left thigh. There were no black fleas infesting the bone. There was a new smell of a different type of metal, but it was not dangerous.
In human medical language, Richie’s original titanium femur that was implanted when he was 12 had shattered when he was grilling outside with Max. This was because the human had been walking on it for the last decade and it had not been able to endure the stressors that working as a chef, or living in general, would place upon it. After this most recent fall, Richie was immediately sent back to the brilliant physician who had fabricated the initial femur; this same doctor created a new femur made of cobalt chromium. Richie is responding beautifully to his new bone and there is no return of his osteosarcoma.
Max is now eleven years old. He remains intently vigilant on the well-being of his humans. At merely 10 pounds in size, Max is entirely convinced that he is the caregiver of his family. Hillarie is actually taking care of everyone, though she would never tell that to Max. Richie has decided to keep his food truck, despite the major physical setback that occurred just as he purchased it. Some dreams cannot be smothered in the wake of adolescent cancer or a fall on the steps. These stirrings of life must keep going. Just as Max waited for Richie, through all of the absences and the sickness, some creatures watch us and wait for what lies in store for us. They know the weight of our vision, even if they only weigh 10 pounds.
There is an older woman from India who lives in a senior building in Perth Amboy, NJ. Her name is Razia and she is very organized in how she keeps her surroundings. Razia’s home smells of lemon rinds, cardamom, and freshly baked naan. Not only is Razia’s apartment lovingly kempt, but the entire building within which she lives is stunning. It is a newly constructed edifice with huge windows, tall ceilings, dove grey walls and exquisite architecture.
As a homecare physical therapist, I have been to many senior buildings. Senior buildings are apartments for those aged over 55 years. Many of the ones I have visited have industrial brown carpeting in the hallways, broken elevators (in spite of the fact that many residents cannot climb stairs because they are older and infirm), and in one of them, the inhabitants use stolen supermarket carts to get items to and from their apartments. This makes for a traffic jam of carts between the hours of 10 am and 2 pm, as residents attempt to get belongings on and off the elevators that are actually working!
Razia’s senior building is nothing like this, however. I am glad for my patient, that she has the luxury of living her life in a placid building with sunlight in every corner of her personal and community dwelling. It was on a Wednesday that I came to see Razia and suggested that she climb a stairwell. While Razia lives in a building with two well-functioning elevators, I knew that she wanted to visit the homes of her two daughters and grandchildren, so stair-climbing was important to her future.
Razia and I entered a stairwell which led up to an atrium. There were windows which spanned the sky at the top of the stairs. I instructed her on how to use the railing and her cane and Razia did a splendid job. It was not until we both arrived at the top of the stairs that we witnessed the snow. It had come out of nowhere. Swirls of snow circled about the window. Razia neared the closest window and placed her fingers upon it. She leaned close to the glass and her elated breath fogged the space near her mouth and nose.
Earlier that day on the news, I had heard that a snow squall was on its way. I had no idea what that meant. Until I watched Razia that afternoon, who was spellbound by the rapture unfolding before her. There were blustery winds that we could not hear, every window captured a view of the heavens, it felt as though we were surrounded by snowflakes. They whirled and they encircled us.
“Do you like snow?” I asked Razia, as we stared at this blur of white energy. She shook her head no. She then whispered in reply. “But I do like this…” Razia and I were within a snow globe. This Indian woman who did not like snow was enchanted by the feeling of being in one of those magical glass knickknacks that she had likely never known as a child growing up in India. I had seen many snow globes, but they had never really charmed me, not until now. I had to peel Razia away from her snow gazing and return her to her apartment. “You should not go home yet. It may be dangerous to drive,” she cautioned. I assured her that I had another person to treat in the very same building and scurried downstairs to my next patient.
He was a round man from Puerto Rico. I entered his apartment as this man sat in his wheelchair, strumming his guitar and playing folk music. “You are playing the Musica del Campo!” I exclaimed. (This translates as the Music of the Country). Jose replied, “This is because I am from the Campo! My grandfather sang this song to me!” Behind Jose was another enormous window with snow blinding the view to the outside. I encouraged him to turn his wheelchair around to look at it. “Oh, no!” He shouted. “It is a blizzard! This is going to leave a terrible mess! I have a doctor’s appointment scheduled for tomorrow. How will I ever get to it?”
Alas, Jose was not nearly as overjoyed by the snow as me and Razia. Still, I brought out Jose’s walker as he arose from his wheelchair and stood. Jose could not yet walk after a long hospitalization which rendered him weak, but the standing was still a victory. Together we stood in front of the snowy window, as I helped Jose get up and timed his ability to stand while using his arms on his walker. After four bouts of standing, Jose was able to maintain an upright position for 70 whole seconds. I grinned at him with encouragement. It was at that very moment that the snowfall ceased. It stopped as suddenly as if an angel overhead had hit a light switch into the off position. And when the snow stopped, there was only the faintest of coating of white on the ground and rooftops, as the sun peeked through the clouds.
“How did that just happen?” Jose asked me, his eyes large and astonished. I had never seen anything like it myself. Apparently, this was not a celestial happening. It was merely a snow squall, a common weather event. However, I had been with two other people who had never seen one either; and we three happened to be safely cocooned in the perfect location when it happened. We were together in a snow globe. Safe, contented, warm and able to observe the beauty of this quirk of Mother Nature as children do.
As I left the senior building, I hurried home to take my dog Ruben to the veterinarian, located near my house in Sayreville. I had chosen a new vet because my dog was having trouble walking. His hind legs were not keeping up with him, even when I bought little traction booties to help to stabilize him (for the low, low cost of $25). Ruben’s previous vet had been fine. I just wanted a second opinion on why he had stopped walking. Was it arthritis? Did he need glucosamine for his joints? But the bigger problem I was grappling with was my own guilt; I no longer walked Ruben on a leash and simply let him outside in the fenced-in yard. Had I created laziness in my own dog? In my line of work, I tell people that they have to get up and out of bed or they will wither and die. If I allowed that for my pet, then I deserved the humiliation that I was experiencing.
The temperature was rapidly dropping. I pulled up outside this vet’s office and noticed that the walkway was covered in coral-colored salt crystals. The pattern the crystals made was winding and led up to the well-lit front door of the establishment. I picked Ruben up and carried him inside; he looked upset with me. Why had I taken him out on this night of bitter cold, his eyes asked?
I was brought into a private treatment room to wait for the new vet. He was kind of famous in town. All of my homecare patients used him for their pets. “Go to Dr. Spin,” they said. “He is the best.” After a few short minutes, Dr. Joseph Spinazzola entered the room. He had that presence of someone completely comfortable with people and animals. He reached to touch Ruben’s head and the dog bowed his head accordingly. It was in that simple exchange that I was certain that everything was going to be okay.
Throughout the process of Dr. Spin’s examination, he spoke and asked questions with the utmost of concern. He bravely opened Ruben’s mouth and placed his fingers inside to examine the teeth and gums. He listened to Ruben’s heartbeat as my dog began to wag his tail. Dr. Spin stretched Ruben’s back legs behind him individually. “If your dog had arthritis, this would hurt him. I do not think that is why Ruben stopped walking,” Dr. Spin told me.
He then waved me closer to the treatment table. “Check this out. You are a physical therapist, so this will interest you.” Dr. Spin took Ruben’s right hind paw and flipped it over, so that the upper side of the paw was now bearing weight against the table. Ruben quickly corrected the position of his paw. Yet when Dr. Spin tried this on the left, Ruben did not realize his paw was in the wrong position and it remained there.
“Your dog does not have arthritis at all,” Dr. Spin calmly informed me. “There is nerve damage on the left side. It is likely coming from a problem in Ruben’s spine. And as you know, nerve damage is irreversible.” My face fell. Dr. Spin shook his head. “Did you hear what I just said? This is not your fault. Taking him on walks would not have prevented this. Your dog is thirteen years old! The fact that he looks this good is remarkable. I just want to double check the heart medications that were prescribed by your last vet one year ago.”
Dr. Spin picked up the file that had been faxed from the previous vet. He had a perplexed look on his face as his eyes scanned the paperwork. This was followed by a sudden smile. Then, Dr. Spin calculated the dog’s weight versus how many milligrams of diuretics he should be taking. He did this all out loud! I tried to follow along with what he was saying, but it was impossible. I could, however, see small mechanical gears turning in the doctor’s head; his mind was a series of well-oiled cogwheels, it was as flawlessly smooth and orderly as that child’s toy Mouse Trap when perfectly assembled.
Dr. Spin quickly rubbed his palms together. “We are changing the dosage on your dog’s heart medications. And lucky for you, I have these same medications in the back room. I know they are not cheap. These meds were donated from the owners of previously deceased dogs, so I will not charge you for them.”
Much like his mind, Dr. Spin moved very quickly. He ran into the back of his office to secure the medications and rushed them up front so that a vet tech could measure and label them for Ruben. Dr. Spin had spent close to one hour with me and my dog. He charged only $150 and the value of the donated heart medications equaled over $200. (This vet had also shaved and cleaned out Ruben’s ears. This was an incredibly good price). But money was not my primary concern for this particular appointment.
Over two weeks have passed since the snow squall. I look at Ruben as he tries to walk on the floor. Somehow, it seems easier for him. I am finished treating Razia, as she has improved to the point where she no longer needs me. I still see Jose, and he sings the Musica del Campo. A different song each day. Some songs are about broken hearts and suffering, some are about the beautiful sunshine of the land of Puerto Rico, and none of them are about snow.
Yet Jose still talks about the snow squall. Even as a guy who is not a fan of Northeast winters, he acknowledges that there was something surreal about it. I think of that afternoon in the snow globe that we shared. I will always remember the look on Razia’s face. She had seemed so much younger during the squall. Perhaps we all had. I recall the coral salt crystals arranged in a winding path that led me to help from just the right person. Dr. Spin had been part of that glorious day. Since then, Ruben seems younger. Perhaps it is because he sensed the protection of being around someone who allowed him to feel like a puppy. Much like my experience in the snow globe of a senior building, we had all journeyed back in our lives, with the wonderment of children. All because of a sudden tornado of snow that enveloped us in deep happiness.
I have since opened the door to the main office at the entry of this senior building. I inquired about the requirements of residency there. It would be a great place to live, I figured. I would have very cool singing neighbors from Puerto Rico. But the cheerful young woman in the office informed me that I would have to be at least 55 years of age to move in, and I am too young. Now that I ponder this, it seems fair. Beautiful buildings that resemble snow globes should not be reserved for the young. Razia, Jose and Ruben the dog have earned their right to be cherished, nurtured and surrounded by brightness because of their age. We as younger caregivers have the responsibility to allow them to feel this way. It is just as Dr. Spin said: “Anything can happen. Just take Ruben home and love him.” It is reassurance that keeps those alive who can no longer walk, it keeps them singing during the storms of life and it widens their eyes to watch the snow fall, while in their eighties, as if for the very first time.