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.
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!
Some things in life are easy to describe. I have a friend named Jessie. We have worked together for years. At first, it was at a physical therapy clinic in New Jersey. Jessie ran the front desk and made sure that the scheduling and insurance authorization ran smoothly. I later convinced Jessie to apply for a job in the nursing home wherein I worked. The nursing home was a slipshod organization; I was not sure if Jessie wanted this job, but I felt that I needed her. The nursing home needed her more. When Jessie accepted this position, everything changed in that place.
Jessie’s job description was to coordinate the care of the elderly for their rehabilitation needs. Not only did Jessie perform these requisite duties, she also adored the residents of the nursing home. When dropping off printed information to each of the four nursing stations at this place, she was found helping residents getting dressed, she lifted them on and off toilets, and she pushed patients in their wheelchairs to her desk and talked to them while she did her computer work. These qualities in a person like Jessie are easy to write about.
This day was somewhat different from the other days that we worked at the nursing home. This day is harder to describe. The patients had awakened earlier, even the ones with dementia. It was as though they knew that something unusual was happening. The nurses were taking extra time with dressing and grooming the residents. By 9 am that morning, the residents had a look of thrilled anticipation, as they sat in circles in their wheelchairs.
It was around that time, in late morning, that droves of families entered the building. Jessie and I had never witnessed this before. People pulled up in SUV’s and carried trays of turkey, mashed potatoes, pumpkin pies, yam casseroles and they set up their Thanksgiving meals in the Dining Hall of the nursing home. As a staff, we had never before seen such attention paid to the residents.
Jessie is an avid football fan, but primarily of the New York Giants. She rushed around to each of the four wings of the nursing home and ensured that football was on every television. We brought the patients to the rehab gym and blasted Chubby Checker, while they walked and exercised and their families watched in awe. Jessie and I ate a Thanksgiving meal made by the cooking staff, after we were finished taking care of everyone.
That was year one of our Thanksgiving tradition. Jessie and I worked together on this day for the next two years. We grew to look forward to it. There were great-grandmothers who held infant relatives for the first time. Toddlers wandered down hallways and banged into wheelchairs, they were picked up and consoled. Middle-aged men shouted against referee calls in football. The cooking staff of the nursing home took great pride in their green bean casserole recipe. Families offered their food to other residents and brought the food to their tables (for residents who had no family at all to visit).
This next part of this story is even more difficult to describe. It was after our third Thanksgiving together that Jessie was involved in a motor vehicle accident. One of the vertebrae in her neck was shattered. Thereafter, everyone in the nursing home asked how she was doing. I never answered them, because I did not know how she was doing. Nobody knew. Not even the doctors.
Jessie had become paralyzed and could no longer walk. She needs a wheelchair to get around now. Jessie also needs a caregiver to address her physical needs. This came as a shock, as this is the same woman who helped others to address theirs. Jessie used to help diaper people. This was never her job. But she did it anyway, because she has a fiery heart and refuses to allow others to ask for help. She just gives it, without question.
Jessie lives a few hours away in Pennsylvania. I think about the losses that we have sustained. We have lost most of the elderly patients we cared for. Jessie has lost her ability to walk. It seems all too easy to fixate on these very hard realities. And these things are quite real; they cannot be reversed. Just as the old people in nursing homes without families cannot be soothed by some green bean casserole made by the staff.
But here is the thing that sustains the holiday of Thanksgiving: there are families who welcome the ones without families to their tables. The clamor of the preparation and dressing of the elderly in their finest clothing for this holiday is important. When Jessie changed the channel of the televisions so that our patients could watch football, she changed everything. Jessie created a holiday, in a place known for a lack of celebration. I will be with my family this Thanksgiving, and Jessie will be with hers.
I miss my nursing home Thanksgivings with Jessie. I miss the woman who made a festival out of nothing at all. When I smell turkey, I remember Jessie hurrying around to push patients in their wheelchairs, so that they could find a piece of joy. Jessie made everyone feel like family. While the New York Giants may not be doing their best lately, I thank the Master of the Universe for football, for crying toddlers who crash into wheelchairs, for the very old people who teach us everything we need to know, and for the Jessies of the world.
There are few people in the world like Mary Frenkel. Maybe there are more than we know, but in the walls of a nursing home, Mary stood out among the rest. She moved in and quickly covered her twin sized bed with paper towels, bottles of baby powder, jewelry boxes, zipped bags of cosmetics and plastic icons of the Virgin Mary. There was so much stuff on that bed that she could not have slept upon it.
Instead, Mary Frenkel had her red velvet recliner delivered from her own living room. She sat upon it, a queen in her own world. This was unusual, for a person recently admitted into long term care. I came into the room of Her Majesty, and asked her how she planned on living in a chair. This would not be good for her health, I told her. Mary held a rescue inhaler to her lips. She puffed from it every few seconds and peered at me with scorn. Her eyebrows were perfect. Were they penciled in, I wondered?
I left her room that day and did not think much of Mary. Until the day I had to return and initiate a walking program with the resident queen of the nursing home. I had learned that the Fire Marshall had come into our place and declared Mary’s room to be a fire hazard. The queen had screamed at this portly man, and he had run away in fear.
Mary had a cell phone. This was an unlikely commodity in a nursing home. Most patients had push button bedside phones, with the extension of the nursing station typed in bold lettering, so that patients could call if there was an urgent matter at hand. Mary bypassed all of this. She used her cell phone to call the nurses station. She left a voicemail every 15 minutes, with the message, “This is Mary from Room B6. I cannot breathe. Send a professional into my room immediately!” When this was unheeded, Mary called the front desk of the nursing home to speak with the receptionist.
Mary had a condition known as Chronic Obstructive Pulmonary Disorder (COPD). This caused her difficulty in breathing and swelling of her legs. The swelling became so significant that she was prescribed a diuretic, so that she might pass out the fluids that were filling her body. Now the queen really had something to complain about. She was incontinent of urine.
I came to her room, in the hopes of giving her some physical therapy. She needed to get out of her chair and walk, so that her muscles could pump all of that excess fluid back to her heart. “I will now allow you to work with me, you cheery little girl! Take me to the bathroom,” the queen declared. I complied with her suggestion, as I needed to keep my job and produce some actual results for this woman.
Mary and I walked to her bathroom with her rolling walker. She huffed and she puffed, but she got there. She plunked herself down on the toilet and caught her breath. I am not sure how long we sat there. The queen looked down at her fingers. She told me that she had been married five times. The first was for love, but he had been an alcoholic. The second was for property; there had been a nice farm. The third was for a chain of grocery stores. I tuned out the rest. Instead, I looked at all of those glistening rings on her hands, as she urinated for what seemed like hours.
Mary finally returned to her red velvet recliner with my assistance. She took three puffs on her inhaler. “Perhaps you are not the woman I judged you to be. A happy woman would not work in this place. You must have something wrong with you. Whatever it is, you don’t have five husbands!” And she laughed, Mary laughed so hard that I had to put oxygen on her face.
I look back on the queen on the nursing home. I wish I could say that she lived to rule the house and continue to scare the Fire Marshall. But her reign did come to an end. What I do hold close to my soul about Mary Frenkel is that she lived according to her own rules. She married several men, she called her staff four times an hour from her cell phone, and she demanded the very best care towards her end. Isn’t this what men have always done? So, why not women?
I often joke with my coworkers about this story. While I hope that I will expect and demand the best for my own care as long as I can, I worry about becoming incontinent, like Mary. Will I require the Leaning Tower of Kotex when I am old? My friends assure me that I will not. They say that because I am a Pelvic Floor Physical Therapist, I can avoid this. I believe that I can. On a larger scale, I believe that women will live very long and very well, with as many husbands, diamonds, and thrones as we choose. A new reign has come.