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!
I met the great Katrina Rolnik while pushing a wheelchair into her grandfather’s room at the nursing home. My patient Henry was sleeping, but his grand-daughter arose from her seated perch at the foot of his bed. She was diminutive and just under five feet tall. Yet her personality was anything but small. Katrina introduced herself and shook my hand. Her two younger brothers were there, and she commanded, “Get off your cell phones. Grandpa’s physical therapist is here to speak with us.”
I explained to Katrina and her disinterested brothers about their grandfather’s rehabilitation plan. We will give him lots of therapy, I promised. Several hours a day. He may not like so much activity, I said. Most people over ninety do not enjoy being pushed to move.
“That is not my Grandpa,” Katrina told me. “He used to get on a bus to Atlantic City to gamble once a week. He was very active until two weeks ago. That is when they diagnosed him with leukemia. But I know he can get better.” At this declaration, Katrina’s grandfather Henry opened his eyes.
“There she is, Katrina,” Henry said. “That Blondie. She keeps disappearing on me. She comes in my room and then flies away like a bird.” I was embarrassed to concede that this old man’s assessment of me was correct. Earlier that day, I had reviewed his medical chart, gone in to introduce myself to him, and then abruptly left to assemble a suitable wheelchair for my patient. It had taken an hour to do this, as the leg rests, cushions and various sizes of the wheelchairs in this nursing home were kept in a jumbled mess in the basement of the building. I had finally been victorious in my quest, so before I went to lunch, I popped in to tell Henry that I did have a wheelchair for him and would be bringing it to his room in the afternoon. Meeting Henry’s grandchildren had been my third visit to his room in one short day.
Henry was doing splendidly in rehab. Until the day that he wasn’t. Katrina had taken that afternoon off from her waitressing job. She was working to pay her way through college. Yet Katrina was always in the nursing home. As a woman in her early twenties, I found this to be unusual, as was her admonishment of her brothers to get off of their cell phones to listen to a healthcare professional. This was not representative of my opinion of millennials.
On the afternoon when Henry was no longer his usual self, he turned to me and said, “No exercise today. I do not want to do this anymore.” I pushed Henry into the garden adjacent to the rehab gym. Katrina followed, her tiny legs keeping up with my strides. The sun was magnificent that day. Morning glories bloomed on a trellis. Henry squinted, so I stood in front of him to shield his eyes with my shadow. Katrina looked at me quizzically. She was alarmed. The three of us sat in the quiet of the solar beams which enveloped us in our confusion.
I knew exactly what was happening. Henry was ready to die. A few days later, I walked past Henry’s room. There sat Katrina, in her constant vigil. She was weeping. I walked into the room and saw Henry’s chest rise and fall rapidly, his mouth gasping for air, like a guppy. Katrina’s beautiful Polish nose was red. “He is disappearing, Blondie. Only he won’t come back, like you did with the wheelchair. He is leaving me forever.”
I had witnessed death several times in this line of work, but I did not know how to help Katrina in that awful moment. Katrina stayed for the next several days, she slept upright in a chair and only went home to shower. It was early one morning when Katrina was gone that Henry slipped away.
When it comes to dying, there are only two kinds of people in this world. The first kind waits until their favorite nephew flies in from Knoxville, Tennessee before they take their last breath. The second kind of person waits until no one is left in the room. Henry was this kind of person. He did not want his grand-daughter Katrina to carry the image of his death with her.
I read Henry’s obituary. He was buried in a plot with his wife. She had died over forty years ago of uterine cancer. Henry had summoned such strength through not only war, but the loss of his true love. Having known him only a short while, however, none of this surprised me. There are some people who can survive as a Polish Jew under Nazi rule and are determined to live in the particular kind of grace that he had chosen.
Almost one year after Henry’s passing, I ran into Katrina at a restaurant where she was a waitress. I was sitting down in a chair and Katrina was standing while taking my order. She seemed so much taller than I remembered. So much older.
I often wonder of the mark that we leave behind in this world. The indelible essence of who we are and who we become throughout life. I really have no doubt that we do leave our fingerprints here as I remember the completion on Henry’s face, when he looked at Katrina before he died and sighed with unbelievable happiness, “I still remember the day you were born.”