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!
“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.
I am one of seven children. Both of my parents are still living. They have two boys, and they had five daughters. The eldest of the clan, named Amy Ironside, left us in July of 2015. It was a startling thing for everyone. We each reacted differently, as do many people in the wake of a death out of sequence. No one is supposed to predecease one’s parents. Amy’s departure disrupted the natural order of things. Some of us clung together with ferocity, others pulled away.
Two months after Amy’s passing, I went on a trip to Portugal. I was numb to what had occurred within my family and tried with all my might to push it out of my mind. On the beginning of this trip to the Iberian Peninsula, I was blind to the rugged beauty of a fishing town along the Atlantic. There just so happened to be a local feast in this village. These elaborate celebrations are meant to honor the local patron saint of each town. This particular feast celebrated Our Lady of Encarnacion, the saint of the village in which I visited. I was unprepared to witness the townspeople carry enormous wooden statues of the Virgin Mary, Jesus, and Our Lady of Encarnacion through the streets. Men in dark suits held these statues high above their heads, a local priest reared the front of this parade, and little girls wore the exact clothing of the patron saint, as the procession wound through the main thoroughfare of the village.
I learned that this pink flower blooms only in early September. It is a member of the amaryllis family and is called meninas por escola by the Portuguese people. This translates into English to mean “the girls go back to school”. The history behind the name for the flower is that in many Catholic countries, girls often still wear pink uniforms when they attend school. Portugal is a very Catholic country. And these pink flowers bloom only in September, the ‘back to school’ month for many people throughout the world.
Amy has two daughters. She had been very sick for several months before she died. Her younger daughter Lucy had finished a bachelor’s degree and applied for a master’s degree program for Speech and Language Pathology. Amy’s elder daughter Maddie had also finished her undergraduate degree and had been vying for a spot in a local master’s degree program in Occupational Therapy. Maddie had been placed on the waiting list to get in.
Our mother, Amy’s and my sisters, had been a bit of a stickler regarding the need for higher education when it came down to her own daughters. She believed that a woman could not only make her own money, but that a woman could command her independence with a college degree. It is because of her insistence in this path for her girls that we have all become successful in our own right. We have all gone back to school at various stages of our lives, in large part because of a woman who refused to allow us to believe that high school was the end of our schooling. In fact, our mother didn’t throw us parties or give us money when we graduated from high school. “Finishing high school is a basic expectation in life,” she believed. Because finishing high school was not the end of our path to becoming women who could stand alone and make our own living. Our mother was on to something. She wanted more for us.
And we all earned more for ourselves. Just as our mother had wanted for us. Until Amy got very sick during the February of 2015. The winter before she knew if her own daughters were accepted into their graduate programs. It was a terrible time, one when we were not sure if Amy would make it from one week to the next. Yet, Amy rallied and became medically stable. She returned home to live with her husband Dave.
Some might say it is unfair to pin hopes and beliefs onto people who have died. I was not in a very good frame of mind after Amy left, though I am one of those people who happens to believe that people wait for something remarkable before they choose to leave this plane of existence. Amy’s husband Dave, a staunch agnostic, recently said that scientists believe there may be eleven different dimensions in which realities can exist. Perhaps Dave and I are on opposite sides of the playing field: spirit versus science. Maybe none of us know anything about life after death. But in this argument, we can converge in the theory that anything is possible.
I do know this. Amy should have died sooner than she did. Her body was shutting down. But something inside her waited to pass into another dimension. Something inside her needed to see her girls succeed. Even after she was gone, maybe something inside of Amy watched that procession in Portugal, as the men hefted large statues onto their shoulders and the local girls marched the streets in their handmade costumes of the patron saint, adorned in pink flowers. Perhaps Amy waited to die until she knew her daughters would march in their graduation gowns. This was her last, and most important act, as the primary caregiver of her children. She must have exhaled her final breath and thought, “My girls are going back to school.”
Amy’s two daughters, Maddie and Lucy, now work together in the same school to help children with disabilities. They both hold master’s degrees. Their grandmother, the mother of Amy and her sisters who hold her close, will now witness two more of her granddaughters go back to school this fall. She is an avid gardener, this mother of Amy. She planted the bulbs of the meninas por escola in her garden a few years back. They used to bloom pink, as they do in Portugal. Yet the soil is different in Baltimore and the blooms have adapted to new land; they are now the color of tangerines. That is what has happened within our family, as we learned to live without Amy. Our flowers still bloom, they are just a different color now. But some things have remained the same in our family and always shall. The girls will always go back to school.