Out Patient Department Quotes

Who am I? Who am I?” “You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. You were treated horribly. You came out on the other end. You were always you.” "And who are you?" "I'm Willem Ragnarsson. And I will never let you go.

Sometimes he wakes so far from himself that he can’t even remember who he is. “Where am I?” he asks, desperate, and then, “Who am I? Who am I?” And then he hears, so close to his ear that it is as if the voice is originating inside his own head, Willem’s whispered incantation. “You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. “You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. “You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. “You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. “You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. “You were treated horribly. You came out on the other end. You were always you.

...as of this moment there's the police department way, the federal law enforcement way, the military way... and my way. If you want me to function at my best then you're going to have to accept that I'm going to have to make up some of my own rules. I don't know enough about your playbook and, quite frankly, I don't like the way you operate. If I'm not a cop anymore then I'm something else, something new. Okay, then from here on out I'll decide what that is; and that includes building, shaping, and leading my team. My team, my rules.

Sometimes he wakes so far from himself that he can’t even remember who he is. “Where am I?” he asks, desperate, and then, “Who am I? Who am I?” And then he hears, so close to his ear that it is as if the voice is originating inside his own head, Willem’s whispered incantation. “You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. “You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. “You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. “You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. “You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. “You were treated horribly. You came out on the other end. You were always you.” ― Hanya Yanagihara, A Little Life

Freud was fascinated with depression and focused on the issue that we began with—why is it that most of us can have occasional terrible experiences, feel depressed, and then recover, while a few of us collapse into major depression (melancholia)? In his classic essay “Mourning and Melancholia” (1917), Freud began with what the two have in common. In both cases, he felt, there is the loss of a love object. (In Freudian terms, such an “object” is usually a person, but can also be a goal or an ideal.) In Freud’s formulation, in every loving relationship there is ambivalence, mixed feelings—elements of hatred as well as love. In the case of a small, reactive depression—mourning—you are able to deal with those mixed feelings in a healthy manner: you lose, you grieve, and then you recover. In the case of a major melancholic depression, you have become obsessed with the ambivalence—the simultaneity, the irreconcilable nature of the intense love alongside the intense hatred. Melancholia—a major depression—Freud theorized, is the internal conflict generated by this ambivalence. This can begin to explain the intensity of grief experienced in a major depression. If you are obsessed with the intensely mixed feelings, you grieve doubly after a loss—for your loss of the loved individual and for the loss of any chance now to ever resolve the difficulties. “If only I had said the things I needed to, if only we could have worked things out”—for all of time, you have lost the chance to purge yourself of the ambivalence. For the rest of your life, you will be reaching for the door to let you into a place of pure, unsullied love, and you can never reach that door. It also explains the intensity of the guilt often experienced in major depression. If you truly harbored intense anger toward the person along with love, in the aftermath of your loss there must be some facet of you that is celebrating, alongside the grieving. “He’s gone; that’s terrible but…thank god, I can finally live, I can finally grow up, no more of this or that.” Inevitably, a metaphorical instant later, there must come a paralyzing belief that you have become a horrible monster to feel any sense of relief or pleasure at a time like this. Incapacitating guilt. This theory also explains the tendency of major depressives in such circumstances to, oddly, begin to take on some of the traits of the lost loved/hated one—and not just any traits, but invariably the ones that the survivor found most irritating. Psychodynamically, this is wonderfully logical. By taking on a trait, you are being loyal to your lost, beloved opponent. By picking an irritating trait, you are still trying to convince the world you were right to be irritated—you see how you hate it when I do it; can you imagine what it was like to have to put up with that for years? And by picking a trait that, most of all, you find irritating, you are not only still trying to score points in your argument with the departed, but you are punishing yourself for arguing as well. Out of the Freudian school of thought has come one of the more apt descriptions of depression—“aggression turned inward.” Suddenly the loss of pleasure, the psychomotor retardation, the impulse to suicide all make sense. As do the elevated glucocorticoid levels. This does not describe someone too lethargic to function; it is more like the actual state of a patient in depression, exhausted from the most draining emotional conflict of his or her life—one going on entirely within. If that doesn’t count as psychologically stressful, I don’t know what does.

Oh, wow. Thank you.” She smiled. “Now I’m actually a bit sorry that I can’t have you on my dissertation committee. Perhaps rumors of your cruelty have been greatly exaggerated.” His mouth twitched. “Maybe you just pull out the best in me?” She grinned. “Then maybe I should stick around. Just, you know, to save the department from your terrible moods?” He glanced at the picture of the failed Western blot in her hand. “Well, it doesn’t look like you’re going to graduate anytime soon.” She half laughed, half gasped. “Oh my God. Did you just—?” “Objectively—” “This is the rudest, meanest thing—” She was laughing. Holding her stomach as she waved her finger at him. “—based on your blotting—” “—that anyone could ever say to a Ph.D. student. Ever.” “I think I can find meaner things. If I really put myself to it.” “We’re done.” She wished she weren’t smiling. Then maybe he’d take her seriously instead of just looking at her with that patient, amused expression. “Seriously. It was nice while it lasted.” She made to stand and leave indignantly, but he grabbed the sleeve of her shirt and gently tugged at it until she was sitting down again, next to him on the narrow couch—maybe even a little closer than before. She continued glaring, but he regarded her blandly, clearly unperturbed. “There’s nothing bad about taking more than five years to graduate,” he offered in a conciliatory tone. Olive huffed. “You just want me to stay around forever. Until you have the biggest, fattest, strongest Title IX case to ever exist.

I have detected," he said, "disturbances in the wash." ... Arthur asked him to repeat what he had just said because he hadn't quite understood his meaning. Ford repeated it. "The wash?" said Arthur. "The space time wash," said Ford. Arthur nodded, and then cleared his throat. "Are we talking about," he asked cautiously, "some sort of Vogon laundromat, or what are we talking about?" "Eddies," said Ford, "in the space-time continuum." "Ah," nodded Arthur, "is he. Is he." ... "What?" said Ford. "Er, who," said Arthur, "is Eddy, then, exactly, then?" Ford looked angrily at him. "Will you listen?" he snapped. "I have been listening," said Arthur, "but I'm not sure it's helped." Ford grasped him by the lapels of his dressing gown and spoke to him as slowly and distinctly and patiently as if he were somebody from the telephone company accounts department. "There seems..." he said, "to be some pools..." he said, "of instability," he said, "in the fabric..." he said. Arthur looked foolishly at the cloth of his dressing gown where Ford was holding it. Ford swept on before Arthur could turn the foolish look into a foolish remark. "...in the fabric of space-time," he said. "Ah, that," said Arthur. "Yes, that," confirmed Ford. They stood there alone on a hill on prehistoric Earth and stared each other resolutely in the face. "And it's done what?" said Arthur. "It," said Ford, "has developed pools of instability." "Has it," said Arthur, his eyes not wavering for a moment "It has," said Ford, with the similar degree of ocular immobility. "Good," said Arthur. "See?" said Ford. "No," said Arthur. There was a quiet pause. ... "Arthur," said Ford. "Hello? Yes?" said Arthur. "Just believe everything I tell you, and it will all be very, very simple." "Ah, well, I'm not sure I believe that." They sat down and composed their thoughts. Ford got out his Sub-Etha Sens-O-Matic. It was making vague humming noises and a tiny light on it was flickering faintly. "Flat battery?" said Arthur. "No," said Ford, "there is a moving disturbance in the fabric of space-time, an eddy, a pool of instability, and it's somewhere in our vicinity." ... "There!" said Ford, shooting out his arm; "there, behind that sofa!" Arthur looked. Much to his surprise, there was a velvet paisley-covered Chesterfield sofa in the field in front of them. He boggled intelligently at it. Shrewd questions sprang into his mind. "Why," he said, "is there a sofa in that field?" "I told you!" shouted Ford, leaping to his feet. "Eddies in the space-time continuum!" "And this is his sofa, is it?" ... 12 chapters pass ... "All will become clear," said Slartibartfast. "When?" "In a minute. Listen. The time streams are now very polluted. There's a lot of muck floating about in them, flotsam and jetsam, and more and more of it is now being regurgitated into the physical world. Eddies in the space-time continuum, you see." "So I hear," said Arthur.

Within the mental-health system in North America, the borderline victim of severe childhood trauma is usually blamed for her behaviour, which is regarded as having no legitimate basis and being self-indulgent; her trauma history is ignored and not talked about; and she is given as little treatment and follow-up as possible. At St Boniface Hospital in Winnipeg, many staff members expressed the opinion, in my presence, that borderlines and multiple personality disorder patients did not have a legitimate right to in-patient treatment, and the out-patient department would not accept patients with either diagnosis. (1995)

But the heavy stroke which most of all distresses me is my dear Mother. I cannot overcome my too selfish sorrow, all her tenderness towards me, her care and anxiety for my welfare at all times, her watchfulness over my infant years, her advice and instruction in maturer age; all, all indear her memory to me, and highten my sorrow for her loss. At the same time I know a patient submission is my Duty. I will strive to obtain it! But the lenient hand of time alone can blunt the keen Edg of Sorrow. He who deignd to weep over a departed Friend, will surely forgive a sorrow which at all times desires to be bounded and restrained, by a firm Belief that a Being of infinite wisdom and unbounded Goodness, will carve out my portion in tender mercy towards me! Yea tho he slay me I will trust in him said holy Job. What tho his corrective Hand hath been streached against me; I will not murmer. Tho earthly comforts are taken away I will not repine, he who gave them has surely a right to limit their Duration, and has continued them to me much longer than deserved. I might have been striped of my children as many others have been. I might o! forbid it Heaven, I might have been left a solitary widow. Still I have many blessing left, many comforts to be thankfull for, and rejoice in. I am not left to mourn as one without hope. My dear parent knew in whom she had Believed...The violence of her disease soon weakned her so that she was unable to converse, but whenever she could speak, she testified her willingness to leave the world and an intire resignation to the Divine Will. She retaind her Senses to the last moment of her Existance, and departed the world with an easy tranquility, trusting in the merrits of a Redeamer," (p. 81 & 82).

But the history of Hopkins Hospital certainly isn’t pristine when it comes to black patients. In 1969, a Hopkins researcher used blood samples from more than 7,000 neighborhood children—most of them from poor black families—to look for a genetic predisposition to criminal behavior. The researcher didn’t get consent. The American Civil Liberties Union filed suit claiming the study violated the boys’ civil rights and breached confidentiality of doctor-patient relationships by releasing results to state and juvenile courts. The study was halted, then resumed a few months later using consent forms. And in the late nineties, two women sued Hopkins, claiming that its researchers had knowingly exposed their children to lead, and hadn’t promptly informed them when blood tests revealed that their children had elevated lead levels—even when one developed lead poisoning. The research was part of a study examining lead abatement methods, and all families involved were black. The researchers had treated several homes to varying degrees, then encouraged landlords to rent those homes to families with children so they could then monitor the children’s lead levels. Initially, the case was dismissed. On appeal, one judge compared the study to Southam’s HeLa injections, the Tuskegee study, and Nazi research, and the case eventually settled out of court. The Department of Health and Human Services launched an investigation and concluded that the study’s consent forms “failed to provide an adequate description” of the different levels of lead abatement in the homes.

Sometimes he wakes so far from himself that he can't even remember who he is. 'Where am I?' he asks, desperate, and then, 'Who am I? Who am I?' And then he hears, so close to his ear that it is as if the voice is originating inside his own head, Willem's whispered incantation. 'You're Jude St. Francis. You are my oldest, dearest friend. You're the son of Harold Stein and Julia Altman. You're the friend of Malcolm Irvine, Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. You're a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. You're a swimmer. You're a baker. You're a cook. You're a reader. You have a beautiful voice, though you never sing anymore. You're an excellent pianist. You're an art collector. You write me lovely messages when I'm away. You're patient. You're generous. You're the best listener I know. You're the smartest person I know, in every way. You're the bravest person I know, in every way. You're a lawyer. You're the chair of the litigation department at Rosen Pritchard and Klein. You love your job, you work hard at it. You're a mathematician. You're a logician. You've tried to teach me, again and again. You were treated horribly. You came out on the other end. You were always you. On and on Willem talks, chanting him back to himself, and in the daytime - sometimes days later - he remembers pieces of what Willem has said and holds them close to him, as much as for what he said as for what he didn't, for how he hadn't defined him. But in the nighttime he is too terrified, he is too lost to recognize this. His panic is too real, too consuming. 'And who are you?' he asks, looking at the man who is holding him, who is describing someone he doesn't recognize, someone who seems to have so much, someone who seems like such an enviable, beloved person. 'Who are you?' The man has an answer to this question as well. 'I'm Willem Ragnarsson,' he says. 'And I will never let you go.

And then he hears, so close to his ear that it is as if the voice is originating inside his own head, Willem’s whispered incantation. “You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. “You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. “You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. “You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. “You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. “You were treated horribly. You came out on

And then he hears, so close to his ear that it is as if the voice is originating inside his own head, Willem’s whispered incantation. “You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. “You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. “You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. “You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. “You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. “You were treated horribly. You came out on the other end. You were always you.

Sometimes he wakes so far from himself that he can't even remember who he is. 'Where am I?' he asks, desperate, and then, 'Who am I? Who am I?' "And then he hears, so close to his ear that it is as if the voice is originating inside his own head, Willem's whispered incantation. 'You're Jude St. Francis. You are my oldest, dearest friend. You're the son of Harold Stein and Julia Altman. You're the friend of Malcolm Irvine, Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. "You're a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. "You're a swimmer. You're a baker. You're a cook. You're a reader. You have a beautiful voice, though you never sing anymore. You're an excellent pianist. You're an art collector. You write me lovely messages when I'm away. You're patient. You're generous. You're the best listener I know. You're the smartest person I know, in every way. You're the bravest person I know, in every way. "You're a lawyer. You're the chair of the litigation department at Rosen Pritchard and Klein. You love your job, you work hard at it. "You're a mathematician. You're a logician. You've tried to teach me, again and again. "You were treated horribly. You came out on the other end. You were always you. "On and on Willem talks, chanting him back to himself, and in the daytime - sometimes days later - he remembers pieces of what Willem has said and holds them close to him, as much as for what he said as for what he didn't, for how he hadn't defined him. "But in the nighttime he is too terrified, he is too lost to recognize this. His panic is too real, too consuming. 'And who are you?' he asks, looking at the man who is holding him, who is describing someone he doesn't recognize, someone who seems to have so much, someone who seems like such an enviable, beloved person. 'Who are you?' "The man has an answer to this question as well. 'I'm Willem Ragnarsson,' he says. 'And I will never let you go.

Sometimes he wakes so far from himself that he can’t even remember who he is. “Where am I?” he asks, desperate, and then, “Who am I? Who am I?” And then he hears, so close to his ear that it is as if the voice is originating inside his own head, Willem’s whispered incantation. “You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. “You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. “You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. “You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. “You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. “You were treated horribly. You came out on the other end. You were always you.

As Dr. Gunnar Biörck, an eminent Swedish professor of medicine and head of the department Of medicine at a major Swedish hospital, has written:   The setting in which medicine has been practiced during thousands of years has been one in which the patient has been the client and employer of the physician. Today the State, in one manifestation or the other, claims to be the employer and, thus, the one to prescribe the conditions under which the physician has to carry out his work. These conditions may not—and will eventually not—be restricted to working hours, salaries and certified drugs; they may invade the whole territory of the patient-physician relationship.... If the battle of today is not fought and not won, there will be no battle to fight tomorrow.20

I gave it up and walked down to the Sphynx. After years of waiting, it was before me at last. The great face was so sad, so earnest, so longing, so patient. There was a dignity not of earth in its mien, and in its countenance a benignity such as never any thing human wore. It was stone, but it seemed sentient. If ever image of stone thought, it was thinking. It was looking toward the verge of the landscape, yet looking at nothing—nothing but distance and vacancy. It was looking over and beyond every thing of the present, and far into the past. It was gazing out over the ocean of Time—over lines of century-waves which, further and further receding, closed nearer and nearer together, and blended at last into one unbroken tide, away toward the horizon of remote antiquity. It was thinking of the wars of departed ages; of the empires it had seen created and destroyed; of the nations whose birth it had witnessed, whose progress it had watched, whose annihilation it had noted; of the joy and sorrow, the life and death, the grandeur and decay, of five thousand slow revolving years. It was the type of an attribute of man—of a faculty of his heart and brain. It was MEMORY—RETROSPECTION—wrought into visible, tangible form. All who know what pathos there is in memories of days that are accomplished and faces that have vanished—albeit only a trifling score of years gone by—will have some appreciation of the pathos that dwells in these grave eyes that look so steadfastly back upon the things they knew before History was born—before Tradition had being—things that were, and forms that moved, in a vague era which even Poetry and Romance scarce know of—and passed one by one away and left the stony dreamer solitary in the midst of a strange new age, and uncomprehended scenes.

We say that we mourn the dead, and there is some truth in that. We lament the flower frozen in full bloom, cut off at the moment of promise, or another long wilted, whose slow fading and drawn-out, painful diminishment cast a shadow over a vibrant and glorious past. And yet. Once the eyes are closed and the heart is stilled, we come to understand that the worst of the pain has passed. For them. The dead have no more use for pain, for memory or regret. Regret is for the living. And so when we stand at the bedside, the graveside, the casket, our mourning is less for the beloved departed than it is for ourselves. We mourn the missed opportunity, the word unspoken or spoken in haste, the hole in our lives and the unsettling of our souls, our own disappointments and the loss of innocence. We gaze upon the stillness that is unending and feel our self-importance crack and the myth of our immortality smash. We stare upon the face of death to see ourselves more clearly, to satisfy our curiosity, to make peace with the inescapable. We hold our breath, try to imagine what it would be like never to take another and what the departed know now that we don’t. We try to conjure what the life we have left would look like if such knowledge were ours. We try to imagine ourselves kind and expansive and giving, balanced and patient, more honest, more thankful, more peaceful, content with what we have, mindless of what we have not. We imagine ourselves happy. For a moment, we believe we can be. And then, because we can’t help ourselves, we breathe and, breathing, are reminded of the many other things we cannot help. The faith of a moment fades and hope is replaced by the intimate knowledge of our imperfections. Lonely, weeping, we stand with our feet anchored to the ground, watching our better angels fly above us and beyond us to time out of mind, and we mourn.

Montgomery, Alabama. December 1, 1955. Early evening. A public bus pulls to a stop and a sensibly dressed woman in her forties gets on. She carries herself erectly, despite having spent the day bent over an ironing board in a dingy basement tailor shop at the Montgomery Fair department store. Her feet are swollen, her shoulders ache. She sits in the first row of the Colored section and watches quietly as the bus fills with riders. Until the driver orders her to give her seat to a white passenger. The woman utters a single word that ignites one of the most important civil rights protests of the twentieth century, one word that helps America find its better self. The word is “No.” The driver threatens to have her arrested. “You may do that,” says Rosa Parks. A police officer arrives. He asks Parks why she won’t move. “Why do you all push us around?” she answers simply. “I don’t know,” he says. “But the law is the law, and you’re under arrest.” On the afternoon of her trial and conviction for disorderly conduct, the Montgomery Improvement Association holds a rally for Parks at the Holt Street Baptist Church, in the poorest section of town. Five thousand gather to support Parks’s lonely act of courage. They squeeze inside the church until its pews can hold no more. The rest wait patiently outside, listening through loudspeakers. The Reverend Martin Luther King Jr. addresses the crowd. “There comes a time that people get tired of being trampled over by the iron feet of oppression,” he tells them. “There comes a time when people get tired of being pushed out of the glittering sunlight of life’s July and left standing amidst the piercing chill of an Alpine November.” He praises Parks’s bravery and hugs her. She stands silently, her mere presence enough to galvanize the crowd. The association launches a citywide bus boycott that lasts 381 days. The people trudge miles to work. They carpool with strangers. They change the course of American history.

Because nobody brought that up to you?” “No, we had no idea that there were any problems that would suggest that.” Besides, as she pointed out later in her testimony, she was not an expert on poison. Dr. Henry testified that Peru was not mentioned in papers on tropical sprue, and that even where the disease was common, those who contracted it had lived in the area for a long time, at least a year. Typhoid fever didn’t fit either. “Even though it’s an acute infection, [it] does not cause a tremendous elevation of the white blood cell count.” Dr. Henry believed that Mike had been septic more than once during his three hospitalizations. Dr. Pam McCoy, the ER physician at the UK Medical Center, testified next. “I work with residents and medical students. I teach them how to work in an emergency department. And usually . . . I go see patients, they go see patients with me; we talk about how you see a patient in the emergency department, how you take care of people, how you put in stitches, that sort of thing.

You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. “You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. “You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. “You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. “You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. “You were treated horribly. You came out on the other end. You were always you.

Who am I? Who am I? You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. You were treated horribly. You came out on the other end. You were always you. And who are you? I'm Willem Ragnarsson. And I will never let you go.

Who am I? Who am I?” “You’re Jude St. Francis. You are my oldest, dearest friend. You’re the son of Harold Stein and Julia Altman. You’re the friend of Malcolm Irvine, of Jean-Baptiste Marion, of Richard Goldfarb, of Andy Contractor, of Lucien Voigt, of Citizen van Straaten, of Rhodes Arrowsmith, of Elijah Kozma, of Phaedra de los Santos, of the Henry Youngs. You’re a New Yorker. You live in SoHo. You volunteer for an arts organization; you volunteer for a food kitchen. You’re a swimmer. You’re a baker. You’re a cook. You’re a reader. You have a beautiful voice, though you never sing anymore. You’re an excellent pianist. You’re an art collector. You write me lovely messages when I’m away. You’re patient. You’re generous. You’re the best listener I know. You’re the smartest person I know, in every way. You’re the bravest person I know, in every way. You’re a lawyer. You’re the chair of the litigation department at Rosen Pritchard and Klein. You love your job; you work hard at it. You’re a mathematician. You’re a logician. You’ve tried to teach me, again and again. You were treated horribly. You came out on the other end. You were always you.” "And who are you?" "I'm Willem Ragnarsson. And I will never let you go.

Thakur’s findings were not news to Ranbaxy’s top executives. Just ten months earlier, in October 2003, outside auditors started investigating Ranbaxy facilities worldwide. In this case, the audits had been ordered up by Ranbaxy itself. This was a common industry practice: drug companies often hired consultants to audit their facilities as a dry run to see how visible their problems were. If the consultants could find it, they reasoned, then most likely regulators could too. The fact-finding mission by Lachman Consultant Services left Ranbaxy officials under no illusion as to the extent of the company’s failings. At Ranbaxy’s Princeton, New Jersey, facility, auditors found that the company’s Patient Safety Department barely functioned and training was essentially “non-existent.” The staff had no written protocols for investigating patient complaints, which piled up in boxes, uncategorized and unreported. They had no clerical help for basic tasks like mailing out the patients’ samples for testing. “I don’t think there’s the same medicine in this medicine,” was a common refrain from patients. Even when there were investigations, they were so perfunctory and half-hearted that expiration dates were listed as “unknown,” even when they could easily have been found from a product’s lot number. An audit of Ranbaxy’s main U.S. manufacturing plant, Ohm Laboratories in New Jersey, found that the company, though required to report adverse events to the FDA, rarely did so. There was no system to capture patient complaints after hours, and no global medical officer to ensure that any potential negative consequences for patients were being monitored. The consultants from Lachman urged Ranbaxy to address these problems globally. Ranbaxy’s initial reaction to the findings was to question the number of hours, and the resulting invoice, that Lachman had sent for its work.

If a patient arrives via ambulance and is seriously injured or really sick or has a heart attack, a doctor checks him out and sends him to the nearest real emergency department connected to a hospital with facilities like operating rooms and a cardiac laboratory. Aside from the risk of delays in treatment, the sequence results in bills for two separate high-level ER visits and a charge for emergency transport.

I was once held hostage by a patient in the hospital. I was fortunate I knew the department layout and I was able to free myself by darting out of a door while my terrorist was distracted.

Years ago, I represented a client, a firefighter/paramedic, in an administrative trial after he had been terminated for allegedly providing patient care that was below the department’s established standards. One central issue was the ongoing, on-the-job training firefighters/paramedics receive. Throughout the trial, senior officers of the department, including the Chief himself, preached and bloviated on and on about how the department is committed to providing only the best patient care and how their paramedics are held to a higher standard; how they are committed to serving the community with the highest level of blah, blah, blah. On cross examination, however, I asked each of them about how many hours a day each provider spends drilling or practicing firefighting technique and equipment. Each of them answered proudly that every firefighter/EMT and firefighter/paramedic, regardless of assignment, spends at least three hours each day practicing firefighting skills and/or rehearsing the use of various firefighting equipment; hoses, ladders, saws, and other firefighter equipment. Ok, that’s great. Through testimony, we determined that, based on a 10-shift work month, each firefighter/paramedic, regardless of assignment, spends at least 30 hours per month drilling, practicing, and/or rehearsing firefighting skills & equipment. That’s at a minimum of 360 hours per year of ongoing, on-the-job firefighter training. Outstanding. When the smoke is showing and the flames are roiling, they will be ready. They all displayed the same proud grin at how well trained their people are. For each of them, however, that smug grin quickly turned when I then asked about the number of hours per day each firefighter/paramedic spends drilling on or practicing patient care related techniques, skills, and tools. Every one of them squirmed as they responded with the truth that the department only offers three hours of patient care related education per month. That’s roughly a maximum of 36 hours of paramedic training for the entire year. It got worse when further testimony showed that patient care related calls account for more than 80 percent of their call volume and fire related calls less than 20 percent, I could see each of them deflate on the witness stand when I asked how they could truthfully say they were committed to providing the best patient care when barely 10 percent of their training addresses patient care, which constitutes over 80 percent of your department’s calls. The answers were more disjointed and nonsensical than a White House press briefing. Of course, across America the 10:1 ratio of ongoing firefighting training to EMS training is pretty consistent, which begs the question: Don’t they get it? Excellence is the product of practice. How can any rational person look at a 10:1 training ratio and declare themselves committed to the highest level of care? How can an agency neglect training on the most significant aspect of the business and then be surprised when issues of negligence and liability arise? Once again, it seems that old-school culture leaves EMS stuck in the mud and the law is not going to wait for agencies to figure out that living in the past compromises the future.

When he finished he had a magnificent house, perched on the edge of a precipice at whose feet the ocean thundered, but it was a house that knew no happiness, for shortly after Whip had moved in with his third wife, the Hawaiian-Chinese beauty Ching-ching, who was pregnant at the time, she had caught him fooling around with the brothel girls that flourished in the town of Kapaa. Without even a scene of recrimination, Ching-ching had simply ordered a carriage and driven back to the capital town of Lihune, where she boarded an H & H steamer for Honolulu. She divorced Whip but kept both his daughter Iliki and his yet-unborn son John. Now there were two Mrs. Whipple Hoxworths in Honolulu and they caused some embarrassment to the more staid community. There was his first wife, Iliki Janders Hoxworth, who moved in only the best missionary circles, and there was Ching-ching Hoxworth who lived within the Chinese community. The two never met, but Howxworth & Hale saw to it that each received a monthly allowance. The sums were generous, but not so much so as those sent periodically Wild Whip's second wife, the fiery Spanish girl named Aloma Duarte Hoxworth, whose name frequently appeared in New York and London newspapers... p623 When the polo players had departed, when the field kitchens were taken down, and when the patient little Japanese gardeners were tending each cut in the polo turf as if it were a personal wound, Wild Whip would retire to his sprawling mansion overlooking the sea and get drunk. He was never offensive and never beat anyone while intoxicated. At such times he stayed away from the brothels in Kapaa and away from the broad lanai from which he could see the ocean. In a small, darkened room he drank, and as he did so he often recalled his grandfather's words: "Girls are like stars, and you could reach up and pinch each one on the points. And then in the east the moon rises, enormous and perfect. And that's something else, entirely different." It was now apparent to Whip, in his forty-fifth year, that for him the moon did not intend to rise. Somehow he had missed encountering the woman whom he could love as his grandfather had loved the Hawaiian princess Noelani. He had known hundreds of women, but he had found none that a man could permanently want or respect. Those who were desirable were mean in spirit and those who were loyal were sure to be tedious. It was probably best, he thought at such times, to do as he did: know a couple of the better girls at Kapaa, wait for some friend's wife who was bored with her husband, or trust that a casual trip through the more settled camps might turn up some workman's wife who wanted a little excitement. It wasn't a bad life and was certainly less expensive in the long run than trying to marry and divorce a succession of giddy women; but often when he had reached this conclusion, through the bamboo shades of the darkened room in which he huddled a light would penetrate, and it would be the great moon risen from the waters to the east and now passing majestically high above the Pacific. It was an all-seeing beacon, brillant enough to make the grassy lawns on Hanakai a sheet of silver, probing enough to find any mansion tucked away beneath the casuarina trees. When this moon sought out Wild Whip he would first draw in his feet, trying like a child to evade it, but when it persisted he often rose, threw open the lanai screens, and went forth to meet it. p625

While further exploring the first floor of the hospital, the friends discovered a dusty room filled with old photographs and crumbling letters; the room was labeled “Archives”. One picture caught their attention — a group of children in tattered school uniforms, their faces frozen in time. The letters spoke of longing and loneliness, and the pain of separation. “These kids do not look like they were at this school according to their own will. They look very sad, almost disturbed.” Emily said as she looked around, cautious of what may be in the basement of this place. Continuing on the main floor, a second room also had file cabinets in it but had no name on the door. Inside the room was an article from the Mountainside times of a time when the hospital had its own tale of tragedy and despair. During the war, the medical facility had been overwhelmed with wounded soldiers, and the staff struggled to provide adequate care. Rumors circulated of a nurse who, unable to cope with the constant death and suffering, succumbed to madness, killing 3 interns and one patient before being shot. It went on to say that since this incident, patients reported she still wandered the desolate corridors, her soft footsteps and distant sobs haunting those who dared to stay overnight. The war department cited an increase in transfer requests out of the hospital citing the interactions with “the inhabitants” that haunt the place. As the friends explored the hospital's abandoned wards and empty rooms, they could almost feel the weight of the past pressing down on them the whole time. Shadows danced along the peeling wallpaper, and the air was filled with an otherworldly chill and the dampness of a bog. Every creak and groan of the building seemed to whisper the stories of those who had lived and died within its walls. Its decrepit walls and shattered windows bathed in the ghostly light of the full moon.

Migraine, like my patient Sarah had, also correlates closely to poor metabolic health. In the ENT otology clinic, we often saw this condition and had limited success in treating it. Sufferers of this debilitating neurological disease—about 12 percent of people in the United States—tend to have higher insulin levels and insulin resistance. A comprehensive review of fifty-six research articles identified links between migraine and poor metabolic health, pointing out that “migraine sufferers tend to have impaired insulin sensitivity.” The review supports the “neuro-energetic” theory of migraine. Additionally, evidence suggests that micronutrient deficiencies in key mitochondrial cofactors may also be a contributing factor of migraine. Research has suggested that migraines could be treated by restoring levels of vitamins B and D, magnesium, CoQ10, alpha lipoic acid, and L-carnitine. Vitamin B12, for instance, is involved in the electron transport chain responsible for the final steps of ATP generation in the mitochondria, and studies have indicated that high doses of B12 can help prevent migraine. These micronutrients usually have fewer side effects than other drugs used to treat migraines, making them a promising option for relief, which can be obtained through a diet rich in these micronutrients, or supplementation. Having high markers of oxidative stress, a key Bad Energy feature, is associated with a significantly higher risk of migraine in women, with some studies suggesting that migraine attacks are a symptomatic response to increased levels of oxidative stress. Less painful and more common tension-type headaches are also linked to high variability (excess peaks and crashes) in blood sugar. Hearing Loss The same story of metabolic ignorance in the ENT department unfolded for auditory problems and hearing loss, one of the most common issues presented to our ENT clinic. We’d typically tell our patients that their auditory decline was inevitable, due to aging and loud concerts in their youth, and we would suggest interventions like hearing aids. Yet insulin resistance is a little-known link to hearing problems. If you have insulin resistance, you are more likely to lose hearing as you age because of poor energy production in the delicate hearing cells and blockage of the small blood vessels that supply the inner ear. One study showed that insulin resistance is associated with age-related hearing loss, even when controlling for weight and age. The likely mechanism for this is that the auditory system requires high energy utilization for its complex signal processing. In the case of insulin resistance, glucose metabolism is disturbed, leading to decreased energy generation. The impact of Bad Energy on hearing is not subtle: A study showed that the prevalence of high-frequency hearing impairment among subjects with elevated fasting glucose levels was 42 percent compared to 24 percent in those with normal fasting glucose. Moreover, insulin resistance is associated with high-frequency mild hearing impairment in the male population under seventy years of age, even before the onset of diabetes. These papers suggest that assessing early metabolic function and levels of insulin resistance is essential in the ENT clinic and counseling individuals on the potential warning signs is paramount.

Prayer for All Things Necessary for Salvation O MY God! I believe in Thee; do Thou strengthen my faith. All my hopes are in Thee; do Thou secure them. I love Thee with my whole heart; teach me to love Thee more and more. I am sorry that I have offended Thee; do Thou increase my sorrow. I adore Thee as my first beginning; I aspire after Thee as my last end. I give Thee thanks as my constant benefactor; I call upon Thee as my sovereign protector. Vouchsafe, O my God, to conduct me by Thy wisdom, to restrain me by Thy justice, to comfort me by Thy mercy, to defend me by Thy power. To Thee I desire to consecrate all my thoughts, my actions, and my sufferings, that I henceforward may think only of Thee, speak only of Thee, and ever refer all my actions to Thy greater glory, and suffer willingly whatever Thou shalt appoint. O Lord, I desire that in all things Thy will be done, because it is Thy will, and in the manner that Thou willest. I beg of Thee to enlighten my understanding, to inflame my will, to purify my body, and to sanctify my soul. Give me strength, O my God, to expiate my offenses, to overcome my temptations, to subdue my passions, to acquire the virtues proper for my state. Fill my heart with tender affection for Thy goodness, a hatred of my faults, a love for my neighbor, and a contempt for the world. Let me always be submissive to my superiors, condescending to my inferiors, faithful to my friends, and charitable to my enemies. Assist me to overcome sensuality by mortification, avarice by almsdeeds, anger by meekness, and tepidity by zeal. O my God, make me prudent in my undertakings, courageous in dangers, patient in affliction, and humble in prosperity. Grant that I may be ever attentive at my prayers, temperate at my meals, diligent in my employments, and constant in my resolutions. Let my conscience be ever upright and pure, my exterior modest, my conversation edifying, my comportment regular. Assist me, that I may continually labor to overcome nature, correspond with Thy grace, keep Thy commandments, and work out my salvation. Discover to me, O my God, the nothingness of this world, the greatness of heaven, the shortness of time, the length of eternity. Grant that I may be prepared for death, fear Thy judgments, escape hell, and, in the end, obtain heaven. All that I have asked for myself I confidently ask for others; for my family, my relations, my benefactors, my friends, and also for my enemies. I ask it for the whole Church, for all the orders of which it is composed; more especially for our Holy Father, the Pope; for our bishop, for our pastors, and for all who are in authority; also for all those for whom Thou desirest that I should pray. Give them, O Lord, all that Thou knowest to be conducive to Thy glory and necessary for their salvation. Strengthen the just in virtue, convert sinners, enlighten infidels, heretics, and schismatics; console the afflicted, give to the faithful departed rest and eternal life; that together we may praise, love, and bless Thee for all eternity. Amen.

Listen to me, Sean—I want my daughter to be happy, but Rosie is the beat of my heart. When Franci told me she was having a baby and having her alone, the first thing I felt was resentment—I was barely fifty! I still feel I have a lot of life left to live! And I’d already raised a child alone, so I knew firsthand how hard it would be for her. Franci was going to need a lot from me, and I didn’t really have a lot to give. But I held that baby and, within seconds, I felt she was as much mine as my daughter’s. If you think for one second I’m going to be patient with you while you try to figure out if you have what it takes to be a good father, you’re wrong. Dead wrong.” Sean briefly wondered if in an earlier life he had pissed off a bunch of tough old goddesses; he was surrounded by strong, opinionated women. “I completely understand. I have a lot to learn about her. About Rosie.” “I don’t care what happens between you and Francine—she’s all grown up and can shoulder disappointment. But you’d better not let down my granddaughter, Sean.” “I know,” he said. “You’re going to have a lot of backup in that department. My mother’s on the job, beating me with the guilt stick every chance she gets, and no one does guilt like an Irish Catholic mother. Are you going to give me a chance?” “Yes,” she said, relaxing back in her chair. “Every chance. Don’t screw it up.” “I’m

Four blue-blazered, gray-slacked guards stood at the entrance—real guards, Myron noted, with cop eyes and KGB facial tics, not the rent-a-uniforms you saw at department stores or airports. The four of them stood silently, eyeing Myron like he was wearing a tube top in the Vatican. One of the guards stepped forward. “May I see some ID please?” Myron took out his wallet and showed him a credit card and driver’s license. “There’s no photo on the driver’s license,” the guard said. “New Jersey doesn’t require them.” “I need a photo ID.” “I have my picture on my health club membership card.” Cop-patient sigh. “That won’t do, sir. Do you have a passport?” “In midtown Manhattan?” “Yes, sir. For the purposes of ID.” “No,” Myron said. “Besides, it’s a terrible picture. Doesn’t fully capture the radiant blue in my eyes.” Myron batted them for emphasis. “Wait here, sir.” He

Most of us figure out by a certain age - some of us later than others - that life unspools in cycles, some lovely, some painful, but in no predictable order. So you could have lovely, painful, and painful again, which I think we all agree is not at all fair. You don't have to like it, and you are always welcome to file a brief with the Complaints Department. But if you've been around for a while, you know that much of the time, if you are patient and are paying attention, you will see that God will restore what the locusts have taken away.

Like the clichéd serial killer, Gosnell kept souvenirs of his crimes. All of those little baby feet in formaldehyde-filled glass jars were trophies. Kareema Cross was so disturbed by them that she took photos of them as far back as 2008. If anyone from the Pennsylvania Department of Health had bothered to inspect the Women’s Medical Society, they would have seen them at once. Gosnell didn’t hide them. But the feet were not his only trophies. Gosnell also collected pictures of women’s genitals. He snapped pictures when his patients were unconscious during their abortions. Steve Massof testified that he often saw Gosnell take out his cell phone and take pictures, ostensibly for “research” or for “teaching.” Gosnell was not in fact conducting any research that Massof was aware of, nor did he teach. The doctor told Massof that he had an academic interest in female genital mutilation...

Cardano was a lot more than a gambler and part-time mathematician. He was the most famous physician of his age, and the Pope and Europe’s royal and imperial families eagerly sought his counsel. He had no use for court intrigue, however, and declined their invitations. He provided the first clinical description of the symptoms of typhus, wrote about syphilis, and developed a new way to operate on hernias. Moreover, he recognized that “A man is nothing but his mind; if that be out of order, all’s amiss, and if that be well, the rest is at ease.” He was an early enthusiast for bathing and showering. When he was invited to Edinburgh in 1552 to treat the Archbishop of Scotland for asthma, he drew on his knowledge of allergy to recommend bedclothes of unspun silk instead of feathers, a pillowcase of linen instead of leather, and the use of an ivory hair comb. Before leaving Milan for Edinburgh, he had contracted for a daily fee of ten gold crowns for his services, but when he departed after about forty days his grateful patient paid him 1,400 crowns and gave him many gifts of great value.

Erik made much of his habit of returning to the water any fish he caught, but Ulf pointed out that these fish were traumatised and were possibly never the same again. “It’s a big thing for a fish to be caught,” he said to Erik. “Even if you put him back, that fish is bound to feel insecure.” Erik had simply dismissed his objection, although Ulf could tell that his remark had hit home. And that he immediately regretted, because it was only too easy to make somebody like Erik feel ill at ease. It was hard enough to be Erik, Ulf reflected, without having to fend off criticism from people like me. Ulf was a kind man, and even if Erik’s talk about fish was trying, he would take care not to show it. He would listen patiently, and might even learn something—although that, he thought, was rather unlikely.

I listened patiently to all he had to say. I was tempted to interrupt, but I realized that would be bad policy, so I let him talk himself out. When he finally simmered down and got in a receptive mood, I said quietly: ‘I want to thank you for coming to Chicago to tell me about this. You have done me a great favor, for if our credit department has annoyed you, it may annoy other good customers, and that would be just too bad. Believe me, I am far more eager to hear this than you are to tell it.

In its first Spanish influenza pamphlet, issued in September, the USPHS recommended that those nursing flu patients wear gauze masks.37 Soon laymen decided that what was a sensible caution in the sickroom would be just as sensible in every situation. Gauze masks became a common sight in the streets and department stores of communities in the eastern United States. People could and did honestly believe that a few layers of gauze would keep out flu bugs, just as screens kept the flies off the front porch. The influenza virus itself is, of course, so infinitely tiny that it can pass through any cloth, no matter how tightly woven, but a mask can catch some of the motes of dust and droplettes of water on which the virus may be riding. However, to be even slightly effective during a flu epidemic masks must be worn at all times when people are together, at home and at work and in between, must be of a proper and probably uncomfortable thickness, must be tied firmly, and must be washed and dried at least once daily. Enforcement of such conditions is impossible and so the communities where masking was compulsory during the Spanish influenza pandemic almost always had health records the same as those of adjacent communities without masking.

As hospitals sprang up, they became a comparatively more attractive place to put the infirm. That was finally what brought the poorhouses to empty out. One by one through the 1950s, the poorhouses closed, responsibility for those who’d been classified as elderly “paupers” was transferred to departments of welfare, and the sick and disabled were put in hospitals. But hospitals couldn’t solve the debilities of chronic illness and advancing age, and they began to fill up with people who had nowhere to go. The hospitals lobbied the government for help, and in 1954 lawmakers provided funding to enable them to build separate custodial units for patients needing an extended period of “recovery.” That was the beginning of the modern nursing home. They were never created to help people facing dependency in old age. They were created to clear out hospital beds—which is why they were called “nursing” homes.

Once, on the train from Washington to Philadelphia, I found myself seated next to an African-American man who had worked for the State Department in India but had quit to run a rehabilitation program for juvenile offenders in the District of Columbia. Most of the youths he worked with were gang members who had committed homicide. One fourteen-year-old boy in his program had shot and killed an innocent teenager to prove himself to his gang. At the trial, the victim’s mother sat impassively silent until the end, when the youth was convicted of the killing. After the verdict was announced, she stood up slowly and stared directly at him and stated, “I’m going to kill you.” Then the youth was taken away to serve several years in the juvenile facility. After the first half year the mother of the slain child went to visit his killer. He had been living on the streets before the killing, and she was the only visitor he’d had. For a time they talked, and when she left, she gave him some money for cigarettes. Then she started step-by-step to visit him more regularly, bringing food and small gifts. Near the end of his three-year sentence she asked him what he would be doing when he got out. He was confused and very uncertain, so she offered to set him up with a job at a friend’s company. Then she inquired about where he would live, and since he had no family to return to, she offered him temporary use of the spare room in her home. For eight months he lived there, ate her food, and worked at the job. Then one evening she called him into the living room to talk. She sat down opposite him and waited. Then she started, “Do you remember in the courtroom when I said I was going to kill you?” “I sure do, ma’am,” he replied. “Well, I did,” she went on. “I did not want the boy who could kill my son for no reason to remain alive on this earth. I wanted him to die. That’s why I started to visit you and bring you things. That’s why I got you the job and let you live here in my house. That’s how I set about changing you. And that old boy, he’s gone. So now I want to ask you, since my son is gone, and that killer is gone, if you’ll stay here. I’ve got room, and I’d like to adopt you if you let me.” And she became the mother of her son’s killer, the mother he never had. Our own story may not be so dramatic, yet we have all been betrayed. We must each start where we are. In large and small ways, in our own family and community, we will be offered the dignity and freedom that learns to patiently forgive over and over.