Thursday, March 19, 2015

OK, So I was Wrong

I have left so many things unfinished; topics merely introduced, follow ups promised, to do lists not done, sequels languishing somewhere that can’t be found. It’s awful. So let me follow up on something.

On the 27th of November, around Thanksgiving and just before my road trip to Florida, I wrote about an ICG-MI (intermediate care facility for the mentally ill) in which a friend of mine was placed. Winter was just underway. It proved to be a very long winter for my friend. So much heartache, but so much change.

I didn’t like the facility. Here’s what I said back then.

As I walked to the entrance a back hoe was digging under the foundation near the front door. Once inside, after signing in, I saw a man on a ladder shining a light up into the suspended ceiling where a tile was pushed aside seeking a source for the water that dripped into buckets below. Five corridors leading to a big day room with coin vending machines, one TV, a Wii play station. Little printed material. Lines of patients at the nurse’s office, the dietician’s office. Their doors are closed. The room is filled with folding banquet tables. At the tables some people play a dice game, others do jigsaw puzzles, while some sleep, foreheads on the fake wood finish or cheeks pressed flat, mouths agape. At the same time the TV blares, yet only a few watch.

You can no longer see where the backhoe was digging that day. The day room is the same, chaotic, but now, after visiting several times, it strikes me as a place full of life as well as woe. I see familiar faces.

The five corridors, long and narrow linoleum tiled halls, with doors to two person patient rooms, floors covered in the same brown tile, on them old hospital beds with hand cranks at the foot that no one uses, metal night stands and dressers, closets built into the wall. In some the plastic brackets that hold the rod are broken, so clothes are simply laid in the bottom of the large compartment. One nondescript picture of an unnamed seascape adorns one of four beige/peach walls. The bathroom is shared with the room next door. Shower down the hall. Hasps on the night stands, added later and attached with metal screws, yawn open with no locks.

I visit my friend in the same room. Nothing has changed in the room, same single nondescript picture, same old bed, the rod in the closet still broken. But the room is changed by my friend’s new found presence. She smiles broadly, animated, putting down the book she is reading, and jumps up to greet me. The first day I visited she was sleeping, curled under a blanket and woke with a start. She looked scared. Through groggy eyes she looked at me and said,

“Did you come to take me out of here?”

It broke my heart.

“No, I can’t. You have to stay till you’re better.”

She’s better. Four months later she’s amazingly better. When I came home from my first visit I researched the place.

The owners of that facility own ten such places. Private company. Perhaps this was their oldest, the facility in the worst condition. No way to tell. Maybe it was their best. The internet offered little information. They maintain no independent web page, the owners, so their online presence is controlled by others. I found an ambitious list of ICF facilities in Illinois that appears to have been designed so that a wealth of information, provided by the facility, could be shared with consumers. Little data existed. Staffing patterns were outlined, few nurses, surprisingly low ratio of mental health professionals. 11% of a full time psychiatrist for 115 patients. Sliver of a dietician. I could imagine the requirements behind their staffing pattern. People you pay for because you have to have them.

My friend saw that psychiatrist exactly twice, each time for five minutes. When she came in she refused to take her pills, refused to leave the room, didn’t want to eat, hated going to the day room. Gradually it changed. They were patient, and gradually she developed relationships. The owners didn’t matter, or the dietician, the psychiatrist in the end hardly at all. It was the low paid staff that mattered, the people in the kitchen, the housekeepers, the people she saw everyday, who shared details of their life with her. After hearing nothing of other people for so long she began to mention the names of staff, and other residents, and the social worker. She grew to like the social worker. He persuaded her to attend group counseling.

She introduced me to the social worker, a man about her age, put her arm around him and told me he was stingy with the cigarettes but a nice guy all the same. Coordinates the color of his canvas Chuck Taylor s basketball shoes with his outfit. Later when he was helping me carry her stuff to the car he confided in me

“She finally came out of it in group. By the end she could have been running it. It took a long time but she made great progress. She’s doing really well. She just has to take her meds. As long as she does that I think she’ll be fine.”

The facility was called a nursing home though there were very few nurses there. It’s intermediate care. Physical disability and poor health is not the main concern inside those walls, but rather mental illness. Were the people inside not mentally ill they would live in the community. This is a private facility housing poor publicly funded patients. I would guess 100% of the people inside are funded by Medicaid. When you are poor you qualify for Medicaid and when you are mentally ill and unable to live on your own a facility such as this accepts you and provides care (think housing) collecting a daily fee for you based on those Medicaid rates. The condition of the patients earns the owners of the home a lower rate than what we think of as a nursing home. The rates are set by the state and reflect the money legislators budget for Medicaid reimbursement to private facilities. If you are the owners of this nursing home you put ten such place together and run it on a business model. Hey, someone has to do it.

My friend never knew anything about the owners, the Medicaid rates, the failure of the Illinois legislature. Those were my issues. She knew that the people she lived with, and who worked there, were kind and wanted her to get better. She came to trust the social worker, and the social worker helped her. That was the key I think.

As we walked through the day room for the last time it was slow going. My friend was something of a rock star. She had gotten better. She was going home. Everyone wanted a hug. There were tears, mine included.

Some societies have much less. America and Illinois at least has a system to care for the mentally ill. Should we be thankful for that system? OK. Can we do better? God, I hope so. Will we in the future? I see little indication we will do so.

Four months ago I was very critical of the system I encountered for serving the adult mentally ill. Today I’m less so. We can still do much, much better. I forgot something in my critique four months ago. It’s not the facility that matters, the light in the day room, the condition of the closets, the roof. It’s the staff. It’s the people we trust our loved ones to that matter. At the very least we should not cut them or their system one dime more. Look closely at what happens to your state’s mental health system in the months to come as Illinois negotiates a budget. People depend on that system. We cannot let them down.

P.S.-I’m leaving in a few hours for Peru, not the town on the other side of LaSalle. I’m going to Peru, Peru” as the young man put it in the phone store the other day. I’m going on an eye care mission to Lima and parts beyond. I’ll be back at the very end of March. Don’t expect a Dave in the Shack blog post till I get back. If you get one it’s not from me.

Friday, March 13, 2015

You Hit me, I Hit you

I put my coffee cup, a little brown cup I bought at a second hand store in 1980, upside down on my wood stove. The cup says “Mitch” on the bottom, crude cursive scratched into wet clay and baked into a permanent signature. I think Mitch, whoever he is, probably made it, God knows when, in one of those beginning pottery classes at a community college. Chances are it was the only cup he ever made. It came out nice and round, the handle looks good, but it’s splotchy. Ugly really. I think something went wrong when Mitch fired it in the kiln. I can almost see the disappointment on Mitch's face when he took it out. It found its way to a junk store. I bought it. That was thirty five years ago.

I bought that cup, a similarly flawed bowl, and a spoon at the beginning of a camping trip after my girlfriend moved out. We were at loggerheads, in a protracted discussion (or was it a negotiation?) about marriage. The house felt empty. I decided I needed some time by myself for serious thinking. I packed in a hurry throwing a pup tent, sleeping bag, lantern, a small pot and frying pan in my Toyota. I had a Frisbee to use as a plate. But as I drove along, taking inventory of what I had, I realized I’d forgotten three essentials. A cup, a bowl, and a spoon. I got them all for under $5.

That brown cup lasted through our break up, eventual reconciliation, became part of our marriage, and has now found its way to the shack. I use it nearly every day. Because there is no one to talk to out here, I’ve taken to calling the cup Mitch by name. Out loud. Sometimes I bid Mitch good morning. I know it’s odd. Like Tom Hanks and his friend Wilson the volley ball in “Cast Away.”

Very early on one of those bitterly cold winter mornings not so long ago I put Mitch on the stove because he was beastly cold and needed a warm up. I had a thermos of hot coffee. But putting hot coffee in an ice cold cup defeats the purpose. That’s why Mitch was on the stove.

It’s a small wood burner, a ten and a half inch hollow cube of cast iron on stubby legs. It sits on a steel table beside me that doubles as a holder for the pine I use for kindling and the oak chunks I burn for warmth. I waited till I heard the oak chunks roaring in the little stove before I put Mitch on the top surface, inches from a glowing chunk of red hot oak underneath. I put the cup rim side down on the hot stove top, but was careful to hang the handle off the side so I wouldn’t burn my fingers when I picked it up. Upside down because I figured the heat would stay trapped in the cup and warm up faster. I returned to my writing.

After a time I picked up Mitch, the little brown cup, put him on a coaster on my writing desk, and filled him with hot espresso. I make a thermos of espresso every morning in a stovetop Bialetti in the house, fill a stainless steel thermos, bring it to the shack and drink it in the course of a morning. Hot cup, steaming hot espresso, below zero outside. Perfect.

I brought the cup to my lips and before I felt the searing pain of overheated glazed ceramic on my lower lip I heard it sizzle. Just a little ssssst, and felt the skin on my lower lip contract. The image of a piece of bacon flashed into my head. And then the pain came. I managed to get the cup back on my desk without dropping it, and in a classic example of scape goating exclaimed, rather loudly:

“Mitch, you son of a bitch.”

I’d kept Mitch on the stove way too long. It wasn’t serious. It was a short arc of white on my bottom lip that would later turn red, then brown, then scab over and slough off. It healed quickly with the aid of Bag Balm. Nothing heals more quickly than sores in your mouth. It wasn’t the burn itself that took me back. It was first the enormity of my own stupidity, and secondly my immediate reaction to blame someone or something else. Just when you think you’re a pretty calm and reasoned fellow, you prove yourself otherwise.

When my kids were little I involved them in Saturday morning leaf raking. I gave them both adult size rakes, the bamboo kind, even though my daughter was six and my son four. They were eager to help. We lived on the West side then in a rented house on a corner and were raking the leaves to the berm. It was all going swimmingly until the kids got near each other. I was away from them some distance but looked up to check their progress and saw the whole incident unfold. They were back to back and without knowing it, too close together. Because they were small trying to manage full size rakes they had both choked down on the handle, with a most of the wooden stick waggling behind them. My son’s rake hit his sister squarely in the back of the head on one of his mightier stabs at the leaves. Before I could yell:

“He didn’t mean to!”

she turned, gripped her rake like a baseball bat, and cracked her brother a good one in the back of his head. Pure reflex. It was ‘You hit me, I hit you’ demonstrated perfectly at a young age. Action, reaction. Call it what you will. It comes naturally to us humans. We have to first know that about ourselves, and then guard against it.

I try to do that, I swear, not give in to knee jerk reaction, but it’s very hard.

That was what I was doing when I finished an article in the New York Times Sunday Review called “How We Learned to Kill” by Timothy Kudo. Timothy Kudo is a 27 year old Marine captain and graduate student at New York University who was deployed to Iraq in 2009 and to Afghanistan from 2010 to 2011. It is best to read the whole article rather than rely on the excerpts and comments I will make about it. You can do so by copying and pasting this in your browser: (Sorry, I can't make the link feature work.)

Here’s what I reacted to both immediately and emotionally. If I was my young daughter at the moment these words sunk in I would have hit him with a rake.

We live in a dangerous world where killing and torture exist and where the persecution of the weak by the powerful is closer to the norm than the civil society where we get our Starbucks. Ensuring our own safety and the defense of a peaceful world may require training boys and girls to kill, creating technology that allows us to destroy anyone on the planet instantly, dehumanizing large segments of the global population and then claiming there is a moral sanctity in killing. To fathom this system and accept its use for the greater good is to understand that we still live in a state of nature.

I don’t accept that. It makes me want to scream. But it’s a nice almost spring day. We’re already at 37 degrees and on our way to the fifties. I’m letting the fire in my stove go out It’s not a day for screaming. I’ll do that next time. Enjoy this day.

Tuesday, March 10, 2015

The Truth Will Set You Free

There are times you learn things you wish you had never known. But you cannot avoid the truth, at least you should not. How does that cliché’ go? “The truth will set you free?” It may, but before it does it may well sadden the hell out of you.

My church, First Congregational United Church of Christ, is using for its Wednesday night Lenten services a worship series developed by an artist named Mary Button. Ms. Button has used the fourteen stations of the cross to illustrate the suffering not only of Jesus during his trial and crucifixion, but of LGBT people throughout their struggle for equality. LGBT is an acronym for lesbian, gay, bi-sexual and transgender people.

Wednesday the series took us back to World War II and the concentration camps established by Germany’s then Nazi government, and the contragenics imprisoned and killed there. Contragencis is a term coined by linguist Richard J. Deppe to encompass all groups persecuted under the Nazis. When we think of concentration camps we think of the Jews, but in reality many other groups were persecuted and killed. Among them were homosexuals, anti-fascists, the disabled, Gypsies, Jehovah's Witnesses, nonconforming clergymen, Freemasons, Polish and Russian prisoners of war and huge numbers of Polish and Hungarian Nationals. I knew that vaguely, but was largely unaware of the plight of gay people during the holocaust.

Homosexuals were forced to identify themselves by wearing the pink triangle. The Nazis created a complicated system of identifying badges that persecuted groups wore, which dehumanized them and made their identity categorical rather than individual. The most famous identifying badge is the yellow star of David signifying Jewish heritage. Homosexuals were forced to wear the pink triangle. Admittedly the number of homosexuals and other groups persecuted during Nazi rule is small compared to the Jews. Between 1933 and 1945, under Nazi rule, it is estimated that around 100,000 individuals were arrested for the crime of homosexuality. How many homosexuals ended up in concentration camps is unknown.

The suffering in concentration camps for all groups there is nearly unimaginable. For many, entering the gates of that hell meant quick death. The old, the young, the lame, those unable to work were simply killed, their bodies summarily disposed. All those who survived that first cut were then worked, starved, beaten, and humiliated, many dying from the experience. Everyone suffered. But at an individual level the suffering homosexuals went through is as profound and extreme as anyone could have suffered. Those imprisoned in concentration camps for homosexuality were often subject to particularly brutal abuse and treatment because of how despised homosexuality and homosexuals were; there are stories of men being forced to watch their lovers eaten alive by guard dogs; torture for homosexuals was routine and extreme; the majority of homosexuals sent to concentration camps would not survive.

For those that did survive, those wearing badges of every category, liberation finally came. In 1944,as the German army was being defeated throughout the Third Reich and as the Allies approached many camps were evacuated. On July 24th, 1944, the Soviet Red Army arrived at the Maidanek camp and liberated those inside. Other camps soon followed with the arrival of various Allied troops, although the largest of the death camps - Auschwitz - was not liberated until January 27th 1945. World War II ended on May 7th, 1945, when Nazi Germany finally surrendered to the Allied forces.

Even after hearing of the horror of Nazi concentration camps again, what I learned next saddens me most. For the homosexuals that survived, it is difficult to call them lucky, many continued to be imprisoned, their Allied liberators becoming their latest jailers. As much as the Nazis and the Allies were enemies, they agreed on the criminality of homosexuality and the need to deny them their freedom based on their sexuality. And so the end of the war offered no relief from persecution and imprisonment. Liberation from Auschwitz and Buchenwald only resulted in relocation to different prisons. Post Nazi, post-war Germany was as unwelcome, unfriendly and as dangerous a place as before for homosexuals. Their time in the concentration camp was merely credited to the outlandish sentences handed down by Nazi tribunals.

After the camps were liberated and the plight of the Jewish victims acknowledged worldwide, the persecution of homosexuals continued throughout post-war Germany. While many survivors were rebuilding their lives and families initially in displaced persons camps, homosexuals faced further persecution and social exclusion. While many victims would receive reparations, assistance after the war, state pensions, and other measures aimed at providing them a means to recover from what they'd been subjected to at the hands of the Nazis, this was not true for the gay and lesbian concentration camp survivors. Homosexuals remained deviants in the eyes of post-war society.

In the post-war years many homosexuals tried to restart their lives; some entered into marriage; others struggled to find anonymity in their communities; some even entered the armed forces. The stigma of the pink triangle was clearly a heavy burden and, without the support and contact of gay friends who were either in hiding or dead themselves, many survivors lived with the silent 'shame' of their experience in secret.

In the 1945 Nuremberg war crime trials no mention was ever made of crimes against homosexuals. No SS official was ever tried for specific atrocities against pink triangle prisoners. Many of the known SS doctors who had performed operations on homosexuals, were never brought to account for their actions. One of the most notorious SS doctors was Carl Peter Vaernet who performed numerous experiments on pink triangle inmates at the Buchenwald and Neuengamme camps. He was never tried for his crimes and escaped to South America where he died a free man in 1965.

What many don't know is that Nazi-era laws criminalizing homosexuality were not fully and finally repealed in Germany until 1994 (though some liberalization of the laws occurred in both West and East Germany prior to that). Gay men were still considered criminals for their homosexuality when the war ended, and would still be considered as such for many, many years following the conclusion of the war. Germany was not alone in this stance. While watching the movie “The Imitation Game” I learned that Britain charged Alan Turing with indecency and demanded he undergo chemical castration, taking a drug which made sex impossible, in order to avoid prison. He died of suicide two years later.

Alan Turing was a brilliant gay mathematician who invented the “Turing Machine” which broke the code devised by Nazi Germany embodied in the Enigma machine. His invention is acknowledged as the predecessor of our modern day computer. Many believe his machine was the single biggest factor in the Allies winning the war. Ironically he was driven to his self imposed death by the very government he helped save.

LGBT people, here and around the world, have suffered and continue to suffer discrimination because of who they are. You can imagine this. If you are a straight person imagine that a basic impulse that is part of both your body and your mind, that you discovered and felt always since you can remember, as normal and as much a part of you as hunger, was deemed criminal. This drive within you, that brings you joy, elation, satisfaction, and release is now seen by others as deviant, dangerous, taboo. What if you were fired or not hired because your employer discovered the truth about your sexuality? What is you were unable to find housing? What if you were bullied and despised by your peers? What would you do?

And how would you feel? How would you feel if you were a survivor of a concentration camp, standing among the other prisoners, striped uniforms hanging off you, walking skeletons every one, and you realized that the other prisoners would go free and be helped to wholeness while you, because of who and how you love, would continue to be denied liberty? After you and the others went through the same living hell only you, and others like you, would continue to be denied their freedom. You hadn’t suffered enough. Imagine it.

Do you think the advancement of rights being gained by the LGBT community is not a matter of civil rights? Think again. It is a struggle for equality. Just as African Americas marched across the Edmund Pettus bridge fifty years ago to gain their dignity as equal human beings gay people struggle today. I believe we are about to make same sex marriage a right nationwide as we should. Will that signal the end of discrimination against the LGBT community. No it won’t. Just as the Voting Rights Act of 1965 did not end discrimination against African Americans, marriage equality is but a step along the way.

We are blessed however with a younger generation that is much more accepting of LGBT persons. I can imagine a day when the stigma of being gay is no more. But we aren’t there yet. The struggle for equality continues. If you’re part of my generation and you are reading this, find ways to be part of the solution.

One of the ways we change our attitudes is through education. If you would like to learn more about the struggle for LGBT equality you can join us at church during the remaining Wednesdays of Lent for soup at 6:15 and a short service at 7:00. You can see Mary Button’s art and learn the history of this struggle for yourself. We’re on the corner of Columbus and Jackson in Ottawa. You are welcome there.

I borrowed heavily from other sources to write this post.
Further reading: 175