Nites Wedder

Approaching the sidewalk in front of me from the cross street, an older Asian woman moved slowly but surely, her posture slightly hunched as she stepped from the street and looked up at me as I paused so she could pass. "Nites wedder!" she remarked, smiling. Minutes before, while pulling my heavy coat more closely around me, I had noted the gathering clouds and dropping temperature and made a mental note to bring the clean sheets in from the clothesline as soon as my quick errand to the grocery store was done. Rain is forecast for tomorrow, and it seemed to be scouting the area already. But that smile and greeting were disarming, and remembering the freak snowstorm that had befallen us twenty-four hours prior I had to agree. "Yes!" I called to her, "Much nicer than yesterday!" And, funny, but a moment later the sun came out again and the air felt pleasantly warm once more. Nites wedder, indeed.

If she were alive today the grandmother who reared me would be looking ahead to her 129th birthday this year, so it's fair to say she was from another era. She also hailed from the old South with its conventions about manners and propriety. She taught me early on to say "Good morning," "How do you do?," "Please," "May I?," and "Thank you." The correct response to "How are you?" was "Very well, thank you. And you?" And passersby on the street should be met with a smile, a greeting, and a bit of small talk, such as, "Nice weather!"

Especially here in the city, the constant onslaught of social stimuli can be overwhelming, and the practical problem of greeting everyone passing on the street while still managing to remember where one is going and why is real. So the unspoken contract that says we properly avert our eyes, focus resolutely on our own business, and silently keep going when we meet others is understandable. But on a quiet neighborhood street on a Sunday afternoon when there is nothing more pressing that buying bones for dogs and a birthday card for a friend, there is time for friendly acknowledgement of another's presence. But for a stranger's "Nites wedder" this might not have occurred to me.

Crudeness, abrasiveness, and snark seem to be the order of the day in 2019. Recently I have heard heated assertions that no one should take exception to the use of profanity anymore, and I have heard young, educated, professional women swear like sailors and seem proud of it, oblivious to the fact that in their torrent of blue language they have failed to make any point other than that they are experiencing emotions. Impressive, provocative, and compelling they're not, but loud and proud they are nonetheless. It's a lazy, self-absorbed habit, and they can do better.

Just yesterday in a community social media group a neighbor posted a warning about a scam to which she had fallen prey, alerting others to be mindful and not as gullible as she had been. For this other neighbors called her an idiot, questioned how she could be so stupid, and said that anyone who is that dumb deserves no sympathy. Harsh judgments of someone who by her own admission made a mistake, learned from it, and wanted to warn others. A response to another neighbor's concern was to call people a**holes. If someone is thoughtless or makes a mistake when driving the response is rage, whether leaning on one's horn, yelling choice words from the window, or trying to even the score, often in dangerous ways. Respecting people while disagreeing with their opinions or choices largely is a lost art, and precious few folks seem to be able to listen to a different point of view and thoughtfully consider what constructive contribution to the conversation they might make instead of hammering their own ideas increasingly loudly and aggressively while belittling the other party.

When we engage in name-calling we set people apart as "other." Viewing people as "other" is the first step towards judgment and condemnation, and once "others" have been judged inferior, lesser, and/or wrong it is easier to justify ridiculing, excluding, restricting, or harming them. So whether it's the libs or the snowflakes or the anti-vaxxers or the baby killers or one or another political party or race, religion, ethnicity, national origin, language, dress, gender, sexual orientation, or social status, someone is painting with a broad brush, and being similarly painted in return. Insults and trolling do nothing but harden positions and buttress the barriers that divide us. I have seen this play out even among sports fans, where devotees of one team assume moral and existential superiority over their rivals, well beyond the bounds of sportsmanship and spirited rivalry.

The negative energy in all this is stark and heavy. It's tiring, as attacking, defending, and ever being on guard take energy. It's an individual health problem and a public health problem as stress levels rise, bodies break down, and then communities do, too. Today there is news of two more mass shootings, and tonight I received a security alert about a shooting just blocks from my own home.

It's time to stop. Not time just to demand that politicians, police, social service agencies, and others take action, but time to act ourselves. This means speaking thoughtfully and respectfully rather than critically and harshly, focusing on positive goals rather than on the shortcomings of others, and actively looking for common ground and common values, on which to build. It means condemning bad behaviors, not people individually or in groups. It means taking to heart for ourselves the lessons we teach young children: "Use your words" when you're upset, not your fists, automobiles, or guns. And as adults, speak meaningfully in ways that advance discussion and understanding, something that a string of profanity and insults does not do.

The task seems daunting, this business of re-civilizing our uncivil civilization. But maybe it's not so bad. Maybe it starts simply with biting one's tongue from time to time, thinking before speaking and then speaking well, and from time to time putting phones away, removing earbuds, taking a deep breath, looking around, and smiling at a stranger who's a little different and saying, "Hi!," "Good morning," or perhaps even . . .

"Nites Wedder."

Thank You

To the patient who said with wide-eyed astonishment and awe, “I thought I just had a bad cold, but you found a problem in my lung and took care of it,” thank you.

To the daughter who said after her mother died, “You kept her alive all those years! She never would have survived without you,” yes, I did, and thank you for realizing it.

To the countless patients who have said, “Now I understand!” or “That makes what I need to do so much easier!” or “This chart you made is so helpful,” thank you.

To the family that texted from time to time for years with “Mom’s doing this now; what should we do?” messages that never failed to end with “Thank you for your time/we’re so sorry to bother you at night/on a weekend/on the holiday,” thank you. Together we kept her home and out of the hospital for the last year and a half of her life despite multiple chronic and progressive problems and a doctor who never came to the phone and whose after-hours calls went to strangers who didn’t know her. I’m glad to accept those texts and to stand by while you carry out my instructions, even though they are nonbillable interruptions of my personal time, because I can do what the stranger in the doctor’s practice cannot, because it makes an important difference, and because you as a family are grateful and non-abusive collaborators.

To the bystander who asked as the ambulance pulled away, “How’d you know what to do? He looked fine to me!” thank you for recognizing that my seemingly unlikely knack for knowing that something wasn’t “normal” just saved a life.

To the myriad of patients who have thanked me just for showing up and being there, thank you for underscoring the loss suffered when “attending physicians” stopped attending and for recognizing what a steady presence with a sharp eye, educated mind, and keen and skilled intuition is worth.

And as we embark on another “Nurses Week,” thank you for understanding my imperfect efforts to be gracious when you describe my colleagues and me as “caring,” “compassionate,” and “hard-working.” A child often is caring and compassionate, and a window washer is hard-working; indeed, most human beings are caring and compassionate in their own ways and most work hard in the endeavors they have chosen or that have fallen to them. Nurses are human beings; ergo those traits pertain to us. But there's more, and it's the "more" that defines us and matters most.

We know that patients and those important to them rarely understand what’s going through our minds as we seem just to chat about the weather or a television program. And we know that the extra warm blanket or the steadying touch or the reassuring smile when life seems most uncertain and scary, these are tangible things people can understand as comforting and so they comment about compassion. So when you recognize our “caring” we hope that’s code for a silent nod to years of rigorous education, finely honed skill, experience and understanding beyond the pale of most people’s imagination, and a great deal of responsibility borne daily for decades that is the glue that holds together all of healthcare.

Thank you for paying attention. And to anyone who has a sense of nurses’ compassion entailing something different from that of a faithful old dog and of their hard work being substantively different from what goes on in an ant colony, a shout out to politicians, regulators, and CEOs about safe nurse staffing, safe workplace environments, reasonable workloads, and compensation commensurate with expertise would be most appreciated.

Another tote bag or tulip won’t make much difference. Recognizing, respecting, and rewarding what nurses actually know and do will, for nurses, patients, and anyone who cares about either. . . . And

Thank You.

Too Many Pills!

Too many pills! The intensity of my visceral reaction to my pill boxes still stops me in my tracks, now five days and ten "doses taken" after I upgraded to a larger size that more easily accommodates their contents. And the kicker is that apart from a generic, over-the-counter tiny tablet that controls any reflux that might pop up from time to time, there is no actual "medicine" in them. My eye doctor once recommended a vitamin, so I take that, but nothing else in there ever has been endorsed by a physician, much less prescribed by one. Instead, everything is a supplement I take to offset any deficiencies my occasionally careless habits might create, or to augment something positive. With pitches for Medicare-related insurance products arriving with my mail almost every day now, I should be glad that at this point in life I have no prescribed medications, no diagnoses, and no pain or other symptoms to be managed. And I am. But the sight of those "jumbo" pill boxes in my cupboard nonetheless momentarily leaves me feeling old and sick the minute I open the door and see them, never mind that I'm about to go out and hop on a bicycle or shovel snow. The small pill boxes were fine, just a convenience. But the exact same supplements I'd been taking all along prompt an entirely different reaction once placed in different containers. I shake off the feeling, down my supplements, and go on my way, only to repeat the experience later, morning and night, every day.

This silly little jolt morning and evening reminds me in a new way that when patients complain about taking "too many pills" or having or doing too much, or too little, of anything, we would do well to listen instead of "teaching the problem away." You know, the very rational, "Actually, Ms. Jones, you don't have much at all. There are just some vitamins, some iron because you're a bit anemic and a stool softener so the iron doesn't constipate you, a couple pills for your blood pressure that are very low doses, and the pill you take at night to lower your cholesterol. It may look like a lot, but it's almost nothing and many people take much, much more."

While it's important that "Ms. Jones" know that, this information does nothing to help her cope with the reaction she has to seeing eight or ten pill bottles lined up on her dresser or alongside the kitchen sink. "Medicine" means "sick," and lots of medicine means "old, frail, failing." Even when it doesn't. Because perceptions matter, and often decisions are made on the basis of perception rather than "facts." Indeed, for the past year or so there has been buzz in the political winds about "alternative facts," the substance of which are not factual at all, but the beliefs about them are very real and often drive action.

Perceptions matter. Often if perceptions can be modified the underlying facts matter less or take care of themselves.

Interviewing for what would become my first Vice President position, years ago I met with the physician "movers and shakers" at the hospital where I was a candidate, i.e., the department heads, medical staff officers, and "big admitters" who brought large numbers of patients, and therefore revenue, to the hospital. They asked me about my background, experience, and interest in the position, and then I asked them what concerns they had about patient care that they would want the new VP to address. Like most of us, I suppose, sometimes doctors are better at complaining than at teasing out a problem and naming it, and there were a few moments of shuffling and awkward silence before one of them chimed in with, "My patients' call lights aren't answered. They have to wait and wait before anyone responds." Heads bobbed and affirming grunts issued forth from around the table, and everyone seemed to agree that this indeed was a significant problem that the new VP should tackle right away.

So, once selected, hired, and settled into my new office, I met with the clinical department heads and shared what the doctors had told me. "That's not true," was the response in one way or another from every one of them. "Our staff is conscientious and our patients' needs attended promptly and well. This is not a problem, absolutely not."

"Well," I said, "Truth is we do have a problem. The question is just which problem we have. Either call lights are not being answered promptly, or our doctors perceive that to be the case even though nurses, technicians, and assistants are swift to respond. Whichever problem we have needs to be solved. So let's figure out which it is and get on it."

I never again brought up the topic with those managers, never had the need.

One day, just one day, I stepped out of my office and glanced down the hall where I could see one long corridor of a general medical unit, and noted that call lights were ablaze as though people had been decorating for holidays. So I walked over and answered the first light I saw, where a patient in an embarrassingly gaping hospital gown was struggling to move her overbed table to reach something. That was easy to fix. After helping her I stepped back into the hallway ready to answer the next light, but all were off. A walk around the unit confirmed that the patients were settled and comfortable, and not that all the lights had been turned off centrally because the VP had been spotted on the floor.

In the remainder of my tenure at that hospital I never again saw a corridor of a patient care area that looked like it had been decorated for holidays, except when holidays indeed were at hand and actual decorating had been done. And a month or so after that meeting with the clinical department heads I sought out the physicians who had reported the problem of unanswered call lights and asked how that situation was now. To a man (and they all were men), there were no concerns.

To this day I don't know what the problem actually was. Were call lights unanswered and an unacceptable status quo shaken up by a new VP who called out the situation, cited unhappy doctors, and once was seen taking matters into her own hands, or was there a new level of attention to physicians' (mis)perceptions and energy given to correcting them and to demonstrating more clearly excellence that had been there all along? Or some of both? Or something else entirely?

What I do know is that without ever knowing the "facts," the problem, whatever it was, was solved.

And in that is a lesson about moving forward and achieving goals.

Too often clinical practice is about the facts of pathology and the teaching of health management, when the need is for reframing a problem and managing emotions. Too often management is about blame-fixing, marching through a punitive personnel process, and making numbers look right, when the need is for light to be shone in dark corners, problems reframed, and people closest to the issues empowered and set free to innovate.

Facts matter, of course, and must not be confused with "alternative facts" and misperceptions. But much of the time the focus needs to be on objectives, i.e., the question, "What needs to happen here?" rather than on arguing, setting straight, or being "right." When we listen hard, widen our perspectives and shrink our egos, and remember that however the mess of the moment came to be we now are looking forward rather than back and that people are energized by the positive and recoil from the negative, we're likely to find that behaviors improve and new avenues open as creativity and vision thrive, whether the problem is bickering neighbors or politicians, call lights that may or may not be answered promptly, or a patient needing to deal with

Too Many Pills.

Assumptions and Expectations

The setting: My old apartment building on Valentine's Day, over twenty-five years ago.

As I stepped into the foyer, my eyes immediately went to an absolutely beautiful, large floral arrangement wrapped in cellophane and waiting beside the inner, locked door. "Oh!" I thought, "Cindy is going to love that!"

"Cindy" was the neighbor who lived across the hall from me, and other than the usual tidbits that city apartment dwellers pick up from sheer proximity to one another I didn't know her well. She was pretty and smart, with an engaging smile, warm eyes, and an easy conversational style that drew people to her. Cindy worked in sales and seemed born for the job; I imagine she was very successful. Although there was a time or two when I saw her with the puffy eyes and red nose that go with a respiratory infection and one instance where she clearly was distraught after a row with a beau, Cindy characteristically was smiling and perfectly decked out for whatever an occasion required, with her long, dark hair falling in easy waves down her back, sometimes corralled with a scarf or pushed aside with sunglasses atop her head. We shared a housekeeper and a hairdresser, and I found my new favorite radio station after noticing the music coming through her apartment door, but although our lives intercepted in the hallway from time to time they didn't otherwise overlap and we weren't close friends.

Nonetheless, I noticed that Cindy usually had a boyfriend, and she and her man always seemed rather like Barbie and Ken. I'd see them heading off to play tennis or go skiing, or notice him ascending the stairs behind her, arms laden with groceries and other miscellany from their shopping excursions, smiling and obviously happy to be of help. The floral arrangement I saw on that Valentine's Day seemed the perfect gesture for Cindy's boyfriend to have made, and I knew she'd be delighted.

I, on the other hand, was dating "William." William always was "William," never "Bill" or "Will," and certainly not "Billy" or "Willy." Named after his father, he hadn't picked up a nickname to help distinguish one from the other, such as Chip or Bud; no, it always was just "William." William was handsome and smart, educated at the best schools and successful in his profession. He was a gym jock as well as a studious dancer who knew all the steps and moves, even if he sometimes seemed to be marching through them more than dancing. My girlfriends envied me: William was a catch: An attractive, accomplished man, trustworthy and reliable, and one who not only would and could dance but also was a strong lead. What more could a lady want?

William was somewhat socially awkward, though, and a bit shy. It could be hard to draw him out, and no one ever would accuse him of being romantic. In fact, after awhile I chuckled knowing that every holiday and special occasion would be met the same way: I would receive a perfectly nondescript card that equally well could have been sent to his mother, boss, or child's teacher, with a generic message of good wishes for the day and William's inscription, "Happy [occasion] from William." "Happy birthday from William." "Happy holidays from William." He might take me out for a lovely evening and would spare no expense, but tangible mementos weren't William's style and the say-nothing cards "from William" made me smile but didn't touch my heart. That just was William and how he rolled.

So on that long ago Valentine's Day I peeked through the slots of the mailboxes on my way by, noted that the mail had not yet arrived, and made my way to my apartment intending to return later to look for mail again, anticipating the obligatory Valentine greeting "from William." Once home I set about putting things away, changing clothes, and perhaps making a snack or lunch before settling down to make phone calls and do paperwork, and thought idly of the lovely surprise downstairs that awaited Cindy. I couldn't help but think that it would be wonderful to have a beau who would send me something like that, but reliable, dependable, rock-solid, hardworking William just didn't do things that way. A woman could do a lot worse than William, I knew, and I needed to appreciate him as he was.

Still, the thoughts lingered and niggled: "I wish . . . I wonder if any amount of hinting or begging would make any difference . . . If only . . . Hmmm. It wouldn't hurt to look. It's a long shot, terribly long, but I could look, and promise myself not to be disappointed to see Cindy's name on the card." After all, the simple elegance of that floral arrangement simply screamed "Cindy," and sending it was exactly what I would have expected her boyfriend to do.

So, having steeled myself against likely disappointment, I retraced my steps and went back downstairs. The flowers were even prettier than I remembered . . . and there on the card was . . . my name! I picked them up and floated upstairs, and even had the pleasure of encountering the man who lived above me and observing that he was duly impressed. Once back in my apartment I removed the cellophane and discovered that in addition to the flowers the arrangement included two mugs adorned with red hearts and assorted small packages of coffees and chocolates. William knew me better than I'd realized, and perhaps better than I knew him. As though to ensure that I kept at least one foot firmly on the ground, however, the card bore the characteristic message, "Happy Valentine's Day from William." I had to laugh!

Last week, the very day after I wrote about "Uncle" in this space, the next mug up in my rotation was the one remaining heart-covered one from that long ago gift from William:

As I looked at it, sitting there in my kitchen with the morning's joe ready to help jumpstart my day, I thought of all the goodness that people overlook simply because they don't expect to find or receive it. Had I not happened to go back downstairs that day, albeit fully expecting to be disappointed, I would have missed William's gift. It's a sad state of being when one walks right by a much longed-for blessing without so much as bothering to glance at the card, and receives it only when the universe clunks one over the head. I've needed many a clunk of that sort over the years!

But beyond being head-shaking sad, expectations and assumptions can be actual health hazards. The assumption that physical and mental frailty are normal aspects of aging, for example, and therefore nothing that should be evaluated and treated, or the expectation that crushing chest pain will subside spontaneously if one just doesn't give into it, robs countless people of both quality and length of life. And some expectations and assumptions can drain the vitality and joy from literally decades of living.

Consider "Viola," a ninety year-old patient whom I first met while she was in the hospital. Her friend "Warren" was at her bedside, and we talked together about her going home and the home healthcare she would receive once there. Viola has a quick wit and sharp tongue, and I liked her at once. Thinking it unfair to use my position to take all the "good" patients before they even left the hospital, I sent her referral to the home care office with no recommendations about staffing but hoping she might come to me. Unfortunately, once home she was seen only once by a weekend nurse before she landed back in the hospital with cardiac complications. I saw her frequently during her second stay, finding Warren with her every time and thinking more and more that I'd like to have her as my patient when she finally returned home.

It happened. The home care scheduler sent a list of patients who needed Case Managers, and Viola's name was on it. So I jumped on it, and as soon as she went back home Viola was mine.

My impressions from those hospital visits weren't wrong. Viola is quick and witty. She reads voraciously, loves crossword puzzles and classical music, and has a condo full of treasured collectibles. We disagree about politics and so stay away from that topic, but she regales me with stories and we "solve the world's problems" together while I unpack and later repack my gear. However, I have seen Viola either in the hospital or at home for two months now, and don't believe there has been a single encounter when she has not mentioned being an orphan.

Ninety years ago, almost a century, Viola was dropped off at an orphanage when she was days old and stayed there until she ran away as an older child, not happy with the nuns' insistence that she eventually enter the convent herself. "I've been on my own ever since," she says.

Ninety years later, every time I see her she speaks of being an orphan. From time to time she remarks, "Nobody loves me" and "Nobody wants me," half joking, but clearly not entirely so. "I'm all alone," she'll say matter-of-factly. "I have no one." Yet Warren, with whom she worked for decades before they both retired, drives over an hour one way to visit her and to take her back to his home to visit, later driving her home again and then driving still more to go back home himself. Warren calls every day "to be sure I'm ok." One of Viola's old doctors, now long since retired, takes her to lunch, and she's busy looking for a book for him now. Until recent health issues slowed her down she was active in the community, and recently intervened with the alderman, who heard and respected her enough to resolve successfully a dispute within the condo association.

One day last month I went to see Viola for a scheduled appointment, but the front desk attendant could not reach her to announce me. I waited in case Viola was in the bathroom or down the hall throwing trash in the chute, but repeated calls yielded no response. We were worried. A building engineer joined us and looked concerned when he learned what was happening; he went to procure a master key from the building office. As other residents passed through the lobby the desk attendant asked if anyone had seen Viola lately. Everyone seemed to know her, but none had seen her in the previous two or three days and each one paused to express concern, with clearly apparent and genuine positive regard. The engineer returned and escorted me to Viola's unit, where there was no response to the door and where it turned out the master key did not fit one lock that Viola evidently had changed. We returned to the lobby, and the desk attendant agreed to ask Viola to call me if she appeared, while I would search the hospital records later for Warren's phone number. I considered calling the fire department to break down Viola's door, a decision that for me often is based on a "gut feeling," but opted against it, which turned out to be a good choice.

Viola is fine. Thinking she could go and return quickly, she had ducked out to pick up medicine from a pharmacy around the corner, expecting to be back in time for my visit. I missed her by minutes.

But I now know that there is a big high-rise condo building full of people who like and care about Viola, as well as loyal Warren, the doctor who takes her to lunch and for whom she seeks books, and who knows who all else, as well as this nurse who singled out Viola early on as someone who would be a special patient. But Viola's self-talk is "I'm all alone," "No one care about me," and "I'm an orphan." After ninety years of such talk, I don't suppose that is likely to change. Yet just as I once assumed that a lovely floral arrangement was for Cindy and walked right by it without even checking the card, so Viola has convinced herself that she is alone and abandoned to the point that she doesn't "see" even Warren, calling every day and driving hours to visit her, much less her neighbors and others whose lives she has touched. Viola literally lives in the middle of a caring community, but because of her assumptions and expectations she doesn't recognize it.

In the "new age," self-help world there's a adage that says, "If you can believe it you can achieve it." I don't know that simple belief always is an assurance of a desired outcome; surely the action taken to effect the achievement is critical. I do know, though, that it's almost impossible to receive and achieve that which one cannot even imagine.

We caution children to be careful, to look out for danger, and to take safety precautions. "Stop, look, and listen," we tell them, "You can't count on drivers to see you and stop." "Don't talk to strangers." "Lock the doors." "Know how to use a fire extinguisher and to call 911." "Don't go out alone at night, and don't go into 'bad neighborhoods' at all." "Don't run on the pool deck or with scissors in your hand." "Be careful; you could be hurt."

What would happen if we invested the same level of energy in teaching them to pay attention to the goodness around them? When he was a boy Fred Rogers' mother used to tell him to "Look for the helpers" when news stories frightened him. The helpers always would be there, she said. Suppose we also encouraged children to look for the people who are happy and smiling, to spend time with those who leave them feeling good, and to expect generosity and happy surprises and to delight in extending those as well. Imagine explaining that sirens in the distance are good signs, because they mean someone who needs help is receiving it and that others have the opportunity to be helpers. What if we taught them to see the value in every type of work that any person does and to appreciate it? Suppose we instilled a sense of wonder and endless possibility, instead of just "stranger danger" and defensiveness. Certainly children need to be careful and safe, however, one-sided teaching that focuses on darkness risks leaving young people oblivious to the light.

This is a season of imagining and story-telling, whether around the Christmas tree, menorah, ceremonial solstice fire, days of Kwaanza, or something else. Thinking of Viola, and of my own failure once upon a time even to consider that a gift might be for me, I wish for all of us times of thoughtful storytelling and conscious listening, both in the immediate weeks ahead and in the new year that follows. May we pause mind and body alike, to listen to the stories around us, others' and our own, and dare to correct errors heretofore unnoticed, so that as we move into the new year we carry with us light and wonder and a sense of the possible, free at last from the binding of unrecognized but powerful

Assumptions and Expectations.

Uncle

I collect mugs. I never intended or planed to collect mugs; it just sorta happened. When my kitchen was redone a number of years ago the designer popped a small section of floor-to-ceiling shelving in what otherwise would have been unused space, and a display area for mugs was born. I still didn't get it, and only after randomly unpacking, trying to put the new kitchen in order, did I realize that the mugs I'd absently set on those shelves belonged there. Looking at them later I realized that most of them have a story. This is one:

Many years ago I visited a quadriplegic patient. Injured in an accident the details of which I long since have forgotten, he was a talking head. He couldn't move his arms or legs at all, and I'm not sure now that he even could turn his head. Japanese, he lived with family who respectfully called him "Uncle," and they couldn't have been more courteous or deferent if he'd been able to rear up and threaten them with every sort of violence imaginable or to dole out wads of cash. As are many Japanese homes, the apartment was minimally appointed and spanking clean, always. That it was a third floor walk-up didn't stop the men from carrying Uncle down the stairs and strapping him first into the car and then into a wheelchair so they could take him fishing. Uncle loved to fish, and a little thing like quadriplegia wasn't about to stop him from going!

All I did was visit once a month to change his urinary catheter. Never did I find a mark on his skin, a drop of water in his lungs, a hint of infection, or any other complication of such profound immobility. Uncle always smiled and always asked after me, while at least one family member hovered in the background ready to assist and eager to hear any suggestion I might have to make Uncle's life the least bit better. I don't recall ever having even one; this family had it down perfectly. Nonetheless, Uncle and family alike never failed to extend heartfelt thanks at the end of each of my visits.

One Christmas they gave me this mug. It probably was part of a Starbucks gift package; I don't remember. Of course any coffee or hot chocolate that might have come with it was devoured with relish long ago.

I use my mugs on a rotating basis so I can enjoy each one and none become too dusty on a shelf. Every time this one comes up in the rotation I remember Uncle, his smile, his appreciation, his spirit in the face of circumstances that would have broken most people, and also his dedicated family. It now has been some fifteen years since he died.

Funny the impact that the smallest gesture can have. A simple, mass-produced coffee mug keeps Uncle and all that he and his family stood for alive in my heart every single time I see it.

For many this is a season of giving, and also for many there comes a certain angst about what to buy, what to do, what another wants or needs. I suspect the perfect gift is simply seeing and honoring that other, as Uncle's family saw and honored him, and that any item chosen to represent this will be just right as long as it is selected with love and good will. Indeed, one need only pop by the likes of a Starbucks and pick a package off a shelf as long as that package contains within it the joy of giving along with a mug and anything else. I can attest that when this happens both gift and giver will remain with the recipient always, much as in my heart I carry to this day the memory and spirit of

Uncle.

A Pork Chop, a Potato, and a Nice Green Salad

Costco began slipping red and green ribbon onto the shelves in July, and I still was riding my bike in shorts and a tank top when I first noticed decorative "snowflakes" adorning city lampposts. Now several catalogs arrive in the mail every day, and in the hospital lobby this morning workers were busy hanging garland and ornaments. A Facebook friend tells me that between November first and January fifteenth there are 29 holidays observed among seven major world religions. It's "that time of the year." Yet among all the symbols and traditions abounding I never would have supposed that for me one of the most powerful images of the season would be a pork chop, a potato, and a nice green salad.

"Marge" was one of my all-time favorite patients. We first met when, at 83, she had both knees replaced at the same time and I was her visiting nurse. Over the years she developed a vitamin deficiency requiring monthly injections, a spell of high blood pressure that was challenging to control, a diagnosis of diabetes, various wounds, and occasional mobility issues resulting in falls and misbehaving body parts. I saw Marge for about a decade, with those monthly vitamin injections keeping her on my "active" list even when everything was going well. She lived in a subsidized senior housing building where I saw many other patients, so between our routine visits I often encountered Marge retrieving her mail, stopping to chat with workers in the building office, or popping in to see a friend.

Marge's apartment had big, sunny windows that faced east, and in the mornings the sunshine streamed in as Marge settled in her recliner, which was tucked in a corner of the living room with everything she might need arranged within arm's reach around her. Marge had been the personal secretary to a senior executive of a large company, and she was nothing if not organized and efficient. A stack of books, the phone, coffee and snacks, a pad and pen, and any projects in which she was involved all were placed carefully around her chair, convenient, but neat and not cluttered. The television was across the room facing the recliner, but in the mornings Marge had jazz softly playing. With the bright sunshine, soft music, aroma of coffee and breakfast, and Marge's smiling face looking up at me from her recliner "command post," I used to tell her that she was my role model for how to do retirement. "It's nice, isn't it?" she'd respond with a satisfied smile.

Marge was as efficient in selecting friends as she was with everything else. Her friendships were carefully nourished, and although she had cordial relationships with almost everyone, "Maude," "Alma," and "Dorothy" were her closest cronies. If one needed something the others stepped up to provide it. They sat together at activities in the building, and checked on one another by phone every morning and every night. "We don't talk," Marge once emphasized, "We've agreed. Five minutes, and then we all have things to do." Maude, Alma, and Dorothy all were my patients at various times, too, and I remember more than one frustrating evening when I tried to call two or more of them to schedule appointments for the next day only to find all of their phone lines busy. Of course I had hit upon the hour that they were checking in with one another, confirming that all were home safely and no one needed anything. In the mornings it would be the same thing: A tizzy of phone calls among the four of them to be sure all were awake and ok, and to pass on such messages as that Maude was taking the "shopping bus" and could pick up small items for the others, Alma had been baking and would stop by with cookies later, and Marge just had finished a book that Dorothy would love, so Dorothy should pick it up when she went out.

Visiting Marge at least monthly, I saw the seasons change through her big windows, and her observances with them. A few items adorned with red hearts appeared around Valentine's day, a green tablecloth with a spunky leprechaun atop it adorned her table in March, and a wreath of artificial pastel flowers hung on her door in springtime. And so it was throughout the year. Often I'd comment: The autumn scarecrow on a shelf was adorable, the red, white, and blue coffee mug was perfect for the fourth of July, etc. So when the Halloween-themed items were replaced with a cornucopia on the table and the kitchen towel sported caricatures of turkeys, I asked Marge about her Thanksgiving plans.

"I'll be right here," she said, smiling.

"You're not having dinner with your cousin or doing something with Maude?" I asked, surprised.

"No, I'll have my own dinner here. I like it that way."

Over the years I often thought about many of my patients who were home alone on holidays. Some were lonely and seemed to have contracted energy that turned inward and left them in dark places of self-pity, regret, and longing. Rarely did anyone ask anything extraordinary of me; nonetheless those living in their own dark clouds were hard to be around.

Marge and her friends were different. Maude's and Dorothy's families lived far away, and while Alma's family visited regularly she wasn't up to many long drives to their homes for hectic days of celebration. Many times as Thanksgivings, Christmases, and other holidays passed and Marge remarked that she would be home alone I considered taking a break from my own holiday to deliver a nice dinner from my own table. Other times I wondered about arranging a small gathering in the building's community room where residents could celebrate together. My colleagues and I could donate some food, and residents could bring dishes to pass as well. And once in awhile I thought about just taking something that Marge could share with whichever of her three friends were home on the day in question.

By the grace of God, something stopped me each time. I might have been called to work or had a last minute change of plans. Once or twice I may have been ill, and I know there were times when I had houseguests who kept me more than busy. Perhaps the car was in the shop or I just hadn't organized my time well enough. But I never assaulted Marge or her friends with my turkey, pumpkin pie, or good intentions. It took years and years of Marge saying quietly that she would be home alone and liked it that way before I truly heard her. This was the story that finally got through to me:

The day before that Thanksgiving Maude was taking the "shopping bus" to the grocery store, and Marge mustered the energy to take her walker and go, too. Once there she spied a thick, fresh pork chop in the butcher's case, with just the right amount of fat. She bought it to enjoy the next day. Then, in the produce department she carefully selected one small potato, just right for one person, and also saw containers of pre-washed mixed green salads. She bought those, too.

Marge always loved the Macy's Thanksgiving Day parade, and as November unfolded she looked forward to settling into her recliner with her coffee and delighting in the entire spectacle, with no obligation to help in the kitchen, no one moving in front of her and blocking her view of the TV, no distracting music or radio in the background, and no not-so-subtle hints to change the channel to the pregame shows before kickoff. When the parade ended Marge breaded and seasoned her pork chop and put it in the oven along with the potato. As they baked and with holiday music in the background she wrote her annual Christmas letter, and after dinner put away the turkey decorations and cornucopia and set about decorating her apartment for Christmas. A small ceramic tree went on the table, a red and green wreath on the door, Santa Claus towels hung in the kitchen, a stuffed reindeer wearing a red hat appeared on the sofa, and assorted figurines and mementos found spots around the home.

No homemaker or medical people came, nor did bills and junk mail appear. Maude and Dorothy called as usual; Alma was away with family. Marge's cousin called, as did her nephew in Phoenix. But the building engineer didn't need to inspect or repair anything in her home, and there were no responsibilities to other people that needed to be met.

Instead, Marge watched the entire Macy's Thanksgiving Day parade uninterrupted and relished every minute of it. Her own home smelled of good things cooking, a rarity for one who as a rule subsisted on frozen dinners, and her music brought joy to her soul. She loved the look of her apartment newly turned Christmasy, and felt a sense of accomplishment when the holiday letter was done. That night she watched an old movie on TV, and then went to bed truly thankful for a peaceful, happy day.

Had I appeared with a plate of turkey-with-all-the-trimmings, or pressured her into a celebration with friends or neighbors that I had orchestrated I'm sure she would have appreciated my efforts . . . and at the end of the day been tired, perhaps a bit out of sorts, and without her holiday season started in the efficient way she liked, apartment decorated and letter written. And the poor pork chop would have needed to wait another day, and then be hurriedly prepared when the homemaker wasn't in the kitchen, with Marge retrieving the mail and filing a work order in the office instead of listening to music and enjoying the aroma of good home cooking coming from her own kitchen.

I didn't appreciate it at the time, but now never will forget the smile on Marge's face and the light in her eyes as she told me, "It was a wonderful holiday. I had a pork chop, a potato, and a nice green salad."

Over time I came to recognize flaws in the common assumptions about holidays and how people do or don't observe them, and I learned to believe what my patients told me:

Widowed after more than 60 years of marriage, "Edna" had made more holiday dinners than she could count, and she was ready to be done with them. Just the thought of all the hubbub of a big gathering was tiring, and she preferred smaller, more personal visits or calls. If she was alone for a day she considered it a blessing.

"Elizabeth" had a tremor in her hands. Her doctors had been unable to come up with a diagnosis or cure, so whenever she reached for something her hands shook. As a result, Elizabeth was a messy eater. She spilled on the table, on the floor, and on herself. She didn't need or want to be fed ("Like a baby!" she said), but mealtime never was neat and clean. Embarrassed, Elizabeth did not want to eat around other people, and with the kitchen being the only other room in the family's small house she could access, Elizabeth chose to stay in her bedroom. She was not lonely or isolated; often I found three generations of family around her bed. For health reasons I wanted her up and walking; it was years before I realized that Elizabeth never would act on my encouragement to walk to the kitchen and sit with her family. There always was food being prepared and served in that kitchen, and Elizabeth was not about to put herself in a situation where she would be expected to eat in the company of others. Uh uh; not happening.

"Thomas" has diabetes and chronic cardiopulmonary and kidney disease. He must avoid sugar, minimize sodium intake, be careful of proteins, and watch how much fluid he drinks. He observes all of those restrictions perfectly, with his strategy being not to have inappropriate foods in his home, because, as he tells me, "If it's in front of me I'm going to have a taste. And then I have another one and another one, and before I know it I'm in trouble." Thomas now chooses not to attend most parties and family gatherings because he knows his own shortcomings and wants to avoid another stay in the ICU. Instead, he asks people to visit him at home, and he controls the refreshments.

Many people, particularly elders, don't hear well in crowds or can't filter out background noise. Some don't see well or can't manipulate tableware well with arthritic hands. Others worry about having ready access to bathrooms, or don't like taking portable oxygen or medications with them when they go out. Many have told me over the years that most of the family they knew have died or moved away, to the point that near-strangers surround the holiday tables as more distant kin bring in-laws and friends to celebrations. "It's more like making small talk with strangers than being home with family," one person told me, and for him that wasn't worth the effort. Some people are shy, some are socially awkward, and some find groups of people tiring rather than enjoyable.

To be sure, there are people who are achingly lonely, perhaps newly widowed, far from home, painfully isolated, people who would relish an invitation, a visit, or being remembered with a plate of leftovers. But in an unthinking hurry to have someone like Marge have the kind of holiday experience that someone like me assumes she would want and should have, there's a risk of doing violence to that person's way of life and creating more stress than joy.

With many wise elders to teach me, quickly before I began loading my car with holiday meals or planning parties few cared to attend, I (finally!) have learned a few things that may be helpful to others who wish to be generous as another season of holidays unfolds. These are some of my lessons:

(1) Instead of asking, "What are you doing for [holiday]?" ask, "Do you observe any holidays this time of year?" Let others tell about their beliefs and practices, and consider what might be offered that would fit in and be appreciated.

(2) Ask before making a gesture: "May I bring you a plate?"

(3) Respect the limitations that others establish. If they say that something is too much, too tiring, too far, too whatever, then it is so.

(4) Offer options: "We really want to see you at [holiday]. Will you come for dinner, or may we stop by over the weekend?"

(5) No one wants to be a "charity case" or afterthought. A call at the last minute to say, "If you don't have anywhere else to go you can come here" is a slap in the face rather than an invitation, as it appears that the caller waited as long as possible in hopes that the person being "invited" would have other plans, and further supposes rudely that she or he has less than a full social calendar.

(6) "I just don't want you to be alone for [holiday]" is offensive to someone who lives alone, as it implies that his or her normal way of life is inferior, ok, perhaps, for some days, but certainly not for [holiday]. Invitations should be issued and gestures made without judgment or comment about the recipient's lifestyle.

(7) Guests honor us with their presence; we do not rescue them by taking them in. Last minute or spur of the moment invitations work when they're phrased well. "George! We just came home and saw your television on. If you're home and have any time on [holiday] we'd love if you would join us for something. Dinner is at [time], or if that doesn't work if you could stop by for dessert or drinks or even just a cup of coffee in the morning or to watch the game we'd love it. We're sure you have plans, but if you could work us in it would make the day all the more special." George may decline altogether, or he may appear before the sun rises and stay until the last dish is washed and put away that night, or something else. But he will know he is a wanted and welcome guest rather than an afterthought or the subject of his hosts' pity or self-conscious guilt.


Soon the media and various social service and religious organizations will be admonishing us to remember those who are alone during the holidays. Thanks to the patient teachings of Marge in particular, and many others as well, I've learned there's, if not an art to this, at least a need to ride herd on assumptions and stereotypes and to muster up a load of respect and courtesy lest charitable intent breed less than comfort and joy. In the weeks ahead I will visit many patients who live by themselves while observing one or more of those 29 holidays celebrated this season. And for me the right gesture to make for days that are merry and bright entails visions not of Santas, angels, trees, creches, stars, candlelight, "winter wonderlands," or anything else, except mindfulness of once upon a time when on the day of a holiday there was in one home just

A Pork Chop, A Potato, and a Nice Green Salad

Listen.

Any who have stayed with this page from the outset may remember that its grammatically incorrect name, "Tell It Good," came from an encounter with a patient and her daughter many years ago. Longtime residents of Chicago's Cabrini-Green public housing development, they had watched its rise and (eventual literal) fall, and ultimately had been relocated to a newly constructed apartment adjacent to the site of the old "projects." Albeit clean, bright, and critter-free, with an absence of drunks in the hallways and drug dealers outside the front door, the new place came with its own set of problems, ranging from tenant-paid heat that they couldn't afford to rules against congregating in common areas, which left them isolated and without both their former community and their usual ways of meeting people and making friends. Reminiscing, they told me that for all the problems in the Cabrini of old, were it possible they'd give up the new apartment and go back in a heartbeat. Listening to their poignant, witty accounts I told them they should write a book, that their story should not be lost, and when I pressed they told me, first one speaking and then the other, "You write it." "You tell it." "Yeah, because you tell it real good." Ever since then I have striven to tell the stories that have played out in my work as a nurse, because stories teach as nothing else can. Stories touch hearts and build bridges, and remind us of our common ground. And sometimes telling a story itself births good; from a new understanding or realization of shared humanity goodness grows such that "telling good" is less bad grammar than an actual movement of energy from words to being in the world. But we must not be so busy telling our own stories, often over and over to those whose stories are similar, that we fail to heed the stories of others, to listen.

"Roshell" was a single mom caring for her young children and for her own disabled mother, "Myrtle," who had suffered a stroke some time before I met them and had several other health concerns as well. They lived on a high floor of a Cabrini-Green high-rise; did I climb six flights of stairs to see them, or was it nine? I don't remember, but it was a considerable vertical trek with a heavy backpack, casebook, assorted supplies, flashlight, and police escort. There were drug dealers outside and often more "working" in the stairwells; we'd ask which stairs we should use so as not to disrupt their "business." It was dark and smelly; often there was human waste or vomitus on the stairs, and always there was trash to be skirted. Occasionally we'd come upon rodents that had met their demise; more frequently live ones scurried out of our way.

Things weren't much better in Roshell's apartment. Cockroaches prowled about in broad daylight, and our shoes stuck to the floor as we walked from room to room. The first time I saw Myrtle she was lying on a sagging double bed in urine-soaked linens and clothing, unable to turn without help, much less stand or walk. "She's wet, Roshell. If you'll bring some clean clothes and linens I'll help you clean her up," I said.

Roshell sighed. "I just did that yesterday. Maybe I can do it again tomorrow or the next day, but I'll help you push her over where it's not so wet."

"How often do you bathe and change your mother?" I asked.

"A couple times a week usually," came the response.

A licensed professional nurse, I am a mandated reporter of any abuse of children or vulnerable elders I encounter. It's the law. And here was an old woman, unable to move about or care for herself, living in filth and left lying in her own waste for days on end. It would be time for me to pick up the phone. Once I made that call an investigator from the state Department of Aging would follow up, and finding what I found no doubt would pursue legal recourse to remove Myrtle from the home and send her to a nursing home where she would be cleaned and changed promptly and also assured the food, medications, and other basic care she needed. Of course what that would do to her spirit and to her family is another matter. So I asked Roshell to tell me about taking care of her mother.

Most of us pee several times a day, and Myrtle was no exception. But Roshell had a limited supply of linens and clothing, and doing laundry entailed taking two buses to the nearest laundromat, after carrying the soiled items down the same dark, dirty, gang-infested stairs up which I just had come. This could happen only when someone turned up to be with Myrtle and any of Roshell's children who were home at the time. Frequent trips to the laundromat were expensive, between bus fare and the cost of the washers and dryers, so laundry days had to be limited for financial reasons as well. And because the old mattress was wet and never had time to dry before being wet yet again, clean linens became wet and dirty as soon as they were placed on the bed. The best Roshell could do was try to push her mother from one side or corner of the bed to another so she lay on the cleanest, driest possible spot.

On hearing this my judgment shifted from Roshell-as-abusive-daughter to Roshell-who-made-heroic-efforts-to-do-the-best-she-could-with-what-she-had, and who was as loving and devoted as she could be given the resources available.

Within a day I had a hospital bed, disposable underpads, adult diapers, and Physical Therapy in that home. Next came a bedside commode, and before long the therapist had taught Roshell to transfer Myrtle from the bed to the commode. Later Myrtle learned to do this by herself. Wet linens became largely a thing of the past, and trips to the laundromat decreased to once weekly, with less expense because there were fewer items to be washed. Somewhere along the way the sticky floor was cleaned, perhaps because Roshell had more time for that part of housekeeping, and gradually as we addressed Myrtle's other health issues the home overall became brighter, cleaner, and calmer. A year or two later Roshell and her family were moved from Cabrini-Green to a nearby new apartment and their old building was demolished. Myrtle died a year or two after that, in her clean home surrounded by her family.

Had I knee-jerked and done my legally mandated duty when I first found Myrtle unable to move, lying in urine-soaked clothing and linens, and in the care of a daughter who didn't seem to think this was a problem and who appeared to clean her mother and do laundry only when the stars aligned to allow it, the outcome would have been very different. I wish I could say that I just was savvy and wise and so knew to elicit and respond to Roshell's story, but the blunt truth is that my early days in "the projects" had brought me up short so many times, so often leaving me feeling helpless and at a loss for how to proceed, that all I knew to do was go back, show up, and see what happened, see what avenues for some, any, kind of progress might begin to open. And so, having shown up and encountered what was there, I had asked Roshell to tell me her story.

No matter how overwhelming the situation, every. single. time. I simply showed up, often without a clue what I'd do once there, an opportunity presented itself. It may or may not have had anything to do with a patient's "diagnosis" or why I might have supposed I was going there in the first place, but a way to begin to make an inroad appeared. I learned to show up, to be as authentically present as I could be, and to listen.


Today approximately half of our country is reeling from the outcome of yesterday's presidential election. The other half is celebrating and hoping that urgently needed change is on the way. In about an hour from now there will be a massive protest downtown in my city, with similar ones taking place across the country. Had the election gone the other way we're told the other side would be plotting a revolt. I have heard many wonder if women, people of color, non-Christians, and those born in other countries would be safe in the new administration. All over social media I see people on both sides declaring that they'll have nothing to do with supporters of the other candidate. Physical, psychological, and financial violence all have been threatened.

But the scariest thing of all is that no one is saying that it's time, indeed, way past time, to show up, be as authentically present as possible, . . . and to listen to the other side.

Writing about problems with healthcare financing some weeks ago I told of a mid-career physician colleague struggling to make a living in private practice and resisting joining the ranks of corporate medicine, to the point that he now works for the government in remote outposts of the western USA, two weeks on, two weeks off, leaving his home, wife, and children behind when he goes. We spoke last week. In the heart of a rural "red state" he just had finished a grueling night shift. There had been a serious accident on a nearby highway, with one fatality and others badly hurt. He had been up all night and was ready to collapse into bed, except that the post-crisis adrenaline rush persisted and he was wired. Exhausted, but still running in overdrive, he wanted to talk. "It's crazy here, Sue, crazy. These are Trump people. There are Trump signs everywhere. It's scary. I have two daughters . . . But the farmers are having a terrible time. It's really bad. The farmers come to the hospital here and talk; I'm telling you, the farmers are screwed. And the government's done it to them."

Between home visits of my own, standing at the side of a busy road next to my bicycle and knowing my next patient was waiting, I tried to cut the conversation short. "When will you be back home?" I asked.

"Tomorrow morning," he replied.

"Good. Let's talk then."

"Done. I'll call you. But these farmers are screwed. I don't know what they can do, and they're mad. And all for Trump. They think he's going to save them. Crazy, man!" Eventually I managed to nudge him off the phone and towards some much-needed sleep. But I wondered. The farmers are screwed? What has happened to our farmers? They're that angry? When was the last time I talked with a farmer? . . . When was the last time I talked with a supporter of the now President-elect . . . and really listened?

Once over the course of ten years I lived in two small towns. But that was almost 35 years ago, and I've been an urban dweller ever since. The farmers are screwed? Now, I'm not totally ignorant of the plight of agricultural 21st century America, but the farmers are that "screwed" and that invested in a Trump presidency?

As election returns came in last night political analysts I respect were stunned, and as I flipped between channels I heard many say, "We were wrong. Our polls were all wrong. We missed this entirely. How did this happen? We need to rethink completely how we poll and report." One who long has struck me as being never at a loss for words, a skillful and determined but courteous and thorough interviewer, sat mutely staring into the camera.

I suspect he and his colleagues haven't been talking with the farmers either. Or with the non-urban natives of the deep South.

Our new President-elect ran on the theme, "Make America great again." If one is a "screwed" farmer, which I imagine means one can't make a decent living off the land any more, to the point that one's entire way of being is threatened with no feasible alternative in sight, the prospect of making America great again might sound awfully appealing. And hearing the other candidate affirm, "America is already great!" might sound like a promise of more of the same policies that have destroyed the lifeways of farming. If one has watched factories close and move to Mexico or overseas, shrinking the population and tax base of one's community and leaving economic rubble in their wake, the appeal of making America great again is understandable. If a candidate says, "I understand, because my father was a small businessman," but that father's business thrived and his daughter received an Ivy League education, the struggling shopkeeper in a dying town might find that candidate lacking in empathy.

It's a normal human response to difficult circumstances to become nostalgic for an earlier, happier, more prosperous and secure time. Who among us hasn't daydreamed about previous homes, friends, old loves, past jobs, and good times and thought, "Those were the days!" So if "Make American great again" seemed to portend bringing back industry and shoring up farmers instead of freeloaders, that might sound pretty good. If it seemed to straight, white, Christian men that they had done everything right but all the perks went to people of other colors and/or from other places or to uppity women, the prospect of a return to 1950s America might have strong appeal. If one side is talking about free college, then those who didn't finish high school but went to work, paid their bills, and made lives for themselves might wonder where they fit in the picture, as their expenses rise and incomes fall. College is fine for some people, they might think, but keeping their auto repair shops or hair salons open would be the greater priority. And how they're going to do that and pay a minimum wage of $15/hour eludes them, while refugees from across the globe are lining up for free healthcare while hardworking citizens can't afford insurance, much less copays. When every time there's footage of war on the news or a terrorist attack executed or thwarted at home and the perpetrators seem to be Muslims, it becomes easier to see how the struggling shopkeeper, "screwed" farmer, or laid off factory worker might think it best just to keep "those people" out, and maybe to build that wall on the Mexican border, too.

It appears that half the country is hurting, and those folks haven't been, or felt, heard . . . until last night. Bring back industry, keep out the "foreigners" who are draining our resources, take care of the farmers and other "real" Americans, put God back in the schools, make Christianity the national religion, have women live the life of June Cleaver, and don't mess with our guns or other rights, and life, and America, indeed will be great again.

It won't, of course. As Abraham Lincoln said, revolutions do not go backwards. We are, always have been, and always will be a nation of immigrants. Separate but equal wasn't, and even now the white offender has his hands slapped while the black or brown one goes to prison for the same offense. The cost to the country, much less to their own sanity, of sending women out of board rooms and universities and back to hearth and home for full-time homemaker careers is unfathomable. We are immeasurably enriched by the diversity of cultures, religions, and talent around us; a "white bread" society couldn't begin to compete. The problem of terror is the problem of terror, not of another's religion or heritage. Etc.

But we have failed to listen to one another. If the squeaky wheel gets the grease, then the "screwed" farmers, unemployed workers, and lost non-urban, straight, white men who don't know quite who they're supposed to be anymore and who never seem to catch a break even though they're told they enjoy "white privilege" and see others receiving "handouts," evidently haven't been squeaking loudly enough. Or, they're far enough away geographically and culturally that it's easy to disregard them. Until they rise up, and elect President Trump.

I am so glad I didn't act on my first impression of what Myrtle needed those many years ago, and regret that it was only in the face of defeat ("What on earth could I possibly do here?!") that I learned to show up, shut up, and listen. As our nation transitions to a Trump administration we might do best to protest in the streets and plot resistance a bit less, and to listen more. And as we're urged to volunteer for causes we fear now may be jeopardized, we would do well to heed yet another lesson from the "great" days of old: Keeping "church ladies" in the kitchen, Sunday School, and choir effectively kept them out of the pulpit, off the governing board, and away from the finance committee. Community service is a good thing, but volunteer efforts can be exploited and can deplete energy needed for strategy, coalition building, and leadership.

Remembering Myrtle and Roshell today I am reminded of the power and efficiency that come with understanding, and that understanding never is one-sided. I also am reminded that stories "told good" and heard well build bridges.

Let's make American great in new ways, building both on the historic greatness to which President-elect Trump alluded in his campaign and on the greatness extant in our country today, stirringly cited by Secretary Clinton. And most of all may we show up, be authentically present and open to those around us, and

Listen.