The Un-Answerable Question

            Last week at this time, I was hunkered down finishing a mid term assignment for my ongoing doctoral studies on a real life quality management project. Buried deep in abstract organizational and management theory, I struggled surprisingly hard to pull real life quality metrics and benchmarks out of the literature and a myriad of government and accreditation agency publications. Got it done. On time. Over the page limit (as usual). Irritated.

            The next day, the real-life process of quality improvement continued at a late afternoon meeting. Anxious to get home, get my head out of academia and work related problems, I flipped on the radio for a traffic report and instead heard breaking news about the bombs at the Boston Marathon. Zap. Back to 9/11/01 with my heart racing, my mind struggling to comprehend the reality, listening for every tidbit that would indicate it wasn't as bad as it sounded. My mind wandered back to what it was like on 9/11/01 working in the hospital, waiting for the casualties that never came because there were no survivors. The fear, the grief, the helplessness, the anguish. The big question-Why?

            I, along with a lot of my colleagues, have PTSD related to the events of that day. We go into health care to be heroes, to save people, to run toward the screams and the danger—not away from it. But that theoretical desire collides with reality big time in disasters—and my heart goes out to the first responders, doctors and nurses in the Boston emergency rooms who had to deal with all that—plus their own grief and horror as they pronounced the dead and made life and death. decisions in minutes on whose leg needed to be amputated and who got to go to the OR first.

            Coincidently, I am working on a Moth Storytelling based event about my experiences on 9/11 to commemorate National Nurses Week. And I made my home in Boston during my residency, not far from the big Citgo sign I see on all the pictures of Kenmore Square, deserted while the good people huddled in their basements and maniacs lobbed a bomb out their car window and shot anything that was moving. I've always said if there was another city I could live in besides New York it's Boston—and now both have their own sad legacy of terror and its aftermath.

            This has infused even more emotion and reality into my oral re-telling but it re-opened the wounds. It's hard to concentrate, focus, complete anything. I refused to make my son an airline reservation for his European trip that goes through Moscow, wishing he wasn't going at all. I'll pay more, much more, for what seems like a less risky itinerary but who would have thought watching a running race was risky? Who would have thought going to work one day in the Twin Towers would have involved mortal peril?

            One tidbit I do remember from the chapter on management of complex systems is to make some changes, no matter how small. So, I got on the subway yesterday to go to ballet class. The trains were packed with weekend construction disrupting several train lines and routes. I read my book, moved like a robot across the platform from the local to express, one eye on all the bags and backpacks around me. Walked from 86^th and Lexington up to 93^rd instead of from 96^th and Lexington down. No choice—the Number 6 was bypassing my usual stop.

            I danced till my legs hurt more than my heart and got back on the train, sipping water from a bottle, scanning the faces, the bundles, the baggy clothes, the hoodies, looking for anything amiss. Got home and went to see "42" with my family and munched popcorn (loved the movie).

            Meanwhile, Bostonians held vigils for the dead and injured, celebrated the capture of the surviving suspect, and the death of the supposed mastermind. They took back their civilized and cultured city. They will recover. We will all recover. But we will never forget. We can't. We'll keep asking the un-answerable question: Why?

This Path: Free Today

This Path is a collection of essays that was just re-released today. It contains two of my favorites: "The Dance Class" and "Endless Possibilities."

If you'd like a free copy on Kindle, you can download it today only. If you have a Nook, contact me.

And please let me know what you think.

I have two new essays coming out this fall, so stay tuned.

Ten Years Later-Tread Lightly On Our Memories, The Pain Is Still Great

I knew this weekend would be difficult and it is. I am physically sick today, and do not believe that my (minor) case of PTSD is not to blame for this otherwise unexplainable pain.


View my photo scrapbook: 9/11, Then and Now here


Please go to my other blog for my thoughts on the tenth anniversary of the 9/11/01 attacks


Here is a retrospective on The Twin Towers and The Lowly Parking Meter that I wrote last year.


And here is part of the 9/11/01 chapter of Someday I'm Going to Write a Book:

It was pleasantly busy. A few women in labor, triage was quiet. I got coffee

from the food cart, Starbucks, with a shot of French vanilla. I made sure to get skim milk because I treated myself to a scone.  They have almost my whole day’s allotment of calories. That Starbucks has enough caffeine to jazz me up for 12 hours.

“Wow, you have to see this,” said Janine the unit clerk. “A plane just hit the World Trade Center.”

A few of us went into an empty patient room and saw live footage of the gaping hole and the smoke.

“Someone must have lost control of a small plane, there have been a few helicopter crashes recently,” I said. “I hope not too many people got hurt.”

No sooner were the words out of my mouth when we saw, live and in living color, the second plane crash into the south tower. Flames exploded, debris and what we now know were people were flying out. Even the news commentators were stunned, stumbling over their words like drunkards.

“Ohmigod!”

“What the hell just happened?”

“Someone just flew a second plane into the other tower!”

“Shit!”

“It’s terrorists!”

I don’t remember who said what. One hand over my mouth to hold back the vomit, I held onto the wall as I walked, my knees like rubber. External disaster codes were activated. Bells clanged and the operator called out instructions.

“THIS IS NOT A DRILL!”

“Blue team to basement.”

“Red team to lobby.”

“Green team to ER.”

Automatic fire doors slammed shut. Strobe lights flashed.  Footsteps pounded in the hallways. Panic bars clicked on the doors as they smashed open against the walls then slammed shut. People ran around like an uncovered nest of roaches.

 “The phones are down!”

“The pagers aren’t working!”

“Make sure all emergency equipment is plugged into red outlets in case we lose power!”

“My husband is in that building!” screamed someone, falling to her knees.

“My father is down there,” said Janine through tears, trying in vain to get a cell phone, any phone to work.

“Joann, let’s get you into the lounge. Turn the TV’s off in the patient’s rooms!” I tried to help her to her feet and ease her out of the hallway.

“A plane just went down near Philly. It was supposedly headed for the White House. There are 8 planes missing from the flight controllers, they are going to shoot them down, the US is under attack.” Josie read the CNN headlines to us but she spoke like she was the President.

Of course, when planning an attack the enemy knocks out communications first. The World Trade Center is very close to here. We have no phones…

The fear, not for myself, but for my country was so profound I was beginning to panic myself. Outbursts and screams from staff that had relatives in lower Manhattan  reminded me that my job was to help others, not to dissolve under pressure.

Our Father, who art in heaven hallowed be thy name…

“Joann, just because he’s not answering his phone doesn’t mean anything, they aren’t working.”

 Thy kingdom come, thy will be done, on earth as it is in heaven…

“Here have a drink of water.”

“Lisa, your husband works blocks away, I’m sure he’s fine.”

Give us this day our daily bread and forgive us our trespasses as we forgive those who trespass against us…

 “I know Denise’s husband is a fireman, they know what they’re doing, in 1993 very few people got hurt.”

 And lead us not into temptation, but deliver us from evil. For the kingdom, the power and the glory are yours now and forever, Amen.

 “She wants to push? OK, I’m coming Josie.”

“Carole, the south tower just collapsed. It’s gone.” Josie whispered in my ear as she tied my surgical gown for me. The splash guard on her mask fogged up with her warm tears.

“Push mommy, the baby’s coming, don’t be afraid. Everything is alright, nothing bad is happening to you.”

Hail Mary, Full of Grace, the Lord is with thee, Blessed are you amongst women and blessed is the fruit of thy womb Jesus…

“You’re doing great, see the baby’s head? I know it feels terrible but really, nothing bad is happening. Just push.”

“One more push, you can do it, you’re strong. The baby’s almost here, soon you’ll be done. Great, here comes the baby! It’s a girl!”

I dried the baby and gave her to her mother. I helped her father cut the umbilical cord. They took pictures. I

delivered the placenta, did some suturing. Josie whispered to me as we cleaned up and got the baby to nurse.

“Carole, both towers are down.”

Holy Mary, mother of God, pray for us sinners, now and at the hour of our death, Amen.

Moving Along and Getting Back in Business

It's been just over a week since my father's funeral and I'm numb and in a fog after being up, up, up for so long. I lapse into these moments where I see or remember some moment I spent with Daddy and either burst into tears (very unlike me) or stare into space for an hour lost in thought.

Going to work for short shifts helps since I get to focus on something and my co-workers give me tea, cookies, and strategically distributed hugs. OMG, Madeleines are just what you need for sinful, buttery comfort.

I don't think those random things are psychosis--rather synchrony. Things happened (and still do) after my grandparents died. On the morning of the funeral, I suddenly remembered my Dad had given me a bracelet when I was little. I'd already found and put on a pair of earrings he'd bought me when I had this really short haircut in my tomboy days and he told me "please wear these so they know you're a girl."

My hands went right to the bracelet buried in my jewelry box. The engraving on the back was June 18, 1971. Forty years to the day before he died. He wanted me to wear it, and it still fits. Synchrony. Some comfort.

Enough, back to work. Thanks for all your kind words of support. I'm looking forward to covering labor and delivery at LIJ this weekend. It's been a long time since I caught a baby.

For more about what I've been up to, writing wise, including another successful pitch for Someday I'm Going to Write a Book, check out my creative writing blog. There is lots of other good news there as well.

What I'm Thankful For Today: Endless Possibilities

A long thread running through Someday I'm Going to Write a Book: Diary of an Urban Missionary is the story of my great grandmother, Jacinta, a/k/a Jenny Bruno. She was as a midwife, and I have the license and instruments to prove it, in the early 1900s (her certificate is dated 1911 which makes next year her centennial), tending to the women (and their families) of the Southeast Bronx, not coincidently, the same ones I am tending to right now.

There are many similarities between us so I feel comfortable concluding Jennie probably didn't love running out of the house at all hours of the night, leaving her eight kids (our of the thirteen she had) to fend for themselves, though I'm sure leaving her purportedly abusive husband and providing for them was driving her along.

My husband isn't abusive, in fact, I'm more likely to hit him someday than he is to ever hit me. Money is what keeps me in this insane business--three kids to put through college, my daily coffee, their daily bread, and some sense that there is a mission in all this. Some overlying need to persist despite the anguish and frustration.

The brick walls I run into day after day, erected by a broken health care system, big government and big institutional barriers, insurance companies, the economy, poverty, racial and ethnic discrimination, and yes, the patients and their families as well, show no signs of coming down. I chip away at the mortar; look for ways to sneak through, over, and around. Am nabbed from time to time for what Mark Legnini, DrPH described as "doing the right thing" instead of "the right thing to do." Get a leg up now and then, so I can climb over, pulling my charges along with me, though some can't hold on or aren't willing to take the risk of falling.

This is deliberately vague, for privacy as well as a myriad of privacy and compliance regulations. But this is a time of year to focus on what we have and give thanks. This article is very long, but its description of the overall mission of the hospital I work for made me proud to be a long time member of its staff. One of the very small dots on the southernmost point of the map is the health center in which I toil, day in and day out. And I've worked in several of the other hot spots over the years with some of the most talented and dedicated doctors, nurses, patient care techs, and other support staff on the Earth.

As an overview, the worker bees aren't acknowledged in the Commonwealth Fund Report. As usual, only the doctors are championed though much of what being done is accomplished by those of us without MD degrees. But coming at a time when I often wonder what it's all about, this affirmed I'm in the right place.

So I'm thankful for my health and family, without which nothing else would matter. But also my job, my co-workers, the patients who continue to place their trust in me and for the knowledge that I've made real difference. And to Jennie, who I have to believe is the little voice that guided me to where I am supposed to be and straightens me out with a kick the ass when I'm ready to give up.

This tribute to her, an excerpt of Someday I'm Going to Write a Book, was published last year in This Path.

Happy Thanksgiving.

The night seemed full of endless possibilities, like life thirty-five years ago. I stood in the lobby of the posh Marina Del Rey at the 75th anniversary of the Saint Frances de Chantal grammar school, Bronx, New York. The '50s vintage dress that called to me at an antique show fit like it had been custom made. I thought I looked pretty good with the gray dyed out and six pounds lighter than last year. Those anti-wrinkle creams seemed to work. They sure cost enough. 

The dawn of the AIDS epidemic and the horror of working in the hospital on September 11, 2001 book ended a career during which time speaking up made me part of the enemy camp, not the liberating forces. 

Video clips of domestic violence deaths, child abuse, infanticide, rape, incest, and the degradation of women played over and over in my mind. My theoretical model for dealing with families in crisis was of little use at 2 a.m., standing in between the guy who just beat up his pregnant wife, the woman bleeding to death, and the clerk getting insurance information before we could get blood for transfusion.

I had bargained with the gods to keep the demons away but no good deed goes unpunished. They stole my soul and reneged. Divorce from my high school sweetheart, the inevitable loss of beloved family members, and my own personal health challenges gave me pause to ponder the endless impossibilities of life.

I focused on my family, thankful for the second chance at marriage and motherhood. I once battled sexism, racism, conservatism, and elitism. Well into my third life and tired of fighting, I moved past activism into escapism.

I'd never attended a high school reunion but instead was drawn way back to my grammar school days. I remember only a few names and faces, most notably, Marianne. We don't see each other often, but just like tuning into a soap opera you haven't watched in years, we easily pick up the story line and move on.

I waited for her, watching the lights of the Bronx-Whitestone Bridge glimmer like tiny beacons over cold, dark Long Island Sound. I moved across the bridge to Queens seventeen years ago. I still work the streets of the Bronx but death, distance, or the ravages of time have broken all ties to friends and family. Alone, mesmerized by the tinkling fountain, I held back tears remembering when this neighborhood was an innocent idealist's only view of the world.

 The cell phone bleated. "Sorry, I'll be there in a minute, got stuck in traffic." Marianne rushed in from the parking lot and gave me a hug. "You look fantastic."

 We studied the collage of old class pictures. Marianne picked me out: the girl with a headband and hair in a pony tail, tights, uniform dress with a bow tie, and a big smile. We sipped drinks, nibbled hors'd'oeuvres, and found the "Class of 1971" table.

John, one of the two "boys" who had been my close friends, smiled when he saw me. "Hi, Carole Ann. You haven't changed a bit."

Sister Mary Lucille, at least eighty, peered at me and waved a gnarled, bony finger. "You're one of the Moleti girls, and none of you took French." Nuns never give up.

"That's right, Sister," I said, "but Spanish serves me well."

George suggested we take the few surviving sisters for a boat ride in the dark and dump them overboard to get even for all those bruises. We laughed, reminisced, and tears flowed on my way home in the pouring rain as I crooned Streisand's tune "The Way We Were."

I drove over the bridge, from my first life, past the second, and into the third. I let the dog snooze on the couch and walked through the dining room where Jennie was still smiling at me. The kids were tucked in; the cat warmed my side of the bed. I snuggled next to my sleeping husband and lay there in the dark and quiet thinking about all the stories still to be told.

"Get back to work," Jennie said.

And I did.

Copyright 2009 by Carole Ann Moleti