OPEN WIDE, Dr. Mark Manhart’s Journey in Dentistry, Theatre, Education, Family, and Life /A Biography

• • The rest of the fall expect occasional excerpts like this one from my first book, Open Wide, a biography of an interesting fellow named Mark Manhart. He asked me to tell his life story in book form and once I satisfied myself he had a story worth sharing and the ability to compensate me we struck a deal and over the course of a couple years I feel I got to know him well enough to at least put down a reasonably informed appreciation and examination of his life for posterity’s sake. You can order the book at the following links:
  • http://www.conciergemarketing.com/open-wide
  • http://www.barnesandnoble.com/w/open-wide-leo-adam-biga
  • http://www.calciumtherapy.com/latest-news/open-wide

 

OPEN WIDE

Dr. Mark Manhart’s Journey in Dentistry, Theatre, Education, Family, and Life /A Biography

©by Leo Adam Biga

 

 

Mark Manhart

 

 

A Life in the Open

We all lead a few lives or, if you prefer, double lives. Mark Manhart knows something about the mirrors of life. In his professional life, he is a dentist. In his personal life, he is a writer, director, history buff, landscaper, father, grandfather, and husband among a few different pursuits. “I think everybody has that kind of dual life going, especially people who get into such specialized things as dentistry. A professional has to lead two lives. Your open life and your other lives,” he said. The Omaha, Nebraska resident has an opinion on most everything, and he usually has a philosophy to support his viewpoint. Try this one on for size: “One needs a real work-a-day life and then at least one other life, some hobby, avocation, distraction, to work on to nearly inane proportions, so one can return to home base refreshed, go to bat again, and make your way before the inning and game is played out. I have gone through many family and professional things that were very much like sitting in the dental chair. All have been adventuresome.”

For this man of many interests and talents, life is also full of what he likes to call “natural wonders”—those unforgettable people and events that he enjoys experiencing and cultivating. He is all about opening new horizons of discovery in his personal and professional lives.

One domain feeds the other; one dimension offers solace from the other. “All of this, in any position or occupation, is terribly important to one’s sanity, pleasure, growth, and accomplishment,” is how he sees it.

For fifty years Manhart has indeed left the confines of home for the office, leaving behind his domestic incarnation for that of the highly trained, working professional who not only practices dentistry but is actively engaged in developing new treatments or therapies.

Then there is the life that revolves around some inner passion that enables him to return to work recharged, ready to resume life in the open and persevere. For Manhart, it is the world of arts and letters that feeds or fulfills him with the sustenance to carry on with renewed vigor. Specifically, it is the life of the theatre and his work as a playwright and director, and occasionally as an actor, that is a source of satisfaction, of solace, of energy, of intellectual and emotional discovery that offers a balance or complement to his professional and family endeavors.

There is also the life he maintains with his spouse. Here, too, Manhart is well-versed in that song and dance called marriage. He has been married twice. His first marriage lasted more than two decades and resulted in eight children. That union ended in divorce, but when he was ready to start a new chapter in his life, he did not hesitate to marry again, to a woman with a pair of children of her own. This second marriage-go-round has now exceeded more than two decades itself, which would seem to indicate he is the marrying kind.

He and his wife, a spitfire named Bonnie Gill, make it work despite being very different personalities. They may not see eye to eye on many things, and they may handle situations quite differently, but when it comes to what is important in life, they are simpatico. They are both searchers, ever inquisitive to turn the next page in life, to see what is over the next hilltop, to experience a new culture or way of doing things. Both are principled people. Both would rather give than take. Both are creative souls.

It seems Mark Manhart’s thirty-year dental partnership with Dr. Tom Steg can be thought of as a kind of marriage in itself. The two men are opposites in most ways but are kindred spirits where it counts most, as people of high character, intense curiosity, extreme professionalism, and with a penchant for pushing beyond the norm of dentistry to find the best ways of caring for patients.

With his tall frame, angular features, shock of silver hair, confident pose, resonant voice, formal manner, and reserved personality, Manhart cuts a striking, classic figure. He comes across at once as a bold, magnetic personality with an authoritative air and yet at the same time as a quiet, pensive, somewhat shy, even insecure soul. It is that duality that is so much a part of him. It is an expression of his charm and his complexity.

Call it fate or coincidence, but this practitioner of the healing art of dentistry also became a creative artist somewhere along the line. More likely, he was an artist  right from the start and his muse simply waited for when the time was right to finally bloom. Many of the qualities that make up a healer, after all, are much the same as those that characterize an artist: empathy, discernment, problem- solving, discipline, craft, even imagination.

Manhart still lives that personal brand, striking a balance between right- and left-brain activities that put him squarely in the mix of Omaha culture, community, and commerce. Long before social networking became a catch-word and lifestyle for the online era, he was engaging people from all walks of life and exploring ideas from disparate sources.

 

 

Calcium Therapy Institute

 

 

He was ahead of the curve on the Internet as well, launching a website for his practice back in 1995. He is on LinkedIn, Facebook, and all the other go-to social media sites. He blogs. He even conducts online training sessions for dentists from around the globe. He is as connected as anyone of his generation.

His inclusive, progressive approach to dentistry may best illustrate how open-minded and receptive he can be to new ideas and new collaborators. Eager to always improve his craft, he makes a habit of seeking out the latest advances by poring over dental journals from around the globe. Staying current this way has spurred him to make his own breakthroughs and to share his advancements with peers in the United States and abroad.

Away from dentistry, his work as a playwright and theatre director reflects his eclectic tastes, ranging from sentimental love stories to historical dramas to bawdy comedies to high- brow treatises to full-blooded biographies to English manor mysteries. From kitsch to classic, Manhart embodies it all.

Not so very different from the way he seeks to break new ground in dentistry, he actively seeks out new forums and challenges in theatre. He has done the same in education, too, as a champion for the Montessori method of early childhood instruction and for home-schooling. Although he has been a clinician most of his working life, he has also taught dentistry formally at the university level and informally in workshops and trainings.

Whether navigating the worlds of medicine, business, education, or art, he is an enterprising, energetic innovator open to new, even unconventional ways of doing things. He is what some people call today “a creative.” It is really another word for “eccentric” or for how one of his own children described him—“a half bubble away from genius.” That missing other half of the effervescent bubble can sometimes make him look like a fool or an idiot some people very close to him will tell you. It is a risk he is willing to take.

 

 

Great Plains Theatre Conference

 

 

His work and life are expressions of an inquisitive mind and a sensitive disposition. His office displays pictures of the charming digs he kept in The Passageway of Omaha’s historic Old Market district, the cultural heart and soul of the city he felt right at home in. Once the wholesale produce center for the city, the district was redeveloped beginning in the late 1960s and early 1970s into a European-style marketplace.

The Mercer family of Omaha led efforts to preserve and reuse the century-old warehouses as restaurants, galleries, theaters, shops, and residences. Manhart fit right in with the Old Market’s creative class denizens.

The Old Market has become one of the state’s largest tourist attractions, along with the world-class Henry Doorly Zoo as a magnet bringing visitors to the city. Due to health issues of his own, Manhart long ago had to set aside this second office in The Passageway at 10th and Howard Streets. The Market and his affection for that Old World location is evident in the photographs he displays of the brick-hewn office and environs he practiced in there. He also keeps an antique dentist’s chair in his West Omaha office as a token of his appreciation for “good old-fashioned” dentistry, craftsmanship, and values.

Manhart’s full life is not just a professional or aesthetic exercise. His life extends to family. He came from a huge clan, and he is the father of eight himself.

“I always wanted a large family of twelve children. A lot of kids who could become ‘adult’ adults. As a granddad, it is hard to see much success in that regard, so I must wait it out. I think I was a good father but that is slightly biased. People would say I am too harsh, too outspoken, too busy elsewhere, distracted too easily, too liberal, too persistent, frugal to cheap, an exaggerator, cold with little emotion, a trouble starter, and more. An old friend, a Jewish lady, hit it for me: ‘You are a starter. We have enough finishers.’ My obligation to the kids was to house, feed, protect them from others and each other in a way that they would be able to do the same as adults, and love them. Most of the love was, and will remain, secret between each one and me. Some day I want to write about that,” he said.

Cast members of plays from Great Plains Theatre Conference

Those who know Manhart from his life in the arts may not even know he is a family man, much less a dentist. Just as those who identify him as a dentist may not be aware of his other lives. That is all par for the course for someone who throws himself passionately into whatever endeavor he is engaged in at the moment. It is not as though he focuses on a passion to the outright exclusion of everything else, but he does tend to lose himself in whatever it is he is engaged in at the moment.

His single-minded devotion is evident in his dental career. He has been in private practice now forty-five years. Counting his time doing dentistry in the United States Air Force Dental Corps and his time in dental college, he has been actively engaged in the field of dentistry for more than half a century. However, the way he has chosen to practice, by utilizing noninvasive calcium treatments of his own design, has made him an outcast of sorts within his field. And being shunned by the dentistry establishment was just the beginning; legal action to stop him followed, but each case served to strengthen his resolve.

To further his somewhat nontraditional approach to dentistry, he founded and directs the Calcium Therapy Institute in his hometown of Omaha. The Institute is the vehicle for Manhart to do dentistry and science side-by-side, using his preternatural inquisitiveness and idiosyncrasy to investigate dental problems and treatment options along lines that do not necessarily conform or adhere to organized dentistry’s prescribed ways. That is just the way he likes it, too. Tweaking the nose of authority is a Manhart trait.

He enjoys playing the contrarian. Much the same way his late father, a farmer-turned-attorney-turned-inventor, was his own man who went his own way, damn the consequences, Manhart is a maverick accountable only to himself. He takes the road less traveled, whether in his personal or professional affairs, following an inner muse that neither brooks compromise nor suffers fools gladly nor worries about what people say.

There have been times when he has severed major threads in his life in order to do what he felt was right, regardless of how others perceived him and his decisions. For example, he and his first sweetheart, Mary, married and raised a large family together. She is the mother of his eight kids. After the kids were grown, the couple decided to end the marriage.

“Mary and I were happily married for a long time,” he said. Then they simply reached a place in time when they determined they would be better off apart.

Following years as an active member of the American Dental Association and officer in the ADA’s Omaha branch, he set aside organized dentistry as well. He has practiced without direct affiliation with the dental establishment— that is, his ADA membership and a position teaching at his dental school. However, the tradeoffs became more focused on his patient care, clinical research, and life beyond dentistry. At the time he won a lawsuit over patient treatment that was egged on by dentists who opposed his research in the advanced uses of calcium materials. When a number of specialists testified against him, there were subsequent, immeasurable losses to his reputation and health.

Aside from getting some of his findings published in the preeminent international dental journal more than twenty- five years ago, and in a few minor journals, his attempts to publish his work in America have been repeatedly rebuffed, much to his frustration. Nonetheless, in 2009 a prestigious European dental journal published his latest findings almost immediately and without reservation. His perceived banishment in the United States is a source of bitterness with him but just how much it bothers him is hard to gauge as he tends to dismiss it or brush it aside as no big deal. His wife, Bonnie, knows differently.

 

 

Bonnie Gill

 

 

How much has he been hurt by all this? “Very hurt. More than you can imagine,” she said. “I cannot even talk to him about it, and some of it I think he has brought on himself. But I think as he gets older it is killing him and I keep telling him, ‘You gotta let it go.’”

Bonnie said her husband can be hard to read, even for her, because he is such a mix of things and because he can hide behind an inscrutable, sphinx-like mask that serves to insulate and isolate him from those around him.

“I know him probably better than anybody else, I would say better than any human being on Earth,” she said. “He is a very complicated soul and a very kind person. It is sometimes the bane of his existence and actually what probably drew me to him. I knew before I ever got hooked up with him that he was incredibly honest. What I do not admire is that he can seem to turn that on and off and be extremely cruel when he wants to be, too. This is one of his flaws—it’s my way or no way—he cannot ever see the gray areas on some of this stuff, which he is very good at seeing on other things.”

She has no trouble standing up to him when she feels he is wrong and telling him so. He can handle being called out on his mistakes and has no problem with Bonnie’s candidness and her telling him like it is.

Bonnie said, “You know, it takes a pretty strong guy to accept being told, ‘I think you’re full of it.’ But that is the kind of relationship we have. It’s perfect because I do not ever have to get up wondering who I should be today.” In other words, she can be herself. With Mark,” she said, “I always know I can be who I am, warts and all, and it might be a little grumpy, but it’s going to get worked out.”

She has been there through the highs and lows of his dental life. She has seen the toll it has taken on him to seek the kind of vindication and recognition he wants but that has not been forthcoming and that likely will not come anytime soon, much less in his lifetime. “One time I asked Mark in the throes of this, ‘Do you want to be rich or do you want to be famous?’ And I did not even have to ask him because I knew what the answer was. He threw me a curve ball though by saying, ‘Both.’ I said, ‘You cannot have both, you can only have one.’ And then he said, ‘Famous,’ and I said, ‘I knew that.’”

Despite setbacks he has doggedly carried on, determined to prove people wrong. Call him intransigent or stubborn or willful or simply determined, he is like the proverbial dog that won’t give up a favorite bone without a scrap. As stressful and contentious as his dentistry battles have been, the bulk of his work in the field has been fulfilling. It is why he still does what he does at an age when the vast majority of his peers are long retired.

“Look at when dentists retire. I mean, dentists retire pretty darn early, and I passed that opportunity up fifteen years ago. I keep on because our calcium therapy works and it is such a delight to practice dentistry,” he said. “You know every day I see people who have troubles and we solve them. What more of an ego trip could you want?”

A pursuit quite apart from dentistry that Manhart is no less passionate or obstinate about is the theatre. This dramatic arts enthusiast has taken the hobby seriously enough to have helped form and operate three community theatre venues: the Rudyard Norton, the Kingsmark II, and the Grande Olde Players (GOP). He co-founded and directed the latter with Bonnie. Their Grande Olde Players established a niche by producing works featuring seniors and intergenerational casts. After a twenty-four year run the Grande Olde Players Theatre, which also featured jazz concerts, staged its final season in 2008.

Manhart has also participated in the Great Plains Theatre Conference hosted by Metropolitan Community College. The college’s historic Fort Omaha campus is the site of play labs where Manhart’s work has been read and where he and Bonnie have directed play lab readings of works by other playwrights. The conference receives submissions from playwrights across America, even from abroad. It is an intensive week-long concentration on craft. Some of theatre’s greatest talents participate as readers, respondents, mentors, and panelists, all in service of furthering the work of new and emerging playwrights.

Manhart does not kid himself. He knows he is not in the same league as many of the participants, who have included Pulitzer, Tony, and Obie award winners. The experience of having his work critically evaluated has not discouraged him but has emboldened him to keep writing and improving.

He has already accomplished much in local theatre. Without a lick of formal training he taught himself how to write, produce, cast, and direct productions and to manage theatre companies. He still writes plays and he still takes directing assignments today. Bonnie also continues to write and direct. Much like his experience in dentistry, he has often butted heads with theatre colleagues and collaborators, but, right or wrong, he has always remained true to himself, which is that of a stubborn, “tough old German,” as he likes to say with a wry smile. He is actually Swiss and German, with a little French thrown in, although the borders of those countries changed so often in the not-so-distant past that his precise lineage on his father’s side, the German side, cannot be determined with absolute certainty. On his mother’s side, the Swiss side, however, the family line can be traced back some eight hundred forty years.

The worlds of dentistry and theatre could not be more unalike on the surface. But look closer and what at first seems incongruent reveals similarities, which is why Manhart has drawn from each to enrich the other. Of course, when you think about it, dentistry entails a performance aspect. After all, the practitioner fulfills the role of expert healer for the patient, who comes in search of relief. The drama and expectation alone make it a kind of theatre. Conflict is at the heart of any drama and the inherent conflict in the doctor- patient relationship is that the healer may have to cause the patient discomfort, even pain, before healing occurs.

For many patients the mere thought of going to the dentist produces extreme anxiety. Sitting in the examination chair, surrounded by all that cold, hard, sterile equipment, which for all the world resembles instruments of torture, is enough to raise anyone’s blood pressure. Then there is the whir of the drill. Add to that the unpleasant past experiences many have had in a dental office, from scrapings to extractions to injections, and you have the makings for a tense situation.

Then there is the often exorbitant cost of dentistry that not all patients have the insurance to cover. The financial burden of care is a source of some resentment. It is routine nowadays for a few extractions or a root canal, for example, to cost many hundreds of dollars. When you talk about bridges, crowns, and implants, the bill ratchets up into the thousands. Finally, some doctors do not exactly have a winning chairside manner with their condescending, paternalistic I-speak-you- listen, I am-the-expert-you-are-the-patient attitude.

 

 

Manhart went to India to lecture on calcium therapies

 

 

In stark contrast to that dysfunctional model, Manhart goes out of his way to provide high-quality service at a reasonable rate and to deal with patients in a respectful manner that makes them a part of the care plan. He has also refined his craft to the point that his supple hands have a sure touch. He said there are qualities, some tangible, some intangible, that separate a master practitioner from a run-of- the-mill one.

“It is their touch, their approach, their finesse, whatever you want to call it,” he said. As a young dentist he had a chance to not only see but to feel some masters at work. “I thought, there is the kind of practitioner I would like to be.” By all accounts, he has become one. He said, “My rule always has been, man, if I can get my hands on you, you will never go anywhere else.”

Such finesse only comes through an assurance and confidence that cannot be approximated or faked. You either have it or you don’t. “That’s everything, yeah,” said Manhart. “You cannot really hide it. It’s there and it’s in everything you do. I worked for an orthodontist named Dr. Elmer Bay, and as a teacher this guy was absolutely wonderful because you never knew you were being taught. I used to make his appliances for orthodontics, and I saw his superlative results in everything. He was very old-fashioned. A few years ago Dr. Steg [Manhart’s dental partner] said to me, ‘I had a patient who was told by so- and-so she should not go to us because we are old-fashioned dentists.’ Well, that is the best compliment anybody has ever given us because those old-fashioned dentists like a whole lot we grew up with were just wonderful.”

One old-time dentist Manhart worked with, Dr. Leo Ripp, was so well-loved and appreciated that at his funeral mourners eulogized what a great dentist he was. Manhart never heard of such a thing. “Old Dr. Ripp, he could make the most beautiful gold crown you could ever believe seeing with the oldest crap you could ever think of using,” he said. “He really just was superb. He would put a crown in someone’s mouth, and if it did not stay forty years, something was wrong here.”

Manhart has the utmost respect for the men who taught him because they were working dentists. They were the first practitioners and second teachers he has tried emulating.

“Most of my training was given to me by dentists who were practicing fulltime and coming in a little bit each week and teaching. That kind of dentist is a clinical, hands-on dentist. They really know what is going on. But since the middle 1970s or somewhere in there, the dental school faculties have been dominated by fulltime teachers who go to practice a little bit and that changes the whole picture. That changes it even in the sense of the patient-dentist relationship. When you are working on your own patients and you are listening to them, you are really listening to them, number one, and you are making decisions together, number two, and you know little things like if this patient is not happy, they are going to go home and tell seventeen people. Now you either make them happy or you are in big trouble,” he said.

Conversely, he said a sense of accountability tends to be in shorter supply among dentists who teach fulltime because in college dental clinics dentists are not seeing their own patients, they are seeing whoever walks in for treatment, and these patients are apt not to get the same attention they would in a private setting. From where Manhart sits, too, there is something to the old adage, “Those who can, do, and those who can’t, teach.” Therefore, let the buyer beware.

In such a setting, he said, the dentist tends to be insulated from any repercussions that attend substandard care. A gulf or separation existing between dentist and patient is not consistent with quality care. He feels this insularity is engendered, too, in some dentists who belong to the American Dental Association, who use the organization as a buffer. “That insulation makes you act differently,” he said. Less compassionately or less empathetically perhaps. Rather than hide behind an association, Manhart puts himself right out there, taking full ownership of who he is and what he does. “When you go onto the Internet—this is the first thing I found out—you open yourself up to the entire world and a lot of dentists cannot allow themselves to do that,” he said.

Furthermore, Manhart strives to do the most for his patients with the least overhead for fancy equipment. He has developed an array of techniques, products, and applications that treats patients in minimally invasive or entirely noninvasive ways that are also quick and painless. He is efficient enough to get patients in and out of his office in short order but without resorting to shortcuts or rushing through procedures. That is because he has reduced procedures from several steps to just a few steps, eliminating waste, excess, and overkill. Yet he still takes time to actually examine the inside of the patient’s mouth, explain things, ask questions, and lay out options. He is all about finding long-term solutions, not quick fixes. It is the way informed consent is supposed to work, he said.

Arlene Nelson has been a patient of his for nearly forty years, and she appreciates his inclusive approach. “He shows me the X-rays every time. He says, ‘I want you to look at this.’ He just explains things to you and you just get a clear picture of what is going to be done and how long it is going to take and how many treatments or whatever. You feel like you are a part of the improvement. You really are, too. He puts you right in there. You are right there and you are a part of the healing process. He gives you an ear-by-ear, side-by-side walk with the healing,” she said. “He has really done me right. I have just been very pleased. He is very gentle, very sure.”

His old-fashioned approach is something she appreciates. “You know, I kind of like that. Not only that, but I had a tooth that was bothering me that was way in the back, and I actually called him at home on a Sunday and he said, ‘I want you to meet me at the office at one o’clock,’ and I did. I did not ever think I would be calling a dentist at home. It turned out he had someone flying in from wherever for treatment that day. I thought, oh my gosh. He is just so ready to help me. He is my kind of dentist.”

Paul Luc appreciates the holistic way Manhart treats dental problems. A Hong Kong native living and working in Tennessee, he is typical of Manhart’s patients from all over the country, even all over the globe, who have discovered the Calcium Therapy Institute (CTI) via the World Wide Web. Dozens more do every day.

Diagnosed with advanced periodontal disease, Luc studied the CTI website, contacted Manhart, and arranged to come to Omaha for a treatment. People from coast to coast and from overseas venture in every other week. Like so many of Manhart’s patients, Luc came to the Institute after “seeing and consulting with a variety of general dentists and periodontists … the options offered to me were not satisfactory. The mainstream approach may be clinically acceptable, but it is too generic and statistical in nature and not patient- oriented,” said Luc, who is a scientist. “I was searching for a holistic dentist. The trip was everything I had hoped for and more. Dr. Manhart’s approach is entirely patient-oriented. His method of treatment and diagnosis is very practical, realistic, and above all very scientific. There was no pain, no surgery, no blood, no X-ray, and no anesthesia. Within twenty-four hours after the initial treatment, my condition was under control. It improved drastically after two more days of intensive treatment.”

Luc found Manhart’s “genuine concern” encouraging. He also appreciated that Manhart was willing to share his immense knowledge with him, patiently answering his many questions and offering him the best options for his particular needs. Like more and more CTI patients, Luc uses several of its self-care products at home, including the Calcium Toothbrush, the Oral-Cal mouthwash, and the Calcium Chip set. “My gums and teeth are getting better every day. I am really amazed by the power and effectiveness of the simple, common sense approach and solution.”

There is more to the story. Luc was so taken by the results that he began focusing his scientific mind on a practical application for determining the presence of periodontal disease. Long story short, Luc devised a home test that he then presented to Manhart, who immediately saw that his patient had hit upon something worth developing.

“Paul came up with a superb test for periodontal disease,” he said. “It is very neat. He adapted our products in a certain way so that you test yourself at home to tell whether you have periodontal disease or anything to worry about with your gums being infected. Paul is very creative, and he came up with a very clever oxidase process for testing. All I did was tweak it and put it in a sequence of what to do. If we had some company to work with, it could be made very inexpensively with materials we have.”

A doctor being open to accepting an idea from a patient is rare enough. It shows that Manhart is not so high and mighty as to dismiss something a mere civilian suggests or, in this case, invents. He has too often been on the other side himself of being cast as the amateur or dilettante intruding into the holy domain of the experts or specialists. So he knows what it is like to be ridiculed and spurned and not taken seriously. He has a long history of being open to ideas from many quarters.

 

 

Manhart found a high standard of care in India

 

 

In September 2009 he and Bonnie were presenting the calcium therapies in Nice, France, when one of the attendees answered the following question Manhart posed: “What causes such an infection?” To which a man in the audience responded with, “Thumb sucking.” Manhart, the expert dentist, was bewildered that he had never thought of that explanation.

In his practice Manhart must be a people-person and thus he can turn on the charm and therefore transform the often awkward patient-doctor interaction into a relaxed exchange that disarms patients and makes them collaborators in their own care. Humility goes much further than arrogance he has learned. But with him, there is no ring of phoniness to the interaction. He is genuinely engaged and in the moment with you. You feel his full attention on you.

“I always remember how theatre helped me become a better dentist, because you have to play a role,” he said. “If you go into the office and play the role of a student, people do not buy it. If you cannot play the role of a dentist who is competent, who knows what the hell you are doing even though you maybe have to go in your office and read a little to make sure you know what you are doing, then you are going to fail at it. And it works the other way, too. You learn things on stage that work and make sense that can be applied to your dental work, and one of them for me was that we were always taught in dental school never to say things like, ‘Ooops’ or ‘Sorry, I didn’t mean to cut your lip off.’ You were taught to be impervious to mistakes. Well, it is an everyday thing because you are hurting people every day, and so how do you respond?

“I remember we were taught you never give a person an injection and say, ‘I’m sorry.’ That is heresy or it used to be, maybe it is not so much anymore. I just figured out, no, I have to say that, and so it has gotten to be a habit with me. Almost every time I give someone an injection and I know I have hurt them, I have to say, ‘I’m sorry,’ and it has to be real. That makes a person a better dentist, just simple empathy. Otherwise, it is not believable.”

Just as he has learned that genuineness is a big part of being a healing arts practitioner, he has learned it is equally critical to being an artist on the stage. In each circumstance it is about transparency and professionalism. It is all about being authentic or real. Anything less than that will not hold or convince the audience. People can smell a phony act from a mile away.

He has taken his ability to authentically, transparently engage people a step further by devoting much time to teaching his craft. For four years he was an associate professor at his alma mater, Creighton University Dental School in Omaha. One of his former students, Tom Steg, is now his partner. The two make an interesting contrast. Manhart is the tall, thick figure whose bigger-than-life vibe and presence draws eyes to him. Steg is a slight man with an insular personality and a just-above-a-whisper voice. But where they differ outwardly they share the same probing intellect that enjoys the give- and-take of rigorous inquiry.

For years, Manhart has demonstrated techniques to colleagues at dental conventions across America, even abroad. At various times he conducts seminars for dentists in his office or their offices, turning the quarters into teaching labs where he works on actual patients while dentists and hygienists observe. His work as a clinician-teacher is widely respected because he is not only skilled and informative but knows how to play to the crowd and work a room. He makes eye contact, he changes the inflection of his voice, he pauses for effect, he gestures with the tools of his trade in his hands. Like any good actor or orator, he uses his entire body and whatever props are available as expressive instruments of communication.

Being able to “perform” in front of people when the pressure is on is a knack he developed early on in competitive athletics and refined as a dentist and later in Rotary International and community theatre. The Rotary International website’s “About Us” section describes itself as “the world’s first service club organization, with more than one million members in thousands of clubs worldwide. Rotary club members are volunteers who work locally, regionally, and internationally to combat hunger, improve health and sanitation, provide education and job training, promote peace, and eradicate polio under the motto Service Above Self.”

Sounds like a hand-to-glove fit for Manhart, the man of varied interests, especially when the Rotary site gets around to the part that says “the benefits of a Rotarian include serving the community, networking and friendship, and promoting ethics and leadership skills.” That is Manhart to a tee. He can and did hold his own with Omaha movers-and-shakers when he was active in Rotary. He is not so much active in it anymore, but he still follows the organization’s principles in his private and professional lives.

He suffered stage fright during his first forays in theatre but interacting with patients and with peers as a dentist and getting up and addressing an audience at Rotary meetings helped instill a composure that he then transferred to the stage. In turn, he took what he learned in theatre and applied it to his profession, especially to the public speaking, demonstrations, and teaching he does. “It taught me in a way how to present myself in giving a clinic or giving a lecture. It taught me that talent,” he said.

He remembers the first time he ever went and presented anything in Chicago, host of the dental convention in America. He said, “It is like being on the best stage in dentistry, it really is,” and how much smoother and assured he was in that rarefied environment after honing his public speaking and theatre chops. He likes being on stage, whether in the playhouse or the examination room or the classroom or the convention hall. His hands are sure, his voice steady, his posture erect, and his demeanor confident in these respective arenas. Each is a turf he feels completely comfortable and competent on.

He transferred this same nonplused quality to local cable television, for which he wrote, directed, and hosted talk shows that produced some one hundred programs featuring guests from all walks of life. He developed and hosted a talk show on Omaha’s KLNG Radio for a time. He has also appeared in a number of local TV and radio commercials. The ham in him cannot help it. Besides, he is just one of those high- energy people, as is Bonnie, who has to be doing something.

Add to that his boundless curiosity, his stage presence, and his gift for gab and you have the proverbial talking head.

He is sure there is a correlation between the intuitive breakthroughs that have come to him in dentistry and the creative breakthroughs he has experienced as an actor- writer-director. Breakthroughs only come if you are open and available to them. It means preparing yourself for invention by putting in the work ahead of time and then letting your subconscious take over to incubate and birth ideas when they are ready to emerge.

“To me it is allowing your subconscious to think for you because your subconscious is always going,” he said. “A lot of these discoveries in dentistry were being worked on just like anything else and then suddenly there it was in front of you.”

He recalls the time the idea came to him of how a paper point used in root canals can be coated with calcium. “I always remember there it was right in front of me all along on the bracket table, and I had seen that a thousand times before, but now my subconscious had put two and two together, and I saw that putting the paper point plus the calcium together gave you a wonderful way of getting calcium where you need it—inside the tooth. I really think there are people who do not allow their subconscious to do much for them or they think, If I don’t think of something right now, I am never going to. But the harder you try, the worse it is. That surrender to the subconscious—I will think of it later—is where those discoveries come from. And one kind of discovery leads to discoveries in other fields.”

 

 

Manhart demonstrating techniques in Poland

 

 

His life in theatre has not only served as an inspiration and gateway for his professional career, it has also served as a buffer and sanctuary from his life in dentistry. For Manhart, there is no greater satisfaction than knowing he has rendered service to patients. But the demands of dentistry, as with any profession, can be taxing. That is why he prizes having the theatre to go to. He can leave the work-a-day world behind in order to lose himself in a realm of make-believe.

“It is such a welcome distraction from dentistry because dentistry would drive any person crazy. The theatre is such a complete change that it’s good for you. It is wonderful to go from the office and go do theatre, and completely forget you are a dentist and really use a lot of your talents and experiences to create something on stage,” he said. “And for so many people, myself included, the theatre is where you discover talents and abilities you never dreamed you had. Theatre is so much a part of the world and you can learn so much from it. In other words, if you can play something on stage and you can do it in front of people and make them a part of what you are doing, you make people laugh and cry and solve their problems … that is irreplaceable.”

“The most fulfilling thing about my involvement in theatre,” he said, “is that I get to show that the world is a stage and it is more rewarding to realize it in different ways than to be lost in a black hole of politics or religion.”

As he says, the theatre can be a place to work things out, such as unresolved issues and emotions. It is a freeing space. Therapeutic even. Seen in that light, it is no accident he has gravitated to the therapeutic side of dentistry. You might say it is his calling. Reading, painting, listening to music, landscaping, dining out, and traveling are other pursuits that help him escape. Tennis used to do the same for him. Before that, as a youth, it was basketball. “Those kinds of things let your other mind work, free it up,” is how he describes it.

 

 

Logo for the Grande Olde Players Theatre

 

 

His appreciation for the finer things extends to home. The residence he and Bonnie share is an open modern showplace whose many windows bathe the interior in natural light. Their passion for art and music is seen throughout the spacious, muted living quarters, including paintings he has done that hang on the walls and an upright piano in the dining room. They love to entertain, and their jazz nights transform their place into an intimate atmosphere.

Their love of nature and design is expressed in a walkout patio and garden whose landscaping Manhart conceived and executed. His knack for gardening comes from his mother and her proverbial “green thumb.”

The serene yet dynamic living space is an aesthetic retreat that reflects the cultured couple who inhabit it. It is easy to see what drew them there.

“We looked for almost a decade for this home, stumbled on it, and bought it the next day in September of 2000,” he said. “It and the three houses to our east were designed by

Stanley How, who must have been a serious student of Frank Lloyd Wright, the iconic architect of Fallingwater, the most famous residence in modern architecture. The design of our home, which was built in 1963, is nothing less than genius. Its modern layout is for all the senses and weather of this area of the world. The only things we did were move the laundry upstairs, put in some mirrors Wright would have liked and kept it simple and uncluttered. I hope to die in it. We have studied Wright’s architecture a long time and have toured his buildings and homes, especially his Taliesin East and West homes. I see our home as an homage to his concrete, long-lasting contribution to American culture.”

Then, too, there is the life we experience with our own siblings or kids. This is a bit more problematic where Manhart is concerned. He likes children. He fathered and helped raise eight of them, after all. But he has been by his own admission a somewhat distracted parent with a tendency to get caught up in his own activities to the diminution of his kids’. He can also be a bit of a distant curmudgeon who unconsciously withholds the affection and approval that presumably his children, even though they are all grown now with families and careers of their own, still crave from him, the strong, patrician-style patriarch. He also is not inclined to do family things or to attend family reunions unless persuaded or nudged, and then he invariably enjoys the gatherings.

Moreover, there is the life we carry on with friends, with neighbors, with associates, and so on. Manhart can hardly count the lives he has touched in the various guises he has filled, whether as doctor or teacher or speaker or director or friend or neighbor. His has been a long, varied life well- lived and one marked by all the connections he has made with people in his many roles. He likes the many hats he has worn and continues to wear. The fact there are many different constituencies and peer groups he can call his own is a manifestation of his diverse life.

Certainly, each of us leads an intense private existence that exists apart from but not entirely separate from our gainfully employed experience. A life of any length accrues with it a host of endeavors, roles, affiliations, associations, not to mention baggage, of both the personal and professional kind, whose whole is greater than the sum of the parts—each a reflection of different aspects of our self.

If nothing else, the biographical subject of this book, veteran dentist Mark Manhart, leads a rich life that seems a bundle of contradictions upon first glance. Now in his seventies, the native Omahan is equal parts old-fashioned practitioner, alternative dentist, “mad scientist,” artist, pragmatist, dreamer, searcher, connoisseur, businessman, inventor, family man, lover, disciplinarian, libertarian, and iconoclast.

A contemporary of Manhart’s, Father Jim Schwertley of Omaha, once told him, “Manhart, you are just like mercury, just when we think we have got a hold of you, you squirt out someplace else.”

Manhart admits, “That is a fair assessment.” Manhart’s wife said, “I am going to put that (the mercury epitaph) on your tombstone.” That is how “perfect” Bonnie thinks the metaphor is in capturing her mate’s fluidity.

The word mercury comes from the quixotic Greek god of the same name. A derivation of that word is mercurial. One definition of mercurial reads: “being quick and changeable in character.” That is not to suggest Manhart is a chameleon or that he acts a certain way one instant and another way the next, at least not anymore than the rest of us play various roles to suit the company or the occasion or the situation. No, it is just that he is one of those people who cannot be easily pinned down or pigeonholed because he is into so many things and seemingly all over the place at once. So, for the purposes of this bio, he might be dubbed Manhart the Mercurial. It not only has a nice, alliterative ring to it, it happens to accurately describe the man’s multifarious nature.

All are expressions of his different sides and lives. But in truth there is no secret life for Manhart. His life is an open book, relatively. Isn’t everything relative? His very public theatre work has certainly been no secret. His running for the Omaha City Council put him out there on the front lines of public-media scrutiny. His lay leadership in the Omaha Archdiocese made him a lightning rod for church- lay issues. His wholehearted embrace of the Montessori method of early childhood education put him at odds with the local education cabal. His attempts to introduce some of his calcium therapy innovations in the classroom met with stiff resistance and, eventually, resulted in his outright dismissal. His outspoken objection to traditional endodontic and periodontal approaches in favor of noninvasive calcium- based alternatives made him a pariah among dentistry’s specialist community.

The person we become at seventy or seventy-five, if we live long enough to find out, is naturally an accumulation and a conglomeration of everything that has gone on before: the incidents, the milestones, the highs, the lows, the decisions, and the mistakes we made. Our lives are the product of many commissions and omissions. No one is without fault or blame. The best we can do, as Twelve-Step recovery programs phrase it, is to strive for progress, not perfection.

Manhart has something to say about this live-and-let-live ethos, too: “Long, long ago I decided to avoid reliving the past myself or through others, like raising the kids. If I had done one thing different, I would not be here talking about all this. All since would have changed, so history is what it is and regret is a cop out or a waste. I try to learn from the past, repeat the good parts. I love to read history and concentrate on the present, and maybe on tomorrow till about noon. I do not wake till 10 a.m., nor believe in God till after lunch. I try to see people from angles and steal the good sides.”

 

 

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A Hospice House Story: How Phil Hummel’s End of Life Journey in Hospice Gave His Family Peace of Mind and Granted Him a Gentle, Dignified Death

 

 

When Omaha Magazine inquired if I would be interested in tackling a story that followed a family’s experience with hospice I immediately jumped on it because both my parents received hospice care in their final days. The Hospice House in Omaha offered their cooperation and identified the family who I profile in the story that follows, the Hummels. The plan was for me to spend an extensive amount of time with the patient, Phil Hummel, and his family and I did at first and then, as things often unfold in such situations, circumstances changed and I was unable to get the same access I had before. But I did get to know Phil, his wife Jo Ann, and their son Al fairly well before Phil passed and then I got to visit with Jo Ann and Al the day of their loss. My piece is the cover story in the November/December issue of the magazine, which is distributed at select sites all over the metro. You can subscribe to the publication. To see the story as it appears in its 12-page spread visit omahapublications.com or http://www.readonlinenow.com.

 

 

Phil Hummel near the close of his coaching-teaching career

 

 

A Hospice House Story: How Phil Hummel’s End of Life Journey in Hospice Gave His Family Peace of Mind and Granted Him a Gentle, Dignified Death

©by Leo Adam Biga

Published in Omaha Magazine

Even though the end of life comfort care known as hospice is better understood today than decades ago, misconceptions linger. Some mistake it as denying care. Others assume it’s only for special cases. The myths and misapprehensions make sense given how death and dying tend to be topics avoided rather then engaged in America. No two end of life scenarios unfold alike. But charting a real life journey through hospice can remove some of the fear and unknown that follow a terminal prognosis, which is why the Hummel family agreed to share their experience at Hospice House, the Josie Harper Residence. Executive director Gary George welcomed this reporter in to give readers a glimpse at a patient-family-caregiver story. The center, at 7415 Cedar Street. just east of the Bergan Mercy Medical Center, is a collaborative between Alegent Health, Methodist Hospital, the Visiting Nurse Association and the Nebraska Medical Center.

 

 

 JoAnn and Phil Hummel with their only son, Al, in 1960

 

 

A Rich Life

Family patriarch Phil Hummel of Woodbine, Iowawas a resident there 10 weeks last summer. Hospice provided a dignified end of life path and offered loved ones peace of mind his every need was met. Hummel, 78, died gently in Room 2 on September. 1. That last day, like each of the 69 preceding it, Phil’s wife JoAnn and son Alan were present. They were with him when he drew his last breath. In the weeks leading up to his death, his daughter Gail was on hand along with other family members and figures from his career as a high school educator and coach.

Married 56 years, JoAnn and Phil met at Tarkio (Mo.) College. She attended on an academic scholarship. He, on an athletic scholarship. Phil, a Riverton, Iowa native, excelled in sports at Sidney High School, where’s he’s a Hall of Fame member. His football-track exploits also earned him a spot in the Tarkio College Athletic Hall of Fame. After the couple married Phil was drafted in the U.S. Army and JoAnn followed him, first to New Jersey, then to Japan.

 

 

JoAnn and Phil in Japan

 

 

Back home, his military hitch over, the couple started their family and taught together at Woodbine High School. Her speciality was business ed. He taught U.S. government and American history. Summers he ran a house painting crew that did work all over western Iowa and the Omaha metro area. He was by all accounts as demanding a boss as he was a coach. During a highly decorated coaching career he led teams in many different sports but mostly made his mark as a cross country and track coach. He won several coach of the years honors and was a longtime Drake Relays official. The Iowa Association of Track Coaches Hall of Fame inductee twice led USA Track and Field youth teams to China. “Sports were a big part of our life, that’s for sure,” said JoAnn. “He was really busy coaching, and then on the side he was an official, and he refereed. He was gone a lot. And then when he wasn’t doing that he was hunting and fishing. It was a good thing I loved sports because that was Phil’s life. I was at all the games.”

 

 

Phil earlier in his coaching-teaching career

 

 

Her husband, who made his runners take the steep cemetery hills on the west edge of town, was a living legend. “Phil was known all over the state of Iowa,” she said. A measure of the impact he had on young people is the seven pages worth of condolence memories on the Fouts Funeral Home web page after his death. Like any good coach, Hummel was a surrogate father to his athletes. One young man he drew especially close to was Guy Mefferd, who with Phil’s guidance turned his life around and went on to serve as a U.S. Navy SEAL. Jan Sauvain, a family friend Phil coached in basketball, said he could be a strict disciplinarian “but never vindictive or to humiliate you or to demean you, just to give you a little insight into what you did wrong, and he cared about the kids after they graduated.” She said Hummel, unsolicited, recommended her to an AAU basketball coach in Omaha and wrote a glowing reference letter for her brother. “He did care, absolutely,” said JoAnn, who typed her hubby’s correspondence in her unofficial role as “Phil Hummel’s administrative assistant.” She said, “He was always interested to see what happened to students down the line. That’s why so many people came to see him in the Hospice House. Sometimes we had five to ten a day. They came from all over.”

Comfort and Care

When word got out Phil was dying, scores of athletes he coached, along with fellow coaches, even old teammates, came to see him. Each shared a piece of Phil’s end of life journey with him. As did Hospice House staff and volunteers. With its many windows looking out on nature and the great room’s soaring cedar ceiling, there’s a bright, uplifting feel to Hospice House. Also an intimacy and communal aspect quite unlike a hospital. Community meals are convened. Families and volunteers share treats. Musicians come to perform music. Children and therapy pets visit. The emphasis, said Ann Cole, a staff registered nurse, is comfort. “

Death is really the final stage of growth and dying is a natural part of life and if we have enough time to work with people we can help them and make this really a positive time,” she said. “We can help them to accept what’s going on. First of all, we’re able to control the adverse symptoms that go along with the dying process — things like pain, nausea, vomiting, anxiety, constipation, agitation. Those are all things we often see in varying stages as the dying process progresses. “If we can control those symptoms and the patient knows you’re going to be with them, you’re going to support them, and you have enough time to develop this relationship, then there’s always something we can offer to comfort them. We can control these symptoms, make them the least they can be, so they can live a really comfortable life until death comes naturally. This is our area of expertise.”

Because Phil was alert and active almost his entire stay, he savored many moments with those dear to him and developed rapport with caregivers. He felt well enough most days to relax in the courtyard. He even went on regular outings to favorite haunts, such as the Horseshoe Casino and Olive Garden restaurant. He told stories and shared memories but mostly he listened, laughed and cajoled, holding court on the deck or in his room.

My intro to the Hummels came via a phone call to JoAnn’s cell. She answered from Phil’s room with, “We just got back from the casino with some of Phil’s friends. Phil just ordered Jimmy Johns.’” It’s not what I expected — a dying man living it up, so to speak. I came to see it as his serene surrender to fate — making the most of what time he had and appreciating everybody and everything around him. ”He wasn’t scared,” said JoAnn.

Phil loved singing the praises of Hospice House. “Oh, I mean, they are so good it’s unbelievable,” he told me, his voice a heavy rasp from the radiation that seared his mouth and throat tissues. “That doesn’t mean we get everything we want. It’s just — they have a care and a love, and people come in and it doesn’t take long for people to understand that. I don’t know where you can move to a better place. There might be one, but I don’t know of any.”

For those, like Phil, given the opportunity to appreciate the life left to them, hospice is not the dour, bitter end but the last bright stage of things.

Bonds

“People think of hospice as a death sentence so often and it’s really about quality of life,” said Cole. “Hospice is working with the patient and family — supporting, teaching, making that quality of life a real possibility, and I think that’s what we did for Phil. If you can help families know what to expect, what will be done, and follow through on those things, they really learn to trust and the trusting relationship is very important.”

JoAnn and Alan praise the staff for easing the path. “They were wonderful there. It’s just a fantastic place,” she said. When she and her son left to go home at night, she said, they could be assured Phil was in good hands. Said JoAnn, “We knew if he needed any little thing they’d be running right over here because the nurse’s station is just around the corner.”

Alan admits he wasn’t sold on Hospice House before placing his father there. After moving him in though he became a convert. “Looking back now it could have been a cave as long as those people were there. The people that work there make that place what it is. Ninety-nine point nine percent go far beyond the call of duty.” JoAnn, a native Missourian with a show-me attitude, noted the sincere empathy. “When they had kind words to say I never felt they were just making it up to make me feel good. I think they really felt that way. That’s why they’re there.” A little warmth goes a long way. Besides, said Ann Carol, “Who wants a cold nurse?”

 

 

 

 

It wasn’t just healthcare providers who impressed JoAnn either. “The volunteers are fantastic. Like the Cookie Lady. Her husband was a resident there and she wanted to do something for the Hospice House, so she decided she’d bake cookies. Every Thursday she brings them in. It smells so good. Even the cleaning ladies are fantastic. Nice, pleasant, do a beautiful job.”

Gary George, who’s headed the center since its 1998 opening, said everyone who works there embodies “a sense of passion,” adding, “We want to be doing this kind of work.” He describes it as “a calling to be working with people at end of life that then links to an honoring of life and a recognition that end of life is part of life, not something to be feared, not something to be run from. It’s recognizing all the rich…things that can come out of end of life when people are being walked through that journey.”

“Compassion,” is the common denominator said certified nursing assistant Joanne Waltsky, who, like Ann Cole, got close to Phil. “These people are like our family. We get some of the crabbiest people in the world and they always end up loving us — I mean, always. It’s awesome, it just makes us feel good.” The Hummels shared how Waltsky’s habit of singing while making her rounds rubbed Phil the wrong way, at first, before he melted under her buoyant charms.

“The first night I came in here it was a helluva night,” Phil said. “Six o’clock the next morning, somebody came in here singing. Who the hell can be that happy in the morning? I told my wife,’ I don’t think I can put up with that.’ By noon she had me won over. You want to know why? This gal had everything we needed whenever we needed it, before we knew we needed it. That’s not a joke. “And she’s still going, and the others are just like her, just happy as clams, which made us happy of course. I can’t say any more about this place than if I tried, and I’m trying, because they’re good.”

 

 

Phil and JoAnn in later years

 

 

Because Phil was there so long and his wife and son there so much, the bonds between caregivers, patient and family had time to to ripen. “Everybody was really attached to him and they were really fond of him,” Alan said. “They want to keep from getting attached but your dad won them over,” JoAnn told Alan. “They won him over,” Alan replied.

Attitude is Everything

Waltsky said in contrast to some patients who sink into despair and wallow there despite her and her workmates’ best efforts, Phil embraced his remaining life. “We try to bring people up but they don’t always want to,” she said, “but Phil every morning got the day planned and told us what he was doing. He touched everybody there. He was so independent. He was everybody’s friend. He had so many visitors. When his coaching friends and past students would come in he’d always introduce me like I was family. I just loved him.”

She said the entire Hummel family made an impression. She was struck by how JoAnn and Alan befriended a woman without any family in the room next to Phil’s, checking in on her, bringing her goodies. “They’re just loving people, you know, and everybody loved that. They were just joy.” JoAnn Hummel returns the compliment by saying she never conceived hospice would be such “a positive thing. I’m so glad we went there. That was the only place for that kind of care. It was either that or go back to Woodbine to a nursing home, and Phil didn’t want to do that. This was just perfect.” She’s certain Hospice House helped extend his life. When he arrived in June, he was given less than a week to live. Ten weeks later, he was still there.

A Life Interrupted

His cancer jolted the couple. They were busy enjoying their hard-earned retirement, traveling to Las Vegas, wintering at a Florida condo, spending time with family and friends. The Council Bluffs casinos were favorite getaways. Phil loved the outdoors. Then, in April, he discovered a large lump on his throat while shaving. After going in for tests at Methodist Hospital, the bleak diagnosis of cancer unsettled his and JoAnn’s world. “The worst you can have,” is how a physician put it. Inoperable. An aggressive regimen of chemo and radiation in Omaha followed. “I truly think the doctors knew it was an impossible slide but worth a shot and I thought it was worth a shot, because the alternative would not be any good if you just left it alone,” said Phil. “I had all the faith in the world the treatments were going to fix it,” said JoAnn.

Only Phil didn’t get better. The tumor didn’t respond as hoped. “I just saw him get sicker and sicker and more miserable,” said JoAnn. Making one-hour drives each way for debilitating treatments took their toll. “We would drive back and forth every day,” she said. “On the weekends he would just go in the bedroom and stay in there in the dark. He couldn’t eat. It was terrible. His neck was getting worse and worse, just burned.” “I couldn’t get anything down,” Phil said. On Mondays it began all over again. “It was a hard time,” said JoAnn. Spring turned into summer when the oncologist reported what the couple already suspected — the tumor wasn’t shrinking. “That was a bad day for me when he said we are going to stop all treatment,” said JoAnn. “I know when it was exactly — the 22nd of June. We came in here (Hospice House) the 24th.”

Phil was precariously near death. “When we came in here the doctor said maybe five days,” JoAnn recalled, “Phil hadn’t had anything to eat or drink for two weeks, only kept alive with hydration. He couldn’t raise his head off his chest.” “I couldn’t move. I was bad,” Phil said to me.

Phil Accepts Impending Death but Continues Embracing Life in Hospice

But then a remarkable thing happened. “When the swelling began to go down from the radiation treatments he began to be able to sip a couple sips of water and eat a little apple sauce,” said JoAnn. “It wasn’t long before he was eating more things.” Alan plied his father with food but Phil could never hold it down. Yet the better Phil felt, the hungrier he got for his favorites, including hamburgers. It’s all he talked about. Alan was reluctant to give him one, until he finally threw caution to the wind. “It took us awhile to figure out it doesn’t matter — give him whatever he wants. I went to Five Guys Burgers and Fries and brought it back. He didn’t eat very much of it but it was the first time in at least a week he was able to hold down food,” recounted Alan. “You would have thought it was the first hamburger, the best hamburger, some kind of divine hamburger. Seriously, the look on his face…That hamburger is when he turned the corner from being where we thought there was no way to maybe there’s some hope he’ll hang in there a little while, and it was.”

Rebounding

Phil gradually regained strength. Not long after his rebound began, tells JoAnn, the doctor that gave Phil precious little time to live stopped by Phil’s room. “He sat down and pulled his chair right up to Phil’s face.” “Nose to nose,” is how Phil put it. “And,” JoAnne continued, “that doctor said, ‘I can’t believe what I’m seeing.’ That he’d come around. And you have to give a lot of credit to this place because it’s a wonderful place.” Phil agreed, saying, “You know, I feel so far from where I was when I came in, but I accepted it (his fate). Maybe it’ll give me some more days down the road, I don’t know.” “It’s a miracle you’re even here,” Alan told him then. Five days turned into 10, 10 into 20…

Certainly no one expected Phil to venture out, albeit confined to a wheelchair, to eateries and attractions, but that’s what he did and if residents get there early enough it’s how hospice ideally transpires.

“The fact he was so positive about going out on his little excursions, and I’m sure he probably didn’t always feel the best, is what hospice is about. It’s to go out and do the things you love to do. You’re not confined to bed in this place. We encourage people to do what they can do. We’ve had people go home and stay overnight a couple days and come back,” said Cole.

The turnaround Phil experienced, said George, “is neither usual nor unusual, it happens sometimes, and for who knows how many reasons.” He added, “Sometimes people do seem to have some spark, some different amount of energy when they get here, and for some people it may be due to more stimulation and activity, for other people it might be a sense of relief — some sort of freeing up and letting go of responsibilities, letting loose of some things.

“Lots of people bring treasures here that mean things to them. For many people that’s photos. For one guy it was a full life-size cutout of John Wayne. For one of our earliest residents, John, it was a little bookshelf filled with these thick novels and I said, ‘Oh, John, you must have brought along your favorite books,’ and he said, ‘Oh, those aren’t my favorites, those are just ones I have left to read.’ I don’t know how many he got to read while he was here but that’s what he planned to do. I thought that was amazing. “People come with a bit of a sense of adventure sometimes. I always admire that attitude of here’s something new and different — kind of leaning into it.”

That same leaning into one’s dying days is what Phil Hummel exemplified. A small bulletin board in his room displayed photos of things and people he cherished: family, friends, track. An American flag emblem. And a hand printed Bible verse from his granddaughter Jessica about the virtues of love. He literally lived for visits by friends and loved ones, former schoolboy tracksters, hunting-fishing cronies, and for those casino-restaurant forays. Not everyone can be so active. For most, their illness is too advanced to allow for much mobility or independence, whereas Phil prided himself on going to the bathroom alone.

“Our residents tend to come to us later in their disease process then they used to, so on the continuum Phil was a little bit more on the active end of things when he came,” said George. “Most of our residents are no longer at a point where they’re any longer coming and going so freely and wanting to do that even. But he also was a person who came, it seems to me, with that drive — this is what I want to do, this is how I want to do this. He kind of made that happen along with his family.”

 

 

 

 

An Unforgettable Character

Phil himself theorized his “cantankerous” spirit may have spurred his comeback. Action follows attitude, even when dying. Phil Hummel’s gregarious, generous attitude set the tone for his end of life experience and everyone around him. “You know, he was one of those patients none of us will ever forget,” said Cole. “He was just a delight, really a people lover. I picked that up. He really, really cared about people. He talked about his coaching days. It was so obvious he cared about everybody. And even the last couple of days, he was not a complainer. “You had to really take a lot of nonverbal cues as to what’s going on, which is something we do all the time. He always thought about other people, never about himself. ‘How was your weekend?’ he’d say.”

Alan Hummel remarked, “I don’t know how he did it. I thought he was in a bad mood for maybe only one day — and that was the first day.”

The Beginning of the End

After thriving for so long, the end came rather abruptly. On Friday, August 26 Phil was, if not a picture of health, a still vital man. He was keen for the college football season to start so he could root on his beloved Iowa Hawkeyes. Still stinging from a “disasterous” day at the casino, he anticipated better-luck-next-time. He played amiable host to two journalists in his room. Small talk came easy to him as he relaxed in the tranquil courtyard. The last image of him was a tired but content man ready to meet whatever life next presented him, even death.

When I called JoAnn Wednesday, August 31about stopping by she informed me in a taught, severe voice, “Phil’s taken a turn for the worse.” The morning after I saw him he’d suffered a bathroom fall, not breaking any bones, but hitting his head and scuffing his arms and legs. He didn’t lose consciousness. JoAnn and Alan were there. Alan was the first one in to help his father. The nurses were soon on the scene to attend to his scrapes and bruises and make him as comfortable as possible in his recliner. The fall precipitated a rather rapid decline.

“Thats what started it. From then on it was down hill all the way,” said JoAnn. “He whacked his head pretty good. I think he might have been a little concussed,” said Alan. “I don’t know he was in a lot of pain, he didn’t talk about pain,” said JoAnn. “He would have never told anybody if he was,” said Alan. “Had to be strong,” added JoAnn.

Acting on cues, the nurses gave him morphine. “We left him in his chair and he slept the whole day, and then that made him sore,” said JoAnn. “He didn’t eat anything. That was Saturday.” “He slept all day Sunday,” said Alan.”He was conscious but he just didn’t want anything to eat, and he really didn’t want to talk,” said JoAnn. Another sign Phil’s body was shutting down and he was slipping away was when he stopped showing interest in the therapy dogs he used to enjoy. Through the weekend and into Monday and Tuesday he was more and more in a somnambulant state. “He’d wake up, talk a little bit, say a few words, and go right back to sleep,” said JoAnn. “He started babbling, too, like talking to someone who wasn’t there, reaching for stuff,” said Alan. “It was the beginning of the end I’m afraid,” said JoAnn.

Into Wednesday though Phil clung on to what he could. “When they tried to put him into bed he absolutely refused,” said Alan. “They had to sedate him to get him out of his recliner into the bed. Mom said he didn’t want to go to the bed because he knew once he did that was it — he wouldn’t come out…” The robust Phil they knew soon disappeared. “That’s the last we heard from him. When his eyes would open it looked like no one was home…they were all glassy,” said Alan. “Usually when I said something he would look toward me,” said JoAnn. No more. “That was extremely hard to watch, extremely,” said Alan.

The Gift of Time

For the family, there was the consolation of two extra months. A true gift. “How many times did I say that today?” Alan said to his mother the day Phil died. Even though they knew it was coming, losing a loved one still hurts. “At the risk of being cliche, and Mom said it this morning, too — you say you’re prepared, you think you’re prepared, and there is no preparing. You just can’t be prepared,” Alan said. “I figured we would have been at this point a long time ago. We knew the outcome was going to be bad, but he had a good couple of months, seriously.”

Sitting at the dining room table in Alan’s home only hours after Phil passed, son and mother recounted the blessing the Hospice House turned out to be. “All those people who came to see him. Dozens and dozens and dozens of people,” JoAnn said. “I should have kept track of the names.” “It’s been really good,” said Alan. “I think he actually had fun.” “He did,” JoAnn confirmed. “It sounds horrible, but it’s true, I think he had a good time,” added Alan. “When all the track people came from eastern Iowa, they stayed five hours. They sat out on the patio and Phil ordered Jimmy Johns. They all had lunch out there. He had a great time. It made him forget what the situation was,” said JoAnn.

If we have the choice, maybe we should all go the way Phil did. “Absolutely,” said Alan. “Millions of people never get that opportunity.” JoAnn said while “it hasn’t been easy” what helped make it more tolerable was the gradual transition Phil made “from one stage to the next stage,” the “wonderful” care he received and his own serene attitude. “Phil was just resigned, too. He didn’t fight it. If this is the way it’s going to be, it’s the way it’s going to be.”

Hospice House became such a routine in the family’s life that being separated from it feels like a loss, too. “I’m going to miss it, I hate to say that. It’s going to be funny not to go there,” said Alan. “We were there a lot of days,” JoAnn said. “It was weird to leave there after cleaning out the room and it was empty. No one there. None of my favorite girls around,” said Alan.

Lasting Impressions and a Request Fulfilled

What workers were present the day Phil died were moved by Phil’s passing. “A lot of tears were shed that day by the staff,” JoAnn said. He seemingly touched everyone there.

“Phil was a leader and teacher all the way to the end of his life,” said Gary George. “I will remember Phil and his family taking every opportunity to continue to come and go from Hospice House to enjoy life to its fullest. On many occasions I saw them heading out the front door for some adventure together.” The same front doors Phil and family came in and out of are the doors Phil exited for the final time after his death. “We do not want to ‘usher death out a side door,’ or make it seem that death is too awful to look at ” George said. “This I believe is an important feature of Hospice House.”

For Ann Cole and Joanne Waltsky, Room 2 will always be Phil’s. Said Cole, “You couldn’t help but love the guy. He was totally about seeking the positive things in people and affirming that and making them better. You would walk away from his room and just feel so good and hope that you had given him half of what he gave you. He was, oh, so gracious.”

George said when a resident dies “families and friends are given the time, space support they need and my co-workers stand by ready to offer whatever they can,” adding, “This may involve tears, hugs, tissues, offers of a beverage, another chair, a shoulder to cry on…silence, storytelling, or tears mixed with laughter.”

The giving goes both ways. JoAnn and Alan brought flowers from Phil’s funeral to Hospice House, where, per tradition, a candle burned in his memory. JoAnn will be back — she has walnuts and gooseberries for the Cookie Lady. The family asked that memorial donations be made to Hospice House and many were made. Typical of the man, Phil Hummel wasn’t interested in how he would be portrayed. But he did request we emphasize the quality caregiving and warm sense of community at Hospice House. “I want you to give as much attention as you can to this facility,” he said.

Related articles

• A Journey’s End Becomes Mainstream Medicine (kitsapsun.com)
• What Is Hospice? (mademan.com)
• A Special Space (psychologytoday.com)
• Book Spotlight: Death with Dignity by Robert Orfali (bookmarketingbuzz.com)

One Day at a Time, A Recovering Alcoholic’s Story

Image by The Library of Congress via Flickr

I met the subject of this New Horizons story, John H., while on assignment for another story.  His intelligence and honesty struck me and when he revealed some hard things about his life I knew I wanted to write his story.  This is the result.  This account of his struggle with alcoholism is written mostly in John’s own words. After all, he’s lived it, and because he came out the other side to become a treatment specialist at a detox unit, he can speak with the authority of someone who’s been there, done that.  I lost track of John after the story appeared.  I don’t even know if he’s still around.  I really like him though. Maybe I’ll make a call and see if he’s still in town.  I have no doubt that if he’s still living, he’s still helping others out of the dark and into the light., because that very service is part of his own recovery process.

One Day at a Time, A Recovering Alcoholic‘s Story

©by Leo Adam Biga

Originally published in the New Horizons

“I always knew I was going to die drunk. Now I know I will die a drunk, but hopefully a sober one. And there’s a difference.”

The bittersweet words belong to John H., an Omaha resident and recovering alcoholic who works as a treatment specialist in the detox unit at the Omaha Campus for Hope, a Catholic Charities counseling and shelter site formerly known as St. Gabriel’s. It is precisely where John finally got dried out some 11 years ago after decades of abusing alcohol and other drugs. If nothing else, his journey from client to staff member there proves addicts can make a fresh start if they really want to.

Born into a family of heavy drinkers in Chicago, John tried quitting booze several times but could never stay on the wagon more than a few months. His drinking wrecked four marriages, strained relations with his children, cost him several jobs and sent him on an odyssey around the country as he fruitlessly searched to escape his worst enemy — himself and his addiction. He suffered frequent blackouts, developed cirrhosis of the liver and squandered opportunities in a constant quest for getting his next buzz or fix. In the end, it took a savage assault that nearly left him dead before he realized a higher power was looking after him and he finally accepted the fact his life was too valuable to waste away in a permanent vodka-induced stupor.

 

Omaha Campus for Hope

 

Today, John shares a modest home in north Omaha with his youngest child, Shawn. The house, whose exterior is ablaze in color from all the flowers John has planted, is mere blocks from both his job and from the scene of his catharsis. A witty and intelligent man with an Irishman’s gift for turning phrases, John works one-on-one with active drunks and drug addicts in trying to help them kick the habit. In detox he sees desperate people contending with the agony of withdrawal.

“Getting clean hurts,” he said. “It’s easier to stay clean than it is to get clean.” It is not a pretty sight between the night sweats and the hallucinations, but it is exactly what John himself went through himself and that experience allows him to empathize with clients and, hopefully, use his own story as a model of sobriety. “I love it,” he said of his job. “Where I work we try to share our experience, strength and hope. That’s all we can do. I think sometimes it helps if clients know you’ve been there yourself. I let them know I have.”

As he sees it, the job boils down to providing unconditional support to those with no where else to turn. “We can’t fix anybody,” he said. “What we try to do is help them fix themselves by talking straight to them. No alcoholic-addict gets clean and sober until they hit bottom and the only place they can go then is up. What we try to do is raise their bottom so they don’t have to go so far down. We never see our successes. They go out and lead normal lives and we never see them again. We see the failures. We don’t really consider them failures as individuals, but they’re people who just haven’t got it right yet and keep coming back.”

He said the last thing users need is reprimanding because that only exacerbates the depression and self-loathing that accompany drug abuse. “Alcoholics-addicts have no self-esteem and no self-worth. I think they know what they’re doing isn’t right, but telling them that won’t do any good. They’re already down and all you’re doing then is deflating their own low opinion of themselves. Besides, they have a disease. It’s not a matter of choice after awhile.”

With the perspective of time, John has come to understand how and why drinking overwhelmed his life. The roots of his problem extend to early childhood, when he and his siblings were weaned on alcohol as a rite of passage.

“Both of my folks were alcoholics, as were my grandfolks and aunts and uncles. From a very early age there was always drinking around me. Being the oldest of four kids, I saw how my folks would pour some Rock and Rye in a glass and stick their finger in it and rub my sisters’ and brother’s gums. So, I suppose, that’s when I started drinking too. My folks were also the type of people who gave us a small glass of wine or a weak high ball with dinner when we were children. The assumption was, ‘Well, they’re going to drink when they get on the outside, so they may as well learn how to do it at home.’ The whole family drank. It was just the status quo. There were lots of arguments because of the booze. It got very, very ugly at times.”

Drinking shadowed every family activity, even the clan’s shared passion for the Chicago Cubs. One of his clearest schoolboy memories is coming home after class and finding his mother well on the way to tying one on while rooting for the Cubs.  “We lived in a 3rd floor apartment within walking distance of Wrigley Field and in the summer I can remember coming home from school and entering the apartment, which had no air conditioning, and there would be my mother in her bra and half-slip with a quart of beer in a Pilsner glass in one hand and an iron in the other while watching the Cub game on television.”

 

Wrigley Field and surrounding neighborhood

 

His own serious drinking habit developed in his teens. “In retrospect, I know now that I was more than likely an alcoholic in high school,” he said. As a young man, he somewhat successfully masked his drinking but in reality he was what he calls “a functional alcoholic.” He adds, “I could still maintain some decorum of sensibility and reasonableness. Then, by the end of the disease, I would just fall off the edge of the world when I drank.” Bothered by the turmoil in his family, he often stayed away from home. He left home for good at 17 when he and his girlfriend eloped the night of their high school graduation. The young couple lived in Texas and a number of other places before the marriage collapsed. He worked his “way back up north” and it was in Kansas City that he met wife No. 2. She was an Omaha native and her desire to return to her roots first led John here.

In his mid 20s John and his second wife suffered the loss of a young child to cancer, an event that may have triggered more intense drinking in the grieving father, who acknowledges he was bitter and inconsolable over his son’s death.

With no real skills to speak of, other than a gift for gab and an intimate knowledge of liquor, he gravitated to the one line of work he seemed eminently qualified for — bartender. He was a natural, plus the job gave him access to all the booze he could guzzle on the sly, only he didn’t always get away with it. “I was a good bartender at first until, toward the end, when I became my own best customer. Then it was not so good. It got me fired a couple of times,” he said.

Between bartending gigs he put his people skills to work selling women’s shoes and hawking greeting cards as a traveling salesman. For several years he hit the road selling door to door, relocating several times along the way. including to Atlanta and Nashville. When regular jobs like these petered out, he always went back to tending bar. All this moving around, he said, was his desperate bid to find “the geographical cure for alcoholism,” which, of course, doesn’t exist. By the time he moved back to Omaha in the 1970s, John had been through three broken marriages and several careers. He was back to tending bar again and his drinking was worse than ever. He was descending into a kind of oblivion whose end result was inevitably going to be imprisonment or death.

“Alcoholism is a progressive disease. It keeps getting worse. By the time I finally got help there was no high, there was no enjoyment, there was no pleasure in drinking. I drank so I didn’t get sick. It was pure maintenance drinking.”

 

 

 

 

His first couple attempts at getting help did not take. “I was in two treatment programs. First, I went to Immanuel Hospital as an out-patient and after a few weeks, I said, ‘I’m wasting your time and my money because by coming in only a couple times a week I keep going right back to the same environment doing the same things.’ Later, I went to Immanuel as an in-patient and I stayed there a month. I stayed clean and sober for, oh, maybe three months and then I went back and stayed out for maybe eight years.” Why didn’t these tries at sobriety work? “I wasn’t ready,” he said. “It wasn’t anybody’s fault. It was on me. Alcoholism is a disease where you’re not going to get clean and sober until you’re ready to get clean and sober. It just depends on you. It’s strictly up to you.”

For a long time, he convinced himself he could control his drinking by moderating it. He knows now he was fooling himself. “I will never control it. Even now, going on 11 years of sobriety, I don’t control it. Abstinence is the only thing that will work for me. So, as long as I don’t take the first one (drink), I don’t have to worry about the last one.”

The leap from dependency to sobriety is a great one because it involves changing an entire mind-set. As John explains, an addict is obsessed with the acquisition and consumption of his/her drug of choice. “Your life revolves around the alcohol or drugs. You wake up in the morning planning on using. I would wake up at a quarter to six. By the time I got up, got dressed and walked to the liquor store on 30th and Laurel, it was 6 o’clock. I would get a half-pint of vodka. That was my breakfast. I would drink it on the way home, come into the house, smoke two cigarettes and start getting the kids up for school. Then I would go back and get a larger bottle and get serious about it.”

As the disease evolves John said an alcoholic alienates and isolates himself more and more from the mainstream of life until he or she is totally, utterly alone. “You start out drinking socially but you eventually hit a point where it’s just you and the bottle. You weed out people one at a time because you don’t even want your fellow drinkers to know how much you’re drinking. I had a drinking buddy for, oh, like 19 years. He had an old, battered pickup truck and we would drive to a park and sit there and drink. He and I would take turns trying to get sober. He did get sober a year before I did and that was the longest year I ever spent in my life because now it was just me and the bottle.”

Just as in the classic 1941 drama about alcoholism, The Lost Weekend, John said the shame of addiction led him to try and conceal his drinking from disapproving spouses and the disorientation of drunkenness put him on constant edge.

“You think you’re hiding it, but you’re not hiding anything. Everybody knows you have a problem except you.” In his case, he usually confined his drinking to public settings, although he sometimes snuck a bottle home. “I would very seldom bring a bottle in the house. I would just go up to the store and get some and drink it on the way back. I could kill a pint of straight booze in a few blocks. When I finished it I’d just throw it in the alley. Once in a while I would bring a pint home and hide it somewhere. I would go to bed, wake up an hour later and take a couple nips, then go back to bed and wake up another hour later to take a couple more. Well, you do this three or four times and you get paranoid, and you move it. Now, the next time you get up you can’t find it. You don’t know whether you can’t remember where you put it or whether your wife found it and threw it away. And you sure enough can’t ask her, ‘Did you find the bottle I hid in here last night?’”

By 1990 John was a wreck. He was separated from his fourth wife and raising their two oldest children alone. He functioned, but moved through life like a ghost. Life was a blur. Everything was muted and dulled in a kind of permanent haze or fog. He was about to get a rude awakening.

On a September night he walked from his house to fetch — what else? — a half-pint of vodka on his way to a meeting at the Viking Ship community center in nearby Miller Park.

“I was cutting through the park and I saw three guys sitting on the side of a hill and one of them stood up as I approached and asked me if I had a cigarette. I reached down to grab one and as I looked up I got hit in the face and that’s the last thing I remember for a month,” he said.

 

Immanuel Medical Center

 

 

The beating he absorbed at the hands of the strangers, who were never apprehended, left him with five fractured ribs, a jaw busted in three places, broken bones above and below his left eye (whose sight is permanently damaged), a broken nose and countless cuts and abrasions. Amazingly, he managed walking home, where his kids answered the door to find a grotesque figure sagging on the porch. They did not even recognize their own father for all the blood, bruising and swelling. He was rushed to St. Joseph Hospital, where he drifted in and out of consciousness and needed weeks for his concussion and other injuries to heal.

What happened to John that night had nothing at all to do with his alcoholism, yet he attributes the event and others following it with finally getting him to make the pledge to stop drinking stick.

“I have very mixed emotions about it,” he said of the beating. “It was a negative event but it had a positive result.”

Before he could make the commitment to stop drinking, he still had one last bender to go on.

“My jaw was wired shut and when I got it unwired I went out and got drunk that night, and I drank for a couple months. My last drunk was like a two-week drunk and it was a real bad one. Eight consecutive days are a total black out. Then, I finally got sick enough that I quit. In the meantime, my wife filed papers with the Douglas County Attorney that I was a danger to myself and others, and I more than likely was. Sheriff’s deputies came to my house and hauled me off in handcuffs to the psyche unit at Immanuel Hospital (Medical Center).

 

 

“Sitting there at three-four in the morning the light bulb finally went off in my head and I thought, ‘Hey, whoever is keeping you alive isn’t doing it so you can go get drunk again.’ And at that time I finally made peace with God. Ever since I lost my son to cancer, God and I didn’t get along. We agreed to disagree for about 30 years. But after I made peace with Him it got easier. And from that point on I’ve never really had the urge to go drink.”

After his release from Immanuel John checked himself into then St. Gabriel’s detox unit. Before entering detox, however, he had a whole weekend on his hands at home, which posed yet another test to his resolve. “I had free reign to do what I wanted and yet I found myself not even wanting to drink. Even in my fuddled-up condition I thought, ‘There’s hope now.’ That was the start of it.”

Upon completing treatment at St. Gabe’s, he joined Alcoholics Anonymous, whose program he continues in today and that he intends participating in the remainder of his life. These days John is a content man who finds love and support among both his AA family and his own family. His son Shawn is living with him and sharing in his new life. He said, “Shawn got a lot of the benefits of my being sober. I’ve taken him places and done things with him that I never did with the older kids, who were out of the house by time I got sober. There was some resentment by my older kids, but we’ve been able to talk about it and work our way through it.” John’s dream is to one day retire to Mesa, AZ, where his beloved Cubs have spring training. Until then, he remains ever vigilant.

“Recovery is a continuing process. The first time I think I’m recovered, I’m drunk. I was an alcoholic yesterday. I’m one today. I’ll be one tomorrow. They’ll always make the stuff. They’ll always sell it. I’ll always be addicted to it. That doesn’t mean I have to give into it, though,” he said.

He realizes that without the support of his AA sponsor and circle of friends, he would be lost again. His philosophy about sobriety reflects the AA creed.

“It starts with attitude. And for the first time in my life I am comfortable in a sober world. I am not comfortable with my sobriety in that I take it for granted. I do what I have to do to maintain it.”

That means attending daily AA meetings. For John and others like him, sobriety is a one day at a time thing,

“All it is a daily reprieve,” he said.

Related Articles

• AA marks 75 years of helping alcoholics ‘rise from the depths of hell’ (seattletimes.nwsource.com)
• Getting Sober: Hope In the Rooms and Online (beliefnet.com)
• Alcoholism: The Basics (addictionts.com)
• A Dry Drunk is a just as mean as a wet one (spreadinformation.wordpress.com)
• Alcoholism and alcohol abuse (addictiontreatmentnow.wordpress.com)
• Is addiction a brain disorder? (theage.com.au)

I’ll Be Seeing You, An Alzheimer’s Story

Alzheimer’s scares me.  I suspect it does many people.  I cannot hardly think of anything more devastating or tragic than having your mind slip away or watching helplessly as a loved one’s mind fades into confusion, and ultimately oblivion. All of which is to say I was a bit queasy when I got the assignment to profile a woman with Alzheimer’s, or more accurately to profile a family and their odyssey with the afflicted loved one in their care.  But I was struck by the love this family has for each other and for their beloved Lorraine, who was variously a wife, mother, grandmother to them. The way they rallied behind her is a testament to the family.  Of course, not all families are as close or loving, and not all Alzheimer’s victims are fortunate to have such attentive support.  If you’re in the mood for a sentimental story that is based in fact, than this might be your cup of tea.  The piece originally appeared in the New Horizons.

 

 

I’ll Be Seeing You, An Alzheimer’s Story

©by Leo Adam Biga

Originally published in the New Horizons

I’ll be seeing you in all the old familiar places, and in all the old familar faces…

Blessed with the voice of an angel, the former Lorraine Clines of Omaha enchanted 1930s-1940s audiences with her lilting renditions of romantic ballads as the pert, pretty front singer for local bands. Billed as Laurie Clines, she was also featured on WOW radio’s “Supreme Serenade,” whose host, Lyle DeMoss, made her one of his “discoveries.”

From an early age, she used her fine singing voice to help her poor Irish Catholic family get by during the Great Depression — winning cash prizes in talent contests as a child and, after turning professional in her teens, earning steady paychecks singing with, among others, the Bobby Vann and Chuck Hall orchestras at area clubs and ballrooms. After the war, she gave up her performing career to marry Joe Miklas, an Army veteran, semi-pro baseball player and Falstaff Brewery laborer. The couple raised seven children and boast 17 grandchildren.

The memories and meanings bound up in such a rich past took on added poignancy at a recent Miklas family gathering during which Lorraine, a victim of Alzheimer’s Disease since 1990, sang, in a frail but charming voice, some standards she helped popularize in the big band era. Her family used the occasion to preserve her voice on tape, thus ensuring they will have a record of her singing in her senior years to complement the sound of her voice on platters she cut years before. While even advanced Alzheimer’s patients retain the ability to hum or sing, Lorraine has clung to music with an unusual ardor that reflects her deep feeling for it and the significant role this joyous activity has played in her and her family’s life.

“There was always music in the house — singing, records, dancing,” daughter Kathy Miklas said. “When we were little we each learned two songs Mom recorded, “Playmate” and “Little Sir Echo,” and we all learned how to dance to “Ball and the Jack.” At their mother’s insistence, the Miklas kids took piano lessons and at their father’s urging, they played ball. “We really were lucky Dad loved sports and Mom loved music. It was a great combination. They made sure we did both. It was a nice foundation to have,” daughter Theresa Ryan said, adding the family participated in neighborhood talent shows and competed in softball leagues as the Miklas team.

 

 

 

 

Even though she went from headliner to homemaker, Lorraine never stopped making music. She harmonized doing chores at home. She sang lullabies to her kids. She broke into tunes on holidays and birthdays. Away from home, she taught music at St. Adalberts Elementary School, vocalized in the church choir, led singalongs on family road trips and performed for her children’s weddings. Ryan said she and her siblings knew that whenever Mama made music, she was in a merry mood.

“You would get a yes if you asked her a favor while she was singing. You knew that was a good time.” Even now, despite the ravages of Alzheimer’s, music continues to hold a special place in Lorraine’s mind and heart. In a reflective moment one September Sunday afternoon Lorraine commented, ‘We gotta get all the music we can.” And then, as if remembering how music enriched life for her and her family despite scant material comforts, she said, “We haven’t had a lot of other things, but we sure have had a lot of music.” Accompanied on piano by Carolyn Wright, Lorraine found most of the words, with some prodding from husband Joe, to ballads like “I’ll Walk Alone” and “Girl of My Dreams.” When she got around to singing the bittersweet “I’ll Be Seeing You,” which is about being true to an absent loved one, Joe broke down in tears — the lyrics hitting too close to home.

“Not having her around” is the worst agony for Joe, who loses a little more of his wife each year. “It’s hard to live alone,” said Joe, breaking down with emotion. As he has seen Lorraine slip further and further away into the fog that is Alzheimer’s, he has had to content himself with memories of “the good old days.” He said, simply, “We had some good times.” A son, Joe Miklas, Jr., said the cruel reality of the degenerative disease is that it feels like losing a loved one, only the afflicted is not dead but stranded in a dementia that makes them increasingly unreachable. unknowable, unrecognizable. They are present, yet removed, their essence obscured in a vague shadowland of the mind. “Physically, she’s there, but she’s not Mom anymore. We’ve lost our mother and yet she’s still here.” Kathy Miklas describes the experience as akin to “a slow grieving process.”

Bill Miklas, the youngest among his siblings, is convinced his mother is, on some level, aware of the prison her impaired brain has confined her to, although she is unable to articulate her predicament. Evidence of that came only last year when, Kathy Miklas said, her mother confided to her, “‘I think something’s wrong with me, but I don’t know what it is. It makes me feel bad that people are having to do things for me that I used to have to do for them.’”

The sad thing, Bill said, is “this disease has forced her to be isolated, not only from those around her, but from herself. She has to live within her world. She has to travel this journey, for however long, by herself. It must be very frustrating to her to realize when she talks she’s not making sense. She can see the reactions on our faces, but her pride won’t allow her to show she’s debilitated. It’s hard for her to look me in the face and say, ‘I don’t remember your name.’ Yet even as debilitating as this disease can be…she still likes to sit and talk, and she’s still a happy person.”

As Alzheimer’s evolves, its victim presents changing deficiencies, behaviors and needs. Mirroring the patient’s own journey are the changing emotions and demands felt by family members. Just as no two sufferers are alike, the experience for each family is individual. Every step of the way, the Miklas clan has made Lorraine’s plight a family affair. “Everybody just kind of took their part in it and did what had to be done,” said Ryan. “I don’t know what I would have done without them,” Joe said of his family’s pitching-in. Not everyone always sees eye-to-eye on how to handle things, but the Miklas’s remain united in their commitment to do right by Mom. And, no matter what, they’ve stuck together, through thick and thin, in illness and in health. “We’ve kind of become our own support group,” Joe, Jr. said. “We don’t always agree, but we always communicate, which is the key.”

Married 54 years, Joe and Lorraine hail from a generation for whom the vow “for better and for worse” has real import. That’s why when she was stricken with Alzheimer’s he put his life on hold to become her primary care giver at the couple’s home, where she continued living up until about a year ago. Lorraine’s first symptoms were shrugged off as routine forgetfulness, but as her memory deficits and confused states grew more frequent and pronounced, her family could no longer ignore what was going on. It all began with Lorraine making repeat phone calls to family members without knowing who she was dialing and not remembering she made the exact same call just minutes before.

Ryan said, “At first, we laughed it off among ourselves. It was like, ‘Oh, did Mom call again to ask who’s making the turkey for Thanksgiving? I told her 10 times.’ And then, we got a little upset with her. We’d say, ‘Mom, would you pay attention. You’re just not listening.’ There were other signs. Normally a precise, productive person who kept on top of her large family’s many goings-on, she could no longer keep track of things. She let the house and herself go. She grew disorganized. And she seemed to just shut down. “I think one of the things we first started noticing is that she just wasn’t doing as many things as she was doing before,” Kathy said. “One of the striking differences was she’d always been very organized and efficient” but not anymore.

Concerned, Kathy convinced her mother to be evaluated by the University of Nebraska Medical Center geriatric team. “When the doctors said she didn’t have any physical reason for this — that it’s probably Alzheimer’s — I was totally shocked,” she said. The entire family was. Lorraine went on living at home with Joe. “I think our family…was in denial,” Bill said. “We didn’t want to mention Alzheimer’s in front of Mom. I think a lot of us thought there was a mixed diagnosis. That, you know, it’s not really Alzheimer’s — Mom just forgets things. It’s not that big a deal.” From denial, the family gradually accepted Lorraine’s fate, the diminished capacity that accompanies it and the demands her care requires.

To get to that point, however, the Miklas children first had to come to terms with how their mother’s condition was affecting their father. “We were all kind of going on with our lives,” Ryan said, “but I don’t think we were focused too much on the disease because Dad was there to do the day to day caring.” As the disease progressed and Lorraine grew more unmanageable, the job of caring for her 24/7 consumed Joe’s life. He halted his active recreational life to attend to her needs. “Dad started to give up a lot of the things he likes to do,” Ryan said. It got so that it was dangerous leaving her alone, even for brief periods, and no longer possible for anyone untrained like Joe, now 79, to always be on call. Overwhelmed by it all, he could no longer hack it alone, and that’s when the family began the long, winding odyssey to find the right care giving situation.

 

 

 

 

Kathy, a private practice speech-language pathologist, steeped herself in Alzheimer’s — from possible causes to drug therapies to support services to care providers. “I felt like I could deal with it better if I understood it. So, I started talking to the Alzheimer’s Association and reading lots of stuff. As a family, we shared information about what Alzheimer’s is and what goes on with it. I didn’t want to miss an opportunity to do something or to have something because we didn’t know about it.”

Family members also attended conferences to glean more understanding — from health professionals and family care givers alike — about what to expect from Alzheimer’s and what adjustments the family could make to ease things for themselves and for Lorraine. For further insight about her condition and how to manage it, they consulted one of the world’s preeminent Alzheimer’s experts, Dr. Patricio Reyes, director of the Center for Aging, Alzheimer’s Disease and Neurodegenerative Disorders at Creighton University Medical Center. “We just lived and made adaptations and accommodations as needed,” Kathy said. “We knew not to ask Mom to do certain things because she wouldn’t remember them and we reminded her to do things she maybe still remembered how to do.”

The family explored several care giving options: first, enrolling her in a respite day care program; next, arranging for a home health nurse to come each morning to assist with her personal needs; and, then, when respite/home care was no longer sufficient to accommodate her unfolding illness, they sought more intensive aid.

“In November, we decided it was not a good idea for Dad to have to constantly be on duty all the time,” Kathy said. “We could see his health deteriorating from the stress…so we started looking at nursing homes.” Lorraine was placed in one, but the family found its medically-based approach and strictly-regulated environment stifling for their mobile, verbal, social mother, who felt uneasy in such a restrictive setting.

According to Kathy, the site “just wasn’t set-up to handle somebody like Mom. They had everybody get up at seven, eat breakfast at eight and go to bed by seven-thirty. Well, having been a singer — Mom never gets up at seven and she’s used to going to bed at about one o’clock in the morning. Plus, they had her heavily medicated. One night, they called and said, ‘Your mom is having a behavior episode we can’t manage.’ Well, I got there and she was having ice cream with a nurse. She was fine. Mom was very frustrated because in her mind this was her house and at night she got terrified. She would ask, ‘Why are all these people in my house?’ After a month of that place, we decided it wasn’t working out.”

Searching for the best care facility for a love one means weighing many complex issues and making many difficult decisions, not the least of which are financial. Although the nursing home was unsatisfactory, it did have the advantage of being Medicaid certified. As the Miklas’s looked around for an alternative, they discovered most quality care centers do not accept Medicaid patients, are cost prohibitive on a private pay basis and, even if the family could afford to pay privately, they would face a two or three-year waiting list.

“We were struggling with what we were going to do,” Kathy said. That’s when they found new hope and the right fit in Betty’s House, a residential assisted care facility, where Lorraine resides today. Where, at the large, institutional nursing home, Lorraine was anxious and irritable, the family has seen “a dramatic difference” in her mood at Betty’s House, Kathy said, adding: “It’s been a godsend. It’s small and home-like, not like a nursing home. The lady who runs it, Mary Jo Wilson, cared for her own Alzheimer’s-sticken mother for 10 years. She knows how to do Alzheimer’s. She knows what you say, when you argue, when you don’t argue, what’s important, what’s not important and she teaches her staff…that you give residents praise and tell them how happy you are they’re there, and I really think that positive feedback is part of the reason Mom’s been so calm and so happy the past few months. She’s doing well.”

And, relieved from the pressure of daily care giving, Joe Miklas began doing better, too. “Now, he can relax,” Kathy said.

 

 

 

 

Joe is just relieved Lorraine is situated where she seems at peace. “She’s safe. She seems to be happy,” he said. “They’re very good out there. The owner does a hands-on job. She’s always around, supervising things. She’s got some good help. It makes a lot of difference. I try to make it out there every other day if I can. Lorraine talks about coming home, and I’m not sure whether she has this (he gestured to mean their home) in mind or what. I thought she considered that (Betty’s House) her home. It’s hard to know.”

He does know she’s content whenever she breaks into song, as she did upon overhearing a conversation he had with another visitor to Betty’s House. “We got to talking about music when Lorraine suddenly sang ‘When Irish Eyes Are Smiling’ and she just took it up right from there.” Anything Irish elicits a response from her, said Kathy. “She’s always been passionate about her heritage. St. Patrick’s Day was a big day at our house. She’d sing Irish songs. Even now, when you mention something about being Irish, she’ll go into her version of an Irish brogue” and maybe start up a song.

Music remains a vital conduit to the past. “Still, in spite of all the things she can’t do, if you put a microphone in front of her, she turns into Laurie Clines, the singer,” Kathy said. “Her body moves as a singer. Her voice changes and her intonation, her breath and her rhythm become that of the singer again.” This transformation was evident the night son Tim Miklas appeared with his band, the Pharomoans, at Harvey’s Casino. “I went down into the crowd where Mom was and we sang “When Irish Eyes Are Smiling” together. That was pretty special,” Tim said.

Family and faith have defined Lorraine’s and Joe’s lives. Growing up within blocks of each other in south Omaha, each lost their father at a young age and each began working early on to support their family during tough times. They attended the same school and church, St. Adalberts, but didn’t start dating until after the war.

“I thought she was the prettiest girl in school,” Joe said, “but I didn’t think I had a chance to get a date with her, so I just kind of put it out of my mind.” After marrying and starting their own family, the pair made sure all their kids attended parochial school, scraping together the tuition from his modest Falstaff salary, and even saved enough for family vacations. “Family was very big to her and she passed that on,” Theresa Ryan said. “I think they both wanted that family environment and worked very hard to achieve it.” Bill Miklas added, “One of their man ambitions was to raise a great family, and I think they did a wonderful job.”

Through the process of Lorraine’s sickness, the Miklas’s, always close to begin with, have drawn ever closer. If there’s anything they’ve learned about dealing with a loved who has Alzheimer’s it is, Tim Miklas said, “to try to maintain the courage to go on and make sure that person is still a member of your family. Maintain your relationship with that person as much as possible. At some level, some of the things get through to them.” Whatever the family occasion, Joe knows his wife still “wants to be part of it, that’s for sure.”

Kathy Miklas advises others to “really value the time and the experiences you have with your loved one because you don’t know what it’s going to be like three months or six months from now. Like many people with Alzheimer’s, physically Mom’s going to last a lot longer than she is mentally.” Another piece of advice she has is: “Give people choices. Give people dignity and the ability to have some control over their lives. For example, giving my mother the choice of when gets dressed eliminated a lot of arguments.”

In the end, this Alzheimer’s story is about the enduring love of a man and a woman and of a resilient family. “Theirs was a very subtle love,” Bill Miklas said of his parents. “It was something you always felt. The same with the faith they lived. It was a constant. There was never a question — never a doubt. It was a very stable reality. I think Mom taught us a lot about faith and about commitment — to ourselves and to our family. She taught us not to focus on what you don’t have but to enjoy what you do have and to find the value in that. Somehow, if I can take that to my family than that will be Mom’s greatest legacy.”

I’ll see you in the morning sun and when the sky is grey.  I’ll be looking at the moon, but I’ll be seeing you…

Related Articles

• ‘Memory Show’ a sweet, painful portrait of Alzheimer’s toll (boston.com)
• Caring for a Loved One With Alzheimer’s: New Insight on Memory Care (health.usnews.com)
• Test may catch Alzheimer’s in earliest stage (abclocal.go.com)
• Maria Shriver Raises Awareness of Alzheimer’s Disease (psychologytoday.com)
• Progress made on blood test screening for Alzheimer’s (ctv.ca)
• Half of All Alzheimer Cases Might Be Preventable (newser.com)

ER, An Emergency Room Journal

The camera rolls as emergency room trauma team goes into action.

To be honest, I was hoping for something dramatic to happen in the ER that agreed to accommodate for a few nights my hanging around, asking medical staff and paramedics and patients questions and taking voluminous notes. Nothing much did.  That is to say, a stream of patients came through presenting all manner of problems, but nothing over the top sensational occurred.  I think I still managed a good story out of the assignment. You be the judge.  The article appeared in The Reader (www.thereader.com) as a kind of companion piece to another story I did based on ride alongs with paramedics.  You can find the paramedics story on this blog as well. It’s titled “Merciful Armies of the Night.”

ER, An Emergency Room Journal

©by Leo Adam Biga

Originally published in The Reader (www.thereader.com)

 

Hours of Boredom and Minutes of Terror

Hollywood portrayals of hospital emergency rooms depict white hot action zones where medical drama and staff intrigue continue nonstop. What’s a real ER like? Recent visits to the NHS University Hospital ER found a medical treatment center, social laboratory, educational classroom and last refuge all in one. An intersection where the gallery of humanity meets and various trends surface. A mission, a haven, a hell. Or, as one ER nurse put it, “We deal with the heart of Omaha here.”

Like many staff, nurse Susie Needham feels the ER is THE place to be on the frontlines of medical care due to its fluid nature, one she summed up as “hours of boredom and minutes of terror.” Unlike television’s ER, long tedious stretches can grind by before a single trauma arrives. Then again, a run of critical or extreme cases can suddenly pile-up, kicking a slow shift into high gear. As Needham put it, “From moment to moment, it can change.

Most people that work here are attracted to the fast changing pace and the variety of different patients we see. It’s never the same. You have to know a lot about a lot of different things, and that’s what keeps you on your toes. It makes it interesting.” On a Friday night in April Needham, a pretty freckled blonde with an impish smile, tended a diverse mix, including a bronchial pediatric patient with difficulty breathing, an adult drug abuser suffering withdrawal pangs and a drunk woman ostensibly there for stomach pain but whose battered body and frayed psyche told a more sinister story.

For the most part, ERs treat a procession of fevers, coughs, sprains, aches, cuts, bruises, breaks. Purely routine stuff. Unless it’s happening to you, of course. Since one person’s trivial complaint may be another’s dire crisis, everyone is treated the same. No condition is refused. Nothing is taken for granted. Trained to assess and treat serious problems, medical staff try first ruling out any life-threatening cause before looking at non-critical or non-medical issuses. Most ER medical staff possess extensive critical care backgrounds, but it seems all ERs (the step-child of acute medical care) are not equal.

“Unfortunately, emergency medicine is still the only speciality where you just need a license to practice, so it’s kind of a buyer-beware situation,” said NHS Chief of Emergency Medicine Dr. Robert Muelleman. “At University, we require physicians be board certified in emergency medicine (spending a minimum three years residency in emergency medicine and passing written and oral exams). It helps ensure a certain standard of care or level of competency. Nationwide, probably only between 50 and 60 percent of practicing emergency physicians are board certified, but I think there are more, better trained board certified physicians today than there were 10 or 15 years ago.”

 

Dr. Robert Muelleman

 

 

 

On busy nights (Sundays are worst) patients stack up and long waits ensue. Triage nurses sort cases on an as-needed basis, with the severest seen promptly and the mildest set aside for a kind of walk-up window service, Fast Track. But again, unlike TV, where patients sweep through the ER unchecked, the real world entails staff documentation-communication for all patient admissions, treatments, releases. In terms of volume, University Hospital recorded 27,018 ER visits last year, a slight rise from 1998. Traumas typically account for about 3.25 percent of all cases.

Not long past dusk on St. Patrick’s Day things were unwinding surprisingly slowly in the ER considering this was a designated trauma night (meaning area rescue services were to feed trauma patients there) on a Friday holiday known for alcohol-related injuries. Earlier in the day, staff treated a 43-year-old Omaha man knocked unconscious in a bar fight. Michael Kimball was brought in comatose. Massive swelling in his brain forced doctors to remove his skull to relieve the pressure. (Editor’s Note: Kimball never regained consciousness and, two weeks later, was pronounced dead. Police cited insufficient evidence to file charges in the case.).

Hours later, during a protracted lull, staff lingered about “the hub,” the ER nerve center,  bantering in the irreverent MASH humor used for stress relief. Attending physician Dr. Paul Tran made a colleague, Dr. Rick Walker, envious by describing his sound sleep the night before, a rarity after the rush of a nine-hour trauma shift. When not hanging at the hub or crashing in the staff lounge, docs, nurses, techs and residents use computers and charts to monitor the condition of patients in surrounding non-critical care rooms and trauma bays (a total of 16 beds), to track the progress of lab workups, x-rays or other procedures and to file paperwork. A large grease board hanging high on the wall is smudged with running patient status reports. This checks and balances system aims to avoid patient-bed-meds. mixups

The staff perked up that night at the static-filled emergency band radio (always droning on in the background) report of a CODE 3 (critical medical) case en route, with an ETA of five minutes. Staff are uncanny at hearing the calls headed their way and ignoring the others. The paramedic’s sketchy details described an elderly man who fell and hit his head outside a Bag ‘N’ Save. The man, whom paramedics found minus vital signs, had been shocked back to life. With the clock ticking, Dr. Tran, a slight Vietnamese native with a gentle bedside manner, conferred with colleagues on whether to summon the trauma team, a kind of in-house medical SWAT squad on call to treat the most severe critical care cases, or to handle things themselves.

 

 

 

 

It Never Gets Better
Dr. Walker, a beefy man whose pockets are invariably overstuffed with paperback novels and stethoscopes, has spent his entire medical career in emergency medicine. He said part of the appeal for him and others is the extreme nature of the work. “I think it’s very challenging, and that’s a large aspect of it. It’s also a big adrenalin rush, and as I’ve assessed my life and career I’ve come to the conclusion I’m an adrenalin junkie, and I think that’s probably what did it for me.”

He said being exposed to the tragedy that accompanies trauma extracts a certain toll:

“You see bad stuff happening here, and it’s stuff that, you know, can make you cry, like kids dying. It’s tough and it can really get to you emotionally, and so what you have to do is build up a wall because otherwise you’d be breaking down every time you saw something like that and you could not function. That wall tends to stay up most of the time and the last few years it’s become an issue in my personal life.” Nurse Jackie Engdahl said it takes a special breed to work there, “Oh, definitely, Type A personalities make good ER nurses. You have to be very aggressive…very assertive because of what you deal with. You deal with not only ill and injured people, but intoxicated people and drug-induced and psychotic people. You gotta love a good challenge and you gotta be strong enough to whip into shape when the going gets tough.”

For trauma nurse coordinator Kathy Warren, it’s a matter of staying focused no matter how horrendous the reality before her. “Some of these cases are just horrible looking when they come in. You just have to totally ignore that and focus in on the task, so whether you’re starting the IV or helping the docs with procedures, you detach yourself and just click into gear. You can’t get nervous. You have a job to do,” she said. Warren, whose job entails her dealing with family members, said staying composed is hard when working with parents who’ve just lost a child. “Sometimes I have to step back for a few minutes and take a deep breath. When I get home after a case like that, everybody knows its been a bad day as soon as I walk in.”

Added Susie Needham, “People think you get callous or something, but you don’t. Some of the things we see are heart-wrenching and no matter how many times you’ve seen them it still really bothers you. It never gets better.”

Things finally began heating up again on St. Patty’s Day once the Code 3 patient was wheeled in on a gurney by paramedics and lifted onto a bed in the T2 trauma bay. The heavy-set man of about 65 lay there in a coma, a breathing tube inserted in his throat and an IV snaked into one arm, his big hairy belly billowing up and down as a bevy of ER medical staff hovered over him to keep him alive. “I need, STAT, six units of platelets…” a nurse called out. “Tell respiratory to bring a vent, please,” called another.

Then, when someone barked, “I need another set of hands up here,” a tangle of arms belonging to eight nurses, techs and docs converged to perform, seemingly at once, multiple tasks, from hooking up a ventilator to running a blood pressure line to starting a new IV to drawing blood to attaching EKG electrodes. “Sir, there’s going to be a tube going down the back of your throat,” one of them said more out of habit than out of any expectation of a response. Lying there, totally exposed and vulnerable, his life completely in the hands of these angels of mercy, the man, referred to then only as John Doe due to a lack of ID, was an anonymous soul brought back from the very brink.

Time is of the Essence
Time is critical in trauma or near trauma scenarios like these. That night’s charge nurse, Scott Miller, said it involves quick, precise coordination and communication. “Everybody swarms in to get the job done as fast as possible. In a case like this you have Dr. Tran coordinating and everybody trying to feed information to him as to what they’re finding at the same time as they carry out his orders.”

When the whole trauma team is activated, a whole slew of specialists — from surgeons to anesthesiologists to radiologists to lab techs — converge on the spot, making teamwork even more essential. According to Kathy Warren, “You have a lot of people and everyone has a different role and, hopefully, they know their role so they’re not getting in your way and you’re not having to tell them everything. It usually works pretty well, and it’s amazing the amount of things that can be done for a patient in a short amount of time when you absolutely have to. But that’s what a trauma center is supposed to be able to do.”

 

 

 

 

Emergency care often starts with the rapid response of rescue squads on the scene. Paramedic Tom Quinlan was among those responding to the 911 call that found Doe lying unconscious. “He was not breathing. He didn’t have a pulse. So we started our CODE 99 (for clinically dead cases) protocol, which is intubate him, start an IV and do CPR. We ended up shocking him a couple of times. We finally got a pulse back and he continued to breathe for us on the way to the hospital,” he said.

Added Dr. Tran, “Time is of the essence here. After so many minutes, it doesn’t do any good, so it’s all speed and skill. The man probably experienced sudden death when his heart went into fibrillation, meaning it didn’t pump any blood and, so, the brain promptly became unconscious and he fell down and hit his head and only by actions of the paramedics did he come back. He was extremely lucky to have had everything done in that time, otherwise he would be dead by now.”

Dr. Tran said the fall resulted in “about a five-centimeter hematoma on the back of the head.” Since Doe was found unresponsive and bore a scar on his chest indicating a history of heart surgery, the question on Dr. Tran’s mind was whether the patient’s vegetative state was due to the fall or to some new cardiac event. Not wanting to overlook a potential cerebral cause, he called in part of the trauma team after all. As Scott Miller, explained, “We’re assuming now he had some sort of heart event that caused him to fall and hit his head. We will be doing a CAT Scan to make sure there’s not something else going on, like a big bleed in his head. We don’t think that’s the case, but you can’t always tell for sure.”  Later, it was confirmed a cardiac event did trigger the trauma.

As for the long-term prognosis, Dr. Tran said, “I’m not sure of the condition of his brain function later on.” By then, Doe was identified and his family contacted by nursing resource coordinator Regina Christensen, who met with family members. Part of hers dutie entails fielding inquiries from news hounds looking for material. She noted with incredulity some sound disappointed when a case is upgraded from critical to stable condition.

When treating a trauma, there is no room for bruised feelings. The required care  must be delivered NOW. Hashing out differences can come later. One of the reasons nurse Jackie Engdahl likes working in the ER is the maturity of the people working there. “When I worked in other hospital areas there were very clashing personalities and people always bickering back and forth. But here, it’s not that way. You say whatever you want to say to someone and then it’s over and done with. There’s never hard feelings.” And, she said, where some physicians resent or reject nurse input this ER’s docs welcome it. “The doctors here work really well with the nurses. The doctors trust our judgment and they really listen to us. They allow us to do a lot of things, which is nice.” What about departmental romances? “There used to be between the nurses and paramedics,” nurse Janie Vipond said. “It just depends on the group you have at any given time. But, yeah, it happens.”

I Felt I Was in Good Hands
Amid the controlled chaos of an unfolding ER trauma, staff attend to myriad details, not to mention other patients. For the trauma patient whose life hangs in the balance, it can be a surreal experience of wailing sirens, flashing lights, antiseptic smells, probing instruments, strange faces and endless questions. There is fear, confusion, agony. There is even a strange sense of peace. Beverly Harter, a 62 year-old wife, mother and grandmother, has been there. How she got there is a story in itself.

On May 16, 1999 the Logan, Iowa resident was attending a graduation party at the nearby trailer home of a daughter. Various family members and friends were present. The weather was threatening that afternoon. When the sky turned ominous and a tornado warning sounded, the 12 partiers fled the trailer for their cars in an effort to outrun the storm. But it was too late. With a twister bearing down, they left their vehicles to take refuge in a roadside ditch. Huddled on the ground, exposed to the savage winds, the group was deluged by parts of farm machinery ripped asunder in the cyclone and propelled like shrapnel. The metal shards rained down on them, tearing skin, cracking bone, crushing organs.

When it was over, Beverly’s daughter was dead and two grandkids, both injured, left motherless. Her son endured a broken clavicle. A family friend died. As for Beverly, she suffered a punctured diaphragm, a perforated bowel and two crushed vertebra. Her house was leveled. Ironically, the trailer escaped unscathed. Transported by a local rescue unit to Missouri Valley, Beverly was then taken by ambulance to the nearest trauma center, the University Hospital ER.

Beverly, who remained conscious during much of her ordeal, did not have to be told she was badly hurt. “I knew I’d suffered spinal cord damage because my legs were on fire, and they stayed on fire.” she said. She also knew her daughter “was gone” and other loved ones injured. As for her Omaha ER odyssey, she recalls “bright lights,” a sense of “time standing still” and “a lot of people doing a lot of things and asking a lot of questions. I was really hurting and kind of fading in and out from the sedation, but I was able to answer a lot of questions. They explained to me what they were doing at all times, and that was reassuring.”

Indeed, despite her pain and grief, she recalls feeling calm. “You just have a sense that everybody’s taking care of you and that they’re all working together doing their jobs. I felt I was in good hands.” She also felt the staff’s compassion. “They were extremely sensitive and caring and protective about what happened to me and my family. They knew the devastation and loss we had. I was just overcome by their concern for our well-being,” said Harter, who today is confined to a wheelchair.

Kathy Warren said she used to doubt whether the time she spent with families who suffered a loss made a difference until her own father died in the hospital and she found comfort in the support her colleagues gave her. “I realized how important it is to have somebody treat you with kindness and to let you grieve however you want to and to explain things to you. Ever since then I’ve really pushed staff here to sit down with families and to talk to them. It’s not an easy thing to do as a medical person. Some people are better than others. But people don’t expect us to be super men and women. To save everybody. They just need us to be there.”

Not all exchanges are so pleasant. Patient complaints over long waits get expressed along the sarcastic lines of, “I’m sure glad I wasn’t dying.” Before things get nasty, staff try defusing the matter. “The basic strategy is to make them see you as being on their side,” said Dr. Bob Muelleman. “On the other hand, you want to be very much in control of the situation. If it’s just a matter of them yelling and cussing at you, well, that pretty much comes with the territory. Once in a while there’s kind of a thrashing or flailing out. If you think there’s the potential of them really getting violent you can call in security or police, but normally you can handle it on your own.”

When care complaints cannot be appeased, they are passed-on, in writing, or addressed on-site by managers like Regina Christensen. “It can be anything from somebody upset that their mother’s IV is out to something as complicated as a gang-related situation where the patient himself or his family is threatening staff. It’s just an array of things,” she said.

The Truth is Stranger Than Fiction
Meanwhile, back on St. Patrick’s, a drunk middle-aged woman involved in a domestic dispute came in with an aching gut. However, the night’s triage nurse, Susie Needham, recognized bruises and marks as signs of physical violence and sexual assault. After questioning the woman, a horrific tale of prolonged torture and bondage emerged that prompted ER staff to follow procedure and report their suspicions to police. Acting on the medical staff’s input two officers, who earlier arrested the woman’s boyfriend on misdemeanor assault charges, returned to open a rape investigation.

According to Needham, “If people come in here with traumatic injuries that don’t really fit their stories, we call the police.” Often, she said, such patients prove to be victims or perpetrators of a crime. Surrounded by staff and police in a room concealed by drawn curtains, the woman cried out, “I can’t take it anymore. I don’t want to take it anymore.”

After examining the woman a visibly shaken Dr. Tran said, “It’s one of the most remarkable cases of domestic violence I’ve ever seen. She has multiple problems. Number one is domestic violence and sexual assault. Number two is chronic alcoholism. Number three is a low platelet count. Number four is what appears to be an upper GI bleed.” As part of hospital policy in such cases, staff called in a domestic violence-sexual assault counselor to apprise the woman of her rights and refer her to appropriate community resources. But, as ER staffers say they’ve seen far too many other victims do, the woman rejected police-medical entreaties to undergo a forensic exam, something required for a criminal inquiry, and declined pressing rape charges. She was admitted and treated for medical problems.

“What do you do?” a frustrated Needham asked. “That’s tough,” Dr. Tran said, “because once enough time passes, the evidence is lost. We can’t do anything. You have to respect the patient’s wishes. Patient autonomy is everything. Why did she refuse? Oh, fear, love rejection, sensitivity. Who knows? Unfortunately, it’s common.”

Bizarre, believe-it-or-not episodes are also common in the ER. Take the time an obnoxious drunk showed up with a fierce but inexplicable pain in his belly. After sleeping it off, he staggered up from his cot and only then did the ER doc notice a speck of blood, on the sheets, which upon closer inspection turned out to be from a tiny hole, splayed by burn marks, in the man’s back. Apparently, he had been shot but was too drunk to recall it. Sure enough, an x-ray revealed a bullet lodged in the abdomen.

Or, take the time a stabbing victim arrived cut entirely from stem to stern, his entire rib cage exposed, yet conscious enough to describe the whole bloody fillet job some whore performed on him. Or, the time a man fell at home on a fireplace iron and walked in the ER with a small wound on his neck which, upon further exam, proved to be a deep puncture penetrating his cervical spine. For Dr. Muelleman, who treated all these cases while working in a Kansas City, Mo. ER, such incidents fall under the heading of “the truth is stranger than fiction.”

 

 

 

 

Perhaps the most frustrating cases are those involving entirely preventable injuries, especially those incurred while victims engaged in some high-risk, reckless behavior, like a young man Dr. Muelleman treated in Omaha who crashed his car while out joy riding and ended up paralyzed from the neck down. “I don’t call them accidents anymore,” he said, “because an accident suggests an act of God. I call them injuries because when people put themselves in these circumstances something is going to happen that didn’t have to happen.”

Anybody-Anytime-Anything
As ERs are traditionally the 24-7 stop-gap or catch-all of American medical care, the entire spectrum of need shows up there. In most public hospitals, no one is turned away, regardless of insurance status or ability to pay. “The emergency department is the safety net for many people seeking care who really have no other place to go, said Dr. Paul Tran. “Admittedly, there’s going to be abuse of the resources because this is reserved for emergency cases, but who’s definition of emergency is it? A toothache at 2 a.m. may be an emergency to you, but it may not be to someone else. We are here to take care of people from all walks of life and with conditions as minor as a toothache or as serious as a heart attack. And from that standpoint, it is very satisfying to provide people the last resort they need and to get the instantaneous gratification of turning them around.”

Given its open door policy, “the ER is where you really see the cross-section of humanity and so, if there are social ills, you seem them in the ER,” Dr. Muelleman said. “Some of the ills we deal with are domestic violence, drug and alcohol issues, child abuse, lack of immunization and lack of access to health insurance. Another segment the ER picks up on are the acute psychiatric and homeless populations.” He said in an era of managed care, ERs play an increasingly large social service and public health role. “

So, if we’re dealing with intoxicated people we try to get them in a shelter or detox center. If it’s an abuse case we bring in social workers, police and protective agency professionals. If we’re dealing with domestic violence, we make sure patients understand the resources available to them.” Nurse Scott Miller is “troubled” by how many kids he treats who “are not well cared for” at home and “very frustrated by the large number of people with legitimate psychiatric problems who can’t get seen” due to a lack of psychiatric beds locally. He said, “I’ve spent many hours fighting on the phone, calling medical staff at home, to get people admitted in the hospital when they don’t really have a medical problem. But when no psychiatric place will take them, we can’t just send them home.”

Dr. Muelleman said where ERs have always tried educating patients about prevention safeguards and optional resources, “Some have gone to the extent of smoking cessation and substance abuse counseling. I’m just reviewing a grant for a hospital to screen Type II Diabetes, which is not something you’d traditionally think of as an ER doing. There is a real move toward ERs getting involved with public health, even things like bike helmet giveaways. Some have even gone as far as to give pneumonia and flu shots. Even here, during seat belt awareness week, we do educational stuff to let people know about the importance of seat belts.”

As a survey of ER web sites will attest, there is debate in the medical community over the all-encompassing role of the ER. On this subject, Dr. Muelleman takes a pragmatic position. “You can’t select why people use the ER. Once they’re here, you can’t ask, Why are you here again?, although you may be tempted to. I mean, I support the notion public health policy in America should be changed to help take care of people’s health needs in a more comprehensive fashion than just having them go to the emergency room, but given that’s not the case, the mantra in the ER continues to be — anybody, anytime, anything. That’s exactly what it is. Should we change medicine so that doesn’t happen? Well, yes, we should, but in the meantime we’ve got to do what we can to help people.”

Related Articles

• Some ERs post wait times by text, billboard (msnbc.msn.com)
• Newly Insured are Likely to Congregate in Emergency Rooms (prweb.com)
• Timesunion.com: If it’s an emergency, they’re on the clock (timesunion.com)
• Text Your Way To a Short Emergency Room Wait [Medicine] (gizmodo.com)
• Lengthy waits in local ERs (windsorstar.com)

Merciful Armies of the Night, A Ride-Along with Paramedics

To date, the only ride along I’ve done as a journalist was for this story following paramedics.  I enjoyed the challenge of reporting and scene description the assignment presented.  It’s the type of project I do from time to time in order to push myself out of the comfort zone I sometimes get stuck in.  The story, which originally appeared in The Reader (www.thereader.com), was meant to mimic and ultimately transcend the television and film depictions of first responders. Perhaps I’ll do a ride along with police officers or detectives sometime.  A companion piece of sorts to this one is also posted on the site — a report I filed based on a few nights observing things at an ER.

 

 

 

Merciful Armies of the Night, A Ride-Along with Paramedics

©by Leo Adam Biga

Originally published in The Reader (www.thereader.com)

The Paramedics Corps
Cutting through the humid summer night, Medic 21 is a rattling five-ton metal box of thunder-on-wheels. The Omaha Fire Department (OFD) rescue squad rushes to another emergency on the near north side. Flashing red, yellow and blue lights pulsate with the same urgency as the wailing siren’s cry that help is on the way.

Two licensed paramedics are assigned Medic 21 on the C shift: Capt. John Keyser, 38, a fair-haired, well-chiseled 12-year veteran of the OFD and Kathy Bossman, 28, a pretty brunette in her third year on the force after a short stint with the Lincoln Fire Department. Partners since last October, the pair work out of a firehouse at 3454 Ames Avenue, one of nine stations in the city housing rescue squads alongside fire engine companies. Anymore, every Omaha firefighter is trained in at least basic Emergency Medical Technician (EMT) skills. Some own intermediate or EMTI ratings. Others, like Keyser and Bossman, are full-fledged paramedics with the most rigorous Advanced Life Support (ALS) training on the force. Paramedics are usually attached to rescue squads, although some serve on fire rigs.

The OFD paramedics corps numbers 147, nearly triple the total from five years ago. Omaha Fire Department Emergency Medical Services (EMS) Battalion Chief Jim Love said this planned jump in personnel came in response to an increasing workload caused by an ever-expanding city: “Last year our medic units responded to 23,558 calls for medical assistance and transported 16,400 of those people. The year before, we responded to 21,272 calls. Our calls are growing at a rate of 4 to 6 percent a year. The population is not only getting larger but it’s getting older, so we’re seeing an increase in the elderly and their associated medical problems.”

Paramedic training is intensive, entailing some 1,000 hours of classroom and field experience, including interning in clinic (hospital) settings and on ride-alongs. A more rigorous curriculum is being implemented in 2001. Omaha EMS Chief Medical Director Dr. Joseph Stothert, head trauma surgeon at NHS University Hospital, said today’s paramedics are more skilled than in the past: “They have better education and better quality assurance in place and I think generally the care in the streets is much better than it was 10-20 years ago. Not only are they able to do more, but they are able to understand more and sort out what’s going on with the patient and to begin treatment before they reach the hospital.” He said things have progressed to the point that medics follow protocols or standing orders to guide their assessment and care in the field where before they called hospitals and awaited orders via radio phone. “Through the years I think the level of confidence has increased in the paramedics because of their training,” he added.

Here I Come to Save the Day
As the gleaming ambulance barrels through traffic (most of which parts to let it past) to the scene of an emergency the vibe inside the squad is part thrilling and part somber as the laconic medics steel themselves for whatever crisis awaits them. With their hearts racing, they are like soldiers driving into a battlefield. Their reactions must be swift. Their minds sharp. As they run through routes and protocols in their head, they keep an eye out for rogue motorists and cock an ear to the radio for updates. They take seriously their role as rescuers. Theirs is a single-minded mission of mercy — responding to a frantic plea for help. It can be anything. A diabetic reaction. An asthma attack. A cardiac event. A gun-shot wound. A personal injury accident. Poisoning. Heat exhaustion. Childbirth. It can be anybody. A child. An adult. Someone hurt in a car, on the street or in their own house. It can be a cop or fellow firefighter, victim or assailant, average citizen or public figure. You name it — these professionals have seen it in the line of duty.

Medics pull 24 hour shifts and no matter when the 911 call comes in — the middle of the night or the fat of the day — and regardless of what it is — a routine health problem or a genuine medical crisis — they show up ready to lend aid. Even when driving conditions stink or the medics are starving sleep, they respond the same. There is a temptation to view them as heroic Calvary riding-in to save the day. That is not how they see themselves, however. “I certainly don’t feel like any knight in shining armor. We’ve just doing our job,” Keyser said. “I really do enjoy helping people. That’s probably the biggest reason why I chose this profession.” His partner, Bossman, added, “It’s nice to be able to help people and to be able to change their life or improve their life in some way. Every time they call us it’s an emergency to them. They appreciate us being there, and that’s a good feeling.”

The anytime-anything-anybody drama of the job is one of its major draws. Even though most runs are routine, no two are ever quite the same. “One of the most appealing things is the excitement,” Bossman said. “It’s a big adrenalin rush. When you get the blood and guts, it makes it more exciting and interesting. You know you’ve got to step it up. You’ve got to move faster. You’ve got to get more things done. You’ve got to use all your skills and training.” Said Keyser, “One of the reasons I went into this is because it’s very challenging. The sleep deprivation is hard to deal with and the stress level is very high.” That stress — of being on call all hours of the day and night to make emergency medical interventions — has a flip side too. “You can get too wrapped up in this job. If you let the pressure and stress mount, all it does is kill you a little bit at a time. That’s why I’ve always thought one aspect of being a good paramedic is recognizing when you need to get away from it,” Battalion Chief Love said. Field medics like Keyser know the demands can overtake them if not careful. “I’ve got at least another 12 years on the job, but I don’t want to be on the rescue squad that long because I don’t want to get burned-out. After a 5-day rotation, I’m exhausted. I have a wife and three kids I want to enjoy,” he said.

On the Run
Medic 21 is among the two busiest EMS units in Omaha. It annually vies with Medic 40, at 45th and Military Avenue, for the title of most runs. The unit is responsible for a wide swath of Omaha — from Bedford Avenue north and from the Missouri River to 72nd Street west. Given that Medic 21 serves a low income area, some residents rely on the EMS system as a mobile clinic and taxi service. “In our territory we seem to have a lot of patients who don’t have transportation to the hospital, so they call 911 even if they have the flu. You treat them the same even though you’re frustrated because it’s 3 in the morning and you’ve seen this patient before and you know there’s nothing seriously wrong with them,” Bossman said. “We tend to see a lot of really young mothers who don’t know much about caring for their kids. We try to educate them a little.” Then there are the repeat customers. “We’ve got quite a few regulars. Most have legitimate medical conditions, but some don’t necessarily take care of themselves very well. They don’t take their medicines like they should and that can worsen their condition.”

Jim Love was a firefighter-paramedic on the streets before taking a desk job. He worked out of Station 21 and said his field experiences there opened his eyes to some things. “I didn’t realize the abject poverty that exists in certain parts of our city until I actively went there, walked into these places, took care of these people and transported them to the hospital,” he said. “I mean, I’d seen poverty on TV and read about it in the newspaper, but until you actually touch it and work with it, you really can’t imagine. For lots of people, we’re their source of medical care. They don’t go to doctors.”

With 3,113 runs made last year by its three crews, Medic 21 is the reigning champ among Omaha EMS units. Through August Keyser and Bossman are averaging 9 runs per 24-hour shift and are 50 ahead of last year’s pace, but on this day (August 10) they are still awaiting their first more than half-way through their shift. “This is highly unusual,” Bossman said. “That’s the thing about this job. A lot of times you’re waiting for something to happen and other times you leave the station and then don’t get back for six hours,” said Keyser. No sooner do the words leave his mouth than an alarm sounds on the overhead speaker alerting personnel to a rescue call. Keyser and Bossman clamber aboard the squad, fire up its engine, roll out of the garage and tear onto rush hour-choked Ames Avenue. With Keyser manning the wheel and Bossman the radio, a 911 dispatcher relays the nature of the call. “Medic Unit 21, there’s a 90 year-female with difficulty breathing…a neighbor became concerned when she didn’t her from her…called police…the female was found on the floor…apparently fallen…police are on the scene.”

Lady in Distress
Less than 10 minutes elapse from the time the call is received to the medics’ arrival on the scene. It is a red brick apartment house at 52nd and Northwest Street. Police cruisers and a fire engine are already there. Curious neighbors and onlookers gather on the small porch or watch from the street corner as Keyser and Bossman stride into the residence carrying an arsenal of emergency medical supplies, including a portable heart monitor/defibrillator and a case filled with meds, IVs, airway supports, bandages, slings, etc.

Police deny access to a reporter along for the ride, citing the tight quarters. The officer guarding the front door, Juan Fortier, describes the situation while Keyser and Bossman treat the elderly patient inside. “A friend hadn’t heard from the resident since Tuesday night at 8. She came by, hollered for her and got no response. She tried entering, but the inside chain was locked. So she called us. We came, we assessed the situation, notified our supervisors what we had and we decided to go ahead and force the lock open. We got inside and the 90 year-old resident was lying on her back on the floor next to her bed with one leg kind of folded up under her. She was still conscious but somewhat discombobulated. She had obviously been there awhile. We just tried to comfort her with our voice and let her know help was here,” he said. Police and rescue squads respond to several such calls each week. Most turn out fine.

Minutes later, firefighters hustle to fetch a backboard and gurney and soon are carrying the patient out on the stretcher, a bag valve mask applied to her mouth, and secure her in place on the squad. With the patient, Olive, designated a CODE 3 (critical condition) Keyser and Bossman tend to her in back while a firefighter takes the wheel. It turns out Olive lives alone and has no family in state. The only prescribed medication found is for some unknown cardiac condition. In cases like this, when a patient cannot provide answers and there is no family member to consult, medics lack basic information to complete a patient history.

Teamwork
“A big part of our job is information gathering,” Keyser said. “Our first job is to assess the patient and determine if there’s a life threatening situation. Then, the most important thing is to find out the history of what brought this person to require our care. We try to get as much of the history as we can for the doctors.”

 

 

 

 

Firefighters often reach a scene first and provide care up to their level of training. Once medics arrive to take over, firefighters remain to assist — providing extra sets of hands and eyes. This team concept is at the heart of EMS. “Most of us have worked together for a long time and everybody knows what needs to be done,” Keyser said. “Firefighters will get a stretcher or set-up an IV or get oxygen going. If we don’t see it being done, we’ll ask for it.” Bossman added, “The firefighters we work with are real good about helping out. They’ll jump in and do whatever needs to be done.” Love said having EMT-qualified firefighters on-site is essential to the continuum of care that extends from pre-hospital settings to the ER. “The important thing about having EMTs on the fire trucks is that not only do they get there quickly, but they take base-line vitals which give the paramedics something to compare with when they take their vitals. It gives us another indication as to whether the patient is getting better, getting worse or staying the same.”

In critical or trauma scenarios, time is everything. “We’re always racing the clock,” Love said. “Our goal is to get somebody to the patient’s side with at least basic level training within 5 minutes and to get someone there with advanced training within 8 to 11 minutes. We try to reach those goals at least 90 percent of the time.” According to Keyser, “Depending on how critically injured that patient is, their best survivability is if they can be treated in the ER within an hour of their injury. It’s called the Golden Hour. We try to get everything done we can in 10 minutes before the patient is loaded on the squad and we’re on the road to the nearest trauma center. We’ll do everything else en route.”

In Dr. Joseph Stothert’s view, “For about 90 percent of the patients paramedics see, their care is absolutely vital and life-saving, including persons in or near cardiac arrest and persons involved in (serious) motor vehicle accidents. Now that there is a defibrillator on every fire and rescue apparatus, there’s been a steady increase of patients we’ve been able to resuscitate earlier.”

With Olive in tow, Medic 21 speeds to the nearest hospital, Immanuel Medical Center, as Keyser radios her condition: “We’ve got a 90-year-old female who has been down apparently since…” During the bump-and-grind ride Olive is dimly conscious. She cannot speak, responding to questions with only her tired eyes or feeble nods of her head. “Can you point for me where it hurts?” Keyser asks. “Olive? Olive, we’re going to give you some nitro on your tongue. Your lungs are full of water. I want you to lift your tongue up for me. There you go. Good girl. Here it comes. Open wide.” Olive weakly responds. Her mottled face is splayed by vomit and pinched in pain. Her eyes close. She is barefoot. Totally vulnerable. Her vital signs are continually taken and any abrupt changes noted. All the while, Bossman comforts Olive by holding her hand and applying pressure to a bag valve mask over her mouth, timing her squeezes in concert with the patient’s inhalation.

“For the short amount of time you’re with patients you just want to try to do something positive. Sometimes, that’s nothing more than holding their hand and talking to them while you’re riding to the hospital,” Love said.

Keyser tries getting Olive to respond again (“Olive, we’re going to help breathe for you, okay? Olive, can you open your eyes again?”), but she has fallen unconscious. The medics scramble to intubate her with a breathing tube and suction out excess fluid clogging her airway. Amid the cramped space the medics handle equipment and perform procedures in a kind of choreographed dance. They anticipate each other’s moves well. Few words need to be spoken. They work with calm precision and dispatch, forming what Love likes to call “a fine-tuned patient care machine.”

Later, after delivering Olive to the ER, Bossman recaps the run. “She had fallen out of her bed and was on the floor since Tuesday night. She was already dehydrated. She’d been vomiting and had it in her mouth and in her lungs. That caused her to choke and quit breathing. It could have been real bad. If her neighbor hadn’t checked on her and called the police she could have choked to death. She got a little bit worse en route. She quit responding, although her vital signs stayed pretty good. We intubated her to clear her airway. She’s actually pretty stable now. Her airway’s secure. She’s getting plenty of oxygen. They’re going to x-ray her to make sure she didn’t injure her back when she fell.”

Breathing difficulty is a call medics often respond to and make a life-saving difference in. “Outside of critical emergencies, the assessment and treatment of airway problems is where they tend to help people the most, such as people with asthma or people with chronic airway diseases,” Dr. Stothert said. Medics also routinely help diabetic reactive patients make dramatic turnarounds.

Heeding the Call Again
After its crew restocks supplies and completes paperwork in the ER, Medic 21 no sooner pulls out of Immanuel when a new call presses them back into service. It is a  new mother seized by severe back pain. The squad heads east and in no time at all reaches the wood frame residence near 46th and Bedford, where a fire engine crew is present. The petite patient, Sandy Dace, sits in a kitchen chair doubled-over in a spasm of pain. Her tall bearded husband Dennis stands over her, holding their red and wrinkled 5-day old baby boy in his arms. At the bottom of a staircase a boy of perhaps 8 peers with wide-eyed wonder and fear at the rescuers tramping in and out. It turns out Sandy underwent a prolonged labor marked by acute contractions, before a Caesarean section was performed. It is thought her pain is related to the childbirth.

“I got up to go to the bathroom when I heard Sandy crying. I found her just like that. She couldn’t get up. And with him (the baby) here, I had to call somebody. It was maybe 40 seconds before I heard the sirens. It was great when you showed up. You guys are excellent,” Dennis tells the medics. As he follows his wife to the door, he says, “I’ll be up at St. Joe’s as soon as your mom gets here. Okay, dear?” “Okay,” she replies through clenched teeth.

En route to St. Joseph Hospital Sandy grimaces with each jolt during the shake-rattle-and-roll run. She tightly clutches the handles at the side of the gurney to brace herself. “It’s kind of a bumpy ride, so we’ll take it easy on the way there,” Bossman tells her, but while the ride proceeds at a slower than normal pace it is just as jarring as ever. Dace remains stoic, only uttering a sound when answering Bossman, who tries taking her mind off her discomfort with easy chatter.

Built on an unforgiving truck frame, rescue squads are notoriously noisy clatter-traps that ride like bucking broncos. Many have been in service for a decade or more. It is not unusual for odometers to read 100,000 plus-miles. And those are hard, stop-and-go miles. Units often break down with a wide array of mechanical problems, forcing even older, less reliable reserve units into service. “Our rescue squads are on their last legs,” is how one paramedic put it. With so much wear-and-tear, it is no surprise then that perhaps the number one complaint by customers is that “the ride is terrible,” said Love. Squads are nicknamed “puke boxes.” Three brand new units were purchased recently (for $117,000 each) and their increased size and smoother ride makes medics stuck with older models rather envious.

 

 

 

 

The squad transports Sandy Dace to the ER just before 7 p.m. and by the time Keyser brings the empty gurney back out, a LifeNet helicopter lands to stretcher-in a middle-aged patient critically injured in an industrial accident. As for Dace, she is logged in as a CODE 1, which signifies no real medical emergency and no treatment performed in the field. She simply gets a check-up in the ER.

Stories from the Frontlines
On the way back to the station, the medics make a fuel stop at a City of Omaha depot where broken-down cruisers, squads, rigs and plows are warehoused for repairs and spare parts in what is known as “the boneyards.” Life at “21s” or any firehouse is a communal thing. Except for captains, who rate their own rooms, everyone, men and women, share spartan dormitory-style sleeping quarters. It is a high testosterone environment. We’re talking big men wielding axes and saws and handling mammoth rigs.

As the lone female (one of 20 among 600-plus fire division field personnel) Bossman is still something of a curiosity. While a Clint Eastwood pic plays on a big screen TV in the rec room, she explains how it takes a certain kind of woman to thrive there. “If you’re the type who gets real upset at a crude joke, you’re not going to last very long. You can’t be overly sensitive to those things. You just have to go with the flow.” She said when she started she was subject to a “feeling out” process that closely scrutinized her ability to handle the job and to be, “one of the boys,” in effect. “Once they saw I was okay with their cracks and I could pull my own weight, then there was no problem.”

Down time is variously spent doing paperwork (a detailed record of every run must be logged in a book and on the computer), washing down or cleaning out rigs, rapping with the guys, grabbing a bite to eat, zoning out in front of the TV or catching some Zs. When a visitor asks Keyser, Bossman and Love to share some stories from the frontlines, they gladly oblige. Like other EMS professionals, they say the toughest cases usually involve children.

“I remember the first SIDS (Sudden Infant Death Syndrome) case I ever went on. At the time I was an EMTI with a little baby of my own, so it really kind of hit me hard,” Keyser said. Bossman recalls a CODE 99 (CPR in progress) case. “What was thought to have been a SIDS baby was revived but it never regained consciousness. It later turned out to be a shaken baby. That had an impact on me because in the ER I was comforting the mother and father and, later, when I found out it was (allegedly) the parents that had done this to the baby, it really bothered me,” she said.

Suicide runs are hard to forget. “You go there and, of course, there’s nothing you can do. You call the police and while you’re waiting you see pictures on the wall of family and friends. It hits home that this was a human being that had a life. It gets you thinking, What got them to the point they felt they had to do what they did? Those are the ones that really stick with me.” Love said.

Bossman said a disturbing run she and Keyser made was to the residence of a man with critical pulmonary edema. “It appeared to be treatable when we first got there,” she said. “At his house he was talking to us, but then he went downhill real fast in the squad. And at the hospital, despite everyone’s best efforts, he died. Sometimes, despite a perfect treatment, the patient may still not make it. It can change at any time. That affects you because you see this person getting worse and worse, and you want to help them, but you can’t…Over time, I guess you just learn that regardless of what you do the outcome is sometimes out of your control. It’s kind of hard.”

“Bad runs” of this sort often prompt a Critical Incident Stress Debriefing or CISD, an informal talk therapy session for every EMS staffer at the scene. The fire division’s chaplain, Rev.. Chuck Swanson, leads the sessions. Select cases are also chosen for run reviews, where crews and supervisors analyze what went right and wrong.

Ready for Anything
At 8:50 that August night, the crew’s brief R & R respite is interrupted by another call. A young woman has dislocated a shoulder fending off an assailant near 24th and Camden Avenue. She screams in agony, “Oh my God. It hurts. Oh my God.” The police are there sorting out the incident. “They’re are always a welcome sight to us,” Keyser said. The patient, tears streaking her face, screams all the way to Immanuel. This is the first in a series of four straight runs Keyser and Bossman make that evening. Next, it is a young asthmatic, Reggie, with difficulty breathing. He’s tried his inhaler, but it’s brought no relief.

The medics arrive at his house and find a scared little boy struggling for breath. They administer Albuterol with oxygen. He breathes easier but a trip to the ER is advisable. Aboard the squad an IV is started. The medics calm the boy down, assuring him how brave he is. Calming kids is “half the battle,” say the medics. When Keyser asks “Have you ever ridden in an ambulance before?” Reggie replies, “Yeah,” and reminds them they treated him once before — for bruised ribs. On the way to Immanuel a much-improved Reggie points out the rear squad window, shouting, “There’s my mom,” waving to her following closely behind in the family van. Upon arrival at the ER a relieved Reggie announces, “I can actually talk now.”

The last two runs are routine. A woman complains of a host of problems, including difficulty breathing. She is quickly stabilized with oxygen, yet continues acting distressed. Her husband explains, “She gets like this when she’s upset.” It seems the couple had been arguing. The patient declines a trip to the ER. Later, Keyser attributes her symptoms to anxiety, which he said can mimic many medical conditions. Then it’s off to an assault call only two blocks from the Medic 21 home base. Police surround the victim lying in the middle of Ames Avenue. The intoxicated man has been beaten about the face by two or three assailants and has  suffered cuts and bruises. Keyser and Bossman dress his wounds and take him to University Hospital. He smells of alcohol, sweat and blood.

By the end of the run it is around midnight and the medics are ready for a break. “When you’re super busy or you’re up many times over the course of the night you’re sleep deprived,” Bossman said, “and that just makes your reaction time slower. You have to think longer and harder about decisions that during the day might come real quick. That’s when it’s helpful to have a good partner. You work together and figure things out.” When a call awakens crews from a sound night’s sleep it is not uncommon, Keyser said, for hazy mates to slam into doors or each other amid the darkness and the mad dash that ensues to reach a rig or squad.

The wee hours find medics intersecting a surreal scene of crowds hanging out in parking lots or cruising the jammed streets. “It’s a different world down here at night,” Keyser said. “Once, we saw a family pushing a baby in a stroller at 2:30 in the morning.” Added Bossman, “It’s odd. There’s bumper-to-bumper traffic. We somewhat gauge how busy our night is going to be by how many people are out.” At time like these the intrepid medics are urban explorers in search of their next adventure. “It’s always something different,” she said. “Part of being a professional is being ready for anything.”

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Lauro Play ‘A Piece of My Heart’ Dramatizes the Role of Women in War Zones

Image by cliff1066™ via Flickr

This is a story I did about a play whose subject matter brought me into contact with some women who fulfilled various capacities during wartime service, whether as nurses or USO performers.  The women I interviewed are sort of the real-life equivalents of some of the characters in the play.

The story originally appeared in The Reader (www.thereader.com), and I hope you find the words of the women, fictional and nonfictional alike, as gripping as I did.

 

Lauro Play ‘A Piece of My Heart‘ Dramatizes the Role of Women in War Zones

©by Leo Adam Biga

Originally appeared in The Reader (www.thereader.com)

 

As U.S. military action in Iraq unfolds, old war stories take on new capital. With women now on the front lines, their wartime roles gain added import. While their presence on the battlefield is new, American women have participated on the sidelines of war — as nurses, clerks, reporters, missionaries, performers — for generations, only their legacy seems lost in the heat of combat.

But since the 1993 dedication of the Vietnam Women’s Memorial in Washington D.C., a bronze sculpture by artist Glenna Goodacre of three fatigue-wearing females comforting an injured soldier, women have begun writing and talking about their wartime service as never before, the fruits of which can be seen in the acclaimed play, A Piece of My Heart, running now through April 27 at the Blue Barn Theatre.

Playwright Shirley Lauro based the characters of her impressionistic drama on interviews with real-life veterans, including those profiled in a book of the same name by Keith Walker. Lauro uses fast-moving vignettes to tell the larger story of American women in Vietnam. The six women characters represent varied backgrounds, roles and attitudes. There are military nurses, from stalwart Martha to sweet young Sissy to flower child Leeann. There’s the aristocratic Red Cross “donut dolly” Whitney. There’s the hard-ass intelligence officer Steele. And the playful, soulful USO trouper MaryJo. Whether sewing sutures, spreading cheer or performing on stage, they are angels of mercy for soldiers trapped in a hellish quagmire.

The women cope with laughter, tears, booze, pot. Some erect “the wall.” Others fool around. The nurses regret not knowing what happens to the boys whose bodies they patch up and spirits they boost. They fear no matter how many lives they save or how many smiles they elicit, they never do enough. Then, when their wartime service is over, they return home as forgotten as their G.I. brothers, wanting to put the war behind them but finding they can’t.

 

 

 

 

Even though each character tells her own story, they really all speak in one voice about the shared female experience of being thrust into the surreal, carnage of war. Regardless of where they hailed from or did their tour or what job they held or beliefs they espoused, they were all volunteers who elected to go there.

“The common ground we had, which is why I felt so strongly about honoring these women, was that not a single one of us had to be there,” said Diane Carlson Evans, a veteran in-country Army nurse who spearheaded the creation of the women’s memorial. “We were not drafted. We were not conscripted. Nobody put a gun to our head and said, Go to Vietnam and do your duty. We could have stayed home, got our master’s degree, had our kids, played golf and tennis and had a good life. But every one of us — Red Cross, military, USO — said, I want to do my part, and did during a very unpopular war. We didn’t have a lot of support from home, from peers or from our country…We just thought it was the right thing to do.”

Evans, who made remarks before the Blue Barn’s April 5 show, used her appearance to givr tribute to “the diverse contributions women made” in the war. “I am proud of the women I worked with and how hard I saw them work and how they asked for nothing in return. It was always, Do I need to give blood? Or, Can I work an extra shift? It was that always going above and beyond and never complaining because we had a job to do. I saw how these women saved lives at the risk of their own. And I just believe so strongly they deserve credit from a grateful nation. A grateful nation that needs to acknowledge they participated in a really extraordinary way.”

The story of women’s wartime service is, for many of us, unknown. “I’m just so glad this story’s being told because I lived through Vietnam and I didn’t hear nothing about the nurses…not a thing,” said Omaha actress Phyllis Mitchell-Butler, who portrays Steele. “The nurses went through as much as any of the soldiers. They saw the devastation first-hand. I’m just amazed how long they kept themselves together with all that inside them. All they had was what was inside and they had to keep that. They couldn’t let it go.”

In her role as state commander of the Nebraska Council of Vietnam Veterans of America, Dottie Barickman, who served at Offutt Air Force Base in the Vietnam era, has come to appreciate what women did in that war.

“I’ve never walked in their shoes, but I’ve heard their stories and I understand what they mean when they say they sacrificed their youth and their emotions. They were the nurturing ones for a lot of young boys hurting over there. Combat soldiers always mention to me that if they ever saw a nurse it was like Welcome Home, and that is what these women were…a touch of home that took them away from that war zone for a few hours.”

The stories in A Piece of My Heart echo those of thousands of women that served in Nam or nearby environs. Diane Carlson Evans is one of them.

“I was 21…right out of college…and I was assigned first to the 36th Evacuation Hospital in a beautiful place (Vung Tau) right on the South China Sea beach. I didn’t feel the war there as much as I did when I was transferred up north…to Pleiku, in the central highlands jungle near the Cambodian border,” Evans said.  “I was with Two Corps supporting the 4th Infantry Division (in the 71st Evacuation Hospital).

“The war was very different there. It was the spring of ‘69…a pretty bad time. The 4th Infantry had something like a 75 percent casualty rate. I was made head nurse in a post-surgical unit where the patients were very sick. We had them on respirators and blood transfusions and chest tubes. It was very hard to see so many young men with such horrific wounds. We had to deal with patients dying on us and, in triage, we had to deal with setting aside dying patients to attend to the most salvageable ones. We blamed ourselves. We carried the guilt. And we were young…and so on our little time off we filled our days in human ways, whether it was playing volleyball or getting drunk or doing drugs or going on dates or falling in love.”

 

 

Playwright Shirley Lauro

 

 

In addition to the stress of dealing with crushing trauma patient loads, the threat of death was ever near. “Pleiku was not a safe area. We were under attack many times. We got to know the difference between the outgoing artillery and the incoming rockets and mortars that would fly in and hit our hospital, sending shrapnel everywhere. We were not only worrying about our patients — we had concern for our own safety,” said Evans, a Helena, Montana resident.

Since getting the Vietnam women’s memorial installed, Evans, whose efforts to make it a reality took 10 years, has become THE champion for female volunteers in that conflict, focusing her efforts on “encouraging women who served to share their stories…so we can understand what the memorial is all about.”

She helped start a storytelling program at the memorial site and on the web that invites women to speak their piece. She said telling it like it was is “very painful. It takes a lot of courage for women to admit how scared they were some young soldier was going to die on their watch or how they were so tired they could have made a mistake or how they were sexually assaulted or harassed. All of this anger and anguish comes out in the play.”

An admirer of the Lauro work, which had its debut in Philadelphia and has been performed across the country, Evans feels it gets to the heart of women’s Vietnam odyssey. “It does not show our service through rose-colored glasses — that we were all these heroic young women who went off to save the world and wore white halos — but instead it shows we were young women who went to Vietnam and did the very best we could amid all this crazy stuff going on. That’s what makes it very real, very authentic.”

As the war in Iraq rages on the director of the Blue Barn show, Susan Clement-Toberer, feels the conflict lends the play added urgency.

“Knowing that it’s happening now it brings it all very close and deepens everything we’re doing,” she said. “It’s real, just like the stories of these women are all real…taken from a myriad of interviews with different women.”

Cast member Erika Hall, who plays the USO entertainer, said, “You know, before it was important to do this piece, and now like it’s necessary.” Most of the cast and crew are too young to remember the war and therefore have immersed themselves in it via books, articles and tapes and by talking to actual veterans.

“What an interesting learning experience this is for me,” Hall said. “I was born after Vietnam and, you know, you read about it in school but you don’t really understand what they (vets) went through.” In her own research Clement-Toberer said she was surprised to learn “the extremes the women survived. I knew Vietnam was a dirty war, but I just didn’t realize they (the women) saw such extremes so quickly. I understand now why these women went and what they mean by honor…they believed in their country. It’s just a very strong feeling in what is right and what is true and what needs to be told.”

The characters have real-life counterparts in Nebraska. Lincolnite Judy Knopp, a former Army nurse at Camp Zama, Japan, treated G.I.s choppered in from Vietnam; Martel native and longtime Lincoln resident Brenda Allacher toured Nam as a member of the all-girl country-western band The Taylor Sisters; and Marie Menke of Superior, Neb. was a fellow Army nurse with Diane Evans at the 36th evac in Vung Tau, regarded as an in-country R & R site except for the grueling recovery and care that went on there. For vets like these, Vietnam seared into their memories and hearts the best and worst of humanity.

“I joined the Army nurse corps and in six weeks did my basic training at Fort Sam Houston and went straight to Japan…Camp Zama, 35 minutes southeast of Tokyo and an hour by chopper from Saigon. I was charge nurse in the orthopedic ward of a 1,000 bed hospital,” Knopp said.

“Back then, we had to make our own IVs and pump our own blood and everything. After the Tet Offensive we were working 12 hour shifts, seven days a week. They used to call us the zombie squad. We didn’t even eat. We went home and slept…then came back. We’d have 30 to 40 evacs a day…20 to 30 surgeries a day, just on my ward. One-half of our cases were dirty wounds…shrapnel wounds or single and multiple amputees. Guys with half their faces blown off. One young man I especially remember…Billy. He was 18. He’d stepped on a land mine and everything was gone from the belly button on down. He was unconscious. We were pumping him full of blood. You wanted to save him but…you wanted him to go, too, because there was no way he could live.

“The guys, they were so young. They used to call me grandma and I was 22. They were all like little brothers. We used to stay up with the guys at night who were crying over having killed women and children. They had a real hard time dealing with what went on over there and the stuff they had to do to survive. A lot of ‘em came back injured and a lot of ‘em we never saw again. We never knew what happened to ‘em. The ones going back to the states we’d iron their uniforms, sew on their patches and go to the chopper to kiss ‘em goodbye. I have very fond memories of the guys and just atrocious memories of the wounds.”

She still regrets how, when her ward was busy, “there was no time for dignity with death…to get patients prepared and stay with ‘em and see ‘em through it. It was like, OK, this one’s dead, clean out the bed…there’s another one coming in.”

A Piece of My Heart cast members marvel at what women like Knopp endured at such a tender age. “They all have stories of their first day…just like in the play where my character takes off a soldier’s boot and his severed foot is in it,” Christine Schwery said. “They were so fragile and so young and yet they survived,” Julie Huff said. “With a lot of alcohol and a lot of drugs,” Schwery chimed in. “Yeah, but they survived and they saved a lot of lives,” Huff added.

Riverdale, Neb. native Marie Menke, then Daake, was a 22-year-old nursing school grad when she got to Nam. Nothing could prepare her for what she saw:

“I was pretty naive about the war. It was very shocking to most of us to see the kinds of wounds and the tragic loss of life,” she said. “It just shouldn’t be. My thoughts about the war didn’t matter because we were there and people were getting hurt and we had an enormous job to do. We were tremendously needed. It was beyond comprehension almost. The nurses did do a lot but most of us downplayed it. We were just there to do our job and to take care of patients and to support them.”

Besides caring for American G.I.s, nurses treated Vietmanese, including children.

An estimated 265,000 American women service in support of the war. U.S. Army estimates place the number in-country  between 10,000 and 12,000. Most were nurses, either Army or Marine enlistees or even civilians attached to field hospitals or more rear echelon units. American Red Cross volunteers were so-called “donut dollies” — a sort of comfort girl corps boosting morale with their short-skirts, smiles and care packages. Others were entertainers touring under the auspices of the USO or, like Brenda Allacher, as contract entertainers via private booking agencies that provided minimal security and scant creature comforts.

 

 

Blue Barn Theatre’s Susan Clement Toberer

 

Allacher, then known by her stage name Brenda Allen, got to see a lot of Nam during her three-and-half month tour in ‘69. She has bittersweet memories of her time in Chu Lai, a central coastal area manned by the Americal Division:

“That was one of our favorite places because we had privacy taking a shower. I remember the commanding officer, ‘Big Daddy’ Richardson, said, ‘I’m going to work your butts off, but when you come back at night your favorite food and drink will be sitting in front of you.’ And it was, too. Lobster and blackberry brandy and Cutty Sark scotch. We’d do five and six shows a day for that man,” she said. “The men, they just wouldn’t let us quit and we weren’t about to leave those boys. The guys were just absolutely beautiful. They called me ‘Crazy Legs’…I’d do wild dancing and kick my legs up. They just went bonkers.

“We’d come back exhausted. One night, we’d come back from a show and a few of us were in the officers club drinking when there was a loud CLAP and the building just shook. A G. grabbed me and threw me down under the bar.” It was the start of a prolonged mortar attack. “We took 16 rounds over a period of four or five hours. We just laid there on the floor and got drunk. I was so scared. Around daylight a young man came running in, shouting, ‘They got a nurse at the 312 Surg-Evac,’ which was like a block away.”

The victim, 1st Lt. army nurse Sharon Ann Lane of Canton, Ohio, was the first Army nurse to die under hostile fire in Southeast Asia and one of 68 American women in all — military and civilian — to die in the conflict. The incident shook Allacher to her core.

“What really gets me is it very easily could have been me, and not her.” she said. She recalls happier times there, too, like when the Taylor Sisters did an impromptu show for Nebraska National Guard troops, leading off with “There’s No Place Like Nebraska.” “The tin roof went off on that quonset hut. They just went nuts.” Or when she was secreted away to give a private performance for some special ops forces who, upon her finishing, “lined up and saluted me” she said tearfully. “As I was walking out, the commanding officer placed his Green Beret on my head.” She still has it. “I wouldn’t trade those experiences for anything.”

Allacher and Knopp have made the recognition of women’s work in Vietnam a personal mission. Together eith Evans they are featured in a NETV documentary, Not On the Frontline, that follows their story from the wartime service they rendered to the emotional “culmination” of seeing the women’s memorial dedicated, something Knopp worked for as state coordinator of the project. More recently, Allacher, who describes herself as “a straight shooter…full of piss and vinegar,” was instrumental in bringing A Piece of My Heart to the attention of local theaters. She and her big booming laugh have become fixtures at the Blue Barn.

For Allacher, Knopp and Evans, the stories told in the play and documentary are part of the healing that’s taken place after the war. Acceptance of women’s service has come slowly, even as they have died alongside their veteran brothers from Agent Orange-related illnesses and have suffered from post-traumatic stress disorder.

Evans said there was once resistance to honoring women’s war record because “I don’t think people wanted to look at women as warriors — as soldiers. But women are soldiers, too. We fought just as hard as the men. We just fought with different instruments.” Or, as Judy Knopp puts it, “The guys were on the physical front lines, but we were on the psychological front lines trying to hold it all together. And we did it with a loving heart.”

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Seafarer Doug Hiner and His Cuban Medical Supply Runs

Image via Wikipedia

A couple acquaintances introduced me to Doug Hiner and he immediately got on my radar as someone I’d like to profile when I learned he regularly sailed down to Cuba on missions that were partly about delivering medical supplies and partly about secreting back contraband, as in cigars.  Hiner is a wheeler-dealer type who denied the illegal trafficking at the time I interviewed him, then expressing upset at my story’s suggestion that he engaged in anything like that, but subsequent events confirmed his smuggling activity because he got caught in the act down in Florida and faced serious federal charges.  He pleaded guilty to one count and received 36 months probation.

Aside from the intrigue, which occurred after my story appeared, his story is really a classic tale about his taste for adventure and his passion for all things Cuban.  A version of the following story appeared in The Reader (www.thereader.com).

Seafarer Doug Hiner and His Cuban Medical Supply Runs

©by Leo Adam Biga

A version of this story appeared in The Reader (www.thereader.com)

More than any other country, Cuba both seduces and vexes Americans. This island of paradoxes is at once a natural paradise fulfilled and a socialist promise unrealized. In a place where bare necessities do not go for want, chronic shortages make hustlers out of peasant and professional alike. Within a closed society and controlled economy, anything, for a price, is a black market possibility.

Fidel Castro may or may not own Cubans’ hearts and minds, but the land and culture definitely hold residents and exiles transfixed.

Social/economic problems don’t change the fact that Cuba, at least geographically, is a tropical island idyll. Sun, ocean, jungle, mountains — much of it pristine. Politicians/bureaucrats aside, the people embrace life with a live-and-let-live Latino insouciance. Music, dance, food, art, love, sun, surf. Fun prevails, if not for all, for tourists.

Omahan Doug Hiner sees the schizoid nature of Cuba every time he sails there on his 53-foot cutter, the Vitamin Sea. He captains the Tampa-docked boat on voyages that transport medical equipment to hospitals and clinics on the island. He’s been making runs like this to Cuba for seven years, a period when official American policy toward that intransigent Caribbean nation has gone from rigid to ultra hard-line. Embargoes of one kind or another have limited trade with Cuba and, in some cases, denied aid.

 

 

Doug Hiner

(naplesnews.com)

 

 

With Fidel’s recent stomach surgery making his mortality and his grip on power a renewed subject of world interest, Hiner prepared for a late December sail to bring in another boatload of supplies. But the gringo’s boat blew an engine, pushing the trip back until this month. He arrived February 10 in Havana, where the gear still sits, waiting for the red tape to be cut so he can move stuff inland.

His artist wife, Christina Narwicz, usually joins him on these maritime adventures but she wasn’t feeling up to it when he shoved off this time around.

The Man and the Sea
Hiner, 67, is a former hair dresser and a retired real estate developer and landlord. He made and lost a fortune. He’s not oblivious to the political realities that hold Cuba hostage in a state of suspended animation. Far from it. He has strong views on what Cuba and its paternalistic neighbor to the north should do to ease restrictions and tensions. His awareness of Cuban medical needs drives his missionary trips there, even as he brings in and takes back his share of contraband.

His journeys go well beyond idol curiosity. Hiner and his wife feel they have a fair handle on Cuba by virtue of not only having traveled there several times — it’s 15 trips and counting for him and about the same for her — but their stays usually last weeks or months at a time. They get around to different parts of the island and really immerse themselves in the place.

“We’re not tourists, we’re travelers,” Hiner said. “A tourist wants to have MacDonald’s no matter where he’s at. We like to enjoy the cultures of different countries and not live like Americans. We try to blend and be friendly with the people, and that’s all it really takes to be accepted. They love Americans, especially if you’re friendly to them. They don’t like the ugly-American types.”

Whatever motivates him, he ultimately makes these journeys because they put him in touch with three of his favorite things — sailing, the sea and people.

Though he grew up in landlocked South Dakota and Nebraska, Hiner long ago felt the call of the open sea.

“I’ve always been fascinated by the sea,” he said, “and I’ve always had this dream of having a boat to sail around the world.”

Years ago he and Christina “were planning to do a sail around the world …” when his “business fortunes changed,” making such a trip “impractical.” Circumnavigating the globe is not such a passion now, not with the expanse of warm southern waters to explore. “You can spend your whole life in an area like that and never see everything,” he said. “The Caribbean is a whole chain of islands. We’ve never been to Colombia or Central America, so eventually I’d like to do that.”

Besides, it’s the carefree, unrestricted, port-of-call lifestyle he enjoys, more than the challenge of seeing how far Hiner can push his sailing skills.

“A boat is like your home. You’ve got everything on it. You’re totally self-sustaining … It’s a real nice feeling,” he said. “You can anchor anywhere you want for nothing. We spent a couple New Years Eve’s anchored off of Key West, one of the liveliest New Years places in the world.”

Still, the allure of cruising wave and wind is like the call of the sirens — hard to resist. Half the challenge is dealing with weather and the other half comes with the inevitable mishaps.

“Weather on the high seas — that’s your biggest danger,” Hiner said. “We’ve gone through some pretty turbulent stuff, some accidentally, some on purpose because we had to. But it’s never been a safety issue. You’re never really out of ear shot of weather” reports via radio/radar.

Nature-related or not, things do go wrong. Take the couple’s 1999 trip to Cuba for instance.

“Going down on the second trip we blew out the sail. We ran into some bad weather. We had to have it repaired. It’s usually mechanical problems. It’s like, not if it’s going to break, but when it’s going to break. The last time we left Cuba the autopilot failed and we had to hand steer for 40 hours. Oh, and coming back from Cuba once we lost our fresh water pump, so we had no engine. There was no wind and we drifted for a day-and-a-half or two days before we finally got close enough to Key West to get a boat to tow us in.

“Our boat is about 20 years old and it needs extensive rewiring and stuff and I really haven’t been able to afford that, so we just kind of patch things together. It’s safe but it’s always a little bit of an adventure.”

Sea-faring is an apt avocation for an inveterate beach bum who, whether inland or coastal, enjoys kicking it with friends over drinks in the Old Market, where he developed some of the first condos, or partying on his boat.

He enjoys the simple, well-done pleasures of good food, good drink and good company. His wife’s the same. The residence they fashioned from an old brick-faced bar and parking lot on South 13th Street reflect their shared interests. The grounds’ richly decorated Great Wall that fronts 13th Street has a gated entry whose mammoth door opens onto a large courtyard filled with her plantings.

Hiner’s no stranger to graceful living, as he once owned a Fairacres mansion “back,” as he likes to say, “when I was rich and famous.” He made big bucks and moved in tony circles in the ’70s and ’80s. Then it all crashed. He alludes to a business partner running his development company into the ground.

The house, featured in the Spring 2000 edition of Renovation Style magazine, is designed with walkouts along the length of the courtyard that connect to a wood deck, creating a veranda. The interior opens up to a loft master bedroom and guest quarters, revealing a 32-foot-high ceiling and a bank of large windows that stream light in. At one end of the property is a screened-in porch. At the back of the lot is Christina’s well-lit studio. It all works toward a cozy hacienda feel.

As soon as he laid eyes on the spot he knew “it was exactly what I had in mind.” When he bought the former Glass Front Bar it was only a shell. But, he said, “I had this vision.” He designed the place himself. The work fit neatly into his years of “retrofitting old buildings. I’ve always had a knack for design and style and just living comfortably.” The result, he said, adheres to “the European concept of zero lot lines…where you basically use the whole property. We don’t have a back yard or front yard or side yard — we have a court yard. The same with our house. We utilize the whole house. We don’t have formal spaces. It’s just more practical and creative in my estimation. It’s just a feeling of well-being.”

His passion for this getaway within the city dovetails neatly with his ardor for Cuba. It always comes back to communing with people.

“It’s just a wonderful country. The people are so friendly and so caring and loving,” he said. “It’s hard to explain. I’ve traveled all over the world and I don’t think I’ve ever been to a country that is so warm and safe. There’s virtually no crime in Cuba. It’s true there’s a policeman on almost every corner, but the people there are so law-abiding. They’ll steal, but their attitude is, ‘If you don’t lock your bicycle up with a chain or padlock, then you must not want it.’ I’ve never had anything stolen off my boat in the marina and I can’t say that in almost any other country.”

Years living under the thumb of a dictatorship has its palliative effects.

“If a policeman on the corner points to a driver and signals him to stop,” Hiner said, “he’ll almost come to a panic stop to obey the order. They wouldn’t even think of not [stopping]. A police chase over there would be unheard of.”

Back to the contradictions bound up there, he said Cuba can seem chaste one minute and carnal the next. “It’s a real straight-laced island. Pornography is totally illegal. Drugs — zero tolerance. One marijuana cigarette would throw you in jail for a week before you’d be expelled from the country and told never to come back.” On the other hand, he said, “Cuba’s a very sexually open country. Even though prostitution is illegal…a lot of people are shocked by the young women that are readily available for sexual encounters. One, there’s a serious lack of men on the island. And two, their culture is not uptight about sex at all. I mean, geez, if some foreigner wants to give you twenty bucks, that’s even better.”

Besides, he said, “Cuba’s all extended families — there’s four-five generations that live under the same roof, and so it’s everybody’s responsibility to help support the family group.”

While Cuba prides itself on a system that accounts for citizens’ basic needs, rampant poverty compels most everyone to be on the make.

“You see very little begging, yet the young Cuban kids and the old folks are out hustling for the family,” Hiner said. “Everybody is sort of doing whatever needs to be done to provide extras. They have to have some access to dollars to really have any quality of life.”

Amid all this naked human need, Cuba takes great pains to put on a good face. “They sweep each block of Havana every day. If you don’t have anything to do, they’ll put a broom in your hands,” he said.

By Western standards, he said, Cubans lack everything we take for granted. He tries to give friends there some creature comforts otherwise unavailable to them.

“I’ve taken personal things down for people, like a microwave oven or VCR or DVD player, because all that stuff is illegal. Everything’s illegal in Cuba. Mainly, if it plugs into the wall, it’s illegal. They have an energy problem and they’re just trying to keep people’s lives basic.”

 

 

Even more basic than that, he said, he brings items like toothbrushes and razor blades that are “not a big deal here, but are a big deal there.”

He’s also brought back, on consignment, works by Cuban artists he and Christina sold in Old Market art shows, the proceeds going toward supplies for the artists.

Beat the Bushes, ‘Bend a Few Rules’
He’s sympathetic to the plight of the Cuban people, whose deprivation goes deeper than a lack of material things, to essential services. Sure, Cuba provides free health care, but many clinics and hospitals lack equipment and technology that can not only improve care but save lives. And while average Cubans and natives of nearby Latin American countries have access to free care, some medical centers are reserved for the elite. It’s why he got involved as a medical supplier in the first place. His awareness began on his inaugural visit to Cuba in 1998. The marina in Havana introduced him to fellow travelers, including many Americans, some of whom became a model.

“I met a lot of people that first time. A lot of just normal people. Some were bringing medical equipment on their boats down there,” he said. He soon discovered an informal network of doctors and suppliers. “As I met people in the marina and friends of theirs I was put in touch with various doctors and got lists of things they needed.”

Over the next year Hiner beat the bushes and made contact with “various organizations” that run aid into Cuba.” He cultivated the names of key suppliers, like Jack Oswald in Chicago, and key recipients, like surgeon Gilberto Fleites in Havana. When Oswald, who works with a group called Caribbean Medical Transport, ran a check on Hiner’s then-fledgling medical mission activities he was duly impressed.

“The medical equipment he gets is a cut above most of the stuff humanitarian aid groups get and I’ve been doing this a long time. His stuff is absolutely flawless,” Oswald said. “I went with him on his last trip because he was packing some really heavy equipment…I came from Chicago to help him figure out a way to put some of this stuff on the boat without it sinking. We put thousands of pounds on the bow…and you no longer could see to navigate…so we had to have somebody at the front of the boat calling instructions out to the captain just to avoid the reefs and boats and weather we came across on our way to Cuba. It got a little adventurous here and there.

“I’ll tell you, the guy’s fearless, he really is. He’s mission-oriented, there’s no question about it. Almost militaristically I might add. He doesn’t really let anything get in his way. Some of the stuff he does is a bit risky. And sometimes he doesn’t have the money, the equipment or even the plan…but he just keeps doing it. I think both sides are willing to let him operate, maybe even bend a few rules here and there…because they know what he’s doing is valuable.”

 

 

Joining Oswald, Hiner and his wife Christina on the voyage was a Cuban American physician who brought medical supplies to a cousin physician in Cuba. The Americans also brought art supplies for an artists collective there. Oswald said of Hiner and Narwicz, “They just know a whole lot of people and they just really enjoy Cuba. The folks I met that know them are like family.”

On Hiner’s first supply run in 2000 he was introduced to Dr. Fleites. “I met Gilberto and his wife Teresa and they were really neat people and we became really close friends and we had a really wonderful time there,” Hiner said.

Hiner calls Dr. Fleites “a bit of a renegade. He ran the national cancer institute in Havana. He was on the Cuban ethics board. He tried to get some doctors removed from practice because he thought they were killing more people than they were saving,” Hiner said. “But his superiors kicked him off the board because he wasn’t ‘a team player.’ He still performs surgeries … but only on important people because they know he’s very, very good. He’s sort of like freelance. It’s kind of a bizarre situation.”

The Omahan’s “become sort of an emissary” to Dr. Fleites. “I get lists of stuff from him” the Cuban medical community “needs,” he said, “and come back and hustle my friends. I know a lot of doctors from when I used to be rich and famous.” As Hiner’s refined his networking, tons of things get donated — once, an entire operating suite. Omaha’s Children’s Hospital donated an anesthesia machine. He works with established humanitarian nonprofits that authorize him use of their license for delivering free medical goods abroad. Much of what he takes there goes to Pedro Kouri Institute of Tropical Medicine, an AIDS hospital directed by Dr. Jorge Perez. It’s not an impersonal process for Hiner, who’s visited there and other sites he’s supplied. He’s impressed by Cuba’s “incredible medical system.”

What began as annual trips became twice-a-year voyages. Their last trip, in 2005, they were in Cuba four months.

He’s transported medical gear worth hundreds of thousands of dollars, including mechanical operating tables and surgical instruments ranging from forceps to retractors to endoscopic devices. The goods ship to a central location and, when there’s enough for a full haul, he loads a truck and drives it to his boat in Tampa. After everything is securely stored and lashed aboard, he rigs his boat and sails for Cuba. Once there everything must be checked and approved by customs officials, a process that can take weeks. Various government stamps and seals are needed. From start to end, a single supply mission can take months.

He cuts what red tape he can with “gifts” to marina workers and ministry officials.

For the current trip, he amassed a large inventory that includes an entire delivery room donated by a hospital, complete with delivery table, incubators and monitors. So large is the haul he left half the load in Florida for a return trip next month.

Donations have never been better, but he said navigating the bureaucratic waters to get them to Cuba has become more problematic. He blames the Bush administration for “tightening travel restrictions,” especially since 9/11. He said the feds have made it harder for the nonprofits he works with to obtain or renew licenses. The main clearance he needs is from the U.S. Coast Guard that grants free passage through “an imaginary security zone between Key West and Havana that no one can define.” Without the permit, he said, “they can seize your boat, fine you $250,000 and put you in jail for 10 years.” When things were more “more relaxed,” he could slide by. Not now.

There are also new Commerce Department and Council of Foreign Currency Control approvals needed.

Cuba’s hardly immune from bureaucracy, but the tropics make the paperwork and graft more bearable. Besides, as “well accepted” as Hiner is there, he can play Lord Jim. He hopes a meeting he’s been angling for with Fidel, whom he admires, happens one day. He knows just what he’d say to the dictator. “I would tell him he needs to make more opportunities. The people there are very industrious but he keeps stifling any kind of private enterprise,” Hiner said. “He’s getting old and overly restrictive. I would tell Fidel, ‘You’ve got to loosen up. If you were a young man today you’d start a revolution against yourself.’”

To Cuba with Love
Ironically, Hiner’s romance with Cuba may never have happened if not for an accident. It was late 1998. Doug and Christina were on one of their Caribbean sailing jags and had put into port in Jamaica. There, Christina took a fall and broke her ankle, putting her in a cast. He hired a young Jamaican boy to help him crew. The trio sailed to the Camyan islands, where Christina’s pain worsened. Doug sent her home by plane. That left Doug and the boy. The idea was to make for Florida, but Doug knew the boy would be denied entry without papers.

“So, we decided to go to Mexico,” Hiner said. “I got in big trouble there because, unbeknownst to me, a Jamaican needs a visa to get into Mexico. They almost threw us in jail. I talked my way out of that.”

Next, Hiner set his sights on Key West, but learned that, too, was off-limits. Desperate, he asked officials, “Where can we go?’ ‘Cuba,’ they told him. “So, the next morning off we went to Cuba. That was my first time. We were there almost 10 days before I was able to get a plane to fly him out to Montego Bay. And while in Cuba I just loved the country. When I got back home I told Christina, ‘I loved it so much we need to go back there.’” Go back they did.

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