Toad in the Hole

More New Orleans

What finally made me break down in tears like a damnfool in front of the TV was the hospitals. People dying there. Bodies stacked in the stairwells. People dying there for lack of electricity, of water. Food, even. No Xrays, no tests, no damn lights!

Never mind the seige of looters at the doors. (For another look at “looters,“ see Gutterboy’s blog.)

Imagine being in a hospital in the United States and dying for lack of drinkable water. Imagine being in a hospital with only flashlights and it’s 90+ degrees and you havent eaten in days and are afraid to sleep because you’re hearing gunshots and there aren’t enough people to take care of everybody and you’re losing patients for lack of water. Not blood, not beds, not even lab equipment: water.

New Orleans

I’m spending my energy reshuffling the house, which we do now and then; being thankful we have a house to reshuffle; and being in shock over Louisiana and the Gulf Coast. Here, go read this for a few days.

Found a cookbook a few years ago from the Spanish-speaking area south of New Orleans; the people there are mostly from the Canary Islands. You might have seen a few of them where I most recently did: that PBS music series that followed the Mississippi River.

Hunger and Memory

Pica commented on the rant below that we can’t imagine the kind of protein starvation Barbara Kingsolver described in The Poisonwood Bible. She’s mostly right; I’m convinced that the letter-writer I was ranting about was guilty more of a failure of informed imagination than even of arrogance… though those might be synonyms.

I didn’t exactly have to imagine it. I’ve seen kids starve to death on the most expensive diet on the planet.

They starved because they didn’t have enough small intestine to digest even that carefully designed diet—which was a powder we mixed with sterile water and put into a hanging bag for continuous NG-tube slow feeding. As I recall it cost something like $385.00 a can at pre-1980 prices, and which lasted a few days to a week depending on the size of the child and how much supplement we could deliver parenterally—that it, through another line that ran into a scalp vein and down through the neck to (again IIRC) the vena cava.(It’s possible I’m naming some wrong vessels here; this was a long time ago. I do remember the reasons and the arrangement.) It took surgery to place this line, and we had to be very careful the child didn’t pull it out. This meant carefully placed restraints. We did manage to get time, or assign a helper sometimes, to free the kids’ hands and play with them.

This location was necessary because the nutritious stuff was also quite caustic to blood vessels, so it had to be run into the vessel with the most volume and fastest possible flow, to dilute and move it enough that it wouldn’t erode the line it was poured into. It ran continuously too. I don’t know what the solution cost, and I’m not even factoring in the cost of all the plumbing, most of which had to be changed at least daily. (Fortunately, it’s easy to put an NG tube in a baby; I could do that myself as a mere LVN. Bet I still could.)

Typically, these were infants who’d suffered an intussusception, in which the small bowel telescopes on itself and ends up becoming necrotized—gangrenous. When the dead gut is cut out, there’s little left to digest with.

An infant’s or young child’s nutritional needs are less flexible than an adult’s; there was (at least 20 years ago) often no way to get enough calories and nutrients into them, even with all this parenteral nutrition and continuous tube feeding, to keep them alive, let alone let them grow. I have heard of adults living for years on Total Parenteral Nutrition, but that’s recent, and they were adults.

Sometimes we did get one healthy enough to go home, even to grow and prosper. That’s why we didn’t give up, even when we wished we could stop the struggle, even when the child’s parents wanted to. Nobody knew, except through experience, what the lower limit was, and I remember seeing one chubby three-year-old I’d taken care of, when his mom brought him back for a visit. I also remember a beautiful kid I fell in love with, who had 10 centimeters of small intestine left. He died, after two big-shot hospitals had tried their best for him, at about two and a half. When I knew him, he was also uncommonly cheerful, curious, bright, playful. And I swear to the god of your choice that he had slightly pointed elven ears.

Starvation hurts, if you’re conscious, if you’re otherwise healthy. (I’ve seen elderly people just give up eating and dwindle away, and that didn’t look painful. There’s definitely something else going on when you get into neurological problems.) Starving babies get furious, then irritable, then detached, then listless. They move as if moving hurts. They want to be held, they they don’t want to be touched. They get cold. Actually, they get cold early on, and this process I’m describing in the nursery is so on the razor’s edge that we had to watch them closely for shivering and such, because they could shiver away all the calories we’d managed to pump into them in one night.

That kid I fell for, his mother wanted to give up several times, especially after he’d pulled his parenteral tube and had to go to the OR to have it replaced… again. In retrospect, she was right. But I stayed neutral, let her cry on my shoulder when she could come in (she, her husband, and their two other kids lived hours away) and let the docs persuade her yet again, because like them I’d seen that chubby three-year-old.

If you want a moral education, try a few years working where there’s no right answer, and you can’t even tell what’s merciful.

Swat

Joe and I wrote a piece for the recent-but-one issue of Earth Island Journal about Heifer International, formerly known as The Heifer Project. It was basically a totally sincere puff piece; they knocked our socks off.

I suspect that might have been partly because we went to their conference in Little Rock a couple of weeks into a month-long driving trip to Arkansas, in the month before last years’ election. After dealing with the godbotherers for rather too long, we were both relieved to hear somebody say that what their Christianity moves them to do is not to prosyletize, let alone condemn, but to love their neighbors in concrete ways.

In fact, they have rules about cultural sensitivity, which they integrate in most interesting ways with matters like women’s rights. They consciously give women power; gender justice and equity is one of their principles. This from a denomination that’s the next thing to Mennonites, who are the next thing to Amish.

Anyway, when you write something for EIJ that mentions livestock and eating meat, you know you’ll get some veggie-sermons. Chris said there were only two letters, which was a surprise, though we’d specifically handled many possible objections, briefly, in the article. EIJ repeated a bit of the original piece by way of reply, but I want to add to it here.

I’ve been farting around with this, hoping I could just import the letter from EIJ online, but the recent issue’s not up yet. (Come on Matthew!) So I’ll just have to type bits of the letter here, with my sore and bleeding fingers, and intersperse my reply.

Someone named Warren Jones, of San Francisco, wrote this:

I was very disappointed to see the article about Heifer International, a well-intentioned group that provides animals to impoverished people.

OK, two buzzwords in the very first sentence. Ever notice how people use “disappointed” to establish their moral superiority when they have none? It’s the written equivalent of steepling. And there’s the devastating “well-intentioned.“ Judith Larner Lowry handled that one well in writing about people who took her group to task for uprooting the pwetty widdle nastily invasive broom bushes along roads in Marin County. (Those people actually analogized what Judith was doing to racism.) Read her Gardening with a Wild Heart for some inspiring fun.

The problem is that what these people really need are tools and education on how to grow organic fruits, vegetables, whole grains, and legumes. These are the foods that will keep them healthy.

It’s hard to know where to begin with this one.

What the fuck does this guy think these people are eating? Whopperburgers? Twinkies? White bread? Eeeevilll white sugar??

And what the fuck does he think they’re growing them with? ConAgra’s latest formula?? Vigoro??

They’re eating organic foods already, just not enough of them! They’re trying to scratch a living out of too little, too depleted soil, in some plot they’ve been driven to by the forces we in the USA subsidize no matter what we eat or how pious we are.

They aren’t suffering from the ills of plenty, from arteriosclerosis or obesity or any such thing. They’re fucking starving, they’re poor, and it’s not like US inner-city or even most rural poverty, marked by trans-fatty fat. They are not getting enough to eat.

They are not getting the means to wear enough clothing to keep themselves warm when it’s cold. They are losing teeth to diseases of undernutrition, to calcium deficiencies, not sugar-fostered caries. When they suffer from vitamin deficiencies, it’s because they aren’t getting enough quantity or enough variety in their diets, not because they’re stuffing themselves with junk food!

Has this guy ever worked on an “organic” farm? Where does he think all that nice manure fertilizer comes from? Does he know what a luxury it is to have enough land to grow the nitrogen your soil needs as “green manure”? Does he have a fantasy that all the human-inhabited land on Earth is deep humusy bottomland, in which one can grow “organic” fruits and vegetables for more than a year or two without adding some serious nitrogen? Has he ever looked at, let alone tried to grow food in, the thin soils of mountain Peru, Nepal, the rockier parts of Appalachia? Has he ever grown his own living, rather than buying it at a store?

Does he really think he’s smarter than these people, who tell Heifer what they need? Does he think they’re poor because they’re dumb?

Did he miss the part where Heifer workers pass ideas along from one group to another, ideas about how to get the most nutrition out of the least land with the smallest possible environmental impact? You know, that stuff that sounds suspiciously like permaculture. That stuff that uses knowledge that people who have made their livings and their lives in the places Heifer reaches, for generations and have some idea of what the local soils can offer, and what their limitations are?

Does he know that tropical soils are often equally thin of nutrients, because tropical ecosystems keep most of their biomass aboveground in the greenery? Does he know what red soil means??

Does he know that one good reason humans started keeping livestock is because grazing animals, seemingly by a miracle, convert the biomass of grasses that we can’t digest into meat that we can digest? Does he know that furthermore, decent grazing is less disruptive to ecosystems—you know, the lives we don’t see unless we sit quietly and look for them—than digging up the land for plants we can eat? That grass thrives under the right kind of grazing? That browsing has gone on in forests for millennia without harming them? That this all matters because screwing up ecosystems has real consequences, and kills animals as well as plants?

Does he really have this fantasy that if These People only knew what he knew, they would suddenly have enough land to grow the scenes he sees on the labels in his pantry, on the shelftags in his market? Does he have any remote idea of what their lives are actually like, of what they actually have to work with? Does he suppose that people who don’t have the means to go buy a goat can somehow acquire precious acres? Does he think Heifer has a magic wand to expand the continents, and give them this land? Does he think there’s such a thing anywhere as “empty land”?

In addition, the animals are not treated humanely. Their web site and brochures feature photos of people hugging and holding animals. They don’t show them slitting their throats. They don’t show the animals writhing in pain.

Evidently the only way one can treat an animal “humanely” by the writer’s lights is to keep him or her as a pet. And he has never seen a kosher or halal slaughter, or even a merely skillful one. If you can’t kill an animal painlessly, learn how. North American slaughterhouses are not the standard of the world, and their methods are recently invented. “Writhing in pain” happens in fevered imaginations or industrial settings, but is wasteful if you’re actually living on the edge where that bit of protein matters. Does he think that farm kids aren’t genuinely affectionate towards the animals who will pay for their college educations? Does he think the people in the photos are any less grateful, or that their affection doesn’t translate into decent living conditions for their animals? Maybe he should look again at the economic base that supports him.

OK, I won’t go for the cheap line that “this is why people get contemptuous about vegetarians” —because in fact I’m not contemptuous of vegetarians—or even vegetarian prosyletizers. I do wonder if things like this mis-aimed sermonette aren’t why some people are contemptuous of First World prescriptivists. Or preachers.

That Recurring Nightmare

I’ve been rassling with some paid work lately, so I haven’t been blogging much.

Last evening, I saw something in one of Pharyngula’s comments that answered a question I’d had in the back of my head for decades, about a possible reason for a bunch of anencephaly and meningocele admissions we’d had in the NICU I worked in 20 - 25 years ago. (To condense: Anencephaly, especially, correlates with high fever at a certain stage of pregnency, so, say, a flu epidemic could lead to a rash of cases.)

Last night I woke from a familiar nightmare I hadn’t had in a long time. It’s effectively the nightmare many of us have about school: last day of the semester, there’s a vital class you haven’t gone to or known about all semester, and there’s an exam foir it now, and you can’t find the room and/or you’ve forgotten the name and of course you don’t know any of the material. Modify ad lib, but it seems to be a common dream.

After I started my brief (just under a decade) nursing career that dream switched for me. I’m at work in a hospital, and it’s the end of the shift, and I realize I’ve forgotten to even check on one patient, or I had one patient I somehow didn’t know about. Ungh. I call it the same dream because it feels the same.

Last night’s dream involved not just one but several patients; I was assigned a few on one floor and a few on another, in a weirdly chaotic situation. I didn’t know any of the nurses around me (which was the case most of the time when I worked out of the registry the first year after school; a nursing registry is a temp pool for nurses and allies) or much about the layout of the place (ditto) and this one was set in a series of open-air mezzanines, which was actually pleasant. It also had lots of new tech stuff that I wasn’t familiar with, which would actually be the case if I were to go back now.

As I hastened to leave so I could get to my car in a big parking garage on the other side of some bigger, airy, glassy civic space, an opera house or something like, I was angry, fearful, of course guilty. I was telling myself I didn’t belong in this job, I wasn’t suited for this kind of work—along with the big Oh Shit! and Now What? and Is Patient OK? and a very primitive Am I Caught?/How Do I Cope? that all occur simultaneously in that dream. I think that anger was new.

I wonder about the structure of dreams. Mine are rarely coherent narratives, so I typically have trouble describing them. They’re vivid pictures, sometimes tied together, sometimes abruptly and mysteriously switching. Maybe I forget the transitions. Maybe I don’t bother with them. Sometimes I suspect that there really isn’t any narration to my dreams, that they’re a succession of feeling-states that I attach narrative to by way of rationalization and explanation, or as a memory aid.

The image I have of this is of being suspended in water on which floats a swirl of colors, like the setup one makes with water and oil paints in a pan to make marbled paper. When I wake up, I’m being drawn up out of the water and the narrative, the pattern of swirling paint, clings to me in whatever order it happens to occur on the surface. But it’s almost incidental to the dreaming state—except that the light coming through the surface to where I’m dreaming is colored and patterned by the floating paints. Still, the pattern I’ve been dreaming underneath is only a little like the pattern left on my skin when I’ve been drawn up through the surface.