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EQUALITY ARCHIVES From The Archives From The Archives Health Healthcare THE FRONT ARCHIVES

When an Abortionist Dies

Dr. Spencer, 1889–1969: Last Trip to Ashland

One month, to the date, before his death last Tuesday, I was privileged to meet the legendary Dr. Robert Douglas Spencer. The trip to Ashland, which was more in the nature of a pilgrimage than a quest for an interview, had come about through the good graces of Dr. Nathan H. Rappaport. A chance to meet Spencer, and through the entree of another abortionist, was an unusual opportunity. Arrangements were made and carried out on a day’s notice. Rappaport drove us to the Pennsylvania coal country in his Citroen. The other passengers were Carol Kahn, a reporter for Medical World News, and her husband, Ira.

We were a high-spirited group, Carol, Ira, and I, and we must have sorely taxed the ego of our friend during the four-hour drive to the little town near Pottsville, pumping him as we did for details of Spencer’s life. It was a journey to Ashland that, I expect, was quite different from the more than 30,000 other journeys that travelers had made to this village, travelers with a secret, urgent mission.

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Spencer, I knew, was back in business again, at the age of 79. The justifiedly famous doctor had reopened his clinic on Centre Street and was now charging the incredible sum of $200, a concession, as he later told us, to the higher cost of drugs and supplies. At $200, Spencer’s price was still hard to believe, well under the going rate for such things. He was still unique in American history.

I tried to recall during our journey just when it was that Dr. Spencer of Ashland had first come into my consciousness. It was, I determined, about 12 years ago. A friend, a painter, had called one day to report that she was pregnant and desperate and did I know of anyone. The only abortionist I had heard of was one another friend, a model, had told me about. She had been taken to him blindfolded and he had charged her $1000. The model had not seen her doctor’s face without his mask and she did not know his real name. The painter, however, was able to make better arrangements. She called back to say that she had gotten wind of a Spencer in Ashland, Pennsylvania, who was supposed to be great, kind, and medically responsible, and who did abortions for practically nothing because he believed in them. A week later my painter friend came over to see me. Spencer in Ashland was a reality. He was, she reported with wonder, a kindly old man. His clinic was spotless. He had a nurse and an attendant. She had slept over at the clinic and had met some other girls who were in a similar plight. The next day, when she departed, he had given her an assortment of pills to ward off infection and build up her strength. He seemed concerned about her, downright fatherly. He didn’t make her think she had done something wrong. The operation hadn’t caused her much pain, and, the biggest wonder of all, it was only $50.

And so it was that Spencer went into my telephone book, under “A” for abortionist. I am poor at remembering telephone numbers, but Spencer’s old number is still in my memory. It was Ashland 404. I was an aspiring actress in those days, and much taken with Tennessee Williams. I remember once passing along the Spencer number to another friend and saying in my best “Summer and Smoke” voice, “Really, I think of it as the telephone number of God.” Young acting students are all over-dramatic, but there was good cause for such intense language when talking about Spencer. Spencer meant deliverance, it was as simple as that. Going to Spencer meant taking an alternative that the culture was doing its damnedest to hide or distort. The public image of an abortionist, through books, plays, movies, articles, or whatever, was of an evil, leering, drunken, perverted butcher at worst, and a cold, mysterious, money-hungry Park Avenue price-gouger at best. And then there was Spencer with his clinic on the main street of a small American town, who charged $50, who believed in abortions, and who was kind. Knowing about Spencer in Ashland was one irrefutable piece in the logic which led one to the conclusion that the culture was capable of the big lie.

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As the years passed, Spencer’s name would come up from time to time. The price had gone from $50 to $100. Some people remembered when it had been $25, or even $10. There were long stretches when the doctor in Ashland would go into retirement, and there were stories of treks to Ashland only to find the clinic boarded up and silent. There was, we heard, a death on his operating table from a reaction to the anesthesia. There was a trial and there was, miraculously, an acquittal. We heard misinformation, too. Spencer had become an abortionist, the rumor went, because his own daughter had died on the operating table of an abortionist-butcher. This story was untrue, unfortunately popularized in a bad novel based loosely on the life of Spencer by a lady novelist with one of those awkward three-name combinations. Maybe the lady meant it symbolically. Spencer’s real-life daughter, better information had it, was alive and well, and so was his son. Other information I absorbed about Spencer, I was later to learn, was quite accurate. He was a committed atheist and free-thinker who often pressed his literature into the hands of the girls along with the antibiotics and vitamin pills. He had gotten into abortion work during the ’20s through the supplication of the miners’ wives in the Pennsylvania coal country, and his work for the miners — he was a pioneer in the technique of bronchoscopy — won him a heavy workmen’s compensation caseload, and, some said, the protection of the United Mine Workers during the years when the protection of the mine workers was something that counted.

Ashland, Pennsylvania. Principal products: coal, homemade wine, and abortions. The sort of Americana that always evaded the Saturday Evening Post. The town of Ashland is in some parts as narrow as the width of two streets. One of those streets is Centre Street, which is also a state highway. For some romantic reason I’d pictured Spencer’s clinic as a rambling, gabled mansion with a front porch. It was, instead, a very ordinary three-story, brick-face structure, flat, characterless, and attached on both side to similar-looking units. Diagonally across from it was the local movie theatre, which bore the legend, “We Burn Coal.” Most of the private homes and business in Ashland resist installing oil burners, and show their defiance with a printed placard.

Spencer’s home was on South 9th Street, just a few blocks from the clinic. It was a little house with a storm door and no lawn. There was a Christmas wreath in the window. The hour was late when we rang the bell. Spencer’s wife, a tall, big-boned woman, greeted us and led us past the formal parlor to a back room: Spencer’s study.

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And there he was, a tiny wisp of a man, frail, dry as dust, with sharp, thin features and bright eyes. He was wearing a suit of some dark material and it hung on him loosely. Rappaport had told us that Spencer had more or less stopped eating this last year, convinced that his health was irrevocably failing. There were signs of his eating habits about: two opened packages of pistachio nuts. He sat in a rocker, with what looked like a bear rug slung over his knees. He hardly looked capable of the energy required to attend to three or four abortions a day, which was his current schedule. (In his heyday, he had handled 10 to 11 patients.)

We were introduced, and we gravely paid our respects to his reputation, which I think pleased him. The interests of the man were evident in his study. Books of every description, some still in their mail-order wrappings, lined the walls and were stacked on tables, fighting for space with the mementoes of his travels: large chunks of mineral rock, strange and beautiful Indian masks, a blow gun, and a fine collection of rifles. “Douglas likes to go boar hunting. Show them your boar-hunting pictures,” Rappaport said, and Spencer got up and obliged. The snapshots showed the tiny figure with a big, red hunter’s cap on his head, standing in a group with four or five other hunters, towering men, each with his rifle proudly stuck in the ground. Behind the hunting party, 11 large black boars were strung up in a neat row, quite dead. Dr. R. D. Spencer was, he informed us, firmly against gun registration.

Carol or Ira called attention to the microscopes. Several of them were about the room, some with camera attachments and light boxes, and one which Spencer himself had designed. Spencer’s training had been in pathology. Happy to show us the microscopes, he went to one of his cabinets and pulled out some slides. As we took turns at the microscope, intently viewing the various specimens of single-celled life that Spencer had prepared, the man grew increasingly more animated. He was entertaining his guests, and thoroughly enjoying it, and we in turn were thoroughly charmed and engaged, so much so that our friend Rappaport withdrew somewhat testily to the front parlor to converse with Mrs. Spencer.

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Warming to his audience, Spencer brought out further treasures. “This,” he announced of one exhibit, “is the life history of a fly.” And it was, from an insignificant speck to the insect as we know it. “Do you know what this is?” he queried, showing us a small, clear plastic block with something red and curled imprisoned in the center. It was, he told us, the embryo of a pig. We passed it from had to hand, marveling at its tiny perfection, examining it more closely under one of the microscopes. Spencer showed us another red, curled specimen in plastic. “A human embryo,” he announced. “Less than four weeks old.” Unbelievable, but there it was, tiny, more intricate than the pig, with a spot for the eye and the definite tracing of a spinal column. In all, he showed us three tiny human embryos, none more than a thumbnail long, but the third larger and more developed than the first. The only human embryos I had ever seen were those in a big picture layout in Life Magazine. These were in my hand, three-dimensional and real. I took the largest human one and compared it with the pig. A sentence from biology class popped into my head. “Well, ontogeny certainly does recapitulate phylogeny, doesn’t it?”

We were gripped by the human embryos and would have liked to see more, if there were any, but Spencer was digging in his cabinet for other exhibits. He showed us something pitch-black ad vaguely cloth-like in a glass slide. “I’ll give you a hint about this one,” he said, playing a game. “It’s animal and mineral and indigenous to the region.” We were stumped. “Carbon?” I ventured. “That’s the mineral part of it,” he admitted. “Well, a fossilized animal in coal?” I tried again. “This is a piece of a miner’s lung,” he stated simply. “The miner died, obviously.”

We didn’t leave Spencer’s house until close to 1 a.m., and we returned the next day. “He’s been expecting you all morning,” his wife said as she brought us to the rear study. We had thought, Carol and I, that we had better make a stab at a proper interview this time, particularly since Carol’s magazine was paying for her part of the trip. She set up her tape recorder and I reluctantly brought out my notebook. It seemed unfair to ruin a social visit. Spencer apparently though so, too. It was hard to keep him to the subject and several exasperated looks were exchanged among us as our host got involved in anecdote after anecdote, complex stories involving his diagnostic skills, but not at all about abortion.

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Trying our best to pin him down to his very first abortion, we discovered that there really was no such thing as a first abortion, a conscious decision to break the law, with trumpets. He had gotten requests from some local women, and he had obliged. “But why,” I persisted, “did you oblige? Most other doctors don’t. Why were you different? Why did you do abortions for women?” He rocked back and forth in his chair. “Because,” he said slowly, “I could see their point of view.”

For Carol, he attempted to describe his medical procedure. After using the packing method for a couple of years, one day he got a circular in the mail for Leunbach paste, manufactured in Germany. “By golly, it worked,” he told us. Later, when the Leunbach was taken off the market, he began manufacturing his own product in his laboratory, a mild soft-soap solution, which he used to dilate the cervix and loosen the conceptus in the first stage of his procedure. The following day he would complete the curettage. Spencer refined his own technique and he stuck with it for 40 years. The newer methods didn’t interest him.

Spencer told us that he was following with keen interest the recent attempts to liberalize abortion laws in several states. He himself had written Governor Shafer of Pennsylvania. “I told him that most of our laws are from the English,” he said spiritedly, “so why don’t we go to work and copy the one they just passed?” He talked about his letter-writing with the righteousness of an American Legionnaire or a Rotarian, which was not surprising, since he later told us that he was a founder of the Pennsylvania Legion and had been an active Rotarian all his life. His father had been the district attorney of the neighboring country. Did that explain his remarkable record of longevity in a career which is usually marked by the law crashing down on the practitioner’s head? “No,” he said thoughtfully. “I’ve been here since 1919. I daresay I’ve helped out half the town. Even on the abortion end, there is probably one of my patients related to a family in half of the town. I think most of the town would stand up for me.”

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It was 4 p.m. and beginning to snow, and Rappaport was urging us to get going. We said our goodbyes reluctantly. “Please come back and visit again soon,” Spencer urged. I had noticed that among his vast collection of books was a Writer’s Market ’69. Had he been thinking of publishing something, I inquired. Spencer smiled wistfully. Did he want an article about him in a major magazine, with a picture, I pushed. He allowed as how once the New York Times had been interested, but his lawyer had thought that the time wasn’t right. He still had an indictment hanging over his head. References to Spencer had appeared in print, but usually he was “the legendary Dr. S.” Time Magazine, as far as I knew, was the only mass circulation magazine to print his name in full. I told him I thought the time couldn’t be more right for publicity. The idea seemed to appeal to him. Punctiliously he gave me the address and telephone number of his lawyer in Pottsville, and then, special privilege, his own private unlisted number at the house. “We’ll do it for your 80th birthday,” I promised. He had told us that his birth date was March 16, and he was going to celebrate by shutting the clinic for a month and taking his wife on a trip around the world.

Last week I got a call from Dr. Rappaport. Spencer had died that morning at 5 a.m. ❖

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From The Archives Health Healthcare NEW YORK CITY ARCHIVES NYC ARCHIVES THE FRONT ARCHIVES Uncategorized

Emergency Room, 1977

Last December Robert Baldwin was brought to Kings County Hospital with lumps, bruises, and facial lacera­tions. The nine-year-old boy’s father wanted him treated quickly and released. The boy’s doctors wanted him kept at the hospital. They suspected Robert was the victim of parental abuse.

The doctors frantically tried to locate a Social Service worker to intercede on behalf of the state, having no power themselves to hold a child without the parent’s consent. But no one was on duty. Six of the 11 Social Service workers assigned to Kings County had been lost through budget-tightening attrition. Robert Baldwin went home.

A month later he was back in Kings County — dead on arrival. His head had been bashed in. His father was indicted for murder.

Robert Baldwin was one of over a million people who last year came to Kings County Hospital in Brooklyn’s East Flatbush seeking medical attention. In New York City, if you are poor and sick, you go to one of the 17 city hospitals. In Brooklyn, for many, that means Kings County.

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At least 50 per cent of the patients at KCH, as it is commonly called, use the institution as their family doctor. The hospital treats them for anything, from a common cold to lung cancer. The majority of the patients are minorities on Medicaid, many are old. Few middle-class whites go there by choice. Those who do are usually accident victims.

On a freezing Friday night I visit KCH. Depression hits as soon as I walk through the front doors. The walls are chocolate brown, and hard fluorescent lights bathe the large lobby. Vending machines offer a selection of processed junk — soda, candy, potato chips, bad coffee. The information/registration booth is jammed with seven staff people watching television. Off to the left of the lobby is a door leading to the long corridor of the emergency room. A sign bears the legend: HOSPITAL STAFF ONLY: NO VISITORS ALLOWED. I walk through the doors, no questions asked.

The long corridor is in a state of commotion. An old man being administered oxygen through a face mask is wheeled by. Nurses carrying clipboards try to meet the demands of the patients and their friends and relatives, who are clogging the corridors. NO SMOKING signs are every­where. So are people smoking: cops, patients, doctors. Three doctors are leaning against the wall outside the X-ray room, waiting for negatives. A badly battered black woman is wheeled by on a stretcher. She looks like she has been beaten, for both her lips are badly swollen. She is wheeled into the Female Treatment Room.

“The chicks that come in here,” one young doctor says. “Christ, you’re lucky if you can find one that isn’t all used up. It’s as hard as finding a good car at a police auc­tion.”

The other doctors laugh.

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A Hispanic man in his mid-thirties limps toward me. He hands me a set of papers. He assumes that because I am white I am a hospital official. It isn’t a bad assumption. The only other white faces belong to cops, doctors, and nurses.

I take his papers. His name is Miguel Avilla. On the form his ailment is recorded in a chicken scrawl of medical jargon. But I manage to make out one word — kidneys. I ask Miguel if his kidneys are bothering him. He nods yes. I ask how long he has been waiting. He tells me since 7 p.m. It is now 10:15 p.m.

I walk over to a group of cops hanging around. Some are here with prisoners. Two of the cops have suffered injuries while making an arrest. Nothing criti­cal — a dislocated shoulder and a sprained hand. Patrolman Gene Getlin from the 71st Precinct is taking a statement from the two injured cops.

“They’re never gonna believe this statement, you know,” Getlin tells his colleagues. “I mean you guys were assigned to community relations tonight and you wind up rolling down a flight of stairs with a couple of punks. You gotta write it down in plain fuckin’ English or else the dummies at the review board will break your balls.” The two cops tell him that shots were fired but no one was hit. It is unclear who did the firing. One of the injured cops is infuriated because the doctor is treating his prisoner, and he wants to go home.

There are two prisoners. One is black, no more than 18. His face is badly beaten. The other is a Hispanic, also badly beaten, wearing torn leather shoes without any socks. He has on a T-shirt and a ski jacket. Both are handcuffed behind their backs as they are being examined.

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I ask a nurse if keeping prisoners in shackles is standard procedure. “I’m afraid it is, honey,” she says.

The injured cop is now ranting: “They’re not even supposed to examine prisoners and arresting officers in the same room, for Christ sakes,” he says. “That directive came down last year. But there they had me sittin’ on one bed and the two punks on the other. The doctor, he asks the Spanish guy, ‘What did he hit you with?’ The spic tells him, ‘With everything.’ I shoulda hit him with a tank, the prick.”

A sobbing black man hobbles along. His sneakers are untied and the laces are wet with mud. His face is a moonscape of deep pockmarks.

I ask him his name. Between sobs, he manages to tell me that it is Jackie Green and that he is 47 years old. I give him some tissues to wipe his eyes and nose. Instead he hocks up an inch of oxblood-colored phlegm and spits it into one of the tissues.

I ask him why he’s here.

“Gimmie a shot, gimmie a shot, gimmie a shot,” is all Jackie Green says.

“A shot of what?” I ask.

“A shot of… for my equal librium.”

“You have to see a doctor,” I tell him.

“I already seen a doctor. I walked out because I know they’ll put me in that other place. Where they put me before. The place with the bars on the windows. But I didn’t do nothin’ wrong. I can’t breathe and I’m shaking in the morning. So I’m goin’ home.”

“How far do you live?” I ask him.

“Near Burger King.”

“Which Burger King?”

“The one near where I live.”

I tell him to sit while I go to get him help. I ask a nurse if someone can treat him. She tells me that no one can understand what he’s talking about. When I return to the waiting room, the chair where he was sitting is empty — except for the two used tissues.

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Karl Adler, an energetic man in his early forties, has been head doctor of adult emergency for the past two and a half years. I ask if staff morale is hard to maintain.

“It isn’t easy,” he says. “We’ve suffered major cut­backs. When you run out of certain medicines and materials — along with a total lack of ancillary care or support services — it can become unbearably frustrating.” There have been cases in which a patient was prescribed antibiotics when they were not needed, because there was no microcosmic urine analysis or no patient case history. Records are not kept. In fact, one of the major problems at KCH is record-keeping. The people who once kept records here have all been lost through attrition. So there are no statistics on things like gunshot victims, knifings, rapes, malnutrition, drug overdoses, or suicides. But Adler insists that health care at KCH is good — “as good if not better than most private hospitals in the city.”

“Sure there are long waiting times and the amenities might be awful,” he says. “But everyone is treated the same. In fact, when President Ford was campaigning here in Brooklyn, someone from the Secret Service came in and asked what kind of treatment Ford would get if he was injured. I told him he’d have to wait like everyone else.”

Clarence Darden is sitting in a wooden wheelchair. He tells me he has been awaiting treatment, since 9 a.m. It is now 11:30 p.m.

“I’m hungry enough to eat me a fuckin’ kangaroo,” Clarence says. “I’ve been sittin’ on this hard-assed fuckin’ chair all damned day and they ain’t give me nuthin’ to eat, man. Shit.”

I ask him what kind of work he does.

“I made manhole covers,” he says. “You know, them round metal manhole covers. They make the manhole covers out of melted-down guns that the police take away from criminals. Well, one of them hit me right in my teeth as it was spinning down the belt, like, I can’t explain just now, but a manhole cover hit me in my teeth and knocked all my teeth outta my head. Then I broke my back last year, too. I spent four months in this place. Lost my job ’cause I broke my back.”

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Clarence receives $47 every two weeks from welfare now. His monthly rent is $52. He takes out his wallet to show me his Medicaid card. There is a photograph on it of a man named Clarence Darden who doesn’t look a day older than his 35 years, dressed in the quality clothes you wear when you have been working for awhile. The man in the wheelchair has aged 15 years in the past 12 months.

I ask him what is troubling him now.

“My back again,” Clarence says. “I was comin’ home from my uncle’s funeral. My uncle was mugged and got himself stabbed to death. He was an old man, they didn’t have to kill him. You know what I mean, mugged? Well, I’m comin’ home and I slipped on some ice and I hurt my spine or my back, I don’t know which one. It hurts like a sonabitch. You heard about my uncle right? Everybody in the neighborhood did.”

News travels slowly from Bushwick these days.

Across the lobby is the pediatric emergency room. A doctor tells me that many children suffering from cold weather afflictions such as exposure, frostbite, and asthma are being brought in. One very young black child, in her mother’s arms, is coughing and wheezing heavily. Congested, impacted phlegm is mauling her small lungs. She cries in bewilder­ment. The mother speaks into a pay phone, explaining to a friend in a melodic Jamaican accent that she is at the hospital because her apartment is so cold the child became ill. “I haven’t been as warm as I am right now in weeks,” she says: “You know, I hate to say this, but I wish my baby was even sicker. I wish she was sick enough so they’d have to admit her into the hospital. At least then she’d be warm.”

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Healthcare THE FRONT ARCHIVES

Round-the-Clock Care, Half-the-Clock Pay

Socorro Toribio emerged into bright sunshine on a recent Wednesday morning in July after spending four days in her bedridden client’s Lower East Side apartment. Although the sixty-year-old home health aide said she hadn’t stepped outside since arriving at work the previous Saturday, she was eager to head home to the Bronx apartment she shares with her eighteen-year-old grandson.

“A lot of work last night,” Toribio said in Spanish, letting her head, wrapped in a Dominican flag scarf, tilt to one side.

Yet despite feeling sleep-deprived, Toribio didn’t head home after work that day. Instead, she took the train to Downtown Brooklyn to the headquarters of the state Department of Labor, where home health aides held signs in Spanish, Chinese, and English denouncing the state policy under which they are allowed to be paid for just thirteen hours of their 24-hour shifts.

The state labor department’s longstanding guidance to home care employers is based on the assumption that aides are able to sleep and eat during the other eleven hours, mostly uninterrupted. But workers say that’s rarely the case. While working consecutive 24-hour shifts, for example, Toribio says she gets up multiple times each night to check her diabetic patient’s blood-sugar levels, help her change position, change her diaper, and respond to the frequent night-time outbursts that come with advanced Alzheimer’s disease.

“Some nights the patient calms down and I get a little rest,” said Toribio, “but not much.”

While Gov. Andrew Cuomo has touted his support for the “Fight for $15” — the movement that succeeded in raising the minimum wage to $15 in New York City by the end of 2018 — his administration is aggressively pushing back against workers like Toribio who are fighting to get paid for a full day of work. Last year, multiple courts ruled that home care workers should get paid for every hour they’re at their clients’ homes. Yet since then, the state Departments of Labor and Health have actively sought to preserve the thirteen-hour policy, arguing that the higher costs could destroy an industry that allows elderly and disabled New Yorkers to remain in their homes.

Critics of the administration’s response say it’s time for the state to come up with a way to sustain the largely government-funded home care industry without relying on free labor. Home care industry groups estimate that could cost billions of dollars. But without the administration revealing, at the very least, how many patients actually receive 24-hour care, it’s hard to get a clear picture of what the impact would be.

What’s needed, says Assemblymember Richard Gottfried, who chairs the Assembly Health Committee, is “coming up with a cost estimate and then making sure there’s money in the state budget to pay for it. It is abhorrent to tell workers that we expect them to work without getting paid.”

***

The number of retirement-age Americans is set to double between 2016 and 2060, according to the Population Reference Bureau, and the demand for home care is rising. But few states make the service as accessible as New York, which helped pioneer the shift toward home care as a safer, more cost-effective, and more humane alternative to nursing homes. In New Jersey, for instance, it’s much more difficult for an older adult to qualify for home care under Medicaid, the government-funded, state-run health insurance program for low-income residents.

Because Medicaid coverage is more robust for home care in New York, 24-hour care is more common. “An aging population is not unique to New York state but New York is unique in that it has an opportunity to set a tone for what home care could look like,” said Amy Torres, director of policy and advocacy at the Chinese-American Planning Council Home Attendant Program, which provides home care services. “That means fully funding the work people are doing and making it so the 24-hour shift is not commonplace.”

Home care accounted for $9.3 billion of New York’s roughly $70 billion Medicaid budget last fiscal year, according to the state Department of Health. In New York City, where more than three quarters of the state’s 224,400 home care employees work, 93 percent of home health aides are women and 79 percent are immigrants. The union 1199SEIU United Healthcare Workers East has estimated that 8 percent of the home health aides in New York state work 24-hour shifts.

The Cuomo administration has declared that it is adding $6 billion in new funds for home care from 2015 to 2021 to pay for the long-overdue gains the workforce has made in recent years, such as overtime and minimum wage protections that were extended to these workers for the first time in 2015 by the Obama administration. Yet the thirteen-hour policy is one relic of home care’s past that has been particularly hard to shake.

Recently, home care workers have filed more than 145 class-action lawsuits against New York home care agencies challenging the policy and seeking back wages for workers’ uncompensated hours, according to the law firm Littler Mendelson, which represents home care agencies. In October, workers achieved a victory when two state appellate divisions ruled in their favor in lawsuits that have the potential to set a precedent for other cases.

But home care employers cautioned at the time that if the rulings are upheld by the state’s highest court, they will lead to rising costs that could cripple the industry. In addition to doubling the cost of providing 24-hour care, the rulings could make home care agencies liable for back wages for any aide who has worked a 24-hour shift in the last six years, per the statute of limitations in New York.

Littler Mendelson has calculated it would cost a single home care employer an estimated $600,000, plus fees, to pay the back wages owed to just a single home health aide if a court rules in the aides’ favor. (That estimate, though, is based on the unlikely scenario of an aide working 24-hour shifts, seven days a week, for the same agency for the entire six years.) Meanwhile, the price of 24 hours of home care under the current wage regulations in New York City would go from about $222 per day before overtime and administrative costs to about $410 — similar to the average cost of a day in one of the city’s nursing homes.

“In other cases employers always suddenly announce that they’re impoverished when they get sued for having egregiously violated people’s rights,” said Richard Blum, an attorney with the Legal Aid Society who has represented both home care workers and patients. “And we see when regulations are proposed that would ameliorate conditions for workers the industry comes out and says, ‘Oh no, we can’t afford that; we’ll go bankrupt.’ We hear that all the time.”

The difference here, Blum said, is that much of home care in New York is publicly funded. Both labor advocates and home care employers hold the state responsible for the situation the industry is in, and are calling on the state to help clean up the mess it created. But how it should go about doing that is a point of contention.

***

On the same day that Toribio and her colleagues rallied outside the state Department of Labor, the department held a public hearing on proposed regulations to codify the thirteen-hour policy into state law, in an effort to fortify it against lawsuits saying the state is violating its own minimum-wage laws. The department issued a temporary update to that effect in October, and has been renewing it without public input ever since by categorizing it as an “emergency”; the department finally scheduled the public hearing in order to make the regulations permanent.

Keeping the thirteen-hour policy intact is necessary to “prevent the collapse of the home care industry, and avoid institutionalizing patients who could be cared for at home,” the Labor Department said in the explanation for its emergency regulations in the state register.

The state stepped in with the emergency regulations after many home care agencies moved to immediately comply with the court rulings rather than risk further liability. After the court decisions came out last year, some agencies started demanding more money from Medicaid, threatening to discontinue care for 24-hour patients if they didn’t get enough funding to pay their employees for all 24 hours, according to emails sent to the state Health Department that were obtained through a Freedom of Information Law request.

“This is a very serious issue for us as Good Care Agency closely adheres to NYS labor laws,” the home care provider wrote in an email to Elderplan/Homefirst, a Medicaid-funded health plan it had a contract with, in May of last year. “We only see two ways this scenario will go from here. Either we are provided with new hourly rate authorizations for live-in cases or we request for these cases to be removed from Good Care Agency effective immediately.”

Elderplan forwarded that email and others like it to the Health Department. It also forwarded the department a letter it sent to Good Care Agency reprimanding the home care provider because it had threatened to “abandon one or more of our members.”

The state’s emergency regulations were supposed to quell home care agencies’ fears and stop this chilling effect on 24-hour care, but they haven’t necessarily succeeded. “Many agencies have stopped providing these services,” making it difficult for Medicaid beneficiaries who need 24-hour home care to find it, Claudia Hammar, president of the New York State Association of Health Care Providers, said at the hearing in July.

Meanwhile, home care workers and grassroots labor organizations have sued the Labor Department and its commissioner, Roberta Reardon, to void the emergency rules, calling them a “drastic departure” from the state’s minimum wage law.

State Assembly members Harvey Epstein and Jo Anne Simon say they want to work with stakeholders to come up with comprehensive policy solutions rather than simply holding onto the thirteen-hour policy at all costs. Epstein, who was elected to the assembly in April after serving in a senior role at the Urban Justice Center, a nonprofit legal organization that represents some of the home care workers who have sued their employers, says, “If the Department of Labor enters these rules [reinforcing the thirteen-hour policy] then it’s up to us in the Assembly and the Senate to pass legislation to overturn this really ridiculous idea that people don’t have to be paid for the hours that they work.”

Cuomo has yet to publicly weigh in on this issue and his office did not respond to a request for comment. But when the governor wants to support a cause — even an expensive one — he has found a way to fund it.

Back in 2016, Cuomo wasn’t deterred by concerns home care industry groups raised that they wouldn’t be able to afford a higher minimum wage. After the Fight for $15 was successful, Cuomo promised Medicaid would cover the cost of the increase for some home care agencies and other health care providers, which will soon amount to more than $1 billion annually.

In the last budget session, Cuomo’s fundraising proposals for health care were diverse: They included new taxes on private health insurers, surcharges on opioid manufacturers, and a tax on a major sale of a nonprofit to a for-profit company. Cuomo also proposed reining in rising home care costs by limiting eligibility to higher-need patients, although that measure wasn’t included in the final budget.

“We make difficult financial decisions all the time,” says Epstein. “The answer can’t be that the government can’t do it, and that this has to be on backs of low-wage workers who are already some of the lowest-wage workers in the country.”

***

Toribio moved to the U.S. from the Dominican Republic about twenty years ago and started working as a home health aide shortly after, reasoning that it was better than working in a factory. “If you don’t speak English there aren’t a lot of options,” she said. Toribio has been with her current patient for about a decade, and says she’s developed a lot of affection for the woman, who is only about fifteen years her senior. While some of her colleagues are calling for an end to 24-hour shifts altogether, she says she just wants to be paid for all the hours she works and “to not be abused.”

Home care agencies insist that no one should be working 24-hour shifts in the first place. “None of our employees is responsible for providing 24 hours of care,” said Jocelyn Lee, executive director of First Chinese Presbyterian Community Affairs Home Attendant Corporation, the agency that employs Toribio. “Workers are responsible for reporting to the agency if they are unable to get their uninterrupted sleep due to the patient’s condition so that a nurse can visit the patient to assess whether a different level of care is required, and to ensure the worker is properly compensated for all hours of work.”

But during the hearing, worker after worker testified before Labor Department officials that they had not been paid for the hours they worked at night, even if they reported them; two aides said they were taken off of 24-hour cases after reporting nighttime hours.

Asked if she had ever reported the nighttime hours she works to her coordinator at the agency, Toribio scoffed. “What for?” she said. “The coordinator knows.”

Although aides are officially supposed to get compensated if they don’t get the requisite amount of sleep and meal time, Medicaid funding for home care isn’t structured to accommodate that level of flexibility. Typically, Medicaid pays a flat monthly rate for each member to cover the cost of the services they need.

A spokesperson for one nonprofit agency that paid 24-hour aides for the nighttime hours they reported for a period of time said, under the condition of anonymity, that the organization pulled from its operating budget and funds raised on its own to cover the extra hours.

Home care patients who require a level of care that regularly prevents 24-hour home attendants from getting the requisite sleep and meal time are supposed to be approved for “split-shift” care, which is broken up into twelve-hour shifts performed by two different aides. However, in the city that level of care is notoriously difficult to get approved by Medicaid.

Shirley Ranz, a retired pharmacist who lives in Sheepshead Bay, Brooklyn, said the state’s labor policies led her to find an alternative to 24-hour home care for her mother, even though she qualified to receive it under Medicaid when her mother’s Alzheimer’s started to advance.

Ranz said her request to have aides care for her mother in two twelve-hour shifts was denied, even though her mom would often wander at night. “Sometimes the aide would come in the morning and every dish and pot and pan in the kitchen would be spread all over the floor,” Ranz said. Eventually Ranz’s brother moved into their parents’ house to care for their mother.

“When I learned the aide would only be paid for thirteen of 24 hours I had two reactions,” Ranz said. “One was, ‘How could they do this to these people?'” The other, she says: “If the aide can’t get to sleep at night, it’s a danger to my parents as well as to her.”

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Health Healthcare Living NYC ARCHIVES THE FRONT ARCHIVES The Harpy

How to Live in a Female Body

There’s a moment in every woman’s life when she discovers her body isn’t her own.

At the first uninvited touch, the first catcall, the first time the word “no” is said but not heard, she realizes it was never hers. Or not entirely — not like she thought it was, elbows and knees and thighs moving under her power, the whole many-celled complex of flesh subject solely to her will. To some it will always be property, to be moved and manipulated, admired or denigrated, for their own fleeting pleasure or gain. To move in a female body is to carry yourself through the world as a flicker of will in a machine others consider a tool for public use.

I was fourteen the first time I let something happen to my body. I hovered just inside myself, in the space where I knew what was happening to me had little to do with what I wanted, or what would give me pleasure. I lay back feeling the minutes pass with unsultry slowness, letting the whole thing commence with little involvement. All I wanted was to keep the peace and keep what I thought, back then, was love. The assignations continued for months. He was older; technically, it was illegal; practically, I channeled the dual forces of self-loathing and love, so potent in me then, into the process of making myself disappear for twenty minutes at a time, and letting my body remain on the bed.

I was too young even to be angry at him.

I displaced my anger at him, transferred it to anger at the strict religion I grew up within that quite literally prohibited women’s voices from being heard and from leading prayer; that partitioned us off in holy spaces, that told us our bodies were unclean. I ate on fast days and hid in the bathroom during morning prayers at school. I turned my anger at him into anger at myself. I burned myself with matches. I learned how much pressure one must apply to cut oneself with a safety razor: Breaking the skin is easy; making a thick scar is much harder. The physical piercing of my skin made the wave of pain I felt crest and break; physically anchored somewhere in the world, it could no longer flood my mind.

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The official doctrine of Orthodox Judaism prohibits all contact between members of the opposite sex outside of the covenant of marriage, even a brush of the hand or a tap on the shoulder, because women exist in a perpetual state of menstrual impurity.

In practice, of course, animal urges dart through the thickets of desire; hands touch hands and more than hands. But throughout those early encounters I grew used to what would define so much of my contact with men in the subsequent fourteen years. My body was a vehicle for the fulfillment of male desires. The ghost of my will flickered in the machine, tapped out for whole incidents, returned. Each time there was a little less of me when I came back to my body. To those I wanted to love so much, my breasts and my thighs were more welcome than I would ever be.

I didn’t know to expect any better.

I still wanted to be touched and to be adored, wanted sexual fulfillment, even if I wouldn’t have phrased it that way back then. That thirst returned me again and again to the brackish, putrid pool of bad love.

But it’s one thing to yield to an advance in the name of peace — to go along out of appeasement or even curiosity, or the hope that what happens will give you pleasure, even if it doesn’t. It is another thing entirely to say “No,” and say it loudly, and have it ignored. It removes all plausible deniability, and exposes the bad bargain for what it is.

I don’t remember all the details of the night that first happened to me; it happened to me precisely because I was in a state not to remember all the details. All he wanted, said my classmate who was mostly a stranger, was a kiss. He pulled me onto his lap and I wriggled away, as I stumbled out of my dorm room and he followed, as I took the back stairs and he pinned me against the wall of the staircase, as I turned my head away so forcefully my neck hurt the next day, as I pursed my lips so hard they swelled. The world wheeled drunkenly around me but I knew I had felt the word “no” in my throat; my vocal cords had vibrated, my tongue made the appropriate motions, my mouth opened, the word arced toward him in the air, and it didn’t matter. It is one thing to be thrust against as you lie there so indifferently you try imagine yourself into bodilessness. It is another thing to have your voice taken from you — to have your dominion over your body challenged. I extricated myself from him like a splinter taken from an eye: painfully, painfully.

The man who raped me, years later, had been my lover for months. He was not a stranger. He had doled out pleasure in miserly fashion and I had taken what I could. But I was drunk — not catastrophically; I could walk; I felt safe enough to have gotten drunk, to be a little dazed, a little dreamy — and I realized too late that he had entered me without a condom, the condom I took from my purse and gave to him and asked him to wear; I had agreed to sex but not this sex, not unsafe sex, I had agreed to sex with a man who had made me feel safe and then had waited until I was weak enough to violate. He tried to placate me but I couldn’t be consoled, not by him, at any rate. I went to his roof and cried until the windows of Manhattan were too blurry to see on the horizon, and melded together into a wobbly blush of light. For a decade I had vacated my body when I chose to, letting men use my limbs for their pleasure; but I had allowed it, I had chosen it, I had known what I was in for. This act of theft rendered my body not my own.

Looking back over fourteen years of involvement with men feels like flipping through a catalogue of trysts and violations. A small Rolodex of assaults, each one still searing to remember — groped by strangers on a train and in a backroom and a city park; fingers appearing where they had no permission to be, or where they had been forbidden to be; kisses taken, not given; an array of wheedling and incessant demands reluctantly acceded to and later regretted. Good and bad love are each represented there, but when I am alone at night the bad love thrums up from my memory, reminding me I am less than I was.

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When I hear women talk about the frustrating ways our voices seem to disappear into a void when we speak with men — when our areas of expertise are explained to us; when our work is undermined; when our contributions are dismissed in meetings, our credentials doubted, the very tones of our voices subject to criticism — I think of how much these complaints overlap with the ways our control of our own bodies is denied us. I wonder how many women have said “no” and had it deliberately go unheard, like so many other words we speak. When I talk about what I know — about the history of the Hebrew language, or Russian literature, or the strange depths of the Internet — sometimes I think of asserting control over my body and having it denied me, and wonder if I should speak at all.

The laws of this country so often dictate what happens to women’s bodies. The noose around our freedom to control our wombs is tightening, with the prospect of the nation’s highest court dictating from above that we are vessels for the growth of men’s seed, prevented by law from reversing the processes that happen just under our skins.

The notions that we are vessels for pleasure or for procreation are intertwined, and the overarching message is identical: Your body is not your body. Your body is a means to an end; the ghost inside that is your will doesn’t matter. You can say no; you can scream it; you can shatter your larynx like glass screaming no, and there will be those who out of sheer indifference or avarice for pleasure or unhearing zealotry treat it like silence.

I am twice the age I was when I first learned how to disappear inside my body. I wish I could say I have attained some combination of wisdom and clairvoyance that would allow me to foresee who may be a caring lover, and who will treat the word “no” as an inconvenience or as nothing at all. All I have gained is rage: rage that I can feel blazing in every limb, rage at a world that would rather I be a voiceless sac for fetal growth, a mindless conduit for the pleasure of others. I have taken the mourning I feel for the larger and less frightened self I could have been and forged it into a hot little dagger, one that I would like to plunge into the fat and self-satisfied flank of a world so willing to steal my voice. There are days and weeks when I feel like crumbling into ash. But I have chosen instead to fight, to raise a big and hideous and ungovernable howl for the girl I was and the girls who have yet to be. I don’t want them to ever have to pass through the ghastly syllabus of bad-love lessons etched on my skin; I want to erase it, rewrite it, dictate a will and testament that grants every woman absolute dominion over her own four limbs and every cell in between. I want to live with pen in hand, mouth open, reclaiming my voice at a volume that can shatter stone.

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Healthcare THE FRONT ARCHIVES The Harpy

Elon Musk and the Cult of the Celebrity Savior

On Wednesday, Elon Musk — celebrity tech genius, aspiring space mogul, and Tesla chief — made a dramatic announcement: He was going to help the people of Flint, Michigan.

It was an unexpected development in an ongoing crisis; two and a half years have passed since the initial declaration of a state of emergency in Flint, in January of 2016. In April, Michigan ended a program distributing free bottled water to the city’s residents, though by the end of June, only 37 percent of the lead pipes in the city had been replaced.

Musk’s concrete plan remains unclear, though he added that he would organize a weekend in Flint to “add filters to those houses with issues.” The proposal rapidly rang up likes, and replies oozing with admiration, including one Twitter fan who expressed concern that Musk was letting his humanitarian impulses interfere with the work of creating very expensive electric cars. “You’re the most influential person on earth right now and you’re already working on some of the most challenging problems facing mankind. If you don’t stay focused, it will take you longer to achieve,” the fan remonstrated

Elon Musk’s adoring fans — who flock to his Tweets in the hundreds, laud his successes, and even write erotica about him — typify a deeply American idolization of the wealthy. His direct engagement of fans and foes alike gives him an outsize footprint online, even for a much-lauded Silicon Valley billionaire, and fans have responded in kind. Musk devotees savage his detractors, portraying him as a savior, someone on the verge of changing humanity’s future. An individual who has made good — even if the foundation for his fortune came from his father’s emerald mines in Zambia — can do little wrong. Musk’s fans (Muskrats? Elon Rangers?) seem to identify so strongly with him that they want to become him: In their ordinary lives, they are, to paraphrase John Steinbeck, merely temporarily embarrassed billionaires. 

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Musk’s instincts as a showman help cultivate this slavish following. His announcement about Flint marked the second time in a week Musk had stepped in to a well-publicized crisis with the goal of playing savior. Five days ago, as the world fixed its eyes on twelve boys trapped in a cave complex in Thailand, Musk began ideating to his 22 million Twitter followers about ways he could contribute. “Maybe worth trying: insert a 1m diameter nylon tube (or shorter set of tubes for most difficult sections) through cave network & inflate with air like a bouncy castle,” he wrote on Twitter.

As rescue efforts got under way, Musk was working on a small submarine, designed for underwater rescue. On Twitter, he posted brief videos of a child-size, torpedo-like tube, dragged by divers through the crystal waters of a Los Angeles pool. Meanwhile, skilled divers from the Thai navy rescued all twelve boys. Perhaps it was a newly ignited messiah complex — or just a simple taunt — that led to Musk’s new overture to Flint residents. His initial pledge was in response to a simple challenge: “Hey @elonmusk I heard a bunch of people saying there’s NO WAY you could help get clean water to Flint, Michigan,” wrote twitter user @DylanSheaMusic. With his boy-size submarine marooned in Southeast Asian waters, the billionaire had found a new puzzle to solve, closer at hand.

It seems more fitting that Musk would be able to enact his desire to rescue desperate people in America. We’re a nation that perhaps uniquely relies on infusions of cash from strangers to meet our basic needs. Americans without health insurance, or health insurance inadequate to meet their medical expenses, routinely turn to crowdfunding sites to appeal for cash. Between 2010 and 2016, $930 million was raised on GoFundMe.com for medical campaigns — nearly half the entire amount raised on the site during that period. In the wealthiest country in the world, hundreds of thousands of citizens hope for haphazard, unpredictable public philanthropy to provide them with blood, breath, and water.

Others have appealed directly to celebrities to deal with financial troubles — including those who number among the 44 million Americans who hold a collective $1.4 trillion in student debt. The rapper Nicki Minaj has paid off thousands of dollars in student loans owed by fans who have appealed to her directly on Twitter. Taylor Swift sent a check for $1,989 to help pay off a fan’s student debt shortly after the release of her album 1989.

In this context, the concept of a big-hearted celebrity publicly stepping in where the government has failed seems almost ordinary. There’s a rich seam of tradition when it comes to the wealthy laundering their mixed reputations via good deeds in this country — from Andrew Carnegie papering over his bloody union-busting past with a spate of sponsored libraries, to prodigiously corrupt political operative Boss Tweed distracting New Yorkers by handing out extra coal and Thanksgiving turkeys. Musk’s gesture to help Flint suits his flair for spectacle; it typifies his attitude toward public action, providing a direct gift to both an adoring public and media outlets, who rushed to cover the statement. Jeff Bezos, the famously parsimonious founder of Amazon, tried out a more muted version of direct-to-consumer philanthropy when he asked for Twitter’s input last year in how to direct his vast fortune toward the public good. His request received nearly 60,000 comments, which boosted everything from tech education for women to voter-registration drives to multiple requests for universal healthcare.

But a society run on the benevolence of celebrities — or even the earnest helpfulness of strangers on the Internet — is a society in a state of permanent precariousness. The distribution of public goodwill is an economy not of labor but of attention. Personal fundraisers are ubiquitous on social — for rent, for debt, for hospital stays. A scroll through GoFundMe’s page for leukemia fundraisers is a heart-wrenching endeavor: hundreds of children in hospital gowns, women with shadowed eyes and patchy hair, men holding dogs and smiling wanly, seeking thousands of dollars from strangers. Of course, these are only a fraction of America’s cancer patients, but in a fractured and inadequate healthcare system — in which American cancer patients spend far more and have a higher mortality rate than their European counterparts — the rise of online medical appeals is striking.

Of the quarter-million medical campaigns on GoFundMe each year, which will raise hundreds of thousands, and which will raise none? In 2017, a diabetic artist named Shane Patrick Boyle died alone in Arkansas after coming up $50 short on a crowdfunding campaign for a month’s worth of insulin. In an attention economy, who will live and who will die is at least partly determined by how attractive or tragic they look in a single picture

I do not mean to denigrate the power of public philanthropy. The rush of goodwill on social media toward worthy causes can be phenomenally inspiring; it can transform the lives of cancer patients, desperate parents, and victims of violence. But crowdfunding medical expenses has real and obvious limits. Life and death, debt and homelessness are questions too big to be left to the curious, alchemical happenstance of going viral — or the lucky chance of catching a wealthy savior’s eye.

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In a country which fails to meet its citizens’ basic needs, the public purse is afflicted with a perennial parsimony, opening swiftly to fund war, but hesitating over the alleviation of pain. The “American dream” is one of hard and unrelenting work to make good; its dark converse is the ubiquitous American idea that those who haven’t made good, who struggle, who suffer, who need, simply haven’t worked hard enough. Against all evidence, many Americans believe that hard work is all that’s required to attain stratospheric wealth, a fortune the size of Elon Musk’s.

It’s far too early to judge Musk’s efforts in Flint. They may achieve wild success in a single weekend where the government of Michigan has failed; they may be a flash in the pan, or an unrealized dream, like his plan for a Mars colony. At the outset, it seems unlikely that he will be willing to replace the remaining 63 percent of the city’s lead pipes, a complex, expensive, multi-year process, or to painstakingly rebuild residents’ trust in water that poisoned them for months before the government copped to its contamination. What seems certain is that it should not take the intervention of a billionaire for Americans to have clean water. It should not take deft Twitter skills or soft-focus photos to be able to pay for cancer surgery, or take until retirement to pay off the cost of a college education. It seems to me it is past time to create a political system that doesn’t leave our lives and deaths to luck. That is the potent, secret promise of sweeping social policies like Medicare for All, free public college, and a universal jobs guarantee: It doesn’t have to be this hard, this desperate. Perhaps it’s time for all of us “temporarily embarrassed millionaires,” and real millionaires, and billionaires, too — to see each other as worth investing permanently in.

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Healthcare THE FRONT ARCHIVES The Harpy

Donald Trump and the Coming War on Women’s Rights

The history of women in America before Roe v. Wade is a history of blood.

When Caroline had an abortion in 1963, she went alone to a “ramshackle little house” in a disreputable neighborhood of Youngstown, Ohio. Later, in her college dormitory, she labored for twelve hours, alone, and began to bleed uncontrollably. “There was more blood than I ever imagined,” she told the Cut. When, at last, she overcame her fear of seeing a doctor for the aftereffects of the abortion, she was told her life had been at risk.

A reader of Ms. recalled his mother telling him that, after an illegal abortion in her teens, she bled so profusely that her boyfriend at the time collected newspapers for her to sit on, as she waited out the pain in a hotel room, unable to seek medical care without facing potential criminal charges. 

In 2018, after decades of erosion, the last levee protecting reproductive rights in the U.S. seems poised to break. The impending retirement of Anthony Kennedy, and his imminent replacement with a Trump-appointed Supreme Court judge, seems to portend the end of Roe v. Wade, which struck down anti-abortion laws in forty-six states and the District of Columbia in 1973.

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The United States government, seeking to restrict women’s reproductive rights, is bucking a global trend, as countries that have criminalized abortion for decades begin to ease their stringent laws in the face of determined feminist outcry.

Just two months ago, across the Atlantic, women all over Ireland rose up in celebration of a hard-won victory: By an overwhelming margin, the country’s 3.2 million registered voters supported a referendum to overturn a 1983 constitutional amendment that effectively outlawed abortion. From as far away as Sydney and Tokyo and Los Angeles, members of the Irish diaspora returned home to vote on May 25 in favor of a woman’s right to choose, detailing their journeys on social media. The voters, arriving to the whoops of supportive crowds, served as a direct parallel to the women who for decades took lonely journeys out of their home country to get abortions.

“We have voted to provide compassion where there was once a cold shoulder, and to offer medical care where once we turned a blind eye,” Ireland’s prime minister, Leo Varadkar, said in a speech the morning the results were announced.

Last month, in Argentina, a bill to decriminalize abortion narrowly passed the lower chamber of that nation’s Congress, and is currently under debate in the Argentinian Senate. The decriminalization campaign was driven by a multiyear wave of feminist activism, in a movement entitled “Ni Una Menos (Not One Less),” that has demanded a stop to the needless deaths of women at the hands of male partners and as a result of unsafe illegal abortions. Argentina’s vote comes just under a year after Chile voted to reverse its absolute prohibition on abortion, despite vehement opposition from Catholic groups in that country.

In Argentina, jubilant crowds of women in city squares celebrated the passage of the decriminalization bill, wearing the signature green bandanas of Argentina’s abortion rights movement; in Ireland, videos of women weeping with joy at the referendum’s outcome flooded social networks.

Here in the United States, the mood among women’s rights advocates is justly somber. With more than 60 percent of the public indicating, in recent polls, that they wish to see the decision remain intact, the coalition in charge of the government seems to be salivating to fully strip women of access to abortion, at which a series of increasingly restrictive state laws has already chipped away. The legal groundwork for a challenge to Roe is already being laid. In Iowa, Louisiana, and Mississippi, state legislatures have advanced strict limits on abortion that could wind up being the instruments in a Supreme Court case — one decided by a conservative majority.

This prospect is the fulfillment of an official promise by the administration. In February, Vice President Mike Pence told the Susan B. Anthony List & Life Issues Institute, an anti-abortion group, that a change to “the center of American law” would happen “in our time.” Now it’s July, and that time seems near at hand.

But a change in the law is only that. It doesn’t change human nature —  or desire, or love, or desperation, or disease, or loss.

There are as many ways to get pregnant as there are to have sex: in bliss, in recklessness, in despair, in traumatic circumstances. The end of legal abortion in states across the country won’t end rape or domestic abuse; it won’t create more money in families’ budgets for more children; it won’t make birth control more effective or affordable. The end of legal abortion doesn’t mean the end of the consumption of alcohol or drugs; it doesn’t mean the end of heated trysts on stairways and in offices and parking lots and narrow, overheated bedrooms. There were extramarital affairs before 1973 and there will be extramarital affairs after Roe is overturned. The end of legal abortion is merely the end of legal abortion. It won’t change the number of wombs yearly inseminated in this country. 

But when Roe is overturned, more women will die.

There will be unwanted pregnancies carried to term with severe complications or postpartum infections. There will be knitting needles and coat hangers and off-label pills. There will be secret decisions, with a bank balance open and a tear in the heart; there will be fledgling careers to preserve, marriages to save, traumas to expunge. There will be herbs, forceful massage, a sudden fall down a flight of stairs. And some of the women who do what they feel they must will die. Every year, across the world, nearly 70,000 women die as a result of complications from unsafe abortions. A country without legal abortion is not a country without abortion. It’s just a country in which more women die.

To know this is to know that what we face is a long walk into the dark, in the cynical, silencing, hideous, hypocritical name of the “sanctity of life.”

And the true cruelty of such laws becomes more clear when you know — as we know, because history is open to us such as it never has been before, a few taps of a keyboard away — that such laws always, always, always spare the wealthy.

There are planes to different states, just a few hundred dollars away. There are other countries with sterile, friendly clinics for the right man’s mistress, the right man’s wife, the right man’s daughter. There will be salvation, for those who can afford it, in the guise of a well-timed vacation to Europe or Canada.

For millions of American women, Roe v. Wade has already been functionally overturned. More than 400 state laws have been passed to restrict abortion since 2010, when a wave of conservative legislators and governors took power. The theoretical existence of a right means little to those who have no ability to act upon it —  those who lack the financial ability or personal flexibility to travel long distances to receive access to abortion care. There is one abortion clinic in the state of Mississippi, for a population of almost 3 million. Mississippi has one of the highest pregnancy-related mortality rates in the United States, and it is rising.

What’s more: Every law in the United States is enforced unevenly across racial lines. Anti-abortion laws won’t buck that trend. What woman is punished and what woman goes free; what woman lives, what woman dies; what woman can feed her children and what woman cannot — in America, little about these answers is incidental.

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It’s difficult to know all this without feeling pure doom; difficult to look at your belly and know that its flesh will be beyond your control, that the soft, yielding, and familiar terrain of your own body will be bound by laws made by men who know their actions might cause you to die, and who do not care.

But all along the long, dark walk we face, there will be those who risk everything to help, in the tradition of those who have battled unjust governance throughout history. There will be women who fight in the streets and in the courts and in state legislatures. There are already networks of abortion funds, some hyper-local, some national, that finance the secret trips and the stays in the motels and the bus tickets and the plane tickets and the journeys home. There are open purses ready to pay the price for a woman not to have a child if she doesn’t want to. There will be women who swap abortifacient recipes; there will be, as there were before Roe, midwives and chiropractors and family doctors who will perform the procedure nearly a quarter of American women have already experienced, in secret, and under legal threat. Perhaps there will be a revival of the secret feminist network that provided underground abortions to the women of Chicago: All you had to do was pick up the phone, dial a certain numberand ask for Jane.

In time, and after many deaths, and irreversible losses; after blood, and pain, and shame, and careers prematurely ended, and women killed for getting pregnant, and women dying in childbirth, the ban — like Ireland’s and Chile’s — will be lifted. Any path to legislative reversal on the subject will be paved with women’s bodies. We know this. The “sanctity of life” touted by opponents of abortion is extended to an embryo but not to the woman who carries it. And that’s why, despite the seeming inevitability of a federal ban on abortion, women and the men who fuck them and love them will fight to the end; and if and when such a ban is imposed, we will claw our way out of that darkness, until we walk in free bodies again.

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Healthcare Immigration Protest Archives THE FRONT ARCHIVES

’Like Being Inside a 180-Foot Bell‘: A Statue of Liberty Protester Remembers

The dozen-odd members of Rise and Resist who dropped an “ABOLISH I.C.E.” banner from the Statue of Liberty’s pedestal on Wednesday — and the one member who took it upon herself to climb onto the statue itself and announce she wouldn’t leave until “all the children are released” (she lasted nearly three hours until NYPD Emergency Service Unit officers brought her down) — were part of a long tradition of protests at the statue, which as both a symbol of immigrant welcome and the second-tallest female statue in the Americas contains a multitude of symbolism.

In 1970, demonstrators with the National Organization for Women draped a sixty-foot banner from the statue reading “Women of the World Unite!” The following year, members of Vietnam Veterans Against the War spent forty-two hours inside the statue’s crown, festooning it with banners. (VVAW repeated the feat in 1976.) In 1977, Puerto Rican nationalists draped a Puerto Rican flag across the statue’s brow, locking themselves inside for eight hours to call for the release of four independentistas in prison for shooting at members of Congress from a Capitol gallery.

By 1991, the threat of the moment was to abortion rights, as the Supreme Court had ruled in Rust v. Sullivan that the Bush administration could impose its gag rule forbidding women’s health clinics that received Title X family-planning funds from counseling women on abortion. On July 29 of that year, a group of activists with Women’s Health Action and Mobilization (WHAM!) and AIDS Coalition to Unleash Power (ACT UP) dropped a pair of banners from the statue, one from the pedestal reading “Abortion Is Healthcare, Healthcare Is a Right” and one from the statue’s crown reading “No Choice, No Liberty.” 

The banners were abducted by national park security, but the activists slipped away unnoticed. In the wake of Wednesday’s protests, two of the 1991 demonstrators shared with the Voice their recollections of the 1991 statue protest, and their thoughts on its spiritual descendants. 

“We were talking about actions we might take in response,” recalls Dana Luciano, at the time a WHAM! activist and currently an English professor at Georgetown University. (Full disclosure: I was also a member of WHAM! at that time.) “And someone said, ‘We should gag the Statue of Liberty!’ It was kind of spontaneous — I don’t think most of us knew, at the time, about the history of protest at the site. I think we just thought that as a high-visibility female figure, the statue would be a good place to stage a feminist action. It was thrilling to learn afterwards that we were part of a much longer history of protest there.”

As it turned out, an ACT UP affinity group called Action Tours — best known for ambushing Dan Rather’s CBS Evening News during the Gulf War with chants of “Fight AIDS, not Arabs!” — had already been scoping out the statue as a site for protest; the two groups soon joined forces. Around 35 people participated at the statue itself, Luciano recalls, with perhaps a dozen more working on press and legal support.

“Early on we’d realized that actually gagging the statue wasn’t feasible, so we decided to drop banners from the crown — the idea being to cover the statue’s face, like a mourning veil — and the base,” she recalls. “It took about three trips to the crown to figure out how to open the windows so we could hang a banner. It was windy up there, so we weighted the bottom of that banner with a heavy chain sewed inside a few layers of fabric so we wouldn’t damage the statue, which would have carried a felony charge.”

On the day of the action, the activists showed up carrying the two large banners, cinder blocks to weigh down the one that would hang from the pedestal, and additional tools. “We get up there and use special hardware to open the windows the way they’re supposed to be opened — no damage was done,” says Jon Winkleman, an Action Tours member at the time. One activist held a helium balloon in front of a security camera to block its view — “it turned out it wasn’t even on,” says Luciano — while others blocked the steps to the crown to buy more time.

“The banner got tangled, so I’m sticking my head out, reaching outside the statue to untangle it,” recalls Winkleman. “And it’s like — oh my god, I’m touching the Statue of Liberty’s nose! Which was the coolest thing in the world.”

One reason the demonstrators had been particularly careful not to break windows or otherwise harm the statue, Winkleman says, is that they had discovered that causing over $2,000 in damages could be considered a felony: “If you do any type of scratch, they can always claim $2,000 worth of damage.” 

“But as soon as we got the banner up, it started blowing around and the chain, despite the wrapping, started banging against the statue,” says Luciano. “Since the statue is made of metal it was like being inside a 180-foot bell — it was kind of terrifying. As we ran down the steps to the base, one of our members shouted, ‘Felony!’ each time it rung. By the time we got to the base, someone had pulled it inside, unnerved, I guess, by the noise.” (The Associated Press credited a Park Service ranger with hauling the banner inside after about five minutes.)

The group that draped the large banner off the pedestal had fewer problems, she recalls — “except that some of them had gift wrapped their cinder blocks to hide them in case their bags were searched, so that delayed things a bit. People looking on were actually pretty excited — some of them started taking pictures. One man asked if they were from Greenpeace.”

Eventually, all the activists joined the crowds of tourists on departing ferries. “We were about to get on the boat, and they grabbed this woman who wasn’t part of us, and they were going to arrest or question her,” says Winkleman. “And then her husband pulls out a badge — he was an off-duty cop.” No arrests were ever made.

Of course, 1991 was a less security-heavy time, when lugging cinder blocks on a ferry to a national monument was less likely to raise eyebrows. At this year’s protest, Luciano notes, everyone was arrested, not just the statue climber.

“With CBS, the moment we did that, they changed their security badges to have a little radio transmitter in it, so you couldn’t fake them,” says Winkleman. CBS staff, he recalls, immediately nicknamed the new cards “ACT UP badges.”

“9-11 definitely had a chilling effect on protest, but the wheels were in motion long before,” Luciano says. “In New York City, for instance, the Giuliani administration was committed to squashing dissent from the beginning. They went after civil disobedience activists especially hard, making sure the arresting officers had them put through the system rather than just giving desk appearance tickets.”

Still, she’s cheered to see that direct action is alive and well despite the heightened security state. “Black Lives Matter, Occupy, Standing Rock — these are and were sustained direct-action movements. Almost 600 women were arrested in D.C. last Thursday in the Senate office building; six senior citizens were arrested Friday for blocking the ICE offices in Philadelphia,” says Luciano. “The woman who climbed the statue yesterday made me remember Bree Newsome, who climbed the South Carolina Capitol to take down the Confederate flag there in 2015.”

And, adds Winkleman, in many ways getting news of a protest out to the public is much easier than it was in 1991, when activists had to hire a helicopter to shoot video of the event. (The weather was bad, and it arrived minutes too late.) “You look at the social media, the live-streaming online that happened yesterday — I wish we had that back then,” he says. “So yeah, things are different: They can’t do what we did back then, but we can’t do what they can do now. And I’m sure some other activists will find a way to do something even more spectacular.”

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Easing My Grief by Eating Like Anthony Bourdain

Maybe it’s because I’m paranoid by nature; maybe it’s because, now, the news cycle is never not stomach-churning. But when I see a celebrity’s name unexpectedly trending on social media, my first reaction is often to worry that something terrible has happened to them. (My second, lately, is to wonder if they’ve been outed as a monstrous sexual predator.) But early last Friday, when I woke up and first spotted Anthony Bourdain’s name on Twitter, the possibility — either possibility — didn’t remotely occur to me. The celebrity chef, writer, and Parts Unknown host always seemed more full of life than anyone I could imagine. Bourdain died by suicide in France, where he was shooting an episode of Parts Unknown. Even now, a week later, it’s difficult to believe. And it fucking sucks.

I lost most of that morning. In a haze of grief, I read his 1999 essay in the New Yorker (a hilarious, blistering piece that, among other things, warned of the dangers of ordering restaurant fish on Mondays), then the profile of the late chef published last year in the same magazine, then thumbed through my paperback copy of Kitchen Confidential, and then scrolled numbly through the remembrances that comprised most of my Twitter feed. It was comforting to see that I wasn’t the only one feeling like the wind had been knocked out of me, and doubly shocked that I was taking the loss of someone I’d never met as hard as I was. Bourdain’s bawdy wit, curiosity, and equal capacity for profound empathy and scathing cynicism made him a hero of mine — an all-time New Jersey great, a true pork roll, egg, and cheese of a man — as he was to so many others. He was, in my estimation, about the best possible representation of America abroad, especially in the Trump era; he was an outspoken advocate for the #MeToo movement. He was hungry in every sense of the word.

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I thought throwing myself into work would make me feel better, but work didn’t want to cooperate: I had a meeting and an interview scheduled that day, but both, for unrelated reasons, needed to be moved. So I decided to eat my feelings instead. Before I left my apartment, on an impulse, I sent off the kind of tweet that I usually delete a few endless unfaved minutes after posting, which is to say that it expressed a genuine, difficult emotion and not just a joke about a squirrel I saw eating garbage: “I am sad, so I have decided not to do my work and instead to go outside and eat something I’ve never eaten before.”

I took the 7 train from Long Island City, where I live, to Jackson Heights. Actually, I accidentally took it one stop too far, to 82nd Street, and walked west down Roosevelt Avenue back to 74th Street. Almost in spite of myself, I felt my mood lightened by the sunshine, fresh air, and being surrounded by other human beings. I started to receive responses to my tweet, from fans of Bourdain’s pledging to do the same, to leave their culinary comfort zones and try something new. That helped, too.

Lhasa Fast Food is hidden in the back of a cellphone store, past a jeweler and above a luggage shop. I felt hungry — suddenly, extremely hungry — for the first time that day when I wandered inside. Despite its unusual location, the tiny Tibetan restaurant is an increasingly less-hidden gem, having been warmly reviewed by the New York Times, Eater, and Bourdain himself. He dined there in the Queens episode of Parts Unknown. I’d come for the momos, Himalayan steamed dumplings, a dish I’ve wanted to try for years. I’d forgottten about Bourdain’s visit to Lhasa until my momo-related Googling led me directly to it — once I remembered, my lunch plans made themselves obvious.

Two oversize thermoses, one full of sweet tea and the other of salty butter tea, invite diners to pour their own cups for $1 each. A large portrait of the Dalai Lama, set before a snowy mountaintop, gazes down from above the register. From where I sat, I made direct eye contact with a photo of Bourdain with owner Sanggien Ben mounted on the wall. The pleasingly pleated beef momos (eight for $6) were delicious, and even more so when dipped in the black vinegar and fluorescent orange sepen, a truly spicy Tibetan hot sauce, available on every table.

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I replied to my original tweet with a photo of the momos, and was pleasantly surprised to discover my mentions were full of reports of first-time eats from around the country and beyond, many with images. There was mofongo and pineapple cornbread, pork and preserved egg congee, tater tots with kalua pork, and a late-night expedition to Waffle House. There was spinach gözleme from a Turkish food stall in Germany, Yukgaejang in Massachusetts, grilled venison in Spain, and (apparently lackluster, but still) takoyaki in Manhattan’s Zuccotti Park. The rapper Heems, who dined with Bourdain on Parts Unknown, sent me a photo of a custom-ordered Swedish biryani. Sometimes, I learned, the results of this experiment were incredible. Sometimes, not so much (sorry, again, about the takoyaki). But there was a universal sense of pleasure in the exploration: The world felt smaller, and much larger, all at once.

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I’m still sad. Maybe you are, too. But expanding your horizons and seeking out experiences different than those you’re accustomed to — and maybe patronizing a small, family-owned business while you’re at it, or having a conversation with someone you might otherwise never have encountered — is a fitting tribute to a man who encouraged us to do exactly that. So go get some momos.

 

If you or someone you love is in need of help, call the National Suicide Prevention Hotline at 1-800-273-8255. It is free, operates 24-7, and provides confidential support for people in crisis.

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Limned With Terror: One Life With Notes of Panic

I had my first-ever panic attack late at night on a couch in Tatarstan. I had gone to Russia that summer of 2010, after my sophomore year of college, for a State Department Russian-language program in Kazan. My hosts were a young couple who appeared to hate their concrete-walled, un-air-conditioned apartment nearly as much as they hated each other. All night I could hear their whispered fights, hissing like a choking gas through their bedroom door to the couch where I slept a few feet away. At first I thought they might have been whispering sweet nothings. Then my Russian improved.

The night it happened I had been drinking — a little — and had indulged in a habit I was just then developing, smoking strawberry-flavored, ultra-thin cigarettes that sold for fifty cents a pack. It was around midnight, and I lay on the couch in my sweaty nest of sheets, feeling my heart beat rapidly against my breast. I breathed in and breathed out and stared at the cracks in the ceiling, but my heartbeat didn’t slow; it rabbited as if I were climbing an invisible staircase, though I was lying flat on my back, my palms pressed to my sternum. I began to feel a star-shaped pain radiating through my hands, and it was accompanied by a wave of such pure fear that I bolted to my feet, gasping so profoundly I must have looked like a silent-movie star enacting surprise, and dashed to the balcony. I stared at the onion-domed cathedral opposite, whose bells woke me at 6 a.m. every Sunday, felt the wind curve off the metal and dry up the sweat that drenched my face. I dialed my mother, a doctor, and confessed: I had been smoking. I had been drinking. Now I was convinced some retribution — divine or simply physical — had fallen on me. My heart hammered like a handyman gone mad, leaping in my chest, and I knew I would die there, on that balcony in Kazan, punishment for how far I had strayed. I was so dizzy I grasped at my host parents’ clothesline for a hold, dislodging several pairs of socks; I felt my gorge rise and choke me.

My mother’s sleepy reassurances — you’re fine, it’s probably nothing — did little to dispel my certitude that the end had arrived for me. I was twenty and not quite ready to give up on the idea of having a future. So I balled my hands into fists and knocked urgently on the bedroom door of my hosts, explaining in my elementary Russian that I was dying, that I needed help immediately. “My heart has gone out of its mind,” I said. “My heart, something’s wrong. I can’t breathe.”

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“That happens to me really often,” my host “mother,” Asya, told me. She must have been in her late twenties, prone to wearing tiny miniskirts and velour; earlier that week, I had watched her husband, Seryozha, smash her laptop because he had seen a photo of her with another man on it. I couldn’t believe that she had looked death repeatedly in the face and survived: She was so thin her hip bones jutted out. I panted like a dog, caught in the grips of my whirring heart and ragged breath, and asked her to call emergency services. After she dialed the number she put on a full face of makeup before the paramedics arrived.

I wound up getting an impromptu electrocardiogram on that saggy couch in the center of a living room that had seen more than its share of despair. The electrodes were cold against my overheated chest; the line they spat out on graph paper made a series of perfectly regular peaks. I don’t remember the medics’ faces, only their hands, and their murmured reassurance. They gave me a drink they said was “herbs.” I hadn’t died, somehow. As dawn broke over the cathedral I finally fell asleep.

The happy part of this story is that I learned what panic was, eventually, and that it isn’t a fatal condition. The unhappy part — the untidy part — is that it’s never left me.

In the eight years since that night, the rhythm of a panic attack has become far more familiar to me, if no more pleasant. I don’t know what caused that first attack, although my family history is rife with anxiety — from the inherited trauma of Holocaust survival to more garden-variety Ashkenazi nerves. Panic has become a looming presence in my life, filling my throat with bile at the most inopportune moments: a job interview or a simple meeting; in the dark crowd of a rush-hour subway; on planes, at my desk, in the middle of the night, when my pulse blares in my ears and I know my body is about to burst all over my sheets like a punctured water balloon.

More than simply the blaze of fear and pain of a panic attack, panic disorder, which I have since come to know with terrible intimacy, is about how panic and escaping panic warp life. In the hopes of staying clear of panic’s terrible sequence of sensations, I bend my life away from its triggers, walking circuitous routes through my days. The ways my phobias control my behaviors are profound, and I keep them secret from most people, evading questions about my own evasions. Panic has its own logic separate from earth-logic; it’s not fear, but another plane, an Upside Down of the mind, in which everyday things (a two-block walk to the bodega in the dark; a ride on the J train; a plate of fish that might have bones) become limned with electric terror. To nerves primed to sing with fear, everything is a monster. Sometimes, after panic recedes, there’s a grim humor to it all: like a shape, menacing in the dark, that turns out to be a blender, or a shirt on a hanger. My life is full of this black and secret comedy.

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Once, just after I graduated college, I could not leave my parents’ house for a week; the thought of stepping out even onto the suburban sidewalk convulsed me with fear. In the end I broke that seal by climbing into the very back of my mother’s SUV, behind the seats, and staying there in the fetal position as she drove across the George Washington Bridge, to her profound bemusement.

There are other times when I wear my terrors lightly. I cling to routine — what’s familiar feels safe. When I push myself, sometimes I am pleasantly surprised; other times, I regret such excursions profoundly. 

I have no tidy end to this story — no “it gets better” tale, except that I’m on medication now, and the full, flushed eruption of panic is a comparatively rare occurrence. Flashes of panic singe me enough; my relationship to sleep is not a happy one. I am not the person I was when I got on that plane to Kazan at twenty: fearless, thrilled to taste new phonemes on my tongue. These days my phone is full of notes to myself, written in moments of psychic agony: You aren’t dying. You haven’t died any of the times this has happened before. You are going to be OK. You are going to be OK. You are going to be OK. Please, please let me be OK. Oh god let me be OK. In the sweat and pain of my brain’s misfired fear, I can smell and hear and feel everything — the hyperarousal of terror, they call it. Perhaps it helps me write, feeling so keenly. I admit that in the grips of this condition my life is smaller than I could have imagined. But still, I live. I am going to be OK.

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Too Sad to Move: On the Paralysis of Depression

On my honeymoon we hiked a glacier at the border of Argentina and Chile, about as far south as you could go before hitting Antarctica. No organic life moved. Neon blue water faded to the shore into a milky hue due to particles of ice. The shore was rock, the redbrown of a lion. The glacier sliced in white sections shot with the same chemical blue as the waters. The guide said the blue came from the sun. When ice gets super cold and dense, light refracts off it differently; the color shows more intense. We slipped and climbed in our rented spiked shoes and caught panoramas of water and rock and air. It was like no sensory experience I’ve had, save staring into a canvas — pure color, something by Gerhard Richter, maybe. Occasionally we’d meet a blue sliver in the ice plunging more than a mile. The guide told us to beware; if we tumbled to the bottom we might not die, but we’d break every bone, lie in pain until they somehow got us out.

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A bedrock of pain linked us, so this caught our attention. By then we’d developed a game, my husband and I, that we called: “Should we just kill ourselves?” It involved saying the phrase, then pondering the question. (The rules were unstated but understood.) We played when faced with a task that felt insurmountable, some paralysis, due to career, or other people, or family. Paralysis was something I felt I would live with always. My first therapist couldn’t figure it out, met with silence my description of sitting on the couch unable to move, circles of thought moving me instead, arguments against living. I’d found her after calling my dad, after considering walking into traffic with a seriousness that was new. No one we knew from India or with roots there had a therapist, at least not openly; but my dad was a pragmatist, and we didn’t need more death. The smell of my mom’s cremation was still in my nose, every word still in my head from the letter I slipped under her bathroom door a few days before she fell from a stroke that came like a surprise wave — blaming her for the hands that touched me when only hers should have, for denying me when I asked for therapy years later.

Now she was dead and I worried she didn’t know that I also didn’t blame her, that I loved her. I went to an old escape fantasy, first shared at the office of my pediatrician in Texas, who laughed when I asked for a pill that could turn me back to a baby. Some darkness always lay in wait to get me and I felt I couldn’t stand it — kids laughing in the shadows, or grown-ups who hated me, or, always, hands. I imagined the whole world sharpened to a point against me, a vision helped along by the many times people would stare: when I walked into a classroom, the only brown kid; when we entered a gas station on a road trip. Some years later a girl around my age, seven or eight, shot herself with a gun in the bathroom of her fancy prep school nearby. I was transfixed by the story, couldn’t stop thinking of a girl my age being so decisive while I stayed wishy-washy. I contemplated the knives in our kitchen, asked my mom what she’d think of a girl my age going that way, covered my tracks by saying I’d heard of such a happening. She said she’d think the girl was sick. I didn’t want her to think badly of me, so that was that.

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I don’t know where the urge to kill oneself comes from, if some of us have it and some of us don’t. My mom didn’t seem to have it. She had no hair or ability to walk or talk, and still she raised her arms every day to exercise them, on the hope she would get strong enough to live through surgery to remove the tumors that caused the stroke, a cancer growing in hiding until it made itself known by wrecking her in a second. Watching her I felt awed, and confused. If it’s not a kitchen knife that gets you it’s a rotting hole in your belly from the feeding tube, physical pain if not emotional. At amusement parks, I’d get to the end of the line and turn around, bow out, push through all the people to exit the experiment. I knew I’d never fight as my mom had, given the chance to die. Why waste time along the way?

Biology tells me I’m programmed to want to live. So many sperm could have made their way to the egg. Clearly the one that did had will, a survival instinct, expressed years later in my dad insisting I live by securing outside help. That day on the ice, my husband and I considered dying, but only because the glacier was more beautiful than anywhere else we could go. Better to die there, we reasoned, than return to a place of paralysis. I’ve found it helps to physically move, the way stretching can stave off the stiffening of joints that comes with another sort of disease. But healthcare is expensive in this country, people too busy to talk on phones, therapy treated as a luxury good. I do not know what one does without a biological proxy for the survival instinct, engaging your will to live when it is lost to you, who calls the numbers, writes the checks, lifts your arms in exercises when you can’t move.

If you or someone you love is in need of help, call the National Suicide Prevention Hotline at 1-800-273-8255. It is free, operates 24-7, and provides confidential support for people in crisis.