A Failure to Care

I like big girls.

More importantly, and to the point, I love my wife. She is a big girl. Not plump, not thick, but big. Fat, if you prefer, or obese.

Even more importantly, she is human. She is worthy of respect and dignity regardless of her size.

She has a host of medical issues. Some of these treatable, but they won’t ever change. Some are barely treatable. Others not at all. All these things are part of who she is – a woman in her fifties who knows her body, diagnoses, and her life.

Healthcare is difficult. I know this. I have some training as a combat medic. I know that some aspects of it are harder, physically harder, with larger patients. I know this very well having been my wife’s full-time carer, especially during this recent four-month episode where she could not bear weight on her left leg much of the time. Even though I was there to help her, and fully committed to that, my first priority was to protect my back. In the end though, when one is being paid to provide care, I don’t care how hard it is – DO THE DAMN JOB! If you need help, get it.

Get over yourself and your attitudes.

Look around at the world. It’s well-documented that Americans are much larger on average than fifty years ago. But that is also only a change in distribution. There have always been larger people.

If you’re going to be a healthcare professional, or run a business that provides healthcare, you have to treat the patients you have, not the ones you wish you had. Or those that you *think* you have.

I have some advice on how to do this.

  1. Start by seeing your patient as human.
  2. Assume from the beginning that they should be treated with dignity.
  3. Treat. Them. With. Dignity.
  4. Start with ensuring they have agency in their own care, save in circumstances where this is not possible.
  5. Know that provision of proper care is not an inconvenience, it is your damnjob.
  6. If a patient suddenly screams in pain, STOP WHAT YOU ARE DOING.
  7. Ask what is wrong.
  8. LISTEN TO THE ANSWER.
  9. Trust that the patient knows their body.
  10. Change what you are doing accordingly.

Above all, apply your common sense and critical thinking skills. If a patient presents as having a broken femur that is being allowed to heal, assume they cannot stand or walk on their own. Assume that they will need assistance. Include this in your planning, that includes having enough staff to assist large patients. This all fits within the Hippocratic oath under “first, do no harm.” You should not make things worse.

When you fail to see people as people, fail to give them their humanity, you will almost always make things worse. We see this is in the stories and research that demonstrate the generally poor medical care Black woman receive. We’ve seen this in the LGBTQ community in the height of the AIDS crisis and every time some legislature gets the ideal to allow gay conversion therapy.

The goal of medical care, of healthcare, is to make people better.

That only happens when you treat them as people, regardless of size, skin color, gender, or who they love.

My wife has now been in surgery for two hours after a night and a day of searing pain. She faces weeks of rehab and a painful recovery away from home. All because the staff of a nursing home chose to ignore her humanity, agency, and knowledge of her own body.

They broke her femur through mishandling her.

And then they tried to say it was her fault.

All of this is after a week in the hospital where the first day was marked by staff ignoring her when she kept telling them to let go of the left leg, it it is the one that is broken. Her right hip turns out an odd angle, they look at that and assumed that is the location of the break. They don’t read the chart. They don’t listen. When I got there I made sure it was on the whiteboard, and she made sure the hospital administrator and the head nurse knew about it. Things got better quickly at the hospital.

But it still the same old thing. A failure to see the person, a failure to listen, a failure to know the patient.

A failure to provide care.

A failure to care.

A Eulogy for Richard Massa

“As I was saying in the last class….” This was a favorite way of Dad in starting the first class of the semester. It was a way of ensuring he had each student’s attention through a moment of questioning.

“What did I miss?”

Indeed, what have we all missed?

Richard Massa, Christmas, 2017

Richard Massa lived a life of passion. Not the passion that you see in movies or read in books where the main character wakes up to the excitement of life and starts climbing mountains, running races, or chasing adventure. Instead, my father lived full of passion for the life of the mind.

Dad related the following story during his remarks on the occasion of his 85th birthday:

Recently I was called for jury duty. During the questioning of the potential jurors, I was always the last to be called on. One question in particular was of interest. “Do you have a passion? What are you passionate about?” Almost invariably, the responses were about sports. Football. Baseball. The Cardinals. The Royals. And others, of course. When he got to me:

“Are you passionate about anything?”

“I try to teach passion.”

“I suppose they call you, ‘Mr. Passion!?'”

The judge said, “I wouldn’t go there. That’s Mr. Massa. He has a reputation for passion.”

Here’s the thing though. Growing up, I don’t recall a single lecture directed at me about passion. Admittedly, I didn’t move back to live with him until I was 16, so it might have been too late to have much real impact after short visits and summers between the ages of seven and 16. Unlike my sister, Daphne, I didn’t take classes from him or become a communications major. However, I do a recall number of lectures, monologues, and exhortations, all delivered with a great deal of passion. I probably assumed at the time that this was simply a device to gain my wayward attention.

I didn’t realize at the time that I was being given the roadmap for my life.

When I was five, Richard Massa took me camping, with the help of his friend, John Graves. This is an experience that is crystallized in my memory. The first, and only, time my dad took me camping. There are a number of images from that trip that I carry with me. Images from a section of wilderness in central Oklahoma. A little lake. A cliff. People jumping off the cliff. A water snake at my feet. Most of all, I remember my father waking in the night to shine a flashlight on two raccoons going through our food.  A moment of wonder for a small boy.  A moment of clear memory 52 years later. Camping was not his thing, yet another reason these memories stand out for me.

What boy remembers, the man becomes.

My father and I had the type of relationship that I think is pretty standard for his generation and mine. Not a lot of touching, not much in the way of chatting, or expressions of love. During Christmas 2016, when it came time for Melinda and me to leave, we were standing in the kitchen with Dad and Teresa. Dad said, “You were a good grandson to my parents, and you’ve been a good son to us.” I simply replied, “It’s been an honor, sir.”

If these had been our last words to each other, I would have been fine with that. They’re not bad words at all. They are somewhat formal and perfectly in keeping with who he was. They certainly reflected our love for one of another, a love that was never decorated unnecessarily. It simply was.

This was also true of his love for his lesser children, my sisters.

I kid, of course, because Daphne and Sara are marvelous people. Part of the delight of his life. They have done as he wished for them – pursued their own visions for their lives.

The true, endearing love of his life, his true passion, was, and remains, Teresa Ramirez Massa. They have been companions, friends, husband and wife, and most of all, equal partners. For nearly fifty years their marriage has been iconic in their devotion to one another and their uniquely powerful habit of communication.  A habit of communication that made their marriage what it was. A habit of communication that caused strangers to remark on how much they talked with one another when in a restaurant.

At their 40th wedding anniversary party, I told this story:

Richard and Teresa were walking in the mall one evening. It was a sweetly fragrant evening, and they were happily together.

Teresa said, “Richard, I’m kind of hungry”

He replied, “Yes, and I’m quite tall.”

It’s communication like this, and outrageously subtle humor, that made them such a strong couple.

Most of you knew Dad as reserved and somewhat formal. He maintained a professional distance in most spaces. He was keenly aware of his role as professor, church leader, and community member.  He taught me early on the importance of knowing what role to play in a given situation, and how to leverage the role to overcome doubt and nervousness. He was deeply private and held on to stories of his past so tightly we had no idea they were there. He shared many of them with us in recent years. If you thought he was special, or amazing, then you might want to at least double that. And double it again.

My extraordinary life is what it is because of his guidance and inspiration. It’s not the type of inspiration that seeks the name brand, the pinnacle of place, but instead it is an inspiration to be where the work needs to be done. I hope what I have done in life impressed him, and that he found it worthwhile.

That was the standard I strove for, the standard for which I expect many of you strove.

In one of his last emails, Dad quoted Dylan Thomas, and since the two of us discussed this poem a year or so ago, I read it to you now because he fought and raged against this day, until he knew it was time to fight no more.

Richard Wayne Massa was a man of immense dignity. If you knew nothing else about him, you knew this. He held on to his dignity every way he could in his last days and hours. Long past the point where I think most people would have traded dignity for comfort and ease. Not my father. He may have wanted to go gently into the good night to escape the pain, but not if it meant giving up his dignity.

Do not go gentle into that good night

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.

Rage, rage against the dying of the light.

Richard Massa taught us to be storytellers. Stories are a vehicle for sharing light in good times and bad. Stories tell our histories, as families, as communities, as a nation. Stories help us tell difficult truths that others can better understand. More than anything else, stories are a way to share our values, our passions. So please, rage, rage against the dying of the light by sharing stories of Dad, let others know who and what he stood for, where and when he did it, and how he did it. But most of all, why he did it, for passion.