They got a quick education there. “We didn’t have any wood the first winter,” Ann said. “We didn’t know about it.… Sandy came home—he actually wrote his college essay on this.… We spent a wonderful Christmas vacation. He came home from the first year of boarding school and we looked and we knew we had about two weeks of wood left. Sandy was going to go back, and Sally and I were going to be there, and I’d never split wood in my life and I wasn’t any good at it, so Sandy and Sally decided that they were going to split wood. So down a half a mile from the house, down the hill, was a big pile of some cut-up lengths of wood … so Sandy and Sally dug them up out of the snow and Sandy split them and Sally and I hauled them on sleds up the hill, and we got enough to get us through all the way until March.” And then someone from church gave them another pile of wood “so we got through the rest of the winter.” When food got very short, they were helped by members of the congregation. By the next winter, they were better prepared.
In the cabin, they talked more and read more, “but it’s easy to get sick out there, and we did.” So after nearly two years they tried to find an apartment with heat and electricity. The rents were too high—$500 to $600 a month. And then, again, the church came to their rescue. In a disused Catholic convent in Claremont, New Hampshire, the Orthodox church had taken a rambling apartment as a place for visitors to stay. Ann was told that she was welcome to live there for the small price of taking care of those who came. It was a sudden joy to have hot running water, warmth, light, and the periodic company. Sally was taking singing lessons, working at a fruit and vegetable store to pay for a piano accompanist. Sandy had also been drawn into the church, befriending Stefan Solzhenitsyn, the son of the Russian author Aleksandr Solzhenitsyn, and was becoming intrigued with computers, though Ann had no money to buy him anything as advanced as his interests.
She pursued her part-time editing and, for a small fee, graded papers for a Dartmouth professor. She carried credit card debt on top of her $18,000 in student loans. And then the church decided to give up the apartment, and she had to leave. As the departure date approached and she could not find housing, she felt herself sliding down into panic. This time, rescue came from one of her church’s parishioners, who asked an aunt with a two-family house whether she would rent the upstairs to Ann at a good price. The aunt agreed to $400 a month, and so once again, supported by the kind of church-based, middle-class network inaccessible to most Americans in poverty, Ann found shelter. She disliked the flowery wallpaper in her new place and cared little for her motley collection of furniture, mostly rejects and hand-me-downs. But a few possessions meant something. “There’s a little stool with some crewel-stitched material on it that actually is ours,” she said. “The silver in the drawers is mine.” It was family silver, some connection to roots now withered.
Ann found a full-time job as production editor for the University Press of New England, a small academic publisher that paid her $23,600 a year plus health insurance. She loved the work, but it didn’t open a way to financial security. She was strapped by huge debt, and child support for Sandy ended when he turned eighteen. Her new dental coverage, with its ceiling of $1,000 a year, proved inadequate to pay for the extensive repairs she needed to recover from years of deferred maintenance.
Her investment in her children began to pay off, though. Both worked hard, spending one summer together as janitors in a church, demonstrating brilliance along the lines of their respective interests: programming computers and singing opera. Sandy, a lanky, taciturn lad, scored 800 on his math SAT and over 700 on the verbal test. He was accepted with full financial aid everywhere he applied: by Dartmouth, Amherst, Williams, and Carleton. Both kids took their shortage of cash in stride and sacrificed gracefully. Sandy could not afford jazz concerts and movies at Dartmouth, and he tried not to order too much takeout food, although he did run up heavy balances on his credit cards. When Sally, in prep school, went clothes shopping with friends, she didn’t buy but just tried things on in the changing room—pretending, acting, playing dress-up. Her small allowance from St. Paul’s she spent on pizza for herself and others. Or she walked in the woods and picked bunches of wildflowers to give to her friends. “They give me what I can’t afford,” she said, “and I give them what they wouldn’t give to themselves.”
In college, Sandy made good friends, came out of his shell, was plugged into Dartmouth’s alumni network of employers, and landed a summer job with one of them at a San Francisco software company for the unbelievable sum of $3,750 a month. He was about to go off to that position one June afternoon when he sat with his mother and sister on the terrace of the Hanover Inn overlooking Dartmouth’s green. It might have been a moment of satisfaction for Ann. She was seeing her children heading into the kind of adulthood she had struggled to make possible. But she was not especially proud of herself at the moment, for she had just violated her moral tenets by declaring bankruptcy. That deleted her credit card debt but not her student loans, which could not be legally forgiven. So burdensome had the debt been to Ann that she was frightfully worried about her children ending up with the same from their own student loans. As she carried on in concern and despair, her children looked genuinely pained and worried. “I have no emotion,” she said. “I don’t care anymore.”
“I’ll have a job,” offered Sandy.
“You took care of us,” said Sally, “and now it’s about time for us to take care of you—when I’m in the Met!”
There was a burst of laughter, and Ann said, “After you clean up your room!”
Following graduation, Sandy probably could have returned to Silicon Valley at a handsome salary, but his ties to family, friends, and church kept him in New Hampshire, where he lived with his mother and worked as the systems administrator for a company in Norwich, Vermont, that provided computer services to travel agencies. He started at $40,000 a year, more than one and a half times his mother’s best earnings, and began to pay off the debt that he had carried out of Dartmouth along with his diploma: $10,000 to $12,000 on high-interest credit cards and $20,000 in low-interest student loans.
When Sally entered the New England Conservatory, she obtained a scholarship and a student loan, but they were not enough. The balance was contributed by a local couple who had been inspired by a newspaper account of Sally’s attempt to raise money to study at Tanglewood one summer. They helped send her to Tanglewood and then to the conservatory, and they advanced Ann the funds to pay off her own student debt. Ann and her family were the kind of folks whom people liked to help.
She did not admire the values of her relatives, nor they hers. Money was an obsession to Ann because it was scarce, and to them because it was plentiful. She saw how easily it could sway the moral compass that she struggled to follow. So she watched dismayed in her mother’s final years as those responsible for her care moved her to a less expensive, lower-quality nursing home, where attendants called her only “Dear” and “Honey” because they never learned her name. Ann spent hours and days visiting, reconnecting with her mother, feeling grief and bewilderment at the choice to place her there. “I second-guess myself,” Ann said. “There must be something wrong with me that I’m not like the others. And I’m not. I don’t value what they value. I’m so horrified at what is being done that I can’t understand it. It’s so simple: It’s wrong to trade somebody’s welfare, somebody for whom you’re responsible, for money.”
The self-doubts notwithstanding, Ann remained a true believer in the way that she had chosen. “We’ve lived for over a decade on no money, and at one point having no house,” she said. “And while it sounds awful and sounds like a strange choice to make, I did it. We all did it. And we all did it in a healthy way. We were much better people for the choices we made than if I had ignored the kids, worked seventy hours a week, paid rent, and lived in a poor neighborhood where other kids were left alone. And so I know what it is to be without money and without a lot of things. It’s not as bad as having a moderate amount of money
but no time for the people in your life.”
Chapter Eight
BODY AND MIND
Most of my time I work as a social worker—fight with Social Services, get people housing.
—Dr. Glenn Flores, pediatrician
Food is one of the few flexible parts of a tight budget. Rent is a fixed amount. Car payments are constant. The charges for electricity and basic telephone service cannot be compromised, negotiated, or trimmed. But the amount a family spends on food is elastic; it can be expanded or squeezed to fit whatever cash is left after the unyielding bills are paid. The result is an array of malnourished children in America.
Dr. Deborah Frank sees some of them: the scrawny baby who looks like a wizened old man, the listless toddler who weighs two-thirds of what she should, the bony boy who cannot resist infection. They come to the fifth floor of the Boston Medical Center’s ambulatory care center, where the doctor runs the Grow Clinic two days a week.
These are not the skeletal faces of famine, but they are desperate windows into the collection of hardships that consume the American poor. Because food money is not fixed, it succumbs easily to the ruthless costs of other essentials, especially housing, which can soak up 50 to 75 percent of a poor family’s earnings. “If there were more subsidized housing there’d be less hunger,” Dr. Frank declared. If there were more generous food stamps, if high-nutrition baby formula cost less, if inner-city stores stocked fresh fruits and vegetables, if all day-care centers provided decent meals and snacks, if families could afford varied foods for children with allergies, if new immigrants were not confused by junk-food advertising, if mothers could breast-feed instead of work, if children of working parents were not passed among multiple caregivers, if parents simply knew to sit youngsters down calmly to feed them, if there were less depression among those at the bottom of the economy, there would be less hunger. The clinics that treat malnutrition stand at a devastating collision of problems, most of which cannot be solved by physicians. That is why Dr. Frank and others who address the condition known as “failure to thrive” try to assemble teams of nutritionists, social workers, and psychologists as well as pediatricians. They make a difference, but for only one patient at a time.
The waiting room was crowded with parents and children Wednesday morning when Debbie Frank strode in carrying a red backpack and sporting a colorful smock like a kindergarten teacher. She wore glasses, and her graying hair was cut short. She did not mince or waste words, and she quickly got to work, mobilizing her staff with an intense air of gentle competence. Slightly harried and tightly focused, she directed a blunt friendliness toward patients and an edge of anger at the conditions that brought the children here.
The first on her list, “Juan Morales,” made a grim picture of starvation. Emaciated seven months after his birth at five and a half pounds, he now weighed only twelve and was vomiting after eating. His right hand would not open fully, and he needed surgery for a deformed right arm, but no operation could be done while he was weakened with malnutrition. His family was not equipped to help. His father was in prison, slated to be deported. His mother, unable to pay the rent without the father working, had been evicted to a homeless shelter that provided no meals.
“This is one sick little pumpkin,” Dr. Frank declared. She ordered a slew of lab tests, and the nutritionist gave his mother a supply of expensive formula, Duocal, which provided twenty-six calories per ounce, compared with the usual twenty. The social worker set out to find government assistance for which Juan, born in the United States, would be eligible as an American citizen. Virtually all aid except emergency medical coverage had been terminated for illegal immigrants. So, against the vast scope of the social, economic, and physical disease that had brought Juan to the Boston Medical Center, the professionals could address only the symptoms.
Then came Jequan Oliver-Bigby, the baby who looked like a little old man. Even his cheeks were hollow, a danger sign that had prompted the family to bring him in. “The facial fat’s the last to go,” Dr. Frank explained, “which is why people often don’t notice that children are malnourished if they’re bundled up, because their faces stay round even if their bodies are very skinny. So it was only when this baby’s facial fat started to go that people got worried.”
Jequan and every other child received an outpatient version of intensive care—first from a nutritionist, then from a pediatrician, then from a social worker. The process began in the hallway, where Jequan was weighed and measured by a caseworker who typed the grim information into a laptop computer. He had lost six ounces, down to nine pounds four ounces, only 63 percent of the normal fourteen pounds ten ounces for a boy his age. He and his parents were then sent to an examining room and seen by a nutritionist, Mary Silva, who had visited them at home two days earlier. She questioned them closely about his feeding, trying to assemble a chronological account of how much high-calorie formula he had taken in. His mother was vague, like many parents who aren’t sure about the quantities that their children eat.
“Any vomiting on Tuesday?” Silva inquired.
“A little bit,” said his mother, Jaqueta Oliver. Silva asked what time he had been given formula before he went to bed. Oliver fumbled for an answer and settled on one uncertainly. Silva then asked what time before that, and before that, and before that, until Oliver was reduced to guessing. The nutritionist had seen partly consumed bottles standing around the apartment, so she suggested feeding him less each time but more frequently. “It might help him keep it down to get less more often.”
Silva then happened upon the key question, one asked routinely in malnutrition cases: “Do you have any allergies?” No, said Oliver. And the subject might have been closed right there had the father not been sitting in the corner of the examining room. He was a smiling man named Jeffrey Bigby, a truck driver earning six-something an hour, not married to Oliver but very attentive to his son. Allergies often run in families, and Bigby offered a clue. He was allergic to bananas, apples, and oranges, he said, as well as pollen, cat hair, and dog hair. “I had bronchial asthma when I was a baby.” Silva was taking furious notes—a textbook case of how critical the involvement of both parents can be.
Next came the pediatrician. Gripping the baby’s chart, Dr. Frank entered in a state of extreme worry. “His weight is really at a dangerous level,” she told the parents. “I think it’s really not safe for him not to be in the hospital. You were back and forth to the clinic almost every day. He could get very sick very fast.” She checked the boy’s reflexes, put him on his stomach to see if he could push himself up; he could, but barely. She stood him up to see if his legs would hold him. “He’s not very strong, is he?” she asked. The parents said nothing.
So little Jequan was kept in the hospital, where tests revealed an intolerance for Enfamil, the only formula that the family had been able to get from WIC, the federal government’s Special Supplemental Nutrition Program for Women, Infants, and Children. During six days of hospitalization, he gained a whole pound. “The kid probably would not have failed to thrive had he not had the food allergy,” the doctor concluded. “On the other hand, if he’d had the allergy in a privileged home he would not have been dependent on the fact that the only formula that WIC supplied was the one that he was intolerant to. Now, with some special letter-writing and stuff we can get WIC to supply some of the other kind,” the much more expensive Pregestamil, “which is a very hyper-hydrolyzed formula,” she said. “The proteins are chopped up in it so that they’re not as allergenic.”
As a rule, the Grow Clinic was able to give families a little high-calorie formula and other food for free, plus $10 gift certificates to a supermarket and vouchers for taxis to and from the medical center. Beyond that, the total cost of each examination of Jequan and every other child, including all the time and attention with salaries and equipment, ran to hundreds of dollars per patient. The insurance carried by Jequan’s father paid only $40. The hospital donated its facilities. The bulk of the clinic’
s $600,000 annual budget came from extensive fundraising: donations from individuals and private foundations, and annual grants by the Massachusetts Department of Public Health.
Boston is a city with substantial wealth alongside the poverty, and Massachusetts is a relatively enlightened state. In a less affluent part of the country, a malnourished child lies in deeper trouble, well beyond the coordinated expertise of a practiced team. And even in Boston, if a parent does not or cannot cooperate fully with the Grow Clinic, she might as well be in rural Mississippi.
“Donald,” for example, could not be helped fully because his mother wasn’t getting the clinic’s instructions on the carefully supervised feeding that the boy required. Her unreasonable boss would not let her off work, so she had to send her son with a great-aunt who seemed unreceptive to the staff’s advice. Donald was so tiny that he looked only half his age of forty-three months, and he was gaining little weight. The staff gloomily predicted that he would be a “lifer,” meaning a kid who never caught up to where he should be. This was a case where a call to the employer from the pediatrician might have helped, but nobody thought to do it.
Few doctors ever do. One exception, Joshua Sharfstein, a young pediatrician who has called about a dozen employers so far in his brief career, saw a baby with a severe rash one day. “When I told her mom she needed follow-up on Monday,” he said, “the mom burst out into tears and said that she would lose her job if she took more time off.” The next morning, Josh called her boss, who was a physician himself, “and had a long discussion about the girl and the need for follow-up.” He didn’t have to mention job security. “Once I discussed the medical situation, he said he totally understood how important it was for her to follow up in the hospital,” Josh said. “I got the sense he would not punish her, and that turned out to be true. The mom called me back very grateful and said she was not going to lose her job.”
The Working Poor Page 27
