SHIELD OF GOLD, WTC 9/11 Attack and PTSD

The Anguish of Attack: Postmortem Post Traumatic Stress Disorder (PTSD)– A Qualitative Situational Analysis: World Trade Center Attacks 9/11/01

Dr. Lois P. Tannenbaum, Psy.D

The experience of death of those we care about is always difficult to assimilate into our lives. A life force so deeply intertwined within our own is now physically gone forever. We go through the stages of grieving as we move towards acceptance to a greater or lesser degree, and at a divergent pace, depending on such variables as age, illness, relationship, and the circumstances of death.

When the causal factor surrounding death is trauma, there are residual effects that affect those involved in the aftermath of that trauma which evidence as Post Traumatic Stress Disorder (PTSD). PTSD is a psychological wound sustained when a person is exposed to an overwhelming stressful event. The magnitude of that occurrence threatens and violates that person's pre-trauma reality. The response/s will be experienced and expressed in a manner unique to each individual; however, all are considered normal responses by normal people to abnormal situations. Reactions may include:


-event re-experiencing
- anxiety
- avoidance

- depression

- isolation

- arousal

- hyperarousal

- social disconnect

- occupational dysfunction

- substance abuse

In sudden-onset emergencies, such as in war, natural disasters, and/or exposure to attack, there is no warning, no retreat, and no predictability of either the experience or the outcome. Such was the reality of the World Trade Center 9/11 First Responders in 2001. The intensity of being in the epicenter of such a massive, collective death experience was beyond assimilation by any human being. The responsibility assigned to Detective Golino, and countless other officers, was to sort and sift through "The Pile" (as they termed it) of debris searching for human remains. Each responder had no choice but to detach to whatever degree possible just to push through that horrific task moment by moment. Yet, the deep scarring of the incomprehensible degree of loss literally experienced through all senses by innumerable bone fragments that were once thousands of people can only result in a shockwave to the mind and soul. Once the "shield" of responsibility is surrendered, the impact of its life-long effect may be fully, devastatingly absorbed.

Following the terrorist attack on the World Trade Center, each person's pre-trauma belief system in their view of the world, and their safety, had been radically altered forever. We had been attacked on our own soil, and thousands were brutally, instantly gone forever. The total lives lost in the attacks were 3,497 people with 3,332 at the World Trade Center alone. The responsibility to identify their remains and provide any sense of closure to the grieving families lay literally in the hands of these dedicated responders.




In total 3,497 people died in the attacks on September 11, 2001.

- 2,735 civilians in the World Trade Center died

- 87 passengers and crew members aboard American Airlines Flight 11 that hit the North Tower

- 60 passengers and crew aboard United Flight 175 that hit the South Tower

- 343 New York City firefighters and rescue workers and 23 New York City law enforcement officers, 47 Port Authority workers and 37 Port Authority Police Officers, lost their lives when they rushed in to save the victims in the World Trade Center

- 36 passengers and crew aboard United Flight 93, who gave their lives stopping four hijackers over Pennsylvania

- 64 passengers and crew aboard American Airlines Flight 77 that crashed into the Pentagon, killing them and 125 people in the building.


- Also there were the 19 terrorists who hijacked four airliners & murdered 3,497 people who died.



According to Alexander & Klein (2009), there has been research focused on major statutory bodies such as fire, police, and emergency services personnel as well as recent research involving other agencies all of whom are first responders. Palm and colleagues (2004) identified key concepts affecting these demographics that include: vicarious traumatization; compassion fatigue; and burn-out. The research states that although these terms require increased delineation, they reflect the principle that providing help for victims of major trauma has the potential to be "psycho noxious" to those who provide it.

Many of the factors explored in previous research are consistent with those experienced by the WTC Search & Recovery Responders including viewing and handling bodies and mutilated remains, family members desperate for answers, and risks to their own safety including exposure to toxic materials. They were further impacted by lack of sleep, poor diet, inadequate equipment, excessive noise, and work overload. Moreover, as reported by Klein and Alexander (2009) first responders may not only be "secondary victims" due to the distasteful nature of their duties, they may also be "primary victims" due to the personal loss of friends and loved ones. These very real experiences may result in one or more of the aforementioned psychological effects related to PTSD.

Post Traumatic Stress Disorder is not an inherent weakness in facing difficulty, nor is it a flaw in an individual's personality, belief system, or values. The development and intensity of PTSD symptoms is concordant with the intensity and duration of the stressful event. Why is it then that some individuals involved in the same traumatic event, to the same or similar degrees, either experience decreased symptomology, or adapt to and resolve adverse reactions more effectively? There are multi-variant factors that contribute to individual outcomes of healing and recovery.

　

　

Pre-determinant risk factors in family history

Negative risk factors:

- Child abuse that is likely to reactivate past traumas
- Under-developed protective skills, problem-solving skills, self-esteem, resilience,

- Personality & habitually negative thought patterns (pessimism, depression, introversion)

- Biology related to overactive nervous systems/heredity/and history of drug abuse


Negative family characteristics:

-Children of divorce might feel that the world is not safe, people abandon you, so don’t trust.
- Children of parents with poor coping skills inadvertently learn to blame others, to take out anger on others, to use illegal drugs to self-medicate, or to just avoid emotions completely.


Parents with PTSD can indirectly transmit their wounds:

Combat veterans

- Destroy your enemies lest they destroy you.

- Don’t show feelings such as grief or tenderness.

- Do whatever it takes to protect yourself.

- It is safer to disguise your intentions.


Children of such vets learn to keep quiet, to feel unsafe, and out of control because parental angry outbursts are fearful, sudden and unpredictable. A child’s self-esteem is disrupted if they feel they are to blame due to lack of understanding.

Police officers

- May protect their family but be emotionally disengaged.

- They worry so much about the danger during outings, that they do not experience or allow their children to experience the joy of the time together.
- They may also be suspicious and distrusting of others, emotions that teach children to be anxious and distrustful.

Abusive and/or alcoholic parents

Children learn to be secretive and ashamed, to appear “normal” at all times to keep family intact

On the opposite end of the PTSD spectrum are the positive risk factors & characteristics.

Positive risk factors:

- Creativity
- Humor
- Discipline
- Ability to express emotion to others
- Ability to tolerate distress

Positive family characteristics:

- When adults have a childhood history of growing up in a secure, predictable setting with warm, loving adults they learn to trust others and themselves.
- They learn to express emotions appropriately and safely.
- They discover that the world is predictable and that they can cope.
- Another important lesson learned in this type of environment is that when there are difficulties, they can share their burdens with people who support them.

In-Trauma Experiences

During a trauma experience, an individual’s recent life stressors; negative perceptions related to the event; or positive paradigm shifts they are able to mentally convert; all contribute to the eventual outcome/s related to PTSD.

Recent life stressors:

In addition to underlying factors in a person’s past, in an adult life there are the added stressors: divorce, illness, financial difficulties, loss of a job, and/or death of a friend or loved one.

　

Negative Perceptions vs. Positive Paradigm Shift

- Purposeful act - Pre-disaster training (military comparable)

- Feeling unsafe in location - Focus on the greater good

- Empathetic to survivors - Challenge vs. threat

- Helplessness in disaster zone - Meaningful not pointless

- Intensity of exposure - Personal growth/resilience

- Developing acute stress - Clear definition of duties

- Becoming dissociative - Teamwork & sense of being appreciated

　

　

　

Post-Trauma Experiences

History reveals how a person’s post trauma experiences influence both mental status and reintegration into his/her home and community. One crystal example is the parallel opposite receptions received by veterans in the United States following the Viet Nam War vs. the more recent wars in Iraq and Afghanistan.

In all three wars, there was death, destruction, and devastation. However, added to the psychological dilemma of the veterans returning home from Viet Nam was finding themselves targets of verbal and physical abuse by fellow countrymen. This point is not raised as a question of political viewpoint of war, it speaks to the personal experience of one who has faced unfathomable trauma, and desperately needs support.

The experience of First Responders in the World Trade Center attacks was analogous to military personnel returning home, each having faced horrific tragedy etched in their minds and hearts forever. The recovery and resumption of “normalcy” was highly dependent upon the nature and degrees of supports they did or did not have upon their return.

　

Negative aftermath Positive healing

- Lack of network supports - Accepting the reality of the experience

- Feelings of aloneness - Psychological debriefing

- Emotional unavailability - Recognition and expression of feelings

- Disbelief, stigmatizing, shame, - Revealing not

shunned concealing

- Secondary victimization - Rediscovering self, family, & friends

- Conspiracy of silence - Allowing network acceptance & support

- Lack of treatment - Being of service to others

- Ineffective coping skills - Rejoining & reinvesting in life

　

　

The Road to Recovery

Treatments/Approaches


Cognitive Behavior Therapy – integrating emotionally disassociated/distorted thoughts

Acceptance & Commitment – recognition and moving forward

Stress Inoculation Training (SIT) – exposure to lesser stressors to build or regain resiliency

Breathing & Relaxation Techniques – focused breathing/activities to decrease anxiety

Cognitive Processing Therapy (CPT) – reinforcing strengths and teaching strategies

Review/revisit/restructure – confront, challenge, and control (from victim to survivor)

Autogenic training – a form of self hypnosis that relaxes and utilizes imagery

Meditation – learning to free the mind of thought for increasing periods of time

Anger Management – developing internal controls and coping mechanisms

　

In summary, it is imperative to reinforce that all survivors will cope with a traumatic experience and resultant after-shocks in a way that is unique to them based on past, present, and future supports and resources. It is “normal” to feel “abnormal” about the magnitude of an event that one is trying to integrate into a life system for which there is no prior frame of reference.

Even those trained to respond to trauma, and perform as they must, come away with healing work to do. Too often, individuals and the media may represent the remarkable recovery of a trauma survivor in a way that seems to say that life for that person has returned to “normal”. This portrayal may cause others who are not faring as well in similar circumstances to feel even more distraught or incapable of healing. Normalcy does not resume it reconstructs!

In the horrific tragedy of 9/11, the global impact was internalized and absorbed by every living human being old enough to process the violation of security which was forever compromised; the assault and grief related to the massive loss of life; and the significantly permanent change in each person’s viewpoint regarding trust, boundaries and the future stability of the world in general. This attack was perpetrated on humanity as a whole, and as such left an open wound which healed and scarred to greater or lesser degrees within each affected person, community, and country. Simultaneously, it also created an appreciation for life and a unified purpose to stand together and support one another. Such is the wisdom of tragedy!

Each person who lived through the 9/11 nightmare will relive and retell it differently. Every first responder left “The Pile” with post traumatic stress, and many were not able to move beyond it resulting in a disorder that would require treatment. Thankfully, there were also many who survived and assimilated this tragedy as one experience in the sum total of their lives in order to move forward in a purposeful manner for themselves and others. Detective Golino, and others like him, returned to their families and their duties with heavy hearts but renewed commitment to protect and serve in every sense of the word.

　

References

David A. Alexander and Susan Klein (2009). First Responders after Disasters: A Review of Stress Reactions, At-Risk, Vulnerability, and Resilience Factors. Prehospital and Disaster Medicine, 24, pp 87-94 doi:10.1017/S1049023X00006610

Matsakis, Aphrodite, 1992. I Can’t Get Over It: A Handbook for Trauma Survivors. Oakland, CA: New Harbinger Publications

Matsakis, Aphrodite, 1994. Post-Traumatic Stress Disorder A Complete Treatment Guide. Oakland, CA: New Harbinger Publications.

Schiraldi, Glenn R., 2000. The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth. Lincolnwood, IL: Lowell House

           Parkinson, Frank, 2000. Post-Trauma Stress.     Tucson, AZ: Fisher Books

　

TING AND I, Tribute to My Mother, Tina Su Cooper

PHIL CHIANG

In late 2007, Phil wrote what follows in response to the MBA application question: “If you could step into someone else’s shoes for a day, whose would they be, and why?” (500-word maximum)

I would like to spend the day in my mother’s shoes, but she has not worn a pair of shoes for years. Every day my mother goes through extraordinary means just to live another day. Despite great obstacles and setbacks, she continues to live her life in a determined, selfless, and gracious way.

Diagnosed with multiple sclerosis 30 years ago, my mother has slowly succumbed to the unpredictable, debilitating disease. She began walking with a cane when I was in fourth grade, moved into a wheelchair when I was in eighth grade, and was bedridden by the time I started high school. During my senior year of college, she nearly died from pneumonia. She is now completely paralyzed from the neck down, reliant on life-support equipment and 24-hour nursing care.

From one day in my mother’s shoes I would learn true determination, the kind that transcends an all-nighter at the office or running an extra mile. My mother’s determination is not only to survive despite the incredible odds against her, but to continue to live life to fulfill her purpose: to be there for her family as a loving, caring wife and mother.

She accomplishes this goal in small but meaningful ways, looking beyond her own problems to focus on those around her. For example, although she seldom leaves the house, she is still an avid viewer of the Weather Channel. As my father heads out to walk the dog every day, she reminds him to wear sunscreen or to take an umbrella. Ignoring the fact that she hasn’t been able to eat solid food in years, she always asks what I’ve had for breakfast, lunch, and dinner, making sure I have had enough to eat. And as a nurse holds the phone to her ear, my mother regularly calls relatives and friends to recommend a TV show or movie that she thinks would interest them.

A day spent in my mother’s shoes would teach me to live life graciously and without bitterness. In the face of tremendous personal losses, she remains thankful for what she has: a loving husband and sons, a dog that keeps her husband in shape, and a new flat-screen HDTV. Rarely feeling sorry for herself or seeking sympathy from others, she treats those around her with kindness. She politely thanks the nurses for every task they do, whether it is administering her afternoon medication or changing the channel to Oprah promptly at 4:00. Asking after the nurses’ families, she treats their problems like her own.

Early last year, I moved back to New York City to be closer to my mother and to help her whenever possible. However, she is the biggest supporter of my decision to pursue an MBA, despite the fact that it could mean moving away from her.

It is my mother whom I could learn the most from if I stepped into her shoes for a day, and it is her unflagging determination and selflessness that make her my constant source of inspiration.

TING AND I, Tribute to My Wife, Tina Su Cooper

MY TRIBUTE TO TINA

This book itself is meant as a tribute to Tina. Here, I add a bit more.

I was a New York City Cub Scout and then Boy Scout. We recited “a Scout is trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.” Tina, herself once a Brownie and then a Girl Scout, meets these criteria, too.

TRUSTWORTHY If Tina says she did it, she did. If she said she will do it, she will. I would trust her with my life, as she has trusted me with hers. To me, a man who has been deceived many, many times on important matters, this is crucial.

LOYAL She did her best in a difficult marriage between a Chinese man and an American girl of Chinese ancestry. She has always been on my side during our marriage, her loyalty never in doubt.

HELPFUL When Tina could, she did. Those who knew her would have to keep her from helping more.

FRIENDLY Quiet, with a lovely smile, and an easy laugh, she makes and keeps friends readily.

COURTEOUS A genuine lady, without airs.

KIND Never seeking to harm, always wanting to console.

OBEDIENT Here we have a little difficulty. She obeyed her parents’ wish that she marry a Chinese man. She obeyed that husband for years and years. I did not want, did not ask for, did not need obedience, though our frequent agreement was a blessing.

CHEERFUL Mostly, and almost always when I am with her.

THRIFTY “Waste not, want not.” With only one exception that I can recall did we disagree on a significant expenditure. I ascribed that to MS, which was likely the cause.

BRAVE Perseverance in the face of known or uncertain obstacles. My family had a cat we called “C.P.” for “courageous persistence. Undaunted. Tina’s approach was no less.

CLEAN Almost fastidious, but not excessive.

REVERENT “Why has God allowed this to happen to me?” has given way to thankfulness for what she has, rather than regret for what she has lost, and together we have regained our faith.

Let me add, STRONG. An exceptional inner strength. She does not give up, does not give in to the “monster that has seized” her (MS). The word “coolie,” once applied to Chinese laborers, comes from the words in Chinese, ku li, for “bitter strength.” Tina is strong, but not bitter.

TING AND I, In Memoriam: Robert F. Starbuck, USMC

Robert F. Starbuck died a hero in Vietnam on February 4, 1967. Only 25, he was a sergeant of an elite RECON Marine detachment holding a hill against overwhelming odds. He was awarded the Silver Star, one of our armed forces’ highest decorations for bravery.

Bob and I were football teammates, high school classmates, and friends. He was very likeable and decent. His death must have been shattering to his family. When I learned, much later than 1967, of his death, I pondered what I could do in his memory. Moving back to Walden, I found that our high school, Valley Central, held an annual awards ceremony for members of the athletic teams. I established the Robert F. Starbuck Captain’s Award in his honor, going each year to the captain of the football team, in recognition of Bob’s leadership, courage, strength, and service to our country.

Recently, a memorial ceremony was held in honor of our local servicemen who died. There is never enough we can do to thank such people.

The story of Bob’s last battle is one of those in the book, Honor the Warrior: the United States Marine Corps in Vietnam, by William L. Myers, published in 2000. Mr. Myers dedicates his book to the nearly 15,000 members of the U.S. Marine Corps who died in Viet Nam. His dedication includes this excerpt from a poem by Laurence Binyon:

But they shall not grow old

As we who are left grow old.

Age will not weary them nor the years condemn,

But at the going down of the sun and in the morning

We will remember them.

We do remember.

TING AND I, In Gratitude to Our Doctors

THANKS!
We are especially grateful to the doctors who have made possible Tina’s continued survival and well-being in the seven years since February 2004, when she nearly died. Most credit must go to Dr. Richard F. Walker, internist and pulmonologist, whose role is described below. His name comes last, as my ordering is alphabetical, but he has been first among equals in Tina’s care.

Asadolah Baradaran, M.D., neurologist. Dr. Baradaran was seen annually by Tina to follow the progression of her multiple sclerosis, to prescribe what few drugs could be of help in her case, and to advise us as to possible new medicines or treatments. When it became very difficult for her to travel, he was willing to advise us by telephone. He correctly diagnosed my hydrocephalus, recommended the treatment we finally chose, and has monitored my progress. Thanks to Dr. B.!

Peter Chidyllo, D.D.S., dentist. Because Tina’s health would be seriously threatened by another aspiration pneumonia, Dr. Chidyllo modified his usual techniques in her dental care to minimize that risk. He also monitored and advised us on the health of her teeth and gums, to lessen the risk of infection.

Alexander Fruchter, M.D., F.C.C.P., internist and pulmonologist. During a life-threatening episode of respiratory and systemic infection, when Dr. Walker was not available, Dr. Fruchter managed Tina’s care to a successful outcome. He has since then shared the responsibility for Tina’s health with Dr. Walker and Dr. Guneratne.

Franklin Guneratne, M.D., family practitioner. Dr. Guneratne is my personal physician and serves a similar role for Tina, and for my mother, unless the situation requires referral to a specialist. Dr. Guneratne is exceptional in his careful and caring attention to our well-being and his determination to assure our health. Perhaps it is a small thing, but I remember his coming out to our special van in the rain to give Tina her flu shot, to spare her from getting wet. It was characteristic of this gentleman.

Michael G. Kaplitt, M.D., Ph.D., F.A.C.S. Dr. Kaplitt performed the brain-saving operation that gave me a V.P. shunt and a re-awakening of my mental acuity. Without his skilled help, our lives would have been diminished and this book never written.

Sergey Koyfman, O.D. Dr. Koyfman has been responsible for Tina’s tracheostomy during the past few years. He performed the surgery that expanded the opening into which the tracheostomy tube is placed, and four times per year he replaces the used tube with a new one, not a trivial matter. He’s a pleasure to visit, so these sometimes painful excursions are not as feared as they might be.

Richard F. Walker, M.D., F.C.C.P. During Tina’s 100-day struggle against death in the Critical Care Unit, Dr. Walker was the one I relied on most to bring her through. He made sure she was getting what was appropriate. He discussed what was happening and would happen and he took our concerns very seriously, being willing at times to modify his own approach to take into account our needs and wishes. He describes some of this in his insightful Foreword. Over the ensuing seven years, we have seen him two to four times per year, when he would evaluate Tina’s health, check the medicines she was getting, perhaps adding or subtracting or adjusting them. We looked forward to our office visits. Clearly, he cared greatly for Tina and about our efforts to keep her alive. His expertise and his firm commitment to us were crucial to Tina’s survival. Thank you, Dr. Walker. Thank you so much.

THE SHIELD OF GOLD, Who or What is Bugging You?



With all the tiny video and audio recording devices now on the market, even people who are not in law enforcement can easily find means to eavesdrop, record, “bug,” others. For example, some families have “nanny-cams” to observe what the nanny is doing with the children while the parents are out.

　

Industrial espionage is a major corporate concern, as fortunes can hang in the balance if trade secrets, bargaining strategies, or marketing campaigns are divulged to competitors. The threat of terrorist attacks on certain sites means that their security measures need to be kept confidential, too.

　

In the corporate world, security concerns can lead to the need for expensive countermeasures, including the “sweeping” of the premises to be sure that there are no hidden recording devices there.

　

At a facility not far from where the World Trade Center towers had been attacked, our client had fired a site foreman, who subsequently returned to the site. Unfortunately, there was minimal site security and no cameras, with the company blueprints available for theft or photographic copying.

　

When this corporation’s executives realized their security vulnerability, they called our firm and we swept 25 offices and 75 cubicles, as well as their halls and other common areas, and we were able to reassure them that there were no recording devices present.

　

Whether concerned about terrorism or industrial espionage, five other New York City companies asked our firm soon after this to carry out similar work. Having done so, we were able to reassure them, as well.

　

Even private homes can be the targets of electronic eavesdropping. One client of ours was a medical doctor who had testified against the local police in a dispute involving alleged police brutality. After the case was over, he became convinced that he was being stalked by the police, sometimes in plainclothes, and that they had probably planted eavesdropping devices as well. Whenever he saw a police car near his home, he suspected that they were trying to harass him.

　

The doctor asked our firm to do a thorough check of his home, to detect any eavesdropping devices which might have been planted there. It was a big house, and we carried out an especially thorough search, sweeping the area with equipment that would detect a variety of snooping devices.

　

Nothing showed up until we reached his bedroom, the master bedroom. We got a signal there that was somewhat puzzling, possibly due to a recording device, though not wholly matching the usual signatures of such devices.

　

It occurred to me to turn off all the power to that bedroom, to be sure that none of the doctor’s commercial electrical equipment was producing the signals that we were receiving. A bug would have had its own power supply, a battery, and would not have been affected by turning the house power off to the bedroom.

　

Sure enough, when we turned off the power to the bedroom, the signal disappeared. It was coming from some piece of household electrical equipment the doctor had in his bedroom. I noticed he had one of those new spirally light bulbs, and I tried unscrewing it, while leaving everything else on. The worrisome signal stopped. That was it.

　

We were able to reassure our client that he was not being recorded in his home. In general, it is rare to find that someone has successfully placed a bug in a private home.

Still, there is nothing like knowing that there is nothing there.

TING AND I, Outside Support

“God helps those who help themselves.” Let’s hope so. More often it seems it is “God help those who help themselves” because few others will do so.

Child support for Phil from Tina’s ex-husband ended after about a year. To me, this was not a big issue, just characteristic of a certain type of man.

The Multiple Sclerosis Society Support Group in Mt. Kisco (near our Bedford Hills place), c. 1985, was pleasant and encouraging. Friendships developed there that lasted years. Still, the newly diagnosed seemed not really happy to see the whee chair-bound members. Too scary. Cognitive losses can create complications. The more you might benefit from such a group, the less able you are to be involved, and perhaps the less willing the group members are to be involved with you.

In April 2011, I received a card from the National Multiple Sclerosis Society’s New York City/Southern New York Chapter, inviting us to register for support groups, one or more of sixty possible choices, to meet for 90 minutes at a session in one of the five boroughs of New York City, some seventy miles south of us. The front cover lists these 17 of the 60, none of which seemed likely to be worth the trek to the city:

—Black Voices in Connection
—But You Look So Well
—Caregiver, Partner and Family Groups
—Children who Have Parents Living with MS
—Cognitive Concerns
—Grupos en Espanol
—Lesbian, Gay, Bisexual or Transsexual
—Living with MS
—Men’s Concerns
—Newly Diagnosed with MS
—Opting for No Treatment Now
—Orthodox Jewish Women
—Pain and Spasticity Management
—Professional Working Men
—Residents of Nursing Homes
—Stress Management
—Twenty [sic] and Thirties Networking Group

To be less critical, I might have found worthwhile the “Caregiver” or “Cognitive” or “Stress” groups, had they been nearer to me.

If you choose a country setting to “get away from it all,” you must not be surprised if you have gotten a bit too far.

Our friends at Ledgewood Commons (Wendy and Zane, Ruth and Mal) were good company and remained our friends ever since, real psychological support. Wendy’s piece in the section at end of the book describes the kind of emotional support that she and Tina gave each other. Ruth was kind enough to accompany Tina and me to church and ended up converting from Judaism to Christianity, with Tina’s sponsorship. Zane and Mal and I have remained good friends, and their visits to us usually include a walk around Lake Osiris and the settling of the political and economic affairs of state, nation, and world.

Emails help, too. We have a few steady e-correspondents.



“A friend in need is a friend indeed.” That must mean that someone who helps you when you need it is truly a friend. It can’t mean that one is more attractive as a friend when needy. Our friends have had a mixed record. Types of support include calls, letters, visits, holiday cards and presents. Some have come through. Some have not.

Neighbors have helped occasionally, but we can’t reciprocate, and we do not request it. Sometimes the coming and going of our nurses inconveniences neighbors, but they do not complain. We do appreciate it and thank them warmly.

How about relatives? By the time MS gets truly difficult, after one is 40 or 50, parents are often too old, perhaps no longer alive or are absorbed in the problems they and their other children have. Tina’s parents made several monetary gifts to us, representing 10 to 20 percent of our income in those years. The trust fund in their wills represents another few years of income, should it be needed for Tina’s welfare. Very generous and much appreciated. Tina’s brother and his wife and their children have visited on the day after Christmas each year, driving from her parents’ home in Delaware, and giving us nice gifts, including a microwave oven for our kitchen and a flat-screen HDTV for Tina’s bedroom. We appreciate it. Her relationship with her sister has long been less warm, so little is expected there.

IBM has been wonderful. We are thankful for all their help. We wish them continued prosperity. Obamacare has us worried, as some companies are choosing to dump their obligations onto the public plan. Such a plan is not going to cover our in-home care 24 hours per day.

After my mother cracked a pelvic bone, we were able to transfer her here from the hospital after a few days. Medicare provided a half-dozen physical therapist visits, after which they stopped, my mother having been “treated,” though not greatly improved. My sister has been a big help. Two of my three brothers have contributed to a portion of the added costs.

In talking with our staff members, I learn a common story: one child carries most of the responsibility of caring for parents; the others do not. We’ve done better than that.

Granted, if you marry someone, you are taking your chances, “for better or worse, for richer or poorer, in sickness and in health.” If you choose to create children, you are signing up for decades of responsibility.

We do think, Tina and I, that children have a responsibility, an obligation, from love and duty, to assist their parents in times of need. We hope ours will not have to be called on to sacrifice for us.