After the CNAs (certified nurse assistants) from hospice bathe and dress J and get him up, I like to hang out with them and have coffee before they go on to the next patient or (since we’re often their last stop) to their family caregiving duties at home. Most of them are black (in all the multifarious shades of golden, freckled, ruddy and brown that word so flatly fails to suggest), and single motherhood is the norm in their community; the men have long since left or been kicked out, and those who’ve stayed are often described as not much help or not worth the trouble. (By contrast, the South American woman who stays with J when I go away is married, and her husband helps with their three boys — all of whom were born with congenital vision problems and/or cleft palate, possibly because of occupational chemical exposure of one or both parents. To paint these trends as monolithic would be stereotypical, but to say they are representative is, sadly, just statistical.) On the plus side, mothers/grandmothers are always there to be relied on and to take care of babies and little children while daughter-mothers go to work and to school, struggling doggedly for education and certification and advancement. In return, they take care of their aging mothers who struggle with arthritis, diabetes, heart failure. It’s a hard life and takes a heavy toll on health.
Talk about the working class, these women work harder than anyone I’ve ever seen in the most palpable sense of “work.” They are extremely conscientious. They need physical strength and endurance, bottomless patience, basic medical knowledge, a strong stomach, a sense of humor, and a kind heart to do what they do. And they get paid, and sometimes treated, very poorly. Home health agencies charge the client $20 an hour and pay the woman or man who does all the work $9. Hospice, I hope, pays more than that, but probably not a lot more. Hospice patients, they say, are mostly grateful and respectful, but home health patients — those just out of the hospital convalescing from something acute and temporary — often treat them high-handedly like servants, expecting them, for instance, to clean house.
As I was thinking about what they’ve achieved against the odds and what it takes out of them, it struck me that poverty is like gravity. The lower in economic altitude you start, the stronger a force you must overcome to rise. Against that down-dragging force, to get an education, to have a career, to raise children and get them into college, you must ignite a solid rocket booster of will and determination over and over again.
It always takes effort and perseverance to achieve anything. Inertia and dissipation are universal drags on our dreams. But those of us who were launched into orbit by the circumstances of our birth — that is, by the struggles of our ancestors — will never know what it takes, and takes out of you, just to get off the ground.