Three fifteen, they go home. You walk them all the way down to the door. You watch them all the way. (Laughs.) I go home. I'm never tired. I go shopping. I give every store on my way home a break. At twelve ' I go shopping, too. I have to get away from the other teachers. They're always talking shop.

I don't take any work home with me. With these children, you show them their mistakes immediately. Otherwise they forget. When I'm home, I forget about school, absolutely, absolutely, absolutely. I have never thought of being a princ.i.p.al. I have fulfilled my goal.

As for retirement, yes and no. I'm not sixty-five yet. (Laughs.) I'm not tired. It's no effort for me. My day goes fast, especially when I go out the night before and have a wonderful time. I'm the original La Dolce Vita. If I have a good time, I can do anything. I can even come home at two, three in the morning and get up and go to work. I must have something on the outside to stimulate me.

There are some children I love. Some have looks and brains and personality. I try not to play favorites. I give each one a chance to be monitor. I tell them I'm their school mother. When I scold them, it doesn't mean I hate them. I love them, that's why I scold them. I say to them, "Doesn't your mother scold you?"

These children baffle me. With the type of students we had before, college was a necessary thing, a must. They automatically went because their parents went. The worship of learning was a great thing. But these children, I don't know . . . I tell them, "Mrs. Hoffman is here, everybody works." Mr. Hoffman teases me: "Ah, ah, here comes Mrs. Hoffman, everybody works." Working is a blessing. The greatest punishment I can give these children is not to do anything. If they're bad, you just sit there and we fold our hands. I watch them. They don't want a teacher, they want a watcher. I say, "Mrs. Hoffman is too dumb to do teaching and watching. If you want me to be a teacher, I'll be glad to be a teacher. If you want me to be a watcher, I'll have to watch you."

The younger teachers have a more-what is their word?-relaxed att.i.tude. It's noisy and it's freedom, where they walk around and do everything. I never learned to teach under conditions like that. The first rule of education for me was discipline. Discipline is the keynote to learning. Discipline has been the great factor in my life. I discipline myself to do everything-getting up in the morning, walking, dancing, exercise. If you won't have discipline, you won't have a nation. We can't have permissiveness. When someone comes in and says, "Oh, your room is so quiet," I know I've been successful.

There is one little girl who stands out in my mind in all the years I've been teaching. She has become tall and lovely. Pam. She was not too bright, but she was sweet. She was never any trouble. She was special. I see her every once in a while. She's a checker at Treasure Island.73 She gives no trouble today, either. She has the same smile for everyone.

PAT ZIMMERMAN.

He is "headmaster" and administrator of the Southern School in Uptown.74 It's an alternative school. It began in 1969. "I knew the kids were getting in trouble around here. I simply felt I could teach them and make their troubles less. Someone offered me a storefront church which was used only on Sundays. Someone gave us desks and a couple of tables. I scrounged up some textbooks, and we began-even though there was no income for a while. There was none of the planning and campaigning that many free schools have for months . . . It began with about eight kids.

"It's changed in its four years. We're much more diverse now. No more than fifty percent are poor Southern whites. The others are Chicago kids-blacks, Puerto Ricans, and a couple of Indians. Mike Mayer teaches a cla.s.s of boys between the ages of eight and sixteen. lean Fisher and Mary Ryan have a cla.s.s of girls between the ages of seven and fifteen. I have a cla.s.s of boys between the ages of twelve and seventeen. There are three cla.s.srooms, a large recreation room, and a TV area. We're up for accreditation in May."

He is thirty-one from South Carolina, of a working-cla.s.s family. He "drifted until '67. Suddenly I had the urge. At one time, I'd have said I had the calling. I started teaching . . ."

I'm a strict kind of teacher. When I say something to one student in a very quiet voice all the way across the room, I want it quiet enough to reach him. I don't have to tell them to shut up very much. It's self-enforced. I make a lot of demands on my students and I get honestly angry if they don't live up to their possibilities. The importance is not whether a teacher is strict. Is it for the kid's benefit or is it to make his teaching role easier and not get involved? My idea of being a teacher is influenced by my idea of being a particular person. I'm dealing with a particular kid.

I don't have any idea what any of them will end up being. So I'm an unsettled teacher in a cla.s.sroom. A certain tenseness, nervousness about me because I don't like facing a lot of kids who have the cards stacked against them. They catch on and have some hope and that helps a little.

It isn't the kind of free school you read about. We're involved in picking up basic skills that others have neglected to teach the kids. Some of them have feelings of rage, undefined, and they're acting it out in school-dangerously. We try to calm them down.

In a neighborhood like ours it's very dangerous. It's low income and there are many ethnic groups. This community has experienced its war on poverty and hasn't changed. The kids now don't believe in politics. They don't believe things will get better for them. There's a feeling of hopelessness and despair.

They're from ages six to seventeen. The age difference doesn't really . . . Certainly a fifteen-year-old kid is not going to see an eight-year-old as his equal. But kids do throw off the age barrier and relate to each other as human beings. Because they see us doing the same with them.

The person's who's sixteen realizes he has a lot of catching up to do, work. He knows I'm not gonna embarra.s.s him. Other kids are having the same problems. I discourage compet.i.tion in the cla.s.sroom. The only one I accept is the student's compet.i.tion with himself. He has to compete against where he is, against where he wants to be, and against where he has been. I think every kid understands that. They don't have to prove anything to me. Each kid has to prove to himself that he's worthwhile. There's no cheating here. There's no reason for it.

We're not trying to jive 'em into learning. We lay out powerful materials in front of them, and tell 'em they're perfectly capable of doing it-and not to make any excuses about it. We use newspapers, too, and catchy urban stuff-but more as diversions. If you con someone into learning, you really believe they're not capable of it. So we're straightforward. Our learning materials are very hard. That's tough.

I have some that may end up in college, but I don't push them. I sent a boy to Latin School.75 He got a scholarship. He was so unhappy there he did everything he could until I took him back. I thought he would have everything to make him happy. Bright, colorful people who smelled of the security of success, friendly teachers, a magnificent building, all the books he could read. But he was missing something-friendship.

I don't think they want to be doctors or lawyers. It's not because they don't know. It's that they have no expectations. Some have vague feelings of wanting to be teachers. They aren't interested in professional roles. See? They just want the security of working-a steady job. Something their parents haven't had in Chicago. These kids are living out their parents' hopes. It's popular today to look at success of minority groups in terms of upward mobility. I don't know that upward mobile groups are so happy.

The majority of our parents are on welfare. When they screw up, they get ashamed and hide from us. The family's falling apart and we've known them for a long time. They can't face the fact. They know it doesn't have to be as bad as it gets sometimes. They know what they're capable of.

We only get to know the families if they want to know us. If a kid doesn't want us involved, we trust that that's the best thing for him, that somehow he needs us all to himself, not to share with his family. If there's a real problem between the kid and his family, the greatest respect we can show him is not to get involved. To give the kid a chance to pull himself out by himself. We trust the kid enough to be an autonomous individual. Hopefully, if he feels better about himself, the family will pick up on that. Very often the kids become effective-quote-therapists-unquote-in the family situation. One kid has carried the major load in helping his father get through some difficulties.

I try to be fairly aware of their feelings. Sometimes I feel guilty that I identify too much. I always let them know when they touch on my feelings, and what those feelings are like. I think children are unaware of what adult's feelings are like. Some of these kids that I've taught for a while-I've had some for four years-who are sixteen and seventeen, are getting a taste of those feelings. On the other hand, adolescents have new feelings, different from the ones I had when I was their age. So they're willing to share my feelings as an adult, because they know that I know they have new kinds of feelings. Maybe that's the pain-trying to share it with them. They're reaching across and trying to touch something they've never experienced before -adulthood. In a specific situation of urban life-poverty.

In my school the teachers have the decision about who they want to take or not. No administrator does that. He decides what he wants to teach and how he teaches it. My only requirement, as an administrator, is that he teaches well.

Our cla.s.ses are segregated by s.e.x. It's easier for them to study. They don't have to play out the traditional s.e.xual roles demanded of them in the neighborhood. They're not secure in being men, so they play at being rough around their women. They have to be. The girls overact and become overseductive and overteasing. We give them a chance to have one place in their lives where they can put aside these roles. Our students have a chance to become more natural in their s.e.x roles as they get away from the defenses that their parents have felt.

We spend so many hours here. Our lives, fortunately or unfortunately. It's very hard for us to get away from it. My work is everything to me. I find myself trying to get an hour or two of personal life now and then-in vain. I'd rather die for my work life than for my personal life. I guess you can't really separate them. The school's not an inst.i.tution. We have a building, that's where the school exists. But it also exists when we leave.

We often work after six. The people we work for-the National Inst.i.tute of Mental Health-once wanted us to do an honest time sheet. After they saw our honest time sheet they said, "Just please put in eight hours a day on the time sheet." (Laughs.) Weekends? What weekends? (Laughs.) I work Sat.u.r.day morning, writing letters, administrative details. I usually work Sunday afternoons and Sunday evenings.

My first year I taught at an all-black school on the South Side. I worked with a very strong woman teacher who was well liked by the students. I picked up a lot of her strength. My second year I was on my own and very unhappy. The students were holding back and I was holding back. I couldn't get involved in their lives and they couldn't in mine. We were playing roles. It was like a polite dance. I liked them, they liked me. We both knew there was a great deal missing.

I have to have complete freedom in what I'm going to teach, and what words I use in the cla.s.sroom. If I want to cuss at them for something, I cuss at 'em. A certain kind of cussing is an emotional release. If I want to discuss intimate matters with them, I want to be free to do so without justifying it to an administrator. I want to go to the parent's house and scream and yell at 'em if I feel that's gonna shape the kid up.

If I see the day's gonna be a rotten day because everybody's in a lousy mood, I want the freedom to pick up and go someplace and not pretend it's going to be an okay day. I don't tell them, "Let's be happy today, have fun." Sometimes I say the opposite. (Laughs.) I say, "I'm very unhappy today and we're not gonna have fun, we're gonna work." They pull me out of it. And when they're in a lousy mood, they don't hide it. They certainly let me know it.

We hosted a free school from Minneapolis. I thought the students were unhappy because they didn't have a whole lot of direction. There was a great deal of liberty that I don't think the kids wanted. The teachers seemed more interested in theory than in the actual work of teaching. It was incredibly well funded with a staff of twenty-five to 180 kids. There wasn't much I could say to them. In these situations adults are robbing adolescents of their childhood. Children deserve a chance to be irresponsible, to learn from mistakes. You lose your childhood soon enough in a low-income neighborhood.

I don't think these kids are capable of being adults-or want to. In some free schools adults are ready to give away their adulthood and take away from students their childhood. It's fraudulent and becomes chaos. They're forcing a young person to be older than he really is. The freedom of our school is bounded by two obligations: learning and no violence against another person, physical or emotional. That includes me too.

Our school has sixty-eight students and we're still too big. I wanted to set the limit at fifty. But I'm too tenderhearted. (laughs.) If someone knocks on our door long enough, they can get it open. I make a distinction between people who deserve to be cared about and some who have completely given up. They don't deserve the attention because they take too much away from the others, who somehow want to pull some worth out of their lives.

The self-destructive ones deserve someone to completely mother and father them. If someone is willing to commit his or her life to that one person, okay. But not in a cla.s.sroom with other people who want to care as a group. You see a kid who's been fine for six months just suddenly collapse, and there's no way . . . What happens is the other kids spend an awful lot of time ignoring the fact that it's happening. They expend a lot of energy protecting themselves emotionally-from it catching on to them. A teacher goes through an awful lot of anguish watching someone they care about give up.

I was very upset yesterday. A kid collapsed in October and was sent away for criminal activities. He reappeared on a furlough, begging to come back when he gets out. Though I care about him very much-I don't know. It's like a ping-pong game. I haven't decided.

Grades? I give grades, but they aren't entered on anything. I simply keep them in mind as a trend . . . Kids like grades, 'cause they like to know where they are right now. Records? No. They have enough records. They have police records, social history records, welfare records. (Laughs.) I should have to keep records?

I think the parents are glad we're around. We take a great deal of pressure off them. We give them a chance to get on with other things in their lives. We've had a lot of families move back South. A great deal of our neighborhood has gone under the bulldozer of urban renewal. Families who haven't done so well after eight, nine years have now decided they'll give the South another try. Kids are getting in neighborhood trouble. City life may be just a bit too hard.

We're really content when our students get a full-time, good paying job. We're always around for him to learn if he wants to. He's still interested in learning about himself. He realizes his life doesn't end when he gets a job. Or when he gets married, his life doesn't end. He doesn't end up in heaven or h.e.l.l because he got married.

From what I've read about concentration camps, there's a similarity in feeling to ghetto areas. The walls aren't built, they're there. How your life can become concentrated. Rather than escape from it, I've tried to do what some survivors did-find meaning in it to share with other people. Not in any martyr kind of a way, because I can always leave. But it's something beautiful to me. Being able to be hurt by things and then understanding how it happened and explaining to others who have been hurt by the same things.

I run into people who say how much they admire what I do. It's embarra.s.sing. I don't make any judgments about my work, whether it's great or worthless. It's just what I do best. It's the only job I want to do. I work hard because I have to. I get tired. At four I feel as though I'm ready to die. (Laughs.) I don't feel bad about it. This is my life. I just am.

KITTY SCANLAN.

She is a.s.sistant professor of the medical-surgery unit at a Midwestern university's medical center. "That's just a t.i.tle. I'm an occupational therapist. It's an emerging profession-like medicine was, maybe a hundred years ago.

"We get a heart attack patient. We try to help him find a life style that is satisfying. We had one wealthy man who could see nothing but work. If it meant dying in three days, he'd rather die working than live another fifteen years in a way he wasn't accustomed to. Some of our patients are death-oriented."

A hospital is a dehumanizing inst.i.tution. People get in and they become arms or legs or kidneys or bladders or something besides Joe Smith the human being. If a hospital was a good place for people to work, it would meet the patient's needs. There would be no need for me.

The nurses, the doctors, the medical students, are set up on a rigid status kind of system. If you buy into this kind of system, you buy the idea that "I'm not quite as good as the guy above me." The resident doesn't strike back at the attending man when he has a bad day. He strikes out at the nurse. The nurse strikes out at the hospital aide or the cleaning lady.

Many patients tell me the best person for them has been the cleaning lady. Yet the doctors and nurses, everybody is saying that the cleaning lady just does a rotten job-"That dirt's been on the floor three days!" The cleaning lady deals with the patient on a human level. She's scrubbing the floor in the room and the patient says, "My son didn't come to visit me today." The cleaning lady smiles and says, "I know how you feel. I know how I'd feel if my son didn't come to visit me if I was sick." The cleaning lady doesn't see the patient as a renal failure or an ileostomy. She just sees a poor lady who's sick.

Until recently, I wasn't sure how meaningful my work was. I had doubts. A surgeon does a really beautiful job. That's meaningful to him immediately. But it's not the kind of sustaining thing that makes a job meaningful. It must concern the relationship you have with the people you work with. We get hung up in the compet.i.tion: "Who's responsible for saving this life?" "Who's responsible for the change in this dying patient?" "Rather than saying, "Isn't it beautiful that we all together helped make this person's life better?"

I worked in the leading rehab hospital in the country. The schedule was very rigid. Everybody punches time clocks when they come to work and when they leave. You get so many minutes for coffee break. The patient's day was regimented as my day was regimented. You have a quadriplegic who at eight o'clock goes to occupational therapy-nine o'clock goes to physical therapy-ten o'clock sees the social worker-twelve o'clock goes back to occupational therapy. We see him as a quadriplegic rather than as a person. We're, both of us, things.

That's what happens in hospitals-not because people are unfeeling or don't care, but because they feel put-down. You have to protect yourself in some way. Many things in the inst.i.tution frustrate me. The doctor who refuses to deal with the patient who knows he's dying. He says, "He doesn't want to know anything." Or the alcoholic with cirrhosis. What's the use of putting him in this hospital bed, prolonging his life, to send him back to the lonely, isolated world where he'll sit in his room and drink and n.o.body to cook for him? You know there's no place to send him. Or the old lady who's had a stroke, who lives alone. She's been very dear to all the staff and you know you can't keep her in that hundred-dollar-a-day bed, and she's shipped to some rotten nursing home that welfare put her into. She can't live alone. And the b.a.s.t.a.r.ds you have to deal with-sarcastic doctors. They're not really b.a.s.t.a.r.ds-it's the way the inst.i.tution makes them. You think, "What's the use?"

For several months I worked with hemiplegics, elderly people who've had a stroke. Half their body is paralyzed. First thing in the morning I'd get to the old men's ward and I'd teach them dressing. They didn't think they could do anything, but they could dress themselves. If people can take care of themselves, they have more self-esteem.

They were in long wards and they had curtains around the bed. I'd start out with just the shirt, work on getting the affected arm into the sleeve. Some people, it would take ten days to learn. Some could do it in one day-getting their shirt on, their pants on, how to wash themselves with one hand . . . The patients taught me a lot. They have better ways they've learned on their own. They'd say, "Wouldn't it be better if I did it this way?" I learned a lot about self-care from them. I try to tell my students to listen to the patients.

Being sick can be like going through early developmental stages all over again. It can have profound growth potential for people. It's like being a child again, to be sick. The doctor is like the parent. I've seen it happen with kidney transplant patients. People who've been seriously ill may come out much stronger, happier . . . Some kind of learning. Something can happen in the sick role. It's one of the areas where we say it's okay to be dependent, as an adult, in our society. It's not intellectual learning.

I think the luxury of individual patients is coming to an end-and I'm glad. Group treatment is far more effective. Patients I've worked with helped each other much more than I helped them. If I get five old men together-hemiplegics-and do some crazy thing like tie a red ribbon on their affected arm, it gets to be a game or a joke. They look at what the other guy is doing-he didn't know he had that side of his body-and say, "Hey, what you're doing is wrong." I could say it over and over and over and it wouldn't mean anything. They learn about survival from each other. They learn it by discussing what their lives were like, what they're like now. I can't tell them. I don't know what it's like. I've never been paralyzed from the neck down.

The kind of thing we do can be done by anybody in a general hospital. It's easy for a nurse to learn how a hemiplegic dresses. If they were able to take time with the patient, they could do what I do. The best I am is a good cleaning lady in medicine-surgery.

I had so many doubts about my work. I'd think, Oh G.o.d, the doctor doesn't see what I'm doing as important. I finally learned it didn't matter what he thought. If I believed in what I was doing, I didn't give a d.a.m.n what the doctor thought of it. I began to see his own protective cover.

There's a doctor who thought we were play-ladies. Occupational therapy uses crafts, fun things. I thought of it as a loss of status. I saw it as not nearly as important as taking temperatures and all these vital, life-saving things. Now I find it exciting, more important than the other matters. I see it as the kind of thing missing in a lot of people's lives. It wasn't the people higher up who didn't recognize the importance of our work. It was I who didn't recognize it.

She quit her job for a time and worked as a waitress at a popular neighborhood restaurant. After her return to the medical center she kept at it, as a part-time waitress. "It put my life back in perspective for me. I pretend being a.s.sistant professor's a big deal. I fell into this status trap because people do act impressed. I'm no different when I'm waitressing than I am as an a.s.sistant professor. They made me quit as a waitress. There's a policy at the university that if you carry two jobs, you have to fill out all these forms. I thought, Oh h.e.l.l, it isn't worth it."

When I had resigned from the university, I told them I was as great a pain in the a.s.s to them as they were to me. I didn't like this rigidity -you have to be here at eight. It doesn't matter if you stay till ten at night, if you're one minute late, people will think OTs are not dedicated. I told them to go to h.e.l.l. They liked my fight, so they said, "What will it take for you to stay?" I said, "A leave of absence." I think I've been good at this job and good for the students. But if I'm not good for me, I'm not good for anybody else.

They needed me, so they got off my back. When I first took this job, they said I couldn't wear earrings. Only s.l.u.ts wear pierced earrings. I told them to go to h.e.l.l. And I said I wouldn't wear the white uniform. Everyone is supposed to wear it. They said, "Okay, wear a lab coat." I said, "I won't wear one." Now the whole staff isn't wearing uniforms. This is very destructive in a status-conscious inst.i.tution that controls people with these kind of things.

Through working on this job I'm coming to learn that I do have some influence, at least over my own happiness. I could have been here, wearing uniforms, fighting, being angry-feeling ridiculous, but helpless. Now I say, "The h.e.l.l with the uniform." And I do wear pierced earrings and they can't pull them off. I was lucky or smart when I challenged them. They gave in, and now I'm learning something of my own power.

I do get some mileage out of my t.i.tle, I hate to admit it. When, I'm uncomfortable with somebody new and they ask me what my job is, I make a joke of telling them. But the fact is, I do tell them. It's status, of course. When I'm free of the fear of losing it, I'll be a much healthier person.

BETSY DE LACY.

I'm called a patients' representative. My job is to admit them into the hospital. I'm the first one they see when they walk in the door and the last one to see when they leave. When they get their bills in the mail, they think of me. I think my name is listed along with the fire and police department on their telephone. (Laughs.) Who to call in emergencies.

She works in a 540-bed hospital, and thirty-five patients are in her charge. She wears a navy-blue dress with a yellow collar and yellow sleeves. "They get to know me not only as a person but as a uniform. I've become sick of navy-blue, I don't have any identification marks as a person. I'm recognized as a department when I wear this uniform. I go home with it. I crawl out of bed and get into it. I don't look in my closet and decide what I'm going to wear that day."

I handle patients A, B, J, and K. We call insurance companies and find out what their benefits are. Then we code the count for the computer. We type up all the necessary forms. This is called pre-admit. We let you know what your benefits are so you won't have to worry about your hospital bill. Our rooms are seventy-five dollars a day. If the insurance pays only twenty-five dollars, that man's going to owe fifty dollars out of his own pocket every day he's here. I get the money ahead of time. You don't have insurance, there must be a five-hundred-dollar deposit. You have to come walking in here with five hundred dollars if you're going to be put to bed.

When you ask for money first thing he comes in, it tends to upset the patient sometimes, unless you put it in a way that they're most grateful. I find the best way to do that, without myself being yelled at and called names, is to charm the patient and they calm down. "Are you aware what your benefits are? Do you have the means to pay the other fifty dollars a day?" They think you're informing them rather than demanding money. But you are demanding money.

When I visit you, I've warned you and I've joked about it. I've taken the edge off the whole thing. So it's not a big shock. I'd rather go up to you and say, "Sir, you owe two hundred dollars," than not bother you and one day you walk out and you owe fifteen hundred dollars and have to drop your teeth and have another heart attack. Health care is expensive, you know.

I don't feel I represent the patient. I represent the hospital. I represent the cashiers. I'm the buffer between the patient and the collection department. This job could be done with a little more finesse. There are times when we dun the patient while he's in bed: "Tomorrow, can you have three hundred dollars paid on this bill?"

I have no problems. A few patients think this is a little crude. Also doctors are very good about warning patients to bring some deposit in the hospital if your insurance is not adequate. If he can't bring in five hundred dollars, you ask him how much he can raise. We work out weekly, monthly payments. Most patients are very understanding and cooperative.

We've had a few we've asked to leave. The doctor is the only one can discharge the patient. If he suggested you be in ten days, maybe you could go home in five. This is brought to the doctor's attention because it affects the bill. Then the doctor decides he can go home. You're doing the patient a favor. You might be saving him five hundred dollars. The guy's not kicked out of bed: "Sorry, sir, no more money, no more bed." It is done with finesse.

We visit our patients as often as we can, so they get to know us as their representative. "Are you comfortable?" "Are you satisfied with your food?" Then, when he gets to know me-"I know your account is going to be a problem . . ." I'm not looking for money, but if the patient doesn't ask such questions, I mention it. I sort of joke with 'em and then lay it out and sock it to 'em.

"They want the bill explained. It's computerized, and it had taken me about three weeks to understand when I started out an this job. The patient's just looking at all these figures and doesn't know what's coming off.

"Computers make it worse than before. You used to have three cashiers. You now have seven. There's the coding, there's the sorting, there's the tearing apart of pieces of paper. At one time all you had to do was write a little figure in the corner and that was it. Something very simple you used to do in five minutes takes you five days. Hospital costs have gone up since computers. The cost of an error is so fantastic. Where if you've paid ten dollars and I've written down a receipt for a hundred, it's a simple little mistake. All I had to do was scratch out the hundred and write ten. Now if that kind of error's made, it ties everything up for five days."

I really do like to visit patients and chatter. Most of 'em, they're laying in bed watching the same old soap operas they've been watching all day. I walk in the room. I can walk down the hall with my chin draggin', I'm tired and hot. The minute I hit that room, shoulders back and a big smile on my face. I go bursting in there like gangbusters. They sit up in bed, straighten their gowns, pull up the sheets, and turn off the TV. They're really glad I've come. One guy turns up the set when I come in. He doesn't need me and he's tellin' me that.

I won't mention the bill to a dying patient, if I can talk with the family. A relative will be grateful to me because I didn't pester the patient. There's no problem here. That's the worst thing about my job, though. I really hate to say, "Oh, did I mention the four hundred dollars to you?" Sometimes I'll sit there and chat for fifteen minutes and sort of squeeze that into the conversation. All of a sudden the visit is canceled and the business has begun. I try to avoid it, but sometimes I have no choice.

People see hospitals as money first and health second. On our admitting forms we ask all these questions-next of kin, who's gonna pay the bill?-and fill out all these blank squares. The last question is: "What is wrong with you, sir?" I'd rather see patient care first and your financial problems second.

Not all my visits are for collection. A guy just had his leg amputated, doesn't have anybody. I go visit, then shoot the breeze with him. Is he going to be able to take care of himself once he gets home? If he's going to live in a third-floor flat and he doesn't have anybody home, this bothers me. He's my patient because he's my letter in the alphabet. When the account's taken care of, I become his friend.

Isolated patients are on my mind. I had one little girl who had rheumatic fever. She was very ill. Spanish. They had very limited insurance and her bills were just soaring. I talked to the oldest son who was seventeen. I took their application to public aid. It was denied because both parents were working. I got her transferred to La Rabida.76 They still owe us fifteen hundred dollars. They've made arrangements to pay forty dollars a month. Sad. But this is an eight-hour-day thing. I can walk away from the job and not worry about it.

I used to work at Wieboldt's.77 In head cash. Counting all the money taken in the day before, getting it ready for the bank. I never saw the customer, I only saw his money. I've worked in drugstores managing a cash register. Everything I've done is money, some way or another. It's hard for me to deal with the emotional factors.

When people ask me, I don't like to say I'm in collections. If I'm gonna work in collections, I'd rather say I work at Wieboldt's. It seems strange that you should have a collection department in a hospital. Patient repersentative has a better sound. n.o.body knows what it's all about. It's like any organized business. They give people such t.i.tles that n.o.body knows what it's all about.

I'd like to see one insurance for all people, one plan-socialized. Free medical care would be wonderful, but I don't know how it would be supported. We'd only end up paying for it through taxes. That would tend to irritate people. Intelligent people realize health care is expensive. They realize hospitals don't make profits. Hospitals misuse money badly. But that's poor management.

That's what I was in at the other hospital. We were on a cash basis. If you didn't have insurance, you paid cash. It hurt those other girls to sit there and ask for money. It didn't bother me. I wasn't out there doing it. I'd say, "If he doesn't have the money, he can come back tomorrow. He's not gonna die." It was easy to have an att.i.tude like that. But I'm the other end of the stick now.

I don't get into many arguments with patients. They're more or less at my mercy. They can't say too much. Once you're in the hospital and you owe me money, if I talk to you in a sympathetic way, you're not gonna get too sarcastic about it. If you owe me money, I can't ignore that fact. You may be sick and dying and I like you a lot and you make me cry and all that, I still got to go in and talk to you about your bill. That's what's hard.

POSTSCRIPT: She has since been transferred to the accounting department. She is in charge. She has-and this occupies most of her leisure time-joined Jehovah's Witnesses.

CARMELITA LESTER.

She arrived from the West Indies in 1962. She has been a practical nurse for the past five years. "You study everything about humanity, the human body, all the way through. How to give the patient cares, how to make comfortable . . . Most of the time I work seven days."

We're in a private room at a nursing home for the elderly. "Most of them are upper, above middle cla.s.s. I only work for private patients. Some may have a stroke, some are maybe confused. Some patients have nothing wrong with them, but relatives just bring them and leave them here."

As she knits, she glances tenderly at the old, old woman lying in the bed. "My baby here has cerebral thrombosis. She is ninety-three years old." 78 I get in this morning about eight-thirty. I shake her, make sure that she was okay. I took her tray, wipe her face, and give her cereal and a cup of orange juice and an egg. She's unable to chew hard foods. You have to give her liquids through a syringe. She's supposed to get two thousand cc per day. If not, it would get dry and she would get a small rash and things like those.

The first thing in the morning, after breakfast, I sponge her and I give her a back rub. And I keep her clean. She's supposed to be turned every two hours. If we don't turn her every two hours, she will have sores. Even though she's asleep, she's got to be turned.

I give her lunch. The trays come up at twelve thirty. I feed her just the same as what I feed her in the morning. In the evening I go to the kitchen and pick up her tray at four ' and I do the same thing again. About five thirty I leave here and go home. She stays here from five thirty until eleven at night as floor care, until the night nurse come.

You have to be very, very used to her to detect it that she's having an attack. I go notify that she's having a convulsion, so the nurse come and give her two grains of sodium amytal in her hips. When she gets the needle it will bring down her blood pressure. Because she has these convulsions, her breathing stops, trying to choke. If there's n.o.body around, she would stifle.

Some days she's awake. Some days she just sleeps. When she's awake she's very alert. Some people believe she isn't, but she knows what's going on. You will hear her voice say something very simple. Other than that, she doesn't say a word. Not since she had that last heavy stroke last year. Before that, she would converse. Now she doesn't converse any more. Oh, she knows what's going on. She's aware. She knows people by the voices. If a man comes in this room, once she hears that voice, I just cannot undress her. (Laughs.) She knows when I'm not here. If I'm away too long, she gets worried, sick. But she got used to it that I have to go out sometimes. She knows I'll be back, so she's more relaxed now. Oh, sometimes I sit here and get drowsy. I think of the past and the future. Sometime I think when I was a little girl in Cuba and the things I used to do.

If I'm not doing nothing after I get through with her, it's a drag day. I laugh and I keep myself busy doing something. I may make pillows. I sell 'em. Sometimes I'll be writing up my bills. That's my only time I have, here. If I don't feel like doing that, well, I'll make sure she's okay, I'll go down into the street and take a walk.

The work don't leave my mind. I have been so long with her that it became part of me. In my mind it's always working: "How's she getting along?" I worry what happened to her between those hours before the night nurse report. If I go off on a trip, I'll be talking about her. I'll say, "I wonder what happened to my baby." My girl friend will say, "Which baby are you talking about?" I'll say, "My patient." (Laughs.) I went to Las Vegas. I spent a week there. Every night I called. Because if she has these convulsions . . .

My baby, is not everyone can take of her through this illness. Anybody will be sittin' here and she will begin to talk and you don't know it. So you have to be a person that can detect this thing coming along. I called every night to find out how she was doin'. My bill was seventy-eight dollars. (Laughs.) If she's sick, I have to fly back. She stays on my mind, but I don't know why. (Laughs.) She works through a nurses' registry. "You go where they send you. Maybe you get a little baby." She had worked at a general hospital before. "I used to float around, I worked with geriatric, I worked with pediatric, I worked with teen-agers, I worked with them all. Medical-surgical. I've been with her two years. As long as she's still going." (Laughs.) In America, people doesn't keep their old people at home. At a certain age they put them away in America. In my country, the old people stay in the home until they die. But here, not like that. It's surprising to me. They put them away. The first thing they think of is a nursing home. Some of these people don't need a nursing home. If they have their own bedroom at home, look at television or listen to the radio or they have themselves busy knitting . . . We all, us foreigners, think about it.

Right now there's a lady here, nothing wrong with her, but they put her away. They don't come to see her. The only time they see her is when she say, "I can't breathe." She wants some attention. And that way she's just aging. When I come here, she was a beautiful woman. She was looking very nice. Now she is going down. If they would come and take her out sometimes . . .

We had one lady here about two years ago, she has two sons. She fell and had a broken hip. They called the eldest son. He said, "Why call on me? Call the little one. She gave all the money to that little one." That was bad. I was right there.

All these people here are not helpless. But just the family get rid of them. There is a lady here, her children took her for a ride one day and push her out of the car. Let her walk and wander. She couldn't find her way home. They come and brought her here. And they try to take away all that she has. They're tryin' to make her sign papers and things like those. There's nothing wrong with her. She can dress herself, comb her hair, take a walk . . . They sign her in here, made the lawyers sign her in. They're just in for the money. She will tell you, "There's nothin' wrong with me."

Things that go on here. I've seen many of these patients, they need help, but they don't have enough help. Sometimes they eat and sometimes they don't. Sometimes there's eight hours' wait. Those that can have private nurse, fine. Those that can't suffer. And this is a high-cla.s.s place. Where poor old people . . . (She shakes her head.) "The reason I got so interested in this kind of work, I got sick. One evening my strength just went. My legs and everything couldn't hold. For one year I couldn't walk. I had twelve doctors. They couldn't find out what was wrong. I have doctors from all over the United States come to see. Even a professor from Germany. A doctor from South Carolina came, he put it in a book. My main doctor said, 'You have to live with your condition 'cause there's nothing we can do.' I said to him, 'Before I live this way, I'd rather die.' 'Cause I couldn't feed myself, I couldn't do nothin'. This life is not for me.

"They took me home. I started prayin' and prayin' to G.o.d and things like those and this. Oral Roberts, I wrote to him several letters. Wrote from my heart. Still I was crippled. Couldn't put a gla.s.s of water to my mouth. The strength had been taken away. I prayed hard.