“In sickness and in health” is what is often said when we get married. “I do” we voluntarily vow, however most of us never think of the troubles and trials the pledge can encompass.

If I remember the time correctly, it was October of 2018 when Nia had a third stroke. The result was that she was essentially bed-bound, which in turn meant that extensive care giving is a required daily routine.

I’m the only care giver in our home. Washing clothes and bed-linen. Changing gowns and underwear. Making groceries. Preparing food. Responding 24/7, sometimes at three or four o’clock in the morning. My blessing is that I’m physically and mentally up for the challenged of consistently completing the required tasks. Plus, on the infrequent days Nia is hospitalized or has a doctor’s appointment, I’m down for that too, usually with assistance from immediate family and close friends.

I really, really dislike hospitals, nevertheless I am at Tulane Medical Center visiting with Nia every day she is there. And me being me, I’m constantly checking out whatever environment I’m in.

From what I have seen, all of the people who clean and do daily maintenance are Black and they are also overwhelmingly female. Plus, they are clearly working class. The way they talk, their physical appearance.

The next level is the nursing staff, which is racially mixed, with the plurality being White. Plus, their profession requires them to be college educated.

The third level is technicians, such as X-ray tech, which is what Nia was before retiring.

The fourth level are the physicians, ranging from the interns to the heads of staff. The doctors are the most diverse grouping racially and heritage-wise. One doctor who treats Nia is an African from Cameroon. Another is an orthodox Jew who wears a yarmulke.

In total, the medical staff is reflective of our overall society. I’m not sure about the administrators, most of whom I don’t see or meet when I visit with Nia. Although the hospital has a distinct and specialized mission, nevertheless, its class structure, skill areas, and authority hierarchy are clear and unmistakeable.

Hospitals, like most aspects of social living, are a reflection of the society along class and racial lines; lines that tend to separate rather than merge personalities while also maintaining easily identifiable areas of concern and lanes of responsibilities.

This hospital is located near the downtown business district. Unlike medical centers across the city away from downtown, in those hospitals and clinics you aren’t required to pay for parking. Both the cost of direct and ancillary treatment (such as parking) are expensive and damn near exorbitant in terms of both time required and money demanded. Capitalism drives the rules and ultimately drives the whole system.

Most of the medical personnel, especially the doctors, don’t directly deal with the “filthy lucre”, don’t receive their payments with each visitation. No. What happens is you get a bill—I should say a “whopping bill” and if you don’t have health insurance or are not a military veteran receiving service at the VA Hospital, that bill is way beyond your means to pay.

It is well known that doctors are high on the pay scale in terms of the cost of their services and at the same time most doctors are not money grubbing hustlers. They genuinely do all they can to help a patient. In fact the doctors seldom think about money–not just what the treatment costs, but also not how much is specifically charged for their services. One of the beauties of capitalism is that more and more often the charges for goods and services are impersonal and indirectly assessed.

We pay with debit and credit cards, infrequently with checks, usually not with cash. Even when it’s a $3.00 parking charge, we often pay with plastic. What this means is that there is a middle-man, or more accurately, a middle-machine, between what we pay and to whom we pay, not to mention who collects the payment and what happens when we can’t afford to pay.

Although we often can make a choice about what we buy, hospitals have us over a proverbial barrel: when you are sick or injured, you really, really need to get well, get back to work, or at the very least get your health back.

Hospital treatment is not a choice, it’s a necessity, albeit an extremely expensive necessity. The ever rising costs of health care far outstrips the rise in our paychecks or in our retirement or social security payments. You want to receive treatment, you want to get well? Well, you’ve got to pay.

Dr. So-and-So is not personally charging you. We do not place a thousand dollars directly in the out-stretched hands of medical providers. Indeed, more and more, you don’t actually put out hard money. To pay bills you use financial instruments, chiefly the debit/credit card. For the privilege of using plastic to pay your debts, the banks charge you a fee for using a financial instrument. From a money-making perspective, it’s a beautiful system that charges you to spend your money. C’est la vie in modern societies.

Yesterday as I stood at the ATM-like machine to validate and pay my parking-ticket, I looked up and walking through the sliding, glass front doors is Shardae Womack who was a former student almost a decade ago. She does more than wave, smile and drop a welcoming “hello”. She is genuinely glad to see me. We hug a greeting and end up conversating for close to twenty minutes.

Shardae is a lawyer now—passed the bar on her first attempt, which is not easy. Louisiana is reputed to have the hardest test in the nation, partially because our lawyers not only have to master national requirements but additionally have to conqueror vagaries of the Napoleonic code that is only used in Louisiana.

“You just have to put aside everything and buckle down for three months to pass the bar.” Shardae believes that being in our Students at the Center writing program in her junior and senior years of high school was a major boost to her academic preparedness but I remind her she was gifted with a can-do attitude.

“I wrote a book. I never thought I would, but it just happened.” She smiles and her eyes light up as she tells me about the book she authored and thanks me for helping prepare her to write her own book.

I explain to her, all students are offered instruction but not every student builds on what they learn. She wants to help young women gain control of their lives.

Taking charge of your life, being a leader rather than simply being led is what Shardae is about. She’s also about helping others, that’s the critical part of Shardae’s story. She wrote the book to share what she has learned with others.

After being inspired by Shardae I head back across the river to Algiers, on the West Bank of New Orleans where Nia and I live. Even though we are less than a block away from a major catholic parish church and down the street from an elementary school, our neighborhood is ultra quiet.

I really enjoy solitary work, especially in our home, where I’m generally on my computer day and night. When I’m not writing, or reading, I watch and listen to programs via computer with earphones on, and seldom watch the television. 

When I’m writing, I am annoyed by being disturbed, nevertheless I really prefer a recuperating Nia being here and requesting this or that, rather than the silence of being home alone.