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To Find Joy in Everything
From Joy's hare to creature-assisted care, one family's history has long been closely intertwined with the story of America's medical system — a legacy that continues to this day, in its own way
by Olga Kaczynski / October 2012 issue, Harper's Magazine
The world of the ER is a paradoxical one: in a place where urgency is so commonplace as to become mundane, there is a buzz, if not of frantic energy, then of action. A phone rattles at the reception; the on-duty makes plans to expect a criticial arrival in five minutes. In the corner, I can hear the pained groans of a man in a delirious stupor; behind me, the pointed questions of a nurse heading that same direction.
"Where's Dr. Chaudry?"
"He's in the O.R.," answered another nurse.
"Does he need his AM?" asks the first.
"I doubt it," says the second. "Gunshot victim."
"Page him. Have him send his AM down," comes the reply. "And get the siphon."
What I am here for today is not simply to watch professionals at work, but as I stop in that corridor, I am struck by the way that even such routine exchanges reveal a depth of medical culture. The AM, something I know from after-work med drama marathons, is hospital code for a Hawaiian muk — though its virulent mainland cousins share its omnivorous appetite for toxins, it is the Hawaiian muk's friendlier, clean-as-you-go nature that makes it a much more welcome aid to any nurse in need of a trash can — or, in this case, an assistant to help sober a partygoer with a BAC thrice the legal limit.
But even the fact that the muk itself is so ubiquitous as to be reduced to a two-letter acronym in healthcare parlance suggests a deeper truth about the system it thrives in: that is, it's unthinkable now even to suggest that an American hospital should ever be without creature-assisted care — another term for which, of course, there is an acronym: CAC. To go without an AM is to consign a reckless college fratboy to a terrible hangover. To admit that JHs (audinos) are in short supply following a freeway disaster is to expose yourself to accusations of negligence, and worse, malpractice suits.
As recently as a century ago, unbelievable as it might sound, this wasn't the case. And what I'm here for, tonight, is to get to the root of the story that brought this all about.
When I come up to the reception, the on-duty asks, "Are you here to see someone?" He doesn't skip a beat. He doesn't even seem concerned by the fact that his critical arrival is probably turning the corner of 9th Avenue, two traffic lights away from the hospital.
"Yes," I say, "but not a patient. I'm told Dr. Mitchell is here."
He purses his lips, makes an irritated clicking sound. "I'm sorry for your info, Miss," he says, reaching for a notepad, "but Dr. Mitchell's on leave."
In retrospect, it might have been a bit unrealistic of me to think that a busy doctor in Emergency would have taken the time to sit down and talk to me (much less even be there) — but in my mind, my visit to Castelia Medical that night had been meant to be the culmination of several months of hard sleuthing: of poring through dusty registers of surnames; of praying this or that person of interest would return my calls; of being so desperate that I was willing to go as far as page three on a Google search.
The story goes back farther than that, of course. In fact, it goes all the way back to 1906 — specifically, to San Francisco. If those two things bring something to mind, you've guessed right: it's the story of an earthquake, of a resulting fire — and of a venturous man named Alexander Joy.
Contemporaneous estimates of the death toll in the 1906 earthquake show numbers as low as 375 or, as the New York Times claimed, "over 500" — a number which, many suspect, had been artificially diminished in order to persuade investors that relief was worth appropriating towards the ruined city, and not, instead, southward to Los Angeles. On the ground, a different reality was painfully obvious to the firemen, the soldiers, and the physicians scrambling to provide their aid — not least of which was Dr. Joy. As luck would have it, he had returned by steamboat a little over a week ago from a trip to China, and the thousands in need of immediate help on the ground provided opportunities aplenty to put into action the knowledge he had gained from his Chinese counterparts.
That was easier said than done: Joy was only one man. As he himself noted in his diary, "There is too much work to be done, and too few hands … I am sore to the heart to see the affliction of the many wounded and grieving in this City." In particular, it was the plight of the Chinese immigrant workers that distressed Joy, who had grown sympathetic to them after, in his own words, "having learned a great deal … from my Oriental compatriots in medicine." Complicating matters, Joy confided, were the attitudes of his countrymen: "If they are not indifferent, they are malicious … I have heard many a whisper that hopes with this earthquake that the residents of the Chinatown of San Francisco shall be driven out for good … little is done to count their dead, or to aid them."
Yet equally as troublesome as repairing the damage and attending to the casualties was restoring order. As though the human element of chaos was not enough — the mayor, E.E. Schmitz, had gone so far as to authorize a kill order against looters — the quake-and-fire combination had the effect of destroying the animal shelters at the city's core, loosing many of their residents wild upon the streets. But, as luck would have it, among the stray arcanines, liepards and herdiers were other animals, too: not least of which was the hare that made it to Joy's doorstep.
Joy could barely contain his excitement. "It was as though the Lord Himself had delivered unto me an angel," he wrote — but when he began his work the next day with an audino by his side, his colleagues were skeptical. Considering the circumstances, they had every right to be. In the 1900s, the abilities of audinos, lepus sanans, had thus far gone unnoticed by American biologists, many of whom had devoted their efforts to more adventurous discoveries in remote Pacific islands or the Far East — a blind spot that likewise explained why creature caregiving was no staple practice in the New World; in comparison, the presence of chanseys had centuries since planted the idea firmly into Chinese ideas of healthcare. Colonial prejudices, too, may have played their part: such ideas were familiar to Native Americans, and so the association with such backward and primitive techniques certainly didn't help matters.
Results, however, spoke for themselves. The swift, almost systematic way by which Joy proceeded to relieve the tent cities of their wounded turned his skeptics into students, and soon enough caught him the eye of the University of California's administration, themselves significantly invested in the relief efforts poured into the city. Sure enough, by the time the college had established its nursing school a year later, Joy found himself among its faculty — at which point, he was well-empowered to spread his ideas of creature-assisted care first to the state, and then the nation — the rest is history.
Back in the present, I am able to explain my circumstances well enough to persuade the on-duty (albeit with some difficulty) to scrawl the work email of one Dr. Cassidy Mitchell, née Joy, on a notepad, and hand it to me. Thus began an on-and-off correspondence with (as close as I could get to) a scion of Alexander's legacy. I discover, quickly, that she is a warm, cordial person, unafraid of accommodating nosy, persistent journalists like I know I must sound — but that, too, she is exceedingly busy, and that her schedules do not line up with mine. I try everything: calls that go to voice-mail, questionnaires that are met with requests for more clarity, and meetings that last-minute commitments always seem to quash.
Then, on a summer afternoon eight months after my first email: "I'll be home, on Tuesday afternoon next week, if you can make the time — and if you can, I'll give you my address and you can drive on up."
How coincidence, fate, or perhaps Joy himself winking from up high might have known I was free that exact day still escapes me, but what struck me more by the message was the intimacy this invitation implied. She hadn't been one to shy away from the idea of meeting at a Starbucks, at Times Square, or even in the hospital cafeteria — so why now, was her home suddenly on the table? Nevertheless, I took the bait, and by Tuesday morning, I was back on the highway straight to New York City.
I descend on a busy street in Queens, hoping perhaps for some identifying mark in the brick-laden rows that will mark the Mitchells' home as theirs, but ultimately I am reduced to sleuthing out their home by the numbers on the doorstep, a hung-up glass chimecho tinkling in the eaves. Whatever trepidation this amounts to, however, melts away when I see the face that answers the doorbell, her rosy pink hair tied neatly in a bun behind her.
"Olga?" Cassidy offers. "Olga Kaczynski?"
The space is cramped, even claustrophobic, but she spares no effort to welcome. "Anything to drink?" ("I'm good, thanks.") "Sorry this place is such a mess." (There's not a speck of dust on the cupboards.) And mindful perhaps of how difficult this one meeting had become to organize in the first place, she quickly gets down to business. But for a doctor carrying on a name with considerable pedigree attached to it, she otherwise defies my expectations: breezy and easy to talk to, she doesn't seem to be weighed down at all by the reputation that history has foisted upon her.
"I've never been good at laying out my thoughts in emails, or memos," she admits, "so I'm sorry I kept making up excuses not to answer those questions you kept writing up." As she says this, she adjusts herself in an armchair and crosses her legs slowly. "It's just so much easier to work through these things face-to-face."
She claps her hands together.
"So," she starts. And as a hundred questions vie for the coveted spot on the tip of my tongue, she chooses the one that perhaps sums up all of them the most. "I guess you'd want to ask what else I know about good ol' Alex."
That I did. And looking up to the ceiling in mock thought, she makes another admission. "To be honest, probably not a lot more than whatever you've already dug up to get to me," she laughs.
There's an idealist part of my brain that goes darn it, but the realist beside her gently reminds that life is not a soap opera with snooty, aristocratic British families. Which is to say that I half expected this, but I'm a bit disappointed to hear it, anyway. She's not lying, either — it's true that she does know more about Dr. Joy than the average Joe or Wikipedia article, but just about the only thing she has to add to my version of the story is that, "like the guy who made Kellogg's cereal, good ol' Alex was an Adventist."
I ask if that's the same for her.
"Nope," she answers, emphatically. "I moved out after graduating, got out of Cali, met a good guy, he was Catholic. I converted," she says, and points to a little rosary around her neck. "Anyway, what I am, what he is, none of it's a big deal, in the grand scheme of things, I think. It's all just trivia."
"Why's that?" I ask.
"Because someone else would have figured it out eventually," she muses. "Maybe then people wouldn't be expecting everyone with pink hair and the name Joy to get into the business." A chuckle.
This, by the way, rings a little more true than I'd like — Cassidy has family, some extended and some not, settled deep into every facet of the American system, from Big Pharma to hospital administrators to med school professors. Joy, Joy, Joy everywhere you look — it probably does give the public the wrong idea. All of them, I recall wryly for her amusement, had contributed to my frustrations over the past few years, with all their refusal to take my calls, their eagerness to flag my emails as spam, and every other way one could conceivably get in the way of a scoop. She laughs again.
"It's not like I got into my career because I cared about any of that, at least," she says. "Some people just, you know, think to themselves when they grow up, 'oh, I wanna be this or that'. That was me."
But surely her family would have egged her on, I rebut.
"I struck out," she recalls. "My dad would be like, it's good to know someone in the family still cares about Alexander, and I'm like — who cares what Mister Skeleton in a cemetery somewhere in San Fran thinks? It's not like I loved every part of the stuff I had to do to get here, you know."
Like what?
"Like my college prereqs," she says. "The licensing route, I mean."
The development she's referencing isn't recent at all, either: the American system has required medical practitioners to have at least standard trainers' licenses since the 50s — a stipulation that is commonly agreed to have emerged in the Jim Crow-era laws of the South as one of many additional double-standard tests blacks were forced to pass through to dissuade attempts to rise above their stations. Although the discriminatory practices behind the rule would be later outlawed thanks to the civil rights movements of the 60s, it was yet argued that the general principle of having a trainer's license was nevertheless sound logic in the field of medicine, and so the rule became a nationwide one.
"I think there's a lot of irony here," she continues. "These days, if you wanna do CAC, you gotta have a trainer's license. And if you wanna have a trainer's license, you probably wanna take Creature Fundamentals. You get what I mean. One of my best friends is in the NPL — he was a battling major, and I sat beside him for two years in that course. He always used to make this joke to me: you gotta learn how to hurt if you wanna learn how to heal."
I think back to my own experience in Creature Fundamentals, remembering faintly that hers matched my own. In my case, I explained, the earth sciences major had actually done a spittake when I told her I was in media studies. Again, she laughs.
"It's one of those things colleges do where they 'consolidate' their offerings to 'offer the best experience to as diverse a range of disciplines as possible'. More like they just wanted to hire less lecturers for the same class."
Did you like the profs, at least?
"Hell no."
It's at this point that I notice out of the corner of my eye a guest. Peeking in from the doorway of the room is a little boy, his bright blue eyes a marked contrast to the messy spikes of pink hair every bit as flush as his mother's. But when she notices, too, he runs off; I look back to Cassidy, and the look in her eyes tells me, this is what I wanted you to see.
In that moment, I realize, coming here, I've played right into her hand. The questions she's answered are only the ones she wants me to ask. The legacy she wants me to envision is the one she imagines for herself — not the lofty, straightforward idea of succession that, while easy for me and my readers to digest, is too simplistic for the reality.
"Anything else on your mind?" she asks, almost too plainly.
In that moment, I feel like a grandmaster defeated on his own board, seeing the imminent checkmate — but who chooses to play on, a nod of respect to their opponent's skill. Perhaps she anticipates exactly this last question, but I press it anyway.
"Where do you really see yourself?" I venture. "What do you think about the future?"
She uncrosses her legs, finally seeming to be at ease.
"I turned thirty-two last week," she says.
"Happy birthday."
"My son, Rose — you just saw him — he's four."
An only son?
"Yep," she says. "Now think about it. Twenty-eight years is a long time to figure out what you want to do with yourself, right?"
And do you think he wants to be like his mom?
"I hope not," she muses. "I'd be happy to know, ten, maybe twenty years down the line, that he's doing something, anything other than what I pursued. Don't get me wrong — I wouldn't want to be anything else. More to the point — I'd rather the whole Joy thing doesn't have to mean nurses, doctors, and pharmacists for the rest of his life. You know what I mean?"
She's about to launch into an example, another witty explanation, I predict.
"Sure," she smiles. "Think about it this way. Alex might have been fine with audinos, but something tells me he'd never have been the kind to bring a muk to the hospital floor. You can look that one up in the history books, you know — there's no Joys anywhere in the story of AMs."
It had been a purely Hawaiian idea, I agreed. What was her point?
"What I'm saying is, Alexander was the one who associated 'healthcare' with 'Joy'," she explains. "But so many other people, none of them Joys, have changed the system, in their own little way too, for the better. To answer your question — I think that means, I'm at the tail end of this whole 'Joy' story. It's time to focus on other people, maybe so we can focus on doing our own thing, too, in the future."
"Sure, there's a Joy in everything healthcare now," she concludes, "but what'd make me happiest, I think, is if I found out my son got to be a little of everything else." ■
Kristina Schilling and Matias dos Santos contributed to this reporting.