Thursday, August 10, 2017

The Manicure



The day after I found out I had passed my nursing boards, I thought, Well, now what? My kids were at day camp, my partner was at work, I’d given my old boss two weeks’ notice and my new boss notification that I’d be ready to start in three.

I figured I was due for some self-indulgence. I’d been wrangling children and work and school for about six years. So on a whim I decided to get my first mani-pedi.
  
People I know talk about these, but the idea of them has always embarrassed me. I actually kind of like my feet, so that wasn’t it. It was just imagining this army of women out there buffing and polishing other women’s appendages. Something about it felt obscene.

I know, I know. We pay people to do all sorts of things. Like cut our hair, for instance—except that doesn’t seem as personal. I get a massage sometimes, too, but that’s got this health-and-wellness aspect to it that just feels different somehow.

Is there anything on a par with having someone work on your feet and toenails? Maybe paying someone to unplug your household drains(?). But those people get paid handsomely to do your dirty work.

Despite these misgivings, off I went.
  
I knew ahead of time that this was a sociological experiment. First off, although I’m a woman, half the time I feel like a fake. (Maybe because I’m gay?) Secondly, the world of nail salons is peopled by a mostly Asian workforce and a Caucasian customer base, so that impacts the dynamics. I knew these things walking in, of course, but I was interested to see what I would think and feel.

Something that surprised me immediately was how much of a “thing” getting a mani-pedi is. After picking a color for my toes, I was immediately seated in a giant, cushy massage chair, complete with a jetted foot bath. And these weren’t pulled-together items. They were pieces of furniture quite obviously created entirely for the nail business at large.

The woman assigned to me got right to work. Meanwhile, I looked around. I was ensconced in the chair furthest into the salon, but there were another ten or twelve chairs to my left along that wall. To my right was a counter with a sink, and a basket of rolled-up hand towels, and along the wall ahead of me was a long countertop at which four or five women sat with hands extended to various manicurists. Above and behind them, an enormous flat-screen TV. (I don’t think I’ve ever seen such a large set. I’m thinking that if sports-minded men in this neighborhood understood this perq, they’d immediately begin getting manicures.)

When I looked down again toward the towel-covered footrest, I was suddenly appalled. Who knew such a pile of dead and calloused skin could come off my feet? I think I blushed. If I didn’t blush, I should have. But the manicurist was seemingly undaunted. Who knows? She may have thought I was the grossest person ever, or maybe a significant pile of ragged skin bits are just part and parcel of this work. I have no idea.

Another worker stopped at the sink area and exchanged a few words with her in a language that was not English. When she walked away, I asked, intrigued, “What was the language you were speaking?”

“Vietnamese,” she told me.
  
I nodded. “Is everyone who works here Vietnamese?”

“Most,” she said. “There’s one from China. She knows three languages.”

I raised my eyebrows in astonishment.

“You work long hours, don’t you?” I asked. (Their door said 9 a.m. to 7 p.m.)  

“Yes,” she said.

“Is it busy that whole time?”

“Sometimes. We have days when we don’t eat or drink because there are so many people.”

“Oh,” I said, concerned. “Be sure to eat.” (Yeah, I’m a nurse and a mother, what can I say?)

“You want regular or deluxe?” she asked.

At first I thought I’d go for regular, but then I figured, Maybe you aren’t ever doing this again—so I told her deluxe.

In addition to having had my cuticles clipped and heel callouses scrubbed down, I got an additional calf massage with lotion and hot stones. She also dipped my feet into plastic bags full of warm wax, which she later neatly peeled off in a single motion. It felt wonderful, but again, I felt slightly sick that my body could produce slough that other people had to handle.

Someone turned on the giant TV set to Netflix and an episode of “Friends” began to play: Chandler and Monica going to the fertility doctor. I can’t imagine that in real life that scenario would ever be funny, but the writers made it zany enough that the plot tripped along with its accompanying laugh-track.

The manicurist slipped a pair of orange disposable flip-flops onto my feet, along with aquamarine foam toe-dividers, and swiftly and neatly painted my toenails blood red. Then she doused my cuticles with oil and spread it all over the skin. There were other steps in there, but I’ve lost tract of it all. It felt amazing.

“Okay, come over here.” She directed me to the long table/counter, and I sat down.

The woman to my left was tall and tan and athletic. Her nails were being painted a gorgeous graying pink. “I love that you paint the ends first,” she said to her manicurist, who looked like a medical professional, her mouth banded with a paper mask so that she wouldn’t breathe in nail and nail polish particulates. “I swear, this last time you guys worked on me, the color lasted six weeks. And I worked in my garden, even.”

“Really?” I asked her.

“Yes,” she said. “There’s regular polish and then there’s this powder type.”

“You want that kind?” my manicurist asked.

“Okay,” I relented. She helped me pick a color—this time a red with a little more yellow in it as well as miniscule sparkles.

She shaped my extremely short nails and asked me if they were okay.

“Oh, yes,” I told her.

She glanced up at me. “You’re nice,” she said.

“Well . . . I’m easy-going,” I replied, abashed. I took piano lessons for umpteen years as a kid, so long, painted nails were a no-go. Plus, mine just never seem to grow. I don’t even cut them with nail scissors—just nip them off with clippers. Who can be bothered, I’d always thought. I was beginning to reevaluate that idea.

So besides there being specialized manicure furniture, here was another modernism I was not aware of: you don’t have to polish nails anymore, exactly. I mean, she did paint on clear varnish, but then each finger was dipped in a colored powder. She’d then lightly flick my finger, buff the nail a bit, paint on more clear lacquer, and dunk the nail once again. I think this occurred four or five times.

“Wow,” I exclaimed.

The athletic woman next to me said, “Yeah, and be sure to ask her what to do when you want that back off. It’s not easy, and you should probably come back in.”

“Oh, really?” I asked. “I never do this. I’ve never done this. I had no idea what to expect.”

“Not ever?”

“No,” I said. “I have two kids with special needs, and I just finished nursing school. I don’t have time for things like this, but I thought I’d try it.”

She turned toward me. “You have kids with special needs?”

“Yes,” I said.

“I’m a physical therapist,” she said. “I work for Boulder Valley School District.”

It turned out she had never worked with my kids but had been at one of the schools they attended and knew who they were.

At this point, a dark-haired woman sitting on the physical therapist’s other side said, “I have kids with special needs, too.” Hers were in their twenties and now lived separately from her in group homes in the area. We all agreed that our local developmental disabilities center, Imagine!, was fantastic, that life with these kids was extraordinary, that school can be amazing and frustrating—real life mimicking “Friends,” which in all honesty imitates “Cheers.”

“This is crazy,” I said, shaking my head. The row of masked manicurists were smiling with their eyes.

The dark-haired woman noticed this, too. “You guys probably see this stuff happen all the time, don’t you? This place is like a bar—the girl bar.” Her nails were nearly finished, and when she got up to go, we waved at her and wished her the best. My athletic neighbor decided to have a pedicure and removed to one of the cushy massage chairs, and I bid her adieu as well.

On “Friends,” another episode was playing. This time Joey and Rachel were having a heart to heart at, of all things, a conference for paleontologists, where Ross and Joey’s newest girlfriend had somehow dragged them.

The manicurist gently pushed my right hand toward a miniature fan. When she finished with the left hand, she pressed it toward a fan on that side.

Once my nails were dry, I got up to pay, but I stopped several times to admire her handiwork before reaching the cash register. Then I pulled out my card and paid, but I stumbled over the bill. What am I supposed to tip, I wondered. I couldn’t land on a figure, so I did twenty percent.

But half an hour later, I regretted that I hadn’t given her more. Usually, twenty percent seems right, but now I felt awful. The nail salon economy doesn’t entirely follow what’s usual, in the gut sense. Though I haven’t asked anyone else, so maybe I’m the only one who feels that way, I don’t know.

In addition to that confusion, I didn’t know what to think of the experience. I had a mixed response. Having a little color on one’s fingernails and toenails is fun—simple fun. Delightful, really.

And it’s nice to be pampered. It was relaxing, though that aspect was negated somewhat by my crazy self-consciousness. And my aversion to some of the wholly-anticipated-but-still-ghastly aspects of this beauty regimen.

I don’t know, either, what to think about the privilege of those of us getting primped versus those of us doing the work. Sure, the women workers have jobs, but this may not have been what they really thought they’d be doing when they relocated to the U.S. (and most of them were immigrants).

I’d read part of the 2015 exposé in The New York Times about nail salons in that city, an investigation that made such places out to be sweatshops. That article must have led to quite a kerfuffle afterward, because when I went online to find it again, my search uncovered headlines about protests, rebuttals, and partial retractions. The latter was somewhat reassuring to me. It would seem that, even in NYC, not every nail salon was performing shady practices. At the one I went to in my town, there was an ease about the employees that would seem impossible to me if they were being mistreated or exploited the way The New York Times had suggested their city’s nail salon workers were.

Still, the manicurists in this shop were hard-working, diligent Asian immigrants. Their fingernails and toenails were not shiny perfection. I’m not sure how they do economically working there, but the situation is certainly stratified, culturally speaking.

I think that’s what made getting a mani-pedi different from other beauty services I receive. For one thing, apart from the sound of the television, and my interaction with the other customers, there was actually very little conversation. During most of my session, I took my lead from the manicurist and remained silent. I had tons of questions, but I didn’t want to pry, so I have no idea if she has children, if she owns a house, if she drives to work or carpools, if she’s married. I know these things about my hair stylist, but here I didn’t ask. Even the few questions I threw out felt invasive, to tell the truth. None of the other customers were having these conversations either, so I’d chalk up the silent worker-consumer transaction in this salon to the cultural differences across the counter. I can’t speak for other places, but this one had mostly Vietnamese manicurists, and they went about their duties with a particularly self-possessed, calm, and quiet air. And that calmness and silence impacted me. I’m a regular Chatty Cathy, usually, but I rather liked it.

I guess that eventually I’ll have to return to get the powder-paint removed. I can’t go to work as a nurse with fire engine red fingernails. But how to proceed after that? I really don’t know.

The only thing I’m certain of is that if I do go back, I’m going to tip more. I know I’m going to want to bring the whole place snacks, but that’s probably paternalistic. I guess I’m wondering how women do nail salon treatments without feeling like self-conscious hucksters. Do most white women feel as white as I do doing this sort of thing? Is getting a mani-pedi a common recreation among women of different races? Is getting one’s nails done really different somehow from other kinds of beauty treatments?

I’m still thinking about these things.

For the moment, I’m just enjoying my crayon-colored fingertips and toenails. I hate to say it, but the five-year-old inside me is delighted. I’m afraid that means I’ll probably go back. I wonder what episode of “Friends” will be playing, who will sit down on my left and my right.
  


    

Sunday, April 10, 2016

Inheritance



My neighbors are leaving for Italy.

The children of my flesh
do not speak in full sentences. I must
think for them, devise ingenious methods
to goad their speech.

They don’t know Italy,
Italian. Nor do I. And yet their great-
great-great grandmother
hailed from Siciliy, driven
to Brooklyn by an earthquake.

Our little family still
feels the aftershocks. The loss
of words for the things
most loved.

Sunday, September 13, 2015






SOME STEPS TO ADVANCE HEALTH                                                                                     1        






Some Steps to Advance Health
Karen Leh
University of Colorado School of Nursing









SOME STEPS TO ADVANCE HEALTH                                                                                  2                                                                                                                                                     


Karen Leh
Professor Susan Strobel
NURS 3277 Health Promotion I
13 September 2015

Some Steps To Advance Health
   In order to serve the public—not just adequately but with excellence—a nurse must naturally be highly skilled. But skill also incorporates certain intangibles: having a clear idea of what “health” means, possessing a thorough knowledge of national health goals, and understanding the larger context of the patient. To this end, a truly skilled nurse is someone who comprehends the aims of documents such as Healthy People 2020, grappling with how to meet its objectives, which would include trying to mitigate the negative impacts of various social determinants of health.
   For me, the word “health” is best framed by Carole Edelman (2014), who describes it as “. . . a state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context” (p. 5). The other definitions—in the lectures and the videos—lacked succinctness, did not feel thorough, or took a too sharp trajectory policy-wise, in my opinion. And still, I find this definition somewhat lacking. Personally, I’d want to add “dynamic” in there (e.g., a dynamic state) to acknowledge that sense that health is often changing, and the physical, mental, spiritual, and social elements shift, tugging a person’s health in and out balance.  
   But the definition is certainly sufficient, and it is broad enough that applying it to any one of the topics and objectives of Healthy People 2020 would present the nurse with a great challenge. As I looked through this document, one of the topics that most interested me was labeled “Disability and Health,” and within that category, objective DH-16 stood out: “Increase employment among people with disabilities” (U.S. Department of Health and Human Services, 2014).
   There is a large population of people with disabilities who are unemployed—I have many contacts with individuals in this population and have witnessed their struggle first-hand. So many of them have sharp minds, but those with cognitive impairment can bring such joy and dedication to whatever they do, so it’s exasperating to see them parked, solo, in front of a television or video games all day, not participating in or contributing to society as fully as they might.
   Meaningful employment enlarges people’s world in unexpected ways. It encourages intellectual growth, adaptability, refinement of gross and fine motor skills, problem-solving, and—finally—friendship. That’s the other side of this particular issue: what do we, the non-disabled, lose when we fail to employ the disabled? Considering the definition of health I chose, the well-being of both the abled and disabled communities would be bettered if we fulfilled this objective. Perhaps for the disabled person there’s a more thorough health advancement in terms of the physical and mental aspects of health, but the growth in the spiritual and social realms would be advanced for all. Employment would certainly aid a disabled person in reaching their potential (a concern encompassed within the definition of health that I selected). And because work is the expected next step when school is completed, this employment objective also addresses the “developmental context” of the disabled employee (Edelman, 2014). In other words, there is synchrony between Edelman’s definition of health and this Healthy People 2020 objective.
   That said, fulfilling the goal would be challenging. One of the difficulties would be addressing the many social determinants of health, those underlying issues that are often silently but powerfully limiting people’s access to health care and, therefore, employment. These include things such as income, education, race and ethnicity, transportation, housing, insurance, food access, and complex health needs.
   Looking at the objective I chose as my focus, I could see many if not all of the social determinants of health needing to be addressed. What I would do as a clinician is to create for myself very measureable goals. For instance, my first job would be to uncover the resources already out there that would make my work easier and solve or at least address many of the potential problems. For instance, Boulder County’s developmental disabilities center, Imagine!, probably already has a list of employment resources, which would create a starting point. I’d need then to talk with the organizations Imagine! had identified so as to understand their approaches and the extent of their services.
   One resource Imagine! would likely refer me to is Workforce, whose whole aim is to match people with businesses. I would need to call them and ask how many disabled people they have placed in jobs; how many of those situations worked out well; do they have an “employment closet” where people with little money can find proper clothing for the workplace or do they know of one; have they had success setting up carpools for workers without automobiles, money for the bus, or the skills to access public transportation; do they have placements for people who have multiple deficits; have they had success placing disabled folks who do not communicate well verbally, or whose first language is not English?  
   Once I had compiled a list of resources and spoken with their representatives, the next step would be to contact the case worker for the person I sought to help, discuss a plan specific to that client and any ways I could be of service. I’d then go on to create a new goal around a social determinant of health that was not being given adequate attention through the agencies I’d contacted.  
   I think going step by step like this, developing measurable goals to address the whole of the social determinants and then chipping away at the rest, would bring me great satisfaction. If I did this, I’d be helping others to find the definition of health advanced by Edelman’s textbook. I might also increase the percentage of disabled persons being employed and so assist the nation in meeting the Healthy People 2020 goals. And that would, by my own definition, make me a highly skilled nurse.



References
Edelman, Carole E., Kudzma, Elizabeth C., Mandle, Carol L. (2014). Health promotion throughout the life span (8th Ed.). St. Louis, MO: Elsevier.
U.S. Department of Health and Human Services (2014). Healthy people 2020. Retrieved from  http://www.healthypeople.gov/2020/topics-objectives