Delivery of Care
‘Loving the universe’
Finding the human equation in our relationships to Narragansett Bay and the world around us — and treasuring all the people and living things who inhabit it
Photo by Richard Asinof
A tattoo on the arm of Mariana Velez, one of the excellent caregivers I encountered in my journey through the health care delivery system in Rhode Island.
By Richard Asinof
Posted 2/17/25
The lyric from the Beatles’ song, “We all live in a yellow submarine,” seems to capture the reality of our shared existence and the need to recognize caring as a human endeavor, a recipe for life.
How can we recognize how important the caring economy in health care is to the future prosperity of Rhode Islanders, as a new generation cares for an aging elderly generation? What is the best way to talk about the innovation economy in Rhode Island as something more than a way to rebuild industry but rather a way to invest in preserving our fragile ecosystem? How can we capture the narratives of the stories of all the residents in skilled nursing facilities and their lives, as a recipe for living? How can we integrate the wisdom of writer Rebecca Altman into a broader conversation about plastics in Rhode Island? How can the voices of those on the front lines of caring — the student nurses, the CNAs, the RNs — be captured and broadcast more widely to a mainstream audience? Why does the tattoo, “loving the universe,” on the arm of a young woman caregiver speak so clearly to the best hope we have of finding the ability to care for and love each other?
The recent news release put out by the Greater Providence Chamber of Commerce asking its members to let them know of funding problems caused by the efforts of the Trump administration to restrict funds appears to signal that the tide may be turning against the new administration. The continuing victories in courts being won by Attorney General Peter Neronha because of his legal acumen and his courage to act to defend the rights of Rhode Islanders is a true vision of how democracy should function. The opening of ECHO Village in Providence this week is a triumph of advocates over bureaucratic hurdles. The decision by the bankruptcy court to honor the sale of Roger Williams Medical Center and Our Lady of Fatima hospitals under the terms imposed by the state is a huge victory.
JOHNSTON— After nearly two weeks of wearing a catheter foli, installed on Thursday, Jan. 30, the foli was removed this morning (Tuesday, Feb. 11,) at 7 a.m., with the admonition that I had eight hours to “pee” or the catheter would be returning. Drink lots of water, the nurses urged.
After a short trickle of urine emerged around 2 p.m., with an hour to go before the deadline of a new catheter, the flood gates opened — 500 ccs of urine, then another 500 ccs of urine an hour later, and two hours later, another 300 ccs of urine.
I found myself overcome with emotion, almost crying at the release of all the tension I had been carrying for two weeks, the foli tethered to me.
This may provide too much information, but it represents a kind of reverse aging parenting lesson: as a parent of a young child, involved with toilet training, one took enormous pride at each successful step your child took in controlling his bodily functions.
Now, as an aging parent, I am the one crowing about the flood released from my bladder, as my body appears to be functioning again after being damaged when a refrigerator fell on top of me.
Yes, this is probably all too much information for a news story, but it is a reminder about how wondrous our own bodies are in preserving and keeping ourselves alive for decades.
The image of the tattoo that accompanies this story translates as “loving the universe.” It is the kind of human sentiment that emerges after tragedy and triumph, a spiritual embrace of life continuing.
“ A refrigerator?”
The reactions from ConvergenceRI readers to my continuing close encounters with the health care delivery system in Rhode Island have resonated strongly, providing an emotional nuance. As Norman Mailer once wrote, the facts are nothing without their nuance.
From a health care professional: A REFRIGERATOR??? Are you okay?? I am very sorry to hear that…. I read this article and the previous ones to see your journey. What a crazy couple of weeks. I hope it starts to improve from here, but I am glad most of the nurses were helpful and you are getting some more hands on care. That is very interesting about the abandoned screws. Sending positivity and thoughts as you heal. I am sure a lot of the readers are enlightened by your experience, and we start to see some positive changes in health care systems.
From an artist: Wonderful piece, Richard! I’m amazed you had the presence of mind to write it. Being around hospitals and nursing home/rehab facilities in the past few weeks, I have a similar sense. So much in a health care crisis depends on the morale, thoughtfulness, and kindness of the whole line of people taking care and pride in their work.
And we as patients also need the courage to rise above our passivity, observe and question as participants in our own care.
From a health care executive: Wishing you a successful continued recovery. Glad you have ConvergenceRI as an outlet to help you through a trying experience.
From an executive nurse manager: I am so sorry to read that this happened to you. Thank you for sharing your experience with your readers; we will do a better job for other patients
From a data scientist: I'm really sorry to learn about the ways in which you're getting a personal look at the health care system, that sucks. Some things are better discussed in theory alone. I hope you can find a way to soldier through and get out of the woods soon. And maybe get the loose screws out, too.
FTR, I once saved a woman at the state Board of Elections from getting crushed by a filing cabinet when she opened too many drawers. It sounds kind of ridiculous, but it was big and full; there was potential for real injury and I think we were both kind of shaken when we had a moment to think about it. Crazy things can happen with big, top-heavy, pieces of furniture. (i.e. I believe you.)
From a long-time subscriber and community leader: Was expecting that somehow you would get an edition out this week and this was both poignant and borderline horrifying...it's amazing how often what we say to, especially, docs, is discounted, minimized, or ignored...what an ordeal you went through and yet you still persevere; you are an inspiration to me.
From a communications professional: Holy shit about (the refrigerator and the abandoned screws). Amazed the fridge didn’t cause any permanent damage and glad to hear you might have a way to address at least some of the pain.
Close encounters with our future.
Tomorrow, (Wednesday, Feb. 12) Gov. Dan McKee will give the keynote at a conference, the Blue Innovation Symposium, which the news release described as a gathering focused on “marine and oceanographic technology companies and their importance to the blue economy in Rhode Island.” It’s being held in Middletown at the Newport Wyndham Hotel.
Tomorrow, (Wednesday, Feb. 12) Gov. Dan McKee will give the keynote at a conference, the Blue Innovation Symposium, which the news release described as a gathering focused on “marine and oceanographic technology companies and their importance to the blue economy in Rhode Island.” It’s being held in Middletown at the Newport Wyndham Hotel.
If my health were better, I would have planned on attending. The Providence Journal had a comprehensive preview of the conference, highlighting the innovator companies involved and the new kinds of technology they were developing, many driven by commercial and military industries building underwater submarines and detection systems and new kinds of boats — as well as the companies developing offshore wind.
A few years ago, in a position paper developed by Bruce Katz, formerly with the Brookings Institution, the Blue Economy was hailed as a kind of technological breakthrough and potential savior for Rhode Island manufacturing. In response, I wrote a story in 2020, pre-pandemic, which asked: “What does public health have to do with future prosperity in RI?” (see link below to story)
Editor’s Note: It is a great example of the in-depth, insightful reporting that ConvergenceRI has always published.
The omission of public health concerns — the Achilles heel of Rhode Island’s current economic malaise — has been on full display in recent months: overflowing hospital emergency rooms, increasing homelessness, renewed mental health concerns, and constant threats to our way of life.
And the flu. During a winter of increasingly turbulent weather patterns and storms, it is not surprising that flu is sweeping across Rhode Island and the nation.
A recent Boston Globe headline warned: “The flu is walloping Massachusetts. “
In Arizona, a Tucson station, KVOA quoted former Rhode Islander Dr. Andrew Saal, who is now Assistant Medical Director at the Pima County Health Department.
Saal told News 4 Tucson the numbers were especially high at the end of last month. "The 2024-2025 flu season is the worst we've seen in about 20 years," Saal said. "Here in Pima County, this spiked starting in December, it spiked very, very high in January. Nearly nine percent of all ER visits was for someone with Flu and respiratory like symptoms. It's now dropped down just a little bit, it's running at about five percent in Pima County." According to recent data from the CDC, Arizona is one of more than 40 states with high or very high transmission of flu.
The story continued: Dr. Saal wants to remind everyone to stay home if you're sick and practice good hygiene.
"Influenza no longer surprises me, it's one of those facts, it keeps you very humble," Saal said. "It reminds you to focus on the basics and the basics are everything your mom and grandma told you. Cover that cough, wash your hands, if you've got a runny nose please wear a mask so you're not spreading it and if you've got a chance, get the flu shot every year."
This is the expert kind of advice that our news media and elected leaders should be championing here in Rhode Island.
The threats we see, those we ignore.
The health threats have increased with the arrival of the latest Trump administration and his efforts to curtail federal spending on environmental programs, drastically cutting or curtailing already authorized federal spending.
Fighting those cuts in the courts has been R.I. Attorney General Peter Neronha, who has won a series of impressive victories.
The connection between our current economic malaise and the overwhelming health care crises we face, post-pandemic, has a remarkable connection to our ability not to see what we don’t want to see, a kind of deja vu all over again situation
Indeed, here is the way that my 2020 story about public health and Innovation 2.0 began:
SOME DAYS, it feels like being stuck in the Bill Murray “Groundhog Day” movie from 1993, caught in a time warp where the scenes keep repeating themselves, over and over and over again, much like listening to the repetitive Dave Clark Five lyrics from 1965 on an AM transistor radio, “I said over and over and over again, this dance is going to be a drag…” while the unplanned forces of disruptive innovation change the marketplace.
Of course, that sense of “déjà vu all over again” [the malapropism made infamous by New York Yankees catcher Yogi Berra in the early 1960s, referring to the frequency in which Yankee stars Mickey Mantle and Roger Maris were hitting back-to-back home runs], re-occurred when “Groundhog Day” was resurrected into a TV ad for the 2020 Superbowl, starring Murray, on Feb. 2, the actual date to celebrate Groundhog Day, in order to sell cars.
Such was the feeling when ConvergenceRI sat down to peruse the draft 118-page report, “Rhode Island Innovates 2.0,” the epic sequel to the 2016 original, “Rhode Island Innovates: A competitive strategy for the Ocean State,” which had been a $1.4 million study produced by the Brookings Institution – and paid for by philanthropic sources, including the Rhode Island Foundation, with CommerceRI as the client. [See link below to ConvergenceRI story, “A history lesson about innovation.”]
The featured author of the new RI Innovates 2.0 report is Bruce Katz, formerly with the Brookings Institution and co-author of the first report, now a principal at New Localism Advisors, an economic consulting firm. This time around, Katz’s fee of $468,600 was paid for by a mix of public and private entities, including: the R.I. Commerce Corporation [$178,600], the R.I. Department of Labor and Training [$150,000], the R.I. Division of Statewide Planning [$40,000], and the Heron Foundation [$100,000].
In an interview, Katz described RI Innovates 2.0 as a report that “essentially updates the performance of the advanced industry clusters and others that were identified in that first [Brookings] report.”
The report represents a “particular kind of thesis of how economies grow in the 21st century. I think it’s worthy for you or others to basically describe the report as covering a certain amount of economic territory, focusing in very clearly on advanced industries.”
Katz stressed that R.I. Innovates 2.0 was “a platform to stimulate broader conversation about the Rhode Island economy. But it starts with a very particular focus on what is, in terms of workforce, a relatively small number of jobs in the Rhode Island economy, but a very large impact on exports, research and development, multiplier effects.”
Rhode Island is a place that doesn’t tend to celebrate success, Katz said. “There are aspects of this report, particularly the assessments of how a group of workforce support programs, and business support programs, and place-making efforts have really been integrated and aligned over the past couple of years. And, they’ve had a real effect, frankly, helping the state grow a more robust and prosperous economy.”
The main message, Katz emphasized, was that it was important to understand the economic development is being practiced differently in Rhode Island today than it was a relatively short period of time ago. “It’s important for stakeholders and observers to dig deep (emphasis added) into the report and see what it covers and what it doesn’t.”
Digging deeper
The first report by Brookings had sought to identify “new sources of high-value economic growth to rectify the state’s heavy losses in manufacturing and advanced industries” which had begun after 1980, according to the summary in the preface of the draft of the new report.
Consider the report’s up-front pronouncement: “Rhode Island’s economy has turned a corner and has made substantial progress since 2016.”
The state, the report continued, “has shown its ability to design, finance, and deliver a series of meaningful projects that support businesses, workers and communities. It now needs to move from individual transactions to structural transformation and to grow the distinctive assets and capacities of this special place into a productive, sustainable and inclusive economy. That will require a shared vision among multiple stakeholders and a collaborative, cross-sector approach to shaping and stewarding the economy.”
Translated, this is what a top-down innovation economic policy looks like. Unlike the first report, it does talk, in a commendable but somewhat obligatory fashion, about quality of place, affordable housing, diversity as an asset, improving public education, and making infrastructure investments – but always through the lens of a top-down corporate vision.
Near-sightedness
Looking back at this study now in 2025, the problem with this kind of top-down approach is that it often comes at a high price: Narragansett Bay is under deluge from microplastics and warming waters caused by fossil-fuel driven climate change. What makes Rhode Island such a special place to live is it’s natural beauty, it’s ecosystem. An innovation ecosystem depends on recognizing that, in ConvergenceRI’s opinion.
In the sidebars that always accompany each story in ConvergenceRI, there is an effort to verbalize the questions that need to be asked and the issues that are often under the surface. The two sidebars, written five years ago, seem prescient
today.
The questions that need to be asked
What is the state’s economic vision for Narragansett Bay as the estuary of Rhode Island’s future prosperity in a time of rapidly increasing threats from man-made climate change? What are the economic implications of the coronavirus as a force of economic disruption? Do the resignations of Annie De Groot and Paula Grammas from prestigious research positions suggest that there may need to be an investigation into a potential problem of bias against women scientists at URI? Why weren’t Health Equity Zones and Neighborhood Health Stations, two homegrown Rhode Island innovation initiatives, included in RI Innovates 2.0 narrative? When will Rhode Island produce its own Index of the RI Innovation Economy, similar to what Massachusetts has done for more than two decades, to have better benchmarks and metrics to measure what is occurring in a longitudinal fashion? How would a Quality of Life Index for Rhode Island help translate anecdotal information about “what a special place this is” into an economic development tool? Has Rhode Island become too dependent on outside private contractors, such as Deloitte, to manage its public benefits, such as Medicaid? Will the R.I. Senate recommend a state audit of private contractors performing Medicaid services? How will the political debate swirling around a national single-payer system to deliver health care play out in Rhode Island? How will the new economic strategy address the structural racism of our housing crisis?
Under the radar screen
No five-year strategic economic plan could have predicted the success of WaterFire, which draws millions of people to Rhode Island each year, attracted by the elemental displays of wood fires in metal stanchions atop a river, surrounding by music, as a flowing pedestrian art installation celebrating the senses. Similarly, the success of Providence Flea as a marketplace was not predicted as part of an economic planning exercise. Both depend on serendipity as a human experience.
Now, a new group, Motion State Arts, in partnership with WaterFire creator Barnaby Evans, is launching the Motion State Dance Festival, with inaugural performances on March 5-7 (2020) at the WaterFire Arts Center, with the goal of creating the country’s next contemporary dance hub. A dance floor is being rented for the occasion, with the hopes that one can be purchased to facilitate more performances.
The serendipity of collisions around art, music, food, dance and theater, which celebrate the diversity of culture, cannot be underestimated as an economic force in promoting a sense of place and performance, as a humanizing force in our fractured world.
The naming of the Providence pedestrian bridge for civil rights activist Michael Van Leesten is an example of how remembering our past can help shape our future. Discussions are underway to create a bench near the pedestrian bridge to honor Toni Morrison and the descendants of slavery in Rhode Island.
The plastics connection.
What is missing from the conversation about the “blue economy” is an understanding of the central role that plastics and the manufacturing innovation driven by World War II, with the desire that the products endure — at a great cost to our health and environment.
What is missing from the conversation about the “blue economy” is an understanding of the central role that plastics and the manufacturing innovation driven by World War II, with the desire that the products endure — at a great cost to our health and environment.
The leading expert resides here in Rhode Island, and I keep wishing there had been a way for Rebecca Altman to participate and to challenge the current thinking around the blue economy. Her book, The Song of Styrene: An Intimate History of Plastics, is under contract with Scribner (US) and Oneworld (UK).
As background, here is an excerpt from a recent interview with Altman published by ConvergenceRI in September of 2024.
PLASTICS are of the category of things both deeply familiar and also deeply misunderstood. How can we begin to alter our future in relationship to plastics without a deeper sense of knowing where they came from? What’s needed are alternate stories about plastics, not about their mythic firsts and founders, but bigger stories about the wider context of their emergence and development, and more intimate stories of the lives bound up by the material, including its making.
The story of plastics manufacturing and its link to climate change is a tale that is still being written. It is a story in which we are all participants and observers, witnesses to the severe biological changes to the world around us – from warming oceans to melting ice caps, from the growing intensity of storms, floods and forest fires to the persistent rise in temperatures across the globe, from the dramatic rise in chronic diseases linked to endocrine disruptors in our air, water and food to the spread of viruses by changing vectors of disease.
One of the foremost experts into what some have called the emergence of the anthropocene era is Rebecca Altman, author of the forthcoming book: An Intimate History of Plastics.
She is co-facilitating a writing seminar, “Narrating the Anthropocene,” with environmental historian Bathsheba Demuth for the Institute at Brown for Environment and Society.
The Providence-based science writer’s most recent reporting, published in Orion magazine in May of 2024, is entitled: “From War Machine to Supermarket Staple: A History of the Plastic Bag.”
The opening paragraph of her story begins: “The history of the plastic carrier bag – the kind so often found caught on a tree branch and flagging in the wind – is a story of persuasion.”
What does that mean for us to understand how plastics and the manufacture of polyethylene define our culture?
ALTMAN: I’m taken with the idea that plastic harbors the imprint of its making, of its makers, of its history.
The other day, on a panel with the National Academy of Science Engineering and Medicine, the moderator asked a lovely question of one of the fellow panelists: How would you explain plastics to a 12-year-old?
A polymer chemist gave an elegant answer about how to visualize the entangled molecular structure of plastics.
But I was thinking of what my own answer might have been. And, it struck me afterwards that I’d probably explain plastics in just this way.
Like, say, how a red rubberized polystyrene cup of the kind often used at parties is, in part, the history of World War Two made manifest. The war laid the infrastructure for the mass production of its primary monomer, styrene, which [especially in the U.S.] wasn’t made anywhere near the scale it was in Germany before the war, or by war’s end [thanks to the investment of the U.S. Synthetic Rubber Program], which in turn churned out the kind of rubber later added to polystyrene plastics to toughen, rubberize them.
But to answer your question more directly: these materials were designed to endure [emphasis added]. Or rather, they endure as designed. Which in turn opens up the possibility for their redesign. To be designed with their end in mind, with perhaps a different ending in mind.
Emotional release
The emotional release of Tuesday’s breakthrough with the catheter removal has left me feeling elated and vulnerable and talkative and generous — realizing that the rapid swing of emotions I am experiencing is very human: anger, relief, on the verge of tears, fearful about how to remove more stress from my life, and still persevering in my writing and reporting.
At my truest self, I am a storyteller, and no matter where I go, I always find a story to tell.
The way that the content of my stories resonated with my readers of ConvergenceRI has been so crucial in my recovery: to be vulnerable, to need to ask for help, and to receive it, is a testament to what makes us human, I believe.
In my time in the emergency room, in the hospital, and now in the rehabilitation facility, I have resisted turning on the TV, which seems like mindless chatter and noise, compared to my ability to come to grips with my own limitations and vulnerability about the future. I am lonely and miss my ability to interact on a regular, everyday basis with people. I keep projecting my emotions, perhaps inappropriately, with lots of transference occurring. My writing, typing away with one finger on my IPhone, is a balm.
I have been careful to try to not talk too much about myself, but it is always difficult, given how fearful I have been, how much of my efforts to persevere are encountering increased difficulty. My bladder is finally working again, but I am fully cognizant that I need to reduce my stress levels.
I think: did I really drink something like 10 big glasses of water to force my bladder back into its normal function?
I can no longer live alone by myself without assistance and home care; I do not want to be a burden.
At the same time, the enterprise of ConvergenceRI which I have built over the past 12 years remains a vibrant example of the important role that local independent journalism can play in reshaping our lives as a community, as neighborhoods, building up immunity to the viruses of authoritian power seekers who want to control the world and remake it as a reflection of their own insecurities.
I will be quite blunt and honest, at the risk of undercutting my future financial stability. It is a trait of my reporting, which one communications professional called “a barometer of truth.”
I need my subscribers to continue to subscribe, but providing them with the knowledge that it is time for me to let go and seek a new home for ConvergenceRI, hopefully as a place where the skills of narrative can be taught as a skill of job development and self-confidence.
My experience interacting with the staff at the rehab center, Briarcliffe Manor, has taught me the importance of the way that such places of caring enable new generations of Rhode Islanders to find their homes and prosper.
The staff is attentive and warm and caring, and the differences between my life in the last half of the 20th century and theirs in the first half of the 21st century are not that far apart that we cannot find common ground.
It is time for me to try to relax and go to sleep tonight and let my body continue to recover.
Thanks! Stay tuned.
