Tuesday, October 24, 2006

Chronic Pain, A Hand Like A Claw, And The Lowest Injury & Illness Rates "On Record"

Secretary of Labor Elaine Chao is happy as a clam over a recent Bureau of Labor Statistics report that the rate of injuries and illnesses have gone down for the third straight year from to 4.8 cases per 100 workers in 2004 to 4.6 cases per 100 workers in 2005.

According to Chao, all credit goes to
1) compliance assistance; 2) health and safety partnerships with labor, and; 3) targeted, aggressive enforcement against bad actors. (emphasis added)
Now I can't quite tell whether she's joking, or suffering from the same delusional disease affecting the Pentagon, but "health and safety partnerships with labor?" Puleeeze!

Oh, and Elaine, you don't get a reduction in national injury and illnesses number by going after a few "bad actors." You also need to go after all the other "normal actors" who cut a few corners here, rush a few jobs there, and ignore ergonomics and chemical hazards. Oh, and if you really want to address a signficant number of workplace injuries and illnesses, you might want to depend a bit less on the "compliance assistance," and issue a few new standards that address issues like ergonomics and workplace violence which make up for hundreds of thousands of injuries every year.

If the numbers are accurate, this is good news. But, of course, all of this assumes that we even believe these numbers -- and with cases of employers being caught cheating, with "behavioral" incentive programs that discourage employees from reporting injuries and illnesses, one could be forgiven for being a tad bit skeptical.

But most important, these are only numbers, statistics, millions of them. And as famed occupational physician Irving Selikoff once said, “statistics are human beings with the tears wiped away.”

What tears are we talking about? Here's one tragic example, and this one didn't even make it into Chao's statistics:
He lost his apartment two years ago, after losing his job. He lost his job after falling off scaffolding in an unacknowledged industrial accident. The company lawyer does not answer his phone calls. Now he has chronic pain, a hand like a claw and a bed in the homeless shelter.

My patient likes to talk about the apartment he used to have, and the honest satisfactions of a home. He liked taking his shower after work, watching his TV. He had a girlfriend who tidied the place from time to time. He took the bus to and from work and said that whenever someone was missing bus fare, he would reach into a pocket and supply it. It felt good, like buying everyone a round. He was not a drinker, but altruism was something he enjoyed.

He especially liked his apartment key. But no job, no key. At first, he slept in a condemned building; it gave comfort, and the illusion of a home: there were doors to walk through. After the building was demolished, he came to the mental health clinic. He had all the profound symptoms of depression one would expect. He understood that antidepressants take weeks to work, and dutifully accepted that fact. He was willing to be patient.
He got thrown out of the shelter, and built himself a nice lean-to in the woods, "using tree stumps and branches, and his one good arm."
He says he lies in it and can see the stars in the roofless sky. There is no heat or electricity, of course, and the house is not structurally safe, but he doesn’t mind. He looks up, and hours pass. In the dark, lying on the floor looking up, he begins to feel the absence of grief, of anger. He feels the blessing of no feelings at all.

The medication is still not working. It won’t work, when his need is for a key. He has begun to talk about train tracks and the uselessness of life. He says one day he may not return to the clinic. He won’t tell me where his house in the woods is, though for now he continues to visit it. It offers respite from the anxiety, rage and heartbreak he faces in the shelter.

Feeling nothing, he says thoughtfully, is almost like feeling peace.
4.6 per 100. I feel much better now.