Determinants Of Infant Mortality Health And Social Care Essay

Determinants Of Infant Mortality Health And Social Care Essay The infant mortality rate of African American newborns within the first year of life is more than twice that of white newborns and higher per 1,000 deaths than any other racial or ethnic group in the United States. Using social ecological model as the theoretical framework, the goal is to understand the causes of racially disparate infant mortality rates. This paper will present health disparities and related social inequities that may underlie these troubling outcomes for childbearing women and infants in the United States. Introduction Infant mortality rates are often used as a measure of a populations general health status, socioeconomic conditions, and availability and access to quality health care. The decrease in the rate of infant death in the United States has been observed for births to both white and black mothers. Although there has been general improvement in infant survival, there has been widened gap in the racial disparity in infant mortality rates. The ten leading causes of infant mortality in the United States are: 1) birth defects: 2) causes related to short gestation or low birth weight (LBW); 3) sudden infant death syndrome (SIDS); 4) maternal complications of pregnancy; 5) complications of placenta, cord, and membranes; 6) accidents; 7) respiratory distress of newborn; 8) bacterial sepsis of newborn; 9) diseases of the circulatory system; and 10) intrauterine hypoxia and birth asphyxia. Infants born to black mothers had the highest IFM due to prematurity and LBW. Additionally, low birth weight and premature infants who survive the first year of life continue to face serious health problems and developmental problems. The social-ecological model has been chosen because it takes in account factors that influence disparate rate among black American infants. Disparities in infant mortality by race and class continue to be a national disgrace. The purpose of this study using the social ecological model will be: (1) discuss individual factors that influence infant mortality and (2) discuss multiple levels of factors that influence infant mortality rate. Methods The literature was searched using the databases of CINAHL, Pub Med (Medline), Eric, PsychInfo, Science Reference Center, and SocioIndex for the years 199-2010. The search terms included social ecological, black women, African American women, parenting, infant mortality, health, social inequalities. Inclusion criteria included a) original research; b) studies published in English; c) peer-reviewed journal; d) articles on black woman and infant mortality; and e) social ecological model. Of the 140 articles identified, only those studies with health, social determinants, black women, social ecological model, African American in the abstracts and full text articles were include (n=39). Social Ecological Model Vulnerable populations are at substantially greater risk of poor physical, mental and social health and have much higher rates of morbidity and mortality. Despite these greater health needs, they also typically face greater barriers to accessing timely and needed care and, even when receiving care, have worse health outcomes than others . The social ecological approach considers the nested arrangement of behavioral and environmental determinants of health. posits that concepts of health promotion require analysis of the health habits and lifestyles of participants, as well as constraints and resources present within participants environments. Secondly, the social ecological approach recognizes the importance of changing interpersonal, organizational, community, and public policy.Finally, the social ecological model has been chosen to analyze personal, community and societal institutions impact on infant mortality. Results Intrapersonal Resources The intrapersonal resources include individual characteristics such as perceived lack of knowledge, attitudes, beliefs, health practices, age, race/ethnicity, income and education and employment status variables effect infant mortality . In order to understand the individual interpersonal characteristics one needs to critically examine the mothers knowledge regarding maternal education and health practices. Social inequities related to educational opportunities and social resources may influence health behaviors or practices that are associated with infant health. Compared with women who receive adequate prenatal care, those who do not seek a reasonable amount of care tend to be young, less educated, single, and/or to have other children . have documented the powerful association between a persons socioeconomic status and mortality. The gap in infant mortality based on mothers years of formal education has also widened significantly over time. Maternal education appears to be an increasingly important predictor of infant survival. Researchers observe that key risk factors for infant mortality, including smoking during pregnancy, delayed or no prenatal care, and lack of health care coverage, vary substantially with socio-economic status and maternal education . Behavioral factors account for about half of premature mortality, and almost all vary by socioeconomic status. The greatest behavioral risk for premature mortality is tobacco use. In 2005, the IFM rate for infants of mothers who smoked was 74 percent higher than the rate for nonsmokers . Those with less education and less income are more likely to smoke. Smoking prevalence reflects likelihood of initiating smoking as well as of quitting, and different policies are relevant for those stages of smoking. However, the more educated were more likely to try and quit, and among those who tried to quit with higher incomes were more likely to succeed. This suggest that efforts to encourage quitting need to be geared more strongly to those with less education and that the means of quitting need to be made more accessible to the poor. Breastfeeding has been shown to reduce rates of infant mortality in the United States and worldwide . However, the rates of initiation and maintenance of breastfeeding are less frequent among black women than white and Hispanic women,. Maternal education again is associated with substantial disparities: women with 9th-to 11th grade education are least likely to breastfeed to 6 months, whereas women with college degrees are most likely to do so as well as to report ever breastfeeding with the most recent birth . Infant mortality rates vary with maternal age, with the highest 2005 death rates documented for infants of the youngest mothers those under age 15 (16.4 per 1,000 live birth), and oldest mothers- aged 40 and older (7.9 per 1,000 live births) . Among older mothers, especially those of low social economic status, infant mortality rates may be affected by pregnancy complications related to advanced maternal age, such as gestational diabetes mellitus and hypertensive disorders. Other contributing factors are black womens higher rates of intra-uterine growth restriction, preterm premature rupture of membranes, placenta previa, preterm birth, very preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared to the white population . Chronic stress can affect health both directly and indirectly through its effects on health behavior. While people in all walks of life experience stress, lower-SES persons live and work in more stressful environments. Higher IFM among well- educated black women has been attributed to their cumulative experience of chronic stress over the life course, which causes wear and tear on their reproductive health over time. identified a number of factors that contribute to greater stress at lower SES levels, including economic strain, insecure employment, low control at work, and stressful life events. determined that lifelong accumulated experiences of racial discrimination by black American women constitute an independent risk factor of preterm delivery. noted association between black American womens exposure to chronic stress from interpersonal racism and infant, very low birth weight (VLBW). Black American women who were exposed to what they perceived as racial bias and internalized their responses to unfair treatment had a fourfold greater risk of hypertension as well. proposed the classic host (i.e., pregnant women), environment (i.e., chronic social stressors), and agent (i.e., immediate emotional stress or physical stressors) are ongoing stressors as well as social and cultural modifiers of stress may have influence on how particular stressors is experienced or what the physical response to it may be. Researcher have also suggested that being a woman is a characteristic that cannot be neglected in the context of maternal stressors. Being a black woman produces a double effect of racial and gender discrimination and related stress which in turn impacts their health and the outcomes of subsequent pregnancies. Interpersonal Resources Interpersonal resources include culturally relevant social support as well as social norms that may facilitate behavioral capacity and health behavior change . Research has confirmed that loneliness is detrimental to health. Good health is positively correlated with involvement and satisfying relationships with other people. Studies show that married people live longer than unmarried people and that there are lower death rates among those who have lots of social support. A social network not only assists with instrumental assistance such as childcare, finances and housing, but it is a persons major source of emotional support. A personals level of social support is one of the most potent indicators her degree of vulnerability . Broken relationships create lifelong conditions of high stress and low support, which in turn pattern physiological, psychological, and behavioral responses that put the mother at risk for poor nutrition during pregnancy, and her baby at risk for fetal and infant deaths. Black American families are disproportionately affected by broken relationships, which contributes to disparities infant mortality . Infants born to unmarried mothers had higher IMR compared to those born to married mothers in 2002. However, the IMRs are significantly higher for married black American mothers than for unmarried black American mothers. In a report, maternal grandmothers were more frequently nominated than other source of parenting help including spouses, current or former partners, relatives, friends and professionals. Grandmothers have a tremendous influence on a womans lived experiences. Maternal grandmothers tend to improve child survival rates, as do potential sibling helpers at the nest. In this study, researcher suggests that while help from family may be a universal feature of human child-rearing, who helps is dependent on ecological conditions of the family. Fathers can also have a tremendous influence on the health of mothers and their infants. Some fathers focused efforts are under way in the United State, including the USDAs Fathers Supporting Breastfeeding Program, which uses a video, posters, and brochures designed to target Black men. Poor family and social support, negative attitudes of family and friends can pose a barrier to good health practices. , observed that there was an association of single motherhood and negative birth outcomes with single parent household, which occurred more often and longer than married or coupled households. Community and Environmental Resources The community resources and environmental resources may have a significant impact on individual characteristics of the mother, for instance, substandard housing, lack of transportation, and child -care problems can prohibit a mother from attending prenatal classes or obstetrical appointments. A key to reducing infant mortality is to address the barriers that stand between low-income women and adequate prenatal care. Racial and ethnic minorities tend to live in medically underserved areas, and many black American and Hispanic families lack a regular source of care, making do with outpatient clinics and hospital emergency rooms in times of crisis . According to a study by the Agency for Health Care Policy and Research, low-income pregnant women are more likely to seek and be satisfied with prenatal care if they can avoid long waiting time, see providers who explain procedures, and have access to ancillary services, especially substance abuse services and childbirth education. Health pr oviders have also begun to understand the need for culturally competent providers and the availability of medical personnel who speak the patients primary language. Exposure to damaging agents in the environment, including lead, asbestos, carbon dioxide, and industrial waste, varies with socioeconomic status. Those lower on the SES hierarchy are more likely to live and work in worse physical environments. Poorer neighborhoods are disproportionately located near highways, industrial areas, and toxic waste sites, since land there is cheaper and resistance to polluting industries, less visible. Housing quality is also poorer for low-SES families. As a result, compared with high-income families, both children and adults from poor families show a six fold increase in rates of high blood lead levels, while middle-income adults and children show a twofold increase Economic differences do not fully explain the persistent high infant mortality rates of black American women and other minority groups. Several studies in the early 90s examined the effect of racial residential segregation on the health outcomes of Black Americans and a positive association between black-white dissimilarity and black infant mortality rates was shown after controlling for metropolitan area poverty rates. After an initial focus on infant mortality, several authors examined the association between racial segregation and mortality in other age groups. Their general finding indicated that black mortality is positively associated with residential segregation and with residence in predominantly black areas. Current research still indicates racial residential segregation as one of the fundamental cause of racial disparities in health. The physical separation of the races by enforced residence in certain areas is an institutional mechanism of racism that was designed to protect whites from social interaction with blacks. The degree of residential segregation remains extremely high for most Black Americans in the United States. The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES was determined to remain a fundamental cause of racial differences in health. The US sociological literature suggests that residential segregation along racial/ethnic lines is not primarily a result of the residential preferences of minority groups. National and metropolitan area surveys have shown that, on average, Black Americans and Hispanics would be more willing than Whites to live in relatively integrated neighborhoods. On the other hand, several studies, including audit studies involving experimental designs, have indicated that Black American and Hispanics continue to face discrimination in housing and mortgage markets even after income has been controlled. Discrimination prevents upwardly mobile members of minority groups from becoming more spatially integrated with Whites. Organizational Resources Organizational resources have a strong effect on the individual characteristics of mother. Lack of access, provider availability and geographic distance, quality of care, timeliness, and types of services creates health disparities for minority women. If a client lives 3 hours away from the regional medical center, the client will have an increased burden placed on her because of the lack of resources available in her own community. used the ecological model as a framework for applying social justice concepts to the care of childbearing women and families. They discovered by addressing health disparities exclusively on an individual level ignores the effect of social practices and institutions on the health of childbearing women and infants and serves as a barrier to achieving the goal of social justice. Although there are a number of mechanisms through which socio-economic status influences health, there is a distinctive link between utilization of health care services and health st atus. Prenatal care most often is associated with medical care, in which case it is an important factor in the prevention of poor birth outcomes, particularly prematurity and/or low birth weight and their associated neonatal mortality . Typically, efforts to improve infant health in the United States have focused on timely, appropriate care during pregnancy and delivery. While these services remain the keys to giving babies a good start in life, they do not sufficiently address the maternal health problems that often underlie infant mortality. There is a growing consensus that prevention efforts need to begin well before conception, especially for those mothers at greatest risk for poor pregnancy outcomes. Several months of medical attention cannot overcome many years of disadvantage and poor health. Women, particularly minority women need good care between pregnancies. Good maternal health requires diagnosis and management of chronic disease well before conception. But lack of health insurance keeps women from getting the care needed to maintain their own health and improve their chances for healthy pregnancies. Before pregnancy, women qualify for Medicaid only if they have extremely low incomes- well below the poverty line (68 percent of the Federal poverty line for working women, and under 41 percent for those who do not work). Once they become pregnant, women are held to a less stringent requirement (185 percent). As a result, many low-income women who qualify for Medicaid only after a confirmed pregnancy test often experience delays in enrollment and referral to a provider suggests that disparities in neonatal mortality are primarily determined by not only the birthrate of extremely premature infants but access to specialized obstetrical and pediatric care. This analysis suggests that the epidemiology and social meaning of disparities in infant mortality are intensely dynamic and increasingly reflect the interaction between social forces and technical innovation. interviewed a total of 6, 2999 white, black American, Hispanic and Asian adults, to view their differences in perceptions of health care system. It was determined that bias and cultural competence are not fully explained by such factors as demographics, source of care, and patient-physician communication, but it may partially explain disparities in patient ratings of individual health care provider cultural competence. As such, interventions aimed at improving access to a regular source of care and enhancing patient-physician communication may improve patient ratings of interpersonal bias and cultural competence of physicians; however, such interventions alone are not likely to substantially improve ethnic minority patients perceptions of bias and cultural competence in the health care system as a whole. Moreover, disparities in preterm births have proven very difficult to overcome. In 2005, the preterm-related infant mortality rate was more than three times higher for black mothers than for white mothers . Infants chances of survival often depend on technology and expertise available at local hospitals. Hospitals serving a high proportion of minority patients have higher than expected mortality rates for infants born at very low birth-weights . In 1999, Congress requested in the Institute of Medicine (IOM) report, entitled Unequal Treatment: Confronting Racial and Ethnic Disparities, in Healthcare, assess is the extent of racial and ethnic disparities in healthcare, the study concluded that although myriad sources contribute to these disparities, some evidence suggests that bias, prejudice, and stereotyping on the part of healthcare providers may contribute to differences in care. From the IOM report, assuming that access-related factors- such as insurance status and the ability to pay for care are the same, the possibility that overt or subtle biases or prejudice on the part of healthcare providers might affect the quality of care for minorities; suggests the need for intervention strategies to improve access to quality health care . Discussion The impact of social and environmental factors on the behavior and health of individuals and populations has been understudy for years. Addressing health disparities from an individual, community and organizational level is important to the social health of United States. Nationally, black infants have the worse birth outcomes than any other racial and ethnic group. By exploring the social ecological model a more comprehensive approach to acknowledging how individual challenges, environmental resources, and organizational structures influences the health behaviors of black women. Social inequities may contribute to differences in access to or quality of health care, which leads to less knowledge and skill in promoting personal and family health, thus results in poor health and birth outcomes. To rekindle concern about infant mortality to the level of effective action, public health professionals must refocus the publics attention on assuring that all women are provided adequate education and services to help them avoid unintended pregnancies, that all pregnant women receive services in appropriate facilities, and that the causes of preterm deliveries are discovered. Effective action in these areas would not only improve infant mortality overall; it would also reduce racial and ethnic disparities in infant health . Implications for Research and Practice In summary, prevention of an infant early death is not a health outcome, but rather a surrogate endpoint for optimum fetal, infant, and lifelong health. Racial and socio- economic disparities in rates of preterm birth and infant mortality area among the most widely recognized but, least understood aspects of infant and maternal health in this country. In particular, the persistent black/white differential requires intensive study. At any age, and at any income, education or socioeconomic level, an black American mother is more than twice as likely to lose her infant as a white woman. Given the complexity of the layered intrapersonal, interpersonal, local, and national contexts in which social justice operates, and realizing social justice is a work in progress; we can certainly help move nursing and medicine toward integrating concepts of social justice for the betterment of society, as a whole . Adoption of universal health-care coverage for women and children and providing optimum work policies for women is worthy goals. Additionally, new interventions designed with the social context of friends, family, and neighborhood associates, can be used to improve birth outcomes.

Construction Of The Great Pyramid Essay -- essays research papers

Of the three theories on how the Great Pyramid was built, in descending order of acceptability, the most suitable theory is Clifford Wilson’s followed by Joseph Davidovits’ and Erich Von Dà ¤niken’s argument. Clifford Wilson’s theory is the best because he illustrates how the pyramids were built and provides the evidence to prove his theory, however; this is unlike Joseph Davidovits’ theory because Davidovits does not fully answer questions that arise concerning his theory. The three theories have similar points, but contain very different ideas on the construction of the Great Pyramid. This is obvious in Clifford Wilson’s argument where he is repeatedly disproving Von Dà ¤niken’s theory that the â€Å"gods† created the pyramids, whereas in Davidovits theory the pyramids were simply casted by means of chemically mixing Natron, aluminum and silicon to produce artificial rock. These three individuals express different ideas on t he building of the building of the Great Pyramid. Clifford Wilson has the most acceptable theory compared to the other two individual’s arguments. In Clifford Wilson’s theory, he suggests that the pyramids were built with the â€Å"heave-ho† method. With the use of sleds made from wood that is easily imported from Phoenicia and rope, it is an acceptable theory on how the Great Pyramid was built. Wilson has also seen workers, using a single rope and pulley, move stones as the supervisor chants out instructions. One question that arises is how the builders were able to lift the stones into place. Wilson explains that during the construction of the pyramid, a ramp made of earth could be increased as the height of the pyramid increased. Once outer limestone blocks are fitted into place the earth could simply be removed. Clifford Wilson clearly verifies his theory with specific details, which displays that his theory is the most logical and suitable explanation of the construction of the Great Pyramid. Although Clifford Wilson’s theory is the best, there are still a few weaknesses throughout his argument. Wilson suggests that by using a system of pulleys, levers and ropes its is possible to construct the pyramid. With recent studies, it has been shown that if using a lever system as Wilson suggests, the fulcrum’s height must be increased, and at certain heights, the whole lever can become unstable. Another problem that is brought up is with the use of... ...nce. Von Dà ¤niken’s theory is clearly the worst when compared to the other two arguments, and this is particularly due to incorrect data. Even though Von Dà ¤niken’s theory is the poorest in quality, he still brings up important ideas that need to be examined. For example, the Egyptians knew the distance between the sun and the earth, and the geographical locations of other continents. This information could have been thought up, but it is more realistic to consider that Egyptians did have contact with extra-terrestrials. Despite Von Dà ¤niken’s bad theory , he still brings up key issues, but generally his theory is of no use because of the lack of significant data. Of the three theories, Clifford Wilson’s theory remains the most acceptable because he illustrates how the pyramids were built and provides the evidence to prove his argument. Joseph Davidovits on the other hand, does not fully answer questions that arise concerning his theory. Von Dà ¤niken’s theory contains incorrect and irrelevant data that makes his theory the worst when compared to the other two arguments. In conclusion, Clifford Wilson had many effective points that disproved many Davidovits’ and Von Dà ¤niken’s points.

A Game of Thrones Chapter Sixty-six

Bran The oldest were men grown, seventeen and eighteen years from the day of their naming. One was past twenty. Most were younger, sixteen or less. Bran watched them from the balcony of Maester Luwin's turret, listening to them grunt and strain and curse as they swung their staves and wooden swords. The yard was alive to the clack of wood on wood, punctuated all too often by thwacks and yowls of pain when a blow struck leather or flesh. Ser Rodrik strode among the boys, face reddening beneath his white whiskers, muttering at them one and all. Bran had never seen the old knight look so fierce. â€Å"No,† he kept saying. â€Å"No. No. No.† â€Å"They don't fight very well,† Bran said dubiously. He scratched Summer idly behind the ears as the direwolf tore at a haunch of meat. Bones crunched between his teeth. â€Å"For a certainty,† Maester Luwin agreed with a deep sigh. The maester was peering through his big Myrish lens tube, measuring shadows and noting the position of the comet that hung low in the morning sky. â€Å"Yet given time . . . Ser Rodrik has the truth of it, we need men to walk the walls. Your lord father took the cream of his guard to King's Landing, and your brother took the rest, along with all the likely lads for leagues around. Many will not come back to us, and we must needs find the men to take their places.† Bran stared resentfully at the sweating boys below. â€Å"If I still had my legs, I could beat them all.† He remembered the last time he'd held a sword in his hand, when the king had come to Winterfell. It was only a wooden sword, yet he'd knocked Prince Tommen down half a hundred times. â€Å"Ser Rodrik should teach me to use a poleaxe. If I had a poleaxe with a big long haft, Hodor could be my legs. We could be a knight together.† â€Å"I think that . . . unlikely,† Maester Luwin said. â€Å"Bran, when a man fights, his arms and legs and thoughts must be as one.† Below in the yard, Ser Rodrik was yelling. â€Å"You fight like a goose. He pecks you and you peck him harder. Parry! Block the blow. Goose fighting will not suffice. If those were real swords, the first peck would take your arm off!† One of the other boys laughed, and the old knight rounded on him. â€Å"You laugh. You. Now that is gall. You fight like a hedgehog . . . â€Å" â€Å"There was a knight once who couldn't see,† Bran said stubbornly, as Ser Rodrik went on below. â€Å"Old Nan told me about him. He had a long staff with blades at both ends and he could spin it in his hands and chop two men at once.† â€Å"Symeon Star-Eyes,† Luwin said as he marked numbers in a book. â€Å"When he lost his eyes, he put star sapphires in the empty sockets, or so the singers claim. Bran, that is only a story, like the tales of Florian the Fool. A fable from the Age of Heroes.† The maester tsked. â€Å"You must put these dreams aside, they will only break your heart.† The mention of dreams reminded him. â€Å"I dreamed about the crow again last night. The one with three eyes. He flew into my bedchamber and told me to come with him, so I did. We went down to the crypts. Father was there, and we talked. He was sad.† â€Å"And why was that?† Luwin peered through his tube. â€Å"It was something to do about Jon, I think.† The dream had been deeply disturbing, more so than any of the other crow dreams. â€Å"Hodor won't go down into the crypts.† The maester had only been half listening, Bran could tell. He lifted his eye from the tube, blinking. â€Å"Hodor won't . . . â€Å" â€Å"Go down into the crypts. When I woke, I told him to take me down, to see if Father was truly there. At first he didn't know what I was saying, but I got him to the steps by telling him to go here and go there, only then he wouldn't go down. He just stood on the top step and said ‘Hodor,' like he was scared of the dark, but I had a torch. It made me so mad I almost gave him a swat in the head, like Old Nan is always doing.† He saw the way the maester was frowning and hurriedly added, â€Å"I didn't, though.† â€Å"Good. Hodor is a man, not a mule to be beaten.† â€Å"In the dream I flew down with the crow, but I can't do that when I'm awake,† Bran explained. â€Å"Why would you want to go down to the crypts?† â€Å"I told you. To look for Father.† The maester tugged at the chain around his neck, as he often did when he was uncomfortable. â€Å"Bran, sweet child, one day Lord Eddard will sit below in stone, beside his father and his father's father and all the Starks back to the old Kings in the North . . . but that will not be for many years, gods be good. Your father is a prisoner of the queen in King's Landing. You will not find him in the crypts.† â€Å"He was there last night. I talked to him.† â€Å"Stubborn boy,† the maester sighed, setting his book aside. â€Å"Would you like to go see?† â€Å"I can't. Hodor won't go, and the steps are too narrow and twisty for Dancer.† â€Å"I believe I can solve that difficulty.† In place of Hodor, the wildling woman Osha was summoned. She was tall and tough and uncomplaining, willing to go wherever she was commanded. â€Å"I lived my life beyond the Wall, a hole in the ground won't fret me none, m'lords,† she said. â€Å"Summer, come,† Bran called as she lifted him in wiry-strong arms. The direwolf left his bone and followed as Osha carried Bran across the yard and down the spiral steps to the cold vault under the earth. Maester Luwin went ahead with a torch. Bran did not even mind—too badly—that she carried him in her arms and not on her back. Ser Rodrik had ordered Osha's chain struck off, since she had served faithfully and well since she had been at Winterfell. She still wore the heavy iron shackles around her ankles—a sign that she was not yet wholly trusted—but they did not hinder her sure strides down the steps. Bran could not recall the last time he had been in the crypts. It had been before, for certain. When he was little, he used to play down here with Robb and Jon and his sisters. He wished they were here now; the vault might not have seemed so dark and scary. Summer stalked out in the echoing gloom, then stopped, lifted his head, and sniffed the chill dead air. He bared his teeth and crept backward, eyes glowing golden in the light of the maester's torch. Even Osha, hard as old iron, seemed uncomfortable. â€Å"Grim folk, by the look of them,† she said as she eyed the long row of granite Starks on their stone thrones. â€Å"They were the Kings of Winter,† Bran whispered. Somehow it felt wrong to talk too loudly in this place. Osha smiled. â€Å"Winter's got no king. If you'd seen it, you'd know that, summer boy.† â€Å"They were the Kings in the North for thousands of years,† Maester Luwin said, lifting the torch high so the light shone on the stone faces. Some were hairy and bearded, shaggy men fierce as the wolves that crouched by their feet. Others were shaved clean, their features gaunt and sharp-edged as the iron longswords across their laps. â€Å"Hard men for a hard time. Come.† He strode briskly down the vault, past the procession of stone pillars and the endless carved figures. A tongue of flame trailed back from the upraised torch as he went. The vault was cavernous, longer than Winterfell itself, and Jon had told him once that there were other levels underneath, vaults even deeper and darker where the older kings were buried. It would not do to lose the light. Summer refused to move from the steps, even when Osha followed the torch, Bran in her arms. â€Å"Do you recall your history, Bran?† the maester said as they walked. â€Å"Tell Osha who they were and what they did, if you can.† He looked at the passing faces and the tales came back to him. The maester had told him the stories, and Old Nan had made them come alive. â€Å"That one is Jon Stark. When the sea raiders landed in the east, he drove them out and built the castle at White Harbor. His son was Rickard Stark, not my father's father but another Rickard, he took the Neck away from the Marsh King and married his daughter. Theon Stark's the real thin one with the long hair and the skinny beard. They called him the ‘Hungry Wolf,' because he was always at war. That's a Brandon, the tall one with the dreamy face, he was Brandon the Shipwright, because he loved the sea. His tomb is empty. He tried to sail west across the Sunset Sea and was never seen again. His son was Brandon the Burner, because he put the torch to all his father's ships in grief. There's Rodrik Stark, who won Bear Island in a wrestling match and gave it to the Mormonts. And that's Torrhen Stark, the King Who Knelt. He was the last Kin g in the North and the first Lord of Winterfell, after he yielded to Aegon the Conqueror. Oh, there, he's Cregan Stark. He fought with Prince Aemon once, and the Dragonknight said he'd never faced a finer swordsman.† They were almost at the end now, and Bran felt a sadness creeping over him. â€Å"And there's my grandfather, Lord Rickard, who was beheaded by Mad King Aerys. His daughter Lyanna and his son Brandon are in the tombs beside him. Not me, another Brandon, my father's brother. They're not supposed to have statues, that's only for the lords and the kings, but my father loved them so much he had them done.† â€Å"The maid's a fair one,† Osha said. â€Å"Robert was betrothed to marry her, but Prince Rhaegar carried her off and raped her,† Bran explained. â€Å"Robert fought a war to win her back. He killed Rhaegar on the Trident with his hammer, but Lyanna died and he never got her back at all.† â€Å"A sad tale,† said Osha, â€Å"but those empty holes are sadder.† â€Å"Lord Eddard's tomb, for when his time comes,† Maester Luwin said. â€Å"Is this where you saw your father in your dream, Bran?† â€Å"Yes.† The memory made him shiver. He looked around the vault uneasily, the hairs on the back of his neck bristling. Had he heard a noise? Was there someone here? Maester Luwin stepped toward the open sepulchre, torch in hand. â€Å"As you see, he's not here. Nor will he be, for many a year. Dreams are only dreams, child.† He thrust his arm into the blackness inside the tomb, as into the mouth of some great beast. â€Å"Do you see? It's quite empt—† The darkness sprang at him, snarling. Bran saw eyes like green fire, a flash of teeth, fur as black as the pit around them. Maester Luwin yelled and threw up his hands. The torch went flying from his fingers, caromed off the stone face of Brandon Stark, and tumbled to the statue's feet, the flames licking up his legs. In the drunken shifting torchlight, they saw Luwin struggling with the direwolf, beating at his muzzle with one hand while the jaws closed on the other. â€Å"Summer!† Bran screamed. And Summer came, shooting from the dimness behind them, a leaping shadow. He slammed into Shaggydog and knocked him back, and the two direwolves rolled over and over in a tangle of grey and black fur, snapping and biting at each other, while Maester Luwin struggled to his knees, his arm torn and bloody. Osha propped Bran up against Lord Rickard's stone wolf as she hurried to assist the maester. In the light of the guttering torch, shadow wolves twenty feet tall fought on the wall and roof. â€Å"Shaggy,† a small voice called. When Bran looked up, his little brother was standing in the mouth of Father's tomb. With one final snap at Summer's face, Shaggydog broke off and bounded to Rickon's side. â€Å"You let my father be,† Rickon warned Luwin. â€Å"You let him be.† â€Å"Rickon,† Bran said softly. â€Å"Father's not here.† â€Å"Yes he is. I saw him.† Tears glistened on Rickon's face. â€Å"I saw him last night.† â€Å"In your dream . . . ?† Rickon nodded. â€Å"You leave him. You leave him be. He's coming home now, like he promised. He's coming home.† Bran had never seen Maester Luwin took so uncertain before. Blood dripped down his arm where Shaggydog had shredded the wool of his sleeve and the flesh beneath. â€Å"Osha, the torch,† he said, biting through his pain, and she snatched it up before it went out. Soot stains blackened both legs of his uncle's likeness. â€Å"That . . . that beast,† Luwin went on, â€Å"is supposed to be chained up in the kennels.† Rickon patted Shaggydog's muzzle, damp with blood. â€Å"I let him loose. He doesn't like chains.† He licked at his fingers. â€Å"Rickon,† Bran said, â€Å"would you like to come with me?† â€Å"No. I like it here.† â€Å"It's dark here. And cold.† â€Å"I'm not afraid. I have to wait for Father.† â€Å"You can wait with me,† Bran said. â€Å"We'll wait together, you and me and our wolves.† Both of the direwolves were licking wounds now, and would bear close watching. â€Å"Bran,† the maester said firmly, â€Å"I know you mean well, but Shaggydog is too wild to run loose. I'm the third man he's savaged. Give him the freedom of the castle and it's only a question of time before he kills someone. The truth is hard, but the wolf has to be chained, or . . . &rdquo He hesitated . . . or killed, Bran thought, but what he said was, â€Å"He was not made for chains. We will wait in your tower, all of us.† â€Å"That is quite impossible,† Maester Luwin said. Osha grinned. â€Å"The boy's the lordling here, as I recall.† She handed Luwin back his torch and scooped Bran up into her arms again. â€Å"The maester's tower it is.† â€Å"Will you come, Rickon?† His brother nodded. â€Å"If Shaggy comes too,† he said, running after Osha and Bran, and there was nothing Maester Luwin could do but follow, keeping a wary eye on the wolves. Maester Luwin's turret was so cluttered that it seemed to Bran a wonder that he ever found anything. Tottering piles of books covered tables and chairs, rows of stoppered jars lined the shelves, candle stubs and puddles of dried wax dotted the furniture, the bronze Myrish lens tube sat on a tripod by the terrace door, star charts hung from the walls, shadow maps lay scattered among the rushes, papers, quills, and pots of inks were everywhere, and all of it was spotted with droppings from the ravens in the rafters. Their strident quorks drifted down from above as Osha washed and cleaned and bandaged the maester's wounds, under Luwin's terse instruction. â€Å"This is folly,† the small grey man said while she dabbed at the wolf bites with a stinging ointment. â€Å"I agree that it is odd that both you boys dreamed the same dream, yet when you stop to consider it, it's only natural. You miss your lord father, and you know that he is a captive. Fear can fever a man's mind and giv e him queer thoughts. Rickon is too young to comprehend—† â€Å"I'm four now,† Rickon said. He was peeking through the lens tube at the gargoyles on the First Keep. The direwolves sat on opposite sides of the large round room, licking their wounds and gnawing on bones. â€Å"—too young, and—ooh, seven hells, that burns, no, don't stop, more. Too young, as I say, but you, Bran, you're old enough to know that dreams are only dreams.† â€Å"Some are, some aren't.† Osha poured pale red firemilk into a long gash. Luwin gasped. â€Å"The children of the forest could tell you a thing or two about dreaming.† Tears were streaming down the maester's face, yet he shook his head doggedly. â€Å"The children . . . live only in dreams. Now. Dead and gone. Enough, that's enough. Now the bandages. Pads and then wrap, and make it tight, I'll be bleeding.† â€Å"Old Nan says the children knew the songs of the trees, that they could fly like birds and swim like fish and talk to the animals,† Bran said. â€Å"She says that they made music so beautiful that it made you cry like a little baby just to hear it.† â€Å"And all this they did with magic,† Maester Luwin said, distracted. â€Å"I wish they were here now. A spell would heal my arm less painfully, and they could talk to Shaggydog and tell him not to bite.† He gave the big black wolf an angry glance out of the corner of his eye. â€Å"Take a lesson, Bran. The man who trusts in spells is dueling with a glass sword. As the children did. Here, let me show you something.† He stood abruptly, crossed the room, and returned with a green jar in his good hand. â€Å"Have a look at these,† he said as he pulled the stopper and shook out a handful of shiny black arrowheads. Bran picked one up. â€Å"It's made of glass.† Curious, Rickon drifted closer to peer over the table. â€Å"Dragonglass,† Osha named it as she sat down beside Luwin, bandagings in hand. â€Å"Obsidian,† Maester Luwin insisted, holding out his wounded arm. â€Å"Forged in the fires of the gods, far below the earth. The children of the forest hunted with that, thousands of years ago. The children worked no metal. In place of mail, they wore long shirts of woven leaves and bound their legs in bark, so they seemed to melt into the wood. In place of swords, they carried blades of obsidian.† â€Å"And still do.† Osha placed soft pads over the bites on the maester's forearm and bound them tight with long strips of linen. Bran held the arrowhead up close. The black glass was slick and shiny. He thought it beautiful. â€Å"Can I keep one?† â€Å"As you wish,† the maester said. â€Å"I want one too,† Rickon said. â€Å"I want four. I'm four.† Luwin made him count them out. â€Å"Careful, they're still sharp. Don't cut yourself.† â€Å"Tell me about the children,† Bran said. It was important. â€Å"What do you wish to know?† â€Å"Everything.† Maester Luwin tugged at his chain collar where it chafed against his neck. â€Å"They were people of the Dawn Age, the very first, before kings and kingdoms,† he said. â€Å"In those days, there were no castles or holdfasts, no cities, not so much as a market town to be found between here and the sea of Dorne. There were no men at all. Only the children of the forest dwelt in the lands we now call the Seven Kingdoms. â€Å"They were a people dark and beautiful, small of stature, no taller than children even when grown to manhood. They lived in the depths of the wood, in caves and crannogs and secret tree towns. Slight as they were, the children were quick and graceful. Male and female hunted together, with weirwood bows and flying snares. Their gods were the gods of the forest, stream, and stone, the old gods whose names are secret. Their wise men were called greenseers, and carved strange faces in the weirwoods to keep watch on the woods. How long the children reigned here or where they came from, no man can know. â€Å"But some twelve thousand years ago, the First Men appeared from the east, crossing the Broken Arm of Dorne before it was broken. They came with bronze swords and great leathern shields, riding horses. No horse had ever been seen on this side of the narrow sea. No doubt the children were as frightened by the horses as the First Men were by the faces in the trees. As the First Men carved out holdfasts and farms, they cut down the faces and gave them to the fire. Horror-struck, the children went to war. The old songs say that the greenseers used dark magics to make the seas rise and sweep away the land, shattering the Arm, but it was too late to close the door. The wars went on until the earth ran red with blood of men and children both, but more children than men, for men were bigger and stronger, and wood and stone and obsidian make a poor match for bronze. Finally the wise of both races prevailed, and the chiefs and heroes of the First Men met the greenseers and wood dancers a midst the weirwood groves of a small island in the great lake called Gods Eye. â€Å"There they forged the Pact. The First Men were given the coastlands, the high plains and bright meadows, the mountains and bogs, but the deep woods were to remain forever the children's, and no more weirwoods were to be put to the axe anywhere in the realm. So the gods might bear witness to the signing, every tree on the island was given a face, and afterward, the sacred order of green men was formed to keep watch over the Isle of Faces. â€Å"The Pact began four thousand years of friendship between men and children. In time, the First Men even put aside the gods they had brought with them, and took up the worship of the secret gods of the wood. The signing of the Pact ended the Dawn Age, and began the Age of Heroes.† Bran's fist curled around the shiny black arrowhead. â€Å"But the children of the forest are all gone now, you said.† â€Å"Here, they are,† said Osha, as she bit off the end of the last bandage with her teeth. â€Å"North of the Wall, things are different. That's where the children went, and the giants, and the other old races.† Maester Luwin sighed. â€Å"Woman, by rights you ought to be dead or in chains. The Starks have treated you more gently than you deserve. It is unkind to repay them for their kindness by filling the boys' heads with folly.† â€Å"Tell me where they went,† Bran said. â€Å"I want to know.† â€Å"Me too,† Rickon echoed. â€Å"Oh, very well,† Luwin muttered. â€Å"So long as the kingdoms of the First Men held sway, the Pact endured, all through the Age of Heroes and the Long Night and the birth of the Seven Kingdoms, yet finally there came a time, many centuries later, when other peoples crossed the narrow sea. â€Å"The Andals were the first, a race of tall, fair-haired warriors who came with steel and fire and the seven-pointed star of the new gods painted on their chests. The wars lasted hundreds of years, but in the end the six southron kingdoms all fell before them. Only here, where the King in the North threw back every army that tried to cross the Neck, did the rule of the First Men endure. The Andals burnt out the weirwood groves, hacked down the faces, slaughtered the children where they found them, and everywhere proclaimed the triumph of the Seven over the old gods. So the children fled north—† Summer began to howl. Maester Luwin broke off, startled. When Shaggydog bounded to his feet and added his voice to his brother's, dread clutched at Bran's heart. â€Å"It's coming,† he whispered, with the certainty of despair. He had known it since last night, he realized, since the crow had led him down into the crypts to say farewell. He had known it, but he had not believed. He had wanted Maester Luwin to be right. The crow, he thought, the three-eyed crow . . . The howling stopped as suddenly as it had begun. Summer padded across the tower floor to Shaggydog, and began to lick at a mat of bloody fur on the back of his brother's neck. From the window came a flutter of wings. A raven landed on the grey stone sill, opened its beak, and gave a harsh, raucous rattle of distress. Rickon began to cry. His arrowheads fell from his hand one by one and clattered on the floor. Bran pulled him close and hugged him. Maester Luwin stared at the black bird as if it were a scorpion with feathers. He rose, slow as a sleepwalker, and moved to the window. When he whistled, the raven hopped onto his bandaged forearm. There was dried blood on its wings. â€Å"A hawk,† Luwin murmured, â€Å"perhaps an owl. Poor thing, a wonder it got through.† He took the letter from its leg. Bran found himself shivering as the maester unrolled the paper. â€Å"What is it?† he said, holding his brother all the harder. â€Å"You know what it is, boy,† Osha said, not unkindly. She put her hand on his head. Maester Luwin looked up at them numbly, a small grey man with blood on the sleeve of his grey wool robe and tears in his bright grey eyes. â€Å"My lords,† he said to the sons, in a voice gone hoarse and shrunken, â€Å"we . . . we shall need to find a stonecarver who knew his likeness well . . . â€Å"

Career Profile of a Private Investigator - 623 Words

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