Across the Great Divide…Part 2

The High Plains are a place where people get by. No one is “hustling.” Instant gratification does not exist. Distance demands a certain level of patience. In the City I live in, Amazon offers Same-Day delivery. Of course, Amazon delivers to the High Plains, but add 1-2 more days than you would expect in any city.

To live in the small towns that dot the old rail lines of the High Plains, you have be willing to accept a ethos of “good enough and making do.” Optimization is just not really an option most of the time.

For instance, I had an patient in the hospital today who appears to have subclinical hyperthyroidism, rather unrelated to his reason for admission. So, he needs a radioactive iodine uptake scan. A Nuclear Medicine service does not exist here.

It’s the weekend, and none of the staff know where the closest place to have this done is. Obviously it is not in town, but it might be as much 2-3 hours away. It will have to wait and be arranged as outpatient. He is asymptomatic, so we can make do till then.

It’ll have to be good enough. He understands and doesn’t demand transfer to another facility or some other extremely expensive and unnecessary intervention.

World’s Apart

Going back and forth from the High Plains to the City can lead to a rather schizophrenic existence. I can have any product or food I could ever desire in the City, often within minutes. Of course, the caveat is – you have to be able to afford it.

On the High Plains, you can have meat and potatoes, and you’ll probably have to wait.

On the other hand, if you want to be able to see the stars at night, know true silence, the City can’t help you.

Being a Millennial, all my friends from before medical school are scattered about all the cities you’d expect: Seattle, Nashville, Oakland, Boston, London, etc.

Their lives, in those cities thousands of miles away, have more in common with my City life, than the lives of the people I treat, who live less than a couple of hundred miles away from me. The residents of the global city-states measure distance in hours in an airplane, not in miles of streets, fields, and people passed.

Few of them know the human and physical geography right outside their back door. They don’t the seasons of planting, the rhythm of sun, rain, and wind that marks the lives of those who live in the Great Wide Open.

Even those not involved directly in agriculture on the High Plains know those rhythms. The timing of calf sales, wheat and corn harvest, hunting season, determine the rhythms of all other economy.

Even the jobs titles and work in the City seem inexplicable. They are analysts, project managers, a few might even call themselves “influencers.” There is no tangible output to their work. Their hands don’t feel the pulse of a heart, the hum of a machine, or dampness of the soil.

They speak words, makes click on computer screens, and paychecks arrive. No goods are made, exchanged, or transported.

In the City, the idea of economics waiting on the rhythms of the natural world is laughable at best, heretical at worst. Why would a product that does not have a direct basis in the natural world hinge on it at all? We should be able to have anything we desire, yesterday.

Dangerously Simple

The City thrives on complex, interconnected system all available from the touch of the button. Understanding and commanding the complex is highly regarding in the City. In contract, simplicity is considered a virtue in much of Rural America.

People pride themselves on a simple, direct approach to life. If a machine is broken, I fix it. If my neighbor needs help, I help them. In small, close nit communities, this generally works well. It is so ingrained that people often view complex explanations with immediate suspicion.

To many on the High Plains, complexity and obfuscation are the same. In the past, the simple solution to complex situations, such as healthcare, revolved around personal trust. If a problem is too complex, I bring it to someone with knowledge whom I trust – simple.

Trust is simple, you either do or you don’t. However, as the institutions who employ the educated experts concentrate more and more cities, local communities have fewer and fewer experts to trust within them.

The decisions made in cities and state governments feel far removed and unrelated to daily struggles of life on the High Plains. Even in my life, I often have to explain to my consultants on the phone the capabilities of facility I am working in, because many cannot imagine practicing medicine where I do.

So, people on the High Plains must choose between trusting unknown people, who sound like chronic obfuscators, or finding someone who offers a simple solution to complex problems. Not surprisingly, they often choose the latter.

It is cognitively easier to believe something untrue which does not challenge the story one knows about the world than it is reorganize the world.

The Story of our Worlds

In High School, I once debated some Christian idea with a more fundamentalist minded classmate. He cited some part of the Old Testament, I stated that a different part of the Bible said the opposite. He looked at me suspiciously, then at our teacher, who said simply, “It’s true.”

“Noooo!” He literally wailed it. He was desperate as the underlying, organizing tenet of his young life shook precariously from the roots.

America is changing, somethings good, somethings bad, but very, very rapidly. It is becoming more complex, more multicultural, and the change is only accelerating, especially in cities.

These rural communities feel as thought the social anchors which have held them together: church, military fraternal organizations, schools, hospitals, are under attack. Whether they are under attack or simply withering from neglect is up for debate but the result is the same.

The gulf is widening, and all I hear on the High Plains is long, wailing Nooooo…. They wail because ‘Merica is under attack. Not the United States of America, but the story of America that their parents recounted to them and that they have since recounted to their children.

And I truly believe it is. I don’t think it is a bad thing, but I do think it is.

A war of narrative is being waged over what it means to be American in the 21st Century. Rural America is losing the that battle in media, popular culture, and demographics. So, they fight harder on the front where they have an advantage, electoral politics.

I have talked before about the importance of Founding Myths, and Rural America’s binding narrative is losing.

This is an important thing to understand about Rural America, they feel under attack and fear they are losing the battle.

Maybe that is necessary, or at least inevitable, I don’t know. But like all cultures which have existed in one form and now do not, we may look back on the rituals of ‘Mericaness and pine over their passing.

A piece of fleeting human culture that is no longer.

In the meantime, Rural America continues to wail, gnash its teeth, and rend its garments in grief over an identity that seems to be disappearing.

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