Back From the Great Wide Open

I open the door of the little, rural hospital I have been tethered to for the last 96 hours.  The bright, plains sun slams into my eyes. I squint and don my sunglasses.  I haul my call bags across the small, gravel parking lot and through them into the back of my car.

My car has become quite the road warrior over the last year.  12 years old, it shows its age. The front end is largely held on with baling wire.  The body is heavily dimpled from hail damage (an eventuality if you spend much time on the High Plains).  After the fifth rock extended the windshield spider web to an unsafe degree, I finally replaced it.

Nonetheless, I hold onto it.  It is effective basic transportation.  More importantly, after fixing the struts, head gasket, oil sensor, windshield etc, I need to get a little return on my investment.  Old, decaying homesteads dot the back roads of the High Plains and remind you of the legacy of the Dust Bowl and its deprivation.

If you spend enough time here, frugality seems more of a moral duty to those who survived than a way to get ahead financially.  Ostentation seems blatantly disrespectful.

I slide into the seat, turn the key, and the engine rolls over obligingly.  Turning out of the gravel drive onto the paved two-lane highway, I feel the first change that marks the return journey to my modern City-State.

That Ribbon of Highway…

I ease down on the accelerator and little four cylinder engine slowly increases frequency until I am at cruising speed.  I pass the grain trucks grinding slowly out of town and engage cruise control.

The City is still sufficiently distant that its radio waves don’t reach me yet.  I rarely use my smartphone to listen to my music, or medical CME, or audiobooks.  I like to listen to the local radio, even though it isn’t particularly good.

I like to hear the classic country and rock songs punctuated by advertisements for farm financing, announcements about the local county fair, and today’s corn, wheat, pork, and beef prices.  The only other options are Christian praise music or Norteno corridos on the Spanish-langauge station.

Occasionally, I listen to a few corridos before I tire of the wailing of lost loves and betrayal.

I never listen to the praise channels.

I drink in the never ending sky and the limitless horizon.  If you are from the lands of big sky, nothing is more comforting and inviting than the long, distant horizon.  You revel in your smallness.  If you aren’t native to the sky, it is nothing but a barren, foreign, emotionally disconcerting country.

No matter what you call it: plains, prairie, steppe, or llano, you either love it or you don’t.  Big sky country demands an emotion.  I have never met someone who is indifferent to it.

Wrapping up a shift and sliding onto the open highway combines two great sensations: the freedom of being both off the clock and off the grid.

It is a moment bordering on intoxication.

The Interstate

An hour later, I take a left turn and merge onto the interstate.  The wet, acrid smell of the nearby feedlot invades my car.  Immediately, I am in a different world.

The large UPS truck trailers remind me of modern e-commerce and our intense, modern interconnectedness.  I navigate the huge RVs doing their seasonal migrations.  I pass turn offs for the large truck stops with chain fast-food restaurants attached.

The local radio station starts to crackle with static.  The City’s more powerful antennas have already begun to crowd out the rural stations.  I give in and switch to one of the City’s stations.  The finely polished voices badges me to consider refinancing to roll my high interest debt into a low interest mortgage.

Or, advertisements bombard me for questionable hormone replacements therapies, which will apparently making aging optional. Not to mention the not-so-subtle adds for clinics specializing in phosphodiesterase-5 inhibitors.

I have officially crossed a boundary.  I have moved from a land where suffering is accepted as an unfortunate part of life to the regions where we are promised the power to opt out of suffering entirely.

“Life should be easy,” I hear. “Just buy this product and all the struggle will disappear.  We have plenty of financing options available for you…”

I flip the channel, hear the start of an old Sheryl Crow song, and settle in for a five minute break from advertisements.  I set the cruise control 10 mph faster than it had been on the two-lane.

The Modern Travelers’ Bazaar

About an hour later, I ease off the interstate, tacking a right into the parking lot of a truck stop.  I pull up to the pump, insert my various plastic forms of identification: my rewards card, my credit card.  I push the fuel selector, remove the pump handle, slide the nozzle into the gas tank and pulled the lever.

The fuel makes soft whooshing sound as it plunges into the tank.

Again, advertisements bombard me. This time a screen on the pump rages at me. “When did these become a thing?” I wonder to myself.  The squawking from the screen is overlain by barking from a loudspeaker informing me of all the deals to be had inside.

It reminds me of an electronic version of market stalls with vendors harassing you for attention and shoving their wares in your face.  Only, I cannot politely decline with my hand across my chest, and slight bow, and say, “Maybe later.”

The onslaught continues, I am powerless to modify it.

The pump thunks, and I replace the nozzle.  I lock my car and record the receipt in my smartphone, for tax purposes.

A dizzying array of crap I don’t need greets me inside.  I rush past the racks of pseudo-cowboy regalia, t-shirts with not-so-witty sayings emblazoned on them, and canes with “Vietnam Veteran” logos on the pommels.

I make it into the bathroom, and even relieving myself, I cannot avoid the advertisements for more shit I don’t need.

A man can’t even piss without being sold something in this country any more.

The Edgelands

Back on the interstate, I see the City starting to spill out and infect the plains.  The traffic picks up, the drivers who were content to go the speed limits now need to go 15 mph faster, driven by innate feelings of competition with the increased road population. I disengage my cruise control.

Billboards for urgent cares, liquor stores, and music festivals start to appear by the side of the highway.  Warehouses and distribution centers pop up like weeds.  Soon, the first exurban shopping center edges into view next to the highway.  The chain restaurants, discount clothing stores, all surrounded by their own asphalt plains.  I am told these are signs of the healthy economic growth…

Growth for the sake of growth is the ideology of a cancer cell.

-Edward Abbey

I look to the horizon, now obscured by scraggly trees, buildings, and semi-trailers.  It has taken on a sickly brown hue.  It is the color of a week-old bruise.  The air, now visible, starts to obscure the sky.   Without the visual escape of the horizon, I am drawn down to the human landscape, so paltry in comparison.

The detritus of homeless camps under the overpasses or next to the channelized, polluted rivers and the irrigation canals sucking them dry greets my gaze.   I turn up the pop-indie-folk-blues-autotune whatever coming out of the speakers.  Numb out.

I slide off the interstate into a cloverleaf and slide back onto another.  I smell the exhaust of the oil refinery waft out of my cars vents.  Soon, but never soon enough, I am at my exit and gratefully leave the interstate.

I jockey into position for the lane which will allow me the smoothest turn into our neighborhood.  The aggressiveness of the other drivers sends an electric energy up through the cars tires.  I let my mind drift back to the serenity of the sky I left behind.

Artificial Eden

I take a left at the park across from our house.  It is broad and flat, colored a deep, artificially green.  European Pines, crabapples, and Elms dot the small plain.  It contrasts with the light, airy green of native grasses and winter wheat I passed on the plains.  The trees on the plains had been ash and cottonwood lining the water courses, while wild plum and chokecherry in bloom clustered slightly higher.

I stop in the alley, step out of the car and open the back gate to our rental house.  The air smells mostly of nothing, but with the faint perfume of exhaust, asphalt, and cigarette butts.  Our old hound bounds out of the back door, wagging her tail excitedly.

Shortly after, my wife comes out, our daughter in her arms, excitedly telling her “Daddy’s Home!”  At 4 months, she is not particularly understanding.  But, I move my face into her view and she smiles her big, unbridled, infant smile.  The bridge of her nose crinkles and she lifts her arms in front her face in apparent embarrassment at her excitement.

I pick her up, kiss her cheek long and hard and she laughs.

And just like that, I am home again.




Across the Great Divide….Part 3

It is Memorial Day on the High Plains. The small, well tended town cemetery is full of flowers. People mill among the headstones. I often walk by this cemetery while I am on call and this is the first time I have seen anyone else.

On the other side of town, the town pool is being prepared for summer and children play baseball in the town park. American flags line main street. It looks like Normal Rockwell threw up all over this little town.

These are all small little rituals that maintain an identity of Americanness for people in small towns across America. There is no Walmart parking lot to negotiate, no traffic to fight. Simply the rituals family, country, and community. It is seductive, in a way.

Twentieth century White America needed all these rituals to form a cohesive identity. Many of the adults were children of European immigrants. On the High Plains alone Irish, German, Germans from Russia, Czech, Polish, Italian, Scandinavian, and Latino immigrants mixed in communities.

So, people got together in these rituals of Americanness in public. Even if in their own homes they cooked their old foods, read their old prayers, and told their own stories.

But, in public, it was all about being American. It was a communal effort to support the idea of being one people, bound together by location and a national ideology. Even if they did not share a historical culture, language, religion, or history, they could share a hot dog, a beer, and a baseball diamond.

America is a Fragile Idea

People tripped over themselves trying to be publicly American. Assimilation was all the rage. My father’s mother spoke German. After WW1 and WW2, his father discouraged her from teaching the children any German because of anti-German sentiment.

In the Southern High Plains, school teachers and classmates mocked and punished Latino children for speaking Spanish. I won’t even delve into the brutality and cultural genocide of the Indian Boarding Schools.

People paid the price of this cultural loss to assimilate and be “American.” Only the oldest resident’s of the High Plains have memories of their European immigrant ancestors speaking the Old Language and practicing their Old Ways.

The modern generations only know that their parents and grandparents did assimilate. They don’t realize it took decades or 1 or 2 generations for their ancestors to assimilate into “Americanness.” Nor, do they acknowledge the change their assimilation brought to American culture as a whole.

Immigration did not bypass Fly-Over County, then or now. The first Arab-American Senator in this country was Lebanese Maronite Christian from a small farm southern South Dakota – James Abourezk.

Fort Morgan, Colorado made news a few years ago. Somali immigrants working in industrial agriculture sued under religious freedom grounds for breaks at work to pray the requisite number of times per day.

What I hear and see when people on the High Plains talk about new immigrants is a feeling that the rules have changed. Their ancestors bartered one culture for another. Now, in the Cities and even in their own communities, they feel new immigrants are not forced to make those same concessions. I don’t know if this is true, but it is what they feel.

I doubt any of this is conscious. Much of it comes out as simple nativist, scapegoating for the pain of being in a world that is changing rapidly and leaving them behind. Nonetheless, I wonder if deep down, there is a jealousy. A sense of “Why did my parents and grandparents have to forget their culture and these new people don’t?”

Rituals of Americanness

Of course, new immigrants are assimilating, but it doesn’t happen overnight. Whereas their presence can change the fabric of a community or neighborhood in what feels like overnight. And, as they assimilate, they change the fabric of America.

Americanness is an identity based around ideas. These ideas have ebbed and flowed over time. Their relative significance has changed as well. Periods of time when these ideas were under debate have always been the times of great discord in American society.

The 1910s and 1920s saw race riots and a swell in anti-immigrant fervor. The debate over slavery that lead to the Civil War was a time of arguing over what it means to be American and who got to participate in the idea of America.

When your national identity is based on ideas, it is so very fragile. You cannot rely on history immemorial to bind you together. Every 3-4 generations we as a country must decide that we still want to be a nation together.

Group rituals are what bind a people together. In many cultures, the communities commitment to a given ritual is necessary to keep the world moving. The planting and harvest rituals are essential to the world continuing to function as it should.

Similarly, in a Russian Orthodox Easter service, Christ ritually dies and is resurrected every year. The community re-enacts it, together, to bind them in a sense of history, purpose, and collective emotion.

The Rituals of Rural White America: the baseball games, the laying of flowers on headstones on Memorial Day, the fireworks and backyard barbecues of the Fourth of July – they are held dear because in their completion, the idea of a certain kind of America is reborn, reformed, and confirmed.

The fragile existence of an American identity is solidified, if only for another year. When White Rural America perceives the mockery and dismissal of these traditions, they feel their identity, their nation is literally under attack. Because, at least ritually, it is.

Stories are what bind us together. From the vantage point of Rural America, the polyglot, postmodernist, multicultural milieu of Urban America is not a force of creative disruption. It is simply disruptive, even destructive.

I live in the City, and even there, I don’t hear anyone offering a new American story, I only hear them railing against the old story. Which is understandable, the old story was exclusionary.

Many in Urban America cannot see themselves in the old story. White, male, Christian Americans jealously guarded membership in the old story and its benefits.

You cannot simply be against something, you must be for something as well. If a large portion of the country, especially one with significant electoral power, cannot see themselves in that story, they will fight it with all their might.

I like the idea of a big, messy, diverse country striving together to make itself and the world better, safer, healthier. So, I am asking Urban America to remember to offer a New Story in return for subsuming the Old Story.

Rural America has its faults, but it is still part of the multiculturalism of this country that you purport to love and admire. So, tell them a story that includes them, don’t just shit on their story.

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.

Across the Great Divide…Part 1

The Urban-Rural Divide, A Culture Gulf.

“You see, this is why they are wrong…” began our guide Ibrahim. My wife had just asked him to explain the difference between Shi’ites and Sunnis. He was Sunni, as are the vast majority of Moroccans.

We prepared ourselves for a very unbiased and nuanced theological discussion…

No place in the world has made me feel so “other” than Morocco. Sure, in Taipei I was an obvious Westerner, a novelty. In Moscow, I was suspicious as an American, but could blend in. In Istanbul, I was barely worth noticing.

In all these other places, I was different – a rare breed perhaps – but still recognized as part of the same species. Only in Morocco have I felt as though I was something else entirely. I came from another world, another plane.

In the mountains of High Atlas, the desert Palmaries of the Sahara, and the markets of Marrakech, my wife and I were more other than I can explain.

Increasingly, I see this dynamic playing out between Urban and Rural America. As someone who now spends two thirds of his time in one world, and one third in another, I want to talk more about it.

This will be the first post on the Urban-Rural Divide I have navigated since I was 18 and currently straddle in my professional life.

A Foot in Two Worlds

I never thought of myself as a two-culture kid, a common phrase for first generation children of immigrants. I am a white male, who grew up in an overwhelming white place. In theory, I fit in growing up.

At least some of my family have been in the US for a couple of hundred years. Some are more recent, but we don’t have any living memory of immigration from abroad. So, I can’t even claim Polish-American, Irish-American, or Italian-American as a second culture.

My father was born in the poverty of the post-Dust Bowl Northern Plains. He didn’t have running water until his family fled to California when he was nine. My mother grew up an Urban girl in the Bay Area of Northern California. Both graduated from UC Berkeley.

Somehow, I was born and raised in the middle of grass, beef, and sky country. A full days drive from a Major League Sports Team.

Where all the women are strong, all the men are goodlooking, and all the children are above average. – Garrison Keillor

I did what a lot of us curious ones did, I left. I began wandering an archipelago of institutions of higher learning. Initially, I enrolled at a highly selective liberal arts college, on scholarship.

For the first time in my life, the majority of people with which I socialized voted like my family. Difference was not an inherently suspect trait.

It was a revelation. After an entire childhood of feeling different because my family wasn’t from “here,” I finally fit in. Then, as I got to know more and more people, it became clear that I was still different.

You cannot spend your formative years in a place like the rural Northern Plains and “fit in” with the children of hyper-educated, suburban Tiger Mom’s.

A common refrain became, “You’re the first person I’ve ever met from that state.” There it was, I was again a novelty, to be wondered at.

“Well, there aren’t very many of us.” Became my standard laconic reply. I fell back on my tried and true survival technique, talk less about myself and more about events, ideas, politics, etc. People like that love to share their opinion on things they think “matter.”

The Trouble with Normal is….It Only Gets Worse – Bruce Cockburn

By the time I reached medical school, my very existence confused people. I had learned Latin in High School. I had lived in Russia and spoke Russian. I could follow a basic conversation in Spanish. I read, I mean really read. Not just because I had to.

Yet, I couldn’t shake all my ruralness. Sushi was still suspect in my book. Professional sports still seemed an alien and foreign thing to me. Traffic left me jittery.

During medical school, I often left for the mountains and spent several days alone, a tonic to counteract the volumes of people I dealt with on a daily basis.

People like me weren’t suppose to come from places like mine. My being in medical school challenged their assumptions about places and people they didn’t think mattered or were worth knowing.

I was aberration, a statistical outlier, noted and then discarded so as not to skew the data.

What Rural People Know

Shortly after I graduated medical school, my medical school started to count people of “Rural Origin” in their diversity statistics. It was a shallow ploy to make their overwhelming white, suburban, upper middle class cohort look more diverse.

Nonetheless, the logic was reasonably sound. Those of us who grow up in Rural, or even Frontier counties face significant health and educational disparities. The geography of suicide is decidedly rural.

In nearly all the indicators which the Left uses to identify historically disadvantaged or marginalized groups, Rural Americans meet the definition. Yet, we don’t make those lists.

And we think we know why. We have all heard what Urban America thinks of us. No one wears “rural origin” visibly. Because when we leave, we learn to blend in. There is no definite marker of being culturally “rural.”

So, we hear what Urban America has to say about us, our families, our communities – in classrooms, conference rooms, at happy hours. That doesn’t mean all of Urban America disdains Rural America.

Nonetheless, it is the strongest narrative Rural America has about how Urban America feels about Rural America.

What is She, from Kansas or Something?

Medical School was where I truly came to know this disdain, it slipped out accidentally, but often. Usually without malice, but with an odiferous smugness.

Once, when discussing a formula for estimating height in a medical school workshop, the professor asked the class if it didn’t apply to anyone. My friend, Steve, a first generation Chinese-American, raised his hand.

The professor, who knew nothing of Steve’s personal background, said, “Well, it doesn’t apply as well to immigrants or children of immigrants.” She assumed, based on his Asian appearance, he was an immigrant.

Later, over beers, he vented. It had clearly touched a wound.

“How the hell does she get off just assuming I’m an immigrant?” He fumed. “She’s faculty for god’s sake. You’d think she’s from…Kansas!”

It never dawned on him he had just made the same transgression he was fuming about. Kansans – coastal code for Rural Americans – apparently weren’t deserving of the same level of consideration he demanded for himself.

Mutant Towns

Another evening, I was sitting having beers with a classmate and her significant other. Both had transplanted from some Coastal megalopolis and we were discussing travel around the state.

In discussing regions of the state, her significant other stopped and said, “Oh, I don’t go there, those are mutant towns.”

“Mutant Towns?” I asked.

“You know, there are some towns in this state that are just full of people who kind of look like mutants. Fat, unkempt, ugly.” I don’t go to those places. He laughed.

I stared in silence and disbelief.

In other words, poor rural people. He thought he was sincerely funny. He also thought he was worldly and cultured. He thought he knew things.

This is what Rural America feels.

Sure there are nice, decent people everywhere, but we don’t remember those people. We remember the people who made us feel like nothing.

Can I get a Witness?

Urban America paid no mind while Rural America stewed in its hurts, limited opportunity, declining population, closing schools, and disparate health outcomes. Rural America doesn’t matter after all, it isn’t wealthy, mass culture is not produced there, fortune 500 companies don’t put their headquarters there.

“Why don’t they just move somewhat nice?”

But, Rural America votes. ‘Merica is religion on the High Plains and many other redoubts of Rural America. And the Religion of ‘Merica demands voting. And, Rural America is the only human community of in this country who has their Affirmative Action enshrined in the constitution – the Electoral College.

Rural America was tired of being ignored and forgotten. So, when a huckster who shits on a golden toilet showed up and made them feel heard, they showed up in return. That is how important it is to people to feel heard, to feel counted.

People want their suffering heard, and will sacrifice a great many other of their values to feel heard.

I hope these posts will help you get to know Fly-Over Country a little better.

You don’t have to like Rural America. I certainly know its flaws better than most. Nonetheless, it is cold and smug to deny its hurts and foolhardy to ignore the power it has to make itself heard.

Cold and Dark Return to the High Plains

moon over the snow

I walk the outskirts of town, the cold and dark are everywhere.  The darkness has returned to the High Plains.   From daylight’s savings until the return of sunlight becomes perceptible again in January are the low parts my year.  I don’t mind the cold, but I miss the light.

The cold can be clarifying tonic on the High Plains.  It is not suffused with the dampness of Eastern cold.  It is a freeze-drying cold.  Bracing is the word for it.  The darkness can be disorienting, but the cold wakes you up – keeps you focused on the fact you are still alive.

Moonlit Night on the Dniepr – Arkhip Kuindzhi – 1880, Tretyakov Gallery, Moscow. Public Domain.

Tonight is cold and brightly dark, punctuated by the shine of a waning moon, though still nearly full.  It has been a tough past few days on call on the High Plains.  The darkness and the holidays bring out dysfunction and mental illness.  Without a clearly lit path, people quickly wander back into their own darkness.

A razor-thin slice shy of freedom

For the second time in 12 hours, I am reapproximating the flesh on the left forearm of a man in chains – offenders as the guards say.  The same man. Two cheeked fragments of a razorblade did the work, the second one not found in time.  I had known he was serious about wanting to die.  While stitching up the wound when it was only 4 inches long, he had calmly made small talk.

Disinterestedly watching me sew his numbed arm, “I guess it is harder than on the movies.  In them it is one smooth slice and they die quick.”

I pulled my running vicryl suture, the fatty subcutaneous tissue tightening. He didn’t flinch – a good anesthetic field.

“The body is designed not to die,” I replied. “The body wants to survive.  I might not be able to get your tattoo back to what it was before.”

I ligate an small oozing vein, luckily for his blood volume, he didn’t know the vital vasculature is quite a bit deeper.

“That’s okay.  It’s just their to cover the name of a girl who isn’t my girlfriend no more.  I don’t suppose you can tell me this, but what’d I do wrong?  Where’d I miss?” He asked.

“You’re right, I can’t tell you that.”

That was the first time. After stitching his arm back together I thought about the safest place for him.  Prisoners don’t have a lot of options.  A locked unit for prisoners in the county hospital 2 hours away?

The prison guards assured me he would be watched and would have access to telepsychiatry within several days.  All the options sucked, this one seemed as good as any other. I discharged him back to their care with signed orders for follow up. I even asked them how they were going to keep him from ripping it back open – they had had an answer.

just looking for some peace

Within 12 hours, he was back.  The wound twice as long, but only minimally deeper.  Still no muscle or large vessel damage.  Killing yourself with a half-inch long piece of broken safety razor is not for the faint of heart.

Shit, I think.  I should have found harder for a different solution.  Clearly that didn’t work.  Was I cavalier with his safety?

Me: “So, how did you get another razor blade?”

Offender/Patient(O/P): “I had another one hidden.”

Me: “Where was that?”

O/P: “Well, I can’t tell you that, its privileged information.”

He sprouted a mischievous grin.

“Was it somewhere sensitive?” I pushed.

“No.” He seemed ashamed of the implication. “I had it cheeked.”

shit, he had a back up plan…

A different facility would not have been any safer – he really wanted to kill himself.  Who tries to kill himself and holds something back, just in case he fails?  Someone who knows life is worse than death.

Me: “Well, why do you want to die?”

O/P: “I just want some peace. I’m tired of my shit getting fucked with, of me getting fucked with.  I am not affiliated, so everyone fucks with me.  I just want to be left alone to do my time.”

(Affiliated, if you are not familiar, means not in one of the prison gangs)

Me: “How much time do you have left?”

O/P: “Well, I am up for parole soon, but I don’t have much hope for getting out.  My latest possible release date is 2024.”

Me: “What would it take for you be able to want to live that long?”

O/P:  “Just to be alone, in peace, doing my time.”

Me: “Like solitary?”

O/P: “Yes.”

I place the last 3-0 prolene horizontal mattress suture – for strength, just in case he has another back plan.  Well-approximated, I muse.

the lonely moon

Sitting on the hill, I take in the pale moonlight glancing off the water tower.  It sands in front of the red warning lights of the wind turbines on the distance ridge, which are blinking in unison.

The guards placed O/P into a prison van and took him to the state penitentiary’s system infirmary.  He would be kept shackled the entire time, to prevent a similar incident.  Likely shackled to a bed, with minimal to no freedom of movement. Additionally, the guards assure me he will have urgent access to mental health resources.

I don’t know what this man did to be in prison.  The prison nearby holds serious offenders.  He likely needs to be in prison to protect the rest of us.  Whatever he did was probably enough to sacrifice his right to freedom.

I can’t help see the irony in his desperate attempt at finding peace.  Trying to free himself from his current version of hell, he lost the last of his freedom.

I take in the peace of the night.  The moonlight reflects off the recent shallow snowfall.  My breath freezes in the air and slowly drifts off, without any perturbation. I think about Johnny Cash’s classic – Folsom Prison Blues.

Well I know I had it coming, I know I can’t be free
But those people keep a movin’
And that’s what tortures me

Shit is fucked up, I think to myself.  I start to slide into my cerebral self-flagellation.  Am I supporting the prison-industrial complex?  Am I profiting from it?  Who am I kidding?  Continuing to breathe in this world necessitates a tarnished soul.

I watch the bank of red lights blink.

O/P seems to have accepted his sentence of time.  I cannot and do not want to pretend he is a gentle man or a kind man.   True compassion doesn’t require a made- up story to make the person worthy of it.  He probably needs to be where he is.

Nonetheless, I do wish him some peace and hopefully it does not require his death.