Coding Mastodons

Posted on January 28, 2025 by ddxdx

Coding Mastodons

Sid and his partners sat around the conference table upstairs from the clinic. They met monthly at 6:30 AM so they could dispense with the clinic business and go off to hospital rounds and then get back to clinic by 7:30. Patient care is always first. Go to the grind.

Paul, their manager was sharing bad news.

The practice had accepted the burden that they needed a manager. So, they hired him and paid him almost as much as they made. In fact, the manager made more than Sid since he was a low producer.

That’s how this group of Sid’s had decided each should be paid. The more money you brought in for the clinic, the more you got to take home. It made some sense to Sid. If you killed the mastodon, you should have first go at the good bits. Sid was a hunter.

Sid looked around the table as Paul was preparing his bad news. Doctor Jones, older than Sid by a good ten years and probably just as cynical as Sid would be in ten years had his system. He ordered a ton of labs (done by the clinic lab, thus generated revenue) and added two diagnoses to the problem list with every visit. This allowed him to charge for a complicated visit, when it took only 15 minutes, like most of Sid’s. Jonesie had figured out how to get a good share of the meat.

Whenever Sid saw one of Dr. Jones’s patients, he did his best to clean up the duplicate diagnoses off the problem list, since it was all so much gobbledy gook. Three diagnoses of heart failure with different modifiers didn’t help Sid understand this poor creature. But such custodial work didn’t add to Sid’s income, so he pretty much just shrugged and gave up.

Then there was Doctor Payne who could truly see 40 patients a day. It didn’t seem his name drove folks away. Maybe it drew them?

Sid had watched him. He was amazing. One-line notes in the chart, always a prescription, often a narcotic, but he got them in and out. Lots of ways to bring down the beast.

All the calls for narcotic refills that came in when Dr. Payne was off were a burden, for sure, but again, Sid kind of shrugged. He so appreciated hunting with this tribe. Figuring out why the 70-year-old needed 90 hydrocodone a month wasn’t billable for Sid, so, shrug. He just needed to pay attention to the hunt.

But now Paul needed Sid’s attention.

Paul had been a worthwhile investment for the group, Sid had decided.  Paul had hired another billing clerk, they were up to four now, and they worked upstairs and were out of sight. But they sure seemed happy on their lunch hours. The clinic was seeing some increased income, so maybe all was good. Sid accepted that you had to spend some to make some. It takes effort to bring down big game.

Sid knew not all clinics paid their doctors this way. But this was pretty much the pervasive medical culture, though Sid smiled to himself, maybe it was Neanderthal. If you “do more”, that is charge more to Medicare, Medicaid, and the better paying insurances, you make more. If you deliver Medicaid babies it would pay about half what Blue Cross paid. But delivering a Medicaid baby paid at least a thousand bucks, 20 times more than one office visit. And you got to do it in the middle of the night so you could still “produce” in the office hours.

Maybe that’s why Doctor Smith was sleepy now, nodding off almost as Paul was starting his news. Was he really sleeping? He did more deliveries than any doc in town, even the Ob Gyns. And he got lots of the good bits.

Sid was always a low charger. What the doctor charges is submitted in the code and then the billing ladies sent the code off for payment. It might be what you do, or it could be what you code. Either the mastodon died, or it didn’t. Sid wished for the good old days. Instead of this mish mash why couldn’t it just be simple hunting on the prairie?

The doctor’s coding was what Paul was talking about now, what they had charged, what they had coded.

Medicare had come in and audited all of their Medicare charges. A doctor’s charge to Medicare must be reflected in the notes of the visit. Medicare is the big government health insurance for the elderly. They have the right, because they are the government, to come in and audit your books. It seemed the clinic’s numbers didn’t add up.

“So, their findings, when they looked at a sample from the last six months, they found we had miscoded 23% of our visits. They then extrapolated that to the last five years, and they say we owe the federal government $1.3M. But…”

There were too many expletives for Paul to finish his sentence. Sid watched Paul’s small smile as his colleagues blustered their umbrage for five minutes. Sid knew he had two hospital patients to see and 30 minutes of records to review before his first patient an hour from now. He interrupted his senior partner’s rant. “Can we get to the chase?”

Paul smiled at Sid. “Yes. These are the usual findings from an audit such as this. Actually, 23% of coding mistakes is a bit below average. We will have further conversations with them. I expect the final reconciliation to be in the low five figures, maybe less.”

The umbrage started to boil up again.

Sid nipped it. “Do you need anything from us at this point?”

Paul smiled again. “I have decided to implement a coding improvement process with all of you. Should this happen again, having such a process in place will greatly improve our standing.”

The questions bubbled up.

“We will pull ten of your appointments from the prior month and have them reviewed by a professional coder. You will get their recommendations. We hope this will improve our performance.”

Sid left the meeting with quite a few questions unasked. But he had never had a beer with Paul. The smiling gnome seemed to understand the system. Sid was just beginning to.

As he walked across the wet street to the hospital, he wondered, if the clinic was already below the average for bad coding, just how much could they improve? But Sid was perplexed by statistics and quality improvement processes. This was totally foreign to the practice of medicine he had learned.

Sid opened the door to the hospital and went up the stairs.

Everything a doctor does is coded. Doctors are paid based on what they code. Can’t you see the problem? Sid screamed this to himself before the first landing.

If surgeries pay more than office visits, won’t more doctors want to be surgeons? And what we need are good family docs helping patient avoid chronic problems. But those codes pay shit.

And if surgery codes pay 100 times what spending 30 minutes telling a patient this surgery probably won’t help you, what do you think the surgeon will say?

Sid went into the ward fuming. He did the visits, talked with the nurses, then wrote his orders. As he did, he considered another coding folly.

Codes submitted by hospitals, though they may be for the same exact service as done in a clinic, were paid 50% more by insurers. It was the “institutional fee” thing. When Sid had learned this, he had first blown a gasket, then rolled his eyes. He was learning the absurdity of the game he was playing. Oh, to be hunting mastodons.

It was like his small band had discovered a weak mastodon, trailing the herd, but another, larger band of hunters had shown up on the plain. Who would get this meat? Who would live? Sid wished it was like the good old days.

As he went back down the stairs, he had calmed down. He knew there were other models. The Mayo Clinic paid docs a flat salary. No incentives to do more. But that wouldn’t fly here. He’d tried it. We still hunt. And we eat what we kill. Mastodon meat can keep you alive.

A month later Sid got his coding report from Paul. Three of his ten reviewed visits were miscoded. Two were coded too low, and one should have had a surgical code included.

Paul was in his office.

“So, what do you think I should do with this?” Sid dropped the two-page report on Paul’s desk.

Paul was again smiling. “It looks like you should code higher and remember to include any surgical procedures.”

Sid looked down at the bland carpet. “Does under coding come up in Medicare audits?”

Paul capped his pen and leaned back in his Office Depot chair. “Of course. Any code not justified is flagged.”

“So how many of those audited visits were under coded?”

Paul was not smiling now. “They don’t share that information. They just tell us our accuracy.”

Sid stared at Paul. The no longer smiling gnome continued. “They assess the accuracy of coding and assign a fine based on the percentage of mistakes.”

Sid did not smile. “So, if most of those mistakes were where we should have charged more, but mistakenly didn’t, we still get fined?”

Now Paul gave a slight smile. It was like he felt some comfort to be discussing the details of a Medicare audit with someone who cared. “That’s why they negotiate. We’ve got it down to about $9K now, so you know.” Paul put his hands behind his tilted back head. He was gloating.

Sid knew the next patient was waiting. He just looked at Paul, so proud of himself. He wondered about just what he was doing. If it was about harvesting meat, he understood the purpose. But this?  He thought of his tirade in a millisecond.

I learned the origins and insertions and innervations of all the muscles in the human body. I learned the bones, they were easy, and I learned the sensory dermatomes. I know all the foramen of the skull and what goes through those holes.  I learned the embryology of the gut rotation and how the testes descended from the kidneys. I know the doses of hundreds of pharmaceuticals, and what the drug companies claim they do. I’ve read their weak double blind crossover randomized trials. I know the side effects of most of these drugs I am expected to prescribe, and I pay attention for them in my patients. I know the value of the blood tests and radiology tests available, and I order them based on their value for the condition of my patient. And now I am expected to know how to communicate this for my reimbursement. Through codes? Through the seven branches of decisions with 3-5 variables at each branch on a little laminated card?

So, I order lots of tests and the reimbursement code is higher. Does that make me a better doctor? Does that make my patients healthier?

Do I freeze off the benign skin tags and get paid more? Are they healthier?

Maybe it makes me, and you richer.

Sid felt his internal millisecond rant winding down with the slow blink of his eyes. He looked up at Paul, leaning back before him.

“I got to go.” Sid went off to the next waiting patient.

And Sid saw patients. All morning he saw patients. He finished his recording halfway through his lunch hour, so he trotted across the street to the hospital cafeteria. A saran wrapped half sandwich was a buck fifty, and he could eat it and walk. So, he did.

He saw the new billing lady smoking her cigarette as he went out. He’d already unwrapped the ham and cheese, so he moved in her direction and thumbed the plastic wrap into the garbage can next to her. She exhaled a big puff.

“Well, you caught me!”

Sid knew that voice. He vaguely remembered a couple round scars on her cervix from previous biopsies that had turned out benign. But not her name.

“Caught?”

She had a winning smile and good posture. The past intimate revelations were lost. “Rhoda” She said her name, with a winning grin, like she knew Sid didn’t.

“Yes,” Sid didn’t fumble. “Are you the new coder?”

Rhoda flicked an ash. “That’s me.”

Sid took a big bite of the little sandwich and chewed fast. He had some food in his mouth when he said. “We should talk about coding sometime.”

Her laugh was so brassy it echoed from the bricks behind them. She took another puff, exhaled, and said, “That’s the weirdest pick-up line I’ve ever heard.”

Sid was surprised. Pickup? “No, really, I’m trying to figure out this coding thing. You’re the expert. I figured you could help me out.”

Rhoda tossed her butt into the landscaped garbage can where it might melt Sid’s saran wrap. She shook her head. “I’m the newbie. I can’t help you with coding. I just do what they tell me.” She looked him in the eye. “If that’s what you’re looking for you’ll have to go somewhere else.” And she strode across the street. Sid finished the ham and cheese and did his four block loop that took just fifteen minutes.

It’s embarrassing when you don’t know what you’re looking for. Hunting mastodons, you look for their brown fuzzy hump above the rise and you slow down and check the wind. But coding? Increased income? Improved quality? It’s such a mess. He kept seeing patients.

But a week or so later he had gotten a coroner call and there was Rhoda, in the alley, smoking again. He could have sprinted across to the Hilux, but he turned as she exhaled and flicked ash. “I really do want to talk to you.”

She smiled. “That’s better.”

Sid ran across and did the dead body. When he came back there was no Rhoda in the alley, just ten more patients to see and code to end his day.

He did some research. It seems the coding part of medical care was a big deal. There were software programs that would up code for you, and there were companies who would code for you and there were venture capital companies buying up doctor’s practices to increase their profitability. He doubted any of this would come to small town Paradise. But he also came across a study of the “coding experts” like Paul had contracted to send their charts to for review. The study found only 60% agreement between them when they looked at identical chart notes. So much for experts.

Maybe this mess was all based on the American medical system’s commitment to paying medical services only for what they did. This had been long embraced by doctors. The socialist concept of paying doctors a flat salary for their services had been fought by the AMA. No, doctors were not fungible. And since we have successfully kept our services dear, we should be funging the payments. Sid felt the skepticism growing in him. He knew family docs like him were on the low end of the IV pole. Code payments were driven by Medicare, and specialists drove these negotiations. And the AMA was complicit. Sid knew that family docs, generalists got paid less because there were 60 specialties on the committee and only 5 primary care representatives. He was getting an idea about the US Senate.

Sid felt some pride that he hadn’t paid any dues to the AMA for years. Then a niggling thought came, shouldn’t he try to change this bullshit? Shouldn’t he get on the inside? Shouldn’t he go to work to slay the monster instead of hanging back and carrying the spears for the others? But this game was so big. It was so big, and he was so small.

Sid finished with his patients and did the dictation, the charting, the document reviews, the prior authorization forms, and he headed out to his family.

Rhoda was ahead of him in the hall. “Hey Rhoda.”

Sid gave her a ride home. It was a dismal duplex over where he’d lived when he and Martha had first come to town. Rhoda’s car was at the shop. “Thanks doc. Maybe next time.” Her brassy laugh didn’t echo off anything. He saw her profile as she turned. He didn’t remember his cursory examination of her young breasts for cancer, like there might be any. At least that’s what he had coded for when he saw her as a patient back when. Sid didn’t remember such. He had trained his mind to put everything, all the naughty bits at least, into little Tupperware containers in his mind, only to be brought out when the right guest was in the room. But she was pretty.

Sid drove home feeling lost. He didn’t know if there was any help. This coding thing was driving him crazy.  But there was the family.

The next day a young man seemed to be very interested in the new electronic medical record Sid was still trying to figure out. The young man did not have chlamydia, though Sid wasn’t sure the nerd had ever had sex. He wouldn’t share his sexual history, just his worry about a “discharge”. Sid suspected a nocturnal emission was mistaken for an STI symptom that the guy had Googled. Sid tried to explain that a good history could save a lot of money and testing, but the nerd would have none of it. So, Sid swabbed and ordered the test.

“Does that program code for you?”

Sid stared at him as he removed the gloves. “No, it doesn’t. We didn’t want that feature.”

The nerd’s head bobbed. “So how long till I get the results?”

“Can you wait 15 minutes?”

“So, you guys do PCR?” Sid was wondering just who the hell this guy was. A “mystery patient” from some insurance company? Or just a really truly health care tech nerd. “You can wait in here or out in the waiting room. Your choice.”

“I’m fine here.” Sid carefully logged out and locked the screen.

He got through two more 99212’s (simple visit codes) before the test results came back. He told the young man the negative results as he sat absently in the chair.

“So hey, if you guys want help with the programming or a patch for coding, I think I could make you some money. I know the language these guys use.” He nodded at the dark computer terminal.

Sid walked him out.

But a chance meeting in the hall with Paul, the highly paid administrator occurred. “This guy said he could augment our program and add in coding, make us some money.”

Paul looked downward, like Sid had offered to sell him his first born. “Sorry, we’ll have to do it the legit way, through the contractor.”

Sid shrugged. Paul sighed with no smile. “If we hack in now, we’ll be on our own. They’ve got us by the balls. We buy their package, so we have to stick with what we got. There’re a million hackers out there who can do this. I get their emails every day. The next Medicare audit would be a nightmare.” Paul shuffled off. Sid had gotten a glimpse. It wasn’t big mammals they were hunting. But it was big money, at least from this small-town perspective. He really didn’t think it should all be his. But just some of it, what he deserved.

Sid felt pretty good about his afternoon patients. He might have helped a couple and hadn’t really pissed any off, so that’s good. And he got out in time to pick the kids up from swim practice and have a family dinner.

“How was your day, Dad?” His youngest asked. She was nearing middle school, but not there yet, maybe fourth grade?

“Just fine.”

She dipped her soup and mumbled toward the table. “How the hell can a person go to work in the morning and come home in the evening and have nothing to say.”

“What?”

She looked at him. “It’s just a John Prine song.” And she smiled.

And Sid was devastated.

This shit was just too much. He finished and went out to the garage.

There was just a mess on the tool bench. Nothing to fix, no project waiting, just a mess to clean up. And it was cold.

He threw some odd screws in the trash and wiped off the table saw. Maybe the problem wasn’t the coding. Maybe he just didn’t like being a doctor. But he’d enjoyed his time with patients that afternoon. He loved it when he could help folks, maybe make a difference in their lives. Why couldn’t he share that at the table? He had come home in the evening with nothing to say.

What was weighing him down? Should he just go fix hay balers, his alternate career path? But he was pretty comfortable. He just knew it could be better. He looked around his cluttered garage and knew it could be better too. Maybe he should change the oil in the old motorcycle.

He had learned to awake quickly when the beeper buzzed, or the bedside phone rang. He could get the call go in and do the delivery, come back, and Martha wouldn’t even know in the morning. So, he picked up the receiver and said softly, “This is Doctor Hawthorne.”

The brassy voice was unmistakable. “Doc, I need your help. Can you bring gloves?”

Martha hadn’t noticed. She slept soundly. Sid was up and having breakfast as the kids scrambled about. Martha guided them and the middle schoolers got in his Hilux and the littler ones headed down the hill. He dropped the older two off three blocks from the school so no one would see the rusty shame. He looked carefully for footprints or trampled cars, but all was in order. Then he headed south into his daily grind.

“Hey Doc, I owe you.” She had said as he left. He’d skinned the gloves into the kitchen garbage can. “Do you want me to up code your visits this month?”

Sid looked at her in the loose robe. The boyfriend was in the bedroom. They had the lube, but he’d brought the gloves. It hadn’t been easy, the retrieval. But the years of delivering babies had taught him the importance of positioning.  He hadn’t once thought about how this could be coded.

“No, you don’t need to do that.”

The brassy laugh burst out. “Hey doc, you deserve it. You can’t code for what you just did.”

Sid laughed too. And he left.

The dark street led to the Hilux but for some reason he looked up. He saw furry backs moving beyond the treetops. They were headed south toward the hospital and his clinic. But they just moved quietly above the dark leaves. He heard no cracks or crushed things as the massive bodies moved. They were silent, but really big.

After he dropped off the kids and turned south, he started to look for footprints or signs of the moving herd. He saw none. Traffic was light. He worked his way down to the doctors parking lot where his rusty Hilux was notable. Sid smiled as he thought of his stain on this herd of shiny high dollar cars.

He could have turned down Sixth, but there was a light at the bottom, so he cut across Monroe to drop right down to the doctor’s lot. In the middle of the street on the steep side hill has a mound. He knew the Hilux wouldn’t clear it and he could put one wheel on it, but maybe it was too solid, so he stopped. Sid set the brake and got out. He checked and the little rusty Toyota didn’t roll so he trusted it.

The mound was still steaming. He touched it with his work shoes. It was bigger than his spare tire. Shit on the way to work. Big shit.

He drove over it and headed down to the lot. Work to do.

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Now What?

Posted on January 23, 2025 by ddxdx

What Next?

So, the talk is that the Republicans want to get rid of Medicaid. OK, but what next?

There would be lots of ways to walk this program back.

Let me remind you, nobody likes it.

Doctors hate it because it pays about 30 cents on the dollar of what they charge. They love private insurance because it pays 70 cents, but they hate the prior authorizations the insurance companies use that extra 40 cents to staff. Keep in mind, what they charge is what they charge.

Patients hate it because it’s “charity” and the doctor’s offices look down their nose at them.

Hospitals don’t hate it too much since they would be having to put these poor dying patients out on the sidewalk and that really looks bad. But the Medicaid payments don’t cover their costs. So, for them it’s a lose/lose.

So, we have built a federal state partnership program everybody hates. What a great government solution. But do you like your private enterprise insurance benefits? Do you like how much this all costs you? Remember, us Americans pay more, almost twice for healthcare than any other country in the world. And this is what we get.

We, our country could do better. Our new President has resolved to make America great again.

Should we redo the primer on what exactly Medicaid is? Skip the following paragraphs if you passed the pretest.

Medicaid was added to the Social Security program in 1965. Idaho agreed to the partnership in 1966, a very early state to agree. The federal government agrees to pay a certain percent based on the state’s poverty level. The state pays the rest. In Idaho’s case, it’s about 70/30, federal/state.

Don’t get confused about Medicaid Expansion costs. That match is 90/10 and always will be unless somebody wants to change that law.

The most expensive patients on Medicaid are the severely disabled. This is a small but expensive group. Do you think they should have health care supported by taxpayers?

The largest group is children in low-income families. They are cheap since most are healthy. Do you think they should have taxpayer supported healthcare?

Then there’s low-income uninsured pregnant women. Do you think…maybe not.

Then there’s the Medicaid expansion population who don’t make enough to get insurance on the exchange. Most (80%) are working with a reportable income, but it’s below the poverty level. I know 60% of Idahoans think they deserve health insurance, but I don’t think the Idaho legislature would agree.

When I got elected to the Idaho legislature, I was all in favor of what Paul Ryan was proposing for Medicaid, block grants to states. I saw the current funding mechanism based on percentage of poverty as no incentive for a state to try to control costs. If we only saved a third of every dollar, would it be worth it? Block grants would offer a greater incentive.

But then I got to understand how block grants get twisted by state legislatures.

It all comes down to the questions I have been asking of you. Do you think all people should have access to health care?

Most, when asked this question, throw up their hands and say, “Of course, if we could afford it!”

They have been trained by the medical industrial complex to consider this as a dear resource. They forget we are already paying TWICE what any other civilized country pays. We have been brainwashed into considering it’s just too expensive.

Your yearly deductible teaches you that. Finish paying out of pocket, then go get what’s fully covered.

Switching insurance teaches you that. Insurance companies are scanning the field for the low-cost enrollees. If they get too many expensive patients or can’t make the right deals with providers, they drop coverage.

We can afford to do this. But it will take a great effort. It could make America great.

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Who Are These Guys?

Posted on January 23, 2025 by ddxdx

Who Are These Guys?

Well, I’m sure you’ve realized by now that the Idaho legislature is in session.

I forgive you if you haven’t.

Most Idahoans don’t even know who represents them in the legislature. I know this from experience.

Prove me wrong. Say out loud, right now, your Idaho legislators by name.

I did this cheap parlor trick at a luncheon where I was asked to speak at when I served in the Idaho legislature. It was a “Day at the Capitol” for Idaho physicians, sponsored by the Idaho Medical Association. At the time, there were three physicians in the legislature. Now there are none. Maybe I’m to blame.

The docs in the room had some gripes and some issues, and the two veteran legislator doctors who spoke before me did a good job of laying out the political landscape so these doctors could know what to expect from certain bills. At the time, Medicaid Expansion was the big issue, and it was going nowhere. The two old veterans did a good job explaining why. I took a different tack.

“Okay, so you guys want to make a change in policy in this state.” I stood up and started walking amongst the round tables with rubber chicken on their plates. I got into my football rallying mode.

There were some quiet nods, but no “Hell yeah!” from anyone. So, I damped down.

“Medicaid Expansion makes sense to you, to me, and out two previous speakers. It makes sense for our counties, our hospitals, our patients. But as they have told you, our legislators don’t see this sense.”

My less aggressive tone got less slumps and more attention. So, I went stronger.

“So, who needs persuasion? It’s not me. It’s not my veteran fellow legislators. It’s your representatives.”

I posed to the woman to my right. “Name your representatives and senator.” She gave me a blank look. “Where do you live?” She told me. I named them for her. I asked the next guy. He was blank too. The fourth guy knew one of his three legislators.

“If you want to have any influence on this process you have to have a relationship with the person representing you. You should have their phone number in your contacts. You need to meet with them in the summer, when they are not down here in Boise, and let them know what is important to you.” I sat down. Since then, no doctor has run for the legislature. I don’t know if I helped anybody do this work.

Healthcare is a big part of Idaho’s economy. More, it’s a big part of our communities, our culture. There are plenty of wacko doctors out there, and it seems the wackos like to run for office. Maybe it’s not all my fault we have little healthcare representation in our Capitol.

But we have representation as the State Constitution and law requires. But who are these guys?

I can name all my legislators. And I can tell you which have been in the local news. One has been at forums and responded to questions from local reporters. Two have not. Two of the elected representatives who vote for me in the Idaho statehouse have avoided public comment.

I didn’t vote for any of them. But they represent me. They vote for me.

I feel like Butch and Sundance after they robbed the Harriman rich guy’s train. They are running from a pack of paid hunters they can’t shake. “Who are these guys?”

I know there are issues that are coming up before the legislature that I care about. I don’t think I have much influence on their vote.

I don’t think they would listen to me.

And that right there is the end of this representative democracy. I will try harder. I wish they would too.

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Coroner Story: Cold and Dark

Posted on January 6, 2025 by ddxdx

Cold Dark

Sid had a garage that could be a refuge. Table saw, work bench, but damn cold in the winter. Frost on the inside of the south windows when it got below 20 outside. But it was barely freezing out, so his coat and vest sufficed. Fingers got cold doing anything. He searched for something to fix.

He thought about better insulation for this place. But that’s a big rabbit hole. Sid didn’t think about just why he was out here, and they were all in there. But they were and he was. He just sometimes tried not to think.

And he didn’t think about that last coroner call just a couple weeks back. He had learned early in his medical training to do his best, then let it go. It was out of his hands.

But maybe he could make it warmer out here. Maybe a wood stove.

The call had come on a night like this evening, just as crisp, a bit after dinner. So, he left the family and went. It wasn’t far. As he approached the twirling red and blue lights told him he was close. It was a dismal part of Paradise. He and his young wife had lived over here back when it was fresh as he tried to get into medical school. Sid had pumped his old Schwinn one speed up over the hill and down, then up the steep slope to the university. He’d been young and could do it all. Soon they found a better place in a couple months. That had helped.

He parked the rusty HiLux and found someone to talk to.

“It seems there’s a domestic dispute in apartment 13.”

Sid rolled his eyes. Called to a scene with no dead body again? His eye roll circumnavigated to a direct glare at the sergeant. He didn’t have to say a thing.

“There was a gunshot. We think he has shot his wife and is now sitting in there with his gun.”

“So, you are talking to him?”

The sergeant looked down and might have bridled a bit, since Sid was not his boss. “No. We have just reviewed his 911 call and talked to the neighbors.”

Sid sighed. “So, what am I supposed to do?”

The sergeant sighed too. Sid appreciated his ability to collect himself and not swear. “We expect to have a dead body for you soon enough Doc. We’re doing our best here.”  Sid liked him.

After some radio back and forth with lots of 20’s and 10’s, Sid asked if the sergeant had a name.

Darrel Emery is the suspect.

Sid drew in a deep breath.

He’d seen Darrel and Sheryl the week before in the clinic. She was getting bad fast. They were both in their late 70’s but her dementia was coming on strong, and Sid had tried to explain it to them, what to expect. Darrel was solid as an anvil. Explaining and sympathy needed to be relevant, like where to hit the hot steel. Maybe Sid hadn’t done his best.

“Can I go up and talk to him? I know him and his wife.”

Sergeant looks downward, figuring. “Not sure she’s still in there Doc. And we know he has a gun.”

“I get that. But I know him. Maybe he’ll put his gun down and let us in.”

The sergeant does some pondering as a SWAT armored guy walks up. He stands in full body Kevlar and rests his hand on the AR15. “We can get a good line of sight from that roof if you will authorize.”

Sergeant now looks like his head might explode. Sid has seen this so many times. In the ER, in the OR, in his own kitchen. He puts his hand on the short man’s shoulder. “Let me just go talk to him. You can get your snipers up there if you want, but I know this guy. He’s a good guy and he might have just shot his wife because she’s really sick.”

The sergeant looked up, much calmer now. “She is, or was?”

“Yeah, she has been showing signs of dementia, you know, Alzheimer’s, for a couple years now and Darrel hasn’t been taking it so good.”

So, Sid went up there.

The little love nest he and his wife had shared was over to the north, unit 9. It was a two bedroom, but they had only needed a bathroom and a kitchen and a place for their foam mattress on the floor. Those were the days. Not like now when he retreated to a cold garage. But two bedroom was what they could get, so they paid. The guy above typed on a table on the linoleum constantly. Sid remembered the rhythm.

“Darrel!’ He yelled as he approached the door of unit 13. “Darrel, this is Doctor Hawthorne. I want to talk with you!” He yelled so Darrel might hear inside. Sid knew they were all hollow core doors, and a bullet could easily pass through the door, the sheet rock walls, the single pane windows. It was like a sheet on the clothesline separated them.

“Doc, is that you?”

Sid paused now in front of the flimsy door. “Yeah, it’s me Darrel. There’s all kid of cops out here but they called me.”  Because he was this man’s doctor? Hell no, but because there was expected to be a dead body and Sid was the coroner. Luck would have it.

“So, they tell me there was a gunshot. You got a weapon in there?”

Long pause. “Yeah Doc. I shot her. You told me she was going. I couldn’t bear it. Now I’m going to shoot myself.”

“Aw Darrel.” Was all Sid got out before he heard the shot. The SWAT guys rushed up in their heavy suits, thundering on the weak steps and the cantilever walkway. They pushed the door open, and Sid had his two dead bodies to be the coroner for.

And he went home.

There were clouds above, no stars. Maybe the kids were in bed now and his presence might be a little more welcome. Maybe not. He looked up. Sid just saw black, maybe a little light reflected back off the low shrouding clouds. He didn’t think of anything. His mind was blank as he walked across the street toward his house.

She was there in the window above the kitchen sink. Her dark curls bobbed like he remembered from their love nest as she scrubbed something.

But then a few weeks later, it’s the cold garage. And for some reason, no reason he can understand, he starts thinking he needs a handgun.

Cause of death: Gun Shot

Manner of Death: Suicide

Cause of Death: Gun Shot

Manner of Death: Homicide

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Faith or Dynamite

Posted on January 6, 2025 by ddxdx

Faith or Dynamite

If Trumps nominees, Kennedy for Secretary of Health and Human Services (HHS) and Dr. Oz to direct Centers for Medicare and Medicaid (CMS) are able to get confirmed by the Republican Senate, which I think they will, I wish them luck. If anything needs disruption now, it’s healthcare in this country.

These two clowns claim they want to disrupt. Maybe they do.

Kennedy points to the bad diets and over treatment. He’s right about that. So, he’ll argue to cut subsidies to high fructose corn syrup producing mega farms? Of offer regulations limit how many chips we can consume while watching the NFL from our couches? I just don’t have much faith.

And Dr. Oz is selling his dubious concoctions on the internet. Seems pretty self serving. But maybe that’s the America we are striving for.

Sorry. CMS is responsible for almost 40% of the federal budget. I would LOVE to see some commonsense solutions applied to this behemoth.

Call me a fool, but I believe good solutions come from careful study and wise choices. But I’m almost to the point of giving up on that. Maybe it is time to just blow it all up. Maybe Oz and Kennedy can be the disruption we need. It’s a dismal place when you see dynamite as a solution.

I started my medical career believing my work as a lowly family doctor could help right this wasteful ship. That was back when healthcare costs were just 10% of our GDP. They are now 17%. And GDP has increased over 15-fold in that long career. Believe me, family docs didn’t get much of that bump.

Do you believe we have a problem? I’d like to know, because us voters sure didn’t hold Trump or Kamala’s feet to any fires about this afflicting behemoth. Maybe I’m prescribing dynamite when all we need is just a reassuring pat on the back.

Think about this:

Half of people in this country diagnosed with cancer have depleted all of their savings within two years of diagnosis.

That’s even with “good” health insurance.

The leading cause of bankruptcies in this country is from medical debt.

And this is after the “Affordable Health Care Act.”

At least one Trump spokesperson, Brian Blase claims Trump will reduce costs for all of us by focusing on “fraud and waste.” Maybe he doesn’t want us to remember Trump commuted the sentence for a $1.3B Medicare fraudster, though political donor. I guess some people’s fraud is OK. Maybe that’s the theme here. Grab what you can for yourself or your heirs before the ship sinks.

I gotta say, this doesn’t give me confidence.

Given the amount of money sloshing around in the leaky hull of this wayward juggernaut, I can see why venture capital is investing.

The New York vigilante who allegedly shot United Health Care’s CEO might have thought a couple bullets could bring a change, maybe even sink this lumbering, misdirected hulk of the American health care system. Sorry, that’s not enough lead to change the inertia. And lead is not the right element to affect change.

It’s going to take something heavier than lead and stronger than steel to accomplish some change.

It will take faith.

Americans give up on changing this mess when they think about losing what they have.

We have a very lousy system. It enriches investors and impoverishes the sick.

But it’s something. We’re afloat. We’re moving across the water. In what direction? Do you know?

Do we have the faith to let go of this horrible mess, when we can’t see anything concrete to grab on to?

Or will we just believe in the disruptor rhetoric, and not notice when they line their pockets as the ship finally sinks.

Faith or dynamite? Maybe we have already chosen.

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Bootstraps

Posted on December 4, 2024 by ddxdx

We all make judgements. We should. But when judgements are made by the people elected to govern us, we should be paying attention. Because those judgements are, by their representative power, your and my judgements, even if some of us didn’t vote for the guy.

Maybe they are yours. If so, please let me know. Because we need to be talking about this.

If you agree with this, then I guess, this is the Idaho I live in. It makes me sad. And angry.

Idaho has passed strong prohibitions on abortion. The only abortion allowed in Idaho at this time is to save the life (not organs, or future health) of the mother. This is portrayed as protecting the unborn, the defenseless fetus that needs the protection of the Big Brother State. I can understand this, though I think it is heartless and an intrusion on the mother’s self-governance. But we can talk about that some other time.

I ask you, where is this Big Brother after this Idaho child is delivered?

Do Idahoans care about giving this little kid some chance at prosperity? Or are we going to insist this mom and/or dad figure this out on their own? Bootstraps: that’s all they need.

Have you tried to pay rent recently? Have you looked at housing prices? Wages? Maybe you haven’t noticed grocery costs are up. Your Thanksgiving turkey was pricey. Maybe this is not a concern for you. Maybe you have a good Social Security check or pension. But it’s hard to get by now on regular wages. Trump knew this, though I don’t think he has these concerns. But he convinced a lot of voters he could solve their suffering. We’ll see.

There are programs in place to help these low-income folks with young children. But our Idaho legislature has choked them off. Our elected representatives must think we Idahoans want these poor folks to tug harder on their bootstraps. I guess that’s the Idaho we live in now. And lots of folks must think this is just fine, based on our most recent election.

The Idaho legislature turned down federal money (no strings attached) for early childhood education.

The Idaho legislature has failed to allow the spending of federal money we already have to support childcare grants for low-income families.

You must have your baby and then bootstrap their future.

I’m sorry if I sound angry. It’s because I am.

How many Idaho legislators take federal money to put in a new center pivot on their little hobby farm in Canyon County? How many Idaho dairy farmers benefit from federal milk price supports? How many former governors are looking to rake in big bucks when the federal mining permits are granted on the South Fork of the Salmon?

While this may not be official corruption, it is a clear statement of values. And I guess it’s values that most Idahoans support. That makes me sad.

Low-income Idaho families are getting squeezed, and so they will vote for a change at the top. And they did. Trump got lots of votes in Idaho.

But these same folks can’t see that their plight has been manufactured by their local representation. The guy who goes to Boise for you has been making your life more miserable. Do you even know his name?

That Federal Childcare block grant has been squeezed by the legislature for the last five years. Less money has been allowed to be spent than was sent from Washington DC. But now, suddenly, there’s a looming deficit, so enrollment is stopped. All while a big wad of money is sitting in the Department of Health and Welfare’s bank account.

Can you imagine what the potato farmers would say about such management? What if this was cattle ranchers’ federal supports being held back? Somebody in Boise would listen.

I guess we know who holds the cards. And it ain’t the folks looking for their bootstraps.

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Coroner Story: Dead Baby, Middle

Posted on December 4, 2024 by ddxdx

This was Sid’s toughest. It’s the last you’ll read, but there were more dead babies.

Jack was taking time to line up his shot. Sid and Jack had been playing pool once a week for the last year and Jack was getting better. But it still wasn’t really even. Sid knew the game.

Jack missed.

Late in his career now, it was okay to play pool one night a week and drink beer. Sid hadn’t delivered babies for ten years, so he couldn’t get an unexpected call on their second pitcher. Delivering babies, something he had loved, was in Sid’s past.

And his clinic days were scheduled, and he didn’t have to take call. Sid was winding down.

And there wouldn’t be any coroner calls. He’d dropped that when he quit the big clinic in town. So now, he could shoot pool.

They had started with straight pool, since Sid thought that’s how a beginner should start. But Sid had made the mistake of setting 100 as the end of the game. When Jack was down by 40 balls, it was a testament of his character that he still put his all into every shot. Jack’s character helped him learn that lesson well. The score can be a distraction. There can be many.

As Sid rose for his shot, he noticed the couple up at the bar. But it was his turn, so he looked at the table and addressed the situation. Drop the three-ball soft, left English and then it’s the seven, and stop for the eight. They had moved to eight ball.

Sid missed.

When he missed, he often cussed. But he always thought about why he had missed. It can be the stance, the stroke, but this time it was the aiming. That had always been his strength. He could know the spot, see it and hit it. But lately, he’d noticed how unfocused he had become. Discipline.

As Sid looked down at the floor, walking back to the chair and beer, he saw the couple again. He recognized the woman. She was no longer a girl.

Amber was a quiet girl with a big belly. Sid always found pregnant women attractive. It was not a sexual thing, at least he didn’t think so. He hoped not.

It helped that her mother was in the room. And her sister. Amber hung her hair across her face. She looked at him sideways, like he was a passing lecher, and she needed some distance. He hoped that wasn’t his demeanor, but he was never sure how folks see him. Attractive is dangerous. He had to clear his mind and get back to business.

Sid found out they had just moved up here. No dad involved. But these ladies’ bonds seemed strong. Amber’s mom seemed to like him. That was reassuring.

Sid listened to the dates, the story. Her last menstrual period put her at about twenty-four weeks. She’d felt movement “quickening”.  Sid’s calculated due date coincided with their expectations. She had not had an ultrasound. Did they want one? Did they have insurance? They were applying for Medicaid. He was okay with that, though many local doctors hated Medicaid reimbursement. It paid just half what regular insurance pays. Sid just liked delivering babies, even with all the mess and irregularities. He felt sharp when doing it.

Sid decided he didn’t need to do a vaginal exam. All the tests should have been done by the doc down south and he could get the records. They had signed for that, so all looked good. This seemed to ease the tension in the room, not probing her privates. Schedule the follow up and do the regular. Just pay attention for problems.  

But she was young. Young moms can have problems. He’d dealt with those with preeclampsia, early labor, bleeding, early rupture of membranes. None of these were just for young moms, Sid knew. It was just the work of delivering babies. Amber and her pregnancy would deal the cards. Sid had learned a long time ago to the play the hand dealt.

Maybe that’s why he had resolved to investigate all child deaths carefully. An unanswered question doesn’t tell you anything. Answers, even painful ones, can give peace, at least some sense of it. And not investigating left unanswered questions. So, he had decided.

Or maybe it had been advice. The doc who had been the coroner for three years of his four year term decided to leave town, he’d handed over to Sid his two volumes of the three volume “Pathological Investigations” and his small wisdom.

He only offered two pieces of advice. “The single car accident with no explanation is best left as an accident. If there’s clear evidence otherwise, then you got to go with it, but I usually called it an accident.”

Sid hadn’t yet experienced the guy who drove down through two fences, no braking and drown in his pickup in the swollen river after 6 shots at the small-town bar. Or the old guy who burned up in his car spinning his tires till they burst into flame to get back on the road, but never trying to get out. Sid hadn’t experienced any of this coroner shit yet.

“Oh yeah, the other,” the departing coroner had advised. “Get an autopsy on all SIDS. Don’t just call them and not investigate.”

None of this was in his mind as he left the small rural clinic and headed back to Paradise in the ’54 Chevy. The sun was low and below the trees. Sid was not thinking about Amber, or dead bodies or investigations, none of that shit, just the road ahead.

Amber kept her appointments. That was one on the tests. Sometimes she was with her mom, sometimes the sister, toward the end she’d come into the room alone.

The records had come. It was all adding up. Things should be fine.

The last weeks Sid always asked them to come in weekly. It was how he had been trained. Things need to be done and bad things can happen late. But these last visits included a vaginal exam, to check the cervix and see how the baby was lining up. Sid had sensed Amber’s reticence in her early visit. But she was alone in the room here at 36 weeks with her pants off and a paper sheet over her legs. Did she trust him?

He measured her belly, felt the babe. Doppler heartbeat. Head down, facing to her left, lined up. Sid turned and got the gloves on with his back to her. “I need to check the cervix.” He said.

“I know.” She said. She was lying flat on the exam table.

He brought the lubricant tube with him, having done this so many times before. He stood to her side and raised her legs under the paper sheet. Then held his gloved fingers up and squeezed the gel onto them. He moved them back and forth to make sure all was smooth. Sid placed the lubricant tube next to Amber on the exam table and brought his right gelled fingers under the paper. He placed his left hand on the fundus, holding the baby, the object of this examination. Sid’s gloved slippery fingers felt her labia and parted them gently. Then he pressed in.

When he felt her cervix, he looked at her. She looked back.  It was firm, hard, closed. He could barely feel the baby’s head. He looked at Amber with his hand in her vagina.

“Your cervix has not softened, and the baby is still high.” Sid said as he slowly withdrew his hand. She exhaled.

They did this four more times.

Then Amber had a baby. A healthy baby boy she named River.

Jack had almost laughed at Sid’s miss. But then Jack was faced with his own situation. He went to work as Sid sat with his back to the bar. He was sitting there, knowing it was Amber up there.

Sid thought she had been a good mother. She had nursed, kept the appointments, though they were now living in a hamlet 40 miles away. Amber’s mom had come to the first visit. It looked like breast feeding was working. It was winter and these were tough appointments to keep. Sid was proud of this young mom.

Early on in his coroner job, Sid had decided childhood deaths needed better investigation in his state. His was the only state in the nation without a review panel over all child deaths. He’d read the reports, the CDC recommendations. But there was no way he could get a panel of experts in this small county, so he called on some folks that already met monthly to review child abuse referrals. He asked for their participation to review child deaths and they agreed.

And he went to training. It was all pretty redundant for him, but he thought he should. Sid was like that. He did what he thought should be done.

The call came in the middle of morning clinic. The hospital had a dead baby, and they needed the coroner. Sid ran across the street. It had snowed the night before, but it was wet pavement now. The ER doc had done everything, but when they had noticed rigor in the lower extremities, they’d called it. It was River.

Sid had to take a breath. “Where’s the family?”

“They are all in the family room. They got here with the ambulance.”

Sid looked at the ER Doc. He’d known him for a long time. Sid almost cried. But he could not do that now. Sid looked up at him and said, “I delivered this baby.” He wondered if he had missed something. Mainly, he just wondered. But he knew what he had to do.

The family room was a shit-show. Amber was sobbing, screaming, the mother and the sister were doing their best. Sid walked in, no longer their family doctor, but now the coroner assigned to investigate deaths. This could not go well.

Amber was still in her nightgown. Her face was puffy from her crying and screaming as she bounced between the two, neither able to console her. There seemed to be some others in the room, but Sid only recognized the three.

All turned toward Sid as he entered.

Amber came up to him screaming “Why” or “How” or something, Sid could not fully understand. Her round puffy creased face was barely recognizable in its torment.

As she screamed at him, she bent forward, and her sagging, breast-feeding mother’s breasts swung below her in the loose nightgown. Amber’s mother must have caught Sid’s glance. She grabbed Amber, her tortured daughter and swaddled her in a blanket. She held her daughter’s face in her hands and spoke to her forcefully, face to face. Amber stopped screaming and listened to her mother. Then she turned to Sid, her doctor.

 Sid gave his speech.

I am so sorry. River has died. I am here now not as your doctor but as the county corner to investigate this death….

The room sobered. Was it coroner or investigate, Sid never knew. The words sobered the room. It is a sober endeavor.

“I need to ask you some questions.” He said to Amber. He looked at her mom and sister. Mom then looked at the others in the room. They politely filed out and then it was just Sid and the three.

Amber was still choking on sobs. Mom and sis were quiet. “I need to know what happened.”

Jack had missed and now Sid rose. He didn’t look toward the bar. He still had his two balls to deal with, then the eight, but Jack had dropped a couple and only had one stripe left. Sid realized he could lose this game. And Jack had left him down at the end with only a long shot. And a tough one. There are a couple ways to play this. Shoot to win or shoot not to lose. Sid chalked and pondered.

It had been hard out in their wintery town. Amber had been tending bar before the baby. She’d stayed home with him for the last few weeks, but her mom had encouraged her to go out. She’d watch him. Amber should take care of herself. She’d gone to the bar.

Did you drink?

Yeah.

When did you get home?

It wasn’t late.

Mom offered. “I kept the fire going and River was asleep. She got home about eleven.”

Amber nodded.

How much did you drink?

She shook her head. “I don’t know. Maybe too much. I hadn’t had any while I was pregnant. It hit me kind of.” She was looking down, talking soft.

Sid turned elsewhere. “Is your bed really soft?”

No, not soft at all.

Did River nurse when you came home?

I think so. She looked at her mom.

Mom looked at me. “I think she just got in bed. She was real tired. She might have nursed him in bed there after I left.”

River was sleeping in the bed all while you were there? Sid asked mom.

Yeah, he was quiet. He fussed once and I held him, but then put him back down. He was jus fine, didn’t need changing. She was only gone for maybe three or four hours.

Sid felt a picture forming. But you have to see the whole thing.

So, Amber, do you remember nursing when you got in bed?

Amber looked at Sid blankly, like the question had no meaning. She looked down at the hospital carpet. “I think so.” Softly.

Did he wake up again during the night?

I don’t think so.

When did you wake up?

It was about nine or ten in the morning. She’s still looking down.

What did you notice?

I just got up. He was quiet.

What did you do?

I went to the bathroom and then got some water. But he was so quiet. I went to him. Amber looked at Sid fierce, her face contorting back into the screams and sobs, but she held on.

I went to him.

And her face melted more into that screaming sobbing round wet ball and her mother hugged her and Sid looked up at the ceiling.

He told them what he had to do. Sid would go out to the snowy hamlet to investigate the scene. And an autopsy would be done to determine the cause of death. And then he would issue his report.

He told them this. They agreed to his investigation. They too, wanted to know just why.

He had to cancel the rest of his scheduled patients. Not because he had to do a delivery. That always got some forgiveness. Investigating deaths wasn’t offered to scheduled patients as an excuse for his absence. They didn’t understand.

The snow was two feet high on the roadsides out there. He followed Amber and her mom down the icy path to the trailer. It was still warm, though they’d been gone hours. “Neighbors must have fed the stove.” Mom offered.

The place was small but neat. Lots of people in this county live in trailers. Some do well, some don’t. This looked like a good home. And the bed was firm, just a thin pad on a plywood base.

He told them again of the process, the investigation, then the report. Sid told them he would share it with them when it was done.

The pathologist that was available was just south. He was an older, very experienced guy, and a good investigator. About a week later he called Sid on another clinic day. He summarized what the official report would say. There were no physical findings to explain River’s death. But the blood alcohol test on the baby was positive, at a level that the pathologist speculated that the mother’s blood alcohol must have been very high. “She must have breast fed him when her level was quite high for the infant to have this level. I’ve never seen this before.”

He concluded that the cause of death was “Overlying”. This means that the mother has smothered her child accidentally. He surmised it was due to her level of intoxication.

And so, Sid filled out the death certificate. He called Amber, but she never came into the clinic to talk to him. They never spoke about the findings. Sid worried about her.

Sid made that tough long shot but left himself bad and missed the next. Now he had to pee. He left Jack to finish the game. Sid resigned, he would win, or he would lose and sitting there watching wouldn’t change anything. The full bladder was urgent. Sid got up and went to the bathroom. He finished and zipped and as he came out, he saw Amber walking down the steps toward the exit.

Sid hurried after her. He called, “Amber?” She turned.

Sid saw she had aged. Whenever he noticed this in others, he reminded himself of his own years. Her face did not do any melting, like it had so long ago. It stayed hers. But she conveyed recognition. She knew who he was. She might have known up there on the barstool as he was losing this stupid game he weekly played.

Yes, she said.

I just wondered how you are doing.

She looked down quickly, then back up to meet him. Just fine. I’m Okay.

Then she turned and walked away.

Cause of Death: Overlying

Manner of Death: Accidental

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Coroner Story: Dead Baby, Last

Posted on December 2, 2024 by ddxdx

This doesn’t mean you won’t have to read about more, the ones in the middle…You should.

Sid wondered just why the prosecutor wanted him to come up to the courthouse. The message had come a couple days before, so he cleared out a couple of the early afternoon slots. Was he in trouble?

He parked the old ’54 Chevy in the lot. The Hilux had rusted away, but he still used it for dump runs. When he struggled with buying a new truck Martha had looked at him with wonder. “What have you always wanted?”

A new 4WD Toyota would be cool and practical. But he’d remembered the old 1953 Chevy his grandmother Lila had. Four speed gearbox, steady engine. He’d told her he wanted it when he’d helped her move from the old place into town.

“But Jason said he wants it.” The truck was worn but in really good shape overall.

Jason was his cousin’s husband. Sid thought he would respect the value. “He’ll take good care of it. You should give it to him It’s a beauty. He’ll take good care.”

Then, on a later visit, Sid had seen the truck beating through the little Eastern Oregon hamlet. The side was caved in and the muffler blasting. It had been beat to shit.

“Gramma, did you give that truck to Jason?”

“No, Honey. I sold it to a guy here in town. He was going to use it to get wood. I didn’t want there to be no bad blood between you two.”

A gem trashed to preserve nothing. Sid knew this sentiment, this insidious peacemaking.

“What did you get for it?” Sid knew it’s value.

“Oh, it was so old. He give me $200.”

All to avoid a worried about conflict that wasn’t there. Now it’s gone.

But Sid had found an old truck and fixed it up and now, in his later years of practice, he had some pride in it. It glowed in the lot.

He’d even taken it on coroner calls. Folks recognized him rolling up. Sometimes, at least. Once on the highway east of town, called to a motor vehicle death, he’d passed around the line of cars a deputy was holding. Sid could see the frown from a distance as he rolled up. “You’re supposed to stay in line.” The deputy had barked at him.

Sid smiled and looked down. “Sorry, but I’m the coroner.”

The deputy smiled back and said to come on.

As he strode up to the steps, he was again wondering just what mistake he might have made. Such was his nature; always had been.

The prosecutor met him in the hall. “Good, you’re here. We’re all here.” He said to a young woman who went into a room behind him.

“What’s this about?”

“I haven’t had time to brief you on this.” Mr. Prosecutor held out a folder. “We’re meeting with a family who had a child die a few years back. It seems the child’s death was declared a natural death by our county coroner at the time, but they have found that such was not the case. I apologize I couldn’t get these documents to you earlier to review, but the medical records are all here.”

Sid looked at the manila folder. It was thin. That’s good. “What’s going on here?”

The prosecutor took a deep breath and launched in. “They have a legitimate grievance. We are trying to assure them such an injustice would not happen again.”

“Injustice?”

The prosecutor handed Sid the folder. “Why don’t you look through this. When you’re done, come on in.” He went through the door and Sid opened the folder.

The top sheets were an autopsy report for a 9-month-old child from the big city in a neighboring state. They described the cause of death as injury to internal organs from blunt trauma. The manner of death was listed as homicide.

The next few pages described the hospital course for the infant before the autopsy was needed. Sid scanned them, knowing the pathways taken.

There were police reports after that, usual observations. But the stories of the two attendants, mother and daughter, weren’t consistent. This had not been pursued.

The last page was the official death certificate, filed by coroner of the county. So familiar, he had done so many of these. And it all comes down to the coroner, Sid knew.

But this prior coroner had put ‘pneumonia” as the cause of death, and “natural” as the manner of death. Sid couldn’t clearly read the coroner’s signature, but he knew of this guy.

This county had elected doctors to be coroners forever. That’s why he was currently serving. Sid had been strong armed into getting appointed to the position by the exiting coroner, a young surgeon strong armed into running for the office by his older partner who had done it for four years. Most counties in this state had funeral directors as coroners. They got called to the scene anyway to pick up the body, why not have them fill out the paperwork? The doctors in Sid’s county thought a medical professional should be involved in death investigations. So, they had handed around the office to the new guy in town, and Sid had been that guy 14 years ago. He had been unsuccessful recruiting any of the next generation.

But Sid knew, doctors, like all people, aren’t always honest. And Sid knew more.

This doctor had left town under a cloud. He had been a member of a prominent conservative church, but his sexual orientation was not accepted by their dogma. Sid just knew rumors of this history. But here’s his name, and here’s this death certificate.

Sid went into the room.

There was a big Formica table and about ten people seated around it. Sid only knew the prosecutor and two others. They were an older couple he had seen in the clinic with some of their many children. He knew them to be of the same faith as the former coroner, the fugitive doctor.

“And this is Doctor Hawthorne, our county coroner.” The prosecutor intoned.

Sid nodded to the couple. He knew them from clinic visits, and they knew him.

The prosecutor continued. “Doctor, you have read the reports. This family is here today to get our assurances that such a miscarriage of justice will never happen again.”

Sid didn’t speak. They needed to.

The story came out. The day care providers were trusted fellow church members. The coroner also was of their faith, though, they acknowledged, he had lapsed. They believed what they had been told. But then when autopsy results were revealed…. Tears flowed. They felt a deep wound.

And so did Sid.

But inside he felt some relief. It was not his fuck up. He slowly grasped just who was around this table. There was probably an agent from the county’s insurance company and at least a lawyer or two representing their interests. And since this had occurred in the city, Sid imagined some lawyers for that jurisdiction were here too. It’s about risk and loss for them. Just what the hell was he here for?

He looked down at the folder. He looked across at the sad couple.

The baby was dead.

“I wish I could assure you.” He placed the folder on the Formica.

“I have done my best to insure good investigations of childhood deaths in this county. I have instituted child death investigations. Whenever a child dies, the death is reviewed by a panel of professionals, not just me. Our state is the only state in the union that does not have such a statewide review, but we do this here in our county. At least we do now, while I am coroner.”

Sid paused and looked around the table. Few of the lawyers met his eye, but the bereaved parents did.

“I cannot assure you that such will be the case in the future. The county coroner is an elected position. The voters will make this call. I am so sorry for this. I wish it had been done differently.”

Sid left the basement room and got into the 54 Chevy pickup. He sat a bit before turning the key and stomping the starter button.

The next day he found the phone number of the former coroner.

It was a brief conversation. Sid told the guy he would be filing an amended death certificate.

That night he replaced the coil on the old pickup in his cold garage. He tried to keep things running. It brought him a kind of peace.

Cause of Death: Blunt force trauma to the abdomen

Manner of death: Could not be determined

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Thanks

Posted on November 26, 2024 by ddxdx

I want to express my thanks to you.

Martha, my wife makes us all hold hands around the Thanksgiving table and say just what exactly we are thankful for. She warns us beforehand, so we think about it.

I’m going to ask the same of you right now. Stop reading this, look up at the ceiling and think about what exactly you should give thanks for. Then say it aloud. If there’s someone else in the room, please explain this exercise.

It’s easy these days to grouse. Some bemoan the planet warming while others are up in arms that transgender people might be considered as they wish.

Maybe you can’t get to the thankful part without the grousing. Then you need to take a deep breath and do better. You’re alive, aren’t you? That’s a start.

This season darkens in these northern latitudes. Some may be looking at the end of their life. I have attended many in such circumstances. Death comes to us all. I have learned, maybe you have to, most of us die just about the same way we have lived. Some are angry and bitter, some peaceful and thankful. I’m pressing you now to move toward the latter.

So, practice.

My thanks I offer is that you read this. I rarely hear from anybody about the words I write. I often use the phrase “We should talk.” But I’m in my shop and I don’t do Facebook or Reddit or X or Truth Social, so I don’t get the social media feedback. And I’m not asking that you send me a postcard. I’m just thanking you for your time to read and consider.

Thanks.

I hope you by now have thought about the things that you consider worthy of thanks.

Maybe it was a neighbor. Maybe they plowed your drive or waved “hi” to you as you sped off on an errand. Maybe they have just lived there for 20 years, providing stability to your neighborhood.

Maybe none of that you consider worthy of your thanks. Be careful. You may die like that someday.

If you want to get big picture, look out the window. That big spruce on the south side of your house that shades you all summer may deserve your thanks. Does it need a trim, some fertilizer? Or maybe it’s reached it’s time and it needs a chainsaw. How we give thanks can come in many forms.

Big picture thanks can often lead to the spiritual and with that comes the religious. Thanking God is almost a given at the Thanksgiving table. This wonderful mysterious world brings me awe and I give thanks.

You might have detected a bit of a moral quandary here. You might be thinking I am saying we should give thanks to ease our passage into the beyond.

Not so. There is no benefit expected from the honest thanks. It is just a gift, freely given.

So what lesson is there in this for an Idaho Democrat and all you other Republicans out there? A pretty big one really.

We are just small players in the big scheme. This state, this nation, this planet will survive us. We are just dust motes in the big picture.

But what we call each other, what we say about each other, how we envision each other just gets in the way of our being thankful for ourselves and each other and this big, beautiful world.

So, I will cook my turkey and I will prepare my spoken thanks as my wife, Martha, asks us to. I will express thanks that we can talk with each other about our fears, our needs. And thankfully, we can listen.

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Coroner Story: Dead Baby, Last

Posted on November 22, 2024 by ddxdx

This doesn’t mean you won’t have to read about more, the ones in the middle…You should.

Sid wondered just why the prosecutor wanted him to come up to the courthouse. The message had come a couple days before, so he cleared out a couple of the early afternoon slots. Was he in trouble?

He parked the old ’54 Chevy in the lot. The Hilux had rusted away, but he still used it for dump runs. When he struggled with buying a new truck Martha had looked at him with wonder. “What have you always wanted?”

A new 4WD Toyota would be cool and practical. But he’d remembered the old 1953 Chevy his grandmother had. Four speed gearbox, steady engine. He’d told her he wanted it when he’d helped her move from the old place into town.

“But Jason said he wants it.” The truck was worn but in really good shape overall.

Jason was his cousin’s husband. “He’ll take good care of it. You should give it to him It’s a beauty. He’ll take good care.”

Then, on a later visit, he’d seen the truck gliding through the little Eastern Oregon hamlet. The side was caved in and the muffler blasting. It was beat to shit.

“Gramma, did you give that truck to Jason?”

“No, Honey. I sold it to a guy here in town. He was going to use it to get wood. I didn’t want there to be no bad blood between you two.”

A gem trashed to preserve nothing. Sid knew this sentiment, this insidious peacemaking.

But he’d found an old truck and fixed it up and now, in his later years of practice, he had some pride in it. It glowed in the lot.

He’d even taken it on coroner calls. Folks recognized him rolling up. Sometimes, at least. Once on the highway east of town, called to a motor vehicle death, he’d passed around the line of cars a deputy was holding. Sid could see the frown from a distance as he rolled up. “You’re supposed to stay in line.” The deputy had barked at him.

Sid smiled and looked down. “Sorry, but I’m the coroner.”

The deputy smiled back and said to come on.

As he strode up to the steps, he was again wondering just what mistake he had made.

The prosecutor met him in the hall. “Good, you’re here. We’re all here.” He said to a young woman who went into a room behind him.

“What’s this about?”

“I haven’t had time to brief you on this.” He held a folder. “We’re meeting with a family who had a child die a few years back. It seems the child’s death was declared a natural death by the coroner at the time, but they have found that such was not the case. I apologize I couldn’t get these documents to you earlier to review, but the medical records are all here.”

Sid looked at the manila folder. It was thin. That’s good. “What’s going on here?”

The prosecutor took a deep breath and launched in. “They have legitimate grievance. We are trying to assure them such an injustice would not happen again.”

“Injustice?”

The prosecutor handed Sid the folder. “Why don’t you look through this. When you’re done, come on in.” He went through the door and Sid opened the folder.

The top sheets were an autopsy report for a 9-month-old child from the big city in a neighboring state. They described the cause of death as injury to internal organs from blunt trauma. The manner of death was listed as homicide.

The next few pages described the hospital course for the infant before the autopsy was needed. Sid scanned them, knowing the pathways taken.

There were police reports after that, usual observations, nothing glaring.

The last page was the official death certificate. So familiar, he had done so many of these. But the coroner had put ‘pneumonia” as the cause of death, and “natural” as the manner of death. Sid couldn’t clearly read the coroner’s signature, but he knew of this guy.

This county had elected doctors to be coroners forever. That’s why he was currently serving. But doctors aren’t always honest, Sid knew. And Sid knew more.

This doctor had left town under a cloud. He had been a member of a prominent conservative church, but his sexual orientation was not accepted by their dogma. Sid just knew rumors of this history. But here’s his name, and here’s this death certificate.

Sid went into the room.

There was a big Formica table and about ten people seated around it. Sid only knew the prosecutor and two others. They were an older couple he had seen in the clinic with some of their many children. He knew them to be of the same faith as the former coroner, the fugitive doctor.

“And this is Doctor Hawthorne, our county coroner.” The prosecutor intoned.

Sid nodded to the couple. He knew them from clinic visits.

The prosecutor continued. “You have read the reports. This family is here today to get our assurances that such a miscarriage of justice will never happen again.”

Sid didn’t speak. They needed to.

The story came out. The day care providers were trusted church members. The coroner also was of their faith, though, they acknowledged, he had lapsed. They believed what they had been told. But then when autopsy results were revealed…. Tears flowed. They felt a deep wound.

And so did Sid.

But inside he felt some relief. It was not his fuck up. He slowly grasped just who was around this table. There was probably an agent from the county’s insurance company and at least a lawyer or two representing their interests. And since this had occurred in the city, Sid imagined some lawyers from them were here. He looked down at the folder. He looked across at the sad couple.

The baby was dead.

“I wish I could assure you.” He placed the folder on the Formica.

“I have done my best to insure good investigations of childhood deaths. I have instituted child death investigations in this county. Whenever a child dies, the death is reviewed by a panel. Our state is the only state in the union that does not have a statewide review, but we do this here in our county. I cannot assure you that such will be the case in the future. The county coroner is an elected position. The voters will make this call. I am so sorry for this. I wish it had been done differently.”

Sid left the basement room and got into the 54 Chevy pickup. He sat a bit before turning the key and stomping the starter button.

The next day he found the phone number of the former coroner.

It was a brief conversation.

That night he replaced the coil on the old pickup in his cold garage. He tried to keep things running. It brought him peace.

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