Immigrants

The Idaho Republican Party is doing its best to keep all immigrants out. And I don’t mean the Border Wall, Shelby Park border fight. I mean you and me.

Well, maybe not me.

You see, I am a registered Idaho Democrat. And I can’t defect. Well, I could, but it would have consequences.

Let me explain.

I have been appointed to serve on a Board that requires partisan balance. The Redistricting Commission I served on back in 2021 required I be a Democrat. We had equal, bipartisan representation. Bring your gerrymandering gripes to me.

And the Health and Welfare Board where I currently serve, requires that there be three members from the minority party, four from the majority. I’m in the minority.

So, you see, I can’t just switch party affiliation, willy nilly. I can’t try to immigrate to the party where my next idiotic legislative representatives will be chosen. No, I have to stay in this measly mess of insignificance. As an Idaho Democrat, I know my place.

But most Idaho Democrats can. And most Idaho Democrats in districts where it might make a difference just got the mailing I did.

The nondescript mass mailing came to my wife and me, both of us registered Idaho Democrats. My daughter got one too. The mailing told us how to register in the Republican Party so we might have some say in the upcoming primary election. They didn’t want to spell it out, but I will for you.

Do you insignificant Idaho Democrats want any say in who represents you in the Idaho legislature? Because, if you do, the Republican primary this May is where you will have a choice. You can support a moderate Republican, or a crazy Republican. Because your Democratic candidate ain’t got a chance come November.

That was how this county was represented for many years. I got my introduction to Idaho politics in the 1980’s and 90’s. Back then, before the Treasure Valley boomed, my county was a legislative district. When I first got elected to the legislature in 2010, I represented Latah County. But Boise boomed and we needed to combine with Benewah in 2012. Redistricting.

But Latah County had mostly Republican legislators back in the 80’s and 90’s. It was wise to vote for Republicans because they could get seniority, maybe become a committee chair, maybe get into majority leadership. You need to know that

Latah County voters have been playing this partisan game for years.

Back then, voters could go to the primary election and choose a Republican ballot. Heck, I really liked some of those Republicans. And I’d vote for them. In the general. I didn’t do the primary switch.

But now that option isn’t informal. Now, if you want to vote in the Republican primary you will need to be a registered Republican. Some idiot Federal Judge decided the Idaho Republican Party’s right of free association trumped the Idaho Constitution.

Yeah. If you want to vote in the Republican primary, you have to register. That’s a public record.

Wait a minute.

The Idaho Constitution says, Article 6, Section 1:

SECRET BALLOT GUARANTEED. 

All elections by the people must be by ballot. An absolutely secret ballot is hereby guaranteed, and it shall be the duty of the legislature to enact such laws as shall carry this section into effect.

How is it an absolutely secret ballot when my registering as a Republican is public record?

Oh, well. I won’t be registering Republican for this May’s primary.

Maybe I should. Then I would get kicked off the H&W Board and I’d have standing to sue the state for not following their own constitution.

Aw heck, I like where I am. I don’t want to be no immigrant.

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Numbers

Nobody roused a crowd talking about numbers. Images stir us. Just look at TikTok. But the numbers tell the truth. Maybe we just don’t want to know the truth.

The brouhaha about how Idaho’s budget committee (Joint Finance and Appropriations =JFAC) is deciding to spend taxpayers’ dollars needs a specific example for you to understand the folly.

It’s about numbers, not dead fetuses, or freedom, so you might not care. But that’s how this country has become the swamp it is. Us common folk don’t often pay attention to the numbers. Rich folk do. And so, they are rich. We all should do better.

Let’s drill down on the Medicaid “maintenance budget” that JFAC has just passed. I encourage you all to read the bill. You’ll have to get to page six to read the Medicaid budget. This bill has passed both the Idaho House and the Idaho Senate. All Republicans voted for it. All Democrats voted against. It awaits the governor’s signature.

Here’s the catch. That’s last years budget. They have not made any allowances for how Idaho or our relationship with the federal government has changed in the last twelve months. Theoretically, that bill with all the changes is to follow. That’s where our majority Republicans want to nitpick.

Then, the rubber will meet the road.

Last year’s regular Medicaid budget had a federal matching rate (FMAP) for regular Medicaid at 69.72%. This year’s will be at 67.59%.

I warned you about the numbers. They are going to get big.

That small change came about because Idaho became less poor. Idaho led the nation in median household income growth.

Medicaid is a partnership with the federal government to get people health insurance who don’t get it through their workplace. If the state is poor, the federal government forks up. If our incomes improve, the state is expected to pay more. Many states are at a 50/50 rate. We have been as high as 80/20. But our household incomes have risen in the last few years. So, we will need to fork over more if we want to keep this health insurance for our citizens.

Maybe we do, maybe we don’t.

Because when the next JFAC Medicaid bill comes to both houses it will include this FMAP change.

I’m sorry, but you must pay attention to the numbers, and the definitions.

I am NOT talking about the Medicaid Expansion population. That small group of Medicaid expense will never be more than a 10% match for the state. That’s why it was such a good deal.

But the regular Medicaid folks, the severely disabled and the children, and the pregnant women are the ones under regular Medicaid. They are the ones who will become more expensive. $68M more expensive.

Legislators are still butt hurt about Medicaid expansion. They throw numbers around with brazen ignorance and it can alarm you. I have seen my elected representative do this at town halls. But he is doing this to build an image. His numbers aren’t real. They aren’t the truth.

But when the real budget bill comes up for a vote on the floor of the Idaho House and Senate, will they know the numbers? Will they know the truth? I deeply regret to say, they will not. They do not understand the details of the budget. And few of us do.

But here’s the punchline in this numbers game. If the Idaho Republican legislative majority doesn’t approve the next Medicaid budget, with it’s $68M dollar bump for the regular Medicaid folks, Idaho will not be following our agreed upon partnership with the federal government. We will be in default.

Every year I was in the Idaho Senate, and on JFAC, and crafted the Health and Welfare budgets, I would watch the votes for the appropriations bills as they worked through. Medicaid might pass the House with a couple votes to spare. In the Senate it wasn’t as close.

This year, the “maintenance” budget has passed. The next budget bill with its bump will stick in their craw. And they will be voting us out of Medicaid.

And they can lie to you that they voted for it.

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Coroner Story: Another Gun

This call came right after dinner. Martha would wrangle the little girls to bed, I could go do the coroner business and keep being a doctor in the morning. I was chipper.

I didn’t have to go far. It was dark, still late winter but not snowy or icy. We were in a thaw that teases the trees and bushes about spring.

This is a small town, and this scene was just about two miles from my house. The roads were wet but no ice. It was just off the two-lane highway heading to the eastern county and four blocks or so off the north south highway. These are two lane roads, no interstates in this country. But they were highways, nonetheless.

Martha and I used to live over here when I was trying to get into medical school. This is some thirty years back. I didn’t know much about this house where I was going, though. We had known some neighbors, but not here.

This area was called “Swede Town” by the old timers. Frame houses 80 years old, some without foundations. Great for renting to students, back when such housing was affordable.

I wasn’t looking for the shiny thing when I decided I wanted to be a doctor. I truthfully, had no idea of the incredible income of physicians. A high school girl friend had a doctor as a dad, and they were sure better off than we were, but not lavish. Then I learned more in medical school, and still. Maybe shiny things draw us. Even when we don’t look to the shine.

I must have looked away from it. I chose the lowest paid specialty in the medical field, though I had all the credentials, scores, recommendations for the top paid ones. Sometimes that shiny thing repulses us. Sometimes it draws us to it.

Our old Swede Town house had wool carpets that got moths in them, and in the winter the walls dripped condensation behind the posters we put up. When it got real cold the electric wall heaters ran nonstop. We loved that place. Our first little baby was born into that hovel.

We liked the little home, and the rent was what we could afford. It was a happy time in our young married life.

This house looked like a rental too as I parked. I found a spot in the alley behind a patrol car. There were two, both city cops here in town. A patrolman was by the door. The house had a board porch, soft and rotting I could feel, and the paint was peeling. But with some work it could have been nice. It seemed to have a foundation.

“Detective Frye is inside.” I went in past the uniform at the door.

All the lights were on, and the unkempt home gritted under foot. The linoleum crackled, though the floor didn’t seem springy. I saw two uniforms in the main room and Detective Frye talking with them. He turned as I came in.

“Sorry to get you out this evening.” He smiled. He and I went way back.

“I wasn’t doing anything. What have we got?” We become four men, listening to one tell the tale.

“The deceased is in the basement.” He gives me the name and age. “Seventeen-year-old male.” I don’t know him, at least by his name. But neither could I remember the names of most the patients I had seen today in the clinic.

I think I decided to forget names early in this small-town practice so that uncontrollable reaction of recognition wouldn’t betray me in idle or stupid conversation. Maybe that’s just my excuse for bad memory.

My medical school board scores refute that. I can remember long lists of nerves, muscles, bones and body parts and I can tell you just how they are connected. But I can’t, or don’t remember the names of the patients I see. I need analysis.

“It seems there was some partying here tonight. There were four, maybe five people here. They have all corroborated the story. We’ve gotten their statements.”

“Four or five?”

“Yeah, it seems one person left before this went down. We have her name. We’re tracking her down.”

“You know these folks?”

His thin-lipped smile again. “Yeah.” And nods.

“So, this is a party house.”

He shifts. “Kinda. We haven’t gotten anybody out of here for selling, but we know these folks use. And we know the deceased from prior interactions.”

“What are they using?”

The smile again. “Lots, doc. Mainly meth, but marijuana and some heroin. Pills. You name it.”

My old neighborhood.

“What happened?”

He pauses. I appreciate when someone is trying to develop a narrative. It can’t always be done.

“Well, they were partying here. There were the three folks who live here, maybe about 6 o’clock. The deceased came in and they all described him as kind of jittery, anxious, high strung. They smoked some dope to try to mellow him out and he seemed to relax they said. Then the girl came in.” He gave me her name, but I didn’t know it, or remeber it either.

 “They were all talking and being friendly, but the kid started bugging the girl and she ran out.”

“Was she his girlfriend?”

“Not according to the three guys. We haven’t talked to her yet.”

The weak couch is behind us, dirty and saggy. The corner has a lamp and there is a low cheap coffee table strewn with life and death and garbage. There’s a dirty soft chair in the corner, and another chair, not very comfortable against a wall. I can kind of see the scene.

“So, what happened?”

Detective Frye winces. Like his narrative might be weakening. We all wait. “The guys say he seemed to snap. He grabs the gun…”

“What gun?”

“Oh yeah, I forgot to say. They all described that they, one of the guys, had a gun he kept on the coffee table there.” He gestures toward the strewn low table.

“So, he grabs the gun?”
“Yeah, he grabs the gun and runs down the hall.” He gestures again, to our right. “They all thought he was pulling his usual drama and kind of laughed about it. Then they heard the shot in the basement. And called us.”

“They didn’t go down there?”

Detective Frye nods, acknowledging he has pushed the narrative. “Yeah, one guy went down and looked at him and that’s when we got the call.”

“Let’s go look.”

He leads me down the hall and down the stairs. Few houses in Swede Town have basements. This one was small and dank, as might be expected. It’s wet outside, and the ground is not fully frozen. But there was no water to walk in down here, no pools, just the damp smell of wet concrete below grade.

There was a bathroom down here. The original builder must have seen some value in excavating so far down. For the deceased young man was sitting on a toilet seat, lid down, in a dank well-lit bathroom, now splattered with his brains and blood.

A large caliber shiny revolver laid on the concrete floor.

He was reclining back toward the toilet tank, his arms relaxed by his sides, like he might be at peace, except the top of his head was gone.

I looked closely at what was left. It looked like he might have had curly blond hair, since the front of his scalp remained. The eyes might have been blue, though the lids were half down. Around his mouth there were short, linear lacerations radiating outward.

I turned to Detective Frye. “How do you read this?”

He shrugs. “He came down here and shot himself.”

“Can you see that he put the gun in his mouth?”

He leans in and looks closely. “Yeah, I can see it. There’s that hole back there in the back.”

“Can you see the stippling around the entrance wound? That’s from the powder from a near contact wound.”

He looks at me and looks onto the open mouth again.

“See the splits on his lips? That means he closed his mouth around the barrel and when it fired, they were blown outwards.”

He looks again and nods.

Might as well share what I have learned. It’s not shiny or bright, this business of investigating death. The revolver sure was, there on the cement.

“You can clear that.”

The detective has his vinyl gloves but looks up. “I’ll have to go get an evidence bag.”

I shrug.

A patrol officer had followed us down. He moves behind and points to a defect in the lousy tile above the toilet. “I think I can get the slug out of here. See, I think it’s imbedded.”

Detective Frye tells him to do his best, then heads up to do his business. I stand upright.

“I’m not sure what that slug will tell you. I can call it. We’ll get blood for tox, but I don’t see the need for an autopsy. I’m going to go now.”

The shiny revolver lays on the damp floor, splattered with just a bit of blood.

“Yeah, doc, you can go.”

Cause of Death: Gunshot wound to the head.

Manner of Death: Suicide

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Borders

Dale found this service both meaningful and convenient.

The militia had discussed the southern border problem for weeks but had finally come to this compromise. The whole militia could have loaded up and gone down to Texas where they would be welcome. But they all had jobs.

Except Fred, the Captain, who was on social security.

And Donnie, with his disability. They were both gung-ho to take the trip south.

Both Justis and Junior seemed to be living off of some settlement, and they didn’t seem eager.

But Dale had to work. So, he’d said he couldn’t go to Texas.

So, they set up this outpost on the southern Idaho border to protect our country from the invasion.

They had their tactical gear and rations. Though Dale’s wife, Betty had pointed out to him the cost of all that gear equaled a car monthly payment, maybe more.

The wind was cold. The sun slanted west. Again, he wasn’t at the barricade, but up on look out. He thought back to when they had been protecting the unborn. That had gotten dramatic. He wasn’t sure of any unborn children saved, but at least they’d made a stand.

But this border thing was a bit harder for him to understand. He really didn’t want foreigners moving into his neighborhood. But Paco and his wife sure seemed to be reasonable folks. Paco did concrete work and she made tamales. They were good neighbors, though their kids were wild. Dale smiled as he thought of their antics.

But he had seen on the videos how there were tens of thousands coming across bringing fentanyl to poison his neighbors. And they were bringing in sex slaves, children to be defiled. He felt a righteous purpose. This righteousness brought him peace. Lord, he needed peace.

He scanned the southern horizon. They had been warned to look for vans, since the unlawful immigrants are often piled together. It was chilly, but he was warm. The low sun and the peace left him time to think.

He thought of his next job. A dairy south of him needed another water line. He could rent the trencher and knew how to make the connections, but working down in that trench was beyond his girth. His last employee was violated and now serving a rider.

The dairy seemed to have lots of Spanish speaking workers. He wondered if any of them were part of this invading horde. He also wondered if any of them knew how to glue PVC.

He shook his head to clear it. Too many thoughts can distract you. But he saw nothing in the distance.

He thought again about the pipes and the trencher and some young skinny guy he could teach down in the ditch.

His radio crackled. “Red Leader to Blue outpost.”

He toggled. “Copy”

“You see the white van from the south?”

Dale looked as far as he could, but the wind brought tears to his eyes. He held his hand up to block it and sure enough, a white van was coming north across Idaho’s border. “Roger. I see it.”

There was a long pause from Red Leader. Then, “We will intercept. Must protect the border.”

Dale dropped below the ridge and got out his binoculars. He could see the militiamen move the barricades out onto the road and shoulder their arms, like in the drills.

The van slowed and stopped. They were interrogated. The road militia stood with arms ready, but after the questioning, the barricades were removed, and the van passed.

Dale asked. “No illegals?”

Red Leader was chipper. “No, just some Mormon fundamentalists coming back from Mexico. They’re OK.”

Dale felt good about his duty.

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Coroner Story: A Gun

I was starting one of my usual working days, seeing patients as a family physician. 

I got a call from the sheriff’s office early in the morning.  I was interrupted from seeing a physical to come out and talk to a deputy on the phone.  He was at the scene of a suicide in the northern part of our county.  We discussed the case.  It was an elderly man who had shot himself in his yard.  He had left a note.  His wife had found him, shot in the neck and head with a shotgun.  The deputy described the scene and the circumstances to me.  The man was suffering from some condition with chronic pain. He had seen his physician in Spokane the day before.  He had been denied his usual pain medication for reasons that were unclear.  This was quite upsetting to the man, according to his wife, and he returned home despondent.  The next morning, he shot himself after leaving the note.  His death was pretty clearly a suicide and the sheriff’s deputies felt comfortable handling the investigation. They didn’t think I needed to come to the scene, and I was thankful.

I spent the rest of the day being a family physician.  Later that afternoon, in a clinic we have in a smaller, rural town, I visited with a young high school student. He described vague abdominal complaints to me.  While I was talking with him it seemed like there may be more to the story.

I found him likable, but he had deficits. He was on a regular seizure medication for epilepsy and his features were a bit dysmorphic. That means, “funny looking”.

I asked him if his parents were with him, and he allowed me to invite his mother into the room.  A prolonged discussion ensued. 

He was not doing well in school. 

He had medical problems, but they were stable.

I could see how he might be labeled by his fellow students as not bright.  He spoke slowly; his speech was sometimes slurred.  However, in my discussions with him he seemed to have insight and be cheerful. 

But he was not doing well in school. 

His mother said he didn’t study or apply himself.  When I asked the student what he would change about school if he could he said, “I wish they’d ask me to do more things.”

“What do you mean by that, more schoolwork, or more activities with your fellow students?”  I asked.

“Both,” he said. “They think I’m dumb but I’m not.”

I looked at his mother.  She looked at her son.  She asked, “What do you do when they ask you to do more?”

“I don’t do it,” he said looking at the floor. I could see this conversation had been done before.

“What does he like to do?”  I asked the mother.

She paused for a moment and the two discussed this. It sounded like he likes to play computer games, listen to music, and play sports.  He really does not like to read or do schoolwork.

The mother has tried to encourage responsible behavior by getting him a job mowing lawns.  But she described continually nagging him to get this done. He doesn’t do it on his own.  The two talked with each other in a warm and open fashion, but it was obvious there had been some conflict, maybe even a lot of conflicts.

I asked the mother if she had tried withdrawing privileges.  She said she had tried but it never really worked.  I asked her how hard she had tried.  She seemed puzzled.  “Have you taken all the things that he likes to do away from him?”

“Well, I’ve tried, but that doesn’t really work,” she replied.

“How long did you do it for?”

“Oh, a day or two, and it works a little bit, but then he slips back into not doing his homework.”

I looked at the mother, and then I looked at the boy.  “What we are talking about here is learning discipline. Do you know what discipline is?”

I looked at the young man. “Discipline isn’t spanking or punishment. It’s what we all need to learn to be happy in this life. It’s the duty we feel and the obligation we fulfill to do the tasks we need to do, when they should be done.”

I turned to the mom. “You’re going to have to do it for longer.  He’s going to have to understand that you mean it.”  As I looked at the boy, he looked at me and actually grinned.  I smiled too.  It seemed like he knew this was coming, and he was somewhat relieved by this discussion.

I outlined the plan to both of them. Everything except the bed, his clothes and a lamp were to be taken out of his room. No extra activities until his grades were at a certain level (C’s-B’s, whatever was an agreed, realistic goal). As he achieved these marks the privileges are reinstated. I warned this usually takes a couple weeks. It will not be without conflict or anger. The two seemed quite comfortable and warm with each other, even loving.

I wasn’t sure if the mother had the fortitude to pursue this.  I had never met this family before. This is what I call, as a physician, shooting from the hip.  You try to get a sense of the family and advise as appropriate.

I had a good sense about the meeting. Maybe even a little elation, like I might have actually helped somebody in the allotted fifteen-minute time slot. But then, who really knows. They go home and I see the next patient.

Later that night I got another call from sheriff’s dispatch. Another suicide. It seems they come in bunches.  This one was in the eastern part of our county; out past that rural clinic I had been in this afternoon. A 16-year-old boy had shot himself. 

Usually, I ask the dispatcher the name, so if I know the person I’m not surprised at the scene. A little preparation helps the mind be clear for observation.  I forgot to ask this time.  Then, as I was driving through the night to the small town, a worry came over me.  A deep sense of dread weighed down that this might be the kid I saw today.  I wondered if I had misread the family and things had gone very wrong.

I drove through the small town where the clinic was. The old brick high school on the hill looked down on me darkly. I didn’t get lost this time on the rural county roads and I approached the location where the dispatch had told me the suicide had occurred.  The deputies’ cars were parked off the rural lane and their lights were circling red and blue in the dark.  I approached Brandon, the deputy in charge of the scene and asked him first thing, “Do you have the name of this kid?”

He scowled and admitted he didn’t. He’d forgotten. He got on the radio to call dispatch to get the name. 

As we waited for the reply he launched in: “Let me tell you the story, Doc,” he said.

Then he turned and started to lead me back into the brush with his flashlight to look at the body.  He’s walking ahead with his flashlight, talking, leading. I follow. “It sounds like the parents weren’t happy with this kid’s school performance.  It sounds like they came down on him pretty hard tonight, and he got pretty upset. They were giving him grief, I guess around dinner, about schoolwork, and saying he couldn’t see his girlfriend anymore. He grabbed a gun and ran out of the house.”

I step over branches and brush, following downhill, listening.

“The way the parents talked he was a hot head and had stormed off like this before, so they didn’t run after him. When he didn’t come back for half an hour his little brother went looking for him.  He found him out here in the brush.  There’s a note by him, and there’s a gun. He’s just back here in the brush down off the bank.”

By now, I’m reeling.  I’m following a bobbing flashlight into the black and enclosing brush. As we step over twigs, and they snap and crunch I tell the deputy he has to stop.  I can’t look at this kid until I know his name. I bend over and put my hands on my knees to steady myself. I say out loud, to the ground and the dark warm air, “If this is the kid I saw this afternoon this family will never forgive me.”  And I wonder if I could either.

There are no blood or guts nor dismemberment, no bloated body to see on this dark brushy hillside, but it’s the closest I’d ever come to throwing up or passing out on a coroner call.

This one might not be all right.

I have come to find that most deaths are forgiven. Homicide, suicide, accident. In some way the sense of it fills in and I can come to peace.

The families do or they don’t, and it wears them down, but peace and forgiveness heal. Maybe not this one for me.

 It’s taking forever for dispatch to come up with the name. I stand up and wait for the name over the radio. Brandon is walking on in the dark, leading the way, unaware of my hesitation. He’s talking away into the radio.

I steady myself and follow.

Down the bank I can see the flashlight beam on the shoes. I’m dizzy and cannot brace myself, but I can see the shoes.

They are not the shoes I looked at on the kid in the office today. 

The name that finally comes through the radio is not the name I heard today. 

It’s not the same kid. So, my guilt is assuaged. And I can now recover the distance. The faint I feel fades.

I climb down the bank to look at the face. It is misshapen now with the top of the skull gone and the bones of the face left with little to hold them up.

The buzzing in my head recedes. I can look at the suicide note to his girlfriend and find myself smirking at the misspellings. Distance lets you smirk.

But it’s still a dead kid. Another dead kid.

I look up at the deputy. I can’t see his face since he holds the flashlight. “Kinda makes you not want to lay down the law on your kids, huh?” I say.

“You got that right Doc. I was riding my daughter about her homework tonight before I came on shift. And soon as I heard this one, I called her on the cell and said, ‘You know honey, it’s OK how you’re doing in school’.”

I thought about the kid this afternoon and his mom.

Was this the horror she thought she was avoiding?  Or did she know she could not forgive herself if this happened.

We cannot prevent the tantrum.

A gun makes a tantrum fatal. And our sense of self can be so confused that we feel responsible for the cause or the cure.

And then there’s the gun.

Cause of death: Rifle shot to the head.

Manner of death: Suicide

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Coroner Poem#7

Apartments full of sleeping students

Draped with white sheets of snow

Over the old apple orchard knoll

Where he shot himself some years ago.

He sat on an old apple tree stump.

Facing south, there was no sun only cloud.

The revolver shiny a few feet from his hand

Now open to the gray overcast shroud.

The clouded-over eyes no longer looking,

Faced upward. The mouth open, teeth dull,

Blood puddled in brown clots on the mud,

Next to the hole on the right side of his skull.

Assume a student, his life unknown pain

Escaping, he thought, days and nights of misery.

With a brief pull of the easy shiny trigger

Died where we left not one apple tree.

Asphalted over his last bloody bed, the mud where he lay.

Awaits my quiet early tread on this sleepy snowy day.

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Idiots

Are we, or are they? Maybe they just think we are.

Megan Blanksma is no idiot. But her posture of protecting us from government intrusion makes me think she might think us so. Shame on her.

She wants to change how immunizations are recorded here in Idaho to “protect privacy”. She should set her sights on Google or Amazon, not the Immunization Registry.

I wish Representative Blanksma could have been with me in the ER on the weekends in Grangeville. I can’t tell you how many times folks showed up with a scratch or a cut from the rusty nail wanting a tetanus shot.

“I don’t need no stitches, doc, just the tetanus.”

When was your last shot?

“Heck, I don’t know. It’s been years.”

We will look it up. The nurse starts logging in.

“That shot keeps it from getting infected, don’t it?”

Well, no. Tetanus is a rare complication from an anaerobic wound. Last year in this country about seven people died from tetanus. But wound infections are much more common, and the tetanus shot does not keep you from getting a wound infection.

The nurse finds that his last shot was three years ago, recorded in the state registry.

It looks like you don’t need a shot, you are well protected from tetanus. But make sure you wash that wound, soak it, let us know if it gets red or painful. You don’t need another tetanus shot for another seven years. Though there is some evidence you only need them every thirty years. You’ll be fine.

The current immunization registry guidelines are that people can “opt out” at their request. If they don’t opt out, their immunization data is recorded in a protected data base. Identified health care providers can access the information.

Do you think your shopping data is protected? Are you an idiot?

When you Google 18 cubic foot refrigerators then log in to Fox News and see ads for 18 CF refrigerators, do you think this is just a coincidence? Then you’re an idiot.

It’s all about information. For some reason, our state does not have the capability to find people we have improperly disenrolled from Medicaid. But our DMV knows if you have car insurance. Why doesn’t Representative Blanksma go after that data base?

I think it’s because she knows an avid base when she sees one. Antivaxxers are at the head of any Trump rally. So why not combine the universal desire for privacy with the antivaxxer sentiment? It’s a win-win. But that’s just because she thinks we are idiots.

I don’t believe we are.

Opt in and opt out is a crucial pivot point.

Most of us don’t think about our retirement.

Nor about keeping up to date on our immunizations.

Good evidence shows that employees enrolled (opted in) into a retirement plan, with no cost to themselves, have more savings in the long run. When the retirement benefit is structured so they must “opt in”, some choose not to. Maybe they are suspicious of their employers’ motives, who knows. But the opt in, opt out pivot point is powerful.

Please, look in your wallet. Do you have a smudged immunization card?

Maybe you think this service of keeping track of immunizations is best done by the private sector. Make sure you give them your credit card information and email address.

Yes, you are an idiot.

Representative Blanksma described being shocked when she found out that her children’s immunizations were recorded in the state registry when she had “opted out” from that process years back. I can appreciate that affront.

But dismantling a good system is an idiotic response.

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Coroner Story: Hunting

It’s hard not to think of the families, you know.  There is a job to do, and you do your best.  Still, it can be heartbreaking.

It was a Saturday, fall, mid day.  I was on call as the doctor in town, seeing walk-in patients in our clinic when my nurse knocked on the door.  She looked sideways at the phone and said under her breath, “Sheriff’s office, line three” like she knew I would not be able to finish with the last six patients in the lobby.

            Dispatch told me of a gunshot death in the Eastern County.  It looks like a hunting accident.  There were two deputies on the scene.  She gave instructions twice as I wrote them down.  No address, just a road off a road off another winding road.

            It was a bit of a relief to get away from the rush of Saturday clinic. All those people searching for the instant cure to get better so they can go back to work or to school by Monday.  It had snowed a bit, but the sun was out now, and it was beautiful.  I thought about my own hunting recently.  I’ve gone off by myself on a weekend day, sneaking through the brush and timber, excited, alone, purposeful.  But I didn’t shoot anything — nor did I see anybody.  The peaceful solitude was enough of a distraction to keep me from asking what I was looking for in my busy days. For the very nature of hunting is not restful.

Seeking.

Wanting.

I could remember times I watched a distant hillside, and the strength of the desire was so great that I would see a deer in the patterns of the bunch grass or brush. Those times I rarely really saw something. The deer most often show up when you aren’t expecting, when you are peaceful. I was working on that being peaceful thing.

The solitude and peace I would get today would be in my little pickup on the back roads of the county, looking for a road off a road.  Almost every other year there was a hunting-related death in our county, either due to firearms or due to accident or sometimes a heart attack in the field.  It sounded like this was an accidental gunshot wound…  Still —

            I found the road off a road and one of the deputy’s cars was at the turn off.  A lane led uphill.  It was snow-covered and I didn’t have four-wheel-drive, so I parked and walked.  The sun was brilliant on the snow.  It was still freezing but a breeze knocked snow out of the branches, and it floated down to join the snow on the ground.  As I crested the hill, I saw the other deputy’s four-wheel-drive rig at the end of the lane.  There was thinned timber here between sections of field on both sides.  The timber was young trees, pretty far apart with little cover.  I saw the deputies 100 yards into the timber wearing safety orange vests.  As I approached, they stood and watched me.  I picked my way over logs, crunching the few inches of snow.  When I got to them, I saw the body slumped back against the log.  His face was ashen pale with a quizzical expression.  Dead.  He wore an insulated hat, a vest, Levi’s, and boots.  His rifle was in his hands across his chest.  I saw the blood-soaked vest as I caught my breath.

            “So, what’s the story?”  I asked the older deputy, Earl.

            “This is a bad one Doc.”

            “So, did someone shoot him?  It doesn’t look like he shot himself.”

            Both deputies looked at me, slow to start the story.  The Earl finally said, “Yeah, his son shot him Doc.”

            I looked at them both.  “Tell me the story.”

            “We got the call about nine.  The neighbor said a boy was there saying he’d been hunting, and someone was shot.  Ambulance was dispatched and so were we.  Alan got here first.” He nodded to the younger man. I drove up-and-down the road half a dozen times before I could find it.  Hell, the ambulance never did find it. We radioed they didn’t need to come when we saw he was dead.”

            I turned to the younger deputy.  “What did you see?”

            “Well first I went to the house where the call came from and picked up the kid who called it in.”  He checked a notepad and gave me the name.  “He showed me how to get here.  We drove up to the top as far as I could.  I had the four-wheel rig.  We come over to where they both were, the dad, he was like this, we haven’t moved him, and a boy was sitting on the log there crying.” He checked his notepad again and gave me the names of the deceased and his son and their ages.

            “Apparently the dad was going to take the son and his friend out hunting.  The boy hadn’t hunted before and so they picked this spot ’cause it’s open.  They know the owner.  They got here early and spread out three across and were gonna walk east this away when a buck jumped and ran between ’em.  The boy fired, missed the deer and hit his dad.”

            I searched the faces of the deputies — they were just looking back at me.  “Do you guys know this family?”

            “No.  They live in town.  Good citizen folks from what I here.”

            “Do you think the boy intended to shoot his father?”

            Both the deputies were quiet.  I looked at the younger.  Alan swallowed hard.  “No sir.”  I turned to Earl.  “Did you talk to him?”

            “Yes, I took him back to the house.  He was pretty shook up.  I don’t think this is anything but an accident.  I don’t know how he is going to live with this.”

                                    Cause of death: gunshot wound to the chest

                                    Manner of death: accident

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Coroner Story: Not made for TV

This is one that I’m sure would’ve had a different ending if it was on a TV show.  Not enough drama in the truth.  They gotta give you a wrapped up bad guy, led away with someone, some detective giving them the Miranda litany.  I’ll bet third graders in this country know, “you have the right to remain silent.  You have the right to an attorney…”  Probably up there with, “I pledge allegiance to the flag…”  And just like the pledge means our day of merciless boredom is about to begin, Miranda means another bad guy is being hauled off and a commercial is coming.  But the beauty of any story is that there can be more than one truth.  But stories like that make it hard to cut to commercial. In other words, this shit doesn’t sell.

So, without commercial breaks…

 I got this call early one weekday morning as I was doing hospital rounds.  It wasn’t even nine o’clock in the morning and my pager gave me the number for Paradise Police Department.  I called and they said I was needed for a death at Garfield and Kenwood.  Fifteen years in this little town and I still don’t know all the streets.  “Where is that?  Is that over by the Junior High or by Safeway?”

The dispatch lady answers a couple radio messages in her code “10 99…  10 36” then replies, “it’s by the fairgrounds.  You can’t miss it with all the fire trucks.”

“There was a fire?”  I remembered all the sirens just a half-hour ago as I walked into the hospital.

“Small one.”  She doesn’t want to tell me too much.  She’s busy.  “It’s out now and one deceased.”

“Do you have a name?”  She gives me a name I don’t recognize, but she’s in our two-year-old computer database. But no office visits, no medication refills so I don’t know anything other than a 74-year-old lady.

Sure enough, I didn’t miss it.  The streets around the fairgrounds were blocked with the massive red pumper trucks.  Our all-volunteer fire department is quite handy and enthusiastic.  They were out in force on this cool spring morning.  It had rained and the streets were wet, no ice, no snow.

I had to park a couple blocks away since everyone parked their second or third cars on the street in this residential neighborhood, and between every second car was a driveway cut.  I walked up in my jacket.

The officer keeping the street blocked recognized me and waved me through.  I rounded the corner and came to the nexus of official vehicles.  The firemen were pulling hose and shouting and bustling.  There were two or three detectives there. Almost like the scenes you see on TV.  Except this was a 1960s ranch home with an unkempt yard, no high-rise or brownstone.  But the resemblance to the drama of TV shows might have explained the pulsing testosterone I could sense from the firefighters.  One recognized me and brought me over to a part of the back lawn where cops were standing. 

A blue tarp had been strung across a line between the garage and a pumper truck.  This was an attempt at privacy for the body I was to view.  Heck even the Chief of Police was there, but he just nodded hello in a professional and sober manner.  He was letting his guys do their job, not needing to steal the show.  I recognized the captain of the city police detectives, and he filled me in as we walked around the hanging blue tarp.

Neighbors had called in the fire about 8 a.m.  The trucks had rolled up to see smoke rolling out of the eaves and the front picture window obscured and black.  They’d gone in through the front door to a living room dense with smoke and junk. 

At this point one of the firemen who had joined us behind the blue tarp started describing the masses of piled up junk. They became an obstacle course in the dense smoke and now shallow flame and heat.  They had knocked down some flame and the picture window had shattered.  He described how he beat down the flareup when the oxygen rushed in.

They felt their way around to find the couch, mostly burned and our body, barely recognizable as such in the smoke.  But once that was confirmed they did their best and brought her out, but she was partially cooked into the position I now was looking at behind the blue tarp.

I imagine she was a difficult carry, since, as she laid on her back on the damp lawn her position was still as if seated.  Her legs bent at the waist and her knees at 90°, cooked into a seated position.  Her clothes, if she’d had any, were now incinerated and her skin was quite a bit also.  There were dark black patches, red raw patches, hair gone, but some areas still fairly normal looking.  Maybe she was slow cooked.  Smoked, or baked, not done yet so the joints were still stiff.

The husband had come back while the crew was here. He was down at the station giving his statement.  But the gist was that he had gone out for his usual 7 a.m. breakfast when McDonald’s opened and had said goodbye to her as she sat on the couch for the first or second of her morning cigarettes.  Nothing unusual reported.  The cops weren’t suspicious.  But it seemed a bit funny, a lady sitting on the couch that caught fire and not getting up, so I agreed that an autopsy might be helpful.  There was no obvious injury on her skull, like he might have cracked her one and then set the fire before heading to McDonald’s for his alibi. But there were enough for questions about the scene that more information from an autopsy would seem prudent. I had become more prudent in these years of doing this. I hadn’t always been so.

So, we might want to break for commercial here for dramatic effect: no definite crime, no real question of right and wrong, everybody kind of just shrugging.  Like I said, I don’t think this would make good TV.

I called the lady’s doctor.  I wanted to see if she had any natural history of diseases that would explain why she’d let herself get burned up:  overdose, suicide, maybe a heart attack or stroke on her third cigarette.  I explained the scene to him over the phone and his first reaction was “Oh!”  like now he understood.

“So, Doc, you think of any reason why she’d die suddenly?”

“No. Not really.  I saw her just a week or two ago.  She had high blood pressure, but I can’t imagine she had a stroke or anything.  But she did drink.  And she took a lot of drugs.”

“Really, what kind?”

“Prescription drugs.  She was always calling for refills.  Let’s see.  She was on Xanax and hydrocodone.  From me at least.  She could’ve been getting more from someone else.”

“She’s not getting any from our office.”

“Well, that’s good. She was beginning to show signs of dementia.  I suspected this from the years of alcohol.  But her husband had commented on how forgetful she seemed. And I suspected that she might be forgetting and taking her medications inappropriately.  And she had started coming into the office in her housecoat, looking pretty ragged.  I just thought she might be drinking more.”

“Did the husband seem odd to you?”

“No, why?”

“Oh, just asking.”

So, I relayed this medical history to the pathologist.  Of course, the toxicology levels took weeks to come back but they were inconclusive.  None were in the toxic or lethal range like she’d overdosed, and her alcohol level was not zero but near that.  Her cause of death that he came up with, since this guy never wanted to be too committal, was “conflagration.”

Maybe he was an English Major.

The way he explained that to me was that there was evidence for smoke inhalation, but also severe burns.  And if you give the smoke inhalation as the cause, then the burns were postmortem, but some microscopic evidence suggested some of the burned injury was premortem or near, so you don’t want to commit to smoke inhalation as the cause…  So much hand waving really just meant he didn’t want to get off the fence and call it one way or the other. Here I had an unhelpful pathologist acting like a radiologist. That’s an inside medical joke that would not bring any TV laughs. And why would a dead body be a reasonable joke?

So, I was left imagining it.  Again, this imagining thing doesn’t do too good for TV.  Fade into fuzzy pictures, maybe black-and-white…  You know.  Anyway, the lady has her third cigarette, forgetful, maybe went back and took another Xanax, forgetting she’d taken the first after she’d peed.  Then she returns to the couch for her fourth or fifth cigarette.  It drops onto the carpet; she falls asleep sitting up.  The smoldering carpet fumes giving off carbon monoxide to further sedate her. They all slowly accumulate, drugs, smoke, CO, and she’s so far gone when the heat finally arrives to her legs, ankles, arms and as her nylon housecoat explodes, she doesn’t move. Maybe this is a merciful ending.

Wah-lah. Is this the answer?

So, I called it an accident. That’s my job, I gotta call it.

I did check with the police, and they were comfortable with that.  I had called the husband on the phone the day after the fire to tell him we were doing an autopsy and he could claim the body at the funeral home the next day.  I had asked him if he’d noticed anything unusual.  When he spoke, I recognized his voice.  I had heard him in the halls of our office when he had come to visit one of my partners.  He had a loud, abrasive voice like you imagine a man telling you to get off his lawn as you are chasing your Frisbee.  “Naw, Doc.  She was her usual self that morning.  I said goodbye like always.  She was there on the couch.”

“So, she wasn’t slurring her words, or she didn’t walk differently like she’d had a stroke or something?  She didn’t complain of a headache?”

“Naw, nothing like that.”

“She hadn’t seemed sick or anything?”

“Naw.”

“OK.  Well, I’ll let you know when we get the results of the autopsy.  It usually takes a good three weeks.  If you haven’t heard from me in a month, give me a call.”

“Sure thing.” His rough voice made me think of a chain saw. Not the big ones loggers use, but one of those small ones your neighbor uses to cut up limbs.

He didn’t seem too distraught, real matter of fact.  So, when I heard his voice in the hall about three weeks later my mind was brought back to this man and his burned-up wife.  I thought of his loss, his wife of 50 years, the drinker, smoking away her hours amid a cluttered living room and he off to get his breakfast with his buddies at McDonald’s.  I wondered about how he felt, his awareness of her growing infirmity, losing her mind, her function.  The coming conflicts of care, home, nursing home, feeding, dressing. Had there been arguments?  Was there conflict?  The receptionist said he was asking for me. 

I came around to greet him and invite him into a room for a private talk.  “Ah naw, Doc.  Don’t want to take up your time.  Sorry to bother you.  I just wondered what you found out and all.”

He wore blue jeans with red suspenders straddling the sides of a big beer belly over a cotton plaid shirt.  His baseball cap had the phrase, “You Want Trouble?”  on the crown.  His face was creased, and he walked with the arthritic roll of an old logger, now relegated to Social Security and tales of the woods, where men were men and the government wasn’t keeping anybody from their work of cutting down trees, building roads.  His eyes were hard and dull, like he wouldn’t mind knocking in the skull of a hippie or an Injun if they came into his bar on a Friday night.

“Did you want to step back here?”  I wanted to talk some more with him, see if there might be more. 

Here the TV show would’ve had the bereaved redneck husband come into an exam room and after a few heartfelt, kind questions from the sympathetic coroner he’d have opened up to how hard it was getting for him taking care of the old lady.  How she just sat and smoked all day and never picked nothing up.  How she wouldn’t even have sex no more Doc.  Hell, he’d look into my eyes, anger, and tears, and he’d demur, it wouldn’t be long before she’d be pissing herself. The conflict of true emotion and an unavoidable honesty resolved with my skillful open-hearted questions. And I’d have the forensic evidence from a state-of-the-art lab that showed he’d slipped her two or three extra Xanax’s, then held the pillow over her face, sat her on the couch and left the fire smoldering as he went out to the morning McDonald’s as his alibi.  But this isn’t TV.  This is life; uncertain, confusing, boring life.

“Naw Doc.  You’re busy.  I guess you didn’t find nothing.”  He turned and walked out.  It could’ve been the only way he could show his grief.  It could’ve been a wily cover. And I was just a county coroner.

            Cause of Death: injuries from a fire

            Manner of Death: accident

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Seasons

The Idaho legislature has its seasons. Old hands know this, and young bucks and does have figured it out too. You, the interested public should also know it.

I don’t communicate this like I’m a wise old sage. Many are far wiser and have seen more seasons than me. But we should get this out there so we can all have a sense of what’s going on.

When I went hunting with my daughter this fall, she commented on how she’d heard rifle shots in her drainage. She was worried the elk had been spooked. “They don’t pay much attention to shots. They move when an animal falls.”

Here in the early season of the Idaho legislature we are hearing the shots.

The “antiwoke” bill proposed to change all the words in Idaho code that said “fetus” would be changed to “preborn child” got introduced for us all to be shocked and appalled. Then, the sponsor said it would go no further. It will be held in committee at her request.

Maybe the sponsor was shooting at something. Maybe she was just letting her fellow hunters know where she was. She didn’t harvest. Harvesting comes later in the season. These early weeks of the legislature are for location shots, not harvesting.

Similarly, we have the long, complicated bill from Representative Redman that would essentially repeal Medicaid Expansion. It has so many clauses, it makes my head spin. Don’t try to read it. It’s not worth your time. It proposes so many restrictions that it would accomplish repeal of the Medicaid Expansion that 63% of Idahoans favored in an initiative vote. Why is he so out of tune? These early season shots are important to let the rest of us know just who we are hunting with.

You see, our elected representatives are not our hunting camp buddies.

It was always fun to come back to camp and hear what the others had seen, build up the fire, eat the food.

You have to understand that our elected representatives aren’t sitting around the fire with you. They are in their own camp.

In my fifth year of Idaho State Senate service, I went to a presentation from the local Soil Conservation Districts. Their goal was to inform state legislators about the work they did. A colleague from north of me commented to the presenters about how, when he discussed this with constituents, he didn’t think this was a reasonable use of tax dollars. I asked him over lunch just which constituents expressed these ideas. “I just meet with my Republican Central Committee.”

These early shots reflect what they are talking about around their campfires, not ours.

Little will be harvested. But it’s something to brag about back in camp. But maybe someday they will harvest.

The middle season of the Idaho legislature is when the menial work is done. Simple budgets get passed; repair bills fix up the sloppy bills from years before. There are always the lingering hot button bills that are held late to consume some drama. Abortion, libraries, pornography, some other issue might fill this middle season when we should have harvested much earlier.

But the harvest is always late since Speaker Moyle has risen to power.

These early bills might garner support back in the Central Committee meetings, whether they pass or fail. But the real juice comes at the end.

And then, at the end of the long hunt, there’s little time to direct the shot.

These last two sessions have seen tax bills proposed in the last week, rammed through committee, transferred long past the deadline for such, and approved. The hero took the final shot and dropped the harvest.

Are we so eager for meat? We should want more.

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