you can go here and complain about doctors. I haven’t found where you can go to complain about legislators.
I have only had one occasion to file a complaint against a colleague with the Idaho State Board of Medicine. They rebuffed me with a dismissive, “This is a local standard of care issue, handle it in your community.” My community colleagues had no backbone to address the poor care. I left the community. A year later the person practicing medicine was finally sanctioned for another incident by the Board.
I offer this preface because you need to know, the Idaho BOM and I don’t always see eye to eye. Prior experience tells me this complaint will not be welcome either.
I hereby file a complaint with the Idaho BOM against the Idaho legislature, and our governor, while we’re at it, for the crime of practicing medicine without a license.
It takes quite a bit to get me riled up. I don’t always approve of choices my colleagues make when they provide care, but I can accept that what we do is a “practice”, and the variations within that practice, when studied, can guide us toward best practice.
The investigation, diagnosis, treatment, correction, or prevention of or prescription for any human disease, ailment, injury, infirmity, deformity or other condition, physical or mental, by any means or instrumentality that involves the application of principles or techniques of medical science…
Patients come to doctors for many reasons. I do my best to understand their complaints and provide care.
I remember a young woman who came to me with what I thought a trivial complaint. She was young, attractive, but had very coarse and prominent body hair. It darkly covered her forearms. She had a dark moustache she plucked. She said it afflicted all the women in her family, but she had researched an antiandrogenic treatment and asked me to prescribe it. I told her I would study it and get back to her. I did.
The drug blocked the effects of androgens, male sex hormones. It had been developed for the treatment of prostate cancer. But I found studies where it had been used for this young woman’s condition with significant benefit. After a week of study and contemplation, I called her to come back so we could consider this treatment.
I tell you this so you can consider what the Idaho legislature and our governor have just done. They have, by the heavy hand of the law, forbade me from considering a treatment for my patient.
No treatment, other than counseling, for a young person under the age of 18 who suffers from their gender may now be prescribed by a medical practitioner under the penalty of law.
The Idaho legislature and our governor have decided how medicine should be practiced in this state. The Idaho BOM should take heed.
I don’t know the best treatment for gender dysphoria. I have seen patients who struggle with this condition. I do my best to treat them with respect, knowledge, and wisdom. But now, I must also treat them with the consideration of prosecution. Is this the Idaho I love? Is this the community that cares for each other?
There are many issues the struggling youth must address. There are issues their communities must address. But passing laws about what treatments are available doesn’t seem a healthy way to proceed.
The Idaho legislature and our governor have proclaimed they know the best way to practice medicine. The Idaho Board of Medicine needs to assert their authority. Statutes clearly describe the penalties for practicing medicine without a license. Drop that complaint in the Attorney General’s lap. We all know where that would go.
Just because you know the enforcing authority won’t act doesn’t mean you shouldn’t voice your complaint.
Our Attorney General is trying for a mulligan from his office in our House of The People down there in Boise. That’s what we get when we elect bullies. They shoot off their mouths, and then expect us to pay for it.
Let me catch you up. An AG’s opinion letter sent to Idaho Representative Brent Crane last month was made public. In it, our new AG, Raul Labrador, stated that a doctor who “referred” a patient across state lines to access abortion care would be guilty of a felony. Further, a doctor who prescribed medication for an abortion for an Idahoan to pick up across state lines would also be felonious.
This “AG analysis” as his signed letter heading indicates, hit the national news and in a few days our AG decides he didn’t really write it. It turns out he, or his staff figured out the analysis was requested by Crane for fundraising, rallying the troops, purposes, so he announced the analysis had never happened. It was “rescinded”.
Still, the alarm bells went off for some folks, mainly the ACLU, and now our AG is spending time defending this letter that he claims was never written in Federal Court. Isn’t that where we want our state’s lawyer spending time? Defending an analysis, he says now he didn’t even write in federal court? I’ll bet some of us do. I doubt AG Labrador serves in the Militia for the Unborn. But I know he wants their votes.
This militia is well organized. I remember getting called out of a room when I first started to practice long ago in Idaho by my nurse. “There’s somebody on line 4 that wants to talk to you.” It was the old days, and I could recognize a long-distance call by the static on the old land lines.
“Doctor Schmidt, will you be providing abortions?”
She waited for my answer.
This last week in the clinic where I work now there were two people scheduled to see me whom I did not know. The reason for the visit was in the computer as “discuss family planning”. I wondered, were they sent to entrap me? Did they want to get me to mention a clinic across state lines where they could access the care unavailable to them in this state? And then would they share this information with our state Attorney General? And would the state troopers roll up as I’m having a beer with dinner?
When asked to clarify his “analysis” by reporters, our Attorney General refused. He did not say this analysis was wrong, he just said it hadn’t happened.
I guess that’s how my fellow Idahoans want this to play out. Only legislatively approved care can be provided by doctors. Really?
It’s going that way with all the hot button issues. Abortion, transgender care, what is next? What kind of personal care will come under the scrutiny of our legislature and the analysis of our AG?
Could a twenty-year-old man request a vasectomy?
Can a 42-year-old woman request fertility treatment?
Can a 95-year-old man get Viagra?
I understand the passion of the Militia for the Unborn. They see the lives to be saved. And what’s a little arson, or a sniper round to save these fetuses?
And now, we have the full power of the government, the state, the marble-halled Capitol, the Peoples House, coming into this conversation.
I talked with the young women about their choices for family planning. I tried to understand their needs, their situation. I decided not to fear that I might be prosecuted. But I considered this going into the room.
Sometimes how you get the call is an important part of the story. Sometimes, it’s who calls you, sometimes it why they thought you needed to be called, sometimes it why you weren’t called. All these little nuances to being a small town, rural county coroner fascinate me. So, when I picked up my phone on a warm fall afternoon and I got gruff old Ivan’s voice yelling into my ear, “Doc!?”, I didn’t expect this to be a coroner call.
“Yeah Ivan, what can I do for you?” He’s 85 years old, a crusty skin and bones old rancher in the east county. I see him maybe once a year as his doctor, less if he had his way. But the time I stuck him in the hospital with congestive failure and told him he wouldn’t make his 82nd birthday inspired him to come in annually after that, mainly to rub my nose in my errant prognosis.
I saw him more when his wife was dying. They cared for her at home right up to the end. She got demented and went fast, thank God. I’d met her three or four years earlier and while I was asking her about her family history, she looked me in the eye and told me a fractured but intelligible story of her brother, five years older, who’d gotten demented and died within a year.
“That old Alzheimer’s can really take you down,” she’d tsk’ed and shook her head. I nodded but silently disagreed. Alzheimer’s usually takes some one five years or more after the initial diagnosis. My mom had taken more than ten years. Usually, it’s plenty of time for families to flounder with personality changes, bed sores, diaper changes, nursing home costs and guilt. But Ivan’s Irene had just gotten pleasantly forgetful and died a year later. Her pattern, and her brothers made me fear I’d missed a diagnosis. None of this was on Ivan’s still sharp mind this fall Saturday afternoon.
“You still the coroner?” he yelled. His deafness made him yell. He was the deaf one, but he yelled to others out of politeness, I guess. “I know I voted for you once but maybe I missed something.”
“Yeah Ivan, I’m still the coroner. You fixing to die or something?”
“What?”
“How can I help you? Yes, I’m still the coroner.” That last part as loud as I could yell into the phone.
“Oh no, I’m not dead. At least I don’t think so.” He laughs. “Say, I got a dead guy for you.”
“Really?”
“Yup. Out on American Ridge. I was out looking to bring in some cows and found him.”
“You call the sheriff?”
“No. Should I? I don’t think he needs arresting, he’s dead.”
“Where are you now?”
“I’m back at the house. But he’s up on the ridge like I said.”
“OK Ivan. I’m going to call the sheriff’s office then we’ll come out to your house, and you can show us this guy.”
“When’ll it be?”
“Maybe an hour. Why?”
“I was gonna get something to eat.”
“You go right ahead. See you soon.”
I hadn’t wanted to suss out details, yelling into the phone and his hard of hearing. I knew Ivan was a solid guy and wouldn’t be calling me about some pile of deer bones or an old flannel jacket on a log. So, I called the sheriff’s office. I think this was the first and only time I ever called them about a dead body. They usually called me. But it can go all sorts of ways. One time the funeral home called the local police about a coroner case. An old guy had driven his ’63 Chevy truck into the funeral home parking lot, taped a note to the driver side window and shot himself behind the wheel. He was trying to save us all the hassle. But we all got rousted out anyway and then had to call to get his bloody truck towed away.
I got to Ivan’s house after the deputy. They have radios. The deputy and Ivan were up on the front porch. Though sunny, there was a fall chill and a westerly breeze that suggested rain. Hunting season was full bore, so my hunch was this body was a lost hunter. But usually Search and Rescue hears about such a thing before the guy’s feet get cold. He doesn’t come back to camp and the word goes out. Still, some guys go out by themselves, break a leg, who knows.
I climb the porch steps. “Hello Ivan. Hello Brandon.”
Ivan smiles. Brandon grins. “Did you take a wrong turn doc?” He knows I’m famous for getting lost on the county roads.
“No, I just had to put the tools away. I’m mudding some sheet rock.”
“Oh yeah. Don’t want that shit to dry on the tools.” He’s being familiar but I doubt he’s ever remodeled or fixed up even his single wide.
“So, what have we got?”
“Ivan here says it’s a plane wreck.”
“Really?” I’m surprised. I felt bad for not asking more over the phone. But in person is best with this old guy. I made him come in once a year at least for his medicine refills, though he only took one or two pills, way below average. He took great glee showing me he had beat my prognosis. I had to go over him pretty good, since he minimized everything. The 2-centimeter skin cancer on his right shoulder I’d found under the Carhart jacket, wool shirt and long underwear.
“Oh, that.” He’d said when I asked him about it. Plane wreck? Small potatoes, I guess.
Ivan was retelling Brandon about how he’d noticed all the broken trees across the canyon. I could figure this was a retelling since Brandon rolled his eyes at me. Somebody had to cut him off; we’re losing daylight.
“So, Ivan, can you get us to this wreck? I wore my boots. How far is it?”
He puckered to an expression of thought. “Well, what rig we gonna take?”
“Which one did you take?” I yell at Ivan.
Brandon interrupted. “You get the twenty doc. I’m gonna tell dispatch about the plane wreck thing.” He went to his rig and the radio.
Ivan’s grinning at me about his answer. “Well, doc, I was on Sadie.” He looked at me intently and waited.
“Who’s Sadie?” You gotta let them tell the joke.
“She’s my old mare!” He slaps his thigh.
Old brittle 85-year-old on horseback with congestive failure rubbing my doctor nose in it.
“So how can I get there?”
“You driving that thing?” He nods at my rusty old Toyota two-wheel drive pickup.
“I drove it here. We need four-wheel?”
“It’s a bit muddy past the gate.”
“We’ll take the deputy’s rig. It’s got four-wheel.”
Brandon said no one knew of any plane wrecks but dispatch was going to check with the FAA. We all got into the deputy’s Ford Explorer. I got to sit in the back where the doors don’t open from the inside, so Ivan managed the gates. They were his anyway.
It was about three in the afternoon now and it would be getting dark by 5:30 or 6. At least it wasn’t raining yet or snowing. We passed three wire gates then we get into broken timber. Ivan was telling Brandon how he’d come at it a different way on horseback so he’s not sure we can see it here from the dirt track. “Hell, Sadie saw it first!” he yells. “I’m looking for cows and she keeps staring off at the far ridge, so’s I think she’s seeing some there, but that’s when I saw the broken trees and the plane.”
“Did you go up to it?” Brandon asks.
“Naw, but I could see something in the pilot’s seat with the glasses. He’s dead.”
After twenty minutes and maybe five miles Ivan suggests we stop. By the rig he offers, “Just climb up this ridge and head south a bit.” He’s gesturing with gnarled hands and stiff shoulders. “We was up on this ridge I think when we seen it.” He twists back. “I could show you but I’m not too good in this downfall.” Another gimped up gesture and I’m looking for a path.
“If you’re staying here, I’ll leave the keys with you if you need to warm up.” Brandon handed the old man the keys.
We clambered over logs and through brush. I didn’t sense any ridge nor even magnetic direction. After thirty minutes we agreed to go back and get Ivan. “I seen you were dropping down too soon” he grinned.
There were the usual jokes about if anybody got hurt at least we had a doctor. And if it really went to shit, we had the coroner. I’ve heard them too many times. Ivan was remarkably agile, though slow and I’m thinking of daylight. He followed game trails and stayed with the grade until we came to a clearing.
“You might be able to see some broken trees from here off that a way.” He gestured again. Both Brandon and I looked off. It was a quarter mile or so below us still. The thing that got my attention was the fine white dusting across a couple hundred yards before the broken trees and white fuselage shined at us.
“Think it was a crop duster?” Brandon asks.
“Nope,” I say. “They don’t spray white powder.”
“OK Ivan, we can see it. Do you think you can get back up to the rig?”
“I think I better stay with you guys. You got pretty fouled up last time I sent you off. It ain’t far.”
We dipped back down into the timber following the old man. There was a temptation, like when you shoot a deer, to head off full bore to where you think it’s down. But long ago I learned that temptation is to be avoided. Slow and steady got Ivan to 85. By the looks of it he’ll make 90 at this rate.
The white powder I saw contrasting the dark needles wasn’t visible on the ground, but I warned Brandon. “Don’t touch the ground and put your fingers in your mouth. You won’t be passing any drug screens the sheriff puts you through.”
“Is it OK to breathe?” He chuckles.
“Only through your nose.”
The wreckage was mostly intact though both wings had sheared, and the fuselage buckled. We could see it was a twin-engine prop, no numbers on it. Ivan had stopped and was looking back. “I think I spotted her from up over there.” He gestures back toward a clearing across the canyon a couple hundred yards up and over; always orienting. “I could see the guy in the pilot’s seat. He’s dead. That’s why I called you.” He reminds us.
Brandon was ahead of us downhill looking into the tilted cabin, past the bent and split open fuselage. There were lots of wrapped bricks and white powder back here. He hustled up the slope a little breathless. “I gotta call this in. They’re gonna want to know about this. I’ll head back to my radio in the rig. Hope I can raise them here. If I can’t I’ll drive out a ways. You guys gonna be OK? I’ll be right back.” He was panting.
“Sure.”
“Take your time.” Ivan advised. “We’ll be fine.”
Brandon scoots up the sidehill back toward the Explorer. I walk down toward the cockpit. Ivan follows. It’s pretty quiet here in this canyon, no wind, but I can see it’s getting gray. We have another couple hours of light I figure.
The windows are all broken out and I can step into the tilted plane pretty easily with the left side torn open. Ivan was right, the pilot was very dead, not days, just pale and stiff. But it’s been cool, and this is a north slope, so maybe a couple days. No animals had gotten to him. There’s blood out both ears and the head is tilted at a funny angle.
I spook when “What do you think killed him doc?” is yelled in my ear. Ivan is all serious and frowning.
“Jesus, Ivan.” I want to tell him to soften his voice here in the presence of the dead, but I know it’s no use. “I think he died in a plane wreck.”
Ivan’s laughter is loud, and he laughs too long; my skin crawls a bit, I don’t know why. He gets serious and asks me intently, wanting to know. “No, I mean doc, did he bleed to death? I see some blood but not that much.”
“Oh, Ivan, it’s hard to tell. Here let me check.” I reach in and twist his head a bit and feel some grating bones. “Yeah, I think his neck is broken.” The yelling I have to do makes this almost obscene.
“But is that what killed him? People survive…” he trailed off as I turned my back to him. I wanted to get some identification. There were satchels that looked like luggage on the cabin floor and more stacked up where the copilot’s seat would have been. I zipped open a small one behind the pilot’s seat. There on top of rumpled clothes were three passports, one Columbian, one Mexican, one Peruvian. Miguel Sandoval was on the Mexican, Manuel Salinas was on the Peruvian and Miguel Santoro was on the Columbian. There were three other satchels jumbled next to him. I unzipped one. Bundles of US currency were neatly stacked and wrapped, some fifties, some twenties, some hundreds.
I jumped again when Ivan said, quieter this time, “Don’t know as I’d called you guys if I’d a known all that was there.”
Brandon got back in about a half hour. He looked troubled. “We’ll stay put ‘til they get here. Won’t be long.” For some reason I didn’t ask who. “Why don’t you take Ivan back up to the rig so he don’t have to scramble around if it gets dark.”
Ivan and I made the slow walk back to the Explorer, then I headed back down and across the slope, a little faster on my own.
When the big black helicopter came over just before dark and all the paramilitary dark suited guys came down the slope, I knew it wasn’t our sheriff’s department. A short man approached us with his combat weapon by his side as the others fanned out and disappeared in the gloom. He had night vision goggles up on his helmet, black clothes, black gloves and a smile. He didn’t offer his hand. He spoke to Brandon. “OK, we got it. You can take off.”
Brandon nodded and softly gestured to me as he turned up the slope. “Hey,” was my simple objection and the short man turned toward me.
“Who are you?” he shot at me.
“I’m the county coroner.”
His smirk didn’t feel so good. “You can go, sir. We got it.”
“And just who are you?”
Brandon was three or four steps up the slope. He stuck out a beckoning hand. “C’mon doc.” Like I’m a balky puppy. The short guy was getting ready to turn away again and I asserted all the authority a county coroner has. “What happens to the body?”
This time he wasn’t deferential. He snapped back toward me and up in the trees I could see a dark shape, maybe two, step into view. The short man looked me directly in the eyes. “You can go. We got this.”
Brandon was now stepping down the slope, impatient with me. “Come on doc. We’re going. These guys are taking over. They’ll take care of it. We gotta get back.” He put his hand on my shoulder, softly, not like he would have grabbed a puppy’s scruff, but like we were having beers. “C’mon.”
The trail back up was dark. I only slipped a couple times.
“You guys see that big black heelocopter?” Ivan asked. Brandon wouldn’t tell us nothing. Maybe he didn’t know.
It was about three weeks later I got a call from the medical examiner’s office in Spokane. “Dr. Hawthorne?”
“Yes, how can I help you?” I hadn’t requested their services for years.
“We have a body here and we need your permission to release it to the family.”
I’m clueless. “Who is it?”
“Manuel Sandoval”
“Why are you calling me? I don’t know this guy. It’s not my case.”
“Our paperwork says you are the coroner on this case, and we just need your permission to release the body.”
“So, are you sending me a death certificate; an autopsy report?”
“Uh, no. Those were sent to Washington. We just need your authorization to release the body.”
“Call Washington. I don’t know anything about this.”
“Uh, we did. They said to call you.”
“Is my name going to be on any record of this?”
There was a pause. “No sir. We just need your permission to release the body.”
Deep sigh. I thought of Ivan’s smile and his slow steady gait. How he looked the graceful scarecrow under the dark pine canopy weaving through the brush and sticks. I thought how he would laugh at this silly joke. I wanted to be sitting on his porch in the afternoon sun, telling him this story, yelling him this story, repeating myself when he said “eh?” and finally getting tired of the whole tale, realizing it’s not a short joke but a long one with nothing really to laugh at. But then we’d just sit there and look at the sun on the hills from his old farmhouse.
“You have my permission to release the body.”
No death certificate filed.
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The wind out of the west was chill and biting on Dale’s face. He pulled the collar on his camo coat up. Patrol could be boring, but they’d gotten an alert about a grey van possibly heading their way.
Dale looked back west at the roadblock, manned by his fellow militiamen. This two-lane highway didn’t have a lot of traffic. But it headed west to a heathen state, so the Militia for the Unborn patrolled it. He was here to save lives.
He regretted missing his son’s basketball game that night. But when he’d joined the Militia, and the legislature gave them the marching orders, he knew this cause was righteous. He accepted the sacrifice. He’d known this cause was worthy all along, but now they could act.
That time they’d crossed the border and set fire to that abortion clinic had been an unofficial act. He knew they were breaking a law in that neighboring heathen state, but Dale believed there were higher laws than the laws of man. Still, when the laws of man sanctioned their actions, he did feel a warm comfort. It felt good to be in a righteous state where he could serve the unborn.
His alert gaze swept back east as he saw a grain truck approach. He radioed down to his comrades. They got up and stood by their barricades in a semblance of attention as the semi barreled past.
Nothing for a while. The property taxes coming due filtered into his mind. How was he going to pay them? Maybe sell that old snowmobile. Might get enough if Craigslist panned out.
He couldn’t get anybody to help with the plumbing business, so that money had been getting short. Doug, his old helper was doing a rider for meth, and he couldn’t get anybody to do the crawlspace work. Dale looked down at his girth and sadly smiled. That belly ain’t getting under a house. He patted it fondly. Hell, it even made kitchen sink repairs tough.
Still nothing coming.
Jenny had said she’d take the three little ones and go to Hiram’s game. He needed the support. The other parents would accept Dale’s sacrifice. Maybe not all of them. He got a sense some thought he was not doing God’s work out here on patrol. Their weakness didn’t trouble him too much.
A red sedan came into view, and he radioed to his comrades. They put up the barricade and shouldered their arms. The sedan slowed. Dale watched from the hill, ready to provide back up. He hoped to be on the barricade next tour. They were due to be relieved tomorrow by the Freedom Militia.
He watched the commander approach the driver’s side as the other two brought their weapons to ready. He couldn’t hear anything from this distance and the wind was just enough to whistle in his ears. Nobody got out. The barricades moved back with the commander’s signal, and the sedan moved on slowly. I guess no one of childbearing age was inside.
That was the protocol. Look for the women who could be bearing. They had the pee sticks in their pockets. And they had the bottled water. Sometimes it took twenty minutes for the lady to get the stick wet. Then you read the lines and make your determination. One lady tried spitting on the stick, but now we make them squat in front of the car so we can be sure.
The red sedan was going really slow, not gunning off to make up for lost time. Dale thought that odd. He stared at it too long and didn’t catch sight of the gray van until it was on the straight heading toward the roadblock. The folks from the sedan had gotten out and were going back to the trunk.
Isn’t it just ironic that President Trump’s greatest accomplishment in his four years of Presidency was something his followers considered folly? It’s a symptom that government has become farce. Theater performs farce. Comedians convey farce. Maybe only government can deliver farce. It should not be.
Think back to when President Trump gets COVID dropped in his lap, like a baby’s diaper spill. He hadn’t drained the swamp; he hadn’t built the wall and now this “China Virus” had his shorts in a twist. Heck, he even got it. And he survived! Old obese man survives the China virus! Maybe we shouldn’t fear this bug.
But then we get Operation Warp Speed. It’s not shining light into all our orifices, it’s not drinking fish disinfectant, it’s not ivermectin for all. It’s dumping tons of money into biofirms that have been sitting on mRNA vaccine technology and getting them to ramp up. They had the capability to make vaccines quickly.
We were seeing deaths mount. Vaccines might help. Give them money to work faster.
And they did.
A vaccine went from innovation to mass production and mass delivery in a matter of months. This had never been done before. This was very new ground. All under the watch of a President whose followers hated the swamp. And huge government funding to Big Pharma is the just filling the swamp, not draining it.
We could all see his discomfort. The press conferences where he waffled, his allusion to possible other treatments. He could not pull off the farce in the face of the mounting deaths. But he tried.
Folks still today hold to the alternative reality. If only everyone had taken ivermectin for a few years, nobody would have died.
But millions did. Even with the vaccine, even with ivermectin, even with mask mandates and state mandated shutdowns. Farce is funny when we can all laugh. It’s not humorous in the funeral parlor.
There is unassailable evidence that vaccines saved lives. A study matching COVID morbidity with vaccine rates is clear. But such evidence does not make converts of the followers. They still line up to cheer for the indicted.
So, why would he agree to send all those billions to pharmaceutical companies if he didn’t believe in the immunization? Was he bought out? Did Donald get corrupted? Were his advisors pulling his strings?
In truth, we’ll never know. Maybe he’s just as dishonest as his Fox News shills.
But the truth is, we didn’t escape the virus. Over a million Americans died from COVID. Over 5000 Idahoans died from the virus. Neither the immunization nor ivermectin saved us. We all went our own way. Theater is supposed to bring us all together in the play. Farce, comedy, tragedy, we should all believe the story before us.
But, as a nation, we don’t do well when farce is the medium. The tragedy of Pearl Harbor united us. The comedy of Bill Clinton’s peccadillo amused us. But COVID was not sold to us as a tragedy. We got the message from our President it was a farce.
Farce makes fun of the prevalent truth.
Then the deaths came.
When the truth has ambiguity, farce has some leverage. Deaths are too solid.
What is truly amazing is that President Trump’s followers haven’t abandoned him for his Warp Speed action. He acknowledged the threat, he acted with decisive action that got immunizations out there for all who wanted. But his followers wanted farce, not tragic death. They didn’t believe the threat.
Now they haven’t rejected his billions to Big Pharma as a sellout. Like they don’t believe his pay off to Stormy was an illegal business deal. This guy has been making business deals to line his own pockets from adolescence. And many people still pay to see his farce. That’s the sad joke.
“You’re still the coroner, aren’t you? Well then, you need to know, we had a 20-year-old lady come in DOA. Head-on car wreck, out east of town, we never got a rhythm. No pulse. We tried for 30 minutes. Oh, by the way, she looks pregnant. We don’t know who she is yet. We don’t have a name. We’ll let you know when we do.”
How pregnant?
Six or seven months may be. No heart tones.
I step back into this room,
To this woman I don’t know either,
they grabbed me in the hall to deliver her child.
Her doctor was unreachable.
Her smile in the sweaty mist of her effort
Gleams from the ruddy face.
Her welcoming generous heart is open to me, a stranger
Between her spread legs.
I have wondered if all women love everything they see at this moment,
a programmed imprintable template of acceptance.
Her work is still downward, but she does it with efficiency.
The babe moves down toward the bulging moist spreading lips.
They part as the wrinkled dome of occiput passes up
and through
and out
and onto her welcoming belly and into her grasping arms
and sobs of joy.
The baby cries, taking its breath of life.
Its first effort in this world of pain and loss and love
and a mother’s welcoming breast.
When I went down to the ER
Her body was sheeted,
The gravid belly a white dome.
Injuries consistent with motor vehicle trauma.
Two dead.
I filled out the birth certificate the next day,
The usual, with a name I didn’t know,
Though we’d shared
The moment.
The death certificates were there for me too.
Both mom and babe
Names I did not know.
The boxes now checked.
Signature.
Doing the job.
The Jobs.
Cause of Death: Trauma from Motor Vehicle Accident
When a majority can pass a law that says broad and powerful things, then ignore those noble sentiments, everybody knows the deck is stacked. That’s how it goes. Everybody knows.
Our Idaho legislature has done such. I ask you to read their noble words. Then ask yourself, was the fight fixed?
Read our laws:
It is hereby declared that the public policy of the state of Idaho, consistent with our constitutionally recognized and inalienable rights of liberty, is that every person within the state of Idaho is and shall be free to choose or decline to choose any mode of securing health care services without penalty or threat of penalty by the federal government of the United States of America.39.9003(2)
Our majority legislature has nobly stated this freedom of healthcare. But I guess it doesn’t apply to those they don’t consider deserving. Maybe it’s just a law they and we can ignore. The poor stay poor, and the rich get rich, that’s how it goes. Everybody knows.
The trans youth or their parents, the young woman, and her pregnancy, through further laws they want to pass, cannot have these freedoms. That’s how it goes.
This law was put into our Idaho Code when Republicans were feeling assaulted by the Affordable Health Care Act, way back in 2010. They needed to defend us from the assault of federal laws, and our Idaho freedoms needed defense. They declared every person shall be free to choose or decline any mode of…health care services. But the health care service of addressing gender or pregnancy, in their eyes, should be the decision they choose, the state legislature. That’s how it goes. Everybody knows.
This law was crafted to combat the Affordable Healthcare Act. Back in 2010, when we had a black Democratic President. The ACA was an assault on our Idaho freedom. So, these noble words were adopted into our code. But maybe not taken to heart. So, it goes. Everybody knows.
Wyoming went too far. They took this American Legislative Exchange Council (ALEC) template too much to heart and adopted this freedom into their state constitution. Their citizens joined the anti ACA mob. The Wyoming Constitution was amended.
Idaho was less enthusiastic and only made it a law. So maybe it can be more easily ignored. Ain’t that how it goes?
This last month a judge in Wyoming cited their state Constitutional language and blocked Wyoming’s abortion ban. That’s how it goes.
But here in Idaho, we have the law on our books, designed to protect us from Obamacare, but no such constitutional mandate. The Idaho legislature has made it secure that you will be protected from any federal restriction on your healthcare choice, but not the decisions of our legislators. If this state chooses to enforce their laws on you, a health care provider, you can go to jail. That’s how it goes. Everybody knows.
This right, so nobly stated in our law: every person shall be free to choose or decline to choose any mode of securing health care services without penalty or threat of penalty…does not apply to you.
If you are a young person struggling with your gender identity.
That’s how it goes.
If you have an early pregnancy you fear, whatever your reasons, you must submit to the will of the old men and women in the Capitol.
That’s how it goes.
I watch the Idaho legislature make its statements of purpose, its “intents”, in so many bills it passes and then puts into our thick book of Idaho code and wonder, do they really mean what they say?
Healthcare freedom should be in our Constitution.
But maybe they just mean the freedom they think you should have, not the freedom you want for yourself.
It was pretty odd to get a convenient coroner call. But this one came right at the end of my day in the clinic. Sheriff’s dispatch called at 4PM requesting me to go out to a home just west of Deary. I told them I’d finish with patients and be out there in half an hour.
It was a warm fall day. The sun was low in the southwest. Some trees had changed; the fields were golden stubble or plowed. As I drove east, I remembered another afternoon coroner call that had been convenient.
I was finishing patients in a rural clinic, 15 miles east of town, fifteen miles short of Deary. The sheriff’s office had requested me to go to a home just four miles east of the clinic. There I found an old man lying face down in the grass under some trees next to a car with the hood up. Kinda weird. But he was really old looking- late seventies- early eighties. Wrinkled and spare, like I have now become.
It looked like a natural death. But the car hood was up and him outside and all made me a little concerned. The deputy told me what he knew. The old man lived by himself here on this property in the country. No one had seen him since this morning. His sister had come out to cook him breakfast. He had seemed fine for the eggs and potatoes. Then a neighbor had dropped by this afternoon and found him here dead in the grass.
I called his doctor. He filled in the story. The doctor had the answer.
“You don’t say.” he responded when I told him of the old man’s death. “I just saw him last week. He’d been having chest pains, so we did a stress test, and it was strongly positive for coronary artery disease. I presented him with the options, you know, medicine, surgery. He said he wanted to go home and think about it. We were supposed to meet tomorrow and make plans. He’s widowed now, five years. His wife died of cancer, and he’s been living on the old homestead there. I’ll bet he just died of a sudden arrhythmia”– And that’s what it looked like to me. He was winterizing the old sedan- checking the battery, oil, and antifreeze- sudden lightheaded feeling maybe and he collapsed on the lawn of the old homestead.
Maybe he was thinking about his options. I wondered if dropping dead in the yard was a consideration. I can imagine a lot of old guys might choose that way. But there are other choices to make.
As I drove on east, I drove past the road up to that house; I could see the trees where the sedan had been parked with the hood up from the highway. It looked like some young folks had moved in. There was a minivan.
The farmed hills rolled off to the south and up to the north the crests of timbered ridges rose. Aspens here and there were yellow. Tamarack hadn’t turned yet but bracken was a burning red. The dust of harvest had been cleared by a recent fall storm. The clarity of the air and the lovely, sharp yellow sunlight brought out the edges of things. Like you could actually see the line someone had drawn.
I finally found the home of the deceased. It was off the main road. There were two sheriff’s cars in the drive. “Hello Jeff, ok if I park here?” I asked the deputy from my rolled down window.
“Why don’t you pull over here. I might have to go.”
I knew he was bluffing but pulled sideways. There was a rutted gravel driveway up the gentle slope to an older two-story farmhouse. It was neatly mowed, but the siding needed paint. The porch was a bit worn leading to the front door. A dog sat alertly on the front porch, looking at me as I parked my truck. It didn’t bark. The deputy and sheriff approached as I got out.
“What do we have?”
“Old man shot himself.”
“Who called it in?”
“The daughter. Seems she’d been bugging him to move into town, a nursing home or someplace, and he’d been fighting it. His wife died a few years ago. He was born on this place. Can you believe it? Eighty-two years old and living on the place he was born. His daughter said she was really worried about him. He’d been failing a lot lately. She said she was really worried about him falling and not able to get up. He’d also become kinda forgetful. He would drive to town and have coffee then couldn’t find his car. And the neighbors told her they’d seen him driving up and down the road, missing his driveway, like he was lost or something. Anyway, finally, he agreed to go to this Assisted Living place. She took him out there Monday and then Wednesday he said he’d move. She was supposed to come out today- this afternoon at 4 pm and drive him into town to make the move. But she got a sense something wasn’t ok. He didn’t come to town for coffee this morning. She called here at about 1 pm and he didn’t answer. But that was pretty common she said. He’d go for walks- or be out in the shed and just not make it back to the house to hear the phone. She usually talked to him on the phone after dinner. Last night she talked to him, and he seemed to be ok, she said, maybe a bit more tired she thought, but not angry, or depressed or anything. But she said she kinda started worrying then.”
“Did he have any health problems?”
“Oh, the usual old age stuff. He wasn’t on any medicines. Didn’t like doctors.” Jeff grinned at me.
“So, who found him?”
“Well, we did. She was worried after her call, but she didn’t really want to come up and check on him. Maybe she knew. She was supposed to come up at 4:00 pm anyway, so she drove by and tried to look up here from the road. His car was parked in the shed. But she really was worried when she saw the dog on the porch. The dog always stayed with him. So, she figured he might have wandered off some place or gotten hurt or something and the dog came back here. So, she called the sheriff’s office to come check on him. She said she didn’t look around any or come up here from the road.”
The deputy turned and started walking toward an outbuilding 80 yards to the east.
“This is where we found him. The dog was sitting on the porch looking this direction. Hell, probably looking right at him. We first looked through the house and in the car, then when we came back to the porch and the dog didn’t bark, didn’t growl or move. I sat down next to her, and she was looking over this away and there he is. I seen the flannel shirt in the grass.”
By now we’ve gotten to the body. He’d sat down against a cut bank that faced north. After the shot, he’d fallen back against the bank. The rifle was still between his knees. His chin is split, and his face is gone, shredded. The top of the skull gone. The remaining skull is empty. The blood on the bushes at the top of the bank still glistens. People don’t appreciate what a rifle does to the human skull.
“You guys clear the gun?”
“Not yet, waiting fer you.”
“Please do.”
The deputy lifts the rifle from between the old man’s arms and checks the chamber. Lever action. No second round in the magazine, just one 30.06 shell spent.
“Is he still warm?” I ask.
“Well, the blood and brains on that tree were still dripping when we found him.”
His boots are laced but worn. The pants are a bit dirty and also worn and a bit big for his wizened, spare old bones. His gnarled hands were stiff in death. Though, I imagined, they were when he last pet his dog. Old hands get stiff.
The flannel shirt seemed big for his spare frame. It was frayed at the neck and cuffs. Like it had been worn.
“Heck, he was probably sitting here when she drove by.” the deputy said.
I looked down at the deceased’s boots, then back to the house and the dog, looking back at me.
“Who knows. He may have been sitting here when you started up the drive,” I said. “Any notes in the house?”
“We didn’t look real close.”
I walk away from the body, looking up toward the house. I see the dog looking this way, though not at me as I approach. I go up the steps, past the dog, she’s still looking east, and I go into the kitchen.
Linoleum floor is chipped and worn. There’s some dirt in the corners like the cleaning may have gotten to be a bit of a chore. He may have, through failing eyesight, not seen the dirt. Or maybe his failing energy did not have the enthusiasm for careful cleaning. Or maybe he’d seen the dirt, intended to care for it, but then became distracted and couldn’t remember the chore. There will be no answer to this line of questions.
What will the coroner find in my house, I wonder.
The house was, by in large, neat. He had, at some point, learned the discipline of neatness. And this stayed with him to the end it seemed. I had seen plenty of old bachelors who didn’t have the concept, probably never learned it. The only clear area in their hovel was where they sat or slept. Not for this man. Furniture arranged neatly and stuff put away mostly. But not tidy. Like his old bachelor ways were not up to tidy. There were a couple dirty dishes in the sink. The oil stove had been on. It was warm, but the day was warm enough. The kitchen table was piled with catalogues, boxes, odds and ends. There was a place where he could sit and eat. Sit and sort this stuff that needed sorting. His bed wasn’t made. But no note that I could find. So, he was tidy, but not neat. My garage will not be judged neat, or tidy.
I come back out on the porch. The dog is still sitting, looking east. I ask the deputy. “Anything missing?”
“The daughter came up here right after we found him and went through the house. She didn’t say she found anything. But she did take his checkbook.”
I look at the deputy. He looks at me.
“She said she was handling all his financial stuff now and had been for a few years. Just put some money in his checking so he could buy gas and coffee. She said she did the grocery shopping.”
“Do you know this family?” I asked the deputy.
“Yeah, they’re ok.”
I look east to where the denim of his pants is barely visible. The dog looks too.
“Well, I guess he just didn’t want to go to the nursing home.”
“Yeah, I guess.”
The trees are still. From down below the sound of a passing car rises up to us. The dog doesn’t move.
It was always a question for me when the House would have the guts to actually kill the Medicaid budget. Every year it would sneak though by 5-10 votes. This year, they actually killed it.
Lead by their wise Speaker, Mike Moyle, just over half the House Representatives wished away health insurance for Idahoans in poverty. It’s like spanking your stepson. What is your point? Other than to demonstrate your authority, or maybe your lack of generosity, or maybe your fealty to the Freedom Foundation?
Make no mistake, Medicaid is a Federal/State health insurance program for low-income people. The trouble is, Wayne Hoffman and most Idaho Republicans think these low-income folks don’t deserve health insurance. I can just see their bluster.
“I have health insurance because I work for it!” They thump their proud, inflated chest. Yeah, you have a ¼ time, taxpayer funded job with full medical coverage, also at the taxpayer’s expense. This stepson sees some hypocrisy.
“I voted against the Medicaid budget because we must control the costs!” comes the other cry of outrage. Well, addressing that problem will take more than a simple no vote. Does the average Idaho Republican legislator know that Medicaid annually costs the taxpayer less per enrollee than their plush state health insurance benefit? Does even the best-informed Idaho Republican legislator know the main mechanism used to control Medicaid costs is to pay hospitals and doctors less? When you take your sick legislative runny nose to your doctor, the state Insurance pays that doctor about three times what the poor person’s Medicaid pays. Do you like that method of cost control? Then I can see why you might think a “no” vote would control Medicaid costs.
Controlling health insurance costs is more complicated than motivating a sullen teenage stepson. Slapping either won’t help. It takes a lot more work than that.
Make no mistake, what we are really talking about here is poverty. I can hear Wayne, and his “vote no” minions scream, “No, it’s about preserving the American Way! People should work for what they get!”
I ask you, Wayne, and House “No” voters, do you know anybody on Medicaid? Do they work? If they don’t, I’ll bet it’s because they are a child, pregnant, a young mother, or taking care of someone. All the Medicaid patients I see are working. But, unlike my three elected Representatives, Medicaid workers don’t get Blue Cross health insurance with their part-time or low pay full-time work. Not all employers are as generous as your voters are.
Don’t complain that they are wasting your taxpayer dollars with their ER visits for runny noses. Doctors’ offices refuse to see Medicaid, where the care would be a third of the cost. Medicaid patients often have the ER as their only choice for care. Doctor’s offices refuse because you, fully insured legislator, have budgeted to pay doctors at a third of the price of what your Blue Cross Special plan pays them.
So, the House finally pulled the trigger and killed the multi-billion-dollar Medicaid budget. And what fiscally responsible substitute solution did they then come up with? The new budget looks a lot cheaper for this year, but there will be a $150M supplemental next year. Kick it down the road.
Nothing wrong with a little posturing, I guess. Maybe that’s all it’s about. Stepsons know posturing when they see it.
I’m going to relent here. There is a plan in the works to study “managed care” as a plan for controlling Medicaid costs. If anybody had been paying attention, they’d have seen the weak results many other states have had with this. I give the legislature a C- for the effort. It’s a mystery to me why Medicaid gets the slapped face, when private insurance costs have beat inflation year over year. Who’s driving this bus?
It’s pretty clear the Idaho Legislature doesn’t have their hands on the wheel.
There are times when it is very difficult to tell, even with careful investigation the manner of death. There are only six choices: accidental, natural, homicide, suicide, pending investigation and of course, Could Not Be Determined. Let’s see what you think of this one.
I was called by the sheriff’s office to go to a mountain area not too far from our town. It was a warm fall Sunday afternoon. I left Martha and the kids back at the homestead. I didn’t usually share much of these calls with them. Maybe I am now.
I got explicit instructions from the dispatch deputy because I’ve been lost looking for these sites on country roads before. With the discovery of a dead body there were a few sheriff’s department volunteers along my route to secure the area so I just kept asking them for directions as I went along. I wound my way up the mountain on gated logging roads. My little two-wheel drive Toyota truck managed. The westering sun was filtering through redden bracken leaves. The ground was dry and dusty. It’s the time of year you feel the corner of the seasons turn. The days are shortening perceptibly, and the nights can be quite cool. There will even be frost.
I stopped behind the sheriff’s detectives jeep. The back was piled high with investigative stuff, camera boxes, test kits. There was yellow tape above the road “crime scene keep out”. The detectives strode down the slope and met me as I turned my little truck around and headed it back down the hill. “What have we got?”
Earl caught his breath and caught me up. “Well, we’re not really sure. He’s a 48-year-old guy. Last seen five nights ago by his sister. We think maybe a city cop saw him three nights back when he was headed up here. He lives in town and works as a dishwasher. She says he commonly would go to the wilderness to be close to nature. I guess he kinda worked odd jobs and worshiped nature. Well, a mountain biker rode by and saw him dead and called us. We got up here about one this afternoon. We haven’t disturbed anything.” By now we’re all hiking up the slope, the three of us. Earl has another deputy with him. There’s a trail of sorts but it looks like mostly mountain bikers use it from the tracks. Steep and clear through the brush. There are also the deputies boot tracks in the soft dust.
“Did you guys look at the tracks when you came up?”
“Yeah, nothing new or recent that we could see. The bikes covered even his tracks if he came up this way. No other tracks that I could find coming or going.” Earl was real thorough. I’m breathing hard by the time I get to the second line of yellow crime scene tape stretched between two bushes. I can see the body. I stop and just look.
It’s a nice spot. There’s a bit of an opening with tall trees around. The sun still shines off to the west and will for another few hours. Then I look at the deceased.
The skin has a taut, grey cast. I can see his back, his knees are drawn up under a cover, the cheap sleeping bag. The back of his head is covered with grey, brown thinning hair. It’s longish.
“Any signs of injury?”
“Well, tell me what you think.”
We cross the yellow tape and circle the body on the soft dry earth. The detective, the deputy and I form a rough triangle. I watch the ground carefully as I step, the area is covered with their recent boot prints. I gaze down on the body now. His face is turned toward the ground, his arms pulled up across his chest. I can see an eye socket, shrunken with flies buzzing. The mouth not visible in this position but the cheek very shrunken. Mostly we can just see his back, emaciated. There are four parallel scratch marks from the left scapula toward the lower back. Bear claw marks. His face and forehead also have parallel scratches.
“You get ID?”
“Yeah, his clothes were piled over here. Some had been spread around but his pants were there, folded. And the wallet was in there. It identified him, a couple bucks still there too.”
I studied his position. It looked like he had laid the sleeping bag on the ground with his head uphill, now his head was downhill, and the sleeping bag folded across his bent legs. “These are postmortem marks.” I say. “Looks like bear. You guys see tracks?”
The deputy chimed in “Not when we first got here. How can you tell these are postmortem?”
“No bleeding. And see how the skin was rigid when it was scraped. It didn’t slide with the claws. He was good and dead when the bear pawed him. I think he laid his head up there in the sleeping bag uphill. Don’t you always try to put your head uphill when you’re sleeping out? And then he died. And then the bear messed him around, a day or two after he died. Must’ve flipped him over and downhill. Probably got him twisted up like this in the bag so he was laying like this. Maybe he was in the bag or just on top. Was he in it?”
Earl offers, “I can’t tell.”
“Can we flip him over? We gotta look for the knife in his back.” Always trying to make light of a dead body.
“OK with me. We’ve got a bunch of pictures of this so far.” We glove up and roll his body to the west. His joints are rigid in full rigor. The face is now fully exposed. The cheeks are very sunken as are the eye sockets. Maggots swarm the gaping eyelids. The mouth is open. He is near toothless. And spawning fly larva like this place too. They are buzzing in and out of his oval-shaped lips. The chest also has the parallel bear claw marks. No signs of a knife. His legs are partway in the half-zipped cheap sleeping bag. But he’s naked from the waist up.
“You guys find any booze or drugs?”
“No. We found some really old beer cans about 20 yards down the hill, but no bottle or anything in his clothes. No cigarettes or dope or anything. No pipe or matches even. No flashlight. Hell, he was packing light.”
“Looks to me like he came up here to commune with nature. He laid down to sleep and died, either of a heart attack or plain hypothermia. It got real cold last Thursday night, our stuff in the garden got real frosted.”
“But could these maggots have hatched since then?”
“It’s been pretty warm in the daytime the last few days. And this is a southern slope, it got real warm in the daytime. I’ll bet he came up here Wednesday or Thursday night. It got colder than he was expecting. I’ll bet it got down to 10° or less up here. He probably froze to death. Then the bear came along and moved him around. Amazing it didn’t eat any of him. Looks like a natural death to me. Unless he was wanting to die. Did his sister say he was depressed? Was he a drinker?”
“No, she did say he’d been losing some weight. You think you’ll do an autopsy?”
“Geez, I don’t know. Should we spend a thousand dollars of the taxpayer’s money on this guy dead and we probably didn’t spend a dime on him alive? Plus, the autopsy findings from hypothermia are negligible, or even a heart attack. If it was acute often there are no conclusive findings. So, could be a thousand bucks with no answer. That’s what I’d guess. There’s no sign of foul play. No, I think I know how he died. I bet he meant to come out here, get close to nature and nature was just a little colder than he expected. Maybe not. Who knows. Maybe he expected it to be cold and he was just testing his ability to be one with the elements. Do you guys suspect anything? He got a record? Has he ever been arrested?”
“No, we checked. Some of the guys said the new him. They seen him walking. That one city cop said he saw him Wednesday walking north around sunset. He had a bed roll with him. Might a been headed up here then. His sister said he did this a lot, to be with nature. She said it was kinda like a religion thing for him. She said he was overall pretty healthy, but he just didn’t quite fit in. People always found him kinda odd. But no, he didn’t have any legal troubles that we could find on the computer. Less he went by a different name.”
“Well, looks like a natural or accidental death to me. I’m gonna takeoff. You guys done?”
“Just a few more pictures. We’re starting to lose the light. We called the funeral home but there was no answer.”
“Are they gonna come all the way up here?”
Earl looks up at me with a smile, “I hope so.”
I smile back, “We could put them in the back of my truck. You got a body bag?”
“Naw Doc, we’lll just wait for the funeral home guys. They’ll haul him down.”
I drove back down the bumpy road to our sleepy town. The late afternoon warmth offering a suggestion of the cool night to come.
Monday, I filled out the paperwork. This guy didn’t fit in well in life or in death. Some of us are like that.
A week later I got a call from the state Department of Vital Statistics secretary. It’s her job to register and classify all deaths for demographic and official purposes.
“Dr. Hawthorne, you sent us a death certificate on Mr. Blank.”
“Yes, is there a problem?”
“Well, you listed the cause of death as hypothermia and the manner of death as natural. We always put hypothermia down as an accident, therefore his manner of death should be accidental.”
“The problem is, ma’am, I’m not sure this was an accident. It seemed to me like this guy meant to go out there, he meant to sleep in the woods on a cold night and didn’t really do a whole lot to prevent his death even though it was awfully cold.”
“Do you think it was a suicide?” She asks me sweetly, following her prerogative.
“I have no indication he wanted to die, but neither did he do a whole lot to get himself warm. Heck, he could have just picked up and walked back to town. The walk would have warmed him up. Or he could have built a fire.”
There’s a long pause on the other end of the phone and then she offers meekly, “There is also the category ‘could not be determined’”.
“So, you don’t want me to put natural. I’d really like to call this a natural death. I think that’s how he would’ve wanted it.”
“Well, we just don’t have hypothermia as a possibility in the natural death category.”
“Let’s leave it “Could Not Be Determined”.
I could tell she wasn’t happy with that. They really don’t like that category. She really wanted me to call it an accident. I stuck by my guns. I felt like I owed it to him.
