Tuesday, February 23, 2016

Justice Scalia's Almost Ambulance Ride to Alpine


The first mistake in the ruminations surrounding the death of Supreme Court Justice Antonin Scalia, at a West Texas dude ranch, is thinking that the closest hospital was two hours away in Alpine, the so-called “capital” of the Big Bend. The closest hospital was actually south not north, just across the Rio Grande in Ojinaga, a small Mexican government facility that serves the locals in a town where Texans sometimes go to buy medications, to see dentists and to have the occasional cheaper medical procedure. Mexicans also come north for healthcare.
The closest major medical center south of the border is in the city of Chihuahua, four hours away by car or by ambulance. Chihuahua is a big modern city and presumably an important American official would have received good care there but it’s a long trip to make in an emergency. Especially for pregnant women: Some Mexicanas living along the border who have at-risk pregnancies decide instead to cross the Rio Grande to the U.S. border station between “O.J.,” as Ojinaga is known locally, and the Texas city of Presidio. The first thing these ladies do when they get across the river is call 911. An ambulance from Presidio takes them to Alpine, to the Big Bend Regional Medical Center where the labor & delivery unit is well-regarded and where a neonatal intensive care-worthy infant can be bundled up and shipped to a bigger city hospital, usually in Odessa. Justice Scalia might not have liked it but that’s the reality of life on this part of the border. Traffic goes both ways. The border is not always a barrier. Texas women go south for abortions and Mexican women come north to have babies. A doctor in Alpine who has cared for some of these Mexican moms describes the events leading to the transfer this way: “You see them walking around the central square in O.J., to provoke labor, and then they walk to the bridge and call for the paramedics.” It may not be exactly like that—but close enough for purposes of discussion. When the mom-to-be gets in the ambulance the Border Patrol doesn’t come along for the ride. So it’s actually a way into the United States without papers and, God forbid, without having passed a security screening. Justice Scalia probably wouldn’t have approved of that either. At least he could've taken comfort in the fact that most of the women are Catholic, like himself, and opted not to have the abortions he disapproved of as a judge.
Everyone wonders about who can declare a death in Texas and the reality in rural Texas, especially this rural Texas, as has been noted elsewhere, is not like the rest of the state or the country. I spent a couple of years working as a R.N. in the Alpine hospital and I declared people dead, even though I’m neither a physician nor a judge. Never did it by telephone—as was done with the late judge—that seems problematic, but in person it’s a pretty easy call for a nurse to make. Unlike Justice Scalia, the folks whose eyes I closed or my sister nurses closed were not sudden deaths. They were patients in the hospital who were on their last journey, for a few days at least, and who happened to reach their final destination on my shift. Outside town, God knows: Some of the ranches in Brewster County for example, Presidio’s eastern neighbor and home to Alpine, are bigger than many cities. In the Big Bend you hear stories, perhaps apocryphal, of people who died years ago and family members put them on ice and are still collecting Social Security checks today. Who would know if you’re dead if you didn’t come to town even when you were still capable of making the trip? About that missing justice of the peace who should have gone to Cibolo Creek Ranch to sign off on Scalia’s death certificate: In this part of the world, if you’re out there in the brush country—which is no country for old men, trust me, filmmakers are right—you feel like you’d have just as good a chance of running into the secretary general of the United Nations, or a prima ballerina from the Bolshoi, as you would of finding a county official. Not a cop, though. They’re everywhere: federal, state, county and local varieties. In that respect, homeland security, somehow you feel Judge Scalia would have approved.
I don’t own a car. Don’t actually have a driver’s license, either. I arrived on the train which stops in Alpine two or three times a week going one way or the other, and I got around town by bicycle. During two long years my only trips out of the Big Bend were to Austin or El Paso by rail, to shop, or by bus to Presidio on my way into Mexico, to go to the beach in Chiapas or to meet the harvest in Oaxaca. Rode my bike one time and never again, it nearly killed me, to the spring-fed pools in the state park at Balmorrhea because they were advertised as being "like Barton Springs in Austin" which turned out to be true, only better, and I bummed a ride with friends to Marfa a couple of times, a completely wasted trip from my point of view. Marfa is a hipster’s mirage—it's all shimmery on the horizon but when you arrive you find nothing there. What about nature, you may ask? What about flora and fauna? Isn’t that why people move to the Big Bend in the first place? In the morning, going to work at the hospital there were javelina in my yard, rooting around for fallen pecans, and in the light from my bicycle all you could see were their startled red eyes. Their vision is supposed to be pretty bad and a javelina is a dangerous animal and you have to be careful not to get between one of them and something to eat. Arriving at work there was invariably a herd of mule deer in the hospital parking lot. The locals say the deer like to stay in town during hunting season, which makes sense. Deer may be evolving, not just getting older as a species but getting better, you know?
My existence in the Big Bend sounds now much more picturesque in the telling than it actually was in the living. Being slow on the uptake, it took me two years to realize there wasn’t much for me there. As an urban and one likes to think urbane black man who likes Marvin Gaye, vegetarian food, and who likes to find the occasional good Christian white woman and rub her nude body with warm olive oil while her husband eats Blue Bell ice cream straight from a half-gallon tub and watches—and, as a Negro who dislikes the police, whatever the uniform—it really was a desert for me, the High Chihuahua Desert in fact. People say that everyone who comes to live in the Big Bend is escaping something and that included me. Let me say from the start that I’m completely normal and well-adjusted. But I was coming from Seattle and I wanted somewhere that wasn’t Seattle where it rained everyday and the people were passive-aggressive and dark but not black. Alpine wasn’t Seattle because it didn’t rain every day and the people were not passive in any way. Even being in the area so long, though, as an essentially urban soul my view of the Big Bend was strictly defined not by nature or wide open spaces but by four towns: Alpine in Brewster County, Ft. Davis in Jeff Davis County, home to the McDonald Observatory where on a clear night and with the naked eye you can see satellites pass overhead; and Marfa and Presidio in Presidio County where Justice Scalia met his maker. On the outskirts of this roughly-defined square are also Ft. Stockton and Pecos, by the way, both oilfield towns, or former oilfield towns now that the boom has bust, and both of which reminded me of a line in an old Bette Davis movie, an observation which applies in West Texas as much as in Hollywood: “What a dump!”
In this area of Texas there are four courthouses, three jails and by my count, four supermarkets—three of which are owned by the same people—and one McDonald’s, in Alpine. There’s one college, also in Alpine, and one hospital, the one Justice Scalia would have been taken to if he had been merely ill and not already past care. There’s one head shop, also in Alpine, owned and operated by a Jewish family from Mexico and which the local authorities have tried repeatedly to shut down. A nurse who was a co-worker of mine and who lasted a few years in Ft. Davis before finally getting a divorce and getting out—moving to Austin, which is where people from Alpine or Marfa go, not to El Paso or San Antonio which are closer, but to Austin—told me not long before my own departure that there are only three things to do in the Big Bend: have sex, get drunk or do drugs. I would add, shoot guns and hike in the national park. You can only do so much of any of this, whether screwing or hiking, it seems to me, and much of my time outside work was spent sitting on the steps of the Brewster County Courthouse—after hours—smoking a fat one and formulating theories about this alien area that was holding me captive. Being in the Big Bend was like being in jail, not that I would know, you just couldn’t see the bars. For me, not understanding the region very well, I admit that, despite my long stay, Ft. Davis was home of a bunch of rightwing nut-jobs and conspiracy-theory types who were so conservative they thought that former Governor Bush was a Communist, and who now think that Justice Scalia was poisoned because he knew President Obama is signing reparations checks for black people that Obama intends to hand out on his last day in office. But I digress. To my mind, Marfa was split between pseudo-liberal artsy types who don’t realize they’ve bid up the cost of living and are forcing out the locals, who are the other half of the split and often Hispanic. It’s kind of like gentrification, but on a small-town, out-in-the-middle-of-nowhere way. Marfa aside, and the unreal facade the town presents, life in the region really does revolve around Alpine. As the center of the local universe Alpine is a good place to hear things because everyone passes through, either to buy groceries or booze or ammunition. Mostly you hear about Marfa: “Beyonce is in Marfa,” a young woman who was working as a waitress informed me one day at the Alpine coffee shop. Then she said that the U.S. Olympic men’s swim team was there too and she knew because she’d slept with one of the swimmers. She actually served the Big B, and her entourage, and found Mrs. Jay Z completely cool. “Mathew McConaughey is in Marfa!” was printed as a headline in the local newspaper. “Chelsea Clinton is in Marfa,” came from radio news. All of which was true, they were all there during my stay, but what no one could answer—this is crucial—what were they doing? Fuck all is my best guess, because there’s fuck all to do in the Big Bend. But who am I to judge? I liked Alpine well enough. One, it has a hospital, which meant a paycheck, and two, many of the people who came there, like me, were eventually headed somewhere else. Which is my life story. Wherever I am I'm headed somewhere else.
If you roll down the highway from the center of Alpine toward the hospital, a route Justice Scalia’s ambulance would have traveled, which is also the road to Ft. Davis, on the right is a satellite federal courthouse where a lone judge arraigns drug dealers and illegal immigrants. I was bored one day and went in to watch American justice at work but the marshals rushed me and said it was not a public hearing. They hustled me back outside without an actual laying on of hands which is good because this black man does not like to be touched by agents of the white power structure. Around a corner near the golf course, behind a high fence, is some kind of government listening station that everyone in town pretends doesn’t exist. Again, Justice Scalia would presumably have approved if the surveillance issue ever came before him. Next along the highway after the federal courthouse is another large building with high walls and an electric gate, and no sign out front, the Big Bend’s U.S. Drug Enforcement Administration headquarters. It’s said that 1500 of Alpine’s 6,000 inhabitants are gun-carrying law enforcement, mostly Border Patrol, a figure that I personally don’t believe but suffice it to say that you wouldn’t want to try to rob either of the town’s two banks because you wouldn’t make it to the door. Someone in line behind you would almost certainly draw a piece. In my apartment complex living next door to me was this hot young black woman with tattoos. There are, like, no Negroes in this part of the world, I was totally misled by the Chamber of Commerce brochuresexcept at the college where a few brothers come to play balland this black chick had a wicked body that got my attention right away. Border Patrol! Stop, manos arriba: You would think, feeling the way I do about cops that I might actually want to screw one, especially a fed after my experience at the courthouse, but no thank you. Saw this chick’s Facebook page and she was from somewhere out east and I felt sorry for her—a fine sister, out in the middle of nowhere—until I read that she liked cowboys which there’s an abundance of in the Big Bend, not in absolute number but relatively-speaking.
Like everywhere else in America, healthcare in the Big Bend is a conundrum although there are resources. Farther along the road toward Ft. David there’s a treatment facility for troubled youth, a boot camp that follows something called the “Positive Peer Culture Treatment Model,” the kind of place Hollywood A-listers have been known to place their children to get them out of L.A. and reacquainted with the real world. The names of parents who have sent their kids to the Big Bend facility would impress you. On the other end of the age spectrum there’s no nursing home in the region. There was one in Alpine but it shut down a few years ago after the state kept citing it for inadequacies. The hospital itself was owned by the county but it cost too much to run and the county fathers and mothers decided to privatize. Community Health Systems of Franklin, Tennessee came in and built a new hospital that is now considered “critical access” by the federal government which means the company gets an incentive to be there at all, which includes wide latitude in charging for services, beyond what Medicare normally allows. This is already an expensive area to live in, even if you don’t consider healthcare costs because everything has to be trucked in and there are no economies of scale for a small population, especially with no competition. The supermarket in Alpine is more expensive than in Austin and has less variety. A meal in Marfa or Alpine will cost you more than in Houston or Dallas. It says everything that needs to be said that the only place the elderly on fixed incomes can go to eat healthy food at a moderate price is the hospital cafeteria which is usually packed with non-patients. A friend of mine named Katie who owns a local tax service spends a lot of her time during the non-tax season driving around, on her own dime, to visit people who may not be able to get their prescriptions filled or enough to eat. It’s that kind of community.
If Justice Scalia had actually made it to the emergency room, and for purposes of argument let’s say it was his heart, which has been speculated upon—he had a bad heart, say some, no heart, say others—he would have been shipped out. Big Bend Regional Medical Center doesn’t do acute heart cases except to stabilize the patient, unless he or she refuses to be transferred which would not be a smart move if you just had cardiac arrest. Transfer here usually means an air ambulance which can be problematic for a couple of reasons. Air travel is safer mile for mile than the highway but that does not necessarily include air ambulances which have a checkered history everywhere. The Big Bend is a divided region economically, a lot of wealthy people who may have second homes outside towns like Alpine or Presidio, perhaps a ranch, and a lot of poor or struggling middle class who live there year round. In the past, one of the rich included a Folger’s brand coffee heir who was being shipped out of Alpine a few years ago, for some ailment or another, and the plane started to rise and then slammed into a mountain. Everyone died. The other risk is purely financial. The air ambulance ride—if you don’t have the right insurance—can cost $50,000 to go to Medical Center Hospital in Odessa where most of the transferred patients are sent. That’s what you owe before treatment even begins. I don’t know what kind of insurance a Supreme Court justice has, presumably it’s good, but if not it might make a conservative jurist think twice about Obamacare.
I was always amazed how few gunshot wounds were seen at the hospital. You would think that with Bubba on the loose, so to speak, we’d fill up every weekend starting Friday night once the alcohol kicked in. But while there’s an affection for firearms in the Big Bend there’s also respect. Justice Scalia would approve the distinction. The Republicans have a point, it seems to me, that weapons are kind of like sex, they’re here to stay and the best solution may be to teach people how to use them—just as sex education may not engender promiscuity, it’s a fact of life, like Democrats argue. There was a story in the L.A. Times back in the day, there’d been a gun battle in the ‘hood and the gangbangers had killed everyone on the sidewalk except who they’d been aiming at. An assistant police chief was quoted saying something that would be considered very non-P.C. today, that if the gangsters were taught how to use a gun the city could cut down drastically on its homicide rate. Rest assured that in the Big Bend if someone pulls a gun they’re probably going to hit the person they’re aiming at and not six other people on the sidewalk. If only because there aren’t six other people on the sidewalk, an unexpected blessing of the low population density. Most places in the Big Bend there’s not even a sidewalk.
The area wasn’t for me. Had he survived, however, this is exactly the kind of place Justice Scalia should have lived, not D.C. This is the place he was writing his judicial opinions for, a way of life that no longer exists in highly-urbanized America but is still the standard here. The reach of government—except the Department of Homeland Security—is marginal. People don’t rely on a publicly-funded safety net, they rely on family and neighbors. Even more than in the rest of Texas, and this is saying a lot, people are packing: in the Big Bend there are guns, gross economic inequality and expensive private healthcare. For Judge Scalia, had he lived, this would have been paradise. In death for him it must be Heaven.