Tuesday, February 23, 2016

Justice Scalia's Almost Ambulance Ride to Alpine

The first mistake made in the ruminations regarding the death of Supreme Court Justice Antonin Scalia, at a West Texas dude ranch, is that the closest hospital was two hours north in Alpine, the so-called capital of the Trans Pecos. 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 and to have the occasional cheaper medical procedure. Mexicans also cross the border going the other way for health care.

The closest major medical center south or north of the border is in the city of Chihuahua, four hours away by car or 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 river to the U.S. border station between O.J., as Ojinaga is known, and the Texas city of Presidio. The first thing these ladies do when they get across the river is call 911. Or so it is said. 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 by aircraft to a bigger-city hospital, usually in Odessa, in the West Texas oilfield. Justice Scalia might not have liked it but that’s the reality of life on the border. Traffic goes both ways. A 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 blessed event 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, btw. 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, most of the women are Catholic, as was he, and they opted not to have the abortion that he so strongly disapproved of as a judge.

Everyone wonders who can declare a death, btw, after the contretemps surrounding Justice Scalia's passing, and the reality in rural Texas, especially this part of 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 Supreme Court justice. That seems problematic, but in person it’s a pretty easy call to make. Unlike Justice Scalia, the folks whose eyes I closed or my sister nurses closed, officially and in fact, were not sudden deaths. They were patients who were on their last journey, for a few days at least, and who happened to reach their final destination at Big Bend Regional Medical Center. Outside town, God knows: Some of the ranches in Brewster County for example, Presidio County’s neighbor and home to Alpine and the hospital, some of the ranches are bigger than whole cities. In the Big Bend you hear stories, perhaps apocryphal, of people who died years ago and family members put them in a freezer and are still collecting Social Security checks. 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 Presidio justice of the peace, who should have gone to Cibolo Creek Ranch to officiate over Justice Antonin Gregory Scalia: In this part of the world, if you’re out there in that brush country—which is no country for old men, trust me, the filmmakers were right. You feel like you’d have just as good a chance of running into the Secretary General of the United Nationsor a prima ballerina from the Bolshoias you would be of finding a public official. Not a cop, though. They’re everywhere: federal, state, county and municipal varieties. In that respecthomeland securitysomehow 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 east or west, and I got around 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 south by bus to Presidio, on my way into Mexico, to visit 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? 

How about the flora and fauna? Isn’t that why people move to the Big Bend in the first place? In the morning, going to work on my bike, 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, so is mine, a bad combination, and you have to be careful not to get between a javelina and something to eat. Arriving at work, there was often a community of mule deer in the hospital parking lot, and raccoons around the back door. The locals say deer like to hang out in Alpine during hunting season, which makes a certain sense. Deer may be evolving, not just getting older as a species but getting better, you know?

My existence in the Big Bend sounds much more picturesque in the telling than it 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 and 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 from a half-gallon tub. And, as someone who dislikes the police with a passion, 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 this area is escaping something and that included me. 

Let me say from the start that I’m completely normal and well-adjusted. But I arrived in the Trans Pecos from the Pacific Northwest and I wanted somewhere that wasn’t Seattle where it rained everyday and the people were dark but not black. 

Alpine wasn’t Seattle because it didn’t rain every day. As an essentially urban soul my view of the Trans Pecos was strictly defined not by nature or wide open spaces but by four towns: Alpine, in Brewster County, Ft. Davis in Jeff Davis Countyhome to the McDonald Observatory where on a clear night and with the naked eye you can see satellites pass overhead. And Marfa and Presidio, both in Presidio County across the Rio Grande from O.J., not far from where Justice Scalia met his Maker. On the outskirts of this roughly-defined square are Ft. Stockton and Pecos, both oilfield towns by the way, or former oilfield towns now that the boom has bust. Both 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 part of the world, there are four courthouses, three jails and by my count four supermarkets—three of which are owned by the same people—and only 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 beyond help. There’s one head shop, also in Alpine, near the university, owned and operated by a Jewish family from Mexico, that 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—she moved to Austin, which is where people from Alpine or Marfa go, not to El Paso or San Antonio which are closer, but to Austin, which says something, I'm not sure what. Anyway this other nurse told me, not long before my own departure, me getting ready to take the train out, 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 park.

Mostly, if you’re in Alpine, you hear about Marfa. 

              “Beyonce is in Marfa,” a young woman who was working as a waitress informed me one day indirectly 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 just slept with one of the swimmers. She actually served Beyonce in Marfa, she was telling someone at another table, and the Big B’s entourage, and found Mrs. Jay Z completely cool. “Mathew McConaughey is in Marfa!” was a headline in the Alpine newspaper once. “Chelsea Clinton is in Marfa,” came from radio news. All of which was true, they were all there, but what no one could answer—this is crucial—what did they do? 

            Fuck all is my best guess, because there’s fuck all to do in Marfa. 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, so there was a certain interest factor, you could ask people where they were from or where they were going. 

            If you roll down the highway from the center of town 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 justice at work in the Trans Pesos, but the marshals rushed me and said it was not a public hearing. These were the very agents of the White Power Structure that the black man had fled to the Trans Pecos to escape in the first place, btw.

            Around a corner near the golf course, behind a high fence, is some kind of government listening post that everyone 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 banks because you wouldn’t reach the door. Someone in line behind you would almost certainly be packing, maybe a chick. 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—except at the college where a few brothers come to play ball. Anyway 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 federale, 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 with a bunch of cowboys. Until I read that she liked cowboys, which there’s an abundance of in the Big Bend, not in absolute number but relatively-speaking.

Farther along the road toward Ft. David there’s a High Desert research station on the right and on the left a treatment facility for troubled youth, a type of boot camp that follows something called the “Positive Peer Culture Treatment Model,” where Hollywood A-listers send their children to get them out of L.A. and reacquainted with reality. 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. There was one but it shut down a few years ago after the state cited it for inadequacies. The hospital was owned by Brewster 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, which includes latitude in charging for services, beyond what law and practice normally allow. 

If Justice Scalia had actually made it to the emergency room in Alpine, 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 was another opinion. 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 a heart attack.

Transfer out usually means an air ambulance. Air travel is safer mile for mile than the highway but that does not necessarily include air ambulances, which have a checkered history. This is a divided region economically, a lot of wealthy people who may have second homes in the Trans Pecos, maybe a ranch, and a lot of poor or struggling middle class who live here year round. One of the rich included a Folger’s brand coffee heiress who was being shipped out on an air ambulance a few years ago, for one ailment or another, and the plane started to rise and slammed into a mountain on the edge of town. Everyone dead. The other risk is 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 we’d fill up every weekend at Big Bend Regional, once the alcohol kicked in. But while there’s an affection for firearms in West Texas 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. Rest assured that in the Big Bend if someone pulls a gun they’re probably going to hit what 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 Trans Pecos there’s not even a sidewalk. 

Ultimately the area wasn’t for me. Had he survived, however, this is exactly the kind of place Justice Scalia should have lived, not the District of Columbia. 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 quotidian near Big Bend National Park. The reach of government—except the Department of Homeland Security—is marginal. People don’t rely on a publicly-funded safety net either. They rely on family and neighbors, even more than in the rest of the Lone Star State, and this is saying a lot, they’re usually packing. In the Big Bend there's guns, gross economic inequality and expensive private healthcare. For Judge Scalia, had he lived, this would have been paradise. In death it must be Heaven.