So far, my father has been lucky.
For decades Jack Crispin worked as the only pharmacist in Lincoln county, Kansas, running his own pharmacy for 26 years before selling it, then continuing to work part time at a hospital. He finally fully retired late last year – just a few months before the pandemic.
On a recent phone call I asked him if he’d go back to work if the hospital needed workers. “Of course,” he said. He paused. “But I wouldn’t be happy about it.”
My father turns 70 this year, making him high-risk for complications from Covid-19. As we spoke, phone on speaker, my mother was mostly quiet in the background. I didn’t ask about potential mortality rates among the ageing population of their town of 1,200 people.
“If I caught the virus, it would probably be pretty hard on me,” he continued. “But if I thought I could go do some good work for them, I probably would.”
It’s lucky there’s even a hospital. Hospitals at nearby counties have shut down over the years, either due to budget crises or inability to find and keep doctors. That’s not unique to Kansas: in the past decade, more than 120 rural hospitals in the US have closed; many small towns now share a doctor, who travels from clinic to clinic.
This lack of consistent care worsens already disproportionately terrible health outcomes for rural Americans. Life expectancy has been dropping for Americans overall, but rural communities, particularly the working class in the midwest, rust belt, and the south, are hit hardest by chronic pain, suicide, and addiction.
As the economists Anne Case and Angus Deaton report in their recent book Deaths of Despair and the Future of Capitalism, regulations restrict the number of medical school graduates and the number of foreign-educated doctors who can practice in the US. This is done to keep pay rates artificially high, and the result is a looming shortage of doctors, particularly general practitioners. Rural areas that can’t afford to pay doctors the same salaries as big urban hospitals have a hard time attracting medical workers.
Lincoln county hospital, which has 14 acute care beds and serves an area of about 3,000 people, has been lucky not to have had a gap in coverage. When Larry Dragone recently retired, after more than a dozen years as the only doctor for miles, the hospital board was able to “dig deep” to offer an attractive package to a married couple, both MDs, originally from Pakistan but recently working in the DC suburbs, to entice them to a small town of 1,200. Lincoln was competing with Chanute, a town of about 9,000 with a doctor who divides her time between Chanute and her practice in Kansas City, a two-hour commute by car. If a patient in my parents’ town gets really bad, they’ll have to be transferred to the hospital in Salina, about 40 miles away, for even the possibility of a ventilator.
So far, there have been zero coronavirus diagnoses in my parents’ town. There have been confirmed cases in 62 of 105 Kansas counties, but the sparsely populated western part of the state, mostly filled with wheat, cows, and the slightly eccentric and gruff farmers I grew up around, has been spared – for now.
The isolation that felt so suffocating when I was a sulky teenager in a small farming community now feels like a blessing. Lincoln is on a highway, but not the interstate. Except for a fill-up on gas, there is not much reason for outsiders to stop while passing through. The New Yorkers fleeing for suburbs, small towns, and vacation homes – often spreading the virus in their wake and further straining already struggling systems – have yet to show up in this little dot on the map.
My grandmother is in an assisted living facility in the larger town of Topeka. No one can visit. My grandmother, who survived a bad bout of pneumonia late last year, reports mostly boredom. She misses playing cards with family; she complains that the prizes for bingo switched from being quarters to little plastic toys. So here, too, we’ve been lucky: where she is staying there have been no cases of coronavirus, which has been devastating nursing homes and assisted living facilities across the country.
Others in Topeka are not so lucky. Thirteen employees at one hospital recently tested positive, including a doctor, and the fatalities are slowly climbing across the state. Meanwhile, the state legislature tried to circumvent the governor’s orders to forbid gatherings of more than ten people so churches could remain operational, despite the death of a preacher in Virginia who held services in defiance of a similar edict. The state supreme court upheld the governor’s decision, so Easter Sunday services didn’t end up transmitting more than just the Good News.
I fear for the many Kansas towns reliant on factories and other non-agricultural industries; they’ll be more vulnerable to layoffs, as are the small towns farther east, where the virus is spreading. Even a small number of cases could quickly overwhelm the hospitals. An economic downturn could devastate the already shaky local economy. Everyone already makes an almost hour-long drive to buy anything beyond the most basic provisions. The empty storefronts could quickly multiply.
But my parents and I didn’t talk about that. Instead, my father just said, “Thanks for calling, Jes.”
“Sure,” I said. “See you soon.”
