St. Mark’s Medical Center is the iconic rural hospital politicians on all sides claim to be saving; it’s also where my mother has worked as a surgical nurse for over thirty years.
In this tucked-away corner of Central Texas, we are close-knit, a population of four thousand and a smattering of farms and ranches for miles on every side. We don’t have much in La Grange but we are proud of what we have: a good school system, a great football team, a Wal-Mart and an HEB, the Colorado River and some of the prettier views supposed to belong only to the Hill Country. And, once we rebuilt St. Mark’s, we had one of the finest community hospitals in the area.
St. Mark’s serves a vast rural population from a fifty-mile radius needing everything from antibiotics to bone surgeries. Previously, the hospital was housed in an outdated building from the 1960s, forever bursting at the seams. That an expansion was necessary was never up for debate.
We envisioned all it could be: brand-new, state-of-the-art technology. The shining beacon of the town, something to put us on the map. A hospital that could actually hold us. We weren’t a wealthy town, but we raised enough to fund a quarter of the building. The hospital borrowed the rest, broke ground in 2003, and finished construction in 2005.
Then came 2008 and the Great Recession. The blue wave of Obama followed by the red backlash of the Tea Party; the Affordable Care Act; the proliferation of unregulated social media upending public discourse, until the 2016 election splintered small communities exactly like the one in which my mother’s hospital was the beating heart.
It is fifteen years after the renovation, and St. Mark’s struggles to breathe.
If the hospital closes. The words had been a drumbeat in my mother’s mind for years. For my mother, nursing is a way of life, a sacred obligation to a purpose not many are willing to serve. The hours are long and unforgiving. Patients come out of anesthesia sedated but swinging, cursing as their lives are being saved. This is not unique to St. Mark’s—the story is the same at any medical facility. But we are a small community; everyone knows everyone else. The people going under the surgeon’s knife aren’t strangers. My mother has held neighbors’ hands as they sobbed. She’s literally seen their organs inside their bodies.
The hospital has been my mother’s identity my entire cognizant life. I still remember the laminated name badge clipped to her shirt, the sterile smell of her hunter green scrubs, the way she importantly answered her work phone with “Surgery, Karen,” the way she pulled her wavy brown hair out of the claw clip when she came home, the hospital’s smell invading our house.
I could’ve grown up hating this hospital. My childhood was made up of on-call weekends, when a ringing phone or a buzz from the beeper at my mother’s hip would ruin everything. She got called in on my ninth birthday and I was so upset I canceled my own party. Similar stories are lost to my memory but not to hers, as maternal guilt runs deep and long, the word “sorry” conditioned down to the synapses.
But I never hated the hospital, or even felt jealous of it. I was a child absolutely in love with my mother. I would stand in the bathroom and watch as she applied mascara before shifts, my face just cresting over the sink in the mirror. Her work was important. A picture of my mother accepting her nursing license was framed and placed in a spot of honor in our house, eye-level to my childhood height. The white uniform, the cute little hat, the effervescent smile on my mother’s face knowing she’d done it. Because I grew up watching her work, I grew up knowing my voice can and should be heard. My mother gave me my voice, and the hospital gave my mother her own.
If the hospital closes. To consider this is an impossibility.
This community is a very patriarchal one. The local industries are oil and gas, ranching, trucking, farming and milling—enough to keep the men afloat. But it is the school and the hospital that bring people in; it is what women create that make the community whole. This gendered emotional labor is all but invisible to the men who live in La Grange and the surrounding areas. It is women who think about the children they don’t have, and women who worry for the grandparents of others. Local leadership likes to say that the strength of a town is determined by the strength of the economy: how many people are at work, self-sufficient, personally responsible for their own destinies. But something women often intuitively understand is that it’s how we care for the vulnerable among us that determines true strength. When the community is hurt, are we there to heal it? If there is a need, is there a supply available without conditions? In other words, where is the mother and how well is she respected? This is a concept women are socialized to understand at their core, and one most men don’t notice until well after the system is broken. By then the wound is deep, the break hard to heal.
There is, of course, a man behind the creation of this new hospital. But this man is different. His name is Kelly, and it escapes no one’s notice that he has a woman’s name.
Kelly is a master of navigating vulnerability. He remembers every staff member’s name, and their family members’ names, too. He wears costumes to meetings (most notably and frequently, an Elvis outfit), and comes armed with jokes that aren’t terrible or at anyone’s expense. He has two-colored eyes, one blue and one green. He knows your insecurities but never exploits them. He is a man unlike any man I have ever come across before because he is a man that demands your respect without demanding your deference. Beloved by the staff and community, Kelly raises the renovation money, opens the hospital to great fanfare, and then succumbs to brain cancer and dies.
It’s not my first experience losing someone so beloved or so young. In small, rural communities each death is known because each person is known. Funerals are a common affair. Always someone’s granny, Uncle so-and-so, faces in the casket I recognize from church. I’ve seen my slew of cancers, heart attacks, car accidents. I’d lost three teachers by high school. One family killed in a horrific car accident. Drowning deaths, oil field accidents, fires, explosions. A little girl who ate a poisonous mushroom. Each loss is unbearable until we bear it. Losing Kelly feels like an unbearable loss. It is the first in a string of mortal wounds.
And yet, when the newly built hospital opens, everything seems perfect. I am seventeen, a senior months away from graduation, the drum major of the band. I drive myself everywhere. I remember feeling so very adult. I wear my nicest black dress, a halter top to show off my lanky teenage arms, a satin ribbon at the waist, heels on my unpolished feet. Because I am my mother’s daughter, everyone knows me. Someone slips me a glass of champagne for the toast. There is so much happiness in the room, more than I can hold. I sip my champagne and roam the hospital halls feeling dizzy. The new building is vast, filled with new technology and bright, natural light. Gone are the dark and drab days of before. Now is the time of St. Mark’s.
Everyone’s favorite part is the water fountain and flower garden at the hospital’s center; we will dub this garden “Kelly’s Healing Garden” after he passes. We’ll place a plaque next to its door. It will hold Kelly’s smiling picture, his two-colored eyes, remembrances from his family. Later, when the hospital falls into debt, the garden will be first to go dormant in order to save money.
I leave for school, I graduate, I get a job. I learn about the hospital’s struggles from afar from my mother. It’s losing money. Employees are chronically underpaid and jumping ship. A management firm brought in from Dallas proves only to exacerbate the hospital’s problems because they don’t understand the nature of its rural location. The hospital is hacked (hacked!) and forced to pay ransom (ransom!) in order to protect their patients’ privacy. It is on the brink of bankruptcy. The board is looking for a buyer. Deals are made and broken. The options grow limited.
Finally, a last-ditch plan materializes: the community will vote on whether or not to fund the hospital through a tax district. I perk up at this news; finally, a plan that may work. After all, the community had demanded the hospital’s expansion in the first place. Funding would require a one-percent property tax increase. It seems a more than fair ask.
But this is 2019, deep in the heart of red territory. As soon as the tax proposal is made public, opposition mounts.
This is where my knowledge of what happens becomes spotty, because my mother, in classic mother fashion, keeps from me the magnitude of the vitriol the hospital receives. I know there is plenty of grumbling over this proposal, but it isn’t until I follow a (since-deleted) Facebook page entitled “Save St. Mark’s” that I begin to understand just how much has changed since I left home.
The page has been created to garner support for the proposal. It posts statistics of how many people the hospital serves, how the hospital boosts the local economy, patient stories thoroughly preaching to the choir. Then, I read the comments.
On every positive post, there are negative comments. People can’t in good faith support the hospital any longer for [insert reason usually connected to taxes and/or the government in general]. If the hospital was well-run, it should be turning a profit. (The hospital is and always has been non-profit.) They knew a friend of a cousin who had a procedure done there that got infected. (Unfortunate, but par for the course at even the best hospitals.) They aren’t interested in putting any more money into something that “gives nothing back.” And, of course, there is the usual grumbling about Obamacare.
The biggest issue, and one that rarely gets talked about, is that the majority of patients at St. Mark’s are recipients of Medicare, due to the large local population of elderly and low-income families. When Obamacare was passed, Texas denied the Medicare expansion that would have come along with it, sounding a death knell on rural hospitals like St. Mark’s. The simple fact is that we live in a community teeming with Medicare recipients, but no one wants to acknowledge it.
Growing up, I was taught never to show weakness. We were raised by Depression-era grandparents who taught us to expect the worst as a given and be thankful if it doesn’t happen. Sons lost in Vietnam loomed large in our collective imagination. Family farms went under in the 1980s because of “go big or get out” corporations in the 1970s. In the early aughts, workers were laid off because “coastal elites” in Silicon Valley let the dot com bubble burst. Then the towers fell, and we sent our children off to yet another war we wouldn’t win. Not our fault. We are not weak. You are not better than us. This mantra like a drumbeat in our internal story.
The isolation of America’s rural communities cannot be understated. Much as we love to deny it, there is a deep and abiding insecurity that runs through the bones of Texas, one I still grapple with today. TV showed me a nationwide idea of poor, rural communities being full of po-dunk hillbillies, rednecks who didn’t know what was good for us, who always voted against our interests. Our homes were ugly because we didn’t know better. Our food was fried and fattening because we couldn’t cook any other way. I went to college believing these myths. Year after year, the kids move away to the cities in search of higher educations, higher incomes, inclusive communities for those of us who are Black, brown, female, queer. When I left home, I left happily. I’d had enough experiences of being belittled, made fun of for reading, told I was too smart for my own good. I was just another kid lost to the liberal media.
I was told that one day I would grow up and want to come home. I did want to go home, so many times, but I never did. I eventually realized the problem wasn’t my rural home—it was the insecurity around the idea of my home. To this day, I still fight tooth and nail with my East Coast husband when he suggests anything that I can conceivably construe as an attack on my upbringing. It’s a game of cognitive dissonance that never ends.
After the 2016 election, cognitive dissonance abounds. It feels like everything stable in our democracy has been peeled away like a scab on an open wound. Truth is subjective. The ground grows false. Nothing can be trusted, not even what we can see with our own eyes. The world fractures and splinters around us and none of us care because we are with the ones who get us, both those who left and those who stayed.
I can hear the isolation in my mother’s sighs. She has stayed all this time; she has been forever loyal. I think about all the times she has been called to save a neighbor’s life. How someone would collapse or feel pain in their chest or go short of breath or any other breakdown of the body that is alarming when you’re minutes away from medical assistance and terrifying when you’re in the middle of nowhere. The CDC released a report a few years prior looking at the rate of deaths from unintentional injuries and found them to be fifty percent higher in rural areas than that of in cities. The cause? Distance to a trauma care facility. I remember several moments in my childhood when we would be out enjoying a day and someone would call, “Get Karen! Where’s Karen?” and my mother would hurry over to where she was needed. Her very presence had a calming effect because it was okay, there was someone there who knew what to do.
I consider all this as I read the Facebook comments attacking the hospital for asking for help. But what about everything I was taught growing up, I want to ask. What about grace and second chances and caring for our brothers? What about the supply without conditions? What about the mother? What about her beating heart?
My mother is called to a town meeting to answer questions about the upcoming vote. She is nervous. She is not one to get up in front of a group and speak, especially not when the group is mired in conflict. The invitation has been sent to everyone who lives in the community and the surrounding areas—sixty RSVPs.
“These people know you,” I tell her. “They’re not going to turn on you.”
“Mmhm,” she hums, having seen far more of the ugliness than I have.
We practice with role-play. I throw some hotly worded questions her way and she answers each one perfectly. We reframe the story, talk about Kelly, the community support of the past, the facts, the truth. We practice again and again. This feels not unlike we are begging for our lives.
I text my mom throughout the day before her evening talk. She is nervous but ready. I watch the clock; I imagine her in front of a large room, microphone in hand, people at attention, ready to hear from Karen.
I call after it is over.
“How’d it go?” I ask, nervous beyond nervous.
“It was fine,” she says. “Fifteen people showed up.”
I go home for my niece’s high school graduation party. We are two weeks out from the vote. I ride in my mother’s car and on the way we pass sign after sign telling passersby to vote no on the hospital tax. The signs are large, red, imposing.
“There’s one,” my mother says, not really looking at it. “There’s one again.”
I’d started to feel optimistic. I’d seen more people defending the hospital in recent weeks. One of the doctors, a known Trump supporter, even wrote an editorial in the newspaper asking the community to vote yes on the tax proposal so we can “Make St. Mark’s Great Again.” Now, driving with my mother, I realize my optimism has been misplaced.
After ten years of a deepening political divide, of separation between those who leave and those who stay, of accelerating climate change (in 2012, we nearly burned to the ground; in 2017, Harvey flooded the town up to the central square)—the sense of despair had crept in until it overwhelmed the area like a bad smell. We had been the toughest of the tough, but nothing is invincible. Despair demands to be felt. I watch as we pass sign after sign. Vote no, vote no, vote no.
My niece’s party is held in the fellowship hall of a local church on the edge of a large, west-facing hill overlooking the surrounding pastures and cemetery. I catch up with old friends, eat barbeque, stay until the party winds down. Then, I go outside to watch the sun set.
To get to the hill, you must walk through the cemetery, a smattering of tombstones dating back to the late 1800s. I read the surnames, most of which I recognize because the families are still present. At the edge of the cemetery, I am shocked to find the grave of a kid I went to high school with. Apparently, he had died years earlier. The flowers on his grave are fresh, crumpled beer cans scattered over the plot as if a group of friends had come out in the night to share a drink. I sit next to his grave and watch the sun. Others come out, too, this being a tradition for everyone. We all stay silent; there is nothing more important than sitting and watching the moment the sun slips behind the hill. Then, my brother calls, asking where I am. I and the others walk wordlessly inside.
“What happened to ___?” I ask my brother about the grave I found outside.
“I don’t know,” he replies. “I think he killed himself.”
The night of the vote, I try to distract myself. But my mother sends me screenshots of the election results. Not looking good, she texts. The comments are so ugly on Facebook. It makes me want to cry.
Later, she sends the final screenshot: 1,360 votes for passing the tax; 5,500 votes against.
At this time, the hospital’s doors are still open. They are again looking for buyers to take them under their financial wing. Or, they will claim bankruptcy. Or, the doors will close. My mother reads a draft of this essay and tells me to include that they have more options than those, okay? Okay, I say.
I go home to accompany my mother for a minor outpatient surgery. I don’t recognize the nurses behind the front desk, nor do I recognize the nurse who preps my mother for surgery. But she is the kind of nurse I remember from childhood—sweet but strong, pretty but determined, hair in a feminine but functional ponytail. You couldn’t push this woman over if you tried.
Through the Obama years, Black Lives Matter protests, family separations, and most recently, COVID-19 conspiracy theories, Facebook has revealed to me exactly where many hospital workers’ priorities lie, and they lie far-right. Even with everything that’s happened. The collective story holds them in its firm grip.
Even so, the nurse checks my mother in for surgery, takes her vitals, gingerly slips the IV under her skin. I sit and watch as they talk. First, the necessary questions before going under, then business. Do you have enough techs? Is ___ still out sick? Can ____ cover call for you? The nurse nods at each question, answers dutifully. I feel an out-of-body experience, like I am watching some other mother and daughter.
“We love Karen,” the nurse says, my mother like the queen herself bundled up on the gurney.
“I know,” I say. “I know.”
Rumpus original art by Lauren Kaelin.