Pullin’ Bear

Ever wonder how big game – shot in the vast American wilderness – gets brought all the way back to civilization?

I recently visited a Cabela’s that just opened in our town. For the uninitiated, Cabela’s is easily the most expansive and comprehensive hunting, fishing, outdoor-gear store on Planet Earth.  They’re basically a small city with a roof.  Along with every gear component you can imagine, they have an eye-popping display of stuffed animals in the center of their store.

By “stuffed” I mean taxidermied.  So we’re talking, real, wild, once-alive animals now stuffed and posed to look alive.  I have stuffed animals all over my house, but none of them ever had teeth or laid claim to primordial carbon.

Personally, I’m not much attracted to killing animals of the natural world, and stuffing them and putting them on a wall isn’t very interesting to me, either.  In general, this city boy thinks of taxidermy as nothing more than bald carnivorism on guiltless parade.  Who ever thought the severed head of a deer, garrishly hung from a wall, would serve as decoration?  Isn’t some version of humility or mourning in order for this kind of thing?  If I were a taxidermist, I would recreate the entire scene, complete with twisted, exposed entrails, horrid death-grimace, contorted body and spattered blood in wide, fan-shaped arrays.  And every display would always include the GUN that did the dirty work.

Anyway, these guys have HUGE bears stuffed and in fierce poses with claws bared.  This includes a real polar bear, over 8 feet tall.  Somebody killed a freaking polar bear! I thought we just studied those things.  Staring up at that ginormous carcass, I wondered first where the hapless thing had been shot (heart?  head? gi tract, perhaps?), then ruminated on the ethics of such an action, then wondered how the freaking hell they carried an object that huge out of the woods and into my Cabela’s.

Today I saw a patient with back strain who encountered a similar problem.

“Hurt my back.”

“Oh?”  I replied, trying very hard to be interested in yet another low-back pain problem.

“Pulling a bear out of Porter Crick.”

I looked up, interested without trying now.  “Like, a bear? You mean with claws and fur and omnivorous urgings and the hibernation thing?  That kind of bear?”

“Yep.  Reared up while we were deer-hunting.  Stood about 6 feet.  Took him down with one clean shot.”

“Holy crap!”  Oops.  Professional, professional.  Be PROFESSIONAL, stuipd!  “Jeez, how’d you get him out of there?  And, on a non-medical note…were you a little worried about getting your face swiped off?”

“Yeagh.  Poor bastard was coming right for me.  About 50 feet off.  He had a bee up his arse for some reason.”

“So, once he was down, what did you do.”

“Me and Jake field dressed ‘im,”  I nodded approvingly at this…I can only imagine what the heck it really is…maybe try wikipedia later.  “Then we dug some motorcycle straps outta our packs and pulled the critter by his paws.”

“You pulled him by straps from his paws,” I repeated, acting normal but thinking of No Country For Old Men. “How far?”

“‘Bout 8 miles.  Through brush and trees.  Plus our guns and packs and all.  Bear was about 400 lbs.”

“Good GOD, man.”

“Yep.  Well, whadda ya gonna do for my back, doc?”

“Pretty much nothing, dude!  Anybody carrying a 400 lb. bear out of the backcountry is going to have back pain.  And I doubt you’ll listen to me telling you to rest it, right?”

“Wahl I was only comin’ in today because we leave for some elk hunting in Idaho in 2 days and I wondered if you could give me something to help with the pain before I go.”

“If you want to stand across the room, I’ll shoot you with one of those tranquilizers they shoot into elephants on the nature channel.  That might make you woozy, though.  It might affect your ability to shoot safely.”

“Nevermind, then.  I’ll be fine.  Just checkin’ in, doc.”

Don’t Forget the Hat, Dammit!

Our rural clinic recently decided to shut down their X-ray machine for good.  Too huge, too clunky and, frankly, just too darn scary.  X-ray equipment – especially the old stuff of Maytag, Depression, Hoover Dam, Manhattan Project era – weighs in the neighborhood of about a billion pounds.

This one, as The End approached, made this guttural spin-zap clunking sound that could put a frown of consternation on Oppenheimer’s face.  The whirring, clacking mechanics required to create a basic chest X-ray sounded so drastic you could practically see the sun-flare levels of ionizing radiation shooting out of the machine toward your squishy, pithy, helplessly exposed chest.

So, the machine needed to go.  Even out here in the woods, we have our standards.

Here in town, when you need something moved, you call “Buck”.  In a land of trucks, Buck managed to procure just the right one for moving seemingly-solid iron equipment put together along side cotton gins at the turn of the Industrial Revolution.  Stuff like our X-ray machine.  Buck would show up reliably.  Reliably late, but reliably.  If you needed something cleared out on Tuesday, you could expect it gone by Friday.  Maybe Saturday if the creeks are running high and salmon’s on the move.

So, you could count on Buck.  Just don’t touch his hat.

The Hat is one of those tall-front white foam with red nylon netting around the back models.  The proverbial truckers hat.  The netting has grease spots scattered in various places and yet – miraculously – the white part seems to have weathered the years without many significant stains, other than a sweat stain you can see around the brim in the right light.  The bill was folded over so completely you might wonder if the guy felt like he looked out through a tunnel when he wore it.  The logo was of some motorcycle engine company I’d never heard of.

The Hat, one could argue, links Buck’s soul to his physical being.  Perhaps the way to look at it is that Buck’s soul has been clamoring for freedom since birth – as if Buck emerged from the birth canal and, laying there in all the slimy glory of new life, his soul looked around and shrugged, “too bright and loud out here, let’s go back.”

Since then, Buck’s restless soul occasionally makes a run for it straight out of the top of his balding head.  Just as it clears the final layers of his scalp, ready to emerge gloriously from a few remaining scraggly scalp hairs, said soul rams into a greasy once-red netting that contains just the right amount of “give” to cause a whiplash, thus flinging his itinerant life force back into his head and, sadly, back into mortality yet again.  Sorta the rural America’s version of Sisyphean existential back-country angst.

So, you can understand why, perhaps, Buck went into florid cardiac arrest when his hat was knocked off as he moved our multi-ton ancient X-ray equipment.  Right there in the back kitchen, Buck dropped to the floor with crushing sub-sternal chest pain.

Hurriedly wheeling our (also quaintly dated) EKG machine over and sticking the little suckie cups on his chest (old timer docs know these machines well) revealed not only ST elevation (bad) but tombstoning (real, real bad).  Buck’s heart was dying…and Buck was soon to follow.

As quickly as it can happen in these parts, an emergency crew was summoned and Buck made his way to the hospital a few towns away.  Unnoticed by any of us, Buck’s ever-important hat lay forgotten, crushed (even more than usual) and forlorn on the floor near where the EMT crew unceremoniously scooped him onto a gurney and into the ambulance.

Early the next morning, before our first patient, suddenly there came a tapping, as of some one gently rapping, rapping at our back door. `’Tis some visitor,’ we muttered, `tapping at our back door – Only this, and nothing more.’

Our back door, the one that opened to the kitchen, the kitchen where Buck collapsed yesterday, leaving The Hat.

And there he stood.  Buck.  Pale, a little weavy, back in his denim.  “Come to git my hat.”  He said, looking squarely at the 3 of us staring fish-faced at him from the doorway.  One of us fumbled around the kitchen until we found the precious object; numbly handing it over and feeling strangely guilty.  “Thanks.  Guess I’ll get on back to the hospital now.”  He said, his entire head visibly relaxing as he pulled The Hat into place.

Shortly after, we received a call from the hospital, “Your patient, Buck, left the hospital early this morning,” squawked a voice on the line.  “He pulled out his own IV’s, his foley catheter (NOT pleasant if done yourself) never got his cardiac catheterization and we’re not even sure how far his cardiac enzymes have elevated because the 3rd set haven’t even been drawn yet.”

After suggesting that Buck would, it appeared, return to their cardiac ICU – hat in hand, as it were – we hung up the phone to see if he’d made it out of the parking lot.  Sure enough, Buck was slowly climbing back into his truck.  A moment later, it rumbled away, a dull red spot just visible in the rear window, driver’s side.

(Note:  Much of this story embellished for fun, and to protect “Buck” from vicious small-town rumors.  But The Hat and Tombstones are God’s honest truth)

Why No Doctors in Them Thar Hills?

‘Cause there ain’t no money for ’em…that’s why.

By ‘hills’ I’m implying rural America, and unfortunately, most people living there pay for doctors through medicare.  As I’m sure you’ve heard, this lovely Guv program pays less than cost in many circumstances, which is a great primer for how to go bankrupt, but isn’t a good way to keep doctors around.

In general, there are many doctors who would gladly forgo the demand for actual dollars as compensation for their years of training and constant hard work.  American history is full of examples of small-town country docs accepting cremed marmelade and a basket of Emu eggs as payment for little Dirk’s delivery and circumcision.  Those days are disappearing, of course.  The reason for it is actually quite simple:  Medical training today costs close to 8 yearly incomes of an average middle-class American family.  In rural areas, where most families are hovering at the poverty line, training a doctor would cost roughly (emphasis on rough) the entire yearly salary of 3 low-income rural families for 8 solid years.

Few can afford this, of course.  Especially altruistic types, who tend to be broke in the first place.  So would-be doctors these days go into debt for the money.

And then the banks come callin’…and they aren’t happy with 3 chickens and a haircut every month for the next 40 years.  They want cash.  Bear in mind that Uncle Ebeneezer will at no time recognize concepts like “quaint Americana” or the notion of “civic duty”.  Civic duty to your average banker consists of leaving only one desk light on at night…the one illuminating the stunning windfall of interest payments soon to be arriving from the hapless big-hearted doc in Flish, SD.

“But!”  Our wise Guv exclaims, “Let’s institute loan repayment program! We’ll make it available to doctors who are willing to work in areas we will designate as ‘under-served’.  We’ll offer HUGE sums of loan-repayment money.  Something like $20,000!  Who can resist that?”

Great idea.  Except that every great idea from government has to be governmented, which then quickly turns it into a really stupid idea.  Governmenting.  It’s my new invention.  I’ve transmorgified a noun into a verb.  Since it’s my invention, I get to define it: 

Governmenting, v. – The act of taking a perfectly reasonable idea that could benefit vast swaths of Americans, endorsing it, and then subjecting it to a kaleidescopic array of regulations, bizarre armchair ethics, vague definitions and hyper-polysyllabic word definitions such that the initial idea is not only forgotten but dwindles into laughable obsolescence.

Yes, the Guv offers an average of $20,000 per year of loan repayment.  Sounds fantastic, right?  Except that the average doc owes $250,000.  “Quit complaining, you brat!”  You might exclaim, “It’s pretty good money even if it’ll take you awhile to pay off the loans.”

Actually, that’s true.  Some people work an entire year just to pull in around $20,000.  In fact, docs are still occasionally heading for the hills with just this argument ringing in their ears.  As he drives down dusty I-90 toward the incomprehensibly-named “Crow Agency” Montana (leave it to the Guv to name a town an agency), young Dr. SW thinks to himself, “Hmmm.  250k divided by 20k equals 12.5 years.  Working out here brings me substantially less in yearly salary, so that 20k will be all I can contribute to my loans.  But 12 years.  That ain’t bad.  I can take it.  Nice view, after all.

But here’s the problem…the REAL problem with Governmental loan repayment programs.  It’s very simple.

The repayment is taxed.

The English language is too limited to describe the stupidity of this.  The same entity that gives the money takes it right back before the hapless doc – standing in his new Wrangler jeans at the bean-mash and Chevy show – actually gets to pay those loans.  And the entitiy who paid the loan doesn’t think of themselves as the same as the entity who is doing the re-taking so they often don’t even mention this taxation concept to docs before they sign their contracts.

To someone’s credit (no idea who), they’re coming clean recently about the taxation issue, inserting a disclaimer into their recruiting material.  Jammed forgettably into the back of the glossy packet I received extolling the virtue and adventure of working on the frontier, was this:

Participants in the LRP (loan repayment) will be paid up to $20,000 per year for signing a 2-year LRP contract and agreeing to serve full-time clinical practice at a designated Indian health program priority site in the United States.

It should be noted that LRP benefits have been ruled to be subject to FICA (social security) taxes.  This means that 7.65% of the loan repayment amount will be withheld and sent to the SS Administration.  Additionally, 20% of the LRP contract amount will be sent directly to the Internal Revenue Service to assist in paying the additional income taxes incurred as a result of participating in LRP.

This means nearly 30% of a doctor’s loan repayment grant is re-taken before it can be applied to the actual loan.  And remember, the base salary of rural docs is significantly lower than that of city counterparts, so the grant repayment is important.

The system needs repairs on many levels.  Universities need to charge less (maybe landscape less or something).  Banks need to make funds available at less profit.  Training needs to be shorter – everywhere else in the world, doctor training is 6 years after high school and then residency.  In the U.S. the training takes 8.  And a big part of the solution needs to be Government programs that are genuinely viable, moral and rational.  The current system tricks doctors into taking low-paying jobs in distant lands and traps them there by helping them with much less of their loans than they expected.

There’s lots of things that need fixing, but one of the first should be to stop all the governmenting.