Sarah takes the clipboard and paperwork the desk attendant abruptly hands her, walks to a seat in the waiting room, and breathes slowly, trying to calm her heartrate. She has dreaded this visit. She looks around, hoping to connect with someone friendly here, but no one makes eye contact with her. Sarah’s new in town, and her body’s been telling her that her blood pressure’s been far too high since she moved here.
She settles into a seat in the waiting room and looks down at the first sheet on the stack of papers she’s been asked to complete. First set of questions is about drug use. Huh. She flips the page. Second set of questions is about alcohol use. Really? Flip the page again, and the third set of questions is about her mental health history. All before you get to any questions about her name, her address, or the reason for her visit. She puts the pages with the screening questions unanswered under the rest of the paperwork. The seemingly constant fear of punishment here sits acidly in her gut. She begins filling out the other, more familiar forms.
“The doctor said I need to take two of these in the morning without food.” Sarah looks up and sees the slightly slumped back of a male patient standing at the front desk. He’s talking to the woman seated behind the desk.
“I don’t think you understood your doctor. He wants you to eat before you take the medication.” The woman’s voice is hard with authority, forcing attention. Everyone in the waiting room can hear this exchange.
The patient quietly responds, “I think the nurse told me the doctor said I need to take them on an empty stomach.”
The desk attendant’s hard tone gets loud and final: “You don’t understand. Do as I say: comply, and you’ll be fine.”
The patient tries one last time: “I think that might be wrong.”
The front desk woman has begun looking at papers in front of her and ignores this response. The patient waits a beat, ready for acknowledgement of his concern about the drug protocol. The woman at the desk looks up, avoids eye contact with the patient, looks past him, and spits “Next,” to the ceiling and to no one waiting in line.
The patient, slumped over from the beginning of the interaction, shrinks even smaller and walks away toward the exit door. Sarah notices many in the waiting room share that slump. When the door closes behind the departing patient, the room is silent except for the copy machine on the corner of the front desk sliding out replicas.
Sarah finishes her paperwork, puts on a smile, and walks to the front desk.
“Hi! Thank you for fitting me in! Not too busy today?” she offers, making small talk to connect.
The front desk woman takes Sarah’s clipboard. She doesn’t make eye contact with Sarah. She ignores the small talk, and Sarah watches as it splats, lifeless, on the desk between them. (It is only one of thousands of little deaths of human connection she’ll experience in this culture.)
The gatekeeper begins looking at the forms Sarah’s filled out on top. She flips through to the blank drug use, alcohol use, and mental health forms at the bottom. Sarah feels the grip of anxiety, making her stomach clench again. (It is a familiar feeling that has not left her body since she moved to this rural place.) She is painfully aware that this is her only health care option.
The woman seated behind the desk looks up at Sarah, openly apprises her physically, and decides to ignore the noncompleted forms.
“We don’t have a doctor on staff who can help you, but you can see the day nurse. Take a seat and we’ll call you when he’s ready,” she states with finality.
Sarah sits, breathes again, trying to calm her body. Her heart is starting to race with the feeling that her health is in hands that keep all the power for themselves. She feels like she’s not safe here; that her well-being is not the objective like it was for her back home. She’s used to office staff, nurses, and doctors who talk to her, who put her concerns at the center of their practices; who respect her and value her privacy. She is used to professionals who share their power with her by making her good health the objective of the interaction. She’s used to professional communication structures that focus the interaction on that goal. That’s normal for her. She is blindsided, finding these unhealthy power relations in a health clinic. Being blindsided in this culture is becoming routine for Sarah.
She’s called back to meet with Dan, the day nurse, in a private room. This is Dan’s second to last day. He seems unfocused and very hyper.
“Hey, okay, we need to take your blood pressure!”
“Yes! Thank you so much! I think it’s been really high. I’ve been waking up with a racing heart at 3:30-4 o’clock in the morning every day. I need a blood pressure read and to discuss my meds with the doctor. I’m new here, so I definitely need to get set up with the doc.” She hears her voice pretending to be in a safe place, trying to create that safety out of thin air and desire.
“We’ve got a pediatrician in back who can’t see you, but he gives me advice. Here, let’s do this. Follow me.”
Sarah has no idea what any of that actually means, but she is without her own blood pressure monitor, and she needs a reading from the one here. She has no choice. She follows Dan back.
She was right: her blood pressure reading is 228/118. Dan starts shouting. His face and bulk are about 2 inches above and in front of Sarah’s face as she sits in a chair below him.
“Oh, hell! Your blood pressure is so high! We have to get you out of here! You need to go into the city, to the hospital! You could get a brain hemorrhage! And if you’re here, we’re liable! We need to get you out of here, now!”
Her brain is frozen. Her whole body feels frozen. In a flat voice she has never heard before, she tells Dan to try to calm down, to remember who the patient is, that she’s here because her blood pressure is 228/118 because of stress. Sarah tells him that his freaking out isn’t helping lower her stress. He’s backed up a little from her and has stopped yelling.
Sarah hears the voice of the man who must be the pediatrician shout from a back room; he calls for Dan, and Dan seems annoyed. He stalks out of the room. During the 3 minutes or so he’s gone, Sarah weights her options. If she has to go to the hospital, what will she do about the kittens? Will she be able to drive herself home? What if they find something worse, what then? She is socially isolated here and has no one to call who could help. She is very aware she is breathing harder and beginning to panic a little.
When Dan returns, he’s calmed slightly, and he has a Clonidine tab in hand. He stands too close to her again.
“Okay, you need to calm down,” he starts.
She almost laughs, but stifles it knowing it’s going to sound a little unhinged. She also knows that she has no choice but to put her life in these hands. She has no choice. And laughing at Dan will only make this worse.
“Take this, lay back, and breathe. I’m going to turn off the lights. I’ll be back in 30 minutes.”
She holds out the palm of her hand and he drops the little peach pill onto it. Dan says nothing, turns, walks to the door, flips the light switch, and closes the door. Sarah feels around on the floor for her water bottle, knocks it over, finds it again, and swallows the pill with a long draught. She didn’t realize how dehydrated she had become. She also takes 10 very deep slow breaths, each settling her into this new rural health care reality.
Maybe the stories were true, she thinks as she lays on the crinkly white paper in the dark room, in a world an eternity away from home. Maybe the whispered stories–about how the health clinic in this town is killing people–were accurate.
 “Sarah” (Cathy) lost the cord to her monitor in the move, there is nowhere nearby she can buy a replacement, she’s too rural for mail or package delivery, and the P.O. box in town has been broken into twice. Self-observation is her best “choice.” It is the first of dozens of DIY rural health care “choices” she’ll be forced to make.
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First Rural Portal Project edition anticipated January 20, 2020 in honor of Dr. Martin Luther King, Jr.
The Center for U.S. Rural Cultures Studies is an Accelerate Publishing project. Accelerate: A Niche Publishing & Communications Consulting Co.,–est. in 2015–is a socially just for-profit small business in California.