fromanyalley

In this little part of this little place people, like people everywhere, get sick or injured. Unlike everywhere else a doctor or physician’s assistant or nurse is not just up the street or a few blocks down. Here they are concentrated in health-care hubs, which means towns of approximately 4,000 to 6,000. It also means there is a hospital in the town and various free-standing clinics.

There is not a lot to lure a shiny and bright new physician to this empty little space in this empty little state. Money seems to be the big thing. Help for payment of loans, a guarantee of low-interest loans to start their practices, or free office space are all part of the package. And the young doctors bite. They are not all the favorite sons and daughters of incredibly wealthy families. Some of them had to scrape and sacrifice to buy the best education they could afford. There is no harm in any of that. A rural state is offered the services of well-trained, intelligent, good-hearted physicians. They are helped along financially. Everybody wins.

Almost.

In the last ten to fifteen years an alarming trend has emerged in the local medical community. Junky doctors. Not bad doctors, or crappy doctors. Doctors who are junkies. They come from the pool of younger physicians. They are, by and large, personable, attractive, bright young men (no women yet, but that will come along), who appeared to be set for a life of service and the material accouterments which an income far above the average can bring. They were married, many with children. They drove very fine cars or SUVs, lived in the best part of town, made friends easily and were given a great deal of respect. Doctors in small towns are always respected and constantly gossiped about. However, when your friend accidentally shoots you in the back with a .300 H&H magnum while hunting, or a power take off takes off your arm up to the elbow, doctors are pretty handy to have around, and then gripe about, especially when the bill comes due.

The younger doctors, those who have yet to entrench themselves in the community, walk a fine line. They are expected to be perfect, and are fully expected to fall from grace. The doctor who just recently had his hands in your guts up to his wrists is the same sonovabitch who should be horse-whipped and run out of town on a rail when he does not live up to the impossible expectations of the community. That also goes for his kids and his wife.
Being a small-town doctor is not exactly easy. Going to the super-market becomes a real challenge when everyone and I mean every single person wants to stop and talk or complain, or, weirdly, pull their pants down five inches below the belt-line to show you exactly where it hurts. Add to that the day-by-day demands of being a doctor making true life and death decisions and you have a man, or woman, who is worthy of respect. They may not be the nicest, or even the kindest, but they do a job which becomes their lives, and the lives of their families, and their patients’ lives as well. To watch even one of these highly motivated, intelligent, highly skilled young professionals burn themselves up is not a thing to celebrate. It is, in a sense, a time to mourn the loss of a potentially life-saving citizen. There are not that many doctors in the health care hubs, or in the entire state. To lose one is to lose too many. To watch them go through the loss and the muck of being a junky is at best painful.

In the past decade this small little area in this small little state has watched highly competent, good men make the most horrible mistakes. These young doctors do not have the cunning or the street savvy to actually be successful junkies. They have so much to lose. The average street junky is a dumpster-diving, system-manipulating, scam-artist. The street addict wears as many masks as he can. The average young physician is absolutely diametrically opposed to any and all of that.

Which is precisely why they fail at being junkies. That is not a criticism. Just as this is not a slap in the face of the medical professionals. This little area which is of little consequence nationally has, however, seen much more than its fair share of young doctors pilloried in the local press, and then tossed into the gaping maw of the legal system. There are drunks and lunatic junkies in every walk of life, farmers, teachers, bank presidents, auto-body repair shop owners. They, however, have figured out, for the most part, how to safely and illegally score the drugs they want to score. They have to spend a certain amount of time and a great deal of money. They know they have to be duplicitous and conniving. That is all part of the deal. The actual street junky knows that better than his own name, which begins to fade into the flushing urinal of his brain. He doesn’t forget his street-smarts, however.

The young preppy peppy doctors who want to be admired and who want to be legends and who want to have public affection are the worst junkies. They do so very little to hide it. They work with people who are trained to notice things, like a stoned colleague. The nurses, many of whom are up to their powdered little noses in junk can spot a fellow user three floors down. The nurse’s aides for crying out loud know when someone is high, or has been high, or is thinking about getting high. A junky doctor, once he, or she, begins to exhibit any signs of a junky, no matter how minute, is fucked. The doctor may keep going, but he, or she, is leaving a trail of needles and ampules even a coked-to-the-tits local cop could follow.

The worst thing is these junky doctors invariably take the junky-mess outside, to people who are minor civilians. These minor civilians are invariably caught up in doing some of the most illegal things in the most stupid way known to all of crooked mankind. The junky doctors more or less employ these mutts to help them, the doctos, maintain their own addictions and they do that by giving the mutts a taste of the product, or money, or both.

JesusMaryANDJoseph that shows the junky doctors are babes in the woods. They get mixed up with assholes and expect to have everything on the down-low. The assholes in the mean time are fucking up royally all over the place.
The local cops, god bless ‘em, finally stumble on to one of these jokers and the first thing to happen is the asshole rolls over on the doctor, no questions asked, as fast as he can roll, and he continues to roll until he is given the deal of a lifetime: immunity. The doctor is the Big Man, the asshole is just, well, the asshole, and the local State’s Attorney wants the Big Man for the Big Show.

Doctors do what they are trained to do, and see what they are trained to see. For those of you who started out with an otorhinolaryngologist(ear-nose-throat) guy and wound up with a proctologist(asshole) guy and are now on your way to a podiatrist(foot) guy, you know that you will wind up with a shopping-bag full of diagnoses, treatments, and recommendations. It has to be something like a through-and-through gunshot wound before there is an agreed upon malady (Fucker’s been shot) and an agreed upon remedy (Fucker needs to be sewn up). Even then it gets tricky if they let an internist in on the deal. (Fucker needs twenty-two different tests and he’s gotta dump in a jar before we touch him.)

When the doctor then immerses himself in the murky world of the criminal, he sees himself as being the goodguy. He cannot think of himself as a badguy. That goes against everything he has been taught, and all he believes. Even the criminals become just “good guys.” They KNOW how to party and the doctor is always treated with a drug-induced reverence because he has the keys to the kingdom–a script pad full of goodies and dreams come true.
Then the badguy rolls over on the doctor, who loses everything and winds up in a fed pen doing twenty to life, while the badguy, who has committed many more crimes, and many worse offenses, packs it up and heads for Arizona.
This is not an excuse for the doctors who became idiot junkies. They held our lives in their hands. Why they became junkies is not interesting. The fact that these bright and gracious and potentially very good young men, and yes, women, became junkies is what is interesting.

Out here, unless one can afford to drive to what is known as The Cities (Minneapolis/St.Paul) or to Mayo, one is pretty much stuck with the doctor who walks in the door of the examining room. That doctor can miss an abdominal aneurysm which will burst four hours after his patient leaves the clinic, meaning the patient will be dead a couple of minutes later, or the doctor will see a small spot on the forehead and save someone’s mother from the agonizing death of skin cancer. Because we have a restricted choice of doctors each one rises in level of importance to each and every one of us.

Fairly or unfairly the doctor in a small town will be judged, most often wrongly from spite or jealousy, but judged the doctor will be. He, or she, has bought the ticket. He or she must take the ride. Or get off and walk away. The choices exist and must be made or people will suffer and they will die.

I write this for all the good young men who have made the wrong choices and who are now paying the heavy toll. This piece is especially for a young man I admired and trusted, J.D. He was one of the smartest, most skilled physicians I have ever know. I wish him the very best.

I also invite the physicians who are actively engaged in feeding their addictions to remember the first line of their oath,”First, do no harm.” If you are a junky/drunk doctor you have to go. We live in a little place in a little state. But we deserve the best health care we can get and we work to secure and keep good strong medical personnel. Do not kill us or misuse us. The doctors I have written about have stopped being a threat to others because they have been put in prison or have been exposed and can no longer practice. I do not worry about them. I worry about you, the ones who are still out there.

And we know, we know you are still out there.

Hell may be many things, but it is not repetition. Hell is the same people, day after month after wearying, horrible year. This year was terrible…and the next will probably be worse. Hell,(Virgil and Dante aside) is populated by every malign, malicious, self-centered, cupiditous, concupiscent cut-throat abomination who has ever crossed your path only to make your life even more miserable than it already is. And to take something from you…love, knowledge, compassion…and turn that into something so incredibly foul and disgusting as to be completely unrecognizable. They beat plowshares into swords. They rape and plunder the helpless, hopeless, voiceless who are taxed beyond all measure by the avaricious and the smug, the sanctimonious and the self-righteous. From the original school-yard bully through the not-so-closet pedophile of a right reverend, through the hundreds of flabby, pig-eyed pukes wandering aimlessly around SatanMart with a plastic, tricked-out name tag announcing their direct lineage to Genghis Khan, they repeat and repeat and repeat. Not in dreams, which can be washed and deodorized by the various legal and the casual drugs we swim in. These monstrosities appear as fully formed, solid entities, taking up air, parking-spaces, that stool at the end of the counter with a red cracked plastic seat. The one you sit at EVERY morning. The grotesques are everywhere you want to be. They get there a few nanoseconds before you, and then look at their watches, tap their feet, assume that looking-down-the-nose posture and proceed to flat-out fuck with you in every way imaginable for as long as possible.
And, and!, there are always at least two. Because you might be a 5′1″ 97 pound 23-year old single mother of two (eighteen months and four months respectively) and you may have just recovered from an end-over-end-over three cows and a cultivator, and your scuzzy boyfriend may be stalking you night and day, it doesn’t matter. You ARE the enemy. You scare what little reasoning power those hideous excuses for humans may possess completely out of their square, cement-block skulls. There are two,( in my case either two very large ones or three little broke-dicks, all called Fred), in to do the job, because they know they are about to be bad human beings. They are going to do something wrong to someone. And the fat gonadless wonders, who thought they were going to be NFl stars, or the buttugly mobile sperm receptacles who just KNOW they could sit and chirp on the View, sweat masochistic bullets while they attempt to mindfuck you because they fear that you can see right through them, and will one day announce to the general world, “That guy, that tank of shit, and that brainless lardbutt alcoholic who is trying desperately for the honor of being the town pump,(known as AssmessAndrun to one and all, which is to say, many at once) are the weakest, most revolting, disgusting, vile, worthless pieces of cosmic trash to ever appear on the face of this earth. They make Jeffrey Dahmer look like somebody you would want to invite over for dinner. They will cut your throat, stab you in the back, blackmail, coerce, and terrify by animal cunning and skulduggery simply because they are so stone-cold scared, so infantile and so nauseatingly proud of their fundamental ignorance. They hate those who are capable of original, authentic thought.”These rapacious, spineless cowards only respect power– cruel , unvarnished, unrestrained power. Civility is for them a con game and revenge is their one true motive for action in a crowd. They are by any and all measurement absolutely worthless.
And they are not brave enough to be truly evil. They are merely the waste products of evil. They are the turds of true evil left behind to foul the atmosphere and stick to the soles of your shoes. They are the same ones you keep seeing, meeting, working with, working for, attempting to avoid, trying to run over and make it look like an accident which was all their fault. They mean nothing. The puny little gutless wonders who invented erectile dysfunction, the pitiful overaged, garbagegut jock suffering from a near-fatal case of cryptorchidism, the tank-of -shit bullies, the brainless, arrogant, self-pitying ground-pounders who missed being ho-of-the-year by this much, all repeat and repeat and repeat in your life. They literally spew out of the mouths of their wretched little hells and demand to be feared, loved, liked, adored, worshiped, blown, elected, married, and treated like gods who stride this miserable planet with purpose, conviction, power, strength, and the grace of pure, elegant thought.
Hell is never repetition. Camus’ Sisyphus found meaning and purpose in the boulder and the hill. He found success in denying the pitiful who feed on vengeance and the pain of others. He continued to roll his boulder up, follow it down, roll it back up, because he had made it his boulder. His meaning was to never allow the cruel, the ignorant, the unjust, the arrogant, the immoral to ever push him into the insanity of those in charge– those who live by their Master’s cruelty. Sisyphus found the honesty at the core of meaning, and did not back down. He remained unique, authentic, and true.
The heaps of shit masquerading as human beings are forever tied to their Master. They are colorless copies of evil, of the Lie which is the black, beating heart of all true evil. They will squander the time, empathy, compassion, money, and love of the authentic people around them. Then, bloated with hatred and malice they will find their own boulders waiting for them, meaningless and agonizing. True evil, the real evil, is at least unique and frighteningly powerful. Those copies, those repetitions do not and cannot even console themselves with that. They have boulders to move, they have fetid pools of self-pity in which they will wallow and whatever wail they might send up will be lost in the noise of the Lie as it seduces and betrays and brays to the skies.
I write this for Matt. His boulder and his hill have depths of meaning which give him true power. He is a graceful and elegant thinker disguised as a thick-fingered fist, slamming counter-tops and the hoods of ancient Blazers. Every single goddamn day he stands up to those who are the filthy leavings of evil to protect those who cannot, or out of fear for themselves and their children, will not. He does not care what any one thinks of him; he cares that they think at all. He will champion and sacrifice and burn as a branded heretic, and the ones he defends will hate and desert him. He knows, and he goes on. The big fucking rock is Matt’s boulder. He owns it. The hill is his and he will occupy it. His courage is this: everyday he will push the same boulder up the same hill. But for a moment, the time is takes to tell one truth, he will be happy.
Then the boulder rolls back down and my brother Matt, a tired silhouette in the face of the sun, will walk behind it, head down, thinking of that one instant when he knew he had done the right thing. And winner takes nothing.