NOT QUITE FAMILY
Small rural hospitals are quite different from the big institutions I’ve known in cities. A complex and personal story has unfolded here since I came in 1999. Dr. Robert Clary DO is key to understanding the Marias Health Center. This newspaper article explains a bit.
In the early 2000’s, when a round of trouble with Dr. Clary began, I was on unemployment and asked to apply for the job of ward clerk at the Marias Center, which specialized\ in older patients. some with dementia.. If you don’t take these job offers, you lose your unemployment. The clerk at the time was Mary Maxwell, a former lab technician and crackerjack ward clerk. She had worked so hard that she began to have symptoms and her doc asked her to take leave for a while. That was me — I was the leave. Before Maxwell they had never had a really good clerk and I was only marginally good enough. Three others applied and none qualified.
One entered through the nurses’s break room and Mary always cleaned up and restored order when she came in. No nurses did this. One wall was a big blackboard. In addition to formal records, Mary would record new patients in a circle she drew on the blackboard that included their needs. The nurses went by these circles, but I could see no order. or system so people felt I was doing the wrong things. On the time I was there, new software programs were acquired but none were easy to use. This continues.
In those days the border was not closed and many nurses were “travel nurses” from Alberta. Someone had given the hospital a house where these women could stay. They were bonded friends. In addition were local women who sometimes served the nearby prison. Janet, the pharmacist, was high quality, fair-minded, alert. In addition to her was a specialist working on the claims indicated by medical coding. This was risky enough in terms of law suits that she kept a lawyer on retainer all the time. Both have retired by now.
Community secret edges included an instance where a little circle of renegades shared drug needles, their bodies, and booze. Effective treatment for Hep C was just starting but never caught up. These people had a super-mutation of Hep C, “galloping Hep” they called it. One person had a “bad cold” and within weeks they were all dead. This is all “nurse gossip” — no media. Shelby is a port city with a highway running north-south and massive traffic flow east-west on highways, river and railroad. Diseases travel.
Some nurses were exceptional. The Center was built in a closed circle so one day Maggie Nutter, who was also a rancher, brought a calf and let it play all day in the yard where the old former ranchers could enjoy watching.. She has left nursing and does ag politics now. It’s hard to realize that so much has changed in a decade or so.
Dr. Clary had been instrumental in forming the county hospital in the first place. He was a DO rather than an MD and not just old-fashioned, but a bit of a throwback. One friendship circle of important men in the town backed him with total trust. Others found him out-of-date and objected. This is probably a common pattern in small local hospitals.
Finally the state intervened and questioned the whole setup. There was so much trouble that Dr. Clary simply moved his practice to Cut Bank and continued. He practices in his own cliinic. Now that Logan has taken over so much, Glacier Community Health Center persists as independent in Cut Bank. Some doctors followed Clary. Other whole groups left. The situation is complicated by the demographics on both sides of the rez border. The tribal people have an Indian Health Service hospital but do not trust it.
Pondera County Hospital has a similar situation to Glacier and Marias. Logan dominates them. The rival is Benefis, 80 miles away and very different in culture than Kalispell where Logan management is centered. The east side of the Rockies is more connected to the Pacific Coast. It is harder to cross Marias Pass from the high line towns in winter through the Rocky Mountains than it is to drive a long way to Benefis. At the moment there are 10 cases of Covid in Pondera County, double from last week in a population of 3,000. Great Falls, Bozeman and the Flathead valley have been and remain hot spots with over hundred cases daily. This will increase.
Pondera has an aging, rural conservative citizenry. An increasing number of people moving in are more right-wing, runaways. Some are city people who don’t know how to do anything but demand.
It’s very hard to have sciatica, as I do at the moment, because I can’t drive and almost everything here is dependent on driving, almost like California. UPS brings my cat food. No one removes the results. There is no social worker interface who checks on people. City people have no notion of all this. The little grocery store brings groceries. I have one friendly and respectable neighbor but they are snowbirds.
This was meant to be my safe place. It mostly has been exactly that, but there are times now when I’m terrified. We all are.
