Chapter 7 Transcript
Editor’s Note: If you are able, we encourage you to listen to the audio of Where It Hurts, which includes emotion and emphasis not found in the transcript. Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.
[Segment 1 — 0:05]
SARAH JANE TRIBBLE: Dr. Maxwell Self is sort of giddy. He's been a family doctor in southeastern Kansas for more than 20 years. But it wasn't until recently that he began to feel like the captain of a starship.
DR. MAXWELL SELF: Kind of like Jean-Luc Picard. And I just say, “Make it so, No. 1.”
SARAH JANE TRIBBLE: Dr. Self used to work at Mercy Hospital Fort Scott. It was the only hospital in this small town. Now he works at the Community Health Center that opened after Mercy Hospital closed. The clinic occupies a portion of the same physical space as the old hospital. But here, they do things differently. Doing his same old job, but in this new place, means these days the doctor gets something called a scribe.
DR. MAXWELL SELF: And what that means is that I don't have to type anymore. OK? So, I get to focus on people. Right? And do what I do best, which is think. And talk. And smile and shake hands.
My new job description is more of like a celebrity. You know, walking out of a room, shake hands.
SARAH JANE TRIBBLE: Eliza Oliver has brought her toddler for a wellness check. Taelyn is a bit shy. But she's watching the doctor carefully and has a smile at the ready.
DR. MAXWELL SELF: Can you say “ah” for me first, and then I’ll give it to you? “Ah.” Open for me. And then I'll let you hold it. Look at that.
SARAH JANE TRIBBLE: Taelyn is 2 years old. Big brother Korbyn leans over to his sister and shows her how to say ‘”AAAH” for the doctor.
DR. MAXWELL SELF: Oh, perfect. Oh, there you go. There you go. So that's fantastic. When you have — yeah, when you have a big brother that can show the way, you're golden.
SARAH JANE TRIBBLE: Dr. Self is paying close attention to what they say to each other and to him.
DR. MAXWELL SELF: You got good-looking shoes.
KORBYN: These are boy shoes.
DR. MAXWELL SELF: You betcha. So any, any, any other thoughts, concerns? Questions?
ELIZA OLIVER: Um, no. I don't really have any concerns for her. She hasn't been sick or anything and she does really good sleeping well and everything like that.
SARAH JANE TRIBBLE: Watching Dr. Self and his staff taking care of patients helps me realize something. Fort Scott may have lost its hospital, but the town didn't lose all of its health care.
AMANDA HARPER: Strawberry? Or this one is raspberry.
KORBYN: Uh, that one.
AMANDA HARPER: OK, you can have that one. And which one did you want? That one?
KORBYN: Thank you.
AMANDA HARPER: You're welcome. Bye, cuties. See you in six months.
SARAH JANE TRIBBLE: The Community Health Center of Southeast Kansas is the biggest health care news in Fort Scott. The health center moved into town and is filling gaps. Providing care in ways that the hospital never could. But there is health care still missing. We can't forget some of the people we've met who ended up worse off when Mercy left. Struggling financially. Trying to get emergency care and cancer treatment. And there's one more big thing that nearly everyone here worries about. There's no place to have a baby in Fort Scott. I asked Dr. Self …
Did you deliver babies here?
DR. MAXWELL SELF: For 10 years, yeah.
SARAH JANE TRIBBLE: So what about that? That's gone.
DR. MAXWELL SELF: That's great. A great question. Umm ...
SARAH JANE TRIBBLE: So … I'm off again. To find answers. I'm Sarah Jane Tribble. This is Where It Hurts. Season one is “No Mercy,” a podcast from KHN and St. Louis Public Radio.
[Segment 2 — 3:38]
SARAH JANE TRIBBLE: When I meet Barrett Beckham, he's so quiet and sweet. Barrett’s just a few months old, and as his eyes flicker open, it's clear he's hungry. His mother, Sherise Beckham, and I have been talking about Mercy Hospital.
So, what was your thought process when you heard the hospital was closing?
SHERISE BECKHAM: Well, initially, I kind of was twofold why it really upset me. Initially, I cried a lot because I would be losing my job as well as losing a place to have my baby.
SARAH JANE TRIBBLE: Sherise Beckham lost her job as a dietitian at Mercy Hospital Fort Scott when it closed. At the same time, she was expecting Barrett. He's her second. Sherise's first child, Warren, is about 2 years old. He was born at Mercy, and there couldn't be a bigger difference between the two deliveries.
Sherise turned out to be my guide for two things. Understanding how much more difficult it can be to have a baby when a town loses its full-service maternity care. And later, when she gets a new job, she gives me a front-row seat to the new vision for health care in Fort Scott.
It's Friday night at Sherise and Tanner Beckham's house and it's getting pretty wild. Their toddler ,Warren, is bouncing around the living room, racing his toy cars. Sherise is in the kitchen cooking, and I'm in the living room with Dad, Tanner. He and Warren have rigged up a makeshift Hot Wheels track with a board propped up from the top of the ottoman so the cars can fly down to the floor. This is exactly what my husband used to do when our boy was about 2. We still have the cars. Anyway, as Warren plays, his dad, Tanner, tells me a love story.
How did you and Sherise meet?
TANNER BECKHAM: We've actually always been family friends.
SARAH JANE TRIBBLE: This is a good time to note, Sherise's dad is City Manager Dave Martin, the town leader who was so angry that Mercy Hospital closed. Tanner had his first crush on Sherise in grade school.
TANNER BECKHAM: She was a high school cheerleader and actually came over for, like, Tiger Days. So the cheerleaders would come over with the football players and that … ever since then and ever since we were — you know, our parents knew each other and always just ran around together. So like I said, we've just known each other for a long time, so …
SARAH JANE TRIBBLE: Sherise went away to college and came back here. It was a choice. They wanted to build their family in Fort Scott. Their family story feels like something that could only happen in a small town.
Tanner is an engineer for the big window manufacturer in town. After Sherise lost her job at Mercy, she took a new one at the new health center, which everyone calls CHC. Sherise does nutrition counseling. Healthy eating isn't just a professional passion for Sherise; it's personal. I can see that as she makes dinner. I look across the countertop — she has all of her ingredients in prep mode.
So, Sherise, this is all very healthy. You've got cilantro flavoring the rice, you've got black bean burgers with onions, and I think I see some avocado over there. Like, very — healthy.
SHERISE BECKHAM: Yes.
SARAH JANE TRIBBLE: OK, can you send me the recipe for these black bean burgers? They do look good.
SHERISE BECKHAM: I'll send you, um ...
SARAH JANE TRIBBLE: When their older son, Warren, was born, the biggest worry Sherise and Tanner had was how long Sherise should labor at home before going to the hospital. In fact, Sherise was so confident everything was good that maybe she waited too long to go to the hospital. Luckily, the hospital was just a few minutes away.
SHERISE BECKHAM: I had contractions where I could feel my body was wanting to push. So I walked into labor and delivery and they checked me and they're like, “Uh, you're complete. We can see his head.” And so they called the doctor and she ran down. I remember her like running in and her hair was all like wild because she had ran from clinic and they just gowned her up and, you know, we had him. So, that one was really fast.
SARAH JANE TRIBBLE: Warren was born in like 15 minutes.
[2-year-old giggling and sounds of Hot Wheels cars]
SARAH JANE TRIBBLE: More than 230 babies were born at Mercy during its last full year of operation. And there's a tradition in this town of less than 8,000 people: When a new baby is born, their name and picture is posted on a tall sign out by the highway where everyone driving by can see it. There's a tremendous sense of place that comes from being born in a small town. Ask anyone. Me, I'm Parsons, Kansas, population 9,600.
Katy Backes Kozhimannil is a public health researcher who studies maternal health. She says the loss of maternity care in rural America can damage a community’s soul. Hurt people's sense of identity. And it can be deadly.
KATY BACKES KOZHIMANNIL: It's so important that we address the maternal and infant mortality crisis in this country. And my own research shows that rural moms have a 9% increased chance of maternal morbidity or mortality. So dying or nearly dying in childbirth. However, it's also really important that we do better than “Did you not die?”
SARAH JANE TRIBBLE: Katy directs the University of Minnesota Rural Health Research Center. Katy said the research on where women live in relation to obstetrics care is a bit old. 2013. That research found that more than 15% of residents in certain rural areas lived more than 30 miles from the nearest hospital where they could give birth. They lived in places like Fort Scott, in counties where there wasn't a town over the size of 10,000 residents. And it becomes so much more challenging for expectant mothers when they have to plan for travel.
Experts like Katy are watching how the reality of hospital closures and scared pregnant mothers-to-be collide.
KATY BACKES KOZHIMANNIL: When a hospital decides to close its doors or close its maternity ward, the risks that are associated with potential emergencies or medical needs, they don't go away with the hospital. They stay in that community and they stay with the individuals and families that have to sit around and come up with a plan.
SARAH JANE TRIBBLE: There's a lot to plan around. Making sure you have gas in the car. Or even access to a car. Knowing who’s going to watch the other children and worrying about having enough time to get to the hospital when the baby is ready to come — all become much bigger concerns when a hospital is 30 or 40 miles or more away.
KATY BACKES KOZHIMANNIL: That burden is real. It's palpable for people. And the stress of that is really difficult for families as they are planning for what should be one of the most joyful times in their lives, welcoming a new baby, and they're busy worrying about the logistics of how you get to the hospital and if things are going to be OK once you get there.
SARAH JANE TRIBBLE: When Mercy Hospital shut down, Sherise Beckham was just a few months from delivering her youngest, Barrett. His birth would have been complicated anywhere. But the fact that her local hospital had closed meant in the end she and Tanner traveled to three hospitals in two states to deliver one baby. Sherise's doctors still had an office in town for routine prenatal clinic visits, but it wasn't equipped for emergencies.
And just about a month before her baby was due, Sherise was really uncomfortable. The pain in her lower abdomen was almost unbearable.
SHERISE BECKHAM: I just kept thinking, like, it will go away. I, you know, I was like laying on the floor. I laid in the recliner. I laid upside down in the recliner, like thinking “If I can just get the baby's weight off …” But it was just this pain that would not go away.
And, you know, at least with labor you get like a break. And no, it was like worse than labor. Like, I was like almost in tears.
SARAH JANE TRIBBLE: So Sherise's doctor sent her to a hospital in the next town over. More than 30 miles away.
SHERISE BECKHAM: There's, you know, nothing really she could do at the clinic for me at that point in time, since we couldn't really figure out what was going on.
SARAH JANE TRIBBLE: That hospital figured out that the baby was blocking Sherise's kidneys. They sent her a hundred miles north to another hospital, in Kansas City, for more specialty care. After a few days, the doctors there stabilized her and Sherise wanted to get back home, to Fort Scott.
She spent the rest of her pregnancy on bed rest, but she was still uncomfortable and worried.
After that, it was clear that the birth would be complicated. So Sherise's doctor in Fort Scott decided that the best plan was to induce labor. They scheduled the delivery to happen back at that first hospital, the one more than 30 miles away.
Tanner's voice gets shaky when he talks about what happened next. Even after the doctor induced the labor, Barrett couldn't get out. His little hand was reaching out, but his head wouldn't slide forward.
The doctors rushed to perform an emergency C-section.
TANNER BECKHAM: If something would've happened, if labor would've happened naturally whenever we were at home, if her water would have broken just like it was supposed to and we were at home, I'm confident Barrett wouldn't be here with us.
I had talked to the doctors that actually performed the emergency C-section and pulled Barrett out of her and said that “if this would have happened anywhere but at the hospital, I would have been pulling a dead baby out of your wife.” So that was really hard to hear. It was hard to hear him say it like that. So just knowing that if that would've happened … I don't know. That's something you'll just never forget.
SARAH JANE TRIBBLE: Their baby boy had gone without oxygen for at least 11 minutes, maybe 15. The doctor told Tanner …
TANNER BECKHAM: He had said that it was a true relief to hear him cry, because if he didn’t hear him cry — to that point he had thought Barrett, he wasn’t alive. Just because he had gone without oxygen and was just in such a bad state.
SARAH JANE TRIBBLE: Wow. Is that who I hear now? Barrett, in the background?
TANNER BECKHAM: Yes, Barrett is awake.
SARAH JANE TRIBBLE: Seemingly on cue, Barrett wakes from his nap. Because of the lack of oxygen right after he was born, Barrett was sent to a third hospital. He needed neonatal intensive care.
The family spent the first days of Barrett's life at a bigger hospital in Missouri, more than an hour from home. As we finish talking, Tanner goes to get Barrett and I head into the kitchen to see Sherise. The kitchen faucet is running and she's chopping an onion.
There's music playing and I turn around and see Tanner rocking Barrett on his hip. The baby is 7 months old and so alert, watching everything, holding his head up high. Tanner says he used to worry about what happened at the delivery, but now that the baby is hitting all his milestones ...
TANNER BECKHAM: It doesn't worry me so much anymore. He seems like a totally normal baby, from what I know.
SARAH JANE TRIBBLE: That's really all any parent can ask for. I can't help but think about what researcher Katy Backes Kozhimannil told me. She said our measurement of success must be better than “Did you not die?” Sherise didn't die; baby Barrett seems healthy. But the beginning of his life didn't need to be so difficult and full of stress. Not having a place to deliver a baby safely is a strike against any small town's future.
[Segment 3 — 15:24]
In Fort Scott, a big green-and-white Community Health Center sign has replaced Mercy's name on the front of the hospital building. CHC isn't some small health clinic with a few doctor's offices and nurses. This location is part of a big regional health center with more than a dozen locations throughout southeastern Kansas and Oklahoma. Clinics like these are a big part of the solution for rural towns that have lost their hospital. Towns like Fort Scott. I'm here to watch Sherise Beckham at work. She talks about being part of a team of people who put together individual plans for each patient.
SHERISE BECKHAM: I love that, and I love that they push that and they push, you know, us working with the doctors closely and just looking, approaching it as the more people that can touch and reach these patients, the better chance they have to be a healthier version of themselves.
SARAH JANE TRIBBLE: When a patient named Becky arrives, Sherise has a list of questions that help her figure out if the patient makes healthy choices on a daily basis. Immediately, she begins asking what Becky eats.
SHERISE BECKHAM: OK, what about veggies? How often do you eat those?
BECKY: Usually when we have a meal at night — a real meal — we usually do the meat and the vegetable.
SHERISE BECKHAM: OK.
BECKY: I try to stay away from starches and potatoes and all that kind of stuff, but it's hard with little kids in the house.
SARAH JANE TRIBBLE: Sherise gives bits of advice. Make sure the label on bread says whole wheat as opposed to enriched wheat flour. Sherise asks about what kind of milk she drinks and how often she eats fruits and sweets. Becky says her weight sits right at 302 pounds. Becky's doctor sent her to Sherise to work on weight management.
BECKY: I really don't eat. That's my whole problem. I don't understand. I can't. But I don't exercise like I should. Because of my job, I think.
SHERISE BECKHAM: What's your job?
BECKY: I work for SKIL.
SHERISE BECKHAM: OK.
SARAH JANE TRIBBLE: Becky's job is to care for elderly people. Cleaning house and helping them with their daily lives. It's the kind of job that requires her to get up really early every morning. I leave the two of them to talk about changes Becky can make to improve her health. The whole idea here is to meet people where they are and make sure they have what they need to be healthy.
At CHC's headquarters, I hear this play out firsthand while waiting in the lobby. I was eavesdropping as the receptionist toggled phone calls. She was trying to arrange a ride for a patient who needed an appointment. Jason Wesco is CHC's executive vice president. And he tells me they find rides for patients all the time. I also want to ask Jason about the scribes, the new employees who sit in on each patient visit and take notes for the doctors. Remember Dr. Self, the family physician who's feeling like a celebrity since starting his job at CHC?
How could CHC afford to give him a scribe, but Mercy Hospital couldn't?
JASON WESCO: Shouldn't his best, biggest brain be focused on the four things you're there for? So, for some of our physicians who have practiced for a while, like Dr. Self, it makes a lot of sense. They can see more patients, they can be more efficient, and they're happier having a scribe.
SARAH JANE TRIBBLE: This is all very idyllic. But of course this is what health care providers want. And of course, they've wanted this all along. How can you do it when others can't?
JASON WESCO: Because we care about it.
SARAH JANE TRIBBLE: No, the money has to be there.
JASON WESCO: No. Sure, but, but watch everything in this organization. We've always done the right thing first and the money has followed. We always have. And that doesn't mean we're Pollyanna-ish. We know what we're doing. Hundred percent know what we're doing. But if I know that I can give Dr. Self another staff member and he can see five more patients a day and he can be happy and the patients can be happy, why wouldn't I do that? Of course I could do that. Right? And we, sure, we have a reimbursement mechanism that helps us do that. But I am tired of it always being about money.
SARAH JANE TRIBBLE: CHC is technically a federally qualified health center. That means it gets extra federal money that Mercy Hospital didn't have access to. They can apply for grants that the hospital also didn't qualify for. Jason tells me that 90 to 95% of the health services that were being offered before the hospital closed are still in Fort Scott. I bring up that worry that so many locals have, that they can't deliver a baby in Fort Scott anymore. Jason says they'd like to have a birthing center, but it's not really realistic any time soon. CHC has tried to recruit an oncologist to provide cancer care, but that hasn't worked either. And maybe, he says, these things — a birthing center and cancer care — are services the community can learn to live without.
JASON WESCO: Easy for me to say, right? But maybe we have to believe that this isn't so terrible. Maybe we have to believe that if we are going to do this right — and that means the Community Health Center of Southeast Kansas, the people of Bourbon County — that maybe we have to go without something to decide what it is that we want. Because in the past, I don't know that it was a big conversation. I think Mercy — it was a Mercy town.
SARAH JANE TRIBBLE: It's no longer a Mercy town. Family physician Maxwell Self worked for Mercy Hospital for more than two decades and was on the hospital's board when it closed. As a CHC doctor, he sees a difference between the then and now.
DR. MAXWELL SELF: What I see, though, is that what CHC says really has teeth. And there's follow, there's real follow-through. I have a lot more, I feel like, freedom to take care of people the way I want to and to get them what they need.
SARAH JANE TRIBBLE: That means giving away medicine or offering it at a steep discount.
DR. MAXWELL SELF: We're going to do a better and better job as CHC has moved in, taking care of the down and out. The uninsured folks who struggle to get their medicine, their insulin. It's not a problem anymore. I think our community is going to get healthier. Actually, I think it's a good future.
As I was closing out my time in town, I asked a lot of people what they thought the future of Fort Scott looked like. Roxine Poznich worked at Mercy for more than two decades. She felt like she lost family when she lost her job at Mercy.
ROXINE POZNICH: I think Fort Scott would probably go downhill because we have lost more businesses than just the hospital lately. I don't see a bright future. That's about all I can say, I guess.
SARAH JANE TRIBBLE: City Manager Dave Martin has a different take. He tells me ...
DAVE MARTIN: Well, I think we will have a very nice clinic, and I think we will be very comfortable with our health care.
SARAH JANE TRIBBLE: He's come a long way.
And then there's Reta Baker, the executive who had shut down Mercy Hospital. Reta took a new job with — who else? — the Community Health Center of Southeast Kansas.
RETA BAKER: As my career ended with Mercy, I had a month off and realized I was not ready to retire. I still wanted to give to the communities that I had spent my life supporting.
SARAH JANE TRIBBLE: Reta’s recruiting doctors to the region. She hopes to have more doctors like Dr. Self who will fall in love with southeastern Kansas.
RETA BAKER: It is a hard recruit. You have to find people who want to live in a rural setting and that are invested in some manner in the communities that they're going to practice in, so they will stay. We don't want them to be there just long enough to pay off their student loans and then be gone. We want them to build a career and stay here and take care of our communities.
SARAH JANE TRIBBLE: As you likely know by now, I always have one more question before I end an interview.
In 10 to 20 years, what does Fort Scott look like as a community itself?
RETA BAKER: It will never be a booming metropolis. But I think in reality it can be what it is today, if not a little bit stronger and a little bit better with some more businesses in it. When you drive to Kansas City, Kansas City keeps getting closer and it can almost be a bedroom community for Kansas City.
SARAH JANE TRIBBLE: Reta knows this is not the answer I'm hoping for. After a year of seeing loss and pain and some glimmers of hope that the health care that's in Fort Scott now will help, I need her to say it.
And you didn't mention that it will have a hospital.
RETA BAKER: I don't believe it will have a hospital. I don't believe it needs a hospital.
SARAH JANE TRIBBLE: The story of Mercy Hospital Fort Scott began in 1886. Two Sisters of Mercy stepped off a train planning to open a school. The town said what they actually needed was a hospital. And they got one. A hundred and thirty-two years later, the hospital is gone. There's no Mercy.
For the people of Fort Scott and millions more who live in rural America, no hospital means jobs go away. Health care disappears and, crushingly, part of the community's soul dies.
This season of Where It Hurts is hosted and reported by me, Sarah Jane Tribble.
More than 130 rural hospitals have closed in the past decade. More than 30 since we started this project. As other hospitals disappear, the question is whether these towns can adapt without disappearing themselves. Fort Scott is beginning to show us how this is possible.
The work on this podcast has changed my life for the better. Thank you to the people of Fort Scott for their honesty and courage in telling their stories.
And thank you to you, the listener, for having an open heart for people you've never met. Please stay tuned and watch your podcast feed. We're planning several short bonus episodes. We've got some extra scenes to share, and we'll send audio postcards from Fort Scott and the people you've met this season.
We already have a couple of updates: Fort Scott City Manager Dave Martin retired during the airing of this podcast. His retirement was not related to Mercy Hospital's closure. And Roxine Poznich, the former Mercy Hospital employee who owned Books & Grannies in downtown Fort Scott, died as we were producing this final chapter of our story.
Roxine was kind and gracious and loved listening to NPR. She was 73 years old.
And one last time this season, here are the people who made this podcast possible. Tarena Lofton is our production assistant. Taunya English, managing editor and managing producer for the podcast, is KHN's senior editor for broadcast innovation. Greg Munteanu at St. Louis Public Radio is our amazing sound and design mix master who made me smile every day. Diane Webber, national editor for broadcast, and Elisabeth Rosenthal, editor-in-chief at Kaiser Health News, are editorial liaisons to the show. Kerry Donahue and Carrie Feibel lent their expertise to this episode.
Just a note: I used the county health rankings research by the Robert Wood Johnson Foundation. It was the backbone for much of the reporting in the series.
Dr. Gianfranco Pezzino at the Kansas Health Institute steadily guided me through health outcomes data, and my former boss, Mark Rosenberger, provided much-needed encouragement early on.
Season one, “No Mercy,” is dedicated to my sister Maggie.
The podcast is a coproduction with St. Louis Public Radio and Kaiser Health News, a nonprofit news service about health care in America. KHN is an editorially independent program of the Kaiser Family Foundation.