by John Lingan
He was born in San Juan del Llanito, Guanajuato, Mexico, in 1986, around the time that Jim and Bertha’s neighbors were starting to visit the bar en masse. Oscar’s father left for the United States shortly thereafter, and ended up working in a nursery in Texas. In San Juan, part of the flat arid desert about a hundred miles north of Mexico City, Oscar lived in poverty but with dignity and joy. Like Joe Bageant’s, his was a life lived largely outdoors; the town was centered around a communal patio at the school which was filled on every holiday with big festivals of dancing, music, and food. Like a Berkeley Springs kid, he walked with his mother and two younger sisters to the nearby hot springs for water since it was cheaper than paying for tap. When money arrived from his father, they’d travel to the city for groceries, where mom would buy them chocolate-banana milkshakes as a treat.
On days when she worked as a maid, she left the kids with her own mother, but often grandma wouldn’t stay the entire shift, so Oscar babysat for his sisters from the age of eight. He taught himself to cook the staples of those big communal parties: beans, fried eggs, tortillas. He warmed their unpasteurized milk on the stove to kill the bacteria.
Then in 1997, they were summoned. In late March, Oscar joined his mother, two sisters, grandmother, and a male guide. They took a train from Querétaro to Nuevo Laredo, a border town where they slept overnight. In the morning they waded into the Rio Grande. The guide helped his grandmother, his mother helped the girls, and Oscar moved through the water while looking out for everyone. They stepped into Texas, and on the very first night, U.S. immigration police caught them and sent them back to Mexico. The following night, they made it across again, then the guide got lost on the U.S. side. The sun set as they wandered through the desert, then rose and set again as they wandered more. They had only enough food and water for two days, and they soon burned through that. They sneaked onto a farm and drank from a slimy cow’s trough, the only water they could find. The guide stole food from a nearby house. Days later—impossible to say how many—another farmer took them in and gave them food and water to take. Then they pressed on, through pouring rain that soaked their clothes, blistering heat that dried everything through, then rain again. Oscar was stung by a wasp in a hunting cabin where they stopped for shade. He flicked away a scorpion before it had the same chance.
After days of desert toil and pilgrimage, they finally made it to a town near San Antonio and met Oscar’s father, who said it had been a full week since he’d lost track of them. A full week with two barely school-age girls and an aged woman. He was already close to his mother but the experience bonded them for life. As an adult, he would still call her “my hero.”
They had one night in San Antonio to bathe and rest in their first bed in a week. The next day it was off again, this time to West Virginia, where Oscar’s paternal uncle was picking apples near Martinsburg. They drove up through coal country and into the Blue Ridge foothills and lived there in one room—three children and four adults, across three generations—while the men worked the harvest. In winter they moved to Hedgesville in the eastern panhandle, near Interstate 81.
Oscar spent a few weeks in the local elementary school, but no one spoke Spanish and he didn’t know any English beyond “Hi, how are you?” He and his sister were transferred to Berkeley Springs Elementary because it had an ESL program, but even with the addition of the two Cerrito-Mendoza children, there were only four ESL students there.
It took Oscar one month to understand English and two to communicate with it himself. Just as he got on his feet, there was another move, this time to Clear Brook, in Frederick County, Virginia, north of Winchester. His uncle was now working on a dairy farm while his father picked apples and his mother sold homemade tamales and tacos at the orchards. Oscar drove all over with her to farms as far away as Stephens City whenever he was off school. The central migrant location was a former POW camp built during World War II, right by Byrd’s processing facility, where the brick wall built by Jim McCoy’s first guitar teacher still stood. The whole place—from the factory to the barbed-wire fence around the barracks—was now owned by White House, the national juice and sauce supplier. Oscar would go with his mother to this and other camps, interpreting when she spoke to orchard owners. By this point he was also interpreting at restaurants and doctors’ offices for his parents, who had yet to become fully comfortable with the language. They had no time to learn: they were always working.
In his new school he was introduced to Katie Pitcock, the director of a migrant education program across the Winchester region. Pitcock was a white woman from Atlanta who arrived in Winchester in the mid-1970s just to drop a friend off there. Following the same wide-eyed, freewheeling sense of fate that brought Joe Bageant to Boulder and Jeanne Mozier to Berkeley Springs during the decade, Pitcock pulled into town at the height of the apple blossom bloom and simply knew this was where she needed to be. She applied for a job at the school district, which asked if she was willing to go into a migrant camp. None of their current employees were.
Pitcock soon became the migrant workers’ advocate to the school board, rejecting, for example, the idea that they should simply have their own schools in their camps. She had pushed this rock uphill for more than a decade by the time she met Oscar, and could tell, even relative to the many resilient, inspiring children that she’d met over the years, that he was special. He had none of the usual shyness or meekness that she’d seen in so many Spanish-speaking kids. Instead, Oscar exuded an indefinable presence, an ability to disarm any situation. He laughed uproariously but focused when he needed to. She took him to an occupational therapist to help him better use his hand, and on the drive there he taught her a song in Spanish. He was barely eleven.
Despite Oscar’s peripatetic couple of years, Pitcock credited his maturity to his rootedness. His family had fought to stay together. His parents were devoted and present. He had lived under the same roof as extended family, and once they arrived in the Virginias, they stayed. Many migrant families moved a seasonal circuit through the South, picking Florida oranges, Georgia peaches, and Shenandoah apples as the weather changed. Not so Oscar’s family. They wanted steadiness and stability. They wanted to make a home.
They were not alone. By the twenty-first century, the Latino population in western Virginia was exploding. Between 1990 and 2000, the Hispanic share of Frederick County’s census more than doubled; in Winchester city, it nearly sextupled. Oscar’s family began attending Spanish-language services at Sacred Heart Church right across the street from Winchester Medical Center and down the road from the Museum of the Shenandoah Valley. It was a tiny congregation when they started, but a decade later it was standing-room only behind the back pews.
Over the course of that decade, Oscar grew into adulthood. In high school he grew to appreciate just how unique he was. More Hispanic kids kept arriving, but they usually came stateside at an older age than he was when he crossed the border. Especially after his accent subsided, he was caught in a no-man’s-land: the white people all saw he was Mexican but the Latino kids considered him half-gringo. He began translating professionally, helping parents talk to teachers for Winchester public schools conferences. He also translated for clients at AIDS Response Effort, his first interaction with the group. And he finally came out as gay, drawing the Catholic ire of his beloved grandmother. She stopped speaking to him, and wouldn’t again for years. But thanks to Katie Pitcock and the greater migrant education program, Oscar had dreams beyond family. He wanted to go to college. No one in his family had even graduated high school before. At home, too, he was both son and stranger.
He went to community college first and couldn’t settle on a major, then went briefly to New York, thinking of a career in fashion. But before long he felt that southern pull, the undertow that tugs at country people when they roam. He also felt the gratitude of a survivor. Oscar had been helped by people who had made a life out of helping. He needed to give back, and he needed to do it in his own community.
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“Our goal is a database of every open bed,” he explained to me in his office. “There’s always the problem of not enough beds.”
I asked him who the Winchester homeless population tended to be. Was he drawn to that field because it was a chance to help fellow immigrants?
“Not at all,” he said immediately. “In my time here, I’ve only seen one Hispanic homeless person, and he was undocumented, with no family. Mostly it’s white people, either mothers with young kids fleeing abusive relationships, or white men with drug problems. Heroin is on the rise here. They’ve burned their bridges and have nowhere to go. In Winchester, homeless people are given shelter but little else. The government has its head in the sand. We need to provide them with wraparound services—shelter, but also employment counseling, medical care, mental health. Hispanic people can at least get help from their families. The Hispanic community is very supportive. People borrow money and stay close. Families understand the hardship.”
I recalled the donation buckets at every outdoor Troubadour show—generously filled, but never enough to support Jim and Bertha as their bills mounted. I recalled the phrase with which Ernest Tubb, the man who invented postwar country, always ended his radio shows: “Be better to your neighbors and you’ll have better neighbors, doggone you.” But neighbors aren’t the only thing that makes a neighborhood. Somebody has to own the buildings and pass the laws. And if they don’t feel the need to treat anyone better, how much good can even the best neighbors do?
“I’ve had white clients that have so much shame,” Oscar told me. “They’ve never had to ask for help before, and now they have to. The safety net is gone for them.”
We left and went to a coffee shop across the street from the Handley Library, a gay-friendly place with a rainbow flag on the sign, called, ironically, The Hideaway. Within many residents’ living memory, it was scandalous for women like Patsy Cline to be seen with married men on this very block.
The café was sleeker than the town’s other latte haven around the corner, where I’d met Barbara Dickinson. The walls and tables were white, the décor more minimalist than purely cozy. It was empty other than a few college-age people with asymmetrical haircuts tapping away on laptops in beanbag chairs. Oscar ordered an herbal tea and we sat at a tall table.
He was thinking of an upcoming meeting with Valley Health. It would be only the latest of his many trips to the vast campus it occupied on the town’s west side. For months now, he’d been traveling to the third floor of Medical Office Building 1, where a bright conference room with enormous windows looked out across Highway 37 onto rolling green hills that used to hold the world’s most famous apple supply. There, along with Valley Health’s clinical manager of social work and one or more representatives from the Winchester Free Medical Clinic, he would continue his efforts to improve and bridge the intake systems between the various members of Winchester’s homeless continuum of care. They had already developed hospital protocols for the homeless population—whom to contact when a homeless person arrived in the emergency room, how to find an open bed, what questions to ask them about their past—and were now working on discharge standards. Oscar was also trying to figure out if Valley Health could, or would, help fund long-term housing solutions, whether by buying apartment buildings to use as shelters, or maybe setting up a field of tiny houses for the purpose. “Housing first,” the notion that homeless people need a roof over their head before any other life improvements can take hold, had been gaining steam for years in social services. But housing is increasingly expensive, especially in a place like Winchester where the population is growing and real estate is a major path to wealth.
So why Valley Health? Ostensibly a medical organization, why would it play such a central role in finding beds for the homeless? The obvious reason is money. Every homeless-serving agency on earth has to fund-raise, and Valley Health, which operates six hospitals and innumerable family and specialist offices throughout the region, reported more than $782 million in revenue in 2015; any local agency with any sense would approach its charitable foundations with hat in hand.
But there were other reasons for Valley Health to worry about housing. A homeless person is more likely to get sick, and less likely to have insurance coverage, meaning they are an expensive potential customer—no insurer will be picking up the tab, and Valley Health has to pay for their care out of a special fund for unavoidable or charitable costs. The homeless are also more likely to return to the hospital chronically, which makes them doubly expensive. For years, the quality of a hospital’s care was gauged according to straightforwardly calculable things like the average length of patients’ stays. But the Affordable Care Act changed the determinant of medical quality to ineffable things like “population health,” including readmissions, the frequency with which patients return for additional care within thirty days of being treated. Beginning October 1, 2012, right as Oscar started working with the homeless, the Centers for Medicare and Medicaid Services began lowering payment rates for hospitals with excess readmissions. Too many people coming back too quickly, and CMS would reimburse for all patients at a lower rate. And in 2016, Valley Health recorded 56 homeless hospital patients who totaled 193 visits—an average of 3 or 4 visits a year per individual, and that’s not including those who use the emergency room.
A cynical person might therefore note that helping the homeless helps Valley Health’s bottom line. But it’s also a worthwhile investment for a company designed for nonstop growth. From colonial settlers to General Sheridan, the Shenandoah has been prone to occasional takeover, but since its founding in 1994, Valley Health has managed one of the grandest in history. The company was inaugurated through the merger of a health services business and a transportation company, which incorporated and purchased Winchester Medical Center, built in 1903, where Patsy Cline and countless other locals were born. It quickly purchased other smaller hospitals around the region, such as the fourteen-bed facility Hampshire Memorial, out near Bertha’s hometown of Romney, West Virginia. Valley Health then started buying out independent family medicine offices, then specialist practices. It opened fitness centers and hosted wellness events. Being exempt from real state or corporate income taxes, it made hundreds of millions from these holdings, and being nonprofit, it had to funnel the money back into business. And so it expanded steadily and constantly, adding multimillion-dollar cancer and heart centers to its main campus, opening a members-only gym, and establishing strategic partnerships with local schools and colleges to improve science classes and career preparations. It is an annual corporate benefactor of the Apple Blossom Festival, where it sponsors a 10K race. Valley Health, in other words, has turned itself into an omnipresent force in Winchester residents’ lives, an unavoidable partner from cradle to grave. Not even Harry Flood Byrd managed such a widespread presence, though surely he’d be pleased to know that his grandson, Harry F. Byrd III, has served on the boards of directors for Valley Health and Winchester Medical Center.
Despite all this, its nonprofit status means Valley Health is still exempt from taxes on its growing real estate footprint and its corporate income. This has led to ongoing arguments about the actual monetary advantage it provides to Winchester. It claimed a total of $118 million in “community benefit dollars” in 2015, a mixture of charity care, educational offerings, and Medicare shortfall. And it must be noted that greater Winchester, unlike many rural areas in the United States, still has hospitals. More than eighty rural hospitals have closed since 2010, and among those that remain, 41 percent have a negative profit margin. So far, Valley Health has kept the worst of rural American health crises at bay.
But heroin and opioids, according to Oscar and others, are on the rise, and are major drivers of homelessness. Obesity, hypertension, high cholesterol, and dental problems are the lot of America’s lower classes, and Winchester’s are not exempt. And despite Valley Health’s growing physical and economic presence in the community, plenty of its active and potential pa
tients struggle to pay their bills, even with insurance. With their ongoing procession of lung, bone, heart, and circulatory problems, Jim and Bertha became chronic readmissions to Winchester Medical Center once they exhausted Dr. Matt Hahn’s ability to treat them in his family practice in Hancock, Maryland. The McCoys were Medicaid recipients who had accounted for a portion of the wealthy hospital’s tally of “community benefit dollars” for years, yet they still fund-raised from their friends and concertgoers to avoid bankruptcy.
As the new ACA laws took hold and Valley Health’s domination of the upper Valley proceeded apace, Dr. Hahn watched Jim, Bertha, and their fellow high-need rural patients leave his independent practice for the plusher confines of Winchester Medical Center and other Valley Health facilities, often by going into deep debt. His own independent practice, too, was newly overwhelmed by the increasing levels of paperwork and technology fees required by the regulations; the push for multifaceted “population health” meant more bookkeeping and more mandated activities, like setting up online health portals and communicating with a minimum number of patients by e-mail. This in addition to the recurring nightmare of dealing with insurance and medical billing companies to discern every patient’s level of coverage and pricing. Hahn’s frustrations became the impetus for a book, Distracted: How Regulations Are Destroying the Practice of Medicine and Preventing True Health-Care Reform, which he published in 2017.