by Sarah Smarsh
He was depressed and exhausted. Beyond the economic troubles, things weren’t going good at home with Mom. When he wasn’t at work, he drank a lot. He fell asleep at the wheel so many times when Matt and I were riding with him. I’d grab the wheel and slap his arm, and he’d veer us back off the shoulder to the other side of the painted line.
When the temporary job at Boeing ended, Dad found more work in Wichita, this time for a national company that supplied and disposed of industrial cleaning products. He drove a van around the city and surrounding small towns, delivering cleaning solvent and equipment to mechanics’ shops. He then collected their spent chemicals, such as engine oil, into a large barrel in the back of the van to dump at a designated waste site.
He’d been working for them all of ten days when, driving alone along an interstate, things started moving in slow motion. By the time he got back to the company yard, saliva was frothing from his lips. Another employee drove him to the Minor Emergency Center at the mall where Mom sometimes worked holiday kiosks.
Dad knew he was dying. He got down on his knees outside the mall entrance and prayed to God while shoppers passed by and stared at him.
Emergency workers put him in a straitjacket and took him to a real hospital, the one where he and I had both been born. He had chemical poisoning.
I always heard it was from breathing fumes formed by reactions among toxic waste materials that his pickup sites had illegally dumped. Maybe the vapors had seeped into the cab of the work van due to improper ventilation and unsafe design.
Doctors put charcoal in his body to absorb the poison and waited to see if he’d make it. The hospital chaplain gave him last rites, the Catholic sacrament performed when death is near.
Dad never forgot the moment he decided to wake up and live: A nurse washed his hair, and the shampoo smelled like roses. It was the most beautiful peace he had ever felt. So he hung on. Mom took me and Matt to see him once, he told me, but I don’t remember it. He wept in his wheelchair when he saw us at the end of the hospital hallway.
Doctors released him after six days, but he still wasn’t right in the head. He was referred to a neurologist, from the University of Kansas Medical Center in Kansas City, who diagnosed him with toxic psychosis.
“It took three years to get my body, mind, and soul cleaned out,” Dad told me. It was such a traumatic event that decades had passed before we ever discussed it.
That cleaning-solvent business—a billion-dollar corporation, when Dad worked for them—changed the design of their trucks because of him, he told me, but he couldn’t say where or how he heard that. Maybe it’s true. Maybe it was just a passing, hopeful, or misleading comment by an attorney, and Dad held on to it—giving some meaning to what he had gone through.
He settled with the company out of court. He walked away with about fifty grand after attorney fees and signed papers saying he wouldn’t seek further damages. Through the Kansas Workers Compensation Act, he also collected disability payments for almost two years for a total of about $22,000. But he was back to work much of that time—messed up yet working anyhow—so the state cut him off.
When I was a young adult, it killed me to sit next to Dad in his work truck and hear him finally tell the story, insofar as a person might remember his own poisoning. It wasn’t the inherent trauma of his experience that got to me but the lack of outrage he seemed to feel—like he knew damn well that dying on the job was his birthright, and his gratitude for having survived outweighed any well-deserved sense that he had been victimized.
We all knew people who had died working. When Dad was a kid in the 1960s, he found his favorite uncle pinned and dying beneath a tractor that slid off a dirt bridge near his family farm. I walked over that bridge just about every day and thought of Dad’s painful memory.
We knew people who had been maimed but survived, too, some having lost limbs to combines during the wheat harvest. Every church or town across Kansas, it seemed, had a man with a glass eye replacing the one he lost in the railroad yard or a woman who limped from when her pant leg got caught in some moving part.
Around the same time Dad was poisoned at work, Grandma Betty had a farming-related brush with death.
One morning at her office in Wichita, she felt so weak that she visited her doctor during her lunch break. A primary reason she applied to work at the courthouse was the good state benefits, including health insurance. “State benefits” was a phrase that adults I knew said with reverence. Many of my uncles, aunts, and cousins worked the Wichita airplane factories, and their union benefits were spoken of like a coveted prize, too.
The doctor told Betty she was fine. Doctors have a way of not believing women about the pain they report, and I’ve observed that poor and working-class women are less apt to argue with medical experts. Maybe their lack of formal education makes them reluctant, if only because they speak different kinds of English and encountering an authoritative professional thus feels intimidating. In any case, Betty went back to work.
When she left the courthouse, before she headed west toward the farm, she stopped at her mother’s little apartment in one of Wichita’s poor neighborhoods. Dorothy was in her sixties and had been diagnosed with paranoid schizophrenia decades prior. She lived alone without consistent treatment, due in part to a distrust of medical professionals but also due to lack of money.
Dorothy needed help at the same moment state mental hospitals were losing their budgets and turning people away. In the 1960s, when she was middle-aged and newly diagnosed, government programs began excluding coverage for patients in state psychiatric hospitals, leaving the mentally ill at the mercy of local economies and private general hospitals. Over the last half of the twentieth century, the number of state psychiatric hospital beds in Kansas for every hundred thousand people dropped from a few hundred to fewer than two dozen. For those who couldn’t afford private care, that left adult children—usually women—to become caregivers.
So that summer afternoon when Betty left the office feeling terrible herself, she stopped to check on her mom. When she waved goodbye and walked to her truck, the afternoon heat hit her. She felt funny. Her left shoulder slumped beneath her heavy purse.
She thought of going to the hospital, but her doctor had said there was nothing wrong. She continued toward the farm, pulling to the side of the road a couple times when she got dizzy and the highway blurred.
Forty miles later, she rolled up the farm’s gravel driveway, got out of the truck, and fell down.
Arnie ran across the yard and carried her into the house. She was shivering. He wrapped her in quilts and hauled ass along the highway back to Wichita, to the hospital.
Betty had pneumonia and histoplasmosis, a rare infection where mold spores settle in the lungs and grow. It’s most common in farmers, who go in and out of damp outbuildings full of moldy hay. A large abscess had collapsed Betty’s left lung. Doctors hooked her to an IV and blasted her with antibiotics.
When Dad took me to visit her, I was surprised when we stopped in the gift shop to buy flowers. I was worried about how much everything cost. I had learned to sneak candy from the gas station into movie theaters because the concessions stand was unaffordable and to put a cooler of bologna sandwiches in the trunk when going to some event whose food vendors would charge an arm and a leg. I was sure we should have bought flowers anywhere but the hospital’s own gift shop, but Dad thrilled me by letting me pick out a bouquet.
Riding the elevator was exciting for a kid from the country, where buildings have two levels at best. I walked slowly down the hallway so that I wouldn’t drop the heavy vase. We found Grandpa Arnie and a few others quiet in a room where Grandma lay in a bed.
“Sarah Smurf, come here,” she said.
I looked at the tubes and plastic on her skin. She touched my hand and smiled.
“Hey, Sarah Smurfenburger,” Grandma Betty said, patting my hand. Sometimes
she called me that when she wanted me to laugh. I liked a cartoon called The Smurfs, and Betty had turned it into a funny play on my last name. We didn’t realize it, but the German was always close in our words.
Grandma Betty’s voice was soft in the hospital, different from her usual buzzing energy. Mom was there and somehow soft, too, like when she bought me pink high-tops and taught me to tie the laces while I sat on her bed’s floral comforter. I liked how hospitals made people well behaved, as did libraries, Sunday Mass, and funerals.
The hospital’s smoking ban was a particular point of relief for me. Every morning when I woke up, the first thing I did was notice the smell of tobacco smoke. Having learned at school that it was bad for me, in cars and at home I often became worried and held my breath. I’d seen Great-Grandma Dorothy, who had emphysema, spend afternoons watching TV with an oxygen tank hooked into her nose and a cigarette hooked between her fingers.
I understood, from television talk shows and the things children said at school, that I was living in an environment full of what society had recently discovered was dangerous: the smoke, the fried food, the unbuckled seat belts. But I didn’t know the half of it: sugary diets that led to cavities, noxious glue in the walls of cheap houses, nitrates from farm runoff in our drinking water, insecticides on the wind that shimmered down from crop-dusting airplanes like daytime comets. I could feel it in my body. I had frequent headaches, my heartbeat drumming against my skull.
When I grew up and made a different environment for myself, the headaches stopped. As children, though, we are helpless. Except in spirit. The way I healed myself back then was by talking to you.
When I was that little, I didn’t quite think of you as a child I might have but as someone protecting the child I was. In either case, there was a kid who needed shielding from something. The shield was an unrelenting awareness of my surroundings. It hurt not to go numb to the world around me, but talking to you kept me away from poison and danger. Talking to you kept me awake.
So much of childhood amounts to being awake in a grown-up’s nightmare. Ours happened to be about poverty, which comes with not just psychological dangers but mortal ones, too.
My childhood happened to coincide with the moment health insurance and drug companies veritably merged with the nation’s for-profit hospital system, creating costs that were prohibitive for uninsured families like ours.
In our parts, health care was rare not just because of escalating costs but because of our remote location. We didn’t put much faith into doctor visits, anyway. To make a health concern feel better, we told ourselves that we didn’t need doctors. But the truth was that we couldn’t afford them. If you had a real health emergency, you were liable to be dead before some small town’s ambulance made it down the muddy, sandy ruts of our dirt roads. But a decade-old dropper of stinging red iodine would fix most cuts, so we went on like everything was fine.
By the time I was born, rural hospitals were closing and American health care had transformed into a slick, big business in urban centers. Being the youngest of six, my dad was the only baby Teresa gave birth to in a hospital rather than in the farmhouse where they were raised. But when I was a kid, the old ways of country doctors were still hanging on in places like ours—places, I would later learn, much of the country thought endured only in movies and books.
As an infant, one night I came down with a dangerously high fever. My parents rushed me miles along bumpy roads to the rural home of Joseph Stech, a small-town doctor who still sometimes made house calls. He had delivered me at a big Wichita hospital, but as I grew up he was still charging a modest fee for a visit at his nineteenth-century office on Main Street in nearby Andale. He gave me all my immunization shots and prescribed penicillin when I got strep throat.
We didn’t have health insurance, but my parents could afford Dr. Stech’s fees. When I came down with chicken pox the day before the Christmas play at school, I cried next to our kitchen telephone while he told Mom over our shared rural party line that I had to stay home.
Once in a while, we’d drive past what to my eyes was a grand mansion on a hill, and my parents would say, “That’s where we took you when you were a baby and had a fever in the middle of the night.” No one remembered what Dr. Stech did to save me. For my family, the more important takeaway was that I just wasn’t meant to die that night.
“The good Lord will call you home when he’s ready,” Grandpa Arnie liked to say. “When it’s your time, it’s your time,” people repeated. The Lord wasn’t ready, and it wasn’t my time.
I would develop a habit of burning up, though. Until I was two or three, Dad told me years later, severe fevers came and went. They didn’t rush me to Dr. Stech again or even to a Wichita hospital; the issue had ceased to seem an emergency, and every doctor visit costs money. Instead they put me in a small tub of cold water.
“We’d splash a little water on you, and every time you were good to go!” Dad said.
I had lived, and that was all that mattered. The medical industry worked by naming ailments and prescribing medicine, but the sort of healing we knew operated in mystery. We didn’t know the word “placebo” but figured that’s all survival ever was, until God called you home. Mind over matter.
But a few years down the road, people like us would face health epidemics that cried for professional care: obesity, diabetes, methamphetamine addiction, sepsis from what we called a “bad tooth” with infection at the root, abuse of opioids overprescribed by the same doctors who were supposed to help. When I was a young adult, I would see all those ailments on the bodies of extended family members: grooves and scabs on their faces, expanding waistlines, swollen feet, missing teeth, the erratic shakes of a body craving a Lortab fix. By then the same forces of privatization that had all but shuttered state mental-health hospitals had compromised an entire system of general care to such an extent that even the middle class couldn’t afford treatment.
What was still preventable in the 1980s would, in a couple decades, become manifest; what once was treatable would become deadly. I’m not sure my immediate family’s brushes with death when I was a kid—mom’s hemorrhage in childbirth, Grandma’s collapsed lung, Dad’s chemical poisoning—would be survived today. Mom would have been less healthy going into labor, Grandma would have been sent home too soon for lack of insurance, Dad would have been given a cheaper and less effective treatment. The mortality rate for poor rural women, in particular, has risen sharply over my lifetime.
Health insurance had been around for a long time, of course, but the power of that industry had swelled up fast, transforming access to care and all the costs that come with it. Betty would forget a lot about giving birth to Jeannie, but she always remembered how much she owed when she left the hospital: $12.
“That was hard to come up with then,” Betty told me. “I handed them the money and told her, ‘You’re all mine now.’ ”
That was at a military hospital in the 1960s. I can’t imagine how I would have paid a private hospital to deliver you several decades later. When I was in my twenties, it took me two years to pay off an emergency-room visit, and I had employer-based health insurance at the time.
It’s a hell of a thing to feel—to grow the food, serve the drinks, hammer the houses, and assemble the airplanes that bodies with more money eat and drink and occupy and board, while your own body can’t go to the doctor. Even though no one complained or maybe even realized it, I could feel that the people around me knew they were viewed as dispensable.
A life full of peril and lacking in care leaves its mark not just on the body but on the brain. Under the surface, the amygdala—the brain’s fight-or-flight center of primal fear—enlarges and remains that way, a physical reflection of the hypervigilance developed by necessity under chronic stress.
This isn’t to say someone facing the daily dangers of poverty lives in a constant state of perceived fear. I didn’t even regis
ter the emotion, because high alert was my constant state. I’ve learned that I still don’t feel fear the way most people do. This has helped in some ways and hurt in others. For the ways it gets me in trouble, someone once gave me good advice.
“Would it be stressful for most people?” she asked.
“Yes,” I said.
“Then assume it’s stressful for you. It’s just that you can’t tell.”
As a child, though, I could tell. Everything felt all wrong. In a rural home with my poverty-scarred mother, I felt her stress first.
Jeannie had a four-year-old daughter and a newborn son in the middle of a countryside she never wanted. The lake was on one side, the wheat was on the other, and Jeannie was in the middle. The narrow woods planted to the north of us as a windbreak couldn’t stop the Kansas weather. The north wind blew hard there, gaining momentum as it passed across the lake and pummeled the house.
One night when Dad was on the road with some construction job, Mom heard something clawing at the window for so long that she put me and Matt in her bed, locked the door, and stayed up all night with a loaded gun in her hand.
During the day, Mom would close her bedroom door and take long naps. I’d open the door and crawl under the floral comforter, get close enough to smell the lotion on her skin and cigarette smoke in her hair. Usually she said nothing. Sometimes she’d feel my cold feet and offer to let me stick them between her legs for warmth, as if the emotional blocks that kept her from touching her child had been surmounted by practical purpose.
I’d shift around to get comfortable.
“Stop moving around,” Mom would say.
I’d hold still, feel every muscle tighten, my body frozen as it was every night when I awoke from the nightmares and watched the door for intruders. She would sigh.