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Chapter 1 — It Is What It Is

Chapter 1 - It Is What It Is

Midwesterners aren’t known for complaining. But after Mercy Hospital closed, hardship trickled down to people whose lives were already hard. Pat Wheeler has emphysema. Her husband, Ralph, has end-stage kidney failure, and the couple are barely making ends meet as they raise their teenage grandson. Pat has simmering anger for the hospital executives who she says yanked a lifeline from residents. “They took more than a hospital from us,” she says.

Chapter 1 Transcript

[Segment 1 — 0:08]

SARAH JANE TRIBBLE: I find Pat Wheeler smoking a cigarette on a wooden bench in downtown Fort Scott. We're in the middle of America, in Kansas. Pat's face is thin and deeply wrinkled.

PAT WHEELER: They took more than a hospital from us.

SARAH JANE TRIBBLE: What else did they take?

PAT WHEELER: They took our security, our dignity, our lifeline. Lot of people's lifeline.

SARAH JANE TRIBBLE: Mercy Hospital Fort Scott closed a few months ago. Pat says it's the latest hit for a town that has seen better times. We're on Main Street and in front of us there are empty storefronts. Their dark windows reflect the big, open sky. Fort Scott is nearly a hundred miles south of Kansas City. In small towns like this across the country, rural hospitals are disappearing.

One or two close every month. Each loss means residents lose essential health care. Rural Americans are more likely to be older, they earn less money and they're more likely to be sick. It's also an economic blow for the community. Hospitals are usually one of the biggest and best-paying employers in town. Here in Fort Scott, Mercy Hospital had been around for generations. Its name was everywhere. On restaurant menus. On the high school football scoreboard. Its ambulance stood guard on the sidelines during Friday night games. And then the hospital was gone. No Mercy.

Dave Martin is Fort Scott's city manager.

And he feels betrayed.

DAVE MARTIN: Mercy figured, as a partner, within our community, and on October 1, that got realized they weren't. It's corporate. It's not what's best for your community. It's corporate.

SARAH JANE TRIBBLE: I'm Sarah Jane Tribble. I grew up in southeastern Kansas, about an hour away from Fort Scott.

The people here, I didn't really know them, but when I heard about the hospital closing in late 2018, I felt like I did.

So for more than a year, I went back home. Again and again. To listen.

PAT WHEELER: I don't understand how they can just so blatantly close the hospital. I mean, I understand dollars and cents. But at the same token, where's the humanity? You know, what are people like us supposed to do?

SARAH JANE TRIBBLE: What we're going to do is tell their stories.

Pat Wheeler and her husband, Ralph, begin our series.

Later, you'll meet others and they'll show us how lives change in the year after a small-town hospital closes. Along the way, we found loss, but also some hope.

This is Where It Hurts, a new podcast from Kaiser Health News and St. Louis Public Radio. It's about the people in Fort Scott, surviving the best way they know how. Season one is "No Mercy." The hole left behind is bigger than a hospital.

[Segment 2- 2:58]

SARAH JANE TRIBBLE: The first time I met Pat, she told me …

PAT WHEELER: I'm just a small-town girl. I have always lived in small towns, and I love this small town.

SARAH JANE TRIBBLE: She told me her husband was sick.

PAT WHEELER: You know, he's had a tough road. The kidneys have really been a major problem. Thankfully, we have — thank goodness — dialysis here in Fort Scott.

SARAH JANE TRIBBLE: And about their money problems.

PAT WHEELER: We've been trying to apply for the state for help to try to help pay for the medical bills.

SARAH JANE TRIBBLE: I learned that Pat hadn't paid her light bill in a couple of months before I actually found out who she was.

What's your name?

PAT WHEELER: My name's Pat Wheeler.

SARAH JANE TRIBBLE: It was as if Pat's troubles defined her more than anything else. You know, I wasn't really sure how Pat fit into this story. But as the months passed, she helped me understand some of the big trends that come with a hospital closure. And that's what I do. I'm a health care policy reporter. I follow the money and unravel complex issues like federal reimbursement and patient outmigration. Pat's hacking cough, her fretting over medical bills … her life is an example of some of our country's toughest health care problems.

PAT WHEELER: I'm resigned to it. That's my life. That's the way it is. You can either dwell on it and get more depressed, or you deal with it and you go on. And I, there's no choice but to deal with it and go on. What's the alternative? What's the alternative?

SARAH JANE TRIBBLE: Pat helped me understand two things about rural hospital closures. First, there's trickle-down hardship for everyone in the community, not just those who used the hospital. Second, I realized that many of the things Pat and her family need to be healthy, they're not necessarily offered by a traditional hospital like Mercy. And that's important to know, too.

The next time I ran into Pat Wheeler, I was in a used bookstore on Fort Scott's Main Street. Roxine Poznich is the owner.

ROXINE POZNICH: Come and peek in all our nooks and crannies. Come and visit Books & Grannies. [sing-song voice]

SARAH JANE TRIBBLE: Roxine worked at Mercy Hospital for 27 years. She opened the store years ago as a hobby. Books & Grannies is so packed with used books that you have to turn sideways to walk down some of the aisles. I stop by to see Roxine every time I come to town. She lost her job in the pathology department when the hospital closed.

ROXINE POZNICH: You just don't know the pain that the employees were in — not just for themselves, but for the community. I mean, there were lots and lots of tears that I saw. And it was just very sad because those people, they were my family.

SARAH JANE TRIBBLE: Just over 200 people worked at Mercy when it closed.

That's a lot of jobs in a town of fewer than 8,000. And Mercy paid well.

ROXINE POZNICH: I don't have enough Social Security to live on, but the income from the store gives me some fluid cash.

SARAH JANE TRIBBLE: Pat hangs out at the store because she loves to read and she helps Roxine out. It's slow, about 10 a.m. on a weekday, so we talk about the hospital. Pat and Roxine start naming off other businesses that have shut down. I already know about the grocery store.

ROXINE POZNICH: Price Chopper was one. And then there was a clothing store that had real reasonable clothes, and it closed, and …

PAT WHEELER: Shoe store closed.

ROXINE POZNICH: Shoe store. But that was before, I guess, wasn't it?

SARAH JANE TRIBBLE: The big fast-food chains like McDonald's, Sonic and Subway seem to do OK in Fort Scott. But other places don't seem to do as well. Price Chopper, the grocery store, was a huge loss for Fort Scott that happened right about the same time the hospital closed. And there were health care places, too. The cancer center announced it was closing two weeks after the hospital shut down. As I talk with Roxine and Pat, I paused the conversation because I'm hearing a bit of a rattle.

I'm going to get closer to you because I'm hearing something on the mic that I think is also worth noting.

PAT WHEELER: Yeah. What’s that?

SARAH JANE TRIBBLE: It's your chest.

PAT WHEELER: Yeah. Yeah.

SARAH JANE TRIBBLE: I can … I can hear your chest breathing.

PAT WHEELER: You can hear me breathing. Yes, you sure can. Because I have emphysema. That’s what I’m dying of. That’s why I’m losing weight.

SARAH JANE TRIBBLE: It literally sounds like a creaking. Can you … can you … can you hear it?

PAT WHEELER: No, I don’t hear it anymore.

SARAH JANE TRIBBLE: I’ve been sitting here thinking something was on my mic.

PAT WHEELER: I’m sorry. No, I don’t hear it anymore. It’s been too many years. I don’t hear it anymore.

SARAH JANE TRIBBLE: You’re dying? What do you mean you’re dying?

I’m seriously worried for Pat.

So, you … when you walked in, Roxine said you’ve been losing weight again. So, why are you losing weight? And that’s not a good thing at 65, is it?

PAT WHEELER: No, it’s not. No, it’s not. It just … well, whenever I look at myself, I see my dad and …

SARAH JANE TRIBBLE: Pat sees her father when she looks in the mirror.

He lost a lot of weight and then died from a heart attack. Pat is already so thin, and she says it’s difficult to eat or really do anything these days.

PAT WHEELER: It was a nice cushion knowing that the hospital was there if we needed it. If my husband needs it. If I get out of breath and can’t catch my breath, you know, or I have my heart attack from my heart having to work so hard.

SARAH JANE TRIBBLE: Is that what you’re expecting?

PAT WHEELER: Yeah. Yeah, because emphysema destroys your lungs and it makes your heart work harder.

SARAH JANE TRIBBLE: Fort Scott has a lot of smokers. There are also more people overweight here than the rest of Kansas and more people with diabetes.

KRISTA POSTAI: We die five to 10 years younger depending on the county you’re living in.

SARAH JANE TRIBBLE: Krista Postai runs the big health center in the region.

KRISTA POSTAI: Chronic disease will get us. Part of this is, goes with the depression that goes sometimes with that. But I, the new generation, I’m seeing less and less smoking. We’re seeing it reduced. But part of it is the culture, certainly. In a rural culture, farming … smoking is a right.

SARAH JANE TRIBBLE: Krista started her first clinic in a double-wide trailer. Now she has more than 20 locations.

KRISTA POSTAI: Well, you know, I was born here. I’m fifth generation, actually, southeast Kansas. There’s a lot of reasons to recommend southeast Kansas, but there’s a lot of reasons on paper to be extremely worried about us. And we need people to stop talking about it and start doing something about it.

SARAH JANE TRIBBLE: About 1 in 4 children here live in poverty. The unemployment rate is higher than the state average. And this year, a big national newspaper listed the poorest city in every state. And in Kansas, they pointed to Fort Scott. When Mercy said it was closing, Krista jumped at the chance to open one of her clinics here.

KRISTA POSTAI: Folks were very loyal to Mercy, but they were the only provider, basically. I’ve never seen a health care organization so interwoven into the fiber of a county. They were everything. And I understand why it’s so painful when they had to let go. But being everything came with a high price.

SARAH JANE TRIBBLE: Mercy lost money taking care of Fort Scott’s low-income patients. But Krista’s clinic can get extra federal dollars to take care of the poor. So she hired Mercy’s doctors and she announced plans to bring in low-cost prescriptions and some mental health staff, things the hospital didn’t provide. City manager Dave Martin told me he expected Krista’s clinic to help.

DAVE MARTIN: The biggest thing — and I think all, a lot of small communities run into this — is we have a lot of — and I don’t really want to say poverty — but we have a lot of people that just have a hard time struggling to make ends meet, whether they put that on themselves or it’s just what they have to deal with.

SARAH JANE TRIBBLE: There’s a lot of people in Fort Scott who don’t have much money. Here’s a quick demographic breakdown: About 90% of the people here are white. Only 18% of adults have four-year college degrees. That’s compared with a national average of about 30%.

Dave is certain Krista’s clinic will do a good job caring for the low-income residents in town. People call the clinic CHC, short for Community Health Center of Southeast Kansas.

DAVE MARTIN: I think CHC coming to our town will help the less fortunate get health care, and we’ll, as yet to see what that dynamic does for our community.

SARAH JANE TRIBBLE: We’ll get to know Dave more in another episode. But for now, let me translate his Midwestern politeness.

Dave is concerned low-income residents will fill the seats of the new Fort Scott clinic but the rest of the town won’t see it as theirs.

[Segment 3- 12:10]

Pat and Ralph's medical bills have been piling up for years. They're on Medicare, but Pat's mad they don't qualify for Medicaid, too. That's the government program for people with low incomes. If they did, they wouldn't have to lay out the 20% Medicare doesn't cover for doctor's visits.

PAT WHEELER: Between Ralph and I, on paper, we make too much money.

SARAH JANE TRIBBLE: They're both retired. And together they get a couple thousand dollars a month from Social Security. But that doesn't cover the bills.

PAT WHEELER: Especially Ralph's. You know, that doesn't include any of that. We make too much money.

SARAH JANE TRIBBLE: Yeah, I mean, especially the medical bills, I imagine, is what you're referring to.

PAT WHEELER: Yeah. Oh, yeah. Oh, yeah. Oh — because for a year or two we were constantly in and out of the hospital, you know …

SARAH JANE TRIBBLE: So are you paying debt to hospitals in Joplin?

PAT WHEELER: Yeah, we still owe Joplin.

SARAH JANE TRIBBLE: Joplin is Joplin, Missouri, about an hour away from Fort Scott. Ralph went there to see a heart doctor because Mercy Hospital Fort Scott didn't have a cardiologist on staff. When I asked Pat about how often they traveled out of town for care before Mercy closed, she shrugs. Like a lot of people in town, they feel like they lost something even though they didn't use the hospital that much.

She believes that if Fort Scott's hospital had stayed opened, well, it would've been easier for them these past few months. She says Ralph could have gotten at least some of his care closer to home. Besides his recent heart trouble, Ralph was also trying to take care of a bad hernia, and then the doctors figured out his kidneys are failing. That's when he had to start doing dialysis in Fort Scott three times a week.

RALPH WHEELER: It's nice outside. It's nice out here.

SARAH JANE TRIBBLE: When Ralph gets home from dialysis, we settle on the porch in the shade. Cigarette butts are scattered on the wooden floor, and cute little frog statues are all over the place. Ralph tells us it was a busy day.

RALPH WHEELER: Yep. They brought in pizza. They made a cake with strawberries in it and gave me some kind of a drink to drink. I said, “Man, this is a heck of a day. Look at this.”

SARAH JANE TRIBBLE: But it's not a happy occasion. The dialysis center is closing.

PAT WHEELER: It's like …

RALPH WHEELER: That's, that’s, that’s the nurses out there that did that.

PAT WHEELER: Oh, it is?


PAT WHEELER: Oh, I didn't know that.

RALPH WHEELER: Oh, that’s the nurses that did that. Yeah.

PAT WHEELER: Well, bless their little pea-pickin’ hearts.

RALPH WHEELER: I can't have no popcorn on Fridays. Popcorn Fridays? I won't have no more of them.

SARAH JANE TRIBBLE: Ralph is sad about losing his hometown health care. His dialysis center is not connected to Mercy Hospital, but it is closing for the same reason. Not enough patients.

When a hospital closes in a small town, there's a ripple effect for health care. Doctors generally leave town, and medical care becomes more difficult to get. For people in Fort Scott who need dialysis, the closing means they have two options: They can either travel for treatment or do it on their own, at home. A few of the patients in Fort Scott will be doing dialysis on their own.

But not Ralph. Ralph points to a big vein on his left arm to show me how the staff do it at the center. The vein is sticking up like a rope on top of his skin.

RALPH WHEELER: This right here and everything like that, this is where they stick the needles in my arm. Feel that right there.

SARAH JANE TRIBBLE: I can feel it moving up and down. Oh, wow.

RALPH WHEELER: Mm-hmm. They stick a needle in here and a needle in here. One to take it out. And one to put it in.

SARAH JANE TRIBBLE: But, but your pulse is just throbbing.

RALPH WHEELER: Yeah. Just like a heartbeat. That's the heartbeat.

SARAH JANE TRIBBLE: I, well, I never. I never …

The way dialysis works, you pull blood out of someone's body, clean it, then put it back in. This is the vein they use on Ralph. It's beating like it has a direct line into his heart. And if this thing gets dirty and infected, well, I can see why Ralph might not want to do this at home. He's hoping that eventually he'll get a kidney transplant and not need dialysis.

RALPH WHEELER: I can get a kidney, but I don't know whether I'm going to be able to get a kidney or not for my age. I'm 75 now, so I’ll just have to wait and see if I'm able to get a kidney or not.

SARAH JANE TRIBBLE: Pat seems almost defeated by her lack of control over Ralph's schedule and how he's going to get to the new dialysis center 30 miles away.

PAT WHEELER: Well, it’s … the last day is here now. And to me, it still feels like, in a way, it's up in the air.

SARAH JANE TRIBBLE: A staff member arranged for Ralph to carpool with other patients.

PAT WHEELER: One guy's providing the car. The girl is driving. She's the youngest. She's in her 30s. And then Ralph. And they're all three going to share the cost of gas. Now, I'm not sure what's going to happen whenever this guy's car breaks down.

SARAH JANE TRIBBLE: After our visit, as I pack up my equipment to head back to Washington, D.C., I almost hesitate. Nothing seems settled. I really need to check back with them.

[Phone ringing.]

PAT WHEELER: Hey, lady.

SARAH JANE TRIBBLE: Hey, Pat. So, uh, I wanna — hey, before I get going any further, I am recording all phone calls at this point. Is that OK?



PAT WHEELER: Yes. Yes, that's fine.

SARAH JANE TRIBBLE: The carpool plan did not work out. Ralph ends up driving himself once a week. Pat tells me next time I'm in town, I should come by the house on a Saturday morning to see how they're making it work. The plan is for me to follow Ralph in my own car and see how he does. When I walk in, though, Ralph has his own plans.

All right.

PAT WHEELER: Come on in. Have a seat.

SARAH JANE TRIBBLE: You're looking up and spry this morning.

RALPH WHEELER: What do you got planned for today, lady?

SARAH JANE TRIBBLE: You. I've got you planned for the day.

RALPH WHEELER: Well, OK. I just, I just wondered if you do. We just might end up riding down there with you. Not taking my car and letting her have my car. And just have you drive down there and drive back.

SARAH JANE TRIBBLE: They only have one car. And Pat needs it to help out at the bookstore. If I drive Ralph, then Pat can use the car.

You want me to drive you down and back?

RALPH WHEELER: Yeah, yeah, yeah.


PAT WHEELER: Unless that's too much time.


RALPH WHEELER: Unless you got something else you got planned down there?

SARAH JANE TRIBBLE: Uh, no. I wasn't planning on staying the whole time, actually.

PAT WHEELER: OK, that's fine.

SARAH JANE TRIBBLE: But let me just go to my car, and …



SARAH JANE TRIBBLE: I want to drive Ralph, because I know this is all hard for them. But I feel like I can't drive Ralph because I'm a journalist. I'm not part of the story, and driving would make me part of it. So I'm thinking I'll just get to my car and I can call my editor for a quick coaching session on what to do. But the thing is, I've asked a lot of Pat and Ralph for months. They've opened up their lives and their home to me. It makes sense that they feel comfortable asking me for something. But I want to see how hard this trip is for Ralph. If I drive him, I can't truly capture that. And there's another reason I don't want to drive. I was hoping to talk with their grandson Josh. He's passed out asleep in a chair, mouth wide open and quietly snoring.

I'm going to just, uh …

PAT WHEELER: Wait a minute. Hey, what were you going to do?

RALPH WHEELER: What were you going to do?

SARAH JANE TRIBBLE: I was going to come back and see if Josh would talk to me.

Josh is 17, and Pat and Ralph took him in when he was 3. He dropped out of high school right about the same time Ralph had his latest heart scare and Fort Scott's hospital closed. So I'm planning to drive back here and talk to him about how his grandparents’ health affects his life. I hope to tell Josh's story later, but before I definitely say no to driving Ralph to dialysis, I just want to make sure Ralph will be safe.

Is he OK to drive?

RALPH WHEELER: Oh, yes. Yes! If I wasn't OK to drive, I wouldn't be driving.

SARAH JANE TRIBBLE: OK. Just checking, 'cause dialysis can take it out of you.

RALPH WHEELER: Yeah. Yeah, I know. I know.

SARAH JANE TRIBBLE: Ralph doesn't want me to think he's weak. So we get in our separate cars. Half an hour later, we've arrived at the dialysis center. It's on the corner of a strip mall next to a Big Lots and Dollar General. He parks close to the door.

Hey, there.

RALPH WHEELER: We're here. We're here.

SARAH JANE TRIBBLE: How was the drive for you?

RALPH WHEELER: All right. How was it for you? How fast was I driving?

SARAH JANE TRIBBLE: About 60. Not, not too fast.




SARAH JANE TRIBBLE: You stayed right about …

He's asking, I think, because Ralph's speedometer doesn't quite work.

RALPH WHEELER: According to my speedometer, gets up to about 70, so …

SARAH JANE TRIBBLE: What year is your car?

RALPH WHEELER: It's a ’96.

SARAH JANE TRIBBLE: OK. That's what I thought.

If you grow up in the country, you know your cars. I've been married nearly 20 years, and I won my husband over by looking out a bar window and saying the exact year and make of his car.

It was a used ’97 midnight blue Camaro. Ralph's car is more than two decades old. If he has car trouble, this plan to drive 30 miles every week could fall apart at any moment.

It's just a short walk inside, but after Ralph gets to his dialysis chair, I notice he's panting with short, shallow breaths and having trouble breathing.

Now, how will it feel when you drive back?

RALPH WHEELER: It'll be the same way. I'll be just a little bit weaker than what I am right now and everything like that, but not that bad. Not that bad. Just watch what I'm doing …

SARAH JANE TRIBBLE: Right. Not that bad. Of course, this is what Ralph would say. It reminds me of something he said months ago, sitting on the porch with Pat.

What do you think about Pat's health?

RALPH WHEELER: Pat's health?


RALPH WHEELER: Well, sometimes she acts all right, and then other times …

PAT WHEELER: It is what it is.

RALPH WHEELER: Yep. It’s one day at a time. Take one day at a time.

SARAH JANE TRIBBLE: Pat says it is what it is. They're scared and uncertain, but they're strong and they are moving forward. That's about how the entire town is handling the hospital closing. But that doesn't mean Fort Scott is letting Mercy Hospital just slip away without a fight. And some anger. Next time, we'll meet a woman who spent her entire career at the hospital, eventually becoming the president.

RETA BAKER: I don't even like going out in the community anymore because I get confronted all the time, but, you know, someone confronted me at Walmart. You know, “How could you let this happen?”

SARAH JANE TRIBBLE: She never expected her last act at Mercy Hospital Fort Scott would be to shut it down.

This season of Where It Hurts is hosted and reported by me, Sarah Jane Tribble. The multitalented Tarena Lofton, who's a jack-of-all-trades, 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 sound and design mix wizard. Tim Eby, general manager at St. Louis Public Radio, along with Diane Webber, national editor for broadcast, and Elisabeth Rosenthal at KHN are editorial liaisons for the show. Shula Neuman and Jenna Weiss-Berman lent us their expertise and fresh audio ears for this episode. Special thanks to Tim Lloyd for helping to launch this podcast collaboration. And this podcast would not have happened without help from my family in Kansas. Season one, “No Mercy,” is for you, Maggie. The podcast is a co-production 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 KFF.

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