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Chapter 5 — Poppyseed Bread, Orange Glaze And Chemo

Chapter 5: Poppyseed Bread, Orange Glaze and Chemo
David Kovaluk
/
St. Louis Public Radio

Sixty-five-year-old Karen Endicott-Coyan is living with a blood cancer and she needs frequent chemotherapy. Before Mercy Hospital closed, she got her cancer care right in town. These days getting to chemo means an hour-long trek on rural roads and narrow highways. The stress and frustration of traveling illuminates one reason cancer death rates are higher in rural America.

Chapter 5 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— 0:10]

SARAH JANE TRIBBLE: Hello, puppy.

There’s a massive St. Bernard in my face as I open the car door.

Oh, you're eating my backpack. Don't eat my backpack, puppy.

I'm visiting Karen Endicott-Coyan. She lives outside of Fort Scott. And this furry beast is the first to greet me.

Hey, Karen.

Out on a farm, dogs have jobs. They're supposed to protect the property. I'm here to ride along with Karen as she goes to her weekly chemotherapy treatment. Karen used to get treated at Mercy Hospital, but that stopped when the hospital closed. The loss of cancer care is one of the biggest ways getting health care in Fort Scott has changed now that there's no Mercy.

Hey, Karen. Help!

This dog is muddy. It's an outside dog and he seems friendly.

Hey, guys? Whoever is here?

But he's blocking my path to the door. Slobbering all over me and my clothes and my bag. We started a tug of war and I'm losing.

Hey, puppy. No, no. Don't chew on the cord. Don’t chew on the cord. All right. Help! Help! Help! Help! Help!

Hi. I had to drop my backpack because they were chewing on it.

KAREN ENDICOTT-COYAN: Oh. Out there? I'll get it.

SARAH JANE TRIBBLE: Yeah. Do you mind?

KAREN ENDICOTT-COYAN: No, I don't mind. Sorry, I didn't know you were here.

SARAH JANE TRIBBLE: Oh, that's OK.

As Karen opens the door, pats the dog's head gently and grabs my bag, I feel a bit ridiculous. Karen’s so strong — even though she's in her 60s and has been fighting a rare form of cancer for years. Karen's weekly trip used to be a 15-minute drive into town, and she'd often get groceries at the same time. Now she travels one hour each way on narrow two-lane country highways. But she's not quite ready to go. I get inside and I smell baking.

Oh, my gosh, that looks amazing. That's banana bread?

KAREN ENDICOTT-COYAN: No, it's poppyseed bread.

SARAH JANE TRIBBLE: Poppyseed bread.

KAREN ENDICOTT-COYAN: I'm going to give it another minute.

SARAH JANE TRIBBLE: Karen's hands are moving very quickly.

So, wait — what are you stirring right now?

KAREN ENDICOTT-COYAN: This is a glaze. It’s sugar and orange juice, butter flavoring and … I think I just put almond flavoring in it instead of vanilla.

It's supposed to be butter and vanilla, but I did almond, so I'll put a little vanilla in it. It's because I'm … the brain’s just not working real good today.

SARAH JANE TRIBBLE: So you did take your medication today?

KAREN ENDICOTT-COYAN: I did. I did.

SARAH JANE TRIBBLE: Did you need it more than usual?

KAREN ENDICOTT-COYAN: Yes.

SARAH JANE TRIBBLE: Why?

KAREN ENDICOTT-COYAN: Well, it was a bad night last night.

SARAH JANE TRIBBLE: Karen's cancer is multiple myeloma. It's in her cells, and it spreads through the bones. Karen's pain is a deep, constant aching. Her oncologist gives her morphine and other painkillers. Sometimes it's just not enough. The pain, the medicine, the travel. Taking care of herself was so much easier when Mercy Hospital was open.

KAREN ENDICOTT-COYAN: Yesterday was, as I call them, a puke day. Or a morning. And so I vomited several times yesterday morning. Now, don't ask me why. But I did. So, we didn't go to church because I didn't feel good.

SARAH JANE TRIBBLE: Karen story shows what it takes to live with cancer in rural America. I'm Sarah Jane Tribble. This is Where It Hurts, a new podcast from KHN and St. Louis Public Radio. Season one is "No Mercy."

[Segment 2 — 4:00]

SARAH JANE TRIBBLE: Fort Scott's cancer center wasn't supposed to close. It was separate from Mercy Hospital, operated by an independent oncology practice out of Wichita, Kansas. But not long after the hospital shut down, the cancer center announced it was closing, too. Nearly 200 patients were treated there, according to former hospital president Reta Baker.

RETA BAKER: Our whole purpose when we designed it was for it to be a place where somebody who was coming to have something unpleasant done could actually feel pampered and feel like they were in a nice environment.

SARAH JANE TRIBBLE: It was called the Unit of Hope. There's a row of chairs with a view of some woods. Each seat has its own television. Plenty of space for visitors. All of the walls and carpets are done up in beige and calming colors.

RETA BAKER: Very heartbreaking that it's currently not being utilized for its intended purpose.

SARAH JANE TRIBBLE: Is it vacant right now?

RETA BAKER: It is vacant right now.

SARAH JANE TRIBBLE: Most of the massive hospital building sits empty. But there are primary care doctor offices up front, with a pharmacy, and the emergency department has reopened. Reta really thought the cancer center would stay.

RETA BAKER: Everything really seemed to be OK. So I was certainly surprised by it. There was a deep sense of disappointment that they were pulling out.

SARAH JANE TRIBBLE: People in rural America are more likely to die from cancer than patients in metro areas. That's according to the Centers for Disease Control and Prevention. Rural patients often get their cancer diagnosed at later stages. And they travel further to get care. Cancer doctors are also hard to find in rural America. In Fort Scott, when the cancer center was open, the doctors came from Wichita and drove in every week or so. Dr. Boban Mathew is one of the few cancer doctors who lives in southeast Kansas.

DR. BOBAN MATHEW: I think the further you have to travel to get care, the less likely that you are going to take the effort to do that. First of all, you're not feeling good. You may not be able to drive yourself there. You have to depend on someone else.

SARAH JANE TRIBBLE: At Karen Endicott-Coyan's house, we're expecting her sister-in-law any minute. That's who's driving Karen to chemotherapy today. And we're still trying to get ready. Karen's in the bathroom brushing her teeth.

Are you … are you in a hurry, or is it …?

Karen seems really tense. I'm worried that recording her is making her nervous, making her feel rushed.

I'm wrong. That's not it.

KAREN ENDICOTT-COYAN: Well, usually, I would just tell John that there's food in the refrigerator. But the last five, six days have not been good.

SARAH JANE TRIBBLE: I'm sorry.

KAREN ENDICOTT-COYAN: It's hard.

SARAH JANE TRIBBLE: Karen's husband, John, has dementia. The illness has progressed fast in the past few months. Both John, who's in his 70s, and Karen seem to be deteriorating before my eyes. Now she's putting foundation and powder on her face.

KAREN ENDICOTT-COYAN: I know it. It makes my wrinkles look worse.

SARAH JANE TRIBBLE: The makeup?

KAREN ENDICOTT-COYAN: Yes, I think it does. It makes 'em ... But I look so pale without any.

SARAH JANE TRIBBLE: She starts to put on diamond earrings. I can't help myself. I ask her, is chemotherapy treatment worthy of diamond earrings?

KAREN ENDICOTT-COYAN: I think so. You don't?

SARAH JANE TRIBBLE: I think it is. I don't know why it wouldn't be, I just ...

KAREN ENDICOTT-COYAN: I mean, I'm not gonna go over there looking, if if I can help it, I'm not going to go over there looking like a sick person. I don't like looking like a sick person. That's just me. The vanity, I guess.

SARAH JANE TRIBBLE: Karen used to be an executive at Mercy Hospital. Her job was to squeeze money out of federal programs like Medicare and Medicaid. Karen worked at Mercy for more than 20 years. And as she puts on those diamond earrings, I can see that career woman. While she worked in the office, John raised cows. When we walk back into the kitchen, John is sitting at the counter eating ice cream.

KAREN ENDICOTT-COYAN: And so I'm going to lay your clothes out, if you're going to take your shower while I'm gone. And you can shave. OK?

JOHN COYAN: Yeah. I haven't shaved in a couple days. I'm saving electric.

KAREN ENDICOTT-COYAN: OK. Well, I'm going to lay your clothes out.

JOHN COYAN: The cows don't mind. Just come on, they say.

SARAH JANE TRIBBLE: How was the ice cream, John?

JOHN COYAN: Pretty good. Oh, my gosh, I didn't save you any, did I?

SARAH JANE TRIBBLE: No, that's …

JOHN COYAN: There's more down there.

SARAH JANE TRIBBLE: OK. Good. Good.

John may be losing his memory, but he still has his sense of humor.

What kind of cows do you have?

JOHN COYAN: Four-leggeds.

SARAH JANE TRIBBLE: Are they Angus?

JOHN COYAN: Oh, no — Beefmasters.

SARAH JANE TRIBBLE: Beefmasters. OK. I wonder about that. And they calved this spring. Did it go well?

JOHN COYAN: Normally, yeah.

SARAH JANE TRIBBLE: “Normally, yeah.” Karen told me later that that's John’s standard answer when he can't remember. John and I are chatting when Karen grabs her purse and seems ready to leave.

Well, I don't want to make you late.

KAREN ENDICOTT-COYAN: What are they gonna do if I'm late? Give me a demerit? Or tell me, “You're late — you can't have chemo this week”? They're not going to do it.

SARAH JANE TRIBBLE: Still, I know Karen doesn't want to be late.

KAREN ENDICOTT-COYAN: And we know that doesn't actually take an hour. Just almost an hour.

OK, bye, babe. We'll be back. They're done in the house, so you can lock the doors. OK?

SARAH JANE TRIBBLE: She's on a schedule and she's juggling a lot. Besides today being a not great memory day for John, he has physical therapy for a bad shoulder this afternoon. And Karen needs to get back to take him. Karen has it all timed out. Her chemo is a shot, not an IV. That takes less than 30 minutes. The whole trip should take less than three hours. It should all work out.

Karen has thought out every detail, even the exact route.

KAREN ENDICOTT-COYAN: You're going to go through the first stoplight. And then you'll see the back of two stop signs. And we turn at the second one.

And there's a turn lane down there. I mean ...

SARAH JANE TRIBBLE: Her sister-in-law, Debbie, is driving. But Karen is always in charge. Plus, it's a bit confusing. I don't see any signs for the new cancer center. And we're pulling into a back parking lot when Karen points and says ...

KAREN ENDICOTT-COYAN: I told somebody, it just feels like, we just go in right by the trash. It just doesn't … it isn't very welcoming.

DEBBIE ENDICOTT: Wow, it's really not.

SARAH JANE TRIBBLE: The back door we walk in is rusted and it is right next to a dumpster. Once we get inside, the cancer clinic is small. Karen walks a few paces and is at a sort of cashier's window.

WOMAN AT CANCER CENTER: Hello.

KAREN ENDICOTT-COYAN: Hi. How are we, ladies?

WOMAN AT CANCER CENTER: Wonderful. How are you?

KAREN ENDICOTT-COYAN: We're good. Well, I say we're good. I, I went to the emergency room Tuesday.

WOMAN AT CANCER CENTER: Aww.

KAREN ENDICOTT-COYAN: I was dehydrated. I had the pukes.

WOMAN AT CANCER CENTER: Oh. Did they give you fluids?

SARAH JANE TRIBBLE: Wait a minute. Karen had to go to the ER?

She didn't even tell me that. Before I have a chance to ask her about that, the nurses tell Karen she needs lab work.

KAREN ENDICOTT-COYAN: Oh, I didn't have down that I needed labs today.

WOMAN AT CANCER CENTER: Isn't it your day one?

KAREN ENDICOTT-COYAN: Well, but I didn't get a schedule. And when I called and I said, “Hey, I didn't get a schedule …”

SARAH JANE TRIBBLE: There's confusion here. Both for the nurses and Karen. It's painfully obvious that nobody is responsible for Karen's care except Karen.

KAREN ENDICOTT-COYAN: And she said, "Well, you just" — I don't know who it was — she said, "Well, you just come for shots and so it doesn't matter what time you come." And I said, “I always get a schedule.”

WOMAN AT DOCTOR'S OFFICE: I heard you talked to Sherry.

KAREN ENDICOTT-COYAN: But I decided, hey, Chanute is different than Fort Scott. Just go with the flow, Karen.

SARAH JANE TRIBBLE: Karen has two options. She could stay here to get the blood drawn, or go to a small hospital that's across the street.

Karen doesn't trust this new cancer center to do it quickly.

KAREN ENDICOTT-COYAN: OK, you want me to go across the street and do them?

WOMAN AT CANCER CENTER: Well, you can.

KAREN ENDICOTT-COYAN: Might be faster. OK, we’ll run across the street.

WOMAN AT CANCER CENTER: OK.

SARAH JANE TRIBBLE: She grabs the paperwork and walks out the door.

KAREN ENDICOTT-COYAN: Now, I would say this even if the microphone were off: If they'd have sent me a schedule, we'd have gone and done labs first.

SARAH JANE TRIBBLE: Oh, she's mad.

KAREN ENDICOTT-COYAN: "We always need labs on day one." Well, how in the hell do I know what day we're on?

DEBBIE ENDICOTT: You're right. I hear ya.

KAREN ENDICOTT-COYAN: They might know, but I don't.

SARAH JANE TRIBBLE: We get in the car and drive to the place where Karen knows she'll be taken care of fast. There's handicapped spots up front and Karen really likes this hospital.

KAREN ENDICOTT-COYAN: And it is so nice. Oh, just take this one.

SARAH JANE TRIBBLE: Minutes are ticking by. John’s at home alone, hopefully getting ready for his appointment. Karen walks through the sliding glass doors.

KAREN ENDICOTT-COYAN: I need to register for lab.

SARAH JANE TRIBBLE: Once again, Karen's at a desk directing her own care.

KAREN ENDICOTT-COYAN: Karen Endicott-Coyan.

SARAH JANE TRIBBLE: The clerk is checking names, addresses, insurance. And remember, John's home alone. Minutes are passing.

WOMAN AT HOSPITAL: OK, I'm gonna have you sign that at the very bottom on that big white area.

SARAH JANE TRIBBLE: Finally, we're walking down the hall.

KAREN ENDICOTT-COYAN: It is a hike down here. Well, at least, I call it a hike. It's a ways. But I can use the exercise.

SARAH JANE TRIBBLE: Yet another person, another introduction …

KAREN ENDICOTT-COYAN: Here we go.

Hi. I need a lab, please. For across the street, Dr. Truong.

MAN AT HOSPITAL: Oh, OK. And you have the orders with us. Awesome.

KAREN ENDICOTT-COYAN: She was going to fax them and I said, well, I'll take them too if you want me to.

SARAH JANE TRIBBLE: The blood draw is quick. We get back in the car. Debbie drives us back to the cancer center. And we wait.

KAREN ENDICOTT-COYAN: OK. Any time, right?

SARAH JANE TRIBBLE: Maybe half an hour? A bit longer? Long enough to where even Karen runs out of things to talk about. When the nurse is ready, the actual chemotherapy shot itself takes less than five minutes.

NURSE AT CANCER CENTER: OK, we're done.

KAREN ENDICOTT-COYAN: Oh, I have to have a Tootsie Roll Pop.

WOMAN AT CANCER CENTER: Yes, I can get you that. What kind do you want?

KAREN ENDICOTT-COYAN: Oh, just surprise me.

SARAH JANE TRIBBLE: Back in the car, Karen gets quiet. We weave our way out through the streets of this small town. Get on the first two-lane highway. I hear Karen swallowing hard.

She takes a sip of water and digs in her purse.

KAREN ENDICOTT-COYAN: And see, I bring my own Ritz crackers. And I have found that if I eat a few Ritz crackers or crackers on the way home. I don't get as nauseated.

SARAH JANE TRIBBLE: By the time we hit the second two-lane highway, the more narrow one, Karen's talking again, for the rest of the ride home. Then we're on her gravel road. And as we pull into Karen's driveway, she's pointing out the damage a recent storm caused on her property.

KAREN ENDICOTT-COYAN: And you can see where the — I thought, Who is that? No, he's not dressed.

DEBBIE ENDICOTT: Nope.

KAREN ENDICOTT-COYAN: You can see where the limb blew down.

SARAH JANE TRIBBLE: John is standing in the driveway wearing just his jeans, no shirt at all. His chest is pale and kind of thin. Karen looks alarmed for just a moment. Then she catches herself.

KAREN ENDICOTT-COYAN: OK, well, I have to get him moving.

Thank you very much, Debbie. Thank you.

SARAH JANE TRIBBLE: I will take off, too.

KAREN ENDICOTT-COYAN: OK.

SARAH JANE TRIBBLE: Thank you, Debbie.

DEBBIE ENDICOTT: You're welcome.

SARAH JANE TRIBBLE: Thanks for putting up with me.

KAREN ENDICOTT-COYAN: Are you flying back tomorrow?

SARAH JANE TRIBBLE: Uh, yeah.

KAREN ENDICOTT-COYAN: OK.

SARAH JANE TRIBBLE: Yeah.

KAREN ENDICOTT-COYAN: Sorry. Probably cracker crumbs.

DEBBIE ENDICOTT: It's OK. Bye.

SARAH JANE TRIBBLE: Thank you. Bye.

Hi, St. Bernard.

[Segment 3— 15:45]

SARAH JANE TRIBBLE: I spent hours with Karen and Debbie and John. Now I'm with my own family, sitting on the front porch of my parents' house, about an hour south of Fort Scott.

I love that my parents still live on the same wide-open land where I grew up. In the mornings, I sit here with a cup of coffee and I can hear the world slowly waking up. That's when I have time to think. My thoughts here always include Maggie. My sister was only 20 months older than me, but she always took care of me. As kids, we roamed these pastures together, finding adventures in the creek beds and nearby abandoned houses. Even in our 30s and 40s, when we lived different lives a thousand miles from each other, we relished the quick phone chats.

[Voicemail from Maggie]

MAGGIE JACKSON: Hey, Sar, Sar. It’s Maggie. I was trying to give you a call. Um, call me whenever you get the chance. OK? Love you, bye.

SARAH JANE TRIBBLE: Maggie lived just outside of Kansas City and close to a hospital. Maggie's regular chemotherapy treatments happened just a mile or so from her home. She did travel, though. For nearly two years, Maggie tried every clinical trial she could get into. She traveled to the Mayo Clinic, then to Boston and Baltimore — all hunting for the best pancreatic cancer treatment. It worked for a while. She'd never had full remission but lived longer than expected for her diagnosis. Cancer is awful, and expensive. And you need experts in big cities to help you. In the end, Maggie came back here. Home.

She sat right here on this porch one last time and took in this beautiful world. She was 46.

Maggie was gone about five months when I realized that I was now the oldest, the one supposedly in charge if something happened to Mom and Dad. I had spent the day with Karen and John Coyan in Fort Scott, watching them dealing with cancer and dementia. And when I came home for a visit, I looked at my dad, who is in his 70s. And my mom, who's in her 60s. They're the same age as Karen and John. They're retired, like Karen and John. They've also been married for decades and they live on a dirt road miles from a major hospital, just like John and Karen. My parents are healthy, for now. And there's another difference for my parents: My little sister lives close by. She will be here when a crisis comes. John and Karen's children? Most of their kids live and work far away. Just like me.

That's what happens in rural America. As kids, we grow up and move away to the cities for jobs and opportunity. It's so common that states like Kansas offer tax breaks to new residents who move to rural places. Already, more than 1 in 5 people in rural America are over the age of 65.

In Fort Scott, there are a lot of people like John and Karen and my parents.

That summer after Mercy Hospital closed, I drop in a couple of times to see Karen and check on her. Karen and John have more than 200 acres and dozens of cows. More and more, John’s struggling to take care of his cows.

KAREN ENDICOTT-COYAN: There's heifers and bulls down there from last year that were born last spring that were not sold. And the bulls weren't cut, clamped, made into steers. Nothing happened. Nobody got fly tags last year. Nobody got dewormed. Nobody got anything last year. And unfortunately, I think it's going to be that way this year.

SARAH JANE TRIBBLE: And no wonder. Karen has been traveling the hour each way for her weekly chemo treatment. She's also been driving John into town for his physical therapy. And there's been more emergency room visits. Some in Fort Scott when Karen gets dehydrated. Some in another nearby town that has a traditional hospital where there are doctors for John's dementia. Last time, John had to stay overnight for a few days. But today's a good day. John's back home and ready to show me his cows.

JOHN COYAN: It's a cow.

SARAH JANE TRIBBLE: A dozen or so mamas and calves are eyeing us. John tells me they would usually let him walk up and pet them. But not today. I'm a stranger and they run. It doesn't matter. John looks content.

Sure is pretty out here, John.

JOHN COYAN: Well, it is. To me. Really, yeah.

SARAH JANE TRIBBLE: Karen drives us up by the feed pen. She never would have been out here helping with the cows five years ago. But these days are different. She's ready to carry buckets of feed and throw the grain in the steel troughs. John knows this is just not how it should go.

JOHN COYAN: Don't carry that. It’s heavy.

KAREN ENDICOTT-COYAN: Huh?

JOHN COYAN: I told you not to carry that. Them buckets are heavy.

KAREN ENDICOTT-COYAN: Oh, yeah. And don't walk in here, because it is muddy.

SARAH JANE TRIBBLE: The ground around the feed troughs is pockmarked with the cows’ hooves. Really uneven. And Karen's feet sink into the mud. She has to tug her feet up with each step.

KAREN ENDICOTT-COYAN: Honey. Oh, yeah. If you fall down, you just go strip off and take a shower.

JOHN COYAN: If you fall down, you're down.

SARAH JANE TRIBBLE: I'm beginning to feel like I should help.

KAREN ENDICOTT-COYAN: You just do the best you can do.

SARAH JANE TRIBBLE: Karen is teetering. She's balancing heavy buckets of grain as she straddles potholes in the ground.

KAREN ENDICOTT-COYAN: I'm fine. I'm fine. Don't grab me.

SARAH JANE TRIBBLE: John is reaching out to help Karen, but it's too late.

KAREN ENDICOTT-COYAN: I'm telling you. … OK, see?

SARAH JANE TRIBBLE: Her foot slips and she falls backwards.

KAREN ENDICOTT-COYAN: But I've fallen down before and you just go in the back door. Now, trust me, I can get myself up.

SARAH JANE TRIBBLE: Well, here. Can, can I help in any way?

KAREN ENDICOTT-COYAN: OK.

SARAH JANE TRIBBLE: I feel terrible. I'm working, trying to catch all these sounds. I'm the youngest and healthiest one out here. What are they doing out here?

Are you OK, Karen?

KAREN ENDICOTT-COYAN: Yes. I'm just trying to get some of the mud off my hands. OK. Now, see, if you weren't here, I would slip off these pants. And go in the house in my underwear.

JOHN COYAN: As long as she makes it safely.

SARAH JANE TRIBBLE: John mumbles to me, "As long as she makes it safely."

They've been married 26 years. And before his mind began to fail, John would sometimes walk up behind Karen while she was washing dishes and sneak in a kiss on the back of her neck.

For Karen, her soft-spoken husband had seemed unwavering and solid through her years of fighting cancer. And then he wasn't.

And now the more Karen takes care of John, the more her own body seems to falter.

KAREN ENDICOTT-COYAN: And so, I did end up in the emergency room and I hated that I'm going to be labeled a frequent flyer because I go too much. But I ended up in the emergency room probably three, four weeks ago on a Sunday because I just, I couldn't handle the pain. Couldn't get it under control.

SARAH JANE TRIBBLE: As Karen talks, I'm reminded that she worked in hospital finance at Mercy. She knows that a lot of ER use is not ideal. And she feels guilty about it. But it's clear as she talks that she needed the extra care. And John needed more care, too. In the four weeks after we all went down to see the cows, a lot happened very quickly. Karen ended up back in the ER, and then John was also back in the ER.

KAREN ENDICOTT-COYAN: They had done a CAT scan that showed — and I don't remember the colors — but whatever color your brain is supposed to be, most of his brain was not that color, because it was dying. But they did a CAT scan and then they did an MRI. And based on the MRI, the place in his brain that was really dead — or, you know, not functioning — they could tell that it was Alzheimer’s.

SARAH JANE TRIBBLE: After that, he never made it back home. John was sent to a nursing home in Fort Scott. The home had staff that specialized in memory care. But he wasn't there long enough to really benefit. He died eight days later. Karen had cared for him right up until those final days, and she knew he wanted to be at home, on the farm.

KAREN ENDICOTT-COYAN: All he ever wanted was to be home with his cows. I told somebody, John loved driving the bus, he loved his cows and he loved me. I don't know what order that fell in, but I know I was in there.

SARAH JANE TRIBBLE: Karen is still here. She's tired. Very tired. And still taking those two-hour round trips to chemo.

Next time, I make it back to visit with Josh, the grandson of the aging couple who helped launch this story. He's a teenager trying to cope. Josh and the entire town of Fort Scott is trying to figure out what a healthy future looks like.

Jesus, Josh is half passed out on a bed that you can see from the front door. Um, and he only has a pair of shorts on. And he was laying with his feet on the ground and his body backwards on the mattress, face up towards the ceiling.

Josh, and the entire town of Fort Scott, is trying to figure out what a healthy future looks like.

This season of Where It Hurts is hosted and reported by me, Sarah Jane Tribble. 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 sound and design mix wizard. Diane Webber, national editor for broadcast, and Elisabeth Rosenthal, editor-in-chief at Kaiser Health News, are editorial liaisons to the show. Shula Neuman, Naomi Starobin and Carrie Feibel lent their expertise and fresh audio ears for this episode. 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.

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