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Chapter 6 — What I Was Raised And Taught To Do

Chapter 6: What I Was Raised and Taught to Do
David Kovaluk
St. Louis Public Radio

Life in a small town often feels like a dead end for Josh, a teen whose mother died of a drug overdose when he was 3. His grandparents became sick just as Mercy Hospital was closing, forcing them to seek care hours away from home. Soon after, Josh dropped out of high school to help more at home, upending his already unpredictable life.
Months have passed since Mercy Fort Scott closed, and some in town have softened their position. Hospital president Reta Baker and City Manager Dave Martin end months of acrimony and begin to realize where they do agree.

Chapter 6 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.

SARAH JANE TRIBBLE: A note for our listeners: This chapter includes language some might consider offensive and content that could be disturbing. So please consider how you listen and with whom. If you or someone you know feels depressed and hopeless or is contemplating suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255. Help is available.

[Segment 1— 0:30]


I'm exhausted, physically and emotionally, when I walk in the door at my parents’ house. They still live in southeastern Kansas. My mom and dad raised me and my sisters on a country road about an hour south of Fort Scott.




SHIRLEY LUNDAY: Come in. You caught me nibbling on something. It's good to see you.

SARAH JANE TRIBBLE: Good to see you, too.

SHIRLEY LUNDAY: I'm so glad you're here. How are you doing?

SARAH JANE TRIBBLE: Good. Where's Dad?

Hey, Dad. How are you?


SARAH JANE TRIBBLE: Good to see you.

I go to give my dad a hug, but he's gross.


SARAH JANE TRIBBLE: You're sweaty. You're sweaty.

KENNETH LUNDAY: Yeah. I'm sweaty. Yeah, I'm sweaty. I've been to work. Someone … somebody works. I've been working on the tractor, been Bush Hogging.

Love you. Glad you're here.

SARAH JANE TRIBBLE: It's good to be here. Thanks for having me. What's for dinner?


SARAH JANE TRIBBLE: My dad has been out all afternoon clearing brush in the pasture. He goes to clean up. Mom and I head to the kitchen counter to talk. Walking into my parents’ house feels like a break. I've been visiting people whose lives changed after the closing of Mercy Hospital, the only hospital in their small town. Some of their pain is directly related to the loss of the hospital. In other cases, it wasn't.

Being home is comforting, and I get my mom's cooking. She makes these homemade egg noodles. It's basically just flour, eggs from our chickens and a bit of salt. They go into a broth and double in size for a thick soup. My mom learned the recipe from her mom.

SHIRLEY LUNDAY: You know why? ’Cause they're cheap. They're easy, and they're filling. Who doesn't like homemade noodles?

SARAH JANE TRIBBLE: Both of my parents were born here, in southeastern Kansas. And they didn't come from much. My dad grew up with only an outhouse until he joined the Army. My mom was a teenage bride. They married after my dad got back from Vietnam. Neither of them had graduated from high school. But they found jobs and started a family.

My dad worked at a metal manufacturing plant, making the steel rods that reinforce our nation's highways. My mom took care of intellectually disabled patients at the state hospital. She worked the night shift for more than a decade before moving to days. They did this for 40-plus years, slowly digging themselves out of poverty.

SHIRLEY LUNDAY: We were really poor. [laughing]

SARAH JANE TRIBBLE: I like how you pause before saying that, like you weren't sure you wanted to say that on the microphone.

SHIRLEY LUNDAY: I know. Sometimes you hate to tell people how poor you were.

SARAH JANE TRIBBLE: So, my family was poor growing up. Whether we had enough money to buy gas to drive into town was a regular question raised at the dinner table when I was a kid. I carried that lived experience with me while reporting about Fort Scott.

It's hard to be uncomfortable in a place that's familiar. Pat Wheeler makes noodles just like my mom. Pat and her husband, Ralph, began our story, and now we're going to spend time with their grandson, Josh. Josh told me he struggles with what he calls his mental state.

His part of their family's story points me to some of the health care that is desperately needed in rural America, but wasn't actually available at Mercy Hospital before it closed.

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 — 4:18]

SARAH JANE TRIBBLE: On the day I went back to visit Josh, walking through Pat and Ralph's door felt all wrong.


[Dog barking]

Hello. Anybody home?

Pat? Hello, Pat, Josh? Anybody home? I said I was coming back, so I hope I'm not surprising you all.

JOSH'S FRIEND: Who is it?

SARAH JANE TRIBBLE: I'm Sarah. Is Josh around?

JOSH'S FRIEND: What the fuck is that?

SARAH JANE TRIBBLE: It's recording equipment.


Yeah. … Should I follow you?

JOSH'S FRIEND: Josh, where you at, man?

SARAH JANE TRIBBLE: I came back thinking Pat would be here. She's not. But I had talked with her about coming back to see Josh, too, so we could talk about the hospital, and I'm hoping to do that now. It would be nice to hear from someone who is young in this town. But instead of finding Josh, the first person I see when I walk in is, I think, Josh's friend.

JOSH'S FRIEND: Oh, it's a lady here with the microphone and stuff in the house.

SARAH JANE TRIBBLE: We've talked before, Josh. It's Sarah.

JOSH'S FRIEND: I don't think she's bullshitting, ’cause ...

SARAH JANE TRIBBLE: I'm totally recording. Right now.


SARAH JANE TRIBBLE: I'm laughing to break the tension. This guy seems nervous. He tells me Josh is in the bathroom. And doesn't stick around long enough for me to get his full name or ask any questions. So I stand there. And wait.

So, Josh, I'm still here waiting for you.

He said he dropped out of high school about the same time Mercy Hospital closed, and he says those two things are related. Today, I'm hoping to get a better understanding of why he connects the two and get his take on the health care challenges his family faces.

Minutes are passing and I'm still standing here. When Josh finally walks out of the bathroom, he looks tired. His face has peach fuzz and his hat is dirty.

He slouches into a big chair.

JOSH: Basically, like, uh, people think I'm a drug dealer. Or they think I do this or they think I do that. And all this other stuff. And overall look at me as like I'm this bad person. I mean, I can be nice if you want me to be, but I can be that bad person that you guys are putting me out as if you want me to be.

SARAH JANE TRIBBLE: Josh is 17. A high school dropout with a pit bull mix named Amber sitting at his feet. It's too easy to see a troubled kid.

But he is also a teenager who is here for his grandparents. When Ralph's heart started failing, Josh helped out as they shuttled to the next closest hospital, and then another.

JOSH: It's 1 o'clock in the morning. And I have to drive from here to Pittsburg with my grandma in the car following the ambulance. When we got to Pittsburg, the next day, um, we had to take all of our stuff that we unpacked out of the hotel that we had in Pittsburg and go straight to Joplin because he was being transported out to Joplin.

SARAH JANE TRIBBLE: What followed was weeks of chaos. Renting hotel rooms in two different towns just to be close to Ralph as he recovered from heart failure.

That's when, Josh says, he dropped out of high school.

Pat has emphysema. And Ralph has the bad heart, plus emphysema and failing kidneys.

So, are you worried about your grandparents right now?

JOSH: Very much so. My grandma and ... She sees my grandpa going downhill pretty fast, and she's starting to get where she doesn't wear her oxygen at night. And she's supposed to sleep with her oxygen on. So I have to wake her up and tell her multiple times: “Hey, put your oxygen on.” And halfway through the night she'll end up taking it off somehow. So it's just getting more and more rough every day.

SARAH JANE TRIBBLE: Pat and Ralph took Josh in when he was 3 years old. And Josh says Pat has been taking pain medicine prescribed by her doctor as long as he can remember.

Months after Ralph came home from the hospital, Pat ended up in the emergency room because of the medicine.

JOSH: It was related to that. She had ran out of ’em and she needed to, uh ...

SARAH JANE TRIBBLE: Josh tries to explain it to me.

JOSH: I don't see how they can take somebody taking 20 milligrams of a hydrochloride form of medication with a no fill and it's straight opiate.

SARAH JANE TRIBBLE: But he's speaking a language I do not know.

I'm not following you. What are you referring to?

JOSH: So, her oxycodones are 20 milligrams. So they're a way higher level of dosage and more medication than what she would, she would be getting more out of taking those to help her.

SARAH JANE TRIBBLE: The doctor had adjusted Pat's prescription, but Josh says the change left Pat still needing pain relief. As we talk, I can't tell what medical condition Pat has that requires opioids for pain relief. But it doesn't seem fair to keep talking to a 17-year-old about this or his grandmother. To understand all of this, I really need to come back another time and speak with Pat.

Eric Thomason works at the Community Health Center of Southeast Kansas. It's the health clinic that moved into Fort Scott when Mercy Hospital closed.

Mercy didn't provide any addiction or behavioral health services. The health center does, and their approach is to treat it just like any other chronic illness. Eric is in charge of those services.

ERIC THOMASON: I get the privilege of working with hardworking, blue-collared folks. And they oftentimes view, you know, depression, anxiety or bipolar disorder or battles with addiction as a weakness. Right? And there's no hardworking person that wants to just sit here and admit that they have a problem. And so a lot of times we avoid it. And what happens when we avoid chronic illness, regardless of if it's diabetes, hypertension or depression, is it gets worse.

SARAH JANE TRIBBLE: Eric says part of the job is convincing people to feel comfortable enough to come see them.

ERIC THOMASON: And so a lot of times it's educating society, saying, hey, it's not a weakness on your part. You may be depressed for things that are completely outside of your control.

The people who struggle with depression or mental health are commonly the same people who reach for alcohol and drugs to cope. The residents of Bourbon County, where Fort Scott is, report some of the highest number of poor mental health days in the state of Kansas. And that's not unusual for people in rural areas across the country. At the same time, it's tough to find help. Rural places often have a shortage of mental health workers, such as psychiatrists and psychologists.

ERIC THOMASON: When in all reality, you know, the depression, the anxiety, bipolar disorder, the substance abuse problems — they were already there. We were just shining a light on them and trying to address them.

SARAH JANE TRIBBLE: And these chronic illnesses, Eric says, show up from one generation to the next.

ERIC THOMASON: I'm a firm believer that people are doing the best they can do with what they know how to do. And so a lot of what they may have seen in their life for coping is substance abuse. They may have had parents who got stuck in that substance abuse cycle and they grew up in that. So they're falling back to things that they observed.

SARAH JANE TRIBBLE: Josh does seem to be picking up habits. He smokes, just like both of his grandparents. But when it comes to taking opioids, he says …

JOSH: I won't touch ’em. I can't do it. I just can't.

SARAH JANE TRIBBLE: So, you're not to touch any opioids that are on the street or anywhere else.


SARAH JANE TRIBBLE: I have that on tape. So you gotta keep with that, OK?

JOSH: I will.

SARAH JANE TRIBBLE: I want to believe Josh. The reason he moved in with Pat and Ralph when he was 3 years old is because of opioids. His mom died from an overdose. Pat told me about it. And so did Josh. Josh, though, was young. He's only heard stories. He remembers almost nothing about his mother. Not her smell or the color of her hair, her touch, he says. But he does remember seeing her take her pills.

JOSH: One moment that I can remember is she was sitting in a chair one day, and she took her meds. That's about all. I don't even remember her face. It's like she's a blur, just sitting there.

SARAH JANE TRIBBLE: I found an obit for Josh's mother, who was only 25 when she died. It’s hard not to make comparisons to Josh’s life. It's heartbreaking. His mom dropped out of Fort Scott High School too. But the obit says she earned one of the top scores on her GED exam.

Josh’s dad still lives in Fort Scott, but Pat is his legal guardian.

Josh tells me he smokes weed, but he doesn't really consider that a drug. When I ask about his health, he says it's a struggle. To protect his privacy, and because he is a minor when we talk, we are not sharing Josh's last name.

JOSH: I mean, there's been points and times where I've been down and out, and I've, I've thought of suicide. I've tried to attempt it. And, I just couldn't go through with it. So, uh. I mean … [trails off]

SARAH JANE TRIBBLE: But how do you go forward and make sure you don't feel like doing that again? And are there any resources in town that you think you could reach out to?

JOSH: Resources, I know I can always talk to him, my friend that's back in the laundry room, and …

SARAH JANE TRIBBLE: Uhh — that guy? Maybe Josh can see the question in my eyes because he gets a bit quieter. He assures me that he knows he can always talk with his grandma or walk into the living room and sit down with his grandpa.

JOSH: But as far as making sure it doesn't happen again, uh, some days it's just like that. And it, it just hits. I, it's mood swings. I can go from happy to sad to angry in three seconds.

SARAH JANE TRIBBLE: What happens when you're angry? I'm just curious.

JOSH: Well, for example, there used to be a picture hanging right there.

SARAH JANE TRIBBLE: I can, I can see the outline from the cigarette smoke. Um, what happened to that picture?

JOSH: Uh, I got mad enough. And the nearest thing close to me was that picture and a wall, and my hand went into it. Needless to say, I might have had glass sticking out of my hand. And yeah, I still pulled it all out and walked on the street.

SARAH JANE TRIBBLE: A full beat passes before I can respond. I sense I need to choose my words carefully. And I find myself wanting to help him. I want to plant something in Josh’s mind before I leave.

Well, I was asking about your mom and I got off on that. But I'm sorry about it all. You know, the new health center has behavioral therapists and stuff — like, you could go talk to them. They don't cost much money. Would you ever consider something like that?

JOSH: I will say, I've went to a therapist before and talked about my problems and the one experience that I learned was they don't … they say that they're helping you, but nine out of 10 chances, they're actually judging you.

And I've already said my mental state isn't good enough right now. And I have anger issues. Temperamental issues. So, uh, if I go to another one, I could see either somebody making me mad, and it going completely bad, or I mean, who knows?

SARAH JANE TRIBBLE: I'm a bit scared to leave this boy, this child. I don't want him to do anything to hurt himself. He tells me he's going to stick around. He says he has to.

JOSH: I'm just taking care of my family. I'm doing what I was raised and taught to do. Gotta survive. Family sticks together.

[Segment 3 — 17:05]

SARAH JANE TRIBBLE: Fort Scott has a drug problem. And the city knows it. The local school district passed a mandate last year requiring all high schoolers and middle schoolers to take a drug test. If students don't take the test, they aren't allowed to participate in sports or clubs or even drive to school and park on the property. City Manager Dave Martin also told me he purposely promoted a police chief who was really aggressive on drugs. Fort Scott has invested in a narcotics dog.

DAVE MARTIN: We are making an impact on the drugs. Is it going to go away? No, I don't think it's going to go away. But we have made, I think, huge impact, especially on the meth issues that we were dealing with as a community.

SARAH JANE TRIBBLE: Meth is methamphetamine, a drug that has long ravaged the rural West and Midwest. This year, the U.S. Centers for Disease Control and Prevention said use of meth was soaring again.

DAVE MARTIN: So, I think we still have a ways to go. I don't know — it seems like you get one closed down and then another one opens up or something like that. But that is constantly our focus. And both our sheriff deputies and our police officers have definitely done a lot to hamper the, what I considered a drug problem here in Fort Scott.

SARAH JANE TRIBBLE: The crass term “drug problem” hangs in the air between Dave and I. I'm the one that brought it up, and it doesn't feel like it fits when talking about this quaint, historic town. When I think about Fort Scott, I picture the good stuff I see on Main Street. Antique shops and decorative flags. There's a museum for unsung heroes. When the hospital was around, it didn't help with tackling the drug problem. But Dave says drugs are a health problem and something the community should care about.

DAVE MARTIN: Yes, if you don't feel good about where you're at or you see no future or you have no desire to have a better future, I would think that would go more towards wanting to self-medicate.

SARAH JANE TRIBBLE: Dave Martin is beginning to have a change of heart about the loss of Mercy Hospital. Still not really happy about it, but his tone is changing. He seems less angry. Now, he seems thankful. Especially that the hospital down the road reopened the emergency department.

DAVE MARTIN: So, I guess I've had time to sit back and reflect on where we're at now, um, and realize that we could be in a lot worse. We could not have health care at all or an emergency room or anything. Again, I feel very blessed about where we're at …

SARAH JANE TRIBBLE: A couple of incidents have happened to Dave's family that make him feel grateful for the health services that are still in town. His youngest daughter needed the ambulance. His second daughter was pregnant with Dave’s second grandchild, and he sees that there are still skilled doctors here to help.

Reta Baker reached out to Dave when all of this family stuff happened. Reta is the former president of Mercy Hospital. She's the person who Dave and lots of people in town blamed when the closing was announced. People verbally berated Reta and she felt alienated. Later, months after Mercy left town, Dave apologized to Reta at a public meeting. He tells me what he said.

DAVE MARTIN: “We both have different responsibilities here. And if I've said anything that offended you, it wasn't meant to be. It's just I have a different role than you do.” And she said, I know what you mean. So, Reta and I, I would consider a good friend.

SARAH JANE TRIBBLE: Reta says the mood in Fort Scott is beginning to shift.

RETA BAKER: Time heals a lot of wounds. And I think the fact that everybody, or at least, I hope — I shouldn't use the word “everybody” — but I think many people in the community that had reservations and doubts about this new model of care are beginning to see that it is effective and that it is working. And I think everybody's relaxing a little bit more. And Dave and I did have a conversation, and it was positive. I think that it's kinda like everybody has to have proof that this is going to work.

SARAH JANE TRIBBLE: While some people may be feeling better, Josh and Pat and Ralph are struggling. When I make it back to talk with Pat, I have some tough questions to ask about what Josh told me. He told me about his suicidal thoughts. He talked about his drug use. And that he feels responsible for and worried about his grandparents. And I'm back to ask about all of that. And I need to ask Pat about her medication, too.

Pat says she has restless leg syndrome. She says that's why she takes opioids.

PAT WHEELER: Whenever I need to. Yeah, whenever I need to. You’re darn right I do. Because, I mean, literally, I have knocked Ralph out of bed before at night.


PAT WHEELER: I have. In a king-size bed.

SARAH JANE TRIBBLE: And Ralph chimes in, saying she kicks her feet.

RALPH WHEELER: Kickin’ her feet.

PAT WHEELER: It hurts clear down to your, into the inside of your bones. And you cannot keep your legs still.

And then there's other times it feels like that there's centipedes just curling up on the inside of your legs. And you're going like this and, you know, and you can't keep them still. You know? And so if my medicine is not working, then I have to do something.

SARAH JANE TRIBBLE: It's a disease she has struggled with all of her life. And lately the doctor has been trying to find medicine that helps. There's a lot of stigma attached to pain medication use, particularly opioids.

And Pat is aware of that. After all, her daughter-in-law, Josh's mother, died from an overdose.

She's quick to tell me it's a prescription from her doctor. Oxycodone is one of the medicines that Pat is prescribed. Researchers are now finding that rural seniors are more likely to be prescribed opioids than those living in urban areas. And in so many families around the nation, opioid prescriptions have led to substance use disorder.

There's even concern among experts that the disorder, and overdoses from opioids, are on the rise in older people nationwide. All of this is on my mind as I speak with Pat.

PAT WHEELER: Every month I do a urine test for drugs.

SARAH JANE TRIBBLE: Why would you be doing that?

PAT WHEELER: Because that's one of the ways that he makes sure his patients are not abusing drugs, the drugs that he prescribes.

SARAH JANE TRIBBLE: Then we talk about the emergency room trip.

PAT WHEELER: Like with that episode, I knew it was my legs. I've dealt with them since I’ve been 13, 14 years old. I recognize them, the old buddies, now, you know, after all this time. And it wasn't the medicine, because I took some of the oxycodone. And it didn't do any good. Did no good whatsoever. None. Didn't even touch it.

SARAH JANE TRIBBLE: I look over at Ralph, who's sitting in his chair.

What do you think of my questions, Ralph?


SARAH JANE TRIBBLE: What do you think of my questions?

PAT WHEELER: They're valid.

RALPH WHEELER: They're valid. They're valid. Just go ahead and ask her. She'll tell you the truth.

SARAH JANE TRIBBLE: Yeah. No, I don't … I don't doubt she's going to tell me the truth of what she's … I don't doubt that. No.

RALPH WHEELER: She's going to tell you the truth. And she's not gonna lie.


PAT WHEELER: If I thought I was addicted to the pain medication that I am on, I would ... I would have to think long and hard because of Josh.

SARAH JANE TRIBBLE: Josh. Pat worries about him. She's talked to me about being able to feed him. He's a teenager and eats a lot. He shouldn't be smoking. And we've talked about what she calls the stray friends he brings home. It's like the place has become a Grand Central Station.

She also fought him on dropping out of high school.

PAT WHEELER: You know, he's gotten to the age, to where, you know, teenagers, of course, know it all. You know, that's just the way it is. They know it all, especially in this day and age. You know? And what's going to become of him I don't know. And it scares me. That scares me to death.

SARAH JANE TRIBBLE: The last time I saw Josh was that day we talked about his mom, the same day he talked about punching the wall. That afternoon, I went back to follow up and find Pat. At the house, once again, no one answered. And once again, I'm in a doorway hesitating.

[in scene] Jesus. Josh is half passed out on a bed that you can see from the front door. I think it's his bedroom. 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 made a noise, a sort of soft grunt or moan, and then his friend came out and told me he was OK. I stood there and asked a couple more times, Are you sure he's OK? I'm wavering, but he's breathing and he's not alone.

[in scene] It seems OK, but I don't like seeing that. I don't like seeing that at all.

Next time, you'll meet a young mother who returned to Fort Scott after college.

So, what was your thought process when you heard the hospital was closing?

SHERISE BECKHAM: 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: She's expecting her second child and she's scared.

This season of Where It Hurts is hosted and reported by me, Sarah Jane Tribble. Tarena Lofton is our production assistant. Greg Munteanu at St. Louis Public Radio is our sound and design mix wizard. Taunya English, managing editor and managing producer for the podcast, is KHN's senior editor for broadcast innovation.

We are especially grateful to Diane Webber for holding space for this project, which gave us time to learn as we created. She’s been this podcast's most constant cheerleader.

Diane is KHN's national editor for broadcast and an editorial liaison to the show, along with Elisabeth Rosenthal, editor-in-chief at Kaiser Health News.

Special thanks to Carrie Feibel, who listened, coached and offered great questions as we closed out this season. 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.

Sarah Jane Tribble

Send questions and comments about this story to feedback@stlpublicradio.org.