“Kenia, meet Kermit,” Thea said as they turned the corner to the backlot of the Med-Dent building. “Kermit” was concealed beneath a blue plastic tarp which Thea unhooked and snapped off with a flourish, revealing a two-wheeled dirt bike with a sweeping frame, fluorescent green paneling, and an expansive mud flap, also fluorescent green, set nearly a foot above the knobby front tire.
“Kermit . . .” was all Kenia could muster in response.
“I call him that because he’s green and he definitely likes to get muddy.”
“Ok, a Kermit is a motorcycle,” Kenia said, wondering how stupid she sounded as she stated the obvious.
“Well, an off-road motorcycle,” Thea corrected. “It is what you will need to get to some of the places in our catchment area.”
Kenia nodded, adjusting the strap on her backpack.
Thea, for the first time, detected her apprehension. “You, uh, ever ride a motocross bike before?”
“Only bikes I’ve ridden had pedals.”
“Oh, well, this is a Kawasaki KX450F,” Thea said by way of an explanation. “It’s a 2009, so its five speed and fuel injected.” She used a key on her chain to open a heavy windowless door into a storage closet, entered, then emerged with a green helmet that matched the color of the bike and a pair of black nylon zipper bags that she slung on either side of the seat. “It’s a good model as Kawasakis go. My brother and I have kept it running pretty good.”
“You ride it?”
“Of course. For all my house visits.”
“Huh, I guess I was expecting a government vehicle.”
“This is our government vehicle.”
“I meant a car.”
“You mean some late-model, gray, boring, domestic four-door sedan that would get stuck in the mud? This is much more practical and fun. I guess we could always ask Ms. Jolene to use her car, but with her at the conference this week, I think you are stuck with Kermit.”
Kenia did not want to ask Ms. Jolene for any favors.
“I guess I will have to use Kermit, then.”
“That’s the spirit. We’ve suped it up, adjusting the swing arm so it’s a bit more rigid. Makes for a bumpier ride, but the trade-off is better traction.”
“You work on it, too?” Kenia asked, taking a tentative step closer to Kermit as Thea rolled it forward, looking incongruous next to it in her lavender scrubs.
“What, you think a girl can’t fix things? You are worse than some men,” she said, shaking her fist in exasperation.
“No, I’m sorry—”
“I’m just messing with you. But you do know how to ride, right?”
“I know fatalities are thirty-seven times higher per mile on a motorcycle than a car and that ER nurses refer to them as ‘donorcycles.’”
“Huh,” Thea said, wrinkling her nose. “I’ll take that as a no. Well balancing is just like a pedal bike. Accelerator is here in the grip—it’s your gas pedal. Transmission is worked through this foot lever. You can move from neutral to first or second, like a stick shift in a car, but higher gears have to be engaged in order. It’s one down, four up action. Neutral is half a click up or down, so you can go from first to second in one motion. Got it?”
Kenia offered a flat, “No.”
They spent the better part of the next hour on the finer points of motorcycle mechanics, riding, and control. Kenia flinched when Thea mounted the bike, jumped down on the pedal, and revved it to life with a sputtering roar.
“It’s got a loud exhaust,” Thea yelled, her wrist flexing as she gunned the engine, a cloud of exhaust dispersing from the rear. “But it’s got good power right off the bottom and continues into the top range.”
Eventually Kenia graduated from passenger, riding behind Thea and holding onto her waist, to taking a test ride around the block solo. She knew she was going painfully slow, the engine coughing and sputtering and choking on numerous occasions. But by midmorning she was feeling more confident, going as fast as twenty miles an hour, even learning to enjoy the quickness of the acceleration and the surprising backwards tug of inertia that came in response. It felt reckless and freeing at once. Although she did feel conspicuous riding through the city streets, the loud exhaust heralding her approach from blocks away. But she grew used to it, since the folks she passed were unperturbed. Some even waved. In the helmet she guessed they took her for Thea.
In the days that followed, Kenia grew more confident. Thea showed her how to lock her phone in the mount on the handlebars so that she could use her GPS to navigate in and around Selah Station. Before long, Kenia was making home visits and initiating the first of her interviews on Healthy-Bytes. The days with respondents in town were easy. Some of their homes were close enough to walk to, but Thea encouraged her to ride for the practice.
In sessions, Kenia ran through demographic questions quickly. Social-economic status was measured by proxy items such as whether or not the respondent owned big-ticket items such as televisions, cars, washer-dryers, HV/AC. She was surprised how many homes did not have these, or if they did, chose to not use them in order to reduce utility bills. Clotheslines were used often in place of dryers. ACs were frequently not even turned on, leaving her to swelter at the kitchen table while she interviewed housewives, retirees, and the unemployed. Those who had jobs weren’t home—two-income households were rare—and many were recipients of welfare and/or disability.
The data did not lie. Through verbal autopsies—asking what close, recently deceased relatives had died of, Kenia tallied up figures that matched her pre-readings. High rates of heart disease, alcohol and drug related deaths, not to mention startling numbers of suicides. Ms. Jolene had not exaggerated the dire picture of poor health and endemic poverty in Selah Station. Kenia determined that the closest hospital in the next county was the largest employer in the region, and nearly half the visits from the residents of Selah Station were to the ER, as a substitute for regular care. The next largest employer after the hospital was road construction, but that was seasonal and inconsistent.
Kermit took her out of downtown into the surrounding “hills and hallows,” as Thea called the outskirts. Kenia followed her GPS off state roads onto unpaved one-lane drives that climbed into the mountains on switchbacks. She learned how to downshift for going downhill in order to save the brakes from overheating. The dirt roads were enclosed by trees, the roads’ surface alternating between gravel, hard-packed earth, and mud. The homes she visited were modest, some only trailers, all without manicured lawns or distinct property lines marked by fences or hedges. Yards blurred with the edge of the woods and driveways with the lawns, as cars sat parked on grass as often as driveways. Nothing was new: old model cars, old rusting swing sets, old lawn furniture, and old lawn mowers populated the yards. Plastic kiddie pools were lined with dead leaves and filled with greenish rainwater. Some houses were foreclosed upon and abandoned, others had foreclosured and condemned signs but were still occupied. A couple were burnt down.
“A lot of fires,” she remarked to Thea one afternoon while she collated her notes from the day.
“Burn your house down then collect the insurance money,” Thea said, as she typed up her own notes from office visits from that day. She was unfazed at the decay and blight that Kenia reported from her trips. Thea knew the neighborhoods and had seen it all before. Each morning she would check Kenia’s list of homes to visit, warning her away from the homes that were known meth labs.
“How do you know they are meth labs? Have you been inside?”
“Oh yeah. I’m the only medical care a lot of them get. But I wouldn’t advise you to go in there alone.”
Kenia considered Thea, this medium-sized woman with girl-next-door looks, reassessing her.
“Why are you staring at me like that?”
“Nothing, I just like your earrings.”
“Thanks,” Thea said, touching them to remember which she was wearing. They were actually studs, made from turquoise. “Got them from a local Native American woman, one of my patients,” Thea said. “She gets the turquoise from her people living on reservations out west.”
Kenia slid her tablet into her bag and began to tie her hair back with a bandana, the helmet resting on the floor between her feet.
“You are starting to get used to that bike,” Thea said.
“Yeah, I had to get over the idea that it’s not something black people do.”
“Why not?”
Kenia paused, realizing that Thea, trying something for the first time, likely had never had to ask herself the question “Is this something white people do?”
“Well, I just have never seen a black person on a dirt bike before. Sort of like, we don’t do NASCAR, microbrews, acapella groups, LL Bean . . .”
“Kenia, you are funny. That’s all I’ll say,” she laughed, turning to the monitor and checking for the next appointment.
In reality, in those first two weeks of interviews, it was riding Kermit that had been Kenia’s favorite part of what were turning into depressing sessions. She found herself sitting down on living room couches or at kitchen tables, trying to put the Trump-Pence signs in the front yard or Confederate flags hanging next to the doors out of her mind. Fortunately, her questions mostly did not delve into politics, although more than once she found herself biting her lip and trying to fix her expression into something neutral when respondents claimed “not to need Obamacare, ’cause they could get their health insurance from the Affordable Care Act.” Or surprise that she was so “well-spoken.” Not a few children asked to touch her braids.
Kermit was an easy icebreaker, and Kenia herself benefited from association with Thea, whose home visits and referrals for treatment had saved more than a few lives.
“Thea is the only doc I see,” a retired postal worker named Shirley said, tapping her cigarette into an ashtray, her inhaler on the table next to it.
The lifestyle of most of the residents Kenia found to be empty, desultory, pathetic—characterized by long hours of watching television in homes isolated from neighbors and separated by large lots and acres of woods. Men passed out from drinking on the couches by midafternoon. Wives and girlfriends made efforts to hide empty beer cans and bottles when Kenia entered, but oftentimes the trash was overflowing with them, if they made it to the trash at all.
She met Tracy, who lived with a herniated disc and took care of her four children and the neighbor’s children too. Her household scored low on Kenia’s SES measures, but they were slightly better off than their neighbors since her husband occasionally had work on a road crew. When they talked about the cost of groceries, taking inventory of the pantry, Tracy explained that she did not pay cash for any of her groceries.
“EBT?” Kenia asked.
“No,” Tracy said, looking down at her hands then back at Kenia. She took a drag from her cigarette then blew the smoke away to the side of them. “You won’t bust me if I tell you?”
“Bust you? For what—I mean, no, of course not, that is not my purpose.”
“Well, I have a doctor who writes me prescriptions for oxycontin for my back. I haven’t exactly been truthful with him. I’m in constant pain, but I’ve got more pills than I need. I trade them for groceries.”
“Trade them?”
“Yeah, there’s a whole market, underground you would call it, I guess. We trade oxycontin for everything here, lawnmowing, groceries, car repair, whatever you need. I try not to take them too much. I’ve never crushed or snorted them. But people do.”
Kenia looked at Tracy’s three-year-old boy, who was wearing a faded T-shirt and pull-up diapers. He was sucking on a box of High-C.
“I know it’s illegal,” Tracy said. “But jobs are scarce here. I need to feed my kids.” She picked up her son and set him on her lap. Kenia’s eyes traced the strings of cigarette smoke curling around his head. “Diapers are expensive.”
“Yeah, I understand,” Kenia said, turning off the voice recording on her tablet and erasing the last few minutes of conversation. Tracy’s husband remained in the living room, sunk deep into an easy chair, the only indication that he was not asleep the steady progression of one channel on the television to the next: sitcom reruns, Fox News, sports, the hunting and fishing channel . . . . “Have you done any physical therapy for your back injury?”
Tracy snorted, “Where would I do it? Nearest hospital is Mercy General, ninety minutes away.” She put her son down, crushed her cigarette in the ashtray, then reached to the pack for another.