2008 Writing D e s e r t E x p o s u r e
September
2008
Small-Town Heart Sutra
Page: 2Gelb, who has interviewed Smith for his health-education radio shows, praises the doctor for "emphasizing prevention and the role of lifestyle habits. We have a lot of overweight and obese people in our community who need to hear what he has to say."
While such efforts are important, Smith thinks other basic health issues also need to be addressed in our community. "We've lost at least 15 doctors, nurse practitioners and physician assistants [in the Silver City area] during the last couple of years," Smith points out. Seeing the nearest endocrinologist involves a 230-mile roundtrip. Local women haven't a single female gynecologist from which to choose. Anyone needing a root canal must drive an hour or more. There will be only one Silver City ophthalmologist by the end of this year.
Compounding the problem is that many young doctors spend only a few years in places like ours, taking advantage of government programs whereby medical school debts are forgiven in exchange for their practicing medicine in underserved communities. I ask Smith if he has seen Michael Moore's Sicko, the hard-hitting 2007 documentary that suggests many nations, including Canada, provide better, cheaper and more accessible health services than our own.
"I don't need to see Sicko," Smith laughs, with a knowing nod. "I live that movie every day."
Smith is convinced that the entire US health-care system is a hopeless mess. "It needs to be burned down and we should start over," he declares. "We're not dealing with its fundamental problems. Instead it's as if we are simply rearranging the deck chairs on the Titanic." Smith feels most leaders in our society — and politicians in particular — are simply ignoring skyrocketing medical costs and associated issues that are driving many Americans into bankruptcy.
"It is basic arithmetic," he says, face flushed and voice raised in frustration. "Who is going to say 'Enough!' and then actually do something?" Smith believes serious reform — the bane of lobbyist-influenced lawmakers — must be initiated by the business community. Like the rest of us, businesses can ill-afford health care's skyrocketing costs.
"The present system," according to Smith, "is insane and corrupt."
Doctors are known for their ability to thread their way across the emotional minefields they must confront constantly. Patients get sick, then die. Families become distraught. Insurance companies are crazy-making. Yet even during a first-time encounter, this physician seems to accept what Zorba the Greek called "the full catastrophe" with calm pragmatism.
This doesn't surprise Alan Spragens. "Scotty is very centered and very smart," says Spragens. "He doesn't flip out." The gallery owner attributes this, in part, to the Buddhist view that all is ephemeral and that suffering is inevitable. Spragens points out that "many doctors want to cheat death, or to invalidate it. A common perspective in our society is to ignore death altogether, but in Buddhism the contemplation of death is a salutary thing. I think this makes Scotty's approach unusual for a physician."
The cardiologist admits to "being worn down a bit" by being the only heart specialist in an area significantly bigger than Rhode Island. So far, it seems, the trade-offs are worth it.
"Yes, it's challenging," Smith concludes, as the hummers disappear and the western glow goes blue-gray. "But I feel I've done a lot more good in two years here than I would have in a big city. The need is here, I want to be here, and I'll keep after it. And our patients are terrific."
Southwest Storylines columnist Richard Mahler is the author of 11 books, including The Jaguar's Shadow: Searching for a Mythic Cat, to be published by Yale University Press in 2009. His byline has appeared in publications including New Mexico Magazine, Santa Fean, Los Angeles Times and Arizona Highways, and on columns for the Albuquerque Journal and Crosswinds. He lives in Silver City.