The Washington Post National Weekly - May 19, 2019

. IN. COLLABORATION SUNDAY, SUNDAY, MAYMAY 19, 2019 19, 2019 IN COLLABORATION WITH WITH

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THE FIX THE FIX

Abortion Abortion foes take foesatake big risk a big risk A ARON B LAKE

A ARON B LAKE

showed Americans opposed showed overturning Americans Roeopposed overturning Roe 66 percent to 23 percent. 66 percent to 23 percent.

There was an argument that There thewas incremental an argument that the incremental or years, antiabortion advocates or years, have antiabortion advocates have approach could be met with approach publiccould approval. be met with public approval. tried to chip away at thetried Roe v. Wade to chip away at the Roe v. Wade This approach is far from This doing approach that, isand far from doing that, and decision incrementally. decision incrementally.

Democrats are already moving Democrats to nationalize are already moving to nationalize They have pressed legislatures They have to pressed legislatures to the Alabama GOP’s effort.the It’sAlabama not difficult GOP’s to see effort. It’s not difficult to see ss laws that shortened pass the window laws that forshortened aborthe window for aborthem making this a centerpiece them making of their this appeals a centerpiece of their appeals n procedures and/or made tion procedures it very difficult and/or made it very difficult to suburban female voters. to suburban female voters. r clinics to operate. But for clinics state lawmakers to operate. But state lawmakers Of course, winning elections Of course, is onewinning thing; elections is one thing; dn’t attempt to outlaw the didn’t practice attempt altogethto outlaw the practice altogethsatisfying the GOP base’s satisfying long-held thegoal GOPofbase’s long-held goal of That’s changed in Alabama. er. That’s changed in Alabama. overturning Roe is quite another. overturning Roe is quite another.

The Alabama legislature The passed Alabama a bill Tueslegislature passed a bill TuesBut there is also reason to But bethere skeptical is also that reason to be skeptical that y effectively outlawing abortion day effectively exceptoutlawing in the abortion except in the this would ever work. Assuming this wouldthe ever lawwork. is Assuming the law is se of serious health risks case to the of serious mother.health They risks to the mother. They struck down or frozen by lower struckcourts, down or it would frozen by lower courts, it would ected exceptions for rape rejected and incest. exceptions for rape and incest. be up to the Supreme Court beto uptake to the theSupreme case andCourt to take the case and The bill is one that even supporters The bill is one admit that is even supporters admit is MARK HUMPHREY/ASSOCIATED PRESSMARKthen HUMPHREY/ASSOCIATED PRESS Roe. actually overturn then Four actually justices overturn need Roe. Four justices need ctical rather than an attempt tactical torather legislate. than an attempt to legislate. to has agree to hear the case, to and agreefive to would hear the be case, and five would be Now that Brett M. Kavanaugh Now that is a Supreme Brett M. Kavanaugh is a Supreme Chief Justice John Roberts Chief hasJustice a mixedJohn record Roberts a mixed record toisoverturn.

It is needed presumed to overturn.

Chief Jus-It is presumed Chief Jusurt justice, effectively tilting Court it justice, 5 to 4 in effectively favor tilting it 5 to 4votes. in favor on abortion When on theabortion issue is back votes. When needed the issue back tice Roberts would be tice the John decisive Roberts vote. would be the decisive vote. conservatives, antiabortion of conservatives, advocates hope antiabortion beforeadvocates the court,hope he could before be thethe swing court, vote. he could beJohn the swing vote.

Roberts’s record on abortion Roberts’s casesrecord is someon abortion cases is somee court will overturn Roe v. Wade, the court will the overturn land- Roe v. Wade, the landwhat abortions mixed. Heup dissented what in mixed.

2016 when He dissented the in 2016 when the tions. Roe effectively tions. abortions Roe effectively up tolegalized to ark 1973 ruling that legalized mark 1973 abortion ruling nathat legalized abortion na-legalized struckBut down a Texas court lawstruck that required down a Texas law that required around theto24th week pregnancy. the 24th But when week of court pregnancy. when nwide and establishedtionwide the rightand to have established an the right have an of around abortion providers abortion hospital providers admitting to have hospital admitting the Republican-led U.S. House the Republican-led in 2013 voted to U.S. House in 2013 voted to have ortion, with the provision abortion, that the withgovernthe provision that the governprivileges.

Moreit met recently, privileges. he sidedMore with recently, the he sided with the ban virtually abortions ban after virtually 20 weeks, all it abortions met after 20 weeks, ent can regulate abortions ment on canthe regulate basis of abortions on the all basis of court’s fourUniversity more liberal court’s justicesfour in delaying more liberal a justices in delaying a with approval. with broadUniversity approval. A Quinnipiac otecting women’s health protecting and prenatal women’s life. health andbroad prenatal life. A Quinnipiac was similar Louisiana to thelaw Texas thatlaw. was similar to the Texas law. poll in 2014 showed 60 percent in 2014of showed Ameri-that Louisiana 60 percentlaw of that AmeriOverturning Roe could open Overturning the doorRoe to acould open the door to athat poll Greenhouse also33noted that Greenhouse many thought also noted that many thought cans Stephen were in G. favor of thecans legislation, were inwhile favor 33 of the legislation, while tional abortion ban. Justice national Stephen abortion G. Breyban. Justice Breythe court was primed to overturn the court Roe wasin primed 1992, to overturn Roe in 1992, percent opposed it. percent opposed it. seemed to worry about er seemed that prospect to worry thisabout that prospect this when it heard when it heard Casey v. Planned Parenthood.

Polls Court have also shown Americans Polls have favor alsolaws shown Americans favorCasey v. Planned Parenthood. laws st week, after the Supreme past week, Court after voided the Supreme voided Ultimately, therequircourt made Ultimately, some changes the court but made some changes but requiring parentalcan consent requiring for minors, parental requirconsent for minors, other of its precedents.another “Today’sof decision its precedents. can “Today’s decision upheld the husbands, right to an abortion. upheld the right to an abortion. married women ing married their husbands, women to inform their ly cause one to wonder only which cause casesone thetoCourt wonder ing which cases the Courtto inform There’s a chance the courtThere’s will never a chance take up the court will never take up to inform forcingpatients providers about to inform patients about ll overrule next,” Breyerwill wrote overrule in his next,” dissent.

Breyerforcing wrote inproviders his dissent.

Alabama law or the other the Alabama very restrictive law or the other very restrictive alternatives, and 24-hour alternatives, waiting periods. and 24-hourthe waiting periods.

By passing a law blatantlyByatpassing odds with a law Roe, blatantly at odds with Roe, law between passed recently in Georgia, law passed assuming recently they in Georgia, assuming they there’s a lot of roomBut between there’slimiting a lot of room limiting en more so than previous evenones, moresupporters so than previousBut ones, supporters are halted by thewhat lower courts. are halted But by bytempting the lower courts. But by tempting abortion it entirely.and And outlawing what it entirely.

And e begging the court to take are begging up the case. the court to take up theand case.outlawing abortion a final is ruling on Roe a final hereruling and now, on Roe it right here and now, it people overwhelmingly people overwhelmingly is the kind of oppose the kind of right But there is a reason thisBut wasn’t thereattempted is a reason this wasn’t attempted oppose seems at least possible seems at least could possible be Republicans could be bill Alabama passed. bill Alabama polling passed. last Quinnipiac polling last Republicans fore, and potential downside before, and — both potential in downside — both in Quinnipiac spoiling what could been a more whatfruitful, could have been a more fruitful, year showsopinion. just 10 percent year want shows abortion just 10outpercent want abortion out-havespoiling urts of law and the court courts of public of law opinion. and the court of public incremental actually had approach plenty that actually had plenty lawed all cases, whilelawed another in all 19 cases, percent whileincremental another 19approach percent that Historically, Americans have Historically, stronglyAmericans suphaveinstrongly supof most support. of support. n it made illegal in wanted most cases. it made It illegal also in cases. rted modest increasesported in abortion modestrestricincreaseswanted in abortion restricn It also

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WEEKLY WEEKLY

CONTENTS

CONTENTS 4 8 10 12 18 20 23

ON THE COVER An ambulance ON THE COVER An ambulance POLITICS 4 checks its equipment outside crew checks its equipmentcrew outside THE NATION 8 the ailing Fairfax Community the ailing Fairfax Community THE WORLD 10 Hospital Hospital in Fairfax, Okla. Photo by in Fairfax, Okla. Photo by COVER STORY 12 MICHAEL S. WILLIAMSON of The MICHAEL S. WILLIAMSON of The BOOKS 18 Washington Post Washington Post OPINION 20 FIVE MYTHS 23

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OPINIONS

The real reason Maduro survives: Dirty money JACKSON DIEHL is deputy editorial page editor of The Post. He is an editorial writer specializing in foreign affairs.

W

hen asked to explain why their efforts to oust Venezuelan President Nicolás Maduro have fallen short, Trump administration officials typically cite the sinister influence of Cuba and Russia, which they say has stiffened the regime’s resis­ tance. What they don’t speak about so much is a possibly more important factor: the Cartel of the Suns.

That colorful term refers to the drug-trafficking network that each year flies hundreds of tons of Colombian cocaine from Venezuelan airfields to Central America and the Caribbean for eventual distribution in the United States and Europe — and that includes some of the most senior officials in the Maduro regime. These men are not clinging to power because they are true believers in socialism, or because of their fealty to Vladimir Putin and Raúl Castro.

They hang on because, despite Venezuela’s economic implosion, they are still reaping millions — and they are likely to find themselves imprisoned in Venezuela or the United States if they walk away.

Cocaine trafficking is just one of a host of criminal activities in which the elite of Hugo Chávez’s “Bolivarian revolution” are immersed. There is also illicit gold and iron mining; fraudulent oil sales; rake-offs from food and medicine imports; and corrupt currency trading. Maduro and everyone near him, including his wife, his No. 2, and the ministers of interior and industry, are up to their necks in it.

Though both the Trump administration and Maduro’s farleft foreign defenders prefer to describe the Venezuelan crisis in political terms, the reality is that the regime is less a government — much less a socialist one —

than a criminal gang. That has two consequences that are complicating its removal. First, the money it is reaping from criminal activity is serving as a prop that allows it to survive U.S. sanctions.

Perhaps more importantly, the toxic taint on almost every top official makes it much harder to pursue the usual formulas for a peaceful transition, including the creation of a transitional government and amnesty for those who step down.

The collapse of Venezuela’s regular economy has created dire shortages of food, water, medicine and power, and caused more than 10 percent of its 30 million people to flee the country. Yet the illicit revenue pouring in for Maduro’s clique appears to be increasing. A recent CNN report said drug flights from Venezuela had risen from about two per week in 2017 to nearly daily in 2018; it cited one U.S. official as saying there had been up to five flights per night this year. In 2018, an estimated 265 tons of Colombian cocaine, with a street value of $39 billion, was trafficked through Venezuela, the report said.

Another new study prepared for the National Defense University by Douglas Farah and Caitlyn Yates found that even while the Maduro regime sold 73 tons of gold in Turkey and

MARTIN MEJIA/ASSOCIATED PRESS

An opponent to Venezuela's President Nicolás Maduro takes part in a march in Caracas. His face is painted with the colors of the Venezuelan flag, and the Spanish word for “Freedom” is written on his forehead.

the United Arab Emirates last year to raise cash, its reserves grew by 11 tons — the likely result of illegal gold mining, including by Colombian rebel groups based in Venezuela and allied with the regime. Those sales could have raised close to $3 billion, more than enough to fund the security forces and paramilitary groups still loyal to Maduro.

Farah and Yates describe the Venezuelan regime as part of a regional network they call the Bolivarian Joint Criminal Enterprise, a “consortium of criminalized states and nonstate actors.” They identified 181 individuals and 176 companies in 26 countries linked to Venezuelan criminal activity.

Thanks to this enterprise, they say, “the Maduro regime has not collapsed and may not for a significant period of time . . .

The network’s ability to adapt and diversify their criminal portfolio means that money continues to flow into the regime’s coffers.”

In theory, the Venezuelan opposition, the Trump administration and others seeking to leverage Maduro out could resolve to forgive all this.

The opposition has spoken about amnesty for military leaders who turn on the regime, and the Treasury Department lifted sanctions from Venezuela’s intelligence chief after he defected.

As a practical matter, however, it’s hard to imagine most of the Maduro mafia simply walking away. At least two of its capos have been indicted by U.S. federal grand juries. Another, former general Hugo Carvajal, defected to Spain last month — and was promptly jailed on a U.S. extradition request. He faces federal cocaine smuggling charges.

Some opposition leaders and foreign governments are hoping to broker a transitional administration that includes regime figures. But, as veteran opposition activist María Corina Machado told The Post, “you cannot have drug trafficking kingpins . . . you cannot have individuals who are part of the mafia in gold trafficking, oil trafficking and gas trafficking, or food mafias.” That, alas, may exclude just about everyone with the power to bring about a peaceful change in Caracas. n

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BY LISA BENSON

Not a ‘que será, será’ sort of gal KATHLEEN PARKER writes a twice-weekly column on politics and culture.

Growing up in the 1950s and ’60s, there was no avoiding the adorable Doris Day. She was cute as a bug, wholesome, winsome and adored, at least in movies, by the swooning-est leading men in Hollywood — Rock Hudson, Cary Grant and Clark Gable, to name a few.

As a young girl, I simply loved her and, of course, wanted to marry Rock. As dreamboats went, he was without par. And Doris (we were on a first-name basis back then) was this motherless girl’s idea of what a woman should be — cheerfully feminine and wise to men.

Today, Day’s characters would be laughable to world-weary children trapped in a sexualized culture. But I can testify that watching grown-ups crawl into twin beds wearing pajamas brings no harm to the underaged.

I’m grateful for the innocence that society then permitted its younger generation, and to actors such as Day, who declined roles, including Mrs. Robinson in “The Graduate,” that defied her values.

Also, Day was honest enough about herself to figure she probably wouldn’t have been believable as a seductress. She was certainly glamorous but was also perhaps cursed by a prevailing perkiness that could be neither subdued nor camouflaged. Besides, who would want to see a lascivious Doris Day? Surely not her fans.

Day’s singing career — about which much has been written — preceded and succeeded her acting career. “Que Será, Será” (“Whatever Will Be, Will Be”) became her theme song, and its lyrics were tantamount to an elegy for the songstress, who wanted none of that. Day, who died Monday at 97, made known that she didn’t want a funeral, memorial or even a headstone.

In her later years, Day became increasingly reclusive and dedicated her talents and resources to animal rights. If long ago I admired her fictional personas, I’m grateful today for her animal activism and find myself in agreement with her reflection: “The more I study human beings, the more I love animals.”

Though Day’s work for animals

BY MORIN FOR THE MIAMI HERALD

is inarguably her greatest legacy, most obituaries have focused on her film and song careers. Eager to know more, I contacted Wayne Pacelle, former head of the Humane Society of the United States, who knew Day and worked with her in pursuing legislative action on behalf of animals.

“Her compassion for all animals — not just dogs, but for all animals — was central to everything she was about,” he wrote in an email. “She attached her name to advocacy organizations to scale up her work for animals — a rare thing for celebrities, who would occasionally weigh in on issues, but not fully commit to engagement on these issues.”

Day frequently called state and federal lawmakers when animal issues hung in the balance. She advocated a 1990 ban on the trophy hunting of mountain lions in California, was strong in urging an end to cosmetic testing on animals, helped with a 2010 ballot measure in Missouri to crack down on puppy mills, and made calls and sent letters on a range of topics to help all animals.

“Lawmakers who were old enough to have been fans were always thrilled to hear from her,” Pacelle said. “She was one of the biggest celebrity names in the

20th century, and her guileless approach on animal issues won her so many admirers and fans.

She was part of the process of making animal welfare a mainstream issue. She is like Jane Goodall in being above the fray and was almost impossible for apologists of animal cruelty to attack.”

Pacelle visited Day in her Carmel Valley , Calif., home 14 years ago to discuss merging the Doris Day Animal League (a political advocacy group) with a planned Humane Society political action committee. A small herd of rescue dogs followed her everywhere. At first, Day was reluctant to combine forces, wishing to remain independent, but she ended the conversation with “Let’s do it.” The result was a union of the Humane Society and Day’s group and the creation of the Humane Society Legislative Fund and its PAC. Come to think of it, maybe Day wasn’t a “que será, será” sort of gal after all. She saw cruelty and used her celebrity to improve the lives of animals and, by extension, helped to create a more humane world. The future may not be ours to see, but Day demonstrated that the future can be made better through activism, helped along, no doubt, by the memory of a wink, a smile and a song. n

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TOM TOLES

One way to tackle student debt HELAINE OLEN is a contributor to Post Opinions and the author of “Pound Foolish: Exposing the Dark Side of the Personal Finance Industry.”

Last month, Sen. Elizabeth Warren (D-Mass.) debuted a proposal that would wipe away the majority of student debt through a generous forgiveness program. It may have been controversial among pundits, but it was popular with the public. Now there’s another plan out there that offers help too — and Warren, along with fellow presidential candidates Sens. Bernie Sanders (I-Vt.), Kamala D. Harris (D-Calif.), Amy Klobuchar (D-Minn.) and Rep. Eric Swallwell (DCalif.) are all co-sponsoring it.

Let’s talk about bankruptcy.

Americans owe a collective $1.5 trillion in student loan debt, an amount that’s increased from $90 billion over the past two decades. In 2018, more than twothirds of college graduates graduated with student loans.

The average amount borrowed (from all sources) by a 2018 graduate is just under $30,000.

The burden is impacting people from early adulthood to those in retirement: Some senior citizens are using their Social Security checks to pay back student loan bills. If all these people were facing unsupportable housing, credit card debt, medical or auto loan bills they could turn to a bankruptcy court for help. But short of something called “undue hardship,” an extremely difficult standard to meet, it’s

essentially impossible to receive court-ordered relief from college loans.

The proposed legislation would seek to fix this. It’s bipartisan, attracting two Republican co-sponsors in the House, including Rep. John Katko (R-N.Y.), who introduced a similar bill in the last session of Congress. It would, as sponsor House Judiciary Chair Jerrold Nadler (D-N.Y.) put it in a statement, “ensure student loan debt is treated like almost every other form of consumer debt.”

The issue goes back to the 1970s, when the banks and media outlets began pushing the narrative there was an explosion in new graduates declaring bankruptcy to unload their student loans. The Government Accountability Office (then the

General Accounting Office) found that such acts were extremely rare. But little matter: In 1976, Congress passed legislation that banned students from receiving relief for their student debts for a period of five years. Over the next several decades, they would extend that period to seven years, and then in 1998 they shut the door almost entirely on relief for federally issued loans. In 2005, as part of controversial “bankruptcy reform” legislation, that stricture was extended to privately issued loans as well.

One man who supported all of this: Joe Biden, then a senator from Delaware. He championed the multiple changes that made it harder for people to declare bankruptcy and receive relief for their student debt.

Over that same period, student loan debt ballooned.

That’s likely not a coincidence.

Many things factored into the rise of debt financing of education, including the decreasing rates at which many states supported their public colleges and, most prominently, the growth of for-profit colleges.

But the usual risk associated with loaning money is that the person might not pay it back; common sense says banning that outcome would lead to an

exploding student loan market.

When you can get blood from a stone, someone — the government, a bank or a financial institution specializing in refinancing student debt — will lend the rock money.

Restoring bankruptcy could protect borrowers in another way too, by potentially acting as a check on the careless treatment of debtors by the student loan servicers. In 2017, the Consumer Financial Protection Bureau sued Navient, claiming the student loan giant repeatedly did not tell borrowers experiencing financial difficulties about income-based repayment options, and instead pushed them into forbearance, a strategy that resulted in further interest charges and increased the amount borrowers owed.

There is little evidence that people frivolously file for bankruptcy. If anything, it’s the opposite; many put off seeking help. There’s no reason to believe things would be different when it comes to student debt.

Restoring the right to declare bankruptcy when one can’t financially handle paying for one’s education is a change that should be supported even by those who believe Warren’s debt forgiveness plan is too generous — or a giveaway to the wealthy. n

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POLITICS

President’s trade war will rage on B Y R OBERT C OSTA, J OSH D AWSEY AND S EAN S ULLIVAN

P

resident Trump is telling advisers and close allies that he has no intention of pulling back on his escalating trade war with China, arguing that clashing with Beijing is highly popular with his political base and will help him win reelection in 2020 regardless of any immediate economic pain.

Administration officials and outside Trump advisers said this past week that they do not expect him to shift his position significantly in coming days, saying he is determined to endure an intensifying showdown with Chinese President Xi Jinping despite turbulence in global markets and frustration within his own party.

Trump’s defiance is rooted in decades of viewing the Chinese as economic villains and driven by his desire to fulfill a core promise from his 2016 campaign: that he would dramatically overhaul the U.S.-China relationship. The confrontation is also fueled by Trump’s willingness to flout the norms of presidential behavior, including his suggestion on Tuesday that the Federal Reserve should assist his trade efforts by lowering interest rates.

“I don’t see him crying uncle anytime soon,” said Stephen Moore, a conservative economist who withdrew from consideration as a Trump Federal Reserve Board nominee amid an uproar. “It’s a high-risk strategy, but it’s not in his personality to back down. This goes back to what he said that first time he came down the escalator at Trump Tower.”

Trump cast the strength of the U.S. economy as leverage this week, saying, “We have all the advantage.” And he reiterated his threat to expand the tariffs to cover virtually all Chinese imports, saying, “We’re looking at it very strongly.”

But as Trump expresses confidence, there have been tensions inside the White House, with some advisers uneasy with Trump’s strident nationalism and firm belief

MARIO TAMA/GETTY IMAGES

Trump is arguing that his showdown with China will help him win reelection in 2020, advisors say in tariffs as economic weapons.

The disagreements reflect broader distress within Republican circles about the president’s sharp rhetoric and refusal to budge.

“I don’t like directionally where it’s going,” former White House communications director Anthony Scaramucci, a prominent investor, said. “The economy is still very strong. It’s not clear to me it will fully derail the economic story. But it could put a dent in the stock and bond market.”

“Tariffs are blunt instruments.

They can inflict harm on competitors and be a source of leverage for negotiations,” said former White House staff secretary Rob Porter, who at times engaged in heated discussions in the Oval Office on trade. “They can also have significant consequences for global supply chains and domestic producers and consumers, and any decision on tariffs should include careful consideration of all these consequences.”

Trump has worked to contain his current advisers as the negotiations have unfolded and present a united front to the Chinese, who he believes are looking for weakness, according to multiple officials, many of whom spoke on the condition of anonymity to share private discussions. With Scaramucci, Porter and others who are alarmed now gone from the White House, Trump has found it easier to navigate his own administration and govern by his own instincts.

Trump was irritated this past week after National Economic Council Director Larry Kudlow acknowledged on “Fox News Sunday” a week ago that American consumers end up paying for the administration’s tariffs on Chinese imports, contradicting Trump’s claim that the Chinese foot the bill, officials said.

“Trump called Larry, and they had it out,” according to one White House official who was not au-

Air conditioners that were manufactured in China are available for sale.

National Economic Council Director Larry Kudlow acknowledged in an interview last Sunday that American consumers end up paying for the administration’s tariffs on Chinese imports.

thorized to speak publicly. Two other officials, however, described the conversation as cordial and said Trump and Kudlow went back and forth on trade, with Trump telling Kudlow several times to “not worry about it.”

Republicans close to the president have said they’ve come to accept the president’s hard line, even if they do not share it.

“The president believes tariffs are good economic policy. They are a tool to bring about trade,” said Sen. Lindsey O. Graham (R-S.C.), a Trump confidant.

Graham said Trump often speaks about China in sweeping ways that underscore his unwillingness to flinch. Aides to the president say he comments about how many goods are made at low cost in China and how he believes China does not pay their workers or follow international laws. These people say he also bragged to aides about how much he has damaged the Chinese economy.

At a “Cocktails and Conversation” gathering of Republicans at the luxe 21 Club restaurant in New York City on Monday night, former Trump economic adviser Gary Cohn said he felt that the president might want to keep the debate over trade alive for the 2020 election because he believed it is a winning campaign issue, according to one attendee who was not authorized to discuss the meeting publicly.

Cohn, who has long been critical of tariffs, also worried aloud that the clash could do lasting damage to the nation’s farming industries and said the Trump administration’s effort to offset the effect of the trade war on U.S. farmers by supplying subsidies for them is not a sufficient approach if markets are lost, two attendees said. Cohn compared Trump’s strategy to treating cancer with a Band-Aid, they said.

When Cohn was in the administration, he and Trump would have loud, profane fights over tariffs, and Trump would sometimes tell him to stop arguing because Cohn wasn’t going to change the president’s mind, according to former aides. n

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Regulating facial-recognition tools BY

D REW H ARWELL

S

an Francisco has became the first city in the United States to ban the use of facial-recognition software by city agencies and the police, dealing a swift symbolic blow to a key technology rapidly being deployed by law enforcement nationwide.

The 8-to-1 vote this past week by the city’s Board of Supervisors will forbid public agencies from using the artificial-intelligence software to find the identity of someone based on a video clip or photograph. Privacy and civil rights advocates have worried that the capability could be misused for mass surveillance and possibly lead to more false arrests.

The law will not regulate local businesses, and the technology is still largely unregulated across the United States. But San Francisco’s ban will resonate because of the city’s identity as a friendly backyard for some of the world’s most powerful tech firms, including Google and Facebook, whose engineers have designed systems that can detect and recognize faces for business and consumer use.

“That a community where a lot of the folks are building facial recognition is the first to ban it is pretty telling of the dangers of the technology,” said Jevan Hutson, a University of Washington law student who advocated a facial-recognition moratorium in Washington, the home state of Amazon and Microsoft. (Amazon founder and chief executive Jeff Bezos owns The Washington Post.)

“For too long we’ve had this ‘move fast, break things’ model on the public side with surveillance,” Hutson added on Tuesday. “We’re reclaiming our ability to say no to technologies that deface democracy and our ability to live freely.”

No federal laws govern the use of facial recognition nationwide, and more than 50 state or local police agencies across the country have at some point used facialrecognition systems in attempts to identify criminal suspects or verify identities.

PHOTOS BY JUSTIN SULLIVAN/GETTY IMAGES

San Francisco is the first city to ban the software, which is still largely unchecked across the U.S. A video surveillance camera hangs from a building in San Francisco. An ordinance before the San Francisco Board of Supervisors makes the California city the nation’s first to prohibit the use of facial-recognition technology by police and other agencies.

Oakland, Calif., and Somerville, Mass., have introduced legislation for bans similar to San Francisco’s. A bipartisan bill introduced in the U.S. Senate in March would ban companies, but

not governments, from collecting facial-recognition data without consent.

The San Francisco ordinance will also require all new surveillance equipment to be approved

by city leaders, who could also seek measures “to verify that mandated civil rights and civil liberties safeguards have been strictly adhered to.”

A second reading of the Stop Secretive Surveillance Ordinance is expected to be approved at an upcoming board meeting, when it will officially become law.

Aaron Peskin, the San Francisco supervisor who introduced the bill earlier this year, has voiced concerns that facial-recognition technology could turn the city into a “police state.”

The law could increase the pressure on companies such as Amazon that have sought to sell facial-recognition systems to police agencies, citing their potential benefits in finding missing children or pursuing criminals.

Amazon investors will vote this week on a proposal that could block the company from selling its system, Rekognition, to government agencies.

Google has said it won’t offer a general-purpose facial-recognition tool until it works through “important technology and policy questions.” Microsoft has urged Congress to regulate the technology, saying companies should not be left to police themselves because of the technology’s “broad societal ramifications and potential for abuse.”

Members of Congress, civil rights groups and leading artificial intelligence researchers have called on Amazon and other companies to stop developing the technology for law enforcement use. Studies have found that the systems perform less accurately on people of color, raising the risks of misidentification.

But the San Francisco law may not slow the growth of facial-recognition technology in schools, sporting arenas and airports, which have folded them into their gate areas for an additional layer of identify verification and surveillance. The Department of Homeland Security said last month that it wanted 97 percent of all departing air travelers to undergo a facial-recognition scan by 2023. n

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A hospital’s struggle exemplifies a rural crisis BY

E LI S ASLOW • P HOTOS

BY

M ICHAEL S . W ILLIAMSON in Fairfax, Okla.

T

he hospital had already transferred out most of its patients and lost half its staff when the CEO called a meeting to take inventory of what was left. Employees crammed into Tina Steele’s office at Fairfax Community Hospital, where the air conditioning was no longer working and the computer software had just been shut off for nonpayment.

“I want to start with good news,” Steele said, and she told them a food bank would make deliveries to the hospital and Dollar General would donate office supplies.

“So how desperate are we?” one employee asked. “How much money do we have in the bank?”

“Somewhere around $12,000,” Steele said.

“And how long will that last us?”

“Under normal circumstances?” Steele asked. She looked down at a chart on her desk and ran calcu­ lations in her head. “Probably a few hours,” she said. “Maybe a day at most.”

The staff had been fending off closure hour by hour for the past several months, ever since debt for the 15-bed hospital surpassed $1 million and its outside ownership group entered into bankruptcy, beginning a crisis in Fairfax that is becoming familiar across much of rural America. More than 100 of the country’s remote hospitals have gone broke and then closed in the past decade, turning some of the most impoverished parts of the United States into what experts now call “health-hazard zones,” and Fairfax was on the verge of becoming the latest. The emergency room was down to its final four tanks of oxygen. The nursing staff was out of basic supplies such as snakebite antivenin and strep tests. Hospital employees had not received pay-

Above: James Graham, 67, is a primary care physician and, with 41 years on the job, is the longestserving staffer at Fairfax Community Hospital. Opposite page: Fairfax Vice Mayor Charlie Cartwright comforts hospital pharmacy employee Kathy Brock after briefing the staff on financial rescue efforts.

checks for the past 11 weeks and counting.

The only reason the hospital had been able to stay open at all was that about 30 employees continued showing up to work without pay, increasing their hours to fill empty shifts and essentially donating time to the hospital, understanding what was at stake. Some of them had been born or had given birth at Fairfax Community. Several others had been stabilized and treated in the emergency room after heart attacks or accidents. There was no other hospital within 30 miles of two-lane roads and prairie in sprawling Osage County, which meant Fairfax Community was the only lifeline in a part of the country that increasingly needed rescuing.

“If we aren’t open, where do these

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people go?” asked a physician assistant, thinking about the dozens of patients he treated each month in the ER, including some in critical condition after drug overdoses, falls from horses, oil field disasters or car crashes.

“They’ll go to the cemetery,” another employee said. “If we’re not here, these people don’t have time. They’ll die along with this hospital.”

“We have no supplies,” Steele said. “We have nothing. How much longer can we provide quality care?”

Everyone in the room turned, as they often did, to the longestserving member of the hospital staff, James Graham, 67. He had worked as a primary care physician at Fairfax Community for 41 years, writing his cellphone number atop new prescriptions, making rounds while on dialysis through two kidney transplants, and sometimes hand-delivering medication to indigent patients out the window of his pickup truck. For much of his career, he had been on call as the only doctor in a town where the need for medical care continued to

rise: Childhood poverty climbing up above 30 percent. Accidental deaths doubling in the past decade. Increasing rates of diabetes, heart disease, drug addiction and obesity.

Graham had been an honorary pallbearer at more than 160 of his patients’ funerals, watching the cemetery expand as Fairfax’s population declined from almost 2,000 to fewer than 1,300 through 40 years of attrition. The hospital remained the area’s largest employer, and the town had sunk more than half of its annual budget into legal fees to file a lawsuit against the hospital’s ownership company, hoping to retake control of Fairfax Community. There was still a chance the town could save the hospital in some form by partnering with a new management company, if the bankruptcy court would allow it.

Fairfax’s vice mayor had promised employees he would come by at the end of the week to deliver an update, and possibly even paychecks if new management could be found.

“Maybe we’ll get good news,” Graham told the staff. “But we’re

Physician assistant Gari Owens, left, prepares to suture a gash that Lucian McKinney, 15, suffered in a fall while fishing.

holding out for a miracle, and if some of you can’t afford to keep waiting and working for free, you can walk away now and nobody will blame you.”

He looked around the room as his co-workers stood in place. A call came over the hospital’s intercom. “Medical assistance up front,” a receptionist said.

Graham waited for another second, until the silence sounded to him like a decision.

“Okay,” he said, moving toward the emergency room. “Let’s keep the doors open until someone tells us we can’t.”

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he hospital was the first building on the winding road into Fairfax, positioned atop the only hill in town, and for 65 years it had served a county that was larger in area than a few U.S. states. Patients came from all over Northern Oklahoma, traveling through cattle farms and across rolling prairie, sometimes driving up to an hour to reach their closest full-service hospital. It was a singlestory building about the size of an average elementary school. An

American flag flew above the open doorway into the main lobby, where the reception staff greeted most patients by first name on sight.

“A small community is only as healthy as its hospital,” read one sign near the entrance, but lately, that relationship in Fairfax and hundreds of other small towns had gone from symbiotic to ominous. Rural America needed more emergency care than ever before. Its hospitals were less equipped than ever to provide it.

In the past decade, emergency room visits to America’s more than 2,000 rural hospitals increased by more than 60 percent, even as those hospitals began to collapse under doctor shortages and historically low operating margins. Hospitals like Fairfax Community treat patients that are on average six years older and 40 percent poorer than those in urban hospitals, which means rural hospitals have suffered disproportionately from government cuts to Medicaid and Medicare reimbursement rates. They also treat a higher percentage of uninsured patients, resulting in unpaid bills and rising debts. A record 46 percent of rural hospitals lost money last year. More than 400 are classified by health officials as being at “high risk of imminent failure.” Hundreds more have cut services or turned over control to outside ownership groups in an attempt to stave off closure.

Fairfax Community had survived a previous bankruptcy in 2011 and then passed through four outside ownership groups before being purchased in 2016

by EmpowerHMS, a Florida company that operated more than a dozen rural hospitals across the Midwest. The company promoted itself as “a savior for struggling rural hospitals,” but within months of taking over, its corporate office had begun defaulting on some of Fairfax Community’s bills and cutting its spending budget. Eventually, four of the company’s hospitals had shut down and nine more had entered bankruptcy, including Fairfax. It could no longer afford to provide X-rays or CT scans. No more remote monitoring for patients with irregular heartbeats. No more blood tests.

And now in came Dr. Graham, a day after the staff meeting,

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COVER STORY walking up to Steele in the hallway and waving another overdue bill.

“I hate to add another problem to your list, but this is a big one,” he said, handing her a letter. It said his malpractice insurance was three months overdue. He had 15 days to pay a minimum of $1,000 on the balance, or he would lose his insurance and his legal right to practice medicine in Oklahoma.

“Does it ever end?” Steele asked. She looked at the letter and thought about the hospital’s diminishing reserves in comparison to its mounting debts: $14,000 for overdue lab tests, $22,000 for leased machines, $9,000 for electrocardiogram readings, $70,000 owed to staffing companies and more than $600,000 in overdue payroll. In the billing office, there was a stack of certified letters and at least one lawsuit from a vendor demanding its money.

“I’m really no good to you without this,” Graham said. “You might as well let me walk out and retire.”

“I’ll take care of it,” Steele said.

“We can’t do much without you.”

Graham had been talking about retiring for a few years, but he was one of just two physicians at the hospital, and he didn’t want to abandon his patients. He had tried recruiting his own replacement, but there was a doctor shortage of nearly 40,000 physicians across rural America, and he couldn’t find anyone willing to relocate to Fairfax. He’d tried mentoring promising students at Oklahoma’s medical schools, but they eventually chose to practice in bigger cities. He’d even tried submitting his resignation paperwork in 2018, selling his farmhouse, and moving 20 miles into the country with his wife, but his patients kept calling his cellphone, and there was no one else to treat them, so he continued returning to Fairfax to make rounds a few times each week.

The past 40 years had turned him into a seasoned generalist, accustomed to treating whatever emergency came through the hospital’s doors. One day it was a mother who’d gone into labor on a nearby road. The next it might be a critical gunshot wound, or an allergic reaction to a bee sting, or a panic attack, or a child with a cockroach stuck in his ear, or a

KLMNO WEEKLY

each month that saved people’s lives.

The helicopter landed behind the hospital, and two paramedics loaded the 16-year-old onto a stretcher to put him aboard.

Fessler rushed to her car to drive 90 minutes to the hospital in Tulsa, since there wasn’t room for her in the helicopter. Graham watched as the helicopter lifted off, the thunder of its rotor shaking the hospital windows, and then he took out his phone.

“Hi, Cassie?” he shouted. “You drive safe, okay?”

T pill seeker trying to hustle the ER out of pain medication in the middle of the night. “The ER doesn’t have a routine,” Graham liked to say, and for much of his career that uncertainty thrilled him, but now he felt something different whenever a new patient rushed in, a sensation closer to dread. “Do we have the supplies left to help these people?” he wondered.

A woman arrived with what appeared to be a broken arm, but there was no working X-ray machine to confirm it. “We have to sling it and send you on to Tulsa,” a nurse told her.

A child came in with his leg gashed in a fishing injury, but the hospital had run out of the correct-size thread to stitch it up.

“This one will work just as well,” a nurse said, returning with a different-size thread from the emptying supply closet.

The doors opened again, and this time it was Cassie Fessler and her 16-year-old son, an elite high school basketball player who was bent over in the hospital lobby, complaining of chest pain and shortness of breath. His face looked pale. “My chest feels like it could explode,” he said, and two nurses took his vital signs while a lab technician attached electrodes to his chest to test his heartbeat and then immediately sent the results to a pediatric cardiologist in Tulsa.

Fessler paced the hospital hallway, and after a few minutes, Graham stepped out to walk with

As the community rallies to support unpaid staffers still working at the hospital, Treat’s Coffee in Fairfax collects tips for the cause.

“Do we have the supplies left to help all these people?”

James Graham, primary care physician at Fairfax Community Hospital

her. “Real sorry you’re dealing with all this,” he said.

“I saw your truck when we pulled up here and almost cried,” she said. “Thank God you were here.”

Graham had pronounced the death of Fessler’s grandfather at the nursing home 35 years earlier.

He had worked with her mother, a nurse, and he had been Fessler’s primary care doctor for the past 40 years. The hospital had saved her 2-year-old daughter after she was stomped by a horse; it had treated another of her sons for acute cardiac distress. Now Graham told Fessler that her son’s heartbeat looked abnormal on the test. Fairfax Community didn’t employ any specialists trained in pediatric cardiology, and it no longer had money to pay for remote cardiac monitoring.

“We can helicopter him over to Tulsa in less than 25 minutes, and a cardiologist will be waiting,” Graham told Fessler, as she signed a few forms. “That’s really the best thing for him.”

Graham had heard doctors in Tulsa refer to Oklahoma’s rural hospitals as Band-Aid stations, places that offered a temporary salve before sending patients along to bigger hospitals for better care. The term was meant to be demeaning, but Graham sometimes used it with pride, because the temporary solutions at Fairfax Community were emergency blood transfusions, chest tubes, intubations, overdose reversals and several helicopter flights

he ER emptied out. The hallways went quiet. The daytime staff went home, and what remained of Fairfax Community were two inpatients asleep in their rooms and a few nurses arriving for another overnight shift without pay.

“Well guys, Jamie and Katie just quit,” announced Donna Renfro, the head of nursing, coming into the staff room wearing sweatpants, slippers and a sweatshirt on what was supposed to be her night off. She had worked 150 hours in the past two weeks, but now the hospital’s staff had decreased by two more, and there was no one left to work the shift.

“It’s just us,” she said, speaking to the entirety of the hospital’s remaining nursing staff, three nurses and three aides.

“I can’t exactly blame anyone for quitting,” said Karen Cook, an aide. “We’re probably the crazy ones, sitting up here every night, volunteering.”

“We’re going to have to start pulling 16 hours instead of 12,” Renfro said, looking at the upcoming staff schedule, where the same six names kept repeating.

“I’m sorry, but I can’t see any way around it.”

“I’m guessing pay will stay the same?” Cook asked. She laughed and then went quiet. She was the primary earner in her family, and now she was running a tab at the grocery store and relying on friends to help pay bills. “I ride for the team,” she said. “Don’t matter what you need. I’ll be here.”

“You know I’m never leaving,” said Julia Smith, who had been born at the hospital and worked as a nurse’s aide for 38 years, earning $10.14 an hour.

“My parents say they’ll disown me if I quit,” said Monica Woods, a nurse at Fairfax for 18 years. Her

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mother had worked at the hospital for 32 years, and her father had been saved twice in the ER. “They can’t live here if there’s no hospital,” she said. “I’m going down with all of you.”

They were bound together by the lonely rhythms of a midnight ER, where on some nights they treated 10 patients and on other nights saw none. They sometimes took turns using the treadmill in physical therapy, watched movies or traded off smoking breaks to kill time, right up until the ER doors swung open after an overdose or a car wreck and they were suddenly administering CPR. “Why does it always have to be either insanely busy or dead?”

Woods asked, at the start of a dead night, watching the clock until a call came in from Room 218.

“Everything all right in there?”

Woods asked.

“Oh, I’m sorry,” said Carolyn Long, 76, one of the hospital’s two remaining inpatients. “I must have hit that button by mistake.

Didn’t mean to bother you.”

“No bother at all, Mrs. Long. I’ll come right in.”

She was reclining in her hospital bed under a knit blanket, flipping channels on an old RCA television and forcing down another bottle of the vanilla smoothie that nurses delivered every few hours to help her gain weight. The entire staff at Fairfax Community called her Mrs. Long, because she’d taught most of them at the local middle school before retiring after 35 years.

Now she’d been in Room 218 for two weeks, working with the physical therapist as she recovered from a blood clot in her heart. One of her assignments was to walk up and down the hallway, where she stopped every few steps to catch her breath and overheard snippets from the hospital staff. The lab was down from four employees to one. A technician had gone $100,000 into debt after having an emergency preterm birth, because none of the hospital’s employees had benefits or insurance.

Long had lived in Fairfax all of her adult life, and like most people in town, she felt some ownership over the hospital. She had given birth down the hall.

She had watched both of her in-laws receive last rites in a room next door. Her husband’s con-

struction company had poured the concrete for the helipad. She had served on the hospital’s community board in the 1970s and ’80s, when the hospital was ranked by state health officials as one of the best rural health facilities in Oklahoma, offering obstetrics, elective surgeries and a cadre of specialists who drove out from Tulsa for consultations each week. But then the oil fields dried up, costing the town most of its best jobs. Farming suffered through a drought, and Fairfax’s property valuations began a steady decline. Now, many shops on Main Street were boarded up, and the pharmacy had moved 30 miles to Ponca City. The school district had consolidated and gone to a four-day week to save money, and the middle school where Long spent her career was scheduled to close for good at the end of the year.

She’d tried to help Fairfax Community again from her hospital bed, asking friends to make donations. The town had established a general fund to help hospital employees pay their electricity bills. One rancher had

Boarded-up stores, tattered signs and empty streets dominate downtown Fairfax, Okla.

come to the hospital with $1,000 checks for every remaining employee.

“How are all of you hanging in?” Long asked, when Woods stopped into her room.

“Isn’t that supposed to be my question?” Woods said, but she smiled and sat down for a minute anyway. “They’re telling us we might get paychecks tomorrow. If not, more people will quit.”

“How many people do you need to run a hospital?” Long asked.

“We’re going to find out.”

A

nother morning, another staff meeting to see who was left.

“Do we still have dietary?” Dr. Graham asked.

“She just put in her notice,” said Steele, the CEO. “How about receptionists?”

Graham asked.

“If we get paychecks today, they’re staying,” Steele said. “If not, they’re gone as of this afternoon.”

“Guess we’ll wait and see what happens,” Graham said. The town’s vice mayor was coming in

a few hours to deliver news about the future of the hospital, but rather than sit and wait, Graham walked out to his truck to take a drive through town. It was a flat, square-mile grid with no stoplight, and he knew almost every house and the traumas that had occurred inside.

He drove away from the hospital and into the adjacent neighborhood, passing the first home, with a collapsed front porch and windows blown out by a tornado.

“I sat with that lady as she died four years ago, and now this house just rots away,” he said. He turned onto another block and drove past a bungalow where the owner had died of lung cancer at 58. Next was a suspected drug overdose. Next was a midnight heart attack in the bathroom, and Graham had checked for a pulse and then stayed to pray with the new widower until his children came from Wichita.

His cellphone rang, and he pulled over to answer it. “Hey, bud,” he said, and he listened as a patient described a pain that was rising from his stomach to his chest. “Trust me. I know history

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COVER STORY on you,” he said. “This medication can help, but it might make your depression worse. Make sure you go up there and see the counselors, all right?”

He hung up and continued down the block, past a house that had belonged to a young married couple. “I might have delivered both of them,” Graham said, and he’d remained their doctor until a few years earlier, when the husband shot and killed his wife in a domestic dispute and police shot the husband. They rushed him to Fairfax Community in critical condition, and Graham had been trying to drain fluid from his heart when he died on the operating table.

He rolled down his window and turned onto Main Street, where redbud trees bloomed outside abandoned storefronts, and his cellphone rang again. Another patient. More chronic pain. “I’ll call in a refill at the pharmacy,” he said. “Remember now, those old boys can’t just trust anybody these days. Make sure to bring your identification.”

He’d been offered easier jobs in Tulsa for better pay, but he’d grown up in another poor town with too few doctors, learning medicine as a teenager by administering his mother’s dialysis. Rural Oklahoma was down to one doctor for every 1,700 people, compared with one for every 400 nationally, and Graham had tried to compensate by opening a clinic downtown and treating uninsured patients free each month at a local church. He’d seen more than 10,000 patients over the course of his career, starting each new appointment with the same rule. “I can’t help unless you give me the truth,” Graham told his patients, and their truths were often depression, addiction, obesity, diabetes or lung disease.

He drove past the cemetery, where he’d buried his mother after treating her for kidney failure and his stepfather after treating him for lung cancer. He continued down a hill and idled for a minute in front of his ex-wife’s home, newly empty after she died three weeks earlier of unknown causes at age 62.

“I’m so sick of watching people die,” he said. “I keep trying to get out from under death, and I can’t do it. Who’s going to take care of these people?”

He looked up the road and saw

one of his patients seated at his refinery business, 82 years old and still working full-time at a business that had shrunk over the years from 40 employees down to three. “What do you know?”

Graham asked, pulling over to say hello, and the man tried to stand up to greet him but fell back into his chair. He had a pinched nerve in his back and pain his hip.

Graham had been trying to get him in to see a specialist in Tulsa, but he was still waiting for an appointment.

“What are you taking for pain?” Graham asked.

“Nothing. I didn’t want to bother nobody.”

“You can’t bother me,” Graham said. “I’ve known you 40 years and never seen you like this. Let me go get my script.”

Graham leaned against the hood of his truck and wrote another prescription to dull the pain of rural Oklahoma. “Are we just getting older, or are we all getting worse?” he said, and then a few minutes later his phone rang again. It was a nurse at the hospital. The vice mayor had finished his meeting with lawyers, and he was on his way to Fairfax Community to update the staff.

“I’ll be right there,” Graham said, and he tore off the prescription, handed it to his patient and drove back up the hill. he original 60 employees on the hospital staff gathered in the main hallway. Some had already quit, others had

T

Few lights are on at the nearly closed hospital on April 21.

The helipad remains in use — to evacuate cases that once may have been treated locally.

“We’re a family. We’ll do whatever we have to.”

Donna Renfro, head nurse at Fairfax Community Hospital

stayed, and all of them were watching as the vice mayor walked through the door. Charlie Cartwright had his hands in his pockets, and he wasn’t carrying a bag. If he’d come with paychecks, they were still in his car. One employee knelt to pray. A few others slumped against the wall.

“I’d rather not be here to see this,” Graham said, but he waited as Cartwright paced the center hallway, trying to compose himself.

“I promised myself I wasn’t going to come up here acting like a mess,” Cartwright said. His wife ran the hospital’s physical therapy department, and he had spent months fighting to get the hospital back under the town’s control.

“I wish I had better news, but I’m coming to you with a major problem here,” he said, and then he explained what he’d just learned from the lawyers. A bankruptcy court in North Carolina had retained control of the hospital, and it refused to give it back to the town. Another management group from Oklahoma had made a bid to operate the hospital, promising to restock supplies, issue paychecks and rehire at least some employees in an attempt to keep the hospital running, but any takeover was still weeks away. If the hospital closed even temporarily before then, state and federal laws would make reopening difficult, but Fairfax Community couldn’t afford to keep operating a full hospital, and the city had exhausted its budget on legal fees.

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“We’re writing checks right now that our ass can’t cash,” Cartwright said.

The hospital doors swung open behind him. A man walked in complaining about a tick bite, still holding the tick. “Can someone tell me if this thing is going to give me Lyme disease?” he asked, and one of the staff members looked at the man’s arm as Cartwright continued.

He said he was aware of only one way for the hospital to survive until new management took over. “We become an empty shell,” he said. The hospital’s patients would have to be transferred out.

All but a few employees would be laid off. Fairfax would close its hospital except for the ER, which would operate with minimal supplies and a skeleton staff — a nurse, an aide and a doctor on call.

“I need you all to tell me if this is what we want to do,” Cartwright said, and he looked over at Graham.

“It seems like the only way,” Graham said, and then he stepped into the center of the hallway to face the rest of the staff. “It’s been a big try, everybody,” he said. “Might not be over yet, and hopefully a lot of us will be back when this place changes hands. I know all of you want to help take care of these people. I know you’ll do it for free. You’ve proven that. But right now, the best thing a lot of us can do is go home. We’ll drop down to just an ER. We’ll take people’s vitals and send them on.”

“We’re a family,” said Renfro, the head nurse. “We’ll do whatever we have to.”

Employees hugged and began to clear out of the hallway as Fairfax Community emptied out.

One inpatient was transferred to a nursing home. The other, Mrs. Long, was released into the care of a friend. The lab director locked the lab. The CEO shut off her computer. Graham walked to his truck and started dialing patients on his phone. “I’ll still be here,” he told them. “I’m always on call.”

He drove down the hill and away from the hospital, where life in a small town began and ended, and where on this night, what remained in the darkness were no patients, two nurses and a lighted red sign.

“Emergency,” it read. n

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FIVE MYTHS

The Midwest BY

K RISTIN L . H OGANSON

As Democratic presidential candidates start popping up in Iowa and President Trump holds rallies in Wisconsin, attention is again gravi­ tating toward the heartland because of its pivotal role in our electoral future. To make sense of this symbolically loaded region, outsiders can turn to newly launched magazines, Midwestern studies programs, the Midwestern History Association and even an interpretive encyclopedia of the Midwest. Nevertheless, the country’s geographic core — and es­ pecially the rural Midwest — remains distorted by the filter of myth.

Here are five lasting misconceptions.

MYTH NO. 1 Globalization hurts the Midwest.

It’s true that blue-collar workers have been hurt by the race to the bottom in wages and working conditions as once wellpaid union jobs have been offshored and foreign competitors have gained market share.

But factory jobs are not the whole story, and such notions overlook the globalizing impulses emanating from the Midwest itself, as well as the long-standing fractures within it. Under the North American Free Trade Agreement, U.S. corn exports to Mexico and Canada increased sevenfold, and pork exports saw similar gains.

Recent tariff hikes have caused financial distress for corn belt farmers, leading industry organizations such as the National Pork Producers Council to underscore their support for free-trade agreements.

MYTH NO. 2 Exports are the foundation of the Midwest farm economy.

Although exports are undeniably important to the region’s bottom lines and global impact, Midwesterners since the 1800s have built their economy by importing capital, equipment and other means of production.

From a historical perspective, this is especially true for the agricultural sector. With the

exception of maize, which originated in Mesoamerica, the region’s staple crops have oceancrossing immigrant ancestors.

Wheat, oats, rye, sorghum, millet, barley, alfalfa, soy: None are native to the Americas.

MYTH NO. 3 The rural Midwest has always been solidly isolationist.

The term “isolationism” took hold in the 20th century as a political slur that distracted attention from specific policy preferences such as noninterventionism and unilateralism. Pinning this overblown term on the rural Midwest made it all the more denigrating, by insinuating that only hayseeds would object to the nation’s expanding projection of power.

Although some Midwestern congressmen did join colleagues from other parts of the country in opposing interventionist and collective policies, these leaders did not urge total abstention from international affairs.

Midwesterners Harry Truman and Dwight Eisenhower rank among the greatest architects of U.S. global reach during the early Cold War. Even Michigan Sen. Arthur Vandenberg, who argued against involvement in European crises in the 1930s, became a staunch internationalist in the postwar years.

JOSHUA LOTT FOR THE WASHINGTON POST

Rolling farmland in Woodbury County, Iowa. Isolated landscapes in the Midwest don’t necessarily give rise to isolationist political views.

MYTH NO. 4 The rural Midwest is a holdover from a less interconnected era This myth overlooks the immigrants, missionaries, military personnel, scientific agriculturalists, consular officers and circus performers, among others, who have connected the heartland to the world since the days of sail and steam.

It ignores, as well, the politics of localism in the region.

Although the pioneers proclaimed themselves locals as part of their effort to assert ownership over newly claimed lands, they had all come from elsewhere. The native peoples they displaced strenuously resisted forced confinement on reservations, in boarding schools, and within national borders.

MYTH NO. 5 White nationalism in the region stems from blue-collar layoffs.

Such a claim downplays the long history of racism in the Midwest. Recent historical scholarship has illuminated the enslavement of African-origin people in Detroit and Illinois.

The soul-wrenching history of the Trail of Tears had ethniccleansing antecedents and parallels in what was once called the Old Northwest, including in the histories of the Delaware people and the various communities in the Sandusky River region of Ohio.

In the antebellum era, Midwestern states denied residency rights and equal citizenship to people of color.

The Ku Klux Klan of the 1920s attracted more than a quarter of all white men in Indiana. Well into the 20th century, the Land of Lincoln was dotted with sundown towns that forced African American workers to leave at the end of their shifts.

Motorists hoping to stop in small Midwestern cities found sparse listings in the “Green Book.” White identity politics has shaped the Midwest — and the wrongheaded perception of the heartland as quintessentially American — from the start. n Hoganson, a historian at the University of Illinois at UrbanaChampaign, is the author of “The Heartland: An American History.”

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BOOKS

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Novel evokes the nature of memory

A portrait of the prankster author

F ICTION

N ONFICTION

O

l

REVIEWED BY

M ANUEL R OIG- F RANZIA

n the East Coast, we are entering one of my favorites times of the year, a bright and fragrant period I like to call the Season of the Bees.

So it seems fitting that the enchanting Mexican novel, “The Murmur of Bees,” a much-loved work by Sofía Segovia should be arriving in an English translation in sync with the first appearances of furtive pollinators outside my windows. Segovia’s absorbing yet accessible prose and gift for sprinkling the mystical into a deeply human narrative is sure to draw comparisons to the writing of Latin American greats, such as Isabel Allende.

The book, translated by Simon Bruni, is set in the fertile fields and rugged hillsides around the city of Linares, southeast of Monterrey, during a tumultuous epoch in the early 1900s when Mexico was ravaged by a chaotic revolution and the scourge of the Spanish flu epidemic.

Segovia writes with lush sensuality about the dynastic ranching family and its servants at the center of the novel, all of whom live on a hacienda scented by “the thyme and epazote that grew in pots in the garden,” and by the rapturous smells of “oranges, blossoms, and honey.” An “incalculably old” wet nurse named Nana Reja, who has nourished generations of the Morales clan, spends each day outside a shed in her rocking chair.

Reja’s wooden immobility is shaken one day, and she disappears without explanation. Later she’s found beneath a bridge cradling a newborn boy whose body is covered in a living blanket of bees.

The child is healthy, but his face has no upper lip, gums or palate.

The patriarch of the hacienda, Francisco Morales allows Reja to bring the child, whom they name Simonopio, back to the hacienda and raise him as a member of the extended ranch family, even agreeing to be his godfather. Reading this, I chafed a bit at the ideal-

ized depiction of the patron and his servant, especially since we have all been exposed to stark and uncomfortable realities of servant life in Mexico depicted in films such as last year’s epic, “Roma.”

But Segovia doesn’t fall prey to sentimentality. For all his laudable traits, Morales has benefited from a brutal system in which poor sharecroppers work the land with little hope of ever becoming owners. Espiricueta’s family had been homeless and starving when they were granted permission to farm on Morales’s land, but they feel trapped, “prisoners of their will to live and the unexpected and cruel kindness of these people who offered only false hope.”

On the hacienda, Simonopio grows into a remarkable child, in tune with nature, even as he is unable to speak. Bees follow wherever he goes, except on the rare occasions when he strays onto the land tended by Espiricueta, whom he imagines as a menacing coyote.

In Simonopio, Segovia has created an unforgettable figure, a character who is both mysterious and endearing. Segovia imbues him with a heavy dose of magical realism — he can sense danger, as well as the promise of good things to come. But he is also an embodiment of uniquely human wisdom that can melt even a cynic’s heart.

The book is narrated by one of Francisco Morales’s sons, who years later returns to the family home to puzzle through the very nature of memory, realizing that “you leave a place or say goodbye to someone, and thereafter, you feel the existence you have left behind is frozen by your absence.”

The memory that resonates most is of the boy who was followed by bees, the boy who belonged to the hills and brambles.

“I didn’t see the defect,” the narrator says. “I saw only my brother, and I loved him.” n Roig-Franzia is a Washington Post staff writer and former Mexico City bureau chief.

I THE MURMUR OF BEES

By Sofía Segovia.

Translated by Simon Bruni Amazon Crossing.

476 pp. $24.95

BECOMING DR. SEUSS Theodor Geisel and the Making of an American Imagination

By Brian Jay Jones Dutton. 496 pp. $32

l

REVIEWED BY

D AVID S ILVERBERG

magine a world without the Lorax, the Grinch, the delicacy of green eggs and ham and the word “nerd.” To be deprived of the imagination of children’s book trailblazer Dr. Seuss, born Theodor Seuss Geisel, would leave readers without the timeless tales and iconic characters that remain embedded in our collective psyche more than 80 years after the first Dr. Seuss book was published.

But who’s the man behind the crafty couplets? Brian Jay Jones comprehensively answers that question in a nearly 500-page biography. Credit either Geisel’s amusing personality or Jones’s breezy writing, but “Becoming Dr. Seuss” never feels like a slog; rather, pages fly by, acquainting readers with Geisel’s frequent pranks and core belief that children’s books should never be condescending or overly simplistic.

Born in Springfield, Mass., to German parents, Geisel read voraciously in his youth, claiming he read Jonathan Swift and Charles Dickens at 6 years old. Later though, his childhood was marred by anti-German sentiment during World War I, and in that era of xenophobia he would sometimes flee from high school with coals bouncing off his head.

His fury at this kind of hate would form the backbone of his story “The Sneetches.”

At Dartmouth College, Geisel found his footing penning cartoons for the college’s satire magazine Jacko, and his art was used in everything from house ads to column filler. He knew he had talent, Jones writes, but he also needed to make a living post-college. Geisel brought his artistic skills to advertising, most notably for Standard Oil and the bug spray Flit.

Moving to San Diego, Geisel pivoted to children’s books partly for financial reasons, but also because of a long-held frustration: “Dick and Jane” books talked down to kids and never chal-

lenged them, Geisel complained more than once. It was time to entertain and educate young readers, he thought, while wrapping the stories in playful language and invented words. (Geisel coined the term “nerd” in 1950 in his book “If I Ran the Zoo.”) The more compelling portions of the book focus on Geisel’s tense relationship with his publisher Random House, whose editors appointed the author the president of their new Beginner Books imprint. Geisel not only had issue with the “word list” — the 200 or so unique words authors were limited to using — but also publication choices.

When Jones turns to the amusing origin stories behind “The Cat in the Hat” and “How the Grinch Stole Christmas,” the book picks up in pace and intrigue. The section on Geisel’s idea for “The Lorax” could be the most relevant today. Jones writes that Geisel came up with “The Lorax” as a response to watching condo development envelop San Diego’s pristine coastlines.

Jones also addresses a few problematic pages found in Dr. Seuss’s earlier work: Geisel has been criticized for using the derogatory term “Chinaman” in “And to Think That I Saw It on Mulberry Street,” and 50 years after the book’s publication Geisel admitted such a phrase was in poor taste. His statement, though, wouldn’t nullify the controversy of a 2017 “Mulberry Street” mural at the Dr. Seuss museum in Springfield.

As all successful biographers should do, Jones doesn’t cheerlead his own writing style by adding unnecessary flourishes or similes; he lets the subject’s actions and quotes energize the book.

Thankfully, Geisel is a hilarious and insightful character whose love of literature is almost as infectious as his timeless rhymes. n Silverberg is a Toronto-based freelance journalist and book critic.

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