Most Southeast Ohio drivers have probably experienced the displeasure of driving disruptions caused by superloads. These gigantic vehicles haul oversized loads of goods on Ohio highways. To move these enormous shipments, the state highway patrol must evacuate the roads to make way. While some see the […]
Month: April 2015
On June 15, 2011, 1st Infantry Division member and Corporal Kyle Hockenberry was in a medevac military helicopter flying out of Afghanistan to receive medical attention in Germany. His legs were gone and his left arm was missing, but Hockenberry lived.
Today, nearly four years later, he and his wife Ashley, like many couples that include a veteran, still adapt to civilian life together. What makes Hockenberry’s readaptation to his hometown Marietta remarkable is the family’s home, a customized “smart house” designed to accommodate his needs as a triple-amputee.
Hockenberry, 19, was on foot patrol just outside army base Strong Point Haji Rahmuddin when an improvised explosion device detonated, destroying his three limbs. Ever courageous, but justifiably traumatized, the soldier’s initial response was concern about his loved ones.
“When I first woke up and was conscious in the hospital, I wasn’t concerned about what had happened to me, I was concerned with how my family was doing with [the news],” Hockenberry says over the phone.
But Hockenberry’s own concerns soon were overshadowed by public support and proclamations of his bravery—an element the veteran contests.
“I didn’t [join the military] for any kind of attention or anything like that,” Hockenberry says. “Everyone around [Marietta] knows I don’t like to be called a hero, because I was doing a job I wanted to do and love to do. I didn’t even want to get out of the military. I wanted to keep doing my job, but that, obviously, wasn’t possible.”
His community wasn’t about to let Hockenberry disappear from site, however.
For Those I Love, I Will Sacrifice
Between his basic training and tour, the solider made trips home to speak with local school children about the Army. Hockenberry’s dedication can best be described by his personal mantra: “For Those I Love, I Will Sacrifice.” Tattooed on his left rib, those words are not his own but rather those of the hardcore punk group Indecision. They lyrics are from their 1997 track “Hallowed Be Thy Name.”
More than anything else, Hockenberry entered the military with a heart committed to serve and protect. He still speaks highly about the work the Armed Forces do for our country. Such passion and pride can leave an impression.
Similarly striking is the award-winning photo by Laura Rauch showing Hockenberry’s ink as the critically wounded solider lies shirtless and under medical care on the flight out of Afghanistan. The photo was republished in numerous publications, including Stars and Stripes and Time magazine. Rauch’s photo brought Hockenberry’s story and recovery into the public’s interest.
Before this picture could make its national impact, however, Hockenberry traveled from Afghanistan to Germany to San Antonio’s Brooke Army Medical Center (BAMC) in nine days time. He would stay under BAMC’s care for the next five months.
“Initially, he was kind of depressed from the nature of his injuries, but over time he grew stronger,” C.D. Peterson, a BAMC wound care coordinator who worked extensively with Hockenberry, says over the phone. “We joked quite a bit, but it took probably six to eight months for him to get his sense of humor back.”
While Hockenberry describes the pre-physical therapy process towards recovery as “horrible,” he pressed on, despite the challenges. When Peterson checks in from time-to-time, he’s happy to see how well his former patient recovered.
“When it came to Kyle, we had great concerns early on about [his] being able to get back into a good, functional life,” Peterson says. “But when [we] see his pictures on Facebook and hear some of the things that he’s done, the nursing staff over here gets really happy.”
In turn, Hockenberry’s pleased he has so many people by his side.
“I’m thankful for the support this has brought on, because so many soldiers get hurt and they go unnoticed,” Hockenberry says. “And I was lucky enough to have a town, and even a state, and even a whole country eventually because of that picture, that supported me. And I’m grateful for it. But, you know, I don’t think I deserve it any more than anyone else does.”
Among Hockenberry’s multiple supporters is Justin Brannan, guitarist for Indecision, who wrote the words permanently embedded onto Hockenberry’s side. Thanks to the published picture, the former Indecision musician—now Director of Communications and Legislative Affairs for New York Councilman Vincent Gentile—found a withstanding kinship.
“I felt an instant connection with Kyle, and the first thing I wanted to do was find out if he was alive and how I could get in touch with him to thank him for his bravery and courage,” Brannan says. “Lots of people have those words tattooed on them, friends and fans of the band across the world, and I never knew what to say over the years when people would wanna show me their tattoos—it’s very humbling—but to see it like that on Kyle … I was speechless. We [the band] all were.”
“Kyle got the tattoo two weeks before he was deployed,” Brannan adds. “It was just one of those things where words fall short. Kyle is really just cut from a different cloth than the average human being: a true inspiration to us all.”
Another person humbled by Hockenberry’s story is Gary Sinise, the CSI: NY actor who created The Gary Sinise Foundation (GSF) inspired by his Forrest Gump character, double-amputee Lt. Dan Taylor. GSF helps war amputees adjust to life as independently as possible. Upon hearing Hockenberry’s story, Sinise immediately reached out and visited the wounded veteran at BAMC.
“He’s very hands-on,” Hockenberry says. “Even being a famous movie star, he’s pretty down-to-Earth. [GSF doesn’t] just build the house and cut all ties with the veteran. They try to help us in any other way they can.”
Sinise worked with Hockenberry and his family to begin the steps towards readjusting to life, beyond his recent handicaps, and GSF continues to work with the Hockenberrys to this day.
The veteran also received strength from Ashley, who met the army amputee when he was on leave in Ohio in October 2012.
“When I met my wife, it got a lot easier, because she was there every step of the way and gave me the motivation,” Hockenberry says. “When I met her, it all changed.”
The Smart House
For the next two years, the Hockenberrys discussed the plans with GSF to get their own smart house in Marietta, funded and paid for entirely by Sinise’s organization. The amputee’s long-term hospital stay and eventual discharge from BAMC in 2012, official un-enlistment from the Army—who disapproves their members receiving gifts of a high price—and deciding details for the house like a location to paint colors kept the immediacy of the house in check.
During that time, Hockenberry lived in Texas with Ashley in a small bunker of an apartment. The non-handicap accessible location was “a challenge” for Hockenberry and Ashley. So when he officially retired from the Army, they moved back to Ohio in a house that attempted to fit the amputee’s living situation. That also was not what he needed it to be, so they still struggled for years after his injuries. The smart house was most definitely an improvement.
Hockenberry describes the smart house as having “a rustic look.” At six to eight thousand square feet, the two-story house is specifically customized to help the veteran be as independent as possible.
The floor adjustments and hallways are wider. The doors automatically open and shut, and there are elevators to the different floors. Also included are lower shelves, taller ceilings, a full-length porch in the front, a half-length patio in the back and other special household appliances. All of those improvements, in addition a downstairs “man cave,” Kyle’s favorite room, make the new home a serviceable and fitting lodge for the couple.
“I’m more than grateful for what they have done,” Hockenberry affectionately says. “It’s almost too much.”
The couple moved into the smart house on June 18, 2014. Their welcome-home commencement was a big service. Sinise was there to welcome the crowd with a performance from his band, Gary Sinise and the Lt. Dan Band, and other entertainment and services were available. That was also provided by GSF, in conjunction with the Tunnel for Towers Foundation, which supports those first responders and most severely injured service members.
“We like to be there for all the different stages—the good ones and the bad ones—but hopefully most of the good ones,” executive director of GSF Judy Otter says over the phone. “This is just the beginning. We are still working with Kyle and his wife and helping them through their various stages. We continue to stay in communication with them and make sure they are adjusting to their new living quarters.”
Those services can include getting Kyle in contact with other veterans to help and service members like him to provide assistance with their business or school plans. It can also be activities such as calling to make sure everything is going well with the house and fixing problems, should they arrive.
Work on the house, however, is not completely done, since Ashley is currently pregnant with their first child due this July. They will need to make sure the smart house is family-safe. Like many new parents, Hockenberry is excited and nervous at the prospect of fatherhood.
“It’s a new thing,” he says. “It’s going to take me awhile to get used to.”
With this new addition to the family, GSF plans to be around for anything the couple needs during that positive adjustment in their lives. Sinise even calls every now and again to make sure they are well.
“We are a full service group,” Otter says. “We continue to give to those who have given so much already, who have given the ultimate sacrifice. The Hockenberrys are pretty special folk, and we’re there to make sure we provide our mantra: serving honor and need. We want to give what everyone in life wants: family, success [and] careers. We want to help them, and they deserve it.”
In addition to being a new father, Hockenberry continues to plan for the future. He hopes to open a gun shop either near his house or in downtown Marietta. Guns have been a hobby and interest for him even before his Army days, and he is still very passionate about them. The details on the veteran’s upcoming business are still in early development.
Meanwhile, Ashley recently took her husband’s passion and surprised him last year with the opportunity to appear on the CMT reality series Guntucky. There, Hockenberry went to a local gun range to try some high-gear firearms on national TV.
With these exciting prospects, this injured war veteran’s future looks quite hopeful.
“I mean, it bothers me, not having legs or an arm,” Hockenberry says. “But life goes on, and you have to get through it.”
By Will Ashton
“William’s leg is infected. I think he’s got gangrene,” the caller says. She is distraught. Scott Anzalone, a family physician in Logan, tells her he’ll be right over. The woman on the phone is one of his patients, and he knows her family. But he doesn’t recall anyone named William.
That’s because William, he discovers, is a chicken. But not just a common bird. The woman and her husband raise show chickens. William is a prized breeder.
And now William has a serious problem with one of his feet. What should she do, the woman asks. Call a vet, he suggests. But can’t you take care of him, she pleads.
So the physician agrees, and snips off the infected foot and bandages the stub. William lives, and adjusts to life as a one-footed Casanova.
Just another day in the life of a rural doctor in Appalachian Ohio. Anzalone and others like him do not just treat medical conditions, they treat families. These doctors are embedded in their communities, and for better or worse, that means they are on constant call for their patients and their problems, medical or otherwise.
“You go into the city, you’re providing a service,” Anzalone says. It’s different for rural doctors. “If you want to be successful as a physician in a small town,” he says, “you have to be part of the community.”
An epidemic of hardship
One of the biggest challenges doctors face in rural Appalachia is dealing with the issues of poverty and mistrust, which are deeply intertwined.
“The poverty issues here are tremendous,” says Jane Broecker, an obstetrician-gynecologist and professor at Ohio University’s medical school. “Understanding poverty is essential to being a respectful physician.”
Understanding poverty also helps doctors deal with some of the choices their patients make, without being too judgmental, Broecker says. “They’re not being cynical when they’re smoking a pack a day and then say they don’t have money for their medicine,” she says. “Tobacco is their coping mechanism. It’s not a good one, but that’s what it is.
“You’re not going to enjoy rural medicine unless you understand where people are coming from, what hardships they face,” Broecker says.
In many cases, people in Southeast Ohio are simply too poor to afford the care they need, or at least not without considerable sacrifice. To that end, rural doctors will sometimes barter for their services, which allows them to provide care and permits patients to preserve their dignity by offering something in return.
Anzalone says he has accepted haircuts, horse feed and pies as payment for medical care. In one case he was going to deliver a baby for a couple that he knew had little means to pay for the birth. The husband pulled Anzalone aside one day to discuss a barter. “I need a fence,” the doctor told him. “I’ll provide the materials, you build the fence and we’ll call it even.”
“I got a fence for a delivery,” he says.
One good deed
The Amish, a Christian sect that lives a traditional agrarian lifestyle largely removed from modern culture, do not have health insurance and pay cash for their medical care. Amish communities will pool their savings to help cover the medical bills of one of their own. But sometimes those collections are not enough.
Tim Law, a family physician and professor at Ohio University’s medical school, has built a medical practice niche treating Amish families. Among his Amish patients are a couple who have three children with cystic fibrosis. One day he was at the family’s house and mentioned that his daughter was getting married. The husband asked Law where the ceremony would be held. Law said he was hosting it in his backyard, and that he planned to build a new deck for the event. The husband instructed Law to pick him up on Saturday at 6 a.m., and he would build the deck for free.
When Law arrived Saturday morning, the man was there with three other Amish men, standing beside a pile of lumber. Law hauled the men and the wood back to this house, and the four got to work at 7 a.m. Nine hours later, which included a one-hour break for lunch, the men had built, from scratch, an 18-foot octagonal deck with a sunken fire pit and a 10-foot walkway connecting it to the existing deck off the back porch. The boards were cut, including the precise angles to make the shape, using only handsaws.
Building trust the first step
Understanding people’s life situations and being willing to work within them helps cultivate trust, which can be hard to earn in this region, especially for outsiders. Appalachia’s rural communities have a reputation for being insular and suspicious, which is not unwarranted.
“There’s a long history of being taken by outsiders,” says Randall Longenecker, assistant dean for rural and underserved programs and professor of family medicine at Ohio University.
Appalachia’s Amish population, perhaps more than any other, has shut itself off from much of the outside world, living their agrarian lives in a time capsule from the pre-industrial age. The Amish do not reject modern medicine, but earning their trust requires a certain approach.
Law recalls a visit to the home of an Amish family to check on a pregnant woman. He pulled up outside the house in his pickup, dressed in blue jeans, a T-shirt and boots, toting a canvas bag. The husband eyed him up and down. “You don’t look much like a doctor,” the man says. “I looked him square in the eye and said, ‘Well, thank you,’” Law says. The man paused for a second, then started laughing. Law knew he had made a good impression. “They appreciate you more if you’re just a real person,” he says.
Lives left to fate
Generations of poverty and struggle also have bred a sense of fatalism that permeates much of rural Appalachia, doctors say. Suffering and tragedy are woven into the narrative of daily life for many, along with a belief that there is little they can do to alter their fate. “Sometimes young people come in and say if pregnancy happens it happens,” Broecker says. “There’s a sense that they can’t control what happens to them.”
At the same time, many Appalachian parents, like parents anywhere, still hope for a better life for their children. Broecker says she has had 30-year-old mothers bring their 15-year-old daughters to discuss birth control, who say, “I brought my daughter to you because I was a teen mom, and as much as I love her I know how hard it was for me. I’m bringing her to you so that she will not be a mom until she’s ready.”
Such cases illustrate the exception to fatalism, in that the women are choosing elements of their own fate. Yet as census numbers show, much of the rural Appalachian population never stray from their communities. Home is what they know. It is familiar and comfortable. It is where they fit in. Some have a fear of the outside the world, and big cities in particular, that is difficult to fathom for people who have not grown up in their world.
“I’ve had patients who’ve never left the county in their lives,” Anzalone says, recalling a patient who had a heart condition he feared would soon lead to a heart attack. Anzalone recommended the patient go to Columbus for treatment, but she would not make the trip. The thought of going to the city was too much for her. “You know doc, you just do what you can do,” she told him.
Home visits offer insight
Working as a rural doctor also means making the occasional house call, which can be a window into a patient’s world that provides valuable insights into their medical care and their decisions. A look inside a patient’s home, at their living situation, may bring into sharp focus why they are not tending to their medical needs with the urgency they should.
“Unless you can identify the problem by understanding the patient’s home situation you’re not going to meet them where they are,” Broecker says. She cites one patient, a young mother who was breastfeeding her newborn but wanted to stop. It wasn’t until Broecker discovered the girl was living in a trailer with several other family members that she realized there was no private space at home to nurse the baby. Broecker showed the girl how to nurse more discretely with a blanket over her shoulder.
It is easy to forget that a patient’s medical condition is part of a much larger tapestry, that it may be the symptom of something not found through clinical exams, Longenecker says. Medical students tend to focus mostly on the content, on mastering the diagnoses and treatments, he says. “The challenge is not so much the content,” he says, “it’s the context.”
Navigating traditional beliefs
Another barrier to earning trust in rural Appalachia is that many people’s beliefs about medical care are shaped by stories that get passed around among friends and family that may have little basis in science.
“People in Appalachia learn from stories,” Broecker says. “Here people believe what their sister said. … What they heard from their sister’s best friend’s aunt. What they heard from their neighbor next door.”
Sometimes the best approach is to respond with stories of her own, Broecker says, about how she took care of another patient with the treatment she’s recommending and how well it turned out.
In his work with the Amish, Law has had to learn how to negotiate beliefs and customs that are not only foreign to his own, but sometimes run against his medical instincts. For example, an Amish father brought his 14-year-old daughter into Law’s office one day. The girl had sliced her index finger on a Mason jar, right through the tendon. The finger was hanging by a flap of skin.
Law said the girl needed surgery. The father balked. Can’t you just stitch up the skin, he asked. Law said he could, but told the man his daughter might never regain full use of her finger. She’s just a girl, the father replied. Does she really need to be able to point her finger? It was clear the man would not budge, so Law reattached the tendon, secured the finger in a splint and hoped for the best. The finger healed and the girl regained full use. She is now a teacher in an Amish schoolhouse.
Law has also adapted to an Amish custom about pregnancy. He had been caring for pregnant Amish women for some time before a midwife finally pulled him aside one day and politely informed him that the Amish do not use the word pregnant, especially in front of children. The same goes for “with child,” or any other explicit reference to pregnancy. Instead, some will use the letter “P,” or say “PG.”
Birth control is another taboo, at least for Amish men. Law typically cannot see an Amish wife without her husband present, so he is not sure how the women feel about the issue. But as he’s built enough familiarity and trust with some families over many years, he has been able to see the women alone. And some of them have taken the opportunity to ask about birth control devices that their husbands cannot detect.
All in a day’s work
Rural doctors remain generalists in an age of increasing specialization, sometimes tending to needs that extend well beyond their medical comfort zones—such as chickens or, in Broecker’s case, pigs. One day a patient of hers, a young women involved in 4-H, said she had a pregnant sow that was due to have a litter of piglets any day. “I told her I’d never seen a sow give birth, and she and her mother invited me out to the farm when she went into labor,” Broecker says.
When the time came, there were complications. The first piglet was wedged deep in the birth canal and the young woman’s mother was trying to pry it free. “She turned to me and said, ‘Well, you might as well give it a try since this is what you do for a living,’” Broecker says. “She showed me how to wash my arm and reach up for the piglet. This is when I discovered the piglets have teeth.” She managed to maneuver the trapped piglet out and the rest followed with no problems.
Along a hallway inside Anzalone’s two-story Victorian medical office on Main Street is a parade of baby faces, photos from many of the deliveries he has made over the years. On his antique desk sits another memento: a clear vial with a yellow plastic cap. Inside, floating in formaldehyde, is an amputated chicken foot, given to him by William’s grateful owner as a souvenir. “You know you’ve had a good day,” Anzalone says, “when you’ve made a baby smile and saved a chicken.”
By David Forster
In December 1903, Orville and Wilbur Wright harnessed the power of flight and achieved the seemingly impossible. But the brother’s successful engineering of the first three-axis control was more than a technique that made fixed-wing aircrafts possible it was an enduring industry standard to this […]
Twenty-six billion pounds of beef are produced every year in the U.S., according to the U.S. Department of Agriculture. In Muskingum County, the weekly Muskingum Livestock Auction sells thousands of cattle annually to the highest bidders to be manufactured into beef consumed by carnivores across the country.
In the barn, the chorus of mooing cows mixes with the hustle and bustle of the auction. The gravel parking lot fills with trucks of every color. Steel trailers stand empty, waiting to haul the cattle away.
Starting at 9 a.m., big buyers come ready to do the business of buying and selling cattle. Fat cattle, ranging anywhere from 1,150 pounds to 1,500 pounds, are sold first. Feeder cattle come next, but their sizes vary compared to their beefier predecessors.
Feeder cattle, for the most part, are bought in the hopes of beefing up and being re-sold as fat cattle. They range from as young as three months to a year old at most.
“Feeders, they’ll be any size. They’ll be as small as 200 lbs up to 1,000 lbs. They need fed,” Denny Ruff says, general manager of Muskingum Livestock Auction. “Finished cattle will be big, you know, stout looking. They’ve got to have some fat on them to grade.”
The auction’s livestock comes from Ohio, West Virginia and Pennsylvania. But the buyers are usually out-of-state large meat manufacturers. “They come from a long way because we got a good market, so they’re just hauling ‘em a long way,” Ruff says.
Cattle of all shapes and sizes begin to arrive at the auction bright and early on Tuesday mornings and filter in throughout the day and into Wednesday. Workers at the auction have their hands full tagging cattle and coaxing them into pens.
“On any given Wednesday, we move about 2,300 to 2,500 cattle,” Ruff says.
And does the auction move quickly. One by one, each cow enters the ring for auction as the auctioneer rattles off its ideal bovine characteristics. The auctioneer has a job that never seems to cease. In one full breath, the auctioneer in his cowboy hat builds a rhythmic pace that is hard to keep up with. His motor mouth keeps a beat that takes years of practice but is necessary to keep the auction moving and grooving.
“They’re just hollering numbers basically,” Ruff says, unfazed by the fast pace. “There’s a couple of ‘little guys’ who buy on occasion, but usually it’s the big processors buying.”
Livestock sold right out of Muskingum County travels hundreds of miles to make its way onto dinner tables across the U.S. “For the most part, we’re probably the biggest cattle market in the state of Ohio,” Ruff says.
Ruff, who has been at Muskingum Livestock Auction since 1987 and general manager since 1999, is no stranger to the task of caring for and selling cattle. “I grew up on a farm in Fairfield County,” Ruff says. “I just basically started part-time right out of high school.”
Standing tall and thick-set in work overalls and boots, Ruff has turned his farm upbringing into a career and he knows his business inside and out. “That’s about all I know, livestock,” Ruff says.