Spirit(s) of Place, Part 1.5

The world without ambulances: an interlude.

Once in awhile, I need to remind myself that I’m not just doing this because it’s interesting, or because it’s fun (although it is definitely those things for me, and hopefully for my readers as well.)

This re-framing of the world is medicine that I need.

As regular readers may have noticed, I have a particular set of anxieties around the failure of systems. It’s not that I think we’re all doomed; far from it. What keeps me up at night is the awareness that so many of the systems we depend on (almost all of them, in fact) are entirely built around the emotional investment of individual people. These systems all have human operators, in some form or another; those operators need to care enough for things to run smoothly, or at least not fail catastrophically.

We rely heavily on other people giving a damn about their jobs, in other words.

And and as you may have noticed—people are having an extremely hard time maintaining their emotional investment.

There is no shortcut around this. People can’t be compelled to care. They can be forced to perform a task, for a while. But if they’re not emotionally invested—if their heart isn’t in their work—it’s only a matter of time before something breaks badly. (This is a close cousin of “losing your will to live,” as I wrote about in my previous post.)

It’s unfashionable to refer to this as a “spiritual” crisis. In our fully modernized and materialized world, spirituality is seen as a weekend hobby—an intellectual pursuit—a quaint anachronism for misfits and eccentrics, like hand-sewing clothes or riding a penny-farthing bicycle. Ordinary people don’t have spiritual needs. It’s certainly not a concern for society at large.

Instead, we frame these problems as “psychological,” which is a kind of materialism of the spirit. Psychological problems are individual problems—someone’s inability to keep up with the rest of us. There is nothing about a person’s psyche that is greater than the sum of its parts. Fixing bad feelings is like fixing a car. Emotional mechanisms can be isolated, diagnosed, and repaired; with good doctors and the right kind of medicine, these holes in our selves can be patched up. We might not be fully restored. But we’ll be in good enough shape to get back on the battlefield of modernity. When we get wounded again, they’ll just drag us back to the chop shop: bad parts cut out, good parts sewn up, empty spaces filled with chemicals. Then back to the front lines. Back and forth, back and forth, until there’s nothing left to stitch back together.

When people eventually break down completely—try to destroy themselves, slowly or quickly, and maybe take a few others with them—it’s framed as an unforeseeable tragedy. An individual crisis. If one crisis becomes several related crises, and then begins to look like a trend, well, that’s just the price of progress.

The system cannot fail: it can only be failed.

This is part and parcel of the Big Story, and also the central tenet of every utopian project for the past century. With the Good People in charge—the right science, the right technology—the world within the Wall can be sustained indefinitely. The people who actually keep the whole thing running will get with the program (or else.)

Unshakeable faith in the system’s integrity means that we discount the warning signs of each growing crisis. And when we are finally confronted with an undeniable failure, the solutions are always administrative. By these lights, we are definitely not looking at the symptoms of a deeply unwell culture. The problem is not widespread anger, despair, and disillusionment—the logical outcome of a society that isolates people and grinds them down. Rather, the problem is that we need better rules, more rule-makers and more enforcers, more measures to keep the undesirables in line. Then the purity of our vision will be fully realized. We have the knowledge and the technology to create a better world—if only these people would stop killing themselves and each other, and cooperate.

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There are far, far too many of these failures to analyze. I’ll limit my observations to one in particular: it affects me personally, and it’s a great example of “it wouldn’t happen here,” happening here.

We live in a statistically affluent college town, in a well-funded state, in one of the wealthiest countries on the planet. The problems with the health care system in the United States are infamous; still, you would imagine that—even if the working class is getting screwed—wealthy people in wealthy places can still get access to all the legendary science and technology that Americans supposedly have access to.

Not so.

A friend of a friend works for the single ambulance and EMT service in the city¹. Apparently, they are badly understaffed and under-resourced, to the point where emergency medical services just aren’t available sometimes. There are times when you could call for an ambulance and it just… won’t show up. And this is just under normal circumstances. God forbid there’s a mass casualty event. If too many people need emergency care at the same time, triage starts immediately, until mutual aid can be brought in from one of the surrounding areas².

That’s fine, you might say—just duct-tape the patient up as best you can, and drive them to the hospital yourself. Messy, but practical. Except that I know somebody else who works in health care, on the hospital side; their advice was to avoid the local hospital, because it’s also understaffed and under-resourced. In an emergency, their advice was to get immediate care locally, and then transfer to a bigger hospital as soon as possible. “A bigger hospital,” in this case, is at least an hour’s drive away.

And who is responsible for doing transfers between hospitals? That’s right: the ambulance company. Part of the reason the coverage is stretched so thin is because the local ambulances are doing road trips to transfer patients as far away as New York City, driving over four hundred miles down and back. A medical tech could get a call for a transfer at the end of a twelve-hour shift, and have to spend an additional twelve hours on the road—driving down, sitting in traffic, coordinating with the hospital on the other end, driving back—all while keeping their patient and themselves alive.

Absolute lunacy.

So despite living in an extremely affluent part of the world—despite our amazing theoretical capacity for technological advancements in medicine—even rich people might not have access to basic medical care in an emergency. Once they get to a good hospital, the options for wealthy people obviously improve dramatically. But that’s assuming they survive long enough to get there. And there are already places in this state where things are much worse—let alone the rest of the country—let alone the rest of the world. On paper, the system can do amazing things; in reality, the human components are breaking down, and can’t be pushed much further.

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What’s the remedy, then?

One option is the old administrative solution: more funding, more rules, more rule-makers, more enforcers. Keep lashing the whole thing together with red tape and imaginary money. This might work in some places, for a little while—but these are cascading failures. Breakdowns in one area put more strain on the rest of the system. Those cascading effects can only be contained for so long. Even now, we’re still suffering the aftershocks of a crisis that was bigger than its initial causes: stuff just stopped working because people stopped working³.

A second option is to use these alternative frameworks as a kind of spiritual first aid. If the crisis is, indeed, a spiritual one—if people just don’t know where they fit anymore, or what to believe in—then a more expansive imagining can offer some relief. You might still have to work your twenty-four hour shift to keep people from dying. But finding space outside of material reality might keep the worst of the despair at bay. As a potential supplement to psychological care, it’s good to be reminded regularly that you are more than just a collection of bad feelings and broken dreams, held together with coffee and mood stabilizers.

The third and final solution is that we all start living in a different world, because this one is too far gone. Ideas like orenda are how we begin to re-imagine who we are, and what we owe to each other, and how we take care of the world that will grow over this one like new skin. The indigenous and diaspora cultures in which these ideas originated all have one thing in common: the world ended for them. These metaphysical concepts are how they continued on after their own apocalypse. The spiritual worlds they built was what gave them shelter after their material world was blown away.

To paraphrase William Gibson: a world without ambulances is already here—it’s just not everywhere, yet. We might want to think about how we can live in it.

1. The owners of the company also own a prominent funeral home, and use the same family name for both businesses. As if no one would notice. Macabre jokes about the apparent conflict of interest are a local pastime.

2. They might send a hearse instead of an ambulance; if you’re lucky, and still alive, they might bring you to the hospital first—instead of taking you straight to the funeral home to save gas.

3. One more example. I was speaking to another friend just yesterday; this one works in education. He was saying that there’s growing concern in the local school district, because a significant number of kids just stopped showing up for school during the pandemic—and haven’t returned. Presumably, they’re being homeschooled, or pursuing some other alternative. But nobody is quite sure where they are. Not college students, or even high school kids, either: children in primary school. They’re just not there anymore. They or their parents just gave up and dropped out of the system.