Since ambulances cannot be driven on dirt roads , those of us out here are always urged to get ourselves to the pavement . Otherwise , if we were to call 911 , the medics could come only in their SUVs to retrieve us , do what emergency medical magic they can do , and then transport us down five miles of dirt road to the ambulance idling on the asphalt . The ambulance would then drive us to No Trash Can Hill to meet the helicopter . And off we would go to probably Odessa or Midland .

This happened to our friend Rick , who broke his hip falling off a ladder a few years ago . The ambulance actually drove all the way down that five miles of dirt road because the medics had not realized just how long that particular dirt road was . Then they drove out with Rick ( Ouch ! So bumpy !) to No Trash Can Hill , where he got his helicopter ride to Odessa for a hip replacement surgery . He was back home in five days .

Over these many years , I ’ ve watched one friend after another move away because of the distance from medical care : Lucille Muchmore , George and Clara Willis , Robert “ Beechie ” Beauchamp . ( Nevermind Nita Brashear , who at 93 is a tough old bird who can ’ t be budged out of this part of the country .)

For 15 years , I went for medical care to a nurse practitioner I liked in Alpine , someone who got to know me and my medical issues . But she retired . This made me change course , and in the intervening years I ’ ve chosen to get my medical care between May and September , the half of the year that I ’ m in Pacific Northwest , near Portland , Oregon , which is full of large medical facilities . So far , I ’ ve been lucky in that my needed tests and surgeries have fit into that restricted calendar . Grappling with various changes in my body has involved MRIs , CT scans , blood tests , and tests with

much longer names . This is no slight to Alpine ’ s Big Bend Regional Medical Center , which can do CT scans and blood tests , nor to the mobile MRI unit that comes with some regularity to Alpine . Over the years , I ’ ve had several procedures and small surgeries there and have been grateful for their care . But in reality , most treatments that would follow these tests require a larger hospital with more specialized services and equipment . Which puts us back to square one .

“ It is recommended that the patient live closer to medical services during the winter months .”

I ’ ve graduated into an age group where the question looms : For my own safety , can I afford to keep living way out here in what that doctor considers a Daniel Boone lifestyle ? Indeed , he says farther on in his notes : “ She lives completely off the grid in Texas without electricity ( solar ) or running water ( rainwater ).” He thinks I live more primitively than I do , but I get the point .

So long as my medical needs can be met in the months immediately before , during and after summer , I ’ m golden . But if I require something complex or worrisome while wintering in Texas , what do I do ? Commute to Midland or Dallas or El Paso ? Stay in one of those cities for however long it takes to resolve whatever medical issue is happening ? It stymies me to think about .

But consider this . Where we live on the coast of Washington state holds a constant danger of a tsunami . No warning . We who live here all know the evacuation routes — signs are everywhere — we know that on this two-mile-wide peninsula , we ’ re all quite vulnerable . Yet we all choose to stay here , to live here . Right next to the ocean , it ’ s another paradise we would never choose to give up . Would that same doctor advise us to not live here ? �