Poke: a Community Acupuncturist's Tale: Community Acupuncture Tales, #1

By Steven Knobler

Two years have passed since his father's death and it's time for Dr. Ray Zywicky to reopen his acupuncture clinic and return to life. But Ray won't practice like before. The insurance companies helped cause his father's demise and that's unforgivable. Perhaps there's another way; with a low cost, no insurance, community clinic. But is it worth the risk and effort?

 

Join Ray in Bibelot, Washington, a little jewel of a town, where Bonnie Brown's brews great coffee, Rusty's bar serves dubious drinks, uncle Mel runs the family funeral home, and an unusual cast of characters poke at each other, while Ray pokes them all, at the Northwest's newest community clinic.

• Language: English
• Publisher: Steven Knobler
• Release date: Sep 6, 2020
• ISBN: 9781393769996

Steven Knobler

Steven Knobler is a Doctor of Acupuncture in Washington State where he runs North Seattle Community Acupuncture with his stalwart crew of acupuncturists and support staff. He also teaches orthopedics and sports acupuncture, as an adjunct professor, for Bastyr University’s doctoral program. When not poking folks, Steve enjoys visiting foreign countries and exploring the great Pacific Northwest with camera in hand and Holly, his wife, by his side.

Book preview

Bibelot

The first shards of cold, morning sunlight snapped Ray out of his trance.

Can I help you, son? You’ve been standing there with your hand on that gas pump handle for fifteen minutes. Are ya frozen to it? said the ancient scarecrow of an attendant.

No. I’m good, just listening to the river and staring at that trestle bridge. Orange is an unusual color. He paused while topping off the tank. I don’t get called ‘son’ very often. I’m thirty-seven years old and a doctor.

A Doc? Don’t even look like you shave yet. What kind?

Chinese medicine, Acupuncture.

Nope. Never heard of that. Where’s your clinic?

Haven’t got one.

Huh. Guess you don’t have the patients for it! he laughed. "See - I made a joke there. A hundred wrinkles squeezed his eyes shut.

Ray smiled. Anyone who still saw humor in life, after so many years, deserved to laugh at his expense. Ray glanced again at the bridge on the other side of the wide, unadorned highway.

Mind if I leave my girl here? I’d like to walk across the street for a few.

Go ahead. Ain’t nobody goin’ to need gas in the next ten minutes, especially this early in the morning. Besides, who’d wanna steal your heap anyway?

Hey, Belle’s got some miles on her, but she’s reliable. I like my girls old and feisty. It shows character. Besides, Subarus are built to last.

If you say so. Sure glad you’re a doctor ‘cause she’s almost bedridden! he flashed his almost toothless smile.  There, I made another joke!

Yes you did, smirked Ray. Don’t give up your day job. I’ll be right back.

Out of habit, Ray looked both ways before crossing the highway, but it didn’t matter this time of day or year. Fall in the Pacific Northwest had arrived. Ray pulled up his collar, buttoned his jacket, and headed to the small, pebbled beach on the other side of the road. There, he stood in silence and gazed at the dance of the roiling water.

Where are you dad? Did your soul pass this way? Am I doomed to follow? Moisture streamed down Ray’s cheeks. It wasn’t the river’s mist or the sky’s trickle. He pulled his gloved hand out of his pocket and wiped his face. Broken branches, roots, and trunks littered the beach and were piled beneath the trestle. Life’s like flotsam, never sure when, where or how it goes.

Ray returned to the minimart and paid the attendant for the gas.

Know where ya heading?

Do we ever? asked Ray.

Forty years ago, I would have said, ‘just passing through Bibelot’. But, I met the right gal, god bless her memory, got the right job, and here I stayed. Home is where your loved ones are, son. Remember that and, above all, be patient. Oh, another joke. I’m on fire this morning!

I may have misjudged you, old man. I think you might have another career on the horizon. As for me, I’m heading to my uncle’s. If I remember him right, the coffee’s hot, the bread’s toasted, and the sausages and eggs are sizzling.

The car door creaked as Ray opened it and the suspension dipped deeply as he sat. Belle’s odometer hadn’t moved since she hit two-hundred thousand last year. Belle, I don’t know how old you are and I’m not asking, but you’re okay with me. Let’s go say hello to uncle Mel.

With that, he flipped on the worn wipers and headed East.

Mel’s House

Ray pulled into Mel’s just as the sun topped the trees. Tall Douglas firs hid his uncle’s expansive front lawn, as well as the long driveway that sloped down from the road to his house. The crushed stone barely made a sound under Belle’s shallow treads. As soon as Ray passed the firs, he saw the glow of the kitchen lights and the smoke billowing from the chimney. Mel started early even on dreary Saturday mornings.

Ray approached the front door and pressed the buzzer. Nothing happened. He pressed again. Still nothing. He wrapped firmly until his knuckles began to smart and redden. Eventually, he heard Mel’s large frame waddle to the door.

Hey Ray. It’s been a while. They shared a brief, manly hug.

Two years, uncle. Two long, numb years. But, I’m glad to be here.

Mel smiled. "I’m glad you’re here, too. We’ll get your stuff out of the car later. For now, come in and have breakfast.  Ray entered the large split-level. The main floorplan was completely open, everything viewable under recessed lights. Furniture divided up the rooms; every piece had a pillow and blanket on it, but not a speck of dust. Ray followed Mel to the breakfast nook, with its large bay window, and took a seat. He gazed outside, head propped on his hands. The morning shadows were still long. A deer rambled through the vegetable beds. Squirrels capered around as they gathered nuts. Hummingbirds danced contentiously at a nearby feeder. Ray smiled. So not Seattle.

Mel interrupted Ray’s blissful moment. I felt like you fell off the face of the earth after the funeral, he said. Would have been nice to talk after I buried your dad, but you were gone before I could say ‘boo’.

Sorry, said Ray, staring down at his plate, one hand on his head pulling at his curly, brown hair. I wasn’t ready for dad to die. Not sure if I was more angry or lonely.

As a funeral director, I can tell you that almost nobody’s ready for their parent to die. It’s even worse with children.

I’m sure it is. But I felt so responsible. Dad and I struggled to get approval for that new medication. It might have shrunk his tumor. The early evidence looked promising.

What happened?

Ray huffed. The insurance company happened. In this case, Capitol, but they’re all the same. They never want to stick out their necks to cover something experimental. As a medical professional, I should have seen it. I should have pushed harder, written better letters, made more phone calls. Who knows what I could have accomplished? And then he died. Brain cancer at fifty-six years old, a god-damned waste of life.

Do you think it would have made a difference?

Ray gripped his knife and fork so tightly, they squeaked.

I don’t know. I just don’t. But, I’ll tell you this.  For years, I’ve had to finagle payments from my patients’ insurance companies. I’ve always had to bill meticulously and they’ve always underpaid. And, as soon as coverage limitations are reached, the patient gets stuck paying ridiculous amounts out of pocket.

Mel kept his focus on Ray. Refill your java?

Ray extended his cup, hand shaking.

The morning dad died, I was working with Brenda, my receptionist. We were trying to fix a payment problem for a patient with shoulder pain that Capitol should have reimbursed. Brenda thought they probably hired a new claims processor for Washington State who didn’t understand the diagnosis codes for acupuncture. Two-hundred fifty dollars for a single visit! There was no way my patient could afford that. I was spitting tacks. That’s when I got the call from the hospital telling me dad was gone.

Ray felt his cheeks moisten again. Breathing hurt and his next words strained to come out. Such a waste, he mumbled.

What have you been doing for the past two years? asked Mel. I’ve always kept tabs on you through your dad. With him gone, you’ve been a total mystery.

Ray looked out the window again. The sun was higher, the shadows were shorter, and no animals, not even hummingbirds, were present. He spoke slowly and deliberately.

"Dad was my compass, my guide, and my best friend in the world. I’ve been lost without him. I took a gig teaching needling techniques at my acupuncture school. It barely paid the bills, but I can’t return to that circus called insurance. I’m a healer. I’m supposed to help people with their pain, not cause more. What good is fixing your shoulder when it injures your savings?"

Mel stared down at his plate. Unlike Ray’s, his sausages and toast were long gone. I loved your father very much. He did everything, and a half, that I wanted to do in life but was afraid to try. He was my best friend, too. When Mel raised his head, tears rolled down over his wide cheeks and trickled across his scraggly, gray beard before dropping to the table.

I want to do for you what he can’t anymore. Please, how I can help?

Both men paused. The house creaked as the wind rustled through the firs and cedars in the yard, and the windows gently flexed in, then out.

I’d like to start a clinic up here. You’re the only family I have left and I’d like us to be close. There’s a new kind of practice called community acupuncture. The first one started in Portland in 2002. Ten years later, more than two hundred of these places have opened. They charge really low fees and they don’t deal with insurance.

Wonderful, said Mel. Small problem though. How do they stay open? We’re both businessmen. Have to make a profit, right?

Volume. They see multiple patients per hour and they do it in community rooms instead of private treatment spaces.

How many an hour? Cram too many in your schedule and your treatment quality will suffer, said Mel. I can’t do more than two funerals a day. Attentiveness is everything.

I’m thinking four an hour would work. The pricing isn’t a fixed amount. It’s a fee range like twenty-five to fifty dollars. People pay what they can afford within the range. If I did this in Seattle, I’d have a hard time covering expenses. Up here, my chances will be much better.

Good plan, Ray. Do you have a place to live while you set up shop?

I don’t.

Well, young sir, this house has three bedrooms and three baths. I use only one of each, but clean all of them meticulously every week. Silly, isn’t it? Stay with me. We’ll enjoy each other’s company and justify my obsession to scrub and polish.

Clinic Space

Snohomish County seemed like the perfect location for a clinic. It was semi-rural and just a stone’s throw from the pristine Snoqualmie National Forest. The moderate, moist climate made everything lush and green during the Spring and Summer, and often beautifully white during the Winter. The area lacked the culture and excitement of a large city, but who wanted that anyway? Traffic, taxes, and politics were over-rated. Seattle could keep them all.

It had been three weeks since his arrival and Ray’s lack of progress chafed his nerves.  He downed his cold, neglected coffee and whipped the real estate circular sideways, scattering it across the floor. Being near Mel meant so much, but every office space from Monroe to Arlington was unsuitable for a clinic. If it wasn’t the rent, parking or signage, it was the noise, layout or infestation. Marmots? Chickens? Who ever heard of a feral goat problem? Ray realized he was getting desperate when he considered a landlord’s absurd logic that electronic medical records would deprive the goats of anything to eat. Even without paper charts, the buggers would still devour the toilet paper and toweling.

Despite Ray’s obvious frustration, Mel kept his attention focused on the Monroe Tribune’s editorial pages. It was one of Mel’s morning rituals, of which he had many. Mel was a certified bachelor. Anyone with that much scraggly hair on his face was completely unkissable. The comb-over didn’t add to his allure either, but he was a big, warm man, a diamond in the rough, who really cared about people. That was especially true when they were dead because Mel was a mortician, just like grandpa Stan.

Tell me about grandpa, said Ray, hoping to break the ice with his uncle.

Didn’t your dad?

No. Whenever we talked, he always focused the conversation on me. What do you want to make of yourself? Where are you going to school? Why acupuncture? So now you’re a doctor! I always discussed whatever subject he chose, and it was never about the family. Honestly, I think he tried to live his life through me.

Mel pondered Ray’s last comment. That can keep you young, I guess.

A loud bang outside announced it was Thursday and time for garbage pickup. The narrow stand of front yard trees did little to block the sound of truck hydraulics and flipping barrels.

"Grandpa Stan started Zywicky’s Funeral Home and Crematorium in this town after being discharged from the army in nineteen forty-five. My understanding is that he saw way too much suffering as a medic, so he decided to care for the dead instead. ‘Death and Taxes,’ he used to say. ‘You could always count on those.’ He was right. Zywicky’s quickly became popular in Bibelot. People came from everywhere in Snohomish, and beyond, to have a proper service and burial. Folks hated and loved to come all the same. 

After fifty years of hard work, grandpa retired and left the business to me. I may be a scraggly, lumpy bachelor, but I know how to care for people."

And houses, too! said Ray approvingly.

And houses, too. Glad you noticed. So, I think I’m well suited for the job. And thus endeth our ‘grandpa Stan’ talk, laughed Mel.

Hey! came a shout from across the street. Bring back my trash bin!

All Ray could see was a huge set of curlers and a hot pink bathrobe.

That’ll be Mrs. Schlosser, said Mel. Monroe Refuse drives away with her can at least once a quarter. I think they do it on purpose just to see her fly out wearing something outrageous.

They both laughed.

THE FOLLOWING SUNDAY afternoon, Mel walked into the kitchen just as Ray pitched back his head for a frothy swallow of Haywire beer. I really like this IPA, said Ray. Nice fresh taste. Is it local? 

Sure is, said Mel. And you’re going to find out how local if you keep drinking them. I’m almost out. 

I’m planning to go to the store anyway, said Ray. I need to pick up the latest ‘For Sale/For Lease’ rags to search for office space. It’s been really depressing, though. There’s something wrong with every place I find.

What about upstairs? he said. 

Upstairs? This house has three baths and none are ADA approved.

Nah. The floor above the Funeral Home. said Mel. "I’ve been using it for storage all these years, but I could move everything to the garage out back. Might need to keep a few caskets in