A few years ago, during the Trump administration, I took a job as the doctor at a country music festival. It wasn’t the cast of country music all-stars that drew me all the way from Brooklyn to central Washington state, so much as the much-hyped Real America, the demographic that had gotten so much consideration since the prior election. The Watershed Festival, also known as the Red-Neck Burning Man, takes place each summer on an immense campground near Yakima, less than 150 miles inland from Seattle, but hundreds of miles off the grid of coastal liberal geographic nodes.
As I prepared for the trip, I was filled with the particular anticipation of a middle-aged man with young kids, which is to say I was pretty excited to do something new. I am a mid-career emergency doctor at an urban teaching hospital; professionally, I had never done an event-medicine gig before. For twenty years I had only ever treated city patients: immigrants, poor people, people shooting or stabbing each other, IV drug users, Hasidic Jews. There was a whole country beyond the horizon, and it had changed profoundly in the time I had lived in Brooklyn.
I arrived in Seattle to find that the organisers had arranged a three-hour Uber ride to the site because it was cheaper than renting me a car. In true Pacific Northwest fashion, my driver appeared wearing what seemed to be mountain climbing gear: technical fabrics with many zippers, hiking boots. Perhaps this was a form of signalling that he was up for anything, a notion that I as an ER doctor understood well. As the Subaru ascended into hills of misty temperate rainforest, he filled me in on the local situation, how hyped he was to live in Seattle, how physically active you could be here, the skiing, the surfing, the climbing, the camping. And also how different the coast was from the centre of the state where I was headed. I fell asleep in the back of the car dreaming of cowboys and awoke hours later in a stark semi-desert, my cheek sweating against the windshield. As we joined a convoy of trucks and trailers on our way to Watershed, hundreds of miles of bleached scrublands stretched around us on all sides—the real America, I thought.
The Gorge Amphitheater sits on a precipice overlooking the Columbia River as it flows south toward Oregon. The nearest town, it should be mentioned, is George, Washington. The gorge itself is a geological wonder of columnar basalt cliffs dropping dramatically to the river below, resulting in a breathtaking backdrop for a concert venue. The amphitheatre accommodates almost 30,000 people sitting on grass and a massive tiered campsite surrounds the stage.
The river of campers and RV’s lining the highway for miles were filing in slowly. Thousands of pale men in cutoff shirts were driving pickup trucks with jacked up tires. They had come from all over the country to camp out, drink beer and hear some music. Here was the demographic, the “real Americans,” who since the eighties have suffered economic and demographic decline and recently voted with their middle fingers to retake control of their country.
I, the immigrant son of immigrants from a Muslim country, had grown up with these people in suburban Detroit. There was no MAGA then, and as far as I knew, no undercurrent of nativist privilege, no pervasive Christofascist movement. The country has never been a perfect place but looking back, I had felt accepted and integrated. Yet during my twenty years living in New York City, the country had undeniably changed and these men in their trucks now seemed imbued with a nebulous menace, animated by a malign purpose well known to history. But then you blinked, and they were just eager fans excited to see some of the top acts in country music on stage that weekend.
The promoters were expecting 25,000 people and I was to be the only doctor until my colleagues from NYC arrived twenty-four hours later. They gave me an all-access badge and a branded scrub top. I clipped a walkie-talkie to my belt. I fastened a flashlight and Leatherman to my belt. I put my stethoscope there too, on a special clip. Part of the satisfaction of being an event medicine doctor was joining the custodial class of security personnel and EMS providers and profiting from their authority–you have lots of gear and suddenly you’re in charge. We toured the site in our official vehicle, a kind of tactical golf cart called a Gator that can go 50 mph and has a selection of sirens. The campground was filling up and the country music superstars were already arriving in their black touring buses. The team had set up a small clinic down near the concert venue and a bigger one higher up near the campground where I was to spend the first day and night.
Things heated up straight away. We got a call on the radio that a patient was already waiting for us up top. A Mexican labourer from Puebla had been stung by a wasp in the fields and had developed hives and trouble breathing. We gave her epinephrine and sat her down for observation, but she was anxious to leave and when our backs were turned she fled. Nobody knew where to find her. Maybe we had the look of men who could make her life difficult. Next to her had been a 20-year-old man dressed in an American flag shirt, pants and socks with an American flag cowboy hat. He was drunk and bleeding from his hand. He had tried to hammer the stakes of his tent with a vodka bottle, but it had exploded and left him with some deep lacerations and a tendon injury. As I sutured him, he seemed most troubled by the loss of vodka. He called me “sweetie” a couple of times and then I realised he was calling me, “scooter.” We called him Captain America. He was married and had a young child at home but was between jobs and so this was to be a kind of weekend off for him, away from his responsibilities.
Outside the long lines of campers and pickup trucks continued to file into the campground, which was organised according to a graded system. The lots closest to the concert venue were crowded with impressive motorhomes and travel campers, many with custom artwork depicting wolves, eagles, and American flags. These were the fans with means. Further from the center, I noted more simple truck campers and tents. One camper had transformed an old ambulance into a mobile home, complete with olive drab gurneys that he set outside as seating. The furthest zones were populated by mostly college age concertgoers. Our field clinic was in a zone called Pivot, which was a cross between Mad Max and The Dukes of Hazzard — disorganised and crowded, lots of hooting and hollering. There was only one campground beyond the Pivot, a no-go zone so wild and out of control that we called it District 9.
Our campground clinic included a well-appointed trailer with 10 beds, ventilators and full critical care capabilities. It served as an air-conditioned oasis from the heat and noise and dust outside. We would have a nurse and half a dozen EMS providers. Surrounding the trailer was an enclosed tent containing a number of cots. Three ambulances parked behind the trailer were ready in case we needed to transfer anyone to the nearest trauma centre an hour away. A Life Flight helicopter waited on call. We were prepared for anything. The paramedics briefed me on what to expect: lots of drinking and lots of fighting.
Though the music would not start until the next day, the drinking and rowdiness had commenced immediately and a vanguard of young women had gotten drunk and were throwing up. They were vomiting in their campgrounds, in their trailers, in our waiting room. They were smooth skinned American girls attired in daisy dukes and bikini-tops—a festival uniform. We lined them up in cots and the medics put IV’s in them and gave them Zofran for nausea. Young boyfriends or girlfriends, themselves also drunk, sat at bedside, tenderly comforting their sick companions. When the patients felt better, we discharged them all back out into the festival, only to have the beds fill with a tide of new drunks. This became a pattern throughout the weekend, ebbing in the morning and peaking in the evening.
The fighting started shortly before midnight. That first night was a succession of bro-country men with facial injuries and lacerations. Someone was cold-cocking festival goers, a blond man with curly hair, according to multiple accounts. He was wearing an American flag shirt—but that was as useful as saying he had two arms. The cumulative square-footage of American flag clothing was impressive. Shirts, shorts, hats. Bandanas. Bikini tops, halter tops. These people were literally wrapping themselves in the flag. Here was a stark difference between conservatives and liberals—the conservatives own the most visible outward forms of patriotism. If someone were to wear the same outfit in Brooklyn, it could only be an ironic gesture. A liberal’s patriotism is less concrete—not for the flag but rather for an abstraction—for free speech or equality or some other notion of justice. How removed from actual experience that is, what a cognitive stretch. How much easier it is to be a patriotic country music fan. I envied their ease and their role-certainty.
I spent the night suturing wounds. One was a deep lip laceration that went through multiple layers to the mucosa inside the mouth and it took me a long time to complete. The victim and his buddies were drunkenly grateful for the attention, repeatedly thanking me. Another guy in a tank top and cowboy hat got so beat up by his ex-girlfriend’s brother that we had to airlift him out to a trauma centre to get a CAT scan of his head and face. “He sure got me good,” he kept repeating through a crooked smile. I struggled with the decision to fly him out—it was, after all, an expensive intervention not without its own risk. But he had fainted after my evaluation (or fallen asleep?) and I worried that something bad might happen on a 90-minute ambulance ride.
Outside, other drunken patients waited on cots like planes stalled on a tarmac. I assumed everyone was drunk. In the crisp air of the desert night, country music fans staggered from destination to destination, always in motion. I’ve treated alcoholics my whole career and know their habits well. As the drunk’s gait is hampered by intoxication, their grip on personal truth is stronger than ever, as is the imperative to make their point, to gesture, to insist. There were heated discussions outside the tent. A short, shirtless man with an enormous cowboy hat, a kind of Yosemite Sam figure, stumbled into our tent but he wasn’t drunk—he had sprained his ankle. I was suspicious of this sober man. What was wrong with him that he wasn’t drinking?
Over the radio, we got a report of a man down in the campsite and took the Gator to a distant plot. We wound through rows of campers clotted with drunk Americans, hooting and hollering at us, alarmingly heedless of our medical golf cart. We cycled through a variety of sirens to clear our way. At the outskirts of the Pivot, we located the injured individual. To our surprise, the man who lay face down drunk in the grass was Captain America himself. The bandages of his hand that I’d meticulously applied were filthy and in disarray. He had defecated in his pants. I thought back with shame to my informal discharge instructions—you can go out and drink again, I had joked. The EMT’s scooped him into their vehicle and we wound our way back to the clinic.
It became clear that this was not going to be any kind of fact-finding mission into the real America or into Trump voters. I was simply to be the adult at a fraternity party. The paramedics weren’t surprised; they went through this every weekend; but even they admitted that Watershed was different. In their experience, at Sasquatch and Paradiso and the electronic music festivals there was less fighting and less trauma. Instead, the kids overdosed on drugs, became delirious and agitated from hallucinogens and required prolonged sedation with powerful tranquillisers. Either way, we could take care of it. And what we couldn’t manage in the field hospital, we’d send out to the local ER twenty miles away in Quincy where they had CT scan capability. I was on the phone with the doctors there during the festival and didn’t envy them. They got lit up each weekend in the summer with overflow from one festival or another, typically drugs and trauma. The real injuries we’d send by ambulance or helicopter to the regional trauma centre in Yakima.
I got a few hours of sleep that night, grateful to the medics who turned a few low-acuity 5am stragglers away, telling them to come back in the morning when the doctor woke up. In the morning, after I had roused myself and washed my face, they filtered back: sprained ankles, trivial cuts. Minor country music injuries.
That afternoon, my colleagues arrived from Seattle, which meant I was relieved of duty until the night shift. The music would be starting later on and so I thought I’d walk around and explore the concert grounds. Closer to the venue, the RV’s were fancier, the hooting and hollering noticeably subdued. There were couples sitting, playing cards and listening to country music. They nodded and smiled as I passed and I nodded back, confused at their friendliness and then realised I was wearing a scrub top. These were respectful, kind, decent people with a regard for authority. I would have liked to sit and have a beer with them but I felt some boundary, as if my medical identity precluded such an adventure. Temperatures were in the nineties and the sun vibrated overhead without abatement. I made a mental note to remember that with the heat and the sun, people would be dehydrated.
Down near the stage, roadies were busy with their roadie-work, fussing with cables and assembling scaffolding. In the small parking lot for the tour buses, I glimpsed a country music superstar for the first time. He wore a black hat, black jeans and a tight-fitting black tee shirt. I had no idea who he was, but he stood immaculate and self-aware as he took a few steps out of his bus followed by two women. Then as if remembering he was too famous to be in public, he turned around and stepped back in the bus. I watched, intrigued, as I always am, by the power of fame—even country music fame. Later that weekend, I would witness the crowd of thirty thousand spectators roaring with admiration, women screaming as a star introduced a song by saying, “how many of you have trouble keeping your trucks clean?”
Country music has always eluded me. It feels like the musical equivalent of eating the same meal for the rest of your life, “like my daddy did.” This repetition in country music, this deliberate sticking to the forms, the idealisation of the “good ole fashioned,” this radical conservatism I find stultifying. If liberals err by holding nothing sacred, the conservative mind holds everything sacred. They are the hoarders of the sacred. And it’s not just the repetition of musical forms, but also the narrow range of permissible topics. The concreteness of thought. Brad Paisley has a hit song about water, not in the abstract sense but rather about sports that could be enjoyed in water such as water skiing and swimming and the good times he had at the river bank. Treading the known trail, not having to bend beyond what you know for sure—these are reassuring to the country music fan.
That second night I got back to the clinic and braced myself for the tide of intoxicated young people. A drunk 24-year-old commercial fisherman had fallen and hit his head, slurring as he asked about his girlfriend, who had returned to the concert. A 17-year-old had gotten fall-down drunk but wanted to leave. Her parents weren’t there. She was crying. Per venue policy for underage drinkers, we sent her to the emergency room fifteen miles away in Quincy. I silently apologised to the ER doctor on call there. A 21-year-old man in one of the Pivot camps was drunk and crying about a girl. His friends couldn’t console him and didn’t want to deal with him anymore. They wanted to go to the show and so they called us to pick him up. We watched him crying for an hour until we couldn’t deal with it and so we sedated him. A 20-year-old woman was throwing-up-drunk and tearful; according to the friend who brought her in for treatment, she’d tried to get into the concert by offering oral sex to the ticket collector. A sober man got his foreskin caught in a zipper. This was bread and butter emergency medicine, and as I often do, I applied my litmus test to the work that I was doing. Was I making things better? I suppose so. I suppose my efforts were paying off in some way and there was meaning to this work–not that this preoccupation was related to my particular mission here. But even so, it was refreshing that nobody would get a thousand dollar bill in the mail since the promoter had paid for everything up-front.
Among the inebriates and walking wounded there were also sick people. A number of dislocated shoulders, much easier to put back in place in the field because there was no time for muscle spasm to set in. A fracture dislocation of the ankle that we reduced with ketamine. A man in American flag shorts had set off fireworks and pointed them at a man in an American flag shirt resulting in serious phosphorus burns to the arms and face. A 50-year-old woman from Missoula, Montana with a handsome, masculine face, someone who could withstand a long winter, came in because she had a pacemaker and felt dizzy. Security had wanded her with a metal detector against her will, and she worried that it had turned off the pacemaker. I excused myself to Google whether this was possible.
Eventually the night was over, young lovers straggled back to their tents, the sun came up and the night shift went to sleep, satisfied at the good work they had done. The next morning one of the managers and I went to the cliffs to fly his new drone across the river. Before us, a cowboy-landscape stretched to the horizon, Wenatchee territory, a post-apocalyptic vision of the breakdown of society in the wilderness. The vastness of the scale put me in a philosophical mood, and against this backdrop, those conservative American values of individualism and self-reliance made most sense, not to mention gun-ownership and justice administered at the end of a rifle barrel. Mid-flight, a text from the concert promoter broke my reverie. One of the country music superstars had a problem and needed some urgent and discreet help. We went to a trailer for the concert organisers who escorted me down to the parking lot. A guy came out of another office trailer and there was a back and forth. This was to be a private arrangement unrelated to my employment at the festival. The man mentioned how close he was to the star, how he went wakeboarding with him or the time he met his brother. Then he brought us to another trailer to meet the manager and we talked some more with him, another exchange of business cards. Money and opportunity emanated from the lone figure hidden in the black touring bus, and we were getting closer to meeting him.
For a long while then we just stood in the hot sun waiting for a sign, and then we finally got the go-ahead to approach the bus. A powerful haze of marijuana smoke issued forth as we passed the driver’s cabin and entered the air-conditioned sitting area. A group of roadies and hangers-on were reclining and watching golf and we nodded to each other. One of the men, a small and weathered stage hand or driver, raised his hand and said hi. This turned out to be the superstar himself. He lay on cushions, an unlikely wizard at the centre of the whole spectacle, utterly devoid of star-quality, only some road-scoured, cigarette-wizened weariness. He was having problems with his knee, he said, it was swollen and tender and he didn’t think he could make it on stage that night. Can you help me doc, he asked.
I examined his famous man’s body then. It was inked with crude tattoos and scars, dirt under the fingernails. His elbows were knotted with tophi from untreated gout. I told him about the gout, said it would need long term treatment and that’s also why his knee was inflamed and swollen. He nodded. The problem had been getting worse but he was always on the road and had never seen fit to visit a doctor. His job, travelling most of the year, earning money to support his family and entourage. The gravity of the situation was evident to both of us, that his livelihood was in peril, but the more pressing issue was that he could hardly bear weight and we needed to get him on stage in a few hours. I can help you, I said. But Doc, he said shaking his head, we’ve gotta do it here in the bus.
An hour later, I reappeared ready to inject his knee with anaesthetic and steroids and his gaze widened in alarm. The country music superstar had a deep-seated phobia of needles. You’ll get through this, I promised, touching him on the shoulder with a practised, reassuring gesture. Minutes later I had a needle deep in his knee joint draining the viscous synovial fluid when he threw up on his tee-shirt. His face was sweaty and grey, and I quickly injected the anaesthetic and pulled the needle out, but he had fainted. The roadies looked at me in panic. I lifted his legs up so blood could flow to the brain, and felt his pulse–it was weak. We turned him on his side so he wouldn’t aspirate.
It occurred to me that I was doing a serious medical procedure in the back of a bus, miles from any hospital. I pictured myself on the witness stand trying to explain my actions. After a minute, the patient groaned, he opened his eyes and we sat him up and wiped his clammy face. As his colour came back, he apologised for fainting. His buddies patted him on the shoulder; we gave him some 7-Up. His knee felt better and he asked me what the bill was, but I waved this off and quickly cleaned up, eager to get off the bus. You’ll need to see a doctor about this eventually, I said, but with luck you’ll be alright tonight. He thanked me again and I left, grateful to get some air.
That night, I stood in the massive churning crowd with something approaching stagefright for my patient. I had peeked behind the curtain of his fame and now I worried that the small man I had seen would not be up for the task. The country music superstar took the stage to a swelling ovation and the jumbotron screens broadcast his auspicious, cowboy hatted image to the cheering fans. From the first giddy-up, I could tell the knee would be alright and he was moving without any problems–no limping, no stumbling, no sign that anything was wrong. The man was almost certainly in pain, but he was a professional. As for the music, it was your basic boilerplate country, but something new caught my ear, something that I hadn’t been attuned to before. He sang about the road, and I knew it was true. He sang about feeling down, and I knew that he meant it. He was just who he was and nothing more. By the end, with the bodies swaying to the music, the flags waving, the beautiful young men and women revelling in their American glory and certainty, I raised my hand and joined the crowd.
Later, after the heat of the day gave way to a chill that demanded a sweatshirt, the moon came out and in its light the gorge looked like a gash across the country. All the musicians had left the stage and all the lights had been turned off and all the groupies had scattered. The open-air stadium was a garbage heap of detritus from the day’s festivities. Hispanic workers walked shoulder to shoulder through the stands, picking up beer cans and Doritos wrappers, leaving behind them a clean carpet of grass.
