Triage

by Kathy Cumbee

1 a: the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors
b: the sorting of patients (as in an emergency room) according to the urgency of their need for care
2: the assigning of priority order to projects on the basis of where funds and other resources can be best used, are most needed, or are most likely to achieve success

Recently I listened to a program on NPR about the shooting of Rep. Gifford and 17 others. It interviewed one of the medical workers who discussed how triage was used that day to determine who to treat first. Since situations like this happen more often in battle than ordinary life, we civilians are spared for the most part thinking about medical personnel having to make such decisions. We are used to events where one person is injured and regardless of their condition all efforts are made to save their life.

I also watched recently a movie called Triage. Based in Kurdistan, it shows a more severe but necessary triage. In the movie those injured who are determined unlikely to be saved are shot in the head to end their suffering and to save scarce pain killers for those deemed able to be saved.

In our Western Industrial Civilization we have come to believe that almost everything is limitless. The idea of a situation in which one would have to decide to save one victim over another is not part of our everyday thoughts. We have believed not only that oil, the life blood of our civilization is limitless, but the services it provides are also limitless. Thus we cannot face the possibility that treatment could be withheld from some victims of an accident. Surely we can treat them all (never mind that in fact the nature of our private health insurance system is already doing triage that negatively affects the poor but that has not been part of middle class thinking).

With the end of cheap oil, the end of growth, and the shrinking of our civilization, triage will face us in multiple ways. We will have to perform triage regarding pets — at some point will we realize that we cannot feed domestic animals that have no useful purpose once it becomes hard to feed just ourselves. We will have to perform triage on our gardens. Flowers with no herbal benefit will be sacrificed for the space, care and water they use up that will be better used for food crops. Fussy plants that take extra water and care will be sacrificed, no matter how good they taste, for those plants that more easily provide needed calories and nutrition. Last summer, drought and heat and low levels in our well forced me to triage my garden and only water the plants that were still doing fairly well. The rest I let dry up.

Triage will certainly be performed on life style –- daily baths and excessive washing of clothes will vanish when all the water is pumped by hand. Housing will hold more people than we have been accustomed to living with in close quarters. Children will be expected to provide useful work at an early age. Lighting will be used only when most necessary. Heating will depend on how large the wood pile is.

As has been done in the past, many of the elderly and the sick will be neglected when they become a drain rather than a benefit, many will in fact perform self triage. “The Eskimo, for instance, are reported to have practiced socially encouraged or enforced suicide in old age ‘not merely to be rid of a life that is no longer a pleasure, but also to relieve their nearest relations of the trouble they give them.'” At times, parents will have to choose which child to let live and which to let die. Even today in areas where people are starving, some parents are forced to make that decision.

It is perhaps an important mental step to take to move the word triage into active conscious thought. The age of “limitless” is over, we humans must make the mental leap back into a world where everything is NOT possible, a world where the limits of time, energy and food make themselves felt. A world where the limit is not the sky. The ability of the earth to provide will be the limit.

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Kathy Cumbee is a retired bookkeeper living in central Alabama with her husband, a rat terrier, and 100 chickens. The chickens range and interbreed freely, the outcomes of which provide joy for their human companions. Kathy and her husband use the Ruth Stout continual mulch method of gardening, and their garden increasingly includes a component of edible native plants that obligingly self seed. The garden supplies food for the humans and daily greens for the chickens, who in turn provide eggs and manure for the garden. Preparations for the world after oil include a well with hand pump, wood-fired cooking stove, candles, bow saws, and other hand tools. As we face an uncertain future, Kathy and her husband increasingly turn their attention to the simple joys of each day, including the pleasures of a simply life in tune with at least some parts of the natural world.