It’s unusual to find a doctor like Dr. Lara Kenney practicing in such a small town.

She works in Leeton, a town of about 500 people in west-central Missouri, about an hour south of Kansas City. She’s a cancer doctor, specializing in hematology, oncology and hospice and palliative care, but she also treats people in nearby counties who just need to see a physician.

About a month ago, patients started calling her about COVID: Maybe they had symptoms, a positive test result or just questions after a close exposure. The calls multiplied by the day. A week later, the county reported a 30% positivity rate.

“It was like dominoes,” she said.

She wasn’t prepared for what happened next, even though the community is familiar to her.

Kenney grew up in rural Oregon and came to Missouri for medical school. After graduating, she enlisted in the U.S. Army, completed her residency at Fort Sam Houston and was deployed to Iraq several times as a medical officer. Kenney came back to Missouri for her specialized cancer training. It’s where she met and married her husband, who had grown up in rural Clinton, Missouri.

In 2014, they left the suburbs of Kansas City and moved back to his hometown, where they wanted to raise their kids and lay down their roots.

Working in such a small town, Kenney knows all the patients in her practice well. Two of them have died of COVID.

“Neither one was in a condition that I would expect them to pass,” she said, adding that they’d been living independently, not “limping along.” They had to be sent to hospitals in Kansas City, where they suffered for weeks, alone.

“I’m a cancer doctor,” she said. “We deal with death on a fairly regular basis; it’s part of our job. But we didn’t plan on it being like this.”

Normally, she would hug her patients when they entered hospice. She would hold their hands. Tell their adult children how much their mom or dad meant to her.

“All of that has been ripped away,” she said.

Instead, Kenney hears comments in her town about how the people who are dying were old, or sick, or going to die anyway. She hears people say, “I gotta live my life” as they continue to attend weddings and social events.

“I’m working my butt off here trying to help people, but I guess ...,” her voice trailed off. “I don’t even know what to say anymore.”

She has said plenty to patients who tell her the virus isn’t a big deal. She asks them: Why would doctors be worrying about it if it wasn’t worth worrying about? They don’t have answers when she challenges them.

Kenney says she’s not really surprised that she hasn’t been able to change many minds, even in a place where people know and trust her.

“We’re nine months into this thing,” she said. “For someone to look back and say they were wrong would mean (acknowledging) they have contributed to someone they love getting ill or even dying. To accept that their behaviors may have changed things for our community.

“We’re pretty far down the rabbit hole for people to change their minds without having a serious reckoning with themselves about the choices they made.”

It also means having to question the people they trusted who misled or lied to them. She said she’s been astounded by the failures in leadership during this crisis. Her military and medical training, combined with what she’s seeing happen on the ground, prompted her to make a personal plea to Missouri Gov. Mike Parson:

“As disappointed as I am in the failure up to this point to do the hard things that are required of a leader, the time to do something is now,” she said, adding that there are no negative consequences to issuing a statewide mandatory mask order. “To not do something so simple is mind-boggling.”

Given Kenney’s rural background, you might think Parson would listen to her; he tends to listen to people in rural Missouri, who have been vocal in their opposition to mandatory masking.

The reaction in her community and the state she’s adopted has her questioning her place here.

She and her husband have discussed moving out of the state once this pandemic is over -- leaving their dream house and the schools where their children are growing up -- and finding a place where she feels her work is more valued, her sacrifices appreciated.

“Knowing that there’s a large percentage in my community that doesn’t respect my concerns or knowledge ... You can’t unsee that,” she said.

Since I was a child, I’ve insisted everyone at the table share what they were thankful for at Thanksgiving dinner. Even though the answers were often predictable, I still loved hearing my family say them aloud.

Once we started staying in town and having Thanksgiving with friends, I thought I hadn’t forced this tradition on anyone else, but my husband and children reminded me that I have indeed taken it outside family circles. Old habits are hard to break, I guess.

This year, our pared-down holiday went back to the basics.

We celebrated with a few friends in early November, when the weather was warm enough to host a small, socially distant meal outside. On Thanksgiving itself, because of spiking COVID-19 rates, we kept our in-person celebration to our immediate family and Zoomed with people we love.

It’s a weird time to be listing gratitudes. We’ve dealt with some serious illness and inconvenient injuries recently. I’m generally a positive and happy person, but this year made me angrier for longer than I’ve ever been. I’ve struggled not to fester in anger over the selfishness, ignorance, incompetence and outright callousness we’ve seen in America’s response to the coronavirus pandemic.

Maybe it’s in these moments it’s most valuable to say aloud what we are thankful for.

Those of us who are gainfully employed and able to pay our bills while in reasonably good health, and as part of a loving family with caring friends -- well, it’s like we won the lottery in 2020. That’s not to minimize how hard it’s been to have kids at home instead of in schools, to miss seeing extended family, to cancel or postpone special life events and give up so many small joys that enrich our lives.

But I’m going to drill down on the specifics of the good we’ve seen.

The tireless selflessness of health care workers during this pandemic deserves more than lip service. Too many have worked in unacceptable conditions to try to save people’s lives and ease the suffering of those who have died alone. They deserve access to therapy to process the horrors they’ve seen, and a great deal of rest -- along with our eternal gratitude and respect.

This year offered a reminder of how our economy depends on essential workers who are not valued as they should be: grocery store clerks, day care employees, nursing home aides and delivery workers. They deserve livable wages, paid sick leave and workplace protections.

It’s hard not to feel overwhelmed with gratitude for our nation’s teachers -- some who have risked their lives to educate students in person, and others who have significantly increased their workload to teach virtually.

Speaking of demanding workloads, how about the scientists and public health officials who have been working around the clock in the war against COVID? I don’t have words enough to say how grateful I am for them.

It’s hard not to feel inspired by all the people who made masks and PPE for those who needed them, by business owners who have tried their best to take care of their employees, and by artists who kept making art. Such bright rays of light in dark times.

I’m usually quick to criticize media companies when I see them falling short of our mission, and there are plenty of legitimate criticisms of my profession. But I’m just as grateful for all the hardworking journalists -- many of whom work far more hours than they are paid for, take a fair amount of public abuse and care deeply about their work to inform us. I’m even more grateful for those who subscribe to and pay for local journalism.

On a personal note, I’ve known nearly a dozen people who have been hospitalized because of COVID. All but two have survived, and some have already made complete recoveries. My beloved uncle spent six weeks in a hospital and in rehab. A few times, doctors thought he wouldn’t survive the night.

He’s home now.

I had to drive my husband to the hospital in September when he was critically sick with COVID and struggling to breathe. I had to leave him there, alone, not sure if he would recover.

He was able to come home, and has been on supplemental oxygen ever since. His doctors are optimistic he will be able to fully recover by early next year.

Maybe I didn’t have to say what I was grateful for this year.

I could look across the dinner table and see him.

Things are about to get worse.

A lot worse, if you’re the sort who believes what doctors and scientists have to say.

On one hand, that seems a little hard to believe when more than 250,000 people have already died from COVID-19 in America. God only knows how many millions who have recovered will continue to suffer with long-term symptoms. But now Missouri and several other states face the scariest scenario: skyrocketing cases and an overwhelmed health care system.

In this nightmare, people who desperately need medical care can’t get it because there isn’t enough space, staff or resources. We aren’t just talking about COVID patients; if a hospital is at capacity, it can’t take victims of heart attacks, strokes or car accidents, either.

We can’t say we weren’t warned.

How many times does Dr. Alex Garza, incident commander of the St. Louis Metropolitan Pandemic Task Force, need to cry during press briefings about record-breaking COVID hospitalizations, begging Gov. Mike Parson for help and imploring the rest of us to do the right thing? Parson has been impervious to the cries of doctors, nurses and hospital administrators asking for a statewide mask mandate.

Just this week, a new study from St. Louis University found that the mask mandates in St. Louis and St. Louis County quickly and drastically slowed coronavirus infection rates this summer compared with outlying counties. After 12 weeks, the average daily growth rate of coronavirus cases in these two areas was still 40% lower than in counties without the policy.

But that’s not going to mean a thing to those who believe that the virus is an overblown hoax, covered incessantly by the news media just to affect the Nov. 3 election. Or that doctors and hospitals are fraudulently listing people as COVID patients to “make more money.” Or that this disease is no worse than the flu, that masks are oppressive and ineffective, and that herd immunity is our best option.

These are flat-out dangerous lies, and I’m sorry if you’ve been fooled into believing them.

Of course, people can believe whatever nonsense they want. But how should we respond when beliefs become behavior that threatens the lives and well-being of others? In other areas of public safety, we make laws requiring seat belts and laws against drinking and driving. Sure, some people break these rules anyway, but we don’t abolish laws and rules because of that.

It’s ironic that a self-proclaimed “law and order” governor like Parson doesn’t understand that, when thousands of people are dying in his state.

Health care is a finite resource -- except for politicians, of course, who get top-notch care at our expense -- and medical workers in some places are having to decide who gets an ICU bed and who doesn’t. The prospect of rationing health care raises some unpleasant questions. Should those who sacrificed and tried their best to follow CDC guidelines be forced to give up health care for themselves, their child, their parent or their spouse just because someone who never wore a mask and carried on with life as usual showed up at the hospital before them?

Well, we don’t have a choice in that situation. Doctors treat whoever shows up, as best they can -- whether it’s the drunk driver or the grievously injured child that driver hit.

Health care workers risk their lives to treat patients in Missouri’s rural areas, where far fewer people take the virus seriously and some are openly hostile to masking or any restrictions. We will never know how many doctors and nurses were infected and killed by COVID-deniers whose lives they helped save.

God love those souls trying to protect themselves and others in communities where they are mocked or ostracized for their belief in science.

It’s fascinating that thousands of people were willing to sign waivers releasing the current administration from liability if they caught the coronavirus after attending one of its superspreader campaign rallies.

Would they sign a similar release waiving their right to medical care?

These QAnon Karens and Plandemic Petes could put their money where their mouths are and do just that.

Somehow, I doubt they’re that committed.