Sara Koelsch has started to regret some of the choices she made in the November election.

“I will probably regret that a lot more once I start paying attention to things outside my house,” she said. Right now, she’s consumed with bigger worries.

Her husband, Don, got COVID-19 back in September, which ravaged his lungs. After nearly a month at Barnes-Jewish Hospital in St. Louis, he was put on a ventilator last week. Doctors said he needed a double lung transplant to survive.

He died Dec. 9, before even getting on the transplant waiting list.

Don Koelsch was just 38.

He had moved to Winfield, Missouri, about a year and a half ago from Vermont after getting a job as a truck driver. He was making good money, and saved enough to move his wife and their 11-year-old daughter here five months ago. He was careful about wearing a mask and taking precautions about the virus from the start: He had an autoimmune disorder that put him at higher risk for complications. But his condition was controlled with medicine, and he led an active life.

Don got sick while out on the road. When he got back home, he tested negative for COVID -- twice -- but kept getting sicker. Eventually, doctors transferred him to a hospital in St. Louis, where a lung biopsy revealed he had indeed contracted COVID, and that it had irreparably scarred his lungs.

Sara joined Don in Missouri shortly before November’s election. She was unfamiliar with local and state politics, didn’t have any connections in town and couldn’t get involved in much because of the pandemic. She knew she wanted to see a change in the federal government, but she figured that her husband had been thriving in Missouri before he got sick, so she voted for Gov. Mike Parson in hopes of staying the course.

“It’s a horrible way to vote, I acknowledge that,” she said recently. Her husband had been on the road on Election Day and was unable to vote, but he likely would have done the same, Sara said, adding that he had been opposed to mandatory masking laws.

She had texted him several days ago to ask if he still felt the same way.

“I disagree with nanny laws,” he wrote back. “However, masks keep others safe, as well. It’s not like a helmet law, where it’s just your head. I think while we are in such a dangerous situation, we should all be taking as many precautions as possible. If we want to keep our families safe, friends safe, people safe, I can see how a mandatory mask (law) is beneficial.”

That evening, Sara and her daughter, Amelia, decorated their Christmas tree while Facetiming with Don from his hospital bed. Later that night, he struggled to breathe for hours, even while on oxygen.

A nurse held his hand while he was intubated.

This week, his three months of short-term disability benefits ended, and his job security was uncertain. A friend started a GoFundMe to help the family with the bills that are piling up.

Sara said it’s hard to see people in her community shopping in stores without masks while her family’s lives have been turned upside down. She wonders if the governor she voted for has ever spent time with a family who is suffering from the pandemic the way they are.

“Maybe he needs to spend a day with a family who’s living it,” she said.

The governor recently took time off to be with his family. Meanwhile, Don was being tested for COVID twice a week, hoping for a negative result so he could be added to the waitlist for a new pair of lungs.

It never came.

When most kids her age are making Christmas lists, Amelia said she had one request for her mom: “I need you to promise me that you won’t leave me, too.”

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.