Board meetings for the Mendocino Coast District Hospital are usually pretty dismal affairs. The facility in remote Fort Bragg, Calif., has been running at a deficit for a decade and barely survived a recent bankruptcy.

But finally, in September, the report from the finance committee wasn’t terrible. “This is probably the first good news that I’ve experienced since I’ve been here,” said Dr. Bill Rohr, an orthopedic surgeon at the hospital for 11 years. “This is the first black ink that I’ve seen.”

The committee erupted in applause, even a few cheers. But the joy was short-lived. By the next month, the hospital was back in the red.

Things first started going badly for the hospital in 2002, when the lumber mill in Fort Bragg closed down. Many people lost their jobs — and their health insurance, which had paid good rates to the hospital. Today, about 7,000 people are left in the blue-collar town, and the economy is propped up by tourists who come to the rugged Mendocino coastline to hike or fish. Visiting the hospital does not usually make it onto their itinerary.

By 2012, the hospital had declared bankruptcy. Now it’s barely hanging on. And some locals are worried that the only hospital in the area might close for good.

If The Hospital Fails, So Goes The Community

“Nobody can live here without that hospital,” says Sue Gibson, 78, a Mendocino resident. “I mean, the nearest hospital is an hour and a half away on treacherous mountain roads.”

It’s not only her family’s health and the community’s that Gibson is concerned about. She’s afraid the local economy would be wrecked. The hospital is the largest employer.

“It has probably the best-paying jobs, and if they close that, all of that income would go away,” she says.

That means less money spread around to the local bait shops and seafood restaurants. Also, Gibson says, the property values of businesses and homeowners would plummet.

Across the country, rural communities share similar fears. Small rural hospitals everywhere have been struggling to survive. Many people who live in these areas are older or low income — not a great customer base for a hospital that needs to make money.

The government used to pay these small critical access hospitals extra to account for that. Medicare reimbursed them 101 percent of their reasonable costs. But after the recession, the government trimmed payments to 99 percent of costs. Medicaid pays much less, sometimes just half the cost of providing the care.

At the Mendocino Coast Hospital, more than 80 percent of patients are covered by Medicare or Medicaid.

“The general health care reimbursement environment is to do more with less,” says Bob Edwards, the hospital’s CEO. “And I would even go so far as to say, it’s a starvation model.”

Plus, the government excludes a lot of expenses from its cost calculation, like doctors’ fees or janitorial services, says Wade Sturgeon, the hospital’s chief financial officer. Medicare basically tells the hospital what it will pay.

“So it’d be like going in to Safeway and saying, ‘Hey, there’s a jug of milk. I really want that jug of milk; I’ll give you $2,’ ” Sturgeon explains. “But the price says $3.50. ‘You’re only going to get $2.’ Often times, that’s what happens to us.”

The upshot: Many hospitals that never had to worry about controlling costs now do. They have to learn to compete in an open market, just like other hospitals, just like many other profit-driven businesses.

Some hospitals have planned ahead and adapted. Down the long, winding road from Fort Bragg, the Frank R. Howard Memorial Hospital in Willits just finished a $64 million renovation, complete with modern technology and a full organic garden that supplies the hospital cafeteria.

But some hospitals haven’t adapted. In the past five years, 57 rural hospitals in the United States have closed, according to data from the Rural Health Research Program at the University of North Carolina. Others have declared bankruptcy, like the Mendocino Coast District Hospital.

Battles Over How To Keep Hospital Afloat

The financial failure led to a lot of finger-pointing in this small town. Administrators blame the policy changes and payment reforms. Some doctors blame the administrators.

“It was economic mismanagement, to put a single label over all these things,” says Dr. Peter Glusker, a neurologist based in Fort Bragg for 37 years. “Because of people who just didn’t know any better.”

The public hospital is governed by a five-member board of directors, elected from and by the community. Glusker says some past directors knew nothing about finance or nothing about health care. Some just stopped caring.

So he and another doctor ran their own campaign, promising to shake things up on the board and change things. They were elected last year.

“There’s a segment of the population that says, ‘Oh good, it’s about bloody time,’ ” Glusker says. “But there’s another segment of the population, in the institution, that says, ‘Hey, you’re rocking the boat and this is bad.’ “

Glusker’s running mate and ally on the board is Rohr, the steely orthopedist, who wears his gray hair long, tied back in a tight ponytail. He spent many years in the corporate world and vowed to bring the kind of financial discipline he learned there to the tiny public hospital in Fort Bragg. A lot of people are afraid of him.

“Look, this is not about being ruthless,” Rohr says. “It’s about keeping this business alive, and it’s only alive if it makes money, OK.”

A lot of his sentences are punctuated like this, with a sometimes impatient “OK,” which seems aimed at making sure you don’t miss his point. Like when he’s giving a presentation at a finance committee meeting, staring daggers at the CEO.

“We keep saying $870,000 loss,” Rohr says. “Not acceptable, OK.”

Edwards, the current CEO, has been on the job six months. He’s the hospital’s fourth chief executive in a year. His right-hand man is Sturgeon, the brand-new CFO, who started in September.

On days the financial committee meets, Sturgeon wears a mint-green shirt and a tie with a $100 bill on it. He says things like, “Do the math.”

Right now, the hospital administrators and the doctors on the board are pitted against each other in a battle over how to keep the hospital doors open — a battle that is echoed at small hospitals across the nation.

Cut costs or raise prices? Board members disagree on best approach

CFO Sturgeon and CEO Edwards say the hospital should focus on increasing revenues. It should find more patients to come to the hospital, maybe develop new services to attract then.

“If you’re not growing, you’re dying,” Sturgeon says.

He says the hospital should also charge more money for services provided to patients who have private insurance — currently about 15 percent of the hospital’s patients.

“Anytime we don’t raise prices, we’re leaving money on the table,” he says.

But Rohr says that would put an unfair burden on the small-business owners in town, the ones who typically buy their own private insurance.

He and Glusker say the hospital should be focused on controlling costs.

“It’s obviously an expense problem,” Rohr says. “And you can come to that conclusion very quickly, just by looking at the data.”

The hospital is going to have to make some very difficult decisions to balance its budget, Rohr says. He offers this analogy: “There’s 20 people in the water about to drown. And there’s a rowboat there, but the rowboat can only hold 10,” he says. “If 11 people get in that rowboat, it sinks and all die, OK.”

At the hospital, this means choosing between a cardiologist and an ophthalmologist, a cafeteria and a new X-ray machine.

“It’s horrible to make the decision that 10 are going to drown,” he says. “But I’ve got to pick the 10. OK.”

One area Rohr thinks could be ripe for trimming? Administrative positions.

“I walk into the hospital to do rounds in the morning, and there are more people standing around with clipboards than with stethoscopes,” he says, “and that doesn’t feel like the right formula to me.”

But CFO Sturgeon says there’s not enough management. “Physicians always think there’s too much management,” he says. “You have some people with 50 direct reports. Does that make sense?”

There are some cuts both sides agree on. All say there needs to be some serious culling of the health benefits for hospital staff. Years ago, the nurses union negotiated to have the hospital pay full health benefits for any full-time or part-time nurse and their entire families. Nurses pay nothing toward their monthly premiums.

“Do the math. How many people are we paying for to have full family coverage?” Sturgeon says. “I’ve never worked in a hospital that provided the type of health insurance benefits that we have at this facility.”

Meanwhile, Need For New Hospital

To understand exactly how dire the financial situation is, one need only walk into the lobby of the hospital itself. It’s like stepping back into 1971. The main patient floor is lined with drab brown carpets. The smell of Salisbury steak spills out of patient rooms.

“I’ve been in Third World countries. This is pretty basic, OK,” Rohr says, walking by the operating suite.

Through the maternity ward and the emergency room, Rohr says the flooring is layered with asbestos. The concrete isn’t strong enough to hold the weight of modern CT scanners and MRI machines. On top of all that, in 2030 new state requirements kick in for earthquake readiness.

It all points to one conclusion. “We’re going to have to build a new hospital,” Rohr says.

So, not only is the hospital struggling to maintain a balanced budget through normal hospital operations but it also has to come up with tens of millions of dollars to replace itself in 15 years.

It’s an especially tall order for a hospital that just posted its first monthly profit in a decade, then slipped into the red again right away.

If you ask the Washington policymakers in charge of payment reform, some will say it’s just a harsh reality that some hospitals will have to close. Some previous local administrators have predicted that the Fort Bragg hospital will one day be replaced by a helicopter landing pad. People will be airlifted out for heart attacks and other emergencies. For other planned surgeries, like hip replacements, people will have to drive “over the hill” to another hospital.

But the people who live in Fort Bragg and Mendocino don’t like that scenario. Gibson has been hosting community meetings in her living room, where people spread out on the pink Victorian sofas to talk about how to save the hospital.

She’s rallying support for a possible solution, and it’s one the administrators and doctors are united around: a new tax on homeowners. Local residents will very likely vote on that in November 2016.

“The only way we’re going to be able to save this place, really, is with a parcel tax,” she says. “But they can’t even think about that until they clean up their act.”

After the Wall Street meltdown, banks were too big to fail. The feeling here is that the local hospital is too important to fail. And the residents will be tapped to fund the bailout.

This story comes from a reporting partnership of NPR, KQED and Kaiser Health News.

One morning last year, when Bryan Bashin sat down to check his email, a peculiarly short note caught his attention.

“A businessman has passed away. I think you might want to talk to us,” it read.

Bashin directs a nonprofit in San Francisco called the LightHouse for the Blind and Visually Impaired, so he gets a lot of email about donations. But this one felt different. It came from a group of lawyers handling the estate of a Seattle businessman who had died, Donald Sirkin.

When Bashin and the LightHouse’s Director of Development, Jennifer Sachs, checked the LightHouse’s donor database, they found no record of him. Don Sirkin had never donated to the LightHouse for the Blind and Visually Impaired before, or used its services.

And yet, in his will, Don Sirkin had left almost his entire estate to the LightHouse, with no explanation.

In the end, the gift totaled over $125 million, more than 15 times the LightHouse’s annual budget. Bashin believes it’s the largest single gift ever given to a blindness organization.

“It’s one of those experiences where time stands still, where you know that every little bit of what you’re experiencing will be engraved in your memory,” Bashin says. “This is the moment that everything is going to change.”

He’s 60 years old, tall and almost always smiling. His eyes are cloudy; he walks with a cane. He gives off the impression of being an entirely functional, confident blind person.

But this Bryan Bashin is a relatively recent incarnation, because for a long time, Bashin didn’t identify as blind at all.

“I didn’t say the “B” word,” Bashin says. “Instead I used euphemisms if I had to. I used the lingo of the day: ‘visual impairment,’ ‘low vision,’ ‘visual challenge,’ that kind of thing.”

Bashin’s vision began to falter when he was in his teens, and gradually got worse. By his 20s, he was legally blind. Today, he says, he sees the world “as if through wax paper.” He can make out some light and color, but not faces or words.

Yet through his 20s and most of his 30s, Bashin squeezed by on the little vision he had, relying on magnifiers and special lamps to read what he could. He memorized the map of his daily route so as to not get lost. He only went out during daylight, to avoid the confusion of navigating in complete darkness.

Bashin says that a lot of blind Americans use work-arounds like these.

“Most never use a cane, or a dog, or Braille or any of the things that are identifiably blind,” he says. “In the blind community we say we’re in the closet, and it is just like being in the closet in the gay community. You try to pass and you try to be somebody that you’re not.”

But as Bashin’s vision declined, these work-arounds became harder to pull off. They were time-consuming and exhausting. Finally, when Bashin was 38, with his vision at about 10 percent of normal, he realized he couldn’t hide anymore. He decided to learn to be a blind person in public.

A friend took Bashin to a local blindness agency that Bashin found dishearteningly shabby. Stuffing was coming out of the chairs. The air conditioners buzzed. The office hadn’t been painted in decades.

For Bashin all of this was symbolic. The place lacked dignity. “None of that period made me feel like I could be a cool blind person and do stuff in the future,” Bashin said. “I felt ashamed. I felt confirmed in my suspicion that blindness would be a diminishment of my potential.”

But he did get something out of it. He learned how to navigate with a cane. He started learning the technologies that make life vastly simpler for blind people than it was a generation ago: the smart phone, text readers and pocket recorders.

And suddenly, everything got easier. For example, using text-to-speech was “vastly quicker” than trying to make out giant letters on a screen.

Since then, Bashin has made it his life’s mission to help other blind people make the leap he did. He got a job at the agency with the ripped up couches. And in 2010, he became the Executive Director of the LightHouse for the Blind and Visually Impaired in San Francisco.

Bashin says that with the right tools and training, blindness can be reduced to the level of inconvenience. “Don’t just hide,” Bashin said. “This is not a tragedy or shame. This is not some kind of deep loss. This is just another side of being human.”

Despite enormous technological gains that have made life vastly easier for blind people in the last decade, there are still significant obstacles to independence. The unemployment rate among working-age blind people is 50 percent — ten times the national average. Job training is expensive, and learning to live independently as a blind person takes time and resources. It’s often easier to get disability checks than to find and pay for necessary training.

Bryan Bashin says Don Sirkin’s bequest can help change the way blindness is perceived, by providing more people who have diminished vision with training and skills to achieve self-reliance at work and at home. The money, Bashin says, ” is about … feeling like we can dream and have options and be proud of who we are.” Jeremy Raff/KQED hide caption

toggle caption Jeremy Raff/KQED

To really master walking around using a white cane, Bashin says, requires 200 to 400 hours of training with somebody who is being paid to work with you. Learning to use a computer requires that same kind of training.

Through constant fundraising, Bashin’s organization has the resources to provide basic services to their clients.

But what Bashin wants is bigger than that: a change in how blindness is perceived. He wants to to encourage more blind people to come “out of the closet,” to embrace and celebrate blindness as a difference, and get the skills they need to pursue their ambitions.

Now, suddenly, thanks to this mysterious businessman in Seattle, Bashin and the LightHouse are looking at a different scale of ambition.

“When you get right down to it, the Sirkin bequest is about … feeling like we can dream and have options and be proud of who we are,” Bashin says.

LightHouse for the Blind and Visually Impaired is just beginning its strategic planning process, to decide how to spend the Sirkin money, but Bashin has some ideas.

One major project — which had begun well before the Sirkin grant – is a new headquarters in San Francisco. The building will have expanded facilities, including a dormitory where blind people can stay while they receive training in blind tech, cane navigation, and other necessary skills.

There’s also the idea of an award for blind people who do extraordinary things — say, travel around the world independently, or invent some kind of game-changing tool for blind accessibility.

For now, Bashin wants to understand the man behind the donation: This mysterious Seattle businessman, Donald Sirkin, left $125 million to an organization that had never heard of him, with no explanation — just a few legal sentences in a three-page will.

Last year, to try to reconstruct this man from the dead, Bashin made a trip to Seattle, where Don Sirkin had lived. He took a tape recorder and interviewed everyone he could find who had known Sirkin, including Sirkin’s ex-girlfriend, a half dozen of his colleagues and good friends.

The interviews reveal a charismatic, idiosyncratic businessman. Sirkin built a hugely successful insurance company from the ground up. He was on a caloric-restriction diet that consisted of large quantities of pomegranate juice and seaweed. He refused to eat in public. His ex-girlfriend Sue Tripp remembers going on a trip to New York with him. But while Sue went to see the Statue of Liberty, Sirkin stayed in the hotel and exercised for hours.

Don Sirkin commanded attention. If left too long in a waiting room, he would walk around on his hands to catch the eye of the receptionist, as change and keys flew out of his pockets. He loved a big gesture, handing out $100-bills to his staff after closing on a big client.

The interviews also reveal a man estranged from his family. Missing from Bashin’s tapes are Don Sirkin’s children. He had two – a daughter and son. Neither of them wanted to be interviewed. The kids received relatively little from his will: $250,000 apiece, compared to the LightHouse’s $125 million.

In May, Sirkin’s daughter Anna sued her father’s estate. Her complaint says that her father hit her and touched her sexually. She says this happened dozens of times. If she wins, she could get a small percentage of what would otherwise go to the LightHouse. Anna Sirkin told us through her lawyer that she didn’t want to talk to us for this story.

As part of the Sirkin bequest, the LightHouse inherited Sirkin’s private residence on the edge of the Puget Sound. Last year Bashin and Jennifer Sachs, the LightHouse’s Director of Development, went to see it.

Sachs recalls that the house was in disrepair. Crows had pecked away at the shingles. The roof was crumbling. And inside, it was packed with stuff: thousands of books suggesting a vast range of interests; piles of old papers; paintings; plastic clocks stacked on top of each other.

What Bashin wanted, of course, were clues. And pretty quickly, he found them.

“As we wandered through [Sirkin’s] house,” Bashin said, “we saw all these gadgets: giant light boxes, magnifiers, enormous plasma TVs in his kitchen and throughout his house.” Bashin recognized these clues because he’d used them himself, back when he was trying to hide his blindness.

It appeared that Sirkin, too, had lost his sight. He kept it a secret from almost everyone he knew.

Instead of getting help, or learning to use a cane, it seems he’d tried to bring his eyes back with special diets, the pomegranate juice and the caloric restriction.

Sirkin’s colleagues said that in his final years, he became more reclusive than ever. He holed up in his house — in a little room off the side of his kitchen.

In that room, Sirkin’s heart gave out on him. His body wasn’t discovered for days.

To Bryan Bashin, Don Sirkin is a black box, a mystery. Estranged from his family, reclusive, even to those who worked with him. A guy who also made this dramatic, final gesture – this extravagant gift– to people he had never met.

What Bashin found in Sirkin’s home reminded him of his own difficulty in “coming out” as blind. Sirkin couldn’t make the leap Bashin did. Instead, he hid. But he also did something else. He left his entire inheritance to a group of people who could have helped him, but didn’t get the chance.

This story was produced for KQED’s new podcast The Leap, co-hosted by Amy Standen and Judy Campbell. You can subscribe to the podcast through iTunes or Stitcher.