January 1, 2024

It was midmorning, the spacious waiting room at the Greer, S.C., Memorial Hospital emergency room was half-full, men, women, old and young, very young. A few families sat together, some folks stared at their cellphones. We all knew of ER waiting-room nightmares: hours upon hours, tense discussions of insurance coverage, arguments over who’s next for care. We checked Sandy in. Someone took her vitals, pulse, blood pressure.

Greer Memorial is an impressive place, an exquisitely designed complex of two-level buildings in the middle of town. It was still under construction when we first visited the area. It now is fitted out with state-of-the-art medical technology, the newest radiological equipment, top-notch OR and ICU services. The opening was nicely timed for our arrival.

Hospitals are places of healing, of renewal, of mercy. I recall a week-long stay in my hometown hospital during high school, where I lay with both eyes bandaged after an eye injury.  I was spoonfed my meals by high-school girls, volunteers called Candystripers. I knew them only by their sweet, caring voices.   

After we moved here I sometimes cruised past Greer Memorial en route to somewhere else. I admired the architecture, the clean lines of the buildings, the landscaping. Eventually I got to see the finely appointed inside when I went there for computed tomography (CT) scans. I liked the modern art in the lobby, the lush, beautiful potted plants, the tastefully decorated corridors.

But no matter how nice the facilities, no one wants to be there. For many the hospital is a place of fear, of unsettling, painful memories.

My scans often were finished in 30 minutes. I never went near Greer Emergency.

Emergency is where most Americans experience the hospital. Emergency captures everything: household and auto accidents, crime trauma, scary chest pain, and everyday illness when the family doctor isn’t available. Many ER patients don’t have a family doctor. Then we had covid-19.

Sandy awoke with severe back pain after a three-day allergy-induced cough that she treated with over-the-counter remedies. She had had the flu, RSV, and new covid vaccinations. The family doc wasn’t available, busy with his schedule. Can you get sick on schedule? A nurse practitioner at the nearby Urgent Care pressed her back in a tender spot. “I can’t help you, you need to go to the ER,” she said.

After checking in we sat for maybe thirty minutes. An orderly fetched us and led us down one brightly lit corridor then up another. Nurses in dark blue scrubs scurried past. At an intersection we found a kind of command center, a section of wall lined with computers, staff people tapping away. The orderly showed us into Room 14, just across the aisle.

The room, as you’d expect in ER, was equipped for emergencies, with gauges, pumps, monitors, hoses, and hookups. A plastic curtain hung along the exterior glass wall. Sandy put on a gown and climbed onto the bed, the orderly gave her a warm blanket. On one wall a whiteboard listed the staff: Nurse in charge, Lauren, RN, Shelby, assisted by Megan, Autumn, and Linda. It had space for a pain chart, ratings 1 to 10, and for diet, comfort, medication. A colorful print of a winter scene hung on a corner wall. The orderly left, we were alone. We waited.

I pushed aside the curtain and peered through the glass. A couple of nurses stood nearby talking. An orderly pushed an elderly woman in a wheelchair and disappeared around the corner. Sandy closed her eyes. Twenty minutes passed. A nurse pulled back the curtain and burst in with “Good morning, I’m Shelby, how are you?” She didn’t look my way, but prepared to insert a conduit for an IV. Sandy took a deep breath.

I looked at my watch, 1:00 PM. Three hours since we arrived. Shelby stood and inspected her work, a tube dangled from Sandy’s arm. Expertly Shelby fitted a vial into the tube and drew blood, then filled a second vial. “We’ll take this to the lab,” she said with a smile, and disappeared.

We waited. Another nurse pulled the curtain back. “I’m here for an X-ray,” she announced. She pushed a mobile X-ray machine into the room, I stepped into the hallway. In five minutes she was finished and gone. A doctor appeared, a tall slim woman. “How are you?” She patted Sandy on the shoulder but didn’t touch the tender spot. “This could be several things,” she said. “We’ll get a CT for a look. I’ll be back.” She disappeared.

Twenty minutes or so later a technician arrived. “I’ll take you for your CT,” he said with a grin. He maneuvered the bed towards the door. “Is it a tunnel?” Sandy asked. She doesn’t like confined spaces. “It’s a donut,” he said.

It was past 2:30. There must be a cafeteria, I thought. I asked at the desk. “It closes at 2:30,” a nurse said. “There’s vending machines in the main hospital.” I wandered back towards the outer waiting room. It was crowded, men, women, children, glumly waiting to be seen. Others were flowing in the front door. A few, very few, wore masks.

It’s flu season, after all, then there’s covid and RSV. A news story that morning reported the Centers for Disease Control found that South Carolina and Louisiana had the highest rates of flu infection in the country for mid-December. Alabama and New Mexico came next, followed by North Carolina, Georgia, Tennessee, and Mississippi, then Virginia, Texas, and Florida. All the contiguous Southern states, sick together.

At 3:45 our daughter Kathleen, newly pinned nurse (last week’s post), wrote that “the good thing is if the staff isn’t rushing around, it’s not too worrisome.”   

I headed back to ER. Sandy was back. Shelby stopped by, no problems with the CT, she said. “We’re doing one more blood test, for creatine.” We waited. The creatine test looked good.

The doctor returned, smiling. “Looks like you pulled a muscle coughing,” she said. “We’ll give you medication for that.” Shelby returned with paperwork. “We’ve called this in,” she said cheerfully. “Feel better!” she called, and headed to help the next patient.

I wondered. A blood draw, X-ray, and CT, which by itself cost around $8,000. From my own experience, this was multi-thousands of dollars before insurance. For a pulled muscle?

“Best outcome,” our son the medical physicist said. “It’s easy to forget that the best possible ending of an ER visit is that it turns out to be not a big deal. Everyone wants to feel justified in making the decision to go, but the best thing is when they say it’s not much to worry about.”

December 25, 2023

Massive, snow-covered Pikes Peak soars skyward 14,100 feet above the chain of mountains running north-south and just west of Colorado Springs. The Garden of the Gods, north of town, serves as a placesetting for the view of the peak, and the rough cast of nature that abides around us today, on Christmas morning.

We walked through the Garden last week, getting a spray of afternoon sun after two days of bitter white winter in southeast Colorado. The sun offered weak warmth, but the craggy red sandstone formations cast deep shadows that held the chill.

Our daughter Kathleen had graduated from nursing school that morning. It was a time for celebrating, even through the onslaught of Christmas. The Garden was, for some mysterious reason, the right stopping point.

The geological formations like the Steamboat Rock, Three Graces, and Balanced Rock and the others tell a strange story of geological upheaval eons ago. Archeologists believe ancient peoples passed through the area some 1,300 years B.C, a split-second ago in the life of the planet. Native Americans entered the Garden region roughly around 250 years B.C. Apache, Commanche, Cheyenne, Kiowa, Lakota, Shawnee, and others hunted and lived in or near the area.

The six of us strolled past the giant sandstone towers, tiptoeing, sometimes sliding across the icy patches, hunching our shoulders against the cold. The bizarre, majestic structures rule this patch of nature, close to the city yet exploding from another time. Those early peoples lived here then died or moved on, long before what we know as the Christmas Miracle, the transcendent moment of Christ’s birth as recorded in the Christian gospels. 

A few miles south the city, like every other in the Western world, was festooned with decorative lights, the stores scrambling to lure the final-week shoppers, the churches frantically advertising, hoping to fill pews for the big day. The breakneck commercial rituals of Christmas attempt to draw us in, the excitable and joyful, the weary and disillusioned. As every year a few oldsters protest they don’t want or need anything. They still will get a pair of gloves, a sweater, a new cell phone or other technology gizmo, or the last resort, a restaurant gift card.

A day earlier we had walked through the giant Broadmoor resort hotel/country club, which sits in a Colorado Springs residential neighborhood with its moats and golf course. The attraction, in the main building, is a gingerbread boat lined with candy, and gaily decorated Christmas trees. A chilling, ghostly fog, the aftereffect of the midweek snow squall, hung over the place. We wandered through the main building, warming ourselves by giant gas-fed fireplaces.

The wide and high corridors show off vintage cowboy-and-Indian oil paintings that trace the rich roughneck history of Colorado, far more interesting than the gingerbread boat. We crossed a concrete curved bridge that poked through the fog at an auxiliary building that housed an expensive shop selling cowboy gear. 

Sandy and I had visited in 1979 for a business meeting, the place looked vaguely familiar, although the prices were a lot higher. We were a mismatch for the place then and still are now. The Broadmoor is one of those grand old hotels that drown guests in pricey luxury; we learned a palatial home on the property rents for $10,000 per night. I wondered why here, in Colorado Springs?

The town, population just under a half-million, is home to the U.S. Olympic and Paralympic Training Center, Air Force Academy and, nearby, the Cheyenne Mountain Complex and Peterson Air Force Base, home to the North American Air Defense Command, or NORAD. The folks who work at those places aren’t the Broadmoor’s target clientele.

Tourists, including us, swarmed across the thick carpets and lounged on sofas near the main entrance. The resort had opened its doors to locals interested in seeing the gingerbread boat, the decorated trees, and scattered other Christmas trappings.

It could have been me, it could have been the weather, but the holiday spirit seemed contrived. A crowd gawked at the garishly decorated pastries in the display case of a coffee shop. The coffee was expensive, everything was expensive.

The Broadmoor and Garden visits were a week ago. The commercial rampage of Christmas then still seemed far off, obscured, at least in my head, by our existence at the fringes of the political, economic, and the “social-media” world.  But we hauled out our tarnished Advent Wreath and the four candles, three purple, one pink, which count down the four weeks of the spiritual content of the season. We did the daily Gospel readings and lit the candles at dinner, we sent cards. Finally we picked up a few things for those close to us.

The Colorado junket was over too quickly. Although we rode to the Pikes Peak summit two years ago, it begs for a repeat; we didn’t get there. The famous Manitou Incline of something like 2,700 steps, on the east side of the Peak is another target, you can’t get to the top without acclimating to the elevation. We’ve never been there long enough.

We were left with our tranquil stroll through the Garden of the Gods in the winter sunlight and bracing chill—not a Christmas light or garland in sight. The rough edges of the place carried to us the brooding mystery of its origins and its past, its raw bluntness. The pocked sandstone, gnarled and unpretty, conveys the brutality and beauty of our world naked of pretense, leaving us with a sense of truth, that is, immortality, which could be the truth of Christmas.

December 18, 2023

The vision for Longwood Gardens, a magical place in Kennett Square, Pennsylvania, dates to 1700, when a Quaker farmer named George Peirce purchased 402 acres of farmland from William Penn’s colonial government. For more than 200 years his descendants cultivated a rich tract of plants and trees on the land, called Peirce’s Park. By 1906 the space was threatened by a logging business.

Pierre DuPont, the then-36-year-old heir to the DuPont family fortune, stepped in and purchased 202 acres of the park, saving it from the loggers. He laid out plans for what is now Longwood’s Flower Garden Walk.

By 1921 he had completed work on the Conservatory. By 1927 he had built an Italian Water Garden with 600 jets in nine individual displays. Du Pont kept buying land.

Every city has its parks and gardens that give spiritual respite both to locals and visitors. Some are famous as beacons of history and culture: Hyde Park and the Bois de Boulogne, among the great urban greenspaces of Europe; New York’s Central Park, Philadelphia’s Fairmont, Boston’s Garden, Chicago’s Grant Park, others.

Woodlands, whether vast or humble, may soothe the aching of human hearts. We walk through our greenspaces, hoping not only to separate from the raucous pace of the city, but also to find in flowering living things a clue to what is good and hopeful in our world.

In the mid-1930s Du Pont’s garden, roughly between Philadelphia and Wilmington, Del., had grown to 926 acres. Today it occupies more than 1,000 acres. Du Pont died in 1954 at 84. By then he had completed plans for the Longwood Foundation, a non-profit that operates the Gardens and its programs offering horticultural education, concerts, and special events.

Building continued. In 1957 Longwood created a new Christmas display in the Exhibition House, filled with red, white, and pink poinsettias, as well as white lilies, hyacinths, and others.

Since 1960 the Christmas display has showcased gorgeous bursts of winter-flowering begonia, lilies, cineraria, kumquats, and lemon, orange, and grapefruit trees.  By 1984 Christmas at Longwood featured more than 80 trees and 60,000 lights.

Longwood takes its name from “Long-wood” a wooded area where escaped slaves could find shelter before the Civil War. The drive to Longwood from any direction is across the rolling meadows of southeast Pennsylvania’s farmland, much of which is still owned by heirs to the area’s railroad, coal, and heavy industry heritage. From the south rural roads curl past massive estate homes through tiny places like Coatesville, Media, and Concordville in that lovely, near-empty country.

Longwood, du Pont’s legacy to the region and the world, is a miracle of botanical artistry, populated by more than 10,000 plant species. The place transports the visitor, young or old, to awed appreciation of nature’s sublime beauty. We visited with son Michael and daughter-in-law Caroline, curators of nature at their nearby home, along with thousands of others, on a drizzly December afternoon. The air was cool but bracing.

The vastness of the Longwood space creates the perception of privacy amid forests and meadows deftly touched by soft pastel lighting. We strolled east from the visitor’s center along a lake, past the Rose Arbor Display and Wildlife Tree. At a bend in the path we paused to warm ourselves, with a dozen other snugly dressed folks, at a roaring firepit.

We turned up a steep trail that offered a view, framed by trees, of the broad Longwood Meadow, now lying fallow. We walked through the Pierre du Pont home which, amid the cheerful Christmas brilliance, recreates his work and family living spaces, with graphics posted describing the history of the place. We moved on.

The Conservatory is the heart of Longwood and the centerpiece of Longwood Christmas. The East Conservatory is set off by the rich luminescence of evergreens, reds, and whites, mounted on holly and fir, the walkways lined with 4,600 plant species, many of them exotic and tropical. A pipe organ filled the place with traditional Christmas music.

The crowds pressed in, adults taking photos, children thrilled by the cascading loveliness; all heartened, renewed by the richness of nature surrounding us. At the south end we turned into a hall festooned with orchids in an explosion of nature’s most brilliant colors, a massive orchid centerpiece suspended above.

As darkness fell we continued around a loop of dazzling light past the Tunnel Light Display and spectacular Gardener’s Tree. The glowing trees lined dark meadows and seemed to light our way in gentle blues, whites, and pinks.

The chill had diminished, we found a soothing, mystical serenity in the quiet beauty as we strolled with other visitors, some pushing strollers and wheelchairs. Together we made our way back around the loop, as a joyful sense of the Season spread far from this vast, peaceful, lovely place.      

December 11, 2023

Nurses Becky and Katie were always on duty, smiling, when I showed up. They found me a seat, offered me water. On a couple of occasions, Katie came to the rescue when another nurse, Alex, was not able to insert the IV needle in my arm. Alex poked me a few times, missing the vein at the bend of my elbow. I gritted my teeth. She called Katie, who expertly got the needle in the vein near my wrist. I relaxed as the saline solution flowed.

They tended to other chores while we waited for the pharmacy to mix my drug.

Outside the one-level Prisma Cancer Institute, brutal wars are being fought, Republicans are backing a sex abuser and traitor for president. School boards nationwide are purging libraries of books. Every day more than 300 Americans are shot.

Inside this building and hundreds of others like it nationwide, people are caring for the sick, defending life.

Katie and Becky both talk about staying active, an important part of cancer therapy. Katie runs a few miles every day and said she’s thinking about entering a half-marathon. Becky said she tries to exercise, although family now takes most of her off-duty time. It was small talk, I usually didn’t pursue it. I showed up every three weeks for a couple of hours. They were there four days every week for twelve-hour shifts, caring for cancer patients, their lives’ work.

The treatment center is a large, cheerful space, nicely exposed to daylight by a wall-length picture window that revealed the lush garden and woods on the north side of the building. In the afternoon the place usually is full of patients in Lazy-Z-Boys, hooked to IVs, some asleep, others chatting or looking at their cell phones. On most days a few wives, husbands, or friends sit next to the Laz-Z-Boys, some looking concerned, others resigned to their hour or hours in the place.

The Institute had become almost a second home, after 30 straight days of radiation two years ago and now a year of immunotherapy. The visits became a kind of ritual: the blood draw, touching base with the physician-assistant, the infusion. The phlebotomists are fast and efficient, asking your name and birthdate, then “right arm or left?” The pinprick, filling the vials, then “band-aid or wrap?” sometimes all inside of three minutes.

A computer analyzes the blood and spits out a report. The PA looks it over then calls the patient in for a chat, sometimes brief, sometimes longer. The blood data determines whether the patient gets infused that day, any abnormal readings may send him or her home. I always was lucky, although my “creatine,” an enzyme that accumulates in the kidney, was consistently high. The PA reminded me to hydrate. I always said I’d try harder.

After the meeting the patient is back in the waiting area. Almost invariably Becky or Katie would escort me into the big space. Then it was all routine, or almost routine, apart from the needle stick. “Sometimes we’re not on our ‘A game,’ but we usually get it done,” Katie said a couple of times.

The delay then is waiting for the pharmacy to get the OK from the lab to brew my drug, pembrolizumab, trade-named Keytruda, which is easier to pronounce. Because it cost $38,000 per 200 milliliters (before insurance), they mix only single doses. The wait could be ten minutes, or thirty, or more. I sipped water, sometimes closed my eyes. Patients came and went, nurses moved around, attentive, compassionate.

Occasionally someone would have problems, the nurses would call paramedics, who would show up with a stretcher and haul the patient off to the ER. But most of us endured.

Once the drug is ready the infusion is just a matter of connecting the IV to the drip bag and hitting a switch. “Thirty-five or forty minutes,” Katie or Becky would say, then turn to help other folks. Sometimes they’d pull on protective plastic coveralls to disconnect patients receiving certain chemo drugs to avoid contact if the drug leaked or spilled. Oncology nursing can be dangerous.

On most days a chaplain would stop by, a friendly young guy from a local Protestant church. He’d take a seat, introduce himself, ask how I’m doing. We chatted about my situation. He’d jot some notes on a clipboard, and remind me he’s happy to offer spiritual guidance. I’d thank him, he’d move on to the next patient.

Not everyone was being treated for cancer. Once a young woman was seated next to me, getting infused with medication for a blood condition. She noticed my Garmin watch and said she enjoyed trail running. She had run in a mountain-trail event a year ago. Then the condition set in, leaving her in agonizing pain. She said she’d been there for two hours and would be back in a week.

After plugging in my IV Becky would visit a bit. Once she mentioned her sister’s husband, a surgeon, worked at Walter Reed Hospital in Bethesda, Maryland, near Washington, which she had visited a few years ago. I told her I used to go up to Walter Reed for meetings of the Navy’s Human Research Protection Program, which I supported at the Office of Naval Research. “It’s been a few years since I went. I’m sure it’s changed a lot,” she said. “Traffic around Bethesda is very tough,” I offered.  

She and Katie exchange this kind of casual talk with their dozens of patients, all day long, all week long. They’re nurses, after all, they’re good at it. They administer life-saving, or at least life-lengthening treatments. But their job also is to convey humanity, in the smallest ways, which for all of us stuck there is, more than anything, what we need.

I was finishing my 12-month sentence, no more visits scheduled. The doc wants to look at radiation therapy. At our last meeting he said, “You’ve had it on the left side but not on the right.” I’m set for a PET scan, he’ll share it with the rad team. Then we’ll see.

When my drug pouch was empty Becky unhooked me. I told her about the plan. “Good luck with that. But even if you’re not back here for treatment, stop in and say hello.” She smiled. I said I would, then said, “Thanks—and Merry Christmas,” and waved on my way out.

December 4, 2023

The Sassafras Trail is a winding path, about two and one-half miles long, through a corner of the local state park. We arrived on an overcast Sunday morning, Noah and I, to get some fresh air and a dose of the woods. He was about to turn 10, and has a lot going on with school and fourth-grade debate team. He doesn’t get to do much hiking.

It was all I could come up with as an outing for the boys. I got them fishing gear last summer, we went once and caught nothing. They weren’t impressed.

I pitched the idea of the hike both to him and the younger grandson, Patrick, who just turned seven. Noah said sure, Patrick wasn’t up for it. It’s a twelve-mile drive, when we arrived at eleven o’clock the parking lot at the trailhead was full, meaning we had to park at an overflow lot about a quarter-mile away and hoof that stretch along the park road.

We took a shortcut down through a leaf-covered ravine, slipping all the way, crossed a creek, and climbed the short rise to the trailhead. It was chilly. I handed Noah his jacket. I wished I had brought one, but usually you can count on warming up as you move. We turned right, or east, onto the trail loop, although the sign points hikers left, or west. We kicked at the leaves.

“What time is it?” Noah asked. I told him, hoping he wasn’t already tired of it. “We have to go two miles. Let’s see how long it takes,” he said earnestly. So maybe he looked at it as a challenge, rather than a boring afternoon with grandpa. I couldn’t tell. “We’ll be done in about an hour,” I said, just guessing.

We moved up the second rise. It was quiet; despite the full lot, we seemed to have the trail to ourselves. Noah was full of pep, striding easily, telling me “part two” of a story he had started a couple of days ago. It was a fantastic, creative yarn mixing bad guys and good guys dueling with lasers, unlocking gates with key cards. Lasers and key cards? I wondered where in heck he picked up this stuff.

Elementary schoolkids today are growing up in a different world than I did, the world of casual technology that we all lean on. Even the first-graders are issued laptops at school that they take home for assignments and then nearly anything else they want to do with them. Ten-year-olds are more comfortable with computers than I am. They play video games, most of them, not cowboys and Indians.

They’re still kids, like all kids before me and since. But they’re busier. Noah played Little League baseball last spring, soccer in the fall, and is signed up for basketball starting in January. Last month he sang in a talent show. Both brothers have been in kids’ golf programs. I asked about debate team. “I’ll tell you when we see grandma, she’d like to hear about it, too,” he said.  

The trail is level for a quarter-mile or so into the forest, curves left then right, rises and falls. Ahead, we could see the rough surface wind up a long hill. The trees had mostly lost their leaves, but were still densely packed. A few weeks ago I had hiked the same way and spotted a mature female white-tailed deer grazing. She heard me and raised her head as I passed.

We moved more slowly, Noah just behind me. He said maybe he’d go to Clemson because it’s a good engineering school and he likes math. Or maybe Penn State, his dad’s school. Or maybe one of the service academies. I hadn’t heard that before. I talked up the Naval Academy, ships, fighter aircraft, world travel. I dropped it before he got bored.

“Maybe you get the math from my dad,” I said. Noah never met his great-grandfather. “It skipped a generation. Your Uncle Michael is good at math, too.”  

We kept walking. I pointed out trail features around us, the steep drop-offs, the hills and ridges, the winding route the path took ahead. “Do you like being out in nature,” I asked. He said, “Sure!”

About midway through the two miles we climbed a long hill, the trail broken up by boulders and tree roots, the going more difficult. The summit was obscured by the trees. We slowed down. I could hear Noah breathing hard behind me. To encourage him I pointed at the next ridge, where the trail levels out and begins to descend. He didn’t say anything but pushed on.

I grew up in a suburb a lot like Noah’s. The land behind our street was a woods-covered buffer between our community and the next one, maybe a half-mile wide and three or four miles long. Over the years before I went to high school my neighborhood friends and I spent many hours in the woods, hiking, exploring, camping, and fishing in a creek that flowed through the area.

Years later my younger brother bought a home on the outskirts of the woods. On one of our rare visits, he led me along an overgrown trail to a dead fallen tree. My name was carved in the trunk. I had no memory of that, so long ago, in a different time and, it seemed, a different world.

The halfway point on the trail loop is also the highest point. We slogged forward. “Just a little farther,” I said more than once. “We’re almost there.” Noah kept moving, still game but a bit winded. “How much more to the top,” he asked again. Finally I said, “okay we’re here, all downhill now.” We could move a bit faster.

My grandfather was a city man who lived all his life in the Bronx, New York. He never took me hiking, and probably had never been hiking himself. Instead, he took me to watch the New York Yankees play in the old Yankee Stadium. That was the era of Mantle, Maris, Berra, Pepitone, Yankees world championships. It was the big city, the Big Apple, the family anchoring place. Those memories are forever.

There’s not as much excitement here in Greenville. No roaring, clattering subways, no Empire State Building or Greenwich Village. No Yankee Stadium. We do have hiking trails.

As we turned on the back of the loop, I reminded myself how time is passing in a bewildering blur. In a few years Noah will face his coming of age. He will find excitement and achievement, and maybe some setbacks and heartache. Like all of us, he’ll engage in life, find his purpose, his meaning, find himself. Maybe in some quiet moment in the middle of all that, he’ll recall our hike on a chilly Sunday afternoon.

We walked a bit faster on the downhill. Closer to the trailhead the route zigzags back and forth through thickets of young tree growth, then turns, and turns again. “How much farther,” Noah called. “Almost there,” I yelled back. He laughed. “You already said that, grandpa.”