September 28, 2026

The fellow on the phone from the hospital last Tuesday sounded exasperated. “I’m Joe. Insurance denied the PET scan. We don’t know why. We’ve faxed an expedited appeal. “We hope we can get this done by the end of the week. I’ll call you.”

“Thanks, Joe,” I said. I thought he said they don’t know why.

I didn’t want to dwell on it, still drugged by the pills I took for the punishing virus, we think it was a virus, that we picked up in Idaho.

Insurance companies deny care all the time. You read the horror stories. I haven’t experienced them, through 30 computed tomography (CT) and a half-dozen positron emission tomography (PET) scans, plus MRIs, biopsies, and surgeries over the past eight years, all covered by the same insurance. Suddenly the streak is broken.

The new oncologist, Dr. Z, ordered the PET a few weeks ago. Ordered? Requested? Was it the scheduling? The cost? These things cost about $8,000. With my insurance, I pay about $350. A good deal, if you have to have it.

This was more or less following a plan set by the former doc, Dr. B, who left in July. The PET involves an injection of a chemical that adheres to cancer cells and causes them to, in effect, glow under the scan, providing a more precise view than a CT.

So what’s the problem now? A paperwork glitch? Did insurance get tired hearing about me? I looked back at my scan scorecard, kept in a notebook. I had one in February 2025. Then Dr. B ordered one back in March. That one sailed through the insurance. The results prompted him to restart me on the oral chemo pill at a low dose.

But the insurance people also keep score. They may have said, “What, another PET, just a year after the last one? Too much for this guy!”

In Wyoming that last morning we said our goodbyes. It was chilly. Just beyond our daughter’s and son-in-law’s front porch the deep green of the foothills of the Grand Tetons glistened with frost. We sped back to the airport over the nearly empty highway past the potato fields that stretch to the horizon in every direction.

The flights were tough, what with the ricochet effect of a circuit breaker failure in Jersey that shut down East Coast airports for hours. In the afternoon showers in Dallas closed one of the runways. You’re never happy, when you finally fasten your seatbelt after a two-hour delay and the pilot announces, “There are twenty-five planes stacked up waiting to take off.”

The plane smacked down at Greenville-Spartanburg International after midnight. Slouching under our carry-ons, we trudged the deserted main corridor to the escalators, then to the luggage carousels.

The plan was get the PET early Wednesday then drive to Tennessee for Sandy’s college-friends reunion. She won’t navigate the 10 or so miles of construction on I-40 in North Carolina where Hurricane Helene knocked the highway into the Pigeon River two years ago. One lane now is open in each direction, hemmed in tightly by Jersey walls. Traffic, which is heavily eighteen-wheelers, moves in gridlock through the work zone.

We scrubbed the trip. We could have thought about the PET results over the weekend until my doc appointment this week. Now we’ll do neither.

A few showers had kept the plants alive, the grass grew scruffy and thick. The end of the week was mild, life fell back into routines.  We got over the sickness that attacked on the trip.   

We felt the tension of the last night’s bad sleep, the grind of packing, the 60-mile drive, the hike, hefting your bag to the aircraft ramp (no jetway), strapping into your cramped little seat—aisle, center, window, they’re all cramped; the airline crackers and pretzels. 

Exhaustion blasts the body and mind, creating numbness. You don’t want to walk or even stand. Cumulative fatigue, our son, the medical physicist, calls it. Athletes feel it after too much running or weightlifting. I did do pushups the first two days.

Impressions, which become memories, race back. In 2006 we got to Yellowstone and Grand Teton. Later we went back to Montana for trail races and did a couple of drive-arounds. We got to Glacier and Little Bighorn Battlefield National Monument and Devil’s Tower. All of it a spectacular, alien world.       

Here, this northwest corner of a small Southern state offers the deep-green, gently rounded-down tops of the Appalachians that stretch west to the Great Smokies. The midstate piedmont is the other direction, melding with humid lowland, then beaches. Myrtle Beach, Charleston, Hilton Head lead to Savannah, Georgia’s Gold Coast, the Sea Islands. Then it’s hard-down vacation country, Jacksonville, Daytona Beach, and south. Swampland, not mountains.

The variety, the richness of all of it lifts the heart. Meanwhile we face the everyday pettifoggery of our medical bureaucracy, which pings at patients with emails and text messages and reminders and surveys. While denying procedures, someone over there wants reviews—how well did we do?

I got over the travel funk. I hauled out my two-inch-thick file of scan reports reaching back eight years and thumbed through them.

In March 2020 a physician-radiologist, in analyzing my CT, didn’t notice something. Seven months later, in October, another CT, another report. This time the reviewing physician found a “large amorphous well-defined mass … centered in the upper abdomen … suspicious for metastasis.” My Virginia oncologist, the day before our move out of the state, said, “this was missed in March. You need a biopsy ASAP.”

So we set out on this six-year journey, CTs, PETs, surgeries, drugs, procedures. Amidst all that, some nice trips, new friends, precious memories. Now another PET, or a request. By week’s end I was moving again. I mowed the front lawn, picked up the van at the shop. We went grocery shopping and got coffee. We waited for Joe’s call.    

September 21, 2026

The broad plains of southeastern Idaho are parched brown by drought. The potatoes are not coming in right now, most of the fields are fallow or growing alfalfa, the off-year crop. The horizon resembles a gently rolling desert, extending through the Teton Valley to Wyoming.

This is not picture-postcard Idaho of spectacular mountain views and white-water rivers. The southern one-third of the state is an extension of the Midwest, flat for miles then adding some hills. The Teton Valley reaches from the suburbs of Idaho Falls east to the Wyoming border, where the Tetons rise. Grand Teton, which is on postcards, towers for sixty miles.

The occasion was our youngest daughter Kathleen’s wedding ceremony. She and Steve had eloped a year ago without having one. So we planned a makeup. The site was Ashton, population about 1,000, an hour north of Idaho Falls. It’s an industry town, just south of fast-moving Henry’s Fork, which flows into the Snake River near Rexburg. The prairie is everywhere.

We had passed through Ashton in 2016 en route to Ennis, Montana from Breckenridge, Colorado. Driving up Main Street then, I noticed the high school. There it is now, pretty much unchanged. The football team and the cheerleaders were practicing. The cross country teams were jogging Main Street. We passed the giant grain elevators, the hardware store, the ice cream place where we had stopped in ’16, worn out from the road.

The highway, U.S. 20, continues from Ashton to West Yellowstone. Before that it meets U.S. 87, which turns into 287 north to Ennis. A right turn on 87 brings you to Earthquake Lake, which memorializes 28 victims of a flash flood caused by a freak earthquake in 1959.

We stayed at a nice place north of town. Sons-in-law Mike and Steve and I hiked a gravel farm road. It winds past untended fields that may serve as pastures. A couple of horses, grazing, stared at us as we passed. We climbed a short steep hill and looked back.

The prairie extends to the horizon dotted with farmhouses and the roofs of Ashton. The long grass waved in a breeze. No other human, no cattle, no vehicle disturbed the quiet.

The emptiness is pricey. Real estate in Teton County, Wyoming, is the most expensive in the country. Affluent people, entertainers, corporate types, environmental and nature tourists have bought big tracts, preventing development of affordable housing. Some property investors qualify for tax breaks by spending a few days each month in the state. The land inflation has spread into Idaho. New homes are running in the $900,000 range.

For folks who have a stake, it is a special place. Main Street in Ashton becomes a feeder to U.S. 32, which runs south through Farnum, France, Lamont then to 33 into Driggs, a bustling metropolis of about 2,500 that sits nearly squarely on the Idaho-Wyoming border.

Driggs is a working town, supporting machine shops, equipment repair, trucking, the underpinnings of the farm business. Main Street is busy, lined with shops and restaurants.

Staying south on 33 the mountains rise. The prairie and ranchland drop away, the highway crosses into Wyoming, dipping in nerve-wracking switchbacks into Jackson, the mecca of northern Rockies tourism. Everything is expensive. The highway enters Grand Teton National Park, a sparkling jewel of America’s most spectacular vistas. Yellowstone, just north, and Glacier, in northern Montana, may be close.

Bozeman is just northwest of Yellowstone. In September 1983, after attending some meeting, I drove a rental from Bozeman into the park, the plan being to come out 50 or 60 miles later on I-90 to Billings. It was a chance to see the park.

I spent the night in Cooke City. The morning was overcast, winter clouds hung low over the mountains. I left early and chugged along U.S. 212, a narrow two-lane road, into Gallatin National Forest. I wore a short-sleeve shirt and a light sweater.

The snow drifted down, I plowed on. The road started to accumulate a light coating, I focused on staying in my lane. No other traffic passed me in either direction, as if I were the only driver who didn’t get the weather report.

Turning back never occurred to me. Just a few more miles to the interstate, I thought, glancing at my paper map. I didn’t know exactly where I was. This was a national forest, meaning wilderness, no settlements or any signs of human life.  

The snow fell, now at several inches, I gripped the wheel, squinting through the windshield at the wall of white. Then a tight right turn, I twisted the wheel then jammed the brakes.  The car slid a few feet off the road and came to rest on a slight incline. I tried backing up, the wheels spun on the slickness. I tried going forward, nothing.

I waited ten minutes then tried backing up again. Again the wheels spun. I got out, and sucked in my breath at the cold. The tires were coated with frozen stuff.

Sitting in the car, I turned up the heat. I turned off the ignition, started it, and tried backing up again. The wheels whined and spun. I cut the engine again, waited a few seconds, then tried starting again. The engine sputtered, but didn’t start. I sat, numb, with a vague sense of the problem.

I pulled my sweater snugly, and tried again. The car started, but wouldn’t move. The snow poured down, this was no light September dusting. I sat staring at the falling snow, the forest on every side, the road covered.

Maybe an hour passed, maybe two. I heard an engine. A park ranger in a heavy jacket rapped on my window. “We’ve closed the road. We’ll get you out.” I got out of the car. A Park Service truck stood on the road. The ranger and a partner fitted a hook to my rear bumper, got in their truck and backed up, hauling my car up on the road and turning it.

“You have to drive back through the park,” he said. “Be careful.” I thanked the rangers and drove slowly back toward Cooke City, then through the park. I picked up I-90 near Bozeman, where I had started. A one-hundred mile detour. Many years passed before I visited Yellowstone again.

This came back to me as we gathered for the wedding, about three hours’ drive from my park experience. The happy couple are expert outdoors people who wouldn’t get caught in a snowstorm. I looked back, but not for long. We exchanged hugs. The next day we headed for the airport.

September 14, 2026

On that awful evening people in New York’s satellite suburbs in Jersey, Connecticut, and on Long Island noticed cars left in commuter rail parking lots. Their owners never came home. Last Friday, for the 25th time, the videos of the Towers’ collapse played, the names of victims were read, bells tolled.

Some feelings just won’t die, the country artist Marty Robbins sang, way back in 1982. And once again, on September 11, 2026, the country and the world venerated that day 25 years ago. The years are gone; the memories, painful for all, excruciating for some, never will die.

Again I recalled walking through the Navy wing of the Pentagon a few days later, inhaling the sheetrock dust. The next week, in New York just off Wall Street, I hiked past the smoldering heaps of broken concrete and twisted steel girders. First responders searched for survivors, but mainly remains.

The event matters, it always will matter, a stark outpost of grief, when time stood still. The agonizing over the causes, the origins of the terror, the political conditions, the security breakdowns and failures, has never stopped and never will.

We recognize that certain experiences, as they recede into the past, have a mystical dimension. We live with the 9/11 legacy but never fully grasp its meaning.

We returned from our Alaska trip and got through the travel hangover and sickness. We brought back our impressions of the standard attractions offered to all the tourists, the iconic mountains, the glaciers, the picturesque native villages. 

But then we encountered, or stumbled on complexity, wonder, mystery. It had to do with Sandy’s sickness. We arrived at the first cruise stop, Skagway. We had to find medical care. We ended up at the Dahl Memorial Clinic, a quiet place just off the nondescript streets, thousands of miles from Ground Zero.

The town has its complicated roots in the years of the Klondike Gold Rush. In the 1870s someone discovered gold in nearby British Columbia. Prospectors rushed in, turning the Skagway settlement into a rowdy boom town, increasing the population to around 10,000 by 1898. A railroad, the White Pass, was built to transport miners to the gold fields. In 1900 the town was the first incorporated in the Alaska Territory.

The miner population melted away as the gold was mined out and the town started living on its history. Tourists arrived by ship during the brief summer, which is the way things are now, and the way we landed there (OTR 8-31-26).  

Three ships tied up at the pier and released their throngs of shoppers. For most the day was about scrounging through souvenir shops for jewelry, Alaska-labeled clothing, local art, plastic and ceramic stuff. We were not shopping. It was our 48th wedding anniversary, but Sandy was sick. As the ship maneuvered to the Skagway pier, we thought “urgent care,” hoping the town had one. We stepped down the gangway onto dry land.

A police officer directed the tourists to the White Pass train for their sightseeing tour. “You want the clinic on 14th,” he said. “Take the shuttle, it stops over there.”

The shuttle drove through the shopping district and dropped us at Broadway and 9th Avenue, the end of the driver’s route. We were away from the billboards, the neon lights, the shopping crowds. We trudged up Broadway through an industrial-residential neighborhood.

We saw no one. The place seemed poor, anonymous, its character obscured in the strange, mysterious history of the place. We passed cramped, weatherbeaten cottages. A few rusted appliances sat on lawns. Here and there the sidewalk was broken and crumbling. Weeds sprouted in driveways.

We found the clinic. The office was quiet, a receptionist sent us to a treatment room. A medical assistant tested Sandy for flu and covid-19. We talked while waiting for the results. He mentioned he’s from Texas, but found the opportunity there. He was getting married at the end of the month and moving to Myrtle Beach, South Carolina, for nursing school. We smiled through our nervousness.

“Well, it’s warmer there,” I said. “Yeah,” he answered. “My fiancée can’t wait to get out of here.” 

Sandy tested positive for flu. All those oldsters aboard the ship, coughing and wheezing. The assistant introduced Shauna, the nurse practitioner.

She sat without fear with us and looked at the test results, then talked about the flu, the progression of the disease, the common sources, the risks of bronchitis and pneumonia. She asked about allergies to medications and proposed alternative treatments, the need for rest, fluids, isolation. She leaned forward and touched Sandy’s shoulder.

She and Sandy talked about health care. She mentioned she had grown up in Alaska. She earned her medical degrees then worked as a volunteer with the Skagway Fire Department. She ordered prescriptions. The pharmacy was on-site. We stood to leave and mentioned the anniversary. “How many years?” she asked. “I have to ask,” she said, smiling.

The clinic called a shuttle to drive Sandy back to the ship. I jumped off into the shopping crowds and browsed in a few places, looking without interest at the stacks of teeshirts and embroidered jackets, the plastic whale and grizzly bear models, the prints of mountain vistas and historic buildings.

From our ship stateroom we looked out on the town, the grid of small one-story buildings hemmed in between the narrow channel and dark mountains, the peaks lost in mist.        

We read the clinic’s mission statement, a warning: “Severe geographic isolation restricts access to alternative care. Winter weather often limits travel outside the community. The only land-based option is driving 100 miles to Whitehorse, Yukon Territories, Canada by a two-lane road. This road has extreme winter weather conditions at least six months of the year, to include white-out snowstorms, black ice, and/or avalanches.”

Shauna, the nurse practitioner, worked with compassion and gentleness in her professional calling, patient care, wellness, recovery. In that small, rough, isolated place she dedicated herself heroically to others, living with and overcoming the obscurity, the mystery, the hardship of the place. Unlikely we will ever see her again. But we look back now, in admiration and good spirits, encouraged and heartened.

September 7, 2026

Lilting strains of opera accompany the coffee in Mario’s on Howe Street in downtown Vancouver. Opera and coffee, a new experience. Vancouver was a new experience.

At dawn last Sunday our ship, Westerdam, was making nine knots, then four. The harbor was filled with tug and freighter traffic. After a week of watching wilderness along the vast Inland Passage that separates British Columbia from the Pacific, we were entering a city. It discharged us with the other 2,000 passengers at the cruise terminal. We found our hotel in the middle of downtown.

The next morning we walked a bit, enjoying the cool northern Pacific air. Mario’s was cramped, a half-dozen two-person tables. An elderly man in a baseball cap brewed the coffee, two young women smiled as they made sandwiches. We listened to the lovely sounds.  The old guy closed his eyes and waved his hand rhythmically with the music.

The city is named for George Vancouver, a British naval officer who explored the Pacific Northwest coast in 1792. He sailed through the region, creating charts in collaboration with Spanish explorers who mapped California. Today Vancouver is the land-sea anchor of “Beautiful British Columbia,” the legend on the province’s license plates.

Vancouver ranks behind Toronto, Montreal, and a few other Canadian cities in urban population, but close to the top among the country’s larger metropolitan areas. The city occupies a wide peninsula across the Strait of Georgia from giant Vancouver Island. The northern boundary is the Burrard Inlet, through which our ship sailed; to the south is the Fraser River, winding 850 miles deep north into the province, then south to the Alberta border.

Downtown is business; banks, brokerages, law firms, international trade, collapse in a couple of dozen square blocks. We were in the middle of all that. I thought of New York with way less traffic.  

We passed the blocks of skyscrapers on our way to Gastown, the eclectic neighborhood named after a talkative bartender, also famous for a steam-powered clock. Like the rest of the tourist crowd, we moved in for a photo and applauded when the clock struck noon. We passed the Catholic cathedral, the stone weathered and dark.

We were relieved by then to be finished with the ship. In the last three days at sea Sandy recovered, slowly, from the flu that called for an urgent detour to the Dahl Memorial Clinic in Skagway. The clinic visit, on our 48th wedding anniversary, was a bit of a downer. But the nurse practitioner, Shauna, was savvy and smart, she diagnosed Sandy’s symptoms and prescribed medication, which we picked up on-site.

We stood to leave, but chatted a bit. Shauna mentioned she grew up in Alaska, and that her medical assistant was heading to South Carolina for nursing school. I mentioned the anniversary. She sympathized. We appreciated that.

The clinic reminded visitors of where they are: “the Canadian border is 10 miles to the north by the only road in or out of Skagway. … For critical or in-patient care, residents must travel 100 miles to Juneau by small airplane or ferry, both of which can be delayed due to high winds or snowstorms.”

Still, a couple of days afterward we sat in easy chairs on the stern, enjoying the sun and watching without luck for the telltale spouts of whales.

The ship pressed on through the Inland Passage, following another sleek liner and leading a third, as if in a cruise-ship convoy. That evening we sat for twenty minutes to listen to the final entertainment, an unfunny comedian. We left after the second joke attempt.

For our first Vancouver evening we hiked Granville Street, looking for dinner. A dozen or more blocks had been closed to create a pedestrian mall. The promenade was filled with younger folks, guys and gals enjoying Sunday evening brews and live music in the late Canadian summer. Not a senior citizen in sight, no political talk, no worries. We recalled it was another country, really another world. We found an unlikely table along the sidewalk and took in the scene.

We found Mario’s. The music echoed on the sidewalk and swept us inside. The fellow in the cap, we learned, is the original Mario’s son, who inherited the business. He asked how we liked our coffee.

We rode the subway out to the airport to get boarding passes. The transit system resembled the D.C. Metro without the business-suit clientele you get in Washington. The train, like the city streets, was full of young people of many nationalities. About 50 percent of Vancouverans speak a language other than English or French.

Back in town, traffic sped through intersections, autos competing with electric bikes and scooters. The city had warmed up, but without our choking South Carolina humidity. From the hotel we could see the cruise ship terminal, the ships that arrived yesterday already gone, retracing the course we had taken with a new company of vacationers.

Many of them would arrive in Whittier and Anchorage unaware of the intensity of Alaska’s emptiness, through the wilderness and across fast-moving rivers of the Great Interior, the rugged peaks, and dense dark fir forests that stretch for hundreds of miles in every direction. 

A light breeze cooled our last evening in Vancouver. We passed the giant Pacific Centre, the iconic Canadian institution Tim Horton’s, a row of Asian places. The city was relaxed, unstressed, Canadians enjoying the crisp self-assurance of their town, the jewel of their vast Pacific-Rocky Mountain refuge.

We felt the sense of the place, the city and the country, new, strong, bold, the heart of the Maple Leaf nation standing apart from and above the political grubbiness that awaited us at home. As we walked we recognized in the air a chord of courage, character, integrity, compassion, that prospers in the town, then soars above it.