Late Fall

November 11, 2019

Three of our kids are in Europe this week: son Michael and daughter-in-law Caroline are visiting Belgium and daughter Laura is visiting friends and doing free-lance work in the U.K., after spending a couple of months working in Costa Rica.

That’s all good. We’re hoping to see them at Thanksgiving or Christmas. We’ve never been to those places, and would like to travel to some exotic locale. But now we’re at home looking out the living room window at the leaves carpeting the back yard. In past years, like everyone else around here, I would be out there raking and sweeping the leaf-blower around like a fencer wielding an epee. We’d drag heavy bags of leaves to the curb. I’d dump some in a mulch pit at a far corner of the yard, with the idea that by spring they would become rich topsoil for planting things. Then we’d watch as the wind deposited another five or ten million leaves.

Gradually it dawned on me that all that work was pointless. What was left of the grass never did any better exposed to the cold winter sun instead of covered with leaves. And the mulch pit never produced much topsoil. I would push the wheelbarrow up the hill in the spring to harvest it, never got a full load. I can’t say it ever did any good.

I didn’t start this fall ducking the yardwork, I was excused to get over my operation. Just as well, the yard looks okay covered with leaves, a patchwork of bright yellows, reds, and browns, like the trees themselves before they shed. Sure, our front yard stands out among the neighbors’ as an example of suburban yard-care neglect. Passersby glance at the leaf quilt, then up at the house, disapprovingly. I’m okay with that. Actually it cheers me up.

Still, this weekend’s cold snap and the end of the leaf-collecting frenzy reminds me that we are in the dregs of fall, post-Halloween, pre-Thanksgiving, when it now gets dark earlier and stays dark later, the woods duller and grayer as the leaves disappear, the TV weather people pleased to issue scary forecasts. We’re wearing sweatgear for our walks, and walking faster against the chilling breezes. This is the season when old people feel the pace of time more keenly, in the rush toward the dark end of year.

That could be because lately we botch even happy things: the anticipation of the powerful messages of Thanksgiving and Christmas now is overwhelmed by auto- and furniture-sales advertising and warnings of holiday highway gridlock. You can’t miss all that unless you avoid TV and newspapers, because bad news is what’s news, for example, the next revelation in the Trump impeachment series of revelations, now breaking with blurring speed.

But that isn’t it at all. December, now hurtling towards us, promises cold and darkness, which together hint at the end, out there for all of us, but not so far out for some of us. Still, we’ll look forward to watching the grandsons have fun opening their stuff Christmas morning. Christmas morning passes, in the inexorable passing of those short cold days and long cold nights. Then there’s the fake holiday, New Year’s, which some of us try to enjoy.

The falling of the leaves is a cheap metaphor, sure, but it’s there, impossible to miss if you see metaphysical meaning in things that have none. You get through November and December by living vicariously through the cheerfulness of others, young children and their parents, who stay young for a while through the happiness of their kids. That’s the way it was for us. But then too, God’s eternal lesson for all of us, old folks and everyone else, is the end becoming the beginning. The dark end of the last year begets the start of the next one. The wait seems interminable right now, but we know that winter gives way to spring. Every year. The bleak gray mornings that follow December eventually reveal sunlight a little earlier that lasts a little later in the day, even while the leaves still are piled in the corners of your yard, turning to mulch on their own accord.

That promise of good news seems remote right now, when we’re battered by relentless, soul-devouring commercialism, the empty glibness of political campaigns, cowardice and corruption in the nation’s leadership, and lousy weather.

But we still look forward to gathering at the dark end of the year, maybe traveling exhausting, dangerous miles to join those close to us at Thanksgiving and Christmas. We genuinely are grateful for getting there, and then to make it to church for too-long, too-elaborate services that may only clumsily express the message we are waiting and hoping for. We take the kids, we urge their parents to attend. We oldtimers sit, trying to look forward to the remainder of life, trying to remember to thank the Lord for all we have and all we’ve learned and experienced. And we brace ourselves once again to start over. Then, if we still care, we can hire a teenager to bag the leaves.

The Network

November 4, 2019

Your family doctor sends you to a specialist, you call his office. When you break through the voicemail, the first thing the receptionist says isn’t “Good morning,” but “Insurance?” When you show up, she wants to xerox your insurance card before acknowledging you exist.

Almost nothing worries Americans today, especially older folks, more than access to health care. Health insurance is the centerpiece of the Democratic hopefuls’ campaigns. Recent federal data show that some 27.5 million Americans don’t have health insurance; roughly the same number have inadequate, bare-bones coverage. Everyone has heard tragic stories of families ruined financially by the costs of medical care for chronic conditions. If you’re frustrated with your health insurance, remember this: someone else is worse off than you are.

We hear too that Canadian and Scandinavian policies are more compassionate, less-costly alternatives. I have a cousin who traveled multiple times to Mexico for complicated dental care—crowns, root canals, and so on. The best dental care he ever had, he says, and the cheapest.

The costs of Medicare and Medicaid are rising, taking a huge share of the federal budget, even while they’re considered untouchable by Congress. Nobody wants to be accused of diddling with healthcare funding for oldsters.

If you’re working and your employer provides health insurance, that’s what you get. You watch the premiums rise, but at least you’ve got insurance.

If you don’t have employer coverage, finding health insurance can be a nightmare but, in an absurdist way, an adventure along the highways and byways of giant bureaucracies, government and non-government.

When you turn 65 you’re eligible for Medicare. You pay your Medicare premium. You can go with “original” Medicare, which pays most but not all health care costs. That means you need to buy a supplemental policy from a private insurance company.

The other route is Medicare Advantage plans, which are provided by private insurers as contractors for Medicare. The principal types are health maintenance organizations or HMOs and preferred provider organizations (PPOs). These offer coverage within local networks. HMOs require you to use doctors and hospitals in their networks and get a referral from a primary care doc if you want to see a specialist. They do provide emergency out-of-area coverage. The PPOs are more expensive, but don’t require referrals, and provide out-of-network coverage.

When I quit working, I tried to be smart about this. The sales pitches from insurers are intense. I started with an HMO with one of the big outfits. In the second year it covered a physical and therapy for a broken ankle. In the third year it covered most of the costs of three days in the hospital for rhabdomyolysis I developed after a tough trail race.

Last year things got crazy. A biopsy found cancer in my left kidney. Then I developed a thymic carcinoma near my heart—higher priority. Our family doc recommended a cardiovascular surgeon. Sorry—he was out of network, can’t see him. I called others, all out of network. After lots of dialing, I found one in network. The surgery didn’t finish the job, the surgeon recommended radiation and chemotherapy. Meanwhile, having discovered the shortcomings of my HMO, I switched to a PPO during the open season (October through early December), enabling me to get out-of-network treatment. That would mean paying the out-of-network costs, but I was covered. I felt bulletproof.

In January we traveled to Philly to talk to oncologists at Penn Med. Penn is one of the best cancer centers in the country, but out of network. The proton radiation therapy offered at Penn and now at Georgetown (also out of network) but nowhere in northern Virginia precisely targets the tumor, avoiding damage to healthy tissue. But the costs, one doctor said, would be huge.

I called their insurance people. Although I had coverage, both Penn and Georgetown considered my PPO to be regional, they wouldn’t go near it. A Penn insurance guy said, “switch to original Medicare—with cancer you can’t get a supplemental, but you can apply for financial aid.” Financial aid. Sure.

I went with the local guys. The medical oncologist who oversees the chemo is in network. The radiation practice is out of network, but in the same building as the medical oncologist, making it easier on the days I had both treatments. So I said okay to that.

The updates from the insurer detailed the providers’ charges and the “discounts” for insurance. Insurance paid a smaller amount. Providers then are free to go after the patient to recoup costs. And they do. We paid. Meanwhile, I’m still feeling the effects of the radiation, eight months out. Last month the urologist lopped off my left kidney.

My PPO premiums are going up next year. I decided to move on. Original Medicare is out, since I can’t get a supplemental until I’m two years out from my last cancer treatment. A competing PPO offered lower premiums. “We cover dozens of providers in your area,” the saleswoman said. (It’s about the sale.) “And if they’re out of network the copay is only $30.”

That’s the copay. I can guess what the actual out-of-network costs would be.

I called our family doc and the urology practice that monitors my remaining kidney. “We take that,” both administrators said. Encouraged, I checked with the medical oncologist who’s kept the thymic cancer in check. “To answer your question,” his insurance manager said, “We don’t accept that plan.”

In a way, that makes the decision easy. You don’t change cancer doctors. Two choices: stay with what I’ve got and pay the higher premiums, or go back to the HMO, since all three docs take it, and hope I don’t need to go out of network.

As St. Thomas Aquinas said, in a somewhat different way, it is what it is. You look downrange, you remind yourself how old you are. You ask the Dirty Harry question: Do I feel lucky? There’s a third option: get better. That’s the one I’m working on.

Country Road

October 28, 2019

We took the long way down to Virginia Beach Friday morning, U.S. 17, avoiding the construction gridlock and speed maniacs on I-95 and I-64. We weren’t in any hurry, my young second cousin Kasey’s rehearsal dinner was not until evening. After a wrenching week of medical stuff, including a setback in getting over surgery, I was set on going. It felt good to pull out of the driveway.

We spent a couple of days in Virginia Beach back in April just to get out of town (this blog, April 8). We’ve done the trip dozens of times going back many years, when the kids were little and so was Kasey, who grew up there with her mom, my cousin Kathy. Later, I drove down many times for conferences and to visit the Norfolk Naval Base. I went to sea a few times on Navy ships, once sailing up to New York aboard the cruiser USS Anzio. Great fun.

This time it’s about a happy event, the wedding of an accomplished young couple, the joy due their hard-working parents, and a reunion with family members from New York and Florida. We’ve been mostly far apart for years, preoccupied, like everyone else, with our own lives. So it matters to see them. But the trip—the travel—also matters. It’s been years since we ditched the interstate because, after all, the purpose of the car trip is to arrive as soon as possible, right?

Not always, not this time. Highway 17, starting in Fredericksburg, takes you on a quiet tour of the austere, nearly flat eastern shard of the state. Sandy is driving. We leave Fredericksburg, heavy with memorials to some of the Civil War’s cruelest engagements, and cruise into the eastern piedmont, the highway nearly empty, bordered by wide expanses of dried-out cornfields and vegetable patches killed off by the lingering drought. The brilliant fall foliage of northern Virginia fades in the temperate, humid piedmont climate. We pass through Port Royal quickly, then reach the hamlet of Tappahannock, overlooking the wide Rappahannock River, which flows down from the Blue Ridge. The high river bank is lined with ostentatious homes that prompt me to wonder what I don’t know about the town.

We stop for a short lunch at Shoney’s in Tappahannock. The restaurant drops hints of the Deep South, which has lots of Shoney’s, although the chain disappeared from northern Virginia decades ago, no doubt for good reason. We hurry on through desolate country, so it seems to me, although that may just be the sickness talking. The scrub woods and sparse truck gardens partly conceal occasional battered farm buildings and goodwill stores but little else. “Where are the schools?” Sandy asks.

We stop for a restroom break at Glenn’s Food Mart. It resembles a thousand other food marts: a few shriveled corn dogs are turning on a rotisserie. A forlorn-looking line of folks are waiting at the register to buy beer and groceries. Five senior citizens are sitting at slot machines. We’re on our way to a wedding and family reunion, but here we’re in a strange world, one we’ve seen before elsewhere, many times on road trips, but one that now, for reasons I don’t grasp, makes me impatient, anxious to move on. It prompts me to recall stories of U.S. 50 in Nevada, called America’s loneliest road. This road is not that lonely, but it’s close.

I take over driving, anticipating the Hampton Bay Bridge Tunnel, which Sandy refuses to attempt. The brown fields and empty warehouses fall behind us as we approach Gloucester, replaced by familiar stripmall sprawl. We cross the broad York River and enter Yorktown, heavy with history. It was at Yorktown that the colonials, with help from the French, outmaneuvered the British and ended the War for Independence. Eighty years later, from March until May 1862, the Peninsula Campaign unfolded between the York and James Rivers. Union General George McClellan sailed down Chesapeake Bay with a huge force to attempt an attack on Richmond from the southeast. He landed south of the York, but the Confederates were ready. The Yanks engaged smaller rebel units in a series of inconclusive engagements, until McClellan pulled back, allowing the rebels to withdraw to defend Richmond.

From Yorktown suddenly we’re on I-64, driving with the maniacs again. I push towards the bay. As we’re about to enter the tunnel a Navy destroyer slides past in the channel above us, heading for the naval base. Rising out of the tunnel you can see the silhouettes of three aircraft carriers tied up at the base, then the busy runways of Naval Air Station Norfolk. In twenty minutes we’re in Virginia Beach, surrounded by familiar, comforting shlock, the tee-shirt and boogie-board and postcard shops, the bars where happy hour is all day, the Miami Beach wannabe pile of high-rise hotels along Atlantic Avenue. We get out of the van and breathe deeply.

U.S. 17 still looks good for the drive home. The happy occasion of the weekend rouses me from my annoying habit of looking back instead of forward. Seeing family fortifies us for the trip through that peculiar strip of a richly varied state—alien territory, unless we welcome it as an adventure. I’ll get over the dark pettiness. One more time, I remind myself that health complaints can taint the rest of life, if we let them. That’s when we call on faith. Time to bear down, and overcome.

Character

October 21, 2019

Forty-three years. That’s forty-three: General Jim Mattis’s service to the United States as a U.S. Marine. He added nearly two more as Secretary of Defense, resigning in December 2018. His departure followed President Trump’s announcement that he intended to withdraw from Syria a U.S. force that acted as a buffer between Turkey and the Kurdish forces that fought with the U.S. against the terrorist group ISIS.

In his resignation letter Mattis wrote that “Because you have a right to a Secretary of Defense whose views are better aligned with yours … I believe it is right for me to step down.”

Earlier in his letter Mattis wrote that “our strength as a nation is inextricably linked to the strength of our unique and comprehensive systems of alliances and partnerships. … I believe we must be resolute and unambiguous in our approach to those countries whose strategic interests are increasingly in tension with ours. … My views on treating allies with respect and also being clear-eyed about both malign actors and strategic competitors are strongly held and informed by over four decades of immersion in these issues.”

He closed with: “I very much appreciate this opportunity to serve the nation and our men and women in uniform.” At that time Trump backed away from pulling the U.S. force.

As the whole world knows, two weeks ago Trump attempted to appease the president of Turkey by withdrawing the U.S. contingent from Syria, over strong objections from his advisers and Congressional Republicans and Democrats. The House of Representatives, split between impeachment-pushing Democrats and Trump-groupie Republicans, still came together on October 16 to vote 360-60-4 to condemn the Syria pullout. After being reminded by Senate Minority Leader Charles Schumer that Mattis had warned that “ISIS would resurge” in the absence of a U.S. force, the president called Mattis “the world’s most overrated general,” adding that “I captured ISIS in one month.”

Trump looks at U.S. Mideast policy and sees not a commitment to stand with allies against aggression by authoritarian regimes and the ravages of extremist factions and terrorists, but a hot campaign issue: a promise to end “endless wars.” Instead, his action of backstabbing the Kurds invites endless war, as Turkey’s powerful military destroys Kurdish towns, the Kurds ally with the bloodthirsty Syrian regime, and ISIS fanatics execute civilians. But his shtick about “endless wars” sounds like a winner among the Trump cult, his so-called “base.” They still show up at those MAGA rallies, and they love those cracks about “fake news” and “do-nothing Democrats.”

What they don’t care about is character, for example, the character of Mattis, who devoted his life to defending America and American allies in bloody places in Afghanistan and Iraq. His mission was leadership and the teaching of leadership in brutal combat environments. He often has been quoted as saying, to Marines in Iraq, that “whenever you show anger or disgust towards civilians, it’s a victory for al-Qaeda and other insurgents,” and “every time you wave at an Iraqi civilian, al-Qaeda rolls over in his grave.”

Character yet again shone through Mattis’s refusal since he left office to join many deeply worried Americans in criticizing the charlatans and amateurs now running U.S. foreign policy.

Instead, he maintained the personal dignity—the bearing—he had honed over those 45 years, offering only that, “If you leave an administration, you owe some silence. When you leave an administration over clear policy differences, you need to give the people who are still there as much opportunity as possible to defend the country.”

Others differ, saying those people have had their chance and failed, that Mattis should speak up.

Early in his career Mattis served at Marine Corps Base Quantico, the “Crossroads of the Corps,” going through the Amphibious Warfare School and Command and Staff College. After promotion to lieutenant general he returned to Quantico to head up the Marine Corps Combat Development Command, or MCCDC, which develops Marine Corps tactics and strategy.

When I finished my Marine Corps service in the mid-1970s—a lifetime ago—I left D.C., where I had worked as a communications-electronics officer at Headquarters Marine Corps, after a year with the Third Marine Division on Okinawa. Sandy and I moved back to northern Virginia a decade later. In my civilian work life I returned many times to Quantico and MCCDC.

In terms of facilities, Quantico is far different from when I was there to attend Marine Officers Basic School and Officers Communications School. But Mattis left his mark. His philosophy is indelible. It starts and finishes with development of character in defense of sacred values. Rather than tolerate ignorance and political opportunism in defense policy, he resigned, reinforcing those values. He gave the nation 45 years of character. The nation is left with: Trump.

Nephro Time

October 14, 2019

Our son Michael and daughter Marie traveled long distances this weekend to spend many hours in my beige-blazoned hospital room, as I heaved and gasped with the aftermath of my “nephroureterectomy” which, to keep this relatively at a layman’s level, involves the removal of several body parts. I went through it Thursday. The other two girls called the hospital over the weekend.

It’s not over yet, as I took a couple of wrong turns on my nicely crafted recovery plan, which called for me to be out of here yesterday. Instead I’m waiting for results of an all-upper-body x-ray while staring at the overwhelming beigeness and, out the window, at the tops of trees, now tinted by fall, above this massive hospital’s parking lot. Friends stopped by yesterday for warm-hearted visits. Sandy and the kids are gone, partly because of their schedules and partly at my urging, since I know, having done this before, that hospital patients quickly run out of ideas for playing host to visitors. Haven’t eaten solid food for four days, but now, Sunday evening, I’m well enough to sit up in the bed.

This being Sunday, a guy came by from our parish to distribute communion. I couldn’t take it because I couldn’t say I could keep it down, which hints at my morning. But he read today’s Gospel. We talked a bit about his time at the Naval Research Laboratory and my time at the Office of Naval Research, which funds NRL. Funny coincidence. He left with good words, “God will help you beat this.” Always helps to hear that.

Life will be curtailed when I get home. I’ll be dragging around a catheter for ten days, so no trips, no visiting, no yard work–except brief walks up the block, nothing that involves movement. After that, camping on the couch. Then a follow-up appointment to this adventuresome weekend. The catheter comes out. Then another visit to the oncologist who’s coaching this little enterprise to discuss what comes next. There will be another scan. I’m still wearing the medi-port in my chest.

That will get us into November, which means Thanksgiving, which means Christmas will be blowing in. We’ve already been talking about the THuG running group’s annual Christmas dinner, probably the group’s only event in which I’ll participate. Sandy will be seeing a neurologist and a cardiologist. So a busy season ahead. An uncertain season.

What I remember, what I always make a point of remembering, are the kind words, even those casual kind words that sign off casual conversations. They gain intensity in late fall as we relive our progress through the year, and that of family members and friends. I hear from time to time of good things people I know are doing for others less fortunate. We may be bewildered or outraged bystanders to the direction the nation is taking. But maybe our personal efforts are redoubled to do good things, or at least to try to do good things. The Holy Family food pantry where I once worked still is operating. Others I know are doing important, similar things.

Here at the hospital, these images come together, even on the weekend, when the docs are playing golf or watching football—whatever they do on weekends when they’re invisible at the hospital. The senior RNs, “nurse charge practitioners,” charge nurses, the student observers, are kind and good-hearted and enthusiastic, jumping in not only to take vital signs and administer drugs, but also to change linens, empty various unpleasant things, and take notes from cranky patients. They smile and wish you well.

If the future is set in the past, the fall is set in the late summer. This one ends for me with a bang, or with a snip—several snips. But we’re stepping out, planning Thanksgiving, maybe something else to look back on happily. But it ends. Then the memories emerge.