October 2014

55 years, 11 months, 9 days

Today I have lived as many days as my mother did. She died when I was 16, and I will always recall the date of her death: April 18. (Also the date on which my former fiancée began, though we did not realize it at the time, the process of dumping me.) I will remember the month of her birth: May. (She discouraged greater specificity because it might have led to either celebrations that would have dulled the edge of her repeated declaration, “I never ask for anything for birthday or my anniversary: I just want you to be nice to me all year long,” or inquiries about the year of her birth, which was not a piece of information she shared lightly.) But this is my last chance to compare when she reached life’s milestones with my own pace down the road. I have already marked the days when I had lived without her as long as I had lived with her, and when I was as old as she had been went she got married—and that was 17 years ago. In a year I will also lap my father, who died six weeks before my mother, and then I will be plunging on into a stage of life they never reached.

I have anticipated this point for some time, and its approach has made me feel quite strange. That might be because I rarely hear anyone else talking about such things. Most friends of my own age still have living parents. My older friends have dealt with parents dying not too early, but, frankly, too late. The first time a person struggling with a parent who had become entirely dependent on his children said, “Brian, you were lucky,” I thought that was a trifle heartless. Having seen more, I now think it was simply true. (And, lest anyone think I had it two easy, my mother’s final illness stretched on for years, and I did not entirely escape the burden of my guardian aunts’ years of decline—although I didn’t have to bear the brunt of it.) My friends don’t think about when they will have lived longer than their parents: they wonder how they’ll live though the years of taking care of them.

My brother crossed this milestone about a year ago, but I don’t expect us to compare notes. He focuses on the positive much more than I do, and he thinks that “dwelling” on this sort of thing unhealthy. But I have been able to talk it over with a cousin. A year after my parents died one after the other of completely unrelated causes, my father’s brother and his wife went the same way. (The Ragen boys’ lungs gave out, due in part to the Judas gene I’m told I have not got; their wives died of particularly cruel forms of cancer.) When I saw Cousin Mike’s at a family wedding, I think he and I were both relieved to find someone else who was troubled by reaching this point. “It was really freaking me out,” he told me. “I knew I had to do something. So I bought a Bentley.” Cousin Mike is an ophthalmologist and spends his days performing LASIK operations. I’m a professional critic and spend my days thinking about things. We’re both native Californians and grew up at the height of the car culture, when gas was cheap and the highways were empty. That experience gave him a solace he can draw on in times of perplexity. It gave me the subject for a book about trying to escape the burden of the past (It’s called A Wreck on the Road to Damascus.)

I don’t have to think very long about why this milestone is troubling. Everyone’s parents–and their whole generation—are barriers between them and age and death. Once they are gone, one feels exposed to the great, unimaginable fact. That is not something everyone likes to be reminded of. After the funeral of the last blood relative in my mother’s generation, I looked at all my first-cousins on that side of the family and said, “Now that Death has completed his work with our parents’ generation, he can turn his full attention to ours.” I don’t recall that anyone regarded that as a helpful contribution to the family conversation.

Of course, almost all my cousins have the other fence against age and death—children. They may or may not be props in one’s old age—but there is a chance. And even if one never thinks about the “serial immortality” provided by generations of heirs, it would be odd if modern people were not moved and comforted by the same things that succored their ancestors. And they wanted heirs. Before the ancient Hebrews had any real hope of heaven, they counted on being rewarded through their posterity.

Somehow, though, I am the only member of my generation to never get married. And only two of us never had children. (My childless cousin, a divorcé, and I both went to Princeton. The only question in the family is whether the place turned us squirrelly or accepted us because we were that way already.) To add some irony to the story, I, the childless bachelor, have written extensively about the malign influence of the myth of the American Adam, who avoids the role of husband and father, and I have devoted myself to the study of heraldry, as symbolic system that encodes marriage and inheritance, and have even been granted a coat of arms—one that will probably never pass to “the heirs of my body.” No one will ever cry about me as they drive to work or while singing that one particular hymn. No one will ascribe his troubles to me when talking to the therapist. No one will think about me on the day he lives as long as I have.

My mother knew many disappointments, but she escaped the ones I am facing. I do have the model of four spinster aunts—only two of whom were regularly described as “crazy.” None of them ever had even a single cat. (And one of them married when still older than I am now.) There are some literary models for the aging bachelor uncle. As I recall, they tend to be disreputable, Dahl’s My Uncle Oswald leaps to mind, as does Digory’s Uncle Andrew from C.S. Lewis’s The Magician’s Nephew. The popular culture of my formative years gives no better models, unless I want to be Uncle Bill on Family Affair. (If I get Sebastian Cabot as my valet, I’ll take the job, even if it comes with three kids.) Uncle Joe on Petticoat Junction was always “movin’ kind of slow,” but that was just as well, since his sloth was a check on his irascibility. The Beaver’s Uncle Billy was such a rotter and blowhard that they had to transform him utterly before he made a second appearance. A couple decades later Alex on Family Ties got a brilliant bachelor uncle who looked like Tom Hanks—but he turned out to be a violent drunk. Still, there must be exceptions. Uncle Charlie on My Three Sons? Well, I do cook, but I lack the years in the Merchant Marine that would let me wear an apron without looking like a sissy. And the purely literary models are no better. Sterne’s Uncle Toby? Too Protestant. Thackeray’s Major Pendennis? Better connected and worldlier than I can imagine myself. I have to say that spinster aunts come off better in books than bachelor uncles, just as they do on television and in popular culture in general. After all, if you call someone a “funny aunt,” they think she makes people laugh. If you talk about a “funny uncle,” they give you the number of Child Protective Services.

But I hardly need go to a second-degree relative for a model. Though tomorrow I will reach an age mother never did, I have been turning into my mother for years. I have always been the one arranging the parties and hoping people will behave. Lately I have become but a part-time writer and a more-or-less full-time philanthropist, rushing from board meeting to board meeting, and that was how she passed most of her adult life. Sadly, I have not become a social magnet who everyone seems to love, and I have not been placed at the helm of every organization that can attract my support. I suspect, in fact, that people wish that I would just sign my checks and shut up. So I face the days ahead with some trepidation. But perhaps I’ll grow into the role. Besides, I can always buy that Bentley—though the truth is, I am more a Prius sort of guy.

Another Hand of Cards

I have mentioned how odd I found it that I had to carry four or five health insurance cards when I was an employee of the State of Illinois, considering that all the money comes out of the same pot. I spent a couple years with another kind of coverage, but now I am back with the State, and they have dealt me a new hard. There are four this time, instead of five, but that is only because retirees are not eligible for the Employee Assistance program, which provides things like “Anger Management” classes and drug rehab. Since I am no longer likely to snap on campus, the evidently don’t care if their medical insurance provider drives me to go postal or start asking my friends visiting Thailand to mail me some Valium.

It, of course, makes no sense for me to have so many different cards and card numbers. I won’t go into what they are all for again, but yesterday I had an experience that reminded me how kludgy our system is—and how the innovations that make American business (and American medicine, until we start paying for it) don’t seem to reach our system of charging and paying for medical care.

This fall I am not worried about Ebola, which I have essentially zero chance of encountering. I am worried about the flu. A quick look at the Centers for Disease control web site tells me that about 200,000 people are hospitalized as a result of the flu every year, and as many as 49,000 die of it. I also know that when I have had it, I have been very unhappy—and that every year I age I am more likely to move from the “very unhappy column” to the “in the hospital” column. So I get an annual flu shot. This year, since I had serious surgery not long ago and have had some respiratory problems, I decided to get a pneumonia shot, too.

So there I am, the model patient. I am not putting in an already over-burdened Emergency Room under still more strain after I have been inflected. I am not taking up time in a busy doctor’s office. I am getting my vaccinations for influenza and pneumonia in the simplest and most cost-effective way possible. In other words, I am at the counter in the back of a suburban Walgreens talking to a pharmacist.

Things go smoothly until she asks for my insurance card. First, we try my health insurance card. Then we try my prescription card. If they were treating my flu shot like other prescriptions, that would tell the pharmacist how much Express Scripts would pay, and thus how much she should charge me. But the flu shot, which may prevent my needing much more expensive medical care and prescriptions, is not covered so simply. After some research, she discovers that I have to pay myself, and then file for reimbursement.

Let’s fast forward to the present, when I have downloaded the Express Scripts claim form. I now have two pages of text, lines, and boxes, which I am to fill out with a pen. I will enter the information encoded on my various cards—the form, in fact, tells me “See your prescription drug ID card.” I also find that I have to go back to Walgreens to get the signature of a pharmacist and the numbers to fill the boxes under “NCPDP/NPI Required.” I trust that either I or the pharmacist will make a mistake somewhere, which will allow Express Scripts to send everything back to me and delay sending me the payment I am now owed. (Why don’t I call Express Scripts for help? Because I know form experience that they will lie to me until I become so nasty that they break down and look in my records—while keeping me on hold—and that even after they can not longer argue the facts, they will invoke policies I have no way of researching until I give up.) Paper, signatures, envelopes, stamps, bureaucrats: the way the State of Illinois and Express Script like to do things.

But back to the pharmacy counter. Our adventure dealing with the people obligated to pay for my health care now being at their normal dead end, I need to pay. No problem. Walgreens takes ApplePay, so all I have to you is wave my iPhone and touch my finger to its “home” button. Done. Walgreens have a rewards program, and I am part of it. No card now either: I just get my virtual card up on the iPhone screen, wave it over the scanner, and my points are in the system. All that’s left is the shots. The pharmacist gets the doses ready with lightning speed, meets me behind a screen already wearing rubber gloves and ready with alcohol swabs and Band-Aids, and in less than I minute I am immunized, wearing two Band-Aids I don’t really need, and on my way.

But I am still left wondering: we me make our commerce ever more efficient and the actual delivery of medical care wonderfully smooth, so why do we still choose to apply none of that knowledge and skill to paying for health care? And once again, I see that neither the proponents of “Obamacare” nor its impassioned opponents are talking about the real problems a patient encounters. (You can, however, find them described quite well in Kafka and Dickens.)

But enough of this. I have forms to fill out. Where’s my pen? I hope I still have some White Out, in case I made a mistake!

[Update: After having had me fill out the the forms and get the pharmacist's signature, ExpressScripts declined to pay for my flu shot. Since they knew what drug I wanted reimbursement for before asking for the form and the signature, I would ask, “Why not just say ‘No!’” But I know that is not how the game is played: They don't want meet notice how often they say “No!” They want me to give up and say “The the hell with it.” If I just give up, perhaps I won't notice how many claims they deny.]