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.
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.]
The Duke and Duchess of Cambridge and Prince Harry each planted a poppy.
Each poppy is made by hand. See the video at the Tower’s web site: http://poppies.hrp.org.uk/about-the-installation.
Poppies, of course, became symbols of the war because of the poem by Lt. Col. John McCrae, the Canadian physician who served as both a gunner and a medical officer though much of the war. During the Second Battle of Ypres, his battalion faced one of the first chemical attacks, but still held. Like so many soldiers, he avoided death by bullets, bombs, and gas only to die of pneumonia early in the last year of the war.
In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.
We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.
Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.
Some critics think the poem falls apart in the third stanza, where the pastoral and elegiac mode with which the poem opens is replaced by “recruiting poster language.” They have a point. But the poppies worn today—like those planted at the Tower—ask us only to remember and mourn, not to fight. We are free to think that if the fallen are angry, it is not at those who refused to “take up the quarrel,” but with those who started it.
About a half hour into a conversation with a fellow who serves as a mouthpiece for ExpressScripts, I found myself asking those questions. He replied that I should take them exactly as my physician had prescribed them. He tried to sound as if taking pills he wouldn’t let me have was an obvious and simple course of action.
During this extensive conversation, the representative of my “health care provider” also told me:
•That the prescription for which I had received a denial notice had never been received by ExpressScripts.
•That, yes, the prescription had been pre-approved, but that didn’t mean the prescription had been received.
•That if I wanted him to look for the prescription, I would have to wait on hold a listen to the same saccharine tune over and over, because he could only address my case while I was on hold. He could not do work that didn’t require my input and then call me back, because . . . well, the why was a bit cloudy.
•That, yes, the drug had been prescribed and pre-approved but that my doctor wanted me to have too much of it.
•That it didn’t matter that I had been told other things at other times.
•That I should not think his story world change, even though he had just changed his story about the prescription not having be prescribed or pre-approved. Or because his colleagues had given me other stories. ExpressScripts was committed to my health and didn’t treat its customers’ health lightly.
•That I shouldn’t doubt either the accuracy of his statements or the goodwill of his company just because they had wasted a great deal of my time and denied me a drug my doctor says I should have.
•That, yes, I should have my doctor waste more of his time pleading for the drug if I wanted to take the drug he had prescribed.
•That I shouldn’t should so hostile.
After that, I called my doctor a couple times, and he and his staff did, indeed, waste more of their time begging ExpressScripts to let me have the drug. We reached a point where I did receive the full dose, but only as two separate prescriptions at different dosages, and I had to produce paper coupons to get one of them. Then another month went by, and, whatever they had done in the past, now they would not let me refill the prescription until two week after I had run out of it again. Then we reached an accommodation whereby I got a month’s supply of the drug at the price I am to pay for drugs according the stated rules of my plan every third month. During each of the two off months I would have to pay more than a thousand dollars for the drug. Things went on like that until a test showed I should not take the particular drug anymore.
Only that last decision was about my health. Everything else was about money. The guy who fronted for ExpressScripts on the phone told me that his company does not care about money—or that, if they do, they make money by fulfilling prescriptions, not by denying them. I tried to reconcile that story with the newspaper reports that came out a couple days later about the company’s deciding to reject a whole class of prescriptions—one’s involving compounding pharmacies—because they cost too much, but I didn’t manage to square that circle. I know that I was promised healthcare in retirement in return for years of labor, but how much healthcare I get seems to be in the hands of people whose motivations do not include looking after my welfare.
I mention this colloquy the ExpressScripts flak as more evidence that our health care system is in a shambles and that neither the defenders nor the opponents of the Affordable Care Act are paying any attention to the real problems. The insurance companies—and I include ExpressScripts in that group—have no interest in the welfare of the patient. They make money by not paying claims. My former employer, the State of Illinois, decides which of these companies to employ not on the basis of how well they further my health and welfare but—let's just say on the same basis it made the decisions that left its pension funds depleted and its former governors in jail.
I am not for having the government—certainly not the state government—take over the health care system. They do a rotten job running some parts of it, though an excellent job managing others. I am for a single, governmental payer. Private providers would complete on the basis of health results and patient satisfaction, not on widening the spread between what they pay for drugs and actual cost of the drugs they deliver. Patients would be better off, and people like the man I talked to on the phone would be able to do respectable work instead of shooting people who are being cheated through the grease.
Mykonos is, I suppose, as lovely an isle as one could hope to see, if one's taste runs to the sun-bleached and Mediterranean. I myself prefer cool places where every living thing does not seem to be fighting a losing battle against drought. I'd prefer the heath of the Hebrides or, still better, the woods of the islands off the coast of Maine, even if that meant clouds and rain and more people appearing fully dressed.
I am not sure what men in Mykonos do now, besides tend bar. Once they must have fished, but there is no evidence of that beyond the fish in the tavernas, and they may have been flown in from the same factory ships that supply St. Louis and Milwaukee. Piracy no longer seems to be a career option, but I suspect it once was. Byron's Corsair would have found this a congenial spot. The piety business takes up a lot of land—there are votive churches everywhere, the fulfillment of vows by desperate sailors and their families. They are touching and beautiful in their own way, but I didn't see a single priest serving them, only the old ladies who lend skirts to the half-naked tourists of both sexes and make sure a euro has clinked in the box before a candle is lit. A few guys drive busses, and in off-peak times I'm sure white-washing a whole town employs many others, but mostly the local men are out of sight. Women staff the boutiques and do more than their share at the tavernas.
I’m told that male visitors can enjoy a gay scene, if Greek love is what they're interested in. For the heterosexual male tourist, however, there seem to be only two pastimes. One is standing outside the shops holding a lady's purse and packages while she shops for jewelry or trinkets or clothes in the over-priced boutiques. I saw retired construction workers and computer programmers and business executives from across the English-speaking world transformed into this sort of emasculated cigar store Indian and planted outside every shop in town. The other way a guy can spend his time ashore is to settle into a bar whose playlist features covers of lighter 60’s fare and get quietly or noisily drunk. Before you down more than a couple, you will have heard "Those Were the Days, My friend,” “Try to Remember the Kind of September,” and “The Fool on the Hill,” several times, along with, as instrumental interludes, several renditions of “Never on Sunday” and the theme from “Zorba the Greek.”
Being a bachelor with a bad liver, and thus excluded from participation in even those activities, I didn't find Mykonos the most interesting place I have visited on my travels. I understand it was a pleasant simple island unfrequented much by outsiders until Jacqueline Kennedy and Aristotle Onassis brought the Jet Set here in the 1960’s. I'm sure it’s more fun for the truly rich, but I suspect that anywhere you go a part of the sad atmosphere of that era lingers. I was but a child in the 60’s, but I recall that the Kennedy era and its aftermath included not just tragedy (the assassinations, the wars), not just nobility (the civil rights struggle, the space program), not just childish rebellion (sex and drugs and rock ’n’ roll), but also a brittle feeling that people were pretending to be having a great time but really were fending off a feeling of emptiness. That is part of what I always associate with the Rat Pack, with the part of “Camelot” that includes Marilyn Monroe at the President's birthday party, and the whole tawdry swinging, girl-watching, faux cool, medallions-and-turtleneck-where-my-tie-should-be atmosphere that pervaded the time as much as pot smoke and rock 'n' roll.
I have no desire to revisit that era. I want to be where people wear their tuxes unironically or dress for a day of fishing. Or perhaps I'm just too old and too single to enjoy any place where you keep hearing a voice asking, “Is that lonely woman really me?” She’s not talking to me, but my only answer would be, “At least you can shop and giggle and swill the ouzo. I’m heading back to the ship.”