December 6, 2024
Dear Interested Readers,
Thinking About Healthcare During A Season of Hope, Peace, Joy, and Love In Conflict With Disappointment, Conflict and Fear
My lake is frozen. There is snow on the ground. The sky is clear. There is abundant sunshine to create a picture-perfect winter day until the next storm comes through. If we don’t have a lot of rain and warm days in the near future, we will have a white Christmas.
I am feeling good about myself and the immediate future of my family. I am three days post-op op from my much-feared and delayed (by me, not the system) left total knee replacement, and I am delighted to be able to report that the pain is minimal. I can walk around with my walker, and do almost everything for myself. My family has been supportive. My son from California who works mostly from home arrived the day after Thanksgiving and has graciously stayed to help out in the first few post-op days.
There is more to rejoice. We had a wonderful Thanksgiving and Thanksgiving weekend before my surgery on Tuesday. My son and daughter-in-law who live in Maine drove down through rain and snow on Thanksgiving Day with our very active ten-month-old grandson, and they stayed for the weekend which gave me plenty of time to enjoy the antics of the latest Lindsey. We had last seen him about six weeks ago. During the interval, since we saw him, he has moved from sitting and early crawling to fast crawling everywhere, and he is pulling himself up to standing on furniture and anything he can reach as he contemplates walking. He is quickly advancing from being a “rug-rat” to the next stage of childhood development— “curtain-climber,” and I am a thrilled observer.
I love watching my grandson begin to explore the world even as I worry a lot about the world he will be given. It is amazing to think that he will reach my current age in 2103. I wonder what the state of our democracy and the quality and equity of our healthcare will be by then. I have many reasons to have a “mixed mood.” My own life is very positive and satisfying. I live in a beautiful place. We have a large circle of like-minded friends to support, inform, and amuse us. We have easy access to very good healthcare, and we can pay for it. Unlike many in our country, my family has no economic concerns. On the other side of the ledger, I am concerned and worried about how the others whom I care about and the nation as a whole will fare under the incoming administration.
I have mentioned before in these notes just how much I love my local newspaper, “The Valley News.” The Upper Valley is predominantly “blue” on both sides of the Connecticut River and includes Dartmouth College, but there are a few communities that lean “red.” With the excellent local reporting of The Valley News, I get a balanced picture of the political thought in my area and the controversies that exist. I also read the obituaries. I enjoy playing a game with myself to see how many of the recently departed were older or younger than me. “Life expectancy” and how politics impact it at all levels–local, state, national– that drive the social determinants of health is of great interest to me. I get the e-edition of the paper and also have the paper delivered because I love reading a “real paper” and then using past editions to start a fire in my fireplace.
The editorial page of The Valley News leans my way, left. Some terrific local voices appear regularly. The occasional column that always gets my attention and leaves me thinking is written by Randall Balmer, an Episcopal priest, who is the John Phillips Professor in Religion at Dartmouth College. His column that appeared last Saturday in the “Weekend Edition” of the paper was entitled “Hoping against hope during Advent.”
When I read Professor Balmner’s column I felt that my feelings about the election had been validated, but more importantly, the points Professor Balmer made helped me look beyond my disappointment and toward a path defined by the hope that all is not lost or vulnerable and that over the next four years we might still be able to make progress toward better health for all Americans despite the radical positions that Trump advocates. We shared many of the same thoughts. He just said them better than I ever could. So, I want to give you my annotations to his very thoughtful column.
Before giving you my annotations to the column, I would like to describe to you my experience with the concept of “Advent” while trying not to offend any reader who is skeptical or even repulsed by a “Christian worldview.” For starters, there is no single “Christian worldview.” I intend to share my personal experience without proselytizing.
I grew up as the son of a Southern Baptist minister in the fifties and sixties. The time frame is important because the far right-leaning orthodoxy of most contemporary Southern Baptist congregations did not exist before the seventies. The church believed in a very strict separation of church and state. To give you a dramatic representation of the huge change in the political posture of Southern Baptists, you may be surprised to know that at their annual convention in 1971, Southern Baptists endorsed a woman’s right to an abortion.
The Baptists of my childhood celebrated Christmas and Easter, but we did not pay much attention to the “Liturgical” calendar. We did not observe Advent as practiced by our Catholic and Episcopal neighbors. Over the last few decades, most protestant churches have adopted the message of Advent which is for me a relatively new practice and seems a little foreign.
For those like me, for whom Advent may feel like a foreign concept, let me say that it is celebrated over the last four Sundays before Christmas. There are four “themes” of Advent. Those four themes in order are hope, peace, joy, and love. (Ironically, the message of Advent is not that different than the attitudes that Vice President Harris expressed in her short campaign for the presidency.) Each week one of those themes is celebrated by the lighting of a candle by a family from the congregation. Each week a new candle is added until all four candles are burning together.
It occurs to me that there is some similarity to the Jewish tradition of lighting the menora during Chanukah. As the candle of the week is lit, one of the family members usually makes a brief statement about the “theme” for the week. Last Sunday was the first Sunday of Advent and “hope” was the theme which explains the focus of Professor Balmer’s thoughts in his weekend column.
Professor Balmer begins by delivering a better version of what I have just said, and I have bolded the words that most spoke to me.
Hoping against hope during Advent
For Christians, the season of Advent, the four Sundays leading up to Christmas, is the season of hope and anticipation. It is a glorious time, one seemingly at odds with the calendar itself because it coincides with the shortest days of the year (in the Northern Hemisphere). In the midst of darkness, we look for — we crave — hope and light.
It’s fair to say that many Americans are not feeling too hopeful right now, though it must be acknowledged that roughly the same percentage feels otherwise. For a second time, we’ve elected to the presidency a corrupt narcissist and scofflaw who will never be held responsible for his crimes, who plans to pardon his accomplices and who promises retribution against his opponents.
We have every reason to expect another four years of cronyism, self-dealing and prevarication. (I’m not a betting man, but I’d take the “over” on the 30, 573 false or misleading statements that Donald Trump tallied in his first term.)
There is no question as to whether Professor Balmer and I are drinking from the same cup and looking in the same direction. He is not finished in his attempts to express his concerns. Later he will try to see the silver lining of the moment to nurture some hope. It is not easy for either of us to just say “Trump is not up to the job he was given.” We feel obligated to expand the discussion of how he concerns us. Balmer is not done yet. Looking forward he is peering into a darkness that we will be forced to resist or strive to change soon, or in four years at the latest, or risk long-term consequences. He continues:
To make matters worse, for at least the next two years (until the mid-term elections of 2026), we face an administration with no guardrails whatsoever. As his Cabinet choices already suggest, Trump surrounds himself with sycophants. Congress is prepared to do his bidding, and the Supreme Court, once a barrier to extremism, has embraced extremism and made a mockery of the rule of law.
We shall test over the next four years the durability of our democratic institutions. Will they be able to withstand the onslaught? And where do we find hope in times like this?
You almost want to say that “hope” is an allusion. Hope it is not a guarantee for what we want, but Balmer feels there is still reason for hope if we look back at our history and look around for possibilities for resistance now. He answers his own question about where to find hope now:
We can look to history. The United States has weathered corrupt politicians before: New York’s Tammany Hall or the Teapot Dome scandal of Warren Harding’s administration, for example, or Watergate in the 1970s.
We can look to various writers and pundits. Emily Dickinson wrote: “Hope is the thing with feathers / That perches in the soul, / And sings the tune without the words, / And never stops at all, / And sweetest in the gale is heard.”
Anne Lamott assures us that “Grace bats last,” and Garrison Keillor says that life is good, despite the fact that we have “elevated a cruel and corrupt man to power” and “now we shall see what good our Constitution is and what sort of senators and judges we have.”
I happen to believe that hope is a mandate. Some time ago, a colleague asked me to write an essay about hope, and it occurred to me that of the three so-called theological virtues — faith, hope and love — hope is the only virtue that is volitional.
That is to say that whereas faith (I believe) is a gift and love defies rational explanation, we can choose to be hopeful. Hope is an act of will. I can — and I do — choose to be hopeful. And I believe furthermore that, as a parent, I do not have the luxury of despair.
It has never occurred to me that my concerns for the future of my children and grandchildren are a responsibility that requires me to do more than complain. My concerns and contemplation are not enough. My responsibility to future generations requires me to take action. Balmer has more to say:
Make no mistake, I’m no Pollyanna. Like many others, I look on the next four years with a sense of foreboding. I have no illusions that the United States is about to enter a golden age. As someone said, MAGA most likely stands for “Make America Go Away.” The best that we in the resistance can hope for (that word again) is to “Make America Good Again.”
That’s it. Balmer is done with painting the dark side of the moment. He accepts the responsibility and is advocating for action:
A heavy lift? Without a doubt. But the season of Advent is about anticipation, finding glimmers of hope amid the darkness.
Christians are often told to “count your blessings.” Yes, we live in a troubled world of autocrats and pollution, of hunger and aggression. But it is also a world of stunning natural beauty, transcendent artistic production and good people doing good things.
It is a world where, more often than not, hope and patience are rewarded. That is the lesson of Advent.
Balmer is a preacher, and like all good sermons this one contains a down-to-earth story to illustrate his message
One more example, albeit a trivial one. I’ve been a fan of the Detroit Lions since 1963, and anyone who follows football even loosely knows that my hopes have been dashed countless times over the last half century. As I write this, however, the Lions are favored to win the Super Bowl in February.
Balmer then elevates the need for hope from an option, past an obligation to a mandate. Perhaps he did so since President Trump is claiming that he has a mandate when slightly less than fifty percent of voters cast their votes for him, his threats, and his empty promises. He boldly says as his last sentence:
Hope, even when it involves hoping against hope, is a mandate.
I plan to make the “mandate of hope” a continuing subject as we muddle through and try to survive what is surely coming our way over the next four years. My two greatest concerns for the moment are decreased support and access for many who depend on Medicaid and the ACA for access to care and falling resources for providers. The best strategy for dealing with the likely fall in resources is process improvement and waste elimination. Free care financed by a sense of mission may provide some relief for those who will lose access to care. Professor Balmer is right. It is time to think and then act as a hopeful choice.
A Brief Report On My Hospital Experience, and a Pretty Winter Picture
I was told in 2010 that my left knee was totally shot from a combination of old football injuries and over forty years of running, and it needed to be replaced. I was apprehensive. An operation would have taken me away from my responsibilities for several weeks at a difficult time in our corporate life. I also feared surgery. I opted for physical therapy, injections, and an expensive “load shifting” brace. I wasn’t too concerned that the leg looked bent.
I was pleased to discover that things got better and I was pain-free and able to walk and jog a little although all thoughts of running another marathon were gone. My rationale has always been that you don’t operate on a joint if your pain is not a problem and reasonable activity is possible. So, I felt pretty smug about my choice until last fall when things began to get worse in both my back and my knee to the point where I had to quit walking and was having excruciating pain. My back was fixed in March, but as I tried to get back on the road using crutches my carpal tunnel symptoms got worse and my knee became a persistent source of pain. I was looking forward to enjoying the fall and my granddaughter’s fall volleyball season so in late July I signed up for surgery with Dr. Sparks at Dartmouth Medical Center on December 3rd. Today’s header is a picture of the main entrance of the huge central facility of the Dartmouth Hitchcock Medical Center complex that was taken by my son for me as I was headed home after discharge.
As I could do less while hurting more, I began to regret the delay, but the delay did give me time to prepare by having bilateral carpal tunnel releases and getting a few bad teeth pulled that could have been a source for a devastating post-op joint infection.
My fears were understandable, but none of them materialized. What I experienced was a very efficient and patient-centered system that turned my dread into a very positive experience. One thing that has changed a lot in the nine months between my back surgery and my knee surgery was nursing. In March, every nurse who provided me care was a “traveling nurse.” In December, every nurse I saw was a permanent local employee. I had a conversation with one nurse who told me that she was ok with using “travelers” when there were staff shortages, but it was much better to have a stable team. As a patient, I could feel the improvement. This improvement in nursing is a source of hope, and perhaps an indication that with focus and innovation, we might weather the storm of vast changes in healthcare that might follow from the appointment of Robert F. Kennedy, Jr. as Secretary of Health and Human Services and Elon Musk’s and Vivek Ramaswamy’s efforts to take trillions out of the federal budget.
My very talented neighbor, Peter Bloch, has once again added joy to my life with the presentation of a gorgeous video featuring “ice-in” on the lake we both love. Tuesday was a big day. I had my knee fixed, and the lake iced over at one of the earliest dates in recent memory. On Wednesday night and early Thursday, we got an additional four or five inches of snow, so we are in a “winter wonderland.” To view Peter’s video, click here.
In his introduction to the video Peter wrote:
Where I live in central New Hampshire, one prominent aspect of the changing seasons is when the lakes freeze over in the fall, or thaw out in the spring, these events are called “Ice-In” and “Ice-Out.” We even hold fun betting-pools to predict the date of Ice-Out on some of the lakes. For many lakes, there is an unofficial definition of Ice-In and Ice-Out, usually having to do with whether you can take a boat from one end to the other. We take these things seriously!!!
Ice-In on Little Lake Sunapee in New London, NH occurred extraordinarily early this year: December 3. At that point one half of the two-lobed lake was thoroughly crusted over, and the next day more ice formed on the deeper northwest part of the lake. I filmed with a drone on both of these days, and it truly was a magical experience to rise up over the landscape and see forms and textures and colors that can’t be observed and appreciated when our eyes are tethered to the ground…
Peter’s drone sees what only the birds get to enjoy. If you don’t have the four minutes necessary to view the video, below is a shot I grabbed that gives a good sense of the beauty, but there is much more to appreciate in the video as you see things close up as they change in time.
It’s easy to appreciate the glacially created peninsula that divides the lake into two almost equal sides causing some to call it “Twin Lakes.” I am on the shallower, frozen side in the foreground. In the distance, you see Mount Kearsarge on the right and Rugged Mountain in the distance in the center-left.
Peter’s work captures the fact that it is good to remember that change can create beauty and the ability to change is a source of hope. Choose hope and action over despair and…
Be well,
Gene
