The Torrents of Spring:Seacoast New Hampshire

Exeter, New Hampshire

It rained throughout the seacoast today, a heavy driving rain which washed out my baseball game in the first inning. I thought we could have played through, but I was out voted.  Hasn't rained for weeks, but it came  Sunday, just in time for the game. 

Could have been worse:  It could have rained Saturday, which would have washed out the Hampton Democrats' annual garage sale, an  important fund raiser and bonding event.  

Boar's Head, Hampton, NH

Put out a bunch of picture frames, golf balls, tarnished silver, china place settings, rocking chairs, lawn ornaments and you draw a crowd in Hampton.  You get to meet the citizenry, and it's an education. 

Exeter Road (Rte 27) Hampton, NH

I have deplorably little experience in the world of commerce. Really, I'm completely at sea when it comes to selling things, but I had my instructions. The deal at the sale was you are given a plastic shopping bag and you can fill it with whatever you find on the tables for $5.  A forty something woman picked through the treasures and filled her bag carefully and I suggested she match her plates and cups with the matching salt and pepper shakers, which she had overlooked and she locked onto my eyes with a look of real gratitude.  "You are a caring man," she said. "I think you are a man who knows where his salvation comes from."

I know even less about my own salvation than I do about retail, and I sputtered something about how I supposed I would find out about all that when I died.  This seemed to disappoint the shopper, but it greatly amused my good friend and fellow traveler, who floated by just as I was being almost saved. My friend looked at me with her blue eyed beamers, an expression of delighted anticipation and she said nothing, just enjoying the moment.  The shopper left with her $5 bag. "Well, that was fun," my friend said with a look.  She handed me a cold drink from an ice chest she had wheeled in to keep the help hydrated.  

This same woman had spent a morning planting Vinca outside the town library.  Some people still do that sort of thing in small town New England.

The sky was cloudless and cobalt blue and the air dry and clean. 

We talked about Fred Rice, a local Republican legislator who prevented a portable toilet from being installed at Plaice Cove beach.  He had argued you could walk over to the bathrooms at North Hampton if you needed to go. "Oh, that's a great help, if you have a five year old in distress," said one of our group. "For that matter, I've had to go into the ocean, in a pinch. North Hampton! Like that's a solution." 

I pointed out Mr. Rice has his own distinctive point of view about most things: He also believes paving over the unused railroad line and building a new motorway would decrease air pollution on the seacoast, better than say, a bicycle path might do. 

We agreed Mr. Rice is a good reason to be a Democrat. It was a bonding sort of day.

The Limits of Superpower: Aaron Sorkin

Sorkin

"Then you are just as dumb as these guys who think that capital punishment
is going to be a deterrent for drug kingpins. As if drug kingpins didn't live their
day to day lives under the possibility of execution. And their executions are a
lot less dainty than ours and tend to take place without the bother and expense of due
process. 

So my friend, if you want to start using American military strength
as the arm of the Lord, you can do that, we're the only superpower left. You can
conquer the world, like Charlemenge, but you better be prepared to kill everyone."

--Leo explaining to President Bartlet why he cannot just kill everyone in Syria for the crime of blowing out of the air an American airplane carrying the President's personal physician who the President liked a lot.

Okay, let's get this out of the way right off: "West Wing" is not "The Wire." And Aaron Sorkin is not David Simon.  

But I do love the way Sorkin writes. Ninety percent of the dialogue is a single line, not even a sentence, exchanges back and forth between people while a very busy world swirls around them. It was the same in "Newsroom" as it is in "West Wing." Put very attractive and likable characters in a pressurized job which seems to really matter and you are just transfixed watching them, wishing your workplace was like theirs.

There aren't all that many fictional accounts, when you think about it, which focus on the workplace. 

Then, every once in a while a character gives a little sermon and you are transfixed, and it's really effective because it's rare for anyone to hold the stage for more than a millisecond and the very duration of the speech gets your attention.

It's the same pleasure you get from "The Thin Man" series with William Powell and Myrna Loy, but without all the jokes about alcohol.  You have really smart women who know what they want and who are not afraid to take it and who are nervy and funny and very comfortable with themselves.  

Not like real life.

Sorry, Maud. I apologize. Of course, there are such women like that in real life and I'm sure you are one, but they are just thick as fleas in Sorkin's world.  Everywhere you turn there's a woman cutting you down to size.

The closest thing to "West Wing" or "Newsroom" in terms of relationships, men/women, intensity of feeling, a pressurized atmosphere, in my experience,  was The New York Hospital. A nurse described it once as, "A cauldron," and she was right.  There was life and death and sudden action and affairs and drama and it was a 24/7 opera, filled with passion and loss and soaring victories.  But I doubt it's like that now.  Commerce has replaced passion and the demographics have changed:  When the interns are 20 somethings, and half are female, and the nurses are mostly 50 something, a potent part of the ingredients for drama is diluted.  

I once mentioned how tame the Washington, D.C. hospitals seemed compared to what I remembered from internship in New York and one of my colleagues said, "That's because you were 20 something then. Now you're forty something, married, raising kids and you're not spending nights in the on call room. You're going home so you can be up to get your kids dressed and off to day care." 

He was right, of course. I would have missed any torrid goings on in those days. It was probably like the seals off Plaice Cove Beach--the water is full of them, but you just don't see them.

But Sorkin can bring all that jazzy, racy feeling back to life and you watch these characters and they become part of you. I particularly like the fact President Barlet is from New Hampshire. Seems right. He is the smartest guy in the room, always asks the most penetrating question and refuses to accept the conventional answer. 

When the plane is blown out of the air, his military commanders suggest a "proportionate response" and the President asks, "What is the virtue of a proportionate response?"  He's right, of course. The Syrians know he will take out a few military headquarters and ammunition dumps, and they've already guessed which ones and evacuated. "So, it's just a cost of doing business," the President says. He talks about the time in history when no Vandal or Visogoth would have dared harm a Roman citizen for fear of Rome's sure and severe retribution. He wants to strike fear into the Syrians. Today he would be talking about ISIS. That's when his chief of staff gives the speech shown above. Things have changed for superpowers since the Roman Empire. You need guys like Leo, the chief of staff to remind you that,  when you are President. 

Everyone, in this world, plays a role.

And I've got 7 seasons ahead of me. What cheer! 

Good-bye to All That: When the Outside World Changes Our Inner World

I've never met David Letterman. Likely never will. But I've seen his image and laughed with him, and though it was a rare night I stayed up late enough to see him, I did occasionally watch his show, and somehow, I'll miss him.

I'll miss Jon Stewart, too. Same particulars there. Never met the guy, but I did watch him many evenings and certainly on line when he did something notable. His form of  subversion was less eccentric and more focused than Letterman's and he provided an anchor of sanity through those bad Bush years. He also offered hope whenever Rush Limbaugh and company got too noisy.

I'll miss Stephen Colbert, too. You will say, "Well, he's not really leaving. He's still going to be on TV," but you know it won't be the same Colbert, not in his new spot.  He's history. 

And then there is Don Draper and Joan and Peggy and Betty Draper and Sterling and Pete and Cooper. All gone now. Of course, you will point out, they never really existed, not like Stewart, Letterman and Colbert, not real people.  But they are no more and no less real to me. They are images on TV who say amusing things and whom I've spent time learning. I know them.  They affected me.

I know I've told this story before, but it's relevant here, so forgive me.   When I was 26, working in the Emergency Room at The New York Hospital, I saw a 19 year old mother from East Harlem, with her 5 year old daughter. The mother had a cough and a fever and the daughter accompanied her to the ER.  I  finished examining the mother and was writing her a prescription when the daughter beamed at me and said, "I know you!" 
I looked at her, trying to remember if I had seen her during my pediatric rotation as a medical student, but couldn't place her. 
"You're on TV!" she said. "I saw you."
I looked to the mother who also grinned. "Yes, we saw you. General Hospital."
Chronically sleep deprived, I struggled to understand. Then I got it. These two sat home together all day and watched the day time soaps and they thought "General Hospital" was real life. Now, this was before "Hopkins 24/7" and "New York Med" brought cameras inside actual hospitals.  For these two, the people on the screen were as real as anyone else. 

For me, the folks of Mad Men are as real as the real people, Letterman, Stewart, and Colbert. They are all just images on the screen. And they have about the same impact on my life. They enrich it. 

For that matter, Bob Dylan, Buddy Holly, James Taylor all had important effects on my life. They made the music which formed its tapestry; they are part of my memory bank.  And it's what makes me American, knowing those songs, which I share with people who've never been East of California. 

I spent two months in London, when I was 24. Vietnam was going on and I was not in love with America. By the end of the first month, I missed America intensely. I'd go to Earl's Court where Americans tended to drift for the good, cheap dinners. I'd go just to hear American accents. The Brits, I discovered, are not just Americans who talk funny. They are very different.  And while they knew a lot about America and were well versed in our music, they had never seen our T.V., and they had no idea what American football was all about and they were only dimly aware of baseball as some perversion of cricket, which is a game totally incomprehensible to Americans. This was in a time we were a less global economy. 

All these things, external to me mattered in what was forming internally.  Not an original thought, but it does well up as I consider the changing landscape of TV favorites. 

Impermanence.  Gotta love it. 

Speaking for Others

A man in Iowa was accused of raping his wife, who had Alzheimer's. The charge was the wife was incapable of consenting to sex. The State presumed to speak for her, or at least in her behalf. The details of the case were murky, but apparently nobody ever elicited from the wife she felt she had been wronged.

There are situations in which we feel we have to speak for others--when children are involved, or when people are incapacitated and when people are clearly inhibited from speaking their minds.
Here are some rules we mostly like:
1. Men, in general,  should refrain from having  sex with a woman who is rendered incapable of judging whether she really wants to have sex. This forms the basis of many college "date rape" cases, where the girl is drunk.
2. No mother should give up her child for financial gain. We've heard about cultures in which children are sold or married off by parents who justify this as a good thing for the family. 
3. Promises made should be promises kept.

But consider three stories, just fiction:
1. "Away from Her" a movie starring Julie Christie
2. "The Adopted Son" a short story by Guy de Maupassant.
3. "Forsaking All Others" a short story by Ulbert.

In "Away from Her" Julie Christie insists her husband take her to a nursing home for Alzheimer's patients as she feels her disease closing in on her. They clearly are still in love and he cannot stand the idea of losing her; it's like bringing her to the graveyard for him, but she insists. He continues to visit her, but over time it's clear she barely recognizes him, if at all. Eventually, she enters a love affair with another Alzheimer's patient, which appears to give her and the man some measure of joy and comfort and the husband  realizes the woman who inhabits his wife's body is no longer his wife. The crucial element of memory is gone. She cannot remember the husband she has left behind.  The nursing home officials are all aghast: They think they should intervene and expel either the wife or her lover, but the husband is not so sure. He does not think he can speak for the wife he has lost. 

In "The Adopted Son," two families live in adjoining cottages, poor, but happy. The many children run back and forth between the homes and the families are almost melded. One day, a rich, childless woman rides by in her carriage and is particularly taken with one of the children and she proposes to his mother she adopt the child. She says she will support the child's mother and family handsomely, if only the mother will give up her child. The mother reacts in a fury and says she would never "sell" her child.  Some time later the rich woman spots a son of the other family and is equally taken by him and makes the same offer to that child's mother, who, agonizes but agrees to hand over her child. 

The two families are fractured by this event; the first mother cannot abide the decision to give up a child. The family which gave up the child prospers in many ways which appalls the mother who refused the rich woman's money. She accuses the mother of accepting blood money, of prospering from the sale of her own son.

 Years later a carriage draws up outside the cottages and a young gentleman emerges, dressed richly and he knocks on the door of one of the cottages--it is the adopted son, now educated, rich and very happy. He thanks his mother for having sacrificed her own happiness for his, for having given him a better life.  When he leaves, the son who was the rich woman's original choice excoriates his own mother for not having given him the opportunity which benefited his friend. His mother had spoken for herself, but also for him, and we are left pondering whether she got it wrong. Had she thought, as her neighbor had, this is an opportunity for a better life for my son, she would have made a different decision. How different would sending her son away with the rich woman have been from the decision to send a 12 year old off to Phillips Exeter Academy? Separation for a better life.

In "Forsaking All Others" a woman is introduced by her fiance to a chivalrous man whom she calls her "knight errant" with whom she falls in love. She has adored her fiance since childhood, and she has grown up thinking she is lucky to have won him and she asks herself how she can give up what she wanted for so long for the knight. She marries her fiance, as she has promised to do. The knight, saddened by her choice, leaves town and eventually finds another woman, and invites the heroine to the wedding. The heroine sees the bride is in some ways the right choice, the right religion and social class for the knight,  but the night before the wedding, the heroine  winds up in bed with the knight. She stops things before the consummation.  She tells him she cannot ruin his life, and  she gets dressed, leaves, and the next morning goes to the wedding. She does not see him again for years, when both couples wind up in the same city and become friends sharing dinners and outings, until her own husband announces he is leaving her.  We are left wondering whether doing the right thing was the right choice. She left the knight's bed that night because she felt it was best for him, and because she was thinking of her own husband. She was thinking for others, but the only feelings she really could know for sure were her own.

In each, we are presented with the conventional demands of love and we presume to know what is best for another human being, but we come to question how well we do know and it is the conventional idea of love and obligation which comes to seem, if not wrong, at least ambiguous.

Death Penalty for Tsarnaev

My father always said the problem with the death penalty is not that some people don't deserve to die, but that it's rare that you can be certain the jury convicted the right guy. In the case of Tsarnaev, there is little or no doubt--he admitted to his role, although exactly what his role was may never be completely understood.

And yet, I am still disturbed about the death verdict for Tsarnaev.

Thinking about spending the rest of my life in prison, I am pretty sure I'd prefer the quick out, the needle. The thought of having to spend day after day in misery would be too depressing.  We used to talk about what disease we'd least like to have and one of my fellow interns said, "Depression, because in every other disease, you have good moments, good days, but there is never a good moment in depression."  That is the way I imagine life behind bars. I may be wrong. Maybe even in prison, there are good moments, watching a bird fly by your window, listening to rain drum on the window in a thunderstorm, but these would only, I'm imagining, make the imprisonment worse.

So my problem with the death penalty is not that it is inhumane--in fact a lethal injection may be more humane than 60 years behind bars. It is not the experience of the man most affected which concerns me, actually. It is the idea that in killing him we do something to ourselves. We are, in essence, saying we are no better, no different than he is. 

Okay, you wanted to kill us. You lost. Now we kill you. It's war. 

In a way, we elevate his murderous intent to respectability. This is war. In war we kill each other. 

But, if we send him away to jail we say, "No, we are better than you. You expected we would kill you, but we will not do what you did. We want you to think about what you did."

Somehow, I'm not sure I feel that way about those two miscreants who murdered the Kutter family, about whom Truman Capote wrote In Cold Blood, which is, I know, inconsistent and irrational. But those two guys were, pretty clearly, psychopaths. They considered themselves the victims, had no capacity for reflection, sympathy, and in fact were more like rabid dogs, simply had to be put down.

Not that it's possible for me to ever really know what they are like. I'm just relating them to people I met on psych wards. But Tsarnaev, from what little you can tell from reading about him, is a recognizable mucked up 19 year old, a type I think I knew from years of talking with boys on wrestling teams, kids who could go in different directions, some of whom wound up in Congress, some in jail.

I'm just thinking out loud here. Maybe I'm totally wrong. I need help here. 

Atul Gawande on Overkill

Columbia College of Physicians and Surgeons has the best name of any American Medical school, hands down, because, among other things, it recognizes right up front there is a difference between physicians and surgeons. This is something which the Brits have institutionalized by calling surgeons "Mr." rather than "Dr." 

This difference is apparent when you read Atul Gawande try to muddle through conceptual landscapes which are plowed and planted by physicians, endocrinologists and oncologists in particular, and he gets swallowed up in sink holes he simply does not know how to avoid.

He does not distinguish between waste in medical practice which occurs because doctors have decided to rape the system by buying medical machines (MRI's, CAT scans, what have you) and various profit centers  (rehab facilities,  etc) and then pumping every patient through the door in the direction of these profit centers, between these sleazy if not illegal forms of waste and the "waste" which occurs because doctors do not have crystal balls to tell them which patients with "cancer" will get into trouble and who will not.

Gawande takes full credit for shining the sunlight on the nefarious doctors of McAllen, Texas, who were sending every patient for the most expensive tests because they profited directly from owning the facilities to which those patients were sent. In the case of that sort of avarice, the role of sunlight is indisputable.

But then Dr. Gawande spins off into something entirely different. He claims all our efforts at diminishing deaths from breast cancer and thyroid cancer have been worth nothing, that mammograms are diagnostic overkill and that surgery for thyroid cancer does nothing to benefit the patient.  Even carotid artery surgery to prevent stroke does not live up to Dr. Gawande's expectations.  His mantra seems to be if the patient has no symptoms and is not currently bothered by his or her cancer, or has not yet had a stroke, then  it is not worth treating to prevent bad things from happening.  One wonders what he thinks of treating hypertension to prevent stroke.

The fact is, there are plenty of studies to suggest breast cancer death rates are falling and falling more among women who get mammograms and less among those who do not. In the care of thyroid cancer, the problem is about 1400 people die from thyroid cancer out of the tens of  thousands every year who are diagnosed with it and we do not have technology which distinguishes between the cells we call "thyroid cancer" which act more like warts from those which metastasized and kill people, which look no different from the indolent variety.

Gawande has so little insight into how medical care is delivered (as opposed to surgical care) he insists that primary care providers are the solution to over use of expensive tests, which, in fact could not be further from the truth. 

He is clearly under the thrall of Dr. H. Gilbert Welch, the Dartmouth "expert in overdiagnosis" and "centers for excellence" like the Geisinger Medical Center, with which Walmart has contracted to see patients with back pain and other complaints. Dr. Gawande believes the Walmart approach results in less "unnecessary" effort, when in fact one wonders whether it simply is a way for Walmart to reduce costs and Geisinger to increase its own income. He is long on anecdote and short on data when it comes to the "centers of excellence."

The fact is, there once was a time when you had to be a neurologist to order a CT or MRI of the head, the exams were so expensive and the machines so over worked, but now every physician's assistant and nurse practitioner has only to click a box on her EMR and the deed is done. Dr. Gawande mentions a patient he saw who had been sent for an MRI of her neck after a fine needle aspiration had demonstrated thyroid cancer--clearly a worthless test. But who does he think orders the lion's share of these worthless tests?  Certainly not the company WellMed, which has paid physicians to avoid ordering expensive tests by paying them to spend more time with patients to avoid ordering such tests.  "Step by step...his team  [was] replacing unnecessary care with care that people needed." 

Oh, you have no idea, Dr. Gawande. Truly, honestly and plainly not.

What I see every day is not what Dr. Gawande wants to believe:  He believes humble is always best, so the NP or PA will take the time to listen to the patient and not order expensive tests or consultations. In fact, those "physician extenders" or whatever you want to call them are the mot likely to order tests which add little to the decision and simply add cost. The whole system of certifying practitioners plays a role in this very complicated miasma:  Anyone who passes his boards in whatever is as good as anyone else in the eyes of the powers that be, but the fact is, what I see is people who have trained in what I can only snobbishly refer to as, "less selective" training programs tend to order every exam in the book because they have never had the discussion with really insightful professors about the nuances of diagnosis which constitutes "good training." These folks are "certified" but not well trained, and they order extravagantly. 

Dr. Gawande ends his piece with a vignette--he is very strong on anecdote--about a young woman who had microcarcinoma of the thyroid, which current consensus suggests does not require complete removal of the thyroid, but because she feared dying from thyroid cancer, he went ahead and did what she wanted. 

To be fair, he is caught in a modern bind: In the age of the patient being part of the team, of not allowing the doctor to be "paternalistic" and dictating to the patient what needs be done, of involving the patient in significant decisions, he went ahead and took his directions from her and did "unnecessary surgery."

Heaven forbid, we listen to the patient. 

But he did what he criticizes others for doing--he acted in defiance of the statistics to do what the patient wanted.

I am about to fly off to a week long conference where I will sit in conference rooms listening to pundits like Michael Tuttle of Memorial Sloan Kettering analyze difficult cases of thyroid cancer and I'll hear Ian Hay from Mayo Clinic rail about over treating microcarcinomas and late recurring lymph node metastases and if the past is any guide, by the end of the day, my head will be swimming because, when it comes down to individual cases, there is always something to make the decision tough. 

When it comes to "unnecessary" tests and treatment done by entrepreneur doctors like those in Texas, the solutions are easy and administrative. Sunshine really is the best disinfectant for these sorts. But when it comes to the well meaning practitioner who is not motivated by profit, but who is simply not well enough trained and versed in current thinking to know when to order what test, the solutions are more complicated. 

And even the best trained, most up to date practitioner will order unnecessary tests because the technology is limited.  When I send a patient to surgery because her fine needle aspiration biopsy showed "thyroid cancer" but once the gland is removed and the whole lump is examined it turns out to be benign, that was unnecessary surgery. It was unnecessary because the patient did not have the disease we feared she had but we did not have any better way of knowing that, short of surgery. 

What we really need is better technology when it comes to malignant disease. What we've had until very recently is the light microscope doctors were using since the late nineteenth century. Cells were defined as cancer, for the most part, by their appearance under the light microscope. But some nasty looking characters turned out to be pretty harmless and some, which looked no more dangerous,   ravaged patients. We've known for some time what we really need is genetic analysis to predict which cancer cells will behave aggressively. Now we have some of those, but the reliability of these tests is still being evaluated and if we use them, Dr. Gawande and Dr. Welch from Dartmouth will accuse us of running up the bill, piling on and doing "unnecessary" tests. 

Dr. Gawande is a certified "genius" (a MacArthur grant recipient) and he publishes in one of the best journals extant in this country, The New Yorker.  And still, he gets it wrong and the New Yorker aides and abets the crime. The New England Journal of Medicine would have sent Dr. Gawande's article to a "reviewer" or "referee" who would, assuredly, have rejected it.  Had it been published, there would have been extensive letters to the editor in a follow up issue with Dr. Gawande's responses.  In the age of connectivity, there would have been a real discussion.  Sadly, we do not have that when medical topics are discussed in the world outside the rigors of academia. 

The Discomfort of Impermanence

Exeter River 

I recently decided to not attend my high school reunion, despite a barrage of emails from old friends and pressure from my family, who wanted to hear about Helga and the Dragon and other people they remember. 

That event was definitely a Last Waltz event, the last reunion we will have, until the funerals begin, and those have happened for 10% of our class already.

Guys You suffered With

Some of the people at the reunion were people I had known between ages 9 and 18, but most were friends for only 3 years.  Even the kids I had gone to elementary school with were not really the same people by the time we had progressed through the grades. Good buddies from 5th grade went down different paths when we got to junior and then senior high school. Even those relationship were impermanent.  I can count on one hand the people with whom I maintained a significant relationship from elementary through the end of high school, and even those faded eventually.

One was The Dragon (a sound play on her last name), the prettiest girl in my 4th grade class and one of the smartest.  I was infatuated with her for two years (4th and 5th) , and still liked her through junior and senior high school, but her star dimmed as other girls shone more brightly. But at age 16 and we still spent hours talking, on dates which were cerebral, not  physical, although they were romantic in some sense. We went to the senior prom, kept in touch through college but then she married, divorced, rocketed through a stellar career as counsel for Lucas films and other glamorous West Coast companies and she retired a very rich lady, with a second husband and two kids. I was not at all surprised by her ascent, although the faculty of our high school missed her talent completely, which says nothing about her but loads about their cluelessness.

The other was Terry Rodgers. We had spent much time wandering through the forests around our homes age 10-11 and we were on the wrestling team throughout high school and in most of the same classes. One summer, two older girls decided we would make good boy toys and we spent a lot of time in their cars and at their homes as a foursome. During the school year, we'd spend hours on the phone every day, mostly Terry talking about what he saw in whatever we were reading in class, Billy Budd, the Heart of Darkness.  It turned out, I am told, there was some darkness in his heart I never knew about. I had not known him as well as I thought. He went to Amherst and became a painter and found great success in Europe where his dark, malignant images of young aristocrats at orgies found homes on, I imagine, stark white walls of childless German couples who always dress in black and are reed thin and drink dry white wine.  His Wikipedia profile and his website give little clue to the boy he once was. 

They Tore It Down: And Well Deserved Destruction

When I moved back to Bethesda, I rarely saw anyone I had known in high school, which surprised me. I had expected to be playing football on weekends with old friends, having old classmates over for dinner, but though some still lived in the Metro area, they were geographically distant and wrapped up in the lives of their kids and there was little or no ongoing contact with people from those years. People who had sworn we would be friends forever, guys I had suffered through three seasons on the wrestling team, girls who cried copiously when we parted the summer before college, simply no longer heard that bell ring.

Dragon  did come to dinner once or twice. The first time, she was in from San Francisco and she arrived on time at our house, but I was late at the office. My wife phoned,  seething. "She's here in a pair of very tight designer jeans, a Chanel scarf, looking like a young Natalie Wood,  just in from Hollywood and she's looking at our kids like they are pets who have not been house trained.  I want you home NOW! I feel fat just being in the same room with her, and very frumpy."

A very different conversation when Terry arrived early for dinner, some months later. I was late again, tied up at the office, and I phoned home to apologize, but my wife was chirpy and not at all irritated I was delayed. "Oh, we're having wine. Take your time. You'll get here when you get here. You know where we live.  We have lots of wine.  You never told me the man is drop dead gorgeous."

He was quite the heart throb age 18, and he looked pretty much the same at age 38. A lot of 38 year old women showed up at the 20th reunion looking for Terry.

But Dragon flew back to San Francisco and Terry disappeared off to Europe and neither made it to another reunion after that. 

You can pick your friends, but not your family. In a way, you feel more intensely about your friends because the experiences you had with them are so different than the obligatory experiences you have with your family.  

We hold on to friends, and maybe to family, for the sense of continuity they give our lives, but that is largely an illusion. Our friendships are transitory; we cling to things looking for a sense of permanence, looking for anchors in moving waters.  Your family may remain close. That can be a major source of happiness, unless the family was not a happy one, but it's not a source of permanence. People change.  And they die. 

The Field House, Unique but Gone Now

As the wise man said, you dip your foot in the same moving stream and it is never the same water, only the stream is the same, and over the years, it is not even the same foot.

Leaving home, going to college, more friends, but the end was always near and you cleaved to girlfriends as an anchor in a world of shifting tides, but then you had to move on, from college to graduate school to a new town for a new job and at every stage you lost people.

Army brats, who were uprooted every 3 years and moved to a new post had some sense of continuity because they kept meeting friends from prior postings. The changed postings allowed them to reinvent themselves, to leave past mistakes behind, but even Army brats were unsettled by that impermanence, at some level.

Impermanence  became the theme of Madmen as it hurdled toward its conclusion. Don Draper shifted from one  identity (Dick Whitman) to Don Draper and as Don Draper he has never become fixed in place, going through women and identities relentlessly.  Sterling tells Peggy theirs is a world where you get hired, you get fired, even if your name is on the door, so don't become too attached to anything. That has got to be a neat summary of their world, and maybe of ours, much as we resist it. We can tether to one world while exploring others. 

Here in New Hampshire, I have friends who still live within 30 miles of where they grew up and they have lifelong friends who serve as touchstones. But I sense in them some dissatisfaction. Even lifelong friends are not permanent because they change, often in ways we are sorry to see. 

My guess is it is best to embrace the new, and not cling too hard to what came before.  If we could relive our lives and benefit from the first living, the way Ursula does in Kate Atkinson's Life After Life, then we really could embrace impermanence and change because it would offer the opportunity to profit from the past. 

As Lincoln noted, impermanence can be a relief--"This too, shall past." 

What would be ideal would be to be able to hold on to the good and keep seeking the new good, while releasing the bad. 

I'm not sure that novel has yet been written.

The Last Muddy Lump

Yep, that's snow behind him. 

Ah, New Hampshire. 
When Robert Frost wrote perhaps his most famous poem, "Stopping By The Woods on a Snowy Evening," he had been up all night working on a poem called, simply, "New Hampshire."  He wrote, "Stopping By," as it were, to unwind from "New Hampshire."

I can see how that might work.

Today, May 2nd, started bright and beautiful in Dover, NH, still chilly at 8:30,  but the sun was warm on our necks and we knew the first real Spring day was dawning. 

But in the corner of St. Thomas Aquinas's field was that last snow pile, encrusted in mud, an image immortalized by Ms. Maud in her complaint last year about the tardiness of New Hampshire Spring. The last lump of snow, crowned with mud in her back yard brought out all the New England in her.  She has mentioned she thinks about that mud encrusted lump at all sorts of odd and inopportune  times, but that's another story.

Doesn't bother these guys.

It is true, where I grew up, it's eighty degrees today and has been for weeks. The cherry blossoms have peaked and the azaleas have long since flowered and there is a green haze in the air from all the pollen, and the air is heavy with water and oxygen from the green lawns and trees and shrubs and the Potomac is rising, green swift, and brown in places, and turtles are sunning themselves on the rocks, and the occasional  snake, and muskrats and beavers and foxes and deer play hide and seek with hikers along the towpath running along the Maryland side of the river.  Spring starts in late March down there, and the snow vanishes by then, and Spring runs through the end of May, when suddenly, it's summer. 

Not so in New Hampshire, where Spring flirts with you, and only shows a bare leg hesitantly, then draws it back and then out again and it's like that until May. But the air up here is so breathable. In the South, the air weighs on you, and you struggle to carry it and breathing is a chore.  Up in New Hampshire, the air lifts you and courses through you like a cool stream, energizing, electric.

I don't care about mud on the snow.  New Hampshire does Spring just right. 

Like granola on your yogurt