Coming to Terms With It - Or Maybe Not

In February my employer of sixteen years – the CIGNA insurance company – eliminated my position. This event was hardly a surprise. Sixteen years is a good run at a place like CIGNA. As an executive told me shortly after I was hired, "Well, Bill, you've got the job. Now let's see if you can hold on to it." And so, as I joke to friends, I spent the next sixteen years playing Beat the Reaper, and doing a little work on the side.

So it wasn't a surprise when my number came up and I found myself tossed into that great metaphorical sausage machine called severance. Still it was a shock. I found that I wasn't angry, and I wasn't sad. Occasionally I had twinges of anxiety about the future. But mainly I was just at loose ends. Work had been the main thing in my life (large corporations demand this), and now there was a void on center.

Because I'd been at CIGNA for quite a while, I got a nice severance package – pay continuation for several months, subsidized medical coverage, even a seat at an outplacement agency, where I met people who were angry, sad, and sometimes just in a state of disbelief.

Gradually I began to come to terms with the tectonic shift in my existence, and I even began to discern the outlines of a new life. A rather pleasant life, actually. My retirement savings will be substantially short of plan, and my wife and I are definitely not buying a house in the south of France, but she still has her job. Is it possible that the Great Recession doesn't look like the Great Depression because of the two-income family? After all, lose one job, you still have one left. Just don't lose the second one.

I do want to get a job. I like to work, and we could use the money. The outplacement agency gave us classes, and I enthusiastically threw myself into the job hunt, but gradually, as the weather got warmer this spring, it became clear that I wasn't going to get a job anytime soon. This recognition came slowly, and I had time to come to terms with it. I keep looking, and I think one day I may fall into something.

In the meantime, I've discovered that there's plenty of work in the world, as long as you don't ask to be paid. I started my volunteering back in the winter, working on Michael Turner's campaign for district attorney in Philadelphia. Michael lost in the May primary, but my volunteer career continued to flourish. I became a volunteer runner at Back on My Feet, a running and rehabilitation program for people who live in homeless shelters. Billy, one of our members, recently completed the Philadelphia Marathon. I tutor at Mighty Writers, an after-school program for young students in South Philly.

And, after an interesting internal evolution, I started working for healthcare reform. I was helped in this process by Wendell Potter, an old friend and former chief corporate spokesperson at CIGNA, who started speaking out on healthcare reform in the middle of the year.

It's not easy to say that you spent sixteen years working at something, and that the result was failure. But that was the conclusion I came to. It may be hard for outsiders to understand how strongly we were focused on trying to control costs in health care. Let's face it: We failed. Time for another approach. I came to terms with it.

Still, to paraphrase The Godfather, it was nothing personal; just business. As I said before, I wasn't angry. Then the letter came. Because of my age, when CIGNA eliminated my position it also effectively made me a retiree. So, after a few months on COBRA (COBRA is health insurance for fired people, and the COBRA subsidy was one of the smartest ideas in the stimulus package), I signed up for CIGNA's retiree medical program. It is the only connection that I still have with my former employer.

CIGNA subsidizes a retiree's coverage through a complicated formula. The price was higher than I expected, but much better than the prices on the open market. I came to terms with it.

Then I got the letter. As of January 1, CIGNA is increasing my premium by 48 percent. There's a very complicated explanation for why this is happening. I actually ran the calculation, and it all makes sense, as long as you're living inside that algorithm. I don't live there any more.

I think I'm less annoyed than astonished. And I don't think I'll be coming to terms with this any time soon.

End of Life Counseling

My brother has a 1966 Land Rover. It’s 43 years old. Not bad for a car, or I should say truck. His wife used to commute in it between Manhattan and New Jersey, but now he keeps it at his place in upstate New York. Over the years he and Scott, who runs a garage in the nearest town, have developed a hobby of keeping the Rover running. As I recall, this once involved replacing all four brakes – only one was functioning. Carburetors and things like that have come and gone. The speedometer didn’t work for about a decade, so the mileage is a bit understated. Recently Scott replaced the rear springs and shock absorbers and welded a new rear quarter frame in place because the old one had rusted out.

I hasten to add that my brother only drives the Rover to the dump, or transfer station as it’s now called, at a pace that would please a Victorian dowager. Cars that are 43 years old do have their limitations. Oh, and he also uses the Rover to drive around in the fields and pick up stones for the stone walls that he likes to build.

The lesson that I draw here is that it is possible to keep some vehicles on the road virtually indefinitely.

What does this story have to do with end-of-life counseling? Simply this: People are not automobiles. We grow old, and at some point we get sick, or perhaps we simply wear out, and we die.

Many, many people have a hard time accepting this simple fact of life. After all, isn’t there a pill for everything, or possibly an operation, perhaps a transplant?

Well, frankly, no. The lack of realism that surrounds the end of life in this country sometimes astounds me.

But then I have an unusual background. I come from a medical family. My father was a doctor – a surgeon – and my mother was a nurse until they got married. His hello line was, “Have you seen Snow White?” And their first date was Walt Disney’s Snow White, at Radio City Music Hall.

During his sixties, my father contracted hepatitis from a needle stick while performing a surgery. The hepatitis severely damaged his liver, which (I’ll spare you the details) led to something called esophageal varices. Occasionally the blood vessels in his esophagus would burst, and he would vomit blood. On his last admission, he warned my mother to insist that the ambulance bring whole blood, because he knew he would not survive the trip to the hospital without it.

There was an operation, called a portal-caval shunt, that my father opposed because the outcomes were often extremely poor. However, faced with the option of death, he agreed to the procedure. I have often thought that he did this for us, and not for himself.

The surgery was successful, and my father was a vegetable with non-functioning kidneys. He went through several rounds of dialysis, in the hope that his kidneys would restart. Didn’t happen. And so, one evening, in a rather scruffy lounge at St. Luke’s Hospital, daddy’s doctor, whom we had all known for many years, sat down with my mother, my brother, and me, and suggested it was time to make my father comfortable and let nature take its course. We agreed.

Years later my mother, having fought breast cancer to a standstill, having fought leukemia to a standoff, came down with cancer of the pancreas. She wanted to stay up in the country, which was where she had been born and grown up. We discussed bringing her to the city and pursuing aggressive therapy. She didn’t want it. She was done. She knew it. She could feel it in her body. She died in the country. Most of the time she was at home, but she spent the last few weeks in hospice. I was sitting next to her when she took her last breath.

One of the great benefits of facing facts is that you may get an opportunity to say goodbye. We had that with my mother. With my father we did not. I recall, as he was heading in for surgery, saying that we’d talk again soon. He looked at me with a look that I did not understand at the time, and replied that he certainly hoped so. That was the last time we talked.

I cannot begin to tell you how important I think end-of-life counseling is. I’m to an age where it’s not just the older generation that’s dying – it’s my generation. And still I see the mind-set. Fix me, Doc. Roll me into the shop and bolt on a new carburetor. Well, maybe. But maybe, in your case, it’s not possible. Or maybe the treatment would inflict agony out of all proportion to the few days of life to be gained.

I do believe this conversation should be between the doctor and the patient, or the patient’s family. But it should take place.