Pam and I have had our share of hard knocks this summer. From the ongoing personal and financial trauma of our sailboat/home lightning strike to our latest bout of COVID-19, the hits just seem to keep on coming. I also (finally) finished a fictional novel, but was utterly unprepared for the hell that is getting published.

It has been a particularly challenging few weeks for Team Buckenmaier. We recently pulled our floating home (a Lagoon 42 catamaran) for much-needed routine maintenance and bottom work at a local yacht yard. Our 3,000-plus miles in the Atlantic had taken their toll on the boat and its systems.

It has been a challenging week for me in my interactions with American institutions. I had a primary care appointment for my annual checkup and to manage my ongoing respiratory issues related to burn pit exposure. I fancy myself savvy in how the healthcare system works (and how it does not), so I used the Johns Hopkins MyChart system to request my routine blood work before my visit. This electronic medical record and communication system performed flawlessly, and my labs were ordered a week before my appointment. I was feeling rather smug concerning my patient prowess after reviewing my results and having the opportunity to inquire about some abnormal values via MyChart. The day arrived for my clinical visit, and I wanted to double-check the appointment time, so I logged on to my trusted electronic medical record. MyChart informed me that my account had been disabled.

I have sworn this oath several times throughout my military career, as did my wife and first daughter. A framed print of the oath of office adorned our living room for years. Often, when asked what I did for a living by a new acquaintance, I will state that I spent a career protecting and defending the United States Constitution. It is an occupation my family has been involved in for generations. Except for my family, nothing has been more fundamentally important to my identity and sense of purpose. Defense of our Constitution is the most important endeavor I have performed to protect my family, posterity and my country.

I am tapping out this editorial on my 60th birthday in May. I prefer the annual and unavoidable nonevent—which is the date of my birth—to go by quietly and without too much hoopla. Family and friends have been asking if I feel any different at 60. I have responded that it seems no different from how I felt yesterday at 59. That is not to suggest I have not noticed the changes to my appearance associated with aging as I gaze in the mirror. I have no idea where all the gray hair is coming from (damned barber) or why less of it seems to be growing on my head but has sprouted with renewed aggressive vigor from my nose and ear canals (God does have a sense of humor).

My wife, Pam, and I have just completed a 413 nautical-mile sail from Key Biscayne, Florida, to Hilton Head, South Carolina, on our Lagoon 42 – Shavasana. It is our most extended passage so far and the furthest out in the Atlantic Ocean we have ventured. We are headed back north towards the Chesapeake Bay and had a weather window that allowed us to sail into the Gulf Stream and ride that fabled ocean river north. The two to three knots of push make for some incredible boat speed over the ground, and we were often logging 8 to 10 knots with stern winds and following seas. From a sailor’s perspective, that is fast. I imagine the powerboat enthusiasts shaking their heads and smiling at such pitiful velocities.

One of the best aspects of the sailing lifestyle is discovering new anchorages and meeting the local people. Recently, after a spectacular downwind sail with consistent 10-15 knot winds off the starboard quarter (what sailors mean by fair winds and following seas), we dropped our hook at Boot Key in Marathon, Florida. Marathon is home to The Turtle Hospital, a fascinating non-profit organization dedicated to the rescue, rehabilitation, and release of sea turtles. Sea turtles are Shavasana’s (our Lagoon 42 sailing catamaran) ‘spirit’ animal, and a graphic of five sea turtles graces our bows. Pam and I felt a visit to the Turtle Hospital a must. We were not disappointed and recommend a tour of this fascinating facility if you happen to be traveling the Florida Keys.

Theresa Tam serves as Canada’s Chief Public Health Officer. Like many public health officials during the COVID-19 pandemic, Dr. Tam was the focus of considerable criticism of her recommendations as the virus spread. Health officials worldwide tried to guide the public on responding to the virus based on few facts. At the time, the virus was new and barely understood. There was no vaccination and little science regarding the COVID-19 virus. Fortunately for all of us, much has improved regarding our understanding and treatment of COVID and other respiratory viruses.

New Year’s Eve 2023 was marked with sadness for my family as my mother-in-law, Susan “Sue” Timperley, passed. Leave it to Sue to pass with fireworks and parties in full swing. She was a vital force within our family, a calming influence on the males of our clan, an example for all and a tireless advocate for her grandchildren. Although she was just a slip of a woman, 5 feet tall and 100 pounds soaking wet, woe to anyone who would mistakenly assume her petite physical appearance belied weakness of character.

I was saddened to learn of the passing of first lady Rosalynn Carter. She and President Jimmy Carter were a leading political team during a particularly turbulent time in America. Although the Carter presidency was marred by the energy crisis of 1979 and the Iran hostage crisis, which likely limited Carter to one presidential term, the husband-wife team had a remarkable list of accomplishments during their four years at the White House. Carter made some difficult and unpopular decisions during his presidency. He pardoned all Vietnam War draft dodgers, returned the Panama Canal, established the Departments of Energy and Education and shepherded, arguably, the most significant talks regarding Middle East peace through the Camp David Accords.

As 2023 passes into history, I cannot suppress the feeling that I am on a perpetual rollercoaster ride, from which I cannot get off. The planet continues to warm, sea levels keep rising, frequent weather extremes, war in Ukraine and Israel, inflation, COVID, and so on. In the era of instant and constant media, one can be challenged to find a respite from the pressure of modern life. For many federal healthcare professionals, the barrage of world events is compounded by the everyday drama of patient care. Society recognizes the extraordinary daily challenges healthcare providers face, which explains our exulted status within the social fabric.

I have been enjoying the summer months (notwithstanding the heat we escaped by hiding out up north), and I hope my readers are doing the same. Sadly, some irritating and tragic medical events have interrupted my otherwise blissful season. The first issue involved my newly minted grandson, who required a routine ultrasound for a skin mass that was determined to be a benign cyst. This was and should have remained a “nothing burger” until my daughter called to tell us she had been hit with a $937 co-pay for the scan.

I am hunkered down at our family camp in Maine, avoiding the sweltering temperatures baking the country’s interior. The environmental demons we have created through our insatiable thirst for fossil fuel energy are exacting their vengeance on our abuse of mother nature. My family is, indeed, fortunate to have a rustic cabin refuge on the shores of a clean Maine lake. I revel in the fact that I often must ask what day it is and rarely know whether the former president has collected another indictment.

My mother is an educator, and I have observed her impact on countless lives. Most of my career as a physician has centered on the medical education of resident physicians. My second daughter has a master’s degree in education. Until recently, she was a second-grade teacher within an economically challenged area. My mother and daughter are the heroines in this editorial, since the resident student material I molded had already been appropriately shaped by teachers of children.

My wife Pam and I have developed a habit of listening to audiobooks while traveling the American continent in our RV (TimBuckTwoBlog.com). A particular favorite for both of us was “The Oregon Trail: A New American Journey” by Rinker Buck. The book details Rinker and his brother, Nick, following the historic Oregon Trail in a covered wagon drawn by three mules in modern America. A recurrent theme in the text was the value of “seeing America slowly” from the buckboard seat of a covered wagon as everyday Americans whipped by on ribbons of asphalt at highway speed.

I took a deep, cleansing breath and calmly explained to the Pentagon officer that pain was as complex and varied as human cancer. No one approach would solve the issue consistently for every patient without unwanted and occasionally severe consequences. Needless to say, this was not the answer these leaders were looking for. We all left the meeting disappointed.

When this editorial charms (or lands with a thud) on the masthead page of the May 2023 edition of US Medicine, Pam and I will be back on the road again. These past few months hanging out in Virginia during Pam’s recovery have been challenging for both of us. We are not used to being this static, physically or existentially. I have been writing extensively during this period, which necessitates a protracted amount of time on my bum (I do my best work with pressure on my brain). This has caused my long-term affair with lower back pain to flare up with a vengeance. I am certainly not alone in this painful condition. Researchers suggest that 8 in 10 Americans will experience back pain at some point in their lives. When I retired from the Army, I noted back pain as an issue during my exit physical review. In response, every corner of my body seemed to be scanned and/or X-rayed. The Army concluded I had the well-used spine of a fifty-something soldier. In short, like so many other humans, I have classic musculoskeletal lower back pain.

I often quoted a version of this Bible verse to residents just before they were about to do something to a patient that was unpleasant. Truly, in medicine, it is better to give than receive. Throughout my career, I have had the good fortune to rarely be on the other side of the stethoscope, needle, or catheter.

I recognize that this column tends to dwell on the many negative aspects of the federal healthcare system, our democracy and the general human condition on this planet. We are a species both fascinated and driven by conflict. I have elected to change tact for February and focus on something entirely positive that has occurred in my family.

As we enter a new year, like many Americans, I am hopeful that the world’s challenges of the last few years will ease. I am somewhat confident that 2023 will bring improvement to the general human condition, since the first three years of this decade represent such a low bar upon which to improve. It is indeed hard to be optimistic in the face of growing consequences of global warming, threats to our constitutional democracy, Russia’s war of aggression, disruptions in world supply chains, ongoing COVID-19 pandemic concerns and world economic instability, among many other adverse events. We must remain hopeful.

Foreign governments continue to weaponize social media to sow doubt in our election system. Political attack advertisements spend little time on the issues confronting our society in favor of slinging barbs and half-truths at political opponents. The predictable consequence of this debased political behavior is violence, which sadly seems to dominate recent news. As this challenging year ends, the growing divisiveness of our politics does not inspire hope in solving the real issues confronting our democracy.

President Roosevelt’s quote is long, but worth every word. I have a soft spot in my heart for Teddy, since he is my favorite president and my great-grandfather, Anton Buckenmaier, was a Rough Rider. I have been aware of these sage words from our 26th president for most of my career. They have served as an inspiration and guide for critical decisions I have made concerning the direction of my professional pursuits. I would never be so vain as to suggest I could improve Teddy’s profound eloquence in his quote. Then again, I have often summed up the meaning of his words (to appease my goldfish-like memory) when I have had a resident cornered and lecturing. My crass and unpoetic summary of his masterful paragraph: There are those that do and those that don’t.

We are presently enjoying the cool climate and spectacular beauty of Acadia National Park. The scenic byways and trails during September are worth a place on your bucket list. Today is Sept. 11, which causes many Americans to pause and reflect on everything that has occurred in this country since 2001. My career and family life were so profoundly sent in an unexpected direction that I still think of my time on this planet in terms of before 9/11 and then after. I imagine many readers of this column know precisely what I am expressing.

Pam and I are presently hiding from the heat of summer 2022 in the lakes region of central Maine. Pam’s family has maintained a cabin in the area for over 100 years. We are indeed fortunate to have the means to travel to cooler climates within the United States. At the same time, so many Americans must withstand the daily onslaught of over 90° F temperatures.

It has been difficult to observe the recent overturn of Roe v. Wade, 410 US 113 (1973), which held that the U.S. Constitution provided citizens the right to choose an abortion. There are few topics as religiously and politically charged as abortion. It is the proverbial “third rail” of dinner conversation and editorialists. It would be safest for both my U.S. Medicine editors and me to avoid this topic at all costs, lest we offend a large portion of our readership.

Pam and I are visiting friends at their lake house on the Sam Rayburn Reservoir in Texas. As we were traveling, we were shocked at the slaughter of 19 children and two teachers at an elementary school in Uvalde, TX, on May 24. This hit particularly close to home, as our middle daughter is a second-grade teacher in Maryland.

When Pam and I picked up the RV we now live in (hanging out in Tampa, Florida, at the moment), we needed to purchase some ‘must-haves’ for full time motorhome living. While I was perusing the sewer hose aisle (how glamorous my retirement life is), Pam had fallen into a conversation with a fellow female RVer about the insanity we had just committed with the sale of our home, cars, and everything we own to live full time in a 31-foot Winnebago.