This holiday finds me feeling penitent.

Thinking back to last year’s American Independence Day, I see how my nation has fallen, seemingly overnight, from robust and rambling health into a shockingly debilitating illness. While it survived the initial trauma, I find my desire to celebrate its bedridden birthday quite muted. And while I hope it will recover, and even help it work towards this recovery, I know it will never be its old self again. My heart aches with both sadness at all the potential wasted with a single, violent stroke, and guilt at feeling that I myself could have done more to help prevent it.

Later this month I’ll have a blood test to determine whether, after six months of significant dietary changes on my part, my doctor will tone down the hyperlipidimia diagnosis they hit me with in January. The lab measured my LDL (“bad”) blood cholesterol level at more than 150 mg/dL, fully half-again higher than optimal. This shock, and the personal struggle since, have done a lot to define my outlook this year — perhaps about as much as the terrible leadership that assumed control of my country on nearly the same day as that doctor’s appointment. I can’t help but mingle the threads.

And I think maybe the U.S. had something like a heart attack, the day of Trump’s election. While nobody deserves a traumatic and debilitating health event, so many who suffer them could have avoided the disaster by paying attention to early warnings and taking the trouble to change course. By dropping processed sugars, popping plant-sterol supplements twice daily, and making other sacrifices, this is the path I try to put myself on now. After forty-odd years of disregarding the chasm whose lying in wait for me my personal genetic history implies, I hope I have enough room left to veer away from it.

A heart attack killed my grandfather, and another forced my father into a different lifestyle than his chosen one. He lived a reasonably healthy quarter-century after that, thanks to modern medicine, whose ministrations he accepted daily for the rest of his life. But he never worked at his beloved sales job again; the stroke took away the stamina required for his life as an ever-traveling company man, and no exercises or blood-thinners could replace it.

I have no doubt at all that this describes America’s health in terms of its global standing. I join countless others in resisting the current administration in its campaign to tear down every neighborly and far-sighted facet of American law and culture that its can get its claws around. Our efforts, hard-fought, bring results, and I have great hope that we can at least contain the damage. You can be sure that I’ll continue materially contributing to causes I believe in after leadership passes to more competent hands.

But all this represents the medicine and attention that comes after the stroke. It’s good that it’s there, it extends a life that would have otherwise been cut far shorter — but it bespeaks the preventative care that could have obviated the need for all these years of painful and expensive crisis-management. I pat my own back about all the dollars I donate, but where were they before last year?

No matter what comes after Trump — no matter whether we can elect baseline-decent leadership again, and maybe even keep it for more than a single cycle — we have become the country that elected Donald Trump to its highest office. A permanent condition, by definition. No future good works or promises will ever erase that, and none will restore the trust we lost, and the leadership roles we ceded, and a result. Just as my father never again saw the open road after his stroke, so America will never again lead any great global effort.

And it feels, heartbreakingly, like damage that we deserve.