Tony Platt GoodToGo

COVERED

    When it comes to access to health care, I’m up in the privileged tier, but the ground still feels a little shaky.

Arriving in the United States in the mid-1960s from England, I was put on the fast track to get my green card. So, unlike the eleven million immigrants without legal status in the United States, I didn’t have to choose between getting health care versus risking deportation.

During my professional career, my family was well covered. I was lucky to enter academia in the 1960s during the short-lived era when there were mostly full-time positions, solid benefits, and a decent pension plan.

My children, Daniel and Rebecca, born in 1966 and 1968, received their first regular check-ups in their mother’s womb. I didn’t have to worry about them getting enough nutrition in their early years, as is the case with some 100 million children worldwide whose growth is stunted or worse by the age of two.

Until now I’ve been fully covered by my HMO plan, though co-pays are on the increase. I’m one of the six out of ten folks who get their medical care through employer-insurance programs. You can count me among the gluttons – the twenty percent of the population who use eighty percent of the country’s medical resources. I’ve been loyal to Kaiser since they shelled out a few million dollars to get my teenage son through his first and second rounds of a brain tumor.

I’m not one of the 47 million folks in this country that try to get by without health insurance. I don’t have to wait until I really need care, then head to an emergency room and engage competitively with other sickies for attention in a system that, officially, is “on the verge of collapse” and “dangerously overcrowded.”

If you’re unlucky to head to a metropolitan ER at night, be prepared to first meet a couple of poorly paid, chunky security guards who ask you, “What do you want?” And if you get past them, you’ll eventually get to see a triage nurse, or at least her head as she pokes through an opening in the wall and tries to find out if you’re sick enough to be there, that you’re not a malingerer who gets your kicks hanging out in a claustrophobic, over-lit, over-heated room, surrounded by coughers and bleeders, watching Jerry Springer turned up loud enough to wake the comatose.

I’m not just better off than the uninsured, I’m also better off than most people in my position. We own our home – in realty-rich Berkeley, no less – have no debts, and pay off our credit cards every month. We own two new, albeit modest cars and a share in a cabin up the California coast where redwoods meet ocean.

Cecilia has a secure, full-time teaching job at a local state college where she has a pension plan and enough health insurance to pay for most of the extravagant costs of her illness. And given her diagnosis, it helps that we live in the San Francisco Bay Area where, thanks to a large middle class and feisty feminist movement, she has access to a female surgeon, a collaborative health care team, drugs and herbs, and yoga for breast cancer survivors.

We’ve also amassed a sizable chunk of cultural capital that enables us to find our way through the medical labyrinth and access the latest information about treatment options.  “If only more of our patients had people like you to support them,” the Lung Transplant and Advanced Lung Disease Coordinator at a local university hospital e-mailed me during Daniel’s last year.

But most patients and their families, even solidly middle class ones, don’t have our resources: a brains trust of medical friends for third and fourth opinions, and the confidence to assert our rights against stubborn bureaucrats. We could be the poster family for “patient-centered care” – we know how to demystify esoteric information, how to network, and call in our chips.

We also know how to plan ahead. Anticipating retirement a few years ago, I invested in supplemental health coverage that promises me $205 per day in a nursing home. If I prefer to receive care at home, my plan allows for $3,079 per month (after I’ve paid off the first three months’ deductions). On paper I felt reassured by this coverage until I read that it costs about $75,000 a year for nursing home care and a whopping $166,000 if I want to pay a health aide to take care of me at home (at $19 per hour). I’m a little short.

It would only take a major disability or an expensively chronic illness to take us quickly from the crème de la middle class crème to social insecurity. “Unless you’re Bill Gates,” says a Harvard researcher, “you’re just one serious illness away from bankruptcy.”

TAKING THE PLUNGE WITH BLONDIE

    After the papers are graded and the holidays spent, it’ll be my time to leap into the void.

This is my last semester of full-time teaching. December 13th was my last official day in the classroom; my grades are due the first week of January; and my Sacramento State University paychecks stop in March 2008. I’ve been doing this for forty-one years, back to 1966 when as a 24-year old neophyte I jumped into the deep waters of the University of Chicago and tried to avoid the sharks.

Five years ago, at age sixty I took advantage of a university deal I couldn’t refuse: officially retire and get my pension, and get paid at the top rate for teaching halftime for another five years. Plus, be exempt from committees if I crammed my teaching into one semester.

The transition in 2002 went smoothly with few anxieties about rites of passage. Probably because I threw myself into completing my last book, a labor of passion that has consumed me for the last few years. When I wasn’t teaching in the spring semester, I was either writing furiously or on the road pitching the book.

And it was a relief to be off academic committees. For years I made recommendations about promotion and tenure, sat in on confidential discussions, and was a big fish in a little pond. As soon as my status changed, I lost the plum office with windows and illusions of grandeur. An occasional colleague still asked my opinion, but most gave me a polite smile reserved for the elderly. “Still teaching? Enjoying your retirement?”

I don’t like being a recipient of paternalism, but there’s an upside to being out of power. One of my first liberated acts was to scream scatological invective at a colleague in my office with the door open for all to hear. I could never do this when I was chair of the personnel committee. “You asshole,” I yelled. “Don’t ever fuck with me again in a faculty meeting.” It felt good, increased my hall rep, even as it marked my descent into academic anonymity.

I started off this year with the same enthusiasm that I had during my last transition. By week two of the semester back in September I had destroyed scores of useless files, thrown out forgotten memorabilia, and packed up eight boxes of books to be donated to the library. Nine weeks later, I’d done nothing else. The boxed books were still stacked in my office. And it’s not as if I’ve had much to do but teach courses I’ve taught for many years. The book tour has dwindled to an occasional talk, and I’ve just laid off my publicist.

This transition is quite different and much more difficult than the one I experienced at sixty years. Maybe it’s because I’m getting documents about Medicare, being targeted by health insurance companies and the Neptune Society, and signing up for my first social security check. It’s a mixed blessing when people tell me, “You don’t look your age,” or “Wow, you’re playing racquetball?” because I know that they’re thinking, “He’s getting old, and I’m not.”

I still feel vital in the classroom, though I find myself leaning in to hear soft-spoken students and need more written notes to prompt my memory. When I taught radical ideas about history, race, and inequalities at Berkeley in the late 60s, most of my students were shocked but open to the new information. That’s not changed. Many of my state college students, undergrad and grad, are angry that “we weren’t taught about this stuff before,” troubled by what they now learn, and morally engaged by ideas of social justice.

I no longer look out at mostly white students with a sprinkling of African Americans representing The Race. Now, it’s not unusual that white Americans are in the minority, surrounded by a sea of colors and languages. Immigrants are the new Black students, bringing in differences of language, sensibility, politics, and history. For many of them, the United States represents something better than what they experienced before they arrived here. African American women and Chicanas – the men are still missing in action – try to educate them about the dark side of Amerika, “You’ll find out soon enough,” they tell the newcomers

When I started teaching in the 1960s, the optimism of The Movement pervaded the classroom. In the 70s at Berkeley I remember bringing United Farm Workers’ officials to my class of several hundred students to talk about their struggle to form a union. They brought with them workers straight from the fields, carrying their flags and flyers, transforming the classroom into a site of activism.

Today, it’s hard to teach the optimism I don’t feel. But I keep trying. The students in my graduate class on International Social Work voted this semester to do projects about the war in Iraq. One group is papering the campus with antiwar leaflets; the other group is making a video about students’ views on the war, which they hope to distribute through YouTube. For the last class, my students drove from Sacramento to my home in Berkeley, where I made them dinner in gratitude for connecting me with my roots.

A few days ago, my partner Cecilia and I returned to an old haunt, the Fillmore in San Francisco, to see Deborah Harry close out her national “Necessary Evil” tour. There was a decent turnout of baldies and greybeards – but no walkers – to witness the 60-something rocker do her thing. “We shall persevere,” she told us, encouragingly.

Wearing her signature blond-spiked hair over a scarlet-red shirt, a mini, black tights, and boots, she looked real good for her age, but didn’t hide it. She sang some oldies – “I have to do some Blondie stuff,” she said, “otherwise there’d be no tour.” But most of her material was new, fresh, and feisty.

“Watch out for the rising tide,” she warned us as we danced into the night with the surging, joyous crowd bobbing around us on the Fillmore’s sticky floor. “Jump right in,” I imagined her saying. “Let’s take the plunge.”

WE SHALL FIND OUT

    Now that I’m going to soon need more medical care than I’ve ever needed in my life, I’ve been thinking about switching to a health care system that is more personally attentive. I’ve probably waited too long. The whole system of primary care, the experts tell me, is in “crisis” and “on the verge of collapse.” A career in internal medicine is the last thing on medical students’ minds these days, and most doctors steer clear of geriatrics.

    For years I saw my HMO doctor whenever I decided to do so. He didn’t miss me; he never called. And when I went in for a check up, we colluded in producing good news. “How’re you doing?” he’d ask. “No complaints, everything’s fine. Just a little heat rash in the summer,” I’d reply, upbeat. “Good, hmmm, looks good,” he’d say, going through my very thin file. “Just watch the cholesterol and I’ll give you something for that rash.” And it was over.

    After I hit 55, he suggested a sigmoidoscopy and then a colonoscopy after they found a few stray polyps down there. It wasn’t a big deal. I was happily drugged out and even enjoyed the part where you sit in a barber’s chair after the procedure and fart happily for half an hour.

    If I had my choice now, I’d like to have an old-fashioned GP like Jack Goldman who used to be my family’s doctor when I was a kid growing up in northern England in the 1950s. He was one of my parents’ oldest friends, so he was always making house calls. He’d drive for an hour to our home, chat for a while, even take out his pipe and puff a few times between diagnosis and prescription. A pipe on a doctor used to be so reassuring, signaling calmness and wisdom. It fit Jack’s avuncular image perfectly, at least until he got mouth ulcers and had to quit.

    As I got older, I admired Jack for being a model of middle-aged vigor. He loved the outdoors and was a strenuous hiker. I was sure that a person like that would age gracefully and die with dignity. I watched closely for lessons. But when he himself became a patient, wounded by strokes sooner than later, he quickly became housebound, land-locked, and wretched. He raged against the living of the darkness and cursed his inability to die quickly.

    When my mother came to visit Jack in a nursing home, his mind and mouth were the only parts still in working order. “That nice Mrs. Platt has come all the way to see you,” she heard the nurse tell him behind closed doors. “Tell her to fuck off,” were the last words my mum heard from her old friend.

    Ruth Goldman, Jack’s wife, who took the brunt of his abuse, embraced life after he died. I knew Ruth for at least fifty years, but until quite recently I envisioned her only in other people’s shadows. After my family made the leap in the early 1950s from Manchester’s lower middle-class, Jewish ghetto into the hoity-toity rural suburbs, the Goldmans would occasionally visit from the other side of the tracks for one of my mother’s “Continental dinners,” followed by coffee, liqueurs, and petit fours in the lounge.

    In the smoke-filled room – mum and Ruth inhaling their Players, dad relishing a Cuban cigar, Jack puffing away – the men held forth on politics and current events, the women holding their own, but the men setting the agenda. The sound of Ruth’s loud voice, firmly anchored in working class vernacular, left an impression on me when I was a teenager and later as an adult visiting the homeland from California, but I rarely listened to what she had to say.

    In the 1990s, after Jack’s death, my trips to England revolved around helping to take care of my parents, and then bury and remember them. Both died after prolonged illnesses: Monty in London in 1993, Eileen in Manchester in 1997. On these journeys home I would visit Ruth, at first out of duty: she was not a blood relative, but she was family. Soon, though, I looked forward to seeing her. Now that she was center stage, I gave Ruth my full attention. We would dispense quickly with chitchat and move on to straight talk about how draining it is to nurse a family member to death, about my parents’ fault lines, and about the difficulties facing single women of a certain age.

    “Don’t be daft, luv, men of my age don’t want me,” she’d respond to my inquiries about her personal life. “They want somebody twenty years younger, it’s natural, isn’t it?” And then we’d argue about what’s natural, but she had a point. She was too independent, too smart, too sure of herself for suburban divorcees and widowers. Her overture to my dad a few years before he died was curtly rejected: he was not used to women going toe-to-toe with him.

    Ruth was close to my mother, loved her as a trusted friend. But Eileen also drove her crazy, as she did me, with her upper class pretensions and an obsession with my father’s walk out in the 1970s that soured the last third of her life. Ruth was the only person still living in Manchester with whom I could frankly share my irritation at my mother’s unwillingness to die gracefully and generously.

    Ruth would hear me out, assuage my guilt, even confide in me her own disappointments about her friend. And then we’d move on to Eileen’s better attributes – her humor, self-taught knowledge, and social finesse – and soon we’d be laughing hard and long at the memory of one of my mother’s ribald stories. Ruth had a wonderful, full-throated laugh. She helped me more than she ever realized to remake my parents into flesh and blood people.

    “I’ve ‘ad a good innings, no complaints really,” boomed Ruth Goldman into the phone when we spoke early in 2002. I’d heard that she had become yet another unwelcome member of the cancer club and I wanted to connect with the person who was my last important link to Manchester, England, the city in which I was born and grew up. “Lung cancer, doesn’t look good,” Ruth told me in a breezy voice. “A good innings,” she repeated, trying to reassure me that this was the right time for her to go, that there was synchronicity in her life and death.

    But actually there wasn’t. She wasn’t dying from cigarettes, which she had given up years ago, but from one of those rare, devastating cancers that specialize in setting up shop in unlikely quarters: in Ruth’s case, a handsome woman in her mid-70s, healthy as a horse, engaged in the world around her, a vigorous hiker who feared no trail.

    “No surgery, no radiotherapy, no nuthin’ for me,” said Ruth. She was determined to not emulate her husband’s slow and graceless death. She intended to leave this earth quickly, with no fuss and minimal mess, and she did, in a hospice, only a few months after the diagnosis. Ruth experienced her death head on, just as she lived the last decade of her life.

    As I stumble into my own seventh decade I hope that I remember Ruth’s example: speak loudly and carry a walking stick. On the other hand, I could exit miserably just like Jack and my parents did. How will I deal with my likely chronic illnesses? How will it end for me after years in training as an observant apprentice? “Well,” as poet Philip Larkin answers after a visit to “The Old Fools” home, “We shall find out.”

December 12, 2007

CHECK UP

    As far as my health goes, for a sixty-five year old I’m in good shape, still working and working out. I live in a metropolitan area crammed with conventional medical resources and non-traditional alternatives. My private insurance plan promises to pick up Medicare’s slack, and I know my way around the health-care bureaucracy. I’m good to go.

I’ve hardly had a sick week all my life. I experienced the usual childhood illnesses, well usual for a child born in the industrial fug of northern England during World War II – measles, whooping cough, tonsils removed, and so on. I’ve spent months in various hospitals, but the only stay involving my own health took place when I broke my shoulder playing rugby when I was in my teens. My Jewish immigrant grandmother, known in the family for dabbling in witchcraft, suspected I was the victim of unsportsmanlike anti-Semitism, but it was probably just a bad tackle on my part. I still have a pin in my shoulder. It aches if I play tennis for more than one set or if the weather’s damp, reminding me of my Grandma Daniels’ paranoia. 

During my prime adult years, typically I had an annual cold, the occasional flu, nothing memorable. Reaching the momentous Five-O was a big deal, maybe because I grew up with the misconception that 50 is like half time, with an equal number of years both sides of the intermission. But of course it’s not. My parents, Eileen and Monty, died in the third quarter after wretched illnesses triggered by lung cancer. Other contemporaries of my parents – my godparents Betty and Nat, my ex-father in law, and my Auntie Freda – were also snared by tobacco. Maybe they all would have had another fifteen good years if not for the three-packs-a-day habit.

My mother-in-law, whom I never met, died from cancer in her 30s. My paternal grandfather Bernard went quietly without a fuss in his 70s, his wife Annie shrunk into her 80s. My maternal grandfather Sam lived well into his 80s, but too many years at the end were devoted to stupor and delusions. His wife Edith, my Grandma Daniels, is the family’s exception. For her, 50 was literally half way: she made her century and exited humming a childhood tune. She was savvy at least until her 98th birthday, but personally I wouldn’t want to spend the last twenty years of my life as she did, in the suffocating cocoon of a residential retirement home in the burbs.

Some of my own cohort is already gone. One of my closest friends in graduate school, Al, cut his wrists after too many years stuck in the mire of an unfinished dissertation. My first girlfriend Barbara died in her 40s from lung cancer. The cancer list is long and growing: three of my close comrades from my political past – Esther, Nancy, and Josepha – received death sentences, as did my wife Cecilia, but she got a reprieve and is resurrecting nicely. My son Daniel, who died in 2006 aged 40, is already gone from the next generation.

For a white, middle class, professorial type like myself, 50 is more like a time-out in the middle of the second half than half time. For a majority of people in the world, 50 is close to the final whistle, and for many the game is long over. Men in Africa have on average a life expectancy at birth of forty years; and if you’re unlucky enough to be born in Sierra Leone, you have a one in three chance of not making it past your fifth birthday. And it’s not just a matter of the West versus the Rest. Middle class men of my age in England are likely to live five years longer than their counterparts living in poverty. Here in the United States, my higher education and income dramatically increase my chances of surviving a heart attack or cancer. And as a white man, the odds give me at least six more years of living than one of my black colleagues.

If you’re a baby boomer, as I am, propelled up the class ladder after World War II, you celebrate 50 knowing that it’s the beginning of a long, slippery slope. Frailty, chronic illnesses, and the wearing out of physical parts lie ahead. Not too long ago, when you got seriously ill in your golden years, you’d die fast. Now you can stretch out end-of-life for a decade or longer. It’s hard to know what’s worse: the body’s undoing or that you and it might end up in some kind of institutional purgatory.

So, not surprisingly, 50 is often celebrated by my sort with a big bash that exudes physical and sexual energy, and an attitude of reckless defiance: dancing all night, mixing drinks, doing acid for the first time in twenty years, staying up until breakfast, and so on. The invitation to my 50th birthday party included photos of me semi-nude as if to announce to the world that the plumbing was still in working order. The great thing about living in a postmodern era is that we can imagine 50 however we want to, even rewriting the rituals to express our creative selves. “You’re as old as you feel.” However, I’m also enough of an old-fashioned materialist to recognize that the thinning and thickening of the body, with its attendant slowing and drooping, not to mention leaking of the mind, have a life and – more to the point – a death of their own.

In my 50s I acquired maladies associated with the good life and genetic predisposition  – too much “bad” cholesterol and gout for which I take lovastatin and allopurinol. Now on the treadmill of obligatory grains, fruits, and exercise, I have my sights set on getting the triglycerides below the magic 200. I haven’t got into the vitamin craze, but I’m a fan of Glucosamine, which I believe (as opposed to know) keeps my joints nicely oiled.

Now in my mid-60s, I’ve started to grow new stuff on my body where nothing used to exist and to lose stuff that used to be there. When did that happen? Various muscles ache from time to time, and I’d feel better five pounds lighter, but overall I’m in pretty good shape. I play racquetball, ride a bike, take a spinning class filled with lithe latexed coeds, walk the dog, and enjoy sex. The mind still clicks away. I feel that I have just begun to master the arts of pedagogy at the moment when I’m about to retire. This December marks the end of forty years of university teaching. I’ll miss it, but I’d rather exit like James Joyce’s Gabriel Conroy who aspired to do so in the “full glory of some passion” than hang on until dementia creeps on board, as it did with two of my colleagues who were allowed to “fade and wither dismally with age” right before their students’ eyes.

Once a year my lower back goes out. I dutifully report to my chiropractor, who adjusts me and encourages ice packs and gentle stretching. For the first time, I’m experiencing a problem in my left knee, which make me get out of bed gingerly. Conceding to these irritating pressures, I now sit down to put on socks and shoes, and get into my car ass-first before swiveling in my legs.

I’m like somebody who just bought a new car and sees the model everywhere. I can spot people with bad backs – the stiff gait and slightly hunched looks are the giveaways. I stare at really old folks on the street – hesitating at a cross walk, keeping close to a wall just in case, taking small slow steps. I still stand to put on my underwear, but my days are numbered.

December 5, 2007