FIFTY YEARS OF MEDICARE

In 1961 I left a lowly job in medical research, and went looking for another one.  An ad for “research assistant” posted by the American Medical Association looked promising,  so I answered it.

It turned out to be my first editorial job , and certainly was the strangest.  I had fallen down the rabbit hole into an unreal world.   At weekly staff meetings, one dormouse-like little old man always fell asleep after the first few moments. Another man invariably came up with bizarre suggestions for editorial projects, a bit like the Mad Hatter.  Every Friday we had a farewell party for whichever coworker was making their escape. One of the secretaries, who  looked scarily like Morticia of the Addams family, sneaked around on rubber-soled shoes and seldom spoke to anyone.  Another secretary began making odd statements about conspiracies going on in the organization. For a long time people simply assumed she had uncovered something sinister in the course of her work, but finally one of the M.D.s in the department realized she had a brain tumor.  Altogether it was a weird place.

 From today’s point of view, one of the oddest characteristics of the AMA was their rabid opposition to Medicare. The costs of medicine for the elderly (and everyone else) were becoming unaffordable, but the AMA officials insisted that passing Medicare legislation would doom the country. Actor Ronald Reagan, who in a few years would be the governor of California, made a film for the AMA in which he proclaimed that passage would lead us down the path to socialism (almost equated with Communism at the time). In the Journal of the American Medical Association ( JAMA) and its other journals, AMA officials insisted that it would destroy the high-quality medical care Americans were receiving.  Luckily for all of us, President Lyndon Johnson made it a high priority, and Medicare became a reality in 1965.

Can any sane American now imagine life without Medicare? Even the most right-wing Republican is likely to rely heavily on it after the age of 65. Conservative opposition today has more to do with cutting the budget for it, which  would be bad enough.

My late husband went through numerous hospitalizations and surgeries before dying of heart disease and diabetes. In his last few years his medical bills came to more than a million dollars. Being a Navy employee, he was well insured; but even with the help of Medicare and a good Medigap plan, the financial cost was enormous for us. We used up our retirement savings, and after his death I had to sell our home. But I have survived and continue to live decently, if frugally. Without Medicare I cannot imagine what my life would be today.

LIVING WITH UNCERTAINTY

Most people seem to have settled down by the time they reach their late seventies. They are either happily staying in homes where they have lived for years, or they are reluctantly moving into some sort of assisted living.

Not me. I am selling the Placerville home I bought only a few years ago, and have not yet bought another one. The reasons are mainly financial (this house was meant as an investment, and has no emotional connections for me), but I seem doomed not to remain anywhere more than a decade.

Where would I go if I left the Gold Rush country? Back to the San Francisco Bay area? I loved that area, and miss it in many ways. Living there would mean constantly  hearing about the Big One arriving at any time, though. After living through the Loma Prieta quake in 1989, I don’t care to repeat the experience.  That area  is also extremely expensive. Back to Chicago? Nah! Again, Chicago is a wonderful place, with incomparable museums, but the winter weather is simply dreadful. Having lived in California since 1980, I doubt that I could survive a Chicago winter now.  Back to Michigan, where I was born and still have some friends and relatives?  And where every summer brings the threat of tornadoes?  Leaving California seems like an unlikely option, even with the continuing drought and the danger of wildfires.

Of course, I can always stay with my companion in his off-grid home.  I am there much of the time now, and enjoy the forested surroundings, but need some of the modern conveniences provided by lots of electricity. The older I become, the harder it is to live off the grid. The hard work is starting to overwhelm my companion, also. It may be easy to persuade him to move.

Or, we can continue to travel in the View. For long periods we can tour scenic and cultural areas, with occasional stops at libraries and coffee shops where I can get my Wi-Fi fix.  I do need some sort of permanent address, if only for storage space and for a place to rest up from traveling. (Perhaps one of the RV resorts where I might buy a small home with an RV pad?) For the next few years, at least, traveling as much as possible seems like the best option. Traveling in an RV is never boring or overly certain; each day brings some new adventure.

As the old saying goes, Nothing is certain but death and taxes. I am not immortal, and the IRS has been dunning me for taxes they say I owe. Everything else is up in the air.

ATTICUS FINCH, REVISED EDITION

Harper Lee’s just-released novel Go Set a Watchman continues the story of Jean Louise (“Scout”) Finch and her father, Atticus. In Lee’s Pulitzer Prize winning To Kill a Mockingbird (1960), set in Alabama in the 1930s, Atticus was a heroic lawyer who stood up to the local rednecks by representing a young black man who was falsely accused of rape. (The book’s popularity was soon ensured by the movie, starring beloved actor Gregory Peck as Atticus.) In the new book Jean Louise and the readers see an older, flawed Atticus who joins a local citizens’ council that opposes the NAACP in the fifties, toward the beginning of the civil rights era.

Many readers who have loved To Kill a Mockingbird for half a century, and revered Atticus, have been horrified. (Reviews of the new book have been mixed, but the quality of the writing is another issue.) Online and in print, comments like “Atticus was a racist” have appeared. In the novel, the adult Jean Louise herself reacted violently when she came home from living in New York and realized what her father was doing. Her love and respect for Atticus were severely threatened. It seems likely that Lee’s relationship with her own father, on whom Atticus was presumably based, was endangered also.

Though I never confronted my own father as sharply as Jean Louise did, during the sixties and seventies we had some prickly disagreements about civil rights. Like Atticus, he was an intelligent, fair-minded man who treated all people equally, but his background and education simply doomed him to an intolerant outlook. Born in 1908 and growing up in a conservative, mainly white, area of the Midwest, he never was exposed to other races and religions as a child. Though college-educated, he never accepted the sameness of blacks and whites, or of Jews and Gentiles. I feel sure that if he had not died in the seventies, he would have become much more liberal. (My mother, who was also born in 1908 and died only a few years ago, had become nearly as liberal as I am by the time she died.) This is not just wishful thinking on my part: my father was anti-Semitic also, but when I married a Jew, his attitude changed quickly. Simple exposure can work wonders.

It is easy to judge people who lived in the past by current standards. History textbooks today are more judgmental about George Washington and Thomas Jefferson, for example, than they once were. However, individuals and groups of people are continually changing. In the fifties, many well-intentioned people had attitudes about race, homosexuality, marriage, and other issues that would seem quaint, if not actually evil, today. We need to try to understand them as products of their environment.

There is a genetic aspect, also: Though in some circles it is politically incorrect to state it, it is obvious from sociobiology that we have some inborn prejudices. Cleaving to the group that resembles us must have had adaptive advantages early in human evolution; so, try as we may, it is hard for those of every race not to distrust or even fear other groups. Understanding prejudices must not lead to agreeing with them, of course. It is important to recognize our prejudices and to strive to overcome them rather than denying they exist. As different groups intermingle and intermarry, tolerance seems to be increasing, but complete acceptance will still take a long time. In the meantime, we need to use education and legislation to lessen ignorance and to protect minorities.

 

DEATH WITH DIGNITY

 Brittany_Maynard had everything to live for. Newly married, the beautiful and intelligent young woman should have looked forward to a long, happy life with a husband and children. Instead, she was diagnosed with terminal brain cancer and told that she would die within a year. She began her painful journey toward death, having seizures, severe head and neck pain, and stroke-like symptoms. At some point she decided not to continue in agony, but to die on a date of her choosing, shortly after her husband’s birthday.

Brittany lived in California, where she could not commit suicide legally. Instead of dying peacefully in her home as she wished, she and her husband had to move to Oregon, which allows physician-assisted suicide. (A physician supplied the aid-in-dying medication she would need, but she would have to administer it herself.)  Though she was fortunate in having that choice available, moving away from her parents and friends must have severely upset her already tumultuous life. She spent some of those last few months working with the Compassion & Choices group, which helps the dying and publicizes the difficulties they face in carrying out their decisions. Her video is familiar to most of us now.

The publicity about her death led to a California legislator’s introducing SB 128, a bill that would have made Brittany’s kind of death legal in California. Many of us (a large majority of the Californians polled) are in favor of death with dignity, and thought the bill would pass easily, but it was quickly defeated by religious and other groups who represent themselves as being in favor of life. They trotted out the usual arguments about possible miraculous recoveries, not letting temporary depression cloud a sick person’s judgment, and so on. It was sickening to read their smug remarks.

I do not want to hear any pious comments about waiting until “God called her home,” implying that it was sinful or stupid for her to end her life on her own terms. What kind of people are these who deny a dying woman the right to end her painful life a little early? Has any person who has watched a loved one die slowly and in agony want to condemn anyone else to that kind of death? We need to pass some version of SB 128 to ensure the right of Californians to escape unnecessary suffering from terminal illnesses without having to move to a more compassionate state.

WRITING VS. RV TRAVEL

Writing and RV travel should go together like ham and eggs. When we bought the Winnebago View, I thought we could travel from place to place with frequent stops at libraries or museums where I could do research; we would spend our days sightseeing; and I would do my writing in the evenings and on layover days. That plan didn’t work, for obvious reasons I should have foreseen. After a day of driving or sightseeing, I have little energy left for writing. Even this simple blog has suffered; my weekly posts have become monthly or occasional.

Do other writers on the road have this problem, or is it just me? Am I too lazy or too old to continue the writing that has been so important in my life? I have known other writers who went on writing well into their nineties, and I should be able to follow in their footsteps.

Even at home, I can no longer maintain the routine I had during many years of freelance work. Housework that seemed so easy when I was younger (or, better, that was often taken care of by a cleaning service) now seems too hard to manage, and my small income doesn’t justify hiring household help now. So, housework too often takes the time that should be spent on writing.

For about fifty years I wrote and edited materials for science education, especially in human ecology. It was occasionally frustrating to work with certain authors or publishers, but on the whole the life was very satisfying, and often it was joyful. I never wanted to change careers.

There have been too many advances in the sciences for me to continue writing competently in that field, though I still avidly read Scientific American and other popular science magazines. I need to do my writing in another area, but what new niche can I find? Many others write more ably than I can about the RV life, travel destinations, and so on. My memoirs were written years ago, and I have no wish to repeat that cathartic experience. The two whodunits I wrote were simply dreadful. What is left?

Perhaps I will go on writing indignant letters to the editor, and posting blogs, about environmental issues that require only superficial knowledge of the science behind them. Heaven knows, there are plenty of those issues—fracking, oil spills along the coasts, women’s right to choose reproductive freedom, wasted resources, GMO’s. In some cases I may even be able to expand a letter or blog post to a magazine article. However this turns out, I need to continue to continue writing in some form about issues that I find compelling. In spite of all the damage humans have done, Earth is still a beautiful planet that must be saved.  In the words of the old Quaker  hymn,

Through all the tumult and the strife
I hear the music ringing;
It finds an echo in my soul—
How can I keep from singing?

OUR CROWDED PARKS

When we visited Canyonlands National Park in southern Utah recently, we failed to make a campground reservation. After all, it was May, surely too early for the hordes of tourists that drive into the parks in summer. We forgot to note that we were arriving just a few days before Memorial Day, a very popular time. (Indeed, on Saturday the entrance to nearby Arches National Park was closed by the state police, for the first time ever, because backed-up traffic onto the highway was so hazardous.) So, we spent two nights out on Bureau of Land Management (BLM) lands before scoring a campsite inside the park. Even then, only my partner’s disabled placard made it possible. We spent three wonderful days in Canyonlands.

For such a huge park (527 square miles), Canyonlands has surprisingly few campsites, possiby as the result of an attempt to protect the park’s fragile desert environment. The two campgrounds have a total of thirty-seven sites. Early every morning, RVers and tent campers circle every loop, watching like vultures for people who are vacating their sites. (No reservations are possible; it is a first come–first served situation. For the elderly, getting up at dawn to drive into a park and then compete for a site can be very difficult.) Fortunately, other campgrounds can be found near by in Dead Horse Point State Park, the BLM’s Horsethief campground, and other spots.

One effective way to avoid disappointment is to travel before May 15 or after September 10, when children are in school, and families are less likely to be on the road. Even then, though, it is becoming harder and harder to travel and find stopping places for the night.

In just the past few years, national parks have become much more popular for a variety of reasons, including Ken Burns’s TV series. As a parks enthusiast, of course I am happy to see this trend, even if it makes my life more difficult. To be sure of having a campsite, reservations for the most crowded places are essential. Barbara Parker, who with her husband has been a host at one of the Yellowstone campgrounds for several years, has written in an online RV forum about her pity for and astonishment at people who arrive in mid-summer with no reservations and expect to camp. They cannot stay, and it is a far, far drive out of the park! When we went to Yellowstone (after Labor Day) a few years ago we found a riverside spot just outside the park that had nice pit toilets, but finding it was just dumb luck.

As we refuse to lock ourselves into a schedule when traveling, the need for reservations is a pain. In the West, where the BLM has vast public land areas, we can simply pull off the road and stay overnight. There is always Wal-Mart, too. As a last resort, private RV campgrounds are common nearly everywhere. So many of them are either too expensive or slumlike that we scarcely ever use them.

This country’s state and national parks still have the features that make them so appealing, and they are the last habitats for some threatened or endangered species. What is the solution to the crowding? Some legislators (including mine, unfortunately) in the House of Representatives feel that more campgrounds and other facilities (such as skating rinks) should be opened up “for the people,” as if conservation is elitist, but I feel that would be a serious mistake. We must preserve our parks, where much of the natural environment remains, and where visitors can learn about archeology, paleontology, ecology, and history in unmatched fashion. If we lose these priceless places, or convert them to theme parks, we can never get them back. Yes, I will be irritated when it is hard for us to find a campsite. In the long run, though, preserving the parks trumps anyone’s personal wishes.

 

CRONE WISDOM

Now in my late seventies, I have been around the block a few times. I can’t pretend to have learned everything about living the good life, and too many things I spent a lot of time or money on are no longer useful, at least for me. For example:

• Learning how to perform a hysterectomy on a Drosophila.
• Reading with the Evelyn Wood method.
• Spotting typos in galley proofs of hand-set type.
• Learning WordStar, WordPerfect, and several other obsolete word-processing programs.

 

Some other things I have learned, though, have continued to serve me well, and seem important enough to pass on:

• Taking notes in Pitman shorthand.
• Baking with a solar oven.
• Doing basic housework for sanitation (but you don’t have to eat off the floor).
• Balancing a chemical equation.
• Doing simple statistical tests to evaluate medical claims.
• And so on.

More importantly, I know the importance of friendship, and appreciate my friends more than when I was younger. Though I am an introvert who prefers spending much time alone, I have learned to place a higher priority on friendship than on accomplishment or education. (Many years ago I told a close friend I was too busy writing a paper to go for a walk with her. When she committed suicide a week later, I felt partly to blame.)

Another important lesson I should have learned when young is that drinking alcohol does not increase happiness. For me, as for many people, the first glass of wine does lead to relaxation and peacefulness; but it too frequently leads to a second glass or more. Being an editor in the sixties meant taking authors to dinner, working at National Science Teachers Association (NSTA) and other conventions where our textbooks were advertised, and otherwise being in situations where drinking was encouraged. I have a low tolerance for alcohol and should have avoided it altogether; instead, I did a lot of silly or stupid things while under the influence. When I went back to grad school later, and became a freelance author and editor, I switched to drinking wine (especially the inexpensive Trader Joe’s “two-buck Chuck”), but began a habit of ending every work day with a glass or two of wine.

That much wine sounds harmless, and for many people it is healthful, but I realized it was more than I personally can tolerate. Occasionally I would mention my concern to a doctor, and invariably got the “That much wine is good for you!” response. So, I went on with mild but daily drinking. It helped me ease the pain of becoming a widow. I’m not sure what the final effect would have been. Only when I met my partner in 2005 did I have to face the issue. He is a teetotaler who feels strongly about drinking, and I knew I might lose him. So, I stopped. It was a little hard at first, like giving up on an unreliable friendship, but now alcohol holds no appeal for me at all. Why did it take me so long to learn such an important lesson? As the saying goes, "We grow too soon old, and too late smart.”

 

THE END OF GRIEVING

 

During the past year, some of my old friends have been widowed. It is saddening to watch them go through the early stages of grief--denial, anger, bargaining, depression--and to be helpless to offer them little but my affection and sympathy. Though I know that in time they will reach the final stage of grieving, acceptance, they are not ready to believe it. Nor should they. Each widow needs to experience the process herself.

April 28 will be here soon. On that date twelve years ago—a lovely, sunny day with all the promise late April brings--I took Harold to the Alameda ER where he had been treated successfully many times. Two hours later, he was dead. I stumbled out to the car in a pouring rain. Like my own life, the whole world had changed.

That first year was the hardest, and when April 28 came around again, I seemed to relive all the events of his death as I lighted a yahrzeit candle in his memory. The idea that I could ever accept life without him seemed impossible.

Over the years since, of course it did happen. Not only did I reach acceptance, but am whole again. This year as always I will burn a candle for him, smiling at the memory of happy times in our thirty-two years of marriage and feeling grateful that healing did occur. L’chaim! To life!  

 

THE HIGH COST OF DRUGS

Like most elderly people, I take several medicines every day--for hypertension, arthritis, and other ailments--and hate to think what life would be without those drugs.

Recently I learned I have pancreatitis, a painful disease caused by a sluggish pancreas.  Just getting the diagnosis took several months, so finally learning the source of my pain was a great relief, especially when some samples of Creon (pancreatic enzymes) helped greatly. Then my doctor broke the news that Creon (manufactured by Abbott Labs) costs up to $10 per capsule. No generic version is available. As I need four capsules a day, this drug could cost me nearly $1200 a month, nearly my entire Social Security income! I do have a good Medicare Part D insurance plan that would lower the monthly cost to about $240, but even that is a lot of money for me. I do not qualify for Medi-Cal or other subsidies; the government thinks I have too much money, which I find amusing. (Most of my retirement savings were spent long ago for my late husband’s surgeries and hospitalizations—his bills would have come to more than a million dollars without Medicare--but that’s another story.)

In desperation, I plan to order Creon from a drug company in Canada. That is a clunky, slow process, and possibly a risky one, but it looks as if I can get my medicine for about $50 a month. At this point, that actually seems like a bargain.

Considering the enormous amounts that pharmaceutical companies spend on advertising (in JAMA and other medical journals, as well as those irritating TV ads), I think they can well afford to make needed drugs more affordable. Luckily, my illness is not life-threatening, but many people endanger their lives by cutting pills in half, delaying having prescriptions refilled, and by other cost-saving actions. When will Big Pharma and the government wake up and realize they may be killing the geese that lay the golden eggs?

MARGARET MEAD, MARRIAGE, AND ME

Many years ago I read one of cultural anthropologist Margaret Mead’s books (I think it was Blackberry Winter) and found myself amused by her comments on marriage. She thought women should marry three times in their lives—as Mead herself did—the first time for the innocence and passion of young love, the second for a home and stable family life, and the last for having the right person to grow old with. Being young and idealistic at the time myself, I thought her advice was extremely calculating. Now that I am elderly, I understand her wisdom. Though I did not intend to follow in her steps, my life has turned out much as she suggested.

When I was only twenty-one I married my first husband, who had been my college sweetheart and seemed like an ideal marriage prospect. We had a lovely wedding in the college chapel that seemed like the prelude to a long, happy married life. Seven years later we were divorced. Neither of us had been mature enough for the responsibilities of marriage.

In my early thirties I married again, with a more realistic view of what the future might hold. At first we argued often—our personalities were very different—and we even separated for a while, but gradually we achieved a good, stable marriage. Though we were unable to have children, we always had a much-loved Scottish terrier, and usually a cat as well. Over the years we grew closer and closer as we shared happy and sad times. When he became extremely ill with diabetes and heart disease, I was happy to be his caregiver. He died after only thirty-two years, and I grieved for a long time.

Now, in the autumn of my own life, I have had the great fortune of finding the ideal man to grow older with. We would not have appreciated each other at all years ago, partly because I am nine years older than he is. He was a free spirit of the sixties, and at that time I was a very serious textbook editor. We had little in common then. Today, he is the perfect companion--a retired science teacher who is as passionate about the environment as I am, and who also enjoys travel and reading. We both have some health problems, and help each other cope with them. Though we have everything we need, our lifestyle is simple and frugal. Departing a bit from Mead’s plan, we have not married for insurance reasons.

So, in retrospect I have to admit Mead had the right idea. In an ideal world, a couple might go through her three stages together, but longer life spans, divorces, and deaths make that impossible for many of us. In our messy real world, a woman is very lucky if she can find the right three men at the right times!