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15 June 2022

Geoff Dyer: How to grow old in America

A tennis injury – and a spell in the US healthcare system – helped cure my delusions of youth.

By Geoff Dyer

In October of last year, shortly after correcting the proofs of my new book, The Last Days of Roger Federer, I decided to follow in the great man’s footsteps and have surgery. Strictly speaking, I was following in the footsteps of Novak Djokovic and Stefanos Tsitsipas, in that I would be having surgery on my elbow (left) rather than a knee, but that’s just an anatomical detail.

I’d been suffering from gradually worsening tennis elbow from the autumn of 2020. On Christmas Eve my primary-care physician (the American version of a GP) administered a steroid injection which cured it, almost instantly. For about six weeks. Then, like Covid, it came surging back, even more instantly, mid-game. Early on in life my parents had taught me that a bad workman always blames his tools, so my first impulse was to blame my racket. I’d hurried out of the house and cycled to the courts in Santa Monica only to discover, when I got there, that I’d brought my old racket, the one I used before devoting many hours to searching the internet and speaking to the knowledgeable staff at Tennis Warehouse in an attempt to find whichever rackets and strings were easiest on elbow and shoulder (I’d also had shoulder problems). That old racket was notoriously tough on both.

“You shouldn’t even be looking at that racket if you don’t want to strain your eyeballs,” a shop assistant had explained, before directing me towards more forgiving options. But here I was, not just looking at it but, like a lapsing addict, once again wielding this suicidally lethal weapon. It’s more likely that it wasn’t the racket; steroid injections tend to wear off after six weeks, especially when the problem is exacerbated by poor technique, which typically means taking the ball late. Good players take the ball early, on the rise. As I’ve got older I’ve taken the ball later and later, partly because I need more time to see it (the sales assistant was right to bring the eyes into play), on whatever is the opposite of the rise, subjecting the elbow to more and more strain, thereby accelerating the dip, the decline and fall of which this trajectory is both technical expression and metaphor.

After this relapse I saw a physical therapist who’d fixed my elbow years earlier (by unexpectedly jiggling some bones in my wrist), this time without success. My wife and I came to England for a long summer, where I saw another physio who worked a side-hustle in acupuncture. My elbow got a bit better but not well enough to play tennis. Then – and this is very common, particularly among the middle-aged – I began two-timing this physical therapist, seeing a younger woman who offered similar but slightly more vigorous exercises. At first this was rejuvenating, but then the deception and strain proved too much, and, like a man whose love affair leaves him with neither wife nor mistress, I ended up having to say goodbye to both of them. The elbow got worse and worse. I had just turned 63 and my tennis life was in tatters.

[See also: George Orwell outside the whale – by Ian McEwan]

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In September we returned to America where, partly in response to the culture of endless affirmation and optimism, and partly because of the availability of extraordinary medical care, I saw my doctor – the steroid doctor – again. He booked me in for an MRI the following week. The day after the MRI, I saw the orthopaedic surgeon (who, to my astonishment, was younger than me) and listened as he outlined the diagnosis and options. The MRI showed tears. I could do this, I could do that – all of which I’d tried, without success, before.

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That left surgery. Clean everything out, mend the tear, use a pin to fix the tendon to the bone. If all went well, I’d be playing tennis again in three months. With American healthcare the distinction between being offered a cure and being sold a product is often hazy, but since I’d exhausted all other possibilities this side of Lourdes, I booked in for an operation the following Friday.

But there was a scare along the way. When I called to check the details of my insurance cover I was told the operation would come to somewhere north of $90,000. Since it was going to cost an arm and a leg to fix my arm, I said, I’ll abandon the operation and soldier on with a defective one. No, no, came the reply. There had been a misunderstanding. That was the total cost – the insurance would cover all of that except for a payment of about a thousand dollars.

It was a business-class experience at the hospital in Santa Monica – nothing at all like the scenes in the BBC’s This is Going to Hurt. Medical hurt in America is overwhelmingly financial: if you have good health insurance you’re effectively anaesthetised against it. Wheeled in to the operating theatre, your only concern is the freezing cold in what looks like both the inside of a spaceship and the cleanest place on Earth. It’s really fantastic. You might as well have a facelift while you’re at it. For half a million bucks you could probably get a soul transplant thrown in, or at least a little soul-rejuvenation tuck. Even though you’re doing absolutely nothing except lying there with tubes in your arm, a team of efficient and happy people keep telling you you’re doing great. You make a mental note to be more encouraging to your students, not to keep writing pedantic stuff like “Grammar!”, “This is not a sentence”, or angrily crossing out “relatable” every time one of them uses it in an essay. Sedatives have been administered but you feel more calmly alert, more consciously conscious, than at any moment in your life. As for the anaesthetic… You breathe through the mask – you’re doing great – and the next thing you know you’re coming round, back where you started in the business-class departure lounge which has turned, in the blink of an eye, into an arrival lounge.

The rich and youthful surgeon came by. I listened closely to his instructions about what not to do. There was no hint of drowsiness, no need to take notes. I could have followed a lecture on how to assemble an Ikea wardrobe without even looking at the diagrams. I’d start physical therapy in two weeks, he said. The most important thing, in the meantime – and for another month after that – was not to open jars: the twisting and gripping motion was the worst possible action. But the worst news – and it was news, this had not come up during his sales pitch – was that I would not be able to ride my bike for six weeks because applying the brake would be like twisting a jar.

My arm was in a big spongy bandage, in a sling, and I was in a wheelchair. A nurse wheeled me outside to the car where my wife was waiting behind the wheel. Getting in the car was meant to be done with extreme caution but I could have vaulted into a virile convertible. Another sign of how good I felt was that within five minutes I started a quarrel about something that wasn’t my wife’s fault. At the hospital pharmacy, as instructed, she had dutifully picked up basic painkillers, stronger painkillers (opiates), anti-constipation tablets and anti-nausea tablets designed to offset the side-effects of the opiates. We’d been watching Dopesick on TV so I was frightened of developing some kind of addiction, but mainly I was outraged at the expense – $170 – and how we were getting screwed by Big Pharma and an endless panacea of pills and side-effects, pills to offset side-effects and more pills to offset the side-effects of the other pills, all of which meant, according to a tennis friend who’d had painful knee surgery (not Roger), that the crap he’d finally had, after the ensuing constipation, was so monstrous that he’d had to shell out another 500 bucks to get an emergency plumber to unblock the overwhelmed toilet.

Having got that off my chest we drove home in the sun-dazzled traffic and I took up residence on the sofa. We ate dinner and watched TV; I brushed and flossed my teeth and we went to bed. Sleeping was awkward – I didn’t want to roll on to my arm – but there was no pain.

[See also: Geoff Dyer’s Q&A: “I love doing housework – I find it extremely fulfilling”]

The next morning I woke in agony. I couldn’t bend my arm more than a few degrees. I was glad we had the strong painkillers. It was a strange, normal and rather strange weekend. We drove up to a little country-music festival near Santa Barbara but left before Ryan Bingham (the person we had wanted to see) came on, and drove back home. The post-anaesthetic clarity had a quality of befuddlement about it, as if past and present might easily be reversed. On Sunday night my wife flossed my teeth. There is a reason for all the narrative attention being paid to teeth flossing (an activity so rarely seen in films it is practically taboo), and there is a reason I was in the state I was.

Unprepared for the trauma of surgery, I had gone from someone with a gammy elbow to a frail invalid, an old person, incapable of washing his right armpit or using a knife and fork. I was in a tizz of constant terror about accidentally bashing my elbow, especially after we took off the big protective padding. A few days later we also removed the masses of cotton wool to reveal the dressing strip. My wife, who is not squeamish, recoiled somewhat at what was revealed.

After two weeks I went to see the surgeon, who said that everything looked great. But it felt odd, I said. A tugging sensation. Could it be, I asked, that the recklessly compulsive act of flossing my teeth that first night, when an abundance of local anaesthetic and anti-inflammatories meant I was able to move my arm in a way that had by the next morning become completely impossible – could it be that I had torn the tendon from the pin on the day it had been attached? Or the pin from the bone, even? That was impossible, he said. Everything would ease with physical therapy, which began the following week.

The speed with which all procedures and appointments had been made was extremely impressive. As was the speed with which my arm, always skinny but not without a kind of sinewy strength, had atrophied.

“Behold, mine arm is like a blasted sapling, withered up,” I said to Jafari, the young therapist who had clearly completed his training only a few weeks previously. He was actually 48 and, in the coming months, we got to know each other rather well.

Life settled into a pattern. I saw Jafari twice a week. There were nights of weird and excruciating pain – difficult to describe, little scribbles of agony, pulsing and shooting – amid the persistent dull and eventually unnoticed ache. I was able to bend my arm slightly more each week. I could straighten it. I could brush my teeth with my left hand again. I kept harping on to Jafari about the possible self-inflicted harm done by first-night flossing. Seconding the surgeon, he said that was impossible. But I had entered a world in which anything seemed possible except a return to health and tennis.

Roger Federer practises before the US Open in New York, August 2015. Photo by Chris Trotman / Getty Images for the USTA

Six weeks after surgery, having regained something close to full mobility, I began trying to build up my strength. Before describing this great leap forward, however, we need to take a step back.

Like many émigrés from the United Kingdom, Christopher Isherwood was struck by the ameliorative imperative sun-baked in to Californian life. Visiting a friend in hospital he was told by a nurse that the patient was “not doing too well”. When Isherwood asked if he’d suffered a relapse she admitted, “It’s a little worse than that. He passed away.” Now that I was actively involved in my own recovery, I was not doing too well, either. There is a delicate balance to be achieved in physical therapy between pushing through certain kinds of pain in order to repair damage – breaking down scar tissue – and not pushing so hard, into other kinds of pain that cause new damage. This requires great attention to your body. I kept mentioning the tugging pain near where the pin had gone in, but progress was being slowly made. Eventually, Jafari said I could swing my racket round at home. The following week I went and hit against a wall for about ten minutes: the first time I had been able to hit a tennis ball in six months. That was the high point of my recovery, after which my arm began to hurt in several ways. I had to scale back the exercises and seemed gradually to be going backwards, downhill, in reverse.

From this point on, the task of building up physical strength became less important than concentrating on being mentally strong in a stoical English way – strong enough to resign myself to never playing tennis again. Which also involved a larger farewell: to vigorous corporeal life.

I kept thinking of my dad, who famously – famously within our family, I mean – said he didn’t believe in physical therapy. In his seventies he’d had a hip replacement that didn’t work. This was not a surprising outcome. He’d had the operation just because it was available, because he was entitled to it, without any serious expectation of being able to walk properly again, and, in truth, he made little attempt to do so. He remained in pain for the last years of his life, though the pain of the hip was nothing compared with the ulcer in his leg and the psychological pain of a colostomy bag and macular degeneration. The final ration of hurt came when he fell over and broke a couple of ribs. After he’d been in hospital for a few days I went to Paris for a couple of nights. When I called the hospital, the receptionist on the ward said he was fine. In fact he’d just done some physio. I should have realised something was wrong – that didn’t sound like him – when she said this. Later the next afternoon, on the train back to England, a nurse called to say that I needed to hurry back. He died, of pneumonia, a few hours before I got there. As I sat next to him, next to his dead body, empty now after 90 years of use, I found myself thinking of another time he’d been in hospital, decades earlier, for his colostomy. He was propped up in bed in his pyjamas, proudly sporting a badge: “Private Medicine Makes Me Sick.”

Here in the land of private medicine, I had wondered if I’d been sold a product. Three months after the operation I worried that I’d been sold a pup. Tsitsipas had come back from his elbow surgery in two months. For someone who had spent seven minutes taking a bathroom break in a match against Andy Murray – “What’s he doing in there?” Murray wanted to know, quite reasonably – this was remarkably fast. Now, just when I was scheduled to be back on court, I felt that were I not recovering from surgery I’d be making an appointment to discuss having surgery.

I was not, as they say, the man I was. I’d always been fit, thin, athletic and sufficiently young-looking in 2017 to dance at a club in Berlin with my shirt off. I trimmed my eyebrows, plucked all hairs from my ears, scrupulously shaved my neck to avoid furry-neck syndrome, but all of this was just fiddling while Rome burned, rearranging the deckchairs while a titanic, potentially catastrophic physical decline was being played out.

About 15 years earlier my main tennis partner, Dan, had dislocated his knee, and, although he made a brief comeback, that was the beginning of the end for him tennis-wise, and my elbow looked like being the end of the end for me. If I played tennis again, I’d have to learn a two-handed backhand to reduce the strain on my forearm. The alternative, if things didn’t improve, would be to learn to play with my right hand. At 63! I thought of Socrates on the night before he was due to drink the hemlock, learning a new tune on the flute and being asked what good that was going to do him.

In America the urge to improve, to get better (in every sense) is inseparable from coming up with new ways to persuade you to part with your money: on trying to perfect your body (yoga, cross-training, Pilates), mind and house (by emptying both of clutter). There is the assumption that, whatever your age, you can continue to invest in your future, by getting in shape, improving your swing (tennis, golf). Life is a lesson and you have to keep learning, but one of the lessons I’ve learned from life is that I don’t like taking lessons. I used to love playing table tennis, and while living in Texas had a lesson once a week for about six weeks. The only significant lesson I learned from this was that I didn’t have much interest in improving my table tennis. What I liked was playing with my friends, or making friends with people I played with.

I also liked thinking that I could still be attractive to women half my age. This, the reader exclaims, was not only a delusion, but a deeply unattractive one. If so, it’s a delusion from which I no longer suffer. To that extent it could be said that the surgery – the opposite of cosmetic – has worked, even if this was not its intended purpose. At roughly the time that Covid was said to have become endemic, something we would have to learn to live with, it looked like I would have to learn to live with a pervasive sense of infirmity.

[See also: My grandmother, the quiet radical – by Sophie McBain]

My elbow woes have obliged me to see myself as I am. In classes with graduate students, looking at their black hair, vicariously animated by their voracious appetite for literature, I forget that I am a grey-haired senior, vulnerable to Covid, but also eligible for compensatory discounts and even a certain amount of sympathy. One of these students, a mother in her mid-thirties, recently had a hip replacement. On the one hand, it seemed a bit precocious to have a hip replaced at her age; on the other, her youth enabled her to make a fast-tracked recovery. While she was literally up and running again in six weeks, I seemed destined to follow in my dad’s lack of footsteps.

I thought of him again last weekend when I was at Bombay Beach on the Salton Sea, a once-thriving resort, since fallen into such an advanced state of dereliction that it acquired a post-apocalyptic charm which is leading, now, to signs of avant-garde regeneration. One of these signs is the festival there, run by my friend Tao Ruspoli. The festival is wild, but there are lectures in the mornings and afternoons, and I agreed to give a talk. After my event, looking out over the pristine desolation of the Salton Sea, Tao told me how, when his sister was born, he’d asked his dad if he intended to have more children. “Maybe in a few years,” his dad replied. “For now, let me enjoy my youth.” Three years later he did indeed have another child, at the age of 73.

Bombay Beach is small, and there’s always a shortage of quiet accommodation. With this in mind Tao had booked me and a couple of other distinguished speakers into a place a few miles away called the Fountain of Youth: an age-restricted resort, accessible only to those who are 55 and over. It was a soul-destroying experience, a form of sunny-side-up ego death, to eat breakfast there, watching all these old people, some of whom were younger than me, enthusiastically keeping body and soul together in the cryogenic pool. Gore Vidal mocked F Scott Fitzgerald for whining on in his notebooks about how “he was young and now he’s middle-aged”. That now seems to me an entirely worthy theme, perhaps the biggest one there is.

I received a copy of my book yesterday. Flicking through the many pages about endings, I realised the question that kept recurring was: what happens after the end? As it happens, I have a specific answer to the elbow question.

Five months after surgery I’m doing… not great but a lot better, certainly. I resumed the physio exercises without setbacks, could feel myself getting stronger, less worried, more confident. I started hitting against the wall again and while doing so got cruised by a guy who asked if I wanted to hit with him. This complete stranger, an overweight fellow who looked pretty old but was probably younger than me, had no idea – until I told him – of the historic significance of what was about to take place, namely that I would be playing tennis again. We rallied for half an hour until, fearful of the potential hangover, I thought it prudent to stop. My arm, the next day, felt OK – partly because of the excruciating pain in my right knee.

Geoff Dyer’s latest book, “The Last Days of Roger Federer”, is published by Canongate

[See also: What does it mean to be British? – by Gary Younge]

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This article appears in the 15 Jun 2022 issue of the New Statesman, The Big Slow Down