Long-time readers of Time Goes By will be familiar with the name of geriatrician, William H. Thomas. I have quoted his book, “What are Old People For?”, extensively in these pages on a variety of topics about elderhood, and it has become a favored reference for me in writing about aging.

It is a remarkable thing for a renowned physician who is as busy and involved as Dr. Thomas to take on a daily blog. And somehow, he also made time in his schedule to do this interview for Time Goes By, which we conducted last week by email. Part 2 will run tomorrow.

RONNI BENNETT: You have a unique simpatico with elders. Where does that come from?
DR. WILLIAM H. THOMAS: I grew up in Tioga County, in the Southern Tier of New York State just south of the Village of Nichols.

I was surrounded by older relatives since the day I was born and thought of my grandmother's house as an extension of my own. I think that the most important thing I learned was that older relatives were valuable and esteemed members of the extended family. In fact, they were the glue that held the family together.

RB: What did your parent teach you about getting old?
WHT: My parents were relatively young (by today's standards) when they had me, and I grew up being most familiar with the idea that my parents were just 20 years older than me. My Mom and Dad were 42 when I graduated from medical school. Even now, when I am in my late forties, they are in their late sixties and both active and working. My mom would always announce that the decade she was living in (40's, 50's, 60's) was the best ever and I tend to agree with her.

RB: Did you have elder friends as a kid?
WHT: Living in a small town I was always aware that people knew me, knew my family and knew where I was supposed and what I was and was not supposed to be. I remember returning home late one evening after being out partying with my friends. The next morning an older neighbor called my mom to ask if I was okay because "Billy got home pretty late last night." This wasn't controlling, it was concern and that kind of concern was all around me when I was a kid.

RB: How and when did you decide to become a geriatrician?
WHT: I backed into it. I had already concluded my formal medical education and figured I would spend my career working in emergency rooms. Then I took a part-time job in a nursing home and fell in love - with the people and the work.

Later I sat for the geriatrics exam and passed on my first try. I can say that NOTHING in my medical education encouraged me to see geriatrics as a noble and rewarding profession. You can see the consequences of this in the fact that the number of geriatricians in America is going down rather than up, as one might suppose.

RB: The opportunities to study cosmetic surgery in medical schools far outnumber those to study geriatrics. Was this a hindrance for you in medical school and after?
WHT: I have often wondered if it was my good fortune NOT to have found and embraced geriatrics earlier in my career. Instead of learning "how it is done", I was placed into a situation where I frequently had to think things out for myself.

I remember once being on the phone with a social worker discussing what we were supposed to be doing, "What is our work?" She got frustrated with me and kept saying, "We help people compensate for deficits associated with aging."

That answer felt wrong to me then and it feels wrong to me now. Luckily I have been given the opportunity to challenge that view of the world.

RB: The incidence of plastic surgery among boomers has zoomed upward in recent years. Not long ago, I saw a news story about home skin rejuvenation appliances and techniques that were previously the domain of physicians.
WHT: Let's be clear: youth and the facsimile of youth are two very different things. The Scots have a great phrase for this: "lamb dressed as mutton."

Because we live in a brutally ageist culture there will always be a market for things that help mutton dress as lamb but, in the end, mutton remains mutton. I do not think badly of anyone who seeks out and makes use of products and treatments that create a more youthful appearance. This activity is a perfectly rational response to a culture that punishes not only age, but even the appearance of age.

RB: What do you think are the cultural consequences of cosmetic surgery becoming routine?
WHT: Many people will be buried with strangely disfigured faces. I feel bad about that but I understand why it is happening.

RB: Some scientists think of aging as a disease. Many million in research dollars are being spent these days on extending longevity. Some even say that one day people will routinely live to be 200. Is this a good idea?
WHT: Not. Going. To. Happen. I won't get into the details of it but the fact is that the human organism has certain dimensions that will not change in less than evolutionary time. Think for a moment: what is the chance that people will grow to be 30 feet tall? Would a woman, ten yards tall, be healthy? Is this a good idea? We, as a species have a largely fixed lifespan, radical extensions of that lifespan would diminish our humanity. Aging is us.

RB: The number of geriatricians in the U.S. is shrinking every year just when the number of elders is increasing dramatically. Why is this, do you think?
WHT: Geriatrics requires advanced training and pays less than other specialties with less training. Do the math.

RB: Chad Boult, a professor of geriatrics at Johns Hopkins University, was asked a few months ago in a New Yorker piece, what can be done to ensure there are enough geriatricians for thye burgeoning elder population. “Nothing,” was his answer. Do you agree?
WHT: Sadly, I agree. Barn door open. Horse gone.

RB: What are the concerns in having non-geriatrician physicians treat elders’ medical needs?
WHT: Nothing if that person takes time to learn about the specific needs of elders. Family doctors, surgeons, and internists can all give quality geriatric medical care, if they know how.

RB: What’s an elder to do to be assured of good medical treatment?
WHT: The doctor no longer knows best. It is now a partnership between doctor and patient.

RB: We live in a profoundly ageist culture. How have you seen this affect elders in day-to-day life?
WHT: Newsweek recently ran a story on the "to gray or not to gray" hair color controversy. The article made it clear that something as minor and functionally insignificant as decreased hair pigmentation can lead to major changes in how people evaluate themselves and others. That is just the tip of the iceberg (which is white).

RB: Do you see a remedy for ageism? Will the aging of baby boomers make a positive difference?
WHT: The dominant vision of aging as a spectacle of decline must be overthrown. We need new stories and new heroes to tell them.

Dr. William H. Thomas - Part 2

[At The Elder Storytelling Place today, Nancy Leitz explains how it is that her husband, Roy Has a Friend in Heaven.]