May 18, 2021

UAB Geriatrics

Returning back to work after being away for a few weeks is always painful. I have piles of papers requiring signature, multiple mailboxes, both regular and e variety, to empty and sort, and there’s always a subtle sense of something vital that got missed along the way. You know it’s going to reappear later and with innumerable complications, usually at a particularly inopportune time. I’ve had a full day at the UAB half of the job and a full day at the VA half of the job. Things aren’t yet fully caught up but there’s a plan in place to get everything back to where it belongs by the end of the week. A lot of my patients and their families seem to think that only I can help with the latest issue. I trust my teams and colleagues implicitly and have them well trained and they do just fine in my absence, even if they are met by grumbling at time that it’s not me. I wonder what they’re all going to do in a few years when I announce my retirement? I’m not exactly sure when that will be. Sometime between 2024 and 2029 I expect. I’m keeping my options open.


I will be bowing out in time to not have to deal with the enormous problems that ‘peak age’ are going to bring to the health system. This happens between 2030 and 2035. It’s the time when the entire baby boom will be over the age of 65 and eligible for Medicare but will not yet have entered their major die off. That will start in full force around 2032 and accelerate through the early 2040s and then end around 2050 or so. The baby boom generation will lose its grip on social power in the late 30s due to these inevitable demographic changes and will basically be irrelevant around 2050 (at that time, the oldest boomers will be 104 – Cher will be doing another farewell tour and the youngest will be 86). In 2060, the boomers will be what World War II veterans are today. A few still around to be celebrated, but the vast majority gone. They will continue to linger on until the very last one dies in roughly 2080 when one of the youngest boomers, almost certainly female, born in 1963 of 1964 will die at the age of 116 or so.


The book I was writing was about this phenomenon and my predictions regarding the impact of the boom on the health care system over the next decade or so as the irresistible force of the aging boom generation with their expectation of eternal youth meets the immovable object of biological aging and the structure of the health care system. Maybe I’ll return to it. Covid sidetracked it into the Accidental Plague Diaries which is in the process of undergoing its last few minor edits prior to publication. It should be available for purchase as of the end of June. Yes, I’ll give everyone plenty of notice and, as things are opening up, I’ll even have a signing party somewhere. It still feels somewhat unreal that I actually managed to finish a whole book which, according to my beta readers, is well worth reading. I don’t know that I’ll actually believe it until I hold a physical copy in my hand. I still believe in physical media and have shelf after shelf of books, DVDs and CDs in my home. I just don’t completely trust ‘the cloud’. I want to know that what I have purchased is mine to do with as I please without some sort of digital overlord able to make changes on whatever whim.


I’m still not sure what to make of the most recent CDC guidance regarding vaccination and masking. I understand that they’re trying to use ‘vaccination’ = ‘ditch the mask’ as a selling point to get those on the fence in for their jabs but it does seem as if it creates a sort of nationwide honor system regarding vaccination status. There’s no way to tell if the nice person smiling at you is fully vaccinated or a rabid anti-masker who believes in vaccine microchips and other such nonsense and is a potential sort of contagion. if the last few years has taught me anything, it’s that I need to be wary of the American population as a whole. They have shown themselves not to be the most trustworthy and it strikes me that a significant part of the population has dumped the Golden Rule and the other teachings of religion in favor of the collected philosophies of Ayn Rand and Roy Cohn.


We’ll all find out if the current optimism regarding Covid is correct over the next month or so. The numbers are way down, the fourth wave that it looked like it was developing in mid-Spring, having sputtered out. Whether this is due to increasing vaccination rates or other phenomena is unclear. The change in behavior over the last week or so with less restrictions will be reflected in infection rates around Memorial day and, if we’ve got it wrong, the death rates will start going up again in mid-June. I certainly hope we have it right but I’m still being cautious. I put my mask on when I go indoors with people whose vaccination status I don’t know. The issues of the unvaccinated and inequality in vaccine distribution pretty much all come down to ‘No one is alone’. We live in a complex interdependent world where the health of all of us depends on the health of all of us. Any group left behind or left out, when it comes to pandemic illness, can serve as the breeding ground for the next contagion. We are lucky that this one was not more fatal than it was. If the next thing that comes around as the mortality rate of Ebola, we’d be looking at wholesale societal collapse. And I’m not sure that Western societies, with their tilt away from public good to private gain will be able to do better in the future with the next inevitable viral illness that comes along.


Have we learned lessons as a society that will stick with us? It’s hard to say. The American attention span isn’t all that long and there are political and economic forces at work trying to downplay a lot of the bad that’s been going on in the society. This isn’t just limited to health issues. I read comments today from a sitting member of congress, one photographed blockading the doors of the house chambers with furniture on the day of the insurrection, describing the events as nothing more than a bunch of tourists. It makes me wonder what his family vacations are like. Did they storm Old Faithful waving flags and armed with assault rifles last summer? Perhaps they broke through the emergency doors to ‘It’s A Small World’ to make sure they got into the front of the boat. There’s an agenda at work here that I don’t completely understand but I’m trying to get a better sense of how it crosses with health policy. I’ll let someone with more experience than I analyze the political trends.

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