Category Archives: Aging

Weak Links in the Chain

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Resilience has become almost a buzzword with regard to how communities handle adversity and disasters, albeit a very useful buzzword. It focuses our attention on how we can better prepare for and cope with such events. The question of the moment is how the concept of resilience applies to our response to coronavirus.

One of many hospitals in Chicago, all of which have visitor restrictions in place due to the coronavirus pandemic.

I am not and never have been a public health expert, though, as an urban planner and adjunct planning professor, I have often worked with such people. I say this because I want to be clear about the prism through which I am viewing the coronavirus pandemic as a public health disaster. What I bring to the task is decades of work, particularly as a research manager, in the subfield of hazards planning. I am known for deep expertise in hazard mitigation and planning for post-disaster recovery. In this article, I am reaching into that toolbox to help identify what we need to learn from the current crisis.

Specifically, part of what has become the standard approach to hazard mitigation planning is vulnerability analysis, the process of identifying what in plain English are weak links in the chain of community capabilities and capacities to manage and recover from a disaster. Every community, every nation has strengths and weaknesses built into its systems, which are really an ecosystem of economic, social, institutional, environmental, governmental, and other elements of the community that comprise the way the community functions in both sunny times and days of turmoil and dysfunction. How well can that community or nation restore itself, rebuild, adapt, and learn from its experiences? One of the most fundamental elements of success, for example, is trust in government and community leadership, something that is being tested right now in the U.S. That leadership can either greatly enable and empower or greatly hinder the capacity for effective response to, and planning for recovery from, a given disaster.

But my focus here is on what a vulnerability analysis of our response to COVID-19, the disease caused by the novel coronavirus, might include. I say “might” because I do not pretend that what follows is comprehensive. It is merely suggestive. A more comprehensive list would best emerge from a summit of leaders and experts when it is time to decide on the lessons learned from this disaster. For now, leaders are rightly focused on using existing authorities and capacities to control the spread of the disease.

The main point of a vulnerability assessment is to identify potential points of failure relative to the hazard under consideration. For instance, with hurricanes or floods, we would want to know what roads or bridges would collapse or become impassable. We would also want to know the locations of substandard housing that might suffer damage or destruction or endanger its occupants. There are dozens of other examples of potential points of failure that I could list here, but presumably, you get the idea.

With the novel coronavirus, we are dealing with an invisible hazard that inflicts suffering and death on people, not buildings or structures, and—most importantly—for which there is not yet an identified cure or vaccine. Most people do not die, and many suffer only mild symptoms, but the spread of the disease is of radical concern in part through the slow rollout of testing kits in the U.S., which exacerbates an existing inability to know precisely who is infected, especially since many people test positive who are asymptomatic, that is, not exhibiting clear symptoms of the disease. Vulnerability depends on various factors, most notably, but not exclusively, age. Respiratory and other existing conditions can elevate that vulnerability, while some older people may be tough enough physically to weather the assault. Thus, identifying and classifying real and potential victims is a business fraught with uncertainty.

Given all that, where are the weak links in our communities? Many can be readily identified from the more routine aspects of vulnerability assessments, starting with governmental capacity:

  • To what extent has the city, state, or the federal government prepared and established capacity for anticipating the problem and quickly enabling the appropriate responses? It is perfectly logical to expect that greater capacity should exist at higher levels of government that have greater resources at their disposal.
  • What is the level of political maturity among the electorate, and the political will for undertaking and enforcing difficult but necessary decisions in a crisis?

The biggest questions surrounding coronavirus seem to relate to institutional capacity, some of which can obviously be enhanced or supported through governmental capacity, for example, in procuring and distributing the personal protective equipment, ventilators, and temporary hospital beds needed by the regional “hot spots” for virus outbreaks, which at the moment include New York, but also a frightening spike in confirmed cases and deaths in the last few days in Louisiana, possibly tied to the huge crowds attending Mardi Gras in New Orleans. These have led to Gov. Jon Bel Edwards issuing a stay-in-place order similar to those in effect in California, Illinois, and New York. Among obvious questions in a vulnerability assessment going forward:

  • What hospital capacity exists for treating large increases in numbers of patients in a future pandemic? This includes emergency room capacity, intensive care units, and other essential elements of the treatment process, as well as the ability to expand access to protective gear. It also involves the adequacy of skilled professionals to work with this increased patient load.
  • What capacity exists to monitor, work with, and even thin the population of crowded jails and prisons, where social distancing is effectively an oxymoron, and the potential for rapid spread of disease can amount to a death sentence for those confined behind bars?
  • What are the sanitary and patient care conditions in local nursing homes, and how effectively are they regulated? Nursing homes and similar facilities for elderly medical care have in some cases become virtual incubators for the spread of coronavirus, leading to situations where relatives can no longer visit.

Many of these questions also lead us to questions of economic vulnerability, which also pertain to social equity. Restaurants in states that have instituted closures of public places where people normally congregate in large numbers have laid off thousands, possibly millions of workers—the numbers change by the day—who often work for hourly wages and need every hour to pay the rent. Workers in the gig economy, the tourist economy, and the travel industry are all similarly vulnerable in varying ways. One result, even under normal circumstances, is that many of these workers, some of whom are also undocumented immigrants, are reluctant to take sick days because they have no paid sick leave. Often, they also have no paid health insurance, or cannot afford it.

That, in itself, needs eventually to be recognized by the United States as a source of pandemic at worst, or a threat to public health, at best. Take, for example, the story of a McDonald’s worker who shared the news that he went to work ill, vomited when he ran to the restroom, but was afraid to call in sick because a missed paycheck was a threat to his economic security. How often does that happen, and how reassuring can it possibly be to customers who even think about the potential consequences? Is anyone attempting to gather data on this problem? A worker rights organization, Arise Chicago, has been fighting for better protection for workers on this front for several years, and won passage of a Cook County ordinance in 2016, but the battle continues. At the moment, these workers either are laid off because of restaurant closures, or are adapting to the temporary new world in which their employers can sell takeout, drive-out through, or delivery.

But whether it is hotel, restaurant, or transportation workers (such as taxi and Uber drivers), among others, the vulnerability lies in the harsh facts that drive them to show up for work despite illness because of their lack of paid sick leave or medical coverage. Nowhere in America can an honest vulnerability assessment of future pandemics ignore these socioeconomic imperatives. Economic facts drive health impacts, which in turn drive at least some of the questions surrounding health care capacity. In this sense, one can see how identifying all the weak links in the chain of vulnerability means recognizing the interrelationships between the various categories of vulnerability I listed initially.

This description of the process could go on for many more pages, but it may be more important to let the complexity and interdependence of it all inspire further thought. With that in mind, let me offer a few other items for consideration:

  • Given the inability of some parts of the population to accept the necessity of temporary restrictions, how well prepared are we to control the wayward behavior of the few, even as the majority of our citizens show adequate consideration for others around them? What are we prepared to do about them?
  • In the event of a lockdown, what are we prepared to do for victims of domestic abuse who are suddenly trapped inside their homes with abusive partners, parents, or relatives? Do we have institutional capacity to remove them to safer quarters and the ability to answer their calls for help? Sheltering in place is hardly likely to make an abuser more sympathetic.
  • How well are we positioned to assist those suffering from mental illness, for whom isolation may increase propensity for depression and suicide?
  • In what ways can we respond to the needs of homeless people, for whom the spread of a pandemic disease may increase due to proximity and unhealthy circumstances?

There are some very hopeful signs of creative thinking on these issues in local and state governments, if not in the White House. For example, the City of Chicago has reached agreement with several hotels to use hotel rooms as isolation rooms for victims of COVID-19, with the city paying for the capacity in advance. This relieves hospital capacity, to some degree, but it also provides some employment for hotel workers who would otherwise be idling at home because of the shutdown of the hospitality industry as both leisure travel and conventions grind to a halt. The workers will provide food in the kitchens and undertake other safe duties, while trained public health personnel deal directly with the quarantined patients. The hotels stay open, some workers stay employed, and some strain is removed from medical facilities. Some members of the Chicago City Council are now calling for the use of vacant public housing units for the same purposes.

Likewise, some otherwise closed YMCA facilities will begin accommodating the homeless while providing necessary social distancing. All of these are creative solutions that can emerge from identifying the weak links in the chain, and can provide cornerstones for sound planning for resilience in the face of future public health emergencies.

In short, let’s all keep our thinking caps on. We’re going to need them not just this time, but for the future as well.

Jim Schwab

For the Love of Public Spaces

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If the doctor’s office had not called, I would not even have been here writing. I would perhaps have been on the CTA Blue Line on the way to my appointment, or more likely walking from the train station to his office. But they called less than an hour before the appointment. The urologist merely needs to follow up on a February 26 procedure, so could we just do a telephone consultation? Frankly, I had wondered why they had not offered that option already, so I accepted. The only difference it would make, I noted, was that I had planned to use the opportunity to shoot photos of the empty “el” cars, the empty streets as I moved up Michigan Avenue across the Chicago River, and perhaps the empty Millennium Park downtown, if it was in fact empty. Deprived of the need to go there, I simply walked the neighborhood, shot photos of restaurants open for takeout only, and took two shots of the empty el platform. Then the drizzling rain began, and it was time to come home and await the call, which came late as the doctor scrambled to maintain his schedule.

The Western Avenue Blue Line station platform, early afternoon, March 19. If you are not from Chicago, trust me: You have no idea how unusual it is for this platform to be so empty. This is the impact of the coronavirus pandemic. Ridership is down by more than half.

But at least I got that first paragraph written, before the nurse called, as I thought about a potent issue for urban planners amid the coronavirus pandemic. Under normal circumstances, there are few subjects most planners like to discuss more than the design and use of public spaces. These come in a variety of forms, such as trails, parks, and plazas, which are generally publicly owned, but they also include a wide variety of privately owned spaces that are nonetheless generally accessible to the public, such as restaurants, outdoor cafes, malls, stores, and recreational facilities like the YMCA. The latter category is more frequently available on a paying basis, but those lines can be blurred under specific circumstances, such as the rental of public spaces for private events. The one overriding factor is that planners are very much aware that the public life of cities is very much defined by the activity levels and density of use of these spaces. An urban park visited by almost no one is not a positive sign of urban vitality. A public concert in the park attracting hundreds or thousands of happy people dancing and swaying to the music is a sign of a city in love with life and alive with culture.

Margie’s Candies, a nearly century-old family and teen hangout and source of sandwiches, ice cream, and candy for residents of Chicago’s Humboldt Park, can only offer takeout sweets at this time.

In the midst of pandemic, however, especially in dealing with a disease for which no one has yet developed an effective vaccine, not to mention a disease that disproportionately slays the elderly and those with respiratory vulnerabilities such as asthma, crowded public spaces are an indicator not of prosperity and vibrancy, but of danger. Social distancing to protect ourselves from unidentified carriers of COVID-19 is now an essential element of survival and personal protection. Yes, it’s nice to greet a friend in the park, but only if they keep their distance, and no, I don’t wish to shake your hand. There is a certain weary loneliness about this that is undeniable. Most of us are highly social beings, even the introverts among us. We like to talk, to exchange news, to share ideas. Thank God for the invention of the telephone and the Internet.

Why order online? Because, for the time being, restaurants in Illinois are not permitted to offer dine-in service. Takeout, drive-through, delivery are your only options. Blow up the photo to see the sign on the door more clearly.

But it’s more than that. Public spaces often provide us, to one degree or another, with the opportunity to move, to exercise, to stay physically fit. I got word just two days ago that the X Sport Fitness gym at which I maintain a membership would be closed until further notice. The trainers, I learned, are left scrambling to determine how they could continue to earn a living. They are joining millions of others whose livelihoods are in jeopardy until this scourge passes. If you know someone in Chicago who can benefit from in-home fitness training, let me know. I can hook them up with capable trainers.  

Coffee shops and restaurants are no longer public meeting spaces. Just get it and take it home.

I will be looking to find other ways to stay physically active. As noted in posts of years past, I am fortunate to live near the 606 Trail. I need to get my bicycle tuned up for another season, and I can ride for miles. On my stroll yesterday, I could see that joggers were making generous use of the trail, as were walkers and others. Interestingly, the Rails-to-Trails Conservancy has posted information quoting medical experts suggesting that people should seek to maintain their exercise routines and use our public parks and trails for just these purposes. There is nothing worse for physical health than being cooped up in one’s house or binge-watching past seasons of whatever. Get out and move around. Just keep your distance.

The joggers, bicyclists, and strollers are still using the 606 Trail. This is near the Western el station shown above and the photo taken less than 20 minutes earlier.

That goes for the kids, too. Playgrounds, for the most part, are still open. If you’re worried about touching the equipment, make the kids wear gloves or use disinfectant wipes on metal and plastic surfaces before letting them ride or play. But, above all, let them run around.

What we are all, I hope, trying to do for the near future is to slow or halt the transmission of this dangerous new coronavirus. That does not mean we become couch potatoes obsessed with watching our favorite 24-hour news source feed us endless details about the latest announcements, as important as they may be. There is still plenty of opportunity for most of us to stay healthy and drink in copious doses of fresh air. But we can also follow the guidance about social distancing and sanitation practices. In short, most of us should be very capable of walking and chewing gum at the same time. Just don’t spit that gum out on the sidewalk, thank you very much. Think about the safety of those around you. Use the trash can.

If we can all learn anything from this disturbing experience, it is perhaps an increased attention to sanitation and cleanliness in public spaces and the need to respect others by maintaining the quality of those spaces. Too many of us have seen public restrooms that are poorly maintained or not cleaned with adequate frequency. Those are obvious examples, but we can discern many others, including coughing and sneezing away from others, using facial tissue or handkerchieves, and simply cleaning up after ourselves, and understanding why some people find it necessary, even critical, to wear face masks or take other precautions. Think about the safety of those who must clean up after us, who often earn low wages and have less access to medical care. Don’t put them in greater jeopardy than necessary. Those of us involved in planning for post-disaster recovery often talk about finding the “silver lining” in each disaster experience. With any luck, that silver lining in the COVID-19 experience is a greater attention to public health, starting with the White House and extending all the way down to our own house or apartment.

The other big lesson for planning is the value of readiness and preparation for disaster. The old saw that “they also serve who only stand and wait” may be far more applicable and relevant than we realize. When President Trump eliminated a White House office that President Obama had created to focus on global pandemics, following the gruesome lessons of the Ebola virus, the assumption seemed to be that those studying and preparing for the next big public health crisis were simply wasting time and money. If that is true, why do we have an army of emergency managers spread across the country, preparing for natural and man-made disasters that, according to that line of logic, “may never happen”? The answer is that we should know all too well that reconstructing such capabilities after a new public health crisis or disaster is already underway wastes weeks and months of valuable time that can never be regained, and in this case, may be costing thousands of lives before it is over. Let us be wise enough as a nation never to repeat that mistake again.

Jim Schwab

America’s Public Health Disaster

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Every day seems to bring shocking news. Restaurants and schools close, conventions are canceled, overseas travelers face unexpected obstacles in coming home. The United States of America, like much of the rest of the world, is facing a crisis unlike any in our lifetimes. While I understand many of the protocols because of a background in disaster recovery, my intellectual and professional focus has dealt with natural disasters, not pandemics, so I will not claim any special expertise. I’d rather listen to the medical experts who have studied the issue in depth.

But at 70, I can relate on a personal level to the concerns of older citizens who are most at risk in a way that I know I never could have done at a younger age. While I remain physically fit, I am also aware that maintaining that fitness requires real effort, sometimes more effort than it might for someone half my age. More importantly, I have become more aware that a fitness routine does not guarantee immunity or invulnerability to some of the impacts of aging. Consequently, while exercising, not smoking, and a sensible diet can afford me significant confidence about facing a challenge like the current novel coronavirus, or COVID-19, pandemic, it guarantees nothing. All the recommendations about avoiding unnecessary travel, social distancing, and sanitary precautions still matter greatly in improving the odds against illness.

Already, I confess, some of the simplest impacts of aging have slowed down my production of this blog or at times made it more irregular than I would like, and that is despite no longer working full-time. I do some consulting, some writing, and some teaching, in various proportions, and my days are full, although much of my time currently is also devoted to a volunteer job—serving since January 1 as chair of the American Planning Association’s Hazard Mitigation and Disaster Recovery Planning Division. That presently has me involved in trying to disentangle commitments for some of our events at APA’s pending National Planning Conference in Houston, scheduled for April 25-28, preceded by some leadership meetings I expected to attend. Tonight, the APA board of directors canceled the conference. Our division executive committee had decided to cancel our division reception in Houston, only to learn that the restaurant planned to close anyway. Life is like that these days. A colleague and I were scheduled, as part of our APA division’s outreach program to planning schools, to discuss hazards in planning at a university graduate class later this month, but that shifted to possibly remote to simply waiting for another school year as most colleges have adopted online learning for the remainder of the spring semester. As I said, life is like that these days.

But back to the subject of aging. One learns we simply cannot control everything, no matter how hard we try. As I detailed in a July 4 blog post last year, life for me had generally gone along well until I began to realize in late spring that my sight was becoming fuzzier and clouded. What began with a visit to an optometrist in April to see if my prescription for eyeglasses needed updating ended in late June with cataract surgery in both eyes, and considerable lost time due to an increasing inability to read a computer screen. That put me weeks behind in preparing a transition of the University of Iowa graduate class in urban planning I teach each fall to an online forum, and with other factors coming into play as the year went on, I never got completely ahead of the curve until the semester was over in December.

But at least cataract surgery, in most cases, is a one-and-done proposition. You get the implants, you have new vision with only reading glasses for assistance, and life goes on. But by late fall, I learned that another malady would force me into hemorrhoid surgery, which took place immediately after the holidays. With certain complications due to an enlarged prostate gland, it sidelined me for the first half of January until recovery was complete.

Now, it may well be at this point that I will not face further difficulties for some years to come. I certainly would be pleased if that became the case. These were the first surgeries of my entire adult life, but they stalled my activities to some extent, and they are a small glimpse of the sorts of things that make many other seniors feel far more vulnerable than I do. It is small wonder that many of them fall victim more easily to scourges like the coronavirus. The elderly and the physically challenged have predictably proven far more prone to the severest consequences of COVID-19, including death.

We also know, however, that many other Americans, and many citizens of other nations as well, will suffer serious economic dislocation as a result of the restrictions placed on economic and social activity in order to stem the upward slope of infections and death. While U.S. accounting is hampered by the lack of testing kits and public access to testing in key regions of the country, the alarm bells are ringing loudly. As I write this, the number of confirmed cases has quintupled in the past week to more than 5,000. We do not yet have any idea when we will reach the peak of this frightening mountain, and how high that peak will be. But we already know that the far smaller nation of Italy has, as of this moment on March 17, more than 31,000 cases that have resulted in more than 2,500 deaths, despite doing far more in an effort to contain the spread of the virus. It is not that we have a smaller problem, but only that we may have begun our steep ascent a few weeks later. Nearly every day, new nations report outbreaks. This is clearly not a “foreign” virus, but a global pandemic.

We have built-in problems in the American system, most notably the lack of universal health coverage as a result of endless political spats over creating a system that better protects the working poor. Many of the restaurant and factory workers who may face layoffs will lose whatever coverage they had, or may no longer be able to afford it, at the very time when they are facing an existential public health threat. This threatens all of us with the possibility that some workers, unknowingly carrying the virus, may feel compelled to work if they can or simply be unable to visit the doctors they need to see. Our myopic approaches to health care have set us up for massive vulnerabilities in this regard. We seem not yet to fully understand that we are no stronger as a nation than our weakest links. One result of this crisis, however, may be a profound rethinking of the role of the federal government in ensuring some form of universal health care availability. The consequences of making health care unaffordable to the poor have never been laid bare before for us in the way that the coronavirus may do. Disasters can force soul-searching under the right conditions. The question is how deeply we are prepared to think about the issue.

The other question we have never faced before is how we will emerge from this crisis. After weeks or months of social distancing and self-isolation, how will we decide the time is right to emerge from our mental caves and greet other again, and join large crowds again? And how will we feel when we do it, and how comfortable will it feel? My hunch is that the human race is highly adaptable, but that there will be no very clear demarcation point when it is okay to say that the war is over.

This particular disaster may end not with a bang, but a whimper, followed by some happy parties among the most extroverted but also the most fearless, perhaps the most reckless, among us. I like to count myself a “compulsive extrovert,” my invented self-description, but I also like to think I know when to exercise some social caution based on circumstances. This may be a disaster where people like me eventually start to poke our heads out of the foxholes we reluctantly entered, not out of fear of social interaction, but to be sure the landscape is no longer infected.

But when the day comes, it will surely be nice to join a big party where the beer flows and greetings are plentiful.

Jim Schwab

I Can See Clearly Now

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Some readers may have noticed that it has been seven weeks since I last posted to this blog (May 13). That delay was not by design but resulted from circumstances. For two weeks immediately after that last item, I was largely on the road, but that has happened before without slowing my pace. What followed most certainly did.

In early April, after sensing some eye strain in late winter, I responded to notices from Pearle Vision that it had been more than two years since my last eye exam. My last prescription for glasses was in 2016. I figured an updated prescription would cure the problem, as it had before.

This time, the optometrist noted some indications of cataracts, though he stated that an ophthalmologist would have to determine whether they were serious enough to require surgery. I took note and arranged for such an exam. There was a little discussion of floaters, and I indicated they had not been a problem. He ordered new lenses, and by late that week, they were installed in my existing frames. I thought I was good to go.

I was dead wrong. Before the weekend was out, I returned to complain that the new lenses had done nothing to cure some blurring, which I attributed to a long-standing combination of astigmatism with my well-defined myopia. I had been near-sighted since childhood and had glasses since I was ten. I am now 69. Glasses have been part of my existence for six decades. The optometrist conceded that he had not tested for astigmatism, noting, to my surprise, that the 2016 exam had shown no sign of it. Astigmatism, which causes blurred vision, can wax and wane over one’s lifetime. In mine, apparently, it had become much less pronounced than I had realized. But he conducted a free second exam and made minor adjustments to the prescription to solve the problem.

By then, there were only two days before I left for San Francisco for the annual National Planning Conference of the American Planning Association. I had to leave with the existing lenses and wait for the new ones to arrive. Pearle called while I was still in California to say that they had arrived, and I visited their store the very evening I returned. I tried on the new lenses. There was still no benefit in clarifying my vision. I decided to be patient and see what would happen—but nothing. I began to realize other factors might be at work.

In scheduling the ophthalmology exam, I contacted the highly regarded clinic at Northwestern Medical Center, part of the Northwestern University hospital system. They first offered an appointment for May 14 because they were booked for a few weeks, but I was already in their system because of a different issue a year before. I had to decline; I would be flying to Winnipeg that day to speak at the Manitoba Planning Conference. The following week, I would be in Cleveland for the annual conference of the Association of State Floodplain Managers. We finally settled on May 30. My own schedule produced the delays.

Dr. Pyatetsky and me during a post-op appointment.

At that appointment, I met Dr. Dmitry Pyatetsky, who conducted the exam. He quickly informed me that my right eye had a serious cataract that needed surgery. The left eye had a smaller cataract, and the wise approach would be to follow with surgery on the second eye. Cataract surgery basically involves breaking up the cataract, which clouds one’s vision, and then replacing the natural lens in the eye with an artificial lens that provides 20/20 vision. I would no longer need glasses, except for reading and computer work. For the first time in my adult life, I would spend most of my day seeing clearly without glasses. Moreover, Dr. Pyatetsky chose to waste no time. Surgery on the right eye was scheduled for June 20, just three weeks later, preceded by some preparatory appointments including a biometric exam to acquire precise eye measurements. That exam also determined that there was nowhere near enough astigmatism to justify Toric lenses, which can correct astigmatism but involve an out-of-pocket expense in the low four figures. I would have spent the money if there had been a problem to solve that insurance would not cover, but I was relieved to find out otherwise.

In fact, I was relieved by many things I learned about modern eye surgery. We live in an age that has made routine many procedures that used to be either problematic or downright dangerous for past generations. I was aware of this already on an intellectual level, but this experience made it personal.

Just a year ago, as an adult nonfiction book awards judge for the Society of Midland Authors, I had read The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine, a remarkable piece of medical history by Lindsey Fitzharris, for which our Honorable Mention was merely one of several prizes, topped by the 2018 PEN/E.O. Wilson Prize for Literary Science Writing. This graphic, often gruesome story made me acutely aware of the benefits we enjoy from medical advances, for only two centuries ago, it was demonstrably dangerous to visit doctors or hospitals, who understood nothing about germs and infections and seldom bothered to clean the instruments with which they performed their surgeries. The result was a high death rate but no grasp of their cause. The story details Dr. Joseph Lister’s struggle to prove that sanitation was essential, in the face of a medical profession in the Victorian era that preferred not to believe that its own practices put patients at risk. One can, of course, read much more about this monumental shift in medical thinking that put many benighted practices behind us. Nearly 15 years ago, in reading Dark Horse: The Surprise Election and Political Murder of President James A. Garfield, by Kenneth D. Ackerman, I learned that Garfield’s death in 1881 was more the result of medical malpractice and the refusal of his doctor to accept modern bacterial science than a direct result of the assassin’s bullet. Historically speaking, we are not so far removed from the Dark Ages, yet the medical advances of recent decades have been stunning.

As someone who will turn 70 late this year, I am experiencing a growing appreciation of all that is possible with modern medical practice. Old age no longer need be the cavalcade of horrors that it once was. What is true generally is certainly true of modern ophthalmology. The time is not long past when cataracts were simply a fact of advancing age. The Bible is replete with references to lost vision as a result of age, such as “Isaac was old, and his eyes were dim, so that he could not see” (Genesis 27:1). The situation was common well into the 20th century. Although medical history documents surgical procedures for cataracts dating back for many centuries, a close reading of the techniques mostly reveals what must seem a catalogue of horrors from the perspective of modern patients. Couching, in which the lens was pushed into the rear of the eye with a curved needle, was replaced in the 1700s, at least in Europe, by extraction, which broke up the cataract and sucked it out. Johann Sebastian Bach underwent couching but remained blind and, in his case, died four months later. Nothing about these procedures sounds pleasant or painless, or without profound side effects.

It was not until the 1940s that British ophthalmologist Harold Ridley hit upon the use of polymethylmethacrylate (PMMA), a type of plastic that lacks any inflammatory qualities (so long as it does not touch the iris) as an artificial lens implant, now known as the intraocular lens (IOL). Among the inspirations for this approach to restoring sight was the observation that Royal Air Force pilots in World War II showed no adverse impacts from absorbing PMMA when their fighter plane shields were shot out by German planes, leaving tiny shreds of PMMA shrapnel in their eyeballs. This biological tolerance for PMMA paved the way for the first transplant of an IOL in 1949 in London. Subsequent innovation introduced the use of phacoemulsification, which permits the use of ultrasound to emulsify the natural lens and eliminate the need for removal with an incision. In short, the past half century of medical improvements in this field has made a world of difference for patients like me in 2019. The surgical success rate is now somewhere around 99.5 percent. Especially considering that I had almost no other health problems that might interfere with recovery, I was happy to take those odds. In fact, by the time the second surgery was conducted, on the left eye, on June 26, I was mostly just anxious to get it all over with. 

The reason was simple. Until April, I was not even aware I had a cataract and had never given the possibility of it much thought. However, by May, aware that new glasses had solved nothing but increasingly aware of my own blurred sight, I found myself increasingly limited in my ability to read or work efficiently. One turning point came while I was in Manitoba. My agreement with the Manitoba Planning Conference was both to lead a three-hour workshop on the opening day (Wednesday) and provide a keynote address on the closing day. The workshop posed little challenge because I had converted a lengthy article I had produced for the Oxford Research Encyclopedia of Natural Hazard Science, on “Planning Systems for Natural Hazard Risk Reduction,” into a teaching format with substantial audience participation. It was a small group in a small room, I knew the material thoroughly, and my need to rely on the screen to see my PowerPoints was minimal. Nothing challenged my visual acuity. Then, on Thursday, I was introduced to the format in the ballroom for the next morning’s keynote, in front of 250 Canadian planners. Two large screens would be on either side of me, facing the audience, but speakers should face the audience and not be looking at those screens, so another, smaller screen was set at the base of the dais, away from audience view, but allowing me to see the slide on display.

Presenting the keynote at the Manitoba Planning Conference in Brandon, Manitoba.

I quickly realized there was one problem: I could not see the slides clearly. I knew right then that I did not want to be squinting at slides in the middle of a tightly timed, 45-minute presentation. I simply had to know the slides intimately so that the broad image reminded me of what I wanted to say even if I could not quickly or clearly discern the details of a graph.

And so it was. I undertook the extra work of memorizing those details overnight because only rarely do I speak from a script. I prefer to be able to remember what I want to say about each slide, but under ordinary circumstances, I can also see that slide in front of me, on a laptop screen or, in this case, a screen sitting on the platform. In this case, I had to wing it. I did it, and all was well. The main lesson was that I realized I had a noticeable problem two weeks before the ophthalmological exam confirmed it. For some people, cataracts grow slowly and can remain small enough not to merit surgical attention for months or even years. In my case, the cataract grew quickly, and my life had to adjust accordingly.

Dr. Pyatestsky with his assistant (and sister) Julia, who plans to start nursing school.

All that said, the adjustment has changed a significant aspect of my life permanently. I have reading glasses for computer work and reading newspapers, books, and the like. But for all other purposes, including driving and physical activities, I now benefit from 20/20 vision. I am grateful to the medical staff at Northwestern, including Dr. Pyatetsky, for their outstanding care and patient services. They have been excellent. I am also simply grateful for living in the 21st century. There was a time when people like me had few options once they had grown old “and their eyes grew dim.”

Instead, I can enjoy life, exercise safely, and continue to contribute to the world and community around me. I consider that the very essence of satisfaction with life.

Jim Schwab

On the Question of 70-Year-Old Men

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There is no doubt about it. President Donald Trump’s latest tweets have rightly triggered a firestorm of disgust and angry responses. The personal attacks on MSNBC reporters Joe Scarborough and Mika Brzezinski have revealed a level of meanness and misogyny even Trump’s most craven defenders find impossible to ignore, with the exception of his White House press team, whose jobs, of course, depend on continuing to justify whatever he says. Thus, we have deputy press secretary Sarah Huckabee Sanders reminding us that, when Trump feels attacked (read “criticized”), he feels compelled to “fight fire with fire.” The problem is that he typically goes off the rails with comments of little substance or truth that would cause most other people to be fired and led out of their office by security. But he is, after all, the President. The people hired him. Or at least, that portion of the public voting in the right places to comprise a majority of the Electoral College even as he lost the popular vote by roughly three million.

My focus in this essay, however, is different from all that, although connected to it. I do not intend to reprise Trump’s acid tweets or analyze or parse or dissect them. My target is certain members of the television punditocracy who should know better and are insulting senior citizens in the process of criticizing Donald Trump. The fact that Trump is their target does not blind me to the ignorance of one statement some reporters have repeated so often I have not kept track of exactly who has said it or how often: “Donald Trump is a 70-year-old man, and 70-year-old men don’t change.”

Poppycock. This is a lazy excuse for failing to take a closer look at the real problem in his case. It is also a display of ageism that should not go unchallenged, certainly not any more than Trump’s misogyny. It is an expression of bias that needs to stop.

Slicing the cake at my APA retirement party, May 31. Not that was I about to disappear to a Florida golf course. Photos by Jean Schwab

I will reveal a personal stake in this debate. In little less than two and a half years, I will be one of those 70-year-old men. At 67, it is not just that I feel very little in common with Trump’s world view. It is that I know in my gut that I remain capable of change, that I have core principles that I hope will not change, and that I have one fundamental quality that Trump appears to lack—that of spiritual, moral, and intellectual curiosity. I approach 70 in the humble knowledge that I do not know everything, have never known everything that matters, and that I never will know everything that matters. I also approach 70 in the certainty that my thirst for new knowledge must remain until my last breath, barring any mental deterioration that might forestall such curiosity. I recall a friend of mine, who had read a biography of former U.S. Supreme Court Justice Oliver Wendell Holmes, telling me of book, Honorable Justice (by Sheldon M. Novick). Although the passage does not appear in that book, he noted a story in which newly inaugurated President Franklin Roosevelt is visiting the retired 92-year-old man and finds him reading Plato.

“Why do you read Plato, Mr. Justice?” Roosevelt asks.

“To improve my mind,” Holmes responds.

Which gets us to the problem of the current President. It is commonly said that he does not spend much time reading. Reading is one activity that informs learning, and learning inspires change, and therein lies the problem. We have a President who is so certain of his own superiority, who, on the wings of inherited wealth, has spent so little time being challenged on his core beliefs, that he has not acquired the habit of intellectual curiosity. This is the only trait that truly explains his poorly informed intransigence on climate change, immigration, election fraud, and numerous other issues where his depth of knowledge often appears paper-thin. It also explains his intense, narcissistic preoccupation with personal image reflected in comments about other nations laughing at “us,” and in his perceived need to strike back at anyone who merely disagrees with him, however honest and honorable that person’s disagreement may be.

To what can we attribute this sad state of affairs? Clearly, not just to Trump himself. After all, despite the distortions in popular will wrought by the Electoral College, no one can win the Electoral College without being at least close to a plurality of the popular vote. No one with a weak base of voter support can even hope to win the nomination of either major party in the United States. Inevitably, we must look at the nature of the support that launched Trump into the White House.

There can be little doubt that some of that support involved a level of dislike or dissatisfaction with Hillary Clinton that allowed voters to overlook the manifold shortcomings of Donald Trump, although polls surely indicate that many are now reassessing that comparison. Let’s be honest. Clinton had her own baggage and an imperious style that turned off a large part of the electorate. She could have spent far more time with blue-collar voters in the Midwest but chose not to. Whether Sen. Bernie Sanders could have beaten Trump, we will never know. History does not afford us the luxury of testing such scenarios. Sanders did not win the nomination, and there is little more to be said. Better luck next time.

Colleague Richard Roths (right), still stirring the waters and challenging conventions in his own retirement, alongside Benjamin and Rebecca Leitschuh, former students (of both of us) and co-workers (of mine), at my APA retirement party.

What I want to emphasize, however, is that Trump’s lack of intellectual curiosity, and his remarkable ability to tune into similar qualities among people very unlike him—the working-class voters worried about job security—reflects a sullen streak in American culture that has long glorified ignorance. Mind you, I am not saying that white working-class voters all fall into this category. I emerged from that environment. My father was a truck mechanic. I have met and known many union members and leaders with much more generous and positive attitudes. (I am married to a Chicago Teachers Union activist.) I am speaking of a particular tendency that can be found anywhere but tends to assert itself in uncertain economic times and under certain cultural circumstances, such as those highlighted by J.D. Vance in Hillbilly Elegy.

There is a cultural tug-of-war within America that is as old as America. It is between the intellectual innovators and their curiosity and all the changes they have wrought that have launched this nation to international leadership in technology, literature, and science, and those who willingly disparage the value of education, knowledge, and curiosity, whether out of jealousy or resentment or stubbornness. There is an element of social class attached to it, but more often it transcends class. Sometimes, aspects of both traits can be found in the same person. For all his innovative genius in science and politics, Thomas Jefferson remained a racist to his dying day. On the other hand, another “70-year-old man,” his contemporary George Washington, rose above his heritage long enough at the end of his life to free his slaves, upon his wife’s death, in his will, believing that the institution of slavery would need to wither away. Jefferson did no such thing.

So, we fight this war within ourselves at times, and as we do, we need to acknowledge it in order to overcome it, so that our biases are not petrified in old age. Trump seems to have chosen the opposite course. Unfortunately, he won election by tapping into an anti-intellectual streak in American politics that runs rampant across age groups, although we can hope that the worst biases are dying off among the young. But beware of the mental calcification that can start at an early age.

Deene Alongi, to my right, will begin managing speaking tours for me this fall. I may have a few things to say!

Seventy-year-old men and women can readily change. Having retired from APA just a month ago, I am rapidly acquiring new routines, setting new goals for the coming years, and trying to think new thoughts. Like Holmes, I cannot wait to read books new and old, and I want to remain intellectually challenged. I hope everyone following this blog has similar aspirations. It is the only way we will keep our nation, and indeed the entire world, moving forward and confronting challenges in a positive way.

And I don’t want to hear one more ignorant reporter talk about how “70-year-old men don’t change.” To them, I say, look inside yourself and ask why you are saying such a thing. Is it because you anticipate being stubborn like Trump when you reach his age? Perhaps you have some biases of your own to overcome.

Beware: From now on, I may start recording reporters’ names when I watch the TV news and hear comments about old men not changing. And I will call them out when they repeat their ageist slurs.

 

Jim Schwab