The world we leave our children

One of the reasons I love Shabbat so much, is that it is an opportunity to sit and talk with people that I otherwise may not get to interact with during the week. Shabbat continues to be that one critical day in the week when the digital tablets are off, the phones are silent, and the group around the table is talking about important matters rather than screaming at the Yankees  on the TV screen. Definitely, there is a great deal of joking and friendly levity with a good amount of hearty laughter. Based on a good deal of medical research, such social interaction, especially if it induces big smiles, is probably healthier than most medications for high blood pressure and even diabetes.

Over the course of weeks to months, trends in our Shabbat discussions definitely manifest themselves. When Israel’s security is threatened, we often have heated debates about how to deal with our enemies. We tend to have a rainbow of opinions around the table, with some of our guests voting far right and some voting far left in each major election. I am a firm believer that no opinion is properly formed until it has been challenged by a well thought out and logical counter viewpoint. I personally have learned a tremendous amount from my guests, and I hope they have had a similar experience from their exposure to me.

Of late, I find that the conversation is turning towards issues of age and employment. The statistics on both of these parameters are very different than what they were for our parents at the same age. One to two generations ago, an individual in his or her mid-50s was already thinking towards retirement, hopefully with a significant retirement package waiting in the wings, either via personal savings and/or via the company that the person had worked at. A career span of 35 to 40 years was often enough to carry a person from graduating university to the magical age of 65.

In many cases though, people of my age, i.e., their mid-50s, were already contemplating life with the children out of the house [in university, married, finding their own way, etc.]. This was a time to start contemplating how to spend the last decade or two of a person’s life. The social structure when our parents and grandparents were in their 50s was such that people really were winding down their lives. They thought about their wills and how their assets would be distributed amongst their children. When I was young, people would be overjoyed to see grandchildren, especially grown grandchildren who were already making their own way in the world. Great-grandchildren were rare for a person to see. I am not a nostalgic individual. But I admit that there were a number of things that were simpler 20 to 40 years ago.

Of late, I have been speaking to people of my age who find themselves having ended a career of 30+ years, but still being too young and financially limited to retire. I often semi-joke with friends that people don’t die anymore. When I was a resident, we would often see men who were in their 50s, with a history of heavy smoking, diabetes and obesity, who would present with a clear heart attack [myocardial infarction or MI]. The treatment of that time was much more supportive, helping the patient to avoid a life-threatening abnormal heart rhythm.

These days, the same 50-year-old patient will have an endoscopic procedure that opens the blockage in their heart’s arteries. Sometimes, that patient will require more advanced surgery that opens multiple vessels of the heart. If a valve is damaged, it can be replaced, sometimes without opening the chest. Heart transplants are much more common today than ever. After surgery, the patient is sent home with a litany of medications and advice about proper eating and exercise. While most patients are less than 100% compliant, the positive effect of all of this treatment is still clear: people who used to die in their 50s and 60s now live an additional 20 to 30 years.

Treatments for other diseases that were once thought to be “widow makers” have also advanced.. And we are in the midst of a technological revolution that is curing more and more diseases every day. Detection of disease is also far better than it was, so that we can treat various maladies before they have spread and caused irreversible damage. Between plain old aspirin and much more advanced medications for high cholesterol and diabetes, patients are spared all types of complications, that in the past were even fatal.

The introduction of minimally invasive surgery, “laparoscopic surgery”, has proven that many patients primarily suffered from the surgical scar rather than the internal “work” that was done on them. It was complications from the skin scar (that was left over from the removal of a gallbladder or the repair of a stomach ulcer) that caused infections and breathing problems that complicated a patient’s recovery. These days, patients can have incredibly involved internal surgery yet be up and walking around and eating freely the next day. This is nothing short of magical when compared to standard surgical procedures from when I was a resident. This means that all those patients who would pass away from pneumonia and blood clots in their legs secondary to pain from the surgical scar, no longer have these complications and thus continue to live many more years if not decades after their treatments.

Reading the medical literature on a regular basis [which is one of my jobs] often describes a near future where we will manage to cure horrible diseases such as cancer and even neurological nightmares such as Parkinson’s disease, Alzheimer’s and ALS [Lou Gehrig’s disease]. When I look at my own children who thankfully are healthy young people in their 20s, there is every reason to expect that they will live in good health and vitality well beyond the age of 100. And in the coming 80 years that they will live, it is extremely likely that medical science will find further ways to set back the clock and further cheat death. Suffice it to say, that people are living much longer, but our social infrastructure, with retirement age still circling 65 years old, appears to be totally impractical.

A few Shabbats ago, I shared a conversation with a couple of friends about the difficulty of finding employment when one is over 50, and competing with young people in their 20s who are well-versed in the latest trends and technologies. My personal background in technology and software development does make me more “useable” for a longer period of time. But I am constantly wrestling with the question of sitting myself down and retraining myself in the latest and greatest programming technologies. Fortunately, in this day and age, one can do so from the comfort of one’s own home via one’s own computer.

From a medical perspective, I have seriously considered retraining myself in the field of geriatrics. The wave of baby boomers will also splash down in Israel and there will definitely be a need for highly professional and dedicated physicians who treat older patients as human beings with cureable (not just palliative) conditions. When I was a medical student, I really didn’t see 70-year-old patients complaining about ankle pain that interferes with their regular tennis matches. Today, 80- and 90-year-old patients present to their doctors about issues related to intimacy with their significant others. This is not a topic that should incur laughter. Such a topic is incredibly sensitive and demands a physician that will take full advantage of today’s pharmacopoeia in order to help the patient in need.

80-year-old patients are no longer just waiting to fill a coffin. They are active, socially adept, possibly employed individuals who still have a great love of life and want to enjoy every second of it. A good doctor should be able to help them achieve such a goal.

What happens, though, when a business owner closes his or her shop after 40 to 50 years of activity. Assuming that this person has sufficient retirement funds to live comfortably, it is critical that such a retiree finds a social group that shares interests and hobbies. Loneliness is a documented cause of disease. Every effort must be made to keep older people in a social circle.

What happens, though to the 70-year-old who physiologically has 30 years left of life, but does not have a nest egg that can pay for anything beyond the most basic needs? If such a person is lucky enough to own a piece of property, such as their own apartment, it might be possible to sell this property and use the funds to support their retirement. Interestingly, a couple of generations ago, children and even grandchildren effectively counted on this money from the sale of “grandpa’s” apartment to pay off their own mortgage and help their children get a footing in the world.

This type of “pay day” will soon be a thing of the past. If anything, the 60 and 70-year-old children of the 90- and 100-year-old parents, may find themselves struggling to financially support their very elderly parents as well as help their younger children. If the 60- to 70-year-old children find themselves retired without significant employment and income, it is quite clear that the social structure of today will fundamentally have to change.

Whether it’s robots, software or other technologies that reduce the need for humans to perform a whole variety of tasks, I think we all have to get used to a world that may have less and less need of our skill sets, especially as we get older. I personally live in a beautiful apartment, in a manner that is superior to the way my postwar parents lived. But as my children get married and need to buy their own homes, I can easily see a situation where they will have to “settle” for a smaller apartment with fewer accoutrements then their parents (I and my wife) have.

As I and my wife reach retirement age, we will also likely move into a far more affordable and smaller apartment, so that we can devote extra funds to helping our children. It may very well be that we are already experiencing a social revolution secondary to the decreasing need for human employment, partially due to the advance of high-end universal technology. It may very well be that we are all going to have to take a step back in terms of what we considered to be comfortable living.

If present-day 20-year-olds have come to expect living their younger years in their own room, future children may have to accept sharing their room with one or more siblings. If my children were lucky enough to travel to various places in the world, my grandchildren might only see “America” once in their lives. My grandchildren might be very happy to be able to afford one car for the family, whereas I and my wife have two [very secondhand] cars. Of course, my grandchildren will probably never learn how to drive and will be chauffeured around by self-driving cars. But I would not dare predict what the cost of such cars will be and whether a middle income family will be able to afford one or two such cars.

I have mentioned before that I think it is fundamentally wrong that first-year medical students are not being warned about their upcoming careers. I think every first-year medical student should be told that by the time they have reached the age of 50, not only will the practice of medicine have changed, but the entire concept of what a doctor is, will have changed as well. I have spoken in the past about the possibility that future “doctors” will play far less of a central role in the management of people’s health. I wonder how doctors’ egos will respond to being reduced to a technical role in the management of many medical conditions.

This last statement about egos is, in my opinion, a positive one. Hopefully, doctors in whatever format they exist in the future, will become much more of team players rather than team leaders. I personally believe that this will lead to an improvement in overall healthcare. And, it might actually inspire people who truly love the practice of medicine (more than the potential for a large paycheck) to apply to medical school.

I have already internalized the fact that I need to be more flexible than ever, if I hope to truly enjoy my twilight decades. I hope that all of my friends will find a way to do the same.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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