How Bob Wachter's Fall & Obsession w/ C19 Reinforces Ageism

Grappling with getting to the age where you might need to put grab bars or a chair in the shower is not the stuff of which dramatic Tweets are made

Bob Wachter is the UCSF Chair of the Department of Medicine - a position he has held since 2007. Appropriate for someone holding a position at an institution as well-known and influential as the University of California at San Francisco school of medicine - Bob has a fantastically accomplished career as a former Fulbright scholar, published author, and as one of the recognized principal founders of the growing ‘hospitalist’ specialty care movement, which focuses on medical care devoted to care coordination and treatment of inpatients (think of internal medicine doctors who are exquisitely skilled at multitasking the needs of multiple inpatients between multiple specialty treating providers).

Bob is also 66, and has over the last three years made a name for himself on Twitter for creating hugely detailed threads describing all of the various “precautions” he takes pains to engage in, in order to avoid catching COVID-19, such as this one:

Or this one. Or this one. My personal favorite, however, was this one he tweeted last Thanksgiving:

This is Bob being “moderately” careful. :-)

While it’s not completely clear how many users actually read these multi-tweet monstrosities and takes them seriously, they have made his Twitter account very popular.

Bob’s tweets are an excuse to trot out various iterations of this meme

Moreover, the fact that Dr. Wachter had avoided, since the beginning of the gigantic sociomedical event known as “The Pandemic,” apparently catching (or testing positive) for COVID emboldened him in his various multitweet thread monstrosities detailing his obsessive litany of mitigation strategies. Also didn’t hurt that Bob’s Twitter account has grown massively over the last three years, particularly under Twitter 1.0 management.

Bob Had a Bad Fall

Although there’s some debate about what precisely qualifies as “geriatric,” my shorthand definition is “Medicare qualifying age” (which is 65 years or older).

By most conventional definitions - Bob Wachter is geriatric.

That being said - one thing about being old is that they tend to fall, a lot - and the older you get, the more you fall, and the more likely you are to be injured from falls, potentially fatally.

According to the CDC, in fact, falls are the #1 cause of injury and injury death in those over 65 years old.

Bob is 66 years old.

On July 12th - Bob tweets this:

And indeed, it was a bad fall:

I won’t go through the excruciating details, but the basics was this -

1. Bob got sick with a virus which turned out to be COVID;

2. Bob likely forgot to hydrate properly (happens), and took a shower;

3. When in the shower, Bob possibly got hypotensive, fainted, and bonked his head really badly (he also could have just slipped).

The fact is - Bob’s fall was not about COVID, it was about getting old.

Although young by geriatrics standards - he *is* an older adult.

He also did get COVID, apparently, and got what sounds like fairly typical symptoms for a URI of moderate severity - sore throat, cough, fever, cold sweats at night. Then, in the morning Bob gets up and takes himself to the shower, and then proceeds to fall, concuss himself, and require stitches:

And as of this morning (July 16th) - here we are today:

So Bob has a neck brace, stitches, and an apparently lingering sense of disappointment (notice the quote above) - “Go figure - I finally got Covid and it was #5 on my problem list.”

Obviously, Bob thinks it should be #1. His position is that his fall is proof that COVID-19 is still potentially deadly!!!!

Really, Bob?

One of the things that I’ve always learned about RNA respiratory viruses like SARS-CoV-2 is that they tend to evolve very rapidly, and although there’s no guarantees of anything (only probabilities), and there are certainly notable exceptions to this - they tend to be driven by some predictable evolutionary pressures towards increased transmissibility / infectiousness, and decreased tendency towards killing their hosts.

Honestly, as much as some people hate to hear it - COVID is, indeed, basically “just a cold” at this point.

Look, I get it - COVID is probably one of the most exciting things to have happened to Bob Wachter’s career since he became department chair at UCSF (not that he hasn’t had a meteoric career by any measure). He’s grown a huge twitter following of over a quarter-million followers, likely few of whom want to hear about the exciting field of hospitalist medicine (instead it’s “how many of these crazy, 20+ long tweet-threat monstrosities can Bob do about the various obsessive calculations he makes about masking?”)

I can’t help but look at Bob’s recent bad fall and feel a sense of sadness as to the missed opportunity.

He’s an older adult now - geriatric by conventionally accepted standards - but at merely 66 and in the position he’s as chair of UCSF’s department of medicine he has an enormous platform and position by which he could start a conversation about some uncomfortable things that we often don’t like talking about.

• When is the best time to start thinking about installing grab bars in a shower? What about shower chairs? What are other reasonable precautions?

• How often do older adults fall? Why is it such a problem?

• What is it like to start grappling with being an older person?

Instead Bob diverts yet again into talking about COVID - as if a 66 year old who gets a URI that’s mild for an overwhelming number of us, and forgets to hydrate properly, and who falls in the shower is evidence of “COVID still being potentially deadly!”

This is a missed opportunity.

It makes me sad - and I think it’s in some ways an expression of the same mental attitude that reigned in our collective response to the COVID pandemic in nursing homes. Instead of being realistic about the realities of aging and engaging in rational risk management in the face of the COVID pandemic - we chose to traumatize entire facilities by engaging in a bizarre, ultimately futile, dystopian, mortality-denying exercise of COVID monomania embodied by lockdowns, forced masking, and extended isolation of older people.

I think Bob’s tweets about his fall, and pretending that it’s about COVID, and not about the realities of aging - I think if anything, he’s expressing “internalized ageism.”

It’s sad, but it’s where we are as a culture.