May 24, 2022

Ten years… Ten years ago, a deeply disturbed adolescent entered Sandy Hook Elementary School in Newtown, Connecticut and killed twenty students, mainly kindergarteners, and six adults. Today, a deeply disturbed adolescent entered Robb Elementary School in Uvalde, Texas and, at last count, killed eighteen students and two adults. In the intervening decade, we have made our children do active shooter drills, discussed arming school personnel, subscribed to the myth that more good guys with more guns would stop mass shootings, watched while the teenagers of Marjory Stoneman Douglas high school did far more to curb the power of the National Rifle Association than any of the adults in our society, and, in general ignored the irrefutable evidence that more guns in more hands always leads to more gun deaths.

What will happen this time? There will be wailing and gnashing of teeth as the news cycle fills with stories of grieving parents and a shattered community until the next ratings grab distracts them and the TV vans pack up and race out of town, leaving a community with an empty center that won’t ever be completely healed. Ask the people of New Town if there lives are the same or if they would be better were there twenty additional teenagers at the local high school, young people who should be negotiating the craziness of adolescence and thinking about college plans, not buried as shattered corpses only a few short years out of toddlerhood. Let’s face it. Our society regards our guns as more valuable than our children. If we didn’t, we would elect representatives who would actually take prolife positions on sensible gun control laws. But we seem to be perfectly happy with our occasional sacrifices to the gods in the form of mass shootings, capital punishment, vigilantism, untreated mental illness, and all the other ways in which innocent individuals meet violent ends in our society.

I suppose the lack of empathy in our society which allows for us to collectively shrug off a school of dead children is the same lack of empathy that allows us to blithely ignore that we’re still in the midst of a world wide pandemic and that our numbers in regards to Covid infection are all trending the wrong way again. We’re over it and we don’t think it’s going to happen to us, so off to some other distraction such as the high cost of gasoline. The current omicron subvariant, BA 2.12.1 has come out of nowhere the last few weeks to now be the dominant strain in the US, moving from less than 30% of infections two weeks ago to nearly 60% this week. And we’re back up to roughly 100,000 infections a day. This subvariant is about 25% more infectious than the prior omicron strains which is why it’s spreading more rapidly. Fortunately, it doesn’t seem to be more virulent and hospitalization rates are remaining relatively low. But if this sort of infectiousness mutation happens in a strain that causes more serious clinical disease, we may rapidly get into trouble again.

Being on the cusp between the Baby Boom and Generation X, I didn’t have anything like active shooter drills in elementary school. We didn’t even really have the famous ‘duck and cover’ drills of the older Boomers. (Someone in the educational hierarchy of the Seattle Public Schools must have figured out that if you’re being vaporized by a nuclear weapon, ducking under a desk wasn’t likely to be of much help). I’m trying to remember what my fears were in elementary school. I entered kindergarten right after the 1967 ‘Summer of Love’ and I do remember walking home from school with my best friend and seeing peace symbols spray painted on the trees in the park by a vandalizing teen and being convinced that they were airplanes and that it meant our neighborhood was going to be razed for a new airport. We kids warned each other of the dangers of eating unwrapped Halloween treats as they could be laced with ‘goof balls’. We didn’t know exactly what those were but we knew they were bad. I was vaguely aware of the civil unrest of 1968 and the Vietnam war news was always in the background but none of that made that much of an impression on elementary school me as that was far away from our placid faculty ghetto neighborhood.

We’re living in a time of high levels of anxiety. It’s a spiral. The politics of divisiveness, the media frenzy, the pandemic. All of these create anxiety which bathes our brain and our bodies in catecholamines and other hormones that ready us for fight or flight, heightening our receptiveness to danger signals which keep coming in. We can’t live with that amount of stress and angst without it coming out in some way. In me, it’s coming out as exhaustion, inattention, and disconnectedness. I notice in others, as a result of my professional work, that it comes out as hair trigger temper, rage at mild or imagined slights, and a need for a feeling of control, no matter the cost. No wonder gun violence, motor vehicle accidents, and other issues linked to anger or erratic behavior are seriously on the increase over the last few years.

I’ve never owned a gun. I’ve never wanted to. I was taught how to shoot and I’m a reasonable shot but anyone who works in health care knows that the number one risk factor for getting shot in life is the presence of a firearm in the home so I’m not planning on arming myself. When society collapses and the hordes are ascending the hill to plunder the condominiums overlooking the Jones Valley, I suppose I’m a sitting duck but I’m not sure I want to survive into the aftermath.

May 20, 2022

Freude schoner Gotterfunken and all that jazz. Tonight was the first night back performing with the Alabama Symphony Orchestra Chorus in twenty-six months. It seems somewhat fitting that my very last performance before the shut down in March of 2020 was Mozart’s Requiem and the return to choral singing of major works is Beethoven’s 9th symphony and The Ode to Joy. The house wasn’t packed, but decent and it was possible to feel the joy wafting off the audience from our perch in the choral balcony as the thundering chords of that 4th movement brought back one of the highlights of the choral cannon to public performance. Many cheers at the end, even though our numbers have been diminished by the prolonged toll of the pandemic and all of the changes in patterns that has brought forward. Usually there are 90-100 of us up there, tonight we were 65 but tried to bring the same fortissimo. One more performance tomorrow night. Now if only Carlos, our splendid Venezuelan conductor, would not take that last bit at quite the tempo di bat out of hell. I can’t turn the pages fast enough.

Tomorrow morning, it’s back to rehearsing The Merry Widow (from which I have been off for a few days due to the combination of symphony rehearsals and most of the rehearsal time being dedicated to principals). The ensemble doesn’t have all that much to do so I think I have most of it down other than the rather insipid English lyrics to the famous Merry Widow Waltz at the end of Act One. They aren’t quite as bad as the English lyrics to Die Fledermaus a few years back, but they run a close second. I find it very difficult to learn bad lyrics as the moon/June/spoon variety have so many possibilities, they don’t want to stick in your brain. Good lyrics, on the other hand, are easy for me to learn. They are so specific to the music that no other word could possibly come next.

Kimberly Kirklin, me, and Diane McNaron performing The Alabama Song

My other task tomorrow is more melancholy. I am MC for my friend Diane McNaron‘s memorial tomorrow afternoon. Diane was instrumental in the development of my performance career when she and I and Ellise Pruitt Mayor devised Politically Incorrect Cabaret back in the spring of 2004. I thought about doing it in my PIC Ansager character but have decided no, I need to just be me, although the Ansager may slip in around the edges a bit. Diane was my first voice teacher, my patient, my collaborator, my friend. We would bump heads bitterly when creating a PIC show as our political and satirical views did not always align but in the end, we were always able to meet in the middle somewhere and some of the pieces we did were inspired. Me dressed as Mrs. Anna from The King and I doing a kinky version of Getting To Know You. Singing The Alabama Song from The Rise and Fall of the City of Mahagonny together with her as a show opener. A salute to Capital Punishment in Alabama to Razzle Dazzle from Chicago. A commentary on the Deepwater Horizon oil spill as a ballet with a seabird trapped in the oil slick to Saint-Saens The Swan. Doing out of town shows in four other states in some of the strangest theatrical venues you could imagine. I owe her the send off.

Covid numbers are inching up again, not enough yet to call it a surge in the making, but enough to be concerning. Case positivity rate nationally has inched back up over 10% which is not good. Of course, with so many home tests now available, it’s hard to know what data is actually going into that number these days. The rates in the Northeast and the Upper Midwest are serious enough for the authorities to recommend universal indoor masking again. I have no idea if the populace is listening, not being in one of those regions (feel free to chime in if you are), but the barometer I follow – Broadway performances – have definitely suffered with more cancelled shows due to infections in the cast and an extension of mask mandates for theaters until at least July. The hospitalization and death rates are also inching back up with deaths having doubled from the 200 a day it had fallen to back to 400 a day this past week. The hospital rates are low enough to be absorbed by the system but I remain worried. It wouldn’t take much of a surge to put us back in overwhelm mode due to the changes in staffing the pandemic has wrought.

Here in Alabama, we are still relatively spared. My last look at the local numbers had us at less than 5% case positivity and with very small case loads both here in the Birmingham area and statewide. However, the trends are heading back up this past week. I’ve had a number of friends who have tested positive in recent weeks but none of them has been seriously ill and the biggest headache has been the inconvenience of quarantine. I’m still feeling relatively safe being maskless in public but I’m keeping a sharp eye on local numbers and trends and will be popping it back on if I don’t like what I see. Of course, I still wear one at work and will for the foreseeable future as I do work in health care with folk with immunocompromises of various stripes.

Why is Alabama still doing so well despite dismal vaccination rates? Isn’t that the sixty-four dollar question. Perhaps the overwhelming number of omicron infections of a few months back has left the population with a certain amount of lingering immunity. Perhaps it’s something climatological. The nice weather we’ve been having without the humidity having quite yet arrived has chased a lot of activities outdoors. I’m going to trust that the combination of my infection from a few months back and two boosters is going to keep me going without too much difficulty. Although, after the last couple of weeks of staycation without the usual work headaches in my life, I don’t think I would mind an additional week of quarantine while feeling relatively well, as long as I could time it so it doesn’t interfere with other life duties. But, knowing my luck, it would likely strike on a performance weekend and I have a few more of those coming up in June before I hit the summer lull. So I’ll keep those hands washed, watch the numbers, and have my mask handy. And I’ll take as many boosters as are proven to help.

May 16, 2022

At my 60th birthday bash

Birthday weekend is over. I’m now firmly ensconced in a new decade. I hope the pattern of my life where the odd decades are disasters and the even decades pretty wonderful prevails and that I have a great ten years coming up. Who knows though? Wouldn’t it be nice to have powers of divination and be able to identify and plan for the pitfalls in advance? Unfortunately. given my usual life patterns, I would end up as a Sibyl Trelawny with true clairvoyance only at inopportune moments and with perplexing results.

The big birthday bash came off on Saturday night with all of the hitches firmly backstage. The attendees all seemed to have had a good time. I viewed it as a chance for me to give something back to the community that has supported me through the last four years of hell between widowerhood and pandemic. It’s been a long time since I’ve hosted a snazzy catered affair and it will be a long time before I agree to do so again. Too many details to parse through and too many bills at the end of the evening. Maybe on my 70th should I make it that far…

A friend, who had been invited, committed suicide just a couple of days before the party. I first met him when he was a medical student at UAB, one of the few out gay male students at the time. There were very few out gay male faculty and as one of the few, I was the advisor to the fledgling LGBT student group of which he was president. Not only was he a brilliant student, in the MD/PhD program, he was also a musician. I sang with him in the opera chorus, our church choir, and Tommy wrote an oboe piece for him and our choir director to play for one of the children’s holiday pageants he put together. He graduated from med school, went off elsewhere for advanced training and returned to Birmingham to join the faculty in the Department of Pathology about a year ago. I saw him some after his return, but not a lot, the pandemic having disrupted so many patterns and activities.

I don’t know and cannot hope to know what made him think he had no other options. I’m not so much sad as mad at the tragic waste of a life and brain. And I expect more young health care professionals of my acquaintance are going to take the same route over the next few years. The healthcare industry is fundamentally broken and the pressures of that crack up are coming to rest on the shoulders of the more junior providers who have the least ability to change their lives as dictated by higher ups and the least experience and resilience to cope with those dictates.

I’ve expected the American healthcare system, excuse me American healthcare industry, to break within my lifetime. I was just wrong about when that would happen. I was expecting it to happen in the decade of the 2030s under the pressure of demands from the aging baby boom – a combination of enormous demographic numbers and unrealistic expectations as to what healthcare can and cannot do. Instead, it’s happening in the 2020s under the pressures of two years of pandemic combined with a general unraveling of American society through loss of trust by the citizenry in institutions and expertise. Those of us who have weathered the last two years, are emerging somewhat shell shocked, no matter the specialty or how tied in to the acute medical issues of the pandemic it may be. This is being compounded by a steady exodus of providers to the exits of retirement or career change, leaving fewer and fewer people to handle the workload, nudging up due to demographic and other factors.

Two years of disrupted patterns have also created some other trends. One, administrative types in the health care system, many of whom spent the majority of the pandemic at home, began to explore the capabilities of big data systems fed by electronic health records. I’m sure much of what they are learning is very useful but the gathering and entering of that data trickles down to providers who are already very pressed for time. Two, patients and families became much more adept at online access to providers through these new data systems and the number of lengthy notes, downloaded blood pressure graphs, photos of funny looking rashes, complaints about valet parking, and other communications have risen exponentially. In some systems, adept nursing staff can intercept and handle some of these before they ever reach my desk but other systems, in order to save salary costs in the ambulatory environment have replaced nurses with medical assistants who have neither the knowledge base or critical thinking skills to address most of this so it all ends up on the desks of me or my colleagues. The end result is the ambulatory workload is skyrocketing without a lot of hope of curbing the trends as there are fewer and fewer providers opting for ambulatory careers and the system, having to absorb the costs of the pandemic, is trying to control costs elsewhere in the system and is loathe to add support staff.

It takes a minimum of eleven years (and usually more – I had thirteen years) of higher education to create a well trained physician. Any solutions posed today won’t begin to make inroads for another decade or so. There’s been a significant move towards nurse practitioners and physician assistants to handle the shortfall (they can be produced in about half the time of a physician) but I am of the opinion that, especially in geriatrics, the greater depth of knowledge inherent in physician training is what patients deserve. Unfortunately, if we’re tasked with spending most of our time on data entry, we don’t really have the time to spend thinking about how to better handle our complex cases. I wish I had a solution to these dilemmas. I don’t. I can only lay them out in easily understood terms.

As the healthcare system starts to fail, more and more patients won’t be able to get what they need from it. There are very few ambulatory services (mine included) that has room for a new patient in less than four to six months – an inappropriate lag time for urgent or emergent issues. The last few reports I have from the emergency rooms are for multi-hour waits. There is a nationwide shortage of IV contrast for imaging studies so anything not emergent inpatient is being bumped back for months. Appointments for mental health services are practically nonexistent. And all of this is without a major Covid surge in the area. It’s going to get worse. Buckle up.

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There was an interesting piece in the New York Times this weekend that suggested that if the US had responded to the pandemic in a way similar to Australia (a country very like ours culturally and economically), roughly 9/10 of the dead would still be alive. That’s 900,000 people that didn’t need to die. The major difference between us and Australia? Trust. Trust in science, trust in government institutions, trust in the health care system, trust in each other. The last decade or so, fed by the media and our political system, has been all about destroying trust in our institutions and in each other. The fault lines have been drawn. The partisans are in the stands, each cheering on their team, red on one side and blue on the other, as the players savage each other on the field. Nearly a million people have died that didn’t need to and we are so ill prepared as a society for the next crisis, which will also likely be politicized for monetary gain, that I can see this pattern happening over and over again. There’s no easy way to rebuild trust once it has been shattered. All I know how to do is try and live a valid life open to everyone and all ideas.

May 11, 2022

So this is sixty. Doesn’t feel much different than my fifties which ended yesterday. Well, I do have a bit of a back ache this evening, but that’s been going on intermittently for the last few decades and is, I suppose, due to the creeping joys of osteoarthritis which is also definitely in my knees. My knees complaining on stairs was one of the reasons why Tommy and I relocated from the Aerie some years ago. A four story house with forty-two steps from top to bottom became less and less of a good idea with each passing year, especially when whatever you needed was always on a different floor than you. We tried to solve that by having a set of common household items on each floor but then they would migrate and there would be four pairs of scissors in the dining room and none where they were actually needed.

The world has been reaching out to wish me a happy birthday today – one of the positives of this age of social media. I’ve had birthday greetings from every continent other than Antarctica. It will take me a while to get back to all six hundred of you who reached out but I will eventually put a ‘Thank you’ if nothing else on each message. The big celebration is this coming Saturday – it’s my thank you to all of those in this community who have helped me through the last four plus years of hell courtesy of widowhood and Covid. People have no idea how much they have done for me by just being a presence in my life as I’ve navigated through some mighty treacherous waters these last few years. It’s why I plan to spend at least my active retirement years here in Birmingham. I am much too embedded in this community to want to wrench myself out of it. Now if Alabama will stop regressing back to the 19th century at every opportunity.

As a birthday gift, I was taken today for my first mani-pedi. I rather enjoyed it and my nails certainly look the best they’ve looked in decades. While I was sitting in the chair with my feet soaking in lavender scented water (no Palmolive dishwashing liquid was involved – Madge the manicurist lied), I let my mind wander back over other milestone birthdays so I thought for everyone’s amusement, I’d run them all down.

1962 – Birth – I have no recollection of this but I have been told that I was indeed there. I arrived in the wee hours of the morning at Grace New Haven hospital as my father was on the faculty at Yale at the time. I read my mother’s letter to her mother about my birth some years later. I don’t recall much of it (and I don’t think it was preserved for posterity) but I do remember my mother writing that I was wide eyes and wondering from the very beginning, drinking it all in. I like to think I’m still that way.

1972 – Age 10 – I felt too grown up for a big friends birthday party so there was a family gathering with a couple of my close friends from the neighborhood. One of my favorite series of books at that age was Elizabeth Enright’s stories of the Melendy family of New York. In the last of the four novels ‘Spiderweb for Two’, Randy and Oliver, left behind at home as their older siblings head off for high schools in the city, are occupied with a prolonged treasure hunt full of rhyming clues. My mother stashed all my birthday presents in hiding places and created similar rhyming clues that we all had to decipher. I got stuck on the one about a ‘cradle where she used to lay’ until I figure out that it was referring to the cradle where my father’s sailboat would sit in his workshop for drydock repairs.

1982 – Age 20 – I was in the throes of directing my first full length musical (The Pajama Game) and my birthday fell on final dress. I still have a soft spot for the show (even if it is a musical about sexual harassment in the workplace) as it’s got such a great score and I remain friends with my leading lady to this day. I figured out I was actually pretty good at the directing thing and thought about switching from premed to drama but decided that I didn’t want to tie my life to a career that might depend more on luck than on hard work and ability.

1992- Age 30 – I was halfway through my fellowship in Geriatrics at UC Davis and my mentors there took me and Steve out for dinner at our favorite restaurant, Max’s Opera Cafe at Arden Fair. The two of us went out to Max’s a lot. The gimmick was that all of the servers were also vocalists, mainly the music vocal performance majors at the local colleges, and your waitress would have her moment with an aria or Broadway diva number between your salad course and your entree. Steve and I became such regulars that the pianist on the weekends, whom we befriended, had entrance music for us when we were led to our table. Mine was ‘With So Little To Be Sure Of’ and his was ‘Don’t Cry For Me Argentina’. I treated myself by buying a Hirschfeld print of Bette Davis.

2002 – Age 40 – This was my first birthday without Steve, who had died about nine months before. This was my year of running away. I spent as much time as I possibly could away from home on any excuse I could muster. I was dating, if you could call it that, a gentleman who lived in Michigan whom I had met a few months before on a cruise. We would meet up in various cities for the weekend and do some exploring together. For my birthday weekend, we were in Washington DC as the annual American Geriatrics Society meetings were there. For my birthday, he bought us box seats for the opening night of the summer long Sondheim Celebration at the Kennedy Center. The show was Sweeney Todd with Christine Baranski (good) and Brian Stokes Mitchell (not as good). Sondheim was in attendance but I didn’t get to speak to him. I treated myself by buying a second Hirschfeld of Judy Garland to commemorate my Mrs. Norman Maine columns.

2012 – Age 50 – Tommy and I were visiting my family in Seattle and he and my sister, Jeannie, cooked up a birthday party for me at her house with most of the family in attendance as well as some old Seattle friends (a number of whom had been at my 25th birthday party a quarter of a century earlier). Tommy and Jeannie spent most of the day ganging up on me and teasing me about various things (they were good at that when they got together). Tommy, as always, spent a good deal of time in the kitchen putting the food together but I believe he bought the cake at a local bakery. I did not buy a Hirschfeld.

Not much to report from Covidland today. I’ll get back to it later. Too busy reading birthday greetings.

May 7, 2022

I had a reading/signing of The Accidental Plague Diaries this afternoon to benefit Opera Birmingham. We sold a few books, we had a good time drinking wine on the back patio of the opera office and I read a few things from Volume 2 for the first time. I think it went well but I can never tell. I’m the last person to ask about any performance I give whether it’s in character or as myself. Actually, they’re all in character. I’m developing a persona for my readings somewhat removed from my inner self so that I can read aloud about painful things from my life and past and it’s almost as if they’re about some other person about whom I can have objectivity. I suppose it’s similar to what I do at work when I slip on my doctor role with my stethoscope. Being someone else allows me to get into sensitive subjects with patients and families with empathy and compassion and without getting hurt too badly in the process. Sometimes I worry that it means there’s no real core – other times I think my real self feels too deeply and has to protect itself and this is the way I can do it.

Several people have suggested that I should adapt these writings into a one character play/monologue. Maybe after I retire. I don’t think I’ll have the energy until then, not to mention learning a ninety minute piece word for word. and replicating the performance from night to night. I’d have to find the right director/collaborator. One thing I know about me on stage is that I am not capable of directing myself. Choices that feel right to me internally as an actor often are completely wrong when seen from the point of view of the audience and someone else has to help me recognize and adjust. I also make it a rule to never direct a piece I have written. There’s strength in having another take your words, filter them through a different lens of experience, and find in them things you had never considered.

We passed the magic million mark of dead Americans from the pandemic this week. The dead would make up the 11th most populous city in the country – between Austin and San Jose by current counts. It’s three of every thousand people who were alive on New Years Day 2020 who are no longer with us. And that’s just the dead. There are no accurate counts on the number of new widows and widowers, the number of children who lost a custodial parent, the number of parents who had to bury a child, the number of people who survived their infection but whose health and function are so impaired that they will not lead the lives they had created and planned on moving forwards. I don’t think we have any real idea what sort of hole has been created in society over the last few years.

Local numbers remain blessedly low. They continue to go up in the Northeast, the Pacific Northwest, Chicagoland, and the Twin Cities area. These are all in the northern latitudes of the country. Is there something climatological at work? Something different in behavior based on climate? Air flow in indoor spaces seems to be key in helping prevent infections (and if we had a functional congress, we might start looking at tax breaks to get public buildings to retrofit their climate systems with higher flows and better filtration but I doubt that’s going to happen any time soon). Perhaps the warmer temperatures we’ve had down south these last few weeks which has had us all running our air conditioning is saving us.

I’ve started rehearsals on a new show, third man from the left in Birmingham Music Club’s production of The Merry Widow. I actually somewhat enjoy performing in operetta. The music’s fun to sing and the book scenes are so stilted and creaky that they’re almost endearing. It performs the first weekend in June. In the meantime, the Alabama Symphony Orchestra is doing Beethoven’s ninth in two weeks so I’ll be up in the choral balcony shrieking out the Ode to Joy. Why did Beethoven have such a fondness for high Fs in the bass part? Fortunately, they’re usually doubled with the tenors so I can just flip into falsetto or mouth those particular measures. I’ve gone back into voice lessons and my teacher thinks that the high F and G are there and will eventually settle in. I have to keep reminding him that I am a sixty year old bass baritone.

It’s mother’s day weekend. Many of you may remember that my mother died just before the pandemic. We have some suspicion that she may have been one of the first Covid victims as she was in senior group living in Seattle, where the virus was first circulating undetected, and had had a respiratory infection the previous week. Maybe, maybe not. My mother, a product of San Francisco society of the 40s and 50s, had a certain refined European elegance about her in how she carried herself and how she dealt with the world. She was always poised, well coiffed, well spoken, but could destroy with a couple of very polite but very well chosen words if you crossed her. She was of the generation that did not go downtown as a young woman without her gloves and her hat, but at the same time was perfectly comfortable in a small boat, or getting grimy over a campfire. She and my father lived in suburban Connecticut in the early 60s, in a society straight out of Mad Men, and she hated the pretension and couldn’t wait to get back to the west coast and her adoptive home of Seattle. She ran every community organization that came her way with a quick competence, she remained liberal in her politics, veering farther left as she grew older, was an avid traveler, a voracious reader, and wrote very well. And she always put her children and their education first, believing firmly that education was what made for success.

I will not be going out to brunch after church tomorrow. There’s no need. I’ll come home after service and make myself a mimosa (she loved a good drink) and toast her before I toddle off to the Petrovenian embassy ball. I think she’d approve.

May 3, 2022

I didn’t sleep well last night. I woke up around 3 AM and I knew it would be one of those nights when I wouldn’t be nodding off again. I should have gotten up and been productive and written something then, but I was weary so I lay in bed taking in another episode of the final season of Ozark while fretting about various work related things. The good news out of all of this is that I’ve been dragging around all day and I should have no difficulty getting a good night’s sleep tonight. I usually sleep relatively well and without the aid of soporifics or other aids so the occasional bad night is, I assume, another price I get to pay for kicking around in this body for a few decades longer than I ever intended, or even thought possible.

I’m of the HIV generation. I was a college student in the San Francisco Bay area in the early 1980s, and the first whispers of something seriously wrong started to reach campus toward the end of my sophomore year. My crazy schedule of double science major during the day and theater nerd at night probably saved my life as it kept me from getting into too much trouble. All the same, by the time I finished college and moved on into medical school the HIV epidemic was firmly established due to the powers that be of that time having no interest in diseases that seemed to be contained to marginalized groups, and so it ended wiping out so many of the men who could have been my mentors and teachers and exemplars .My reaction to this was to remain firmly closeted during my medical school years and to assume I’d probably be dead before the age of 35. I eventually wised up and came out and, obviously, I’m still on the right side of the dirt, at least as of this writing. I’m not to sure of any or our life expectancies these days… too many unknowns.

One of the things that’s kept me interested in our societal response to the Covid epidemic is the obvious parallels between our flawed responses to HIV and our flawed responses to Covid. In both cases, proper public health responses to epidemic infectious diseases were hijacked by political considerations and many thousands of people died needlessly. Eventually, science won out in the HIV epidemic and it has, for the most part, become a manageable chronic disease. We’re still adjusting to the Covid pandemic and it’s unclear where that’s heading next. Case rates are ticking up nationally, especially in the Northeast, but the mortality rate is remaining mercifully low. Is it a new phase where it’s becoming less virulent? The effect of widespread natural and vaccine immunity? Are we just not yet seeing the mortality from the current increase of cases as that usually isn’t apparent for a month or two? Then there’s a number of new omicron variants popping up, especially in South Africa, where omicron initially originated. It’s unclear if any of these is going to be a particularly bad actor but initial reports suggest no worse than the original omicron strain.

The big news this week is, of course, the leaked Supreme Court opinion which scuttles Roe v Wade. Chief Justice Roberts has acknowledged its veracity. There’s a lot of running around and beating of chests in shock and surprise. I am neither. The movement conservative forces in this country, playing a long game of many decades, have telegraphed every move well in advance with great fanfare and publicity. Why be surprised when they do exactly what they’ve told you they’re going to do. I am more than a little Susan Collins concerned about what comes next. In the opinion is legal language which sets up the repeal of Obergefell (gay marriage), Lawrence (striking down sodomy statutes), Griswold (allowing contraception), and even Loving (interracial marriage). I expect the current conservative bloc on the court will start looking for cases which will let the rest of the dominoes fall.

Without legal protections, people like me will become vulnerable to the state. I am planning on remaining in Alabama, at least through active retirement years, but I don’t know if it will be possible if the state is allowed to legally harass and subjugate my marginalized community. I’ve been out too long to go back to my closeted life of the late 70s and early 80s. At the same time, LGBTQ citizens of Alabama live life normally somewhere between stages 3 and 4 on the scale of the ten stages of genocide and if we start sliding toward stage 5 or 6 or beyond, it might behoove me to get out before something really bad takes place. And I’m too much of a realist to think things like ‘it can’t happen here’.

If more liberal individuals want to have the ship of state come about, they’re going to have to stop sniping at each other and start doing the hard work of organizing. It means going to precinct meetings and putting in the work as committee chairs and running for local offices, prepared to lose, but getting an alternative vision before the voting public. It’s going to take a unified front on social and political issues that’s going to require compromise and which can’t be beholden to various idealogical purity tests. It’s going to mean building a network of interlocking activist agencies willing to cooperate rather than spending their time in never ending turf wars over issues and funding. It’s going to mean developing a certain intellectual rigor in liberal philosophies and ideals and training thinkers to write clearly and cogently about policies and positions in a way that will capture broad public interest. Politics in this country works from the bottom up, not the top down.

This kind of work can be done. Ask my generation of the LGBTQ community and those a few years older than I. When the US government condemned us to early death from HIV, we fought back and built the various HIV service organizations and LGBTQ advocacy groups that continue to be a focal point of our community. It wasn’t easy but it was an emergency and needed to be done and there was no white knight coming to the rescue. No white knight is going to stop the Supremes either. Time to roll up the sleeves and get to work. Just get your booster before you go out and do it.

April 28, 2022

Tommy left us four years ago today. Obviously, he’s been on my mind as I’ve dragged myself through one of my usual work days. It wasn’t an especially hard day, one of my VA house call days in Sumiton and Jasper, but I still was feeling a bit beat down by the world. I suppose it’s normal to feel like this on an anniversary of this type but I have this negative reaction to emotions. They’re messy uncontrollable things that make it difficult to get things done with speed and efficiency. VA house calls are more about a previous loss, that of Steve. I was in the middle of one, talking about the mundane details of diabetes management with a lovely elderly African American vet and his wife, when I got the call that Steve had suddenly collapsed and died at home. There’s this little piece of me that always equates my walking into a patient’s home in the role of VA physician with circumstances of sorrow and loss. Perhaps that’s why I’m so comfortable talking about uncomfortable subjects when I make these house calls. I’ve been there.

Last night, in my role as board president of Opera Birmingham, I attended the final dress rehearsal of our current production of La Boheme. It’s the first time we’ve been able to mount a fully staged opera in a couple of years. Cendrillon, the last one scheduled, was cancelled half way through staging rehearsals in March 2020 when the world shut down. The exigencies and uncertainties of pandemic life made going into this production, less than a sure thing so the decision was made to scale it way down. We moved to a smaller house, arranged to share a physical production with several other small opera companies, and pared the cast down to the seven principals and an ensemble of twelve and a reduced, but full orchestra. The result was stunning. The smaller house puts the audience in immediate touch with the performers, allowing them to draw you into their world. The set proportions were those of Parisian attics, and not garrets the size of a suburban McMansions. And the singers and orchestra entwined together to bring through the true emotions of the piece. Note to self. Sitting through Act IV and Mimi’s death scene of the eve of the anniversary of one’s own loss is not recommended. It plays Friday night and Sunday matinee at the Day theater this weekend. Don’t miss it. I’ll be there again Friday night.

We haven’t run the numbers for a while. Anecdotally, I keep hearing of friends succumbing to Covid infections but no one seems to be getting particularly ill. Inpatient numbers at UAB have dropped to single digits since the pandemic first hit the Birmingham area in the spring of 2020, despite significant changes in behavior patterns regarding indoor gatherings. Maybe we’re kind of through this thing. Maybe we’re just enjoying a lull. As the virus is continuing to rocket around the world through all sorts of populations with all sorts of behaviors, anything is possible. Mutation marches on. We’re at something over 81 million documented infections in the US. This amounts to roughly 25% of the population. A recent cross sectional study of the population looking at antibody prevalence suggested that exposure is much higher than this, maybe closer to 60% of the population having had an infection. This would mean that the number of subclinical cases that were never tested for is enormous.

If 60% of the population has at least some natural immunity and roughly 66% of the population is vaccinated, the virus may be having a harder and harder time breaking through and forming effective transmission chains. Maybe not. I think we all tend to forget just how new this disease is and how little we really know about its natural history. Even at this low rate, we’re losing between 600 and 700 people a day to the disease and we’re something over 991,000 total deaths. This will put us over the million death mark sometime in mid May. This means that three of every thousand Americans who were alive in January of 2020 has died of Covid in the interim. Covid has been the third leading cause of death for the last two years, lagging only cancer and heart disease. And this is only the deaths. I care for a number of people who caught serious Covid, were hospitalized, some for a very long time, and who are now gravely incapacitated with multiple health issues. But they aren’t dead, just drowning in medical debt and unable to work.

I don’t think we have any idea yet about the ripple effects on survivors. The hundreds of thousands of new widows and widowers. The children who lost a parent, or both. The parents who had to bury their previously healthy adult children. The burdens of caregiving, for what might be years, on those left chronically ill. Then there’s the ripple effects on social and economic institutions. Entire industries and sectors of the economy are in precarious shape. The one I’m dealing with the most is the long term care industry. I know of no nursing home that’s not short staffed. The extra work piled on those left behind to cover for missing coworkers is burning them out leading more to quit and a vicious cycle rolls on. The short staffing is leading to basic needs of dependent people not being attended to promptly, corners being cut, and declining health outcomes which in turn is pushing people out of the nursing home back into the hospital with a preventable acute illness, using up precious resources and putting additional strains on exhausted medical staffs. Add in the aging of the Baby Boom and a perfect storm is brewing with which the health system and American society is not yet prepared to cope.

I got a notice that the book was short listed for the Grand Prize for the Eric Hoffer Book Awards, which only about 1/20 entrants makes, so someone somewhere has been reading it. I have a reading and signing at the Opera Birmingham office on May 7th if you haven’t yet obtained a copy. I’m busy reading and editing volume 2 to try and stay vaguely on schedule. It would be nice to win something prestigious but I’m not holding my breath. I didn’t write it for awards or sales, but rather to help myself cope with a rapidly changing world and putting it down on paper helped me make sense of the madness swirling around.

I was going to write a treatise on medications and deprescribing, but I’m too tired. Next time perhaps. In the meantime, the best vaccine is one in the arm. I got my second booster on Tuesday. I didn’t feel to horrible afterwards. And keep those hands washed.

April 24, 2022

Barbra Streisand turns 80 today. If that doesn’t make me feel old, nothing will. By coincidence, it’s also the opening night of the first Broadway production of Funny Girl since the original launched Ms. Streisand to superstardom two thirds of a century ago. I’m sure that all means something on a cosmic level, but I can’t begin to tell you what. As a gay man, I got the diva appreciation gene but not so much the diva worship gene. I don’t make pilgrimages or overspend on concert tickets or set up little shrines in my domicile as some do. I’ve often wondered where the relationship between gay men and larger than life female entertainers comes from? I imagine it’s that many of these entertainers enter a persona of womanhood that occupies a traditional dominant male space of commanding attention, and does so with affectations that are easy to mimic, giving birth to thousands of bad drag acts. Those few times I have done classic drag, I have done it as MissClairol Channing. Carol Channing is easy for me to do. We’re roughly the same size and shape, she’s got a distinctive voice I can imitate, and a little of her goes a very long way meaning I’m not asked to drag her out terribly often. She will not be making an appearance at my birthday this year – and my Birmingham friends have all let out a collective sigh of relief.

Tonight feels like a free association night. There’s not much going on in covidland. I’m still waiting for the other shoe to drop now that we’re more or less pretending the pandemic is over. The virus will use our changed behaviors and how that’s all going to play out is anybody’s guess. As long as it doesn’t send another major surge through the healthcare system. It’s gotten awfully rickety and I’m thinking it’s not going to take a whole lot more for it to become nonviable. In some ways, it already is. The waits for appointments and elective procedures aren’t going down. they’re actually going up locally. The mass of retirements and departures from the sector is ratcheting down the number of services available and the timeliness of those services. There are a few common referrals I make where I can find no provider with an opening for four months, either inside of or outside of the UAB network.

Personally, gross exhaustion has been setting in from the UAB piece of my job. For various reasons, UAB Geriatrics Clinic can only offer about half the appointment slots we were able to offer pre-pandemic. We still have roughly the same number of patients. We are still trying to squeeze in new patients who desperately need our counsel and advice. We haven’t had much luck replacing departing providers. The aging Baby Boomers, having had a couple of years to contemplate themselves without major interruptions have decided they don’t like bodily change and are banging on the doors. Everyone has gotten a chance to experiment with patient portal e-mail systems, quite like them, and send in messages about every little thing. The administrative heads of health systems have had two years to dream up all sorts of projects using the big data capabilities of electronic health records are requiring more and more inputs. All of this is falling squarely on the shoulders of me and the other providers in our clinical system. Then throw in a maternity leave and a prolonged vacation before pouring in the blender and hitting frappe. Whine over. Things will get better.

I’ve been through professional periods like this before. The difference this time around is the pandemic having created a whole new set of complications – for patients, for providers, for health care systems, for society. There hasn’t been a lot of fat in the system for a long time due to the economic structures of for profit health care that have been slowly put in place over the time of my professional career, but the pandemic took the last little bits and a good portion of the muscle and skeleton as well so it’s all we little neurons can do to keep the system upright from day to day. I’ve started to think that every day I go to work, and I come out at the end of the day feeling like I haven’t left a patient in the lurch is a successful day and should be celebrated.

My performance life is going to rev up again starting next week with rehearsals beginning for the symphony next week and for The Merry Widow the week following. I have a bit of trepidation about putting that back in on top of the work stresses of the moment but I know that those sort of commitments create what I call good stress in my life rather than bad stress. Besides, I’m going to be on staycation during most of the symphony rehearsal period so it shouldn’t be a problem. And I’m only doing ensemble in The Merry Widow so I’m thinking I’ll be able to handle that without too much difficulty.

I’ve got the first 40% or so of the second volume of these Accidental Plague Diaries edited. It should be fully edited by the first of June at the current pace and I should be on schedule for an early fall completion. It’s been interesting rereading things from a year ago. It reminds me of how fast and how thoroughly our society has changed over the last few years, too fast for us to really understand what all has actually happened and what all it means. And that’s why I keep writing. Even if the pandemic were over (and I don’t believe that for a minute), the ripple effects are just beginning and are going to cause vast changes over the next decade or so. I don’t see these writings going to ten volumes (no one would read them, unless they’re the sort of person who thinks Robert Jordan’s Wheel of Time needed to be a bit longer) but I won’t be surprised if there’s a volume 3 in 2023. I won’t make that decision for another year and it will depend on all sorts of things that I cannot predict at this point.

It’s coming up on the 4th anniversary of Tommy’s death so I’ve been reflecting back on him a bit this week. He’s still very much present in my life. Clothes he wore still hang in my closet. I’ve been sorting bins of miscellaneous paper and finding notes of his from various projects, theatrical and otherwise. I haven’t noticed his physical presence, but my house guest swears he’s heard him in the kitchen a time or two. (It’s probably just the cat). If he is hanging around the condo, the kitchen is the most likely place for him to be. I’m sure he’s not very happy with the way I’ve arranged it but he’s likely to approve of the new refrigerator and dishwasher as both of the ones that came with the condo decided to give up the ghost recently. I bought his favorite kind of fridge. I didn’t get his favorite brand of dishwasher as I always had trouble with the adjustable racks myself and broke more than a few of them over the years. If the new dishwasher has issues, then I’ll know Tommy’s in the kitchen and won’t rest until I get a Bosch.

April 20, 2022

IT’S NOT OVER! If I had the budget, I’d like to hire a skywriter to write it in large letters in the sky over the capitol dome. Do we even have skywriting planes any more? I haven’t seen one in years and years. I suppose the chemicals they used to create the stable clouds are bad for us, like so much else in modern life, and they have gone the way of the dodo. I think small planes towing large banners remains a thing so I suppose I could do that but it doesn’t have quite the same impact. Then there’s the Goodyear Blimp. I’ve always wanted a blimp or a zeppelin ride but I was born in the wrong decade for that to be of high likelihood. I love the images of the elegance of between the wars travel with slim people in suits and hats sitting in elegant art deco lounges on ocean liners or the Orient Express. I’m sure the actual experience was nowhere near as refined and sophisticated as the image but wedging myself into a seat on a plane between two overweight people in faded T-shirts, cutoffs and flip flops is getting a bit old.

And why do I say it’s not over? Society is tired of pandemic life after two plus years and the political system as more or less abandoned all restrictions in the name of public health. One of the last bastions to fall, being the lifting of masking requirements on public transport by a judge in Florida earlier this week. If you actually read her opinion, that she was determined to find fault with the administration’s rule and just needed to come up with some specious legal reasoning to allow it. (Three guesses as to which president appointed her and what her family and social connections are…). Her opinion depends on a new reading of a 1940s public health law which permits the executive to exert necessary ‘sanitation’ measures by saying that the definition of sanitation refers only to something like a cleanser, and not to the much broader definition of sanitation in public health parlance, referring to any measure that prevents the spread of infectious disease which the drafters of that law were obviously referring to. Ah well, a few more people die due to preventable infection. What’s that to people who feel inconvenienced by a bit of cloth on their faces.

At the same time as this, over the last two weeks, new infections in the US are up about 40% from their low last month. These increases aren’t distributed evenly and are concentrated mainly in New England and the Northeast. There are a few other hot spots here and there but outside these areas things are pretty calm. They are being driven primarily by newer strains of omicron. It’s certainly not spreading at the astronomical rate it did this past winter (likely because it’s running into the walls of the vaccinated and the previously infected) and it hasn’t put huge strains on the health system yet, but it’s early days still. We shall see what we shall see.

We tend to be a bit myopic in this country and not pay much attention to what’s happening outside of our borders but, for those keeping score at home, Shanghai is in complete lockdown to try and contain omicron which has caused so much illness that their hospital and public health systems are basically non functional. This is likely due to China’s not pushing and prioritizing vaccination in their older population leaving a highly vulnerable group under protected and now dealing with heavy morbidity. Shanghai is the third largest city in the world. (By comparison, the largest US city, New York, is only about a third of the population and is ranked #45 in the world in population). If you look elsewhere, there are reports of new omicron sublineages emerging in South Africa, deaths in the United Kingdom are actually a bit higher than they were at the peak of omicron and cases in Canada are going up similar to what’s happening in New England, likely due to trans-border traffic. Keeping all of this in mind, I think it’s fine to enjoy the lull we’re currently having but we must all be mindful that our peace may be more fragile than we think.

I’ve been racking my brain to try and think of an amusing anecdote from my past to tell. People always seem to enjoy those. The problem is that over the last four years of writing these posts, I’ve told the majority of my really good cocktail chatter tales. But here’s a brief one involving Steve and the very beginnings of my professional career. It was brought to mind as I have been dealing with caterers this week. If you go into any sort of professional position, especially in academic life, one of the skills you must develop is negotiating a hotel ballroom full of people with a glass of wine in one hand and a plate full of nibbles in the other. When I finished my internal medicine residency and transitioned into my geriatric medicine fellowship, I was invited by my department chair to give a brief presentation at a gathering of the Northern California chapter of the American College of Physicians meeting that was taking place in Monterey. As I was speaking briefly, I would get an expenses paid weekend, some exposure, and a little notch in my anemic academic CV. At this point, Steve and I had never been to Monterey so he tagged along (he bought a copy of Steinbeck’s Cannery Row for company as he had no intention of sitting through the medical programs).

One thing that had to be understood about Steve is that he was the exact opposite of a foodie. If we went out to eat, he would always order the same thing and he had a huge aversion to seafood of any stripe. If he even smelled fish, he would grab my arm before we were seated and lead me out until we could find a dining establishment that smelled more like steak and potatoes. Finned fish, shellfish – it didn’t matter. If it lived in the water, he wouldn’t eat it. So anyway, here we are in Monterey, a town known for its seafood history, in a large downtown hotel and it’s the opening night reception. Plastic tumblers of wine (not for Steve who was sober in AA for thirty years when he died), chafing dishes with various hot hors d’oeuvres, people greeting colleagues they hadn’t seen for a while. I was chatting with a friend from residency when Steve came over, his little plastic plate piled high. ‘I’ve just discovered this stuff called calamari’ he said. ‘It’s delicious’ as he popped another piece in his mouth. Our mutual friend, who knew about his seafood aversion, looked at him and said ‘Do you know what calamari is?’ He admitted he didn’t and she made the mistake of telling him. He spat it out, let out a shriek and made a beeline for the door. I had the good taste not to refer to the incident the rest of the weekend.

It’s late and it’s bedtime. What should you do about masking in the light of what’s going on? It’s never wrong to wear one, no matter what others may say. I wear one at work when I’m in clinical areas and on house calls. I judge other indoor spaces by the number of people, the kind of people and the amount of ventilation. Study after study shows that one of the best ways we can control Covid is by adjusting ventilatory standards in public indoor space. It’s one of the reasons why I’m hosting my birthday party where I am. It’s a large open very high ceiling area with plenty of appropriate ventilation. And wash your hands. And have some calamari (it was always my and Tommy’s favorite starter when eating out).

April 16, 2022

I’m still battling fairly consistent fatigue. It’s not bad enough to keep me from meeting any of my usual obligations but, when I get to the weekend and some free time, all I want to do is sleep. It remains unclear to me if this is a stress response (work is particularly hellacious at the moment due to significant understaffing coupled with increased demands on clinical geriatrics), my version of ‘long Covid’, or the fact that I’m older than I ever intended to be by several decades and my body is simply starting to require more down time. It might be all of these together I suppose. Anyway, I slept for ten hours last night and am retiring early tonight as I have to get up for church in the morning in order to sing with the choir and those high Es won’t even begin to come out without rest, relaxation, and hydration.

The Unitarian church, having been founded in opposition to the Trinitarian belief of God the Father, God the Son and God the Holy Spirit, doesn’t celebrate Easter in the usual way. We have what is known as the flower communion created by Rev. Norbert Capek nearly a century ago. The congregation arrives with flowers which are gathered and then, during the service we choose and depart with a different blossom – the flowers symbolize spring and renewal and they are all different just as we all are different, coming with us and departing with another member of the beloved community. It, like other religious rituals, comes around every year and the older I get, the more I recognize the importance of ritual and tradition in all of our lives. The world changes fast. As we age, our abilities to absorb and reorder ourselves for those changes decreases. The part of culture and religion that is unchanging becomes more and more of a touchstone, an anchor point in a world that is more and more unfamiliar. If I feel like this at sixty, I can just imagine what I’ll feel like in another generation when I’m eighty, should I live so long.

Most of the planning is done for my sixtieth birthday bash, which I’m regarding as a party I’m giving as a thank you for all of my local friends who have helped me weather the last few years of loss and pain and pandemic. Invitations are going out this week. Should you be local and not receive one and you’re really interested in attending, message me privately and I’ll get you the particulars. I haven’t given a significant party since Tommy and my last open house at the end of 2017 and it feels strange to put one together without his input. I don’t have his culinary skills to fall back on so I’m going with professional catering and I hope he’ll forgive me. I’ve picked a venue with space to spread out and good air circulation and I’ll keep my fingers crossed that Covid keeps its head down for the next month.

FILE – Boxes of BinaxNow home COVID-19 tests made by Abbott are shown for sale on Nov. 15, 2021, at a CVS store in Lakewood, Wash. The Biden administration’s plan for health insurers to reimburse consumers for over-the-counter COVID-19 tests is recalling the model of a bygone era when the companies processed large volumes of claims from individuals _ with paper receipts. (AP Photo/Ted S. Warren, File)

I’ve heard through the grapevine of a number of friends catching Covid over the last week or so. No one has been particularly ill and it’s mainly been picked up on positive home tests without PCR confirmation so it’s hard to say what’s going on. At the moment, the US is flying blind. The federal government’s payment for Covid testing for the uninsured has lapsed keeping large segments of the population away from testing. The large testing centers have closed. Exhausted health departments aren’t doing the contact tracing or surveillance they have been doing in the past. We really can’t trust the data being reported into the central data banks regarding numbers of positive tests to accurately reflect what’s going on out there the way we could a few months ago. What do we know? Numbers are creeping up in New England thanks to omicron variants spreading in the major cities. It does not appear to be enough to have a serious impact on hospitalizations. As a heavily vaccinated region, it may not get much of a hold on the population as a whole following the major spike of the initial omicron wave.

The local numbers here in Alabama are quite low. UAB hospital is holding steady at roughly ten inpatients with no one on a ventilator, giving the ICU teams a much needed break and allowing the system to open up for long delayed elective procedures. Given the prevalence of home testing, with no good way to actually collect that data, we may need to look for other numbers to help us make sense of the world. The first is the percent positivity rate of the PCR tests that are collected in hospitals and clinics and testing centers. If fewer than 5% (1/20) of those tests is positive for Covid, than, per WHO definitions, the disease is under reasonable control and spread in the community is limited. That number isn’t generally reported but it’s out there. I’ll see what I can find. The other major marker is wastewater surveillance which I think I have mentioned before. As all our bodily wastes, which will include virus, go through the same sewer systems, testing at water treatment plants for the amount of virus coming down the pipes is a pretty good marker for how sick the community is. This methodology is inconsistent across the US and can’t really be counted on for national planning.

There are a few studies out of Europe that suggest that we are not the only ones having difficulty figuring out what’s going on in real time. Studies there are showing an uncoupling of the data curves of testing from the data curves of reported illness as not all tests are being done quickly and reported to the authorities the way that they were being as recently as January when omicron reached its peak. Our current valley and more than two years of battle has left us somewhat spent and taking advantage of the lull. However, one must always remember that the virus never takes a break and simply exploits changes in human behavior in its inexorable need to replicate. I shan’t be in the least bit surprised at another surge coming up and that it will surprise it when it does come as we simply haven’t been looking for it, now being distracted with domestic politics and the situation in Ukraine.

If I am reading the tea leaves right, we’re about five years away from a major collapse in the health care system. Now that Covid is improving to the point that older populations are getting out and about more, the aging lead edge of the baby boom, now in their mid 70s, is reevaluating its health needs and trying to turn to geriatrics to make sure they age with eternal youth. (It doesn’t work, but my newer patients seem to think that I am Miracle Max and I’m just hiding some perfect concoction of turmeric, mineral supplements, biotin, blood pressure medication, and memory enhancers somewhere in my files and that if they just keep pushing, I’ll give them the secret – sorry Ponce de Leon did not leave me the map). They are about to be joined by their younger brothers and sisters clamoring for help from an exhausted group of health care providers, many of whom have left the profession leaving more work for those left behind. On top of that, the commercial insurers, who took a bath on Covid, are looking for ways to replenish their coffers and are ratcheting down on payments and fighting against even basic testing and medications – denials and prior authorizations and calls to adenoidal individuals at call centers with no medical training other than a script are way up and that just adds more and more time and busy work to our day. It now takes me about 6-8 hours on the weekend to catch up from my average work week. It used to take about 2. It’s going to continue to drive people away from primary care disciplines. Just another gift of the pandemic to our post pandemic world.

Enough kvetching. Time to end this and put on an old episode of Supernatural as I fall asleep. Be careful out there. I’ve gone back to masking in crowded stores. It doesn’t hurt me and it may help. Have an appointment for my second booster coming up as well. I figure it won’t hurt and it might help.