The cats have decided that the living room carpet under the piano is some sort of third litter box. I have moved from placing pads to bopping them on the nose when I catch them. I suppose the next step is to pull a Susan Collins and tell them of my great concern in a sternly worded letter. As anti-Republican sentiment continues to rise over the execrable behavior at the top of the party, it appears that no amount of attempts at moderation through gravely troubled rhetoric, while continuing to vote the party line, is likely to save her her seat. There’s a lot of worry about what sort of shenanigans will be pulled prior to the midterms and various forms of disenfranchisement continue, abetted by the court system, but what happened in Hungary last month shows the solution. If people will just bother to vote at all, the balance of power will shift, no matter how heavy the thumb on the scale. We don’t have a voting problem in this country as much as we have a non-voting problem. When half the electorate sits home, an energized minority can grab outsize influence due to the winner take all nature of our electoral system.

The Supreme Court’s decision this week in Louisiana v Callais which basically invalidates the Voting Rights Act. Spits in the eyes of John Lewis, Thurgood Marshall, and Martin Luther King Jr. and then dances on their graves. I’m expecting a repudiation of Brown v Board of Education next. Gerrymanders can be undone. It requires time, patience, and energy. Movement conservatism has been playing a long game for more than fifty years to achieve the ascendancy they currently have. And it started with movement conservatives taking over the structure of the party at the grassroots level by doing the thankless work of precinct committee chairs and the other nuts and bolts requirements of local governance. They volunteered and stepped up at the municipal and county level. They never focused on losses or setbacks other than to learn from them for the next election. They found individuals willing to commit resources to building an infrastructure which would help reframe public debate on social issues. They identified allies and came up with causes around which they would rally.

Progressives need to remember that all politics are local and that change starts at the bottom and works its way up. You can’t start at the top. Moving public opinion requires time and careful incremental changes. Anything too rapid that takes the general population outside of their comfort zone, even when it’s the right thing to do, will always provoke a backlash. Our current backlash is, of course, moving from carefully coded to overt racism and in a lot of quarters is bringing outright white supremacy into the public conversation. I am hoping that this proves too rapid too quickly for the other side and that there will be a backlash which will push us away from some of the more odious policies of the current administration. The white wine moms of Minnesota went to bat for their Somali neighbors and things changed.

War in Iran (which may or may not be ongoing – the White House can’t seem to come up with a consistent policy on that one), an attempted assassination (which appears to be exactly what it seems – a lone figure tired of waiting for those with the power to do something about evil action deciding to take matters into his own hands), a ballroom cum bunker that no one asked for or wants have driven the immigration story off of the front pages but it’s still very much out there. Markwayne Mullin is smart enough not to treat the post of DHS secretary as some sort of self-aggrandizing continuous Vogue cover photoshoot but he’s busy continuing what Kristi Noem put into place and Stephen Miller is still giving the marching orders. We continue to build out concentration camps, have an untrammeled federal law enforcement arm in ICE reveling in inflicting misery, ship lawful residents overseas to countries where they have no resources and ties (including unaccompanied minors and in a couple of cases US citizens), and in general flout the rule of law. I say we because all of these people, in theory work for us – we, the people. We either voted for this or did not convince enough of our friends and neighbors to vote against this.

The weaponization of DOJ continues apace as Trump continues on his revenge tour. The indictment of James Comey over a photo depicting ‘8647’ spelled out in seashells on a beach is one of the more ludicrous uses of taxpayer dollars in recent memory. ’86’ has been around in American slang since the 1930s. It came out of the shorthand waitstaff and cooks used in diners and meant ]’to throw out’ or ‘not available’. It has never meant to kill or to assassinate. It’s not a threat, it’s protected free speech under the first amendment, and I haven’t seen DOJ try to indict anyone from the Trump campaign for selling merchandise labeled ‘8646’ during the 2024 election season – and there was plenty of it. I’m no fan of Comey. His insistence on reopening the FBI investigation into Hillary’s emails in 2016 may have done more than anything else to gift us with the Trump presidency so maybe this is karma. Then there’s the unwise indictment of SPLC for paying informants in white supremacy organizations for the inside scoop. Those at the top of DOJ aren’t the brightest (those have all departed a department focused on ideology and vindictiveness for more satisfying careers) but the lawyers at SPLC are still pretty savvy and have wasted no time in showing that the feds have known about their informant programs and shared in them for decades. I predict that case will quietly disappear.

I’m about to start throwing myself into The Tempest as I get my ideas and concepts ready for production this summer. If you’re interested in being part of it, let me know. First rehearsal is June 22nd, Tech starts August 1st and it runs the weekends of August 6th and 13th. I’m unpacking a lot of the subtext at the moment and trying to decide which themes to emphasize. There’s a lot about imperialism and oppression. There’s manipulation, betrayal, familial bonding, love, the power of the natural world. It’s a lot, like all Shakespeare. I think I’m going to lean into the more positive and mystical elements but want to acknowledge the others are there. Perhaps the ultimate theme is one of balance. Things are out of balance at the start with the storm and Prospero’s displacement but by the end the pieces fall back into place and balance is restored.

And perhaps that’s how we need to view what’s going on in the US right now. We are definitely out of balance. Those in ascendancy feel that they have the right to carry us back to Jim Crow (and are busy calling special state legislative sessions to do it) and that the hopes and dreams and futures of people not like them are really not their concern. But don’t we do better when we make policies that cater to all of us in all of our crazy polyglot diversity? If we look at the historical record, more open societies are those that have made advancements in the arts and sciences and standard of living. Societies that close themselves, especially in strictures of religious fundamentalism, fossilize. They may go on but change, not stasis, is the engine of progress.

It was the anniversary of Tommy’s death this past week. It’s hard to believe it’s been eight years. And it will be twenty-five since Steve’s been gone this coming August. I’m getting old.

I want to write some light comedy and satire again but the society we live in makes this nearly impossible.  Every time Mrs. Norman starts rattling around in my head and I feel like I can let her out to play and write some new movie columns, reality trumps anything (pun very much intended) I could possibly dream up for her outlandish adventures.  Maybe my vacation next month and a few weeks in a culture not subject to the whims of a would-be autocrat in decline will align my brain cells in such a way that she can creep back into my regular writing routine. I have thought of a way to explain her prolonged absence and perhaps she’ll get involved with the Kennedy Center on some sort of production celebrating 250 years of the USA.  I’m old enough to remember the bicentennial summer of 1976 quite clearly and all of the various celebrations, and bicentennial minutes, and American flag 70s couture etc.  It was a time when the American Dream was feeling achieved.  It was a decade after the Great Society programs had bettered the lives of the working class.  The turmoil of the late sixties was in the rearview mirror.  Vietnam and Watergate were over.  Everything and anything seemed possible.  A few years later, though, the election of Ronald Reagan set the country on a very different course which has led us to where we find ourselves now.  I’m trying to think of something to celebrate this July but with the Project 2025 led destruction of our social, political and cultural institutions and our reputation in the world in free fall, all I’m seeing is the amount of work that will need to be done when we’re finally allowed to get out the dustpans and brooms.

My May vacation is set.  For those of you inhabiting cultural capitals and who might like to get together as I pass through, I will be in New York May 14^th-18^th.  London May 19^th-22^nd.  Paris May 22^nd-26^th. Milan May 26^th-27^th and Rome May 27^th-June 1^st, heading back to Birmingham that afternoon.  This means, of course, that this space will devolve back into travelogue in a few weeks.  I’m not sure that I’ll have all that much to say about New York and London as I’ve been to both quite a few times over the last decade.  I have not, however, been to Paris in over forty years.  The last time I saw Paris, there was no glass pyramid at the Louvre.  I’m checking a few things out for a planned longer trip to France in a year or two and will be in and out of the company of my friends David and Jonathan (not the biblical ones) both there and in London.  The best train service from Paris to Rome stops in Milan, so I am going to spend a night there, a city new to me.  I shan’t be there long but I should be able to see the Duomo and La Scala.  La Scala is doing Nabucco that night and, while it would be lovely to hear Va Pensiero sung in the hall for which it was first compose, it was sold out many months in advance.  I may wander by to see if there’s some sort of standing room rush available. It’s been decades since my last Rome trip as well, but only two rather than four.  There I’m hanging out with my friend Thomas who has a summer gig digging up Hadrian’s Villa at Tivoli.  I have been to Tivoli many moons ago and recall the fountains in the gardens of the Villa d’Este quite well but don’t remember a thing about Hadrian’s Villa.  Maybe they hadn’t dug much of it up yet in 1984.

I have firm retirement plans in place.  My official retirement date from UAB will be July 1, 2027.  I may step out of clinic earlier than that depending on the implementation of the new electronic medical record system.  Having been through a number of those changes in the past, I refuse to do this one when I am planning on retiring just a few months later.  I have asked to be considered for emeritus status so that I remain affiliated with UAB and can bounce around offering a few dollops of sage wisdom garnered over my more than forty years in medicine.  My division thinks this won’t be an issue, but we shall see.  I will probably step down from the VA at the same time but that will depend a lot on what will happen over the next year with a pending change of leadership and how the federal government budgets and supports the kind of programs with which I work.  Of course my carefully laid plans are likely to blow up due to life’s usual curve balls.  It’s the sort of thing that usually happens to me.

I did a one-off theatrical gig last night for Terrific New Theatre.  Their current offering is a British play, The Events, in which a female chaplain who leads a community chorus is confronted with a young man who commits an unspeakable act of violence.  The play is told in short, non-linear scenes, leaving the audience to puzzle out the whole story with some gaps that must be closed by inference.  It’s sort of like a jigsaw but with a couple of missing pieces.  There are only two actors in the piece.  The chaplain (played by my long-term friend and stage companion Holly Dikeman) and a young man (Ryder Dean whom I have known since toddlerhood) who plays the perpetrator and everyone else who interacts with her.  The third character is the chorus – part Greek chorus, part church choir, part plot device.  Director David Strickland (whom I first worked with when he was a twelve-year-old wunderkind) and the theater company made the decision to invite the church choirs of greater Birmingham to participate rather than to cast a chorus with actors.  It’s not complex for the chorus.  You basically just sit on stage and sing on cue (with a few other things thrown in which can be learned in less than an hour).  The UU church choir did the honors last night.  I found the play engrossing and timely and I’ve been reflecting on it all day.  It runs one more weekend so if you’re in town, it’s worth a trip to 5^th Avenue North across from the Redmont Hotel.

While acts of violence are committed by deranged individuals on stage, they continue to be committed by the men and women who ostensibly work for We The People in real life.  Iran remains a quagmire from which the only plausible exit is going to be putting ourselves in a worse and Iran in a better position than the thoughtful diplomacy of previous administrations.  Leaks suggest that Iran’s bombing of our Middle East bases has been far worse than the Pentagon is willing to admit and the repair costs will run in the billions.  The rest of the Middle East appears highly unstable, and the Netanyahu government continues its usual rapacious and aggressive policies.  INS announced this week that protesting or criticizing the state of Israel could be grounds for the denial or revocation of a visa or green card. They’re also hard at work on facial recognition technologies which could easily be turned against political opposition.  The president threatened to throw Spain out of NATO (something he does not have the power to do) as the Spanish Prime Minister remains highly critical of our adventures in Iran and the president still seems very confused about the role of a defensive alliance in an aggressive campaign.

The weaponization of the DOJ against Trump’s political enemies reached a new low with the somewhat laughable allegations against the Southern Poverty Law Center.  Basically, DOJ is trying to criminalize standard techniques that they themselves have employed for many decades when dealing with terrorist groups of any stripe. As there are few competent attorneys left at DOJ, I don’t really see this going very far – it’s more a battle of propaganda and public opinion and the news cycle than it is of actual criminality and most judges will toss it on merits (they can’t assign every federal case to Aileen Cannon).  I have to wonder Cui Bono?  Who benefits if SPLC is hamstrung?  Predominantly right wing nativist racist groups and it’s just one more example of this administration wholeheartedly embracing their repellant philosophies.

Then there’s the news tidbit that suggests that no one at the White House understands high school physics. This involves the ‘renovations’ to the Reflecting Pool on the Mall. Trump was upset that the pool is dark and lined with a dark granite.  He wanted to paint it turquoise as if it’s the pool at Mar-a-Lago.  (Someone did step in and get it changed to ‘American Flag Blue’ which is a bit darker.  Due to the nature of light and optics, for a pool to be a reflecting pool, it must have a dark lining.  That’s what allows us to see a reflection.  Light colors don’t do this.  It’s why your average backyard swimming pool isn’t very good at reflecting.  I keep telling myself physical objects can be repaired and replaced.  But it’s going to be a lot harder to replace the institutions that are so casually being decimated.  The latest being Trump’s firing of all the members of The National Science Board today.  This body, which provides expert advice to the National Science Foundation, Congress, and other federal agencies, was created by Statute of Congress decades ago, so this move is of dubious legality at best and just another step in the continued destruction of education, science, and academia on which the last century of America was built.  Maybe when I retire, I shall retire into some sort of bubble where no media can penetrate.  I might be a happier man.

It’s the middle of opera weekend. The economics of opera production plus the fact that the principals need to have a day off prior to a performance so that their voices will be able to deliver for an audience mean that we only have two performances – Friday night and Sunday matinee. Friday night went relatively well. From my point of view, Pagliacci was stronger and more sure musically than Cavalleria. There were a few wonky moments in the latter, nothing that most audience members would notice and nothing that derailed the show to any major extent. The audience reception was rapturous. I put this down to two things – first, we hadn’t produced a full scale grand opera since 2019 due to a few minor hiccups like a pandemic and associated economic fall out. Second, almost everyone involved is local. The only imports were three of nine principal singers and the maestro (who is busy playing Tommy’s piano in my living room at the moment – I think he’s getting ready for his next gig).

We’re certainly living in operatic times. When the Trump era is over, and it will end as all historical epochs must, the only art form that can truly encapsulate the hubris and fury within the man is going to be opera. I haven’t quite figured out if he’s a Verdi baritone or a Rossini basso buffo. I’m going to go with the former. Anyone who, at this point, writes him and his impulses off as some sort of joke is clearly not paying attention. I can see some future singer blasting out rage and delusion in something akin to Rigoletto’s Cortiagani and it hitting the audience with all the force of Mike Tyson on one of his better days. Speaking of Rigoletto, that’s Opera Birmingham’s grand opera for next season. It’s one of my favorite scores and I love the chorus part.

Our present Duca di Mantua and his court have been all over the airwaves again this week with comments so farcical that they would be considered uproariously funny were the consequences not so serious. What all is going on? Various ceasefires and peace agreements don’t appear to be worth the paper upon which they are inscribed as there appears to be absolutely no coherence within the administration as to messaging to either enemies or allies, diplomatic unity, or military plans that make any sense. The rapid change in the government from a cadre of individuals chosen for ability and expertise to a group of toadies willing to implement the whims of the day no questions asked has had an entirely predictable result.

I play the village priest in Cavalleria Rusticana and, as it takes place on Easter Sunday, I’m in a costume that makes me look something like the pope and something like the Pillsbury Doughboy. We did a little viral marketing video in which I took ‘confession’ from my friend Holly who is the wig and makeup person for the opera, falling out of my chair with a scream when she confesses to not having purchased her opera tickets. Our little bit of satire fit right in with the Secretary of Defense quoting the screenplay of Pulp Fiction thinking it was the Bible, the vice president stating that the pope’s antiwar stance was theologically in error, and the president’s now infamous ‘doctor’ meme. It takes a special kind of chutzpah to tell the pope that you know more about his religion than he does, especially when you only converted seven years ago. Why Vance did this is a bit of a mystery to me. I’m assuming it was politically motivated as a way to get chummier with the Opus Dei crowd. The current pope is a kid from the South Side of Chicago. He’ll have no trouble taking care of himself and the Catholic Church from any additional buffoonery

Due to the peculiarities of the opera schedule, I had Thursday night and today off from responsibilities so I did what I usually do when I have unexpected free time, I went to the theater. On Thursday, I saw Samford University’s production of Oklahoma! and today I saw the Virginia Samford Theatre’s production of Thornton Wilder’s Our Town. I hadn’t intended to take in two seminal works of American theatre on the same weekend. It’s just the way it worked out. And it got me thinking a bit. I went to see Oklahoma! as I knew Samford would do it with the full orchestra and Rodgers and Hammerstein always sounds better with the full instrumentation. I’ve seen a Broadway revival, semi-pro productions, cheap community theater productions, and high school productions in my time. The younger generations like to belittle Oklahoma! as they only really know it through way to many Yee Haw cornpone (or is it corn puddin’?) versions done in school auditoriums and church basements.

In its day, it was seen as revolutionary. It was the first American musical that fully integrated book, music, lyric, design and dance into an integrated whole. There had been steps in this direction earlier (most notably Showboat which predated it by sixteen years) but mor most of the first half of the 20th centuries, musicals were star driven vehicles built around particular talents and things like plot were an afterthought and half the songs had nothing to do with the show. It’s why so few shows prior to Oklahoma! are consistently performed. I caught the movie Blue Moon on Netflix the other night. It follows Lorenz Hart, Rodger’s previous writing partner, as he proceeds to get drunk at Sardi’s during the opening night party for Oklahoma! as he begins to understand that he is the past and is going to be left behind as the art form moves forward without him. The movie is predominantly one long monologue by Ethan Hawke as Hart. It’s a great performance and there’s a lot of subtext about the changes coming to America as a result of World War II. These are the people that built post war America – the society that the current administration is rapidly trying to dismantle.

A lot of people think Oklahoma! is about who gets to take a girl to a picnic. But it’s much more than that or it would not have resonated with the World War II audience who first saw it and become a phenomenon. It’s about the poor (Curly and Laurey are basically Ma and Pa Joad earlier in their lives). It’s about community. It’s about the power of belonging and ostracism. A lot of people hated Daniel Fish’s recent reworking of the material but I think he got a lot of the dynamics around Jud, the ostensible villain, correct. It’s about sexual awakening and the battle of agape and eros. It’s a tragedy in the Greek sense of the word with a happy ending tacked on (invented by Hammerstein – it’s not in the original play Green Grow the Lilacs on which it’s based). Seeing it with a college cast was nice as it meant that most of the performers were the correct age for their parts. Laurey and Ado Annie are about fifteen or sixteen. Curly and Will are probably about twenty.

But most importantly, it’s about what’s really important in life. Human relationships. Community. Family. Not triumphal arches that will be seven stories taller than the Arc de Triomphe in Paris. Our Town, which, like Oklahoma!, has been a staple for every community and high school theatre since it was first produced in 1938, reinforced that message in my head. The story of George and Emily in turn of the last century Grover’s Corners is an everyman tale of ordinary people. The various theatrical conceits such as the bare stage without props, the breaking of the fourth wall, and the character of the stage manager, makes you concentrate on the human elements. As I was watching it, I kept thinking back on my life, my parents, my family and also forward to my eventual death and reflecting on life patterns and what’s really important in the long run.

I’ve been watching the unfolding changing of the guard in Hungary with some interest. Magyar is moving quickly. He’s hardly a progressive. He’s fairly right wing (but to the left of Orban which isn’t difficult). I’ll be interested in seeing how he undoes Orban’s autocratic rules or if he does. I think we could take a lesson from him as we head toward our midterms and how he was able to overcome all of the rules changes that should have made ousting Orban impossible. He went from town to town all over the country, into various public institutions in various states of disrepair and asked a simple question. Where did the money go? Everyone knew it had gone to Orban’s cronies and that simple message was one which allowed him to prevail. We can and should do that here. The Federal government, when under the control of the Republican party, has been selling off the commons to private enterprise for decades and our public works and infrastructure are dilapidated. Most of our public buildings look stuck in the 70s because they are. The money began to be siphoned out in earnest under the Reagan administration. If the Democrats would run candidates that continually ask where are your tax dollars? people might start putting two and two together. It will require centrist candidates and the more progressive wing of the party will need to understand that this is not the time to make the perfect the enemy of the good.

Must get up and get dressed for this event I’m going to this evening. The theme is LGBTQ prom – I’ll look through my various formals and find something.

In the midst of a world that seems to be spinning further and further apart, forty people have been gathering in an old auto body shop daily to create art. It’s not the cleanest space. The climate control leaves something to be desired. It’s furnished with folding chairs, some tables, and a piano. There’s a maze of multicolored tape on the floor indicating where walls and doors are supposed to exist. For two weeks now, this group is giving of their time, their talents, and subsuming their egos into a greater whole, taking direction from a master musician and a theatre professional who are working to make something that both entertains and illuminates the human condition. We have one more week together and then, as is the ephemeral nature of stage production, we scatter our separate ways. Those who wish to view the finished product can purchase tickets from Opera Birmingham.

When Pietro Mascagni and Rugerro Leoncavallo separately sat down in a recently unified Italy in the early 1890s to create Cavalleria Rusticana and I Pagliacci respectively, they could not have conceived of our modern society. But their tales of contemporaneous Southern Italian peasantry and their passions still resonate more than a century later. Their glorious music still speaks. Primal human instincts to love, to belong, to mistrust the outsider don’t change. We can see ourselves in Santuzza’s ostracism or Canio’s feelings of betrayal. And creation is the antithesis and the answer to the destruction that is happening all around. It’s the way to cope and to move forward. The arts often flourish in times of political trouble for this reason. There is a distinct human need for creation during periods of destruction. Unfortunately, the current political circumstances are playing havoc on the arts ecosystem in this country. Most performing arts institutions, with the removal of federal and state support (which was never all that much to begin with when compared to most Western countries) are facing budget reductions of 30-60%. You know what to do. Go to the theatre. Visit a museum. Attend a concert. Encourage a young person to explore their artistic talents. Make a donation to an arts institution or to a school or training program. The arts are going to make the next decade or so more bearable in ways that impulse purchase from Amazon won’t.

Where to begin in trying to parse current events? I haven’t a clue. An American delegation consisting of presidential family members and hangers on with no diplomatic experience or training seem unable to negotiate with Iranian leadership at talks in Islamabad. The secretary of state, who should be the point person on anything of this significance is busy attending cage match fighting in Florida. Iran appears to continue to hold the upper hand with its blockade of the straits of Hormuz despite the barely coherent rhetoric coming from the president’s mouth and social media accounts. I’m seeing an enfant terrible having a tantrum because in this instance, he is not getting his way. No amount of calling the press who report the truth liars or firing of military leaders who point out the insanity of his decisions or attacking our allies for not joining in a pointless war of aggression (he doesn’t seem to understand the basic fact that NATO is a defensive pact) is going to change that he charged into a conflict all past presidents avoided due to the entirely predictable consequences that we all now see playing out.

At least the monolith of the right wing media echo chamber seems to be fracturing with various conservative pundits disavowing Trump and his policies over his entanglement in Middle East politics. When you’ve lost Alex Jones and MTG, you no longer have your base locked in permanent adoration. And apparently Viktor Orban’s poll numbers in Hungary have dropped even lower since Trump and Vance attempted to sway the electorate with endorsements, visits, and promises of aid. US reputation has been so badly diminished on the world stage over the last eighteen months that even when we have a new administration, it will be decades before we will be able to be recognized as a major force for good in the world.

I’m going to Europe in a month for a couple of weeks. I’m calling this my Gary Indiana trip as stops include Paris France, New York and Rome. (I suppose, to do the full Gary, I would have had to start in New Orleans). I know that the Europeans I meet will look at me very differently than they would have two years ago. I’ll make no secret of my disdain for our current government but how do I explain that our bastion of democracy has so easily surrendered itself to antidemocratic forces? We have all seen the negative consequences of this administration and what have we collectively done to combat that? Have we demanded of our elected representatives that they do their jobs as a check and balance? Some of us do but we are a minority. The majority continue to think that either politics has little to do with their day to day lives or are steeped in a media culture that has little to do with objective reality. As long as we continue to tolerate the current state of affairs, we all remain complicit with them.

I live in Alabama. I know that someone with my way of seeing the world is distinctly in the minority. After all, the great achievements of our state legislature this session appear to be abstinence only sex education, officially changing the name of the Gulf of Mexico to the Gulf of America, and displaying the 10 commandments in schools. But in my travels around the state and my spending time with people of a very different background than mine (courtesy of my VA house calls), I know we have more in common than we think. It’s just a matter of identifying those shared ideals and using them to communicate so that we can respect the differences and learn to live with each other. The biggest barrier is the 24/7 news cycle with its deluge of infotainment untethered from reality. To me, that’s the issue we most have to grapple with if we’re going to move this country forward.

I don’t recall being this tired during an opera rehearsal period in the past. But then it’s been seven years since I last rehearsed a fully staged opera on top of my usual work schedule and in the interim I have aged rather more than I might like to admit. A pandemic and a few other health issues probably didn’t help. I’ll make it over the finish line in nine days but I’m finding myself with a certain need to pace myself and not take on even more obligations. The opera, well operas as there are two relatively short ones in Cavalleria Rusticana and I Pagliacci, are coming together and the finished product should be quite enjoyable. Get your tickets now from Opera Birmingham. I have some fun bits of staging, especially in Cavalleria where I play the village priest as well as random Italian peasant. It’s always nice to be given something on which to build a character arc when one is in the chorus. I also have my traditional opera stage drunk moment – but it’s not especially showy.

We certainly live in interesting times as the events of the last few days have shown. Since Easter, the President of the United States has tweeted a vulgar and blasphemous Easter morning message, delivered a random political rant at the White House Easter Egg Roll confusing some poor staffer in an Easter Bunny costume no end, not to mention the small children in their sun dresses and bow ties, threatened genocide and various other war crimes, and acquiesced to a cease fire which leaves the declared enemy in a much better position than they were at the start of hostilities. When the definitive history of the Trump administrations is written by some future historian, it will be interesting to see what is made of all this. Unfortunately, I am unlikely to be alive to read it as it usually takes forty or fifty years to get enough perspective on historical events to really understand what was going on and I am not planning on living to age 115 or so. Most of the healthy centenarians I have met over the years have the same complaint. They’re lonely as all of the people who understand the world through the same lens as they do are either gone or too infirm to me much fun.

While Easter is not an especially important holiday for the Unitarian Universalist church (the divinity of Jesus not being one of the tenets), we did have a sermon on resurrection in all of its meanings. It started off with the story of an aged cat who wandered away from home and was gone for a Biblical forty days before returning to the bosom of his family. And it got me thinking about the meaning of resurrection in my life. No one has risen from the dead around me to my knowledge but I’m quite familiar with the concept of rebirth from loss, having had to do this several times. The collapse of my professional life in California drove me to a state that I had never visited prior to my job interview and now, nearly thirty years later it is home and full of people who accept and support me just as I am. The death of Steve left a void which I ended up filling with music and theatre. The death of Tommy led to introspection and writing and books.

And maybe that’s what we need to think about as a nation. All of the craziness and all of the destruction may be setting us up for being able to move forward and create something better. We’ve been fossilized socially and politically for the last few decades and until we get rid of the old, the new cannot flourish. We used to have a culture that constantly changed as each new generation came of age but since the 90s and the Baby Boom obtaining hegemony, we’ve been in stasis without a whole lot of the new and an unintentional holding back of younger generations from really being able to mature and have their time on the national stage. I have lots of younger friends and I know what creative and dynamic people they are but you’d never really know about what they have to offer as the media focuses on what remains static and comfortable and as crazy politics sucks all of the air out of the room leaving little room for reporting on things outside of the mainstream.

What comes next. Who knows. Events in Hungary may be instructive. Viktor Orban has spent the last decade and a half building an authoritarian regime and hollowing democracy out by slowly changing the rules regarding elections and the judiciary, leading to a party political elite. Guess what, the elite began to think that the remaining rules no longer applied to them and corruption began to creep into all of their dealings. The population tends to notice when the ruling class begins to operate under ‘rules for thee but not for me’ and a meaningful opposition has appeared and coalesced and Orban may go down to electoral defeat in the coming election. The Western World’s right wing superstars have been rushing into Budapest to try and change things. Vance, LePen, Meloni have all been there but it doesn’t seem to be making much difference in the polls.

Something similar can happen here. We need to coalesce around a candidate and set of ideals that we all can agree on as Americans as they are part of our political DNA – freedom, fairness, kindness, equality of opportunity and before the law – all things that have been in short supply with MAGA thinking. The left will have to set aside its ideological purity tests and its rigid thinking regarding progressive values. The right who have become disillusioned by Trump and all of his destructive impulses and broken promises will need to be welcomed without shame or blame. Religious ideals and impulses will need to be returned to church and taken out of the political sphere. We may all have to give up some private wealth to build a stronger public commons. I just don’t know if we’re ready to do all of that yet or what conditions are necessary to push people into taking the necessary steps.

I return time and again to Masha Gessen’s seminal essay ‘Autocracy: Rules for Survival’ originally published in November of 2016 after Trump’s first victory. In it, they laid out six very simple rules for what was to come: 1. Believe the autocrat. 2. Do not be taken in by small signs of normality. 3. Institutions will not save you. 4. Be outraged. 5. Don’t make compromises. 6. Remember the future. I’ve seen far too many people in positions of power and influence violate these rules repeatedly. Media figures, attorneys, and university administrators who have complied in advance. Pundits on both left and right making light of horrific things by focusing on incidentals that are more normal. Religious leaders rejecting all of the lessons that all religions teach regarding love and welcome for a chance to increase wealth and temporal power. Perhaps I should have these placed on a t-shirt next to my simple ‘Get up. Get dressed. Go out. Do good.’ They do complement each other.

Between Opera Birmingham, UAB, and the Birmingham VA, I have pretty much zero free time between now and April 19th. It’s been seven years since I’ve done opera chorus in a fully staged show and I had forgotten how much mental and physical energy it takes to sing for three hours, try to remember lyrics in a language you don’t speak, keep your staging correct so you don’t end up in someone’s way, and try to act all at the same time. I’ll make it but I can tell both body and brain have aged over the last seven years. It’s not as easy as it once was. For those interested in seeing me playing a priest and an Italian peasant, further information can be found at Opera Birmingham – two performances only. Friday evening April 17th and Sunday matinee April 19th at the DJD Theater at ASFA. I’ll post production photos when they are available but that isn’t going to be for another ten days or so. I don’t know about all my looks yet but I tried on a great pair of pants with all sorts of buttons at my costume fitting last week.

Not much out of the ordinary happening on the work front. I continue to plow forward caring for my patients the best I can, both in clinic and with house calls. All the clinical programs with which I am involved appear to be relatively robust at this point and should be well positioned to survive my pending retirement. (Still slated for 2027 and likely staged in between February and July depending on things over which I have zero control). Whether they will survive the calamities happening in the greater world of American health care, I know not nor do I have any sway over the more ridiculous moves of the current administration. There are those in congress and the federal court system who do have some power and, while the court system has been pushing back in recent months against executive overreach, congress continues to be content to blissfully abandon its article I powers to a rapacious regime.

What’s going on in health? On the Covid front there’s been a number of headlines about the Cicada strain. The clickbait sensationalistic articles on social media have been overstating its dangers. As a strain, it’s been around for some years, much more prevalent in other parts of the world than in the USA. It’s still an omicron lineage variant so the population is relatively well protected from prior infections/antibodies and from vaccines. It’s about 10% of current US infections and clinically, these patients do not appear to be any sicker or have any more risks than those infected with other covid strains. It just has a jazzy new nickname that’s easy for the public to remember.

I’ve seen a bunch of misinformation circulating recently regarding covid infections and covid vaccines. The truth is that we’re currently at a relatively low ebb in terms of both infection and hospitalization and there’s nothing in current data (still collected by various state and municipal departments of public health even if the feds have abandoned the job) to suggest any sort of surge coming in the near future. Six years later we’re pretty much reaching a more commensal state with the virus. It’s still quite capable of making you sick, however, and I wouldn’t go seeking it out. Should you get a new booster this fall? There’s no reason not to if you haven’t had issues with prior vaccinations – but that’s assuming we have new boosters this fall. That’s not a done deal.

There’s been a bunch of chatter about covid and premature dementia with some doom and gloom stories that everyone now in their fifties and sixties is going to end up demented before the age of seventy because of (depending on the source) covid infections or covid vaccinations. I went and looked at the literature to see if there was any real scientific reportage suggesting this was true and found little to support this. What is true is that those with severe covid and prolonged infection and hospitalization have some evidence of inflammatory brain states and amyloid plaque deposition similar to that of Alzheimer’s disease. It’s not inevitable and there’s no evidence yet showing that those with serious covid actually develop Alzheimer’s disease sooner or that it progresses more rapidly than it does in the population at large. There was one study done on macaques showing that those infected with covid were more likely to develop Lewy bodies (another brain pathology which causes a different type of dementing process than Alzheimer’s disease). This finding has not been found in humans. Therefore, if you are like me, in your mid-60s, I wouldn’t assume that your mind will be gone within the next decade.

We’ve got plenty of issues afoot with older generations now in their 80s and 90s in whom dementia is endemic. (In general, dementia as roughly a 20% prevalence at age 80, 40% at age 85, 60% at age 90, 80% at age 95 and it’s pretty universal at age 100). We all know of anecdotal evidence of people in their 90s and beyond who remain quite sharp but they are the exceptions, not the rule. The uncertain 80s, which I have referred to before, continues to change the population from roughly 75% fully functional at age 80 to about 20% fully functional at age 90. As the Boomers now enter their uncertain 80s, I’ve been watching certain trends in elder care, especially when it comes to funding care for those of age who can no longer live independently. Medicare has been on the chopping block for a while (it can’t be eliminated without a riot but they can certainly cut out benefits or make them harder to obtain) and the president announced in a national address this week that the federal budget should be going to his war efforts rather than to health and human services programs.

Medicare, however, does not, for the most part fund custodial care for the elderly. That is the purview of Medicaid (for the impoverished) or a private responsibility of older folk and their families. The senior living industry is undergoing a huge transition. Much of the corporate ownership has been gobbled up by venture capital interested in the real estate and the money that can be extracted, not in the actual desires and needs of aging adults. Costs have risen about fifty percent since the start of the pandemic and changes in the workforce have left the majority of facilities, no matter how nice the dining room or how many chandeliers in the grand foyer, significantly understaffed. Then there are the desires of the aging boom generation. Shuffleboard, bingo, and bridge club aren’t necessarily going to be to their taste and most facilities have not yet begun to revamp their programs for a generation with very different wants and needs than their parents. Then there’s family structures which have shifted. Generation X is a small generation so there are fewer children available to pitch in for aging parents. Broader divorce and remarriage may make a Gen X household responsible for more than two parents and two parents in law. The Boom, as a whole, were not the savers their parents were and in general don’t have as many resources available to put towards their own maintenance as they age (not to mention the generational belief that they remain the youth generation and really don’t age. Biology would like to have a word.)

I am asked, pretty much on a daily basis, to recommend one senior living facility over another in the local marketplace. I can no longer do so. Things have changed so drastically over the six years in terms of administration, staffing, programs, facility maintenance, kitchen quality, and all the rest of it that I’m as at sea as the rest of the world. I hear good things. Then, a month later, due to turnover, I hear bad things. I have a few places which I consistently hear bad things about (mainly due to their having been purchased by a new corporate owner that has come in and slashed functional programs in the name of profit) and which I will tell people to avoid but, beyond that, who knows? What may be functional in April may be a disaster in May or vice versa.

My personal plan is to remain in my condo as long as possible. I bought a space that is easily adaptable to needs should I have either mobility or cognitive problems. It has the capacity for me to have a live in if needed (and I would rather have that than live in assisted living) and I have been socking away money for decades to allow that to happen should it be necessary. I am hopeful that I have about fifteen to twenty more good years before I really have to make a major change but you never know. I wasn’t expecting to have emergency surgery earlier this month and we all know how that turned out.

Must write progress notes, get sleep, get up, get dressed. go out, and do good tomorrow. With a visit to my accountant to go over the taxes (Eeek!) and an opera rehearsal thrown into the mix.

In an uncommon occurrence, I have an evening off from pretty much everything. This does not imply that I have a dearth of things to do. There are still boxes of crap all over my study from the deconstruction of my academic office that need to be sifted and put on to book shelves and in file cabinets. I have a few progress notes from this week that are not yet written. The writing projects pile up and I look at scraps of outline and think ‘not yet, not yet’ and I still have plenty of score study for Cavalleria Rusticana and I Pagliacci to do (but rehearsal on Monday showed me that I know it better than I thought). I also have to start giving some thought to The Tempest which I am directing this summer and figuring out how I’m going to configure it for our church basement performance space with limited technical capacity. I know what I want but how to do it on a budget of $1.95 and an old book of Green Stamps.

And so I am reveling in not too much to do and nothing due immediately. The weather is lovely so I have the doors to the terrace open. That may be a mistake because it makes me look closely at what I need to do to bring that space up to my standards of housekeeping and decor and there’s a bunch that needs to be done out there. But not this evening. I’ll make my trip to the garden center for pots and new plants sometime in April and, if the taxes are favorable, I’m thinking of getting some sort of recycling water fixture for my strange little courtyard that has no particular purpose. The HOA prevents bird feeders. I need to see if there’s anything about leaving out some peanuts for the crows so I can do my best Moira Rose.

Public health news remains strangely quiet, other than a proliferation of ads for various wellness regimens that seem to cross my social media regularly. All of them, which have the formal correctness, repetitiveness, and lack of any idiosyncrasies whatsoever that strongly suggest they were written by AI prompt, are urging me to uncover the secrets that modern medicine has tucked away for decades and that all of my ills can be cured by their patent formula of mushroom extract or antioxidants or jellyfish protein, etc. etc. Caveat emptor and good luck finding any peer reviewed science that will substantiate the manufacturer’s claims. Under US law, these products are considered food supplements, not drugs and therefore are not subject to FDA testing and regulation. There’s no requirement that they actually do anything (which is why they are sold for such vague conditions as enhanced well being) and there’s no guarantee that the contents of the bottle match what’s on the label. When my patients bring these products in, I give the same spiel – I have no science which tells me if this will be helpful or not. You’re welcome to try it and if it makes you feel better, great. I’ll keep my eyes on your liver and kidneys and other vital organs to be sure you’re not slowly poisoning yourself. (It’s happened a few times in my career).

We’re now a month into the Iran war. Billions are being spent. The president is being fed a pablum of talking points and film of things blowing up to soothe his nerves. The Secretary of Defense/War appears to be playing some sort of Christian Nationalist version of Call of Duty and there don’t seem to be a lot of adults with a true understanding of war and strategy calling the shots. More and more troops are being moved toward the Middle East which suggests there is some sort of plans for a ground assault somewhere. The Iranian army is nearly a million strong. The war is deeply unpopular as it’s unnecessary and it’s causing general inflation and economic chaos. The number of troops that would need to be committed to achieve any strategic goals in a ground assault is way beyond what we’re likely willing to muster. It could easily turn into another Ukrainian war with us playing Russia. This congress and administration can’t keep O’Hare and Hartsfield running smoothly. We’re expected to believe they can take Kharg island or reopen the Strait of Hormuz by force?

In the meantime, more and more dribbles out about just what’s in the Epstein files. I imagine some very rich and very powerful people are pulling all the strings to try and keep that bottled up within DOJ but the implications for the national security of other countries are strong and they have every reason to dig and I’m sure other intelligence services have copies of some of the more important and salacious material. DOJ is certainly not holding together well as a firewall directed at protecting the president at all costs. The release of materials related to Jack Smith’s case regarding Trump’s illegal retention of classified documents was certainly illuminating showing that it was all about the president and his family attempting to monetize state secrets. No wonder he was hell bent on the second term as those charges would likely have put him in jail for the remainder of his life. I have to wonder if those documents getting out was a mistake due to the caliber of folk left at DOJ or if there’s someone quietly working to slip damning evidence into regular outgoing document dumps.

The choice of TV tonight is The Pitt. I’m finally catching up with it. I’m about two thirds of the way through season one. It’s better than most medical shows. There’s obviously excellent technical advisors on set as I haven’t seen any false moves or mispronunciations. All of the cases are the kinds of things I’ve seen in ERs during my career. The only false note is that they’re having about six months worth of gut wrenching cases happening within a single twelve hour shift. We all have those days but THIS DAY is definitely fantastical. I am particularly taken with the portrayal of the med students and residents. They usually get the dynamics of learners all wrong but the writers have got the personality types and interactions down pat with all of the subtleties. Dr. Duxbury says two thumbs up.

We continue to live in interesting times. I can’t let myself get too invested in the craziness. It’s not good for my mental health. I’ll keep myself sane, involved in my usual pursuits, doing my best to leave the world better than I found it, and trying to stay calm and objective. It isn’t easy. But it’s all I can do.

Six years ago this week, the world shut down. I had just come off a career high production of ‘Cabaret’ as Herr Schultz, was in the throes of rehearsing Cendrillon for Opera Birmingham and had a couple of other juicy roles lined up for the rest of the season, none of which happened. Like everyone else, I was disoriented by the rapid changes to my ‘normal’, was desperate for news based in science, and continued processing my emotional state with the open form journaling I had started with Tommy’s death some two years prior. I had no idea the musings I began that week would go anywhere and could not have conceived that they became the three volumes of ‘The Accidental Plague Diaries’ and a social history of the next two and a half years as American society reeled from the Covid pandemic and then recovered.

As a physician and someone relatively well educated and versed in history, I had long expected that American society would be visited by pandemic illness. It’s not possible to predict where and when a pandemic will arise but it’s pretty darn easy to understand that they are part of the natural rhythms of life on this planet and they have always been with us and always will be with us into the foreseeable future. We may like to think in our society, with all of our modern conveniences and technological wizardry and medical miracles that the rules of life don’t really apply to us in our privileged position but that’s never been true. Biologically, we remain Cro-Magnons. Our brains are wired the same way those of our distant ancestors were at the time of the last Ice Age. One thing forty years of medicine has taught me is that people are people are people and human nature doesn’t really change that much. You can change our clothes and styling and our cultural beliefs and give or take away the various trappings of wealth but deep down we’re all pretty much the same. We want security. We want love. We want the familiar. We want joy. We want to avoid pain and suffering. We want to protect those who are important to us.

The pandemic ripped away at the societal anchors which have allowed us to get what we want for the last four or five generations. We lost the sureties of work and income. The young lost educational opportunity. We lost trust in medicine, science, and expertise in general as a fragmented media landscape and the politics of the time prevented the public from understanding why there were uncertainties in a rapidly evolving public health environment. Various entities seized on these uncertainties and exploited them, many in bad faith, often for temporary gains in power and position. And so we are left with a rickety health system hollowed out by a loss of expertise and redirection of funding, a federal public health system in tatters controlled by individuals with minimal knowledge of how health and disease actually operate, and media full of misinformation and half truths which are preached as a new gospel by some rather loud voices with personal agendas.

Because I like to stay informed, I don’t remain in my professional class socially liberal media bubble. I read things written by people with diametrically opposed viewpoints. I don’t think my worldview is perfect and I can be persuaded by facts, reason and cogent arguments to change my position on any number of things and have over the years. Politically, I am left of center but I don’t subscribe to liberal orthodoxy on all social and political issues. It tends to deal with the world in sweeping generalizations about groups of people in the same way that the right wing does and I really detest smearing of groups through the use of cherry picked examples. The father you go either left or right and the more rigid and fossilized the views, the more likely you are to meet coming around the circle.

However, I am not keen to change most of my positions on the pandemic or society’s response. When I look at right wing sites, i see more and more subscribing to the idea that the pandemic was some sort of cabalistic plot, often referred to as ‘the plandemic’. For proof, they often refer to pre-pandemic documentation from federal and public health sources on how a response to a future pandemic should be handled. This is idiocy. Anyone with even a middling education and understanding of the world should get that a pandemic would eventually happen and that one of the roles of government is to help society weather catastrophe when it happens. Of course there were plans in place. Most of them were ignored by the administration in power in 2020 when the unthinkable began to warp our lives but that’s what happens when you let ideology take precedence over reason. Our current government seems determined to throw out the ideals of the Enlightenment from which our understanding of the world derives but I cannot and will not agree with this. There are some Enlightenment fundamentals that I think we should reconsider, especially Cartesian dualism which separates our understanding of the life of the body from the life of the mind which has led to our woefully inadequate system for mental health when compared to that for physical health, but most of the thinkers of the 17th and 18th centuries were pretty brilliant and I would rather not see all of that advancement demolished in favor of a new fossilized age of faith.

I was asked by a patient today if they should get a Covid booster this spring. The messaging on vaccines of any kind has become extremely muddled with the current leadership of the Department of Health Services and the CDC doing their best to cast suspicion and doubt on settled science that conflicts with their belief system. Fortunately, a successful lawsuit by the American Academy of Pediatrics (among others) has scuttled much of the vaccine denialism before it could be institutionalized. Currently, covid numbers are blessedly low but it is still out there, people still get it and people still die from it. It seems to be settling in in similar numbers to influenza in terms of its impact on the population, a far cry from the years when it was the third leading cause of death, killed well over 1.2 million (and recent research suggests this is a serious undercount) and became the largest mass casualty event in US history. My read of the data is that covid boosters, as long as they remain available, are useful for adults on an annual basis. They provide significant protection against death, hospitalization, complications, and long covid symptoms should you happen to become infected. There is some data that those at higher risk from covid (immunocompromised, over the age of 75 or 80) can get additional protection by upping their boosters to every six months. There are no sure things here. I leave it to everyone to make up their own minds about what they feel is best for themselves. Personally, I’m going to continue with an annual booster in the fall but don’t see a need for me to take one in the spring. I might calculate differently if I were twenty years older.

Are covid shots dangerous? There is very little science to suggest that this is true. Like any medication, there is probably a small percentage of the population whose personal genetic makeup will react badly but this does not appear to be widespread. Most of the evidence against the shots cited comes from VAERS (Vaccine Adverse Event Reporting System). This is an unmoderated database to whom anyone can report anything and it has been flooded with thousands of reports of dubious provenance placed there for political reasons. In terms of real risk, there is definitely a small risk of myocarditis (inflammation of the heart muscle) in healthy young men between 15-40. The rate is somewhere between one in ten thousand and one in a hundred thousand and nearly all affected recover without incident. Using my usual metric of risk of fatal automobile accident as a marker (about one in eight thousand annually in the US), a young man is much more likely to be killed on the highway than from a covid shot. As young men aren’t at particular risk from the disease, they may want to make different calculations regarding boosters than I do for myself.

No need to bore everyone with details of my health going forward. I’m at about 90% of my baseline stamina and I had my post-op check this morning and everything has healed up without incident and I was told to go away and only come back if I develop new symptoms. I’m not planning on doing so. My two week pause has put me a bit behind in terms of learning the opera score but I’ve got ten days before we begin staging rehearsals so I should be able to catch up. The maestro is going to be staying in my spare bedroom during production period so maybe I can get a coaching on anything with which I am having difficulties. Life should be routine from now until mid-May when I have a two week break planned for pleasurable activities.

What to say about the war with Iran? The administration continues to prove that it has no clear objectives, no exit strategies, and they keep provoking Iran into more and more retaliation that spills over into the other Gulf states which is likely to make any solution infinitely more complex. There’s likely diplomatic strategies to be pursued but the administration gutted the State Department in the name of efficiency during the DOGE era so there aren’t many left with deep understanding of what all is going on and how best to navigate treacherous waters. What does this mean for all of us? As petroleum (on which the world runs), fertilizer, helium (necessary for the manufacture of computer chips) are all blocked by the closure of the Strait of Hormuz, expect prices of pretty much everything to start skyrocketing in the coming months. I feel so bad for so many of my younger friends who are underemployed and who are about to get socked with all of this on limited incomes.

Last day of my first full week back at work tomorrow and I managed to meet all my obligations without falling out of my chair once. I consider that a win. Up tomorrow, getting dressed, going off to clinic, and working to make my patients’ lives just a bit better.

I think my health has more or less returned to baseline. The stamina is back. I’m not feeling unwell in any particular way. I took a weekend out of town (under appropriate supervision) without incident so back to the usual grind I go starting tomorrow morning. With luck, I will be able to avoid further abscesses, episodes of sepsis, emergency surgeries and the like for the foreseeable future. I now just have to close up the unexpected two week hole in my life that is just now ending. Most things should track into place without much difficulty but I’m definitely behind on learning I Pagliacci and Cavalleria Rusticana and will have to do some score pounding the next two weeks to bring myself up to speed. I’m also behind on a couple of legal cases but those can wait. I’ll get myself reoriented to all of that this next week.

This last two weeks taught me how very lucky I am. This is the first time in the nearly three decades I’ve lived in Birmingham that I have required significant physical help and my village proved to be quick to respond and the outpouring of concern, offers of help, actual in home help (I was nursemaided by a few friends for nearly a week once I returned home from the hospital), offerings of food, cards, texts, messages, and all the rest was a bit overwhelming. I’ve always been a little nervous about aging alone here in Birmingham but I think the life I have built for myself is going to see me through, no matter what the challenges may be. All of you who pitched in, and you know who you are, you have my deepest gratitude.

I was pretty much back to normal by Thursday of this past week so I kept to my long laid plans to spend a weekend out of town with my friend Patti Steelman doing the theater thing. We went to Atlanta on Friday and had a very good vegan dinner at Cafe Sunflower in Buckhead followed by a trip to The Shakespeare Tavern theater to see a production of Much Ado About Nothing. (Not my favorite Shakespeare comedy – I find Dogberry, Verges and the watch painfully unfunny and I really dislike the shaming of Hero scene as it’s so mean spirited). But it was well done and a good time was had by all. On Saturday, we continued on to see Frank Thompson on stage in Columbia, SC as Nathan Detroit in Guys and Dolls (quite a good community theatre production). Got to spend a few hours catching up with Frank overnight before we returned back to Birmingham today, fighting our way through the early rainbands of the promised storm system and through far too much construction on I-20 throughout the state of Georgia.

Time to look at the state of the world, something I’ve been rather successfully avoiding most of this past week. The public health sector seems relatively quiet. They’re still trying to make an MD without an actual license the surgeon general and she seems to be trying to hold fast to antivax credentials while acknowledging the wisdom of vaccinating children. It’s a sort of contortion that’s likely to snap her spine but I’m not sure she actually has one. A number of Republican legislators seem to have come to their senses and recognized that the anti-science anti-medicine movement within MAGA may be going too far and they are quietly pushing back and some of the more ridiculous bills that are being brought forward are being quietly quashed. I’m still expecting more measles outbreaks and I won’t be surprised if we see the return of polio this summer.

On the immigration front, we seem to have reduced the pressure on Minneapolis but ICE is popping up all over the place and continues to violate judicial orders and constitutional norms on a daily basis. Every time I look, there’s another story about the illegal detention of an American citizen, legal immigrants being disappeared from courthouses as they go through the process of obtaining citizenship, and symbolic targeting of family members of political opponents of the administration. The most recent one being the taking of a veteran who lost both legs in Iraq, husband of a Democratic house candidate, and legal and on path to citizenship and holding him in squalid conditions for weeks.

DHS, with their untold riches courtesy of the Big Beautiful Bill, appears to be buying up property to use as mega detention centers holding up to 10,000 detainees in relatively small areas. Might as well refer to them by their proper designation, concentration camps. From what I can discern, the contracts for creating these facilities and their operations seem to be held by insta-companies created by administration insiders. I’m interested in the practicalities. How are they going to feed that many people confined in small space? None of these buildings are equipped with large commercial kitchens. Where is the water to come from? The federal government does not appear to be dealing with local governance regarding such things as water/sewer/power grid. How would they be evacuated in an emergency? I have a feeling in a year or two we will find that hundreds of millions were spent and there’s little to show for it. Sexual abuse of young female detainees appears to be rampant with little being done to curb it but this is the same administration which won’t confront the Epstein files so there’s little surprise there.

Then there is the situation on Iran. The two basic conclusions that the last fifty years of geopolitical strategy has come to in regards to an attack on Iran is that 1. They would shut down the strait of Hormuz which will prevent a significant fraction of the world’s oil from reaching market (not to mention fertilizer, major precursor chemicals for most industrial processes etc. etc.) and 2. They would immediately activate their proxies such as Hezbollah, Hamas, and the Houthis leading to escalation into regional war. The administration (or at least those with the decision making power which seems to be the president, the vice president, the secretary of defense, the president’s son in law and a couple of others) seems to have chosen to not pay attention to the conclusions of fifty years of study and, guess what, the strait is closed and the regional conflict is escalating. There were reasons why no previous administration attacked Iran.

Now we’re stuck with a war effort that’s costing a fortune, starting to cost American lives, and for which the administration can give no coherent report as to either strategy going forward, or objectives to be achieved. Instead, they seem to be flailing around looking for allies to help at least get the strait back open. Guess what, you spent the last year alienating all of our traditional allies with tariff idiocy, decimation of soft power programs, and downright insults. They have no interest in helping us out of a boondoggle of our own creation. There’s one person who could really help, and that’s Zelenskyy as the Ukraine has learned an enormous amount about modern drone warfare, both offense and defense. But Trump has more or less screwed that relationship with his Putin worship.

I’m prepared for gas, power, food, and travel costs to spike over the next few months. We may think it’s bad now but I don’t think we’ve seen anything yet. I can’t fix it. I’m just planning on getting up tomorrow morning, getting dressed, going to work, and saving the world one patient at a time. That’s all I’ve ever been able to do.

Life comes at you fast as Nationwide used to say on various late night TV spots and that has certainly been true this last week. I was feeling unwell last weekend with the relapsing fatigue and distress that had been ongoing for several months. I had put it down to some sort of viral syndrome I was unable to completely shake off, a nuisance to be endured. I went out to lunch last Sunday followed by a matinee of Yasmin Reza’s play ‘God of Carnage’ with its portrayal of how fast social niceties can break down under the stress of primitive emotions including a major sequence involving a bodily loss of control I would soon experience for myself. I went to bed early, not feeling the best but wasn’t sick enough on Monday morning to consider calling in. My work week is front loaded with Monday being my heaviest day. I went in, saw my patients, and then headed off for that evening’s rehearsal for the opera. Forty-five minutes in, I fell off my chair somewhere during the Cavalleria Rusticana drinking song in a vasovagal faint.

Going down in a room with thirty some other people always causes a bit of a kerfuffle. It’s not my first time at that particular rodeo. I have a genetic colitis (thanks dad) which has acted up from time to time over many decades and, when it does, it will often overstimulate my parasympathetic nervous system and drop my blood pressure. And then I have a tendency to low blood pressure to begin with. The stories of my public passing out over the years are somewhat legendary. The gold standard is the time in medical school when I went down in a room with forty medical students and eight attendings. That one caused much uproar and a free stretcher ride through the halls of University Hospital to the Emergency Room to recover. There have been others through the years, most recently about fifteen years ago when I had a colitis attack when out shopping. I went down while standing in line at the liquor store buying a bottle of Cointreau. I collected myself, paid for my purchase, headed across the parking lot and went down again. That’s when the clerk, assuming I was drunk off my butt, called the police. I got a free ride home in a squad car.

Back to the present… EMTs were called, I had no interest in being hauled off to the ER to check for a non-existent head injury. My vital signs and rhythm strip were stable, so I had a friend drive me home and another to come spend the night to keep an eye on things. Shortly after coming home, the start of about twelve hours of major vomiting, which came under control the next morning with an emergency prescription for Zofran. I slept most of the day and decided to give it one more night to see if I would turn the corner. When I still had no appetite, was getting dehydrated, and still feeling like crap the next morning, I knew it was time for the doctor. I called first thing in the morning and got an urgent appointment right after lunch. During that few hour interim, it became apparent that even though I really hadn’t had any of my usual colitis symptoms, I was developing a colonic abscess. I arrived at my primary care’s office, told them my suspicions, had them confirmed and was sent straight to the Emergency Room for poking, prodding, scanning, and additional evaluation, especially as it was pretty clear that I was beginning to go septic. I’m admitted that evening, scheduled for surgical abscess drainage around lunch the next day, monitored overnight and then sent on my merry way.

Two days of IV antibiotics and my physiology has more or less normalized, but I am learning firsthand the lesson I have gone over in theory with thousands of patients over the decades. When you get older, you do not bounce back with anything near the speed with which you think you should. After a couple days of rest at home, I definitely feel like I am over the acute illness and antibiotics through the end of the week should stamp out any last little beasties crawling through my circulatory system. But boy do I feel tired and have no real energy. I usually don’t have more than a day or so of lassitude following acute illness but I can tell this one is going to take a week or so to come under control. I’m smart enough to understand this so I’m taking this whole next week off from work and I am looking at my calendar and am going to strike some commitments and reduce my usual frenetic pace for a while.

There are reasons why we battle with ourselves as we age and do not understand why it takes longer to recover, which often leads us to pushing ourselves too far too fast and makes ourselves upset over our inability to do what our brains say we should with facility. The brain changes and matures very rapidly over our first quarter century. Five, ten, fifteen, and twenty year-olds are all very different from each other despite only being five years apart. At twenty-five or so, the brain finishes its maturation process and stabilizes. We remain that same healthy young adult as our interior self for the rest of our lives and our brain patterns and autopilots and macros are all set up for who we are at that time. We spend the rest of our lives looking in the mirror asking ourselves what happened. When we hit later years, and we have bodies with many more decades worth of where then our brains can understand, we continue to try and understand things through that young adult lens and if we just let our auto-processes run our bodies, we do it the way we did it then. And that doesn’t always work. We can engage our intellect and use them to override those pathways, but it requires discipline and vigilance.

So here I sit, binging prior seasons of Bridgerton before launching into season 4, trying to measure a certain level of activity with much needed rest. I made it to church this morning (I had the solo in the anthem and those who know me know I am not going to miss a scheduled performance of any stripe, come hell, high water, or a bout of sepsis) and I have a few other things over the next few days to keep me integrated with light without over taxing anything. I won’t hesitate to cancel at the last minute if I don’t think it’s a good idea and I know everyone will understand.

I’m also starting to catch up on the national news, most of which I have been ignoring for the last week while dealing with more personal matters. We seem to be something over a week into an undeclared war with Iran. This war seems to have been started on a whim and a gut feeling by the president that Iran was going to attack us (no evidence of this has yet been produced that I can see). The DOD (I’m not going to use Hegseth’s unilateral name change) seems to be playing catchup in regard to attack strategies and no one seems to have thought through any of what comes next. This was a huge problem with the Iraq war where no one in the halls of power appeared to have planned for how to handle the power vacuum and regional reactions and destabilization after the removal of the Baathist regime. There also appears to be no real attempt by the administration to communicate clearly about either gained advantage or culpabilities with the American public. I imagine I’ll have to spend some time with the BBC and Al Jazeera to understand what’s really happening.

It also seems to have exposed the mirage fantasy of the UAE and Dubai. Dubai, like Las Vegas, was built as a playground for the wealthy in an inhospitable desert just because it could be done and because it kept money rolling upwards in certain directions. I’ve never cared for Las Vegas either, but it at least has sex, gambling and alcohol which are not in such abundance in the Islamic world so I could never really see the point of visiting Dubai and never have (and it was never on the bucket list). The idea of it being a paradise free of the sectarian and regional conflicts that have plagued the Persian Gulf for millennia has been shattered, likely permanently, and I’m not sure what the sheikhs are going to do when the trust funders and nepo babies and influencers all find a new haven for their sybaritic lifestyles.

Kristi Noem has fallen at DHS and, with that, it’s becoming just how corrupt the institution has been from the top down under her leadership. The amount of money funneled by her paramour, Corey Lewandowski, in various shady dealings is rather breathtaking. And certainly far greater than any the Minnesota Somali community might have been obtaining fraudulently. If you want to make bank, perpetrate your schemes at the top, not the bottom. If you’re high enough up, when you conduct one of the largest frauds in Medicare history, they reward you with the governorship and then senate seat from Florida. Unfortunately, it’s unlikely to help those caught in the clutches of a rapacious and out of control immigration detention system through which much of the money is flowing. It’s going to take a change in congress to get that one under better control. I can’t help but wonder what Mr. Noem and Mrs. Lewandowski are making of all of this, other than calls to the best divorce attorneys they can find.

Now you’re caught up. With luck I can cease writing about my health for quite some time. I am getting up and getting dressed. Not going out so much but still endeavoring to do good from my land of counterpane and laptop.