March 16, 2020

OK stream of consciousness time. This is my first world wide viral pandemic so I really am not sure how I’m supposed to feel or to react. If anyone knows, please send me a message and in the meantime, we’ll continue to all muddle through together and make it up as we go along. Our society, which has escaped most bad things for about 75 years, is learning what bad is very very quickly and it’s coming thicker and faster than I think most of us can actually absorb which might explain some of the stranger posts I’ve been seeing on social media over the last couple of days. I have great faith in America and Americans. When tested, we usually rise to the occasion. I have a lot of hope for the Millennials in particular – if you believe in the four generation cycle of American history, they occupy the same place as the World War II generation and we’ve had the Depression and Pearl Harbor rolled into one over the last two weeks.

I feel, at age 57, like I’ve been drafted and am preparing to ship off to war. The enemy is coming, implacably and inexorably. It is microscopically tiny, impervious to usual weaponry, and no amount of drilling or stripping of field rifles is going to help. The weapons are going to be maintained supply chains, good hygiene, availability of medical care, and necessary equipment. The home front can contribute by staying home. This will all rip a giant hole in our economic lives but we’re all in this together and on the other side, we may need to rethink our social priorities a bit. I don’t trust the gerontocracy of the federal government to handle post pandemic life terribly well. They’re not the kind of flexible thinkers who adapt to new norms. I think, as communities, we’re going to be a bit more on our own than we’re used to and have to be prepared for that.

Today, work was mainly about planning. How do we switch most of our clinic work from face to face visits to telephonic visits? Who can be pulled from outpatient to inpatient duty to cover all the usual medical issues if the inpatient docs are all either busy with Covid 19, under quarantine, or ill themselves? I last did inpatient ward duty in a previous millennium, so i hope I’m pretty low on the list. We’re all stepping up to do our part without complaining. It’s what we signed up for when we decided to go to medical school. It’s just a particular bill that’s coming due. Same thing tomorrow with the VA part of my job. And then, on Wednesday, we’ll figure out the hospice piece. One of the most interesting problems to surmount is how to deal with the myriad rules from the medico-legal-financial complex such as Medicare or HIPPA. They aren’t suspended until they’re suspended and working within those constraints makes things a bit more difficult than they might be otherwise.

My much older patients, those over 90 who survived the Depression and World War II and have clear memories of them, are fairly philosophical about the whole thing. They’ve seen a lot and they know that death lies in wait for them, just outside their field of vision. It’s my younger patients, the cusp of the boom who still believe in eternal youth and immortality that are struggling the most with the reality that this is not something they can wish away and that affluence or influence are not protective. For the most part, they’re taking my basic advice of good hygiene and staying home but, no matter how vigilant, I’m pretty sure I’m going to lose some of the familiar faces I’ve been taking care of for decades. I have a number of people I’ve had since I first arrived in Alabama – in their 70s then and in their 90s now and together we’ve seen social changes, health catastrophes, major improvments in function, widowhoods, and all the other little triumphs and tragedies that make up life. I learned how to say good bye in the 80s with HIV. I’ll make it through this.

We’re roughly ten to eleven days behind Italy in terms of the population disease curves which means we’re about three or four days away from the time when they locked the country down. From my latest news reports, they basically have started to do that to the SF Bay area and the Seattle area and I expect most urban areas will be that way by this coming weekend. How long? I don’t know. I have enough food in the house for me and the cats for about a month if it comes to that. I’m writing to my mortgage people this week to tell them that if closing needs to be delayed on the new condo, fine with me. I’ve never tried to complete a real estate transaction during a pandemic. I can’t imagine they have either. All of this has made me in no hurry to get to work sorting and packing. I came home from work after a not overly busy day and immediately fell asleep on the couch trying to play Words with Friends.

Everybody be well – use your downtime to clear your heads and practice a little zen or tao of letting the times carry you along instead of fighting against them. And keep a vigilant eye on your politicians. Some of them are itching to use this as their Reichstag fire moment to rush new policies through while we’re all distracted and prevented from protesting en masse. Watch out for your neighbors, your friends, your communities. We’re going to need them in coming months. I’ll try to keep these musings up every couple of days. If you’re a latecomer to my circle and being at home makes you bored enough to want to explore all these posts of mine, they’re archived at http://lifetheuniverseandeverything.blog