August 29, 2020

Life is settling down into a new normal. I can’t say I like it but it is what it is and must be dealt with. Corona virus has profoundly altered so many things that even the mundane day to day existence of my life just feels very different from what it felt six months ago. I look at the numbers and trends here locally and nationally and there is guarded cause for optimism – the trends are down, likely due to better adherence to mask wearing and social distancing in public leading to broken transmission chains and a decline in the infection rate. Will they remain down with the spikes beginning to arise in schools and on college campuses? Time alone will tell.

What are the changes? On the University side of my job, which revolves mainly around outpatient ambulatory clinics, the amount of time I need to spend outside of actual clinical hours dealing with patient needs has roughly doubled. A four hour clinic session used to create about one to two hours of out of clinic work (paperwork, charting, phone calls, emails, patient messages etc.) and now it generates three to four. I think Covid is directly responsible. People no longer save up their questions for their next visit to the doctor. They’re uncertain about life and want some certitude in at least the area of their health and are much more likely to make multiple calls or send multiple emails, each of which must be dealt with individually by me or my staff. In order to ensure safety and isolation, our bar for enlisting home health services for patients is a good deal lower. We’d rather have a professional go in who understands infection control than have patients go out and rub shoulders with multiple individuals that may not. Each of those referrals generates a mountain of paperwork, required by Medicare for documentation, so that the Center for Medicare and Medicaid services knows for what it is paying. On the VA side of the job, I’m managing all my house call teams from my bunker in a VA out building. This saves many hours of car trips to such exciting destinations as Holly Pond and Nauvoo but sitting there staring at a computer screen for hours on end, whether it’s with patients and families or with federal systems stressed by Covid makes me cross eyed after a few hours. We’re also using this period for program building and over the next six months my patient panel will increase by 50-100% as we create new teams based out of Huntsville.

I just know that when I come home in the evening after my usual ten hour work day, I sit on the couch and just zone out for an hour or so. That’s not something I ever used to do in the past. My usual pattern was grab dinner and head for rehearsal and not get home until sometime between 9-10 pm and I would feel perfectly energetic for a few more hours and be able to get the necessary chores done. I can’t imagine doing that right now. The tiredness is probably a stress response, my limbic system and primitive brain reflexes making me store up energy to fight the omnipresent danger later. I’d rather go to rehearsal. I even miss technicals. I have a few major projects to do around the condo over the next few months but I’ve had a hard time getting started on any of them. They don’t need to be done on any particular calendar. I do keep lists of minor tasks that need to be done and do get a bunch of them done on a weekend and can make a great show of crossing them off the list. I’m waiting for the cats to applaud. So far they haven’t.

So far so good on the personal Covid front. My surveillance testing has been negative. I haven’t had a repeat of the feeling rotten of last weekend which I am fairly certain could be traced to something I ate. As I wander through my life at UAB, I’ve noticed that about 1/3 of the population wears their masks below their noses, completely defeating the purpose so I figure it’s only a matter of time, especially as I have to keep closeting myself up in my too small exam rooms with demented people who have child like or toddler brains and who won’t keep masks on for love nor money. I’ll continue to trust in providence and the fact that the majority of demented tend not to hang out in sports bars.
I’m not completely sure what to make of the social battles over the opening of schools and universities. Not a day goes by currently when I don’t hear about a younger friend from theater circles or the college aged child of a peer being diagnosed at school. They’ve all been fine and should recover without major incident (although the long term effects remain obscure and potentially dangerous). The smaller schools seem to be doing better than the larger ones, although they have smaller problems to solve. UAB itself seems to be doing well and has policies in place that are well thought out and there haven’t been any major clusters or super spreader events that I’ve been aware of. Down the road in Tuscaloosa, it’s been a different matter but the culture of the institution is not the same. UAB is an urban, mainly commuter campus while Tuscaloosa is an isolated traditional campus in a small college town. The biggest question is going to be the effect of the football season. The SEC has not cancelled (big money I expect) although the stadia are supposed to be socially distanced in seating. I just don’t see how that’s supposed to work and will not be in the least surprised if one of the early match ups turns into a super spreading event.

The debate over whether schools should be in person or on line continues. I don’t know all the answers here. I just think that the administrators of educational institutions have been put in an impossible position due to the political failures of six months ago that allowed the virus to become so firmly entrenched. They have so many constituencies that they must try to satisfy. The needs of students, the needs of parents, the needs of faculty and staff, mandates on education from the local, state, and federal level, the rules of accrediting bodies, the needs of donors in the case of private institutions. It’s a nigh impossible task to please all of these disparate viewpoints and I like to think that the majority of educational administrators are trying to do their best with inadequate resources in a highly stressful time. Of course, I also feel that some I have read about are complete bone heads, but that’s just me.

I did get my creative juices going this week by writing some parody Christmas Carol lyrics for a friend’s choral group. I’m hoping ‘Walkin’ in a Covid Wonderland’ and ‘Have Yourself a Covid Little Christmas’ will be heard in heavy rotation on the radio this yuletide. If anyone else needs some quick satire, you know where to find me. In the meantime, I’m going to finish my hard pineapple cider, and put on a movie. MNM needs to write some more columns.

Wear your mask, wash your hands, keep your distance. It’s really that simple.

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