Today is the last of my days off before heading back to the salt mines of geriatric health care again tomorrow. They weren’t anything like I expected them to be when I initially scheduled them back in the late summer. At that point, with Covid-19 on the wane, I assumed I would have some days in Seattle with my family and some days taking myself to the beach or somewhere scenic. Given the skyrocketing numbers of infections throughout November, those plans all went out the window and I spent the majority of the last two weeks puttering around my condo working on various projects and taking naps of various lengths. If I sat on the couch or the bed for more than about ten minutes, out I went for anywhere from 15 minutes to two hours. I’m not usually a napper so I’m assuming my body and brain are working a program of resetting and energy storage to be ready for what’s going to come over the next few months as cases engulf the health care system. I may not work directly on Covid wards but the huge increase in hospitalizations has downstream effects on all of us, no matter what our roles in the system may be.
When I fell into writing these entries nine months ago, I had no idea what I was doing. I was as unprepared for what was to happen as the rest of us. As I began to figure that out and tried to puzzle through what was happening for myself, I found that more and more of my friends were turning to what I had to say about all of this as a place of stability and rationality in volatile times. I figured out that these bursts of text were helpful to a wide community of people and were making their way to folk that I have never had the pleasure of meeting. This brought me up a bit short as I realized I had better make sure that I was clear about what was fact, what was opinion, and what was just random musings. I hope I’ve been able to do that as I don’t want people making important decisions based off of anything other than good science, unlike a number of politicians I could name.
There’s a part of me that wonders if I was born for this particular moment in history. If there’s something unique about my experiences that allows me to put all of these ideas with a certain candor and clarity that others might not be able to do so easily. There are certainly a number of traits that have collided. The first and most obvious being my medical training. There is a strong tradition of medicine on my mother’s side of the family. Both of her parents were physicians. My grandfather was an orthopedist and anatomist, later dean of the medical school and then chancellor at UCSF. My grandmother was a pediatrician. My grandfather’s father was a physician in Scotland and later in colonial South Africa. There was a certain expectation in someone in my generation of the family going to medical school and I was the one best suited. I was nudged toward the sciences in high school, majored in Chemistry and in Biology at Stanford (they didn’t have a Biochemistry major so I decided to just do both…), and entered medical school at the University of Washington in 1984.
At that time, one of the serendipitous chances that have marked my life happened. I was placed in the WAMI program – Alaska, Montana and Idaho did not have state medical schools but sent their residents to U of W as ‘in state’ but required them to spend their first year in their home state and to return to rural hospitals in their clinical rotations to continue to increase their ties with their home states and create a cadre of physicians who would serve those states after training. Washington participated as well and I was placed in that program and sent away from Seattle to WSU in Pullman for my first year and then off to various destinations in the other states for clinicals. By the time I graduated, I had rotated through fourteen hospitals in four states: University medical centers, VA hospitals, large community hospitals, small rural hospitals. The end result was that I was comfortable in a wide array of settings and I found that I really enjoyed working in smaller venues where physicians were much more a part of the community at large and not removed from the lives of their patients.
Serendipity and the residency match system sent me to UC Davis in Sacramento after medical school where a number of things happened very quickly. One, I met Steve, came out of the closet and started to live an authentic life. Two, my original idea of using medicine as a springboard into a research career in occupational medicine (born of summer jobs working with hazardous waste) was quickly knocked off the life goals list. Three, I came to realize that I was a lot better at ambulatory medicine than hospital medicine. Four, my ideas of how a physician should function as a member of a community, intimately familiar with human ecology and the lives of their patients found a home in geriatric medicine, a field that I had never been introduced to in training. With the choice of geriatrics settled, my interest and comfort with ambulatory care, especially in smaller communities led to my learning quickly about home health, house calls, case management programs, and other such animals, something completely alien to most physicians who leave what happens outside of the hospital to nursing, social services and discharge planning.
My education is broad based. I was fortunate enough to attend a very good college prep school for high school and a top tier university. I don’t know that the classes I got at either of those places were better or worse than ones I would have gotten anywhere else but it did put me among a peer group that required full throttle thinking in order to stay caught up and engaged. I was also determined to take advantage of the opportunities provided and took at least one class a quarter that was something different just because I could – Japanese Religion, Introductory German, History of the Roman Empire, Modern Philosophy, Music Theory I, Computer Programming in PASCAL, Introduction to Petroleum Engineering. Add this to growing up in an academic household and a mother who was basically brought up in a British household (and gave me all the British classics to read at a young age), and I emerged as a bit of a polymath. My college roommate once gave me a T-shirt that read ‘The Expert on Everything’.
Lastly, I am a gay man of the tail end of the generation that was wiped out by the HIV pandemic. I spent the early 1980s in the San Francisco Bay Area and saw first hand how my peers began to languish and die. By the time I hit clinical medical training, the virus was raging and I sat by the bedside of many young men, only a few years older than I and held their hands while they died as there was no one else to do so. I began to understand that the US government and society is perfectly fine with large swaths of its citizenry dying as long as they can define the victims as ‘other’ in some way. And I saw and was part of a gay community that rallied and built the institutions to take care of our own when help was not forthcoming. The thing about being a gay man of my age is that the group of men who would have been my mentors and guides and helped me with life and career for the most part ceased to exist leaving me to have to forge ahead without a lot of guideposts. I’ve come out OK but I made some huge mistakes along the way which might have been avoided with the availability of counsel.
Putting that all together: a broad based understanding of many subjects, the trained mind of a physician, the use of that mind to find new ways to work in collaborative structures for better patient care, especially for underserved communities, a realization of how government and society are not there for us the way we think they are, and some communication skills picked up along the way through my theater endeavors, plus a dollop of loneliness and needing to connect due to life circumstances, and you have how and why I write these pieces. How could I not write them? All I wish at this point is that I could offer better news about the progress of the current pandemic but, alas, that’s not possible. The numbers look bleak and we’re only starting to see the effects of Thanksgiving travel now. Hang on. It’s going to be a rocky road but there are chances to change course upcoming, especially after mid-January.