February 9, 2021

I wasn’t going to write an entry tonight but when I opened up my laptop after work, some siren song seduced me into starting into the woods again. I’ve been doing this long enough now to know that when the muse calls, you better answer because those half formed ideas at the back of your brain won’t be there when you look for them later. I’ve always written best by just letting my brain go into a sort of detatched zone where I’m not really thinking, just letting the words come as they will. When I write these essays, I sometimes have an idea or two, sometimes a whole paragraph is in mind. Other times, I just start writing and off we go. It’s a bit of a dissociative state that lasts usually about 75 minutes or so and I find there’s 1200-1500 words on the screen. I don’t rewrite. I just hit post and hope for the best.

It’s been interesting going back as I edit these Accidental Plague Diaries into book form. They weren’t written with that in mind and the chore of analyzing the ideas in each one, making sure there’s a certain stylistic and thematic unity, getting rid of odd tangents, the occasional major grammatical error, misspelling, or wrong word choice is teaching me a lot about what my writing actually is. The first pass edit is nearly done. A second pass with shorten the manuscript to acceptable length and then there will be something to show people and see if I can drum up any interest outside of my immediate circle of friends. My editor asked me the ultimate question in our last conference. Why is such a book important? I want it to be a primary source document of a particular moment in history written as that history was unfolding from the perspective of someone with some understanding of both the health and sociological implications that are happening all around and the impact the corona virus had on both one person and the country as a whole. We’ll see if I managed to actually do that.

There’s not a lot to report from the battlefield from the last few days. The number of hospitalized cases continue to dwindle locally as the holiday fueled surge continues to recede. UAB hospital, which topped out at about 300 inpatients at the peak, is down to just over half that at the moment. I am breathing a major sigh of relief as that means it is unlikely that I will be called in to work jeopardy inpatient duty later this month. If I was called in, my plan was to go in, tell the residents that I hadn’t really done this sort of work since before they were born (not quite true) and to please lead me gently by the hand through anything for which they needed staff authorization. The vaccination centers are also apparently working relatively well and I see more and more friends outside of healthcare proudly holding up their vaccination cards on social media. We just need to get more vaccine into the state faster. We’ve also got to keep working against some of the more ridiculous disinformation that’s circulating out there. Tyler Perry did a very good PSA on the vaccine aimed at the African American community (it’s on YouTube) which does a nice job dispelling many of the worse myths. The most worrying thing at the moment is the rapid spread of the UK strain that is much more infectious. It’s currently doubling in prevalence roughly every ten days. At that rate, it will be 1,000 times as prevalent in three months and nearly 10,000 times as prevalent in four (ah the magic of exponents).

The creators of modern myths were on full display today as the curtain rose on Impeachment 2: Electric Boogaloo. It’s quite something when the second worst performance by an attorney on a given day involved a zoom court appearance and a cat filter. I try to be evenhanded in my approach to politics but I’m having grave difficulties listening to even sound bites from the pundits trying to gaslight me into believing the Capitol Insurrection was not what it was. The ceremonies will play out. There will be some sort of legalistic coda. But nothing will really change as nothing has been done about the media and political landscape that has let untruth and half truth flourish to the point of having two societies trying to coexist with alternative facts. I don’t know how to fix it. All I can do is try and understand it.

I was thinking about our divided society and how to really grasp what it means when I realized it’s something I deal with everyday, only in microcosm. Perhaps the most common serious health problem for which I am consulted is cognitive change. The memory loss that afflicts the aging which is usually, but not always a dementing illness. It’s relatively uncommon before the age of 75, and then starts to rise exponentially (meaning the Baby Boom is just starting to enter the dementia years this year). Prevalence of significant memory loss is less than 10% at age 75, 20% at age 80, 40% at age 85, 60% at age 90, 80% at age 95 and pretty universal at age 100. There is plenty of evidence that if all humans lived long enough, we would all develop Alzheimer’s type dementia (there’s even some evidence that it’s a life long process, wired into our central nervous system’s design – the price we pay for our intellects). In previous generations, the majority died of other causes long before it would have become apparent. Will the boom, still considering themselves young in their late 60s and early 70s, and living to age in reasonable health be able to cope with the combination of physical health and cognitive failure?

An interesting thing happens to long term married couples where one partner develops dementia with age and the other does not. The well partner is usually the last to come to grips with the changes and deficits in their spouse. Alzheimer’s type dementia is usually of such slow onset and progression that the well spouse unconciously adapts to that change, taking on more and more of the life and life tasks without necessarily understanding that they are doing so. It’s the child who lives out of state who hasn’t been home in several years who arrives for the holidays who can truly see the changes as the delta between what they expect to see and what they do see is large enough.
Once the spouse starts to understand that there partner is not reacting to them in the way they are used to, they try all of the techniques a lifetime of marriage has taught them in terms of cajoling, fighting, teaching, and just being. They don’t work. So they double down and try even harder and get the opposite resutls of what they expect. They show up in my office angry, frustrated, resentful, sad, and not understanding why the dynamics of their relationship aren’t working the way that they think they should. It’s my job to begin the process of teaching them that the demented spouse lives in a different reality with different rules. Time may not exist in the same way. They may both look at the same thing but see something different as the demented brain may interpret signals in unusual patterns. Reality is what our brains tell us it is. As most of our brains function in roughly the same way, we agree on it or, as Lily Tomlin once put it ‘Reality is a collective hunch’. When a brain no longer functions in the same way, reality becomes different and that person no longer lives in our world and we aren’t really capable of visiting their world either.

There are tantalizing clues as to what the world of dementia is like. When one looks at demented visual artists, they pick strong and vibrant colors and simplify line and detail. Other people strip away adult dissimulation and artifice and become plainspoken and absolute truth tellers. It’s no accident that in classical literature the fool is always the one who speaks truth to power. Shakespeare brings it all together in King Lear when the king and the fool confront the storm on the heath. Lear is a portrait of dementia robbing a powerful man of independence, but not self awareness and the fool is the one person who understands him. The relationship between Lear and his daughters is acted out in my waiting room about once a week as adult children try to figure out what to do with daddy as he’s losing his faculties.

Our current society is much like a long term couple where one partner has dementia. (I won’t say which one – people of different political persuasions will pick different sides but the analogy holds either way). Red America and Blue America are trying to exist in two different realities and the relationship is frustrated and foundering because they’re trying to use the same old same old communication methods to get through to each other and all it’s doing is raising the level of anger. Perhaps we all could take a lesson or two from a friendly geriatrician and take a step back and not try to force each other into old roles, but gently explore who we are as new and evolving people in a spirit of mutual respect. Some of my usual suggestions, like distracting each other with cookies to help change brain patterns aren’t going to work but an acknowledgement that we have to move forward towards new ways of rapproachment might be useful.

We’re going to have to do something to get us all on the same page regarding public health if we really want to bring COVID to task. In the meantime, wash your hands, wear your mask, keep your distance, get your shot, have a cookie.

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