May 22, 2021

I’m back in my usual groove. I can tell because I fell asleep three times this afternoon while attempting to finish up my progress notes from this past week. I still have quite a number to go but have finished the batch that will be delinquent if they aren’t done this weekend. I write about 1500 of them a year – that’s about 50,000 over the course of my career to date and they have morphed from hand written documents to dictated notes transcribed by a specialist to computer assisted notes where the computer kept track of things like the med list but where you still dictated the meat of the note to now full electronic health record full of little point and click boxes and various free text fields in which I have to type various things, most dictated by payment systems, and not by clinical care. I’m not sure if that’s progress or not. My first job in high school was as a key punch operator working with Hollerith cards. I seem to have come full circle.

Covid continues to come under control nationally with fewer and fewer cases and deaths being reported. This is likely from a combination of the relatively speedy vaccine roll out over the last few months with some contribution of natural immunity due to the roughly 10-15% of the population that caught and recovered from the disease. The health system is breathing easier and there are reports of Covid units with no patients for the first time in well over a year. Does this mean we’re done? I don’t think so. It’s not a US disease, it’s a world disease so we are still at the mercy of trends and problems of other regions and what happens in them regarding vaccine and in the spread of variants with possible higher levels of contagion and higher mortality. India continues to be a problem spot. The official numbers there are echoing those here at the height of the winter surge this past January but the excess mortality in that country is much much higher given the number of bodies appearing everywhere. Their official statistics only count those who die in a hospital with a positive covid test. Those who die at home or those who die waiting for care who have not yet been tested are not counted.

Here in Alabama, we seem to have more or less reached the limit of the easily vaccinated at a measly 35% of the population with at least one vaccine and 28% fully vaccinated. The demand has fallen off and the large vaccination centers are closing one by one despite the huge number of residents that could still benefit. We’re a few percentage points higher locally in Jefferson county but we remain at risk with about a 4.5% positivity rate on tests and between 6 and 7 cases per 100,000 population daily. On my wanderings through life this past week, people are still masking up when going indoors in public places but generally wearing them under their nose which defeats the whole purpose. Can we get those numbers up? Only with some massive public health campaigns to counter some of the more ridiculous propaganda that has spread and I doubt any of our state or local agencies have the funds or the energy for that. Our mask ordinance expires in another week and probably won’t be continued.

I’m not worried about myself at this point and I’m not overly worried about most of my patients as they fought tooth and nail to find vaccine when it first came out. As elders, they understood they were at much higher risk. The CDC guidance is likely to keep evolving so that the vaccinated will be given free run of society while the unvaccinated will be told to continue to use caution and restraint. This is going to put in a sort of society wide honor system regarding masks which isn’t likely to be terribly helpful. After all, the great American public was hoarding gasoline in plastic garbage bags only two weeks ago. There’s going to be no way to know if the maskless are vaccinated or simply deranged. My rules are no need to mask outdoors, no need to mask with a small group of friends who are vaccinated, but I still mask in a store or other place with a lot of people that I don’t know. Health facilities are likely to continue the masking rule for quite some time as it’s cut down quite a bit on disease transmission of all stripes so I’ll continue to wear one at work for the indefinite future, at least while I am working in clinical care.

I went out last night (masked) to one of the first performances at the new Red Mountain Theater Arts Campus that’s taken shape near the ballpark. A table read of a new script about the history of lynchings in Jefferson County in the past that acts as both exploration of the real lives of the people and a memorial to them and condemnation of the heinous acts perpetrated on them. Powerhouse cast including Marc Raby, Brandon A. McCall, Shronda Major, Nick Crawford, and Rebecca Yeager ably directed by Aija Penix. Quinton Cockrell (whom I have known slightly for years but don’t seem to be Facebook Friends with) took the historical research and his imagination to intertwine the stories, the social trends that created the conditions that allowed for this to happen, and, as with all good theater, a mirror for the audience to see themselves and a litany of present day names and incidents showing how the stains of the past continue to color the present. It has a great future as a theater piece but it was so powerful in the simple way it was presented, that I worry that a wish to create a fully realized staging might lead to temptations to overproduce and lessen its impact.

I just finished Isabel Wilkerson’s new book ‘Caste’ which posits that the way in which we need to view American society is as a caste system, every bit as complex and rigid as the one in India and that many of the difficulties of our times and much modern politics – everything from the white working class consistently voting against their own economic interests to the poor response to the pandemic can be explained by the thousand and one little social rules we unconsciously abide by to keep certain people in the ruling caste and other people locked into subordinate castes. I highly recommend it. I am not a product of the deep south, having not come here until my mid 30s, and I have always been able to see certain things that I have considered wrong and called out which others have considered normal but the more reading I have done, the more I have come to understand my own socialization and unconscious biases and I have spent years trying to unlearn them and replace them with more equitable ways of viewing the world. It’s a constant battle but it’s a good fight and I hope my African American friends see me continually working to improve. Tommy, coming from a Walker County white working class background always accused me of having been born with a silver spoon. I suppose I was in some ways, but I’ve been trying to use it to dig my way to a better understanding of all of us.