July 1, 2021

The Aquarium – Branson Missouri

It’s another month and we’re half way through 2021. At times, the days fly by, and at other times each one seems to drip drip drip by at an interminable pace. I think pandemic thinking and experiences have screwed up my brain’s inner understanding of time. It no longer seems to be uniform with each hour identical, but more elastic stretching or compressing like Silly Putty depending on events or my inner moods. Society, at least around here, seems hell bent on restoring itself as if the pandemic were over and there’s a need to make up for lost time. The trouble is that it’s not. The number of cases and the death rate continue to inch up. We’re at something over 605,000 dead now, not that much further until it surpasses the Civil War and becomes the second largest mass casualty event in American history – the 1918-19 flu epidemic is likely to hold on to the number one spot, at least for a while.

The big problem area at the moment is Southwest Missouri, home of the Ozarks and Branson. I would venture to guess that the latter is why this region has become the first major cluster of the Delta variant. The type of person who vacations in Branson (and the usual tourist traps are booming as people come out of a year or so of restricted life and movement) is less likely to be vaccinated. They have come from all over, crowded into various theaters and attractions, and brought their viral hitchhikers with them passing them on to employees who then carry them into the surrounding communities. The local hospitals are inundated again and transferring patients to St Louis and Little Rock. I have a feeling that this is a canary in the coal mine moment and, as visitors to the area return to their homes, Delta will soon be popping up in a community near you where, given it’s increased transmissibility over the original strains and its predilection for young and unvaccinated people, numbers will start rising in hospital systems elsewhere. Given the usual timelines between seeding of virus, a significant population developing virus, and when that population starts getting seriously ill, I’m thinking we’ll start seeing a spike in casualties at the end of the month.

Of course, the vaccine will help, but the lack of enthusiasm for vaccination by a majority of the unvaccinated crowd means that even if it becomes clear that numbers are going up, the mass vaccination sites have been dismantled due to waning interest and there is roughly a month delay between first jab and full immunity so they would have to begin the process now to be protected by August when we’re likely to start seeing some more concerning numbers. I don’t have a lot of empathy for willful antivaxxers who are becoming ill at this point. Who I do have empathy for are the burnt out health care workers who are being called on to keep on keeping on in a preventable situation. This has very real consequences. People are quitting clinical health care positions in droves and there aren’t a lot of folk standing in line to take their place. Almost everyone I know of my generation and older is taking a fresh look at their retirement plans and the stories of docs having to not only do their work, but pitch in to change the sheets, administer the medications, and mop the floors due to a shortage of other clinical workers are legion. Most physicians I know will buckle down and do anything necessary in a crisis but it’s not a sustainable long term model for a functional health system.

I wish I had a better read at the moment on the business of health care. I knew I should have gotten that MBA when I seriously looked into it a couple of decades ago. From what I can tell, there’s a major acquisition spree going on in the C suites with small and medium size players being swallowed up for larger interstate players and this seems to be true in most sectors of the business. The AMA released a report this week that for the first time, a majority of physicians worked for a hospital or health system entity rather than for themselves in private practice. I don’t think that’s necessarily a bad thing. I have always worked for a large academic health system as faculty – it’s a model I grew up with, allows me a certain amount of freedom to feed my intellect and soul as well as make money, and I like knowing how much money is coming in each paycheck. I haven’t gotten rich doing it but I keep the bills paid and can afford to retire when I think the time is right. The problem is that most of the big players are not academic health systems, which are not for profit public goods but rather private companies whose only goal, ultimately is profit.

As the profit motive has invaded sector after sector of our economy and lives, there’s been a certain level of degradation of our way of living. The wheels of capitalism grind on, lifting a few up and right over the backs of most of the rest. That’s because of when we are asked to choose profit or people, we currently choose profit and turn a blind eye to the people that creation of profit may harm. In medicine, the profit motive at upper levels leads to additional layers of byzantine bureaucracy as each tiny kingdom attempts to minimize its cost centers and buff up its balance sheet. It leads to clinicians being asked to do more and more with less support. (Support salaries are expensive). It leads to an obsession with data and numbers over the actual patient. I keep having to teach medical residents that lab numbers are not interchangeable with the patient and to go talk to him or her and get a decent history about how they’re feeling and symptoms before relying on what spits out of a lab computer.

The sucking of money out of systems for profit is leading to other problems as well. Compare our decayed public infrastructure with that in other wealthy countries and a political system that is having extreme difficulties coming up with solutions as it might require additional public spending. It’s seeping over into private spending as well. Would the Surfside condominium tower have collapsed if the squabbling residents in the HOA had been willing to fund the urgently needed repairs when they were identified several years ago? Now I know a few readers are busy calling me communist in their heads. I’m not. I’m just not a vulture capitalist that believes that everything should always be about profit all the time. The profit motive is a good one and keeps us industrious but I do think it has to be shaped and managed by good government and policy so that a handful of families control more wealth than half the country. My work on rural house calls routinely takes me into the homes and lives of those that capitalism has completely crushed through no fault of their own and I get a lot more of the downsides than most in the professional classes, who have minimal contact with others not like them, do.

I’ve been booked as a ‘celebrity’ story teller at a fund raising event in a few weeks. I’m trying to decide just which of the stories of my life I need to tell. I’m leaning towards the saga of Steve’s cremains as it’s a classic but I’m afraid it may be just a bit morbid so I should think of something a bit more uplifting. While perusing the internet this week, I found that a previous blog (written from 2005-12) is still on line and accessible. Maybe I should poke around that. I have had two other blog lives – one from 2001 started just after Steve died and kept off an on up through meeting Tommy in 2003 (which I cannot find a trace of on the internet although it may be archived somewhere I haven’t thought of looking yet) and a group blog called Eternity LTD from the late 1990s that covered the period where everything fell apart in California and Steve and I had to relocate to Alabama. (I think I know where that one may have an archive.) Do I dare read any of them? Will I even be able to read these posts in another decade without cringing? And what about the book? Am I going to look at it in a few years as a significant accomplishment or a slight embarrassment? I would like to think that practice is making my writing better with time but one never knows, does one…

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