August 20, 2021

The cast of Downton Abbey

Today is my early day so I came home early after my lunch meeting to do my zoom meetings I had scheduled. I finished them up around 3 PM and made my list of all the wondrous things I was going to get done with the rest of the afternoon. Next thing I know, it’s after 6 PM and I’ve been asleep on the couch for three hours. The lizard brain has me going into play dead mode again, making me save energy for further disasters to come – add that to the very long and somewhat toxic work week this week and nothing was going to get done whether I wanted it to or not.

I’m tired. No, I think a more correct way to put it is I’m tired of being tired. The health system is under severe strain again due to the never ending spread of the Delta variant and things are rolling downhill and I and what I do are squarely in the way. We’re pivoting back to more telemedicine appointments, on-line team meetings, virtual house calls, and losing our trainees to Covid surge teams. UAB and the Birmingham VA have got this. 2020 taught us all what to do but everyone in clinical medicine is getting tired and in need of a little R and R for rejuvenation. The other major difference between what’s happening now and what happened last year. Prior to the vaccine and a better understanding of Covid, everyone was at risk of serious complication and those of in health care understood that but for the grace of God, the person in front of them could be their spouse, their parent, their child. Now, the vast majority of those presenting with serious illness belong to a self selected group who have chosen not to take advantage of some fairly basic preventive measures. It’s getting harder and harder to generate empathy as the Delta surge rolls on.

Readying the cow pasture

The current local numbers are still running about 3,700 cases a day statewide. In the last two weeks, Birmingham metro has had about 10,000 new diagnoses. The number of children hospitalized has increased 500% in the last month and the state now has the highest rate of child hospitalization in the country. Statewide, we’re technically out of ICU beds (although here in Birmingham metro we’re still OK). The US death toll now stands at 628,000, surpassing the Civil War and moving Covid to the second highest mass casualty event in US history, ranking only below the Flu pandemic of 1918-20. The exact US casualties from that are not known. Estimates range from 500,000 – 850,000 with most coming in around 700,000. We’ll be there by the end of the year. In the meantime, the governor and state officials refuse to do much of anything regarding public health measures besides widely ignored suggestions. The mask wars rage on, especially in the schools where the virus is running rampant. And to top it off, the prior president is holding one of his rallies in a cow pasture roughly 50 miles north of town. I doubt there will be a mask in sight and I won’t be a bit surprised if we see an uptick in local cases in a couple of weeks that can be traced to the event. Our wet summer continues and I won’t be in the least bit downcast if it rains tomorrow and all the attendees find themselves up to their ankles in mud. It might be a reasonable metaphor.

The images of the last week, from babies being tossed over the wall of the Kabul airport to get them out of a Taliban controlled Afghanistan, to severely ill people lying on the floor of the main library in Jacksonville waiting to get monoclonal antibody treatments to hopefully keep them out of the hospital. (There are no hospital beds to be had), to right wing extremists frothing at the mouth as they confront school boards, city councils, and public health hearings full of high dudgeon and misinformation are enough to exhaust anyone. I gave up television news long ago. I realized it was bad for me. I’m currently giving Downton Abbey a rewatch. It’s a bit deceptive though. While it’s placid on the surface and full of lovely costumes and crisp dialogue, the subtext of a world undergoing wrenching changes from the Edwardian period to the Jazz age in some ways mirrors are current times where we are definitely evolving from something to something. Part of our problem as a society at the moment is that this process is happening so fast, that we can’t see very clearly where we were or where we’re going and all any of us can do is hold tight to the back of the dragon and try not to fall off.

Cliveden House, Berkshire

My mother’s parents grew up in the society of Downton Abbey. They were teens during World War I, and emerged into adulthood immediately thereafter as members of the Lost Generation. My grandmother, whose father was a physician in Edinburgh who died young, applied herself to her studies, went to medical school and qualified as a pediatrician going to work in the Lake District caring for the children of the villages there. She was well educated, somewhat fearless, making her rounds on a motorcycle, and as a woman in medicine, a bit of a novelty giving her a bit of an entree, but not a place in ‘society’. My grandfather, who came from a family of social climbers who had emigrated to South Africa, was sent to England for schooling at sixteen, also went into medicine (his father too, was a physician) and was a member of the Bright Young Things set in London. He was a popular extra man at country house weekend parties, being tall, good looking, athletic, an excellent golfer, and perfectly charming when he wanted to be. I don’t know if he ever spent a weekend at Highclere castle, but he was frequently a guest of Lord and Lady Astor at Cliveden. He eventually met my grandmother when he too finished his medical training at the University of Edinburgh. Various twists of fate brought them to this country in the early 1930s where they settled in San Francisco. My grandmother never practiced after she emigrated. She became the power behind my grandfather’s rise at the University of California, all the way to chancellor and became a friend and beloved mentor to the few women in medical school during the 30s, 40s and 50s. My grandfather used his charisma, his erudition, his athletic prowess, and his force of will to succeed. Unfortunately, he saved it all for his professional facade. He was nowhere near as nice a man in private life. But those are stories for another day.

I am supposed to go to Europe in two and a half weeks for my R and R. I keep expecting the trip to be cancelled by the tour company or flights to be grounded or some other disaster. It would fit in with this whole crappy year. There’s also a piece of me that feels incredibly guilty for wanting to go. That somehow it’s a flaunting of privilege in a world of suffering and discontent. I realize that I am very lucky. I am not in danger of losing my job. I have enough money to pay my bills. I can even afford a few little extravagances now and then. So many cannot say these things. But I do what I can. I get up in the morning, go to work, and try to save the world entire, one patient at a time. It’s all I can handle. And these days, there are times when I’m not sure I can even do that.

Enough… Time for the Dowager Countess of Grantham and her continuing battles with Mrs. Crawley. They knew a few things then. They washed their hands, kept appropriate distance from others, wore a mask when indicated, and believed in modern medicine.

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