October 15, 2021

On stage this afternoon

I had a speaking gig this afternoon. It was an hour on geropharmacy, one of the topics I do fairly routinely as it’s an important one for anyone involved in the area of elder health to be somewhat conversant with. I covered things like changing physiology, adverse drug reactions and adherence strategies – the usual things. It was still a hard gig to do. It hadn’t occurred to me when I agreed to do it that the venue, Canterbury United Methodist Church had some loaded associations. When I’ve spoken there in the past, it’s usually been in there large conference hall so I assumed this program would be there. It wasn’t. It was in there modern worship space. A space I last entered just a little over three years ago to attend Tommy’s memorial service. I’m pretty good at turning myself off and doing my job when I need to so when I started to feel things as I prepared for my talk, I shut them down and got myself ready to do what I was tasked with doing. I gave my talk, I told my jokes, I shut the part of me that was uncomfortable and emotional away until afterwards.

When I give lectures, especially on topics I speak about frequently, I have set bits of patter and anecdote to go along with the topic at hand. I don’t really remember them per say, but when the right slide comes up with the triggering factoid in place, they drop into my brain and I run through the macro and then it’s on to the next bit. I have no idea if other people do public speaking this way, but it seems to work for me. Tommy and memories of Tommy kept intruding as I went through my hour but I stuck to my talking points and was told by various attendees that they really enjoyed and listened to my remarks so I guess I did the job I was supposed to do. I left, went home, and didn’t feel like doing much of anything for a couple of hours. Then I took myself out to dinner and had a large Manhattan with my meal. That seems to have helped. As I live in the same city with many of the same routines for decades, I am frequently in spaces that hold memories of Steve or Tommy. They’re usually passing thoughts. This time was unusual, likely do the nature of the association and the fact that I am rarely there.

I have a little bit of trepidation at the signing events and other book promotion stuff I have coming up. I’m fearless on stage when I’m in a role – directors can ask me to do pretty much anything and as long as I can make sense of the character and theatrical moments I’ll do it. I’ve cursed, made racially insensitive jokes, appeared in nothing but body paint and a bunch of grapes, and other such things and haven’t thought much of it. But when it comes to just being me without a character to hide behind (and I count Dr. Duxbury as a character…), I don’t know what to do with myself. I guess I’ll have to develop an author persona I can conjure up for these things – an erudite, but warm individual who can act as psychic armor for when I’m not sure what’s next. I’ve always been terrible at self promotion. There’s something deep in my core that feels that no matter what I’ve achieved, it’s not really worthy of any sort of attention. I suppose we all feel that way somewhat, at least in medicine. One of the things I’ve always done with medical students is validated those sorts of feelings when they have them and explained that we all have them and that when they think their classmates have it all together while they do not, their classmates are thinking the exact same things about them.

The Delta wave continues to recede locally. UAB’s inpatient load is down to about half of what it was in late August and there’s nothing in the local numbers to suggest that it’s about to accelerate again. The Mountain West, however, remains exceedingly stressed. They’re a month or so behind where the Deep South was. Their October was our August. And still, so my sources tell me, the stubborn strain of Covid and vaccine denialism continues in those communities. There’s going to be some serious long term damage from this. First, the hospitals and health systems, already stressed pre-pandemic by the fiscal realities of rural medicine, are going to start collapsing and leaving many communities without good local health care resources. The psychic burdens born by the health care workers in these communities over the last couple of years as they have labored to care for their friends and neighbors, only to be reviled and scorned for accepting science over wishful thinking cannot be born long term by anyone and the human capital on which these institutions depend is going to melt away. The older generation will retire. The younger generation will depart for greener pastures and communities where their skills and compassion are embraced and not spat upon.

The big news of the last few days is twofold. The first is that the FDA is well on its way to approving booster doses of both the Moderna and Johnson & Johnson formulations of Covid vaccines. I would expect both of them to be out and available by the end of the month. Should you receive a booster? The answer is yes if you fall into one of three major groups: 1. If you have a disease process or take a medication that impacts your immune system in some negative way. 2. If you have a job or other life pattern that brings you frequently into close contact with individuals of uncertain vaccination status. 3. If you are an older adult over the age of 65. Outside of those three groups, the answers are less clear: talk to your physician. I took mine as I fit into those categories. It didn’t bother me any more than the original shots did. I also got my flu shot this week. It’s a condition of my remaining gainfully employed.

The second is that data has been submitted showing safety and efficacy of vaccination against Covid down to age five. Shots for children are also expected to be approved by the FDA shortly. This will allow all school age children to be vaccinated and reduce some of the risks inherent in the school environment. One would think, that as a society, we would make the health and well being of our young of paramount importance. We did it with Polio and Smallpox vaccinations in the past but we seem to be having more difficulty this time around. The reasons for this are multifactorial and have long and deep roots. I may consider a full essay on these later but the Manhattan tap dancing through my central nervous system precludes my ability to do that tonight.

If I had children, I would be fighting like mad to get them vaccinated but that doesn’t seem to be a universal position. Some school districts and some states seem enamored of policies designed to appeal more to their parents sense of righteous autonomy than to the safety and well being of their charges. I read the daily updates out of Florida and Texas in particular and all I can do now, after months of lunacy, is roll my eyes and move on. I suppose we’re seeing the chattel origins of family life, where a woman and children were essentially the property of a man, continuing to play out through our social DNA. If children are the property of their parents, then there parent’s wishes are paramount and sacrosanct and if they wish them to be exposed to potentially fatal diseases, that is there right. But we’ve moved away from that thinking over the last century or so to a view that children are also a societal good due to their potential to become functional and contributing adults which has led us to invest in public education, child labor laws, child protective services, the frowning upon of corporal punishment, and the like. Where the lines between a parent’s wishes and society’s needs should be drawn is ever evolving and often somewhat murky. Children are removed every day from parents who use drugs, parents who are physically violent, parents of extreme religious beliefs who deny their children medical care, and the like. Is sending children to school without masks different? Is refusing vaccinations a form of child abuse? I don’t have the answers to these questions and the Covid pandemic, having happened and changing so quickly, hasn’t really given us time to calm down, rationally think through the issues, and come together on common ground.

Too much thinking is making my head hurt. Time to knock it off for the night. I wore my mask to my talk and only took it off on stage. I washed my hands. I kept my distance. I’m a good boy… most of the time…

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