March 25, 2022

It’s Friday. I’ve had a couple of glasses of wine so pretty much anything might come out of brain and on to the page this evening. I was going to do something highly constructive but I continue to feel tired and burnt out so I’m allowing myself an evening off from absolutely everything other than getting this written. The notes of the week, the legal case review, the sorting of the bin of miscellaneous papers, the study of the song for voice lesson this next week, the movie review column, and the planning of various social events can all wait for tomorrow or Sunday. I’ll lie here on the bed with Oliver the cat purring beside me and just let stream of consciousness take over.

The news on the Covid front continues to be reasonable if not exactly good. Local numbers have dropped back to where they were a year ago before the Delta and Omicron waves took over all of our lives. There are fewer than two dozen total Covid patients at UAB, and fewer than ten in the ICU (almost all unvaccinated). Deaths, however, remain around 1,000 a day nationwide and, while trending down in general, lead to an inexorable increase in the toll. We’re at 975,000 now in the two years of the pandemic and will almost certainly pass the magic million in the next few months sometime.

Here in Birmingham, where the spring brings all four seasons every forty eight hours or so, society has more or less decided the pandemic is over and pretty much everything is back to normal, or as normal as it gets after two years of pandemic havoc on all segments of society. The CDC lists Jefferson county as being in the green zone with low transmission. There’s one thing to be wary of in the new CDC red/yellow/green maps and levels. Where previous data was based on absolute case and transmission rates (the number of persons testing positive), the current data is based on whether or not the local health system is capable of handling the number of people expected to become seriously ill given vaccination rates and transmission in the area. In an urban county with large medical centers like ours, transmission can actually be quite high and not be reflected by higher risk levels as we have the capacity to provide care. I think it’s a bit of a cheat and most people don’t really understand these nuances when evaluating their personal risks. As it has been for some time, the best thing to do is get vaccinated and boosted. We’re all still waiting for updates on recommendations for second boosters. There’s data from Israel and Europe suggesting that it will be a very good idea for older people and those with immune compromise but the CDC hasn’t quite gotten its act together yet.

The theme of the week at work has been lack of services for lack of staffing. The enormous numbers of retirements in health care mixed with better opportunities for elder health workers has led to an exodus of staff from nursing homes, home healthcare agencies, and other senior services. Finding a hospice or a nursing home with adequate staffing and the ability to provide requested services to which elders are entitled has become quite the challenge over the last few months. The needs are becoming greater as the huge boom population continues to age and the leading age, now in their early 70s, has a few members with bad genetics or life choices which are pushing them into positions where they need support to live their lives and those supports are becoming scarcer and scarcer. It’s going to be an absolute nightmare in another five years or so when the early boomers have aged into their eighties. And upper level senior care positions aren’t exactly finding takers either. We’re continuing to shed geriatricians around here to retirement or other opportunities with no one coming in to replace them. There’s no one coming up through the ranks currently who could replace me. I’m not sure how I feel about that. On the one hand, it’s kind of nice to know you’re valuable, on the other hand, I know I can’t do this forever and I don’t want to see everything I’ve helped build over the last few decades crumble and fade as there’s no one left to do the work.

My burnout fatigue continues and likely will until I can arrange some time off. I might be able to do it in May but there are so few of us, we’ll have a very difficult time keeping clinical services open five days a week if I take any time off and I don’t see a lot of good solutions presenting themselves. It’s not like we can create a new geriatrician in a year or two. It takes a minimum of twelve years of higher education under the current system. We can create a geriatric nurse practitioner quicker than that with five or six years of higher education but they really need some clinical practice seasoning for a few years in addition to that to be up to the rigors of the job. I don’t have a solution. Those of you heading into your golden years or my younger friends with parents heading that way better start planning now for the potential complications of aging as there’s going to be a lot more ‘you’re on your own’.

That seems to be the current political ethos anyway. Our society seems intent on dismantling the commons for private profit and tossing anyone out of the boat that can’t pull their own weight. Some blame rapacious capitalism, some religious fundamentalism, some human nature. It doesn’t really matter. What really matters is if we can’t hang together, we will all hang separately as Benjamin Franklin wisely once said. I didn’t have the heart to watch the hearings for Justice Jackson but the little I did catch, full of rich white men who had got theirs trying desperately to demonize a capable black woman as ‘the other’ for political points was enough to make me nauseous. This week we also were treated to sitting US senators opining that Obergefell, Loving and Griswold were all wrongly decided so if you think that the right wing forces at play in this country will stop at an undoing of Roe v Wade, you’re delusional. They’re coming for anything that interferes with their nostalgic world view of a 1950s never never land gleaned mainly from reruns of old black and white sitcoms.

OK, I’m grumpy now so I’m going to put on some bad television. I’m trying to decide what to write about over the next few weeks while I begin editing volume 2 of The Accidental Plague Diaries and Covid seems to be in relative abeyance. (This is unlikely to last. Omicron BA2 is now 50% of new cases and there are new peaks happening overseas from this – it’s just a matter of time). If there are any requests, let me know. In the meantime, hand sanitizer, booster, and keep that mask handy. You’re likely to still need it.

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