July 3, 2022

And it’s another new month. This time, we enter the second half of 2022, the second sequel of 2020. I don’t think any of us expected, when we entered the new decade two and a half years ago, that we were going to enter an era of time compression and continuation. I know that I have a difficult time keeping my sense of time about these last few years straight in my head. In some ways, things feel like they have moved quickly and changed radically and in others, I feel like we’re still in the midst of 2020 or maybe early 2021. It’s another long weekend – happy Fourth of July to all those who celebrate. We’ve made it for 246 years. Maybe we’ll make it a few more. I read somewhere that the average life span of an empire is 250 years. On that scale, I suppose we’re about due for a fall but we really haven’t been an empire since 1776. That didn’t really start to happen until some sixty or seventy years later with the westward expansion and the Mexican American war. And there are others who would use the Spanish American war, fifty years after that as the start of our imperium.

So what am I doing for my long weekend? Very little. I’m caught up with immediate work tasks and with book editing on Volume 2 of the Accidental Plague Diaries. I’m therefore treating myself to some naps and some television and a couple of films. I’m just about finished with the last two mega episodes of Stranger Things, a series I have quite enjoyed mainly as I remember the 80s fondly and the Duffer Brothers have got the period details right. I’m about ten years older than our fictional protagonists. While they are in middle school and just entering high school in the mid 80s, I was in late college and in med school so my interests were a bit different than theirs but I was still aware enough of pop culture to absorb all of the media images and trends. You lay down the patterns of your life between roughly ages 10 and 25. Whatever you were watching, whatever you were playing, whatever you were listening to in that period is what informs your adult life ever after. After 25 or so, you’re interest in pop culture drops off quickly and it’s pretty much gone by 35, left to a new generation to reorder that aspect of our world. For me, that key period is mid 70s to mid/late 80s. To this day, ABBA and disco classics and 80s movies evoke a certain nostalgia nothing else does. As the early Boomers are starting to enter the middle old years and will edge into the dementia belt in about another five, I wonder how nursing facilities and dementia day programs are going to retool for the radically different generation that’s going to shortly need their services. It will be interesting to watch from a professional point of view.

The Covid numbers continue to march upwards. The CDC is now recommending indoor masking again for much of the country. From what I can tell, no one is paying much attention. I was one of the few masked on my Costco run today. I’ve decided I’m going to retrain myself to mask indoors in public again. I’m not worried about me in the least between two boosters and native immunity from my previous omicron infection but I do feel like I should lead by example. I’m keeping tabs on various health websites to try and figure out what’s going on but, as society as more or less moved on, the quality of data out there just isn’t as good as it was. The one good thing is that hospitalizations don’t seem to be zooming up at all. I hope it stays that way.

The airline industry seems to be a complete disaster due to understaffing, Covid absences, and lack of air traffic controllers. I suppose this is what we all get from deregulating the airlines fifty years ago and letting them all work as for profit companies rather than as public services. Everything is always going to focus on next quarter’s balance sheet rather than what people actually need in regards to travel. I am glad that I did not book a major vacation this summer given some of the horror stories I’ve heard back from friends. I’ll look and see if the budget can support something this fall and I do have my long delayed trip to London at New Year’s. I did book a round trip ticket to Seattle for mid August to go see my family for a couple of days but I did it on Delta, not on a discount airline. The initial fares I was encountering were nearly $1800 from BHM to SEA but by driving to ATL and flying directly in and out of there, I was able to reduce it significantly. I also have some date flexibility so if flights are canceled and/or rerouted, I shouldn’t have too much trouble. Famous last words…

I’ve been getting a lot of complaints from friends about the health system in general over the last couple of months, mainly regarding delays in care and difficulties in getting appointments in a timely fashion. Some of this is warranted. Some of this is not. American consumers are used to same day service with a smile and do not like to be told that they will have to wait. This has been one of the main arguments used against adopting more socialized models of health care rather than our crazy backwards employment driven system (that exists nowhere else in the world as no other population would put up with it). ‘You’ll have to wait’ has always been anathema to us, whether it’s for an MRI scan or for an oil change or for a McDonald’s burger. The delays in the health world, just as frustrating to me as to everyone else, are due to a host of reasons in our late pandemic world. The first is short staffing. An enormous number of physicians, nurses and other providers of services used the pandemic as an excuse to leave the health professions. In addition, the relatively low salaries that systems have been used to offering support staff aren’t attracting new hires. (We’ve been looking for a lead nurse for my clinic for a year now…) Nursing, in particular, has been rocked by the migration of nurses away from staff jobs to temp and travel jobs which pay better and which short staffed institutions are forced to rely upon. There are supply chain issues in healthcare as there are everywhere else. Not a day goes by without a notice of shortfalls in some pharmaceutical or contrast material or the inability to get some part to keep some machine in proper repair.

Then there’s the rapid aging of the population, many of whom delayed care for this and that the last few years. The sheer numbers of the boom means that disease case loads, especially in the chronic diseases that start to strike significantly in the 70s, are way way up and there just aren’t the numbers of specialists available to handle these increases – and the medical education system is not designed to pump out more doctors quickly. It took me thirteen years of higher education to become what I am. I figure I have somewhere between two and seven more years of full time working life left, depending on health – physical, mental and financial. That’s enough time for me to train up three or four clones but we can’t find much of anyone interested in dedicating their career to geriatrics. Over the last five years, we’ve lost eight clinical faculty to retirement, other job opportunities, or spousal needs. We gained two during that same period so we’ve got a significant net deficit which is really affecting how all of our clinical programs run.

There’s not too much for me to write about Covid currently as I continue these Accidental Plague Diaries. That could change at any time. It’s not over and I’m pretty sure it has one or two more nasty surprises to throw at us before it fades away. So, I’m thinking I’ll probably be writing more about the cracks in our various institutions that have widened under the strain of the pandemic and its inherent social changes. I don’t think we have a good understanding of all that yet and I’m trying to educate myself on it, at least as it applies to the health care system where the order of the day seems to be stamp out today’s fire today and stamp out tomorrow’s fire tomorrow. I would love to have a work day where I didn’t feel like the whole system could come crashing down overnight (or over a long weekend). If it does, I’m pretty resourceful and I’ll take care of my patients the best I can. My focus for this year is trying to catch up on preventive measures that fell by the wayside over the last few years and which might be helpful.

If anyone has a particular topic you’d like me to think about and maybe tackle, drop me a line. All reasonable requests entertained. In the meantime, the mask is in the back pocket, the sanitizer is on every desk I use and in the car, and I muddle through one day at a time.