November 18, 2022

It’s Friday, the sun is sinking in the West and so we say goodbye to another work week, the last full one before the holiday season begins in earnest. I only have to work a half week next week but I did volunteer to take the clinical call for the long weekend so that those with families and kids wouldn’t have to. I don’t have particular plans for the long weekend. I’ll probably keep up my tradition of doing my Christmas shopping on Saturday during the Alabama/Auburn game when the majority of the population is glued to the television set and the stores are relatively empty. Shopping shouldn’t be difficult. I’ve evolved into that eccentric old uncle that gives everyone books. It just becomes a game of finding just the right title for just the right person.

New books were always one of my favorite things to find under the Christmas tree when I was small. The first Christmas I can remember is the one when I was three (Christmas 1965 for those of you keeping score at home) and there were picture books for me which held more interest than the Tonka bulldozer or the blocks, but maybe not as much as the Viewmaster. I still have a few of my childhood picture books, and many of the good editions of the children’s classics that my father read to me over the years, some of which had been my parents and even my grandparents as children. Reading remains a fundamental pleasure and I try to get through a book or two a month when I have the time and I make it a point to either read or listen to one of the great works of world literature every year that I missed along the way. Recent choices have been Madame Bovary, Anna Karenina, Moby Dick, Barnaby Rudge, and The Mayor of Casterbridge. Next up is Martin Chuzzlewit. I plan to get through all of Dicken’s major works before I die, including the ones that no one ever reads anymore.

Work has been pretty steady without a lot of pandemic issues. There remain a good deal of tangential problems however including short staffed senior care agencies, mental issues in patients and families, worsening disease from delayed care, and general administrative oddness. The biggest problem has been the loss of physician faculty from the UAB geriatrics section. We are down roughly 50% over the last decade and trying to run a similar clinical footprint on half the people is becoming more and more difficult. I don’t know where we’re supposed to get new faculty as no one in US medicine goes into the field. I’ve written extensively in the past as to the reasons why this has happened so I’m not going to repeat them all again. Let us just say there are days where I feel content with work and other days when retirement cannot come soon enough.

The VA system has made a conscious decision to reallocate resources to programs designed to keep veterans out of custodial care and out of emergency rooms so the house call program is gaining rapidly in prestige and finances. We may be able to meet my goal of expanding to a point where every veteran in North Central Alabama who lives within the Birmingham VA catchment area can access house calls within the next two years. I was thinking it would take a decade. I’ll be thrilled if we get the whole thing up and running, taking in the whole territory with strategically placed teams of case management nurses and ancillary services. The biggest obstacle will be in finding qualified and quality team members who are resourceful and motivated to work in the unique niche of home based primary care. It’s very different than working on a ward or in an office. When you enter someone’s home, you’re not the one in charge and you have to respect that shift in power dynamic and learn how to get patients and families working together with you in partnership to improve health and function.

I am getting a new boss at UAB, the new chief of the UAB Division of Gerontology, Geriatrics, and Palliative Care arrives the week after Thanksgiving. He is coming into academic senior care at an, as they say, interesting time. I’ll help him the best I can. I have no idea what his goals or priorities are going to be. I’ll just try to give him the history of the last twenty-five years and let him know what has worked and what has not and why and see what he runs with. It’s hardly the first time I’ve gone through a change in leadership. I’m just glad it’s not me. It’s a very difficult time in medicine and navigating it is not for everyone. I’ll just remain in my own little clinical world saving society one patient at a time. It’s all I can really do.

What’s up with Covid? Well, the pandemic remains unfinished. Cases in Los Angeles are up 50% over two weeks ago. (Thank you Omicron variants BQ 1 and BQ 1.1 which are becoming dominant there). It doesn’t appear that hospitalizations are going up at that same rate but it’s early times yet and hospitalizations are a lagging indicator, usually going up about three weeks after the case rates start going up so we should have a better picture in mid-December. Meanwhile, in New York, the current production of Little Shop of Horrors had to all off a recent performance at intermission as key cast members got sick during the first act and there weren’t enough understudies and swings available to continue. I suppose they could have pulled an Audrey out of the audience. If she had been able to belt out ‘Suddenly Seymour’ without rehearsal, it would have been a real Shirley Maclaine moment.

I’m off to a wedding tomorrow. It’s my first one since the ‘before times’. One of the advantages of my performing arts life is that it keeps a lot of younger people in my social circle so I do still get to go to an occasional wedding and not just have to satisfy myself with pictures of my peers new grandchildren. I’m not sure if wedding etiquette has changed to conform to new social realities in a more virally conscious world. I guess I’ll find out tomorrow. If nothing else, it will give me the excuse of breaking out some fancier clothes. That may help my mood. Time to go put on some Jerry Herman and sing along to ‘Put On Your Sunday Clothes’ from Hello, Dolly!

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