March 8, 2023

Tonight, I’m wondering what we’ve learned from the last three years. From my news feeds of the last day or two, I’ve come to the conclusion ‘not much’. I had hoped that the pandemic, with its overwhelming concerns and the risks that were universal might have unlocked a certain amount of cooperation in society. It didn’t. Where we should have emerged a bit of a kinder, gentler nation, more empathic toward each other and more willing to extend a hand after suffering under a natural disaster beyond any of our control, we seem instead to have become more and more bent on driving anyone out of our social circles who might not view the world in quite the same way we do ourselves.

The landscape is littered with new laws that will gut the public health system’s ability to deal with the next viral pandemic that arrives. And there will be a next. Some states and localities have banned public health authorities from instituting any sort of societal shut downs or banning of public gatherings. Others have carved out special exemptions for religious services, as if viruses would know not to travel within the confines of a church or a temple versus a theater or a school. Some have defunded public health infrastructure to the point of minimal function. We can only hope that the next pandemic is less lethal than Covid. If it’s more lethal, especially if it’s a filovirus like Ebola or Marburg we are well and totally screwed as the spread won’t slow down while we consider whether our previous actions were ill advised and whether we should backtrack. It’ll just spread and the tools we have to stop it will be locked in the woodshed for political reasons and unavailable in any sort of timely fashion.

There are congressional hearings happening on Capitol Hill regarding the pandemic and its response. From what I can tell, they seem more interested in political revisionism and arguments over issues that cannot be resolved on the current evidence such as natural vs. lab origin than in any sort of debate that could help protect us and do better in the future. After looking at a few clips and a bit of the transcripts, all I could do was roll my eyes. There seems to be a complete lack of understanding of what science is and is not on the part of most of the speakers. I am assuming the loudest voices in the room will suck all of the oxygen out and we’ll end up with a lot of sound and fury signifying nothing by the time the television cameras have moved on to the next sound bites.

The failures of society have, of course, created a need for useful distractions to keep public debate going, centered far away from the items we should be discussing such as the continuing collapse of the health system and education as pandemic stoked changes have chased away so much human capital from the sectors. The big issue at the moment appears to be protecting children from the horrors of transexual people and drag queens. The legislation being passed left and right would be risible if it didn’t have such real world effects on perfectly innocent people just trying to live their lives. The vaguely worded laws in Tennessee, Florida, and other states could be interpreted in such a way that you could be prosecuted for a felony if you take your grandchildren to a matinee of Peter Pan where a young woman traditionally plays a boy. As children understand the concept of dress up quite well, they aren’t going to be psychosexually confused by drag. Besides which, while I see any number of news stories about church officials involved in crimes against children, I don’t believe I’ve ever seen one about a drag queen behaving inappropriately with them. I know lots of them and, like most gay men, they are well aware of societal opprobrium and are most circumspect in their behavior around kids. I’ve made it a hard and fast rule for years that I don’t let underage people in my home without their parents or other adults around at all times. It’s just one of those things you have to do as a responsible LGBTQIA adult.

While the media continues to melt down with sound bites about drag brunch, I continue to try and function in a fundamentally broken health care system. I’ve had three work days so far this week and each has presented another aspect of how it no longer functions properly. Over the weekend, a patient of mine fell at home. She went to an outside emergency room where Xrays showed she had fractured her third cervical vertebra. Broken necks are a major emergency and that hospital tried to admit her. No beds were to be had. She waited in the ER the whole day and into the night, got tired of waiting and signed herself out and went home to get some sleep, calling me on Monday morning to let me know she was wandering around with a broken neck. I had her come in to our ER post haste for evaluation as she was one bad neck jerk away from becoming a quadriplegic and needed urgent spinal evaluation. I then had to deal with multiple calls from various administrators mad at me for having sent her to the ER without evaluating her in clinic first. Now there’s a lot I can do in my clinic, but treating cervical fractures is way out of my pay grade so I had to waste a bunch of time telling these individuals who apparently had no critical thinking skills that ‘her neck done broke’ was indeed an emergency. That’s time and energy I’ll never get back.

The next day had to do with mental health issues. A patient of mine with a significant dementia has a serious problem with violent acting out. Her senior living facility couldn’t handle it and she was sent to the ER. She was admitted, given some tranquilizers, and sent back. She was returned to the ER again in a few hours once the tranquilizers wore off a bit and she started throwing things at the staff. She is badly in need of a good geropsychiatrist and a psychiatric bed but there are none to be had so she is in four point restraints on the medical ward waiting for next to non-existent services. Geriatric medicine and geriatric psychiatry have been decimated in recent years by departures from the field and no attempts by the American health system to attract new blood. At the same time, I was attempting to help a friend find psychiatric help for her son who has developed a major anxiety disorder and in need of psychiatric care. There are no appointments available with anyone in the metro area for the next three to four weeks.

Today’s theme was a number of complaints from patients regarding their medications. Many of the Medicare Advantage plan formularies shifted as of the first of the year, dropping some drugs, adding others, changing copays. Patients who have been stable on a particular regimen for years are now finding that some of their medications are now no longer covered and are getting huge non-formulary bills at the pharmacy. They then call us and we have to spend hours on the phone with their insurers trying to figure out how to substitute and adjust their medications in such a way as to keep their medical conditions under control and keep them from having to mortgage the house in order to afford them.

I and my heroic staff spend most of our time these days doing things that really don’t contribute much to stabilizing chronic conditions or making people well. The energy is going into administrative black holes at all levels. It’s the disrespect of the system where non-clinicians question and micromanage the decisions I think are best with my more than thirty years of experience in geriatric medicine that’s driving me towards contemplating retirement. The pandemic, with it’s wild effects on staffing and medical economics has just aggravated this to the nth degree and I just don’t know how much longer I can put up with it all.

I can put up with it this week, and this month. I just have to keep breaking it down to one step at a time. Sorry for the whine. I’ll go have some cheese with it.