July 2, 2023

Well I seem to have gone down to once a week long posting from the twice a week or more that I was doing during the throes of the pandemic. There are things left to write about, both public health and non-public health related, but there isn’t the sense of urgency that I was feeling the last few years. That doesn’t mean things have improved. We’re still trying to figure out just what Covid has done to American society and it’s going to be a few more years before that’s all sorted out. In my own little corner, there are a number of things that I have noted.

First, the health system is fundamentally broken. We all get up and go to work every day and do our best but in terms of the system being able to provide timely services as needed for ailing Americans, fugeddaboutit. Roughly 20% of the clinical providers of health services left their jobs between the first of 2020 and today, mainly the generation slightly older than I (and I’m practically retirement age myself) and they are the folk with decades of experience and knowledge regarding how to best provide services and individualize care. The latest statistics suggest that, with this loss of senior individuals and the continued aging of the Baby Boom, we are going to have a shortage of somewhere between 50-100,000 MDs and up to 500,000 nurses by the middle of the next decade. The educational supply cannot keep up with the industry demands. It takes years to create a competent clinician in any capacity in health care. I had thirteen years of higher education (and I didn’t really become good at what I do until about 7-10 years after that) so even if we were to turn the spigot on now and start enrolling people in training programs now, they won’t really be ready before the crunch comes.

The bottlenecks are in weird places. Some of them are coming about due to issues with the supply chain. We’re always running into spot shortages of medications which is a new thing. And if there’s no antibiotics or IV normal saline, there’s no way to do surgery safely. Some of it is in support industries. There’s an elevator in my hospital that’s been out of service for six months as they can’t get someone with the requisite skills (or the parts) to repair it. Appointments in chronic care specialties are hard to come by. The combination of aging and long Covid symptoms are creating a larger and larger number of individuals with chronic disease burden in need of care and they fill up the available appointments making it more and more difficult to get others in to those specialty clinics. If you need a psychiatrist, neurologist, rheumatologist, or geriatrician – be prepared to wait six months. If you’re lucky. There are no real national plans in place to address these issues from what I can tell. And local leaders are more focused on next quarters balance sheets than any sort of long range planning.

Then there’s the music-theater performance world which is nationally in free fall. It was buoyed through the worst of the pandemic by PPP loans and other government granting mechanisms but with the official end of the pandemic, it’s in grave difficulties. Not a week goes by where I don’t hear of some respected theater company going out of business, scaling their seasons way back, or pausing in production for a period of time for additional fund raising. All of the financials are down. Audiences are down – the older core group of the theater going public is still not completely comfortable going out and crowding into enclosed spaces. Plus, how many died or are more disabled from long Covid symptoms? We don’t know. Donations are down – these are uncertain financial times and people are directing their money elsewhere – plus the redirection of money upwards means that it gets spent at the whims of those who control it and the current generation of corporate titans aren’t the type to spend their money on libraries, museums and concert halls. Corporate giving is down – corporate America is holding its cash close. Government grants and donations are down – theater in particular can be a difficult sell. Some view fine arts as inherently elitist and others do not approve of the mirror that good theater holds up to society, preferring a sanitized version of the culture over the realities.

We have completed our first week of A Midsummer Nights Dream rehearsals. It has minimal budget but does need to recoup some in ticket sales so mark your calendars for the weekends of August 10th and 17th. I am very proud of my actors who seem to get what I’m trying to do with the show and it’s pace and easy breezy tone. This may come together with fewer difficulties than I feared. I still have a number of technical things to figure out though, mainly dealing with lighting. Set and costumes are under control. My Lysander was involved in auto accident last night and suffered a concussion. He will be fine but has been told to rest over the long weekend. I went and sat with him for a bit in the ER. They are very scary places when you’re the patient but I am very good at translating medicalese into English and back again.

I was in his position myself thirty five years ago. In June of 1988, I drove from Seattle down to Sacramento to go apartment hunting so I would have somewhere to live during my internship. I knew what neighborhood I wanted and was running around and looking at apartment units when I was T-boned at the corner of 25th and K streets in Midtown. I hit my head, had a concussion and woke up in the back of the ambulance being taken in to the ED at UC Davis where I was to start work in just a few weeks. The confusion cleared rapidly but I didn’t feel quite right for about another three months and had a penchant for falling asleep anytime I stopped moving – but maybe that was internship. Some say I made a full recovery. Some say I’ve never been quite right in the head.

The sequel to that particular story involved the ER nurse assigned to care for me while I was under observation. I was a trauma patient so full body check and she helped me out of my clothes. She must have seen something she liked because she was in hot pursuit for the next year. I wasn’t out yet. That happened about a year later. That was when she showed up on my doorstep looking for a date seven months pregnant with someone else’s child and when Steve and I, having breakfast in our bathrobes, basically told her to get a clue. Steve thought it was hysterical. I wasn’t so sure.