It’s nearly 8 PM on a Sunday. I am finally finished with the 37 progress notes I had to write this weekend and my eyes are a little bleary. But that may be the peppers in the left over Szechuan chicken I had for dinner still tap dancing across my nasal and lacrimal tissues. I’m all for capsaicin in my food but a day or two in the refrigerator seems to have leached out a bit more than usual into the fried rice. I really don’t like devoting hours every weekend to finishing up progress notes but it’s one of the curses of primary care medicine. I could do them as I go, but to do that I’d have to cut about ten to fifteen minutes of face time off of every visit and that extended face time is what allows me to be a healer, so that’s not really an option. I could do them in the evening but it’s usually the last thing I want to do after a long day, especially if I’ve had to go from work to rehearsal and am not getting home until between 9 and 10 pm. That leaves the weekend. I tell my patients frequently that on the day I retire, I am going to take one of the EHR computers over to the atrium and drop kick it off the third floor landing. And I’m only partly in jest.
UAB is full and the ER is swamped this past week. I haven’t been able to get a good read on how much is related to Covid and how much is other things. I’m guessing some of it is heat stress on aging and otherwise unhealthy physiologies. We continue to be mired in the high 90s low 100s with high humidity around here making outdoor activity uncomfortable at best and downright dangerous at worse. I don’t go out in this weather. I stay in air conditioned office, air conditioned car (fully recovered from this last week’s little adventure), and air conditioned condo. The complex pool is right next door but it’s too hot for me to even want to walk over there. Covid hospitalizations and deaths are both up about 20% over last week per CDC data and have been steadily increasing all summer. We’re not back where we were by a long shot but all the trends are heading the wrong direction.
Another week, another mass shooting, this one at a discount store in Jacksonville, Florida. By all accounts it was perpetrated by a radicalized young man full of racist and misogynist hate as an act of violence against African Americans. Ron DeSantis turned up at the public memorial today and was promptly booed and had the mic taken away by the assembled crowd. Who could imagine that his policies of allowing anyone to purchase semi-automatic weapons and demonizing minorities would lead to actual tangible results? The stochastic terrorism coming out of the right wing is going to continue until such time as the population as a whole rises up and states enough. I’m not sure when that is going to happen. The politically active classes in our society are far too comfortable in their gated communities, insulated from real concerns by various structures of privilege to flex their muscles as of yet. Someday they will wake up to the fact that they traded the lives of their children and grandchildren for slightly better returns on their 401Ks but today is not that day.
My background in rural health and home care/house calls means that I have been in all sorts of homes over the decades. Apartments inhabited by extended families of newly arrived immigrants, trailer homes of the impoverished rural with the meth lab out back, waterfront palaces, old money mansions smelling of slightly decaying furniture, tarpaper shacks with more animal residents than human. They were all home to someone and home, whatever it may be, exerts a powerful force. I have learned over the years to not stick my nose in things that are not my concern (like the odd person that crawls out of the pile of dirty clothes in the corner and lurches naked to the bathroom), to honor that the place in which I am a guest usually represents a culmination of living and life choices, and to enter into a healing partnership with a patient and family, not march in and lay down the law like some white coated Moses bearing the tablet in the form of a prescription pad.
In times past, at least in cities, the rich and the poor lived cheek by jowl and had at least a limited understanding of each others lives. The invention of the automobile and then the suburb changed that balance and the rich tended to withdraw into bubbles that the poor could not penetrate and left the poor to separate cultural and geographic spaces. Occasionally, due to geography or other factors, they are thrown together again. San Francisco, now being held up by the right as a failed city, is one such place. It isn’t failed. It’s just a city where the rich and poor exist in tight geographic proximity and the rich are forced to confront the real lives of the poor and what fifty years of vulture capitalism has actually accomplished.
I often take med students and residents out on house calls with me. Usually I have one or two a year who is a native Birminghamian, almost always from one of the neighborhoods known here collectively as Over The Mountain (translation – wealthy and white). I take them to places within twenty miles of where they have spent their lives and into homes that they have no idea exist, having never been invited into the home of someone who is not of similar caste. I’ve never lived Over The Mountain. I’ve lived on it but always on the city side. And I don’t feel uncomfortable in neighborhoods and homes different from my own. I figure it’s my time to learn about different ways of living and different perspectives on all sorts of things.
The show I’m currently rehearsing, 12 Angry Jurors (12 Angry Men for a mixed gender cast), is being produced by the only African American theater company in town with its own stage. They usually do African-American shows for an African-American audience but they’re reaching out with this one with a mixed race cast trying to reach a wider audience. Usually when I attend their shows, I’m one of the few white faces in the audience but I am always made welcome and most of the regulars now know me. I would like to challenge my Birmingham theater friends to come on out to this production, explore a new venue, help support artistic excellence for a different group than you usually support. You might be pleasantly surprised.
Life, The Universe, and Everything 