September 24, 2022

And Volume II of the book form of these Accidental Plague Diaries is complete. Proof copies should arrive in a week or so and if they pass muster, I will announce a publication date so y’all can run to your local bookstore and tell them to order it for you. (And have them order a couple of copies of Volume I to put in the window while you’re at it.) This is about the extent of my PR campaign this time around. Neither the publishing house nor I have a budget so it’s going to be social media and word of mouth, unless someone can figure out a way to get a copy to Oprah or an article in the New York Times literary section. When I started these essays, I had no idea they would become a book, much less two. And all signs are pointing towards a third volume in another year. I think I’ll call it quits at that point. I’ve pretty much said everything I can say, unless Covid makes some sort of strange epidemiologic turn this fall – which could indeed happen.

I have no idea where to end a projected and final Volume. Does it end with various public figures declaring the pandemic is over, even though it obviously isn’t? Does it end with the American public returning the control of congress to a political party riddled with science and public health denying charlatans? Is there some grand announcement yet to come from WHO or the CDC? Or does Covid simply peter out, slinking off into the background of our lives. One more social problem we blithely ignore the same as we have made our peace with excess gun violence, underfunding of education and social services, and a mental health system in tatters. I suppose it will eventually become clear and an inflection point that makes sense to me, even if it doesn’t to anyone else, will present itself.

Covid continues to run rampant through my circles of acquaintance. Not a day goes by when I don’t hear of someone down with it from some area of my life. My acquaintances are, for the most part, vaccinated and have had at least one booster so no one is getting sick for more than a few days and it’s been months since someone I know has had to be hospitalized. We can live with this. But there are a couple of big unanswered questions. It is not known how long both natural and vaccine mediated immunity will last in the face of a virus that mutates as rapidly and in as many different ways as a coronavirus. We may be able to keep ahead of it with annual boosters but that is no sure thing. And even if the vaccine and boosters prevent severe disease, they don’t seem to be all that effective at preventing long Covid.

Long Covid is here to stay. We don’t know what it is. We don’t know the mechanisms behind it. We can only palliate symptoms. When I had my first bout of omicron nine months ago, I was significantly ill for about 36 hours. Felt unwell for another three days and then felt pretty normal. My most recent bout last month had me feeling far less acutely ill but the post viral fatigue has continued to this day. The first two weeks after my acute symptoms went away, I could barely drag myself to where I needed to be. Things improved some this past week. I am feeling more energetic but I can still tell I’m not at 100%, maybe 75% on a good day. Is this the way I’m going to feel going forward? Will I be able to keep up my usual life pace? Are there unpleasant Covid related surprises busy percolating in my heart or my brain tissue? I don’t know. At least I’m not feeling so rotten that I don’t want to get out of bed and my breathing is fine. I may have a little brain fog, but that’s been hanging around since I turned fifty.

I did something highly unusual for me today. I took the day off from all responsibilities and vegged. It was probably good for me but it does mean that I’ve got a ton of neglected work to do tomorrow to catch up. This next week is going to be busy with dress rehearsals and performances of The Hallelujah Girls (Eastlake Methodist Church fellowship hall – Thursday Friday and Saturday at 7:30 PM and Sunday at 2:30 PM). Then I’ll be over the hump with both the literary and theater careers quiescent for a month or so. And I’m finally going to get a vacation week in October. Granted, it’s only to Florida but I haven’t been much of anywhere since last holiday season.

Tomorrow is a reading of the new opera Touch that Opera Birmingham has commissioned. We’re doing the premiere production in January of 2024. It’s about Helen Keller’s life after her schooling and her complex relationships with Annie Sullivan and others as an adult. As president of the board, I’m helping steer this project forward. I’ve seen pieces on Zoom and video and I’m looking forward to hearing the music sung live. No, I will not be in it. I do not have a voice capable of singing opera roles. I can sing chorus, but I’d be laughed off the stage as anything other than Lillias Pastis in grand opera. I’ll stick with my musical comedy character parts when it comes to singing solo.

The bivalent vaccine is now available pretty much everywhere. Go get it. I would, but I have to wait for a while. You should allow twelve weeks between an acute infection and a booster. And keep your hands washed.

September 19, 2022

The pandemic is over. How do I know? Joe Biden said so yesterday on 60 Minutes. I wish I had his confidence but I’m not quite so sure. Today’s statistics show that we’re still losing more than 400 people a day and that number, while trending down, has remained relatively static for some months and is nowhere near as low as the troughs after the Alpha variant wave and the original Omicron wave. We still have over 30,000 people hospitalized nationwide with a coronavirus infection, roughly 10% of whom are in the ICU, and the test positivity rate (percent of tests done which are positive for illness) is something over 10%. The WHO sets a ceiling of 5% on this to declare an epidemic or a pandemic controlled. So, by any measure, Biden’s statement is one of wishful thinking.

There are also new Omicron variants in the wind. The one that is currently most widespread and causing most clinical illness is variant BA.5. However, variant BA.4.6 is on the move in New England from wastewater surveillance studies (fortunately, it doesn’t appear to be more infectious or virulent than other omicron varietals). It could lead to a surge if there happens to be a mutation. There’s also a new variant BA.2.75.2, not yet widespread but with multiple new mutations on the spike protein which could greatly increase its affinity for human cells and its chance of causing clinical disease. While there are very few cases, the number have been doubling every week the last few weeks and we should not forget the power in exponential numbers. Think back a year. At Thanksgiving last year, the original Omicron variant was just a whisper in South Africa. By Christmas, it was everywhere and cases were skyrocketing.

The end of the pandemic will come when the disease and its effects fade into the background of our daily lives as yet another endemic disease, something that isn’t going to seriously affect our lives and plans, but rather those of some comfortably distant other. We’re well on our way to doing that. The classes in this country who run our politics, economy, and society are predominantly healthy and vaccinated and as the virus interacts with them these days, it’s mainly as a nuisance. My recent infection wasn’t that bad as far as disease goes. The quarantine and time off work was more of a hassle. My long Covid symptom of fatigue feels like it’s beginning to lift. I definitely have more energy this week than I did last.

So what does the end look like? Ticker tape parades and church bells pealing out? More likely, just a willful indifference to something that can be relegated to the background as we all return to our usual daily distractions. We seem to be content with letting Covid settle in as the third leading cause of death after heart disease and cancer just as long as it’s not wreaking havoc in our particular social group. The health system can handle the current burden of 3-4% of hospital beds nationwide taken up with Covid patients. It’s only when the number gets up to 10% and above that the system completely breaks down. Like flu, the serious cases will be pushed more and more into populations of the old, the ill, and the marginalized.

There are still a lot of unanswered questions. What is long Covid and what causes it? Is it autoimmune in nature, the body’s natural defenses being over activated by the virus into attacking normal body tissues? Is it continued viral infection with the virus hiding deep within some organ system and continually causing minor flare ups? Is it a complication of micro clotting and hemorrhages in the capillaries leading to malfunctioning body systems? We don’t know. But more information comes out daily suggesting that the virus is bad news long term. A study from today has shown that older people with a Covid infection are 75% more likely to be diagnosed with dementia within a year than those without. Is the virus neurotoxic? Are there tiny strokes involved? Will this lead to much higher levels or earlier onset of dementia among the rapidly aging Baby Boom?

There’s still a lot of vaccine and Covid denialism out there. It’s not as prominent in the mass media as it was a year ago but those attitudes have not disappeared overnight. Most of the older generation got their vaccines but they haven’t been nearly as popular with the middle aged for political and other reasons. Unfortunately, today’s middle aged adults are tomorrow’s elderly and as the unvaccinated age and have the normal decline in immune function that accompanies getting older, they may find themselves in the cross hairs of the more serious complications of the virus. The vaccines remain our best weapons against this. I’m getting my bivalent booster shortly and, if you’re over fifty, I strongly recommend you do as well. I’ll get my flu shot in October. Living in a Southern climate, our flu season comes a bit later so getting the shot mid to late fall is usually OK. The Southern hemisphere flu season, especially in Australia, was rather hot and heavy this year. That’s usually a good predictor of what’s likely to happen to us. And I really can’t recommend getting Covid and flu together at the same time.

I’m going to get every booster that comes down the pike. There’s no reason not to and I kind of like living with most of my organ systems functioning to original manufacturer’s specifications. I’m a bit eccentric like that.

September 15, 2022

I am almost finished with the final edits for Volume II of the Accidental Plague Diaries (book form). It will be available for purchase next month sometime. I’m not sure how I feel about it. I never intended to write the first volume and now there’s about to be a second and there’s the strong promise of a third. What does it mean? Should I feel proud of the accomplishment? Maudlin at the ending of this phase of the project? Excited about holding a physical product sprung entirely from my intellect and imagination in my hands? Dejected that the total royalties will likely be not quite enough to buy dinner for one at Automatic Seafood? All of those at once? If I had more energy or time and wasn’t spending far more of my limited psychic resources trying to hold everything together at work, I might start putting together plans for readings and signing events but I just don’t know that I’ve got it in me at the moment. I’ll just throw the book out there and see what happens. In my wilder daydreams, somebody gets a copy to Oprah and she loves it and puts in her book club list and my career is made. Fat chance.

I think I’m still suffering from post Covid lethargy. Most of my friends who have had it this most recent go round have told me they were just tired for about a month after recovering from acute symptoms. I don’t feel sick. I just don’t have my usual energy. I’m making myself do all of my usual activities but at the end of the day when the circuit is done, I sit down and feel completely drained. Mid morning and mid afternoon I go through low periods where if I’m sitting still in a car or at a computer work station, I just black out and sleep for a few minutes. Coffee doesn’t seem to help. It doesn’t happen if I’m in constant motion, such as in clinic where I’m dashing from room to room with patients or back and forth from my office. It happened twice today. Once this afternoon while writing notes after today’s house calls and once this morning while doing house calls when I blanked out for a minute sitting on a patient’s too soft living room couch waiting for him to return from the bathroom.

If this is the extent of my long Covid, I can live with it. I’m keeping my fingers crossed that it’s going to lift in another week or two as it seems to have with peers. I’m not going to invite trouble and assume this is a new normal but I know from decades of doctoring how life can turn on a dime. You can be hale and hearty one minute and next saddled with a disease process that will keep you from leaving your house without grave difficulties. Good health and long life is promised to no one. You can increase your chances by making wise choices but sometimes the wheel just comes up green double zero and that’s that. One of my high school classmates passed on this past week. We’re now all sixty or so so we’ll start dropping more and more frequently from natural causes. There were only a hundred of us. A couple died young but most of us made it into healthy middle age but as the years go on, ‘natural causes’ will catch up with more and more of us.

Those of us in our sixties and seventies, who are generally in good health thanks to reasonable genetics, access to decent medical care, and good life choices are probably all sitting around and looking at the number of people in our parents generation still living vital functional lives in their late eighties and early nineties and assuming that we will be able to do the same. I’m not so sure. That generation, having come of age in a time of scarcity, may have gotten a longevity boost from the semi-starved rat hypothesis and we, their children, coming of age in a time of plenty, may not have that and our years may be less. Add to that the rather precipitous drop in life expectancy from the Covid pandemic and other social ills. And then there’s the unknown effects of climate change that may cause totally unpredictable health hazards going forward.

I read a number of sources of material on Covid and the pandemic and digest it before sitting down to write these musings. I look at charts and graphs. I read scientific papers. I look at opinion pieces from both sides of the divide. Perhaps the best general source I have found are postings by Katelyn Jetelina who writes as Your Local Epidemiologist. She has far greater training in public health and epidemiology than I and has a gift of translating complex data into an easily understood format. Her most recent posting was a succinct look at who is still dying from Covid in the US. We continue to lose 400+ people daily nationwide, making Covid still the third leading cause of death after heart disease and cancer. The biggest predictor for mortality remains unvaccinated status. The more vaccines and boosters you have on board, the less likely you are to die. The second big predictor is age greater than 65. The majority of elders in the country have gotten their vaccines but not all and many, while they got their original vaccine, have not gotten boosted. So, if you’re an older individual, just keep getting your shots as they come down the pike. The bivalent omicron booster is becoming more and more available. I’m going to go get mine this next week.

Struldbruggs as envisioned by Louis Rhead

I can’t think of anything much worse than immortality without eternal youth. If you end up with an extra decade, it’s going to come in your 80s and 90s, not in your 20s and 30s no matter who you may be. Jonathan Swift got it right with his Struldbruggs of Luggnagg. If I cannot maintain my own body or am descending into the dream state of dementing illness to the point where I require 24 hour babysitting, I’ll be happy to go. At that point, death will be an old friend and I’ll be asking what took you so long. I have enough difficulty keeping up with the young uns and the way they look at the world at sixty and it’s going to be even harder in another generation or two, when those who understand the world as I do are slipping away.

We’re about to enter an interesting time. The Baby Boom, the generation that has dominated American culture for so long is going to start it’s die off in a few years. It really hasn’t begun yet. The oldest Boomers are 76 this year and will start turning 77 in a few months. This is still a relatively healthy cohort. In 2030, when the oldest boomers are turning 84, it’s going to be a very different equation. Assuming there aren’t more pandemics or other major disasters and death patterns are similar to what they have been recently, about 80% of the Baby Boom dies between 2030 and 2050. And given what I know about them characterologically, there will be a lot of raging at the dying of the light. Will this change the way American culture thinks of death? Will our death rituals change? What will younger generations do with the transfer of social power? Interesting thoughts to ponder on. But I’m not going to do that tonight. I’m too dang tired.

September 11, 2022

She was there for more than 70 years. You assumed she was eternal and would forever be part of your life. And then, one day, pffft… gone. I am referring, of course to Bogue’s restaurant, my local greasy spoon American diner that’s been a fixture in Birmingham since the 1930s. It closed suddenly this past week. For years now, my routine was to have a big breakfast there on Saturday morning, any weekend I was in town to tank up for the chores of the weekend, be it shopping, laundry, yardwork, or wading through dozens of unfinished progress notes or other work projects. I guess I’ll have to find another Saturday morning bacon, egg and country gravy place to patronize.

Queen Elizabeth II also died this week. Having seen various news photos of her over the last year or so since the death of Prince Philip, her death did not come as a surprise to this geriatrician. I have no idea what her health conditions actually were but I could tell from posture, fit of clothes, skin tone, and other clues that she was not doing well. When I heard that her brief meetings with Boris Johnson and Liz Truss regarding the changing of the guard at 10 Downing Street had pretty much taken all of her strength, I figured the end was near. Her Majesty had been on the throne for a decade when I came along and I’m no spring chicken so there’s really no one under the age of about 76 with any sort of memories of George VI’s reign and to have even childhood memories of George V and the short reign of Edward VIII and the abdication would require you to be in your mid 90s or older.

There’s going to be a lot of reassessing of the monarchy and the direction of the UK in general with this particular passing of the torch. The Empire is no more. The Commonwealth is on somewhat shaky ground. Brexit has done a number of the economy and society. Will Charles III have the skills necessary to walk the tightrope between tradition and modern needs? It remains to be seen. He’s been preparing for the job for more than half a century. Let’s see if any of that training has paid off. As I read some of the social media kerfuffles regarding the Queen, it strikes me that there is a certain confusion between the Queen, the person, and the Queen, the symbol. By all accounts, the person was intelligent, perceptive, had a great sense of humor and dedicated her entire life to the well being of her country. The Queen the symbol is more difficult. With the various titles and roles and the concepts of being anointed by God and head of the Church of England, she got boxed into a corner numerous times between her duties as the monarch and her duties to her family as wife, mother, sister, aunt, and grandmother. This of course led to the rather disastrous marriage of her sister Margaret, the doomed story of Charles and Diana (I actually have a lot of sympathy for Camilla – she and Charles were perfect for each other even in youth but the Queen and court could not permit the marriage as she was not a virgin among other reasons), and some of the nastier exploits of Prince Andrew. She was not responsible for the depredations of the British Empire (it was pretty much dismantled by the time she took the throne). She had very little say in legislative affairs. And while the monarchy is an expensive institution, when you divide the amount of public funds appropriated to it over the population of the UK, it comes out to about $1.50 a person which isn’t a bad price for that much pomp, pageantry, tradition, and connection to the past.

My mother, although American, was basically raised in a British household. Her parents emigrated to the US just before she was born and never became US citizens. They always retained their British citizenship and passports. The books she grew up with, the cultural references around the dinner table, the way in which the household was run – very British upper middle class. A certain amount of that trickled down to me and my siblings a generation later. We read British children’s classics that aren’t as popular on this side of the pond and were steered towards Dickens and Austen and the Brontes by middle school. We watched the Britcoms on PBS and I soon realized that I got more of the jokes than most of my peers. I became fascinated by history relatively early on and my mother would read children’s histories of the world and of Britain to me and by the age of ten or so I was more certain about the names and historical importance of various British monarchs over the years than I was of American presidents.

My mother was the same generation as Queen Elizabeth II (the Queen was a few years older) and her mother, the Queen mother, was the same age as my beloved maternal grandmother. Watching those two royals function and age in the press over the course of my life has always reminded me of my mother and grandmother and of maternal love and maternal pride in my accomplishments so I have always viewed the Queen through a somewhat different and more personal lens than most. My grandfather, with his intense social climbing inherited from his people, also never let it be forgot that we were quasi-related. He and Anne Messel, Anthony Armstrong-Jones’ mother were second cousins and palled around together in the Bright Young Things society of between the wars London. Anthony, of course, married Princess Margaret becoming the Earl of Snowden and their children, the Queen’s nephew and niece, are therefore my fourth cousins. Never met them. Never will.

The Queen’s impending funeral is likely to keep Covid off the front pages for the next week ago so we should probably check the numbers to see how things are faring. Numbers are continuing to go down. The daily death toll has dropped under 400 a day for the first time in some weeks. That’s all well and good until you start to multiply it out and you start to realize that the weekly death toll all this past summer has been higher than the death toll of the 9/11 attacks. There hasn’t been much chatter about new variants. The new bivalent vaccine with additional omicron protection continues to come on line. If you’re more than about ten to twelve weeks out from a previous booster, it’s a good idea to go out and get one.

It is the 21st anniversary of the 9/11 attacks today. I haven’t forgotten. The news telecasts have been running news footage from that day all day. I don’t need to tune in. I lived through it and remember it all to well. I feel no need to relive that day visually or emotionally. I will quietly mourn for the victims, and more for the country that squandered the good will of the world in misguided military adventures in the years following.

September 7, 2022

The VA has allowed me to return to work so I guess I am no longer Typhoid Mary. I went in today and cleared out various boxes that were overflowing with important messages, on paper and electronic, and tried to get everything ready for resumption of my normal rural house call schedule tomorrow. It wasn’t too bad. As a number of other people in my unit went out with Covid at the exact same time as I (making the VA the likely source of my infection), it has been relatively quiet over the last ten days. I haven’t been allowed back at UAB yet. I should get the all clear tomorrow but anything is possible. I’ve been doing as much of my work on that side from home as possible so it shouldn’t be too bad getting everything up and running again.

I’m in the process of editing the galley proofs for the new book, Volume II of these Accidental Plague Diaries. The material is only just over a year old but so much has happened in that year that in some ways it feels like I’m editing some sort of historical text. Does anybody remember the delta variant? Last summer’s school mask wars? Does anybody care? I guess I’ll find out when the book is done and out there and if anyone actually buys a copy. Going through it line by line, I think there’s some good stuff in it and there’s some stuff that I’m cringing at a bit but it’s what was going on in the world and in my head at the time. When will it be done and available through a book retailer near you? I was hoping the end of this month. It’s likely to be mid-October though as I’m not progressing quite as quickly as I might like as other things grab my attention.

So where are the numbers now? Trends are all going the right way, but slowly. Daily deaths have dropped from the mid 400s to the low 400s. Test positivity rate is down from about 20% to about 15%. New diagnoses are down about 20% from a couple of weeks ago. Not as low as we have been during some of our previous lulls but not as bad as it certainly good be. Will we go shooting up again this fall and winter? It remains to be seen. Some will depend on the numbers and kind of people who go get their bivalent booster shot for additional omicron protection. Some will depend on our social behavior patterns over the next few months (which may in turn depend on all of the rather strange weather we’ve had this year due to climate change). Some will depend on whether a new viral mutation comes into play.

The chatter in the science community is that the government is gearing up for a future with an annual Covid booster, likely in the fall, to coincide with the annual flu booster we’ve all gotten used to in recent years. That would certainly help with messaging and with convenience, especially if they work out a way to combine the two vaccines into one (it’s being worked on). The only flaw with this tentative plan is that it assumes that Covid and influenza are similar viruses with similar annual patterns. Unfortunately, they aren’t. Influenza has significant seasonal variation. Flu season usually runs November to April with minimal cases outside of that window. This allows us to predict with some success, the timing of when a flu vaccine will be the most effective leading to the annual fall campaign. Covid hasn’t shown a seasonal predeliction. We’ve had surges in the winter and in the summer. The flu virus tends to mutate in a predictable pattern allowing us to guess how to adjust the strains in the vaccine in advance. Covid is more random in its mutation (or it has a pattern we just haven’t ferreted out yet). The bivalent omicron vaccine has been approved and is in the process of heading out through distribution networks and is already available at some locations. If you’re more than sixty days out from a prior booster, it’s probably a good idea to go get one, especially if you’re over fifty or have any issues with your immune system.

My own personal Covid case has essentially resolved. The only symptom that remains is fatigue. It’s not a bone weariness, it’s just a feeling of weakness and that I just don’t have the stamina I think I should. I’m capable of doing everything I need to do but I find I need to sit down more and I’m more likely to nod off once I find someplace comfortable. Most of my friends of my generation who’ve had a recent second omicron infection like mine have had similar feelings and have told me it takes about two to three weeks for it to go away so I’ll give it another ten days or so to resolve itself. I’m keeping my fingers crossed that this is not the beginning of some sort of long Covid nightmare that’s going to haunt me for a while. It also better not keep me from learning my lines. I have enough trouble with that already at my age.

Rehearsals for ‘The Hallelujah Girls’ are going smoothly. It’s not Shakespeare but it’s good fun and it’s not often that I’m asked to play a sex symbol so I’ll take it. I’m having difficulty finding just the right southern dialect for the character. It’s supposed to be rural Georgia but I keep slipping between Charleston and backwoods Tennessee, neither of which is quite right. I’ll figure it out. Dialect is not my strong suit. I suppose that’s what comes of going into acting without much in the way of formal training. I do take the occasional class but most of what I do these days is dramatic improvisation which is very helpful for character building.

‘Too Darn Hot’ from The Kiss Me Kate I directed – Virginia Samford Theater – June 2006

I’d like to direct again. It’s been a decade since I last did. I love directing big old fashioned musicals best but few companies are doing these at the moment due to the expense involved and the size of the casts. Everyone is in a period of financial retrenching after the last few years of disaster and so things have titled more towards chamber pieces. My favorite directing assignment was Kiss Me, Kate, Cole Porter’s musical send up of The Taming of the Shrew. It’s a great show, if a bit dated (and some of the gender politics are questionable but can be dealt with with proper staging and interpretation) with an absolutely fabulous score. When I directed it, now sixteen years ago, it became clear to me why it isn’t done more often. It depends heavily on men (often in short supply in community theater) and is basically two different period shows happening together at the same time. One of my less stellar moments came at the first orchestra rehearsal. I had this idea for the top of the second act, leading into ‘Too Darn Hot’ that we would hear the orchestra at a distance as if they were playing inside the theater, while the cast cooled off outside. This would necessitate a prerecorded track and a sound cue, and then the live orchestra would take over. So I sat there and explained what I wanted and told the music director and orchestra in all earnestness ‘So when we get to this orchestral entrance, I want you all to play with yourselves’. Silence. Then hysteria. And that idea was quickly jettisoned.

It may still be too darn hot out there, but not so hot you can’t keep your hands washed and sign up for your boosters.

September 3, 2022

The acute Covid infection is over. It’s been a week now and all that’s left is a bit of a stuffy nose and a feeling of significant fatigue that leads me to needing a nap and ten hours at night rather than my usual seven. There’s no fever, no myalgias, no feeling sick. I hope the fatigue clears itself up over the long weekend and isn’t going to settle into some sort of post viral chronic fatigue. Ain’t nobody got time for that. But what will be, will be and I’m pretty good at reading my body and what it needs. I still haven’t heard much from my dueling employee health departments on when I can actually return to work. I’m hoping Tuesday, but who knows. I may be stuck teleworking another week… or two… or three… It’s hardly ideal but I can at least stay caught up to a certain extent, at least on the UAB side. The VA decided somewhere in the last six months to revoke my telework privileges over whatever arbitrary unfiled form so there’s not much I can do there until they clear me for duty.

So how have I occupied my last few days of confinement? I’m working on the final edit of Volume II of these Accidental Plague Diaries and if all goes well it will be out by the end of the month. I’m working on my lines in a prayer of being off book when I get back to rehearsal this next week. I’ve done some clean up around the house. I broke out the Xbox and realized I’m just no good at Grand Theft Auto V. I’ve read most of The Once and Future Witches which I quite like, other than some rather ham fisted political allegory. Just the usual things a sixty year old man does when left to his own devices at home for a number of days.

I’ve been living with a ghost. Binx, my new cat, absolutely refuses to have anything to do with me or Oliver, my geriatric cat who seems to live mainly on my bed these days. I know he’s here in the condo. Food disappears. Poop appears in his litterbox. I occasionally hear him late at night or catch a glimpse of him out of the corner of my eye. I figure one of these days he’ll figure out I’m not that scary or dangerous and he will start coming out of his hidey holes more often. I’ve found a few more he’s utilizing – behind the washing machine, on one of the bookshelves behind the foreign language dictionaries – he’s going to run out new ones soon. There’s only so many possibilities.

This evening, I ventured out. It’s been more than five days so under current CDC guidelines it’s OK as I have been asymptomatic and afebrile more than 24 hours as long as I keep a mask on (which I did). The opera chorus got together to sing Libiamo from La Traviata at the wake for one of our own who died a suicide a few months ago. I had known my colleague for a very long time. He was a physician like myself, although a generation younger. He had sought me out early in his medical school career as I was one of the very few out gay male faculty at the time and I helped him as a gay man in a homophobic profession through his med school years. He eventually went away for residency for a while and then came back to Birmingham about two years ago when he joined UAB as junior clinical faculty. He attended my church, sang with me in the church choir and the opera chorus and we were always friendly.

When someone commits suicide, especially someone who seems to have a happy and functional life, there are always unanswered questions. The what ifs. The did I miss somethings. Having lost a number of friends to suicide over the years, all I can say is they’re fairly useless questions. We can never really know the interior lives of another, even those with whom we share intimacy. I lived for well over a decade with both Steve and Tommy and never completely understood what they were thinking or how they would react to a given situation. There were always surprises. That’s part of what held the relationships together. There were new discoveries and hidden facets there to be found.

The gathering tonight was a party in a local nightclub/bar, hosted by his fiance (it was the place where they had been planning to have their wedding reception) and it was very much a festive wake. Music, dancing, food, drink and celebration for the fact that he had lived and touched all of us. Despite the surrounding gaiety (much of it literal), I was melancholy. I was having flashbacks to Tommy’s memorial of four years ago. Tommy’s affair was more sedate and had far fewer hula hoops in evidence but had the same air of festivity combined with sorrow for a life cut short. I suppose, at least for the next few years, any memorial I go to for a younger person is likely to jerk me back in that way. The memorials for older people who have passed in their eighties or nineties that I’ve gone to haven’t affected me in the same way. They’re much more of a bravo for a full life well lived.

As I read through the Covid news digests that I receive regularly in one form or another, I wonder if we’re about to head into another surge with the fall and if that is going to lead to more lives cut short, especially younger ones with so much yet to accomplish. US life expectancy has plummeted nearly three years since the beginning of the pandemic, from 79 to 76. Got to remember what that number means. Life expectancy from birth is the calculated actuarial statistical average length of life of the cohort born in that year. Babies born in 2019 could look forward to an average life of 79 years. Babies born in 2021 could look forward to an average life of 76 years. The last time there was this precipitous a drop was in the early 1940s when World War II killed a lot of young people; for it is early preventable deaths that have the most effect on the number. A person that dies at 30 loses about 50 more years of life than someone who dies at 80. And Covid continues to kill young healthy people.

The government of South Africa has a very robust wastewater monitoring program. They take sewer samples (as we all shed virus into our toilets when taking care of business) and find the coronavirus and genetically sequence it and map out the various subtypes that are turning up week to week. They were the first to identify omicron through their diligence last fall. They’re starting to find some new variants in their recent samples. Whether they are more contagious or virulent remains to be seen but when I hear of reports from there, my antennae go up.

On the good news front, both Moderna and Pfizer have had their bivalent vaccines approved for use (Pfizer for 12 and older, Moderna for 18 and older). The bivalent means that there are two different targets, one for the original Covid and one tailored specifically for omicron. Both vaccines are now being manufactured and are working their way into the supply chain and may become available quite soon. Check with your pharmacist. You can get it if you have had a recent Covid infection as long as you’re fully recovered. You can get it if you have had either one or two boosters prior. It appears to work best if there’s roughly a two to three month window since your most recent booster. So, if you had a booster in July or August, I would wait a few weeks. If you had it earlier than that, go ahead and get it ahead of fall. The more I see of the disease and the unknowns, the more I believe that you can’t have too many boosters. There have been hundreds of millions of doses given in this country with minimal problems and it’s certainly best to have as much immunity in place as one can. I’ll be marching out to get my bivalent booster within the next few weeks as I had my second in April.

August 30, 2022

Vintage engraving of a scene from the Charles Dickens novel David Copperfield. It is much better as it is! llustration by Fred Barnard

Covid Chronicles – Tales from the sickbed day #3. I wish I could tell you I was dying like the heroine of a Victorian novel, all pallor and white linen and the soon to be bereaved weeping in the hall, but no such luck. I’m feeling relatively normal, just tired and a bit under the weather. I never had a fever this time around, just a horribly stuffy/runny nose and a bit of a cough and that general feeling of unwellness that tends to accompany viral infections. I’m just keeping my fingers crossed that the fatigue clears itself up in the next few days and doesn’t settle into any sort of long Covid pattern. That’s the only thing that scares me at this point – some sort of prolonged post-infection syndrome that keeps me from living my life on all eight cylinders the way I usually do. To try and prevent that, I am adhering to a five day quarantine here at the condo and puttering through various projects. I can’t completely duck work. We’re so short staffed in geriatrics that I had to drag myself out of bed yesterday by 8 am and do my UAB clinic work from my laptop at the dining room table through various telehealth means. Supposedly we have new hires with clinical responsibility coming in but in the meantime, it’s all hands on deck as the demands for clinical service grow in an environment with shrinking resources and collapsing systems. I think I know how an 18th century midshipman felt as the sailing vessel headed into a gale.

Besides my usual work, I’ve managed to get a number of chapters read in two different books I’m working my way through, binge watched the first half of The Sandman on Netflix, completed a project for one of the non-profit boards on which I serve, and started working on the lines for my next stage appearance. I had nothing on my theatrical calendar for the fall and then the part of Bobby Dwayne Dillahunt in a play called The Hallelujah Girls fell into my lap. It’s one of those ensemble comedies calling for a number of women of a certain age which are popular at the moment. I call them descendants of Steel Magnolias, Crimes of the Heart and Sordid Lives. They usually involve a bunch of Southern women with interlacing friendships getting caught up together in a project or event – hijinks ensue. In this one, one of the women has bought an abandoned church building and is turning it into a day spa ‘Spa-dee-da’ with the help of her eccentric friends. I play her old high school boy friend, now a contractor who ends up doing the repair work around the place. Others include the head injured music teacher who loves all the holidays, the befuddled town clerk with the deadbeat son and a thing for bad romance novels, the acerbic manicurist, and a priggish mama’s boy. It should be fun, especially as we’re performing in an actual church auditorium.

The process of having to rearrange life for quarantine has been cumbersome. I have to deal with two different employee health departments at UAB and the VA who have very different rules regarding when clinical folks may be on premises again for patient care. While my formal quarantine is up on Thursday afternoon, it doesn’t look like I’ll be allowed back at work until the Tuesday or Wednesday after Labor Day at the earliest. In a normal year, with Labor Day weekend free, I would head down to Southern Decadence, an annual gathering of the LGBTQ folk in New Orleans, but I don’t want to push my luck or overdo it with just recovering from Covid so I think it will be wise not to do any such thing. Tommy and I would go to Southern Decadence fairly routinely if we didn’t have anything else on the calendar for Labor Day weekend. We’d do all of our usual antiquing and gallery hopping and then add in dancing at the street party on the gay end of Bourbon Street, cheering on the parade, and drinking entirely too much. I seem to remember an afternoon of one too many hurricanes at Pat O’Briens. Fortunately nobody got sick although we were both a little wobbly as we made our way back to the hotel.

I’m trying to think of a good Tommy in New Orleans story. We would go two or three times a year for a long weekend and we had this idea that when we retired, we would get a little studio condo down there so we could come and go as we liked. One of many dreams that will never be. It was very much our city together because of the food and the art and the music and we never grew tired of it. We made friends with a number of the artists and gallery owners in the French Quarter. We had our favorite restaurants from casual (The Gumbo Shop) to fine dining (Bayona). We liked to explore interesting little shops out past the Garden District and in the Marigny. One trip, we went to mass in the cathedral at Jackson Square and Tommy was inspired musically by the Latin and decided that he wanted to write a musical setting for the mass. This led to a trip to the Catholic bookstore for a missal and various mass translations, and to a couple of music stores for some scores of a couple of the lesser known Requiems and other sacred music. I was pretty sure he would put about five weeks of intense thought into the project and then move on. He was like that. He would become enthusiastic about something and throw himself into it and if it didn’t hold his attention, move quickly on to the next idea. The ones that held him, like wigs, became part of his daily life. The ones that didn’t created piles of paper and notes to be filed away, to be pulled out someday. I have some of these in my various bins of ephemera that I am way behind at sorting. Roughly six months before he died, Tommy was making diligent plans to return to school again. He was interested in M Div programs with an emphasis in sacred music and hymnody. If he had lived, would he have entered one of those? Completed it? Would that mass have actually begun to take musical form? Unanswered questions due to a life cut short.

Since announcing my current infection to the world, I have heard from any number of friends who are also currently battling Covid. And a number of my VA colleagues all came down with it at the same time I did making me wonder if that’s where I caught it. The Joint Commission was at the VA this past week doing their triennial survey. It would be ultimate irony if they were the source of this particular cluster. Someone should call up the surveyors and see how they’re doing.

I wonder if this is where modern life is heading? Boosters and infections. Get a booster to your Covid vaccine that’s tailored to the most recent variants and get sick anyway once or twice a year with a couple of days of misery until either unknown complications, long Covid, or your own advancing age takes you out. It’s too soon to tell. We’re still less than years into this even though 2019 feels like a couple of decades ago. In the meantime, you know what to do. Don’t make me repeat myself.

August 28, 2022

Round two. I suspected something was up last night when I woke up a couple of times feeling not my usual self. When I got up this morning with myalgias, a runny nose, and a mild sore throat, I suspected the worst and got out my handy dandy federally funded home Covid test and sure enough, the pink line appeared and I spent the next few hours getting hold of everyone who is depending on my over the next five days to let them know alternative arrangements would have to be made. I’m assuming this is locally acquired omicron. I flew last Tuesday and that’s sort of outside the window of getting sick on early Sunday morning. God knows I’m running around enough places these days trying to keep all the balls in the air that I could have picked it up practically anywhere. It’s a sharp reminder that we’re not out of this yet no matter how busy we may be or what responsibilities we may have.

I apologize to anyone I may have encountered in the last couple of days to whom I may have transferred virus. I’ll be keeping my mask on for the next couple of weeks just in case any stray critters are still lurking in my nasal passages. All I can say is that this bout doesn’t seem to be anywhere near as problematic as my last encounter with omicron eight months ago. That one felled me for a couple of days. This one just feels like a bad cold and, in normal times, I would be making plans to work normal hours this next week. I’m not allowed to go in to either UAB or the VA until I am cleared by their employee health departments so I’m switching all my clinical work to telehealth this next week and I’ll become a disembodied head on someone’s iPad in clinic. We’re too short staffed for me to loll around the house with bad television. I will go to bed relatively early tonight and try to get some decent sleep before the morrow.

We’re rapidly approaching the end of a fiscal year. Why fiscal years are based around October 1, I haven’t a clue but it does mean that a large number of tasks need to be completed in clinical medicine in order to close the books on fiscal 2022 and begin reeling in the numbers for fiscal 2023. Crossing this arbitrary boundary is going to change a number of things regarding the pandemic, mainly concerning federal funding. The federal dollars for immunizations, medications, testing, and other public health measures more or less run out with the new fiscal year and there’s been no motion in congress to continue these programs, likely due to pandemic fatigue and a general societal feeling that it’s over (even though it’s not – we’re still losing about 500 people a day nationwide and the numbers, while trending downward over the last month, are still way above what they were in the spring). In practical terms, what that’s going to mean is that if you want any additional boosters or test kits after the first of October, it’s going to cost you, or your health insurance which can set whatever coverage rules it chooses within federal guidelines.

Because that’s what we do in this late stage capitalistic society of ours. We monetize everything. If it can’t be harnessed in some way to create profit for some owner of industry, it must be worthless or, if it has obvious value as part of the commons, it must be brought down to size or destroyed through the manipulation of public opinion. (The current wars on public education and public libraries over idiotic ‘save the children’ issues come immediately to mind). What will a Covid booster cost on the marketplace? Hard to say. The federal government is playing Pfizer/Biontech and Moderna roughly twenty dollars a dose for huge bulk orders. The prognosticators are expecting the price to increase to about forty dollars a dose when the government is no longer the sole customer. By the time that goes through various middle men and administrative fees, I imagine boosters will have a cash price of about a hundred dollars. That may be reduced dramatically if we have another more virulent variant and insurance companies run the numbers as to what it will cost them to take care of an increased number of seriously ill patients and they may drop the price significantly in order to encourage more people to be boosted. But this is all pure speculation at this time.

Assuming we stay around five hundred deaths a day (and a certain percentage – somewhere between 15% and 40% depending on whose numbers you believe) of those are in individuals who have been vaccinated and boosted. Most of the vaccinated who die are either quite elderly or have serious underlying health conditions (in other words, my patient population). This is similar to what one finds with influenza. The difference is in the absolute numbers. Flu tends to kill about 20,000 Americans a year. In a really heavy flu year, it doubles. Covid is on track to kill nearly ten times as many if what we are starting to see now is the endemic pattern. If we as a society want to make the decision to bear that burden as part of living, just as we do at all of the other causes of death that we shrug our collective shoulders at, we can. But it doesn’t have to be.

I think we’re falling into our usual myth of control. Americans accept shockingly high risks regarding activities that we think we exert some sort of control and understanding over (driving, high fructose corn syrup, nicotine, alcohol) and are averse to risks we think are outside of our purview (alflatoxin in peanut butter, Alar on apples, cyanide in the Tylenol, shark attacks, lightning strikes). The early pandemic was clearly in the latter category. Anyone could get sick. We weren’t certain how it was being spread. Healthy people were rapidly becoming seriously ill and dying. Now with vaccines and a certain amount of natural immunity, especially after the huge omicron surge of last winter, it’s starting to feel more and more like the former. Yeah, I could get it but it’s not going to be that bad.

Perhaps the most serious issue with the turning of the fiscal year is going to be the drying up of US funding towards international efforts to get vaccines to poorer countries. We often forget, this isn’t a local disease, this is a world wide human disease and any population that is not granted immunity can become a pool in which the virus can grow and mutate. Perhaps our problem is that we’re trying to use the 19th century nation state as the model for solving 21st century problems. Pandemics, climate change, population migrations. All of these things are going to require transnational solutions.

If you’re over fifty and haven’t had a second booster, go get it before the end of the fiscal year.

August 24, 2022

CHICAGO, IL – MAY 16: Passengers at O’Hare International Airport wait in line to be screened at a Transportation Security Administration (TSA) checkpoint on May 16, 2016 in Chicago, Illinois. Waiting times at the checkpoints today have been reported to be as long 2 hours. The long lines have been blamed for flight delays and a large number of passengers missing flights completely. (Photo by Scott Olson/Getty Images)

I am back in the Southeast but haven’t quite made it back to Birmingham. I’m getting older and wiser so when I had a flight from Seattle that didn’t get in until 8 pm, I decided it was best to spend the night in Atlanta and drive back today rather than to brave I-20 after a travel day. I looked forward to sleeping in, but my biological clock is a bit screwed up so I woke up at 5:30 AM local time, but that doesn’t mean I have to get out of bed at an early hour. So here I lie, listening to the muffled sounds of an Atlanta freeway outside the window. I am not getting on the road until after morning rush hour which, knowing traffic in the ATL, should be around 10 am.

Yesterday was a travel day that once again showed the lingering effects of the pandemic on society. I got up relatively early, had breakfast with my father, and headed out the door about 8:15 to catch the light rail to the airport, about a five minute walk. Due to construction, only every other train runs through downtown to Sea-Tac so it was a bit of a wait but I ended up at the airport at 9:30 AM, plenty of time one would think for a 11:30 AM flight on a Tuesday. The departure terminal was a zoo. A lack of Delta baggage and ticket agents meant that the line to drop off bags snaked 100 yards down the concourse. Only two of six stations were manned (and I seem to have been behind a large number of extended families who spoke little English ) so nearly 45 minutes to accomplish that chore. Then into the TSA line, another 45 minutes due to a shortage of TSA agents. I made it to my gate just as my boarding group was called. It’s a good thing there were no transit delays. I was worried about ATL this trip. SEA was the problem.

It’s going to be quite some time before all of the issues with services recover from pandemic related effects. And it’s not going to sit well with a population used to instant gratification. I don’t know what all of the causes of the current bottlenecks are but I can guess. Workers who have died or become disabled from Covid and its complications. Workers who are not seriously ill but who are continuing to quarantine as they should when infected. Workers who have had to leave jobs as the caregivers for children or the elderly within their family systems died and they have had to step up into those responsibilities. Corporations that have not adjusted salary scales for new realities making some jobs simply unattractive. Early retirements. Vacancies in better paying jobs and workers moving up leaving the more menial positions open with fewer entry level employees available due to demographics and anti-immigrant sentiment. Workers unwilling to face the public day after day given the decline in civility and increasing abuse they have to face. The same trends are leading to airport lines (inconvenient but bearable) and the inability of me to get services lined up in a timely fashion for my patients (which will lead to people getting sick and dying when they need not).

For some reason, while waiting in yet another queue, I was inexplicably reminded of my grandfather. John Bertrand de Cusance Morant Saunders was a man of short temper who had no time for the inconveniences of the world. When faced with something like a delay in travel, he would bluster and look around for someone to blame and then let them have it if he could identify a convenient target. He was usually polite but between his imposing physical size, his British colonial accent, and his force of personality, he usually got what he wanted. He mellowed a bit late in life, especially after driving his car into a ravine at the age of 83 in what, given my personal experiences with him behind the wheel, was likely a fit of road rage. He was not seriously injured and he continued on for another five years after that particular incident. When he finally did pass on of natural causes at the age of 88, he left instructions that he be cremated and his ashes interred with my grandmother.

Melrose Abbey

There was a slight problem with this. No one in the family was quite sure where my grandmother was. She was a Scot from Dumfries who grew up and spent most of her young life in Edinburgh, which is where she had met my grandfather (he was in medical school, she a practicing physician). When she died, my grandfather made arrangements for her cremains to be returned to Scotland and buried there. He would not let the rest of the family in on the details but let us know that he had her buried in a cemetery in Melrose. Melrose is a lovely little town, site of the ruins of Melrose Abbey (mainly destroyed in the 16th century wars between England and Scotland). Why he would put her there, we do not know as there were no family connections to the town. Her family were buried in Dumfries, on the opposite side of the country.

She died and was interred in 1976. In 1983, my cousin Jenny, while on her semester abroad made her wat to Melrose and combed the cemeteries looking for our grandmother’s grave. No luck. I followed on my European jaunt in 1984. I too checked every cemetery in town and inquired at the town hall. Still no luck. My parents and my aunt and uncle, on various trips to the British Isles in the late 80s also had no luck. My grandfather was approached but didn’t want to talk about it (he had since remarried). He died in December of 1991 and Steve and I headed up to Seattle for the Christmas holidays that year. While we were there at my parents house, UPS rang the bell and handed me the box with my grandfather’s ashes in it. All I could think of was to call over my shoulder to Steve ‘Grandad’s home’. He wasn’t amused.

Grandad’s box lived in my mother’s shoe closet for the next year or so while my mother and aunt tried to figure out just what had happened to my grandmother so that he could be sent to join her. This involved a number of letters to local authorities inquiring where human cremains sent internationally some sixteen years before might have ended up. We did find out that she had indeed been buried in a cemetery in Melrose. The reason none of the family expeditions had been able to find it was that my grandfather had neglected to purchase and install the headstone as he had claimed. My grandfather was eventually sent over and laid to rest with my grandmother. My mother and aunt had the last laugh though. In Scottish tradition, a woman, when she marries, does not lose her own identity to her husband and family so the marker that was erected reads ‘Sacred to the memory of Alison Jean Maxwell-Wood MD and to her husband John Bertrand de Cusance Morant Saunders MD’. I haven’t been back to Scotland since it was erected but I will eventually go and pay homage. They, for better or worse, are part of what made me who I am.

August 20, 2022

I was a voracious reader as a child. I pretty much taught myself to read between 3 and 4 and was pretty solid by the time I entered kindergarten, having graduated from picture books to chapter books. I started in on adult literature around age 10 and anything that was left lying around I was likely to pick up and try. I don’t think my mother was amused when she found me reading Kurt Vonnegut’s Breakfast of Champions at that age or Mario Puzo’s the Godfather a year later. My mother was, however, relatively shrewd so she figured out that if I was going to read adult material at a young age she was going to guide me and soon she was handing me paperback editions of various classic novels and modern literature for me to read and discuss. By fifth or sixth grade I had worked my way through Jane Eyre, Wuthering Heights, The Count of Monte Cristo, The Three Musketeers, A Tale of Two Cities, Brave New World, 1984, and Auntie Mame among dozens of others.

One of her selections for me was Richard Llewellyn’s story of a Welsh coal mining community, How Green Was My Valley. I don’t think anyone reads it much anymore but the film version with a child Roddy McDowall in the central role is still played on Turner Classic Movies as it was a Best Picture winner back in the early 40s (now chiefly known as the movie that beat Citizen Kane). I read the novel several times as the child protagonist of roughly my own age, the themes of the tight knit family and community being ripped apart by forces beyond their control, and the degradation of the landscape by the byproducts of industry all spoke to my still developing mind. I hadn’t thought about the book for years but today, while wandering the streets of Seattle, it came back to me in full force.

The city of Seattle I grew up in peeks through here and there but the city that is now is unfamiliar. Landmarks have been bulldozed, the rapid increase in population has led to more and more single family homes being replaced by multiunit dwellings, usually cheaply manufactured and ill maintained, the parks and green spaces have been allowed to deteriorate. The city just feels dirty in ways that it didn’t in the past. There’s less care of private dwellings and yards. There’s graffiti everywhere. The streets are full of pot holes. There’s probably very good socioeconomic reasons and stresses behind this that I’m not fully briefed on, not having lived here for thirty five years. But as I was musing on this, I had a sudden recollection of the last line of that novel I read nearly fifty years ago: “How green was my valley; the valley of them that are gone.” It’s a brief sentence that combines the ideas of you can’t go home again with wariness of childhood nostalgia. So I guess that’s where I’m at. Feeling on one level that I am home and this is where I belong and on another level that it’s moved on without me and that Birmingham is where I need to be.

Not much has happened in the few days that I have been here. The weather has returned from Alabama heat and humidity to Pacific Northwest room temperature and breezy. I attended a birthday party at one of the parks on Lake Washington this afternoon and looked out over the blue waters thinking of my endless childhood summers at the Laurelhurst Beach Club where we all spent our time digging in the sand, swimming in the lake and flinging ourselves off various diving platforms. The crows in the trees were eyeing the picnic goodies and the ducks from the lake were intent on my Cheetos. (I gave in and fed them a few. I know you’re not supposed to but I’m a sucker for a soulful glance from any sort of animal). I did not swim.

The Laurelhurst Beach Club

My talk to the residents of my father’s senior living facility was a success. I’ve figured out just the right balance of stand up, story telling, medical information, and common sense to hold a senior audience for ninety minutes. I just hope they all buy a copy of the new book when it comes out. I did meet my editor/publisher briefly and we should be on track to have it finished and available by the end of September. At that point, I will take a little break and start thinking about Volume III of these Accidental Plague Diaries around New Years. I am hoping that will be volume the last. If enough people will get their boosters and the virus doesn’t have a a particularly nasty mutation in the next few months, we may be at the end of the pandemic and firmly into endemic territory by the end of the year. We shall see.

Tomorrow, we have a gathering of the clan at my brother’s house so we can all catch up with each other for a few hours. Then I have one more day of unstructured time before returning back to the Southeast on Tuesday. I haven’t decided what I’m going to do with Monday yet. Something will present itself, it usually does. In the meantime, to bed. I have more sleep to catch up on.