It’s Monday evening. I survived another double clinic day at UAB without too much disastrous happening. Most patients were in for what I term their well baby checks – a four to six month follow up to make sure their chronic diseases aren’t acting up to much, they’re still functioning as independently as possible, their medication list makes sense, and their health maintenance is vaguely up to date. It takes about 20-30 minutes to do this for your average octogenarian so, with another patient coming in every half hour, there’s not time for the fifteen or so minutes required to craft even a short electronic health record note so they are all batched and I get to them sometime over the weekend, having to do somewhere between ten and thirty on either Saturday or Sunday. This is why it’s somewhat difficult for me to take weekends off. If there is a bit of downtime in the clinic, it’s spent on the sixty portal messages and forty faxes that arrive on the average day. And I’ve been doing this for twenty-five years. When I start to multiply it out, it comes to tens of thousands of patients and tens of thousands of hours of work. And I am getting tired. I can tell that I just don’t have the energy at the end of the day that I once had. I’m trying to keep up my usual pace, balancing medicine and performance and writing but it doesn’t come as easy as it did even five years ago.

I returned from my Augusta jaunt this past Wednesday evening. The drive back was uneventful other than hitting Atlanta at rush hour making the forty mile trip from beltway to beltway take something like two hours. I had to go through the center of the city as I had a late lunch/early dinner with an old friend Brad Greene who lives just north of Piedmont Park. Brad was the first friend that Steve and I made on moving to Birmingham in the late 90s. We met him when he sold us a desk at Storehouse Furniture at the Summit. He was in and out of our lives over the next few years and was incredibly supportive of both of us during Steve’s terminal illness. Brad left Birmingham not long after Steve’s death for Atlanta and has bopped around the Southeast quite a bit over the years but we’ve always remained in touch and try to catch up occasionally.

Waiting in my home email when I finally got to the condo on Wednesday night (I detoured to church choir rehearsal first), was the script to Two Boys Kissing, an oratorio for men’s voices and instruments by Joshua Shank from the young adult novel by David Levithan. The piece, which is for men’s chorus, requires six narrators who tell the intertwining stories of gay teenagers in a small town. One of the six slated to do the performance with Birmingham’s gay men’s chorus, Steel City Men’s Chorus, had had to drop out and I was asked to be a last minute replacement. Fortunately, it did not require me to memorize the script, but I still had to learn how my lines fit in with the other actors, the choral music and the orchestra parts. I was able to read it Thursday morning in the car heading for house calls, got a tech/orchestra rehearsal Thursday night where I had absolutely no idea what I was doing, a dress rehearsal on Friday night, and off we went to the races on Saturday night. The composer was in attendance and told us that we were the best set of narrators this work has had so I must have dome something right.

I found it interesting that the composer considered the piece an oratorio. They are usually defined as a long work, using soloists, chorus, and instruments, to tell a story, usually on a religious theme. They were very popular in the Baroque period, the most famous example being Handel’s Messiah. Two Boys Kissing doesn’t strike one as being a particularly religious piece of material (and more conservative denominations would shriek with horror at the very notion) but the more I was immersed in the work, the more I felt that it was exactly the right way to describe it. The chorus and the narrators function as Greek chorus, commenting on the stories. It doesn’t take long for us to understand that they represent the previous generation of gay men, the ones lost far too young to HIV, whose souls remain to watch over the younger generations coming up and help tell their stories, both comic and tragic to an indifferent world. There was something religious about a group of gay men, most of a certain age who have real lived experiences with the HIV epidemic, singing and speaking in the voices of their dead peers to an audience with younger gay people and their allies about their generation as seen through older and sadder eyes. But isn’t that one of the most important functions of religion? Transmitting the culture of shared values through story and song? As I was up there performing, ghosts of my past – men who should have been my mentors, my allies, my supporters – kept rising up in my brain demanding to be remembered.

This whole weekend has very much been about the power of narrative. On Sunday, I went to see the tour of Come From Away which played this week in Birmingham. I had seen the show in New York a few years ago and thought it was one of the best directed pieces of theater I had ever seen – a cast of twelve playing thirty odd roles on a simple set with some tables and chairs and you never lose track of who or where they are. Christopher Ashley absolutely deserved his Tony for direction. Originally, I wasn’t going to go as I didn’t want to disturb my memories of that terrific Broadway production but my friend Mackey Atkinson convinced me otherwise and I’m very glad I listened to him. The show was every bit as good on tour as it had been in New York. Often times smaller shows get swallowed in the barn of the Birmingham Jefferson County Convention Center concert hall but this one felt OK there. For those of you who don’t know it, Come From Away is the story of what happened to Gander Newfoundland on 9/11 when US airspace was suddenly closed and sixty planes with 7,000 passengers were diverted to its airport, straining the abilities of a town of under 10,000 in terms of coping. It’s funny, tragic, brilliantly written, and above all human, showing the best of what we can do for each other in times of crisis. One of its major themes is the importance of story. Of the twists and turns that happen in the lives of both Newfoundlanders and plane people as they are suddenly thrown together. If you haven’t seen it, there is a pro-shot video of the Broadway production available on Apple TV.

All of this informed my other major task for the weekend. I am scheduled to give the pulpit message at church in two weeks and I needed to get that written for pastoral review. I was asked to talk about my writing and books but was otherwise given fairly free reign. The essay I’ve crafted is entitled ‘Unfinished Stories’ and weaves together my writing and whence it comes, the losses that have powered it, the need for story and how unfinished stories are sometimes the ones that are most needed. I’ll post the text and the link to the stream of the service after I give it.

This entry, however, is finished. I’m tired. To bed, to bed…

Dateline – Augusta, Georgia

I’m away from home but I can’t say I did any traveling today, unless one counts the four miles from the Doubletree hotel to the Augusta VA medical center and back. The VA, a large national organization, is broken down regionally into subgroups based on geography. Alabama, Georgia, South Carolina and Northern Florida together make up the 7th region and it’s a conference regarding the issues surrounding the house call, geriatrics, and extended care (nursing facility) programs. It’s the first time in several years that such a conference has been held in person rather than on zoom. I was asked to participate due to my many long years of work with the rural house call programs in Alabama and because folk at the regional office had read the first volume of the book and had liked it and thought a wider audience should be aware.

So I came, I spoke, I read from the book, and I finished it off by falling over when I stepped back from the lectern. I had made the mistake of locking my left leg for better standing balance as I had to refer from notes to book I was reading from and back. Doing so irritated my sciatic nerve and when I went to put my weight back on the leg, it gave way and down I went. The irony, especially as one of the entries I had read was one on fall prevention. I was unhurt, other than bruised dignity and the audience was woken up and likely to remember what I had to say a bit more. We shall see if it translates into any sales. Sales of the first volume have been reasonable. Sales of the second volume have been a bit anemic but I haven’t had a lot of energy to put into promotion. I’m thinking I’ll get the third volume out and then I’ll spend some time really trying to push it. Perhaps a commemorative box set with a free Covid bookmark…

The issues that came up today were familiar and universal. Lack of staffing, lack of resources, increasing service needs from an aging population. Heck, they’re the same things we were dealing with more than thirty years ago when I first went into geriatrics. Le plus ce change… I have to face it, it’s a dying specialty. No one wants to go into the field and there’s minimal institutional support for the kinds of work we do. The Baby Boom has decided that aging simply doesn’t apply to them and therefore programs dedicated to aging are irrelevant. I’m not sure how I’m supposed to feel as my life’s work is pretty much written off by society. I guess I just have to wait fifteen or twenty years when I’ll be able to say ‘I told you so’ as the Boom generation finds that it is unable to prevent its die off and the pieces of the medical system that might have been helpful have disappeared through neglect. Palliative care programs will be around and functioning. Most of the younger physicians who would have been attracted to geriatrics in the past are now entering these programs instead. They aren’t quite the same but there is a lot of overlap. I guess when I hit my dotage, there won’t be anyone around to created a decent care plan for my dementia, but there will be someone to make sure I don’t suffer while I go through it. It’s something I suppose.

I was looking forward to a quiet weekend but I received an urgent missive looking for help with a performance happening this weekend so I’m going into a Saturday only performance after rehearsals on Thursday and Friday. Fortunately it’s on book but I still have to become familiar with the material and, as it’s got music involved, figure out what the cues are supposed to be. More on that later…

In the meantime, I ate too much (ribs and loaded mashed potatoes) at the Texas Road House with the VA gang so I am going to lie down and digest for a while before sleep. Another half day of conference in the morning and then the trek back to Birmingham, broken by a late lunch/early dinner with an old friend in Atlanta. If it all works out properly, I’ll be back in time for church choir rehearsal which will make my choir director happy. We are singing an anthem on Sunday – either an old Shaker hymn or selections from ‘Hair’. UU music is nothing if not eclectic.

Dateline – Augusta, Georgia

He’s in travel mode again… But it’s nothing terribly exciting. Just a quick hop over to East Georgia in order to make a presentation about The Accidental Plague Diaries to the regional VA geriatrics consortium. I wish I could give you a breathless description of cultural wonders and impressive scenery but five hours of I-20 eastbound simply isn’t conducive to that. The best I have to say is that the redbuds and the wisteria along the interstate are all in bloom. And something is blooming that’s making my eyes sting and water occasionally. It only seems to happen when I’m in the car so I assume it’s something that gets into the air circulation system from the outside and then blows repeatedly in my face until I’m tearing so badly that I can barely see.

There is one respite from rolling hills and vegetation at the half way point, but that’s downtown Atlanta, which remains one of my least favorite American cities. At least I timed it so I didn’t hit it at rush hour and there were only a couple of brief slowdowns as I made my way through. I do take an occasional Atlanta weekend, mainly around a theater production or opera I want to see. Atlanta Opera is doing Paul Moravec’s The Shining next season (yes, based on that novel) and I will make an attempt to go see that as I just want to see how it adapts itself to the opera stage. The themes are certainly operatic in scope and the word of mouth on previous productions has been pretty positive so I’m hopeful. Although I assume blowing up the hotel and a few things of that type will have to be presented conceptually rather than fully staged. The fire department frowns when you burn down the theater with an audience inside it. Shades of the Iroquois in Chicago…

I made it to Augusta unscathed and am ensconced at the Doubletree on the federal government rate. I’m also in one of the oddest hotel rooms I have ever occupied. It’s a pretty standard queen double, but the one window looks out into a hallway and this floor’s elevator lobby. I have drawn the blackout drapes as I really don’t wish to have an audience of random passers by as I sleep tonight. I can’t imagine this was designed deliberately but is rather a consequence of some building addition blocking the previous view of the parking lot. But one never knows, does one.

I think I’m ready for my presentation tomorrow morning. As it’s more or less about narrative in medicine and how my interest in that subject was one of the impetuses that led me to do the writing that became the two, soon to be three, volumes of The Accidental Plague Diaries, I’m pretty much going to wing it from an outline. If you’re going to tell stories, it’s best to just tell them but have a good idea beforehand where they’re supposed to go so you don’t wander too far out into the rough. I’m giving a pulpit message at church in a couple of weeks on a somewhat similar topic. That I will fully write before hand. When you’re in a pulpit you need to consider all of your words carefully. Plus I’ll want Reverend Julie to vet it before hand to make sure there’s nothing in there that would rebound on her or the church in someway, particularly as we now stream all the services on YouTube and who knows who is watching.

I missed the Oscar telecast last night due to Opera Birmingham commitments but there were a couple of awards that connected into my life. The big winners were, of course, the team behind Everything, Everywhere, All at Once which is an incredibly unique film and worth a watch if you have not yet seen it. I’ve now seen it twice and I’m sure there’s lots I still haven’t got what with its multiple parallel universes and interacting story lines. It was written and directed by Daniel Scheinert and Daniel Kwan, collectively known as the Daniels. Daniel Scheinert is a local boy who came out of Birmingham theater. I met him a couple of times fifteen years ago when he was doing local stage and before he gravitated to film but I can’t say I really know him, but lots of friends know him and his family well and all of Birmingham performing arts has been rooting for him all awards season. I can certainly see the influence of the anarchic early Theater Downtown and enfant terrible Billy Ray Brewton in his movie work. The other winner I crossed paths with years ago was Brendan Fraser, back when he was a gawky teen drama student at Cornish Institute and the box office assistant for my friend Sue at Intiman Theater in the late 80s. Those of us who knew him then would not have picked him as he once was to be a movie star and Oscar winner. Things change.

This isn’t my first time in Augusta. Tommy and I spent a few weekends here over the years. We had a few favorite restaurants and walks we used to do. I don’t think I have the heart to look any of them up this trip. I’ll probably stick pretty close to the hotel. I wouldn’t turn down an invitation to see the club that’s the home of The Masters but I doubt that’s forthcoming. I’m not important enough.

It’s spring ahead weekend again so here I am on what I think should be Sunday morning and it’s already Sunday afternoon. Thank goodness the choir was off this morning at church so I didn’t have to get myself up and out the door in time for rehearsal or I would be sitting there bleary eyed trying to sight read the first hymn while the congregation is busy singing the second. This is my 20th continuous year with the Unitarian Universalist Church of Birmingham choir and I have aged into being one of the more senior members. There’s only a half dozen or so who predate me. If someone were to tell my younger self that I would be singing in a church choir much less for decades on end, I would have assumed that person either had a major Axis I disorder or was on some sort of drugs, but here we are.

I was raised with church affiliation. My parents thought it was important that we have some understanding of religious life and its place in society and had very strong ideas of what religion should not be. It should not coerce. It should not narrow a world view and allow for exploration and free thinking. It should not preach one thing from the pulpit and practice something else the other six days a week. But, I was also raised in the Pacific Northwest, the most unchurched region in the country. The denizens of Seattle had figured out how to organize society without a significant religious component before World War II. I suppose it had something to do with all of the free thinkers being driven west and north by the attitudes of their more church going neighbors throughout the 19th century.

My father was of the Pacific Northwest, having been born and raised in Olympia, gravitating to Seattle for college. He grew up in a strong fundamentalist Methodist household but he rejected it as he hit later adolescence due to the blatant hypocrisy he found between what church members said in church and what they did the rest of the time. My mother, growing up in her transplanted British household in San Francisco, was nominally Church of England on one side and Church of Scotland on the other, but again, found much of the thinking too narrow for her taste. After they married, they didn’t have much to do with church. They were briefly members of a Unitarian fellowship when they found themselves in rural Texas as my father finished his PhD but I think this was a survival mechanism as it didn’t stick. Once they were settled in Seattle with multiple children, they decided to find something.

What they found was the local Congregationalist church, under the Reverend Dale Turner. Dr. Turner was an outspoken voice for liberal values and the inclusion for all at the table within the confines of church teachings and was very much to their taste regarding the role of religion in public life. Dr. Turner was a much beloved figure in Seattle religious circles for years and, even after he retired from the pulpit, wrote a much admired weekly column for the Seattle Times. So, even while we were not particularly regular church goers, we were active in the congregation (my mother ran the holiday food box program for decades), and it was my home church. I suppose a lot of my underlying empathy for the other, strong belief in equitable solutions for society, and belief that religion, while important, should be kept within oneself and one’s spiritual home rather than trumpeted in every public sphere all comes from these beginnings.

In adulthood, I moved a little bit further left from Congregationalist to Unitarian-Universalist. When I look at the style of worship, the content of sermons, the function of religious education and all the rest of it, there’s not a lot of difference between University Congregational Church in Seattle and the Unitarian Universalist Church of Birmingham. The major difference is that UCC had a cross at the front of the sanctuary and mentioned Jesus a bit more while UUCB has a flaming chalice and Jesus comes up as a great teacher rather than as a divine being. The move is courtesy of Steve who wavered back and forth between Metropolitan Community Church (of which he was one of the twelve apostles – having been one of the twelve at the very first service in Troy Perry’s living room back in the early 70s) and the UU church in Los Angeles. He did the same thing in Sacramento during our time together. When we ended up in Birmingham and truly needed a religious support group due to the stresses and strains of his terminal illness, the UUs won out and so here I am. The music piece is, of course, thanks to Tommy who pretty much demanded that I join the choir soon after we got together as a couple.

I hadn’t planned on writing about my personal spiritual journey today. it’s just what came out. When I sit down to write these pieces, I just get in the zone and let the fingers fly across the keyboard. Any number of things can happen. Church is on my mind as we had our annual Stewardship dinner last night. It’s the focal point of pledge season where we try to chivvy the membership into giving enough money for the next fiscal year so we can pay the salaries and keep the lights on. As a relatively young church, we don’t have an enormous endowment to draw on but we do own our building and land outright and are out of debt. I was asked to be the MC. Twenty-one years ago, I was the MC for the first time and, as things were a bit more free wheeling in those days, the character who became the Ansager for the Politically Incorrect Cabaret was born. He’s now old enough to drink. Watch out world…

Today, on the other hand, is all about opera. It’s the weekend of Opera Birmingham’s annual vocal competition. Ten young artists competing for prizes and a gala dinner. As president of the board, I’m expected to show up. One of the competitors, a tenor, is lodging in my guest room, likely as a sneaky way to make sure I don’t forget to turn up and make whatever speech and toast is expected of me this evening. While UU is Steve’s gift, opera is definitely Tommy’s. Over the last two decades I’ve gone from being an irregular attendee to an active participant on stage, behind the scenes, and in the rarified world of movers and shakers that keep the art form alive in this country, not easy when younger generations have greatly shortened attention spans and music training has been tossed out the window in many of our schools.

It’s nice that the pandemic has receded enough that large public dinners are a thing again. I’m still keeping my hands washed. And I’ve had all my boosters.

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.

It’s a new month. I guess that means roughly 1/6 of 2023 has already gone by and I’m just at the point where I’m writing 23 rather than 22 when I’m dating things. I have to sign and date a lot of paperwork. Nothing happens in US healthcare without a physicians signed order resting behind it and, as I work in a specialty which requires a lot of coordination with outside agencies, the pieces of paper fly thick and fast toward my inbox, demanding a hastily scrawled signature and date. No one really cares what I scrawl as long as it’s something that can be attested to as my mark at a later date should any questions arise. Light days see 20 or 30 pieces of paper looking for my pen. Heavy days are closer to 75 or so. More and more of the intra-system works on electronic records and electronic signatures which are relatively easy but the minute you get outside of your home system, that all breaks down as no two electronic health records speak to each other and so off to the fax machine you go with your little pile heading off to home health agencies, assisted livings, hospices, and the like. We’re the only sector still dependent on fax as we’re still operating under 1980s and 90s rules regarding data management. Someday, they will be overhauled and we’ll join the 21st century. I’m likely to be retired by that time though…

I’m feeling a bit beat down by it all at work currently. My clinical partner is on an extended leave. We’re so short staffed this means I basically have to do both jobs until her return. We’re also onboarding new staff and are facing a move to a new suite in June. It’s always something. If the system were operating smoothly, all of us this could be handled in good grace, but it’s not. There’s a lack of both clinical and administrative staff which means referrals are not handled in a timely fashion. No senior living facility has adequate staffing at the moment meaning that those who live there are not as well monitored as in years past and are brought to attention at a later stage of disease making patients more difficult to care for. The pandemic driven consolidation in health care agencies has led to a noticeable decline in the quality of services available. The level of comfort with email and portal messaging on the part of patients and their families has led to an explosion in the number of contacts as they write in for every little thing, most of which are variations on normal. I really don’t need to review pages of unsolicited blood pressure readings and I really don’t need photographs of mom’s bowel movements. OK I’ve got that off my chest…

It will get better. My mood will improve or I’ll have a really good day at work or I’ll meet a new patient with a really interesting story about his or her life and I’ll be reminded why I do what I do. In the meantime, let me wallow a little bit. I think I deserve it. As long as it doesn’t continue for more than a couple of days…

I am slowly getting my backlog of projects under control. The financial records have all been collected for the taxes and my usual accordion file is ready for my accountant. I made my quarterly run to Costco. I got the shopping for the week done. I’ve reviewed the Sunday school lesson I need to teach tomorrow. (Pity the elementary class that gets me as their teacher). I finished up the legal case I needed to have done by the weekend. On the docket for tomorrow is getting the back broken on the talk I have to give in Augusta on the 14th. I have a basic gist of an idea in my head but I do have to get something on paper. As it’s going to be more or less about the importance of narrative in health care and senior services, I’m not going to prepare powerpoints or anything, I’m just going to talk and tell the story, but I sill need to have some signposts in front of me while I do that to be sure I don’t wander too far off into the rough. (See what I did there – Augusta – golf metaphor…)

I’m behind on my editing of volume 3 of the book. I should be able to get to that this next week. To be frank, I’m a bit scared to look over those entries. There’s this piece of me that’s afraid that I’ll read them and hate them all as they’ll be too repetitive and too filled with navel gazing to be of any interest. But there’s another piece of me that feels the story of the pandemic, as told in the book, remains unfinished and that third volume is necessary for the work to make sense as a whole. I’ll let me cognitive dissonance fight with itself for a while and something will eventually come of the battle. And what emerges usually ends up being pretty good.

I’m feeling the need to rant in depth on something in regards to the health system but I’m not sure what I can talk about that I haven’t already dissected in some way and I don’t want to repeat myself ad nauseam. Maybe I should move out of health care but the only other subject area in which I have significant learning is in musical theater and I’m not sure anyone wants my in depth analysis of the works of Rodgers and Hammerstein as compared to Kander and Ebb. If anyone has a request, I’ll take it under advisement.

A friend from opera circles made his Met debut today. I will never sing on stage at the Met (unless I join the cleaning crew) but I’m always thrilled when someone of my acquaintance attains that milestone. The combination of pandemic and finances has kept the Opera Birmingham chorus relatively silent in recent years but I should be back on an opera stage in 2024 (I know what the show is but I’m not authorized to reveal it). It will be the first time since 2019. There’s been some operetta in between but Covid pretty much knocked out most things the last few years and the 2022 and 2023 grand opera offerings used very small choruses and I’m not at the top of the list when you only have twelve slots. I have been back in voice lessons so my technique is improving slowly so by spring of 2024, I should be up to snuff.

I did get to sing once on a Broadway stage. I was invited backstage at the 46th Street Theater after a performance of Hamilton a few years ago. I made sure to go down to the lip and sing a few bars to the empty house so I could say truthfully that I have sung on Broadway… It counts, doesn’t it?

And just like that, Dearly Departed has departed; whether dearly or not can be debated. On the whole, I was very pleased with the run. The cast really found their footing and timing in the second weekend and the audience responded with hoots and hollers to all sorts of highly inappropriate material such as family fistfights, adulterous affairs, funeral price gouging and diarrheal vicars. I’m not really sure that the play is a comedy, even though it is sold as such. I see it as much more of a dramedy with a slightly heightened reality and I kept telling my cast that for the humor to work, it had to be grounded and centered in real lived experiences. If you’ve ever spent any time in the small town South, you will have met people just like them and the play works because it balances the ridiculous situations with moments of heart where we realize that these are not caricatures, but characters just trying to live their best lives through the crap life flings at them. Will I direct again? Who knows. I seem to remember what I’m doing and I’ve been doing it for 43 years so maybe someone will ask again.

I have nothing else specific on my theatrical calendar moving forward but I’m not worried about it. Something will turn up. It usually does. There aren’t that many actors of my age and type in town and there’s lots of character parts written for aging men. I have the advantage of easily aging up on stage due to the white hair and that has opened up even more opportunities to sink my teeth into some interesting roles the last few years. I’ve been asked to reprise my performance as Mr. Pendleton in Choir Boy for a production in Utah this next season. It’s unlikely to work with my medical professional schedule but it’s highly flattering to be asked. When I do retire, I’ve thought about exploring film/TV work in Atlanta some. Screen acting requires a very different set of skills than stage acting and I’m not sure I have them though.

Our old friend Covid is not gone. Other viruses are making their usual seasonal rounds as well. Norovirus, which pops up every February and March, has been making local inroads the last few weeks. It causes a rather nasty watery diarrhea which is uncomfortable and inconvenient in most adults but which can cause grave issues in my patient population with their reduced physiologic reserve. It doesn’t take much to tip them over into dehydration which can then start a cascade of events that you really don’t want. I was on call this past weekend and I got an emergency call yesterday evening from a patient family. Patient and adult children all came down with Covid. Paxlovid now! I got everybody’s prescriptions called in to profuse thanks. More messages first thing this morning. The patient’s Paxlovid was somehow left in the middle of the front lawn overnight and rained on. Can a new prescription be sent now? I’ve learned never to ask, just accept and move on to the next semi-urgent message in the queue.

Katelyn Jetelina, whose substack is incredibly helpful for understanding the public health science around Covid and other disease processes, put together a very good summary of what we know about vaccines based on reports that came out of the Advisory Committee on Immunization Practices meetings that recently happened at the CDC. Takeaways included that the bivalent booster vaccine, offered since September, has been very effective at preventing hospitalization from Covid. This is particularly true for the over 65 population. (I’ve been reading, writing and thinking about the over 65 population for decades and it’s finally dawning on me that I will be one of them in just over four years). It looks like the data is supporting the idea of an annual booster moving forward but time will tell and I still think there are a few surprises in store for us from Covid before it’s done with us.

There is still some unease in the use of the boosters in adolescents due to the chance of myocarditis, especially in young men. Fortunately, the bivalent booster has had no reported cases of myocarditis and the calculated risk of the vaccine is below the risk of hospitalization and death from no vaccine. The chance of myocarditis is no higher than 1/10,000 and probably closer to 1/100,000, well below my threshold of the 1/8,000 chance all Americans have of dying in a traffic accident in any given year.

I thought about taking every evening this week off to veg after the business of the last few weeks but, alas, I still have to finish the taxes and have talks to write and a book to edit so, as we say to the god of death, ‘Not today’. But I will allow bad TV and musical cast albums in the background as I go through these chores.

Does one wish others a happy Ash Wednesday? The start of Lent should probably not be thought of as an occasion for merriment. The day before however… As I am neither particularly Christian nor residing in New Orleans, the last two days have not been anything outside of the usual work load. I did have yesterday evening off from all rehearsal and other obligations but rather than running naked through the streets, begging for beads, I used it to break the back on sorting my 2022 financial records so my accountant can make some semblance of sense of my 1040 when I take them all in next month. I’ve decided I’m not broke yet and can afford to live another year as long as I continue slaving away for UAB and the VA.

I am participating in Unitarian Universalist social media Lent which involves posting a picture a day through the forty day period exemplifying various positive qualities and emotions. That’s something I can get behind. As far as giving something up, I’ve decided that this year it’s ice cream. I don’t eat a lot of it anyway, not that I don’t like it, I just don’t so it shouldn’t be too hard for me to deny myself of something pleasurable. Other thoughts were women (not at all difficult) and exercise (not the best of ideas) so ice cream it is until mid April. Given that it was 83 degrees this afternoon in Birmingham and feels more like June than February out there, this might be trickier than I first assumed. As we’re in the semitropics and most of the rest of the country is in frigid storm, I’m assuming we’ll have another clash of weather fronts shortly and we’ll all be watching our weather maps around here for tornadoes. They rarely bother us here in the Jones Valley where central Birmingham is located and where I live and work so I don’t spend a lot of time worrying about them. Besides, I live in an eight story concrete fortress of a building that’s not going anywhere. My house call territories are within various tornado belts in the hinterlands but we’re smart enough to cancel or postpone if the weather looks that dubious.

Dearly Departed has one more weekend to run. Tomorrow, Friday, and Saturday evenings at 7:30 and Sunday matinee at 2:30. Those of you locally whom I have supported over the years by attending your shows and financially donating to your companies and productions need to get yourself over to a performance and honor your fellow creators of theater. What will fill its place in my social/artistic calendar? It’s not completely clear yet. I got a message about doing a one off special concert earlier today and I have some other oddball gigs on the books in the spring, but no specific shows are there yet. There was one I kind of hoped to do coming up in May but I took another look at the production schedule and I have conflicts the last weekend of performance so that’s out.

I had two multi hour board meetings this afternoon/evening for two different social service agencies. I currently sit on four boards – two performing arts companies and two social service agencies with programs for seniors. That’s about my limit with my work and other commitments. I can see that part of my life expanding greatly when I retire and having far more than four in my life. I was raised in a culture that believed that professionals such as myself were obligated to give back to their communities in exchange for the relatively high status their qualifications give them and I’ve always sat on boards and taken part in civic affairs in one way or another. One of the destructive things to come out of the last five years or so, as we tear ourselves apart into various armed social camps, is a deterioration of this sort of understanding that society doesn’t function properly if we don’t give back to it each in our own way and learn to cooperate and work together with others who may view things very differently than ourselves. The gut reaction today seems to be if your ideas are different, I’ll just call you names and then go home and post nasty memes about you and people like you to my social media. If we all keep doing that, there’s not going to be a civic organization left that actually functions.

Jason Robert Brown’s musical, Parade, is having a major revival on Broadway. It’s first preview was last night. It’s not an especially well known show outside the theater community despite having won Tony’s for best book and score. It dramatizes the Leo Frank trial and ultimately his lynching outside of Atlanta in the years leading up to World War I. It’s a heavy subject and the incident still casts a pall over Southern Jewish life more than a century later. (If you’re unfamiliar with Leo Frank and his saga, read up on it). Theater goers in New York were met with neo-Nazi protesters in front of the theater last night. I’m not exactly sure what their point was, probably just free publicity, but the fact that something like that even happens in this country today shows just how low public discourse has fallen over the last few years. Between that, book bannings (which haven’t quite reached the stage of book burnings yet – but it will), members of congress advocating the dissolution of the union, politicians meddling with the free expression of ideas in higher education, and various steps being taken to reintroduce the subjugation of women, I sometimes wonder just what historical period I’m living in. At first I assumed it was the 1930s but with various revelations of child labor and an Alaskan politician advocating for the death of abused children as an economic benefit, now I’m thinking the 1830s. We may get back to the 1730s in another six months.

Theater is the mirror of society. Each generation takes the text and mounts it in a new way to reflect the current audience. Parade may be just the show we need to show us who we are.

Dearly Departed opened last night with the first of its six scheduled performances. Was it flawless? No. A couch made an unexpected appearance in the middle of Act I, there were some minor lighting and sound kerfuffles, and at least one key prop didn’t make it onstage for its starring role. But most of it were things that an audience unfamiliar with the production would\not have picked up on (except the couch – no hiding that one…) and the comments I heard from the audience were highly complimentary, declaring the show a success given the limitations of budget, equipment, and time that plague any community theater production. I was very proud of my actors. It was the first time I was able to simply sit there and watch the show without picking apart the myriad details that my minds eye tells me would make it better. I had no notes to take, no technical snafus to try and solve, no trying to figure out how to coach an actor to the next level through positive reinforcement. Tommy once said that his goal was to go to local theater and see everyone he knew on stage and still see no one he knew on stage. I think my cast achieved that. As I just let the rhythms and language of the misadventures of the Turpin family envelop me, I was seeing those characters, not the actors I’ve been working with so diligently.

Much of Dearly Departed is relatively short blackout scenes, usually of two or three people. I’ve seen other productions of the piece where two or three people talking at a kitchen table quickly gets boring. I was never bored. My cast has learned to work together as an ensemble and support each other and create layers and nuances that keep the ball rolling. My favorite scene in the play is just two brothers sitting on the porch steps with pint bottles of bourbon. It took me all of about fifteen minutes to stage it – what can you do with sitting on the porch steps? But, as it was performed last night, there was a current of humanity and universal concerns of love, death, and family that came through to me in ways it never had in rehearsal when I was so caught up in the details. So, if you happen to be in Birmingham next weekend, honor those eleven people on stage (and the other three behind the scenes) and go see what they’ve created. I’m not sure I had that much to do with it.

Now that the show is open (my job ended when the lights went down last night – I can turn up for performances but I’m certainly not needed), I have to start turning my attention to the various piles of things that have fetched up on the dining room table these last few weeks, dropped there to be dealt with ‘once the show is open’. I have a talk to give on The Accidental Plague Diaries and how it relates to trends in senior care in Mid March, a pulpit message about my writing in early April, a trip to Seattle to check up on the paterfamilias, a symphonic choral work to learn, and a couple of legal cases to delve into. Should keep me off the streets the next few weeks.

There’s been almost no reportage on Covid over the last few weeks. At least there’s been nothing that’s penetrated my little theatrical world bubble. So I poked around a bit this afternoon through my usual sources. We’re still losing about 2500-3000 people a week and there’s still 30,000 people in the hospital nationwide (with about 3500 in intensive care. It remains way down from the previous peaks but it’s still an unfathomable number of people in the aggregate. As a comparison, it’s roughly three times the number of women who die of breast cancer weekly and about the same as the number of Americans who die of stroke. One of the programs under the federal pandemic response legislation was one that has subsidized data collection from all of the individual health departments at state and local level and allowed us to see the total numbers in something approximating real time. As of May 11th, when the emergency phase of the pandemic officially comes to an end, that funding ends as well. The numbers will again come piecemeal and poorer states are likely not to report much at all. We’ll also lose things like wastewater surveillance which has been very useful in determining where Covid is actively spreading even when the official numbers have been somewhat murky.

Healthcare is pouring money and resources into community based care programs to try and decentralize medical care away from the hospital and back to the home and the community for things that do not require hospital care. This is laudatory but the ravaged landscape of healthcare post Covid means that we simply don’t have the man power to enact all of the programs and ideas that the ‘Make It So’ administrators sitting in corporate offices are churning out. Somewhere around 10-12% of the healthcare work force quit or retired during the acute phase of the pandemic and there’s a couple of other percentage points headed towards the exits as their lives have become more and more intolerable as they have to pick up the slack for their missing colleagues. It’s going to take a generation to replace those numbers and the expertise that was lost as most of the departed were older and seasoned professionals. We sit around our conference table in our clinic and house call program offices trying desperately to figure out how to find more qualified providers and how to fairly divvy the workload among those we do have. And try not to roll our eyes too much when someone in central administration wants to replace our house call vehicles with an all electric fleet. (Bureaucrats haven’t quite figured out that there are no charging stations in rural Alabama and that the lightweight vehicles they are considering will never make it to the mobile home in the holler where you take the county road, turn off on the gravel road, head down the dirt road and then descend the creek bed.) As one of the few physicians around who understands the world of community medicine and the world of long term care medicine and all of the weird interplays between them, I’m constantly putting out fires that I think simply require a little common sense. At least I have job security. There simply aren’t younger ones coming up beneath me with the same skill set.

Going to eat the other half of my Hawaiian pizza (pineapple does belong on pizza and I will die on this hill) and make my way out to tonight’s performance of Dearly Departed to provide moral support.

I feel like things are moving a bit and I’m coming out of the funk and torpor of the last week. It’s not my doing. It’s just what seems to be happening to and around me. All three careers are heating up a bit and making me have to move forward on commitments and goals. My usual coping mechanism is to keep myself so busy that I don’t have time to wallow. It works pretty well until I get to the point where I look at the calendar trying to find a weekend for a get away for self care purposes and find I’m having to look into July. As the old saying goes, I’ll rest when I’m dead. It’s a side effect of having been born into a generation of gay men who watched their peers and mentors die, lives cut short by societal indifference to HIV in the 1980s. You know there won’t ever be enough time.

I’ve been asked to be in the pulpit in early April at church and to talk again about my writing and books. I’ve come up with a title – Unfinished Stories – and some vague concepts about how that relates to my writing, my life and society at large. I haven’t started to write the sermon yet. It will have to wait until Dearly Departed becomes a finished story as of the 26th of February. I don’t have another theatrical project on the horizon, just a symphony concert or two so that should give me the time to get that done and to break the back on editing of Volume III of the Accidental Plague Diaries. I got a nice mention in the local on line press this week. Hopefully that will translate into a few sales and the Northern Alabama bookstores displaying it more prominently on their local authors tables. We no longer have a daily paper in Birmingham, just on line. As a geriatrician, I find this problematic as so many of my patients have developed lives free from the chains of modern technology and now they’re being forced into the cesspool of television news if they want to keep up with the world. And I’ll have to chase after them with amlodipine and lisinopril trying to keep up with their blood pressure.

On Tuesday, I received an email from regional VA headquarters inviting me to be their keynote speaker at their annual convention for senior care next month. I was flattered but a little mystified as it was very short notice and I had no idea why they would single me out. I learned long ago that the best way to cope with a large federal agency was to keep your head down and just do your job and stay off the radar. It turned out that someone at regional headquarters had been given the book (Volume I I assume) and actually read it, loved it and then figured out that I work for them. So, off to Augusta I go in mid March to speak on the book and the pandemic and the long term effects of the pandemic on elder care programs. That gig should be good for some sales. I wonder if I can get the VA to order and sell a few cases in the vendor’s area?

Technical rehearsals for Dearly Departed begin tomorrow. I’m not worried about my actors but it remains to be seen if lights and sound effects and set changes will all come together as envisioned. I guess I’ll find out. Someone at church asked me what does a director do when it comes to putting a piece on stage? My first thought was what doesn’t a director do, but that struck me as an impolite answer. I basically said that a director is responsible for everything the audience experiences from the moment the doors open until the moment the audience files out. The producer or production company finds the resources for a show, human and material and manages the nuts and bolts of the theater as a space and place of business. The director creates the world of the show using performers and collaborations with the design departments (set, costume, light, sound etc.) to take the words on the page and turn them into something more than any individual could achieve. If theater is a team sport, they’re the head coach.

My favorite thing about directing is watching all of the half formed ideas in your head take shape and appear in front of you. Sometimes they are exactly what you envisioned. Sometimes an actor finds a different nuance that takes a scene in an unexpected direction and then it becomes my job to make sure what they are doing supports the whole and to shape and change things so that they become cohesive and part of a unified vision. An actor cannot see their own performance. It’s up to the director to watch it and help them adjust, to help them identify the conflicts, to make sure they work together with other performances rather than against them. And then there’s the technical departments. I’ve worked in most of them over the years but my knowledge base is limited. It’s not really my world and I trust in a design team to bring it. For this show, I knew, for instance, what I wanted for the set conceptually and the genius set/costume/technical director guy I’m working with took his knowledge base and kicked it up a couple of notches.

There are some things I tend to do differently when I direct. For instance, I hate curtain speeches. Having someone who is not part of the show come out and give the announcements bothers me and takes me right out of the suspension of disbelief I’ve been working to create from the time I sat down. I know that information has to be there, so I always try to put it in as a voice over and to somehow have that fit in with the style of the show and the preshow soundscape. That was relatively easy to do with this one. I also try to make sure that shows flow and that scene shifts are as quick and minimal as possible. We’re still having to work on that one with Dearly Departed. When I first started directing, nearly 45 years ago, I took almost all negative notes. What was bad and needed fixing. I now try to take a balance of negative and positive. What I’ve learned from working with teams in health care has carried over into theater and vice versa. Positive reinforcement is a good thing.

The directors job during tech is to sit out in the house and take copious notes about how to encourage, fix, adjust, and make the show better. I’ll do my best to get everything right by Thursday night…