April 11, 2022

t’s what I call birthday week again. Yesterday would have been Tommy’s 57th birthday and Wednesday will be what would have been Steve’s 74th. It’s a bit hard to wrap my head around that latter one. I have enormous difficulties imagining a septuagenarian Steve. He was a pure early baby boomer, always conceiving of himself as young, even into his fifties when I lost him. He would have fought the infirmities and indignities of age every step of the way and I imagine by this time the bills for hair treatment, botox, teeth whitening, and various other youthening procedures would have been relatively exorbitant. Tommy was much more philosophical about the aging process, given his burden of various diseases due to bad genetics and bad luck long before his early departure. He did spend a small fortune at the hair salon every few months to stay strawberry blond but other than that he just let the chips fall where they might.

Having been a student of aging and watching the psychological battles of thousands of people from a number of different generations over the years, I just let my body do what it’s going to do. I don’t color my hair (I figure I’ve earned the white), do botox, expend large amounts on various facial creams or the like. I try to keep my weight under control (sometimes difficult to do on an erratic diet due to my erratic hours), shower routinely and occasionally put a little cheap moisturizer on my face. That’s it. It seems to have worked so far. I haven’t had a surgery since my tonsillectomy at age three, rarely become seriously ill, and my aches and pains are pretty controlled with judicious use of Tylenol. I know I’ll have to have my knees done eventually. They let me know that every time I climb stairs, but they’re not bad enough to have to think about that prior to retirement when I’ll have time to cope with such things.

Why are we so afraid to grow old in our culture? Our youth obsession is fed by our capitalistic society. Everything revolves around the advertising dollar and advertising is a science that’s been studied fervently for well over a century. One of the things that’s well known is that it’s not possible to brand or sway a consumer over the age of thirty five by advertising. Older brains are too savvy to fall for the ploys and the glitz and the glamor. Therefore, general advertisers really aren’t terribly interested in attracting much of anyone over forty. This makes our pop culture skew young and explains why when you’re fifty or sixty, you can’t find a movie or new music that speaks to you. As television has migrated away from advertising based networks to subscription based streaming, there’s less need to grab a younger audience, just to grab a paying audience and older people have disposable income for Netflix so television over the last decade or so has created the well written well acted dramas and comedies leaving the movies the purview of super heroes and special effects that entice teens and twenty somethings.

I suppose as we go hurtling through the space-time continuum to our inevitable destination of mortality, we have difficulty coming to grips with our non-existence. This chafes at the Western mind. Ever since Rene Descartes posited Cartesian dualism – life of the body and life of the mind separate but parallel – we’ve built our culture around the cult of the individual. The most fundamental building block of our economics, politics, and social arrangements is that we are all different, unique individuals and the self is the most important thing in our lives. Anything that threatens the self is anathema and the annihilation of self posed by death, combined with our very linear thinking about time, means we tend to become more and more frightened thinking about the end of the journey. It’s also why Alzheimer’s is so feared. We recognize it as obliteration of the self while still leaving the body alive. That’s too scary a prospect for most of us to contemplate.

Personally, Alzheimer’s and dementia doesn’t scare me. If we just approach it as a regression backwards through the stages of development, we recognize that most of the misery is caused by trying to make a person who no longer has a functional adult brain still lead a functional adult life. At the beginning of the life cycle, we’re very good at matching development with environment. One does not send a five year old, a ten year old, and a fifteen year old out into the same world, we tailor it to needs. If we do that for the demented, constantly fitting the world around them to their needs and abilities, they are quite capable of being happy and contented. We’re just horrible at doing that, both as a medical system and as a society. It’s one of the first things I start to evaluate when I get a new patient with cognitive problems. My mother had a genetic dementia. As such diseases are autosomal dominant, I have a fifty percent chance of carrying it. Fortunately, it doesn’t start showing up until about age 75 so I have plenty of time. I’m leaving strict instructions to my family to help my environment and abilities match. Give me someplace with my books and my music and a cat to cuddle and dessert with every meal and I’ll be fine. I am much more scared of diseases such as ALS which leave an intact mind in a completely nonfunctional body. To me, that’s the definition of hell. Over the years, I’ve met a number of people with what is know as locked in syndrome. It’s a condition where a serious stroke leaves the thinking and feeling part of the brain intact but destroys all motor function. They can’t use their bodies, often can’t communicate, and usually end up spending years in nursing facilities as their care is too burdensome for home. I’d likely have a psychotic break internally if it happened to me.

I’ve often thought that we’d be better off as a society if we had formal death education. Classes in school or in community institutions where there was frank discussion about mortality, the causes and mechanisms of death, what kinds of medical care can help serious disease and which simply prolong the inevitable, the importance of wills, powers of attorney, and advance directives, and other such subjects. The problem is that death is probably even a bigger taboo than sex in American culture and we all know what sorts of wars are propagated by sex education in the schools and elsewhere. The cultural battles over death education would probably touch off fighting in the streets. Speaking of sex education, the governor of Alabama signed bills this past week stipulating felony charges against those who try to provide medical care to trans children and major threats against anyone who tries to bring discussion of gender or sexuality into elementary classrooms. The bills are badly worded and vague and will be tied up in court for some time. They are so vague that I suppose I, as a concerned citizen, could lodge a complaint that Sally, DIck and Jane should be banned as there are clear gender roles present in the material and such things are not to be discussed. Sally, Dick and Jane need to be retired for all sorts of reasons but it does go to show how piling on the conservative bandwagon is not the best of ideas.

Trans issues are being used as a wedge to open up anti LGBTQ sentiments again. Three steps forward, two steps back. I really resent the ‘grooming’ language that has all of a sudden become ubiquitous when it comes to issues of gender and sexuality and the education of children. Kids are curious creatures. They’re going to start making assumptions about such things whether you want them to or not and often at earlier ages than you might think. You can either give them correct information or don’t and let them pick it up haphazardly from peers or the internet (and every ten year old has hacks to get around parental filters and controls). I don’t groom kids. I’ll answer questions appropriately and honestly. None of my LGBTQ friends grooms kids. We don’t want to or need to. Those kids who understand that we are their tribe seek us out of their own accord when the time comes, usually in later adolescence. As for the parents of trans and non conforming kids. They aren’t trying to push an agenda on anyone. They’re frightened to death that a cruel and misunderstanding world will push their children into misery, addiction, and suicide and they’re doing everything in their power to prevent that. Being told by the state that that’s abusive is unconscionable.

I have no idea why I wrote about this tonight or where this all came from. I was going to write about BA 2 and Covid numbers but they remain low and I hope everyone is enjoying a bit of a pandemic respite. I’m not certain it’s going to last. But get out and enjoy spring weather while you can. Just keep your hands washed and pay attention to local transmission rates and put your mask back on if they start going up. (This has already happened in Philadelphia – other large cities my need to follow suit. We shall see).

April 7, 2022

And merrily we roll along as if the pandemic is definitely in the rear view mirror. I am not so sanguine. BA2 continues to spread in this country. It hasn’t caused a trend upward yet in cases or deaths (which still remain mercifully low) but the pace of decline has slowed over the last few weeks which could mean a new equilibrium or it could mean it’s just about to start back up again. Time will tell. I was reading today about yet another omicron variant that’s been identified and that’s spreading rapidly in the UK. This one, known as XE, has genetic material from both the original omicron and the BA2 or stealth strain. So far, there’s no reportage that morbidity or mortality is higher from it but there is some evidence that it is much more contagious and spreads even faster than the original omicron – and that one went from a few hundred cases in South Africa to the highest levels yet seen worldwide in a matter of weeks. Be prepared to fasten your seat belts, or at least put your masks back on.

What’s been preoccupying my mind this week as I march through my daily round of clinical geriatrics problems to be solved (this weeks include a man whose friends keep sneaking large quantities of vodka into his assisted living, a family who is majorly unhappy about surgical complications from five years ago with which I was not at all involved, a daughter demanding a letter certifying her mother, who is bed bound, is safe to be left alone all day so she can get Adult Protective Services off her back, and a schizophrenic who has destroyed all the appliances in his house) is what comes next. We may actually be at the point where Covid slides from pandemic into endemic mode, always there in the background like the flu but not enough to cause major social disruption.

I wish I knew. I don’t think we yet know exactly what social disruptions have been set in motion or where they’re going to end up. The flu pandemic of 1918 helped lead to a rapid closure of World War I and the disastrous Treaty of Versailles in Europe while, in the US, it helped create the social conditions that led to the demise of the Victorian way of thinking toward what we would consider a more modern way of viewing the world. The societies of the Titanic and The Great Gatsby were only about a decade apart but everything changed in that decade. I think we’re in the middle of a very similar social transformation but, because we’re all stuck in the middle of it, we can’t really see it or understand it in any sort of objective way. It may not be clear for years yet.

I’m toying in my head with this idea that there’s some sort of fundamental connections between various pieces of our social turmoil, kind of like the unified field theory of physics that explains the failures of our politics and social institutions and Eastern European unrest and horrible public health responses. I’m not quite smart enough to see them all or draw all of the parallels that need to be drawn, not being the Kwizatz Haderach, but there’s something there and I think the stressed of the pandemic are making it more and more visible. Perhaps the simplest way of thinking about it is the failure of the neoliberal globalization of capitalism which has been the grand design of the Western democracies over the last couple of generations. I think the pandemic has exposed the extreme inequalities that have been brought to bear, both domestically and internationally by our current economic system.

We’ve been able to paper things over with the traditional bread and circuses but over the last two years, it’s become very clear that when faced with an external threat which was equal opportunity, that that did not come with equal consequences and there wasn’t a lot of attempt to level the playing field. Wealthy populations were able to cocoon and isolate themselves with aid of modern technology until vaccines became widely available and still have managed to figure out a functional life with fewer social contacts. Poorer populations had to do go out and do the jobs that allowed wealthy populations to maintain this existence, and died. Meanwhile, the poorest populations internationally couldn’t even get vaccine for months and months and months. The system we’ve built which puts profit at the top of Maslow’s hierarchy of needs as created a totally dysfunctional society which no longer serves its denizens, only the profit motive. And this rapacious hunger is leading to climate change, conflicts over resources, tribalism, a lack of empathy and caring, and a steering of religion away from its ancient function of bringing people together to separating us from them through a myriad of rules. Perhaps this is how civilizations fall and its just time for Western Civilization to go the way of the Minoans, the Romans, and the Mayans.

Both Tommy and Steve had political views that were predicated on the flaws in modern society. Steve liked to agitate and always called himself a Gay Communist for the shock value. Shortly after I joined the faculty at UC Davis, I was invited to some sort of fancy cocktail party honoring some political figure (I’ve forgotten whom) and Steve marched up to the then Dean of the Med School and said ‘Hi, I’m Steve. I’m a Gay Communist. What are you going to do about it?’. It was not one of his finer moments. Steve, as a kid who had grown up near the studios in Hollywood, was very savvy about appearance and media. In the late 80s, when California was chafing under a Republican governor and considering a bunch of anti-gay legislation, pushed as a reaction to HIV, he would turn up at all the protests at the Capitol dressed in a three piece suit and looking quite dapper. He could be well spoken when he wanted and he usually ended up on the evening news as ‘Gay Activist’. Tommy, for the most part, absented himself from politics as he felt that the whole system was corrupt and, with his nursing work among the poorest of the poor, that it had nothing much to offer the have nots so he wasn’t going to engage until it did. Personally, I’m more hopeful than either of them. The system is flawed but is capable of responding to fixes if people are willing to put the work in. The current conservative ascendancy is the culmination of sixty years of movement conservatism and a lot of grunt work at the local level that showed little result for decades. The left generally doesn’t seem to have the patience to do what’s going to be necessary to right the ship.

Several people have asked me over the years if I would be interested in going into politics. My answer has always been not just no, but hell no. I have far too many skeletons in my closet and I’m not that interested in compromising my core beliefs for campaign donations. I’m also not a particularly good equivocator. Someone once said that politics is just show biz for the unattractive. I’m not especially good looking, but I’m OK for regional stage so I’ll continue to do my performing in the world of musical comedy and let others perform for the cameras of C-Span. Not that I’d mind being a political adviser of some sort. As the Baby Boom continues to age and demand more and more of society and the health system to help them cope, there may be a role for me in retirement for something of that stripe, but I’ll gladly remain an eminence grise.

It’s late. Time for bed. One more work day to get through this week, then four more weeks before I get some time off.

April 3, 2022

Capitol Building – Columbia SC

I took the weekend off. I haven’t done that for some months. I am now staring at a pile of work that should have been done and will have to be squeezed in this next week but I’m not feeling in the least bit guilty. Well, maybe just a little bit guilty, but not enough to really worry about. My Anglo-Scot heritage gives me that Puritan work ethic that makes me feel all uncomfortable when I’m not doing something constructive with my time. I might have been better off with a heritage that’s more about work to live than live to work but we can’t do much about the genetic lottery that predicates where and when we are born and to whom. Perhaps my mantra for my next decade should be something along the lines of ‘you don’t have to finish that today’.

I used my weekend off to drive to Columbia, South Carolina to visit an old friend who relocated there a decade or so ago and whom I try to visit a couple of times a year. He was one of the first true friends I made in Birmingham theater when I turned my hand to performing twenty years ago and we shared the stage many times in various projects. Our favorite thing to do together were the various incarnations of Politically Incorrect Cabaret as we’re both highly verbal people and we have the ability to sling improv zingers and repartee back and forth at each other without missing a beat. We had several good meals together; I got to see some of the Columbia theater people I’ve gotten to know through him and the zoom projects we all worked on together during the worst of the shutdown; and I got to see him perform in a very silly production of the stage version of Clue. (Basically the mid-80s film with ending A adapted for theater – not a great drama by any sense of the imagination but the director and cast took advantage of the more ludicrous aspects and went for broke so it ended up being highly enjoyable). Back to the grind in the morning.

The pandemic is winding down in the minds of American society and American governance. It’s not over. The omicron BA2 variant has spiked in both Europe and Asia and is causing significant increases in caseloads. It’s now more than 50% of cases domestically so it’s going to start spiking here shortly as well. What will that look like? Nobody really knows but there’s a few things that we can conjecture. One, the omicron wave was so steep and fast (with more than 800,000 cases daily at its peak) that a significant portion of the US population was infected. BA2 is a subvariant of omicron which means that there’s significant natural immunity circulating. Two, vaccination rates ticked up during omicron and while they aren’t what they should be, they’re better than they were. We’re at 2/3 of the US population fully vaccinated. Alabama is far worse with only 1/2 fully vaccinated. But, if you start breaking the numbers down further you find that there are populations that are pretty much fully vaccinated and other populations where vaccination is uncommon.

This suggests that the BA2 wave is likely to be highly uneven across the country, hitting different communities with very different rates of infection and morbidity/mortality. Urban populations which have high levels of vaccination and which omicron tore through are likely to have somewhat limited issues while willfully unvaccinated populations in isolation may have very severe outbreaks if they managed to escape much omicron earlier this year. We shall see what we shall see. At this point, if you are vaccinated and boosted (and a second booster won’t hurt…), you’re probably not at significant risk of major disease. But there are populations (the extremely elderly, immunocompromised individuals, seriously obese/diabetic) who will continue to sicken and die needlessly without a certain amount of public health vigilance. The problem is, we’re in the process of dismantling all of the systems we’ve put in place over the last couple of years. They’re expensive; federal dollars are drying up and a quarrelsome congress isn’t in the mood to keep up the largesse; there’s a general feeling of it’s over. Tracking officials are being let go or reassigned. Reportage systems are no longer being operated on a daily basis making data more suspect or incomplete. The distribution of home tests without a means of tracking the results means that lots of cases aren’t even being caught by the authorities.

I wonder if we’ve learned anything from the last two years? Covid is here to stay. It’s no longer novel as we’re moving into a third year with it and it’s human nature to always want to move on to something new. Are we going to banish it to history books and medical research papers no one reads? We can, but if we do, we’ll continue to lose susceptible people. Are we willing to categorize them as acceptable losses? Collateral damage in our need to move ahead to the next thing in life? The poison of distrust in science is now part of our national landscape. When the next virus comes through, one potentially more contagious and more deadly than Covid, the antivaxxers of the future will have social attitudes and infrastructure on which to build which will make containing something like a filovirus much more difficult than it otherwise need be.

Sorry to be a bit of a gloomy gus this evening but I’m feeling a bit worn down by life. The weekend helped but wasn’t long enough. Five weeks to go until I get a bit of a longer break. And in the meantime, I have social events to plan, work to do, a second volume of The Accidental Plague Diaries to edit, promotional events for the first volume (it’s up for some more awards) but one thing I don’t have is a show to perform in this spring as the one I had been cast in has been cancelled. Ah well… time to look and see if there’s another opportunity out there. In the meantime – wash the hands, get your vaccines, and keep a mask in your pocket and stick it on correctly when appropriate.

March 30, 2022

The wind is howling outside the window as the stormfront from the west continues to march on Birmingham. It’s not here yet and, from my study of the weather map, it won’t hit for another hour or two but we’ve been under a tornado watch for the last few hours and I’m prepared to move into the master bath if anything starts to look too serious out there. The condo building is a large concrete fortress, but I’m not terribly worried as long as I’m away from any of the picture windows. I imagine there’s a metaphor to be drawn between such weather fronts and the coronavirus, but I’m much too tired to sit down and work it all out tonight. The general fatigue of the last few weeks continues. I did actually get my request in for time off in May and I’m hoping that, as the idea of respite sinks into my subconscious, it will alleviate somewhat – but I’m not holding my breath.

The news from covidland this week remains something of a mixed bag. The most important thing was yesterday’s announcement of the FDA approving a second booster shot for those fifty and over or those younger with immunocompromise. The FDA didn’t recommend it, they just approved it and so the messaging from both the government and the media has been somewhat confusing, at best. And this has been a constant bone of contention between me and the current administration – make your messaging about public health measures absolutely clear, consistent, and understandable by the general population. The Biden administration hasn’t done a whole lot better than the Trump administration in this regard. So what does the science say? It’s also somewhat unclear. The data that everyone is looking at is out of a very large study in Israel but there are some flaws with it. It wasn’t a randomized controlled trial, it was done in a self selected group of individuals concerned about their health and more likely to be proactive in various ways against Covid infection. Therefore, we are left with the question of whether the reduced risk of infection was actually due to a second booster shot or due to a set of improved health behaviors. The data doesn’t allow us to really distinguish.

U.S. President Joe Biden receives a second coranavirus disease (COVID-19) booster vaccination after delivering remarks on COVID-19 in the Eisenhower Executive Office Building’s South Court Auditorium at the White House in Washington, U.S., March 30, 2022. REUTERS/Kevin Lamarque

Therefore, what we’re left with is a conclusion that a second booster shot may indeed be beneficial (although there is data from other smaller studies that show additional boosters give diminishing returns in terms of protection) but it’s not completely proven. The good news is there is no evidence that an additional booster is harmful in any way. I’m over fifty; I’ve had a case of omicron; I’m planning on getting a booster this weekend or next. Everyone is going to have to start doing their own risk/benefit calculations about what’s right for them. Ultimately, what’s going to be the most useful is rejiggering of the mRNA vaccines to make them more effective against new variants and, when that happens, we’ll probably all need an annual or biennial booster, something like a flu shot.

I ran into an interesting predicament today while dealing with some community elder health issues. There is only one population group guaranteed the right of health care by judicial fiat in American society. Prisoners. It’s usually not the best health care but it must be provided. One of the side effects of lock ’em up mentality is an aging prison population who must be provided with health care which gets more and more complex and expensive as they age. if they become bedridden or demented, they aren’t usually much of a threat to society but until they are released, they must receive health care from the Department of Corrections at public expense. Covid has caused some huge issues with this. Aging prisoners who developed Covid were hospitalized to protect other inmates and, those that recovered, were often too sick to return to hospital infirmary wards due to their acute needs for oxygen or wound care. They have been occupying hospital beds for months as the prisons can’t handle them, nursing homes don’t want them and hospitals have nowhere to send them.

This weekend, in one local town that shall remain nameless, the hospital decided enough was enough and discharged a number of long hospitalized prisoners back to the custody of the local prison, calling ambulances for transport. When they arrived at the prison, the staff refused to accept them and the ambulances returned to the hospital where the medical staff refused to admit them. A full third of the city’s ambulance fleet was tied up all day in the stalemate and unavailable for any other calls. What was the resolution? A judge was rousted out on the weekend to change their sentences to ‘time served’ to keep them from having to go back to prison and the social services staff was busy calling every nursing home in a fifty mile radius to see if they could be admitted anywhere so that the ambulances could go back in service. My source didn’t know the end of the story so I can’t relay it.

This is emblematic of the hidden problems that are currently shaking the American health system to the core. A large new chronically ill population combined with the normal aging issues of the huge Baby Boom generation combined with the great resignation combined with the grossly inefficient system we’ve allowed to continue for decade after decade is going to lead to more and more incidents of this kind. I have absolutely no solutions to any of this. All I can do is point a spotlight at some of the more ludicrous aspects. Why is it allowed to continue? Money. It’s always money. More and more private equity is moving into the health care center and they have one motive and one motive only. Profit. If a crazy quilt system that doesn’t serve the population’s needs allows the dollars to keep flowing, they will lobby congress long and hard to prevent any sort of reform.

I’ve been listening to the audiobook of Dune in the car this past week. I’ve read it several times before, but not since college. The politics of Arrakis, Giedi Prime, Caladan, Corrino and the rest, all culminating in ‘The Spice Must Flow’ seem eerily prescient and appropriate to our current moment. It’s just that we’re living in a system where the cash must flow. In the meantime, consider a booster, keep your hands washed, and remember we’re not exactly out of the woods quite yet.

March 25, 2022

It’s Friday. I’ve had a couple of glasses of wine so pretty much anything might come out of brain and on to the page this evening. I was going to do something highly constructive but I continue to feel tired and burnt out so I’m allowing myself an evening off from absolutely everything other than getting this written. The notes of the week, the legal case review, the sorting of the bin of miscellaneous papers, the study of the song for voice lesson this next week, the movie review column, and the planning of various social events can all wait for tomorrow or Sunday. I’ll lie here on the bed with Oliver the cat purring beside me and just let stream of consciousness take over.

The news on the Covid front continues to be reasonable if not exactly good. Local numbers have dropped back to where they were a year ago before the Delta and Omicron waves took over all of our lives. There are fewer than two dozen total Covid patients at UAB, and fewer than ten in the ICU (almost all unvaccinated). Deaths, however, remain around 1,000 a day nationwide and, while trending down in general, lead to an inexorable increase in the toll. We’re at 975,000 now in the two years of the pandemic and will almost certainly pass the magic million in the next few months sometime.

Here in Birmingham, where the spring brings all four seasons every forty eight hours or so, society has more or less decided the pandemic is over and pretty much everything is back to normal, or as normal as it gets after two years of pandemic havoc on all segments of society. The CDC lists Jefferson county as being in the green zone with low transmission. There’s one thing to be wary of in the new CDC red/yellow/green maps and levels. Where previous data was based on absolute case and transmission rates (the number of persons testing positive), the current data is based on whether or not the local health system is capable of handling the number of people expected to become seriously ill given vaccination rates and transmission in the area. In an urban county with large medical centers like ours, transmission can actually be quite high and not be reflected by higher risk levels as we have the capacity to provide care. I think it’s a bit of a cheat and most people don’t really understand these nuances when evaluating their personal risks. As it has been for some time, the best thing to do is get vaccinated and boosted. We’re all still waiting for updates on recommendations for second boosters. There’s data from Israel and Europe suggesting that it will be a very good idea for older people and those with immune compromise but the CDC hasn’t quite gotten its act together yet.

The theme of the week at work has been lack of services for lack of staffing. The enormous numbers of retirements in health care mixed with better opportunities for elder health workers has led to an exodus of staff from nursing homes, home healthcare agencies, and other senior services. Finding a hospice or a nursing home with adequate staffing and the ability to provide requested services to which elders are entitled has become quite the challenge over the last few months. The needs are becoming greater as the huge boom population continues to age and the leading age, now in their early 70s, has a few members with bad genetics or life choices which are pushing them into positions where they need support to live their lives and those supports are becoming scarcer and scarcer. It’s going to be an absolute nightmare in another five years or so when the early boomers have aged into their eighties. And upper level senior care positions aren’t exactly finding takers either. We’re continuing to shed geriatricians around here to retirement or other opportunities with no one coming in to replace them. There’s no one coming up through the ranks currently who could replace me. I’m not sure how I feel about that. On the one hand, it’s kind of nice to know you’re valuable, on the other hand, I know I can’t do this forever and I don’t want to see everything I’ve helped build over the last few decades crumble and fade as there’s no one left to do the work.

My burnout fatigue continues and likely will until I can arrange some time off. I might be able to do it in May but there are so few of us, we’ll have a very difficult time keeping clinical services open five days a week if I take any time off and I don’t see a lot of good solutions presenting themselves. It’s not like we can create a new geriatrician in a year or two. It takes a minimum of twelve years of higher education under the current system. We can create a geriatric nurse practitioner quicker than that with five or six years of higher education but they really need some clinical practice seasoning for a few years in addition to that to be up to the rigors of the job. I don’t have a solution. Those of you heading into your golden years or my younger friends with parents heading that way better start planning now for the potential complications of aging as there’s going to be a lot more ‘you’re on your own’.

That seems to be the current political ethos anyway. Our society seems intent on dismantling the commons for private profit and tossing anyone out of the boat that can’t pull their own weight. Some blame rapacious capitalism, some religious fundamentalism, some human nature. It doesn’t really matter. What really matters is if we can’t hang together, we will all hang separately as Benjamin Franklin wisely once said. I didn’t have the heart to watch the hearings for Justice Jackson but the little I did catch, full of rich white men who had got theirs trying desperately to demonize a capable black woman as ‘the other’ for political points was enough to make me nauseous. This week we also were treated to sitting US senators opining that Obergefell, Loving and Griswold were all wrongly decided so if you think that the right wing forces at play in this country will stop at an undoing of Roe v Wade, you’re delusional. They’re coming for anything that interferes with their nostalgic world view of a 1950s never never land gleaned mainly from reruns of old black and white sitcoms.

OK, I’m grumpy now so I’m going to put on some bad television. I’m trying to decide what to write about over the next few weeks while I begin editing volume 2 of The Accidental Plague Diaries and Covid seems to be in relative abeyance. (This is unlikely to last. Omicron BA2 is now 50% of new cases and there are new peaks happening overseas from this – it’s just a matter of time). If there are any requests, let me know. In the meantime, hand sanitizer, booster, and keep that mask handy. You’re likely to still need it.

March 20, 2022

I haven’t written for a few days. Sorry about that, those of you who seem to hang on my every word. As the world is opening up and at least entering a breather, if not a true post-pandemic phase yet (I’m still expecting at least one more ugly surprise waiting for us), my schedule is starting to pile up and look more like it once did pre pandemic with my having to keep careful notes to make sure I am in the right place at the right time on the right day. I get more than 90% of it correct but I occasionally find myself heading for a meeting an hour early, or forgetting about that zoom call I should have been on twenty minutes ago. At least I’m not currently in rehearsal for anything. As that stands, that’s not going to happen until late April or early May with the first two projects lined up being Beethoven’s Ninth with the Alabama Symphony Orchestra (no I’m not singing the baritone solo – no one wants to hear that. I’ll be one of the cast of thousands in the choral balcony) and a role in a bucket list musical that I think I can announce but I haven’t fully cleared it yet with the production so I better keep mum in public forum for just a little while longer.

I had hoped to get away for awhile in late April and turn these missives back into a travel diary for a week or two but that is not to be. Outpatient geriatrics is becoming more and more short staffed with only two doctors and one nurse practitioner there more than once a week and, in late April, the other physician needs to visit her family on the other side of the planet and the nurse practitioner will be out on maternity leave. Yours truly will be pretty much last one standing so heading out of town just wasn’t in the cards for a functional clinic system. We’ve been through periods like this in the past but have always managed to claw our way back to adequate staffing so we can spell each other after a few months of hell. I’m not so certain about what’s going to happen this time. The number of qualified individuals looking for jobs in geriatric medicine is cratering just as the demand is starting to go into overdrive from the aging baby boom. I just don’t know where we’re going to get a new generation of providers from. This situation is not unique to UAB. It’s nationwide. It’s easily fixed by aligning some economic incentives such as loan forgiveness and salary structure in such a way for people to self select into the specialty but there’s been no motion from the powers that be to do anything of the sort. And they wonder why I’m contemplating retirement….

I can’t say I’m in despair regarding the future of clinical geriatrics. Concerned, yes. Despairing, no. Those of us who choose to practice in this way tend to be committed and resourceful individuals used to thinking on our feet and problem solving way outside of the box as the clinical issues dumped in our laps on a routine basis are not often amenable to textbook answers and yet we still have to come up with some sort of solutions. Someone once asked me to define geriatric medicine and my answer was ‘creative solutions to unsolvable problems’. I think I came up with that in the early 90s and have found it to remain true all of these years. What I am expecting is increased demand will start to spread to those in society with loud voices and the economic power to make those voices heard and that’s when things will begin to change for the better. I found out many years ago that the best way to get what you needed for geriatrics clinical programs was to take care of the chancellor’s mother in law.

There is, however, a great deal of despair abreast in the land and it’s about to get worse and it’s fueling a deadly pandemic that’s been traveling in tandem with Covid and which has largely fallen off the public radar screen and that is hospitalization and death due to the maladaptive coping mechanism of substance use. Most people don’t wake up one day and think ‘geez, I’d like to become an addict – it sounds like fun’. Instead, social situations and pressures create unhealthy stresses and toxic life events and there becomes a psychological need to escape – and, when there’s not a physical means of escape, there’s always drugs and alcohol. They buy at least a temporary and fleeting time away from the pressures and problems of the world. Unfortunately, they carry a lot of bad life choice baggage along with them.

In the two years since the start of the pandemic, deaths in the US related to alcohol have risen by about 25% over what they were at baseline. The lack of diversions of lockdown and the economic worries of lack of income and the stress of jobs that put people in harms way are probably all contributors. Some of this was mitigated by the various programs that paid extra federal dollars to individuals and prevented eviction for nonpayment of rent, but all of these programs are set to expire, along with the federal dollars that have paid for Covid care in the uninsured. Those on the lower rungs of society are about to be significantly squeezed by all of this and, if they do get sick, are going to be out of luck regarding medical care. This is going to set up social conditions ripe for new variants to percolate to the surface and spread and, if there’s one thing the history of infectious disease has taught us, it never remains contained in ‘those people’ while ‘we people’ are immune. It always spreads.

I expect the alcohol death rate to start going up again this summer as social stresses increase. How that’s most going to affect the general population is more drunk drivers on the road and we all know that they don’t only hurt themselves when there’s an accident. Traffic fatalities were up about 12% in 2021 over 2020. I haven’t seen any breakdown as to which percentage were alcohol or drug related but I have a sneaking suspicion it’s a cofactor. There’s always been something sort of bohemian romantic about drinking ones self to death. I don’t advise it. Anyone who’s in medicine can tell you that a death from liver failure is highly unpleasant and not something you wish to experience before you go.

The drug overdose epidemic continues unabated as well. Pre pandemic, the number was about 70,000 a year (which was extremely high when compared to a generation prior when it was about a third of that number) and it’s now topping 100,000 a year. And that number is rising astronomically despite the prevalence of naloxone, the opioid overdose anecdote being widely available. I cannot even write a prescription for an opioid in the VA system for anyone unless there’s a prescription for naloxone in the prior year. It’s a much lower number than Covid deaths but as these deaths are mainly young and healthy people, the number of potential years of life lost are similar, if not greater. There are any number of experiments that show that people (and other species) shy away from drugs as long as they have enriched, fulfilling lives without an over abundance of stressors. Unfortunately, we live in a society that tolerates the perfect conditions for creating addiction in certain subgroups.

It’s no accident that the current wave of drug use, triggered by Purdue pharmaceuticals outrageous peddling of OxyContin inappropriately in the late 90s and early 2000s, took shape in Appalachia. Appalachia, as a region, has an economy mainly based in extractive industries, such as coal, and some heavy manufacturing. With a globalized economy, and improved technology, the union jobs that supported the population and society collapsed leaving a hollowed out husk of mining towns that the young and energetic had to flee in order to have a future. The mining industry, in particular, with its company towns and health care, turned the population on to the power of the pill back in the 20s and 30s. The backbreaking labor of manual coal mining left the men with orthopedic issues and chronic pain which required meds for them to be able to continue their work underground. Their women were always anxious about their husbands, brothers, sons coming back up alive and were routinely prescribed sedatives so they could get through their days without being crippled by anxiety. Fast forward a few generations and a population with incredible economic stressors who have been socialized to believe in the power of the pill meets OxyContin and voila… When the medical system realized the extent of the opioid crisis and began to ratchet down the supply, the population turned to other sources and heroin use surged. And then some drug lord came up with the great idea of cutting the heroin with various fentanyl related compounds, many of which are deadly in very small quantities and the overdoses came thick and fast, spreading out from Appalachia through other small towns and inner cities and then creeping tentacles into suburbs and into the house down the block. And then came the pandemic…

People in these sorts of desperate straits long for an easy solution. They’re ripe for an autocrat who will tell them that they have the answers and a road to salvation. Most of DC, living inside the beltway and knowing no one and nothing of these people and towns and ways of life, have ignored them and their needs for decades but one populist presidential candidate a few years back got it and fashioned a message for them and they have responded with fealty that has completely changed the face of our political system in just a few short years. I have no ideas where it’s going but such political movements eventually gain their own momentum and no one can completely control where they end up. Just ask Maximilian Robespierre or Leon Trotsky.

The CDC is still pretty gung ho on the current state of Covid infections and there are no local requirements or suggestions for masking. I’m still wearing mine at work due to the number of immunocompromised who enter my clinical workspaces. I pick and choose about where to wear it indoors currently but if I see the numbers start to tick up (and given trends in Asia and Europe, I think it will happen) I’ll be back to masking everywhere. Stay safe. Get your booster. And wash your hands.

March 15, 2022

Ukraine and related subjects continue to knock Covid off the front pages. Between this, the arrival of spring, and everyone exhausted from two years of at least pretending to comply with some basic public health members (I’m talking to you wearing your mask as some sort of chin strap), the media and society have sort of declared the pandemic over, not with a bang, but with a whimper. It would be nice if it were true but while we may be done with Covid (and around these parts, that happened a long time ago – at least the adherence to basic public health measures), I suspect it is not at all done with us.

Case rates in Europe are shooting back up and in some Asian countries such as South Korea and Hong Kong, case rates and mortality are higher than they are ever been. In our globalized world, this means that we have a chance to shoot back up again ourselves. What’s driving the numbers up overseas? If you look at it, it’s the BA 2 strain of omicron making inroads. The morbidity and mortality statistics are varying wildly from country to country depending on their various strategies over the course of the last two years. Hong Kong’s numbers are incredibly high as a relatively small number of their elder population was vaccinated and most were vaccinated with the Chinese product Sinovac (not available in the USA) which has proved relatively ineffective against omicron. This has led to high mortality rates. In Europe, on the other hand, where the vaccine rates are much higher and elderly are more likely to be vaccinated with one of the mRNA products, case rates are ticking up with the lifting of restrictions and mask mandates, but significant morbidity and mortality is not increasing concurrently. In other words, yes the disease prevalence is increasing but it’s not making people sick enough to need hospitalization or to die.

BA 2 is present in the US but not at very high levels. Will it cause another surge? I suspect there will be a case surge as it multiplies and starts to outcompete earlier strains but, with more than 90% of our elder population with at least one vaccine and more than 80% of them fully vaccinated, it may not make inroads. There are rumbles of a second booster for older and immunocompromised individuals coming down the pike shortly. I think it’s a good idea and even though I’m still a few years away from being officially ‘old’, I’ll get it if and when it’s released. At last count, somewhere between 45% and 55% of the US population was exposed to omicron between last Thanksgiving and now. That means there’s still a large number of omicron naive individuals out there in which BA 2 can catch hold and spread. Then there’s ‘deltacron’ which was generating some scare headlines. It’s a cross which basically has omicron spike proteins grafted on to a delta core. As the spike proteins are what make the virus infectious, it’s no worse than omicron in general. If you want a lot more analysis than this in easily understood terms, I highly recommend reading Katelyn Jetina who writes under the name ‘Your Local Epidemiologist’ She’s easy to find on social media and Substack.. She knows far more about all this than I do.

The mood is better after some sleep this weekend. It’s still not great and someone’s going to get an icepick through the eyeball in the near future if I don’t get some time off this spring. I’m still trying to calendar it in. With all of the various things that I seem to have become responsible for, it looks like late April will be the best time for me to absent myself for a few weeks. I’m taking nominations on things to do. I have several ideas but I’m open to thinking outside the box. Perhaps some beach time is in order. I haven’t had a dip in the ocean in a couple of years.

Marie’s Crisis

My long term house guest is kicking my rear and getting me to move ahead on some of my projects that I’ve been quietly tiptoeing around for the last year and a half. Art is being rehung and reframed as necessary. The filing cabinet is starting to fill back up with organized files. Some things that are purely in the way have been purged and demoted to storage. The ostensible reason is thinking about having a party, my first since moving. It’s a milestone birthday in two months. The question is whether to have it here or to have it in a larger venue to allow for more social distancing and air circulation. I wish I could predict what Covid is going to be up to the second week of May. My initial thought is to hire one or more of my pianist friends to play and tell everyone to bring their rep books, have a few drinks and let ‘er rip. It might not be the most dignified of 60th birthdays, but it could be fun. Sort of a Marie’s Crisis like thing. It’s already been dubbed ‘A Night at the Duxbury’ and various plans appear to be afoot that I am not privy to.

Kimberly Kirklin, Some Guy, Diane McNaron in Politically Incorrect Cabaret

I hosted a meeting tonight to begin planning a celebration of life for the irreplaceable and irrepressible Diane McNaron who died so suddenly a few weeks ago. I’ve told the story before about how various threads of life came together nearly twenty years ago to allow her and I and Ellise Pruitt Mayor to create the Politically Incorrect Cabaret. (Don’t worry, it’s not dead yet… It’s been left in my hands. The Ansager, Waffle House Lady and others will return at some time in some form). PIC was very much the start of my performing life in Birmingham and will always hold a very special place in my heart, especially the out of state trips to venues involving a cast of fourteen changing in a hallway, no heat in January and no air conditioning in July, llamas outside the stage door, and pagans hoisting each other up by their piercings. However, it very much needs some new blood and a younger generation to join the merry band so if you’re a twenty or thirty something in the Birmingham theater scene and have an interest in Cabaret forms, political theater, street theater, or just general mayhem, come sit next to me. As the celebration comes together, details will be released.

Do you still have to wear a mask? While the CDC has said that transmission levels are low enough that you don’t have to, I still put mine on indoors in crowded situations and in health care buildings where there might be immunocompromised individuals or those who work or live with immunocompromised individuals. It’s become second nature to me now, like breathing out and breathing in. It doesn’t hurt me to slip it on, I barely notice it, and I’m not ready to write off older or ill persons as being unworthy of consideration. So keep it on you, put it on when appropriate, and keep those hands washed. I’d also still stay out of the mosh pit.

March 11, 2022

Another work week has come to an end, just in time for the beautiful and balmy days we’ve been having to replaced by a storm, a sudden temperature drop and a threat of snow. I won’t believe that last one until I actually see it on the ground. I’m feeling a bit less pressured this weekend than I was last. Work stuff is more under control so I can turn some energy and attention to some other projects like Volume 2 of The Accidental Plague Diaries. A lot of the text is done but there’s still much to do in order to make it a worthy sequel. I don’t want it to be like the usual Hollywood part 2 where the plot’s the same, only there are twice as many explosions and it’s only half as good.

Ukraine continues to push Covid off the front pages. The big news on the pandemic front this week was a study in the journal Nature which used various scientific methodologies to try and gauge the real impact of Covid deaths. The authors estimates are that the mortality rate was roughly three times the official counts meaning we’re at about 18 million deaths world wide rather than the 6 million showing up on the various Covid counters. The vagaries of reporting, especially in non-Western industrialized societies, has kept the real scope of the disaster from being appreciated. 18 million, roughly the population of Guatemala or The Netherlands, is a huge number. It’s 34 years worth of minutes. It’s the number of people in the US of Asian and Pacific Island Ancestry. It’s about half the distance between the Earth and Mars in miles. When you divide it over the total human population of the earth, it comes out to about 0.25%. Seems small until you consider that the total world death rate in 2019 was about 0.75% for all cause mortality. In other words, Covid, in it’s two years of existence, has killed about 1/3 the number of people that die for any reason in any given year. We haven’t had something like that come along in a long time.

I’m going to accept the current lull in cases with good grace and enjoy the fact that some of the pressures are off the health system. UAB is down to about 25-30 inpatients rather than 200 or more allowing us all to heave a sigh of relief and regroup for whatever comes next. There will be more. Hopefully the awful reports coming out of Eastern Europe will start to convince some of the vaccine holdouts what a real fight for freedom looks like and their courageous stands against public health measures, in the true scale of human catastrophe, just make them look foolish. It’s actually been rather amusing watching a right wing noise machine, that’s been awash in Russian money of dubious provenance for some years, trying desperately to back pedal. Then there’s the internecine skirmishes breaking out between main stream right wing and far right wing. I guess they’re learning that simply being against things and trying to move the Overton window as far right as possible isn’t really a viable policy position for a complicated global economy and political system.

My mood’s better. I have made the decision to take some time off late spring and that has definitely helped. Now I just have to figure out how to shoehorn it in to the work calendar, the theater calendar, the opera calendar, the church calendar and all the other things that vary my days. The last two weeks of April are looking the most promising. I don’t know what I’ll do with it yet but if I can get it blocked off, I can figure that part out later. I think the stresses of earlier this week were due to good old fashioned burn out and with some renewal time to look forward to, it shouldn’t be as much of an issue going forward.

I can feel a subtle, but definite shift happening at work in terms of the needs and wants of patients. My new patients and families who are establishing these days have a different set of goals. The questions are much more about prevention of the problems of aging, how to adjust diet for optimum health, what sort of exercise is necessary to maintain vitality and physical function. What supplements and vitamins work best. I wish I had good answers for all of these questions but I don’t. Generations living into their 80s and 90s in good health is a new phenomenon that has only really come into being during the time I’ve been in medical practice. We’re learning a lot about things (and when I think back on some of the commonplace interventions we made back in the 80s, I shudder) but there’s so much that’s unknown. With that, here are Dr. Duxbury’s rules for healthy aging.

1. Choose your parents carefully

2. Don’t fall down

3. Recognize that medications (including over the counter) are really controlled doses of poison and treat them with proper respect

4. Eat a balanced diet but realize life is too short to not eat dessert

5. Don’t force yourself into someone else’s sleep patterns

6. Walk when you can and don’t be afraid to use a stick

7. Don’t fill your head full of problems you can’t solve

8. Create something new

9. Make time for sunshine, children, pets, music, and green growing things

10. Try to find something interesting about tomorrow to look forward to

I should probably add to this, wash your hands and wear your mask indoors in times of respiratory illness pandemic.

March 7, 2022

I’m in a bad mood. It’s just as well that the only thing home besides me is the cat. I have no idea why I’m in such a bad mood. It was a pretty ordinary Monday at work without anything too crazy happening and I got all my meals and even caught up on a couple of work projects on which I had fallen behind, but by the time I got home, I felt like being a praying mantis and biting someone’s head off. Usually when I get like this, the mood doesn’t last too long and a decent meal and a good night’s sleep take care of the issue. As it was Monday night dinner at Tommy’s parents house, I am full of pork ribs, fried okra, potato salad, and chocolate pie so the first has been taken care of. I’m hoping some knitting up the raveled sleeve of care in an hour or so will supply the second.

At least in part, some of it is likely due to the demands of the world on me. I am a nurturer by nature and a fixer. I’ve been playing Dear Abby since I was in high school with my peer group and I have a certain amount of wisdom regarding how to approach life. The problem with that role, now that the world is opening up more and everyone is emerging from their cocoons with all of their personal mental health issues exacerbated by months and months of isolation and a constant barrage of bad news, is that a lot of people are turning to me for help. I give it freely. It’s my reason for being. But occasionally the well starts to run dry and my engine is barely running on fumes. The things that allow me to replenish, theater, travel – are coming back but I’m in the middle of a stretch without much going on besides work and that’s an issue. I’ll look into taking a long weekend or two off over the next month or so and maybe just the act of getting those on the calendar will be helpful.

The news of the outside world doesn’t help, of course. I’m trying to avoid following the ins and outs of Russian and Ukrainian politics and warfare too closely as I’m afraid I’ll identify too much and feel too deeply. It’s all connected. Russian imperial ambitions. Dark money flowing in to Western political groups whose intention is destabilization of democracy. Interference in the US, Brexit and Scottish independence elections. The firing up of cultural wars that are merely distractions from the real political and socioeconomic realities that we’re facing. I’m going to have to let others unpick that Gordian knot. I left my investigative journalist credentials in my other pants.

There is good news. Covid cases in the US continue to fall to much lower levels than they’ve been at for some time. Even the death rate is starting to come down now that we’re through the omicron hump but it’s still an unacceptably high 1200-1400 a day. We’re at roughly 960,000 US deaths (and the world death toll hit six million today, although that is most assuredly an undercount – the real count could be two to three times that). We’re still on track to hit the magic million in the US around Easter. Locally, the CDC has dropped our metro area to medium risk (masking not required indoors unless immunocompromised). As most people stopped wearing masks around here months ago, I can’t really tell the difference when I go out. I still slip mine on when going into stores or other places with quantities of people I don’t know. It’s easy to do. It’s polite. And, I have to wear one at work in clinical areas to protect patients anyway so half the time I don’t even notice whether I have one on or not. We may be done with Covid, but I don’t believe for a minute that it’s done with us and I’m not going to be in the least surprised if there’s a new strain or some other wrinkle popping up in the next few months.

I need to get cracking on Volume II of the Accidental Plague Diaries. Now that I’ve committed to do it, I have to actually do the work necessary to get it into shape. It won’t be as hard as Volume I as I know what I’m doing this time around but there’s still bunches of stuff to write and reshape and make interesting for the casual reader. I found out this morning that Volume I won another award. A bronze medal from the Readers View Awards in the category of Non-fiction/societal. I’m not sure that means anything other than I can order some very nice bronze colored stickers to put on the cover if I so choose. It’s a finalist for a few other awards as well and, if it wins anything interesting, I’ll let everyone know. I don’t often win things. I’m not a very good self promoter and a huge piece of winning in competition, especially in arts awards, is creating the brand and playing to the crowd of potential judges. Ain’t nobody got time for dat. And that’s why the name of Duxbury isn’t as well known as that of Kardashian. I did win a stuffed tiger once in a raffle at Nordstrom’s (when it was still Nordstrom-Best). I was five. I still have him.

I’d like to see a tiger in the wild sometime. Not up close and personal, but at a safe distance from a guided tour in a well protected jeep. If Covid had not derailed all travel plans, I was supposed to be in India this spring and I might have been able to see one there. That is a trip that has been postponed to a later date. I have seen a few interesting species in the wild. When I was nineteen, I paid a visit to an elephant seal rookery in the Pribilof Islands. Bull seals smell horribly of fish, have a nasty temper, and move much more quickly on dry land then one would expect. I’ve seen one of the Puget Sound pods of orcas from a small boat. I once sailed up the strait between Maui and Lanai during calving season when the waters were full of blue whales. I walked into a very surprised black bear on a trail in Mount Rainier National Park. I’m not sure who was more startled, me or the bear. I was once kicked in the chest by a white tailed deer who took offense at the fact that I would not feed him my grapes. Just the usual run of the mill stuff.

Per usual, writing one of these missives has done the trick. My mood’s better. Time to watch some bad TV, get some sleep and face the world again tomorrow. Together with my hand sanitizer and a mask in my pocket.

March 3, 2022

War Damage in Ukraine

If it’s not one thing, it’s another. Covid continues to recede both locally and nationally so let’s have a land war in central Europe and start shelling a nuclear reactor. I really have to stop reading my news feeds. They’re enough to drive anyone slightly batty. Fortunately, spring is in the air, the day has been lovely with the daffodils all coming up, the Japanese magnolias in full bloom, and the forsythia starting to come out. We’ll be in full pastel season in about another three or four weeks. It’s happening earlier than it used to. When I moved to Birmingham nearly a quarter century ago, the spring bloom tended to peak around the second week of April. Now it’s often the third or fourth week of March – global warming I presume. I may spend my dotage in a beachfront condo with a subtropical clime without having to actually move should the more dire predictions hold true.

The lovely spring weather and the reduction in Covid cases and reporting on Covid have led to a wholesale shedding of masks and activity restrictions in a lot of places. Is the pandemic over? I don’t think so. The coronavirus likely has a couple of nasty surprises left that are going to clobber us just when we think all is over and done. I’m expecting at least one more significant variant with either heightened transmissibility or heightened virulence sometime in the next few months. There’s too large a reservoir of unvaccinated individuals out there, and not just in the US, for something else not to rear its ugly head. There’s also the potential for some mixing and matching with other viruses in animal hosts and something entirely new arising somewhere. In the meantime, I’m planning on taking advantage of some of the weather over the weekend with some outdoor activity. It’s time for a visit to the botanical gardens and maybe even the zoo.

Crowd at Pro Truck Rally

As war in Ukraine pushes Covid off of everyone’s news feed, I worry a bit about some new wrinkle not getting the public attention it will need when it arises and additional people getting sick and dying that need not because of a combination of ignorance and indifference. On the positive side, war has also pushed a lot of the antivaccination nonsense off of the public radar as well. Attempts to gather truck conveys to replicate the siege in Ottowa that dominated the news cycle last month have been an abysmal failure. Lack of attention plus a sudden spike in gas prices have put paid to those shenanigans. I saw photos somewhere of a rally in support where fewer than two dozen people turned up. It was rather sad, sort of like the birthday party that none of the invitees bothered to attend.

I received notification this week that the book is a finalist for a couple of other awards. I’ll know in a few weeks if it actually won any of them. It’s nice to know that one’s efforts are appreciated but the whole thing still feels a little surreal. When it comes to my writing, the impostor syndrome continues to loom large and I have a hard time believing that anyone is truly interested. Interested or not, I have begun work on a second volume of The Accidental Plague Diaries covering 2021. I have a goal of having some supplemental material written by the end of the month. As I don’t have anything theatrical in the hopper, that should be possible. I need to write some passaged that my editor and I refer to as ‘explainer’ topics – the rants where I set forth the history and workings of various aspects of the health care system. If anyone has a favorite thing that I haven’t tackled and it’s in my wheelhouse, drop me a line and I’ll add it to my list of things to prep.

I haven’t told any good stories lately. Probably because in the nearly four years I’ve been writing these entries, I’ve used up all my best stories at some point. Sorry about that. I’ve had some interesting things happen in my life, but it hasn’t been an unending well of incident. The news out of Eastern Europe has me thinking back over my experience of war. I, like most Americans, have been relatively untouched by the cataclysms of combat. The last major conflict on American soil was 160 years ago and I don’t think we realize how lucky we are that our infrastructure and cities has remained intact for well over a century. As I’ve been seeing stories of bombing in Ukraine, it seems incomprehensible and I imagine that’s how it felt to my grandparents when they saw newsreels of Germany invading Poland or the Japanese invading China in the late 1930s, before the US was drawn into the conflict. Some of my first memories of national politics are of war. I was born shortly before the Cuban missile crisis and Vietnam was in full swing during my young childhood. I think my first memory of Vietnam and what it meant was seeing the famous photo of the ‘napalm girl’ on the front page of the Seattle Times. Kim Phuc and I are roughly the same age and seeing a child of my age naked and screaming in pain as she ran down the road to escape the flames still haunts me. I remember my mother trying to explain how this could happen to children and being pretty much at a loss for words. For those of you who knew my mother, you know that was a rare occurrence indeed.

My childhood understanding of Vietnam, which included seing the huge antiwar demonstrations, were enough to turn me off of the military. I was the first year that had to register for selective service on turning 18. I did it using my college PO Box as my address figuring that would take the powers that be some time to find me and I studiously avoided anything that smacked of the military through my young adult life. Of course, some of that also had to do with my closeted gay self in a time even before ‘Don’t Ask Don’t Tell’ when gay people were routinely drummed out of the military simply for being themselves.

My first adult experience of war was the Gulf War of 1991 when Iraq invaded Kuwait and the US went in to restore the status quo. It didn’t affect me much as a third year medical resident other than, once again, not really having the psychic tools with which to process my feelings. Steve and I had been together a couple of years at that time and he helped me with that as he had been an adult in the Vietnam era. As an out gay man from the age of fourteen, he was not wanted by the military in the sixties and had never had to serve. His older brother had gone and returned with significant psychological damage. Some of my fellow residents, who had used military scholarships to pay for their medical education, were shocked to find themselves plucked out of their residency programs and bundled off to the Middle East. I had little sympathy. You take their money, you play by their rules.

Decades later, having seen Vietnam, the Cold War, the Gulf War, Afghanistan, Iraq, and lots of other conflicts, major and minor, I no longer get personally upset by images of death and destruction. It’s old hat and part of the human condition and has been going on since time immemorial. We’ve just traded in broadswords and javelins for howitzers and hyperbaric bombs. I can’t do anything about it. I can just support the younger generation who are processing what I had to process at that age, make appropriate donations for war and refugee relief, and put my energy on the side of moral right.

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