It’s been a Monday. What does that mean chez Duxbury? It means a double clinic day (seeing patients at my UAB office all morning and all afternoon – I’m supposed to get an hour for lunch but given that the morning patients always run late and the afternoon patients are always there early, that hour is usually more like fifteen minutes) followed by an opera administrative meeting via zoom followed by a drive across town to arrive at rehearsal on time for two and a half hours of work trying to get Shakespeare on its feet for an opening in two and a half weeks followed by a drive back across town and coming home to two cats upset that no one has been home for the last fourteen hours to give then any kitty treats.

I’m feeling less tired this week. Perhaps I’ve gotten a second wind. Perhaps I’ve had enough nights of decent sleep. Perhaps I’m revved up as the show is getting to the point where we’re starting to stitch the scenes together into a coherent whole. (We ran the first half tonight for the first time. It’s rough in places and lines are not yet sure and firm but the general shape is coming together and the staging is flowing the way that I want it to with the human world within the proscenium and the fairy world of the woods spilling throughout the house). We do the same kind of rough work through of the second half tomorrow night and then I’ve arranged for a crash course in acting Shakespeare for them all from a professional to give them some tips that I just can’t, not being the trained pro that they sometimes think I am.

Tickets are now available on line. I’ll try to remember to put up a post with the link in the comments or later this week. It’s going to be an inexpensive way to spend an evening with some classic theater and some four hundred year old dirty jokes. Our ticket prices are cheaper than ‘Barbie’ and ‘Oppenheimer’, at least at my local multiplex which is one of the reasons I have not yet ventured out to see either. The American Theater may be heading back to its community roots rapidly given the current financial disasters besetting the industry. The model for professional theater (outside of Broadway, which is its own animal and which has more or less become a showcase for expensive and overlong theme park attractions that can get 1500-2000 butts in seats night after night, year after year) has been one of professional (union) and sem-professional (paid stipend, but non-union) companies presenting seasons where their cash flow has depended on a reliable subscriber base ordering up season tickets year after year. The pandemic has changed all that. Some of the subscriber base has died, some is uncomfortable going into closed quarters with others. Some simply got out of the habit of regular theater going during the shut down. But without that reliable income, budgets are out of balance, and companies are hanging on by a thread. Well regarded professional companies are canceling seasons, retrenching, reducing the size and scope of offerings, jettisoning experimental work and everyone is trying to figure out what is going to put butts back into seats.

From what I can tell, if a production speaks to an audience, it sells. The problem is that the professional/semi-pro theater hasn’t figured out who its modern audience is and therefore hasn’t been able to design seasons that will appeal. Not to mention, the all at once expense of season tickets isn’t necessarily easily born by those outside of certain demographics. The audience for theatrical entertainment is out there. Broadway does well (but it’s not necessarily aimed these days at a discerning theater audience). This past weekend at the movies where not one, but two auteur films not part of franchises or featuring superheroes both smashed box office records showed Hollywood that their recent anemic returns may have something to do with having shoveled out little other than recycled manure for most of the past decade. Our local theater companies routinely sell out shows by marketing the community aspects of local theater. Local talent, many of whom are as good as you will see anywhere out.

I ventured down to the Alabama Shakespeare Festival this past weekend to see their production of Cabaret. If you’ve been reading my musings for a while, you’ll know that’s one of those shows (along with Sweeney Todd and Into The Woods) that I’ll go see in almost any incarnation. The ASF is the only professional regional theater in the state. Tommy and I used to go routinely when they did festival programming when they ran multiple shows in rep – you could go down for a weekend and see four to six plays – half Shakespeare, half modern. They stopped doing that a number of years ago for a more traditional season form and making the trek to Montgomery for a single show just isn’t as appealing a proposition. Cabaret was a terrific production – incredibly well cast and performed with elements of Hal Prince, Donmar Warehouse/Studio 54 and the current London production all seamlessly blended. The staging of the title number was perhaps the most uncomfortable I’ve felt in a theater for a performer for a long time – which was a good thing. And the house was half empty on a Saturday night. It wasn’t a lack of PR. It wasn’t show quality. It wasn’t recognizability of the title. Something was still missing that was necessary to bring in what should be brought in. And until that missing piece is identified, we’re going to see the collapse of the professional theater industry in this country over the next decade.

My theater career will survive. It’s not professional and doesn’t depend on professional venues and companies. Community theater isn’t going to go anywhere. I’ll be able to perform on local stages, perhaps in somewhat scaled back productions depending on what budgets will allow and I and the other local thespians will continue to feed the need for story telling which creates a unique and intimate bond between performer and audience, something film cannot replicate. Imaginative directors and designers will come up with ways to transport audiences to other places and times with techniques to get them to suspend their disbelief and buy into so much cardboard and muslin and paint are what they purport to be. The budget for the original Broadway production of Oklahoma! was $83,000 in 1943 (roughly 1.5 million in today’s dollars). You couldn’t get a show anywhere near Broadway for that cost now. Most musicals are in the 20 million dollar capitalization range. Would it be so bad if we were to scale back and had simpler productions that fully engaged an audience and fewer flying DeLoreans? Just a thought.

If you’ve ever wondered what audiences saw in 1943, the University of North Carolina produced a meticulous recreation of the original production, researching the sets, the costumes, the lighting plots, the choreography (aided by a few of the dancers who were still living at the time), and every other aspect that had been archived away. It was professionally filmed. Act I –

Act II –

It’s quite the piece of theater history. I wish more of the classic shows would get this treatment.

I’ve been running on fumes this week. I think my age is starting to catch up with me. I normally can leave the house by 8, do a full work day, run to rehearsal, get home around 9:30 or 10, feed the cats and then lather rinse repeat. This week I’ve been straining to keep that up and I’ve had a couple of nights where I’ve felt exhausted by six pm, and I’ve fallen asleep at my desk and while being chauffeured to house calls by other staff more than is my usual want. Could be that my over sixty body and brain are calling on me to slow down a bit. Could be that the energies drained by three years of pandemic have somewhat altered my usual sleep/wake cycle. Could be a lack of caffeine in the system (although my usual coffee consumption isn’t much changed). Could be that my personal bouts with Covid have somewhat altered my physiology and I’m going to have to adjust to a new normal. Fortunately, I don’t have all that much down for the weekend other than putting in some tech time on Midsummer and a drive down to Montgomery to see Cabaret at the Alabama Shakespeare Festival. (You may have noticed that I try to see every production of that show I can).

Midsummer is coming together, bit by bit. We have three weeks until opening. Tickets are now available on line for those in the area who want to see what I’ve done to Shakespeare. The cast are slowly coming off book, becoming more and more comfortable with the scenes and flow of the show and I’m starting to figure out how to solve some of the technical issues we have given that I’m trying to create environmental theater in a cafetorium with minimal budget and inadequate lighting and sound. If I’m reading the tea leaves right, the end result is going to be rather enjoyable – it won’t make anyone forget Peter Brook’s RSC production of 1968 but it should be entertaining and engage the audience. At least I hope so.

A good friend of mine called this morning from where she lives in Tennessee, a small town in the part of the state that hosted the Scopes Monkey Trial a century ago. Similar things are brewing there now. The mayor and vice-mayor are coming after the town librarian for daring to put up a display of LGBTQ themed books for Pride month. There are meetings planned to pack the library board so they can fire the offending librarian and purge the library. My friend and the other liberals in town are trying to figure out how to stop the writing on the wall. I gave what little advice I could, including a suggestion that they play a satirical look at book banning written nearly seventy years ago which highlights how ridiculous it is. I am, of course, referring to ‘Pick a Little Talk a Little’ from ‘The Music Man’. I would also remind everyone that Scopes lost the court case but if that battle was lost, truth eventually won the war. As Galileo muttered as he was led out of the court after his heresy trial ‘Nevertheless, it still goes round the sun’.

That’s what I think we all have to hang on to at the moment while we all watch a once great political party try to legislate science, literature, and human nature out of existence because it disagrees with either their theology or their short term political needs. Truth will out. It’s unchanging. It’s why cross examination works. It’s why the scientific method has allowed most of us to live lives that would be considered full of unspeakable luxuries to the royalty of a previous age. You can pledge allegiance to alternative facts but the true ones are going to get you in the end. That doesn’t mean that those who prefer a society built on half truths and platitudes can’t do a heck of a lot of damage in the meantime. Things are going to get more and more interesting as time goes on.

However, demography is destiny. Immigration to this country, which was basically shut down in 1923 for racist reasons opened up again in the 1970s. Who emigrates? Generally not the well off and comfortable. Why should they. It’s usually the industrious but without resources who are desperate to build a better life for their children. The Baby Boom is a very white generation because of the lack of immigration during its engendering. The generations that come after, especially the Millennials and Generation Z are filled with the children of newer Americans and are heavily minority and have a very different perspective on the American story. The Leave it To Beaver ideals of the past are collapsing rapidly as those generations age. The Baby Boom is very close to beginning their mass die off which is why the urgency to try and rig the game for certain classes to hold political power at the expense of everyone else before it becomes demographically impossible to accomplish this. Will it happen? Some will try. There may be violence but ultimately its a project doomed to fail as 40% of the Boom generation dies in the 2030s and another 40% in the 2040s.

The aging boom will turn to the health system en masse in a few years demanding that it save them from the inevitable. They’ve gotten everything they’ve wanted from society through the years because of their sheer numbers. This time it won’t work. First off, the conversion of the health care system from a public good to a private profit center has made it impossible for it to function as originally designed. The system done broke and I see nothing happening to try and repair it coming down the pike. Second, this idea that force of belief trumps the natural order of the world is going to prove psychologically traumatic. I see it routinely even in earlier generations. Someone comes in saying ‘I’m 80 and I can’t do the things I could do twenty years ago’. And the next sentence is always along the lines of ‘But I heard of this person who’s 90 and who can (insert choice of activity here) – why can’t I do that?’ There is this failure to recognize that you heard about this person because they are an extreme outlier on the edge of the bell curve. People tend to internalize the outlier they hear about as the norm and question themselves. The world doesn’t work that way.

When I do retire, I have a feeling I’ll need to completely back out of medicine and let all my licenses and certifications go. Otherwise, I’m going to be getting calls and texts from everyone wanting help to stave off normalcy and I just don’t have the energy to deal with that. Perhaps if I retire to Burkina Faso…

I’m trying to decide what to write about this evening. One of the downsides of the end (or at least the pause) in the pandemic is that I can’t just look at the latest Covid related headlines, check the statistics and assume the muse with hit me with an angle that will let me churn out another entry in the now completed Accidental Plague Diaries. For the ten or twelve of you eagerly awaiting the publication of the third and final volume, it is complete and edited. It’s being put into proof form as I write this. Once that’s completed and thoroughly checked, I’ll have a publication date. Sometime between mid August and October is likely. When the third volume comes out and the whole saga is complete, all 300,000 words and roughly a thousand pages, I’ll have to think about what to really do with the project. I really need a PR firm but that’s a bit outside of my budget.

I could write about politics. About how one of the senators that purports to represent me in ‘the world’s greatest deliberative body’ seems to have zero understanding of white nationalism, racism, or any other ism when you get down to it. Unfortunately, we’re stuck with him for another four years. Perhaps he’ll have started allowing senior military appointments again by them (personally holding them all up in a fit of pique as the military believes that reproductive decisions should be made by physicians, not polticians). I don’t quite understand why the senior party leadership don’t take him out behind the woodshed but they appear to still worship at the altar of Ronald Reagan’s eleventh commandment ‘Thou Shalt Not Speak Ill of Any Fellow Republican’. The problem with this, in the social media age, is that the most extreme voices are being amplified, the Overton window gets yanked further to the right, and silence becomes complicity as the business of governing becomes more and more dysfunctional.

I could write about the war on education and literacy happening left, right and sideways in the name of protecting the children. Moms for Liberty has sprung out of nowhere in two years to become a well oiled machine pushing policies completely lacking in educational value, destructive to minorities of all stripes, and of dubious morality at the local and state levels. I am very suspicious of any grassroots group that goes from zero to a hundred in a very short period of time. That doesn’t happen without a lot of money and organizing knowhow. So I always ask two questions – who is funding it and who benefits? It doesn’t take a lot of poking around to see that the money and organizational savvy is coming from the usual suspects on the right – groups like the Alliance for Defending Freedom. Groups that are funded by a handful of right wing billionaires whose goal is the overturning of the New Deal society and the eradication of any constraints on capitalism and if people and social institutions are hurt by their methods, it’s necessary collateral damage. Those that would truly benefit are those who are investing in the materials necessary for alternative right wing private education. They would love to see the public schools knocked down and replaced with the equivalent of the Southern White Academies that sprang up as a response to desegregation, but on a national level. Well funded with public dollars, but closed to those who are not like them with the remaining public system underfunded for those that would not be welcome in the gated community.

I could write about the continued slow collapse of the health care system in the US. My last checks showed that if you were to move new to Birmingham and wanted to establish with a new primary care physician, the earliest appointments available now are in November. In another year, it will be more than six months. The combination of the aging of the boom, the increase of the population, and the pandemic’s creation of a significant new population faced with the challenges of chronic illness are leading to a spike in demand. The retirement of roughly 20% of the workforce, the economic pressures which push newly minted providers into certain high paying specialty areas, and the massive growth in administrative hassle factors are at the same time reducing supply. It’s not going to get any better for the foreseeable future. Add to that the paralysis in long term care systems due to a lack of workforce, supply chain issues, and a fixation of the system for short term profit over long term problem solving pretty much guarantees havoc is going to reign for some time. And people wonder why I am contemplating retirement.

I could write about the experience of turning fifteen enthusiastic community volunteers into a troupe of Shakespeareans. They’re turning up for rehearsal, they’re full of energy, they’re working on their lines. I seem to have made some relatively smart decisions conceptually on how to put A Midsummer Night’s Dream together so that the show should be a reasonable entertainment when it is completed and ready for the public as of August 10th. That’s four weeks from tomorrow. I’m going for a sense of brio and summer popcorn flick so, if you’re expecting King Lear as performed by the RSC, you might be disappointed but if you just want to be entertained for a few hours with hijinks and some lovely language, you might have a good time. I’ll post the ticket link and other information when it’s ready. It runs the weekends of the 10th and 17th so mark your calendars now.

I could write about my personal continued march towards decrepitude and irrelevance. I through my back out last week. It’s nothing new. I’ve done it every five to ten years my whole adult life. It doesn’t happen because of anything I’ve done or overdone. I’ll just bend over to pick up a piece of paper or get something out of a low drawer and wham – the lumbosacral muscles go into spasm, pain sears through my lower spine and pelvis and I cannot move or bend without grave difficulty. It goes away in a week to ten days and is usually only bad for the first two or three. Heat, Tylenol, the occasional muscle relaxer and I can continue to live life. This was the first time this has happened since I’ve lived alone. All other times, I had a roommate or a partner around who could help haul me out of bed, fetch things, and take the brunt of my waspish disposition when I was in pain. I had to figure out how to get myself out of bed doing a strange crab like eight point turn as I wiggled this way and that until I could get myself finally to a standing position. I had to get my own glass of water from the kitchen. As I scuttled around, looking like Quasimodo after a three day bender, the cats watched me in what I assume was detached amusement – never bothering to offer to help. I am now on day eight. I’m moving fairly normally but I still have to be somewhat careful. I should be fine by the end of this weekend – until I need to pick up a dropped pencil or something and it spasms again.

But maybe I won’t write about any of that. Maybe I should just wait until the muse strikes. I’m waiting…

Supposedly the last few days have each broken successive records for the hottest days on planet earth, at least since modern humans began keeping accurate weather records. Given the oppressive sauna bath that is Alabama July going on outside of my comfortably air conditioned condominium, I’m inclined to believe it. It’s been somewhere in the 90s all week, and then add to that a rather nasty level of humidity. Occasionally the skies cloud over, thunder rumbles and there’s a brief respite of rain and a quick plunge of temperature by twenty degrees. But half an hour later, the cell is past and all that extra moisture is now in the air, raising the humidity and making it feel worse than it did before the rain. I shall not miss this climate should I ever move elsewhere. There are things I will miss – fireflies, mockingbirds, lighting storms observed from the safety of my back deck – but Alabama summer is not amongst them.

I remain a West Coaster in terms of what I believe is proper for climate. That begins with minimal humidity and temperatures topping out at about 80 to 85 at a maximum. I did learn to appreciate the dry heat of California Central Valley summers during my years in Sacramento but even that could get ridiculous at times. My first summer there, we had a heat wave in July. I was on night shift in the ER and it was nearly 90 degrees at 3 AM. They have no idea how hot that week actually got as the official thermometer stopped functioning at 117 and the temperature was still going up when that occurred. It did mean that the population of Sacramento was all out in the streets at all hours that much and imbibing far more beer than was good for it. I spent a good portion of those night shifts sewing up head lacerations on various young men who had made serious errors of judgment when it came to motor vehicles and power tools and, in one memorable case, a fight with someone armed with a shovel.

I’ve been watching some old reruns of ER late night on Hulu before bed. I never saw it during the 90s when it was in its heyday. I was busy living it and had no need to introduce those storylines into my home as entertainment at the time. Having worked in a few ERs over the year, they got the pace and the chaos and the camaraderie down pretty well. The soap opera plots involving everyone’s love life generally don’t happen in the work place and are a bit fanciful. And I hate it when the actors mispronounce a technical term. There’s nothing that takes me out of the moment faster than someone screwing up pseudomonas aeruginosa. Medicine does have its own language. I refer to it as Medicalese. It has about 50,000 words and most clinicians know and use roughly half of them. Which ones you use depend on specialty and job description. It has more acronyms than the military and even a few bizarre standard mispronunciations. Those of us who work in health care become fluent during our training as a matter of survival. The problem is that a lot of clinicians forget that the whole world is not privy to the language and they have grave difficulty reverting back to common English usage when discussing health subjects with patients or other lay people. I spend a good deal of my time as a translator and have worked very hard through my career to develop a bedside manner and language that can be easily understood.

One of the issues that’s currently bedeviling medicine in the wake of the pandemic is certain attitudes put forth by some in administration. The three year gap with work from home and other slowing down in clinical functions allowed them to become much more familiar with the power of big data sets. (An enormous part of my clinical effort is data entry to supply this unending appetite). More and more proposals are coming down from above on chronic care programs which have the stated goal of improving care. The problem is, however, that most of these administrative types are of upper middle class/professional class background and they therefore make certain cultural assumptions based on that, thinking that their way of viewing the world and problem solving is always correct. They have no practical field experience with case management, house calls, home health, long term care and the other areas in which I spend my days. They do not understand that huge swaths of the population do not have smart phones, well appointed homes with all the latest appliances, budgets that allow for dietary manipulation, resources for child care and elder care, or the hundreds of other battles that most of the population who live outside of gated communities must contend with. And then these administrators get very put out when I explain basic facts of life to them. My colleagues and I get together sometimes, look over the latest directive, and just laugh. It’s either that or cry. I’d be more than happy to introduce them to the real world of home care – to places where you dare not touch the furniture for fear of picking up some unpleasant insects, to places where you need to spray yourself down with Febreze before you get back in the car, to places where you can barely move from room to room because of the garbage piled everywhere. It might give them some ideas for more practical research projects.

I received an email today from the brand new chief of geriatrics at UC Davis inviting me to consider joining their growing division and looking for ways that UC Davis might collaborate with my own work. I wrote back explaining why I vowed never to set foot back on that campus again because of how that institution treated me and Steve, more or less destroying our lives. It may have been petty, but I felt better after sending it and even though those events were 25 years ago, the current chief better have a good handle on that history as the fallout from all of that caused significant problems between UCD and most of the eldercare service agencies in the region and reverberations went on for years and years. I wish her the best of luck in her endeavors.

I’m still in a bit of a churlish mood after that but I do have some things to look forward to this weekend. The Dungeons and Dragons group meets tomorrow for brunch (mimosas will be had) and I’m seeing the matinee of a new play, Boy, at Birmingham Festival Theater on Sunday. I’ve also got to figure out where to write the fourteen unfinished progress notes for the week in there somewhere. At least it’s not thirty two.

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

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

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

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

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

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

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

I haven’t written a long post for a week. I suppose this is what comes of trying to balance a more than full time job with directing Shakespeare and trying to get the final edits in on a third book. Not that I’m complaining or anything. I figure that my usual round of over commitments has a net positive effect on the world and I usually am in the right place at the right time for whatever is expected of me. I perfected the art of being in two places at once a number of decades ago. I just have difficulties with three places at once.

What should I write about? There’s really nothing new to report in regards to pandemic news other than it’s still out there and there should be new boosters available in the fall. There’s a new omicron variant XBB that seems to be causing some issues and I believe they are tweaking for greater efficacy against that one. Most of the cases I’m hearing about at the moment are the stay home and feel miserable for a couple of days and then you’re over it variety. The problem is you’ve got about a 1/8 chance with every infection of developing significant long Covid symptoms so every case you avoid can save you mucho grief in the future.

The big news story of the day is the rapidly deteriorating situation in Russia where the Wagner group has turned on the Putin regime in a mutiny which may or may not be a well planned coup. The stories that are emerging from Russia and the Ukraine are conflicting and all I can say is that I hope not too many innocent civilians get caught in the cross-fire. I’m also rather concerned as to just who is going to end up with the various armaments, nuclear and conventional and just what they’re going to do with them. The Wagner group are no heroes; they’re a band of thug mercenaries so I can’t say they’d be an improvement on Russia’s professional military.

I do have travel plans for Eastern Europe this fall, but I’m going no further East than Poland and Slovakia so I don’t think there will be any problems. I’m putting off visits to Kyiv, Moscow, St. Petersburg, and Belarus for a while. I have no particular wish to experience being a tourist in a war zone. I’ve been a tourist caught in a hurricane a couple of times and that’s been bad enough. I cannot recommend riding out a hurricane in a beach front hotel on a Caribbean island as Steve and I once did. Fortunately, we had not splurged for the ocean view room. We had a garden view on the back of the building and were relatively well protected.

I am taking a passel of children to a production of Peter Pan tomorrow afternoon. The last time that show was done in this particular theater, I played Mr. Darling, but that was 19 years ago and I’ve aged out of the part. I could probably still get away with Captain Hook or Smee. Two of my charges are teens who will probably roll their eyes at the ‘Do You Believe in Fairies?’ moment. The other is seven so I am hoping for some strong belief from her. Personally, I will probably mutter sotto voce ‘Believe in them? Why I know hundreds…’

First read through for A Midsummer Night’s Dream happens on Monday. I haven’t directed Shakespeare since 1984 so I hope I’m up to the task. I’ve been doing a bunch of script study and making some cuts of some of the more esoteric classical references that do absolutely nothing to move the plot along. I think I’ve got a grip on it and have about seven weeks to mold it into shape. If I can get my actors to get the tone right, the end result should be a lot of fun. I was out at the theater this morning meeting with the tech folk. Set and costumes are well in hand.

I’m still casting about for the next writing project after the third volume of The Accidental Plague Diaries is complete and out. Suggestions are being taken from the floor.

The jet lag has come under control, things are relatively calm at work and I’m on the first day of a three day weekend, so I suppose things are right with the world. Of course, the prospect of A Midsummer Night’s Dream which must be analyzed, annotated, blocked, and led through a design process, is hanging over my head and there’s that pesky third volume of The Accidental Plague Diaries that must be finished up and unleashed upon the world later this summer. It should be enough to keep me out of trouble for the next few months. The rest of 2023 is coming into shape: Midsummer, book launch, trip to Europe, holidays. 2024 remains terra incognita. There’s a show in early 2024 for which I’m lobbying for a role and I want to do a trip to Asia or the Middle East later that year sometime but the rest, as they say, is silence.

We haven’t looked at the pandemic for a while. Part of that is because I’ve had other subjects about which to write (at long last) and part of that is because, with the end of the public health emergency, primary source information regarding morbidity, mortality, spread, hospital utilization and all of the other myriad details that the federal government collected and standardized so that we could try to understand what was happening in real time, have once again devolved to the hundreds upon hundreds of individual city, county, and state public health departments with no central collective authority. In fact, monies allocated for continued study of the pandemic for a better understanding and preparedness for the next one (and there will be a next one) were stripped out during the recent budget negotiations. I’ll bet you can guess at the insistence of which political party.

Some basic truths: The pandemic isn’t over. That’s wishful thinking. No one really knows how many people are getting sick and dying currently due to the ending of federally funded data collection, but when that came to an end, the number of new cases daily nationwide was holding relatively steady at somewhere between 15-20,000 and the number of daily deaths was running 200-250. Assuming that these are the new steady state, that’s about 6 million infections and 90,000 deaths annually, bringing Covid into 5th or 6th place in the annual causes of mortality race moving forward. There is going to be some reshuffling among the top ten over the next few decades due to the senescence of the enormous baby boom generation and due to Covid itself.

Somewhere around 12-15% of Covid survivors develop post Covid syndromes of various stripes. We’re still trying to figure it all out and come up with standardized diagnostic criteria, not to mention effective treatment. But pretty much every time you get a Covid infection, you have to make a d8 at best and d6 at worst saving throw and, if you roll a one, you’re in trouble. Post Covid more than doubles the risk of venous thrombosis and pulmonary embolism, diabetes, heart arrhythmias, chronic lung disease, and death. As Covid continues to circulate, we’ll all have a chance of being exposed over and over again through our lifetimes… and every time the fates roll the dice.

The one real weapon we have remains the vaccines. They continue to be in steady supply and any number of virologists world wide who understand these things far better than I do continue to look at the data regarding vaccine protection, genetic mutation, and all the rest and make the best recommendations they can regarding boosters. The last big push was for the bivalent booster that became available last fall and which had a better effectiveness against the various omicron strains. Fortunately, we are still in the age of omicron – or at least the WHO hasn’t found it necessary to reach into its bag of Greek letters for a new name since omicron wiped the field at the 2021 holidays. So, if you’ve had a booster at any time from September 2022 on, you’re pretty up to date.

Patients are asking me about future boosters. The messaging on this has been somewhat muddled and reports are not easy to ferret out since the end of the public health emergency. As I understand it, the FDA made a very weak recommendation for a spring booster for the elderly or those who were immunocompromised but didn’t really follow through with any sort of push. The data wasn’t great that it would improve things over the previous fall’s bivalent booster. However, there appears to be a push gearing up for a fall booster together with flu shot season. Full details aren’t available yet so I would just keep an eye on your favorite news source and see what they report. I’m planning on taking one.

The official CDC death toll for Covid remains a bit over 1.1 million to date. Assuming the numbers don’t change, it will take us a decade or so to finish up the second million. The first only took about two and a half years. These are just the pure Covid infection deaths. Deaths from disease processes developed due to prior Covid infection or from Long Covid aren’t included. The ancillary deaths from societal disruption – deaths in accidents, suicides among mental health patients, homicides – they’re all up substantially. The Reagan era wholesale attrition of the mental health system ensured that when we ended up with a society wide stressor, that the resources to assist the more fragile would not be available and we have all noticed the increase in anxiety, fear being channeled into anger, depression and dysthymia, and risk taking behaviors that have accompanied the wrenching changes of the last few years. And I think things are going to get worse before they get better. The federal government seems to be heading down a path of lets pretend the pandemic didn’t exist. All of the economic social supports that made the last few years bearable are being dismantled. Vulnerable sectors of the economy are going to have a very difficult time. As president of the board of Opera Birmingham, I am privy to the financials and the company did well through the pandemic given its eligibility for the payroll protection act. But all of those funds have been reappropriated and we’re faced with a traditional cultural event attending audience that still doesn’t feel fully comfortable gathering in theaters and public and private funding streams majorly reduced due to the number of competing needs. I think over the next five years or so a lot of arts producing organizations will be unable to continue. The ones that survive will get stronger with less competition for resources. But fewer producing companies means fewer opportunities for artists and fewer voices out there in the marketplace of ideas and the community as whole becomes poorer.

I can’t solve any of this so I’m going to bed early to fall asleep to reruns of ER on Hulu. I never saw it in its original run so I decided to finally give it a whirl. It’s a bit over the top, but the actual patient and staff interactions are fairly true to life. I do, however, wish they had employed a medical dialogue coach. There’s at least one major mispronunciation of a technical term per episode and every time it happens, it takes me right out of the story. And then there’s the weird mispronunciations in Medicalese which I’ve never been able to figure out. Why should centimeter be pronounced sawnameter by highly educated English speakers? I’m sure there’s a perfectly reasonable explanation but I haven’t a clue as to what it might be.

Dateline: Birmingham, Alabama –

A brief entry to let everyone know that I have returned safely from across the pond and will be settling back into Birmingham life over the next few days. I return to work tomorrow afternoon, just in time to pack my things so that the UAB Geriatrics Clinic can move from the 3rd floor to the 4th floor at the end of the week, replacing the Family Practice Clinic which moved from the 4th floor to the 3rd floor. No one has been able to explain to me why this change was necessary for financial, patient care or aesthetic issues. I have a feeling an administrator, working at home during the pandemic came up with the plan as part of a reason to justify salary. I’ve also going to have to get cracking on A Midsummer Night’s Dream if we’re going to begin rehearsals in two weeks.

Yesterday, the last full day in London, was a low key day. Vickie went off on the Harry Potter studio tour to look at the sets and props and costumes from the movie franchise and had a great time. I didn’t go as I’m still working out my rather complicated relationship with the Potterverse and just didn’t feel it was the right time for me to immerse myself in that. Both the books and the films are very bound up in my memories with Steve’s and Tommy’s illnesses and other issues and I didn’t want to pick the scabs on those wounds at this point. I got up, and headed over to Carnaby street and Covent Garden to have breakfast with Natalie Riegel whom I have watched mature from a theater kid to competent young woman over the course of the last couple of decades. She’s currently working for the National Theatre in their production department in an outreach position and loving it. We had a long conversation about theater, reminiscences, and what it’s like to be an American expatriate living and working in London. (She loves it).

After breakfast, I did some shopping, wandered the West End a bit, an then decided a nap was in order and headed back to the hotel for a bit to snooze and rest up for the grueling travel day to come. I then had a wander around Kensington and Knightsbridge, enjoying the first break in the weather all week with a smattering of raindrops and the temperature descending out of the 80s for the first time in several days. While the hotel had air conditioning, it was having difficulties keeping up with multiple days running of weather in the 80s, something that used to be a rare occurrence in the UK but which is becoming more routine with climate change.

Vickie returned from Hogwarts and we headed back to the West End for dinner and a show. (Dinner – Vietnamese convenient to the Theatre Royal on the Haymarket – edible, but not anything special. ) Our choices of play were somewhat limited as it was Monday evening and that’s traditionally a dark evening for most productions. After seeing what was available, we chose the first public performance of a new production of Dario Fo’s ‘Accidental Death of an Anarchist’. Fo, who was all the rage when I was in college, and eventually won the Nobel for literature for his mordant satires of capitalism and his laceration of Western thought processes. This play, which premiered in 1970, and which centers around the death of a likely innocent suspect while in police custody, is topical and timely to our present day. Fo’s theatrical techniques, which harken back to the Commedia Del Arte, require a lot of improvisation, physical comedy and topical references to have the intended impact so the current London production is, in some ways, an adaptation of the original script rather than any sort of faithful remounting. I haven’t seen a lot of Fo staged, and it has usually been in college productions that have been quite deadly so it was interesting to see a full West End mounting which uses a lof of fourth wall breaking, Brechtian alienation techniques, and societal mirroring to get the points across.

I ended up liking it a lot, but not loving it. It may be, as this was the first public performance, that the piece hasn’t quite gelled yet. The female lead had a bit of an impenetrable dialect and no concept of how to hold for laughter which should be corrected by the end of the week. The male lead, while very good, starts his performance at a nine and then dials it up to eleven. It needs more rhythm and build. I’d tell you who the actors were but London theater has abandoned physical programs and I’m hopeless with name retention unless it’s someone I know from other context. The director seems to have found a blend of The San Francisco Mime Troop, Agitprop, Monty Python, and Joe Orton which holds the piece together and the audience was laughing and recognizing it as a comedy, but with very serious themes underlying.

This morning, we got up, packed out bags and boarded a bus for Heathrow. And so began a very long process by bus, foot, airplane, second but, and Uber, dropping us off at the Condo roughly 16 hours after we began. It was better than the 24 hour process from the last trip as we weren’t routed through Amsterdam this time around. During all of this, my travel agent called and I now have a firm booking on a fall trip for me. Expect more travelogue in October.

As for now, I am heading for bed and trying to reorient myself to the Central Time Zone.

Dateline: London, England –

As I did not return to the hotel until sometime after 1 am last night, I was in no condition to write the usual travelogue. The two glasses of wine with dinner and the glass of champagne as an hors d’oeuvre likely did not help. Therefore, I need to condense the weekend into one entry. I hope you will bear with me. I do wonder sometimes who reads these things. The ASO Choir director Philip Copeland told me that he is an avid follower, and as he is the ringleader of this trip, I figure I owe it to him to not peter off just as things are getting interesting from his point of view. So I have at least one fan out there…

The weekend has been quite warm for London with temperatures yesterday and today both ascending into the 80s. It has been clouding over this evening so with luck it will be a bit lower tomorrow. It’s not that hot by either Alabama or even Central California standards but it’s quite warm for a climate that does not have air conditioning has a standard accoutrement. And those places that do have it, it’s not really keeping up with the temperature and the numbers of people occupying them. A few spaces have been sweatboxes. The same thing happens in Seattle when there’s the occasional summer heat wave. It’s likely these are going to become more common due to climate change and HVAC will become more standard in the northern temperate climes that have been able to avoid it in the past.

Saturday morning, I slept in. It had been a busy few days and I felt a bit of a need to recharge the batteries, especially as today was performance day. I did get up midmorning, wander a bit around Kensington, the part of London where our hotel is situated, and finally found some decent coffee at a local Starbucks. It certainly does not exist at the hotel. Vickie was off at the National Gallery and the National Theatre for a matinee of a new play about John Gielgud and Richard Burton and the interpersonal troubles they had creating Burton’s Broadway production of Hamlet in the 1960s. I put on my concert blacks, not the outfit I would have chosen for one of the hottest days of the year locally and eventually made my way to Southwark cathedral for our dress rehearsal with the orchestra.

After some milling around figuring out lineups (the bane of every choral concert – how do you get a hundred people on stage so they look professional and everyone is in their proper place), we were finally able to rehearse our piece with the full orchestra assembled for the occasion. The orchestration, which I had not previously heard, was exquisite and brought new power and nuance to the work. I wasn’t expecting it, but being in a Gothic church (dating back to the middle ages) which was constructed as part of a wealthy priory originally (until Henry VIII had other ideas) and singing the text of the Latin mass gave me a visceral feeling of connection to the space and all of the other people over centuries who have lifted their voices in song and celebration in that sanctuary. I hadn’t really expected to feel that.

Southwark cathedral has a long and varied history which I will not repeat in its entirety but its origins as a religious site go back as early as the 7th century and the original priory appears to have been under the control of William the Conqueror’s half brother Odo after the Norman Conquest. The current church was constructed in the 13th century sometime after the original was destroyed in the great fire of 1212. It was improved and enlarged in the centuries that followed but was falling into ruin by the early 1800s when there was a major restoration. It was damaged by bombs in the Blitz but not destroyed. There are shrapnel scars still visible on the exterior walls. Shakespeare’s brother is buried there and parishoners have included everyone from Geoffrey Chaucer to Charles Dickens over the years. It’s most famous current resident is Hodge, the cathedral cat, who made appearances both at rehearsal and the performance but wisely refrained from entering the stage area.

I can never judge how a performance I am involved with is perceived by an audience. The viewpoint from stage is so strange and your mind is so occupied with technical issues regarding vocalization, blocking, and being aware of other performers, that you can’t possibly just sit back and enjoy it. However, I was fortunate enough to have some friends turn up. Besides Vickie Rozell who has been my companion for the week, Richard Polley who was our tour guide when I was here six months ago came and then David Pohler and Sophia Priolo also made appearances. David had spent the day on the coast swimming in the English Channel and had quite the journey back to London as many trains kept getting canceled out from under him. But he did make it. Their feedback was that the piece we sang was marvelous and the acoustics of that centuries old nave were absolutely wonderful.

Afterwards, following a bit of a yackfest, Vickie and I headed off to the celebratory dinner for the concert participants. I thought the name of the restaurant sounded familiar and, when we arrived, I recognized it as being the same restaurant in which David and I and the rest of the Alabama seven had had our celebratory New Years Eve dinner six months ago. What are the chances… There is a story about that dinner, David, and a bottle of Dom Perignon but that one’s not my story to tell. You’ll have to ask him. Much drinking was had that night. Maybe not quite so much, but enough drinking was had last night.

This morning, Vickie and I got up and had a stroll up to Kensington Palace and through Kensington gardens. We found the memorial plaque to my great-great-uncle Maury Meiklejohn on the wall of the Hyde Park Barracks. He was a military officer who had won the Victoria Cross in the Boer War (and lost an arm in the process). He remained on active duty with the army. He was killed in 1913 when the horse he was riding in Hyde Park spooked and ran. He was having difficulty controlling in with only one arm and the horse was heading for a nanny with a pram and other small children. In order to save the children, he managed to turn the horse but in doing so, was thrown, suffered a head injury and lost his life. He was regarded as quite the hero in Edwardian London for that act. The family has a scrapbook with all the news clippings from the time.

From there, we headed to Regents Park to see the rose gardens but the day was becoming entirely too hot for that much walking so we cut that short and headed off to tea at Fortnum and Mason’s with David Pohler and his partner Jonathan Uday Ramteke. A lovely two hours of champagne, many pots of tea, finger sandwiches, scones with clotted cream, petit fours in the elegant surroundings of Fortnum’s Jubilee tea room (completely redone for Elizabeth’s Diamond Jubilee in 2012). I hadn’t had a proper British tea in some years and it was tres elegante. The four of us then wandered through the West End for a while before catching a taxi for the other major event of the day.

We went out to the middle of nowhere East London where a prefabricated arena seating 3,000 people has been erected to host a show unlike anything I’ve ever seen. Entitled ABBA Voyage, it is a holographic recreation of the group in their heyday performing a concert mixed together with live music and enough technical wizardry to make us hardened theater geeks keep looking at each other going ‘How did they….?’ Most of the greatest hits are there (but each of us missed at least one favorite song that was not included). There was much dancing in the aisles. Many of the aging boomer attendees were dressed in ABBA 70s-80s garb. It was an experience. I thoroughly enjoyed it and sang along with thousands of my best friends. The entire arena can be dismantled and the show moved to other places. The original plan was for it to run in London for a year, and then move on, but it’s been so wildly successful here that it’s going to stay until at least next spring. In a few years, it may be coming to an industrial wasteland near you.

This is the first iteration of this sort of technology in entertainment. One wonders what will come in the future as it continues to be perfected and expanded. A Rolling Stones concert as it would have been in 1968? Elvis Presley with a first act of young Elvis and a second act of Vegas Elvis? Judy Garland singing her Carnegie Hall concert eight shows a week? As long as enough archival footage exists, they should be able to create something using current techniques. Is this a good thing or not? I haven’t made up my mind. It can let others experience the ephemeral moment of entertainers from the bast, but isn’t that what’s special about live performance? That it is never the same night after night. It always responds to the energy and cues from the audience and, if the entertainer is only so many bits and bytes, doesn’t that subvert all of that? It will be interesting to see what happens.

Dateline: London, England

Today was another low key, but busy day. It started with a morning rehearsal of the piece for tomorrow night. It just keeps getting better and better and I think we’re going to be proud of the end result. The composer was in attendance at the rehearsal and seemed pleased and he will be at the concert. It’s a new piece, having only been written in 2019. It’s been recorded but not yet released due to Covid delays. It’s been done in Belfast and Kent and some other places in the British Isles but this performance will be the London premiere. Fingers crossed that there won’t be any major hitches tomorrow but the folks behind Vox Anima seem to know what they’re doing and everything has been efficient and well organized so far.

After rehearsal, as it was another day of simply glorious weather, I wandered down past Buckingham Palace and St. James’ Park to Westminster where Vickie had spent her morning. We met up and headed over to Westminster Pier and took a brief cruise down the Thames from Parliament to Tower Bridge and back. It gives another perspective on the city which would not exist were it not for its vital, navigable waterway. The Thames has been a water road between sea and countryside since the ancient Celts and Britons. The Romans used it and constructed their town of Londinium around what is now Tower Hill. Then came the Angles, the Saxons, the Danes and the Jutes each adding a layer, culminating with the Normans in 1066 with William the Conqueror who began construction on his great fortress, the White Tower of the Tower of London in 1075. And here we are nearly a millennium later, the Tower stands. The monarchy William founded stands, although greatly changed. The English people stand despite some of the recent idiocies of their government.

Apres boat tour, we grabbed a quick snack and rode the London Eye. Vickie had never been on it and I had never been on it during daylight hours. The weather was perfect, the views panoramic, the crowds somewhat dismaying. Fortunately, we had had the good sense to pay extra for Fast Track passes and were able to jump the queue. We eventually descended to earth, after sharing our pod with, from what I could tell, was an extended family of Germans, and several French couples, and ambled up the south bank toward the National Theatre where we had our show for the evening. We were several hours early, so we found a table in the shade outside of the NT where a riverside stage was occupied by the London company of ‘A Strange Loop’ who were having a tech rehearsal prior to doing some preview work for their opening next week. I haven’t yet seen the show but I quite liked some of the music we heard.

This evening’s show, Dixon and his Daughters, at the National Theatre was a compact play about the effects of domestic violence and sexual abuse on family systems. The six actresses in the cast were all fantastic. The script is tight and nuanced, but it’s not the most comfortable of things to sit through. I’m glad I saw it, but it’s not a feel good night at the theatre. It was in the small house in the complex formerly known as the Cottlesloe and now known as the Dorfman. Vickie and I, being theater people, immediately assumed that it was named after Ariel Dorfman, the Chilean/American academic and playwright of Death and the Maiden. We couldn’t figure out why the NT would be honoring him so. I then looked it up and it was renamed in honor of a Lloyd Dorfman who gave the NT a rather enormous sum of money. Oh well…

The show was not long so we had dinner after at a South Bank eatery called Giraffe. Why I could not say as there was no giraffe on the menu nor was there anything about the decor to suggest the savannah. Forty years ago, nay even twenty years ago, the South Bank was pretty much a desert. It’s been transformed into the place where young Londoners go to relax and party and avoid the tourist crush in the West End. Restaurants, bars, musical entertainment, and lots of Gen Z and aging Millennials doing what young people do. At times I miss being that age and not being able to keep up with them but then I remind myself that I’m exactly the right age for one born in 1962 and I had my chance to be a twenty something in the 80s and it’s somebody else’s turn now.

Some thoughts about London today: There is construction everywhere and the skyline is dotted with construction cranes promising more and more large buildings and public works. The service workers are cheerful, kind, and really want to help. I presume that this is because those sort of jobs are paid better and the pandemic hasn’t decimated the workforce as it has in the US so those remaining in the sector aren’t overly worked and stressed out. They also don’t have the issues of employment based health insurance here which lead to so many problems on our side of the pond. It’s a cosmopolitan and welcoming place. It’s June and there are pride flags everywhere and no one seems to care at all one way or another. I am reminded of Mrs. Patrick Campbell’s famous quote regarding homosexual relationships. ‘My dear, I don’t care what they do, as long as they don’t do it in the street and frighten the horses’.

Long day tomorrow… and so to bed….