It’s been almost a week since I last wrote a long piece. I don’t know if it’s because my need to write is receding along with the pandemic or if I’m just lazy. I certainly could have written something this weekend, but I was slothful instead. Well, not completely, I made it to my improv class, wrote my notes for the week, attended and sang at Easter service and did the laundry. Maybe it’s the sense of melancholy I usually get in mid-April as I pass through what I refer to as birthday week. Tommy’s birthday was yesterday, the 10th. He would have turned 58. Steve’s birthday is this Thursday, the 13th. It would be his 75th. I am trying to imagine a 75 year old Steve and I simply can’t. Maybe that’s why he was destined to die young. He simply couldn’t have existed in an older model.

It’s probably fitting that I’m spending birthday week in rehearsal with the Alabama Symphony Orchestra for the world premiere of Carlos Izcaray’s Requiem. Carlos is the conductor of the orchestra. He’s a generation younger than I am and his wife died tragically young of cancer a few years ago. This Requiem is his musical tribute to her and their life together. I, of all people, understand the emotions that produced the music. I’m generally not a huge fan of modern classical music as most contemporary composers seem to write pieces full of dissonance and strange harmonies that seem to be about showing off rather than pleasing the ear of the audience. There are some exceptions. The first time I heard Gorecki’s third symphony, I had to pull the car off the road and completely stop what I was doing in order to listen, I found it so affecting.

So Carlos’s Requiem, a memorial to his wife, in some ways is feeling a bit like a memorial to my dead husbands in my head. Tonight was the first rehearsal with the symphony and, after hearing the full orchestration rather than just a piano reduction, I can report that I liked it very much. Some of it is gorgeous and lyrical. Some of it is a little strange and the Dies Irae is very much in tempo di bat out of hell that is an Izcaray specialty. If you have nothing better to do this weekend, come on down to Jemison Hall at the Alys Stephens Center on either Friday or Saturday night and make up your own mind.

The first major work I sang with the ASO on joining the chorus a decade ago was also a Requiem, the Cherubini written as a memorial to Louis XVI and Marie Antoinette after the Bourbons were restored to power under Louis XVIII and they were properly entombed. I rather liked the music and it was fun to sing it with a full orchestra. As an experiment, the symphony decided to try projecting specially commissioned visuals on a large screen above the musicians. I do not know who selected the artist but the end result looked something like Terry Gilliam’s animations for Monty Python. I remember something about bunnies frolicking on the lawns of Versailles while Marie Antoinette’s head rolled by. Boos were heard when the artist took his curtain call and, to my knowledge, it is an experiment that has not been repeated.

I continue to feel like I’m in a bit of a state of suspended animation regarding life in general. I know I’ve entered a period of transition and that my life patterns are changing and I’m going to be living somewhat differently in a year or two but just how that’s going to happen and what the end result will be remains unclear. I’m trying to be relatively upbeat about it and, as usual, when I’m in a place of doubt and uncertainty, I’ve turned to Sondheim. The lyric ‘Could it be? Yes it could. Something’s coming, something good, if I can wait’ has been running through my head nonstop. I’ll try to hold on to that positivity but, as an Eyore by nature, it’s difficult.

I’m about a month behind on the third book so it will probably be out late summer. I’m not in a rush, but I would like to get it done so that I can cross it off of my ‘To Do’ list and put something else in its place. I’ve decided to get a new tattoo (courtesy of my sister, the tattoo artist) of the cover character from the books to commemorate the accomplishment of completing the whole project. I haven’t decided which of the three versions to use, or maybe she’ll draw some sort of composite for me before rendering it permanent.

I’m tired…. must end this and put on Netflix. My current binge is The Chilling Adventures of Sabrina. I’ve decided I’m really a sixteen year old girl on some levels.

The muse is whispering in my ear. Write something, write anything. But I have nothing to write about I answer her in a vexed tone. She doesn’t care so I open the laptop, plunk myself down on my bed and begin to type away, hoping that something worth reading might come of this. I’ve thought about commenting on the state of our politics, but it just makes me sad. There’s no sense of jubilation in seeing an ex-president indicted for various crimes and misdemeanors, just a sense of melancholy that our politics has fallen to such a base level. And it’s everywhere. Attempts to expel sitting legislators based on party affiliation, rapid passing of non-sensical laws designed to inflict cruelties on individuals who don’t conform to usual social norms. A refusal to even think about common sense firearms reform when more and more children are dying every day. I see only one glimmer of hope, the significant turn out of young voters in Wisconsin yesterday which led to a blow out for progressive forces in their supreme court judiciary race. We’re about to see a shift as was seen a century ago when the youth of the lost generation, scarred by World War I transformed politics or when the youth of fifty years ago, scarred by Vietnam did something similar. How will it play out? Who knows but those setting policies antithetical to what the young people of today are looking for are likely to find themselves going the way of the dodo in short order. It’s not an international conflict this time, but the failure of our nation state to protect our children from entirely preventable dangers, be they gun or pandemic related, is going to have very real consequences when those children attain voting age, and they are doing so rapidly.

I received very kind and very positive feedback on my pulpit message from this past weekend. I never know what to think when I’m asked to speak ex cathedra; there’s a special feeling of responsibility that comes with that assignment and I’m always afraid I’m going to get it dead wrong. I don’t see how pastors come up with a sermon on a weekly basis. I have to think about the ones I’ve written for several weeks before I can even begin to get something down on paper. But once I do have a theme and an idea of how I want to explore it, the words do come rather quickly. And then I reread it a few days later and want to throw most of it out. This time, though, there weren’t a lot of changes from initial draft until finished product. I thought I caught my ideas relatively well and I got a thumbs up from Rev. Julie when I showed it to her a couple of weeks ago.

I still don’t know where to go with these writings, or with any writings for that matter, now that the pandemic recedes into our collective unconsciousness. We’re three years after the initial shut down and it all seems like it was a bit of a bad dream. I reread things I wrote at the time and there’s a sense of unreality about it all. Our psyches are probably designed that way. To take horrific experiences and to minimize them once they are safely past so that we can keep on with the myriad tasks of living in the present. This is all well and good but it does mean that when the next bad thing comes down the pike, our collective knowledge base and ability to cope has severely eroded and we find ourselves having to reinvent the wheel. And, of course, this time around we’re enshrining in law lots of things that have more basis in our believes of how we want the world to be when it comes to biologic reality than how the world actually works. Which may make the next time even more difficult that this past has been.

The pandemic, of course, continues to hum along in the background. I get a call about three times a week from a patient who has turned up Covid positive and requires Paxllovid. Most of these have been mild cases but I still have people I care for hospitalized. No deaths in the last month or so but the national mortality rate remains around 250 a day and 1.125 million over the last three years. I will lose more people this year, and the year after that. It’s here to stay. There are rumblings that the FDA is going to approve another booster for those over 65 or with immunodeficiencies in the next month or so. My general feeling: it won’t hurt and it might help. The general trend seems to be that the more an older person is boosted, the more they are likely to continue to survive and to avoid long covid symptoms (which remain significant, affecting somewhere between 5 and 15 percent of patients and with chances going up with each reinfection.

We’re getting towards crunch time with Alabama Symphony Orchestra and Chorus rehearsals for Izcaray Carlos new Requiem which gets its world premiere next weekend. It continues to grow on me musically. It’s been difficult to learn but as we continue to attack it in rehearsal, I’ve started to understand the effects he has been going for. His music and my writings both come from the place of deep pain that comes with early widowhood so perhaps that’s the thread that makes it speak to me in ways that a lot of modern music does not. For those of you in Birmingham, it’s on the masterworks program being performed the weekend of the 14th and 15th along with Brahm’s Fourth Symphony.

I’m itching to get on stage in a play or a musical but there’s nothing happening locally that fits my personal schedule. I have commitments in May and early June that knock me out of participating in most of the late spring productions happening around here. Things free up after June 15th but there doesn’t appear to be a whole lot of summer theater going on. Something will turn up. It usually does. I suppose I better roll those energies into getting Volume III edited and out. Then I can sit around and try to figure out how to sell a few copies and how to get Kindle and Audio editions of the books completed. There’s also still the idea of adapting it into a Spalding Gray type monologue/performance piece. There’s a piece of my ego that thinks that would be a really interesting project and another piece of me that thinks trying to learn a ninety minute monologue, even one based on my own life and experiences, would be an almost insurmountable task at my age. And then I remember that Elaine Stritch was a good ten or fifteen years older than I am now when she did At Liberty and I think Quitcher Bitchin. I do have a Spolin technique dramatic improv class scheduled for Saturday so that should help scratch the itch a bit. I have found that the things I have learned there from master teacher Jeanmarie Collins over the years have served me well in both performance and medicine. I am much better at thinking on my feet and presenting myself the way I want to be seen in unusual situations and on very quick notice. It works very well in the house call environment when anything can happen and usually does. There’s only one thing that really scares me about house calls (and I’ve dealt with meth labs, collapsing structures, brothels, drug dens, puppy mills, and chop shops) and that is demented individuals with access to guns. I’ve only had to take a pistol away from a demented person once, and that was one time to many. I’ve also unloaded shotguns while people weren’t looking, and slipped boxes of ammo to family members to hide, but that’s nothing. I’ve also cooked breakfast for patients, set up their pill boxes, played with their pets (including the snakes), rescued baby goats, and had every body fluid you can name dribbled all over me. All in a days work.

I gave the pulpit message today at church. Rather than write a long post, here’s the text of my remarks…

Most of you know that I am a physician. I still sometimes find that a little hard to believe, even after nearly forty years in the field, but I did graduate from medical school and pass some board exams so I get to carry around a little piece of paper in my wallet that says I am a licensed quote physician and surgeon unquote in the state of Alabama. I have another one that says California on it but as I’m not there very often, it’s of no real consequence. I kept that one current initially as I never planned on making Alabama my home. I came here for what I assumed would be a temporary job, lasting maybe five years before I went back west to where I was supposed to be. Boy did life have a few surprises lined up for me and here I am, nearly twenty five years later. I now keep it current out of habit.

I’m always amused that my license says surgeon on it. You don’t want me anywhere near you with a scalpel. Back in medical school, when I had to do my required surgery rotation, the surgeons and I took one look at each other and it was mutual loathing. My wide open way of approaching problems and lack of concern for technical minutia did not sit well with them. Their ridiculous morning hours and ingrained narcissism did not sit well with me.

We parted ways at the end of eight weeks with my receiving perhaps the most scathing review I will ever have. I keep it still and every time a medical student comes to me sobbing about how they are a failure as they did badly on a test or in a class, I pull it out and let them read it. It helps them understand that, in the story of their life, this little blip that seems all consuming really doesn’t matter. The surgical staff of the mid-1980s at University Hospital in Seattle didn’t get to complete my story, heck, they didn’t even cause it to turn the least little bit. I went into that rotation knowing that surgery wasn’t going to be for me and that it was just a hoop that had to be jumped through. I jumped. They passed me as my work was good, even though we were never going to see eye to eye.

I had no idea what I wanted to be when I grew up other than not a surgeon. Even in medical school, I was completely unsure. A lot of that was because of the very peculiar time period in which I went through my education. I did my undergraduate studies at Stanford University in the San Francisco Bay Area. I arrived there in the fall of 1980, hoping to major in biochemistry. They didn’t have a biochemistry undergraduate degree, so I did the next best thing. I majored in biology and in chemistry… and spent all my free time doing theater. If Stanford had had minors, mine would have been in drama. During my sophomore year, the first whispers of a new disease hitting gay men up in the city arrived on campus. I was well aware of my sexuality but I was also firmly closeted. I hadn’t yet figured out how to reconcile being gay and achieving what I hoped to achieve in life. It was the Reagan era. The world wasn’t very kind to those who were different. My crazy schedule of class in the mornings, work in the afternoons, rehearsal in the evenings and lock myself in the library on the weekends to catch up kept me away from too much temptation and trouble and, in hindsight, likely saved my life. By the time I graduated, in the spring of 1984, HIV had gone from embers to conflagration up in the city due to governmental inaction in the public health sector as the disease was seen as being confined to expendable types of people.

I entered medical school that fall. Medical circles were all abuzz about this new disease but it still hadn’t really entered general public consciousness yet. That wouldn’t happen until the summer between my first and second years of medical school when Rock Hudson announced that he had the disease and soon AIDS and AIDS fear mongering were everywhere. Ideas were floated that gay people shouldn’t be allowed to deliver health services, shouldn’t be allowed to teach, should be ostracized and ghettoized. My closet door slammed even tighter. As the disease spread and I saw more and more peers sicken and die, I internalized the idea that this would happen to me as well. I figured I wouldn’t make it much past the age of 35. I wouldn’t have time. My story would be left unfinished, cut short. The only thing I knew how to do was pack as much living as I could into the short time I would be allotted. I carried this idea with me through the remainder of my medical school years and into my internship – don’t get attached, don’t let them see the real you because it will be used against you, stay in your lane but do as much as you can within it so you won’t regret the things undone when your turn comes. I sat by the beds of a lot of young men as they died alone, unvisited and unloved in the hospital. I wasn’t afraid – I figured my turn was coming and everyone deserves someone to hold their hand as they died. Too many lives cut short. Too many unfinished stories. I did my first few experiments with writing at this time, mainly in the form of letters to friends. I found that writing what I was thinking and feeling, as it forced me to carefully choose words and formalize ideas, was soothing. The internet was not yet a big thing and the world wide web had yet to be invented. I bought fun stationary and colored pens and began quite the correspondence with various people in my life.

I didn’t know it at the time, but my life was to undergo a tectonic shift in early February of 1989. I was halfway through my internship. This was in the years before residency hours were limited so I was working 80-100 hours a week and was incredibly sleep deprived. I remember very little of that year because of those conditions, but one thing I do remember was a chance encounter with a somewhat older man on a park bench which led to a dinner invitation and an exchange of phone numbers. I say somewhat older. He was forty to my twenty six but there was something about him in terms of his force of personality and zest for life that intrigued me. He was all the things I was not. Extroverted, quick with his emotions, not in the least bit afraid to be open with the world about his sexuality. He didn’t read especially effeminate or stereotypical but you knew within a few minutes of meeting him that he was definitely unconventional. Steve had grown up in Los Angeles, close to the studios in the San Fernando valley. He came out at the age of fourteen in 1962 when such things were just not done and defied the world not to take him as he was. As an out young man in Los Angeles of the 60s and 70s, he went everywhere and met everyone. He started off originally as a window display artist and then gravitating into property management (so he could retire to the beach in his 30s as he used to say) and eventually went to UCLA as a returning student for a history degree and paralegal training. HIV crashed into his world in the mid-80s completely upending his life. He lost his partner, most of his friends, all of his social supports. His mother lived outside of Sacramento in the little town of Lodi and, when she became ill with cancer, he used that to springboard himself out of the carnage of LA for something a little less traumatic, being a caregiver. A year later, we met.

There was something about the oil and water of our natures that solidified into a glue which quickly brought the two of us together into partnership. I was still very much closeted and, after a few months, Steve made it very clear that if we were going to be together as partners, that would have to change. I knew it too. Steve was not the sort of person you could hide. It wasn’t long before I found myself out to my family, my friends, and at work. No one was shocked. The general response was ‘I’ve known for years… I was just waiting for you to say something’.

Steve and I had thirteen years together. It encompassed a decade in California and then a sudden and somewhat traumatic move to Alabama for professional reasons. Within a year of that relocation, Steve became ill with the pulmonary disease that would kill him. When he knew his time was short, he didn’t withdraw, he used his remaining energies to create beautiful artworks, to engage with new communities, to make sure that I would be OK without him. He may not have been able to finish his story, but he did well with his last completed chapters. He was the happiest I had ever known him as we settled into a quiet life of medicine for me and art for him. And the UU Church of Birmingham, which he found and dragged me to, became a focal point in our lives.

I had nearly two years between the time Steve became ill and the time he died, time to finish up some business between us, even if we were leaving our life together incomplete. I wasn’t quite so lucky the next time around. Tommy, whom I met about a year and a half after Steve’s death and with whom I spent the next sixteen years, went from his usual overactive and over stuffed life to death in just under six weeks. His life was truly an unfinished story. He was expected to recover enough from his heart issues to be discharged from the hospital and slowly get back to usual activity. During our last conversations we discussed his thoughts about going back to school (again) for a degree in church music, his plans for the children’s music program, and the designs for wigs for the summer shows he was contracted to do. None of that was ever to be.

One of my reactions to Tommy’s untimely death was to plunge myself back into writing. Getting those words to line up in such a way so as to begin expressing grief, despair, and a slow rebuilding of self into something without him. I made my journalistic writings public. People started to write back about how much they enjoyed my storytelling and perspective. I obviously missed that piece of Harry Potter and the Chamber of Secrets about the dangers of journals that write back to you and kept it up. A year and a half later, a mutant coronavirus arose in Wuhan, China and we all know what happened next.

I found myself, as a physician, and someone with a keen interest in culture, history, literature, and the like, writing about this new disease, soon to become known as covid and its impact on my life and what I could see about what it was doing to our society. The writings started as essays, became a plague diary, and eventually became a book. That first book was about the failure of our government to protect us, due to the chaos and priorities of the previous administration. I assumed it was going to be a one off, a finished story, but I continued to write as things weren’t progressing the way I had thought. Rather than lining up for our vaccines and having the virus retreat, the failure of government spread until we had a full blown failure of society with a third of the population embracing fact free propaganda and rhetoric and the virus was able to use this to march on and mutate into new strains with new public health issues arising. It was clear the story wasn’t finished and, voila, there was a Volume II, picking up where the first book left off. But even that hasn’t been enough to really finish the story of the pandemic and a Volume III is forthcoming. It will be the last and will cover up through this past fall when things began to change enough for society to have a different approach to Covid, no longer an acute phase reaction but rather more of an endemic disease we have to learn to live with. Covid is by no means a finished story, but I think the piece of it worthy of a plague diary may be and it’s time for me to move on to other projects.

The books are finished, the pandemic recedes into the background. People ask me all the time ‘What’s next? Or ‘How has the pandemic changed us?’. I think the answers to that question are the true unfinished story of our current time. The last viral pandemic of the scope of Covid was the flu epidemic of 1918-1919. In hindsight, it was one of the factors responsible for ending World War I, and upending society enough to sweep away Victorian/Edwardian social and political norms in favor of something new. The society of Titanic and the society of The Great Gatsby are just over ten years apart. I think we’re poised on the edge of another massive shift fueled by Covid and our reactions to it. It’s happening so fast and so completely that our brains can’t really comprehend it and we won’t really be able to interpret it for another decade or so when historians start putting the narrative pieces together into a story our brains can actually understand. I catch glimpses of it here and there. The health care system is becoming more and more dysfunctional. By the end of the decade we’re going to be short about 50,000 providers and half a million nurses -Covid denialism has turned a significant portion of the population against medical science leading to a loss of societal respect. The need for health care workers to put themselves in harms way has become an obstacle as it was shown over and over again that a for profit system will fail to protect its employees. The older generation has departed for retirement earlier than they had anticipated. There is no way to replace that loss of expertise and system based knowledge. The educational system is not gearing up to produce new workers as that would be an expensive proposition that no one wants to pay for. Senior care is a disaster everywhere you look. Those industries were built on a low wage pink collar work force that now has other options. There is no nursing home, care agency, senior living facility, or senior social service that has anything approaching adequate staffing. This is happening as the early Baby Boomers are rapidly hurtling towards their eighties. Of course the Boom, as a generation, has always conceived of itself as eternally youthful and they are certain they shall never need such things. Public education is under attack on all sides. Right leaning individuals are using issues of race and sexuality to push for narrowed world views and privatization. Left leaning individuals push new ways of thinking and models for instruction without thought as to how they might be perceived by those outside of their bubbles and react negatively to constructive criticism. The virus itself remains with us. There are thousands of people in the hospital and hundreds of deaths every day in the US from Covid but it has been pushed off the front pages by newer click bait headlines.

The pandemic is an unfinished story. I may be done with publishing books about it, (Volume III is in the editing process and should be finished this summer), but I’ll continue to keep my antennae up and see what’s going on out there. Our societal response to Covid is an unfinished story. The dominoes continue to fall in our politics, our economics, our health care system, our educational system, and elsewhere and those macro forces are beyond anyone’s control. But most of all, I remain an unfinished story. I’m still here, plugging away at my job at UAB, having fun at my night job as a jack of all trades performer, writing a bit of this and that. And when I, like Steve and Tommy, have to get on that train that takes us who knows where, I hope I’m still an unfinished story – that I leave behind questions and unknowns, and enough of an imprint in the lives of others that the marks of my passing remain signposts even though I am no longer here.

Thank you.

As the world and my life continue to transition from pandemic to post-pandemic (or at least to Covid is no longer one of the top things on everyone’s mind times), I figure I’m going through one of those times of transition we all get to at some point. The old patterns and models don’t work. The new ones aren’t yet clear. Yet. we all must continue to live and work day to day without benefit of a proper map or compass which will spell out exactly what’s coming or how it will affect us. It would be a whole lot easier if I could knew what was coming for health care so that I could make some reasonable choices going into the next (and possibly the last) phase of my career. But we don’t get to know these things. We simply make leaps of faith and hope we land , if not where we were aiming, at least somewhere safe and stable.

I have two major professional responsibilities, the ambulatory outpatient geriatrics clinic at UAB and the rural piece of the house call program at the Birmingham VA. There’s some other minor things but that’s the vast majority of what I do during my work days. Both programs are beset with issues that are common throughout US healthcare and which are hardly unique to the institutions with which I work. And all of it has been made far worse by the effects of three years of pandemic. They include a lack of money in the system directed toward preventive and primary care, a system that tilts towards procedure dominated specialties, a severe shortage of qualified individuals for clinical positions, a rapid aging of the population, and a change of expectations of what healthcare should be and should provide on the part of the aging baby boom.

I’ve thought about walking away as a significant number of the generation older than I in health care has done over the last few years. But that’s not really my style. I want to be sure that the programs I have given my time and energy to over the last quarter century are capable of surviving my departure and continuing to thrive under a new generation and I don’t see that as happening quite yet. The problems are macro-socioeconomic forces far beyond my ability or even the ability of a single institution to change in any significant way. So I keep going to work day after day hoping that I will, at some point, see the sign posts that will tell me which way to go. They may already be there, but just disguised enough that I haven’t been able to see them clearly. I can be a bit dense sometime.

I believe that my way of practicing medicine, built around a team approach, a deep understanding of patients as people, and treatment of disease within the context of each individual’s life and circumstance creates the kind of care most people are looking for from the health care system. However, it’s not the kind of care that a system that becomes increasingly corporatized and systemized around computer driven treatment algorithms can sustain. And being caught between the push and pull of those two opposing forces can get quite wearisome. The system will continue to evolve, as it has rapidly under the influence of the pandemic and its changes to society. And how it will evolve will depend entirely on where the money flows. If there is money to be made in better patient care, the system will reward that. If the money is made by catering to the big data tendencies of health systems, government entities and insurance companies, that’s what will determine what happens next. I think we all know which side is currently in ascendancy. Will it remain that way? It’s hard to say.

The Baby Boom, through force of numbers, has long held sway over US social priorities. They still consider themselves young, despite the lead edge turning 77 this year. There hasn’t been any sort of wholesale grappling of the boom with the needs of aging. It’s coming. No generation remains forever young. And it will all happen within the next twenty five years or so because the boom will cease to be a social force by 2050. There simply won’t be enough of them left after that point. 40% of the boom will die in the 2030s and another 40% in the 2040s. I can’t imagine they’ll pass through the American healthcare system as they age, decline, and die off without leaving some sort of significant imprint but I have no idea what it’s going to be. Will it be towards a more personalized care or will it be towards a more technological standardized care? Will it be some new model that hasn’t yet really taken hold?

The transitions apply to my writing life as well. The last volume of The Accidental Plague Diaries should be out this summer, covering the age of omicron. I have no idea what to write next. Do I have another book in me? Do I have the energy and will to complete something significant without a world wide pandemic spurring me on? Thinking about writing thousands of words on a single subject and nurturing it through the publishing process simply seems like way to daunting a task to contemplate at the moment.

The one part of my life that seems immune to worrying about transitions is performing. There will be another symphony season. There will be another opera season. There will be more plays that require the old guy. The biggest issue there is the precarious funding for performing arts. The changes the pandemic has wrought has left most non-profit performing organizations in tight times. Theater and music companies continue to close their doors as they can no longer afford the expenses of production or because they are being priced out of available space. I’ve lived through a number of boom and bust cycles in performing arts over the years. Companies will go under but creatives have to create and there will be new companies forming in church basements or civic halls. They’ll start out small and the offerings may be of lesser polish but a new generation will get trained up and grow. It’s always been like that and always will be.

Perhaps it’s time to go back to Voltaire. Work hard without regret for yesterday or hope for tomorrow and make our garden grow.

UAB has dropped their mask requirement for clinical spaces as of this week. I keep forgetting and automatically putting it back on when I leave my office and head for the exam rooms. Some patients are glad to be rid of them. Some feel more secure in enclosed space still wearing them. I’m taking my cues from the patients and their families. I don’t mind much either way. The VA is keeping its mask mandate for clinical encounters for now so I wear one when out on house calls. I’ll take it off if the veteran or family desires or if we’re sitting out on the porch or otherwise outside. It’s just another physical reminder that we’re moving beyond the pandemic and going back to before. Or are we? I don’t think that’s even possible. We can only go forward, never back.

When I think of how masks and mask wearing became such a cultural flashpoint about two years ago with various factions in high dudgeon over their use, this dropping of mask requirements in health care seems like a whimper and not a bang. I never could understand why people were as het about them as they were. Those of us in health care have worn them in sterile settings as a means of infection control for well over a century without ill effect. And there are cultures where facial coverings are considered entirely appropriate in public. Just because they had never been part of Eurocentric American cultural roots shouldn’t have made them anathema. People can get weird, and then double and triple down rather than admit that they might have been in error in regards to their first impulses.

Did masks work? That question seems to be coming up a lot in the pandemic revisionism that seems to be making its way through political public health circles. There’s been major cherry picking of data to try and downplay the use of masks, social distancing and all of the other tools we had prior to vaccines and a lot of very bad public policy is being enshrined in law in more conservative states to prevent quarantines, shutdowns, mandatory masking, or other tried and true measures due to their inconvenience and economic consequences. We can do that, but if a really bad virus gets out and into the population, something with a mortality rate of 10 or 20%, we’re going to wish we had those tools quickly without having to go through the process of repealing ill thought out laws. In general, the consideration of the did masks work question depends on your definition of work. Did they slow spread and flatten the curve in the first year or so of the pandemic? Yes they did. Did they prevent infection over the long term? That’s not as clear but everyone that had their infection delayed until after they were vaccinated had a much lower chance of death, hospitalization and/or the development of long Covid symptoms.

Far better public health minds than mine are now sifting through three years of pandemic data and looking for the various trends that can explain who got sick, who did not, where the hot spots were and what the true risk factors for significant morbidity and mortality were. What seems to be falling out of that data is that vaccines are life saving. Will we need more? That’s unclear but it looks like the elderly (of whom I will soon be one) and those with immunocompromising conditions (about 3% of the population) may benefit from repeat immunization. We should have additional data on this in the next few months. Other things that have fallen out: the various social determinants of health status had a huge impact on which populations carried the brunt of infection related damage. Poor, marginalized populations with less access to health care had much higher rates of morbidity and mortality. Politics played a factor. Those in blue states and communities had significantly lower rates of negative outcomes than those in red states and communities.

The data will parsed and analyzed and many learned papers and policy reports will appear. I have no idea if we’ll have learned anything from all of it however. As it’s likely to be another generation or two before the next major pandemic hits, I have a feeling we’ll have forgotten most of the lessons we’ve learned as a society about all of this, most of those reports will have been misfiled and we’ll have to go through this all again. I’m not likely to still be here at that point and some future person will have to chronicle that process in his or her own accidental plague diary. I hadn’t looked at the numbers for a bit, but we’re still at about 20,000 people hospitalized in the US, 3,000 of them in the ICU and 250 people dying a day. It’s been a leisurely decline through the spring but remains at a rate that will kill about 100,000 a year – twice as many as the flu in the worst flu years and five times as many as a normal flu year. And it will remain in the top five causes of death.

The social forces that were parading in the streets against public health measures and masks a couple years ago seem to have all gotten together to save the children from drag queens, Dolly Parton songs, Michelangelo’s David, musicals based on 75 year old New Yorker cartoons, and even a whisper of talk about gender and sexuality in the public schools. Per usual, whenever a new social movement appears to erupt everywhere at once, I have two questions. The first is cui bono? Who benefits? and the second is where’s the funding coming from? I have a sneaking suspicion that the answer to both questions is the same. The forces poised to make big money from the privatization of public education. There are a number of very powerful people out there who wish to continue to move of the commons to for profit enterprise and they’re ready to take on the education system after having marched through health care, corrections, utilities, the military, and other previously publicly funded endeavors. Erode trust in public education, offer a viable alternative outside the public funding stream, tailor your message to certain political and religious world views and voila – you can sell copyrighted curricula through private academies via instructional staff who are at will employees that can be easily cowed and replaced.

I also suspect that the right’s huge win with the Dobbs decision on abortion has added fuel to the fire. With the success at restricting abortion and women’s rights in conservative states firmly in place, there needs to be another bogeyman to keep the faithful in line and to keep the dollars flowing. Drag queens and the transgender community (conflated by some but having little to do with each other) are an easy target. Laws are being passed where the cruelty is the point. What I don’t understand is where is the allyship in all of this? I haven’t heard much of anything out of the Human Rights Campaign or the Democratic party organizations in terms of push back. Have they just written these tiny populations off as expendable? Because it won’t stop there. As these forces feel emboldened, they will take more and more steps toward eliminating what they feel are heretical lives and behaviors. I’m not expecting to be loaded into a boxcar yet but I’d like to see things stopped well short of that point and not much seems to be happening in terms of organized resistance.

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

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

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

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

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

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

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

Dateline – Augusta, Georgia

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

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

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

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

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

Dateline – Augusta, Georgia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tonight, I’m wondering what we’ve learned from the last three years. From my news feeds of the last day or two, I’ve come to the conclusion ‘not much’. I had hoped that the pandemic, with its overwhelming concerns and the risks that were universal might have unlocked a certain amount of cooperation in society. It didn’t. Where we should have emerged a bit of a kinder, gentler nation, more empathic toward each other and more willing to extend a hand after suffering under a natural disaster beyond any of our control, we seem instead to have become more and more bent on driving anyone out of our social circles who might not view the world in quite the same way we do ourselves.

The landscape is littered with new laws that will gut the public health system’s ability to deal with the next viral pandemic that arrives. And there will be a next. Some states and localities have banned public health authorities from instituting any sort of societal shut downs or banning of public gatherings. Others have carved out special exemptions for religious services, as if viruses would know not to travel within the confines of a church or a temple versus a theater or a school. Some have defunded public health infrastructure to the point of minimal function. We can only hope that the next pandemic is less lethal than Covid. If it’s more lethal, especially if it’s a filovirus like Ebola or Marburg we are well and totally screwed as the spread won’t slow down while we consider whether our previous actions were ill advised and whether we should backtrack. It’ll just spread and the tools we have to stop it will be locked in the woodshed for political reasons and unavailable in any sort of timely fashion.

There are congressional hearings happening on Capitol Hill regarding the pandemic and its response. From what I can tell, they seem more interested in political revisionism and arguments over issues that cannot be resolved on the current evidence such as natural vs. lab origin than in any sort of debate that could help protect us and do better in the future. After looking at a few clips and a bit of the transcripts, all I could do was roll my eyes. There seems to be a complete lack of understanding of what science is and is not on the part of most of the speakers. I am assuming the loudest voices in the room will suck all of the oxygen out and we’ll end up with a lot of sound and fury signifying nothing by the time the television cameras have moved on to the next sound bites.

The failures of society have, of course, created a need for useful distractions to keep public debate going, centered far away from the items we should be discussing such as the continuing collapse of the health system and education as pandemic stoked changes have chased away so much human capital from the sectors. The big issue at the moment appears to be protecting children from the horrors of transexual people and drag queens. The legislation being passed left and right would be risible if it didn’t have such real world effects on perfectly innocent people just trying to live their lives. The vaguely worded laws in Tennessee, Florida, and other states could be interpreted in such a way that you could be prosecuted for a felony if you take your grandchildren to a matinee of Peter Pan where a young woman traditionally plays a boy. As children understand the concept of dress up quite well, they aren’t going to be psychosexually confused by drag. Besides which, while I see any number of news stories about church officials involved in crimes against children, I don’t believe I’ve ever seen one about a drag queen behaving inappropriately with them. I know lots of them and, like most gay men, they are well aware of societal opprobrium and are most circumspect in their behavior around kids. I’ve made it a hard and fast rule for years that I don’t let underage people in my home without their parents or other adults around at all times. It’s just one of those things you have to do as a responsible LGBTQIA adult.

While the media continues to melt down with sound bites about drag brunch, I continue to try and function in a fundamentally broken health care system. I’ve had three work days so far this week and each has presented another aspect of how it no longer functions properly. Over the weekend, a patient of mine fell at home. She went to an outside emergency room where Xrays showed she had fractured her third cervical vertebra. Broken necks are a major emergency and that hospital tried to admit her. No beds were to be had. She waited in the ER the whole day and into the night, got tired of waiting and signed herself out and went home to get some sleep, calling me on Monday morning to let me know she was wandering around with a broken neck. I had her come in to our ER post haste for evaluation as she was one bad neck jerk away from becoming a quadriplegic and needed urgent spinal evaluation. I then had to deal with multiple calls from various administrators mad at me for having sent her to the ER without evaluating her in clinic first. Now there’s a lot I can do in my clinic, but treating cervical fractures is way out of my pay grade so I had to waste a bunch of time telling these individuals who apparently had no critical thinking skills that ‘her neck done broke’ was indeed an emergency. That’s time and energy I’ll never get back.

The next day had to do with mental health issues. A patient of mine with a significant dementia has a serious problem with violent acting out. Her senior living facility couldn’t handle it and she was sent to the ER. She was admitted, given some tranquilizers, and sent back. She was returned to the ER again in a few hours once the tranquilizers wore off a bit and she started throwing things at the staff. She is badly in need of a good geropsychiatrist and a psychiatric bed but there are none to be had so she is in four point restraints on the medical ward waiting for next to non-existent services. Geriatric medicine and geriatric psychiatry have been decimated in recent years by departures from the field and no attempts by the American health system to attract new blood. At the same time, I was attempting to help a friend find psychiatric help for her son who has developed a major anxiety disorder and in need of psychiatric care. There are no appointments available with anyone in the metro area for the next three to four weeks.

Today’s theme was a number of complaints from patients regarding their medications. Many of the Medicare Advantage plan formularies shifted as of the first of the year, dropping some drugs, adding others, changing copays. Patients who have been stable on a particular regimen for years are now finding that some of their medications are now no longer covered and are getting huge non-formulary bills at the pharmacy. They then call us and we have to spend hours on the phone with their insurers trying to figure out how to substitute and adjust their medications in such a way as to keep their medical conditions under control and keep them from having to mortgage the house in order to afford them.

I and my heroic staff spend most of our time these days doing things that really don’t contribute much to stabilizing chronic conditions or making people well. The energy is going into administrative black holes at all levels. It’s the disrespect of the system where non-clinicians question and micromanage the decisions I think are best with my more than thirty years of experience in geriatric medicine that’s driving me towards contemplating retirement. The pandemic, with it’s wild effects on staffing and medical economics has just aggravated this to the nth degree and I just don’t know how much longer I can put up with it all.

I can put up with it this week, and this month. I just have to keep breaking it down to one step at a time. Sorry for the whine. I’ll go have some cheese with it.