Dateline: Seattle, Washington

I’m spending my birthday weekend with the family in Seattle. I hadn’t been up here for six or eight months so it was time to check in on everyone, especially my 90 year old father and my uncle who also turns 90 in just a few weeks. Geriatric assessments are done. Advice has been imparted to various family members. There are no major looming disasters and I just have to get through my usual talk to the residents of my father’s senior living community in order to complete my busman’s holiday. I haven’t done much the last few days other than be with family. Not strictly true, I allowed my sister to give me a second tattoo as a birthday present. When the cover artist for your books is also a tattoo artist and a close relative, it was only natural to have the cover character emblazoned on my left shoulder in celebration for having actually completed somewhere around1000 pages of accidental published writing over the course of the last three years. When the last volume comes out this summer, it will have been less time than I spent in high school, college, or medical school from the time I wrote the first words of what became The Accidental Plague Diaries until the completion of the project. And that is with working full time and all the other things I do. I figured a celebratory tattoo was worthwhile. I’ll post a picture when it’s healed up a little.

I would be remiss if I did not send out a huge message of thanks to all of you who reached out by phone, text, message, Facebook etc. with birthday greetings. (Something over 600 at last count). Having been raised to acknowledge some things, I did try to thank everyone individually. Of course, by typing Thank You many hundreds of times, I fell afoul of some Facebook algorithm and was blocked from posting anything for 24 hours for ‘violating community standards’. I’ll remember to tell Zuckerberg that apparently thanking people is verboten and not to be borne next time I see him. It’s always interesting to scroll through the greetings, no matter how brief, and see the names of those who sent them and then recall how and when they entered my life. Elementary school playmates, high school and college classmates, old colleagues, performers I’ve worked with, internet buddies – they’re all there. When I get grumpy and down and worried that my efforts in life have not been particularly worthwhile, I need to go back and look at that list of how many lives of how many kinds have intersected with mine and realize that yes, each of us is a thread in the pattern and every thread is important for the tapestry’s picture to be whole.

Seattle is having lovely weekend weather. I’m going out for a walk to enjoy the sunshine in a bit. And then, after my talk, the family gathers for grilled salmon and conversation and catching up on everyone’s life. I am fortunate in my family. We all seem to have matured into adults who are friends and we don’t fall back into traditional roles from childhood when we get together. There were some family traumas in the late 80s/early 90s that forced us all to confront each other as mature adults and reforge relationships. I can’t recommend that particular method of learning to get along better with siblings and parents but the end result was a positive one. No, I’m not going to go into specifics on what all happened as much of it is not my stories to tell. I try to tell my stories (or dead husbands stories as they no longer have their own voice) but not the stories of other living people. That’s their business, not mine.

The flights out were uneventful. I was seated next to a very nice couple on the cross country flight who were traveling with two small dogs, a maltese and a bichon. Both animals were very quiet and well behaved in their carriers and I didn’t hear a bark all flight. They did come out and were lap dogs for a bit midflight. I have no objection to other people’s animals and they both gave me a bit of a tongue bath. With all my house calls, I have been around other people’s pets in close proximity more times than I care to count. I am fine with being sniffed, jumped upon, licked, but I draw the line at biting. Those that bite must be put up before I’ll come in the house. I’m even OK with the occasional ferret, parrot, and snake (as long as it’s not going to wrap itself around my neck).

Flying in these post pandemic days isn’t the most pleasant. The airports cannot hire enough people to staff its services so lines for food and coffee are long and slow. The planes are stuffed to the gills with minimal service. I’ve taken to paying extra on Delta for their Comfort plus seats so that I’ll at least have a bit of leg room for my longer shanks. I wedge myself in my window seat, put on bad movies, or read a page turner and hope for it all to be over soon. My current plane book is an alternative history novel about modern America had the Revolution been lost and the scientific method regarding medicine never developed. A cholera epidemic has started and is spreading. It’s a prepublication proof sent to me by the publisher who have asked for a cover blurb from the author of The Accidental Plague Diaries. It’s not bad so I will oblige. Someone somewhere is reading them…

I was sidelined this weekend by a medical issue (relax – it was just a routine colonoscopy and I’m fine) and a couple of days of enforced inactivity for prep and anesthesia recovery did not sit at all well. It made me wonder if retirement will be good for me. I get very antsy after just a few hours of doing nothing. There’s a part of my brain that feels its necessary to be productive during all waking hours and that leisure, vegging, and wasting time are not to be borne. Culturally, I received the protestant work ethic but I think it’s been magnified in me by life experiences which have had me call into question the ability to ever have enough time to accomplish everything in life that one should. Tommy, years ago, was a member of the IATSE crew that worked the touring shows that come through town and when The Lion King came in the early 2000s for a five week sit down, he was the wardrobe laundry person eight shows a week – forty loads per show plus all of the hand washing of the beaded and specialty pieces. His souvenir T-shirt read ‘The Lion King Crew – More To Do Than Can Ever Be Done’ which is a lyric from the opening number, The Circle of Life and was certainly one of his mottos and he passed that style of living on to me during our years together.

Fortunately, or unfortunately depending on how you look at it, working in a primary care discipline during the slow, but inexorable collapse of the American health care system has certainly left me with a continued scramble to keep all of the work tasks up to date and the clinical systems for which I have responsibility, in a vaguely working order. But if I were to remove all of that from my life, just walk away (which I am occasionally tempted to do…) what then? I say I would put that time and energy into the performing arts here in the greater Birmingham area (and I have a few ideas as to what that might look like) but would I really? I have a feeling I had better take a more measured approach to retirement and a more gradual slow down over several years rather than something abrupt – health permitting of course. I’ve worked in medicine long enough to know there are absolutely no guarantees in that department. Body betrayal can happen at any time, usually when you’re busy planning something else.

I’m in the process of editing the last part of the manuscript for Volume III of The Accidental Plague Diaries. If all goes well, it will be out in late July or early August. I am, again, looking at material that I wrote less than a year ago and it feels like I was writing about a completely alien time and place. The end of the pandemic has had ‘normalcy’ spring into place like a bear trap, and its making me feel like I’m being detached from my recent past in peculiar but very real ways. The three years from March 2020 to early 2023 is starting to feel like a bad dream and it’s certainly messing with my perception of time. It’s almost like that period has become nonexistent in my calculations so 2018, which was five years ago, feels like it should only have been two years ago.

I’m trying to write a fitting epilogue to Volume III that will sum up the whole experience of the pandemic, not just for me, but for our society. I haven’t been able to find the right words yet. The attempts so far? Maudlin and trite are the words that come to mind and they’re really not what I’m going for. And how to acknowledge that even though the acute phase of the pandemic is over that Covid remains a significant and continuing cause of morbidity and mortality that is likely to remain throughout our lifetimes? And how to honor the over one million dead in the US and the millions more whose physiology has been irreparably harmed?

Two local journalists of my acquaintance, John Archibald and Kyle Whitmire were awarded Pulitzer Prizes this week, John for reporting and Kyle for commentary. Once I get the third volume done, I’ll submit the whole thing for Pulitzer consideration next year. And I won’t even make the short list. I have to keep reminding myself that those two have been writing for decades (I’ve been reading their stuff for 25 years, since I first moved to Birmingham) and I’ve only been published for two. I’m thrilled at their success. I love it when good things happen to deserving people. And it’s nice to know that even though Birmingham no longer has a daily newspaper (thanks to the greed of the Newhouse family), we still have a tradition of top notch journalism that finds a way to shine a light on the more corrupt elements of our society.

Thirty-six hours from now, I’ll be on a plane heading for Seattle for a little family time. I may write while there, I may not. I will most certainly try to get some more editing done as, once again, enforced down time is not my forte. It’s going to be a bit of a working weekend as I have some private geriatric assessment to do and I’m giving a talk on aging issues at my father’s senior living community as I usually do. At least I’ve gotten smart enough in recent years to make those off the cuff Q and A so I don’t have to spend a lot of time preparing in advance. Thank god for Jeanmarie Collins and the improv training over the years. It may not be what Viola Spolin envisioned when she was putting her technique together but I’ve been able to use it to impress a lot of senior adults.

It’s the fifth of May, Cinco de Mayo, that totally made up Mexican holiday which was developed to popularize Mexican beers some decades ago. I like Mexican food as much as the next person but I am staying well away from my usual Mexican joints today as I don’t particularly care for the species of young Alabama male who has imbibed entirely too many beers and margaritas. I’ll have my chimichanga some other day. Instead, I am home from work a bit early, looking at my ‘To Do’ list which seems to have tripled over the last week, and despairing of ever getting to the bottom of it.

The WHO today declared that Covid is no longer a world wide health emergency. This will bookend neatly with the upcoming expiration of the US public health emergency status upcoming on the 11th. Mind you I don’t think that Covid is done with the human race yet, not by a long shot (and I was reading somewhere earlier today that some authorities think that the chance of another omicron type wave arising within the next two years is somewhere around 20-25%) but we are more or less at a point where we can pretty much resume where we were pre-pandemic, at least as long as we have functional immune systems and have taken advantage of vaccinations. When I last checked, we’re still losing about 1,000 people a week in the US to the disease and that number has been holding fairly constant for a while so I don’t imagine it will drop all that much in coming months. Of course it will be tough to tell. The ending of the public health emergency will mean the ending of federal funding for appropriate data collection so we won’t be able to track things in real time the way we have been.

I think, at least in part, my burgeoning ‘To Do’ list is a side effect of journey’s end. As more and more people feel more and more comfortable doing the things they were used to doing pre-pandemic, the social obligations begin to mount and the projects with deadlines start to multiply and they all seem to end up in a neat little list on my dining room table. I’m keeping up so far, although those things without specific deadline tend to slide further and further down the list with time and there are a few that are unlikely to be crossed off until at least 2025. I’d like to say that this is an OK state of affairs but a trained physician with a protestant work ethic is never very happy at seeing tasks unaccomplished.

The problem is, of course, that while the world wishes to go back to 2019 as if 2020-2022 never happened, it can’t. The second law of social thermodynamics prevents it. We are all fundamentally changed by our experiences of the last few years and trying to lay a 2019 life on top of a 2023 reality is doomed to failure. It’s a variation on You Can’t Go Home Again (unless you’re Thomas Wolfe). I’m still trying to tease out the differences between who I was then and who I am now. I just know I can’t pick up the same burdens and shoulder them in the same manner. I’m trying to do so but it just doesn’t feel right somehow. I think my capacity for multitasking has just lessened. Is it my personal aging? Is it the still unknowable mental/cognitive changes that years of stress have caused to happen? I just know that at times there’s a sense of deep exhaustion that I did not have in the past. And it’s not something that can be alleviated by a nap or an afternoon vegging.

I’m continuing to edit the final volume of these Accidental Plague Diaries. It will run from Thanksgiving of 2021 through September of 2022. In looking back over my writings, last fall was a major inflection point regarding how I and society as a whole were dealing with the pandemic and pandemic issues and little I wrote after that would be of much interest to future readers trying to puzzle through just what was going on in the US during this period. If anyone wants to read beyond that, there’s always the blog where these posts are archived and will likely dance around in the electronic ether long after I am gone. I’ve been trying to figure out what the third volume is really about. The first is about the failure of our government to do the first job of government, protect the citizenry. The second is about the failure of our society to care for each other. I think the third volume, in some ways is about my own failures – mainly my failure to be the person I conceive of myself in my brain. I have to settle for the messy contradictory human being I am over the idealized version I try to construct for myself and for public consumption.

Theater is creeping back into full swing locally. I went to see a production of Agatha Christie’s The Mousetrap at Belltower players last night. I’ve seen a number of productions over the years (but never the original which is still running in London’s West End 70 years later… maybe I should fix that when I’m there next month). I therefore, of course, knew whodunnit going in so it was more of an exercise in cheering friends in the cast on, admiring the construction of the play itself (whodunnits and thrillers are amongst the hardest plays to write which is why few playwrights have ever managed more than one classic in the genre. Christie is unusual in that she has three – the other two being And Then There Were None and Witness For The Prosecution), and admiring the absolutely terrific set Greg Boling and Ichabod Temperance skillfully constructed and decorated. By all means go see it. It runs this weekend and next.

I’ve been a huge fan of the classic British mystery for decades and worked my way through all of Christie, Dorothy L. Sayers, P.D. James, Ngaio Marsh, Josephine Tey, and others while in high school. They fit in with my general love of puzzles. I’ve written a few interactive mysteries for fund raisers over the years so I’ve figured out a thing or two about putting them together. I did one as a Halloween game for my college roommate’s tech company back in the late 80s. We created a number of fictious employees, had them assigned offices and voice mails and other such things and let the several hundred real employees try to puzzle it out at work that day. Somebody did solve it so I guess I made it not too difficult. I don’t remember all that much about it other than the big clue was a missing fake red fingernail that was among a bunch of spilled peanut M&Ms. A few years later, I did my first that required live actors where there was skullduggery among turn of the century residents of Sacramento with everyone having a whole lot of sordid secrets they were trying to conceal. Steve played one of the suspects, a local businessman who secretly ran the local brothel. He had great fun trying to entice some of the players into visiting his wholly fictitious establishment. Steve would have been brilliant on stage. He was a natural performer. Unfortunately, he was also totally undisciplined and you would never have gotten the same performance (or set of lines) twice out of him so improv murder mystery was about right for him.

I will continue to ponder the changes Covid has wrought as I launch into my sixteen unwritten progress notes for the week. Pray for me.

It’s the first of May. I suppose I have my choice of putting some flowers in a basket and leaving them on a neighbor’s doorstep, donning a red arm band and marching down Arlington Avenue, or putting on the Original Broadway Cast album of Camelot and singing along with Julie Andrews. But, alas, I am likely to do none of these things. I had a doctor’s appointment this morning so I took the whole day as sick leave and spent this afternoon catching up on work paperwork and taking a nap. I don’t get a lot of those these days and they can be salubrious in the right circumstances.

I haven’t written for a few days. Some of that was due to various and sundry things going on such as rehearsals and some of that was due to not having a whole lot to say. And some of it was due to the calendar. Last Friday marked the fifth anniversary of Tommy’s death. Five years feels in some ways like an eternity and in other ways like yesterday. The pandemic has played a lot with my perceptions of time in recent years. A couple of years of standstill in my usual patterns and it now feels in some ways like those years have ceased to exist and things from five years ago should only be a year or two in the past. And then there’s the scary thought that we are nearly a quarter of the way through this new century. And it’s the century that will encompass my death as I’m highly unlikely to make it to age 138. I really should go out to Parrish and visit his grave. But I don’t feel like going alone. If anyone wants to take a day trip to the wilds of Walker county sometime, let me know.

The big activity of the last few days was my fetching my drag persona of MissClairol Channing out of mothballs in order to let her MC my church’s drag fund raiser. Alabama, like most of the other Southern states is in the process of passing anti-drag laws under the ridiculous premise of it’s damaging to children or some such. It’s really about trying to put the LGBTQ community firmly back in their place and it’s not going to stop with transgender bashing or outlawing drag shows. More is coming and from what I can tell the big national advocacy groups have more or less written off the red states and are doing very little to prevent this. Given that national surveys have shown that there are more LGBTQ people living in the Deep South than in any other region, this strikes me as being a rather stupid strategy but I noticed some decades ago that the national LGBTQ organizations, after their major wins, more or less became more interested in building K street lobbying offices and the DC cocktail circuit than in actually doing grassroots work where people are suffering.

The Alabama Law, which hasn’t been signed yet but certainly will be when it hits the governor’s desk will ban the performance of drag in public places where minors may be present. The bill mentions schools and libraries but does not mention churches so I suppose the UU Church of Birmingham can continue to put on a family friendly drag show going forward as an annual event and flout the law as it won’t be applicable. Personally, I think a good police raid on a local conservative academy’s elementary school production of ‘Little Red Riding Hood’ when the male wolf appears dressed as grandma would be just the ticket to show everyone how ridiculous and wrong headed the whole thing is. These laws are written so vaguely and are so punitive that they’re really designed to make entertainment producers stop and think twice about doing certain kinds of material just in case it might fall afoul of the law. One of our local theaters is doing Peter Pan this summer. I wonder if that will be allowed as the title role is traditionally cross gender cast as it comes out of the British pantomime tradition.

MissClairol was a success, but let me tell you, two and a half hours in those shoes and doing her voice was enough to leave me in need of a quiet weekend with a dish tub full of epsom salts for a foot bath. There was nothing risque in my material or in any of the other performers, mainly lip synching to female diva ballads, and I can assure you that none of the children in attendance came to any harm and had a great time dancing along. As a bit, I asked one four year old if he had had his psychosexual development permanently damaged by standing and talking to a man in a dress. He didn’t understand the question. Kids understand dress up. They love doing it. They aren’t in the least bit confused by men dressing up in traditional women’s costume or vice versa. It’s just an extension of ‘Let’s pretend’ and, after all, isn’t that what all theatrical performance art boils down to?

I’m back into editing mode for Volume III of the Accidental Plague Diaries and hope to get the majority of it done by mid-month. Then I can start thinking about what comes next. But first perhaps, a few weeks of down time. I haven’t had a lot of that in recent years and maybe it’s time.

We’re now well into the fourth year of Covid. It’s still out there. I’ve had two friends come down with it in the last few weeks. Fortunately no one I know has been sick enough to require hospitalization in recent months but I’ve had a couple of patients who have done badly and at least one where the additional strain on the body and physiology was likely what caused their death. We remain around 20,000 hospitalizations and 1500 deaths a week in the US. And we’ve decided that we’re just going to live with that as background noise as our lives careen along. That’ll come out to about 75,000 annual deaths assuming we have no additional surges or mutations. That’s slightly more than double the number of US deaths in motor vehicle accidents. Speaking of those, since the pandemic began, traffic accident deaths have spiked up about 20% over where they were in 2019. I wonder why that is? I doubt Covid is causing brakes to fail or engines to explode. I suspect it has to do with the significant uptick in mental health issues as we have all had to cope with the pandemic and its associated social changes. There’s probably a higher prevalence of distracted driving and possibly some increased willingness to take risk.

I’ve been fielding a lot of questions regarding another Covid booster. Here’s my latest advice. The bivalent booster which is more active against omicron has only been available since September so, if you haven’t had a booster since then, getting one to get a bivalent dose is not a bad idea, no matter who you are. If you have had a bivalent booster, the word out of the FDA is that a spring bivalent booster is reasonable if you are over 65 or if you have a condition that compromises your immune system. They aren’t pushing hard, but it’s an option and you’d be covered by federal payment should you trot on down to your local Walgreens. The caveat is that the federal public health emergency will expire on May 11th of this year. After that date, the federal government is no longer guaranteeing payment for shots or tests. It’ll be up to you and your health insurance company to cover the costs (and we all know how much private health insurance cares about public health).

It’s been a weekend of theater around here. Thursday night, Steel Magnolias at The Virginia Samford Theater. I remember the first time I saw it on stage, sometime in the later half of the 80s and being impressed at how Robert Harling built a whole small town world in the confines of the beauty shop and the words of the six women who worked or patronized it. I’ve never really cared for the film (sacrilege for a gay man living in the Deep South) but I thought that the material lost something when it was opened up and we met the men in the women’s lives rather than simply seeing them through their eyes. Anyway, the production was quite good, well performed and designed. My old friends Celeste Burnum as Ouiser and Jan Hunter as Clairee walked off with the show as they always do. I can’t wait to be onstage with either of them again.

Friday night was Hansel and Gretel at the Day Theater produced by Opera Birmingham. As president of the board, I am obligated to say nice things but I would be saying them anyway. The music was spot on between the singers and the Alabama Symphony Orchestra under the baton of Cris Frisco. The singers were in excellent voice and I find that the size of the Day is such that it’s easy for a smaller scale production to seduce you into its musical and artistic world, letting you forget yourself for a couple of hours. There was an unexpected entrance during the prelude that I will not soon forget which greatly added to my mood of enjoyment.

Last night, my friend Holly McClendon and I went to Shen Yun, one of the seven wonders of the PR world. I’d always been at least mildly curious, having been bombarded by their advertising for some years. I can now say that I have seen the ‘Chinese Mormon Space Cult Dance Show’ (Holly’s words, not mine, which seem to perfectly encapsulate the experience). The aesthetic is Mormon church pageant. The production numbers reminded me of The Ice Capades, only without the skates. The costumes are gorgeous, if occasionally wrong headed (like the pale green ones with the long sleeves which made the ensemble look like dancing celery sticks). The set is a huge LED screen on which they project computer generated backdrops which seem to have been done by the same artists that do videogames. The big trick is having dancers run up a set of stairs towards the screen, drop down behind them, and be immediately replaced by a digital counterpart which can continue on in an animated way. It was fun the first four or five times. There’s nothing wrong with the big dance numbers, although they’re a bit repetitive. There are a few times where the descend into Falun Gong cult propaganda (if you don’t know who they are, look them up. Shen Yun is an outreach program of theirs). And there was a bass solo of some sort of Falun Gong hymn by perhaps the worst professional singer I’ve ever had to suffer through. I can now say I’ve seen it. I have no desire to return.

Heading off to the other performance of Hansel and Gretel. When you’re the president of the board of directors of the opera, you do these things.

The performances of Carlos Izcaray’s Requiem are over and done. It appears to have been well received by Alabama Symphony Orchestra audiences, but then the story of the loss of his wife a few years ago which prompted the composition is well known locally so there was understanding of the emotional impulses underlying the music by the listeners. I think this is the fourth Requiem I’ve sung as a chorister since Tommy immersed me in the classical musical world a decade or so ago. This one felt more personal than the Verdi, the Mozart or the Cherubini. With my personal history, I suppose I’m always going to feel a sense of underlying sadness when visiting those works, born as they are out of a place of grief and deep emotional pain, religious, historical, and personal on the part of the composers. I have heard rumors that both the Faure and the Brahms are on the calendar for next season. If that is so, I’ll just be missing the Britten to have hit the top five. Speaking of Faure, this concert opened with a brief piece of his, Pavane (Opus 50) which, after listening to it in rehearsal and performance, makes me understand whence Jerome Kern cribbed ‘All The Things You Are’ .

I wonder if this piece will get much play outside of Alabama? It requires full symphonic orchestra and chorus (and I can tell you from experience that a piano reduction just isn’t going to cut it. None of us cared much for the piece in rehearsal with piano accompaniment but when we were able to hear the orchestral parts, it all of a sudden made musical sense and the piece solidified very quickly after weeks of ‘Huh?’) It’s short for a requiem, only about 25 minutes long. It has some traditional Latin text, and some colloquial English. I don’t know how the symphonic world learns about new pieces or how they get added to standard repertoire these days. Do they trade bootleg recordings over back channel listserves? Are there international associations which review and rate new pieces and suggest them to major orchestras? I haven’t been able to figure out how to sell my books to a wider audience and they’re relatively inexpensive and simply require one click ordering from Amazon, not weeks of rehearsal and several hundred musicians working together in concert.

I returned to the Alys Stephens Center (site of the Jemison Symphony Concert Hall) again today to attend UAB Theater’s production of Into The Woods. The Alys Stephens Center has multiple performance spaces and the Theater Department uses the Sirote (proscenium) and the Odess (black box) spaces for their productions throughout the school year. It was a last minute decision. I wasn’t going to go as I have a bunch of other things I needed to get done but the siren call of Sondheim proved to be irresistible so I ran down the hill half an hour before curtain for a last minute ticket. (And I implicitly trust any musical that has Carolyn Violi as musical director – she is a genius). I have a soft spot for this show in particular as it was the first Broadway musical I actually saw on Broadway on my first trip to New York (original cast – second week of the run). I ended up seeing it a number of times (thank you Billy Livsey) including a couple of second acting episodes when such things were still possible. That original cast had one of the best and most affecting performances I’ve ever seen on stage, Joanna Gleason as The Baker’s Wife. I still hold it up as a yardstick by which I measure others on stage.

This production made some interesting, but unified design choices, throwing out Disneyana for a steampunk aesthetic. The set was inspired by the late 19th century cast iron and rivet behemoths of Sloss Furnaces, familiar to all residents of Birmingham and environs and perfectly in keeping with the Jules Verne look of the costumes. While there were some individual choices in terms of look that I wasn’t especially fond of, the whole production under the direction of Valerie Accetta reached out and grabbed the audience and held their attention for nearly three hours. I’m often a bit non-plussed at college productions as young performers have such a difficult time portraying maturity and middle-age but I had no such qualms this time.

For those unfamiliar with the musical, the first act is a comic romp of fractured fairy tales in which familiar characters such as Cinderella, Jack and the Beanstalk, and Little Red Riding Hood end up playing parts in a new quest involving a childless baker and his wife who are determined to break a curse. All comes right at the first act curtain, but then the show continues into act two where we learn there is no such thing as happily ever after as life does not end. Deceptions and actions from the first act, seemingly innocent at the time, have enormous repercussions in the second as the fairytale characters are threatened by a crisis that is too large for any of them to handle as individuals.

The show was created in the later 80s, during the Reagan administration, and much was made at the time as to the disparate natures of act one and act two (and the show is often done in schools with just the first act as a rousing good time). I remember having huge debates with my theater friends at the time about the second act and its meanings and themes and whether book writer James Lapine had failed to contextualize his ideas in the drama as it unfolds. The Act II giant who wreaks havoc was considered, at the time, as a metaphor for the cold war (rapidly drawing towards its conclusion but still very real in 1987 when the show premiered) by some. Others considered it a metaphor for the HIV epidemic which was decimating performing arts communities at the time. I could have gone either way but, through the intervening decades, during which I have seen multiple productions of the show of various size, scope, and quality, I’ve come to the conclusion that the question of what the existential crisis is is immaterial.

Societies of all types face crises all the time and they always will. We’re certainly dealing with a number of them currently including the pandemic and its after effects, the devolution of our politics into two armed camps operating in somewhat separate realities, and the slow collapse of public sector health, education, and welfare. None of these was especially prevalent in the 1980s but they are uppermost in our mind now and we can revisit this theater piece with those ideas rocketing around our brains and learn something about ourselves and our approaches to problems from watching these characters grapple with theirs. And that’s what makes a play immortal. It can act as a mirror for each new audience allowing them to see themselves in a new way. It’s the Sondheim show that’s most likely to still be produced a century from now because of this.

Traditional fairy tales have a role in society. They always have. They help us teach our children who they are. They teach about right and wrong. They teach about social roles. They teach that the world is a dangerous place. They are used, as they are so familiar, in propaganda, in mass media, and in attempts to enforce gender conventions that may not be as healthy as we would like to believe. When the brothers Grimm set about collecting up the German versions of these tales for publication in the 19th century, there were ulterior motives in terms of using the impulses of German Romanticism toward unifying German culture (which eventually led to a modern nation state in 1871). We do somewhat the same thing with our Disneyfied versions of the tales which push for mid-20th century American ideals of a golden age that never truly existed.

What has become important to me, and why I now find the show as affecting as I do, is not the fairy tale aspects, nor the banding together to face danger aspects. It is rather the narrative aspects, the understanding of the power of story and how telling the story of what happened and passing it along it perhaps the most important thing we can do as human beings in regards to our posterity. Every generation will make mistakes. Every generation will forget to look back with the understanding that those in the past were just like us and that if we would take the time to understand their stories, we would be a few steps further ahead on the road to enlightenment. I don’t and won’t have children. But I have created and collected enough story, especially about the pandemic, and made a vessel for transmitting it forward with The Accidental Plague Diaries. And someday, far in the future, someone may pick them up thinking once upon a time, there was a middle aged doctor, and his world was falling apart and he was afraid… and here is his story and hopefully children will listen.

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.