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

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

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

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

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

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

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

I’m having one of those periods where I’m feeling disconnected. I assume I’m not alone in having those. It’s as if I were almost an observer in my own life. There’s nothing particularly wrong but I’m still just sort of going through the motions, almost as if it were someone else’s existence while the part that I feel is most truly me sits curled up in a corner of my brain just watching it all unfold. I’ve always felt like the person looking in through the window at the party rather than the person who’s in the middle of the dance. It might explain why I love Sondheim so much; most of his art revolves around outsider characters who never quite belong and that ends up being their tragic flaw and source of dramatic conflict. It may also explain my affinity for ‘Cabaret’ – the whole ‘I am a camera’ thing that infuses Christopher Isherwood’s original Berlin Stories.

I don’t feel bad or depressed when I get like this. I’ve had true depression before, fortunately not for quite some time. When I have it, it’s a true physical feeling and it takes all the energy I can muster to get out of bed and meet my obligations. I’m feeling normal, other than the post inflammatory reactive airway cough that continues after my nasty respiratory virus of last month. I’m getting up and greeting the day in my usual way – which is often accompanied by a few curses and a couple of raps on the snooze bar. I am not a morning person. But as I spend my time with patients and in rehearsal and coping with all of the usual vicissitudes of life, nothing is feeling quite real, as if I’m marking time, waiting for something new to begin.

Perhaps this is my next phase of post-pandemic recovery. I went through the exhaustion and sleeping too much phase and now I’m in the detached and protect myself from the craziness phase. My life isn’t particularly crazy at the moment but I can’t say the same about society. Politics seems to be more about self-aggrandizement than improving of society. Education appears to be falling into thousands of little pieces. Economic life continues to descend into late stage vulture capitalism. My own little world of medicine continues to reel from the forces unleashed by Covid and there’s no end in sight.

I read somewhere this week that over the three year period of 2020-2022, coinciding with the pandemic, roughly 115,000 US physicians retired or otherwise left the practice of medicine. The number of active physicians in the country runs just under a million (roughly 940,000 at last count from the statistics I’ve been able to find). That’s 12.2% of the physician work force gone in three years. All is not lost, during that same period, 40,000 new physicians began their careers after graduating from training or through immigration so the net deficit is only about 8%. It’s no wonder that none of us can get an appointment in any sort of timely fashion. The design of the US health system to run lean and mean and pretty much at full capacity without any fat in the system means there’s no elasticity when 8% of the work force suddenly disappears.

Another news article that came to my attention this week reported that fifteen Alabama hospitals are insolvent and in danger of shuttering this year. That’s out of 126 total. That’s a similar 12%. The hospitals in danger are predominantly smaller, rural, and often the economic engines of little downs being one of the few employers offering stable positions and good wages. Alabama is one of the Republican dominated states that has refused to expand Medicaid under the PPACA legislation and, twelve years later, disenfranchised populations will pay the price. They’ll lose local health care and doctors. The wealthy populations of Birmingham, Huntsville and Mobile won’t be inconvenienced. But those poorer folk who have lost their local emergency department will still need care and will have to go somewhere and they’ll start occupying beds in communities where the system still functions leading to more shortages and so it goes.

These existential crises of manpower and economics should be making the C suites of health care companies sit up and take notice. They are, but not necessarily in the way you might think. American health care has drifted away from patient care to care of the quarterly balance sheet. More and more decisions are predicated on the profit motive than on the societal good motive. Health care providers of all stripes are waking up to this basic fact and the cognitive dissonance being created in the wake of the war between their ethical and clinical mission and the corporate rules under which they are forced to live are creating a bit of a moral crisis in the profession. It’s becoming more and more obvious that the flow of funds, which for clinicians boils down to data collection and signing of forms and choosing the correct codes of various stripes is far more important to the powers that be than empathy and active listening or even accurate diagnosing. After all, if you don’t get it right the first time, there can be more tests and more charges. I’m probably being unfair as most of the hospital administrators I know are good people trying to do a good job and they’re probably just as frustrated by what’s happening in their own ways.

Suffice it to say, that I have come full circle in my professional life. My first grown up job, in 1977 at age 15, was as a keypunch operator. (My younger readers will have no idea what a keypunch is – they’ll have to resort to Wikipedia). Basically, I was doing data entry. And now, 45 years later, I find myself again employed as a data entry clerk. And God forbid if I hit the wrong button or choose the wrong code because when I do and the form won’t go through or the note is kicked back because something is outside the computer’s understanding, the nasty grams start arriving in the email to make sure I fix it quickly because the funds must flow.

I’ve made a pact with myself. On the day I retire, I’m taking one of the computer terminals out of the office, carrying it out to the three story glass atrium, and drop kicking it off the top level to shatter on the marble below. There would be something immensely satisfying in seeing all of its electronic guts spread across the floor, winking in the fluorescent light. When I was in college, I came across a great way of stress relief finals week. Head off to the thrift store, buy some real cheap porcelain dinnerware, and heave it off the roof of the dorm into the dumpster. The sound of shattering crockery could bring even the highest levels of anxiety down a notch. I’ve always had to be controlled in the destruction of things as I don’t like making a mess. Neither Tommy nor Steve was that way. If they were in high dudgeon, they would often reach for the nearest object and fling it in a fit of pique without regard to its value or fragility. More than once I had to look at them and say something along the lines of ‘Clean that up. I’m going to bed.’ I’ve got far too many things stuffed into this condo. Maybe I ought to break a few of them. Maybe it’ll get me out of my head and reconnected.

It was the best of times; it was the worst of times. Sounds like it could be a good opening line for ‘A Tale of Two Viruses’ – one of which became a pandemic and one of which did not. The one that did, Covid, arrived and swept through the general population, causing chaos in its wake and permanently altering our society and the trajectories of many of our social institutions. What about the one that didn’t? Mpox, formerly known as monkey pox, arrived about six months ago, was spreading rapidly and is now basically contained with only a few cases here and there. Why the difference?

In the case of mpox, the public health system swung into action and there were no arguments. There were no internet forums devoted to the evils of the mpox vaccine. There were no promotions of dubious cures by national figures. No one was suggesting injecting bleach or gargling betadine. The populations most at risk were identified and they quickly took precautions and got themselves vaccinated, breaking the transmission chains and keeping the virus from spreading wider and wider. That’s because the most at risk group was gay men. Gay men have had significant interplay with viral pandemics over the last couple of generations. They’ve learned how to listen to public health authorities, accept their expertise, and do what is required for the greater community good with a minimum of fuss. Covid could have gone the same way but the wider American society couldn’t pull it’s act together for common cause as the vaccines rolled out. Maybe it should take a few cues from a marginalized population, once again under vicious attack (this time in the name of protecting the children), who knows that it has to hang together in the face of threats.

There’s little to report on the Covid front. Numbers remain fairly constant. Hospitalizations are around 25,000 on any given day and about 3,000 people a week continue to lose their lives on any given day in the good old USA. At current trends, Covid looks like it’s going to settle in as the fourth leading cause of death for 2022 and it’s likely to remain that way for 2023 and beyond. I suppose coming down from third, where it ranked in 2020 and 2021 is an improvement. I was digging through some mortality data from the pandemic and ran across something interesting. Throughout the pandemic, mortality was far above what actuarial calculations foretold but, when Covid deaths were subtracted out, there remained a significant excess mortality – higher death rates than were predicted all through the 2020-2022 period. What’s more, the excess mortality rates pretty much tracked with the rise and fall of Covid numbers. What’s suspected is that these deaths, natural causes of various stripes, were likely Covid induced but not counted in official statistics due to lack of documentation of infection. Say a ninety year old who lived alone at home and was found dead in bed. If there was no one to observe symptoms and no testing, the death might have been coded as cardiac in nature as often happens in such cases. If even half of the excess deaths are from unrecorded Covid cases, the number of total deaths from the disease goes up fairly significantly from the 1.1 million currently on the books to something closer to 1.4 million. The pandemic killed roughly 1/200 Americans who celebrated New Years 2020.

We now have an official end date for the pandemic emergency. May 11, 2023. On that date, all of the various public health emergency orders put in place over the last few years to combat Covid will come to a close. There’s a piece of me that wants to think it’s a personal salute of some sort as that’s my birthday (I’ll be 61 if anyone is counting). Of course that doesn’t mean the disease goes away on that date, but it does give bureaucracy something to work with. It needs hard figures like dates. And it does give me the right date on which to write the epilogue for the final volume of The Accidental Plague Diaries. The last book won’t run through then as I’ve sort of spent all my ideas regarding pandemic tangential topics to write about but I think it will be a satisfying coda. There could also be another mutation in April and all bets will be off.

The next couple of weeks will be consumed by getting The Bell Tower Players production of Dearly Departed up on its feet. Scripts are coming out of hands, actors are finding their characters and rhythms, scenes are coming together and are finding the blend of comedy, pain, and humanity that I’m looking for. In some ways, that was the easy part. Now it’s a never ending sea of details regarding costumes and props and set changes and sound cues and lighting instruments and all of the hundreds of things that have to come together just right for theatrical production. There comes a time in every show I’ve ever done where I’ve turned to the person next to me and said ‘Why do we do this? Why don’t we just go out in the alley and beat each other with pointed sticks? It would be less painful.’ Why do I do it? It fulfills my need to create. It’s my version of team sports: getting a group of people to do something that none of them could accomplish on their own. It restores my soul and faith in humanity to work together with friends on a larger goal. All I can say is ‘Gods of the theater smile on us…’

It’s cold out tonight. There are freezes and ice storms in neighboring states but so far they are missing us. We’re just cold and wet and dreary. I think it will be a good weekend to stay in and work on sound cues and catch up on progress notes and maybe finally finish taking down the Christmas Tree. Binx the cat has made a good start; he’s decided it’s a fun game to bat at the low hanging ornaments until they come down on his head, then he bolts under the couch. At least he hasn’t tried to climb it or knocked it over or anything else equally disastrous. I should also try to do some writing – but I still haven’t figured out what the next major writing project should be. I assume it’ll come to me eventually. It usually does.

I’ve launched myself into the editing process for volume 3 (and volume the last assuming American society will quit collapsing for a while) of The Accidental Plague Diaries. It’s going to cover the age of omicron and has a definitive ending date of mid September 2022. Something happened then which makes a good marker for a shift in societal attitude toward Covid away from constant reaction to one of more basic indifference, a change from the acute to the chronic phase of the disease as it were. When I started writing the material that became The Accidental Plague Diaries, I had no idea I was writing a book much less three. Actually, it’s pretty much one long narrative in three volumes covering March 2020 to September 2022, roughly two and a half years. That’s not all that long a time span but it was enough to change pretty much everything about our society and we’ll be coping with the fallout for decades; that’s even if the virus doesn’t mutate into something exceptionally nasty or cause some long term side effect like early death of cardiac muscle or brain tissue.

The FDA had a big pow-wow this past week trying to figure out how to deal with Covid boosters going forward. They’re trying to clarify their messaging, make sure that public health is protected, and make sure that the more health illiterate among the population know what they should do moving forward to keep themselves well. No final decisions were made but my reading of the tea leaves of reportage that emerged from the sessions is that we are likely to enter a period of annual booster updates, much like we have with influenza. Some will take them, some will refuse (which is also true of flu shots) but my advice remains that we should all get any sort of booster that comes down the pike. There’s one significant difference between Covid and flu and that’s the rate of mutation of the virus to new strains. Covid mutates roughly four times faster than influenza. There are some arguments that we should really be aiming for boosters every six months going forward because of this as, by the time strains are identified, vaccine is manufactured, distribution is in place, and shots go into arms, they may be seriously behind the times. Fortunately, mRNA vaccine technology allows vaccines to be tweaked relatively rapidly. The other big issue, of course, as is so often the case with the American medical system, is one of economics. There is a feeling in the political landscape that the pandemic is over and the political will to keep publicly funding vaccines is fading fast. This means they will likely be privatized under Big Pharma and we can guess what that’s going to mean to American pocketbooks.

My work life has settled down somewhat over the last few weeks. I still can’t get people into specialty care in any sort of timely fashion and the emergency department remains a zoo due to the wide spread respiratory virus season which continues in full swing (mine is finally calming down after nearly three weeks – it wasn’t flu or covid, just the cruds but boy has it lasted…) But the office and house call programs seem to be flowing as designed, even though we remain significantly short staffed. We should be OK until somebody gets sick… or pregnant… or needs to take a vacation… I’ve decided that as long as I can get my breaks and staffing stabilizes and improves, I can probably do this for a few more years but who knows what’s to come? Would any of us have expected to be where we are at New Years 2020?

I went to Opera Birmingham’s production of dwb(Driving While Black) last night. It’s a short one woman chamber opera about a Black mother as she watches her son grow and she starts to fear what could happen to him given societal racism. It was a bravura performance by Allison Sanders who has never been in finer voice and who brought her own personal perspective, as the mother of a young son, to the role. When Keith Wolfe-Hughes had brought up this piece as a good fit for our chamber opera slot a couple years ago, I knew that it would rise or fall on just the right director and I happened to know just the right person, Aija Penix. I had met Aija a few years earlier when I was cast in Birmingham Black Repertory Theater Collective’s production of Choir Boy. She was responsible for the musical staging and, as I got to know her over the next few years as a musician, director, actress, and committed activist for a more just world, I knew she was exactly the right match for this project. And sometimes my good ideas bear fruit. The nature of the piece is such that it would be easy for a director to bring its messages forward from a place of anger. This production did not do so. Ajia and Allison and their collaborators create it from a place of deep humanity which makes the end result much more powerful and moving. It’s a production that needs to tour so other audiences can see it because, while it is an opera, it speaks to far more of the world than an opera audience.

As for my current theatrical project? I’m quite pleased with how Dearly Departed is shaping up. My cast seem to get the tone I’m going for (a sort of heightened reality, but firmly anchored in the plausible and not just played for laughs). They’re supposed to come off book this week and then I’ll really start to know what we have. The set, props, and costumes are all on schedule. We’re a bit behind in the son et lumiere department. We’ll figure it out. We’ve still got two weeks until tech. I think I know what I’m doing as a director, but it’s been so long since I put together a straight play that I occasionally have to take a deep breath and remind myself that I’m an intelligent human being and that this remains within my skill set.

Should probably go to bed now. Have to be up for church in the morning. It remains to be seen if the laryngitis has improved enough for me to join the choir for the anthem or not. Either way, I said I’d teach upper elementary Sunday school so I’d better turn up.

I’ve been thinking a lot about death. Not in a particularly morbid way and I’m not especially concerned about my own, despite the fact that I am now on day number twelve of the never ending respiratory viral illness, but in a more existential way. We live in a death denying society. The sometimes messy and painful processes of the winding down of our biologic selves had been removed from sight and as part of private family life into the alien world of hospitals and nursing homes. By the last quarter of the 20th century, fewer than 15% of US deaths happened at home. Shifting public opinions regarding end of life and the rise of the hospice movement began to change this and through the first two decades of the 21st century there was a steady rise of home deaths to something between 25 and 30% of deaths by the end of 2019. The world turned upside down in the spring of 2020, of course, and the 1.1 million US deaths caused by the Covid virus over the next three years occurred predominantly in hospitals and home deaths were very uncommon from this disease, reversing this recent trend.

We’re heading into a new equilibrium. It’s too soon to tell what the pandemic may have done to the American way of death. My guess is we’re going to see a major rebound towards home death, driven by the reduction in capacity of the nursing home sector (pandemic job market changes are making it nigh on impossible for nursing homes to staff and stay profitable and they are closing rapidly, especially in rural areas), and by the personal economics of families who just don’t have the financial resources for long term care. Remember kids, nursing home care is not a Medicare benefit. It may be a Medicaid benefit but Medicaid is different in every state with very different eligibility requirements and payment systems and alternatives. In Alabama, Medicaid only pays for nursing home care, not for assisted living or for in home care to prevent nursing home placement (with limited exceptions under a program known as Medicaid waiver). Other states use their Medicaid dollars in other ways or may have a larger tax base to offer more generous programs.

There is private long term care insurance which will pay for these costs but, for the most part, these products have proven actuarially unsound and are no longer sold so if you haven’t already bought a policy, you may be out of luck. There are still some on the market but the premiums are extremely high and they are pretty unaffordable to all but the highest socio-economic strata. Consequently, as the Boom generation starts to enter it’s dying off years, most of them will die at home cared for and observed by their families, biologic or of choice, and this is likely to cause some significant changes in how our society views mortality over the next few decades, especially when added on top of the somewhat shell shocked state we find ourselves in as the pandemic continues to percolate along in the background, always threatening to explode once more.

The Boom generation is enormous. 76 million babies were born in the US during the boom years. Accident and bad luck has carried off some at early ages but about 60 million of that cohort remain living. And then they’ve been joined by another 10 million in that age group who immigrated to the US at some point so there’s about 70 million in the demographic band between 58-76 today. The lead edge of the boom, born 1946, is busy turning 77 (think Dolly Parton, Sylvester Stallone, and Cher). US life expectancy is now currently 76.1 years (having dropped significantly from 78.9 a few years ago due to Covid and the opioid crisis). The unstoppable force and the immovable object are just about to collide…

Now it’s a somewhat specious argument as life expectancy is a calculated statistic that suggests the average length of life of a baby born today and really has nothing to do with the health and senescence of older individuals. The rapid drop is because of the number of young people who have died recently of Covid and overdoses. The younger a death, the more impact on life expectancy. Life expectancy for a 75 year old in the US is roughly 11 years so most of the boom is going to be around for another couple of decades. If you look at the projections, and we assume that there isn’t a new pandemic or major climate alterations that cause famine, Boomer deaths really start to take off around 2030 when the oldest boomers are in their mid 80s. 40% of the boom population dies in the 2030s. 45% dies in the 2040s. They’re demographically irrelevant after 2050 even though the very last member of the US boom cohort won’t die until sometime around 2080.

What’s going to happen first, and is already happening and you’ve begun to notice if you’re paying attention, is the death of the cultural figures who created the pop culture of the 1960-1985 from which the boom takes its identity. They tend to be a few years older than the boom, young adults when the early boom was still in its adolescent phase. The most recent is David Crosby who died this past week at age 81. Paul McCartney is 80. Francis Ford Coppola is 83. Robert Redford is 86. As the boom has been such a force in American culture for so long, its icons have remained constantly with us for five, six and seven decades in the public eye. They’re mortal. They’ll start falling and over the next decade or so the pace is going to accelerate. American culture has, in some ways, been in stasis for some time to boom norms with younger generations not really being able to make significant impact on our understanding of the world.

That’s about to change. The old will die to make room for the new. That’s how nature is designed to work. My favorite symbol of this rebirth and renewal is the phoenix, made hip again by Harry Potter a few years ago. Because of my arts work and my teaching, I mix with Millennials and Gen Z all the time, They’re bursting with ideas and with life, and with new perspectives. I’m looking forward to seeing what all they come up with and, if I have to get out of the way to let them do it, fine with me. We’re going to see some battles though. I can’t help but think that, at its core, the current fuss regarding transsexuals and drag queens is a generational battle. Generation Z has decided to toss old ideas of gender expression out the window in favor of freer and more human ways of experiencing the world. Boom and Gen X politicians and religious figures, raised with tight binary views of gender are digging in their heels and, as they control the levers of power, we are where we are. They won’t always have the control they have now. Change is inevitable. You can either accept it and ride it or you can be left whining and irrelevant. Death, life. Just points on the ever turning wheel.

I’m taking a rare sick day today as, while I am slowly improving, I have not been able to completely shake whatever this viral horror is that’s held me captive for nearly a week now. I know it’s not Covid as I tested and I doubt it’s influenza as I haven’t had any fever to speak of. It’s probably some crud cooked up by children freely swapping germs in day care and then carried to me at either church or work as I likely was exposed a week ago Sunday or Monday given the timing of my symptoms. The plan is to go back to work tomorrow as Wednesday through Friday tend to be my lighter days so I shouldn’t over do it too much.

I was lying in bed this morning scrolling through my Twitter feed when I was side tracked down an anti Covid vaccination rabbit hole. The anti-vaccination forces are out in number again and they have a bunch of new ‘proof’ regarding the dangers of vaccines made up out of the usual whole cloth. A couple of things: Damar Hamlin did not suffer cardiac arrest due to Covid vaccination. Cardiac arrest following a significant chest blow that aligns just so with the cardiac rhythm cycle is a well known phenomenon and has been happening to athletes involved in contact sports forever. Mr. Hamlin’s issue was promptly recognized and treated and, as a healthy conditioned athlete, he’s beating the odds for cardiac arrest in the field and more power to him. Hopefully he will avoid the issues that I have seen in all of the ex-NFL players I have treated over the years: dementia secondary to chronic traumatic encephalopathy – especially common in football players and boxers. Another: Lisa Marie Presley did not die at a relatively young age due to Covid vaccination. Her cardiac arrest appears to be related to previously undiagnosed heart issues that had been thought to be GI in nature. Heart disease is often underdiagnosed in women for this reason – cardiac symptoms are attributed to the wrong source. This doesn’t only happen in women. Tommy died a year younger than Lisa Marie as his cardiac symptoms had been attributed to his underlying lung issues.

If you look at all cause mortality for young people (all deaths from all causes, whether natural, accidental, Covid related or anything else), you can start to see the real role of vaccines. Death rates were fairly stable during 2018 and 2019 and slowly started to rise during 2020 as Covid spread and vaccines were not available. Once vaccines became available to the general public in the spring of 2021, they go down again, spiking a bit in late 2021 with the delta variant which was more virulent and more likely to be fatal. It then starts to go down again throughout 2022 and is nearly back at the baseline numbers of 2019. If the vaccine were busy killing large numbers of young people, total mortality would remain up and it hasn’t.

There’s some sort of fauxcumentary making the rounds full of arresting visuals blaming the mRNA vaccines for serious blood clotting including graphic shots of clots being removed from arteries post mortem. Of course, this film fails to mention that blood clots post mortem so you’ll find something similar on any autopsy. There’s also a lot of anecdotes about so and so receiving a vaccine and dying soon after. The only way for no one to ever die after receiving a vaccine would be for the vaccine to prevent death from all causes. People die. When you vaccinate a large population, some of them will die and the reasons are generally unrelated to the vaccination. We just tend to see events linked temporally as events linked causally. It doesn’t work that way. If I received a vaccine and died the next day in a car crash, the correlation is not causation. As is the case with most anecdotal stories of vaccine death which have been politicized.

In terms of actual known risks from the mRNA vaccines (Pfizer and Moderna). There is about one case of anaphylaxis for every 200,000 vaccines. This is somewhat lower than other common drugs such as antibiotics. The J and J vaccine (but not the mRNA vaccines) was linked to about one case of fatal clotting disorder for every 250,000 vaccines. As a comparison, oral birth control pills kill about 1/30,000 users from blood clots. Because of this, the J and H vaccine is no longer recommended. The mRNA vaccines were linked to myocarditis in young men (inflammation of the heart muscle). Roughly 1/10,000 young men would have this happen. I have not been able to find any reports of fatalities. The myocarditis caused by the coronavirus itself is not so benign, having killed hundreds, if not thousands (I can’t find any accurate statistics).

By getting into a car on a routine basis, my chance of dying in an auto accident in America in any given year is about 1/8,000. The risks of the vaccines are so much lower than this thing we all do without thinking that I remain flummoxed by the remaining and resurgent antivaccine movement. It’s a dangerous world. Life is risk. Vaccines aren’t one to be concerned about. Get your Covid booster.

I’m sick. Now if you’ve been reading my musings for a while, you probably already reached that conclusion some time ago and are wondering why I am just now getting there myself. But I’m talking about the physical stuff. I started to develop cold symptoms on Wednesday which shifted into bronchitis by mid day on Thursday with full fledged laryngitis by Thursday evening. Fortunately, with a long weekend, I was able to spend most of the last couple of days trying to sleep it off, alternately dosing myself with DayQuil and NyQuil, my concoction of choice for such times. I am improving slowly, and should be more or less back in fighting strength by the time I get back to work on Tuesday morning. I had had some plans for the long weekend involving a little time away and a walk in the woods, but those have been dashed. I am here with my Kleenex, a couple of cats curled up beside me, some hot tea with a dollop of rum, and a bunch of films lined up on streaming.

Now that the holidays are over, I have been in touch with my editor regarding the future of the Accidental Plague Diaries. We have come to the decision that there will be one more volume in book form, covering America in the Age of Omicron (which sounds like something out of the Marvel Universe). We’ll launch into the editing process starting in February and should have it in shape by June and it should be out late summer/early fall. It will end with Joe Biden’s Sixty Minutes appearance announcing the end of the pandemic. We all know that wasn’t the end, but it’s a good marker for a change in thinking about the pandemic by society away from the reactive to the more contemplative of how do we live with this as part of our lives going forward. Once the last one is done, I suppose I’ll have to turn my attention to the next writing project. And we’ll have to get a Kindle version and an audiobook out there as well. And perhaps we’ll have to sell them as a boxed set, maybe with a premium? Accidental Plague Diary tea towels? Ginsu Knives?

So where are we with Covid? It felled a couple of celebrities at the Golden Globes award show. The new omicron variant XBB 1.5 is now up to somewhere between 40 and 50% of the infections in the US and remains highly transmissible. Fortunately, it doesn’t appear to be any more virulent than previous strains and vaccines continue to hold it at bay. It would be a really good time to get your bivalent omicron specific booster if you didn’t get it this past fall as it appears to have additional protection against both developing a new infection and lessening the duration and severity of the infection should you happen to get it. The mortality rate has ticked up some from about 350 deaths a day to about 550 deaths a day. As the majority of the deaths are in the elderly with significant chronic disease burden at baseline and not so much among the young and healthy as was happening in the past, society doesn’t seem to be as concerned as they were a year or so ago. Should we be? Covid has been the third leading cause of death in the US since it appeared and doesn’t look like it will be dropping out of the top five anytime soon. The current relatively low levels will have it come out with about double the numbers of breast cancer or prostate cancer in terms of total mortality.

In non-Covid news, I’m through the first week of rehearsals for Dearly Departed and it is coming together quite nicely. We should have no trouble having a show for y’all next month. I am in need of a tech type or two to design/run sound and lights so if anyone is interested or has a friend that might be interested, send them my way. It’s pretty basic. The lights are mainly of the up/down variety with a few isolated areas and the sound cues are mainly offstage noises of various stripes that can be done via a playlist. Most everything else is falling into place.

My headache is coming back so I’m going to end here and go make myself another cuppa and try to sleep again. This isn’t Covid but whatever virus it is, it’s unpleasant and I am decidedly ready for it to depart.

I’m two rehearsals in on Dearly Departed and it feels like the process is going well. The cast seem to be enjoying working together. I feel like I’m adequately prepped for rehearsal and we’ve been able to get two of the four big scenes up on their feet with minimal fuss. I was worried about directing as it’s been quite a while since I’ve done it and it’s been a number of decades since I’ve directed a non-musical. In some ways it’s easier, in others it’s harder as you have less bells and whistles to hide behind and you can’t turn things over to the music director or choreographer when you’ve hit a sticky spot.

It’s always been my practice to block on paper prior to rehearsal and to have the basic shape of the scene in my head before ever putting the actors on stage. I have a reasonable visual imagination for stage picture so I generally do OK but then, when I have the actors walk it, I notice all the things I hadn’t thought of before and the things I wish I had done differently and then I start second guessing myself and I have remind myself in my head that I know what I’m doing.

I’ve never taken a class in directing. I’ve learned by observing, doing, emulating, taking things from other skill sets, and avoiding things that other directors have done in the rehearsal room which I, as a performer, have found unhelpful. I have no idea if I’m any good at it or not. The shows I have directed in recent years have turned out OK but I don’t know how much of that has been me and how much has been talented casts and creative teams. And then there’s Tommy. The only other two shows I’ve directed in the Birmingham phase of my life were collaborations with Tommy, me as director and he as producer. Tommy was a demanding colleague, especially of me. He knew what I was capable of and would not let me rest until I had it done. I would sit at the dining room table with a set floor plan and my bunches of colored pom poms representing various characters, maneuvering them in and out of doors and up and down levels and he would make sure those ideas were formalized and legible on paper before bed. I don’t have him here on this project to keep me focused. I worry about that. Will I be able to do the same thing without his energy?

I just hope we keep moving forward at a proper pace and we don’t have anything that knocks the production for a loop such as a Covid outbreak in the cast. Covid numbers locally appear to be relatively stable. I hear about new cases routinely, but my patients or acquaintances that are falling ill aren’t getting terribly sick and are pretty much back on their feet within a day or two. The current recommendations remain five days quarantine and five days masking after a positive test even if you’re feeling fine. The local ERs are melting down with excess patients again but the issue doesn’t appear to be Covid. There are some cases of course, but the numbers of inpatients aren’t appreciably higher than they were this past fall. It seems instead to be the cumulative effect of pandemic changes on the emergency medical system that are leading to an inability of the system to function as designed. The departure of clinical folk to safer, less stressful jobs has led to short staffing. The wholesale retirement of senior clinicians means those most able to work quickly through the complexities of patient care on missing. Certain specialists are in such short supply that the ability to get the testing and care necessary in a timely fashion has ground to a halt. The receiving institutions for the ill such as rehabilitation centers and nursing homes are so short staffed that they can’t admit, leaving those ready for discharge, but not for independence at home, languishing in inpatient beds, blocking them from being used by new admissions, leaving them hanging out in the emergency department or some hallway as there is nowhere else for them to go.

The acute phase of the pandemic may be over and my Accidental Plague Diaries may be morphing into something new and different, but the effects of the coronavirus are going to continue to tear at our society for years. Today, I heard of a friends child who may have permanent speech issues as their impaired hearing could not be treated during the pandemic as no pediatric ENT would see them in person during a crucial year for speech development. I heard about an acquaintance with newly diagnosed colon cancer who was at risk and whom had had their colonoscopy postponed for three years. I had to deal with a patient on a house call who had had nothing to eat or drink for a day or so as he was unable to get himself out of bed and there were no staff in his senior facility available to assist him. None of these are especially noteworthy on an international level, but they mean the world to the families involved. There’s also the butterfly effect. We cannot begin to know the outward ripples from each of these small issues that the pandemic has brought to bear.

The new congressional term is beginning. Per usual, the lunatics are running the asylum; perhaps a bit more than in the past. I can’t help but wonder what the pandemic and the political battles over public health are going to do to shape governance for the next few years. How will all of this determine what rises to the top in terms of new legislation? Will the needs of the diva egos of certain congresspeople trump common sense? What happens if a new mutation makes our vaccines and relative immunity useless? The currently spreading omicron variant in the Northeast, xbb 1.5, is spreading so quickly and appears to be so much more contagious than the previous variants, it’s been nicknamed The Kraken. It’s gone from about 2% to 40% of cases in the area over roughly three weeks. It’s not here in the Deep South yet but it’s coming. It doesn’t appear to be more virulent, but monoclonal antibodies are ineffective against it. (Paxlovid still works). Vaccines and natural immunity appear to be holding the line. If you still haven’t gotten a vaccine, be prepared to fall ill due to its R0 which seems to be somewhere between 5-10.

With my luck it’ll get to Birmingham and the set of Dearly Departed round about tech week.

Dateline – Birmingham, Alabama

Sorry about the delayed update on the last piece of the UK trip but I was tired after a long double show day on Tuesday and Wednesday turned into an interminable travel day of some twenty-five hours between the London hotel and my Birmingham condo so I am only just surfacing now with enough energy and functioning neurons to be able to string a coherent sentence together. I’ll bring you all up to date today and then I’m likely to be dormant for a few days while I figure out which end is up, what time zone I’m in, and how to piece together all of the crazy pieces of my life.

On Tuesday morning, David Pohler and I got up, breakfasted and under way across town to The Tower of London. Our very smart guide suggested that we get there within a half hour or so of opening at 9 am and that we make a beeline for the jewel house. We followed his advice, tubed from the west suburbs to the east end, were on the Tower grounds about 9:15 and in to see the crown jewels by 9:20 as no queue had yet formed. By 10 am, the line was significant and was somewhere between 40 and 75 minutes the rest of the day so here’s your travel tip of the day. If you want to see the diamonds and the gold, go early. St. Edwards’ Crown, which is used to crown the monarch as it’s being prepared for Charles III’s coronation in a couple of months. These are working pieces after all. The rest of the sparkle was all very much there. I’ve been to the Tower several times before but I’ve always enjoyed letting my mind drift back over a thousand years of history and who was walking which halls when. They’ve redone a lot since my last trip fifteen years ago including opening up some new apartments from the 13th century in the Wakefield Tower which I found quite interesting.

Then we took one of the river ferries across the Thames to the south bank and the Globe Theater. Those who recall their theatrical history know that Shakespeare’s Globe burned in the early 17th century when one of the cannons being used in a performance of Henry VIII malfunctioned and set the place on fire. The current Globe is a loving recreation as close to the original site as they could put it. As the Globe was open air (no theatrical lighting…), it’s not very practical to stage shows in the winter months so there is a second theater, The Wanamaker (after Sam Wanamaker, the actor who spearheaded to recreation of The Globe project) which is indoors and uses the same sorts of proportions that an indoor court theater of the Elizabethan period would have had. Small, intimate, the audience seated on benches in three tiers, and best of all, lit by candlelight as would have been done back in the day.

The play was Henry V. A company of six men and four women in modern dress concentrating on delivering the language clearly. No major technical effects (although an upstage drape rises to reveal a silvered wall when we get to the battle scenes). Some very interesting interpretations – casting Orleans and Prince Louis with opposite gendered actors gives that relationship new meaning and depth; the princess’ translation scene played for fear and highlighting her lack of autonomy over the usual comedy. I quite liked it.

After the Shakespeare, the five of us who had attended wandered the south bank and stopped in at a temporary holiday bar devoted to curling. I had a cocktail. I did not play with the curling stones. David and I then bid adieu to the rest, crossed the Golden Jubilee footbridge to Charing Cross station and to The Kit Kat Club (The Playhouse Theater) and the most recent revival of Cabaret. We were a bit early so we ended up being the first in. You enter throgh a rear service door and down through maintenance corridors hung with beads as the staff welcomes you to the Kit Kat, hands you a shot of schnapps to chug, and the lighting is mood and haze hangs around. You emerge in a bar. The Kit Kat performers are starting to warm up, the band is playing jazz. And then it’s upstairs to a second bar with charcoal drawing murals a la Schiele or Grosz on the walls. The Kit Kats are dancing on the bar and hanging from the ceiling. Up to a third bar for champagne and charcuterie while waiting for the house to open. Then into the theater for more champagne and light supper before the show begins. The interior has been completely renovated for theater in the round. The stalls are now cabaret tables. A second set of stall sits with its lights and telephones where upstage and backstage would normally be and the dress circle continues fully around in the fly space. The drum rolls. black out. The lights are up on a blond MC in a silly little party hat who has appeared out of nowhere center stage and we’re off.

Most of you know that Cabaret has a certain significance in my life from playing Herr Schultz twice to my late life performing career beginning with the Politically Incorrect Cabaret Ansager who owes a good deal to Joel Grey. It’s a show I have seen over and over again. Sometimes done well, sometimes not. This version is the same script as the Studio 54 production with Alan Cumming. It’s inventively staged, hits the right political points and does some things with the finale which are new and different and which are scary in a completely different way than the usual Nazi tropes.

Back to the hotel for a few hours of sleep before having to be up at 5 AM London time to catch the car for Heathrow. Heathrow was packed. For some reason we were booked back to Atlanta via Amsterdam which meant a quick flight to Schipoul and sitting around for hours so we didn’t board the transatlantic flight until some nine hours after first hitting an airport and, as it was a smaller plane, about nine and a half hours to Atlanta. And then having to get through all the usual immigration and customs and on to a Birmingham flight. I hit my condo roughly twenty five hours after leaving the hotel in London. I have rarely been so happy to see my bed when that was all finally over.

Here endeth the London travel diary. I have no idea what’s going to come next in this space. The Plague Diaries are also pretty much finished and I haven’t figured out what I should be writing about going forward. My next big project is directing a play which I have not done for some years. I may discuss my process for approaching that. I may write some sample chapters for a couple of pieces of fiction swirling around my head. Something will make itself known and demand to be let out. It usually does. In the meantime, I’m going to bed early.

Dateline: London, UK

And now on to the important part of any trip to London, cramming in as many West End shows as possible given the vagaries of ticket availability, holiday scheduling and the like. Over the years I have seen Lena Hone, Rex Harrison, the original never replicated staging of Starlight Express, the original production of Noises Off, Les Miz, the musical version of The Lord of the Rings, and various other productions – both exceptionally good and of the ‘what were they thinking variety’. Today and tomorrow are both two show days before packing up my bags and winging my way back across the pond to some semblance of my normal life. I need another week here. Fortunately, that’s already scheduled and is due to happen at a time when the weather is likely to be a bit better.

Prior to curtain, up and breakfasted and then headed to Buckingham Palace to watch the ritual of the Changing of the Guard. Large crowd, fancy medieval costumes, and for reasons that surpass understanding, the Horse Guards band playing ‘Diamonds Are A Girls Best Friend’. I looked at David Pohler quizzically asking ‘is that what I think it is’ before we both started singing along. Any other show queens in the crowd would have gotten it but it seems to have flown over the heads of most of those assembled. I could not quite understand the choice (the piece immediately prior was Non Piu Andrai from The Marriage of Figaro which was also a bit odd given its plot function in the opera). I surmise a music director with a cheeky sense of humor or some political points to make whose superiors aren’t smart enough to get it.

From there, David and I had a few hours to kill so we headed over to Mme Tussaud’s . I had not been there for some years. It’s expanded and taken over the planetarium building next door as well as its traditional headquarters. I was disappointed that most of the historical figures from the 18th century that she sculpted from life (Ben Franklin, Voltaire) were not on display as they have been in the past, replaced by the likes of the Kardashians and Taylor Swift. But it was still good fun and we took lots of pictures. I’ve always wanted to have breakfast with Audrey Hepburn as Holly Golightly.

We then marched from Marylebone to the West End for our matinee. It was a bit longer distance than I had calculated so we had to race walk the last half mile or so but we arrived at the theater with five minutes to spare to take in the new musical version of Back to the Future. I booked tickets as I was interested in the stage craft, not because I thought that was a property that called out for musicalization. It’s supposed to arrive in NYC this summer at The Winter Garden. It needs a bit of work if it’s going to succeed. The score is pedestrian – the few musical bits interpolated from the film (The Power of Love, Johnny B. Goode) being much stronger than any of the new material. The lyrics are downright clunky – a myopia/utopia/hopin’ ya rhyme made me audibly groan causing the family in front of me to turn around and stare at me in disapproval. The first act has a number of completely unnecessary musical numbers like a big gospel production number for Goldie Wilson (the African-American guy in the diner who ends up as mayor), a minor character who has absolutely no bearing on the plot. There’s also a big song for the father when he’s being a peeping tom on the mother that’s a complete misfire. It’s no ‘Someone in a Tree’. The second act is better structured and paced and redeems the show which also ends with an impressive coup de theatre that I’m still puzzling out how they did.

Met up with others of the Alabama gang for a pub dinner in Covent Garden and then on to our second show, the new stage version of The Life of Pi. This was a triumph of staging with the animal puppetry being absolutely stunning and seamlessly integrating the animal and human characters. The basic design concept of the animals was driftwood sculpture fitting in to the sea setting of most of the story. It has not yet come to New York, but when it does, it’s very definitely worth seeing. I’ve never been terribly fond of either the book or the film but this production is making me rethink my relationship with the material.

And so, as Samuel Pepys says, to bed… One more full day before this week draws to a close.