The problem with writing these essays, especially when I diverge into travel writing, is that I need to make sure I write a finish to each journey or people start to assume that I’m not coming back or that I’m felled by illness or accident in some foreign locale, languishing alone and forlorn. I assure you I am safely home in Birmingham, currently lying on my bed with my laptop in my lap and banging away at these words while Oliver the cat purrs beside me. Binx, the ghost cat, is no longer in hiding. He now wanders in and out of the room repeatedly, playing with various things on the floor, getting under the bed and clawing at the mattress, and shrieking and scampering out of the room should I happen to look at him for more than five seconds or make any sort of motion in his general direction. I assume it’s some sort of improvement in human cat relations and, at this rate, he may let me approach him from time to time around the holidays.

The trip back from Miami was uneventful. It’s about 800 miles, more than I will drive alone in the car on my own at my age so I stopped for the night in Tallahassee. Most of Florida is flat. The part of the panhandle with the capital at least has some rolling hills making it a rather nice small city, not that I saw much of it as I arrived around dusk and didn’t exactly feel like sight seeing the next morning. I finally got back home around dinner time on Sunday and did the usual post trip things. Unpacking. Laundry. Unwinding from long hours in the car (roughly 1,800 miles in toto over the week). I celebrated by doing not much of anything and starting House of the Dragon in HBO Max. I’ve read George R R Martin’s Fire and Blood so I know what’s going to happen to the various branches of the Targaryen family but now that all episodes have dropped, I can binge it over the next couple of weeks and get my medieval fantasy fix.

Of course, returning from a week off means having to dive into everything at work again. The issue with being gone for only a week is that the system isn’t very good about taking care of things in your absence, understanding that you’ll be back relatively soon and so things just pile up in inboxes rather than being dealt with. If you’re gone for two or three weeks, things actually get done in your absence as no one wants to be the person who let the urgent clinical issue molder for a couple of weeks leading to complications and unhappy patients. I got the last of the inboxes emptied today so I’m pretty much back at my usual square one. There were no major disasters while I was gone. The fire and blood were left to fantasy television rather than in my waiting room.

While I was gone, I was cast in a new show, The 1940s Radio Christmas Carol. A group of radio players, demoted from New York City to Newark, are doing a live broadcast of Dicken’s A Christmas Carol. Backstage drama, musical numbers, live foley sound effects, a Shakespearean lead in a dissociative state, hijinks ensue. I’m playing the host/narrator that’s trying to keep the whole thing moving along. It should be fun, although I have far too many lines. I think I’m going to cheat on the radio drama piece and keep my lines on my clipboard as I’m supposed to be reading them anyway…

The health press is full of provocative, if not entirely accurate headlines about a possible ‘triple threat’ this winter of colliding influenza, respiratory syncytial virus, and covid. Will that happen? It’s too early to say. What does seem to be going on is that covid numbers are remaining relatively static. Various new variants continue to circulate but none of them appears to be surging forward with major increases in infection or percentages of cases. The surges in Europe, Singapore, and elsewhere over the last month are abating without huge impacts. Respiratory syncytial virus (RSV), which usually affects children, is having a significant impact on childrens’ hospitals nationally with localized outbreaks in Texas and on the Eastern Seaboard. It’s a virus that causes mainly a bad chest cold in healthy adults but can cause serious pneumonia in the very young and the very old. The current thought among epidemiologists is that this is a result of pandemic era behavior. Most young children have been kept at home most of the last two years. This fall, daycares started to open up and fill at something closer to prepandemic rates. All sorts of toddlers who had had minimal exposures to peers and their viruses have all suddenly been exposed relatively quickly and so cases that would have normally happened over a year or two are happening over just a few short weeks.

Influenza is circulating. For some reason, there are relatively high rates currently here in Alabama and elsewhere in the Southeast. Usually it gets here later as it’s warmer here than most other parts of the country. Why this should be this year is unclear. I’m guessing that at least in part it’s because this is the part of the country least likely to have individuals mask or stay home when they’re having signs of respiratory illness so things just spread a little faster here, but that’s just a guess. Anyway, if you’re in this part of the country, I’d go get your flu shot now instead of waiting for later in the season. I got mine Monday morning. It made me a little under the weather for 24 hours but nothing I couldn’t handle or that required me to adjust my schedule at all.

No, I don’t know when Volume II will come out. My publisher and the book distributors are having words of some sort. When it all gets resolved and I have a proof copy in hand, I’ll be able to let y’all know. In the meantime, keep those hands washed, stay home if you’ve got respiratory illness symptoms, and get your flu shot and bivalent covid booster. You can get them at the same time for convenience, one in each arm. Just pretend you’re a military recruit in basic training.

Dateline – Miami, Florida

It’s been a lazy couple of days hanging around the South Miami / Coral Gables part of the metro area. I’ve been staying with my friend who lives just a few blocks away from the University of Miami campus as he does not like to drive. He moved here at the same time I moved to Sacramento to start my internship so he’s been in this job and this house for nearly thirty five years. I’ve been down to visit him a half dozen or so times over the years, to say hi to his dogs (several generations now), the peacocks that wander through his yard and jump up on his roof (A peacock on the roof, sounds crazy, no?), and the very large banyan tree in his front yard that looks like it came out of a theme park Adventureland. We’ve spent a couple of days catching up, reminiscing about our times together in undergraduate and graduate programs, trying to outdo each other with outrageous puns, and reminding ourselves why we have remained close friends for over forty years.

Having been to Miami a number of times over the years, I did not feel a particular need to sight see. I did head over to South Beach to people watch and to have brunch at the Birdcage Cafe, occupying the building where the movie was filmed, and to walk a bit along the beach. The locals are beautiful but as vapid as ever. I remember my first trip to Miami with Steve thirty some years ago. We went to the beach in South Beach and started to tune in the conversations of the pretty people around us and realized there were only three topics – the gym, drugs, and nightclubs. We looked at each other and wondered what was going to happen to them in another decade or two when they weren’t as pretty, there was a new generation of hot young things, and they hadn’t managed to build a life. We both remembered that attitude vividly when we had the opportunity to move to Miami Beach five or six years later and it was one of the things that pushed us towards Birmingham instead. I also spent a little time in Coconut Grove and at the Biltmore Hotel which is just up the road from where I’ve been staying and remains one of my favorite pieces of 1920s fantasy architecture.

Tomorrow, I begin the trek back to Birmingham. I could do it in one very long day but I’m getting too old to put that many miles in alone in the car so I’m going to split it in half and spend the night in Gainesville or Tallahassee or some other equally exotic place. Then, feeling somewhat rejuvenated, I’m going to sit down and take a long hard look at all the projects that have to be completed by the end of the year and make sure they are on appropriate timelines and that I haven’t forgotten anything significant. The second volume of the book is chief among them. There’s been a bit of a delay with Ingram, the book distributors, so the proof is still not ready. It should be ready next week and, as soon as I get it and check it, I’ll announce the publication date, likely mid November sometime. As long as it’s out for the holiday shopping season so you can all add it to your Christmas lists.

On the Covid front, it’s kind of hard to know just what to think. As so much of the world has acted as if it’s over, the data just isn’t being collected in the way that it was and it’s hard to determine just what trends are at this point. From what I can tell in the national numbers, we’re holding pretty steady. Daily deaths remain in the mid 300s and new cases remain around 35,000 a day. As so many of the diagnoses are now done through home tests and are relatively mild, it’s had to know how accurate those numbers actually are. All signs point to new strains of omicron rapidly arising and promulgating. Whether this will change the trend of the numbers back up into another surge remains to be seen. That’s certainly happened in Europe so it’s likely. Whether that surge will translate into more seriously ill individuals requiring hospital care is also unclear. There’s some data out of Germany suggesting that serious cases, while going up, aren’t soaring so that’s relatively good news. I suppose we won’t really know if there’s going to be a fall/winter surge until we’re actually in it given the lack of data and the disinterest of the media in actually presenting or explaining what data there are.

What can you do? Get your bivalent booster this fall. From what we can tell immunity, whether natural from infection or from vaccination starts to wane after about six months so regular boosting is likely going to be necessary going forward, just like flu shots. It won’t necessarily keep you from catching Covid but it will help keep you from needing the hospital and there’s some evidence that it reduces the chance of long Covid symptoms. (My fatigue, after two months, is still there but continues to improve). Keep your hands washed and sanitized. Should you continue to mask and where and when? Isn’t that the $64 question. I don’t know that anyone has exact answers on that. I continue to mask at work as I am in close proximity in enclosed space with people for some time. I’m not masking much in my private life unless it’s going to be contact of more than fifteen minutes in enclosed space with poor ventilation and a high likelihood of individuals who are unlikely to follow good public health measures. I think we all have to run our own risk benefit calculations.

Dateline, Miami Florida

Sorry for the lack of an update yesterday evening but twelve hours of theme park/roller coaster riding and 25,000 steps logged on the pedometer left me with little energy to write yesterday evening when I got in. It was a matter of laying on the bed, putting my feet up, and not moving for several hours. The days (and years) of where I could do that sort of activity unscathed have definitely receded into the past. I have a decade or two more of roller coastering in me yet but I will have to do some pacing of myself going forward. Fortunately, I did not have that much to do today other than drive the five hours to Miami from Orlando and that didn’t need to happen until after I got some decent sleep.

When I decided to stop in Orlando, I realized I would have a day for theme parks and thrill rides should I so choose. What should it be? Disney to see the new Star Wars attractions? Universal to see the expanded Harry Potter land? Sea World or Lego Land or one of the other ones I’ve never been to? I opted for Universal. I was pretty sure I could manage both sides (Islands of Adventure and Universal Studios) in one long day and I remain a huge Harry Potter fan, despite J. K. Rowling’s somewhat uncomfortable politics. I was introduced to Harry Potter when Steve was sick and an old friend sent me the first three books (all that had been published at the time) as a cheer me up sort of present. One of the things I did during the evenings during Steve’s terminal illness was read to him for an hour or two after dinner every night. It was togetherness time. I had always read to him on long car trips while he drove (the days before Audible) and it always reminded me of my childhood when my father, no matter how busy he was, took half an hour or so to read to me from the children’s classics at bedtime.

Harry became a favorite of Steve’s and I read him the first three a couple of times, joined by The Goblet of Fire, when it was published in the year before he died. He did not live long enough to read the others or to see any of the films. The first one opened a few months after his death. Tommy came along a couple of years later and was a big Potter fan. On our first vacation together, The Order of the Phoenix was released and we went out to the late lamented Times Square Virgin megastore at midnight to buy our copies. We made it a special date night to see each new film as it was released. We saw them in Birmingham, Seattle, and Orlando over the years.

And so, armed with a park hopper pass with an express add on in order to skip the longer lines, I headed to Universal Resort Orlando yesterday morning, arriving at City Walk just after the parks opened for the day. The weather was perfect – sunny, high 70s, no humidity. Warm enough for the water rides but not so warm as to be uncomfortable with running about. By 6 PM, I had hit the majority of the major attractions, had my body shot into the air, corkscrewed, and accelerated in reverse, and was pretty much sated. Thoughts on the Universal parks. Islands of Adventure is better designed that Universal Studios and more fun to spend time in. They have cleverly split the Harry Potter themed areas over both parks (connected with the Hogwarts express) so you have to go to both (for an extra fee) to get the full experience. Their newest ride, Hagrid’s motorcycle ride through his bestiary is great fun and well designed but I still prefer the original Hogwarts ride. The Escape from Gringott’s is fun and the interior design for the queue through Gringott’s bank is marvelous and worth seeing, even if you chicken out and don’t get on the coaster piece at the end The new Velocicoaster which is themed to Jurassic World and the raptors is perhaps the best roller coaster I’ve ever ridden. Dizzying drops. Multiple loops. Incredible theming. Definitely worth the half hour in line.

At dinner time, I met an old friend from Birmingham who has relocated to Orlando and works at one of the hotels on the property. She has an annual pass so we trotted off to Harry Potter land together and had dinner at The Three Broomsticks. Madame Rosmerta was not in evidence but the fish and chips were remarkably good. We caught up on each others lives and then she was kind enough to drive me back to my hotel so I didn’t have to walk that last mile. Collapse followed as mentioned above.

This morning, after sleeping in, I pointed Hope southward on the Florida turnpike towards Miami. The cold front bedeviling most of the US has arrived to Florida. It was in the low 50s in Orlando this morning, didn’t get much about 65 all day and has been raining off and on. Rain and Florida interstates are not the best combination so I did not make great time but eventually arrived in South Miami to spend a few days with one of my oldest friends, having been close since my freshman year of college, who teaches at the University of Miami law school and has for more than thirty years. We try to spend some time together every few years to catch up on life. I have no agenda for the next couple of days with him. He teaches in the mornings but we’ll come up with something to do in the afternoons, even if it’s just conversation. He’s one of the few people I know that can outdo me in the pun department and I’ll have to brush up my rusty skills.

I’ll do some reading up on covid variants and vaccine rates and other pandemic news in the next day or so and will update y’all on that front either tomorrow or the day after. In the meantime, I’m in the mood to wax poetic on any of the elder care issues I haven’t tackled yet. Requests are taken by sliding into my DMs as the kids say.

Dateline, Orlando Florida

I woke up to sun streaming in off of Tampa Bay and through my windows (where not blocked by the parking garage), had the usual tasteless Hampton Inn free breakfast, arranged for a delayed checkout and set out to explore downtown St. Petersburg on foot. The bay was lovely. The pelicans were soaring overhead and there were herons and egrets breakfasting on the lawns nearby. Or maybe they were ibises. I didn’t have a copy of Roger Torey Peterson close at hand to double check. I ended up walking down the bay front, past the arts center and arrived at the Dali museum just as it was opening for the day. It’s the largest collection of his surrealist works outside of his own museum in Catalonia so I popped in to take a look.

Seeing somewhere between eighty and a hundred of his canvases arranged in chronological order, it was possible to see his development from his early classical work (influenced heavily by the impressionists and the fauvists) to academic studies from art school to his rapid transition to surrealism in the late 1920s to his more dreamlike enormous canvases of his later post war career. I hadn’t seen a lot of his earlier work before and that’s one of my favorite things to do, trace a visual artists development over time and see how they are influenced by other artists or social movements so I now feel I have a better understanding of Dali than just floppy watches. (Although I must admit I did buy a pair of Persistence of Memory socks in the gift shop). The museum is encased on the harbor end in a multitude of triangular glass tiles that look like they were put together by Buckminster Fuller after a three day bender. I was wondering a bit about the wisdom of having a museum made of glass in a hurricane zone but the collections themselves are in another part of the building constructed in a style best described as concrete bunker.

A further walk through downtown and then a battle with the valet to retrieve my car from the overnight parking as they had mislabeled my key as belonging to a large black van looking like it had been driven last by Ted Bundy but we eventually got it straightened out and I headed a little further to the west to St. Pete beach in order to spend a little time on white sand and dip my toes into the Gulf of Mexico. The Gulf beaches really are some of the nicest in the world and, being a Monday morning, there was next to nobody there. Then, back in the car and across I-4 and the flat lands of central Florida to Orlando, arriving late afternoon. I had dinner this evening at a very good Indian restaurant in Winter Park with an old friend from early UAB days whom I have not seen in person for seventeen years and we caught up on each others lives. I am now stretched out and conserving strength before theme parking it tomorrow.

I’m trying to detach from all things work related but I am in Central Florida and not far from The Villages so there are constant reminders around me about the clinical geriatrics part of my life. When I travel alone, I people watch and have spent the last few days observing the Florida retiree in their native habitat and have been busy diagnosing gait disorders, memory issues, and various neurologic complaints in the passers by. Many years ago, after UC Davis decided in a fit of pique to eliminate their clinical geriatrics program, Steve and I found it necessary to relocate away from the west coast. Our initial plan was Florida. I interviewed for a number of jobs in Miami, Fort Lauderdale, Orlando and some other town whose name I don’t even remember at this time. I left almost every one of those interviews with a very bad taste in my mouth. It was clear that the purpose of Florida geriatric medicine was to maximize reimbursement at all costs and that the actual clinical needs of patients was much lower on the list of priorities. (There was one exception – Mount Sinai in Miami Beach. I nearly took the job there but the finances of the program were tenuous at best and it was clear it would collapse in a few years – it did).

The Villages, just up the turnpike from Orlando, is the largest senior living development in the country – with a population of about 80,000 people in planned communities of homes for ‘active seniors over age 55’. It’s just one of many types of senior living available in the US. These type of communities, popular in sun belt states, are basically subdivisions with HOA rules restricting residence to certain age groups. You’re expected to maintain your own property and, as the majority of the residents are retirees, there’s plenty of people with too much time on their hands running around and ensuring conformity. The larger developments of this type have ‘care centers’ for those who can no longer live an ‘active life style’ where those who might remind the healthy residents of the inevitability of illness, incapacity, and death can be safely tucked away out of sight.

More popular than these behemoths in most places are independent senior living facilities, usually large apartment buildings with some central services such as dining facilities and recreation rooms. They may also have campuses with independent houses. Again, you’re supposed to be able to live your own life, just as you would in your own condo or house. The community may offer services such as housekeeping or meals for additional fees. You generally must be able to care for yourself (independent in your ADLs (activities of daily living) as we say in the biz) and have ways to maintain your IADLs (instrumental activities of daily living – the big four are meals, wheels, bills, and pills). Senior living isn’t cheap (usually 2500 to 4000 a month depending on the amenities) and is not paid for by Medicare or other health insurance as it is not medical care. There are some facilities that are run by charitable institutions for certain social groups and there are buildings which offer submarket rents to low income seniors through federal subsidies known as Section 8. Some states also allow for senior boarding homes or board and care homes which can function in this way on a much smaller scale. Regulation is left up to each state with different licensure, inspection and support programs. In some states, Medicaid dollars can be used for this sort of support, but not in Alabama.

The next step up (or down) is Assisted Living. This is for individuals who have difficulty maintaining their own bodies without assistance. (Their ADLs are compromised – the usual one being that they need help to bathe or shower safely). Assisted Livings are not that different from Independent Senior Living facilities architecturally and often both sorts of facility are housed in the same building or community on different floors or in different wings. In some communities, services, can be adjusted without someone having to move to a different unit. In general, to qualify for assisted living, you need to have no needs that would require a skilled nurse (such as a catheter), enough wits to know your medications (as they generally don’t have a nurse to dispense), and enough physical ability to exit the building with the assistance of no more than one other person. Again, this is not paid for by Medicare or health insurance, is more expensive than senior living, but can be covered by long term care insurance, if you’re lucky enough to have purchased it. As it has proven actuarially unsound, it’s difficult to find these days.

Similar to assisted living, is dementia living for those who are still physically active but who have lost their cognitive abilities. These facilities are licensed to keep the doors locked and to prevent residents from leaving against their will for their own protection. (In regular assisted living, you can walk out anytime you want – the facility may have rules but it’s not a jail). They also must take custody of medication to prevent misuse or errors. Again, it’s even more expensive than regular assisted living and, again, is not paid for by Medicare or medical insurance.

What we tend to think of as a nursing home (although all of these places might be considered such) is the skilled nursing facility or SNF. These are tightly regulated by both federal authorities (as Medicare dollars are spent here) and by states (as they are a major cost center for Medicaid dollars). They are designed for people who cannot care for themselves (in general missing multiple ADLs) or who have complex medical care needs such as indwelling catheters, feeding tubes, or major wounds requiring dressings and treatments. They, in general, offer three kinds of stays. Acute rehabilitation (such as after a serious accident or stroke). For this, a person must have the stamina for four or five hours a day of physical and other therapy and is generally reserved for younger people with a good chance of recovery. This is covered, to a certain extent, by health insurance with various terms and conditions. Subacute rehabilitation, which has far less intensive therapy and is the most usual kind of short term stay for an older person following a hospitalization for a serious illness or injury. It is a Medicare benefit which can be accessed as long as there has been a hospitalization of three days duration (defined as being admitted over three midnights) and generally lasts for up to twenty days. (It can be extended beyond if additional rehab will be helpful and the patient is willing to pay additional copays up to a total of 100 days). Lastly, custodial care, admission without plan for discharge. This is not paid for by Medicare. It can be covered by Medicaid if you are impoverished but most states are looking for ways to recoup those costs from families. SNF care is quite expensive (generally more than 6000 a month) and a good argument for long term care insurance as the average stay in a SNF for someone admitted for custodial care is four and a half years. People in these facilities are required to have medical care and evaluation on a monthly basis.

Lastly, there is Long Term Acute Care (LTAC). These are specialized hospitals for those who are critically ill but medically stable (think long term coma or ventilator patients). You never want to see the inside of one. Again, there may be some insurance coverage as it’s considered ‘medical’ in nature.

Most people think of these places as being populated by nurses. They’re not. As there has been a move away from not for profit to for profit in this sector as in every other, there has been more and more consolidation in the industry and most senior living facilities of whatever stripe are now owned by for profit corporations whose eye is on the bottom line, not on the comfort or needs of the residents. The average facility usually has an RN on duty day shift whose job it is to complete the paperwork that only an RN can do under federal and state regulations. Below them there will be a couple of LPNs whose job is mainly medications and more complex care such as catheter care. The fast majority of care is provided by CNAs, certified nursing assistants, who generally have a twelve week course in the basics to obtain their certification. They have traditionally been paid not much more than minimum wage.

The pandemic has upset this model. The women (they’re nearly all women) who generally filled the CNA jobs are no longer taking them. In some cases, they are finding easier jobs at higher wages. In others, they’ve been called back home to take care of children or elders due to changes in family structure due to the death or disability of a prior caregiver. We used to import a lot of women for these jobs through immigration but anti-immigrant sentiment has cut that way down. Whatever the reason, 98.5% of senior facilities in this country are currently short staffed just as the Baby Boom is beginning to age to the point where they will need them. This is obviously unsustainable. There’s going to be a major disruption in senior living, sooner rather than later. I have no idea what form it’s going to take but I expect that in another twenty years when I will need to consider such a facility, they won’t look like the ones of today.

Dateline – St. Petersburg, Florida

I slept in this morning before setting off on my continued journey south. It wasn’t all that exciting a drive through rural Georgia. The front entrance to Fort Benning with its statuary and flags was somewhat impressive but that soon gave way to cotton fields, peanut farms, flat stretches of scrub land with scraggly pine trees, and the red Georgia clay peaking through where the locals had been busy with their off road vehicles. I was off the interstate and soon found myself going through towns named things like Ty Ty. I think I passed by Plains, home of Jimmy and Rosalynn, but if I did, it made no impression. Kind of like the Carter presidency. He may not have been that great of a chief executive but we’re likely never to have another ex-President of his stature and moral fiber and I will be sad when he finally goes.

Eventually highway 82, or whatever it was, hit I-75 and I turned right towards Florida passing through such exciting towns as Valdosta. I had been to Valdosta once before. Many long years ago, I was brought in to be a lunch program on dementia for the local hospital staff. There were no good flights back to Birmingham that day so I was put up at some ranch in Thomasville that had been made into a boutique inn. It was notable for having been the gathering place for the Hollywood types in 1939 who came to Georgia for the premiere of the film version of Gone with the Wind in Atlanta and my room had a number of framed newspaper accounts of the festivities on the walls. I fully recognize the issues with that film in this day and age but I still love Scarlett and all of her gorgeous costumes. There is an infamous picture of me as her in the barbecue dress from one of the Politically Incorrect shows hanging around somewhere.

Traffic came to a standstill on I-75 southbound somewhere around Lake City, Florida for no particular reason – at least I never saw an accident. Fortunately, I have good air conditioning and audio books so 45 minutes of staring at the back of a semi-truck didn’t pass too slowly. Eventually, the road swung a bit to the east and, as the sun set I was driving into the Tampa Bay area. (Tampa being one of the few major American cities I have never visited). It was too dark and too late to do any sight seeing and I ended up booking a hotel in St. Petersburg across the street from the St. Petersburg Yacht Club for the night. I arrived about 8:30 PM, found that I had a lovely view of the parking garage, took a walk out the St. Petersburg public pier and back and have retired for the night. I’ll leave more exploring until daylight hours tomorrow. I have some time as I’m not due in Orlando until the dinner hour and it’s not that far.

I promised a quick update on the coronavirus situation. We must take all information about what’s going on these days with a very large grain of salt as the data is not what it once was. Data isn’t being collected or being collected at much lower rates and intervals. It’s sluggish at being reported to CDC or other national authorities who can synthesize incoming information streams form hundreds of autonomous public health departments into reasonable predictors. The epidemiologists of my acquaintance are simply shaking their heads, unable to offer the guidance they once did. A quick perusal of news stories and coronavirus information sites shows that we continue to be in a relative lull, if you can call a continued death rate of 300-400 people daily a lull. At least the general trend is still slowly down from earlier in the summer.

At the same time, there’s a new Omicron variant on the scene. This one, dubbed BQ 1.1 went from being less than 1% of cases a week ago to more than 10% of cases this week. This suggests an exponential growth curve and there’s some evidence that it’s better at evading the immune system and vaccines that previous omicron variants. If you’re over fifty or have a chronic illness affecting the immune system, the new bivalent booster with the omicron specificity is looking like a really good idea. It’s most efficacious if there’s a twelve week gap between any other booster or infection which is why I can’t get it yet. I’m only about six weeks out from my recent infection so I can’t get it until about Thanksgiving. I’m champing at the bit. Will the BQ cause a new surge this fall? Only time will tell. Numbers are definitely up in Europe but that’s likely due to a combination of colder climate driving more people indoors and German Oktoberfest celebrations acting as super spreader events. I look at that BQ and my brain either wants to add another B and order the pulled pork sandwich or shift the B to a D and order a Heath Bar Blizzard. I think that’s my road trip brain calling. Dairy Queen is one of the few things you can count on off the beaten track.

I feel like I need to write a learned post on another senior health topic. Have I done how senior living facilities work and the differences between them yet? If not, I may tackle that this week. But not tonight…

Dateline – Columbus, Georgia

A number of obligations prevented me from getting out of town on my make it up as I go along week away as early as would have liked so I haven’t exactly made it terribly far. As these obligations included dinner with a friend, a fund raiser for the theater with which I have been most frequently affiliated over the last few decades, and a children’s opera in the park, I can’t say it wasn’t a pleasant delay before I was able to toss my bags into my Prius, the great red Hope, and finally start heading southward. The major last minute delay was getting the last of the notes and emails for work finished up. For reasons known only to the laws of firewalls, I can only get those to work properly on my old laptop which is not the one I use for browsing and writing and I didn’t feel like dragging two laptops down south with me. I hit send on the last note around 2:30 this afternoon and was able to leave the condo to the cats (Binx has finally come out of hiding and is doing the cat exploration thing which seems to consist mainly of knocking things over about 3 AM) and get on the road.

I thought about heading to the gulf beaches first, but after looking at hotel prices on Saturday night, I thought better of that and decided instead to head down highway 280 towards Georgia whence I could turn either towards western, central, or eastern Florida. As the miles hummed along, I realized that I would pass through Auburn, home of the university of that name and then it struck me. I’ve lived in Alabama for two dozen years and I’ve never been there so that would need to be the first stop. So a few hours later, I parked near campus, took a walk through some of the quads, saw Jordan-Hare stadium and Toomer’s corner and the other landmarks of which I have heard for years but never actually seen. Working at UAB, which is an urban campus without the rolling grounds and gardens and quadrangles typical of most American universities, you don’t get the usual rhythms of campus life, especially at my end, the medical and health professions end where everything goes hell for leather 365 days a year. This afternoon, in perfect weather, the Auburn campus was full of young people playing frisbee on the lawns, studying under trees, gathered around picnic tables with their lattes, the sort of things I did more than forty years ago when I was a college freshman just starting to discover adult life.

Fall is my favorite time of year. I think it has something to do with having always lived and worked in the educational environment. Fall is the time of new beginnings, the changing of the seasons away from excess heat (and humidity in the south), the colors of the leaves (orange is my favorite color – I have no idea why), and the expectations of the holidays to come. As I was watching those eighteen and nineteen year olds, young adults whose educational lives have been upended and scarred by the pandemic, I drifted back to other falls and other campuses: The Lakeside School in Seattle where I spent my high school years with its maple trees and New England style buildings of red brick, white paint, and the occasional cupola. Stanford University with its sandstone archways and red tile roofs. Washington State University with its views of the rolling wheat fields of the Palouse stretching off in every direction. The University of Washington with Mount Rainier always hovering in the background when the sun was out.

I figured I had to at least get across the state line and into the Eastern time zone prior to stopping so I kept on going and decided to spend the night in Columbus where I am ensconced in my usual Hampton Inn close to Fort Benning. It’s dark so I can’t tell too much about what’s going on out there other than there seem to be a great many pine trees and there seems to be some sort of marsh across the road. Maybe there will be some interesting bird life tomorrow. Today’s bird life consisted of a flock of lazy and somewhat bad tempered Canada Geese at Avondale Park. I had gone to the amphitheater there this morning to see Opera Birmingham’s children’s opera about Little Red Riding Hood. The geese were lounging besides the path leading up to the seating. Fortunately they stayed where they were rather than pestering the toddler patrons for their veggie straws.

Little Red Riding Hood’s Most Unusual Day was highly amusing. Like most good children’s theater, it operated on two levels, one for the children and the other for the adults. For the kids, the story was the familiar one (with some twists) and there was a certain amount of breaking of the fourth wall. For the adults, the music included spot on parodies of such familiar pieces as Largo al Factotum and Offenbach’s Barcarolle from The Tales of Hoffman. Children should be introduced to opera and serious music early. I know as a child I had kids records of a number of classical pieces such as Peter and the Wolf, The Carnival of the Animals, and selections from Gilbert and Sullivan. I attended my first adult opera in fourth grade under the aegis of the Seattle Public Schools. In that period, the early 1970s, Seattle Opera did school matinees in English and all those who wished to pay a small fee for the field trip, were bussed down to the Opera House at the Seattle Center for the performance. As an adult who now performs on stage, I wonder what those singers thought of a house of several thousand fourth and fifth graders (plus long suffering chaperones). As I remember it, we were reasonably well behaved for children and stayed in our seats but boy we were noisy before and after the performance.

I recall performances of Faust, The Valkyrie, and The Barber of Seville. I think there was a fourth one in there but I’ve forgotten what it was. Did they make me an opera fanatic? No, but it raised my consciousness as to what opera was and kept me from being scared of it so I would catch the occasional broadcast of Live from the Met on PBS or see a performance and have a pretty good idea as to what I was in for and how it worked and what to listen for. It left me primed for being open to learning a great deal more when I met and eventually married a true classical musician in Tommy who had opera in his blood. (He made his debut at age 10 as the shepherd boy in Tosca). And now here I am as the president of Opera Birmingham’s board of directors. Something ten year old me, sitting in the audience of Faust in Seattle back in 1972 could never have conceived of.

I haven’t done much reading of my usual Covid materials and blogs recently as everything seems to be fairly quiet. I don’t know if that’s going to last. Apparently there’s a bunch of new strains beginning to spread. I’ll see what I can put together and try to write about that tomorrow, wherever I end up. Tampa? Orlando? Dexter’s boat?

I’m getting a lot of complaints from patients and their families about the lack of timely availability of specialty and other services these days. There isn’t a day in the office where I’m not having to try to end run scheduling software in order to get someone something before next March. It’s become yet another daily task for which I was left unprepared by medical school. We didn’t have classes in data entry either but that’s become a big piece of what clinicians have to do these days. Fortunately, my high school career as a keypunch operator gave me certain skills that I have retained. I suppose I have come full circle. The requests for additional data fields that have no clinical relevance in some parts of my job have required me to put my foot down occasionally. The data is there and the administrative office that wants it can hire an abstractor rather than make me fill out yet another form.

My patients keep asking me why the American health system, at least form their point of view, is falling apart. It’s a complicated question without an easy answer but I’ve been able to piece some things together and, of course, a good deal of it is pandemic related. I think we’re all going to continue to find that a lot of the changes that are coming in our society over the next decade will be traced back by historians to the pandemic and political upheavals of the last five years or so. Don’t expect any of this to end any time soon. The closest analog is likely the impact of World War I and the 1918-19 flu pandemic. Take a look at the society of Titanic (1912) and The Great Gatsby (1923) – only eleven years apart but everything has changed.

Once upon a very long time ago in the spring of 2019, I had an idea for a book. It was to be called Boom! and, as I leisurely wrote it over the next five years or so, it would come out in the mid 2020s explaining how the health care system would be changed by the pressures of the aging Baby Boom which would start needing geriatric care en masse starting in the late 2020s and early 2030s. I wrote a couple of chapters over that spring and summer and then, as fall arrived, got caught up in various theatrical endeavors so I put it aside to work on again in the spring of 2020 when the theater season would be slowing down for summer. Nature, of course, had other ideas and upended all of our lives in March of 2020 and I, as part of my coping with wrenching change, began these writings, completely unaware that they would morph into what is now two and almost certainly to become three volumes of The Accidental Plague Diaries. The rough chapters of Boom! were transformed into some of the material that has gone into these essays – perhaps I’ll pull it out again and rework it and Boom! will live again. Perhaps not. I’ll just have to put aside those daydreams of being hailed as a clairvoyant as my predictions regarding the health system came true.

The pandemic put various trends that were already present on steroids and so here we are in 2022 starting to have problems that I thought we wouldn’t see for another five to ten years. The inability to provide services in a timely fashion is a key one. I won’t say that the US health care system is irreparably broken at this point, but it’s definitely on the critical list and it’s going to take some major changes in policy to right the ship. If that doesn’t happen, we’re going to see continued and worsening delays in the system and people will die as they won’t be able to get what they need when they need it.

So why is this? The first pandemic related reason is departure of skilled clinical staff. This doesn’t just apply to providers but to all of the other professions that make up modern health care – nurses, therapists, social workers, pharmacists, dietitians… the list goes on. Being on the front lines in the early pandemic prior to the availability of vaccines meant that some died or developed long covid related health issues that kept them from working. The older generation used the pandemic as a reason to retire. Loss of other family members forced some to leave the work force to take over as caregivers for suddenly parentless children or family elders who no longer had a consistent adult to help them at home. Most of these positions require a highly skilled individual with many years of training and licensure requirements. They can’t be created from scratch in a year or two. Personally, I had thirteen years of higher education. When everyone has a job, there’s no one left to hire. (Our current anti-immigration sentiment, even against highly skilled immigrants isn’t helping).

Tangential to this is that a lot of the departures to retirement are of senior individuals with decades of experience who are adept at caring for large panels of patients. It’s not something you can do right out of training. You have to have a great deal of real world experience to learn how to juggle all of the balls at once. I didn’t really become good at my job until between five and ten years after completing my training. That was now twenty years ago so I feel like I’m really good at it at this point but there are very few around who could step up and do just what I do. Every one that retires throws hundreds to thousands of patients back into the system looking for new medical care and snatching up new patient appointments.

The pandemic also prevented the system from operating normally for several years. It’s only really gotten back to working in its usual way this past summer. Two years of seat of the pants ad hoc medicine and postponement of routine procedures and screening tests means two years of disease that might have been detected early getting away and presenting at a more advanced and complicated state requiring more intensive treatment and more appointments. There’s a huge backlog of mammograms and colonoscopies and other such things that have to be worked through. I would like to think that we’ll be able to operate normally going forward but I’m not so sanguine in thinking that everything is over. New variants keep circulating and human nature, politics, and inertia are keeping people of getting their boosters.

After the pandemic, the next most important issue is demographics. Here comes the Baby Boom. The lead edge will turn 77 next year and the years form 75-85 are generally when individuals start to transition from the robust health of late middle age to the collections of chronic diseases and dysfunctions that characterize old age. The Greatest Generation and the Silent Generation (to which most of my current patients belong) tend to be a stoic and accepting lot who understand that as their bodies age, things will change and they aren’t happy about it, but they do get the basic biological issues that aging presents. The Baby Boom is not of this mindset. They consider themselves forever young and the problems of aging, being diseases, must therefore have cures and they must have them dealt with and removed now, thank you very much, for they are interfering with their life plans. As they continue to age, more and more of their problems will not be amenable to any sort of curative treatment and they are not going to like that one bit and make demands of the health care system that cannot be met. There is also the impact of their huge numbers. The Baby Boom in the US has had 10,000 people a day celebrating their 65th birthday since the first ones did on January 1, 2011 and that won’t end until December 31, 2029. We haven’t substantially increased training programs for health care providers since the turn of the century despite this demographic imperative. It’s too expensive.

Politics comes into play. The passage of the Patient Protection and Affordable Care Act (Obamacare if you will) substantially altered the US health insurance market and, in the decade or so since its implementation, the number of uninsured has fallen from about 15% to about 5% nationwide. This is a laudatory goal (and has anyone else noted that the Republican Party is no longer introducing bills to repeal Obamacare ever other week?) but it has had the effect of granting an additional thirty million people or so easier access to the system and all of them are wanting and should be entitled to services.

Then there are the rather peculiar capitalistic beliefs under riding American medicine. In most countries, the health system is studied and planned and the pieces are designed to maximize the health of the population and to provide the widest possible service for the lowest possible cost. This means the types of specialties are controlled to the needs of the population, not the needs of the stockholders of hospital corporations or other such motivators. Our system is more of a free for all. There are limitations on the number of specialty training positions but less popular specialties, which tend to include those that provide the majority of ambulatory care are often going begging. We need about 35,000 geriatricians in the 2030s and 2040s due to the needs of the Boom which will be in their 80s and 90s during that period. We have about 6,000 currently and we’re only producing about 200 new ones a year, just enough to offset retirements.

Put all of these things together and, yes, you’re going to have to wait for that appointment. I’ll do my best for you. I’ll pull strings when I can. But it’s just where we are.

It’s been a week of endings. The Hallelujah Girls closed on Sunday after a glorious four performance run. As a character guy, it’s been quite some time since I’ve been asked to be charming on stage and I’ve gotten the girl at the end of the show. People seemed to like what I did with a redneck contractor trapped in rather absurd circumstances with a long ago flame so maybe more of those type of parts will come my way in the future. One good thing about the aging of the Boom (and their refusal to admit it) is more plays calling for older characters and scripts that allow older adults to have more fully realized lives and even a spot of romance or two. I don’t have anything specifically lined up for my next gig yet but something usually lands in my lap when the theatrical juices get flowing. At the moment, they’re at a low ebb and will be until I get back from my week off toward the end of the month.

The other major project ending is the very last gasp of edits on the second volume of these Accidental Plague Diaries. I now await a proof copy to double check for a major missed typographical disaster and as soon as that happens, the publication date will be set. I guess that puts me in week 39 with my second child. It will soon be here and launched upon an unsuspecting world to sink or swim. If you want me to come do a reading or a signing, slide into my DMs, as the kids say, and we’ll set something up. It’s very odd putting the book forms of these writings together at the same time as I continue to spew out these missives. Volume II covers most of 2021, which wasn’t all that long ago, less than a year, and as I have written and edited and retouched some of the entries, they feel so foreign and far away. It also makes me wonder about the putative Volume III. The story isn’t over yet so I feel compelled to keep telling it but when does it become too much? Is there an ending? Does it just trail off in the way that society would like the pandemic just to vanish into the mists of time.

Looking at various data points, the pandemic isn’t going to blithely depart at any time in the immediate future. If you look at trends in Europe, numbers are going back up again in terms of cases (but not necessarily in terms of morbidity and mortality). We tend to lag behind Europe by six to ten weeks in general. As a good deal of Europe is further north than most of the US, the fall weather is already well established there and, with that seasonal change, human behavior regarding indoor versus outdoor activity changes. There’s some thought that this is why they’re going up and, as fall continues to come to our more southern latitudes and we do the same thing, our numbers will echo what is being seen there and the slow decreasing trends we have seen over the last few months will start heading back up.

All of the variants spreading worldwide still seem to be subvariants of omicron. There hasn’t been a huge antigenic shift since that became dominant last December. But we’re only doing about 10% of the testing and gene sequencing worldwide that was being done in 2020 and 2021 so we’re not getting anywhere near the same type of accurate picture as to what’s going on as we used to. It’s possible that there are new strains with highly unpleasant tendencies brewing out there but that we just haven’t yet detected them as no one’s looking. We do have one decent weapon, the new bivalent vaccine booster which has been formulated specifically around the omicron BA.5 variant which had come to dominate over the summer. Unfortunately, few people are taking advantage of it’s availability. Last I checked, only about 15% of the people who could benefit had actually gotten a shot. I’m hoping those numbers start going up a bit more later in the fall as people start thinking about flu shots and spreading respiratory viruses of all stripes.

The social scientists are starting to study and measure the changes in American society wrought by the pandemic. I’m not well trained in these methodologies but, from what I can tell, there are a number of scales on which American personality traits can be measured from various large data sets. In 2020, the first year of the pandemic, there was an improvement in general well being and a lessening of neurosis. The feeling of everyone being in this together and having to lay aside differences to help overcome a common adversity made a positive mark. This has apparently become completely undone over 2021 and the first half of 2022. The politicization of vaccines and public health measures, disagreements over best practices in education, and economic worries as the various pandemic linked shocks have hit different financial sectors have caused us to become more tribal, more suspicious, more distrusting, more willing to circle our wagons and not care about those outside of our camp.

I think the clearest place to see all of this is in the education system. The havoc wreaked by societal shutdowns and the failures of on line learning have left American parents somewhat frantic. At all socioeconomic strata, there is an understanding that a good education is the ticket to forward motion in society and anything that can impede that is anathema. The late high schoolers of the last few years are entering college without good study habits in place. The elementary and middle schoolers are behind where they should be. Energetic parents are helping their kids catch up and supplementing. Less energetic or more distrusting ones are looking for scapegoats. Masks! Critical Race Theory! Drag Queen Story Hours! I don’t know how the great pause is going to shake out in the arc of Generation Z’s life but there’s likely to be impacts felt for years to come. In another few years, the first of those who had truncated high school experiences will start turning up in medical school. It’ll be interesting to see what that will bring about. We can’t dumb down standards or coddle students when creating doctors. If we do, people will die.

I have seven more work days before I get a week off to recharge. I’m trying to decide if I’m going to completely unplug for the week or if I’ll keep up my usual social media presence. I’m heading to Miami to see an old friend for a few days. Leisurely drive down the Florida peninsula, more hell for leather return. I was going to go down the West coast as I have never been to the beaches or cities on that side but Hurricane Ian has put a stop to that plan. I’ll probably just go down the turnpike but I’ll keep an eye on the weather and flooding and adjust my route accordingly. I’m thinking about stopping in Orlando and spending a day at Disney or Universal. But I’m not sure I want to do that alone. It’s much more fun with a companion.

Time marches on and summer turns to fall. Around here, that means that the humidity has finally left the air and we’re having lovely days of 70s and low 80s that don’t feel like a malfunctioning steam bath and I, at least, don’t mind being out of doors. There’s also a bit of a nip in the air when I walk out the door in the morning and I’ll have to get out my official UAB jacket soon so I don’t develop too many goosebumps in my daily race from one office to another, trying to keep all the professional balls in the air.

The pandemic has done a number on health care. The effect on my specialty is not one of direct effect. Most of my patients were smart enough to isolate through the worst of it in 2020 and then get vaccinated as soon as they could in 2021. It’s the indirect effects. Disease processes having worsened because of delayed care. Impossibility of getting timely specialty services due to retirements and short staffing. The inability of senior living facilities and other services to meet demand and the endless array of complaints this brings to us from fed up patients and families – as if we had any control. The significant increase in mental health issues, especially anxiety which has led to more and more communications with our offices over relatively minor issues. Phone calls, emails, faxes, notes, complaints all up. Staffing down. One very tired and somewhat exasperated geriatrician caught in the middle. One of these days I will be able to convince the powers that be that for every person who comes through the door providing a billable visit, we hear from another eight or nine people that require some assistance that day (unbillable work and therefore not part of the computations regarding the need to increase staffing). Perhaps I should take an unscheduled vacation and forward all my phone lines and messages to the Dean’s office for a week.

A review of the numbers shows that we’re holding relatively steady at about 400 deaths daily but cases have continued to decline somewhat. I don’t know how much to trust the data in general as so there’s now so much variation in reportage but it looks like the current hot spots are Appalachia, especially Eastern Kentucky and Western Virginia and the Mountain West. I wonder if that’s related to lower vaccination rates in those areas due to political leanings. There’s still a lot of fear in the epidemiologic community that we’re going to go back up again significantly later in the fall as various omicron subvariants continue to spread and because people continue to not take advantage of our best weapon, vaccination.

The new bivalent vaccinations have been out for about a month now with their increased specificity against omicron. Not a lot of folk are taking advantage of them despite widespread availability. It may be due to the collapse of media coverage of Covid in the wake of other stories of national interest and the lead up to the midterm elections. It may be because the populations most likely to take advantage are waiting a bit more to take them a bit later in the fall along with their usual flu shot. It may be that there are a lot of folk like me, who had a mild infection within the last few months and are waiting out their three month post infection window before getting another booster. As more and more data comes in on the bivalent vaccine in populations, it is becoming clear that it provides longer protection, stronger protection, and broader protection allowing the immune system to react positively against new subvariants as they come into being. There’s a lot of reasons to get boosted if you’re over fifty or have an immune system issue or a chronic illness and not a lot of good reasons not to.

The Hallelujah Girls is up on its feet and half way through its glorious four performance run. It’s been a good time. It’s very rare for me to get cast as a romantic comedy lead as I’m a character type so I’m making the best of it as it’s likely to be a while before I get the girl on stage again. It’s not Shakespeare, Sheridan, Shaw or Shaffer, but it’s good fun and audiences are enjoying it and laughing appropriately at the antics of the Southern Belles and Rednecks inhabiting the Spa-Dee-Da day spa in the old church building in Eden Falls, Georgia. Most of the cast are people whom I have not worked with before and it’s been fun getting to know some new and talented folk. After closing on Sunday, I am turning off my theater brain for a few weeks, forgetting my pages of bad grammar dialog, ditching my redneck accent, and taking a few naps. I’m still not recovered from my recent Covid bout and just get tired far too easily. I can tell I’m improving but I keep falling asleep in the passenger seat on house calls or sitting in front of my computer writing notes and haven’t been able to do much outside of work/dress rehearsal/performance all week and the laundry and grocery store are calling.

I don’t have a publication date on Volume II of The Accidental Plague Diaries yet. Stop asking. As soon as it’s set, I’ll make sure everybody knows. There’s still a few more tweaks to make sure it’s all finished and good as it can be. In the meantime, go get your booster if eligible, stay home if you’re sick, and keep your hands washed.

And Volume II of the book form of these Accidental Plague Diaries is complete. Proof copies should arrive in a week or so and if they pass muster, I will announce a publication date so y’all can run to your local bookstore and tell them to order it for you. (And have them order a couple of copies of Volume I to put in the window while you’re at it.) This is about the extent of my PR campaign this time around. Neither the publishing house nor I have a budget so it’s going to be social media and word of mouth, unless someone can figure out a way to get a copy to Oprah or an article in the New York Times literary section. When I started these essays, I had no idea they would become a book, much less two. And all signs are pointing towards a third volume in another year. I think I’ll call it quits at that point. I’ve pretty much said everything I can say, unless Covid makes some sort of strange epidemiologic turn this fall – which could indeed happen.

I have no idea where to end a projected and final Volume. Does it end with various public figures declaring the pandemic is over, even though it obviously isn’t? Does it end with the American public returning the control of congress to a political party riddled with science and public health denying charlatans? Is there some grand announcement yet to come from WHO or the CDC? Or does Covid simply peter out, slinking off into the background of our lives. One more social problem we blithely ignore the same as we have made our peace with excess gun violence, underfunding of education and social services, and a mental health system in tatters. I suppose it will eventually become clear and an inflection point that makes sense to me, even if it doesn’t to anyone else, will present itself.

Covid continues to run rampant through my circles of acquaintance. Not a day goes by when I don’t hear of someone down with it from some area of my life. My acquaintances are, for the most part, vaccinated and have had at least one booster so no one is getting sick for more than a few days and it’s been months since someone I know has had to be hospitalized. We can live with this. But there are a couple of big unanswered questions. It is not known how long both natural and vaccine mediated immunity will last in the face of a virus that mutates as rapidly and in as many different ways as a coronavirus. We may be able to keep ahead of it with annual boosters but that is no sure thing. And even if the vaccine and boosters prevent severe disease, they don’t seem to be all that effective at preventing long Covid.

Long Covid is here to stay. We don’t know what it is. We don’t know the mechanisms behind it. We can only palliate symptoms. When I had my first bout of omicron nine months ago, I was significantly ill for about 36 hours. Felt unwell for another three days and then felt pretty normal. My most recent bout last month had me feeling far less acutely ill but the post viral fatigue has continued to this day. The first two weeks after my acute symptoms went away, I could barely drag myself to where I needed to be. Things improved some this past week. I am feeling more energetic but I can still tell I’m not at 100%, maybe 75% on a good day. Is this the way I’m going to feel going forward? Will I be able to keep up my usual life pace? Are there unpleasant Covid related surprises busy percolating in my heart or my brain tissue? I don’t know. At least I’m not feeling so rotten that I don’t want to get out of bed and my breathing is fine. I may have a little brain fog, but that’s been hanging around since I turned fifty.

I did something highly unusual for me today. I took the day off from all responsibilities and vegged. It was probably good for me but it does mean that I’ve got a ton of neglected work to do tomorrow to catch up. This next week is going to be busy with dress rehearsals and performances of The Hallelujah Girls (Eastlake Methodist Church fellowship hall – Thursday Friday and Saturday at 7:30 PM and Sunday at 2:30 PM). Then I’ll be over the hump with both the literary and theater careers quiescent for a month or so. And I’m finally going to get a vacation week in October. Granted, it’s only to Florida but I haven’t been much of anywhere since last holiday season.

Tomorrow is a reading of the new opera Touch that Opera Birmingham has commissioned. We’re doing the premiere production in January of 2024. It’s about Helen Keller’s life after her schooling and her complex relationships with Annie Sullivan and others as an adult. As president of the board, I’m helping steer this project forward. I’ve seen pieces on Zoom and video and I’m looking forward to hearing the music sung live. No, I will not be in it. I do not have a voice capable of singing opera roles. I can sing chorus, but I’d be laughed off the stage as anything other than Lillias Pastis in grand opera. I’ll stick with my musical comedy character parts when it comes to singing solo.

The bivalent vaccine is now available pretty much everywhere. Go get it. I would, but I have to wait for a while. You should allow twelve weeks between an acute infection and a booster. And keep your hands washed.