I’m tired again. So tired that I fell asleep at my VA desk in the middle of writing a progress note and it was the weird little sounds from my computer as my hand had depressed the front slash key, leading to a page of little diagonal lines that woke me up and got me going again. I’m not sure if it’s physiological or psychological. I’m thinking the latter as it’s been nothing but bad news coming in for the last few weeks – the clouds of war in Europe, continued turmoil and bad behavior on the domestic front, the slow motion collapse of both health care and education. I think my brain just wants out. This usually means its time to schedule a vacation. I’m hoping to lay out travel plans for the year over the next few weeks and that might bring things back into a focus.

On the good news front, my editor/publisher and I have decided to move forward with Volume II of the Accidental Plague Diaries. We think it should come together a bit quicker than the first book did as we both have more or less figured out how to do this thing. If we can keep on schedule, it should be out around Labor Day. i’m rather pleased that the original book has sold enough to make a continuation worth while and has won one award and is up for several others, but then there’s the piece of me that’s going oh lord, more work on the table. One thing that I’ve learned about myself over decades is that I do relatively well under deadline and pressure. It forces me to focus and organize and get things done. When left to my own timelines and devices, I’m apt to devolve into lazy afternoons of reading or bad television or long meandering walks that may clear the brain, but do little to accomplish anything constructive.

Covid numbers continue to fall so we’re more or less through Omicron at this point. I think people are taking the masks off a little too fast. I’m still wearing mine indoors with folk I don’t know and it remains policy at UAB and the VA (and in most health care institutions) to wear it at work, especially in clinical settings. It doesn’t bother me. I’ve been wearing them to work for two years now and I haven’t suffered much other than continuous glasses fog. Looking at the national numbers, even the mortality figures are starting finally to descend and we’re below 2,000 deaths a day finally. We’re coming up on 940,000 total and I imagine we’ll pass the magic million before the first of May. The new omicron variant is still out there and spreading, but it doesn’t appear to be catching hold the way the original strain did. This is likely due to a combination of vaccine and natural immunity given the number of people who caught the original Omicron strain over the last few months. Omicron did at least prod more people into getting the vaccine. Nationally, about 70% of the population over age 5 is fully vaccinated and it’s closer to 90% in my senior adult population.

It’s been a long and difficult road getting people vaccinated over the last fourteen months due to the amount of vaccine misinformation out there. The rabid antivaccination population, the sort that are driving truck convoys cross country and battling with the authorities over mandates is actually a relatively small minority of the population. They just make good copy in our multimedia news environment and generate clickbait headlines. One must always remember that the media does not exist to inform the population. It exists to make profit for the owners of said media and that has definitely colored reporting as more and more reportage moves away from print to online sources. Stories that guarantee clickbait headlines and photos or videos of visual interest will always move to the front of the pack, even if they’re not really the most pressing issues of the day.

I’m not sure what to make of the Russian moves on The Ukraine. It could be Putin’s megalomania coming to fruition as he attempts to become Tsar Vladimir the Great. It might be Russia’s way of testing how well their seeds of social unrest in the Western world are actually working. I really don’t understand the conservative wing of the Republican party going all in for the autocracy against the democracy. That does not bode well for the next few election cycles. We’ll be in real trouble if Russia succeeds in making NATO back down in Ukraine and then starts moving on the Baltics which are NATO members. I wasn’t expecting the next big conflagration in Europe. I’ve long predicted that it would erupt between China and India over declining water resources from the Himalayas as both countries have armies of excess young men due to the social pressures in those societies for sons over daughters. I can’t do anything about it and I’m too old fight. I’m not too old to be drafted though. The US can call up physicians of any age in a national emergency. I don’t imagine that geriatricians will be very high on that list, unless they need someone to take care of the Lieutenant Colonels’ mothers.

I was given a ticket to the National Tour of Cats this past weekend. I’ve seen Cats several times before, but not for some years. This is a newly staged/choreographed production (that’s not all that different from the original to my eye) and, while entertaining, just wasn’t all that good. I believe it was Sondheim, on seeing the original in the early 80s, who said something like it would have been more interesting if they’d spread the two million dollars it cost across the stage in small denomination bills and let the audience look at them. Cats was the big show of my college years. It opened in London early in my college career and came to New York my senior year. I didn’t see it in either place (tickets being expensive and hard to come by). I saw it for the first time in the summer of 1984 in the Theater an der Wien in Vienna, the theater in which Mozart’s later operas premiered, translated into German. I knew the score and lyrics so had no trouble with Jellicle Katzen. A month later, in London, I saw the original cast and production of Andrew Lloyd Webber’s follow up, Starlight Express, at the Apollo Victoria, the production where they built ramps all through the house for roller skating. It was technically marvelous, the skating was thrilling, but it was still The Little Engine That Could. And people wonder why I prefer Sondheim to Lloyd Webber. I’m hoping to get to UAB Theater Department’s production of Noises Off this weekend. I saw the original production in London on that same trip and I have never laughed so hard in a theater in my life. I’ve seen countless productions since (and it’s a bucket list show) but I’ve never seen a production come close to getting the laughs the original did. I think it was the British cast who so thoroughly understood every nuance of every joke, coming as they do out of British theater tradition.

I’ve nattered on long enough. House calls tomorrow. Complete with hand sanitizer, masks, and vaccines.

I had just about finished a number of paragraphs of deathless prose about life, the universe, and everything when the neighborhood was hit with some sort of power surge and kablooie, everything dissolved into electrons and transported itself into the ether. Now my immortal phrasing and the one paragraph that would have won me a Nobel in literature are gone and I have no idea exactly what I wrote so I shall never be able to recreate it. I know I should write these things in Word and save as I go and then paste them into Facebook to prevent this from happening, but I’m too lazy. I just open up my social media on my laptop, do some scrolling and, if I’m inspired, I just start writing. I should have written something last night to keep to my once every four days schedule, but after finishing up collecting everything my accountant is going to need for taxes last night, a rather heroic task that I am grateful comes but once a year, I just wasn’t feeling it and went to bed early.

The deep dive into my finances that I do annually told me that I can afford to retire as early as age 62 if I so choose. I doubt I’ll do that as that date is uncomfortably close and I don’t feel like I’ve gotten old or run out of steam quite yet. When will I retire? It’s likely to be in stages, dropping down from full time to part time for a while, jettisoning the more draining parts of my job. The last piece to go is likely to be my UAB outpatient clinic. I’ve invested a quarter century in making sure it can continue and I have such a deep relationship with so many of my patients and their families that I just can’t see putting up a ‘Gone Fishing’ sign on the door there until the very end. When that will be is going to depend on a lot of things – working conditions at UAB and the Birmingham VA, the continued effect of the pandemic on healthcare, new stresses as the aging Baby Boom begins to knock on my professional door, and my personal physical and mental health (which has taken something of a beating these last few years for various reasons all too familiar to my readers).

I do have to begin phase one of retirement in the next couple of months. I must officially retire from the University of California, an institution from which I have not drawn a paycheck in nearly a quarter century and from which I parted on not good terms due to internal political battles over funding of geriatrics programs (but not before vesting in the retirement system). The plan stops accruing on my sixtieth birthday, less than three months from now so it’s time to become an official retiree. I suppose I’ll need to go to McDonald’s for my morning coffee and start wearing shorts and sandals with black socks. At least I don’t have a front lawn from which to chase the neighborhood children. I love watching small children at play. The previous house was across the street from the neighborhood park and I could see them out the windows and hear them while doing housework or writing. Like all gay men of my generation, I have to watch from a distance unless invited as there are too many who would ascribe nefarious motives to my wanting to be close to children. It’s not fair, but it’s one of those things you recognize if you’re gay, especially in a culture as judgmental as the one of the deep south.

We’re more or less over the omicron wave. I’ve been looking at the numbers and the national and local numbers are back where they were earlier in the fall before omicron swept through. Our inpatient and ICU numbers have come back down to manageable levels. It’s not gone by any stretch of the imagination and there should still be a certain amount of caution exercised. The mortality figures still remain high with more than 2,000 people a day dying. It’s going to take another month for those numbers to go down as the small percentage of those (mainly unvaccinated) who became extremely ill with omicron lose their battles. What’s reasonable as to behavior at this point? I think it’s fine to go out and to go into indoor space with others, but I would still remain masked for both yourself and as a courtesy to others. It’s not that difficult to keep a mask in your pocket and slip it on at the door. As long as you’ve been vaccinated and had a booster, you should be fine.

People have been asking me about the need for a second booster. There are no official recommendations for this yet for the general public of any age. Studies are ongoing. For those with significant immunodeficiencies or who are undergoing medical treatment that cause immunodeficiency, it’s reasonable to do. You should check with your physician to see if he or she thinks you fall into one of those categories and would recommend a second booster at this time. I believe a general recommendation for second booster is coming eventually and we’re likely going to need additional boosters at some yet to be determined schedule going forward. We deal with annual flu shots. We can deal with Covid boosters.

I’ve been lying on the bed going bleah most of this week when not at work. I haven’t been feeling physically the best, something in my weird gut is out of sorts. Generally I find that if I don’t eat a lot and get plenty of sleep, it works itself out. Given the close intertwining of gut health and mental health, I think at least some of it is due to the fact that I don’t have any particular joy to look forward to for a while. Since Tommy’s death, I’ve found I do best as long as I have about one thing a month – a performance, a weekend trip, a vacation, a visitor from out of town – that sparks a feeling of happiness. There’s just not much on the calendar at the moment. I have a theatrical project coming up that I’m looking forward to but that’s not until June. The Alabama Symphony Orchestra Chorus is gearing up again with Beethoven’s Ninth but that’s not until May. I like singing the Ode to Joy. Tommy and I were both in the chorus the last time I did it. He did it a couple of times prior to that before I was a member and I have a very nice photo on the wall of the symphony and chorus from one of those performances. The only issue is that Izcaray Carlos tends to take that last part at tempo di bat out of hell and I have a hard time turning the pages fast enough to keep up. I have an out of town weekend on the books in April. I need to find something for March. I also got hold of my travel agent so I can start thinking about the big trip for 2022. Likely September. No specific destinations in mind yet as I’m still, like everyone else, trying to figure out what Covid’s next move is likely to be and how the world is going to respond.

In the meantime – vaccinate, hand wash, mask up.

It’s February 14th. The day before half price on chocolate and adorable stuffed animal day at your local Walgreens. I actually received a valentine’s surprise on my doorstep this morning, courtesy of a good friend. It was not roses or chocolates or a teddy bear, it was a jigsaw puzzle which is much more appropriate for me as a gesture of affection. It’s also what would have been mine and Steve’s 33rd anniversary. There’s a lot of water under the bridge since we first met on a dreary February day in Sacramento and had dinner together at Carrow’s restaurant just off Alhambra. (Carrow’s is like Denny’s only with wooden rather than plastic furniture). Steve’s been gone for more than twenty years now, which is just as well as I doubt he would have enjoyed being a septuagenarian and I’m staring down the shotgun barrel of a milestone birthday coming up in a couple of months myself.

Today also marks the 77th anniversary of the Dresden fire bombing. When I first came to Birmingham, where there is a sizeable German emigre community courtesy of the rocket industry in Huntsville, I took care of several survivors of that horrific event. They didn’t particularly care to talk about if but it was clear that although they lived full and productive lives after the war, that particular experience was a defining moment in creating who they were and what they became in later years. They were kind, charming people who spent their lives outside of their careers working for various antiwar causes, having seen the sort of destruction war can wreak on the innocent at first hand.

It makes me wonder what the pandemic will do to Generation Z, our current young people, and it will inform their lives and their choices going forward. Will it push them towards greater cooperation and harmony in society as they learn the lesson that great problems are only solvable by working together or will they pick up on the backlash of ‘freedom’ that’s permeating the air and become more separated from each other and less caring about those not of their own tribe. I guess we’ll find out over the next ten to twenty years. This will also coincide with the aging and the beginning of the passing of the boom generation and how those two societal forces will rub up against each other is anyone’s guess.

Omicron continues to recede. At UAB, we’re back under 100 in the hospital for the first time in several months. Case numbers in the community are also falling precipitously. I figure at least, in part. that omicron pretty much felled anyone at major risk of contracting it already and can’t find new populations in which to spread. The only number that hasn’t particularly declined nationally is the mortality rate which is still sitting around two and a half thousand deaths a day. (Think five or six fully loaded Boeing 747s crashing a day or just a few hundred less than 9/11). This number should start to come down in a few weeks as the seriously ill move through the system and don’t recover.

I’ve been reading a lot about the truck convoy nonsense in Ottawa and elsewhere over the last few weeks. As always, when something idiotic is going on (and a group that’s busy pissing all over the Canadian Tomb of the Unknown Soldier really deserves a much unkinder word than idiotic but I’ll let you choose the one you prefer) I ask myself cui bono – who benefits? It’s certainly not the Canadian trucking industry (90% of Canadian truckers are vaccinated and all official spokes organizations for truckers such as the Teamsters union on both sides of the border have denounced what’s going on). It certainly isn’t benefiting truckers or transportation. It’s not benefiting the American or the Canadian governments. It’s playing havoc with the supply chain. There seem to be two beneficiaries, the conservative Republican forces who gleefully gin up trouble to keep systems for working so they can blame the Democrats in power for problems and foreign actors (whose troll farms seem to be behind a lot of the ‘grass roots support’) who benefit from general disarray in the West. Then there seems to be a huge grift in terms of accepting ‘donations’ to assist the demonstrations. I doubt most of that money gets anywhere near Ottawa.

I would be more willing to listen to political opinions different from my own if they contained anything constructive in terms of policy that was designed to move the country or society forward in some way. Most of the rhetoric, however, is about being destructive and tearing things down. I’ve never found that a way to success. The only constructive idea seems to be reducing taxes again on the wealthy and corporations to free up capital for private ownership. We now have forty years of data on ‘trickle down economics’ – it doesn’t work. The tearing down of things keeps spilling over into new areas. The recent local one is the education system of the wealthiest of the local suburbs. Conservative parents are now going after state mandated standards on social emotional learning which teaches students to be empathetic and listen to each other as some secret way to teach their precious children critical race theory. This in the same district where a Jewish child was reprimanded for reporting that a lesson in which a teacher was getting the class to do a Nazi salute made him feel uncomfortable.

‘What About The Children?’ is going to play into suburban angst and is going to help the Republican party pick up Suburban votes they may not otherwise get and help them regain control of congress. The other side of the aisle is ignoring this issue and not reframing it as the coded racism and classism that it is and that’s a problem. Playing ostrich never made a political problem go away. These sorts of divide and conquer tactics may be a win in the short term but they’re going to be a huge problem in the long term as every win is going to energize the Dominionists and other ultra conservative forces into pushing just a little further and a little further, moving the Overton window until any outsider community is firmly put in their place as those individuals see it. I can’t fix it. I can just identify the trends. And wash my hands. And stay vaccinated. And still wear my mask at Costco.

This is the first evening for weeks when I haven’t had a pile of things to finish before bed. It feels a bit odd. There’s still a lot on the to do list but it’s all optional and non deadline stuff that can wait for the weekend, or next week, or next month so I took a little time for myself and did some reading, watched the video of the recent 9 to 5 so I could finally tell what some of the scenes were actually about, and ate a few more jelly beans than I probably should of. (I’m going to put those fifteen pounds back on if I don’t watch it…) It’s very hard for me to do nothing and relax. I think it’s the medical training. One of my colleagues wrote an essay on this recently which I posted as I found it quite profound. Physicians have enormous expectations placed on them by their patients, their peers, their systems, and themselves and there is sense of pride instilled early on in the training at the being able to power through, no matter the challenges, the sleep deprivation, the physical health, or the emotional state.

We all went into the pandemic with an adrenaline charge and with that sort of thinking imbued in us for our entire professional careers and it certainly sustained us in those initial uncertain months of lockdowns, unknowns about the disease itself, and need to change pretty much everything about how our jobs operate within weeks. The vision of the vaccine on the horizon sustained us that first year and, when it became available, a mere ten months or so after the first US cases (a medical miracle), we all breathed easier thinking things would improve and wind down. I don’t think any of us had counted on the ugly politicization of health care that rose up in the spring, ensuring the continuation of the pandemic and unsustainable working conditions. Now, two years in, with the politics firmly entrenched, even the waning of the fast and furious omicron crisis evokes no joy in Mudville.

There’s a lot of speculation about how much more the American health care system can weather before it breaks down. I think that’s the wrong question. The American health care system is already broken at this point. We’re just driving the car on a couple of flat tires and hoping that the pistons don’t give way. How is it broken? The selfishness of a certain portion of the American population, putting their need to belong to a certain political ideology ahead of their health, their neighbors’ health, or societal needs, put a system, that was designed to run close to maximum capacity with just in time ordering in order to maximize profits and minimize expenses, into overload and I’m wondering if it can recover. Currently, American health care can’t do its most basic job, which is treat curable disease. Elective surgeries are postponed. Screening tests don’t happen. Getting a new primary care provider is nigh on impossible. Rehab facilities can’t get staff. Nurses are leaving floor and clinic jobs for the astronomical salaries being offered in understaffed Covid units. A friend of mine, who works per diem nursing at a local hospital, worked a weekend shift recently. She walked on to her ward and found one of the patients working as the unit secretary. There was no one else to do the job.

The biggest driver of the breakdown is, like with so many other social movements, the Baby Boom generation. Aging in good health, many of them had been working well into their sixties and early seventies. Covid and its stresses have caused many of them to reevaluate their life priorities and to retire and leave the work force all at once. Retirement of people over age 60 is the biggest driver of the Great Resignation, not government payments. Women leaving due to childcare issues is a distant second contributor. In health care, that means those with the enormous repositories of clinical experience are departing. There is a phenomenon in human learning and intuition. When you work in a field for decades, you become so attuned to the nuances that you just know things. You can’t really explain why you know, but somehow your memory banks are comparing the current situation against decades of prior experiences and the answer is just there. I’ve been finding this happening more and more frequently to me personally over the last decade or so. This is my 38th year in medicine so the data bank is vast but it took me decades to build it.

Losing those senior people as providers and nurses and therapists and pharmacists and all of the other myriad professions that make the American health system go round is going to cause issues for years because it’s going to take years for younger people to amass that sort of knowledge base. Seasoned people don’t just pop out of medical or nursing school. They require years and years of nurturing and exploring and occasional failure. And, this loss of these individuals is just about to collide with the aging Baby Boom turning to the health system for the problems of aging. Their first impulses, given their generational behavior to date, is going to demand that the system fix them so they can keep what they view as their eternal youth. It won’t be possible and the tensions that are going to develop between them and health care are going to rise significantly. No health system is ready for this. They’ve been kicking that particular can down the road for decades and now Covid issues have become all consuming. The lead edge of the boom starts turning 80 in less than four years.

I’ve poured nearly a quarter century, most of my adult career, into making geriatric medicine viable within the UAB system. It will continue to work as long as I carry it, but the teetering system is taking its toll on me as much as it is on the pulmonologists who man the Covid wards. Will I be able to do this for another two years? Another five? If I step down, who steps up? US medical graduates continue to avoid training in geriatrics like the plague. These questions haunt me sometimes at night. And then I remember what I figured out years ago, the world is not saved all at once, but rather one patient at a time. Focus on the work in front of you, not the potential work that is not yet yours. And do the health system a favor. Wash your hands. Get your vaccines. Stay home if you’re sick. Carry a mask with you and put it on when appropriate. It’s not that hard to be part of the solution.

Those of you who read these essays can now claim that you are privy to the first drafts of the award winning Accidental Plague Diaries. I’ve been awarded a gold medal from the Nonfiction Authors Association in their Nonfiction Book Awards for the first published volume. It’s sort of a nice ego boost to think that people I don’t know have read my musings and found them worthy of something. Of course such an award and five dollars might just get me a caramel macchiato at Starbucks. Maybe they’ll send me a certificate suitable for framing. It continues to sell a few copies here and there. If it wins a few more awards, it might garner some attention and begin to sell even more. I keep hoping someone will slip it to Oprah. A boy can dream, can’t he?

9 to 5 has been put to bed. We ended up doing just over half of the original scheduled performances due to Covid felling a couple of the leads shortly after opening. The show turned out well – a greatish production of not the best material. The songs are decent. (Dolly Parton does know how to turn out a tune). The book isn’t bad in the first act but kind of falls apart in the second act. Once our heroines, kidnap Hart and send his henchwoman Roz away, there really aren’t any antagonists on stage and there’s not much conflict left to actually resolve until the very end when my character arrives from on high to reward the heroes and punish the villains and everyone sings and dances to the title song – again. I did like my white linen suit second act costume and it’s likely to make further appearances. My first act costume was just a pair of white shorts and a toe tag. I kept the toe tag as a memento.

So what does any of this have to do with Covid? Nothing much directly. Indirectly, I suppose it’s a sign that even a world wide pandemic can kill the artistic impulse of the human spirit. Performers are going to perform. Writers are going to write. Singers are going to sing. Dancers are going to dance. And we are all going to be the richer for it. If you look back at history, times of stress and strife tend to provide rocket fuel for the arts. The problem is, of course, that after such times of uncertainty, authoritarian regimes get a boost as society wants stability and order and one of their first agenda items is to squelch the arts as they tend to offer a critique and an unflinching mirror on societal and governmental ills.

We passed 900,000 deaths this last week, roughly eight weeks after we hit 800,000. They’re not accumulating as quickly as they did just over a year ago, prior to vaccines being widely available, but they’re still mounting steadily. The number would make #16 on the US city population list, between Indianapolis and Columbus. As the mortality rates from omicron are actually continuing to increase, the curve being about a month behind the case curve, we’re likely to see another 100,000 or so added to the total and we’ll hit the magic million mark around Easter. Will it continue to go up by the hundreds of thousands throughout 2022? That’s a question I can’t answer. It will depend on viral mutations, politics and its interaction with basic public health measures, and millions upon millions of individual choices and whether the virus can seize upon those to propagate.

I’m not very hopeful on the political front. We’ve been through several years of chaos, much of which predates the pandemic and its preexistence determined its spread and the much higher death toll in the US compared with most of the rest of the developed world. As is natural at such times, a great portion of the populace is looking for anyone that will promise stability and a return to a prior sense of order. You can’t put the genii back in the bottle. The second law of thermodynamics applies to social as well as physical systems. You can’t unmix that which has been mixed. There is no return to times past, only a movement forward into an unknown future and it’s necessary for us to understand that clearly before casting our ballots. Those who vote based on nostalgia are likely to be severely disappointed. Personally, while I would like to see a little more order in life, I cannot bring myself to support the party promising such as its the same party that has created the majority of the chaos through blind obeisance to a false god. It’s sad. The saddest piece of this is the lives lost on an altar of pseudoscience, many of the dead willing martyrs to a political stance that has no place in the control of infectious disease. Lives wasted in service of a leadership that could care less about them while those that love them are left to grieve. The Washington State Patrolman whom Fox News lionized when he was fired for refusing vaccine and whom was ignored by that same organization when he died of Covid some months later being a good case in point.

Republican politics are crystalizing around a position of rigid antipublic health positions, to the point where Republican officials who espouse any favorable opinions of vaccines, masks, or other basic measures, are being summarily removed from their jobs despite qualifications and experience and being replaced by party hacks. Eastern Europe spent decades experimenting with systems where party membership and loyalty became the only major test for holding any sort of significant position in society. It didn’t work out so well for them and I doubt it’s going to work out well for us. Conservative public school boards will continue to dismantle public education. Conservative local health authorities are unlikely to do much to actually protect public health. Conservative legislators are unlikely to put the business of the people before the business of capital. I think we’re going to be in for a bit of a rough go.

Of course, the pandemic doesn’t care. Viruses are going to do what viruses do. We can either alter our behavior to make their job easier or tougher. It’s our choice. I just don’t see political figures who have spent the last few decades destroying rather than creating and obstructing rather than cooperating having the skills or the initiative to do much to help with the latter choice. But maybe that’s just me. I’m just one person adrift in this confusing world, trying to live right and help out as best he can. What can I do currently? Support my friends. Support my patients. Support local artists. Stay vaccinated. Wear my mask indoors. Wash my hands.

Let’s run the numbers. The omicron wave appears to have peaked and is on the downward slope. Case loads are down about 40% nationally from where they were a few weeks ago and hospitalizations, after peaking at numbers higher than we saw in the surge last winter just prior to vaccines becoming available, are also starting to trend down. Locally, UAB is down about 20% on the inpatient side from 250 cases to about 200 cases currently in house. There’s only one number that’s still going up, and that’s deaths as the numbers work their inexorable way through cases to hospitalizations to deaths over a four to six week cycle. The mortality numbers, currently somewhere between 2,500 and 3,000 a day won’t peak for another week or so, and they should join the downward trend, but not before cresting 900,000 for the pandemic in toto (a number we’ll hit in a week or so) and it’s pretty inevitable that we’re eventually going to hit a million deaths in the US by this summer. That’s a number that would have seemed inconceivable a couple of years ago but now is just one more dull statistic flapping against the numbness of our daily lives as we all continue to try and make sense of our crazy world and carry on.

We’re all in the midst of pretending just a few more weeks or a few more months and then we can get back to normal. I’m not sure we were ever at normal when the pandemic hit. I always tended to be rather sunnily optimistic about how our society worked and that we had the ability to rise up and meet challenges cooperatively. Tommy was very much a pessimist and saw the disasters lurking in our social, economic, and political institutions much more clearly than I. We had a number of very long complex late-night arguments over such things over the years and, were he still here, I could see him sitting up in his side of the bed with a smug grin saying ‘I told you so’. Steve, on the other hand, tended to ignore politics with the exception of LGBTQ rights issues. When it came to those, he was at the forefront of every protest or activist movement. I suppose when you come out at age 14 in 1962, it positions you for that sort of battle. I would join him in his later years, but not quite so noisily and a little back from the front lines.

As I look around, I see the institutions that are most important in my life are cracking in myriad ways. I’ve discussed the issues with the health care system that the pandemic has laid bare ad nauseam in these entries so I’m not going to go into details on that one other than to opine than to say I can’t see it continuing to operate moving forward without serious reform. We’ve lost too many good and experienced people from clinical roles – burned out, retired, chronically ill or dead. We have a population that’s rapidly changing demographically. The boom will start turning 80 in four short years and health care systems have been all about just trying to survive over the last few years so they have spent no energy or resources figuring out what that’s going to mean or what they are going to have to do to retool to provide the services that aging population is going to need. And in the meantime, the administrative arm of healthcare, determined to justify their importance (and their salaries) keeps drifting off into weird tangents. I shall cite one recent example. A large national hospital chain recently did a big data analysis of in hospital suicides (a very low number and generally confined to psychiatric wards) and determined that successful suicides were more frequently accomplished with hanging/strangulation using fitted sheets rather than flat sheets. The chain then removed every fitted sheet from its hospitals, requiring nurses to use flat sheets on mattresses. This might have made sense in the psychiatric wards, but it was applied to all inpatient units. The administrators who made this decision have obviously never tried to make an adjustable hospital bed using flat sheets and it’s leading to huge issues on already overworked nursing staff. Pressure ulcers to begin increasing in 3… 2… 1…

The public education system is also cracking up under the pressures of Covid, between battles over mask mandates, lack of support of classroom teachers by administration, unreasonable demands of parents who are busy taking their stresses out on a convenient target etc. Perhaps the most essential public employee for society to function is a first grade teacher but the opprobrium and scorn and poor salary scales we’ve foisted on public school teachers for years is coming home to roost. Latest polls suggest that 50% of current public school teachers are considering leaving the profession in the next couple of years. And who will be willing to replace them? Conservative legislators are meddling with public schools with all sorts of draconian bills whose purpose seems to be to drive teachers out the doors faster. I’m assuming the end game is to make the current model of public education non-viable so that it can be privatized and monetized like pretty much every other section of the economy. They’re using parents rights as the rallying cry. The thing of it is is that parents are not the customer/stakeholder in education. The stakeholder is the general public who needs a well educated populace in order for its society to function. People seem to forget that relatively basic fact.

Then there’s the political system. Our winner take all system of power pretty much ensures a two party system with both parties in a position to potentially take all the marbles every election, unlike most European democracies where parliamentary systems lead to more proportional representation. When there was a certain amount of comity and behind the scenes cooperation between both parties as they had similar goals, but different ideas about the best way to achieve them, the system had the ability to work. Now it’s mired in partisanship, obstructionism, and, in the case of at least one party, a seeming desire to turn the clock back to the Victorian Age.

Then there’s the performing arts, which are trying desperately to survive in a time of performers getting sick and being unable to perform, audiences that are leery of gathering in groups, and younger generations who are not being taught to appreciate and support the fine arts, not to mention living lives of quiet economic desperation so that they for the most part can’t even if they wanted to. The theater and music groups I work with are all trying desperately to raise funds, to come up with productions that can be mounted safely, and dealing with only a fraction of the ticket revenue they used to generate. They’re limping along but how many more seasons before it just no longer works?

I think we’re coming to a crossroads. We can either try to patch all of these things up with baling wire, spit, and superglue or we can let some things collapse, clear the land, and build back better. To choose the latter course, however, we have to have some time, energy, leadership, and a forward course charted and I haven’t been seeing a lot of that recently. I’d love to say I have the answers but I don’t. I’m as overwhelmed by all of this as everyone else. I think it’s why I’ve been as fatigued as I’ve been this past week or so. Hopefully the last weekend of 9 to 5 will provide some rejuvenation. We’re back on tomorrow night presuming somebody else irreplaceable doesn’t become sick overnight. We had a brush up rehearsal tonight and I still remember my lines and how to fake the choreography so I’m good.

Another Saturday night and I ain’t got nobody… Feeling a little alone and melancholic this evening so I guess it’s time to write. Per usual, I have absolutely no idea where this is going to go but some of my best essays just start with a mood and a little bit of free association. I’ve had a friend staying in the guest suite the last couple of weeks and just having someone else around the place a bit is a reminder of how alone my home time has been over the last few years when Covid made most of my usual pastimes and escapes impossible. I remains optimistic that we’re going to get past the omicron crunch in the next month or so (case counts are coming down in the areas that were impacted earliest) but we still have the hump of hospitalizations and the hump of deaths to get through before we get clear. I’m pretty sure we’ll pass one million US deaths sometime this spring. That’s an obscenely high number, higher than usual all cause annual mortality, and so many of them have been unnecessary and were preventable with better adherence to public health measures and a more robust early response to the pandemic by the previous administration.

Why am I optimistic? Because at least partial immunity is becoming widespread. We still don’t have the vaccination numbers we would like by a long shot but I read earlier today that roughly 95% of the US population is now showing antibodies to Covid, either from vaccination or from earlier infection. That’s quite a wall and is giving us significant protection going forward. If the antibodies could last, we might be close to achieving the mythical herd immunity that keeps being brought up, but they fade with time which is likely going to result in continued boosters in the future or suffering multiple bouts. I don’t recommend this latter as it really is a nasty bug and we still don’t really understand all of its end organ effects from its thrombotic characteristics. We’ve also managed to get roughly 10 billion shots in arms over the course of the last year world wide. That’s a rather stunning achievement. It’s not enough, of course, as there are 8 billion of us sharing the planet so we need to raise that number up over 15 billion. Africa, in particular, lags as the richer countries take care of themselves first leaving a very large unvaccinated population pool on that continent, a problem in our global and independent society.

It’s snowing fit to beat the band up and down the east coast with low temperatures reaching down as far as Southern Florida – wind chill in Miami and the Everglades is expected to dip into the low 20s. Expect a lot of stunned iguanas falling from trees as they cannot regulate their body temperatures and their nervous systems fail. It’s the eighth anniversary this weekend of the great Birmingham Snowpocalypse of 2014 so my time line was full of a number of ‘do you remember’ posts. Of course I remember, the Pick’s disease variant that I may inherit from my mother hasn’t set in yet. For those not of Birmingham, some explanation may be needed. When snow is forecast this far South, panic sets in. Grocery stores immediately sell out of bread, milk, and toilet paper. Most optional activities are canceled and everyone waits with bated breath while less than an inch falls. At the end of January, 2014, snow was forecast but the local meteorologists read their tea leaves and assured the populace that there would be none in the greater Birmingham metro area – it would pass well beyond. It therefore became a normal Tuesday with everyone headed off to work and to school. Around 10:30 AM it began to snow, a few flakes at first and then an unpredicted heavy fall. The alarm went up. Schools to close immediately -parents come get your children. Work schedules went quickly into snow day mode. By 11 AM, most of Birmingham was on the road trying to get the kids, get home, get to the grocery store for milk, bread, and toilet paper. Then mother nature played her joke; there was a sudden drop in temperature and all moisture on the streets flash froze and every pavement in town suddenly turned into a skating rink. Mix this with heavy traffic and complete and utter disaster. Everything came to a shuddering halt as the roads were quite frankly undriveable. People were stranded on highways. Kids were stranded in schools for several days. People had to spend the night bedded down in the aisles of the local Wal-Mart. It took several days to unsnarl it all.

I was oblivious to it at the time as my Tuesday morning was spent on a prolonged conference call with folks in Kentucky and my academic office lacks a window. I finished up my call, walked down the hall to the chief’s office (which had a window) and was just in time to see a car go spinning down the 19th street hill. It was pretty clear nothing else was going to happen that day so I started for home. After three hours, during which time I managed to go about a mile and a half, I abandoned the car to a parking lot and walked the other two and a half miles back to the house. Silly me hadn’t worn my winter coat that day so I was quite the sight wrapped in my car blanket trudging through Avondale Park and down Crestwood Boulevard. When I finally got home, I found that Tommy, who was off that morning, had made homemade soup so all was right with the world as I thawed myself out. Needless to say, since that storm, if there’s even a hint of a freeze, Birmingham goes to full scale red alert and probably will continue to do so for some years until 2014 recedes into a comfortable past.

We seem to be having significant issues at the moment with uncomfortable pasts with a sudden and pervasive movement around the country to protect our precious children from naughty words, alternate sexualities and the hard truths of racism and the holocaust. Everyday, there’s a new news story about a school district banning Pulitzer winning novels, self appointed parent groups demanding that titles be removed from libraries and reading lists, and right wing policy czars going in to school libraries and removing ‘objectionable’ titles wholesale before any sort of review or public hearings are actually held. When something like this happens ‘spontaneously’ in many places at once, I get very very suspicious. This reads to me as carefully planned, probably some years ago, but put into action at this juncture as omicron, with its effects on schools and school staffing in particular, has weakened the ability of the educational system to fight back so someone is striking while the iron is hot. Some enterprising investigative journalist needs to start digging through these various groups and start following the money. I don’t know where the trail will lead but I suspect it’s a very small and very coordinated cadre of very wealthy individuals behind it all.

Why would they do this? I can think of several reasons, most of which have nothing to do with religious zealotry – that’s simply a smokescreen that allows them to recruit a certain type of parent into their ranks and gives those individuals hot button talking points that will resonate well in the press. First and foremost, it’s probably about money. Public schools are just that – public, owned by the people for their benefit. This is anathema to capitalists who believe that the purpose of society is profit and that the commons needs to be privatized and monetized. As the profit motive enters education, wealthy communities will be just fine. Poorer communities will struggle and we could easily be back in the days of separate but equal within a generation. Second, it’s about destroying the trust society has in teachers and education and that’s being born out in some of the other harebrained ideas that have been coming out of the right wing in the last few months such as putting all teachers on constant audio/video surveillance to make sure they aren’t touching on verboten subjects such as ‘critical race theory’ or the latest goofy thing that just cleared the Indiana House that would make teachers make publicly available all of their lesson plans for an entire year to be scrutinized by anyone who could challenge anything. Anyone who has actually taught knows that lesson plans and rubrics are where you start but not where you finish as they must be constantly adapted to the needs of individual students and a constantly changing environment and trying to figure things out a year in advance is pure folly.

If trust is undermined, then fewer capable individuals will choose education as a career path and, more importantly for the right wing, the political power of the teachers unions will be undermined. These unions tend to be a base of Democratic politics and therefore they need to be destroyed. It’s similar to the shenanigans at the Post Office over the last few years which are, for the most part, aimed at weakening the postal unions. No one seems to be giving a thought as to what the students might actually need in their educations to compete in a globalized society. The extreme right wing seems to think a little readin ritin and rithmetic should do the trick. I’m not sure where they think the next generation of physicians or engineers are going to come from if education is limited.

Of course, the kids will be fine. The current high schoolers of generation Z have probably downloaded all of the banned titles through torrents and are busy reading them under the covers at night to see what all the fuss is about. There’s nothing that will drive an adolescent faster to a book or a film, or a piece of music than a societal proscription. Back when I was in 8th grade, the books were The Godfather, The Exorcist, and The Happy Hooker. We weren’t supposed to read them but I can assure you that every 8th grader at Eckstein Middle School had devoured all three through clandestine copies handed around by the middle of February.

To sleep, perchance to dream… I wonder why the modern day Parrises and Danforths have not gone after Shakespeare yet. My guess is they’ve never actually read him. Better not give them a copy of Titus Andronicus.

Where are we with omicron? I suppose it depends on whom you ask and how you look at it. National statistics are all well and good but we have such different social patterns in different parts of the country, some based on climate, some based on population density, some based on politics that pundits declaring this or that about the country as a whole rarely gives a coherent picture of what’s going on. It’s much more nuanced than that. Case counts appear to have plateaued and are starting to descend in some of the large metropolitan areas where it first took hold. Case counts continue to dramatically rise in more rural states.

The interesting thing about omicron is the speed at which it has spread and transformed our understanding of the virus. It was first reported in South Africa at Thanksgiving, only eight weeks ago and rapidly became the dominant strain everywhere thanks to mutations that significantly increased its transmissibility between hosts. If that wasn’t enough, there’s now a new subvariant of omicron that’s starting to spread that appears to be even more transmissible than the original. Fortunately, it doesn’t appear to be any more virulent in terms of clinical disease.

We’re at something over 2,000 deaths daily in the US, roughly double where we were prior to omicron. We’re also at about 700,000 new infections daily, a huge number, but one that seems to be starting to plateau. The number of people who have fallen ill in the last few weeks is such, that even with a significant vaccinated population, the absolute number of critically ill individuals, even if it’s a much smaller percentage of the population than before, is inundating the health care system. The numbers of inpatients at UAB is back around 250, similar to the numbers prior to the release of the vaccine last winter. Reports from the local ICU front, however, show a very different hospitalized population now than then. Last year, those in the hospital were predominantly elderly or people with critical service jobs who were not able to isolate at home (in Alabama, predominantly people of color). This year, those in the hospital are predominantly white men between 40 and 60 who refused vaccination for political reasons.

We’re in the peak hospitalization period which follows the peak infection period by several weeks. Hospitalizations nationwide are up 25% from two weeks ago and are still trending up. The mortality curves will likely go up in early February. Vaccines continue to hold the line somewhat. A vaccinated person is 1/16 less likely to be hospitalized and 1/68 less likely to die than an unvaccinated person according to the most recent CDC data. Most vaccinated people who fall ill enough to require hospitalization are, of course, generally not healthy individuals at baseline. If you’re healthy, vaccinated, and boosted, I wouldn’t worry a lot – I would still quarantine if you get infected though. It’s not about you. It’s about breaking transmission chains so it doesn’t pass through you to someone whom it might seriously endanger due to their underlying health conditions or immune status.

Omicron has done a bit of a number on my life this week. After two knock ’em dead performances of 9 to 5, one of the leads developed Covid and needs to quarantine leading to the cancellation of the rest of this last weekend’s run. We’re awaiting word on scheduling for this next weekend. Having already had my omicron, I’m not personally worried about anything but I don’t want to be a conduit back to my patient population so I continue to abide to good hygiene practices and CDC guidelines. This is live theater in the age of Covid. Even local productions are going to have to start using swings, double casting, and understudies if they want to eke out their runs. Oh brave new world…

I haven’t told an anecdote for a while so I’ll tell the first one that comes to mind. It has absolutely nothing to do with omicron or with theater or missed performances. (I am proud to say that in my years of performing, I have never missed a scheduled performance – I’ve had to back out of a few projects that I have been cast in when life circumstance changed my schedule and I realized I would miss performances but that’s a different matter). This involves my siblings whom I rarely write about. I get along very well with my brother and sister, but due to the weird spacing in my family, there’s five and six years between me and my sibs while there’s only thirteen months between the two of them so growing up, it was always two against one. They loved to gang up on me and tease me mercilessly, especially when they were around five or six and I was a very grown up ten or eleven. At that time, we had a jungle gym in the backyard, a sort of miniature boot camp exercise thingy which I was a little too big for, but which was the right size for them. They were hanging it off it one day while I was keeping an eye out to make sure no one fell and broke anything important and they decided that my name was just wrong. Andrew just wouldn’t cut it. Trying to get a rise out of me, and noting my somewhat ramshackle posture (which I still have), I would have to be known as Androopy or Droopy. My brother, thinking that was hysterical, took it a step further and decided my name should be Buzzoopy. Somehow, the names stuck. To this day, my sister calls me Drew (the only person who generally does) and my brother calls me Buzz. My father calls me Butch. I’m not sure what the etymology of that one is. He’ll have to explain it as I’m a soft butch at best…

Making some decisions about whether to publish a second book covering 2021 over the next few weeks. If you have strong opinions, let me know. And if you haven’t bought the first one yet, it’s still for sale (and only about 15% of you have – I get the sales figures…) Be well all – keep your hands clean, your mouth and nose covered, and get your booster.

It’s opening night! Opening night! It’s Virginia Samford’s latest show… will it flop or will it go? And now that all the theater people are busy singing along in their heads, time to launch into another long post in the age of omicron chronicles. I haven’t really written much about my latest theatrical venture, Dolly Parton’s 9 to 5: The Musical. I’ve had reasons for that. The first is that I’ve been a bit ambivalent about doing a large cast musical at this stage of the pandemic. The show was planned and I was cast before anyone had ever heard of the omicron variant and there has been grumbling in some quarters that the show should have been cancelled or postponed due to potential risks. I understand that thinking and I have certainly thought that way myself. I was somewhat relieved when I developed my mild breakthrough case when I did as it was over and my quarantine was up before I was really needed for rehearsals. My part, while integral, is small in terms of stage time and technical need so I really didn’t come into the show until late in the rehearsal process.

Part of the problem with writing these Accidental Plague Diaries is that some who read them have confused me with some sort of expert in virology and epidemiology. I’m not. I have a well trained mind and a breadth of knowledge, but I’m as human as the next person, bewildered by all of the conflicting information flying around the world through the system of tubes known as the internet and my writings are my way of trying to sift through it all and make some coherent sense out of what’s happening to our world. Like all humans, I have my biases, my short sightedness, my choices and lack thereof. Unfortunately, a lot of my friends seem to forget that and want to anoint me as some sort of Covid oracle, all seeing and certainly perfect in knowing just what to do when faced with the unknowable. Sorry… I don’t know that guy. Like everyone else, I’m trying to work out the risk benefit of various activities and how to stay safe myself and keep those around me safe as well. That’s the world we’re going to be living in for the foreseeable future.

Living in a world that does not have live music/theater performance is, to me, a world that’s devoid of life. Theater is as much of a calling as medicine or the priesthood, and it’s probably no accident that it developed, in the Western Tradition, out of religious rituals in Ancient Greece. Those of us with the calling, which includes all of us on and backstage at 9 to 5, are compelled to make this sort of art. In the height of the pandemic, we adapted to various on line versions of theater but we need to tell our stories in real time to live people. The audience gives us life as we give life to the audience, the one mirroring the other. If you don’t have that calling, or if your risk/benefit calculus is different than mine, I can understand not wanting to perform or attend a show at the moment and I support your decision. We’re all vaccinated, rehearsed in masks until dress rehearsal and, being actors and singers, know what to do to keep our bodies healthy and away from infection. Just as I trust my colleagues in medicine to look out for me as I look out for them, I trust my colleagues in theater.

When I accepted the part of Tinsworthy, the deus ex machina who appears late in the second act to make sure the plot comes out right and to reward the heroes and punish the villains, I figured I was just getting involved in a light piece of fluff that wouldn’t be too taxing. They added a second role for me in the first act as a corpse so I’d have something to do. It’s actually the more technically difficult thing for me. It’s not easy to lay motionless under a sheet on stage for ten minutes on stage while slapstick comedy is going on all around you. There is a verb in theater parlance ‘to corpse’ which means to crack up inappropriately on stage in front of an audience. Having now played a corpse, I understand completely where it comes from. I had seen a previous production of the show at the same theater ten years ago, but I remember very little about it other than it was innocuous fun. Tommy and I came in during tech and helped fix something. It may have been wigs, it may have been props. I can’t remember now what it was.

Having now spent some time with the show, it’s resonating in a very different way and this production is digging at some of the deeper themes under the surface. In this age of Covid and the Great Resignation, where we are grappling with whether we should Live to Work or Work to Live and our whole relationship with the workplace being rapidly redefined, this parable of feminism turning the tables on masculine corporate culture has a bite that it didn’t a decade ago. In many ways, our whole cultural moment is a tug of war between a masculine individualist ethos and a feminine cooperative one. That’s certainly been true in the social approach to the pandemic. One side is firmly on the side of individual choice and a belittling of precaution as fear mongering while the other side is about caring for all and trying to set up systems to protect families and friends and the vulnerable. I’m of the opinion the show sends the correct message and that’s resonating on an unconscious level with the audience. Theater goers tend to belong to social classes more in sync with the feminine approach.

I’ve worked with most of the principals multiple times on various projects so it’s old home week backstage. Everyone is bringing their A game and there’s not a weak link in the bunch with everyone having a couple of stand out moments. To me, though, the real stars are the young folk in the ensemble who are in constant movement throughout the show. The staging is cinematic with a lot of dance transitions and I don’t see how they can do all of that for more than two hours. I can’t and couldn’t even when I was their age. I’d have fallen over from exhaustion half way through the first act. They don’t get anywhere near the credit they deserve and I privileged to appear on stage with them. I can’t even really sing the chorus parts. Most modern musicals are written with all of the male vocal arrangements for rock tenor and the tessitura is just too high for this bass baritone. I have the choice of screeching falsetto or singing down the octave. Fortunately, the only musical number I’m in is the finale and it’s not that difficult.

When you’re in the audience at a well produced musical, you’re watching just one facet of a complicated, well-oiled machine that starts ticking a couple of hours before the house lights go down. For everyone you see on stage, there’s someone else backstage you don’t see and it’s a whole other show there in the wings and the dressing rooms. This show is full of mass quick changes, rolling set pieces. and choreographed furniture, all of which has to be done to set musical cues. The offstage show in the wings is often more fascinating than what’s actually on stage. We’ve got most of the kinks worked out and the only person who missed an entrance tonight was Dolly Parton herself due to a technical glitch with a video cue. The amount of complicated team work and absolute trust one must have in ones cast and crewmates puts any team sport to shame. To me, it’s a lot more absorbing that sportsball. But there’s that masculine/feminine dichotomy again.

So, the show is good. It’s selling well so if you’re in the Birmingham area and want to see it, get your tickets now. I’m looking forward to the next three weekends. And yes, we wear our masks in our dressing rooms, keep our hands washed and sanitized and have our vaccines.

And the hits just keep coming. Omicron cases continue to mount both locally and nationally and we’re over 150,000 people hospitalized nationally with Covid. From what I can tell, that number includes incidental cases in people hospitalized with other things so it may not represent the true state of what is bedeviling the health system. All I know is that the numbers at UAB have gone up enough to send us back into surge emergency mode with housestaff being pulled from their regular rotations to manage Covid and the call going out for volunteers from the faculty to staff additional care teams. I volunteered last surge (and was fortunately never called up – I’m not sure how useful I would have been not having done acute inpatient care since the last millennium) and will likely volunteer again this surge. Again, I hope it doesn’t come down to me but if it does, I will cheerfully and willingly do what I can.

I still believe very strongly that a society is strongest when it is a society of ‘we’ rather than a society of ‘me’. And I think that’s the major issue underlying most of what’s causing our fractures in our various social institutions. For the last fifty or so years, the US has been on a course favoring the individual over the collective, the private over the public, the have over the have not. It’s metastasized into all of our social institutions. Politics has tilted in favor of money and corporate profit over public good. Religion has found the prosperity gospel which conflates economic success with piety (despite Balzac’s dictum ‘Behind every great fortune is a crime’.). The educational system has been tilted towards economic success for the individual and away from personal fulfillment or even societal needs. The result has been a hollow and brittle sphere, unable to meet the challenges the pandemic has forced upon us.

We are now two years into this thing and the richest society this globe has ever produced still cannot vaccinate its population, provide real time testing and tracking of cases, guarantee adequate health care for the sick, or provide clear and concise information to its population on how to stay well and what the individual can do to combat the pandemic. These problems are not unique to the US but they are a bit more pronounced here than they are in other countries and societies; and I don’t see any of them being solved at any time in the near future. The structural issues run too deep and many of the wounds have been left to fester far too long.

Why are we here? It’s easy to point the finger at the former president and his administration, but that’s a symptom of underlying disease and, while it might feel nice to use an easy scapegoat, his recent treatment by his followers for even suggesting that vaccination might be a good idea shows that our problems stretch far beyond what goes on at Mar a Lago. We have an entire political party that decided last year that vaccine denialism, and posturing against public health measures was good politics. And people died. These positions remain. And people are still dying. When there’s a change in administration form Democrat to Republican, it’s become political orthodoxy to undo public health measures, as we are witnessing in Virginia where the recently elected Republican governor, as his first acts, is issuing executive orders to undo mask and vaccination mandates. The judiciary has jumped into this as well with the Supreme Court using some rather peculiar logic to undo OSHA’s demand that all large workplaces have vaccine mandates (or a test/mask alternative for those who refuse vaccines). The irony of watching a set of masked and vaccinated judges whose workplace requires vaccination ruling that the coronavirus is not a workplace hazard as it exists outside the workplace was not lost on anyone with more than a few functional brain cells.

These politics, like all of our politics, are driven by money. There’s a lot of right wing dark money pouring into various groups keeping all of these sentiments ginned up. When the sources are traced, it runs back to all of the usual suspects, mainly extreme right wing billionaires who have been playing a very long game of trying to undo all of the regulatory progress of the 20th century which stands between them and maximum profits. I presume that the Scaifes and the Adelsons and the Kochs of the world have some sort of plan in place to protect their assets once society has devolved to the point when the population can no longer afford the goods and services that they sell. Or maybe they’re content with Louis XV’s philosophy of ‘Apres moi le deluge’. The professional classes have tacitly supported this agenda as it’s been good for their 401K balances but I’m not sure how much longer that’s going to last. Economists like Piketty, who is probably the most important thinker in the field of the last fifty years, have been sending up smoke signals for years that Western Civilization is built on an economic house of cards.

I have always identified with Cassandra, ever since I first learned the stories of the Trojan War. The prophetess with the ability to see the truth and the curse of never having anyone believe her predictions. As I look around at the world today, I feel like I am a member of the Divine Family of Cassandra Like Oracles. (I should be able to make that into a cute acronym, but I don’t have the energy). I went into Geriatrics in part because my reading of demographic charts prepared in the 1950s and 1960s, before I was even born, alerted me to the needs of the population and how I would never want for people who could use my skill set. For the last thirty years I have discussed demographic changes and the needs for medical care with several generations of healthcare administrators, generally getting nowhere. I’ve spoken about the likelihood of a viral pandemic and the changes that would need to be brought to bear in eldercare since the mid 1990s, mainly to yawns. There’s a part of me that’s getting tired of fighting the good fight and that wants to retire into a hole and say ‘You figure it out, I’m done’ but I know I’m not going to do that quite yet.

I figure I can muster up enough energy for a few more years of crazy town, at least if it can be done along with those things which renew my internal energy sources – theater and travel. But I really wish our society would understand just how much deep damage they are doing to their healthcare system and the people in it. The political refusal to expand the health care system so that the whole population is covered is both disgusting and hugely problematic in the face of a viral pandemic without seeming end. The emphasis on profit in health care rather than outcomes is going to continue to drive workers out of the sector, especially under high stress conditions. Nursing, in particular, is in bad trouble and it’s going to take some years to replace the skilled nurses who have retired or who have been lost to stress, illness, or death. The aging boom, with their demands for instant satisfaction from all things in life, are going to be in for a rude awakening over the next few years when they can’t get everything they want from healthcare when they want it as the system has been too damaged to deliver. Most of my older patients are very good at following basic public health measures, but their children… Perhaps I should suggest a few trips out to the woodshed…

In the meantime, you all know what to do. Get those vaccines and boosters. They work. Keep your hands clean. Wear your mask (N-95 or KN-95 if possible as long as omicron is rampant). Watch your distance when you can.