700,000 – that’s the number of American deaths from Covid since the beginning of the pandemic. That’s roughly equivalent to the population of Boston or Washington DC. It’s also about the same number as American deaths from HIV (just a bit over 714,000). HIV took forty years to hit that number. Covid has done it in just over 18 months. The death toll has been pretty steady over the last week or so as those sickened by the Delta wave in August are in the midst of their inevitable die off. There are still plenty of critically ill in the hospital. Even though the admission numbers on a whole are trending downwards (fortunately), the ICU numbers remain shockingly high, and mainly previously young and health people. A number of states – Alaska, Idaho, the Dakotas – continue to have maxed out their ability to care for the seriously ill and are working under various sorts of triage and rationing of care. It’s just not possible to be all things to all comers in the situation we currently find ourselves.

Someone much more intelligent than I once said of health care that it can be inexpensive, it can be universal and it can be of high quality – but it can only be two of those things at any one time. No one has yet invented a system that can deliver all three simultaneously. At the moment, given the stresses of the coronavirus, a lot of our health care is having difficulties even delivering one of these things at a time and I don’t foresee that getting a whole lot better in the near future. Eighteen months of societal stress, toxic work environments, emphasis on payment over people, bad behavior by the general public, and a host of other factors, large and small, has ground down the human capital of our system. Nurses are leaving their jobs in droves, some to do other things, some to take advantage of the enormous salaries being offered by temp staffing agencies in providing qualified bodies to desperate hospital systems. I’ve heard of travel nurses making roughly double what I make with assignments to Covid wards – and I don’t begrudge them a penny. I had my annual review this week with UAB (relax, I have a job for another year, my twenty-fourth with them) but my big comment was what is UAB going to do to help me not to choose early retirement as my best option in life. Something for both me and my powers that be to think upon.

I did a couple of Zoom book club meetings this week about The Accidental Plague Diaries, one with a civic group and one with a UAB audience. The most interesting question I got was where do I stand with the idea that the willfully unvaccinated be refused treatment for complications of Covid infection. That got me thinking about medical ethics and what I truly believe. Everyone knows about physicians and the Hippocratic oath. Most US medical schools no longer use it, as it’s something over 2500 years old and has a lot of odd things in it that probably made sense to the Ancient Greeks but which don’t really apply these days such as not having sex with the maids when making a house call and prohibiting surgery. At my graduation ceremony from medical school, we used something called The Physician’s Oath which is similar in spirit, even if it doesn’t have quite the same storied tradition. Med schools these days make a lot more pomp and circumstance about such things than they did back when I was in training. There is now a ‘White Coat Ceremony’ for entering medical students where they are given their white coats and swear to uphold medical ethics. My white coat ceremony was going to the bookstore, grabbing the right size off the rack, and being told ‘That’ll be $17.95’ by a bored cashier.

There is significant symbolism in the white coat. It’s the ceremonial robe that reminds everyone that we are descended from the priesthood, interceding with the gods for a favorable outcome in the eternal battle between health and disease. And, just like with priests, there is a sacred bond between the intercessor and he or she who seeks help. We are told things that people do not share with anyone else. We’re regarded as a safe space for unburdening of feelings, emotions, unanswerable questions. In the ideal world, the healer and patient become a dyad that together can find a path forward. The healer becomes the advocate for the patient on the journey and is answerable to no one and nothing but the needs of the patient. But we don’t live in an ideal world. In the American system, there are multiple layers of entities inserting their tentacles into that bubble. Financial, quality assurance, legal, clerical – the list goes on. It’s easy to lose one’s way. It still boils down to the fact that the physician is responsible to the patient – the one sitting in front of him/her at any given time and ethically the healer is bound to put the needs of that patient above all other considerations. Therefore, the willfully unvaccinated are as deserving of treatment as the smoker with lung cancer, the overweight with diabetes, the rock climber with a broken arm. We cannot make judgement calls on the circumstances that bring patients to us, we only look forward, not back.

The argument then becomes, what about the costs to society of these choices? Society has every right to impose whatever rules they see fit on people over these costs and that’s happening. Surcharges on insurance, requirements for vaccination to continue employment etc. But those are not rules for a physician to employ within the dyad of care. If you’re my patient, I will do whatever I think is necessary to get you the treatment I think you need to restore health and function. I may run into brick walls imposed by the system or by society at large, but then it becomes my job to try to find a way over or under or around if I can. Sometimes I win, sometimes I don’t but I have to try. I suppose this particular tilting at windmills is what gives me my love for Don Quixote. My gift to myself from my recent vacation is a hand painted tile of him and Sancho Panza.

The costs to society run up by the willfully unvaccinated are now in the billions of dollars. Money spent on acute care hospitalization, money needed to care for orphaned children, money to help support those who have survived but who are not healthy enough to return to their previous lives. Society will continue to react to that. Some of that will be through the legal system with new laws and rules but most of it, I think, will come through the economic system as corporate interests of various stripes will seek to shield themselves from losses and liabilities. Where and how will it end and what will things look like six months or a year for now? I don’t know but I imagine it’s going to be harder and harder for the willfully unvaccinated to access public transportation or venues of public accommodation. I read somewhere that a significant portion of these individuals would like to secede from the country. I wonder how their utopia would fare in a globalized world and economy without continued support from urban and coastal America? I imagine it would devolve into something akin to one of the poorer countries of sub-Saharan Africa within a decade.

It’s Saturday night. I should be out pitching the quick fantastic somewhere, but I’d rather stay curled up with the cats (one of whom leapt up on the dinner table and started lapping up my ranch dressing and had to be whacked on the butt) and a nice bottle of red wine. Be safe, be well, wash your hands, get your vaccines.

It’s back to the grind tomorrow. It’s been nice to have been off for a few weeks and had a chance to do some fun things and to rest up, but there are people to care for and bills to pay and house calls to make and all of the other usual chores of my workaday life. I’ve been spending this last day making sure I have all of my tasks and deadlines for the next few weeks ready to go. Three lectures to write -check. A show to audition for – check. Two signing events to plan – check. Various social invitations responded to and entered in the calendar – check. My next door neighbors are in the process of a major remodel. Usually, this isn’t a problem as I am rarely home during working hours but today, a day that seems to have involved workmen pounding on the shared wall most of the time, when they weren’t using power tools with various dissonant pitches, I was getting a little frazzled. At least they knocked off for an hour at lunch when I had a zoom call – a brief reading and Q and A about the book for a local civic group.

I decided to drown out the cacaphony from next door with some television turned up high and put on Apple TV in order to catch up with a couple of streaming series that have made a lot of stir in my social media circles but which I had not yet seen. The first was Schmigadoon, the send up of the golden age Rodgers and Hammerstein type American musical. I enjoyed it as I had no problems recognizing all of the tropes, visual, musical, and characterological, that the makers were lampooning. From the orchestration of the overture (right out of Oklahoma!) to deft parodies of Marian Paroo, Og the Leprechaun, Billy Bigelow, and Daisy Mae, I was smiling throughout but was rarely bowled over with laughter. It was cute and was clever but it was missing the thing that those shows all had, which was a solid emotional core. Ya Gotta Have Heart! and it was missing. I couldn’t figure out at the end who the audience for it was supposed to be. Most people under fifty or sixty wouldn’t recognize the references and the numbers of theater kids and theater queens are quite small when compared to the total population. I guess that’s a bonus for this new model of streaming services. The ability to create shows for niche audiences that need not have the best ratings.

I then turned to Ted Lasso. I haven’t finished it yet, being only on episode four, but I quite like it. What is amazing to me about the show and the character is that an example of goodness and empathy, which would have been a fairly standard type in the programming of not so many years ago is now, in the age of Trump, being seen as something of a novelty. Ted is a fish out of water, not well spoken, puts himself in ridiculous situations, but is at the center such a decent and moral person who sees his mission as helping others become their best selves, that you cannot help but root for him and the joy of the series is watching the transformations in the other characters (surrogates for ourselves and our society) grow and change under his presence. It’s the perfect antidote for these Trumpian times and it’s no wonder it cleaned up at the Emmy’s recently. Perhaps more flawed, but empathic and generally good characters will enter our pop culture consciousness and help nudge the pendulum back a little bit from the selfishness and negativity that seem to be the order of the day.

Speaking of selfishness, time to return to the Covid wars. The CDC produced a very sound scientific study of schools yesterday showing that schools with mask mandates were far less likely to have Covid breakouts than those without. It’s one of those water is wet studies whose conclusions seem relatively obvious but it is nice to see some science behind the common sense that can be used with recalcitrant school boards who feel that owning the libs is more important than protecting the health of children. The current Delta wave is going to create a huge bill to pay in terms of children’s issues in the future. The deaths are spiking and many of the dead are relatively young adults between 25 and 50 who are leaving orphaned children behind. I don’t know that anyone is tracking the number of minor children who have lost one or both parents to Covid so far but I’m sure it’s in the thousands, if not the tens of thousands. In the original waves, before vaccination, it was a tragedy but now, with the disease being more or less preventable, at least in its fatal version, these parents are choosing an idea based on fallacies and cynical political opportunism over the love and needs of their own children. When the kids mature enough to understand that MAGA was more important to their parents than they were, what is that going to do to their mental health and to their understanding of their place in the world.

War and opposing political philosophies have always created orphans but usually, those sacrifices have been made in the name of something positive, something better – a freer society for the children, protection of the populace from invasion. The current conservative philosophy as espoused by those who would deny science and public health doesn’t appear to stand for much, at least to me. It’s rooted strictly in being in opposition – to progress, to a more equal society, to benefits flowing down the socioeconomic ladder rather than up. This is my major objection to much of the current rhetoric on the right. Tell me what you want for the country and how you want to get there. I’ll listen. Throwing a tantrum at every suggestion just makes me want to put you in the corner for a time out. There seems to be some idea espoused that they want to go back, ostensibly to the America of Leave it to Beaver and Sally, Dick, and Jane. A time that never actually existed other than in carefully crafted cultural items designed to lull the developing Baby Boom into a false sense of security. You can’t go back, ever. Time doesn’t work that way. You can only go forward. The only thing that seems to motivate the way forward is entrenching a minority rule through selective legislation. You may be able to do that in the short run, but it’s rarely a successful long term strategy for societal stability.

If I have to choose between an America as embodied by Ted Lasso or an America as embodied by a horde of screaming suburbanites invading the local mall food court because they’ve been asked to do something as simple as wear a mask, I’ll take Ted. I’ll bet he keeps his hands washed, wears his mask, keeps his distance, and got his shots publicly in front of the whole team as an example.

I’m starting to surface for air after a couple of days of torpor following the protracted trip back home from Spain. The flights were uneventful, just a lot of hurry up and wait as one usually gets these days with air travel. Air traffic appears to be picking back up. It’s nowhere as crazy as it was pre-Covid but both the Madrid and the Atlanta airports were more full than they were on the outbound journey not quite three weeks ago. No episodes of air rage or bad behavior on my flights. It may becoming more frequent as mental health in general deteriorates as the pandemic grinds on but if the airlines start sharing their no fly lists with each other and people start to find themselves barred from all air travel if they don’t act like adults rather than toddlers in a snit, that particular issue of modern life is likely to take care of itself. The only hitch in the return trip was the complete dearth of ground transportation when I landed in Birmingham. Attendees at the Furnace Fest music festival apparently commandeered every taxi, Uber, and Lyft in the metro area on Thursday. Fortunately, I have phone a friend capabilities.

The weather has broken and the humidity is gone and the tang of fall is in the air. We’re getting into my favorite time of year. I’ve always been an autumn person. Fall to me means new beginnings and gearing up for new possibilities as I have been tied to the American academic calendar since age 5. Growing up, fall also meant the glorious Indian Summer days of a Seattle September, sunny without being warm, leaves beginning to change, and a prolonged magic hour in the late afternoon with a golden light from the setting sun so thick, you can almost cut it with a knife. I’ve never seen anything quite like it anywhere else I have lived. Must have something to do with the latitude. It also means a chill in the air at night so I’ve flipped the HVAC from cool to heat. The cats, who went into hiding for the first twelve hours or so after arrival, have decided I’m me and have reemerged and are going about their usual routines. I’ve done the laundry, the grocery shopping, unpacked, and in general started the process of going back to usual life.

The number of Covid inpatients at UAB has been steadily declining. Hopefully, that means that the worst of the Delta surge locally is over and things will calm down a bit and let everyone take a breather. However, the death rate is skyrocketing (as it does about four to six weeks after a surge begins). Alabama’s death rate per population is currently the highest in the country, about double that of every other state. We had 123 deaths yesterday and our seven day average is 125 deaths a day. In comparison, Spain, where I just was, had 44 deaths yesterday with a seven day average of 64. When you consider that Spain has three and a half to four times the population of Alabama, which place is doing a better job keeping its population out of harms way.

It’s been a bit of an adjustment coming back and seeing people serenely waltz in and out of buildings without masks, hearing about local schools lifting mask mandates due to their ‘conservative values’, seeing various snake oil cures (some of which are downright dangerous like nebulizing hydrogen peroxide) being touted as appropriate protocols by people without medical training, and having prominent politicians bragging to the media about how they have spent the last eighteen months listening to professional public health advice and then doing the opposite. Just a few weeks in a society that understood and accepted basic mitigation measures as necessary for the common good and which did them without complaint or fuss and who got their vaccinations without a major blowback movement seems to have spoiled me. The State Department still has Portugal and Spain as Level 4 travel advisories (do not travel there without urgent need due to Covid risk). They’ve been listed like that since July. It’s ridiculous. I feel much more endangered here than I ever did there. If they are Level 4, we should make Alabama level 5 (and Florida level 6).

The book is continuing to sell slowly, but steadily. A big thank you to those of you who have purchased it. I have a major ask to those of you who have read and liked it. Please, please, please go to Amazon or Good Reads or any of these places and write a short review and rate it. ‘I liked it’ is perfectly acceptable. This has to do with the way the modern publishing/book world works. Automatic algorithms will start doing their thing, but only if they are prompted by people supplying them with data. A couple of other things that you can do if you are so inclined. Tell people about it (social media or in person) if you think they might enjoy it and ask your local independent bookstore to order it for you or others and to stock it. They can easily order it from Ingram Book Distributors. Book marketing on a zero budget is a guerilla affair and I need some help from shock troops.

I’m trying to decide what the last few weeks of away time and decompression has meant. Was it just a chance to get away and see a part of the world I had not yet been to? Was it a time to contrast and compare a society that has done public health basics in a non-political way with our own craziness that seems bound and determined to push the death toll ever higher? Was it a way to get my head in a different space so I know where and how to point myself next? (If it was that last one, it was pretty much a flop – I still haven’t figured out what the next chapter of life holds so I’ll more or less return to old patterns until I do). One thing I did figure out is I’d like to find a travel companion(s) for my next major jaunt. If you think you’re that person, give me a call and we’ll discuss. I don’t have my big 2022 trip set yet. It’s going to depend on Covid and work and theater and books and all the rest of the things that collide on my calendar. I do have a companion set for my trip to London at New Year’s so I’ll be able to do some compare and contrasting with how that works.

Another decision I’m trying to make. What next with the writing? A second volume of The Accidental Plague Diaries? (there will be enough material by the end of the year). Just expand the book as is with new material? Move on and try something completely new? (I do have a couple of ideas rocketing around my brain for novels and plays). Go back to my original book idea about the impact of the aging Baby Boom on the health system? Just keep writing these pieces and let them go where they go? Turn the diaries into a performance piece/monologue? (Anyone want to help me give that a go – would need a genius director…) White, a blank page or canvas. So many possibilities…

Dateline – Toledo and Madrid, Spain

Today is the last day of the tour and one more destination to hit, Toledo. Madrid is the current capital city, but the capital was only moved here in the 17th century – the Hapsburgs and the Bourbons needed more room for palaces and additional population and Toledo, the capital since the Visigoths occupied Iberia during the collapse of the Roman Empire was left in the dust. It’s only about an hour away by train, car or bus so an easy jaunt first thing in the morning. We had a few brief showers on the trip and the skies were glowering when we got there, but things brightened up considerably through the morning and our luck with the weather continued. Toledo, as the medieval capital, is very much still a medieval town, built on a high bluff where the River Tagus makes a large oxbow bend through a gorge, it was easily defensible as a walled city and it’s also easy to see why the kings scampered after the introduction of gunpowder into warfare made such fortifications obsolete. The city retains a true middle ages feel. Winding narrow lanes with no rhyme or reason; fortified buildings, some dating back nearly a thousand years; it has a sense of unreality to it as if it’s some sort of movie set or theme park and, if you go around the next corner, you may stumble into Adventureland. The approach to the city, by a winding road on the opposite side of the gorge, lets you see it displayed out before you, looking all the world like one of the city sets of Game of Thrones, I half expected the Alcazar of the Cathedral to suddenly start unfolding as a little mechanical toy.

Tour of the city on foot, much my favorite way to do things. Highlights are the cathedral – Spanish Gothic with a great altarpiece and stunning collection of El Greco paintings (he was based in Toledo most of his working life). I’ve always liked his work. It’s incredibly modern looking for a Renaissance master. I’m not sure about the Baroque addition in the apse , a dome and rococo fantasia of a back altar constructed several hundred years after the original building was finished in order to let in more light. A few other stops including a small chapel to see a massive El Greco and the original synagogue from the 11th century, built for the Jews by the Moors and looking all the world like a mosque.

Lunch in a hacienda snuggled up on the town walls. Roast suckling pig plus several other courses. Then a bus load of napping and sated tourists heading back to Madrid. Did a little last minute shopping and wandering and then back for the second gala meal of the day (not having fully digested the first) a farewell dinner (sea bass) accompanied by several wines and champagne. Dinner entertainment provided by a rather good quartet of Spanish guitarists/mandolin players/vocalists doing the few songs in Spanish that American tourists tend to know. Guantanamera, Malaguena, Granada, Bessame Mucho etc. After a cocktail and three glasses of wine, plus champagne for toasting and to accompany dessert, the assembled crew demanded that I entertain them with something. I was just tiddly enough to do it so I found a karaoke track on YouTube on my phone and gave them a rousing edition of Don’t Tell Mama. (I figured I had to do something unexpected…) Hopefully no one recorded it.

Now bed and returning home through three airports and two airplanes tomorrow. Have my passport, have my ticket, have my negative Covid test. I figure the US will let me back in.I’ll let everyone know when I have safely returned home. Keep your hands and noses clean and wear your masks indoors. Spain is lifting more and more restrictions as no one is dying over here and most of the population is vaccinated. They may be back to full normal in the new year. I wonder where we’ll be?LikeCommentShare

Dateline – Madrid, Spain

Today was our full day in Madrid. It’s a large city of roughly four million people, but the historic center where most of the interesting sights are located is much smaller and easily walkable. Cities have always been constrained by time. The inhabitants don’t want to spend more than 90 minutes a day in a commute, no matter the technology. When transportation was mainly on foot, cities could be walked across in 30=45 minutes and were limited to about four square miles (two miles in diameter). The horse and carriage opened that up some. In the 19th century, the invention of the street car and public transportation allowed for things to expand greatly and then, finally, the private automobile took over in the mid 20th century with the development of endless suburbia. It’s less of an issue in Europe than in America, but even European cities have their more modern high rise districts, usually a ways from the historical center and their far flung suburbs, usually small outlying towns incorporated into burgeoning metro areas.

I have always loved visiting the historic centers of European cities as they are designed around the pedestrian with cars as an afterthought and I have always enjoyed just walking. (My pedometer is very happy with this trip as I am averaging 16,000 – 20,000 steps a day). On my first trip to Europe, when I was 22, I crammed as much into eight weeks as I could, often sleeping on the train overnight between destinations and then covering things on foot at a fast clip. My knees are no longer that age and are complaining a bit as we approach the two week mark, but I only have a couple of days to go – they’ll make it with the help of some Arthritis strength Tylenol. I just have to keep reminding myself that 22 was nearly four decades ago. Most American cities were laid out later in historical development than European ones so they aren’t walkable in the same way. They came to be after public transportation or the car were well established and took primacy and few of them are walkable. I treasure the exceptions – Boston, New York, San Francisco, New Orleans.

The first part of the day was a bus tour of the city including some of the outlying districts. It’s my least favorite way to see a city and I can’t say I enjoyed it all that much but it did give me a chance to get properly oriented. After an hour, we ended up at the Prado Art Museum, one of the few great museums of Western Art that I had not previously been to. Multiple masterpieces of the great Spanish painters – Velasquez, Murillo, Goya, El Greco. And some decent Italian post Renaissance art commissioned when Spain was the richest country in Europe during the late 16th and early 17th centuries. Also some interesting Dutch pieces as Spain ran those at the time including most of the masterworks of Bosch. It was great fun to finally see ‘The Garden of Earthly Delights’ in the flesh for the first time. I have long been familiar with it, having had a poster of it up in my college freshman dorm room, as one does….

After the Prado, Fernando, our fearless leader, who lives in Madrid gave us a walking back streets tour of his favorite haunts. This was much more to my taste than the bus ride, as I was able to get more of a feel of the look and the rhythms of the city when not seated at a height, sealed away by air conditioning and glass. We ended up back at the hotel where I got a brain biopsy of a Covid test so I can fly back to the US in a couple of days (negative again) and then we were on our own until tomorrow morning. I used my time to do a little shopping, to wander some back streets in more usual residential areas, and to have dinner and a margarita in a little hole in the wall that turned out to have really good food. We’ve got one more tour day, tomorrow, and then, on Thursday, I have to surface back in reality. I was originally supposed to stay in Madrid until Sunday but I canceled the extra days so I would be under the care of the tour operators regarding Covid testing and flights home. After logging in something over 24,000 steps today on the pedometer, my legs are tired so I have gone back to the room early so I can be refreshed for the trip to Toledo in the morning.

There have been a bunch of Covid vaccine headlines over the last couple of days. I don’t have complete information but here are my takeaways. 1. Kids – Pfizer has released study data showing it’s vaccine is safe and effective down to five years of age. This is drug company data that has not yet been vetted by the FDA so don’t bother your pediatrician for shots yet. If the data is as clean as it appears to be, the FDA will approve shots for children 5-11 in a couple of months, at least on an Emergency Use Authorization. Moderna hasn’t released their data yet but it is likely to be similar. I haven’t seen anything about J and J for kids but it’s likely being studied. 2. Boosters – Get one if you’re immunocompromised in any way or if you’re over 65. While it’s recommended you remain on the same team, it probably doesn’t hurt to switch hit. J and J released data today showing that a booster of their formulation is helpful, but there are no formal instructions yet as we are, again, still dealing with drug company data. (I have learned over the years to take drug company data and press releases with a very large grain of salt).

We have officially passed the 1918-1919 flu pandemic in terms of numbers of deaths. Covid is now the greatest mass casualty event in the history of the US with deaths of 675,000 and climbing. The Delta spike will continue to add to the death toll at a rapid pace over the next couple of months, then there may be a lull. It’s really hard to predict. There could be a new variant with significantly higher transmission or mortality. We could have a new outbreak of politically fueled negative behaviors. A variant could outsmart the vaccine. Then there’s the whole question of Africa. A continent of poor countries that has had little luck getting any vaccine whatsoever for its populace giving a huge potential population in which trouble could lurk. We tend to forget that a pandemic is global and, for it to be brought under control, will require global solutions which means more than just the wealthy countries of the world taking care of themselves.

Tired. Must get some sleep…

Dateline – Cordoba and Madrid, Spain

And on to the last leg of the tour… The intrepid eleven (twelve if you include Fernando, our guide, font of all knowledge, translator, and general herder of squirrels or thirteen if you add in Armenio out stoic Portuguese bus driver) headed out of Granada as the sun rose. Spain is on the same time zone as France and Germany but significantly farther west which makes the sun come up late as it should be at least an hour earlier. After battling rush hour traffic in the suburbs, we entered hilly country, marked mainly by commercial olive groves of gray green trees with the occasional small town in the distance. The towns all look about the same. Whitewashed houses clinging to the side of a hill with a church and citadel on top, the citadel usually in a state of some disrepair as castles haven’t been terribly useful since gun powder came on the scene in the 16th century. According to Fernando, there are more than 2,000 castles in Spain, most of them in various states of decay.

After a couple of hours, we arrived in the city of Cordoba and were dropped near the old city. Armenio and the bus kept heading towards Madrid with the luggage while we had several hours to explore the town. Cordoba was a Roman town way back in the day and, under the height of the Moorish occupation in the 10th and 11th centuries, was the largest city in Europe with a population in excess of a million while London and Paris had fewer than 20,000 apiece. It’s wealth was fueled by its prominence as a river port, complete with Roman bridge across the Guadalquivir, and from nearby gold and silver mines. The Sultans built an enormous mosque on the banks of the river, enlarged it multiple times, and, when the Christians reconquered the city, rather than raze it as happened in most other Spanish towns, they kept it intact and converted it into the cathedral. Over the years side chapels were added and eventually, during the renaissance, a complete Latin cross nave, apse and transepts were plunked down right in the middle of the building. The end result, the mosque-cathedral, is highly unusual with elements from Arabic/Byzantine all the way through Baroque in the same building, but it kind of works in an endearing way. The old town is similar to Granada – lots of twisting alleyways with house abutting the street opening into interior courtyards with fountains and flowers.

Then, on to the train to Madrid. Non stop express of less than two hours. We arrived just after the bus and luggage and checked into the Palace Hotel, just off the main boulevard, across the street from the parliament building on one side and the Prado museum on the other. It was nearly 6 PM when I got settled and dinner was at 7:30 so not a lot of time to explore so I walked around the immediate neighborhood and ended up at the Reina Sofia museum, home of Picasso’s masterpiece, Guernica. As it’s free admission after 6 PM, score! And in I went. I’ve seen the painting reproduced many times over the years but nothing quite prepares you for the monumental size of the canvas, as large as a wall. It’s displayed in the midst of a series of galleries that puts it in context, both historic and artistic that make it even more powerful. Paintings from what I suppose is the Spanish equivalent of the Ashcan school of the early 20th century depicting the brutal conditions of urban life and factory work. The explosion of new ideas in the years leading and following World War I – Cubism, Surrealism, Dadaism. Galleries of how art was used as propaganda including posters and magazine covers. Galleries devoted to the decadence of between the wars society including a whole lot of Grosz and loops of Bunel film clips. As I was passing through these, all of the parallels between those times of wrenching change and our own came leaping off the walls so by the time I got to the Guernica canvas itself, I was in a heightened emotional state. I had to walk around a couple of blocks after to maintain equipoise. Dinner, in the gorgeous hotel rotunda, was a bit unnerving after – a sort of pleasures of the bourgeoisie built of the backs of the suffering of the proletariat moment. I had one more glass of wine than usual and toddled off to my room to ruminate.

I’m sure there’s some sort of grand meditation on the nature of society, my place in the world, and how life works germinating in my brain but I’m not sure tonight’s the night to get it out. It’s been a long day and I’m going to settle in to mindless TV dubbed into some language I don’t speak very well. As one does…

Dateline – Granada, Spain

Granada, as it’s in a mountain valley near the Sierra Nevada range, was deliciously cool this morning as the mountain winds descended overnight. I actually needed a pullover for the first time this trip. It rapidly warmed up and was in the 80s by noon, but without the humidity of the coastal areas. Our guide met us this morning and we headed off to the Alhambra. One of the nice things about Tauck Tours is they arrange everything in advance so there is no waiting in line. The Alhambra is one of the most visited sites in Europe and access is strictly limited to keep the flow of visitors down to protect 13th and 14th century buildings and interiors. Tickets often have to be reserved months in advance. However, through whatever magic, we were able to walk right in through the magnificent gate of justice and spent the next two and a half hours in the halls, courts and gardens of the sultans of Granada, the last of the Muslim kingdoms on the Iberian peninsula, lasting from the mid 1200s after the fall of Seville to the Christians through a negotiated settlement and withdrawal to Ferdinand and Isabella in 1492. The fortified palace the Sultans built for themselves on the crest of the hill with its intricate Islamic decorations, beautifully hydraulically engineered fountains (still using the original plumbing system), and acres of courtyard and terraced gardens was never attacked in war. Napoleon, on leaving the city late in the Peninsular wars ordered that it be blown up to deprive the Spanish of a stronghold, but the French were only able to damage the east end of the complex due to some enterprising Spanish soldiers who cut the fuses to the munitions placed in the west end.

It’s a site that must be seen and that I cannot adequately describe. (Pictures appended, per usual in a separate post). Washington Irving did in the early 19th century in his Tales from the Alhambra, the literary work that put Granada on the cultural map after some years as a backwater. I haven’t read it (or much other Irving except The Legend of Sleepy Hollow and Rip Van Winkle) so I’ll have to take our guides word for it that he got it right, even though apparently the majority of his tales were pure fantasy with no historical truth behind them. I’ll settle for the fact that some of the Dorne sequences from Game of Thrones were shot there. What I’ve learned from this trip is how little I really know about Portugese/Spanish history. I know some of the general outlines and a few dates but that’s about it. American World History tends to focus much more on the British and the French. I’ll have to do some reading. If anyone is aware of any works that make Iberian history palatable, point me to them.

After the tour, a walk down the hill through a woodland park to the center of Granada proper. Most of the downtown area is late 19th century neo-Renaissance of no particular distinction, but coming off of the central commercial district are older residential neighborhoods dating back to Moorish times that could easily be in Marrakesh. Whitewashed walls, a rabbit warren of narrow streets and alleys, small little interlinked shops in the manner of an Arab bazaar filled with cheap stuff that seems mainly imported from India (I did not purchase). The cathedral is an amalgam of gothic, renaissance, and baroque built smack in the middle of a residential/commercial district and without a surrounding plaza making it very difficult to get back from it to get a good look. There were a number of other interesting looking old churches, some converted mosques from pre-1942. A few hours of wandering was enough so I took a taxi back up the hill so I wouldn’t have to climb. My nearly 60 year old knees are noticing the amount of walking I’ve been doing. A brief nap and then dinner and a show at the hotel. Dinner -a spicy pork roast. The show – a small revue of traditional flamenco music and dance styles. It was well done but I couldn’t help but think of Ya Ya in Strictly Ballroom saying ‘You dance the Paso Doble?’

Covid news of the day… The FDA has more or less made its rulings on booster shots clear. If you’ve had either Pfizer or Moderna and you are either over 65 or have some sort of immune compromise, get a booster. If you don’t fall into those categories, you don’t need to. Of course, getting a booster won’t hurt you there just isn’t good science that it’s of enough benefit to justify a recommendation. Those who got J and J are somewhat in limbo. The science regarding boosters just hasn’t been done with the same rigor as with the first two so there are a lot of unknowns. There are no formal recommendations yet. However, a booster, either of J and J or of either of the other two, again, is likely not to hurt and may be of some benefit, at least of more benefit than gargling betadine.

Alabama case counts are coming down, fortunately, but the death rate is going up, up 175% over the last two weeks. This is right on schedule. Remember that cases spike first, hospitalizations spike two or three weeks after cases and deaths spike two or three weeks after hospitalizations. The big increase was through the month of August so mid September is exactly when we should begin seeing mortality statistics increase. I just can’t help but feel sorry for the survivors of the recently deceased. Knowing a thing or two about grief and how it changes your world, there are a lot of people in for some very rough times over the next few years, and it’s all so unnecessary. Meanwhile, here in Spain, case counts continue to fall, vaccinations continue to rise and people don’t fuss about having to prove vaccination status or wearing masks. I’m going to miss that attitude when I return home this next week.

We’re up early tomorrow and on to Cordoba. I promise to wash my hands, wear my mask as needed and keep my distance as much as possible.LikeCommentShare

Dateline – Ronda and Granada, Spain.

I had breakfast as the sun rose over the Mediterranean, promising another lovely day on the Costa del Sol. However, I and my traveling companions had a schedule to keep so it was back on the bus. We left the environs of Marbella and soon found ourselves climbing a winding mountain road over the original Sierra Nevada Mountain Range which backs up on the Spanish coast line. At first, we were winding through neighborhoods of opulent villas, reminiscent of Malibu or Bel Air. The occasional Lamborghini or Maserati cruising by completed the picture. Eventually, we were far enough a way from the sea that the cars turned into Renaults and Peugeots and we passed over the crest at about 3000 feet in one of Spain’s National Parks – forests and the occasional white washed village. We then descended into an agricultural plain, mainly ranching rather than crops and were soon in the town of Ronda. a small fortified town on top of a bluff riven by a small canyon formed by the Guadalevin river.

Inhabited since it was first settled by the Celts, centuries before the Romans, it has been fortified, fought over, changed hands, and been the scene of general mayhem many times over the years, most recently in the Spanish Civil War when the Fascists and the Nationalists spent their time tossing each other into the gorge (an episode made famous by Hemingway in The Sun Also Rises). Now it’s relatively peaceful and sleepy, only besieged by hordes of tourists who come to see the gorge, explore the old town, and see the famous bull ring, continuously operating since the early 18th century. We peered into the gorge, took in the stunning views of the Sierra Nevadas, had a guided tour of the back ways of the town and ended up in the bull ring (Pepe our local guide being something of a bullfight fanatic). One of my trusty New Balance sneakers decided to separate from the sole halfway through the walk and it detached completely in the middle of the bull ring. I’m sure there’s an omen in that but I don’t think I want to know what it is.

After a leisurely lunch (I had the local specialty – oxtail stew) at the edge of the gorge, back on the bus for a few more hours and to the old Moorish city of Granada. I was on the fatigued side so I did not explore much beyond the immediate surroundings of our hotel as we will be here tomorrow as well. Our hotel, the hotel Alhambra Palace, is on the same hill as the palace itself (being visited tomorrow morning) and has the same spectacular view out over the city. The hotel was apparently designed and decorated by the same people who created the great Moorish 1920s movie palaces in the USA and is delightful in a rather Arab kitsch fashion. Can’t beat the views though and the room is comfortable, although I’m not sure what to make of the combination toilet-bidet that has a control panel more suitable to the Space Shuttle than a bathroom fixture. I’m really afraid to push too many buttons. We all met up for dinner at a charming restaurant just down the bluff from the hotel where we all overate and drank too much wine on the terrace watching the sun set. (Lamb shank with couscous).

I dialed into the American news as I was curious to see what had happened with the DC rally in support of those arrested for the January 6th riot at the capitol. It looks from the coverage I’ve seen that it was a complete fizzle with more security present than protestors. I’m wondering if the MAGA movement is beginning to lose steam, what with its leader out of power, sane adults in power helping keep the economy on track, and finally an awakening that being a contrarian in the face of a deadly virus may not be the best strategy for one’s health. I don’t think it’s gone by any stretch of the imagination and it will only take the right cultural fertilizer to have it blossom in some new malignant direction. Those sorts of antiestablishment feelings are as old as the country. They need to be acknowledged and their energies channeled in ways that can benefit rather than destroy.

As a physician, the thing I worry about most is what happens when the next pandemic hits. Pandemics are the easiest of natural disasters to predict. They have always happened and always will. We can accept that inevitable truth or ignore it at our peril. We got away relatively easy with this one as, to date, it’s only killed about 0.2% of the population. What happens when the next one comes – a decade from now, two decades from now and it has a mortality rate of 5 or 10 or 20%? The rancorous distrust of the government, basic public health precepts, the medical system, and the scientific medicine that has now become firmly rooted in the culture will hamper our ability to deal at that time in new and unknowable ways. I worry greatly that Covid, as bad as it has been, is not going to be the real problem. The next pandemic, a more serious disease still, hitting a rickety health care system and a population primed for rejecting the most basic of precautions, is more of a worry.

Here in Spain, with vaccination rates now over 75% and case rates falling, the rules are changing. Masking is no longer required out doors in any circumstance (although most people do it in crowd situations as a courtesy). Masking is still universal indoors unless eating or drinking – and the climate is such that most of our meals have actually been out of doors. I feel perfectly safe moving around the country. I’m not sure I’ll feel as safe back home next week. Our local bell weather school system, where the parents fought back against a ‘conservative’ school board and got them to require masking has noted a significant drop of cases over the last few weeks since masks went into effect. So, of course, they’re lifting the mask rule now. Cases to spike up again in 3…2…1… And the parent groups, full of physicians and university professors, are marching on the school board again…

But that’s not my problem today. My only issue is getting a decent night’s sleep before exploring Granada tomorrow.

Dateline – Marbella, Spain

Today was a down day. We’re just a little over half way through the tour and it’s been fairly busy so a day without agenda or having to get up or get on the bus was welcome indeed. I can’t help but think that Fernando, our guide and general herder of cats and Armenio, are bus driver, quite skilled at maneuvering a full size Mercedes tour bus through narrow European streets needed a day away from the intrepid eleven. Today was about swimming pools, beaches, walks on the esplanade, and a couple of naps. A number of us also got together at a beachside restaurant for a lunch of paella and other treats and the whole gang had dinner tonight in the hotel restaurant, mainly steak although I opted of pork loin as I’m really not that much of a beef person.

Today was the first day on this little jaunt that I’ve felt a bit lonely. My travel companions are very kind and gracious and make sure I am not left out in any way but there are times when, as in Side By Side By Side, it’s obvious there’s an empty place next to mine. Tommy’s been gone long enough now, that I think I’m more or less over my acute grief and, while I am not looking for a new romantic/intimate partner, I am starting to feel the need for some reliable activity/travel/shenanigans companions with whom I could share an occasional adventure. I’m sure someone will turn up at the right time. One thing I’ve learned from life is that things usually fall into place when you don’t look too hard and don’t force them.

I went through a backlog of UAB emails earlier today and caught up on the local Covid statistics. The number of folk hospitalized at UAB has been trending down over the last ten days or so which is a good sign. The percentage requiring ICU care, however, is not declining at the same rate. I’m hoping this means that Birmingham, at least, with its significant health care worker population, will be on the downside by the time I get back to work in about ten days. The various trackers I follow show that this is likely in urban Alabama, but the rural parts of the state where vaccine hesitancy is so much higher, continue to be hot spots. Vaccine numbers continue to trickle upwards but the damage done to public understanding of vaccines by politics remains extensive and very difficult to overcome. The FDA met today and came to what I think is a reasonable decision on booster shots: not necessary for most healthy younger adults but appropriate for older adults over 65 and for those with significant immune system issues. How that will be rolled out to the general public remain to be seen but I imagine older adults will be able to receive a booster from most pharmacies no questions asked and no payment necessary as of the first of the month, maybe even as early as next week. As far as the significant immune system issues go, if you don’t know what they are are, you probably don’t have one so don’t worry about it.

I just don’t have much to say this evening. I’ll likely have more tomorrow what with us being back on the road (Ronda and Granada if I read my schedule correctly – I’m not following it too closely, preferring to let the trip pleasantly surprise me from day to day.). Then there’s the gathering in DC in protest of the prosecution of the January 6th protesters. Who knows where that one will end up. As I read the European perspective on American political news, I’m more and more tempted to take my retirement savings and purchase a golden visa for resettlement in the EU where people still look out for their fellow countrymen, rather than be at each other’s throats. Of course the Catalonians and the Castilians might disagree with me on that one. The bar singer below my window is busy destroying Elton John, I have The Last Action Hero dubbed into Spanish on the TV and there’s a lovely moon out so I’m going to sign off and drift off to sleep.LikeCommentShare

Dateline – Gibraltar, UK and Marbella, Spain

We all said goodbye to the King Alfonso XIII hotel in Seville early this morning, boarded the bus, and were soon headed out of town in a southeasterly direction. Seville may be a port city but it’s river port, about fifty miles inland on the Guadalquivir river, and we were bound for the coast. Our route led across some rather arid agricultural plains, through olive groves, the ever present citrus, and occasional fields of corn and cotton. Closer to the coast, the terrain became hillier, with limestone outcroppings and we passed through a large nature reserve, supposedly home to deer and antelope but they were not posing for tour busses by the side of the road. We topped a final rise, and there, spread out was the Mediterranean, blue and calm with a large lump on the horizon which we were assured was the Rock of Gibraltar.

Half an hour later, we were in the customs/border control line, getting new stamps in our passports thanks to Brexit and boarding a minivan for a tour of the rock and surrounding town. Having a very British mother, I’ve heard of Gibraltar all my life and have always wanted to see it. Of course, my mother’s knowledge of Gibraltar ended somewhere around the Battle of Trafalgar and the death of Lord Nelson during the Napoleonic Wars so I really didn’t know what to expect. The rock itself, a huge limestone outcropping on the edge of the seacoast, has roughly the same footprint as Central Park in NYC although, it rises to about 1400 feet, as a very steep cliff on the east and a bit more gradually on the west. The old town of Gibraltar and its fortifications cling to the base rising to about a quarter of the way up the west side, with multiple bastions from the 15th through the early 20th centuries and topped by a Moorish castle dating back to the 11th. Various sea powers dating back to the Phoenicians have recognized that Gibraltar is the key to controlling the straits of Gibraltar and passage between the Mediterranean and the Atlantic which is why the British, awarded the fortified town by the treaty of Utrecht in 1715 have never wanted to give it up, much to the disgruntlement of the Spanish. Franco closed the border for most of the 60s and 70s which didn’t exactly please the Gibraltarians and they had a plebiscite in which more than 98% of the residents voted to remain British rather than to join Spain. Over the last few decades, enterprising Gibraltarians, a mix of various European people but the language and culture is British, have filled in some of the bay around the base of the rock giving more land to build on and there are now gleaming new high rises and other supportive structures allowing the population and economy to expand. There is still a lack of space. The one land road into the territory crosses the tarmac of the airport and has to be closed every time a plane takes off or lands. There is a new road being constructed with a tunnel under the runway to hopefully solve that problem in the near future. Apparently, the airport is one of the most dangerous in the world, not because of errant traffic on the runway, but because of the crosswinds coming in off the Atlantic and sent into unusual patterns by the bulk of the rock. Frequently, flights have to be diverted to Malaga in Spain, about an hour or so away.

We met David, our guide and a native Gibraltarian in our small bus suitable for the narrow roads on the rock. It was interesting hearing him switch back and forth from Spanish to English with an East End accent but that appears to be what the natives do. We drove through the town, and began the zig zag ascent of the rock over a series of progressively narrow and steep roads. We stopped at Europa Point, the southernmost point in Europe and admired the coast of Africa across the strait (roughly 8 miles away), my first sight of that continent. Then climbing higher, we stopped at one of the many caves within the limestone of the rock, St. Michael’s. Waiting for us there was one of the famous troops of Barbary Macaques, tailless monkeys brought over from Africa as pets which have flourished in the wild. They were bored by our presence (other than the one that reached down and stuck one of his paws into one of my tour mate’s ears) so we entered a lovely cave full of stalactites and stalagmites. I could have done without the tacky son et lumiere show in one portion, but the rest of it was quite spectacular. Then, more monkeyshines and a drive back down to the village for a lunch of fish and chips.

After lunch, another drive up the coast to the resort town of Marbella where we are to spend tonight and all of tomorrow as an R and R day of sun and surf at our half way point. Marbella is a lovely little town, obviously on the upscale end of the Costa del Sol, with a paved esplanade along the water, whitewashed buildings in the original old quarter, and any number of fine hotels, white table cloth restaurants and the boutiques selling jewelry, resort wear, and assorted bagatelles that one finds in beach towns the world over. I stuck my toes in the Mediterranean (the first time since my trip to Italy and Barcelona in 2002), took a dip in the pool and had a light dinner with a very large gin and tonic watching the sun set. Now I am on my ocean view terrace at the Dom Pepe Real Melia typing this and listening to the vocalist from the restaurant below me massacre her way through the pop hits of the 70s and 80s.

I am looking forward to sleeping in tomorrow and having no agenda, other than keeping my hands washed, and wearing my mask indoors.