Dateline – Seville, Spain

The weather held today. Intermittent rain showers throughout the area, but none directly overhead. The storms did help keep the temperature down in the 70s for most of the day which was quite comfortable for touring. (My pedometer is most happy with me this week). The humidity, however, has been a bit above my comfort level but not nearly as bad as Alabama in August. This morning started with the usual upscale hotel breakfast buffet. Lots of choices and always something that appeals but European scrambled eggs tend to be runny and every country does bacon and sausage somewhat differently. The highlights of this morning’s tour were the buildings constructed for the 1929 World’s Fair (most of which remain standing around a large public park). We had glimpsed them on yesterday’s carriage ride but today was a chance to get a bit closer to see the detail, especially on the monumental Spanish pavilion and plaza. I had my picture taken with the medallion honoring Don Quixote and couldn’t resist serenading my tour mates with a few bars of ‘I am I Don Quixote, the Lord of La Mancha’. I’ve always been partial to the Don and his tilting at windmills as I have spent a good portion of my life doing the same thing metaphorically.

Then, back to the center of town for a tour of the cathedral. Very impressive and the largest Gothic style cathedral in Europe. The nave and chapels are impressive in terms of sheer size and some decent artwork including large Murillo and Goya paintings. After the cathedral, a ramble through the winding streets of the old Jewish quarter, empty of Jews since the pogroms of 1391. Per are guide, there are still almost no Jews in the city (fewer than 100 total at the last census). Recently, the Spanish government has had a case of the guilts over the expulsion of the Jews in the 14th and 15th centuries and, if you can prove Sephardic Jewish ancestry back to Spain and that time, you can claim a visa and a path to citizenship. Given the craziness of our current politics, if I could do such, I might consider it but I’m about 100% Anglo-Saxon/Celt. I am eligible for a Portuguese ‘Golden Visa’ where, if you purchase real property in the country and bring a certain amount of wealth in, they’ll allow you to emigrate. I’ll keep that in mind just in case our politicians continue to drive us over the cliff. My mother was the child of two British citizens living abroad when born and could have claimed British citizenship if she chose. With a good lawyer and a great deal of money, I might be able to do so as well, but with Brexit, I’m not sure that would be much of an improvement to my current living situation.

We then boarded the bus and headed out into the country to a 16th century hacienda, lovingly restored as an event venue. The location, between the motorway and the aerospace factory, was not promising but the strategic placement of walls and the opening out of other areas to country views made it pleasant. An entertainment program featuring a flamenco dancing horse (I did not know they had such things) and an excellent leisurely tapas lunch followed. Then back to town where I used the rest of my afternoon to visit the Alcazar, the Royal Palace of Seville (and still in use as royal residence if the King comes to town). Very Moorish in its architecture and design but would be a trifle uncomfortable to live in as it’s nothing but stuccoed brick and tile. It has its own private gardens, walled off from the city parks that abut it. full of fountains, flowering trees and bushes. The plants remind me a lot of Southern California – oleander, lantana, jacaranda, bougainvillea, banyan trees and the like.

We passed a rather grim milestone today. The 665,500 US deaths over the last nineteen months means that 1/500 US residents has died from Covid-19. That’s 0.2% of the population. And does not include those who recovered but who still have significant health conditions. It’s roughly the population of Boston. It means that none of us has a life that has been untouched by the disease. All of us have now lost a family member, friend, or acquaintance. And still, a significant portion of the US population remains mired in a bizarre sort of denial. Denial of the disease, denial of the risks, denial of expert opinions. Here in Europe, denialism exists but is a fringe minority opinion. The majority accepts common sense advice like masking, hand washing, social distancing, and vaccinations as something we all do for each other so we can live as normal a life as possible. The rates are therefore somewhat lower here and, quite frankly, I feel like I am far less likely to run into issues here than at home. If I didn’t have patients depending on me, I might be tempted to stay on a while longer. I could get used to a life of 5 star hotels, cathedrals, chateaux, and a populace that actually culturally cares about each other.

Up on the bus in the morning and heading for the UK, or at least a little outpost of the UK known as Gibraltar. I’m betting the Gibraltarians wash their hands, wear their masks and keep their distance.

Dateline – Seville, Spain

Today’s leitmotif has been classic musical/film. We all had to get up at an ungodly hour in order to catch the early plane from Lisbon to Seville. I’m not sure why we didn’t just take the bus as they are only just over 200 miles apart. By the time we got through the flight process, arrived at our hotel in Seville and had lunch, the bus had arrived with our luggage on board and it was stowed away in our new rooms. The new hotel is also a five star Fancy Schmantzy called the King Alfonzo XIII and built to house the well heeled and dignitaries who came to Seville for their World’s Fair in 1929. It’s all marble and tile and Moorish influences although my favorite part are the original elevators, mirrored on all four sides giving a bit of a Willy Wonka vibe to trips up and down from the lobby. The room is comfortable. I have a room with a view (but no Cockney Signora manning the desk). And the bathroom has adequate water pressure in the shower. I am a happy man.

As I was standing in line in the Lisbon airport, waiting to board our prop plane puddle jumper, it was dark and foggy with a misty rain. I had my envelope of letters of transit from Lisbon – boarding pass, check – Covid clearance, check – entry card for Spain, check and all I could think was how Victor Lazlo can you get? Or maybe I’m Ilsa. I suppose it depends on the day. The short flight went without incident, although the rain in Spain was mainly on the plane and we were motor coached from the soggy Seville airport into the heart of the city. As we were sitting around the hotel bar waiting for our lunch, it occurred to me that I am making this trip with five married couples, a sort of Iberian bus and truck of Company. I wanted to suggest an impromptu of Side by Side by Side in the lobby, but I don’t think it would have gone over terribly well.

After lunch, a horse drawn carriage ride through the historic center of Seville, a town of Moorish influenced architecture, winding streets, pleasant public gardens with flocks of wild parrots chattering away in the trees, and a placid river. After the carriage ride, I spent a pleasant few hours just wandering through historic neighborhoods, poking into shops, and stopping for the occasional gelato. At the end of the day, as I was having my third gelato in the cathedral square as the sun was setting, I did some people watching and had a true Here We Are Again Leona Samish moment (and kudos to any of you who pick up on that obscure reference). We have a formal tour of the cathedral and some of the other historic buildings tomorrow so more on them later.

It’s been interesting comparing the general societal response to Covid measures here as they differ from home. Indoor masking is universal. Outdoor masking is common in crowded situations but isn’t done when just walking on the street unless you want to. People pop on their masks when approaching others or entering a building without fuss and there’s just a general sense of this is what we do for each other as we’re all in this together. The high rates of vaccination are leading to more and more relaxing of rules, but there’s no sense of a wish to race out and push boundaries, rather just one of cautious optimism but tempered with an understanding that things need to be studied and rules adjusted constantly around science and data. Meanwhile, at home, when the science is uncertain and recommendations revised as new data comes to light, people take those uncertainties as a failure of science rather than the result of the scientific method and instead of absorbing and coping with change, decide that their own preconceived notions or gut feeling must therefore be more correct. The latest thing to take off in domestic circles, oral ingestion of Betadine (iodine based antibacterial goop) as a prophylactic. Kids, do not try this at home. It’s highly toxic and we’ve got enough people in the hospital without adding more poisoning victims.

I shall have to change my shoes tomorrow. My usual walking shoes have worn soles and much of the pavement in Seville is of marble or polished cement. This, combined with rain water has made balance somewhat precarious and I really don’t wish to be rushed to Seville General with a head injury. My sneakers have decent tread so I’ll use those instead. I can see a need to take some of my own advice and having to pack a walking stick for cobblestones and other uneven ground in another decade. I’m thinking a gnarled wizard’s staff and a pointy sun hat to go with it. But now, I’m going to turn in. David Lynch’s Dune, dubbed into German for some reason, is on TV and that should be a proper distraction as I get sleepy.

Dateline: Lisbon, Portugal

High thread count Egyptian cotton sheets, a great mattress and a quiet room on the 10th floor of the Lisbon Ritz, far above street noise meant a good night’s sleep and up for breakfast and more adventures this morning. The intrepid eleven were on the bus at 8 AM and headed into the old part of downtown for a brief orientation to the city, and then a drive out to the port district of Belem for a stop at the national maritime museum (much devotion to the 15th and early 16th century Portuguese voyages of exploration launched by Prince Henry the Navigator) complete with a collection of the Royal river barges. Then along to the Palace of Ajuda, the Lisbon home of the Braganza dynasty of Portugal during most of the 19th and early 20th centuries until they were shown the door in 1910.

The Ajuda palace is contemporaneous with Buckingham Palace and has the same general neoclassical proportions. The state rooms are lovely, the banquet hall impressive, and the wandering around between various suites through the servants corridors gave a feeling of Downton Abbey mixed with The Crown. The Portuguese abolished their monarchy a few years prior to World War I, a little earlier than most of the rest of Europe, had a republic for a while and then a dictatorship under Salazar paralleling that of Franco in Spain. In the 1970s, Spain restored the constitutional monarchy. Portugal did not. I looked up the heir apparent should that happen. He’s a descendant of some second cousin of the last king, there being no direct line left. I don’t see him being plucked from obscurity and installed as a monarch at any time in the near future.

After the Ajuda tour, we were turned loose to spend the rest of the day as we wished. I wandered through downtown Lisbon for a while. Not all that different from the downtown areas of any other major world city, and then headed into the old quarter to see the cathedral and to climb the hill to the castle of St. George on the summit, begun by the Moors, and chief defense of Lisbon against invasion by both land and sea for several centuries. The cathedral was unimpressive. A rather blocky Romanesque affair without much in the way of decoration. The original cathedral was destroyed in the great Lisbon earthquake of 1755 and the one that stands was painstakingly rebuilt shortly thereafter to the original plan using what could be salvaged of the original materials. The castle was more interesting with its original fortifications full of arrow slits and murder holes and the like. The view from the castle over the town and the Tagus river were such that it was immediately obvious why it was such a strategic location. Walking up the hill, I stumbled across some partially excavated Roman ruins, part of an ampitheatre and a building whose walls were originally constructed as a public bath. I imagine that if they dig under the castle, below Christian, Moorish, Roman, and Phoenician layers, they’ll probably find some ancient Celtic or Iberian settlement. It’s interesting to think of places being continually inhabited and built upon for thousands of years when in most places in the US, it’s rare to find anything much more than 200 years old. Then, a long walk back to the hotel for a nap and dinner.

The news in Portugal today was that they have successfully vaccinated more than 75% of their population and should be up to 85% in the next month. Cases are falling and the government is relaxing outdoor masking mandates (but keeping indoor ones) and is allowing more and more types of businesses to open up. (Nightclubs are next, expected in another two weeks). We could be there in the US but we’re not. Alabama’s vaccine rate remains stuck at around 40%. I feel a lot safer here with mask and common sense than I do at home. I’ve been watching the continued debate over vaccination in the American press. It looks like the general consensus is that the government blanket mandating of vaccination is not overly popular due to the various bodily autonomy/civil liberties arguments. The Biden administration appears to have threaded the needle. They’re not mandating vaccination of all adults, they’re mandating vaccination of those employed by the federal government and those that receive funding from the federal government through contracts and programs. And that’s likely within their purview, especially given years of supreme court precedent. They are also mandating that work places be safe under OSHA. Companies with more than 100 employees have the option of either vaccinating employees or testing them weekly to protect other employees with whom they may come into contact.

The other consensus that seems to be gelling is that mandating vaccines to access life’s necessaries (the grocery store) is not necessary but that it is perfectly OK to mandate vaccines for life’s little luxuries (air travel, sporting events, theaters etc.) I think we’re going to be in for a year or two of carefully danced compromises like this where those who willfully do not choose vaccination will be tolerated but will find their lives more and more circumscribed. Is this a proper strategy? Only time will tell. It is likely to be accelerated by commercial health insurances demanding vaccination for access to their products. The thing that gets left out of this strategy is what to do about that small portion of the population that cannot be vaccinated for significant medical or other reasons. If we all stepped up and got our shots and had a 75 or 85% vaccination rate, then herd immunity would start to kick in and they would be protected without vaccination. With a 60% unvaccinated rate, this just isn’t possible.

Tonight. I’ll celebrate with the Portuguese at achieving their 75% milestone. But I’ve still got my mask, keep my hands washed, keep my distance, and had my vaccines.

Dateline Porto, Aveidra, Costa Nova, Pasaitas, Sintra and Lisbon, Portugal.

Today was a long day of bus riding down the length of Portugal from Porto to Lisbon with a number of stops along the way. You would think that would be an interminable journey, but Portugal is about 2/3 the size of Alabama so it was a slightly shorter drive than Birmingham to Mobile. It’s just as well as it was another night of somewhat indifferent sleep. Apparently Saturday nights in Porto are spent having drunken singalongs in the wee hours of the morning under other people’s hotel windows. I eventually figured out that housekeeping had not closed my windows properly behind the blackout curtains and when I was able to get that issue rectified, it quieted down somewhat. Although I could still hear the serenades and various other noises until about 4 AM.

After breakfast, all aboard the tour bus and the eleven intrepid guests on the tour, our guide, and the driver, headed across the Ponte Maria and towards points south. Our first stop, an hour or so out of town was the small town of Aveida. Close to the Atlantic coast, it has a series of canals which were used in times past to ferry sea products to storage and processing and now are a tourist attraction. We stopped, took pictures, used the facilities as necessary and then a little further down the coast to Costa Nova, a Portuguese fishing village which has now become a summer resort with all the fisherman’s cottages now painted in bright stripes and turned into Air B and Bs. Time to stretch legs. One more drive of a about an hour to another resort town, Pastais, which has a lovely beach, the usual shops and restaurants one finds in any beach town anywhere in the world. Stop for lunch – delicious Portuguese style salted sea bass caught fresh. (Also some sort of spice-pear upside down cake which was also very good).

Then another hour or so, with pretty much everyone sleeping off their post prandial torpor with the exception of the driver, and on to the town of Sintra, just west of Lisbon. Sintra is built on the sides of an extinct volcano (I imagine it belongs to the same chain as the Azores, Madeira, Vesuvius, Etna, and Santorini) and due to its height and its position near the ocean, it receives the Atlantic winds and is considerably cooler than the surrounding area. Here the Royal family and nobility of Portugal built their summer palaces, places to escape the heat, crowds, and plagues of Lisbon. We toured the Royal Palace, a hodgepodge of buildings built over six centuries so no wing lined up with any other. Beautiful tile work, painted ceilings and an enormous kitchen dominated by two huge conical chimneys that tower over the rest of the complex. As we drove into town and I saw the building, I immediately recognized it. My maternal grandmother had an etching of it hanging in her dining room when I was a child. I had completely forgotten that until I saw those unmistakable chimneys appear. I have no idea if Lisbon and Sintra meant something to my grandparents. They were European and certainly could have taken a holiday there sometime in the 1920s from the UK. It’s a story that never made its way down to me.

Then on to Lisbon, where we are staying at the Ritz, perhaps the poshest hotel room I’ve ever had the pleasure to be in. There appears to be some sort of diplomatic group from a French speaking African nation on my floor. Many distinguished gentlemen in expensive suits coming and going and a bodyguard parked on a chair in the hall just down from my room. While the interior is sumptuous, the exterior looks a bit like a 1950s girls’ dormitory from an undistinguished state college. I’m assuming the building was repurposed in some way from a more pedestrian use. The only issue this time around is the electronic lock on the door refuses to recognize my key. They’ve switched it out three times and it still isn’t working properly. I’ve locked myself out twice and the front desk is getting tired of escorting me up with the master. I heard someone futzing with it a while ago. We’ll see if it works in the morning or if I end up locking myself out again.

The Ritz overlooks a large city park. Parque Eduardo VII, named after Edward VII of England who helped strengthen the ancient English/Portuguese alliance (dating back to John of Gaunt’s daughter marrying into the Portuguese Royal Family) in the early 20th century. Currently, it is the site of the famous Lisbon Book Fair. If I had done my research properly and realized this was going on at the time I was here, I might have had some copies of The Accidental Plague Diaries sent over and handed them out. I couldn’t do that, but I did have a copy with me and could not resist running down and having some pictures taken with the signage.
It’s the weekend.

News from Covidland has been quiet and it’s late so I’m going to wind this up now. Spending a long day tomorrow exploring Lisbon, then on to Spain to Tuesday…

Dateline – Porto, Portugal

Today was lovely. Sunny, no humidity, not too warm. A perfect day for walking tours and boat cruising on the Douro. After my sleep of the dead, the night before, I slept a more normal amount of hours and actually managed to make my way down to breakfast. Portugal definitely works on a different schedule than America. I was finished with breakfast by 7:30, had some time to kill and went out for a bit of a walk. I’ve always loved walking in European cities. One would think that at 8 AM the streets would be bustling. Deserted… even the local Starbucks didn’t open until 9:30 AM. Some of this might have to do with it being Saturday but as Iberian culture breakfasts between 9 and 10, lunches around 2 and doesn’t eat supper until after 9 PM, my guess is they don’t generally get up much before 8:30 for any reason.

The first part of the morning was a walk with the group through the old town. The highlight was a stop at the Church of St Francis. The exterior isn’t much – undistinguished early gothic with a bunch of clashing baroque additions, but the interior is a rococo fantasy of carved wood with every available service covered with gold leaf carried back from Brazil in the 16th and 17th centuries. The estimates are about half a ton of gold in total. It’s no longer used as a house of worship, just as a structure to be admired. I liked it very much but the choice of piped in music was a tad odd. (I got why Schubert’s Ave Maria but it was followed up by the William Tell overture and the Waltz of the Flowers.) Then further down the hill to the Douro riverbank and on to a boat to see all of the bridges from the river’s mouth to the highway bridge somewhat upstream of town. After that, on to one of the ancient port wineries on the other bank of the river. The one we toured was Taylor’s I’ve been to lots of wineries in my time but this was the first time I’d been in one in continuous operation since the 17th century. The process of creating port is somewhat different than table wine involving the adding of brandy very quickly in the aging process to stop the oxidation, and a major reason why port is about 20% alcohol compared to the usual 12% for table wine. Lunch at the winery accompanied by a Fado concert. (Think Edith Piaf songs of longing but sung in Portuguese and accompanied by guitar). Then back to the hotel, some shopping and sitting in sidewalk cafes people watching before turning in. Up relatively early tomorrow again as we make our way to Sintra and then to Lisbon.

I would be remiss if I did not note that this was the twentieth anniversary of 9/11. I have very confused emotions about that day and its images due to its interconnectedness with my own private grief. Steve had died on August the first of 2001. It was not unexpected. He had been quite ill with his interstitial lung disease for some time and I had been taking care of him at home along with his paid caregiver Tameka (who was there when I was at work) and hospice services. When his battle was finally over, I decided to take two months off of work with a planned return on the first of October. I wrapped up the affairs that I had to right away, and then I loaded the car and headed out of town. I had no specific itinerary. I’d just been cooped up in the house for a couple of years in my 30s, unable to go much of anywhere other than work. I made a long meandering drive cross country, using the opportunity to connect or reconnect with various friends, eventually ending up in Southern California where I scattered Steve’s ashes in the Anza-Borrego desert (his favorite place on the planet). Well, there’s a very long convoluted story about that which I’ve written up before and which I won’t repeat now. I then headed north to Seattle to spend some time with the family, arriving in early September. I was staying at my brother’s house, sleeping in. He was at work, my sister-in-law was downstairs with my then two year old niece dealing with toddler breakfast things and she flipped on the news. Shriek and then yells up the stairs that I had to get up and see what was happening. She and I stayed glued to the television all morning, watching the drama unfold as the towers burned and collapsed.

Over the course of the next week or so, I flew to Alaska to see my old college roommate (I had been slated to fly out on the 12th but of course that didn’t happen), drove back across the country and ended up in Manhattan about two weeks later. The haze was still in the air. The flyers were still affixed to walls. The smell, a mixture of burning electrical systems and pulverized stone was endemic. I mourned for Steve. I mourned for the ugly scar in my beloved Manhattan. I mourned for the thousands dead and tens of thousands whose lives were uprooted by the tragedy. Even to this day, I cannot separate my grieving for Steve from my grieving for the country. I had hopes that such a national tragedy might unite us and make us stronger. Instead, as we all know, those sentiments were hijacked by the military industrial complex into fruitless conflicts across the globe which made elites wealthy and drained national wealth away from poorer classes helping exacerbate the economic conditions which leave us so riven.

I was wondering today what Steve might have made of this trip. He would have complained about the food (fortunately, McDonalds is close by and I could have sent him there). He would have complained about too much walking on cobblestones. He would have loved the weather and the boat ride. He could have done without the winery. He was seventeen years sober when I met him, and thirty years sober when he died and was prouder of that accomplishment more than anything else. Tommy, on the other hand, would have loved the winery. He never passed up a winery or a wine tasting if he could help it. As a super taster, he could identify all of the notes in a good wine. I can’t do it and he would always make fun of me for that genetic imperfection. The only time I remember him having an issue with wine was on one of our trips to Northern California. We drove up to Napa. He was having a snit about something (at this point I have no idea what) and, even though we stopped at several wineries, I could barely get him out of the car and he was sullen in the tasting rooms. Even a little alcohol in the system didn’t help. He made up for it on other trips where we went out of our way for Washington and Oregon wineries and Biltmore Vineyards in Asheville was a habitual stop.

Enough for tonight. On to the morrow. I have my hand sanitizer, my masks, and my CDC card all ready to go in my day bag.

Dateline – Porto, Portugal

Having access to my CPAP last night plus two nights of poor sleep kicked off a chain reaction and I ended up sleeping for nearly fourteen hours. Fortunately, I had nowhere I needed to be or things I needed to do today so sleeping in and then some wasn’t a particular problem. I finally did bestir myself, was somewhat shocked by the time, and made myself move and get out out doors. The weather was pleasant. Yesterday’s rains have gone and we have blue skies, but the weather is still relatively cool in the 70s so it’s not too hot to amble about. The first order of business was brunch, a traditional Portuguese combination of espresso, port wine, custard tarts and something that I decided was a combination of deep fried seafood and potatoes. The server’s limited English precluded my being able to discover more. It was perfectly palatable whatever it was.

I headed in a different direction, up the hill to the cathedral, the oldest extant building in town, dating back to the 12th century and Romanesque in style as Gothic arches and flying buttresses had not yet been invented. they came along a century or so later. Impressive but not as fancy as some others I have been to. I have always been impressed by European medieval cathedrals. They were generally built over the course of centuries, mainly by individuals who knew that they would never see the completion of their work but who kept at it through war, famine and plague, for their love of God, culture, and their fellow humans. We could take a lesson or two from them. There’s more to life than that which gives us immediate gratification. Then, across the top of the Ponte de Dom Luis I which I had seen from below yesterday. Lovely views, a major plunge to the river far below, and a chance to marvel at the combination of beauty and ingenuity that those of the late 19th century brought to wrought iron. Some exploring of back streets, accompanied by generous helpings of gelato and an occasional glass of port and then it was time for dinner and a gathering of the tour group.

Cocktails and dinner with the ten others (five couples roughly five to ten years older than I) with whom I will be spending the next two weeks. They all seem pleasant enough. Three of the couples had met on a previous small group tour with the same company in Italy a few years ago and had old home week. It looks like we will all be compatible as we spend the next few weeks together in various hotels, busses, airplanes, museums and the like. I am odd man out, being companionless, but I learned long ago how to be the extra man in polite society so I don’t think it’s going to be an issue. Dinner, at the hotel restaurant, was quite good. I had salmon, well cooked but I suspect farm raised rather than wild caught. Being from Seattle, one just knows these things.

I have been watching the reaction to Biden’s pronouncements on Covid control and vaccination with some interest. I turned on the local Portuguese news to see what they might have to say, but found that my understanding of spoken Portuguese was wholly inadequate to the task and had to resort to various internet news sites instead. The reactions from the Republican party and conservative governors, including Governor Meemaw in Alabama were wholly predictable, mainly of the third grade ‘No one is going to tell me what to do’ variety. I understand that argument, believe me I do. Bodily autonomy is fairly sacrosanct in terms of cultural mores, the legal system, and medical ethics. Having a governmental entity step up and say ‘Thou must’ is a significant issue. The question is, of course, where do you draw the lines when your choices in bodily autonomy are causing other people to get sick and die. Does the protection of those individuals and their bodily autonomy and right to life start to outweigh your personal beliefs and choices? In terms of vaccination, I thought we had settled that a century ago in the Supreme Court’s Jacobson decision of 1905. In that 7-2 decision, the court ruled that the state’s role in protecting others trumped the individual’s right to refuse and that vaccine mandates were permissible. We’ve been living with them for years and no one has been too fussy at the wiping out of smallpox, polio and a host of other feared diseases over the course of the 20th century.

The decision by various forces to politicize the Covid vaccine as a weapon for partisan purposes is something that’s a bit new in American politics and I can’t say I’m in favor of it on any level. If there were any proven extreme dangers, I could understand the trepidation but there really aren’t. Various people state that the VAERS database is full of underreported complications but if you look at it, it’s a database to which anyone can report anything without any vetting and I would suspect that a significant portion of the negative reports are there for political, rather than for medical purposes. There have been roughly 200 million doses of vaccine administered in the US over the last eight months and the number of serious complications that can be directly related to the vaccine is very, very small. On the same order of magnitude as being struck by lightning (1/500,000). That’s 400 serious complications for 200 million doses for those of you who aren’t so good at math.

My publisher continues to be happy with the book’s performance. Apparently it has been picked up by Target. I don’t know if that means it will be available at one near you or if it’s just going to be available through their website, but it does mean more exposure. There’s been a bit of a hoorah in the press about Amazon. The majority of their best seller titles for vaccination (one of my categories) are books full of misinformation and downright lies. This means, of course, that a lot of people are looking at the category and perhaps they shall see a new book with a sage green cover and some interesting pen and ink art of a medieval plague doctor and decide to add it to their carts while they are there. It’s all good. I’m not in this to get rich or hit a best seller list, but I do think there’s some good and rational perspectives about our trying times included that might help others sort out what we have to deal with.

I have to get up tomorrow for a walking tour (likely covering things I have already visited) and a boat tour up the Douro to a port winery complete with tastings. I shall wash my hands, wear my mask, and keep my distance while boarding.

Dateline – Porto, Portugal

Today was a very Seattle in the summer day. Low overcast with temperatures in the high 60s/low 70s – perfect for urban walking in the morning and early afternoon with drizzle and winds beginning mid-afternoon with the rain getting stronger and stronger around dinner time. I have no objection to rain, even on vacation. No native Seattleite does. If we fussed every time it turned gray and drizzly, we’d never get anything done in that corner of the world. Just pack your rain gear and go do it anyway. The rain showers were likely pushed this direction by hurricane Larry and my reading of the weather map shows sunshine coming the next few days.I got up relatively early this morning, at least for me on vacation, and was out on the street by 8 AM. My body hasn’t quite figured out what time zone it’s in. That will take another day or two. The fact that my CPAP was in the lost luggage didn’t help. I kept waking up last night unable to breathe properly. I don’t know which of my ancestors gave me the genes for a soft palate that won’t stay elevated when I’m asleep but I have a few choice words for him or her when we meet in the afterlife.

My first stop on my self guided walking tour was Igreja dos Clergios, an 18th century church on top of the hill just beyond my hotel with a three hundred and some foot belfry that you can ascend for views of the entire city. I had hoped that in some 20th century renovation they might have installed an elevator, but that was not the case and I marched up and down all 216 steps (yes, I counted… I do things like that). My lungs did not like me on the way up and my knees did not like me on the way down. The church was lovely. The view was great. The family of selfie taking teenagers from somewhere in the South of France (judging my accent) were not good company.

From there, a ramble through the old down to the riverfront. Porto is built on the Ria Douro (which means River of Gold if I’m learning my Portuguese correctly). We’re very close to the Atlantic coast, a mile or so away. I’m assuming the Romans, who founded the city about 2300 years ago, decided that having it upstream a bit on the estuary protected it from Atlantic storms. The Douro snakes across the Portuguese countryside and into Northern Spain. There are week long boat tours up and down its length, but not for me this trip. The waterfront is dominated by an enormous wrought iron bridge, Ponte Dom Luis I which was designed by Eiffel and various other compatriots in the late 19th century. The old city is a UNESCO world heritage site and most of the buildings are 18th and 19th century with baroque detailing and painted tiles. A number are abandoned as the population moved away to the suburbs but, as in Birmingham, a new generation is discovering the positive things about living in reclaimed urban space and there is renovation happening everywhere. Out of curiosity, I stopped at a real estate office. I could afford a loft here but I don’t think retiring to a country where I know no one and don’t speak the language is the best of ideas.

Back up the hill from the river and more wandering through commercial and shopping areas. There was quite a line up outside of one establishment, something one rarely sees at bookstores. Then I realized that this shop Livaria Lello was a hangout of J.K. Rowling’s when she lived in Porto and was the model for Flourish and Blott’s in Diagon Alley (and used as the location for the film). It’s dominated by a gorgeous Art Nouveau staircase and central skylight. Of course I had to go in and I bought a copy of the first Harry Potter book in Portuguese and Camus’ The Plague in the original French. I’ve been meaning to read it all year and I’ll be interested to see if my rusty French is good enough for me to get through it without Larousse at my side. More window shopping and then, as the rain was strengthening, dinner al fresco in a sidewalk cafe accompanied by several classes of the local port (named after the city and where the grapes are grown and the wine manufactured). I returned to the hotel to find that my errant luggage had returned from its romantic tryst in Paris so all is well with the world on this Thursday evening.

Nothing major going on in the world of Covid around here. The only issue I’ve run across is that sit down restaurants are starting to demand vaccine passports on weekends (at least for indoor dining). The unwillingness of the US to do such things means I cannot easily get one. I do have my vaccine card and I can get an instatest if need be. It shouldn’t be an issue as I am in the hands of Tauck tours as of tomorrow at 1800 and they take care of all that. Looking at America from a lens of several thousand miles, I noticed that Jim Jordan tweeted that ‘Real America is done with Covid-19’. That’s nice Jim, because Covid isn’t done with America. The numbers keep escalating, the health system is buckling, the schools are a shambles, and all because a once great political party decided to kowtow to science denialism and anti-intellectualism just so they could be against what the other side was for. The Biden administration is tired of letting that minority destroy lives, public health, and the economy for no particular reason and, as I write this is coming down hard with some new mandatory vaccination policies. Cue the howls of outrage in 3…2…1

Bedtime for Bonzo. I haven’t figured out what I am doing tomorrow day yet. I’m going to play it by ear. But whatever I do, I have my mask, I have my hand sanitizer, I don’t crowd up on people I don’t know, and I have had my vaccines.

Dateline – Porto, Portugal

International Travel in the time of the Delta variant. I wouldn’t have booked this trip last spring if I had any idea of what was going to happen over the last couple of months but I did and when push came to shove, I decided Europe, where the population still believes in basic public health measures and community values was likely safer than the rural communities of North Alabama that I make my house calls in so here we are. My general takeaway from a twenty hour travel day involving four airports, three flights, two continents, and one set of lost luggage? Europeans are much better at universal masking than Americans, no one fusses about it, and everyone fills out a whole lot of paperwork so the authorities can find you and get you tested if you’re determined to have been in close contact with an infected person. Testing and contact tracing are believed in as general public health tools that have been used for centuries to mitigate epidemic disease rather than as some sort of impingement on ‘freedom’.

I arrived at Birmingham airport yesterday afternoon with plenty of time to spare just to give me some breathing room in case anything went wrong with my sheaf of travel and health documents. The lady at the Delta counter was very nice but thoroughly confused as to what I needed to have for the various legs of my flight as the rules keep changing and they no sooner get training in how to assist passengers then it all proves to be out of date. Bags checked through to Porto, a quick snack and then the hop to Atlanta for the trans Atlantic flight. We board in Atlanta and get settled in our seats. At takeoff time, we don’t – instead of phalanx of maintenance guys come down the aisle bearing mops. Not a good sign. The intercom comes on in English, and then French with a Chinese accent (my French is pretty good, but I could barely make out every fourth word. The flight attendant responsible for the French announcements was a native Chinese speaker and some of the pronunciations were quite new to me…) One of the aisles is dripping with water and we’re not going anywhere until the source is found and it’s cleaned up and repaired. The mop guys figured out the problems pretty quickly, a broken water line in one of the lavatories and not something that was going to bring the plane down, replaced a section of the aisle carpeting and we got underway an hour late.

The long flight was uneventful, save for a closed lavatory on the opposite side of the plane, and we arrived at Charles De Gaulle airport in Paris safely, just an hour later than planned. That took my two hour layover down to one hour and it was a quick sprint through a maze of tunnels and concourses to find the domestic terminal. The only real issue being that the airport is designed so that you exit the secure area on leaving the international terminal and therefore have to go through security screening again. Fortunately, the line was moving without too much difficulty. On to the next plane for a flight over the Pyrenees from Paris to Porto. Unfortunately, I did not have a window seat so I didn’t get to see very much. Porto airport looks like every other midsize city airport you’ve ever been in. Down to baggage claim to wait for suitcases that never arrived. All of us who had been on that trans Atlantic flight, about ten of us, were luggageopenic. Apparently the late arrival kept the Delta carts from interfacing with the Air France carts or some such. I have a feeling that anyone who had less than a two hour layover that was on my transatlantic flight arrived at their destination sans baggage. Large crowd at the baggage office to register our missing bags (all apparently happily spending a night in Paris) and I have been told they will be on tomorrow’s flight and delivered to the hotel – unless the flight is late in which case they’ll show up on Friday. As I’m here until Sunday, it’s all good.

I was met by a lovely young man with a luxurious Mercedes who drove me from the airport into town and to my hotel, the Intercontinental, right in the middle of the old city. I got to my room, threw open the curtains and discovered that my usual luck was holding. I have a lovely view of the construction site next door. As I had no clothes other than the ones I’d been wearing for thirty six hours and had slept in, I located the nearby pedestrian shopping street, wandered up there, and found an H & M and a Benneton which supplied the basics for the next few days. The only thing in the suitcases I’m going to miss is my CPAP machine, too bulky for my carry on. Ah well, I just won’t sleep as well tonight as I might otherwise. I haven’t seen a lot of Porto yet. I’ll take care of that over the next couple of days. It appears to be a pleasant enough small city, full of baroque building covered with decorative tiles and with red tile roofs being the order of the day. Lots of tourists so plenty of different languages on the street. I can understand the English, French, some of the German, and some of the Spanish I’m hearing. I haven’t figured out the Portugese yet. I can read it without too much trouble but I haven’t figured out the rules of pronunciation.

I’m going to bed early this evening and will try to sleep as well as I can and that should adjust me for the rest of my sojourn.Be like the Portugese – wear your masks, watch your distance, wash your hands, get your shots.

It’s a double holiday today. Happy Labor Day and thank the union members of earlier generations who fought and died for weekends and the forty hour work week. Union membership as a counterweight to capital built the middle class in this country and it’s no accident that the decline of unions following the Reagan administration’s union busting tactics and successful campaign of rebranding unions as parasites in the eyes of voters parallels the decline of the working class into impoverishment. In addition, La Shana Tova to all of the members of the tribe out there. As a proud Unitarian Universalist, I’m happy to celebrate any religious tradition’s holiday that comes along. As we enter the year 5782, I have lots of things to look back on and lots of things to look forward to as well.

The most immediate one is I think I’ve made it through all the hoops and should be able to leave on vacation tomorrow. Fully vaccinated? Check. Negative Covid test yesterday? Check. Passport still in date? Check. Compression socks to keep the legs from swelling? Check. Forms filed with the Portugese Government so that they can track me down if the wrong person coughs on me on the trip? Check. I still fully expect something to go wrong and be turned back at one of the four airports I need to pass through in the next thirty six hours. But no one can say I won’t have tried. There’s a piece of me feeling very guilty about not having voluntarily cancelled this trip, booked in the heady optimism of last May when everything was improving on all fronts. Am I flaunting my privilege? Is it irresponsible of me to be traveling, especially by air, while Delta is running rampant? I’m not especially worried about being exposed during the trip. The tour company is mandating full vaccination for all guests and staff and, given the way things have been going around here, I’m likely less likely to be exposed in the museums and cathedrals of Iberia than I am in the local Wal-Mart. Travel journaling plus a look at American society and politics with an outside perspective should commence soon. If I don’t make it successfully, I’ll take some pictures off my back deck with the cats and we can all pretend they’re exotic.

I had dinner with Tommy’s parents tonight. We stay in touch and see each other every few months. They’re good people and we’ve worked out an appropriate friendly relationship now that Tommy is gone. Actually, I’ve always gotten along better with his parents than he did in our time together. I think deep down he wished that they had been a different kind of people, maybe more like my parents where I have always been perfectly happy to accept them and meet them where they are. I gave them a copy of the book. I wonder what they’ll think of it? They aren’t on line so they haven’t read any of the material before. I warned them that they might know far more about me than they want to know by the time they finish it.

On the way to and from their house, I had the XM radio on the 80s station and they were rebroadcasting a special they did last month celebrating the fortieth anniversary of MTV which began broadcasting August 1, 1981 with, as every trivia afficianado knows, the video to the Buggles’ Video Killed the Radio Star. All of the surviving original VJs were participating along with artists whose videos were played that first day. I didn’t see MTV at its debut. On August 1, 1981 I was floating somewhere in the Bering Sea on the University of Washington’s research vessel running water sampling equipment. I arrived back in Seattle a week or two later and did some odd jobs before heading to California and my sophomore year at Stanford. My parents didn’t have cable, so the early cable channels were something I enjoyed when visiting the family home of my college roommate Craig Mollerstuen, whose father was an executive in the Silicon Valley tech industry and who had all the latest gadgets. I do remember catching MTV with him, his younger brother David Mollerstuen, and a few others in their family room lat that summer and early fall. The songs they featured: Rick Springfield, Huey Lewis and the News, Men at Work, and all the rest immediately take me back to my undergraduate days, a period of time I enjoyed immensely. I also remember having quite the crush on the young, cute blond VJ Alan Hunter, never dreaming that our paths would actually cross about a quarter century later.

We all lay down the soundtrack of our lives from about the age of 11 to 25. I read somewhere that the pivotal year is the year we are 14. Whatever we are listening to at that time is what we carry in our brain as good music for the rest of our days. When working with my dementia families, one of the things I encourage them to do is figure out what the patient’s musical life was like at that stage and then get recordings of that music and keep them handy. When they’re getting restless or agitated, put that on and encourage them to sing along. It usually works and it’s a lot safer than antipsychotics. For my patients that grew up country without a lot of recorded music exposure, it’s the old hymns in traditional arrangements that work best. For those who had radios, Big Band, Frank Sinatra, Jo Stafford, Patti Page, Dinah Shore and others of that ilk. When I become demented, which I sometimes feel could happen as early as next week, people better start putting together a mixtape of 70s-80s pop, classic Broadway, the great American songbook, and symphonic music of the Romantic era, especially Tschaikovsky.

I’m going to try and get some decent sleep tonight as tomorrow night is a redeye flight and I doubt I’ll get a lot. Got my masks, got my hand sanitizer, got my shots, and I’ll try not to get too close to anyone.

We’re inching up on forty million confirmed cases of Covid-19 in the US since the pandemic began about 18 months ago. Over the last four weeks, there have about 4 million new infections and about 27,000 deaths. We’re not quite where we were last winter when no one was protected by vaccines but we’re rapidly approaching it, and have certainly surpassed it in the Republican states that have decided basic public health measures are somehow un-American. Florida, of course, continues to lead the way with numbers blowing last winter out of the water and Texas isn’t far behind. Alabama is not doing well, but at least our governor is taking a laissez-faire attitude towards tried and true means of spreading infectious disease rather than actively campaigning against them. The 7 day average for cases in Alabama is now about 15% higher than it was at the peak of the winter surge. How that’s going to translate into hospitalizations and mortality in a month or so remains to be seen as it’s unclear to me how many of those cases are in at risk for serious complication populations and how many are breakthrough cases in the fully vaccinated.

The resident I took on my rural house calls rotation today just came off the medical intensive care service and had a couple of interesting things to say about it. Last year, the residents did not work with Covid cases. Before the vaccine, we were not about to risk the health and lives of young people just beginning their careers. Now that health care workers are vaccinated, the risks are much lower and the house staff are working with those patients on those floors. This young woman mentioned that all she took care of during her month of ICU was Covid. She felt good about handling those individuals but feels that maybe she was cheated out of learning about other medical conditions that require intensive care, everything else having been crowded out. She also was very interested in the family dynamics of the people she treated. The majority were in their forties and fifties, previously healthy, and, therefore, had not given thought to their mortality and prepared no advance directives and had no discussions with their families about such things as code status, CPR, or final wishes. Time and again she found herself in the waiting room with their children, mainly high school age to mid-20s asking them what should be done and these young people not really being able to comprehend what was being asked of them. They almost always said ‘Do Everything’ because it’s their understanding that they should have their parents until they themselves are comfortably middle aged and they can’t imagine being young without them. They don’t really comprehend that ‘Do Everything’ in an ICU situation with a disease that destroys the lungs rarely turns out well for anyone concerned.

I was wondering what I should write about this evening when I ran across yet another news story about ivermectin, the antiparasitic drug that has caught on as a treatment for Covid-19. In this particular column, the author was talking about people getting the veterinary version as a topical paste, diluting it with water, and then injecting it. The trained physician in me just shivered as there’s so many things wrong with that approach that I don’t know where to begin. Perhaps they’ll start rubbing it into their eyeballs next. As I believe I wrote earlier, there is good scientific evidence that ivermectin blocked replication of the virus in the laboratory. Experiments to show what dose might be appropriate in a living human and whether it has that same effect in living tissue rather than in cell culture have begun but have not yet produced any data that would allow the FDA or any other regulatory body to approve the drug for use in the treatment of Covid. These experiments are in process and, if they show promise, I’ll certainly write about it at that time. In the meantime, ingesting topical horse paste or injecting dewormer mixed with tap water is a really bad idea. There are a number of people in ICUs nationwide with liver failure from ivermectin toxicity, taking up those few beds not occupied by Covid patients. And take it from a physician, dying from liver failure is not a pleasant way to go.

Physicians, with our ceremonial robes of the white coat, descend from the priesthood. We are the intercessors with the gods and with fate who miraculously restore the balance of the world through the healing of the individual. As George R. R. Martin put it, ‘What do we say to the god of death? Not today…’ As these age old archetypes have come down to modern America, a little of the idea of healing magic has continued to cling around the edges. We’re a very literal people so we like our magic to take physical form so we embody it in the prescription. Most healthy people, when they have need of medicine, have developed an acute illness or complaint that has some sort of reliable cure or amelioration. If we’re going to take a day off work, drive downtown, spend twenty minutes trying to find a parking space in the over full deck, wait while the doctor is running an hour or more late thumbing through an old Golf Digest, and then sit in a too cold exam room in our underwear, we figure we better get something for all that inconvenience or we’ve wasted our time. The prescription in part of the deal and its implicitly understood on both sides of healer and patient. We therefore tend to imbue the prescription with supernatural powers for good and we carry that idea of medicine is a good thing with us throughout our lives. When this gets mixed in with our cultural ideal of the quick fix, we lose track of what medications actually are. Medications are controlled doses of poisons.

What is a poison? A poison is a substance, which when taken into the body, alters that body’s balance and physiology to a negative end result. A medication is a carefully measured and tested substance, which when taken into the body, alters that body’s balance and physiology. It’s more or less the same thing, only with medicine you trust you aren’t going to get that bad thing happening. Some medications are literally poisons. The most famous example is the drug warfarin (brand name Coumadin) which is used as a blood thinner. It’s called warfarin because it was developed at the Wisconsin Army Research Facility (WARF) – it’s intended use when first invented? Rat poison. In the 19th century when medications were not regulated, people were poisoned and died from them all the time. The public outcry during the progressive era is what led to the creation of the FDA to begin with. It coincided with the Flexner report that helped to standardize medical education and society accepted that only trained individuals should handle and dispense medications as they could be dangerous in untrained hands which is why physicians, nurses, pharmacists and the like all have to go to school for a very long time and pass innumerable exams to get licensed. Every state in the union has a vested interest in making sure that even controlled doses of poisons are used judiciously with appropriate understanding – something one does not find in social media groups of people hawking outlandish cures.

The biggest issue I have with medications as a geriatrician is in convincing older people that sometimes deprescribing is better than prescribing. Older people, as they sail through life, collect up various ailments and disease processes. It’s inevitable. With access to Medicare and an almost unlimited number of specialists, they also collect up any number of medicines to treat these, or the side effects of the original medications (controlled doses of poison, remember…) Sometimes you need to put the ship in drydock and scrape a few of the barnacles off. Geriatricians are comfortable with this. Patients, their families, and most other doctors are not. There was a great experiment done a few decades ago using family practice residents. The residents sent their older patients to a geriatrician who would then make recommendations for care and send them back to the resident for implementation. Residents are young, impressionable, want to be the best they can be, and take their elders ideas and ideals as gospel as they prepare to move up in the world. You could see this in this experiment. If the geriatrician suggested that the resident start a new medication, they did this more than 95% of the time. However, if the expert recommendation was to stop a medication, the resident would only do this about 30% of the time. They would not deprescribe. Deprescribing is antithetical to how we are trained to think as doctors and it’s a concept that’s difficult for a brain, trained to hone down through a differential diagnosis to find just what the problem is an just the right medication to fix it, to wrap itself around.

As the baby boom, with its generational love of substances of all types, continues to age, becoming more and more geriatric by the year, it’s going to become even harder for I and my colleagues to keep people out of trouble. Not only do we have to worry about medications, we have to worry about substance use, over the counter medicines, herbal and other natural remedies, things hawked on late night infomercials, and stuff they borrowed from the neighbor which may or may not be appropriate for who they are. The average older person takes seven medications daily (four prescribed, three over the counter). There has never been a controlled study published in any language on a human body with more than three drugs circulating in their system at the same time. It’s too hard. We have no clue from a scientific point of view what’s going on in someone with 7…9…16…22…37 medications entering the blood stream daily. That’s the art of medicine and it’s more medicine Jackson Pollock than medical Rembrandt.

It’s late. I have an early morning meeting. You know what comes next. Wash your hands. Wear your mask. Keep your distance. Get your vaccine.