Dateline Boise, Idaho

I’m definitely back in the West and heading into old stamping grounds. Today’s drive wasn’t difficult. Starting in Southwest Wyoming, along Interstate 80 over the border into Utah and then threading through the various canyons and mountain ranges outside of Ogden and up into the Snake River country of Idaho until reaching the flat river valley of the Boise River and the city of Boise itself.

Thirty five years ago, I spent a summer in Boise with a couple of wild women doing my OB/GYN clerkship. We lived together on the upper floor of an old house containing a local OB/GYN practice and spent our time catching babies at St Luke’s hospital and observing gynecological surgery at St Al’s across town. The house is still there. The practice is not. (It dissolved not too long after our summer there – we medical students had ferreted out the inappropriate relationship between one of the partners and the office manager. We weren’t going to say anything but we did make bets about how long that was going to go on before it caused an explosion). I don’t remember too much about downtown Boise from that summer. It was hot. The downtown area was tired and old – feeling stuck in a decaying 1950s-60s. The Boise of today appears to be in growth mode, like a lot of older cities. Much of downtown has been redone with new restaurants, bars, hotels and businesses and the millennials are flocking to new housing units in old buildings. A block away from my hotel is ‘The Basque Block’ a collection of Basque restaurants, a Basque grocery, the Basque cultural center, and some upscale watering holes. I had a very nice dinner and drink under a large Basque flag.

As I was sitting there looking at the millennials having their dinner and drinks, I couldn’t help but wonder if I helped deliver any of them. All those babies are turning 35 this summer and are likely parents themselves. I also wondered what I might say to 24 year old Andy if I were to meet him coming down the street. If he would even begin to believe some of the twists and turns that life was going to start throwing his way shortly after that summer. I doubt I would have believed any of it. At 24, I was just trying to get through medical school with sanity intact and wasn’t really thinking about much else. Highlights of that summer were innertubing down the Boise river, and a side trip to Yellowstone and the Grand Tetons. The actual OB/GYN work was not a highlight. Although I did like playing with the newborns. I just wish I hadn’t had to send some of them home with their parents who were obviously unequipped for the rigors of child rearing.

One more driving day tomorrow and should be in Seattle in time for dinner.

Dateline Rock Springs, Wyoming

I don’t know what was wrong with me yesterday, but ending my driving early, going to bed and sleeping for ten hours was the right decision as I felt pretty much back to normal today and had no difficulty with today’s long drive of over 600 miles. My initial thought was to cut back down to Denver and cross through the Rockies on I-70, but then I checked the weather report which announced a significant winter storm in central Colorado with up to foot of snow so I decided that might not be the best of ideas so I stayed on I-80 through Nebraska and in to Wyoming. It started to snow as I passed through Cheyenne and continued to do so through the mountains surrounding Laramie but it wasn’t more than a dusting so it didn’t cause too many problems other than a little bit of issues with visibility – the entire world being reduced to shades of gray and white between snow, cloud, and mountains. It was all over, by the time I hit the Continental Divide and I coasted on in to the exciting town of Rock Springs Wyoming without incident.

I can’t say a whole lot about today’s drive as it wasn’t terribly exciting. Western Nebraska was flat and the highway seems to continuously cross various branches of the Platte River (so named after the French word for flat). It’s a steady incline in elevation over the miles, barely noticeable, and then, you’re in the mountains of Wyoming and going over passes at 8,500 feet. On the other side of the mountains comes miles and miles of high plains scrub land full of sagebrush and sweeping skies and only needing Clint Eastwood to complete the picture. I have two days of driving left to Seattle. I’m not sure which route yet. I’m going to check out weather maps and such tonight before making a final decision.

The news from Covid land today was not good. The CDC experts are despairing of the US population achieving anything like herd immunity due to the political unpopularity of vaccines in certain quarters. What does this mean? It means Covid is likely to be with us for years, decades, permanently. I don’t think we need to panic about this as individuals. Those with a belief in science and a couple of hundred years of epidemiological understanding will be OK. Amongst those who don’t, or who belong to less privileged communities that are more difficult to reach with vaccine and the like, the disease will continue to spread and pop up in epidemic fashion and we’ll continue to see serious illness and death, but not in the numbers of the last year. It didn’t have to be this way, but that’s the political reality we have to live with.

I’m starting to get a little worried about the next couple of election cycles. The speed with which the Republican party is trying to whitewash the Capitol Insurrection and various other criminal enterprises combined with a complacency amongst the Democrats now that vaccines are distributed makes me think that maintaining congressional majorities is going to be difficult. And, if there is a shift in power at the midterms, all of the social trends that have led to an anti-science/anti-knowledge/anti-enlightenment approach to governance will come roaring back emboldened and who knows what sort of national problem they will intersect with to cause some other sort of disaster. Rant over.

Time for some bad TV and sleep.

Dateline Grand Island, Nebraska

The headache went away but I still wasn’t feeling great this morning when I headed back down the road. After a few hours, it became clear that my original plan to haul myself all the way to Denver was not the best of ideas as it would require more driving hours than might be good for me and I would rather not fall asleep at the wheel and run off the road if I could avoid it. So, I ticked off the Kansas towns as they went by – Topeka, Junction City, Salina… Looking ahead on I-70 it became pretty clear that by the time I hit the high plains of Western Kansas and Eastern Colorado, there would be a paucity of population centers and Hampton Inns so I turned right at Salina, headed up through Kansas and Nebraska farm land, and stopped early for the night in Grand Island, Nebraska for a nap before dinner and family Zoom night conversation afterwards.

Not much to say about the Prairie. It goes on forever and is very flat. Most of the fields visible from the highway are beige spring stubble giving it all the sepia tone of the Kansas sequences from The Wizard of Oz. I can’t say much about Grand Island other than its the home of the Nebraska State Fair and, was one of the heartland towns that had a terrible Covid outbreak earlier in the pandemic. I’m keeping away from the natives, snuggled up here in my hotel room as it begins to rain, the bolts of lightning vying with the green and red of the Applebee’s sign that dominates my view for the attention of my visual cortex.

I don’t think I’ve got any good stories about driving across the Great Plains. Tommy and I never did it together. Steve and I did it more times than I care to count. Amongst other things, he was a genealogist who kept himself busy tracing all of the Spivey descendants from the three Spivey brothers who originally immigrated to the Ashville, NC area in the 1760s. We would pack up the truck and head out for a couple of weeks in the courthouses of the Midwest and Appalachia looking for clues. He did the driving, I read to him. In later years, when I had routine work in DC, he would come with me and we would rent a car and head south, removing the need to cross the empty quarter of the continent. This was all before GPS and smart phones and there would be any number of fights over the large road Atlas as we tried to figure out the best way to get to some small county seat in Arkansas or Tennessee or Kentucky. During one of these trips, late in the year and I can’t remember where we were going or why, we were driving along I-65 through Kentucky when it began to snow. Steve, having been raised a Southern California boy, had never actually seen snow fall before so we pulled over at the next rest stop so he could caper about and catch snowflakes with his tongue and all of those usual childhood rites of passage that had been denied him until his forties.

More Great Plains tomorrow and then into the Rockies.

Dateline – Overland Park, Kansas

I have a headache. I don’t usually get such things but I very definitely have a frontal headache tonight which started more or less when I got out of the car at tonight’s Hampton Inn. I think it’s just eye strain from driving all day and a couple of Tylenol and some rest should take care of it without too much difficulty but it is reminding me of how much I don’t like not feeling well, especially when I’m not at home. This last year or so of isolation not only kept me Covid free, but it also kept me away from all of the other viruses and cruds I usually come into contact with so I’ve kind of forgotten what feeling under the weather feels like. As I have gotten older, I’m getting less interested in powering through work when not feeling up to snuff and am much more willing to use a day or two of my eight months of accumulated sick leave.

Today’s drive was uneventful. West from Memphis across Arkansas (typical rural Americana) and then I decided to turn North and drive through the Ozarks. I had been through them once before with Steve on one of our trips when we were tracking down some 19th century branch of his family tree but remembered little about them. What I found most interesting were the outcroppings of sedimentary rock sticking up from placid green hills, a gentle reminder that the central US was once a vast inland sea for many millennia. Things like that are reminders of how relatively unimportant anything going on today is in terms of geologic time. 6,000 years of recorded human history is a blink in the history of the planet. The Ozarks these days bring two cultural touchstones to mind: Joan Hess’ delightful Maggody murder mystery books and the recent Netflix series with Jason Bateman which suggests that rural Arkansas is full of feuding drug cartels.

Descending from the Ozarks into Southern Missouri brought me to Branson where I managed to resist the siren call of theaters featuring Biblical spectaculars, acts from Hee-Haw, and half forgotten comics. I also skipped the jeep tours through the cave, the indoor water parks, and the zip line tours. (I have no idea which of these may actually be in operation during these times of Covid, but the billboards live on). Then on to Springfield, Joplin, and up a Missouri Highway toward Kansas City that apparently passes through a large Amish community as I passed four of their horse carriages and a number of barns with hex signs. Stopping for the night on the outskirts of Kansas City and considering what tomorrow might bring. No matter how you slice it, it’s likely to be the Great Plains.

I looked over Covid coverage this evening to find most of the articles are about the slow down in vaccination rates as the portion of the population seeking vaccine has been accommodated and the portion of the population avoiding vaccine remains resistant. I don’t know how to solve that one and I’m not certain that governmental mandates over our currently divided population are going to be helpful. I think it may start solving itself through the marketplace. As Covid becomes more and more of a preventable disease, the health insurance industry will become less and less interested in paying for its costs in those who are eligible for vaccine but refuse. I suspect we’ll start to see insurance companies requiring surcharges, much as they do with smokers, or having riders to their policies excluding coverage for Covid complications in those who could have been vaccinated. We shall see.

Going to find a bad movie and go blah for the next few hours.

Dateline West Memphis, Arkansas –

And he’s on the road again… roughly three years after the last time I did the cross country drive. I seem to do them when I am in turmoil. Disconnecting from my usual life and patterns and driving for hours seems to help me recenter in some way. At least this time, I’m not in acute grief over the death of a partner, but I do figure I’m grieving in some rather odd ways – mainly connected to the ongoing saga of Covid that’s defined all of our lives over the last fifteen months. It’s led to lots of little deaths. Deaths of plans, deaths of certainties, deaths of possibilities. And then for me, there’s been the very real deaths that I’ve had to help people through – children grieving parents, parents grieving children, spouses grieving and adjusting to widowhood – as there are now 576,000 empty chairs at the American table and some of those are for my patients and their connections.

The vaccine has been a game changer, of course. My patients, many cooped up for over a year, are able to venture out some without being panicked and families are able to gather together for the first time in a while. Even with that, the legacy of mental health conditions that have been left behind is enormous and I’m only just beginning to unpack that particular box. A large part of my day is spent working through grief and depression and anxiety left in Covid’s wake as that’s now the major thing affecting my patients’ health, far more than their blood pressure or their diabetes. I feel a bit inadequate to the task but I usually muddle through somehow.

I finished up my usual work day around one thirty this afternoon, ran by the accountant to drop off my tax paperwork so I can get my refund, and then headed home to pack. I like to travel and can usually pack pretty quickly and get supplies for anything from snowstorm to desert heat into a single suitcase (one of the things one learns growing up in Seattle when the weather can do anything over the course of a weekend). Suitcases packed, trusty laptop in its bag, I kissed the kitties good by, threw things in the car and headed out. I’m making this trip up as I go along. I have nearly a week to get to Seattle and a continent full of possible routes. We’ll see where I end up.

I decided Northwest was as good a direction as any so took I-22 out of town past all the Walker County towns I know and love from VA house calls, and then on beyond into Mississippi. After Tupelo, which seem s to have little reason for existing other than housing Elvis Presley’s birth place (will he be remembered in another few decades, after the boomers are gone?), I was driving into a glorious sunset straight out of Gone With the Wind for an hour or so as Mississippi gave way to Tennessee. I figured Memphis was far enough and stopped in the West suburbs, on the Arkansas side of the Mississippi for the night. With the crossing of the river, I guess I am officially in the West again. Can’t say much about Memphis. The famous civic pyramid seems to have become a Bass Pro Shop and it was too dark by the time I got to the bridge to see anything of Mud Island.

Tomorrow, I’ll either head west towards Little Rock and Fort Smith or north towards St Louis. We’ll see what I feel like after breakfast. Twenty three years ago, on our drive across country from Sacramento to Birmingham to start our new life, Steve and I stopped for the night in Fort Smith. It was Halloween weekend and, while in the motel room we turned on the TV and a local commercial blared for an Evangelical church’s Harvest Festival party, an alternative to demonic Halloween. Biblically correct costumes were encouraged. Steve looked at me, rolled his eyes, and announced that he wanted to stay an extra day so he could show up as Jezebel. (He would have too, if I had let him, but we had a van full of furniture to meet in Birmingham and could not afford the extra time).

My stops for gas and Dr. Pepper show that masks appear to be unknown here in the heartland. I’m trusting in my vaccinated status and I’m still wearing one when going indoors. And keeping my hands washed and sanitized. And keeping a wide berth. It’s not over until its over.

It’s April 28th again. Another year past and now Tommy has been gone for three years. I thought about going out to Parrish to put some flowers on his grave but other life chores intervened. I don’t think he minds. He was never one for fuss and ceremony and ritual unless it involved children and socializing them into the mysteries of the grown up world. Valentines? Anniversaries? Forget about it – he had no patience for the Hallmark holidays. I once made the mistake of bringing him roses at work on our anniversary. He was not amused and let me know just what he thought of that gesture and my lack of imagination for executing it in no uncertain terms. But, if a child or group of children of his acquaintance had something special that needed celebrating, he was all over that. While packing up the house this last year and moving, I found his stash of all purpose child gifts. They’re being used appropriately over time.

Tommy and I didn’t talk about death much. I think there were two reasons for that. The first was the shadow of Steve that hung over our lives. As Steve was dead, he was both omnipresent and unknowable to Tommy. They never met (well – I did figure out later that Tommy had probably waited on Steve and I at the Eastwood Olive Garden a couple of times after we first moved to Birmingham but neither Tommy or I had any real memories of it). Talk of death with Tommy would, of course, rope Steve into the conversation and that was a subject best left in the past. The second was that Tommy had far too much living to do and way to many plans to let a little nuisance such as death get in his way. Even during that last hospitalization, he was working on wig designs and plots for his summer shows and trying to figure out how to go back to school again for yet another degree (he was interested in seminary with an eye on a concentration in church music and hymnody. I found a few sketches for an idea for a musical setting of the Latin Mass in his papers. That would have been an interesting – and massive project). The one time I remember asking Tommy about what he would want in terms of arrangements should he die, he looked at me and said ‘You’ll have to figure it out, I won’t be here’ and went back to whatever he was working on.

Tommy’s relatively quick decline and unexpected death was very different from my experience with Steve. With Steve, we had roughly two years from the time we learned he was seriously ill with his pulmonary fibrosis until his death. We both knew it was coming, made some basic arrangements and then, basically never revisited the subject until it actually happened. There was no need. We lived our lives around his living, not his dying and those two years were some of the best times we had in our thirteen years together. Steve let go of the rat race of trying to be successful and make money and buried himself in his art and his garden and his love of the little things in life and was pretty much at peace, possibly for the first time in his life. He had not had an easy existence as a younger man. He came out as a gay man in high school at age fourteen. That’s not an uncommon story these days, but that was 1962 and his attitude from the beginning was to defy the world and anyone in it who would not accept him for exactly who he was. He spent his 20s and 30s in Los Angeles, part of the avant garde set around West Hollywood and Studio City, where he knew everyone and went to all the parties of the demimonde in the late 60s and 70s. He had all sorts of stories. The 80s and HIV destroyed his life and decimated his social circle and friendships, causing him to flee North to the Sacramento area to become his mother’s caregiver after she was diagnosed with cancer and where we met.

Between the two of them, I had nearly thirty years of partnership/marriage whatever term you want to use for it. I wrote a sermon a few years back, before the Obergefell decision, on the word marriage as applied to gay couples and how our inexact language uses a single word in law for two radically different constructs -a civil contract that defines a family unit in the eyes of the state and a sacred covenant that defines a union in the eyes of a church. The pro gay marriage forces were fighting for the contract. The anti gay marriage forces were fighting to protect the covenant. They’re still talking at each other rather than to each other so I don’t believe for a moment that this particular war is at an end. I miss the coupled state, having been out of it now for three years, but I don’t know if I want to do the work necessary to get back in to one.

Keeping a gay male relationship alive and solid is difficult. There aren’t a lot of supports and foundations for it within either gay culture or straight culture. One believes that you should be free to find the next hot thing, the other believes that you’re intruding on sacred ground in some sort of burlesque. This requires two men in union with each other to have to pour enormous resources in terms of emotional energy into the relationship and to be willing to make sacrifices to their socialized roles for the good of the unit. It’s very hard. I have nothing but admiration for my friends who have managed to do it over the years because I know just how much work they have to do behind closed doors and nothing but sympathy for my other friends who can’t overcome all of the obstacles and make it work over time. I’m never going to say never in regards to a potential third husband, but I have no plans to start looking in the near future. There’s a number of hoops any potential candidate would have to jump through and I know I’m not going to just settle to have someone in my life. Maybe I’m a victim of Mona’s Law from Tales of the City as defined by Armistead Maupin – you can have a hot lover, a hot job, and a hot apartment but you can’t have all three at once. I’ve got the job and housing covered so the third might be asking a little too much of the universe at the moment. If I do find someone, going back to Mouse and Tales of the City, I just would like someone with whom I could buy a Christmas tree.

Sleep well, both Steve and Tommy, and know that I am forever richer and better for having been yours.

I still feel like I’m running on empty. Fortunately, only five more days until I get my time off and can hopefully recharge the batteries. One of the major reasons I decided to turn this into a road trip was a chance to simply disconnect from my usual world for a while. The nature of my job and career is such that there are lots and lots of people out there who rely on me for succor and counsel and empathy. I have a lot to give but every one of those encounters leads me to give away a bit of my self and my energy and eventually, the well starts to feel like it’s running dry. A couple of weeks without feeling like everyone wants a piece and I will hopefully start feeling a little more in balance.

Tonight is the Oscars. I’m not watching. This pandemic year as upended my usual moviegoing habits and I’ve seen none of the films up for the big awards. There are a few that are on my radar and which I should catch streaming on one service or another eventually. The theaters are starting to open up again but I don’t think I’ll feel comfortable going in to sit among strangers with my overpriced bucket of popcorn and soft drink for a while longer yet. I’ve been watching more long form television than film recently – that seems to be where all the good writers have drifted to and it comes in easily digestible chunks between work projects, writing projects and keeping things up on the home front in the evenings. There are plenty of older films out there to keep me going when I truly want a movie (or when MNM needs something to review for her column). Will I be able to go to the movies again? I’m sure I will but I can’t imagine feeling safe prior to the fall and even that is going to depend on what happens with Covid numbers and with all of the ramifications of the never ending politics of vaccines.

The big hotspot at the moment in Covidland is India, likely driven by variants which are more highly infectious, although the authorities are still trying to figure out why cases, beaten back over the winter and early spring, started to skyrocket over the last few weeks. There’s so much that we still don’t know about this disease, its pathology, and its epidemiology. Apparently, last month was election season in India with Prime Minister Modi and other politicians addressing huge crowds. Per usual, the virus exploited a change in human behavior patterns to its advantage. There is one variant in India that has the health authorities concerned. It has changes in spike proteins allowing it to bind more tightly to human host cells making it significantly more infectious. If this variant combines with the ones originating in Britain that make it more transmissible person to person, we may have cause for alarm. I have a trip planned for India in the spring of 2022. I shall, as always, be cautious.

This week marks the third anniversary of Tommy’s death. I know it’s time to move on (and in a lot of ways I have) but the whole pandemic nature of our lives keeps me cocooned away from the world when I’m not at work. I’m getting better about going out than I was a few months ago, but seeing people socially still seems a bit awkward and forced. It’s as if the usual rules of etiquette have been put in suspense and we’re all feeling our way together into some new patterns of being with others that are not of ones immediate family circle. Handshakes and hugs are still pretty verboten. Subjects to talk about are somewhat limited when no one has done much over the last year. I feel like I need to take a lesson from Eliza Doolittle and stick to two subjects – the weather and everyone’s health. So if you hear me asking about a new straw hat that should have come to me, you’ll know the reason. I’ve been told the next of the Zoom theater projects is Pygmalion with me as Colonel Pickering so I may be picking up a few Shavian epigrams honestly in coming months.

I had Hope, the Red Prius, serviced and detailed this weekend, making sure she was ready to drive 6,000 or so miles the next few weeks. The folks at Hoover Toyota told me that all was well so, if the pistons fall out in the middle of South Dakota, you know whom I will be calling on the Gods of the Lakota to strike down in vengeance. I’ve downloaded some decent books to the audible account and I’ve mapped out at least four different routes. Having driven across the country a half dozen times, I’ve seen a good deal of it so which one I take is likely to depend on weather patterns, snow reports, and my mood of the morning after downing a caramel macchiato from the closest Starbucks. Now I just have to pack a few necessities (travel was easier before my dependence on CPAP which takes up a third of a suitcase) and find my decent sunglasses. Yes, I will write my usual travelogues. I need something to write with them: family stories? Covid updates? Discussions of aging and health topics? A bit of all three? I generally don’t know what I’m going to write when I sit down to bang on the keys and produce these musings but I do take requests and often a comment or something someone says to me will inspire a topic.

The weather is lovely – get out and enjoy it, as I did this afternoon with Opera Shots in the Opera Birmingham Parking Lot. The next one is Sunday May 16th at Collins Bar downtown. That block of 2nd Avenue North will be closed so get a drink from Andrew J. Collins and enjoy some good singing. I’m planning on returning from the road that day and whether I turn up or not will depend on when I get back to town. Enjoy your martini, but remember to social distance and keep your mask on around people you don’t know. And grab some Opera Birmingham branded hand sanitizer while you’re there.

I’m back to normal. Or as normal as I ever get. I think I was born under an eccentric star and have been just a bit off kilter ever since. A number of long deep sleeps and a few naps have restored my equilibrium somewhat and I am back in my usual physical space of feeling just a little bit aged but with the ability to power through usual work days with some left over to expend on a project or two at night. With the book more or less done and nothing much theatrical coming up in the near future, that means the bins of family papers, photographs, old theater programs, and other ephemera that have been staring at me from the front hallway since January must be tackled. It will give me the excuse of scanning in a few more pieces of visual memorabilia to share with my stories I suppose.

My Facebook timeline is a plethora of vaccine selfies as the full opening up of appointments for everyone over the age of sixteen has been accomplished. This means by Memorial Day, a significant portion of the healthy population will have received vaccine and by the Fourth of July, most of those wanting to be vaccinated will have finished their six weeks of marinating and will be good to go. I’m hopeful that means that the pandemic will be under reasonable control by fall and we can resume most normal activities. There are two things that are going to hold this back.

The first is the significant portion of the population that is still holding on to political ideas about the virus and vaccination that are making them avoid getting their shots. If it was a small minority, it would be pretty immaterial as that misunderstood concept of herd immunity would take over and protect society from significantly spreading coronavirus anyway. But it’s not a small minority. Polls suggest it’s more like 30% of the population and that’s a large enough group to prevent eradication of the pandemic. It’s also a big enough group to keep trading virus back and forth setting up new strains which could potentially become more lethal or which will slip by the vaccination rendering that immunity useless. The second is the usual American ideas of exceptionalism keeping us from understanding that this is not a uniquely American problem.

This is a global pandemic. It’s everywhere from the concrete canyons of Manhattan to the jungles of the Amazon to the plains of central Asia. And we live in an interconnected world. Given modern travel technology, most of us are capable of reaching pretty much anywhere on the planet within 24-48 hours and our microbes come along for the ride when we board that Airbus A-320. To truly beat the pandemic, it has to be forced back not just here but everywhere. That means getting out billions of doses of vaccine, many to much poorer countries with sketchier transportation networks and governmental institutions. I wouldn’t want to be the guy in charge of figuring out how to get vaccine to the population of Somalia. With more stable leadership now in place, we can come together with other advanced countries and help with a world wide concerted effort but it’s still going to take a bit of time, energy, and money.

While the pandemic is coming under control domestically (and Alabama still looks pretty good number wise at the moment), it’s still been inching back up around here with cases up about 10% over two weeks ago. Mind you the absolute number looks pretty good, about a tenth of what it was at the peak of the winter surge in January, but any uptick is worrisome. It’s probably the result of spring break, the governor’s letting the mask mandate expire, and a general movement of people back into public space as vaccines take hold. Anecdotally, most of the people being admitted currently are young/middle aged and the mortality rate isn’t quite as high, but a number of them remain extremely ill so please, everyone, don’t fall of the horse right before the finish line. Keep up those good habits until six weeks after your initial vaccination and beyond to protect your neighbors who are behind you in the line.

The world picture is not so good. There were more new cases of Covid world wide last week than in any week since the beginning of the pandemic. Numbers are pushing upward in Brazil, India, and Southern Africa due to more infectious (and in some cases more lethal) variants. They will get here eventually. It’s inevitable. But, with luck, we’ll have enough vaccine out there to keep them from getting a significant foothold in the population and our reinvigorated public health institutions will be able to identify and isolate them quickly, as should have been done last year.

I had a recurring dream with all my weekend napping. I reenrolled at Stanford and decided to start anew on my college career. But I was trying to do it with my nearly sixty year old brain and I was floundering and failing and having a fairly rotten time. None of my classes was meeting where it was supposed to. The layout of the campus kept changing. The bursar’s office was dunning me for tuition bills for courses I was pretty sure I hadn’t taken (History of Roman chariot racing? Advanced Bioplar disorder?) After the third time I found myself back in the same general milieu, I woke up wondering what my subconscious was trying to tell me. Was it a Groundhog Day phenomenon born of this incessant pause in living patterns? Had I sniffed a madeleine before falling asleep and was I trying to recover lost youth? Perhaps my brain knows that I’m approaching a crossroads of some sort and is warning me not to take the same old road but veer onto some other path in the yellow wood.

Seven more work days until I have a chance to try and clear the brain and the plague diary morphs at least in part into a travel diary for a while. In the meantime. Wash your hands. Wear your mask indoors around people you don’t know. Stay out of the mosh pit until at least six weeks after your initial vaccine.

I’ve been exhausted this week. Tired to the point of forgetting to set my alarm yesterday and waking up twenty minutes after I should have been at work. I did prove that I can be in a patient room within fifteen minutes of opening my eyes in the morning and I was able to get my schedule back on track but I haven’t done anything like that in years. Usually, on the mornings when I don’t have to get up, I wake up within about twenty minutes of my usual alarm time and then, when I realize I can sleep in, I roll over and go back to sleep for a while longer. The weariness this week, however, has been bone deep. I figure it’s due to the one two punch of Pirates of Penzance being over and having finished the book and gotten it out to my first group of beta readers. I have little on my schedule the next few weeks other than usual work things so I’m going to listen to my body and try to unwind.

We passed three million Covid deaths world wide this weekend. The US total continues to inch up as well and is now at 567,000. It’s not racing upwards as badly as it could, likely because new cases are more likely to occur in healthier and younger individuals, older populations being more likely to have received vaccines at this point, but it’s still on the upswing. It wouldn’t be so bad if the US character regarding health care weren’t out in full force. We’ve more or less decided as a society to allow the vaccine to do all the heavy lifting for us so we can all get back to our usual lives. And the current administration has done a phenomenal job of getting the vaccine out. Half of US adults have now had at least one dose and somewhere between three and five million jabs are happening daily.

US culture has always had a quick fix mentality when it comes to health care. People come to us, as healers, expecting a pill or a shot will take care of whatever ails them. While this may be true of common infectious diseases of the young, it’s certainly not true of the disease processes of aging and body neglect such as diabetes or atherosclerosis. Successful treatment of these generally requires lifestyle modification, prudence and moderation in regards to such things as diet, exercise, and sleep, and a willingness to partner with us for the long haul. Most Americans have difficulties with these concepts. Successful primary care physicians, like myself, have to figure out where the boundaries are between what we can control and help with and what are the responsibilities of patients and their family systems. Those who don’t negotiate that tightrope successfully generally don’t do well with ambulatory care. It’s difficult and most doctors who work with inpatients have, at best, a limited understanding of it. Unfortunately, it’s the inpatient docs that have political clout and the ear of administration.

It takes roughly six weeks from the first shot, no matter which version you get, until you develop full immunity. (Shot one, then shot two three or four weeks later, then two more weeks until full immunity develops for Pfizer and Moderna – Six weeks after the single shot for Johnson and Johnson). Six weeks ago, we were in early March and vaccine was just beginning to become more widely available after having been reserved for health care workers and at risk seniors. The people given vaccine the first week of March have only just become fully immune. Everyone who has received them after that isn’t there yet and we’ve only really opened up the vaccine lines to all comers in the last week or so. We’re not going to have significant population immunity until Memorial Day. This is why it’s so important to continue to wear masks indoors with other people and keep up the social distancing. We’ve still got a ways to go.

The vaccine isn’t 100% effective. There have been roughly 5,800 covid cases in the US in individuals who were previously vaccinated. When you divide that out over the 125 million of us who have been shot up so far, that’s a very small number. The majority of the cases have been mild but 78 of those 5,800 died of the disease. Don’t let all those good habits built up over the last year go to waste yet. It’s going to take a combination of the vaccine and proper social behavior to restore things back to a semblance of normal, not just vaccine alone. There are very few quick fixes in medicine outside of antibiotics and some surgeries.
Sometimes, though, the fixes are unique and idiosyncratic and dependent on the individual. I learned long ago never to argue with success when it came to my patients. Some years ago, an elderly man came to see me. He had an obvious dementia to which he and his family were somewhat oblivious (even when the family had taken him for his drivers license renewal and the examiners insisted on a road test and the first thing he did was drive the car into the dumpster, none of them was willing to admit that perhaps his mentation had changed in his ninety years). When I asked him why he had come to see me, he told me it was because someone had replaced his nose with a metal valve and he was afraid that when he slept at night, someone was going to close it off and then he would die. I sympathized with his plight and asked him how he might prevent that. ‘Oh, I have a sure fire way’ he said. ‘Before I go to bed, I wrap a plastic bag around my head and then rubber band a washcloth over that. Then I put two scoops of vanilla ice cream on the washcloth, put on a stocking cap and go to bed. Works like a charm’. I was a bit taken aback – the only follow up question I could think of to ask was ‘Does it have to be vanilla? Will other flavors work as well?’. He was so pleased with himself, that I let him and his family work all of that out… including the laundry.

Today was Prince Philip’s funeral; he missed completing his hundredth year by only a few months. Her Majesty looked very small and frail and alone. I expect her to go on for a few more years but its likely that her public schedule will be greatly reduced. My cousins, the Earl of Snowdon and Lady Sarah Chatto were amongst the cortege, looking decidedly middle aged. I guess that means none of us is young anymore. I wonder what will happen when the Queen dies? She’s been on the throne for nearly 70 years. Few are left with adult memories of life under any other monarch. I expect the institution of the monarchy will survive. It’s one of the things that makes Britain Britain.

It’s the other side of the weekend. That means it’s Steve’s birthday today. He’d be 73 were he still here, likely running around making art and stirring up trouble wherever he could. That means it was twenty years ago this evening that we had his last birthday party. He loved birthday parties as much as he hated actually growing older. We invited over the few friends we had managed to make since moving to Birmingham – mainly church people as a combination of culture shock and his illness had somewhat limited our socializing over the previous few years. He wore our birthday shirt. It was a shirt he had bought me for my birthday some ten years before. He gave it to me, then decided he really liked it and declared he was taking it back. I wrapped it up and gave it to him for Christmas, he wrapped it and gave it to me for my next birthday and so on. I think it was wrapped and unwrapped more than a dozen times over the years and was a standing joke between us until the end.

That’s the hardest thing about losing your partner. You lose the person with whom you’ve built a history of hundreds of private jokes and pet moments. You want to say ‘do you remember when…’ but the only person that could possibly answer that with a yes is just no longer there. I suppose, in part, that’s one of the things that’s spurred me into writing these pieces over the last few years. I want to keep remembering when and this is one way to get those stories out to a new audience that might appreciate a few of them. Most of my Birmingham friends never met Steve. He became ill about a year after we arrived and before we had had a chance to create much of a social circle and he was gone before I returned to the world of the performing arts that I had left for medicine so many years prior.

I suppose the second week of April is always going to be a bit of a difficult time, as long as I live, due to the proximity of Steve and Tommy’s birthdays. Note to self. Try not to plan anything too emotionally involving for that week going forward. Fortunately The Pirates of Penzance is not Ibsen or Arthur Miller. And it is now over, to be replaced eventually with whatever the next theatrical project shall be. There’s nothing on the horizon yet; I’m not worried. Something’s bound to come along for the summer as things continue to open up. Perhaps this is the summer to revive Shakespeare in the Park. I’ve only done that once and, as much as I enjoyed it, outdoor theater in Birmingham in August is not overly pleasant for either cast or audience due to certain climate peculiarities.

I still have great hopes for summer, despite today’s not so good news about the Johnson and Johnson vaccine. A couple of things everyone should keep in mind. 1) Correlation is not causation. Just because two things happen together in time does not mean that they are linked. 2) The number of reported cases of clotting is very small (six out of seven million doses of vaccine administered). All the case reports involved women between 18 and 48 and the background incidence of significant clots in women of that age isn’t all that different. Women are more prone to clots than men as estrogens are thrombotic in nature. About 0.3% of users of oral contraceptives develop clots because of this. Other risk factors include smoking and being sedentary and we know nothing about how any of these may play into this cluster of cases.

If you’ve received the Johnson and Johnson vaccine, don’t panic, even if you’re a woman under fifty. The chance of you having a problem is about the same as being struck by lightning this next year. If you were scheduled to get it and your appointment has been canceled, don’t panic. There’s plenty of Pfizer and Moderna in the pipeline to make up the short fall and the system has figured out how to get vaccine into people in record numbers over the last month with between four and five million shots happening daily. My biggest fear in all of this is that the media, who long ago abandoned in depth reportage and nuance for sensationalism and click bait, will write a lot of misleading headlines that will push people on the fence away from vaccination and, if we’re going to return to a sense of normalcy, we need as many people immune as possible, whether from immunization or from having had the disease (something I wouldn’t wish on anyone – even mild cases seem to have significant issues with cardiac and nervous system inflammation that have unknown long term consequences).

Alabama may have abandoned its mask mandate, but the city of Birmingham has not. We were doing really well the last few weeks with one of the lowest levels of transmission in the country (only Arkansas had better numbers) and it will be interesting to see if the dropping of the mask mandate by the state will start leading to an increase around the end of the month. I’m still wearing mine. I’ve gotten used to the thing, other than when trying to march and sing at the same time. The British variant has, as predicted, now become the predominant strain in this country which is a problem given that it’s significantly more transmissable than the original strains. The patterns in high transmission states such as Michigan show that it is spreading rapidly in young, unvaccinated populations. The majority of those folk, being healthy, will weather the storm but there are more and more thirty and forty somethings being admitted to hospitals in dire straights with no prior significant health history. These are people who don’t need to die if we will continue to toe the line just a while longer.

Wear your mask in public, even if no one else does. It sets a good example. Keep your hands washed. Get your vaccine.