People don’t believe me when I tell them that I don’t plan these pieces out in advance. I simply feel a need to write and then I open up the laptop, chase a cat or two out of the way and set my mind in brain dump mode and out it call comes. Sometimes there’s a theme or a throughline. Sometimes one develops as I sit there for an hour letting my fingers doing the talking. Sometimes it’s a bit of an incoherent muddle. But still I keep it up – nearly 700 long posts/rants/musings/travelogues/history lessons/meditations over the last seven plus years. If I were to collect and publish them all the way I did the Covid posts, we’d be running somewhere in the eight to ten volume range and ain’t no one got time fo’ dat. I’ll just leave them here quietly moldering in cyberspace, of interest to few but myself and perhaps some future historian looking for primary sources on how ordinary folk felt and coped with the extraordinary times in which we find ourselves.

Someone told me this week that I am Birmingham’s answer to Kevin Bacon. you can connect pretty much any two Birminghamians through me in only a couple of steps because my circles of acquaintance are so large and so disparate – aging services, liberal religion, classical music, musical theatre, LGBTQIA issues, patients and their families. I suppose that’s a compliment. I’ve never met Mr. Bacon but he seems to have had a great career, a nice stable marriage, and I’ve never heard anything particularly negative about him through my Broadway and Hollywood connections so I suppose I could do worse. He’s a few years older than I and seems to be keeping his looks better. But then he’s likely got a personal trainer, a photo shoot makeup artist, and doesn’t havve to deal with the absurdities of the American medical system on a daily basis. When I was younger, I looked very like Nicolas Cage (to the point that people who knew him mistook me for him). Now, I just look like me. I think I’m OK with that.

Time for an update on the health system as it pertains to someone like me. RFK Jr. is in the process of firing the entire United States Preventive Services Task Force. I predicted this some weeks ago so I don’t find it particularly surprising. It’s just more of the administration’s war on inconvenient scientific facts which don’t fit their political agenda. The practical result of this is that a packed new board is likely to discount many of the findings and recommendations that have been promulgated in the past. Legislation that was part of the PPACA required that health insurers cover screening tests and preventive services that USPSTF rated highly. If these are downgrated or discarded, health insurers will be under no legal obligation to continue covering them. My guess is the first to go will be vaccine recommendations. There appears to be a multipronged attack on vaccinations happening. They’re opening up vaccine manufactuers to all sorts of liability which will make it economically unfeasible for them to continue to sell to the US market and, by eliminatiing payment mandates, those vaccines that remain will quickly become unaffordable to a majority. So, if you’re behind in any of your shots and boosters, it’s probably best to get them quickly before you simply can’t unless you can afford some medical tourism to a country which still believes in the findings of medical science. Meanwhile, the rest of the Kennedy family are expressing their ire at renaming the opera house at Kennedy Center after Melania Trump. Well, she does seem to have modeled her life on Cunegonde’s Act I coloratura aria.

What’s going on with covid? Numbers are increasing. There’s been a surge each of the last few summers starting in late July and this year is no exception. What drives it? I would guess that the oppressive heat is driving more and more of us into airconditioned shared spaces and therefore we’re simply more likely to run into the virus. Mortality rates don’t seem to be particularly increasing, so that’s good news and there doesn’t appear to be a lot of new mutations out there yet. The right wing propaganda machine continues to try and rewrite history casting the covid vaccine as the cause of the increase in chronic illness over the course of the last few years rather than the virus itself. Most of us caught the virus at least once. The vaccines kept a whole lot more of us from dying of vascular and respiratory collapse. I’ve long predicted that the virus, by its nature, was going to have nasty surprises waiting for us as time went on. I think the increase in general unwellness happening at the moment may be part of that. It’s far more likely than some of the more far fetched ideas I’ve been reading on the site formerly known as Twitter (where millions of people seem to have conspiracy theories over such natural phenomena as clouds).

Of course the big story of the week continues to be the Schrodinger Epstein files and what’s in them which seem to both exist and not exist at the same time. Given everything that’s been known about Trump (and I’ve certainly known who he is and his reputation with women for about forty years now), I can’t for a minute believe that he’s not all through the 300,000 pages of evidence collected on Jeffrey Epstein and his bad behavior. However, by making Epstein a rallying point of an anti-Democrat conspiracy theory (Comet Ping Pong Pizza anyone?) he has painted himself into a corner. If he allows everything to become public and everyone sees the depth of his involvement, he’s toast. If he uses his powers to try and make it all go away, it becomes a massive coverup and he’s toast. The Republican legislators appear to be collapsing like a pile of wet noodles as they’re smart enough to understand the perdicament. And then there was the icing on the cake – this week’s episode of South Park. Parker and Stone know that the way you destroy a narcissist is not to hurl invective and not to try and show fact and reason to counter the narrative, the only true weapon is to laugh at him and refuse to take him seriously.

There was an executive order this week calling for all homeless to be rounded up and removed from the streets, promising federal grants to states who stepped up with plants to execute this. Buried in the language of the order are some very vague terms which would pretty much allow the government to declare anyone they feel is mentally ill an undesirable who could be detained. This could easily be used against the trans or the wider LGBTQIA community. They seem to define ‘woke’ as a mental illness so it could easily drag in minorities and those of liberal political affiliation. Perhaps this is the true purpose of the rapid building out of detention centers. It’s not truly about immigrants. Once they are built, economics will demand that they be kept full with someone. All I can say is that when I’m shipped off to one, I’ll likely meet some interesting people with whom I can have some meaningful conversations.

And this is why I am directing Richard II the way I am. I’m setting it in the holding cell of a detention center that has rapidly been put together in a church basement. It’s not supposed to be America of today. I’m deliberately making it vague. The ideas regarding the abuse of power that led to England tearing itself apart in a four generation civil war whihch Shakespeare so eloquently puts forward in his play are the same issues we are confronting today. My cast are finally getting what it is I’m trying to do and are beginning to play both the Shakespeare history and the framing device of the prison together. Thiis crazy idea of mine, which I dreamed up very early in this second Trump administration, before even a fraction of what we are now dealing with surfaced, appears to have some prescience and traction and I hope audiences leave thinking about how human nature hasn’t changed over the centuries and that we must look to the past if we are going to take control of the future.

I’ve got rehearsal in the morning. Trying to clean up the interactions between prison guards and prisoners and how that highlights certain major themes and plot points. Wish me luck.

Pulpit Message given today, July 20th 2025 at the Unitarian Universalist Church of Birmingham. For those who would prefer to listen, I attach a link to the stream of the service. The sermon begins at 37:45. The service ends rather abruptly due to a medical emergency. I swear it wasn’t my fault…

Moral Injury and Evil: American Health Care

Good morning. I’m Andrew Duxbury. I’ve been a member of this congregation for twenty-five years and when I’m not making good trouble around here, I’m a professor of clinical geriatrics at UAB. Someone decided it was a good idea for me to speak from the pulpit today. I have decided to speak about a world in which I have been steeped for more than four decades, the American Health Care system. To paraphrase Mark Twain – everyone complains about it but no one does anything about it despite becoming, as the kids like to say, problematic. So, I thought I’d take a little time to examine what that’s all about.

I’ve entitled todays remarks Moral Injury and Evil – American Health Care. I did this because, in the four decades that I’ve been part of the system – and I can’t always tell if I’m part of the problem or part of the solution – I have noticed certain issues and themes which violate the first rule of medical ethics- Primum non nocere – first do no harm. These trends seem to be accelerating these days, driven by all sorts of forces far outside the control of any one individual and, in my case, they are driving me out the door. Earlier generations of physicians felt a calling to practice as long as they were physically and cognitively able. I can’t do that. I was created by medical education for a different era of healthcare, and I find that I no longer fit. Trying to change to fit more would violate some fundamental ethical codes – it’s going to have to be new generation that carries things forward, one trained for the times in which we find ourselves.

If we’re going to talk about what is moral and what is not, I suppose we’d better define what moral means. So I went to Google, the fount of all knowledge, and asked it to provide a definition. Here’s what I got – concerned with the principles of right and wrong behavior and the goodness or badness of human character and holding or manifesting high principles for proper conduct. This sounds reasonable to me. I was raised by parents who had expectations that we would live upright lives. I wasn’t beaten over the head with religion. I was raised Congregationalist and our services were very similar to what we do here in UU but we had a cross rather than a chalice and we talked about Jesus a little bit more. But I was guided to be truthful, to myself and others, to follow through on commitments, to share, to give others a hand up when I could, to do my best and learn from my failures rather than let them defeat me. By the time I was an adolescent, I had a strong moral code embedded throughout my personality. Sin was not what you did, it was the harm your choices caused to others. (Hey – it was the 70s).

There is a good deal of soul searching going on among the thinkers in the American Health Care System regarding moral injury among health care providers. It’s been one of the main drivers that is causing workers to leave clinical care fields – and they are in droves. 20% of the workforce that was in clinical care at the beginning of 2020 no longer works there. The reasons for this are not strictly due to moral injury, the changes wrought by the pandemic are a more proximate cause, but the transgressions of various types keep piling on. Again, we should probably take a minute to make sure we’re all using the same definition. Dr. Google says moral injury is a specific type of psychological harm that results from experiencing events that violate a person’s deeply held moral beliefs and values. It can occur when someone perpetrates, witnesses, or fails to prevent actions that go against their own moral compass. This can lead to feelings of guilt, shame, anger, and a sense of betrayal, impacting their self-image, worldview, and sense of well-being. The last five years have seen a rise in bad behavior, an undermining of the scientific principles upon which American healthcare is built, a significant shift in the power structure away from the needs of patients to the needs of big data, and an out of control profit motive warping everyone’s missions.

Most practitioners would deny that they are agents of moral evil or that the American healthcare system exists for purposes other than good. Again, to make sure we’re all using the same definition, Dr. Google says moral evil, in philosophical terms, refers to harm or suffering caused by the intentional actions or inactions of moral agents, such as human beings. I would beg to differ somewhat. My personal ethical code, for instance, refuses to let me consider the effect a patient’s treatment plan may have on my personal income. I have navigated this comfortably by making the decision early in my career to always work for salary. I’ve made a lot less money, but I can sleep at night. I give every patient the same care and attention no matter what their financial means are, and I don’t make decisions based on what it might mean financially for me or my employer. I know plenty of health care providers whose decisions are much more based around maximizing revenues and tricks of billing and deciding what is the minimum they can deliver and remain within terms of contract. There are also social moral evils – various isms such as racism and sexism which have dogged the healthcare system and which continue to cause inequities – the current presidential administration wishes to punish those who point them out.

American healthcare is an odd amalgamation of scientific knowledge, historical accident, capitalism run amok, and beleaguered allegiance to the past. No one sat down and planned it to be the way it is. Even as we all despair and curse over its current structure and function, it was not conceived and constructed by idiots. It was put together over many generations by very smart people confronted with specific problems which needed to be solved. For the most part, their decisions defeated the issues that plagued their time but they were unable to foresee and project what their solutions would do over the course of decades, especially when fossilized by commerce and custom.

What we have now in this country is unique. There’s no other system like it in the world in terms of structure, cost and results. We continue to have a cultural belief in American exceptionalism in medicine. That we are cutting edge, that we can do things that can’t be done elsewhere, that this is where the rich and powerful of the world flock for treatment. And for decades, there was fact and data to back up those beliefs. Unfortunately, we continue to carry them with us, inscribed on our cultural DNA despite the world having changed significantly in recent years.

We are the only developed country who ties health care to employment. It’s a historical accident but it reinforces the concept that those who are productive are deserving and that those who are not productive are undeserving of health services. This false dichotomy rears its head in political discourse more times than I care to count and has been particularly prevalent in current budget discussions and the obfuscation of very real cuts to public funding of healthcare.

We put more money into our healthcare system than any other developed nation. Fully 16 percent of our GDP enters the health care sector of our economy. The next highest, Switzerland, spends 11 percent of its GDP. Most developed nations spend somewhere between 9 and 10 percent. We are an extreme outlier. One would think, with that much money sloshing around the system, that we would be close to the top in terms of results. Wrong. Our life expectancy is amongst the lowest in the developed world, our maternal mortality and infant mortality rates are very high and in some of our poorer areas approach those of sub-Saharan Africa. When our health system is ranked against other world health systems on access, efficiency and results, we usually end up somewhere between number 15 and 45 on the list depending on the exact measurement criteria. We’re usually down around Slovenia and Costa Rica. Who’s on top? Taiwan.

As I said earlier, none of this was created with ill intent. To understand what happened and why, we have to dive back a bit into history, going back to the beginning of the 20th century and what was known as the progressive era. 19th century medicine, to our eyes, seems barbaric relying on primitive surgical technique, a poor understanding of hygiene, a lack of anesthesia, and a medical education system that varied widely in its ability to train physicians. Some schools granted diplomas with no clinical experience or exposure to anatomy at all. Most medical treatment was delivered in the home by Granny with the help of various patent medicines that were nostrums at best and poisons at worst; they often contained significant amounts of alcohol or opioids turning a large portion of the population into addicts. The political pressures that led to the creation of the Food and Drug Administration, public sanitation projects, and the clearing of tenement slums, spilled over into the medical profession.

In 1904, in a bid to prevent the federal regulation of the practice of medicine, the American Medical Association created a council on medical education determined to improve the standing of the profession and hired the Carnegie Foundation to aid it in its quest. In 1910, Abraham Flexner, under the aegis of the Carnegie Foundation, produced a report on the state of medical education in the US. His report called for standardization of medical education based in medical science, the closure of schools that could not meet basic standards, and the selection of students based on demonstrated skill and aptitudes. Within the next decade or so, there was a major reduction and consolidation of US medical schools and a domination of the field by allopathic schools, those granting an MD degree and based on the disease model of acute care medicine. The Flexner report also emphasized that a physician was responsible for his patient and not for the community at large, leading to the split between medicine and public health which continues to this day.

Flexner’s report, while protecting the public and laying the groundwork for licensure, board certification, and the specialization system that still prevails, had some inherent flaws. Like many things of its time, it was steeped in systemic racism, advocating that African American doctors should only treat African American patients and that the needs of that community were lesser. Most of the predominantly African American medical schools of the time did not have access to the resources necessary to bring themselves up to new standards and subsequently closed severely limiting the ability of minorities to enter the profession. The Flexner report also discounted the role of women in medicine and actively discouraged the admission of women to training, something that was not to change for more than sixty years. Medicine in this country very much came under the control of and was limited to WASP men and the moral evils of racism and sexism were very much part of how the modern system was put together. Even the Jewish community was shut out but they pooled their own resources and built their own parallel institutions such as Mount Siani and Beth Israel.

As the first generation of newly trained physicians entered society in the years after World War I, America was still dubious regarding the medical profession. In the 1920s, the average household spent more on cosmetics than on health care and most treatment was still happening within the family. The new medical schools needed patients to train their future doctors and nurses and the economy of the roaring 20s was leading them to expand their physical plants and to construct new hospital facilities. Advances in asepsis and anesthesia were creating significant improvements in surgery. In 1929, Baylor University, in Dallas Texas, built a new hospital to benefit its medical education programs but were having difficulty finding patients to admit. Justin Ford Kimball, then Baylor’s vice president for health sciences, had a bright idea. He went to the Dallas Teachers Union and struck a deal. If the union would pay a flat fee monthly to Baylor for each of its members, than any member who became sick would be entitled to a stay at the hospital and use Baylor’s medical services free of additional charge. It was the first modern health insurance program and eventually changed its name to Blue Cross.

A few years later, everything changed. The US became involved in World War II. This cataclysmic event radically transformed the American health care system in a number of ways. First, an enormous number of American citizens were shipped out and put in harms way some were killed, but even more were wounded or became ill from exposure to unfamiliar disease vectors and the rigors of warfare. More and more healthy young bodies with significant pathology returned to the US allowing our medical system to study illness and injury in great depth and our understanding of pathology and how to better care for ill and wounded humans skyrocketed forward. This coincided with one of the great medical discoveries. Alexander Fleming had discovered the penicillium mold on oranges in the 1920s and its antibiotic properties were known by 1930 when it was first used to treat an infection (conjunctivitis in newborns). There was a problem, however, the means to isolate the chemical which we now call penicillin from the mold and then produce it in quantity had not yet been figured out. This puzzle was cracked in the early 1940s, shortly before the US entered the war. This new miracle drug gave the US a new weapon in the war which every army has faced since the beginning of time, that against wound infections. As it was of national security importance, research on antibiotics amped up and by the mid-1940s, they were available not just to the military, but to civilians causing a revolution in the perception of health care.

Antibiotics, which initially needed to be administered intravenously and therefore required hospital care, led to more and more people, whom loved ones would have witnessed dying at home just a few years earlier, going to the hospital and walking out. Our infrastructure, including our health system, was intact following the war while that of most other developed countries was in ruins. We were able to get the jump on everyone else and the idea of American exceptionalism in medical care was born and, within a few short years, we had developed our current acute care hospital centered system of providing care.

In addition to this, the industrial economy was heating up. American factories needed to produce goods not just for the US but for the world suffering form fifteen years of pent-up demand caused by the Depression and World War II. Jobs were plentiful and everyone was hiring. However, there were wage and price control laws on the books left over from the economic management of the Depression. These prevented employers from boosting salaries to attract talent, so they turned to other inducements which became the benefits package. By 1947, the titans of industry turned to congress and had the tax code rewritten to make it financially advantageous for employers to provide health insurance and an employment-based system was born. It took root nowhere else.

It was quickly realized that an employment-based system left out the post-employed and the unemployable so steps were taken to create legislation which would provide a federal safety net for these individuals. Unfortunately, these attempts were branded as ‘socialized medicine’ and ran into the red scare of the late 40s and early 50s and went nowhere. It wasn’t until 1964 that the political moment became right and under the Johnson administration, the major federal health and welfare programs such as Medicare and Medicaid became law. There was abundant opposition to these programs, led by the AMA who believed firmly that inserting a federal dollar into the patient/physician dyad would add a third decision maker, causing problems for both sides. They hired an out of work movie actor to be their celebrity spokesperson for their campaign against Medicare, Ronald Reagan. He found he had a knack for politics.

Fifteen years later, Reagan came to the presidency on a tide of government isn’t the solution, it’s the problem. His economic policies began a transfer of wealth upward and encouraged economic consolidation. Reaganomics hit medicine as much as any other sector. Before the creation of federal payment systems, medicine was primarily a small business operation. Physician practices were privately owned. Hospitals usually were owned and run by not-for-profit institutions of charitable mission, whether religious or secular. Medicine was by law and custom a not-for profit-enterprise which existed for social good. In 1974, when Richard Nixon, at the behest of his old friend Charles Kaiser, signed the HMO act, he opened the door for private enterprise to purchase and make profit from entities providing medical service. Reaganomics put this move on steroids and by the mid-1980s, for profit hospital chains and insurance companies began to dominate the market. Wall Street took notice of the amount of money that could be gleaned from the system. It came calling and an earlier generation of clinicians sold out for personal profit.

Since the 1990s, the trend has been consolidation, corporate ownership, additional layers of management such as pharmacy benefit managers which add complication but do little to actually improve healthcare. The rise of computers and AI has added a whole new set of complications as medicine as an entity increasingly reacts to aggregate big data and less to the needs of the individual. This has placed the physician in the midst of a moral dilemma. To whom does he owe allegiance? The patient or the paycheck? Our time is spent in data gathering and data entry (my day is becoming reminiscent of my very first job at age 15 when I was a data entry clerk and keypunch operator). The computers track our every move. If we don’t meet our metrics, we will be dismissed and replaced allowing us to help no one. I didn’t know I was spending thirteen years in higher education to learn to type.

Starting in 2020, it’s all started to unravel. I call this ‘The Great Undoing’. It began, of course, with the Covid-19 pandemic. The lack of preparation, the neglect from the highest levels of government, the trauma of provision of care in impossible circumstances, the indifference of administrative layers safely cocooned in their working from home environments led to a wholesale rush for the exits from the older generation. Everyone is short staffed. It takes more than a decade to train a doctor and almost as long to train a nurse practitioner. You can’t replace the workforce with a couple of weekend seminars and some YouTube videos. Everyone has noted the inability to get appointments and the delays in care that have become commonplace. We want to help but there’s only so many of us left to go around.

In addition to this, this past year has led to a presidential administration determined to bring down American medicine for political gain. The great institutions created from the ideals of American exceptionalism are being decimated. The research universities which create our knowledge and train our future providers are under attack and having their funds sharply curtailed. Those put in charge of our major health programs proudly advertise their ignorance of science casting aspersions on centuries of learning. I’m all for making America healthy again but throwing out the last century and a half of medical advancement is not the best way to accomplish that goal.

This leads the average practitioner open to the death of a thousand cuts of moral injury. On a daily basis we must pay more attention to a machine than to our patient, constantly try to do more with less as the money in the system dries up, argue with clerks at insurance companies and pharmacy benefit management firms to try and get what we, with our many years of training and experience, know our patients need but which keeps getting shut down by someone with a high school diploma and a company manual, endure arguments from patients and families, based not in science or logic, but on the latest misinformation advocated by media conglomerates or fueled by direct to consumer advertising, try to bolster the morale of our colleagues who may be in a worse position than we are in, have to fill out the same form for the third time because an insurance company doesn’t like our choice of wording (what part of both legs amputated don’t they understand?) and on it goes.

These moral injuries, to me, have root in moral evils. What are they? The first comes out of the old adage: Radix Malorum est Cupiditas. Greed is the root of all evil. I’m not against capitalism and I’m not against making a profit. I am against the making of money to pay shareholders being the be all and the end all of such a vital part of our lives. There is a role for the federal government to manage important sectors of our economy so that they can exist and work for the entire population. A second moral evil is our construction of a system that exists to prevent care. The ubiquitous middlemen that are now part of every decision process need to be replaced with people who understand the nature of clinical medicine and the sacred bond that develops between patient and physician which allows true healing to occur. Our third major moral evil is the rejection of knowledge, science and fact for political expediency. This one is probably the easiest to deal with. Fact is fact no matter how hard you deny it and, as will eventually happen, when something arises to bite us all in the butt because we refuse to understand how nature works and our place within natural systems, we may quickly reverse course.

So how do we fix this mess? It’s fixable but it’s going to take a lot of political will and a certain amount of uniting of the country behind a movement to accomplish this – and our current politics don’t allow for uniting over much of anything. If we eventually come around to an understanding that we are stronger together rather than on opposite sides of the football stadium, we may be able to take on some of these tasks. These include resource redirection away from administrative functions to clinical functions, a better understanding of morbidity and mortality so that we no longer hold impossible ideals like ‘death is optional’ , creation of universal data systems so that information can be quickly shared throughout the system, development of single payor mechanisms, and subsidization of medical and nursing students so they don’t enter life with six figure debts that require them to concentrate in higher reimbursement specialties.

What comes next? I haven’t a clue. Stay tuned. I’ll probably write something about it eventually. There’s only one thing of which I’m fairly certain. Retirement in 22 months. But who’s counting? Thank you.

I’ve been meeting to write a long post for days but every evening when I have completed the tasks of the day, I’ve just been too tired and crawl under the covers instead. I’m still somewhat more fatigued than I think I should be. (Nothing seriously physiologically wrong as I had my usual medical check up a few weeks ago and everything was fine). Maybe it’s just the thing I discuss constantly with my patients – a brain that thinks it’s somewhere around thirty years old and a body that is definitely not. I continue to keep up with everything I need to do (although rehearsal on top of a full work day is a bit harder than it used to be) and I’ll just continue to carve out naptime.

What may be going on is a natural phenomenon deeply connected with primitive brain reflex arcs. Our brains are built from the inside out with the most primitive functions tied to keeping us alive in the deepest and most ancient structures (what I usually refer to as the lizard brain). Our lizard brain is what keeps our internal organs running, provides the circuitry that creates such things as hunger and thirst, and is acutely aware of danger and makes us do what is necessary to preserve life and limb. Our primitive reaction to danger is usually referred to as fight or flight. But there is a third setting – play dead. I don’t know about the rest of you but modern politics and pandemics have created a constant stream of danger stimuli for roughly a decade now which is pretty inescapable if you’re an informed person. My danger circuits may just have worn out and gotten stuck in the play dead setting making motion and activity just that much harder than it needs to be. I’ve certainly noticed this for some years in subtle ways like a need to sit in the car for a few minutes when first arriving home after work and allowing my brain a little off time before I get out and head into new patterns and activities. When I query friends, many of them have noticed themselves doing something similar. And it’s a new behavior for all of us.

I attended a performance of Big River at Virginia Samford Theatre this evening. For those of you not conversant with everything Broadway of the last century, it’s a musical adaptation of Mark Twain’s The Adventures of Huckleberry Finn written by Roger Miller in the mid 80s. I last saw it staged about forty years ago in Sacramento at Sacramento Music Circus. (Music Circus is one of the last surviving old fashioned summer stock companies staging eight or so musical revivals, one a week, in the round in a large tent). When I first moved to Sacramento for my residency, my apartment was three blocks away so I saw pretty much everything they did. I eventually moved about twelve blocks uptown but Steve and I continued to walk down on summer nights seeing sll sorts of terrific Broadway names in the classics. As far as I know, Music CIrcus continues strong even though I haven’t been back to Sacramento for any significant length of time since being forced out by UC Davis’ bad decision making in the late 90s. I hope the tent has better air conditioning than it used to.

As I was watching the show tonight, I began to think about Mark Twain’s ruminations on the American character as exemplified by Huck and Jim’s journey downstream on their raft and how there are observations that he made with Huck’s awakening to Jim’s humanity that very much apply to our political moment. The electorate, both red and blue are together on a metaphorical raft at the moment and, like Huck, prey to being forced to share their space with con men like the King and the Duke (who are cut from the same cloth as some of our current power figures). We too can open our eyes, join together, help each other, and come out the better. But we need to want that and I’m not sure that either side has decided they really want to bridge the divide quite yet. I don’t know what it’s going to take. And that’s one of the things that scares me most.

This week has been about the base of MAGA, the part that organized itself around a bunch of nonsensical social media posts by someone purporting to have the real truth of the so called deep state and how it has something to do with sex trafficking and cannibalism amongst other eddifying issues, erupting in fury as Trump has tried to downplay the various scandals involving his old buddy Jeffrey Epstein. For those who were hoping MAGA would implode, it won’t. It’s going to take a lot more than decades old gossip about bad behavior amongst the rich and powerful to undo that particular brain fever. It does, however, give some interesting insights into the mindset of those who follow the QANON cult thinking and how detatched from obersvable reality they seem to have become. None of the Epstein issues really bothers me one way or another. Let the court system sort it all out and if there has been illegal behavior and it has been proven, let it be appropriately punished, no matter who was involved or what their political affiliation. I read someone’s opinion piece that this is all coming to a head now because Trump has started to realize how badly played he has been by Putin and he has therefore tilted the US back toward the Ukraine. As Putin’s only real interest in Trump was for him to hand him Ukraine on a silver platter, with that moving out of reach, he’s now trying to push the Epstein narrative as a way to take Trump down. Given that many of the loudest social media voices on the right are amplified by Russian bot farms, there may be something to this.

There’s been lots of bad news in the last week but there’s only two things that truly scare me. The first is the speed with which the administration is busy building and consolidating an extrajudicial detention and punishment apparatus. The politicization of the military with the National Guard in California, the building of detention centers with zero information and oversight, the enormous increase in budgets for iCE which is being remade in the mode of a secret police force does not bode well. They’ve pretty much limited themselves to detaining immigrants at the moment but there are signs that they are spoiling to go after those whom they feel are getting in the way of their detention plans. I can easily see rounding up and detaining of citizen demonstrators and monitors of ICE action coming shortly and it will only be a short step from that to detaining those whom they feel fund or provide support to these people and then it will be open season on political opposition. And when citizens are disappeared into detention without warrants or judicial review, what will you do? It’s not that much of a step to make the disappearance of inconvenient persons permanent.

The other is the silencing of media opposition through the leveraging of corporate power. Anyone who thought that corporations would stand against the current administration is awfully naive. Corporations exist for the sole purpose of producing profit. They will bend whatever way they think is necessary to keep the money flowing. It took less than six months for most of corporate America to back away from DEI and support of the LGBTQIA community. The government has essentially killed PBS and NPR with the recision bill that it forced through congress. CBS, as its parent company Paramount Global is desperate to complete a merger with Skydance which requires federal approval, has essentially emasculated Sixty Minutes and offered up Stephen Colbert’s head on a silver platter to appease Trump. From what I can tell, both the Washington Post and the New York Times have both backed off any hard hitting reporting on the administration at the behest of corporate ownership. Pretty much all media in the US is owned by one of six large corporate entities which will do whatever is necessary to preserve their bottom lines. Given recent history, this means not leaning too hard on the administration or its policies. So how are we supposed to get the information we need as to what’s actually going on in DC?

Only about 10% of the population pays attention to politics and federal policy. The vast majority of Americans have no idea of the enormity of the change that’s currently going on or what it is likely to mean for their lives over the next year or two. A compliant media isn’t likely to inform them. It’s not in their interest. When things start going south for more and more of us, I have no idea how people are going to interpret that or where they are going to try and place blame. That’s one thing I really despise about American culture – the idea that everything bad must be somebody’s fault and that you need find the culprit and blame/shame them. The world doesn’t really work that way. But we’ve never been a country willing to accept how the world works – either the natural or the man made.

Sometimes I think I need to get on a raft and head off somewhere myself.

Exactly eleven years ago, at this hour, Tommy and I stood before a judge in the King County Washington Criminal Court (right after the Grand Theft Auto Case that had dragged on a bit longer than anyone had expected) and said our ‘I Dos’. Tommy, who always hated ceremony of any kind, wasn’t too thrilled with it but it meant something to me as I never expected that a legally binding marriage contract would be available to me within my lifetime and yet, there we were – signed, sealed, and delivered. It wasn’t a wedding with the usuall fripperies and the only people in attendance were my father and my cousin Jenny as witnesses. It was followed by a dinner in the backyard of my sister’s house with the rest of the family and a few friends. We had been together for over a decade at the time and didn’t want a fuss made. Later that evening, in bed, we both changed our Facebook statuses to married and were highly amused at the rapid appearance of exclamations of surprise and good will as we had told no one in Alabama of our plans.

Our marriage didn’t last. Tommy’s death four years later saw to that. But I did have a marriage and it’s recorded in various legal databanks for posterity. That means something. As I sit here and watch the current administration industriously trying to rewrite history, weaponize politics against individuals with whom they disagree, and blithely erase data which might contradict their belief system, I sometimes wonder if the record of my marriage will survive? It really won’t make any difference in the history of the world one way or another but as a member of a suspect class in a time when conservative forces are trying to eliminate the rights of members of suspect classes, I feel it’s important that my marriage, and all of the other legal same sex marriages that have come into being over the course of the last couple of decades continue to stand as evidence of lives and achievements.

The various DC meltdowns over the Epstein files and their Schroedinger’s cat like existence and the finger pointing regarding the tragedy of the flooding in Texas have knocked most other stories out of the headlines over the last week or so. I don’t care who or what is in the Epstein files. If there’s evidence of criminal wrong doing, let justice take its course. I don’t believe in the bizarre conspiracy theories that are being swapped around on the seamier side of social media. The number of people who would have had to have been complicit and never talked makes it unlikely that it’s anything other than garden variety sleazebag behavior among the class with more money than sense. If there’s one thing that forty years in medicine has taught me it’s that human beings are terrible at keeping secrets. Someone always spills the tea. This is why these exotic and far reaching conspiracies are just not possible. There’s always a repair guy or a maid or a low level functionary who sees or reads something and they don’t keep quiet. Just like the nonsense about chemtrails. The number of pilots, airline ground crew, chemists, transportation workers, and manufacturing plant employees that would have to be in on it and then keep quiet for decades is impossible.

I don’t have much to say about the flooding. One of the girls killed at Camp Mystic was the daughter of a colleague here at UAB and my heart aches. Murphy’s law was in full force that night regarding weather, official reactions, federal responses, and all the rest and sometimes tragedies occur. We have two choices. Sitting around finger pointing and shifting the blame or learning form what happened and making changes in our behavior to lessen the chances of this tragedy recurring. Given that a nearly identical tragedy happened back in 1987, I can bet as to which one is likely to take place. The average American, and their governmental representatives have decided since about World War I that development and building is about profit and natural forces are immaterial. Just because you build does not mean the flood plain vanishes, the storms don’t form, the fires don’t race up the hillside and the earth won’t shake.

What has been driven off of the front pages, and even the middle pages, is what’s happening in public health. Measles, a disease that had more or less been eradicated, has come roaring back with a vengeance fueled by vaccine politics and misinformation that has infected the entire body politic. Measles is so contagious that it’s the canary in the coalmine. It’s always going to be the first one back if public health fences start to fall. Other previously eradicated or controlled diseases are likely to follow. And the building of unsanitary concentration camps in swamps may accelerate this. DHS has decided to cease all reporting on H5N1 bird flu so there is no way of knowing where it is, whether it’s increasing, if it’s showing more signs of human to human transmission, or anything else that might be useful. Keep in mind that it’s mortality rate in humans is approaching 50% so it might be a good thing to know what’s going on with it. Out of sight, out of mind is not a useful public health strategy. Covid-19 numbers remain relatively low in terms of hospitalization and mortality but it’s still out there. About one in two hundred Americans is infected at any given time and the biggest issue currently is multiple subclinical infections which can still lead to long covid. I have found that I am requiring a good deal more sleep this last month or so than usual and am having to budget in time for naps. This is new for me. I don’t think it’s just my advanced age. I truly wonder if one of my endless series of respiratory infections this past winter was subclinical covid that didn’t show up on testing and this is my version of long covid. Covid shots should still be available this fall for those who want them. I am still going to get mine. Chance of severe complication from covid vaccine = 1/1000000. Chance of severe complication from covid 1/50.

Our illustrious head of DHS, RFK Jr. has cancelled the next meeting of the US Preventive Services Task Force. When he did this for the advisory committee on immunization practices this past spring, it was in preparation for firing all of the vaccine scientists on the board and replacing them with, from what I can tell, a lot of anti-vaccine cranks. I don’t know if he’s going to do the same with USPSTF but I won’t be surprised. Why should you care? USPSTF is an impartial group of experts in public health who go over all of the evidence regarding health screenings and rating them as to their effectiveness and whether they should be pursued in the population at large. Language in the PPACA requires health insurance plans to cover any screening that USPSTF rates at an A or B level (it’s a cost effective measure that saves lives). If USPSTF falls, then insurers will have no mandate to cover screening tests for cancer or other diseases. You’ll still be able to get them, but they’ll cost you a lot more.

I’m still hearing about fallout from the Big Beautiful Bill signed last week. Now people are actually starting to read those thousand pages and project out what they mean. In regards to the Medicaid cuts, and yes they actually exist, they won’t hit Alabama as hard as a lot of other states. We never took the Medicaid expansion and we have always had one of the stingiest of plans so there’s almost no fat to cut. There are no able bodied guys eating Cheetohs and playing video games on mama’s couch receiving Medicaid in this state. Able bodied men are essentially ineligible. Nor does Alabama Medicaid enroll undocumented adults. The very narrow margins that exist in rural healthcare in this state will almost certainly be upended and we will lose rural hospitals and clinics. UAB is going to be heavily impacted between Medicaid cuts, grant cuts and reduction of indirects. In 2023 (the last year for which I can find numbers), UAB was the state’s largest employer and provided just over 5% of the state’s total GDP. Major cuts there will have ripple effects absolutely everywhere. I’m still trying to hang in there for another couple of years but if all hell breaks lose after next year’s budgets come out, I may need to gracefully exit stage left, pursued by bear.

Happy Fifth of July or, as it is known in theatre circles, Lanford Wilson day. And no, I’m not going to explain that. Google and Wikipedia are your friends. Until they are made to conform to ideology rather than fact. Given our reliance on these sorts of digital tools, it’s now a good deal easier for an authoritarian regime to rewrite history. The right programmer, a few keystrokes, and poof! Inconvenient facts and events vanish from the record. I imagine they’ll start experimenting with the erasure of inconvenient people in the not too distant future. I’d probably end up on that list if anyone actually read these random musings of mine outside of my immediate circle of acquaintance. I’ve been rereading some of my Accidental Plague Diaries in preparation for future writing projects. So much of what was written there, less than five years ago, has been stricken from the current narrative of the pandemic. The books will remain as an acurate reflection of what really happened.

Facts and science, however, remain immutable. Yesterday there were devastating flash floods in Texas and dozens were killed. There was apparently little warning of the rainstorms that sparked the flooding. Perhaps axing the budget of the National Weather Service and taking a number of its data bases off line was not the wisest of ideas. And I’m dure Greg Abbott and Ken Paxton will get right on clearing the debris and putting things to rights now that FEMA has more or less been dismembered. Meanwhile, in Florida, the first rainstorm to hit Alligator Auschwitz (a non uncommon occurence in central Florida in the summer) seems to be disrupting the various tents and there are several inches of standing water on the floors. I don’t think I need to tell you that the combination of stagnant water and crowded human beings is a set up for infectious disease. And once seeded, they are not likely to remain conveniently solely on site.

What is the purpose of the detention camp in the swamps of Florida? Which, if the current administration has its way, will be replicated in a town near you in the ridiculous attempt to deport every undcomumented or paperwork error or funny accented or anything else that strikes ICE’s fancy person in the US over the next few years. The legislation signed yesterday pours billions into this shameful project so they’ll have all the resources they need to do it. The true purpose of something is often not evident. Take the famous example of the McDonald’s Ice Cream machines. (The ones that are always broken). It would seem that the purpose of these machines is to dispense frosty goodness to the great American public but as an investigation by Wired showed, this is not so. The true purpose is to continue to enrich the Taylor Company (the machines’ manufacturer) who also have an exclusive contract for maintenance and repair. The more they break, the more money flows through the service contracts.

Given the economics of these concentration camps, built by companies with strong ties to the administration and major donors to the Republican party, the cost being charged to the federal government comes out to about $250 per bed per day. Hampton Inn would be cheaper. The annual budget for Alligator Auschwitz is an astonishing 450 million dollars. The inner workings are shrouded in secrecy. Just as ICE is refusing Democratic lawmakers access to their federal facilities in violation of federal law, the state of Florida is refusing Florida Democratic lawmakers access to this place despite it having been built with tax revenues – a violation of state law. Nothing good happens behind closed doors. These camps are likely to be a profitable business and healthy investment for those behind them thanks to the largess of the federal treasury. The purpose of these camps will, therefore, be return on investment. And once built, they will not be allowed to be empty as that would reduce the revenue stream. We will start seeing native born citizens rounded up and incarcerated eventually if things do not change. The MAGA drummers are already talking about the need to deport 65 million Americans. This is the entire population of the US of Latin/Hispanic heritage, many of whose families have been here far longer than the arriviste northern Europeans.

I did not watch the signing of the Big Beautiful Bill. It’s big. It’s hardly beautiful and signing it on the 4th of July (which MAGA loved) is a perversion of that date in history. I can hardly wait to see what they have in store for this next year, our 250th anniversary. Fifty years ago, for the bicentennial, we had the rather staid Bicentennial Minutes on CBS every evening. And with only three national networks (four if you count PBS), we all watched them. I’ve heard rumors Trump is going to give us a UFC smackdown at the White House. The bill is full of heinous cuts to social services and various mechanisms to continue the flow of capital to the very few at the top. Most of the pain, however, is delayed with most of the cuts set to go into effect at the end of 2026 (after the midterms) and 2028 (after the general). Because of this delay, a lot of them will be relatively easy to undo by a new congress. Presuming we have egalitarian elections next year, if all of those who dislike what’s in the bill (about 70% of the country) vote against the party that drafted and passed it, it can be made to go away.

I decided to forego the fireworks last night (I wasn’t in the mood) but I did get a little time in the sun and had a large sloppy hamburger for lunch. Today, I’m planning on going to see the new Jurassic Park movie. I’ve heard it’s terrible but I have a fondness for dino disaster tales. I’ve never quite figured out why Steven Spielberg’s original, one of the finest summer popcorn movies evver, has been able to spawn so many grade z sequels. Even Spielberg wasn’t able to capture lightning in a bottle twice. He directed the first sequel and it’s one of the worst of the lot. I have Monday off so it’s a four day weekend for me. With luck all of the little tasks I’ve been putting off will start falling off of my To Do list, struck through in the turquoise ink from the pen that’s currently sitting next to my notepad. That is if the cats haven’t expropriated it for a toy. No matter how many cute little cat toy things I give them, they prefer pens and pencils knocked off whatever flat surface they’ve been resting on. At least it’s just writing implements and they haven’t graduated to vases and serving platters.

And so, with Lisa Murkowski being granted a heaping helping of pork belly and Susan Collins issuing her usual statement of being gravely concerned (which never seems to change her vote), it looks like Trump’s Big Beautiful Bill will cross the finish line in the Senate. Thom Tillis, who took a somewhat principled stand against it, has had his political career served up on a silver platter next to John the Baptist’s head. The writing on the wall is clear. If you wish to maintain the perquisites that come with a little R after your name, you will toe the line or you will be excommunicated. It’s not surprising. What’s happening here is no different tan what happened in Rome under the later Caesars or Europe in the age of absolute monarchy. We used to think that we Americans were special and above the problems that graced so many other nation states. Turns out we’re perfectly ordinary. Any American Exceptionalism that used to exist was pretty much toast a decade or so before I was born. We just liked to pretend that it still existed and the result is a culture that’s pretty much a Potemkin village.

I did not listen to the 16 hour reading of the 900 page bill. Neither did the Senate. I don’t think a single senator stuck around for that particular piece of political theater. But then there’s a lot of not showing up happening. Such as not a single influential member of the Republican party on a national level showing up for Melissa and Mark Hortman’s funeral – gunned down by a sick individual influenced by the stochastic terrorism of MAGA rhetoric. And that’s not going to be the last political assassination. Details are murky but someone was taking potshots at the police and fire department in Kootenai County Idaho after deliberately setting a wildfire to draw them into an ambush. I can guess the political affiliations of the shooters. Being from Washington, I am quite familiar with that piece of Idaho and the white nationalist tribe that has been gathering there since the 1970s. (See Gary Yarborough and the Aryan Nations incident in Sandpoint – 1984).

There are still intelligent people on the right side of the aisle (at least I hope so) and they must know that much of what is in the bill is incredibly destructive in its attempts to continue the moving of capital upwards to the billionaire class. All I can think is that some sort of Apres moi, le deluge mania has taken over their brains. We’re rapidly creating a society in which the young cannot economically survive. Children become a financial risk and birth rates fall, not to mention the biologic issues of delayed child bearing. (There are some interesting studies that suggest that autism is most related to older age fathers). We’ve managed to escape most of the demographic disasters waiting for Western societies due to robust immigration. Well, that’s being thrown out the window along with dissident Russian oligarchs.

I think a bunch of this all comes back to the structure of the Baby Boom and their delusion that they remain the youth generation, despite the fact they are six months away from turning eighty. If they are young and immortal, no need to worry about or create a better world for the succeeding generations. They’re babies. Well, the Millennials and Generation Z are starting to wake up to the fact that they actually outnumber the surviving Boom and, as the Boom begins their major die off in the next five years or so, it’s the young who will decide elections, as long as they vote. It’s what propelled Mandami to victory, a huge turnout by NYC voters under 35. They know that they’ve been screwed as a generation by the boom and they’re pissed. The wealth transfer in some ways is the last gasp of the boom to scarper off with the treasure before the invading army captures the citadel.

The measures in the bill, particularly when taken together with the various imperial executive orders and the wrecking ball of DOGE, (I saw a quote from someone in DOGE somewhere saying that they really couldn’t find any waste, fraud or abuse but they were under huge pressure to do something and call it that), have either knocked out or will severely damage the pillars of American society. When the roof collapses on us all in the not to distant future, no one will be able to say they didn’t intend this result You remove enough supporting walls and the building will inevitably collapse. It’s called physics. It’s a science. It doesn’t care about your belief system.

I am, of course, most concerned about what other nightmares are coming for the healthcare system and senior care. I do have the bolt hole of early retirement if necessary but I am trying to hang on for another 22 months. The bill succeeds in killing Obamacare by removing the subsidies that make it affordable. Somewhere between 20 and 40 percent of smaller and rural hospitals will close due to cutbacks in Medicare and Medicaid. (And don’t believe the twaddle about there are no cuts. There are. Billions upon billions of dollars). One quarter of the nursing homes in the country will go out of business. If you have a relative in a skilled nursing facility, be prepared to take them home and care for them there. The closures combined with the needs of the rapidly aging Baby Boom will make beds nearly impossible to access. And, if your relative is lucky enough to actually have a bed and is in a state with a filial responsibility law (Alabama does not have one), the cash strapped state will begin garnishing your wages and taking your property as restitution for their care. It’s a mess, but eldercare in this country has always been a mess (it’s one of the things that attracted me to the field). I’ve fought the battles for thirty-five years. It is someone else’s turn.

Not a lot of personal news to report. I had a meeting this evening with the costume designer for Richard II. Rehearsals resume tomorrow. I’ve come to the conclusion it’s either going to end up as brilliant or an unmitigated disaster. I don’t know which yet but I’ll take full responsibility for it either way as the whole conceptual framework is out of my fever dreams of modern politics. Yesterday was my day of civic service for the month. I had a board retreat with the good folk of Central Alabama Theatre (a company that does mainly cabaret shows and small scale musicals) looking at how we position ourselves for the next few decades and then ran from that to my board responsibilities for Alabama Equality which was having a fundraiser entitiled ‘Love Wins’ celebrating enduring LGBTQIA relationships. I approached that one with mixed emotions as death cheated me out of many years of coupledom with both Steve and Tommy. Fortunately, I had taken a relatively simple task of limited scope. I was responsible for the raffle (excuse me – door prize drawing). A trip to Office Depot for tickets, and the creation of three gift baskets filled with World Market’s finest merchandise. Sixteen years with Tommy taught me a thing or two about the creation of gift baskets and I thought they came out rather well. Tickets were selling at a brisk pace when I left (I was dog tired so I didn’t stay for the whole thing) so I guess they were attractive enough to pique some interest.

I also managed to attend Tracy Letts’ new play The Minutes at Terrific New Theatre with a cast of some of Birmingham’s finest actors. I knew a bit about the play going in. (A small city’s city council meeting devolves). Without directly commenting on current politics, it brilliantly showcases many of the tensions we currently face. And the metaphorical ending, which could have easily fallen apart with a less committed cast, showed how difficult it is to escape group think. I went with my friends Patti and Ellise and Ellise drew parallels to MAGA, remarking that Trump is the fire around which they all dance. Birmingham theater has been showing up and showing out over this past season or two with productions that make you think. The Minutes, Assassins, The Crucible, for that is the job of theatrical artists. To hold up the mirror to society to help to teach it to be better. Now if I could only find some young uns to run with Politically Incorrect Cabaret.

And that’s a wrap on the first week of rehearsals for Richard II. I think it’s going to come together well and be the show I’ve had rattling around in my head these last few months. At least the parts we’ve put on their feet are working relatively well. I’ve always liked conceptual Shakespeare. At least as long as the concept helped clarify theme and character. We still do the plays after four hundred years because the ideas and insights into humanity remain timeless which in turn makes it easy to set the plays anywhere and at any time and not confine them to Elizabethan drama. Richard II may be about specific political events in late 14th – early 15th century England but thos are just surface trappings to exam how a man with absolute power undoes himself by his unwise application of that power. It’s something we see all the time – and it’s become pretty much a daily occurence under the current administration. Richard is not our current president. Richard has self awareness and that’s the tragedy. In hindsight he understands what he has done that has caused his downfall. The president isn’t a tragic figure. He’s an operatic one. He’s larger than life and if he is taken down by the gods, he will be unable to comprehend his role in that process. He’s the Duke in Rigoletto, not a conflicted Shakespearean protagonist.

So what has our Duke of Mantua and his court been up to these last few days? NATO still holds (but it’s unclear just what the outcome is going to be for Ukraine or the Baltics – it’s a good thing Russia is running out of men). The Iran/Israel contretemps remains somewhat obscure. Iran’s nuclear program was permanently damaged… no it wasn’t just set back… the news is wrong… congress is wrong… the Democrats are leaking falsehoods… the Democrats were not given the intel for political reasons… I am in agreement that the mullahs of Iran should not have nuclear weapons. I am not in agreement that the best way to deal with the issue is lobbing ballistic missles back and forth. Diplomacy is much more likely to come up with equitable solutions. The trouble is that the current administration seems to have gotten rid of all the experienced diplomats with true knowledge of the parties involved.

There is much wailing and gnashing of teeth that a Muslim with progressive views has come out of nowhere to be positioned as the next mayor of New York City. The far right are exclaiming that he should be denaturalized and deported. If we’re going to start playing that game, a future Democratic administration could deport the current first lady, the movie star former governor of California, and a large portion of the right wing voting block of Southern Florida. The left wing is soul searching as to how a corporatist third way democratic insider was defeated (despite significant compromise in the past). The current leaders of the Democrats need to wake up to the fact that demography is destiny and that their attempts to keep all power in an entrenched circle is doomed to fail. Their refusal to embrace the candidates of younger generations, public repudiation of David Hogg, and general tone deafness in dealing with the concerns of younger millennials and generation Z do not bode well. They are supporting a system which has continuously economically squashed younger generations preventing them from developing and achieving the milestones of maturity that we have valued in this culture. These are the conditions that breed revolution. If we didn’t live in a time of birth control and these young people had masses of children they couldn’t properly feed and care for, it would already be upon us. There will be more and more candidates like this on the left and they will win more and more elections.

I am waiting for more and more exposes as to what’s acutally going on in ICE detention facilities. None of it is good. They are over crowded, under staffed, and appear to be run by for profit entities interested in government contracts but not in those entrusted to their care. Throw in a bunch of masked bully boys with no professional training and it’s a disaster in the making. When the madness passes and we hear about horrors, I don’t want to hear any ‘we didn’t know’ from anyone. Yes you do. You just don’t want to admit that we could do such things in this country. A better term for the tent city they’re setting up in the Everglades is Alligator Auschwitz as there’s no other proper term for it than concentration camp.

Something I have noticed. Pretty much every report on someone snatched off the street is of how they are ordinary workers, mothers, students. They are gleefully rounding up those that are legal permanent residents who had a run in with the law years ago. There have been almost no reports about gang members being or criminals being taken. First off, there aren’t that many and they aren’t going to be easy to find as they aren’t likely to show up at scheduled court dates. Second, they’re likely to fight back and the passel of quasi-legal bullies aren’t about to enter a situation where they might be injured. If they were really rounding up hardened criminals, wouldn’t it be the easiest propaganda in the victory to parade their mugshots and rap sheets on the nightly news? The lack of such things tells me everything I need to know.

And this brings me back to my staging of Richard II, taking place in a holding cell of a political prison. We should all be thinking about the misuse of power these days and it should inform what we do in terms of voting patterns and holding our leaders to account. Shakespeare had a lot to say about power and its abuse and misuse. I want people to leave this show thinking. I don’t want them feeling that their side in our current divide is right or wrong. I want them to dig deeper than that and soul search about the meanings of political power and what are right and wrong ways that it is used. I hope I’m smart enough to get that on the stage.

Today is the Summer Solstice, the longest day of the year and, starting tomorrow, we begin the long march back towards darkness. Of course, there are those who would argue that we havve been marching towards darkness since January 20th, no matter what the relative positions of earth and sun happen to be and, given the news of the last week I am a bit inclined to agree. I don’t even know where to start any more when musing about politics and doings on a federal level. The brightest spot is that the center is not holding. As reality continues to intrude on ideology and science continues to trump wishful thinking, a government consisting of sycophants, toadies, and know-nothings seems to be buckling around the edges. Quelle surprise.

The administration’s positions on all major issues are sinking rapidly in every major opinion poll, including those put out by Fox News, leading to various mouthpieces attacking their favorite propaganda outlet for not toeing the party line. Pretty much every special election has had the Dems overperforming and Reps underperforming, often by double digits. This suggests that, assuming we have midterm elections, that there is likely to be a change in control of congress. Hopefully this will lead to a reinstitution of some of the constitutional checks and balances the current congress appears to be snoozing through.

Trump is, of course, trying to get the media spotlight back on himelf, especially after that sad little fiasco of a military parade. Attention is his oxygen. Ignore him and the tantrums get bigger and bigger until he’s back again center stage. The best way to deal with him would be for everyone to go about their daily business and ignore him no matter what comes out of whichever orifice. His current attempts to control the narrative include paving over the rose garden. (I’m not worried about that – it can be jackhammered up again and resodded – and if they sold chances to wield the jackhammer for substantial donations to The Kennedy Center, it would likely be properly funded for a century). He’s also installed flag poles so out of proportion to the White House that the design principle appears to be used car lot.

The Big Beautiful Bill is in definite disarray as there is more and more reportage on just what it will do, especially to the poorest amongst us. Even some of the Republican senators are backing away from some of the crueler measures. The Senate parliamentarian is providing political cover by explaining that significant portions violate the rules of reconciliation and must be stricken in order to use simple majority voting. I’m sure something will eventually emerge but whatever it is, it’s likely to be a Frankenstein monster with a few extra limbs rampaging across the Federal landscape for a while. With luck, a future administration will trap it in a burning windmill.

Speaking of rampages across the government, what has happened to Elon Musk? He was everywhere just a few short weeks ago and he seems to have fallen off the radar other than his usual activity of blowing up rockets on the launchpad. I think he has a long way to go before he can think about making us an interplanetary species. Unfortunately, the Muskrats are still embedded throughout federal agencies, vacuuming up all of our personal data for the benefit of Palantir, and cancelling out decades of scientific and medical discovery. Speaking of medical data, the right wing’s favorite judge, Matthew Kacsmaryk (judge shopping is just fine when they do it) has decided that your reproductive health and HIV health records are not private and can be shared with legal authorities. Expect pregnancy test centers at conservative state borders and confinement to prevent travel for any sort of termination services in 3…2…1.

And then there’s Israel and Iran lobbing ballistic missles at each other on the other side of the globe. The secretary of defense and director of national intelligence appear to have been sidelined due to general incompetence. The secretary of state appears to be unfamiliar with the most basic concepts of diplomacy. I wouldn’t be surprised if no one in the upper echelons has any understanding of Shia vs Sunni or why the split exists. The war hawks are careening one direction. The isolationists another. And the religious zealots seem to think the more lunatic ravings of Cyrus Scofield are becoming reality. At least Europe, after very publicly sidelining Trump at the G7 meetings, are being the adults in the room and dealing with the issues in the way in which they need to be to keep the planet from going up in flames.

So what’s next? Who knows. I look at the headline digest in the morning from the day before and just kind of shake my head, try to forget most of it, and put my clothes on and head in to work to save the world one patient at a time. It’s all I can do. Rehearsals start on Richard II Monday and I will soon learn if my ideas which work just fine in my head actually work when other people try to put them on a stage. I’ve also got a bunch of non-profit board work to do over the next few weeks to help raise funds for various worthy causes.

I’ve had every intention of writing one of these essays? missives? screeds? for the last couple of evenings but as I’ve bumped up on the end of the day, I have just been too tired to put coherent thoughts together and have crawled into bed and the deathless phrases forming in my mind have petered out in dreamland. I’ve been far more fatigued than usual this week. I don’t know if it’s readjustment after two weeks off and now back to the usual grind or perhaps its post viral slowdown after having had yet another respiratory virus while off in Ireland a couple of weeks ago. Whatever the cause, I hope it wraps itself up soon as I have to begin directing Shakespeare in just over a week and I’ll need all of my wits and energy about me. Fortunately this next week is a short week due to the Juneteenth holiday so that may helpme get back into fighting shape.

There’s not a lot going on in my life other than the usual work stuff, hopefully soon to be made a bit easier by the arrival of my nurse practitioner to help spell my patient care duties in the VA half of my job. That process only took about eighteen months, interrupted as it was by the federal hiring freeze and the like. She’s someone I worked with at UAB for years so I know she’ll fit in very well with the VA rural house call program that’s my major responsibility on that side of the street. So far the shockwaves that are roiling academic health systems and federal agencies have spared my little corner of the world. I’m wise enough to know that it’s a temporary reprieve while the system rebalances. The ultimate endgame will be the usual one – forced to do more with less. I’ve been playing it for decades and know how to respond and how to push back but I am getting tired. I’ll have been part of the medical system for forty one years this August. It’s time to let younger generations take it all on.

There’s not a lot to report on the covid front. Hospitalization, mortality, and complication rates have all been in significant decline in the US for the last six months and we’re now well below where we were a year ago. Will there be a surge again this fall or winter? Time will tell. Vaccine remains available and the recommendations from the experts continue to be for an annual booster in the fall (with an additional spring booster if you have significant risk from the disease due to immunodeficiencies or serious lung issues). It’s unclear if there will be vaccine available this fall given the moves HHS secretary Kennedy is making. Despite his promises to the senate to not monkey with the vaccine system in order to get the votes he needed for confirmation, he went full antivax this past week, firing the entire CDC expert panel on vaccines, all researchers with years and years of expertise in evaluating vaccine science. His replacements have, so far, been individuals whose major qualifications are covid vaccine contraryism, many without significant credentials or expertise. Kennedy’s reasoning is that the prior panel members were compromised by ties to industry (all conflicts of interest were transparent and members recused themselves if an issue came before them that impacted any industry ties they might have), that vaccines haven’t been subject to rigorous testing for safety and efficacy (they have), that vaccines are linked to autism (they aren’t – that’s been debunked in dozens of studies) and that it’s best to start with a clean slate. We shall see. I don’t really want to see us return to a society where pretty much every family lost a child before age 5 due to a preventable disease but maybe that’s just me.

Tomorrow our president is hosting a military parade ostensibly to celebrate the 250th anniversary of the US Army but more about self aggrandizement and his 79th birthday. To me, it reeks of Soviet Russia or North Korea and not the sort of thing we do in this country but I suppose those with inflated egos must be placated. At least that seems to be the general attitude in the capital these days. The opposition is planning widespread general demonstrations in response. I approve in theory but I’m afraid that they may end up doing more harm than good if agent provacateurs – from either side – lead people into asinine action. Peter Coyote, the 80s indie film actor who now appears to be a professor of zen buddhism released an essay recently regarding protesting in the age of Trump that I found very interesting. It’s easily googleable. Taking a couple of pages from his book, he notes that the optics of demonstations and how they can be portrayed in the media are as important, if not more so, than what actually happens on the ground. We can see that in how the administration has handled what happened this week in LA. A relatively minor disturbance there (less violent and widespread than those after major football championship upsets) became defined by smoke, flame, some half dressed young men waving Mexican flags and it was turned into a narrative of a city in flames with both the National Guard and the Marines called out which has now led to major standoffs between federal and state power. Side issues have included the tackling of a US senator in a Homeland Security press conference, the administration’s continued ignoring of judicial orders regarding immigrant cases, and the president’s backtracking on previous positions as his wealthy friends start complaining about the depletion of their workforces.

I don’t know what’s going to happen tomorrow but if I ran the protests, I would encourage everyone to dress as if for church, leave the flags and the signs for pet causes at home, and carry American flags to represent the people and constitutional power, and be as quiet and polite as possible. An overreaction against crowds of well dressed average Americans decked with the symbols of the country would create a powerful visual statement which could help sway the middle back away from the fascist impulses of the current administration. Those of us in Birmingham should be well versed in the optics of Bull Conner acting in the name of ‘public safety’ back in the early 60s.

Must run – have a show to cast. Hopefully we’re not all living under martial law next week but I put nothing past the collection of zealots of various stripes to whom we’ve turned over our public institutions.

I should be watching the Tony Awards, but I’m being a bad theater gay and using the time go catch up on life before I have to go back to work in the morning. 16 days off has allowed my brain and body to decompress somewhat and there’s a certain amount of prep work I have to do in order to get everything lined up so that I can move forward in the morning. I know this from long experience of vacation returns in my chosen vocation. I routinely tell new medical residents that one of the worst days they will experience will be their first day back from their first vacation. They hit the ground at the start of internship, all hyped up on adrenaline and new experiences and responsibilities; then, in a few months, they get to return to normal life for a week or so and they reset. And then they have to return to the very abnormal stresses and schedules of which clinical medicine training is composed.

I am back home in Birmingham. I don’t have a lot to say about the last few days in New Orleans in the company of Frank Thompson. Good food was eaten. Walks with window shopping and gallery hopping were taken through the French Quarter. Drinks were consumed. Many heart to heart conversations were had. Rapid onset rainfall caused a couple of soakings. It was good for both of us. We’ve been friends for more than 20 years now and even though we no longer live in the same state or get to play together on stage routinely, we remain excellent touchstones for each other in dealing with the vicissitudes of life. The only truly notable event was walking up Canal Street last night when we found ourselves between a group of young Black women on the sidewalk having a good time and a group of young Black women on a party bus stopped next to them having an equally good time. They began having a twerk off. There was nothing for a couple of old white guys to do but to join in, general hilarity from the young ladies and passers by.

I was a good boy and wrote the first half of my sermon on morals and health care during my down time this weekend. Shouldn’t take all that much more to finish it up. I think it reads well so far and will hopefully get the points I’m trying to make across with a minimum of didacticism. I believe it’s scheduled for July 20th at the UU Church of Birmingham but I’ll have to double check that with the powers that be. I’ll also have to run it by ministerial staff to be sure I’m not saying anything from the pulpit I really shouldn’t. But I’m not completely sure what’s actually considered off limits in a UU space given some of what I’ve seen and heard there over the last quarter century. (My silver anniversary of having signed the membership book is next month).

I decided to take a look at the most recent Covid news as I hadn’t for a while. There are various omicron strains. They should all be covered reasonably well by the current formulations of vaccine. Vaccine remains available and the recommendation remains annual in the fall for mature adults, with a six month booster in the spring for those at significant risk due to age or underlying disease process. The CDC, under current leadership is continuing to reevlaute all of this and these recommendations could change. They have withdrawn recommendaitons for vaccination of children and younger adults (most of whom do not have severe cases). The biggest practical effect of this is going to mean that vaccinations won’t be covered by insurance for these individuals. I have no idea what will happen if there’s a mutation that renders current vaccine ineffective or even how to really track what’s going on given the degradation of public health reporting for political reasons. Keep your eyes and ears open.

The very public spat between Trump and Musk appears to have died down somewhat. I haven’t seen anything quite that viscious since a couple of old theater queens nearly came to blows over whether Patti LuPone or Glenn Close was the better Norma Desmond. (The answer is, of course, Betty Buckley). Maybe it was all a performance piece for Pride Month. I have a couple of tasks I’m responsible for for our local Pride celebrations so I better get on the stick and figure out how to get those responsibilities shoehorned into my life.

I am far more concerned about what’s going on in Los Angeles and the stand off between local/state and federal authorities. The administration is obviously trying to provoke response for propaganda purposes and there are moves of dubious legality in regards to martialing the National Guard and putting the marines on alert. We shall see what we shall see. From what I can tell, what’s going on is far less violent and destructive than January 6th 2021 so there’s definitely a bit of a double standard going on in regards to calling protest an insurrection. Domestic reporting on the situation does not appear to be terribly accurate and is fraught with media companies protecting their profits so I am getting my news from the BBC.

Wish me luck tomorrow – hopefully I won’t have left the building screaming sometime before noon.