October 25, 2020

Today has been an odd day. When awake, I feel like I’m about to explode out of my skin and take off like a rocket. And then I sit down for a minute and promptly enter torpor and fall asleep. Neither state is terribly conducive to getting things accomplished so I’m going to have to settle for having finished up my progress notes of the week for work, a self taping for a Halloween project, and several loads of laundry. Not the most exciting of Sundays but it will have to do.

I’m not good with emotions. I have a hard time differentiating between them and can’t always even tell positive from negative ones so when I have a day like today when they’re swirling around, my first instinct is to try and figure out how to tamp them down and wall them off somewhere so that I don’t have to feel uncomfortable and can get along with life and make a couple of further steps forward on my endless ‘To do’ list. The key to both of my relationships is that Steve and Tommy, each in their own way, were able to figure out how to block those natural impulses of mine to lock my emotional self away so that we could connect and build something together. It takes a particular kind of personality structure for that to happen with me which is one of the reasons why I’m not holding out a lot of hope for a third husband. The numbers of eligible men in my age group with whom that would be possible is shrinking.

I went to Opera Shots this afternoon. It’s something that Opera Birmingham has been doing for the last few years – gather a bunch of singers together recital style in a bar or brewery and have them belt out their favorite songs and arias while the audience sits around and has a few beers and catches up on old times. Covid, of course has changed the game. Opera Shots is now taking place in parking lots and its bring your own lawn chair, BYOB, stay six feet apart and wear your mask. Still it was nice to see people. Part of today’s funk comes from some programming. The second half was musical theater songs and half way through, someone sang ‘Someone to Watch Over Me’. That was Tommy and my song. He serenaded me with it very publicly when we were courting and it was the last song on his recital for his music degree – a gesture of thank you to me for having helped him to achieve that long delayed dream of his. Sitting there in the parking lot, I could feel waves of feeling. I held it together but the follow up was my friend Drew singing ‘You’ll Never Walk Alone’ and that one two was a bit much so I had to close my eyes and try not to feel for a while or I was going to become a complete basket case. So, at least one of the things roiling around is sadness and grief, stirred up by the great American song book. When I got home, I put on the original Broadway cast recording of Mack and Mable. Jerry Herman is always good for restoring happy thoughts. Sondheim for intellect and introspection, Herman for dancing around and singing along.

I think the other major emotion is a feeling of righteous anger over this morning’s headlines about the usual subject of these Accidental Plague Diaries. I have desperately tried to keep politics to a minimum in these writings and to be as even handed as possible but I just can’t after two things came to my attention.The first were remarks that the president made at one of his rallies last night which more or less accused physicians of over diagnosing Covid-19 so that they could be paid more. I have worked with thousands of physicians over the course of my career and the vast majority of them set much of themselves aside in order to do the best work that they can do in caring for the health of others and the number of times I have seen credible evidence of gaming the system for payment is very very small. Besides which, there is no system which would increase payments for a Covid-19 diagnosis over other diagnoses. The very suggestion that those of us who are getting up and going to work daily under very trying circumstances and putting ourselves in harms way for the good of our patients, our profession, and our country is somehow only in it for the profit motive just makes steam come out of my ears. 1700 US health care workers have died so far from Covid-19 caught on the job. Many thousands more have been sickened and may have permanent health effects. How dare you! Have you no decency sir? (Yes, I know the answer to that question…)

October 21, 2020, Washington, District of Columbia, USA: White House Chief of Staff Mark Meadows speaks to the media for the second time today at the White House in Washington, DC on Wednesday, October 21, 2020 (Credit Image: © Chris Kleponis – Pool Via Cnp/CNP via ZUMA Wire) “We’ve given up on the pandemic”

The second was Chief of Staff Mark Meadow’s remarks to CNN this morning where the administration finally made full admission to what has been apparent for months to anyone who has been paying attention. The administration more or less has no plans to bring the power and resources of the most powerful and richest society the world has ever known to bear on the worst public health crisis in a century and more or less is just going to let it infect the population and good luck to you. This complete abandonment of the foremost responsibility of a government, protection of the citizenry, also has me internally enraged. Even though I have known this is what they have been doing for quite some time, to hear it finally articulated in an official way just makes me want to punch a wall.

What does not fighting Covid-19 with good public health measures mean? It means the virus will continue to spread, because that’s what viruses do. To date, it’s infected somewhere around 7 or 8% of the US population so it’s got huge inroads still to make. Without any mitigation, it’s likely to infect somewhere between 70 and 90% of the population before it’s done. To make the math easy, we’ll say the population is 320 million and it will infect 75% or 240 million. Currently, it appears that about 40% of those who become infected, mainly children and young adults, never know that they are sick. Another 40% become ill enough to recognize that they are sick and get tested but do not become so sick that they require hospital care. About 20% are sick enough for the hospital. So, of our 240 million cases, about 100 million are well, 100 million get sick at home and 40 million are sick enough to require advanced care.

Of those requiring advanced care and support, about 20% require ICU care with about half of those needing a ventilator. That’s 8 million ICU patients and 4 million ventilator patients. We only have about a million hospital beds in the country and only about 130,000 ICU beds. We’ve developed a model of just in time medical care without excess capacity in order to maximize profit and there’s no easy way to get the system to accept millions of cases at once. That was what the whole ‘flattening the curve’ thing was about. Slowing the rate of spread so as to not overwhelm the health system’s ability to handle it. The overall mortality for the disease is about 0.6%. Six in a thousand. That doesn’t seem very high until you consider that’s about one and a half million deaths for the population. That’s nearly 500 9/11s, 25 Vietnams, or more than two Civil Wars. As the average American as a circle of acquaintance of roughly 5,000, that means every one of us will lose roughly 30 people we know before this is all over. I’ve lost friends, patients, close relatives of friends – colleagues or family is likely coming and I’m steeled for it. Smaller cities are out of ICU beds. (I read a news report earlier this weekend that the state of North Dakota was down to one ICU bed). We’re getting close to the medical system becoming overwhelmed in some areas. And there’s the downstream issues – me and my colleagues are getting burnt out. Disruptions in the health care industry are leading the more experienced among us to move up their retirement plans. Our complete inability to react to a thoroughly predictable pandemic as a modern nation will continue to make us a pariah state when it comes to such things as travel. Institutions which require us to congregate indoors in social groups will continue to suffer.

I don’t know how to fix any of this. All I can do is report on it and on how it impacts me and how I see it impacting health care and society at large from my vantage point of a little bit of knowledge.

October 22, 2020

The third and final presidential ‘debate’ is on this evening. I am not tuning in. There is nothing either candidate could say that will sway my mind in the top of the ticket contest. Besides which, I have already filled out and filed my ballot in early absentee voting. I’m a big believer in the old adage that democracy is not a spectator sport and that it is a civic duty to vote and that those who do not vote don’t get to complain about the state of the country. I’m very good about voting and have been for forty years now. I even turn up for some of the odd city elections and primary run-offs that have very low turn out. Generally, I get up a bit earlier on election day and vote on my way to work but this year, I decided to vote absentee given all of the uncertainties regarding Covid-19. The state of Alabama does not make voting absentee terribly easy but I qualify under the ‘works more than ten hours on election day’ so I sent in for it around Labor Day with the correct forms and copy of my state issued ID, filled it out a couple of weeks ago, got it witnessed by two independent adults and returned it via the post office. The ballot tracker told me yesterday that I had dotted my is and crossed my ts correctly and that my ballot was in the accepted pile awaiting counting week after next.

The news from the front lines in the Covid wars is not good, despite the optimistic drivel emanating from the White House. Locally, the numbers of patient’s hospitalized with the disease is slowly inching back up to the numbers we had in the late spring. Nationally, in a majority of states, the percentages of positive tests, which had been declining towards the 5% benchmark, are back up over 10%. (WHO suggests that there be a number of weeks of community testing prevalence of less than 5% before societies emerge from lockdown and the current 10% is a public health emergency). Deaths keep going up. Morbidity seems to be a bit on the decline and the reason for that is uncertain. Probably due to the fact that the majority of the spread these days is in populations with less susceptibility to severe complication, mainly young adults. It doesn’t stay amongst them, though. The majority of senior and chronically ill adults in this country are community dwelling in multi-generational households and even those in isolated senior communities rely on younger staff coming in and out. It’s where the whole herd immunity thing falls apart. It’s not possible to isolate those in danger from the rest of society while we let the virus spread.

The epidemiologists are starting to get a better hand on the big data. We’re at about 220,000 official deaths. The excess mortality for 2020 to date is about 285,000 deaths according to the actuaries and demographers. (285,000 more people have died in the US in 2020 then would have been predicted given the trends from 2019). Most of these are Covid. A few are probably from people who delayed health care due to fear early on in the pandemic. A bunch are probably Covid cases that were not diagnosed. As the disease rolls on it’s becoming clearer and clearer that it’s actually a disease of clotting and the circulatory system that shows up in the lungs rather than a respiratory disease so some of the deaths were probably coded as heart attack or stroke or from whatever long standing chronic illness the victim was suffering from that the altered physiology of the infection allowed to run rampant and tip a previously compensated person over the edge. Considering that we’re only about seven months into the pandemic, I expect these numbers to shoot up a lot higher before the end of the year.

Between an incompetent federal response and a third of the population believing that even the most basic of public health measures are some sort of cabalistic plot and that science should and must be ignored, I don’t forsee us having much success getting out of our current patterns this winter. I know we’re all bored with sitting alone in our rooms and want to get out and hear the music play but it’s just not a very good idea. Performing arts people are going to do what they do anyway and I am encouraged at the creativity that’s starting to pop up in the arts world. Rigoletto performed on a baseball diamond. La Boheme, stripped down to its essentials performed in a bay front stadium. Opera arias from the back of a flatbed in a parking lot. Any number of on line videos where people are stretching the capabilities of Zoom and other videoconferencing software to create new hybrid virtual forms of performance. Not to be left behind, I have turned my dining room into a temporary studio space where I have been filming my bits for Oscar Wilde, church choir, Politically Incorrect Cabaret and Arts in Medicine. I’ll post links as these various projects are completed and launched upon an unsuspecting world. I have a couple of unpublished plays I’ve written. Maybe I should recruit casts and get them out there.

I tend to keep my two careers of medicine and performance somewhat separate although they have been known to bleed into each other from time to time. Obviously, those in my theater life know I’m a doctor by day and those in my medical life occasionally turn up at something I’m performing in to see what I do in the evenings but, in general, they are separate arenas of existence. The overlap has been a bit more since the pandemic began. Generally, when I go to work and put on my white coat, I put on a persona that’s different from what I consider usual me. It’s a role. One I’ve been playing for thirty five or so years so I have it down pretty pat. The pandemic, however, has shaken up the system so much and created a major need to unleash my imagination to problem solve that my more usual self is popping up at work. I think it amuses the staff somewhat who are used to me being a little bit more buttoned down.

The Ansager and Marlene

Story time…. About ten or twelve years ago, my dear friend Jan Hunter was in charge of something for one of the cultural groups that involved thirty days of random acts of art. She came to me and Ellise Mayor, my co-conspirator with Politically Incorrect Cabaret and asked us to participate so the two of us found ourselves one noon hour in our full cabaret get ups on the street in Five Points South doing our PIC schtick. My cabaret Ansager look has morphed a bit over the years but it usually involved white face makeup, lots of colorful eyeshadow, rouge, lipstick, and eyebrows that would make Eugene Levy proud. Tommy did my makeup in those days so he met me at my office with the kit, got me made up, blacked my hair (an affectation I’ve dropped from the character recently – I figure he’s gone grey with current politics) and I threw on my white tie and tails and met Ellise who, if memory serves me correctly, was in her Marlene Dietrich get up. After an hour of prancing around to the bemusement of passers by, we had done our part to make Birmingham a more artistic place. I decided that I should go down to my clinic before I took the make up off. My office staff weren’t very familiar with PIC and I thought it might amuse them.

At that time, the geriatrics clinic was in its own little building, the Spain-McDonald clinic so I let myself in the backdoor, snuck up on the office and launched into my best rendition of Wilkommen complete with my Ansager Mittel-European by way of Monty Python dialect. As I reached the big finish, the door of one of the patient rooms opened and out stepped the then president of the university (who was having her mother seen by one of my colleagues). I’m not sure who was the more unnerved – me having my ultimate boss run into me while I was capering around the office or her seeing the medical director of her mother’s health clinic looking like a refugee from one of the seedier parts of Weimar Germany. After a beat, we both laughed and had a nice conversation about the clinic and plans for geriatric medicine over the next few years. I did learn an important lesson… Always check the clinic schedule to see who’s coming in before performing impromptu musical numbers in the hall.

I had a mental health day today. I’m not sure that it worked. I’m still neurotic. But I do remember the litany:

Wash your hands

Wear your mask

Avoid crowds

It’s that easy.

October 21, 2020

Pope Francis this morning announcing the Catholic Church’s support for same sex civil unions.

(A Very Long Post but not part of the Accidental Plague Diaries)

After reading this morning of the Pope’s decision to throw the weight of the Catholic Church behind obtaining civil union status for same gender couples, I decided to repost this sermon I wrote seven years ago as the Church is coming to the understanding of my central thesis – that religion is defining marriage as a sacred covenant and LGBT folk are defining it as a civil contract providing rights and benefits of the state – one word for two distinct concepts that has prevented appropriate dialog. I wrote this in the spring of 2013, a year before Tommy and I were legally married and two years before Obergefell made same sex marriage legal nationwide. It’s dated somewhat because of the sea change that court decision caused to happen but the likely appointment of Amy Coney Barrett to the Supreme Court means that Obergefell may not stand so this central clash has not gone away.

Sermon for LGBT Sunday 6/23/13 – Unitarian Universalist Church of Birmingham

When the Worship Partners Committee asked me to deliver the pulpit message for this Sunday and also asked me to focus on a topic related to LGBT issues, two thoughts immediately crossed my mind. The first one was “Why me?” I’m no student of history, hold no degrees in sociology or anthropology that qualify me to speak for an entire culture. The second one was “Take the opportunity to share with fellow congregants”. The follow up to that, of course, is how do you share around sensitive topics without over sharing. Most of you who have attended this church for a while know who I am. Some of you have even been around long enough to know the rather complicated story of my life over the last fifteen year. It’s been one of personal tragedy, resilience and rebuilding. When I arrived in Birmingham, fifteen years ago, I was 36, fleeing a bad career situation on the west coast and brought with me Steve, the man with whom I had shared my life for ten years. It was a very different relationship than I have now. I was the quiet one. And the last time I had been on stage was 1983. Within a year of our arrival, Steve developed the lung disease that ultimately killed him. It was our being in a strange town, thousands of miles away from our families and support system that led us to this church. UUCB was there for me as a widow and was in part responsible for my meeting and developing a relationship with Tommy, the man I have shared my life with for the last ten years.

I started out with a question – Why Me? The answer to that one is because I’m a gay man, a minority even in a welcoming congregation. What makes me gay? I suppose at least in part it’s that I came out. Coming out is a difficult and painful process for some. For me, it was relatively easy. The hardest part was admitting to myself I was gay as it just didn’t fit the ideal life I had sketched out for myself as an adolescent. One which included wife, children and a white picket fence. Once I made peace with myself and moved on to telling friends and family, there were no serious issues. Pretty much everyone gave a variation on ‘we’ve known for years and were just waiting for you to say something’ response. My parents and family offered unconditional love. They just worried that I was going to find life far harder than what they wished for a son or a brother. It’s been harder than necessary due to the rule that every LGBT person who’s open learns rapidly. You have to be twice as good as the next guy to get half the credit. I’m lucky I have my family. A friend and colleague of mine who recently came out was disowned. He recently ran into his mother when they both pulled into the gas station at the same time to fill up. She refused to acknowledge his existence.

Gay is a label that society has given me, not one I chose for myself. I have a lot of other labels that have been pasted on over the years that I think of first when I think of my self identity: son, student, writer, partner, doctor, healer, performer but the one that sticks and trumps all the others is the gay one. It becomes an adjective that modifies all of the others. I hear myself referred to as the ‘gay doctor’ all the time but no one has ever called me the ‘son doctor’ or the ‘writer doctor’. I think this is something that every LGBT person who is out and open knows. It’s just the way things are. In the eyes of the world, your sexual identity will color everything you are and do, whether it’s a part of your life that involves gender, love, sex or not. Labels are convenient, but destructive. They perpetuate stereotypes and lazy thinking. What labels do you have? Ones bestowed because of a surname or a skin color? We all carry the UU label which in the deep south is majorly misunderstood.

Who’s gay? Here are brief biographies of several men I know, and I am using men because I know more of them than women, not because I’m trying to be sexist. The first is a Jesuit priest. He has lived quietly with a man in domestic partnership for decades. They have never physically touched each other except accidentally in day to day living and he would be offended at being considered gay despite the very real and valuable relationship that obviously exists. Friends have learned to accommodate the relationship but never, ever to mention its existence. The second is a prominent Birmingham citizen whose name most of you would recognize. He has been married for decades to a woman but seems to spend most of his spare time chasing young men in their twenties. Even though I was in my mid thirties when I moved to town, I was warned about him and, sure enough, within three weeks the pass was made. The third is a man who married his high school sweetheart. He always felt something was missing and, one night on a business trip after too much to drink, he began a relationship with his male business partner. That relationship foundered as did, eventually, his marriage. He then began to date men and is now in a committed relationship with one, but remains on good terms with his wife (they have not divorced) and children. The fourth is a man who came out in high school, dated men through college until he met the right one and eventually married his long term partner in a large wedding with all the trappings. Society is likely to tag all four of these men with the gay label as if they were one size fits all, kind of like something on sale on the table in front of the dollar store, despite vastly different patterns of expressing their sexual selves.

As a culture, we tend to conflate the very different concepts of sexual identity: gender identity (whether we conceive of ourselves as male or female), sexual preference (the types of individuals we prefer to have intimate relationships with) and sexual orientation (the way in which our brains are wired to experience sexual attraction)into a nebulous whole which can then be split in a dichotomous way – straight or gay (with perhaps a little bit of a fudge factor for bisexuality). This is a cultural construct and this is pretty much Post World War II American culture speaking. In the late forties and fifties, millions of returning GIs came back to find a world with burgeoning equality for women and minorities due to the domestic needs of World War II. This could not be allowed to continue and there then came a time of reassertion of white male privilege and domination. Women went back to the kitchen, racial minorities were taught their place and pretty much erased from popular culture, and any man who dared to challenge masculine norms of sexuality was, at best, suspect and probably communist. However, that genie was already out of the bottle and within a generation, the women’s movement, the modern civil rights movement and the gay rights movement all came into their own. The reassertion of white heterosexual male privilege happens routinely. Another example comes from the late seventies when disco, a musical world dominated by women, African Americans and homosexuals, had to be eliminated from pop culture in favor of more masculine musical genres.

This dichotomy of straight/gay, based solely on sexual acts, is a modern invention. Before then, there were certainly people of all sexualities, but, at least in American culture, you were classified solely on the behaviors you presented to the public. Only an effeminate man, especially one who deliberately cultivated an effete style, would have been considered homosexual by most people in the 1920s and 30s. Those who acted within the usual gender expression norms were more or less given a pass. Confirmed bachelors were just fine, as long as their private lives and private behaviors stayed that – private. And women living together were considered normal. No one thought anything of two maiden ladies living together and supporting each other; people were just sorry they were never lucky enough to have found the right man. Modern culture, with its need for instant infotainment and its celebrity/paparazzi engine makes it difficult to divest of this notion of people being defined solely by behavior. I don’t think I believe this myself. I think Gore Vidal, in his writings, got it right. He wrote that there are no such thing as gay or straight people. There are only people. And those people, depending on all sorts of social, cultural and biological factors, choose to engage in certain acts, with somewhat infinite variety. Our human need to categorize does grave disservice by introducing the either/or rather than allowing all of the possible shadings of the rainbow to peacefully coexist.

There has been a sea change in American culture in the last few years regarding LGBT issues. In a poll two weeks ago, 72% of American adults stated they felt that gay marriage was inevitable. Such a result would have been unthinkable a decade ago. For the gays and lesbians of my generation, marriage wasn’t considered any sort of realistic goal when we were young. We were busy fighting simply for the right to exist and to be validated as human by our culture. The thought that our unions could be sanctioned in the same way that straight unions are through the institution of marriage was far less important than being declared as non-persons by society or being condemned to death from HIV through governmental ignorance and inaction. Personally, I am still trying to process that I can get married to my partner in 12 states when a decade ago I couldn’t get married at all. Some people have asked me why I don’t. The answer to that is simple. What’s the point of getting married if during the plane ride home, the union will exist and dissolve several times depending on the flight plan. I don’t have a lot of hope for the state of Alabama to recognize a marriage to my partner in the near future and there’s not much point in a marriage that won’t be validated by my community.

I work in a relatively conservative professional field. My branch, being very touchy feely, and looked down upon by the surgeons as something akin to social work, is fairly open and accepting of human beings as human beings. I have had out LGBT colleagues in my group at UAB the whole fifteen years I have been employed there and haven’t had many issues in the work place in regards to my relationship and how I conduct my life. One of the things that I do professionally is medical house calls. Over the last 25 years, I have been in hundreds of homes of the frail and infirm elderly and I have seen a lot of patterns in terms of family living. I’ve been to tar paper shacks in the hollers of West Virginia, suburban McMansions in wealthy California communities and the modest working class homes of the local African American community and, no matter the surroundings, I am always struck by the commonalities of family bonds, the need for us to be with our own, especially in times of adversity and that the outward trappings of wealth and position don’t matter anywhere near as much as what’s in the hearts of the people who reside there. One of the things that happens when doing rural house calls, is long hours in the car with nurses who may be different from you. I have a new nurse I’m working with in Jasper and a few weeks ago, the car conversation turned to gay marriage and, knowing I was gay, she told me she was against gay marriage because she was afraid that allowing gays and lesbians to marry would be against the teachings of her religion and that the government would force her church to have to perform such ceremonies.

I could have been angry. I could have read her the riot act. I could have pouted and played words with friends in the passenger seat all the way to Double Springs. Instead, I gave her my perspective. Marriage is two things. It’s a secular state sanctioned contract which contains rights and responsibilities and which governs such things as property, legitimacy and inheritance. It’s also a sacred covenant between two people before the god of their understanding. Unfortunately, in American jurisprudence over the last three hundred years, the same word, marriage, has been used for both. Because of this, LGBT people cannot have access to the secular and state defined benefits without that particular term being used as that is the word that is used in law. If the civil and the religious had been split with two words several hundred years ago with union for the one and marriage for the other, we wouldn’t be having these arguments. Everyone would just go down to the courthouse and get unioned and then, at another time, get married within the tradition and community that welcomes them. Everyone would have to recognize the union by law but the marriage could be left up to each individual religious tradition. Most LGBT people of my acquaintance have no particular interest in getting married in a church or temple that devalues them for who they are. If you read the transcripts of the Proposition 8 trial in California, the only arguments presented by those opposing gay marriage more or less boiled down to ‘The Bible says it’s wrong’. The opposition is so invested in the word married for its sacred meaning that they cannot see that the battle is actually over the secular institution of the same name.

The label married is important. It opens the door to legal and societal benefits in a way nothing else can do. Most people notice a sea change in how they are treated as a couple or even as individuals once they are officially married. Social supports slide into place to help maintain them as a couple when the times get rough, which they will for everyone eventually. There is an assumption, with marriage, that your family, no matter its actual structure, is a family and not just friends hanging out together. Marriage is perhaps even more important for children. By latest statistics, there are more children being raised by LGBT parents in this country then there are adoptive children being raised in this country. These children are put at immediate disadvantage as their parents cannot marry. For instance, if something happens to the non-biologic partner and the state, like many, does not allow for second parent same gender adoption, there may be difficulties in the surviving parent being able to prove they are a parent and another relative may swoop in and take the children away. DOMA, the defense of marriage act, prevents same gender marriages from being recognized on a federal level keeping the children of such marriages from accessing federal programs and benefits. They may be ineligible for dependent benefits or employment based health insurance policies. Rights of inheritance and property may become convoluted leading to court battles which only end up enriching the legal system.

So where does that leave us? The UU Church of Birmingham in 2013? Most members of this congregation are pro-LGBT. They’ve told me and the other LGBT members of the congregation this over the years. We have a very nice ‘Welcoming Congregation’ sign in the Narthex placed in a none too prominent place. But are we really? Why isn’t the LGBT population of greater Birmingham beating a path to our door? We host PFLAG, parents and friends of lesbians and gays, a support group for those coming to terms with LGBT members of their families and are a home for BAGSLY, the Birmingham Alliance of Gay, Straight and Lesbian Youth for teens just beginning on their life journey. We don’t, however, have much for active LGBT adults which makes us somewhat invisible to the community at large. UUCB has a proud heritage of being at the forefront of Civil Rights. The injustices visited upon LGBT Alabamians daily should be our concern. Anyone can be fired in the state of Alabama for being LGBT and I know plenty of people to whom that has happened . What have we done to combat that? Should we be silent when local political, social and religious leaders defile our relationships and characters with comparisons to pedophilia or bestiality. The LGBT community is less than 5% of the population. We aren’t strong enough to win the necessary battles on our own. It’s our straight allies that will refuse to remain silent any longer and make equality possible.

Labels are important. The groups we belong to give us those labels. One of the ones that I wear with pride is UU. Make me proud. Stand with me as another person trying to make his way through a crazy and confusing world. I’ve got your back – I’m grateful to you all that you’ve got mine.

Thank you.

October 18, 2020

Annual Review – do I measure up?

We may all be preoccupied with dodging coronavirus but, against that background, life continues on with its minor domestic triumphs and tragedies. There’s part of me that wants to hide from the little curveballs life throws as I’m just tired of things happening and there’s another part that revels in them as it’s proof that I am alive and that the story goes on. It reminds me of the period when Steve was so sick and much of my energy went to taking care of him. The little ups and downs of life felt greatly magnified as the battle against his disease process took so much of usual living away from us. Now it’s Covid-19 stripping things away and leaving that which remains to occupy time and energy. It may not be much but when all your general connectedness is gone, it can feel like too much.

On the up side, I’m going to have to put my virtual film studio back together in the dining room. Someone dropped out of the Importance of Being Earnest so I’m picking up the slack and playing the other servant in Acts 2-4. I have to come up with a different look, voice, and physicality to try and disguise one person two butlers but I figure if Peter Sellers could do it, so can I. Holly, Tommy’s wig and makeup assistant is coming over later today and we’re going to experiment and see what looks good on camera. On the down side, something has gone wrong with the drain pipe from my kitchen sink. It’s not the trap. It’s deep inside a wall or maybe in some central piece of plumbing – I’m trying to find out if this is is something I need to take care of or if it’s the responsibility of the building. I’m hoping for the latter.

I had my annual review on Friday and I am happy to report that I have a job for at least another year. My 22nd anniversary at UAB comes up in a couple of weeks and it looks like I’ll be with them a total of 25-30 years by the time I get around to retiring. It seems funny to be contemplating that milestone as it doesn’t feel like it was that long ago that I was in college – med school – residency – fellowship but it was all a lifetime ago at this point. I have two things to do before I can contemplate stepping down – making sure health insurance issues are covered (Medicare or otherwise) and paying off this condo. I want the mortgage gone.

Back to some accidental plague diary thoughts. Numbers are spiking again in Europe leading to further shut downs. Numbers remain way out of control here. On the other hand, most of Asia has the disease under control and things are pretty much back to normal. It’s never really gained much of a foothold in Africa. If you look at rates in first world countries after mid-May (the time when there was enough understanding of the disease, its spread, and modes of transmission for governments to get their act together) some interesting things appear when you look at case rates normalized to population. While most of Europe and the rest of the first world was wildly out of control in March and April but came into control as more strict lockdowns were imposed and case rates were pretty low throughout the summer, just beginning to increase in the last few weeks. The two major outliers with much higher case rates are Sweden, which made a societal decision to let the disease spread and herd immunity take effect, and the United States where there are two populations divided by politics, one of which is vigilant in undertaking basic societal containment measures, and one which takes great joy in flouting those rules. Rates in the US are higher than in third world slum districts.

Why has Asia fared well and the first world not? I think there are a couple of cultural factors at play here. First, Asia is well versed in the spread of pandemic respiratory illness having been through SARS and various avian flu strains. Their populations, as soon as it became apparent that Covid-19 was going to be a problem, did the things they have been trained to do . They masked up and started practicing social distancing and obeyed their public health authorities as they have done many times in the past and the virus had difficulty getting a foothold and, where it did, was easily detected and abatement measures were targeted and put in place without public outcry.

Asian cultures are not cultures of individuality. They are cultures which put the well being of the group or the society ahead of the well being of the individual. People are willing to endure personal inconvenience as they innately understand a greater good is being served. We don’t do that very well in the USA. Modern Eurocentric culture comes into being in the post-Renaissance world with one of the lynchpins being that of Cartesian dualism with its corollary that every mind and individual is unique and that the needs of the individual and the ego should be paramount. Four centuries later, and we have constructed a technological society (with a heavy dose of Ayn Rand’s objectivism thrown in for good measure) in which people are not only unwilling to endure for the sake of the collective good, but are downright hostile to the idea. This ‘I have the right not to do anything I don’t want to do’ mentality is so ingrained in American thinking that it’s going to be very, very difficult to even begin to bring Covid-19 spread under control. The populations of those who understand what needs to be done and those that bristle at what they view as governmental intrusiveness are so intermixed that things will be dragged down to the lowest common denominator as the virus doesn’t care about these issues. It will spread where human behavior allows it to spread.

If there’s a change in administration in a few months, will we be able to start emulating societies with better track records? Not without good leadership and I am afraid that governmental leadership has been badly damaged. It’s going to take some sort of institution that a majority of Americans still trust to deliver messages and model behavior to start and turn things around. I have some hope that faith communities might start filling the gap. From what I can see, some of the leadership there has started to figure out that they have been rendering more to Caesar than to God in recent years and that this has seriously damaged their reputation and standing. This might be an area of the ‘love thy neighbor’ variety that they could enter and start turning the tide. Beyond that, I’m not sure if there’s a societal institution that both red and blue America trust in the same way. The military, perhaps, but public health really isn’t it’s role. Both sides tend to trust doctors but we aren’t given much of a public platform these days. The concerns of practicing physicians, especially in primary care are overwhelmed by the concerns of the administrators and money side of the system and that’s the narrative that makes it into the media and public discourse.

As the Emcee sang in the last show I did before theater vanished along ‘Money makes the world go round’CommentShare

October 14, 2020

I finished shooting my bits for the Fine Arts Center of Kershaw County’s online Zoom theater production of Oscar Wilde’s ‘The Importance of Being Earnest’ this evening.  It was the second project this week for which I was able to get my tailcoat out of its garment bag and give it a little fresh air.  The other was some filming for an online video from the Politically Incorrect Cabaret.  I took a moment afterwards to take down my jury-rigged green screen until it will next be needed, put my props away and turn my dining room back into some semblance of order.  Next up is another online classic, Moliere’s Tartuffe in which I am essaying Orgon. 

We may be all in some form of quarantine/separation these days and gathering together in a playhouse is going to be one of the last things to come back from coronavirus restrictions, but theater people are going to theater one way or another.  One bright spot for me as been being asked to be part of projects originating with my dear friend Frank Thompson and his merry crew in Columbia South Carolina and getting to work with them on a piece after having known them casually through social media and the occasional theater party for many years now. Online theater does allow you to pull together a cast from all over and the technical requirements are minimal – a laptop with a camera, a Zoom hookup and a green screen for a virtual background and there you are.  I am considering driving back and forth to Seattle for my November vacation and, if I do, I will likely be hanging green Party City plastic and emoting Moliere in a selection of the country’s finest Hampton Inns.  I’ll just need to remember to pack some electric work lights as the lighting in most hotel rooms is suboptimal for filming.

One of the reasons I’m thinking about driving, other than giving myself some very long stretches to let my brain decompress and think about plenty of nothing while making my way across Kansas or Wyoming, is to get a sense of how the country is really reacting to Covid-19.  Most of the reporting on community issues is tainted by a certain amount of political agenda. Given a crisis where we should all be pulling together, politicians and the media have banded together to do their darndest to push us into one of two camps – the red and the blue for want of a better shorthand.  One group for political advantage and the other group for ratings and the money those translate into over time. One wonders what would have happened if, after Pearl Harbor and FDR’s call for entry into World War II, half of the population had enlisted and gone to work manufacturing armaments while the other half had paraded in the streets waving Nazi and Rising Sun flags and calling those that were preparing for war all sorts of unpleasant epithets and the press had covered it all with both sidesism and egged domestic disturbance on.  The ultimate outcome of the conflict might have been just a little bit different.

Now that we have more or less managed to create two very different approaches and attitudes towards a single universal problem, what do we do?  The red side’s denial of the seriousness of the problem angers me personally as I watch more and more of my patient population fall ill and hear of more and more young healthy people who have succumbed.  To me, those are lives wasted, not acceptable collateral damage.  Rates per unit population are surging in less populated conservative states but, as their populations are low, absolute numbers are low so there is a feeling in these communities that Covid-19 isn’t a problem other than for certain at-risk classes of individuals.  The trouble is that somewhere between 25 and 40% of the population falls into those at-risk classes and it is not possible to isolate those individuals.  Take the elderly.  Only about 10% of older Americans live in some sort of congregate facility.  The vast majority are in the community trying to live their lives day to day just as the rest of us are.  Even those in congregate living cannot be completely isolates.  Staff, caregivers, delivery people, and all the rest that keep a housing facility running cannot be isolated with them.  They are going to come and go in the community and many of them will return home to school age children who seem to be among the primary vectors.

Urban blue populations have adapted relatively well to new ways of living.  Most city dwellers mask up, gauge six or so feet appropriately, don’t crowd into small spaces, and have figured out how to protect themselves and their families through a thousand and one little changes and risk stratifications. They look down on red populations and their unwillingness to adapt with scorn.  The trouble is scorn and shame aren’t going to make anyone do things any differently.  People respond very negatively to it and a huge piece of our current divide comes from forty years or so of urban populations in service and tech economies looking down on rural populations in resource utilization economies.  Something I learned very early on when working with the mine workers programs in Appalachia that I medical directed for many years was that if I, a doctor at a medical school in an urban center, were to call a doctor in a rural community to suggest a different treatment plan for a patient, I would be frozen out and unheeded.  No one likes an outsider butting in and telling them how to do their job.  The strategy we hit on was to make sure we hired nurses of and from these small rural Appalachian communities and I would teach them modern approaches to geriatric medicine and how to think through problems.  These nurses could then go to the local doctors, their friends and neighbors for decades and present things and would be listened to as they were of that world. 

We need something similar at the moment to bring red and blue American together in better public health planning.  I don’t think it can happen under the current administration which has basically withdrawn the federal public health system including the CDC and the FDA from the battlefield but, if there is a change in administration, there can be strategies adopted that then flow to the states and then counties.  If untrusting populations see trustworthy information coming from local sources, they may begin to change their behaviors and we may start to make some inroads on bringing things under better control.  If we don’t, I feel we’re going to be in for a very long time of it with deaths approaching, if not over 7 figures.

In the meantime, do what you can do:  Wash your hands, wear your mask, stay out of crowds as much as possible.  It’s not that difficult.

October 10, 2020

Today’s South Lawn Rally

Hurricane Delta is busy churning somewhere to the west of us as it takes leisurely course inland. It’s expected to stay well west and north of the Birmingham area so we shouldn’t have any major issues around here. The outer bands have been passing over all day causing intermittent rain showers with rainbows in between but we haven’t had much in the way of wind. It’s a good weekend to stay sequestered in the condo and work on various projects that are coming due. A couple of distanced theatrical things, a taped story for UAB’s Arts in Medicine program, several legal cases that need reviewing, and the slow methodical clean out of various bins and files as I keep working on life simplification.

Of course, a weekend alone and cooped up does nothing for my existential angst about the rising tide of insanity in the world outside. I speculated some on the president’s medical condition with my last entry in these accidental plague diaries. Nothing I have seen these last few days has suggested to me that his health has improved markedly. There was some sort of rally at the White House today. I did not tune in but someone in the campaign decided to give all the attendees periwinkle blue T-shirts to go with their red MAGA hats. With that color scheme, the few pictures I saw made the south lawn of the White House look like it had been suddenly taken over by a group of fractious garden gnomes. One wonders who is in charge of such things and whether they think before they order or if they’re just trying to enrich a certain vendor. The president’s appearance and remarks were about fifteen minutes in length. As he usually spends several hours extemporizing at his rallies, I assume his stamina is way below what it normally is as the adulation he receives at such affairs appears to be his oxygen. I doubt he’s out of the woods yet and I don’t see him being able to stand up to the rigors of campaigning during the home stretch.

There’s an interesting set of moral questions regarding his treatment with the monoclonal antibodies manufactured by Regeneron, a company in which he appears to hold financial interest if various media outlets can be believed. First, the treatment is not FDA approved so there is no good science that it works. Second, the antibodies are developed from lines of fetal stem cells. (The pro-life movement would say they come from aborted babies and has successfully campaigned republican administrations, including the current one, to halt any science using such tissues – actually, they are usually obtained from embryos made during an in vitro fertilization process and which would be discarded as no longer needed after a successful pregnancy). Third, the cost for such a drug would be likely to run to six figures and, as it is not approved, would not be covered by even the most generous insurance plans. The claims that anyone can and will get the drug for Covid-19 are, excuse my French, horse shit.

So what happens next with monoclonal antibodies? Does the FDA fast track them for approval, possibly undercutting long established safeguards for a political win for the party in power? Does a Republican administration embrace a drug that owes its existence to a line of scientific research that is anathema to its evangelical base? Do they open up additional public coffers to pay for the treatment when much of that money will go into private hands tied to the president? I can’t answer these. All I can do is stay home alone with my cats and my projects as I am not stupid enough to attend mass gatherings at the White House which seem to turn themselves into super spreader events.

Covid-19 is going to have some very peculiar effects on this election cycle. It remains to be seen who will choose to vote early, who will choose to vote in person, or who will be forced into voting through a means not of their choice due to various voter suppression tactics such as limiting all counties to a single drop off box, be they population of 1500 or 1.5 million. Anyone who says they know what the outcome of November 3rd is going to be is deluding themselves. The dozen weeks between the election and the inauguration will also be anybody’s guess. There are so many unknowns regarding the behavior of the population under these stresses and so many knowns such as unstable personalities and large quantities of money wanting certain outcomes that it’s likely to be a very wild ride. One thing I’m fairly certain of is that the president has lost the loyalty of the Secret Service to his person rather than his office. I think the ride in the hermetically sealed limo which endangered them did that. Various Caesars found out that alienating the Praetorian Guard during times of political instability was an unwise choice.

There is an old curse that goes ‘May you live in interesting times’. I’ve had enough of interesting, thank you. I’d rather have some boring ones instead. At least boring enough for me to plan an interesting trip and an interesting show or two. In the meantime. Work – home – work – home – lather rinse repeat.

May you all stay well and remember:
Wash your hands
Wear your mask
Stay out of crowds

October 6, 2020

Donald Trump removing his mask before entering the White House

Like everyone else I know with formal medical training, I have been watching the events unfolding in Washington DC over the last few days with increasing puzzlement. Absolutely nothing that’s happening makes any sense from either a personal or a public health perspective. There are those that claim that the president’s recent diagnosis with Covid-19 was some sort of elaborate ruse but that seems exceedingly unlikely with the thick and fast news of multiple collateral diagnoses within the executive orbit. Then there was the very real evidence from yesterday. I have more than thirty years experience at sizing up aging adults and determining whether they are sick or not in the first thirty seconds of walking into the room and beginning to converse with them. It’s dozens of little cues from behavior to body posture to the look in their eyes that allow you to either tense up and prepare to send them immediately to the emergency department or relax and let them tell their story while you leisurely ponder differential diagnoses in your head. The man I saw walk up the stairs to the South Portico of the White House yesterday evening was sick.

His walking into the White House, a crowded workplace, with full blown Covid-19 while blithely removing his mask told me everything I need to know about the situation. I don’t think this there’s any sort of sinister cabal going on. I think we’re in full blown the inmates are running the asylum mode as anyone with either the knowledge or ability to deal appropriately with highly communicable infectious disease has either been purged or silenced. The virus will therefore continue to keep leaping around the executive branch and I expect the vast majority of those with easy access to the White House will likely be positive by the end of the week. Will any of them die? That remains to be seen. Likely not many but some are likely to become incredibly ill and others are likely to have permanent health complications.

There’s been a lot of posting about karma and schadenfreude (a word most American’s had to look up) over the last couple of days. As much as I detest the politics and policies coming out of this administration, it is made up of human beings and one thing that my religious tradition of Unitarian Universalism teaching me is that every human life has dignity and worth so I cannot wish ill on any of them. I can only say that when you go swimming in a lagoon posted ‘Danger: No swimming. Alligators’ don’t be surprised if you come back to shore missing a limb. Actions have consequences and people who take certain imbecilic actions better be prepared to live with the consequences of those actions.

The White House Medical Team obviously obfuscating

Will the president recover uneventfully? Will he get worse? Will he be well enough for his next scheduled debate appearance? I can’t answer these questions. All I can say is that by all objective evidence available to me he’s sick, possibly seriously ill, and the puffery coming out of his medical team makes no sense from either a diagnostic or a treatment perspective so there’s really no way for me to have any sort of informed opinion. Things will happen as they will; hang on – the wild rollercoaster of the last few days isn’t likely to slow down for a while. In the meantime, there will be more and more blather of the uninformed, opining on the unintended consequences of the actions of the uncaring. It’s all making me a bit tired so I have gone to bed relatively early.

All I can say is that at this juncture in history, I’m glad I live in a smaller city with a relatively informed population with a high percentage of folk employed in health services. In Birmingham proper, most people are pretty good at social distancing, wearing their masks and not doing anything too crazy. This has kept our caseload relatively constant and allowed the local hospitals not to get too overloaded. I do my part and have given up much that I love for the greater good. Watching those to whom much has been given in terms of money and power blithely wander through life as if those were any sort of protections against the way the world actually works makes me a bit sick. As I have said, actions have consequences. I just hope that my positive actions in favor of protecting people I don’t know lead ultimately to positive consequences in my life. I’m a past master at delayed gratification. I can wait a while longer to find out.

October 2, 2020

Walter Reed Military Medical Center

I’m trying to process the events of the last 24 hours or so. In my ongoing saga of chronicling my peculiar take on the effect of Covid-19 on my life and American society, we may have reached an inflection point. I can’t say that I am the least bit surprised that the President has caught the virus. His very public behaviors over the last six months more or less made that inevitable but I’m a bit surprised at the rapidity of change from he’s fine, to he has significant symptoms, to he’s being airlifted to Walter Reed. None of us has reliable data on his health and speculation, while intriguing, is not especially useful. I’ve compared the White House’s response to the novel corona virus to Poe’s The Masque of the Red Death a number of times over the period that I’ve been writing these accidental plague diaries. I have a feeling that midnight has struck and that Prince Prospero and his guests are going to pay the price of believing that wealth and privilege somehow insulate one from science and fact. You can believe in virology and epidemiology or, you can pooh-pooh them for political reasons, but that doesn’t make the science any less true. Viruses have no political allegiance. They simply exist to propagate themselves from one host to the next.

There are those who are descending down the black holes of various conspiracy theories regarding Covid-19, now that it has reached the highest offices in the land. It’s a little silly. The current group of politicians in power in DC haven’t been able to run the government with all of the tools at their disposal. Imagining them running some sort of shadowy network of interconnected outrageous plots out of a Ian Fleming or Robert Ludlam defies belief. Anyone who has ever been a corporate project manager can tell you that human beings in groups just aren’t capable of such Byzantine and opaque maneuverings without the whole thing crashing down because someone wanted to binge watch the latest season of Schitt’s Creek rather than do their portion of the assignment.

The Ancient Greeks would have loved the current situation in the capital. President Trump very much fits their mold of the leader who rises too high, too fast in mockery of the gods and it ultimately undone by his own nature and character flaws. The rapid fire revelations about his tax and financial status, the economic collapse of his campaign, and now the illness, likely linked to the stubborn refusal of him and his followers to obey even the simplest precepts of public health measures to prevent viral transmission. We don’t know what the next act of the drama is going to play like. I know what I would write if I were creating a drama of hubris, but it’s not up to me.

I’ve tried to leave politics out of these diaries for the most part. When it comes to Covid-19, politics is immaterial as the virus is completely apolitical and I feel very strongly that what I’ve been able to learn about the disease and how it affects our lives is a subject that should be of interest to the entire spectrum of opinions. It sneaks in occasionally because the US response to the virus has been allowed to become politicized at nearly every step of the process of pandemic response. We are the weaker for it, hundreds of thousands are dead and, within a month or so, it will move from the fourth worst mass casualty event in American history to the third, surpassing World War II. (If it kills more than 600,000 eventually, it will surpass the Civil War, leaving it only behind the Flu Pandemic of 1918.) Would the impact have been lessened with a less political response? It’s tough to say but we probably wouldn’t be having a mask war in society and adherence to things like masking and social distancing would probably be much greater and our casualty rates would likely be more in line with those in Western Europe.

To mask, or not to mask, that is the question

I hope I live long enough to be able to read the definitive history of the Trump presidency that some Barbara Tuchman of the future will write sometime after 2030, when enough time will have passed for us all to be able to get some perspective on what we are living through. I also have the feeling that this particular moment in history is going to inspire some great artistic works. Trump, himself, is too big a character for traditional film or stage. He is an operatic figure and I think only a grand opera in the Verdi tradition can totally explore his psychology and motivations. (Ricky Ian Gordon – here’s your potential masterwork…) The Black Death gave us the Italian Renaissance. What is Covid-19 going to give us?I too will be checking my news feeds in the morning for the next chapter.

In the meantime, you all know the drill.

Wash your hands.

Wear your masks.

Keep six feet apart.

September 30, 2020

And it’s another evening of feeling a bit like Neville, my favorite Gashlycrumb Tiny with whom I have always identified. I should be celebrating as the sale of the old house closed yesterday but there’s not a lot of joy in life and society and I really don’t have anyone much to rejoice with once I leave work these days. I did get to meet the new owners of 4334 Clairmont Avenue South at the closing yesterday morning. (I knew who they were through some mutual friends but had not yet had the pleasure of meeting them). They seem sympatico with what Tommy and my ideas for the house were had life turned out differently and we had stayed there for a few decades as originally planned. Their plan for the much needed kitchen remodel was pretty much exactly what we had intended so I feel the house is in good hands and I wish them much joy in the years to come.

Not much exciting going on in my new abode other than a few lessons learned in regards to the production of Zoom theater. The Kelly Green plastic tablecloths from Party City ($1.49 apiece or a roll of 100 feet for $10) make an acceptable green screen for inserting virtual backgrounds, but if you cut them too long and they hand too low, your cats will love batting at them and trying to pull them down at inopportune moments. Those projects are taking up a little time and creative energy but I still have more hours to fill so I bought myself the unlimited access Rosetta Stone language plan and am going back over all the basic languages I have learned over the years for some additional ear training and grammar. I’ve started with French, which I learned as a child and is still fairly intact when I need it but I have to use it routinely to have it come with any fluency.

Where are we with the accidental plague diaries? One million dead world wide, 200,000 dead in the USA and a significant portion of the population still refusing the most basic public health precautions through some sort of misguided political allegiance that I just don’t understand. I did not watch the presidential debate last night. I prefer not to torture myself after hours. From the continuous comments on my Facebook feed, it seems it turned out pretty much as expected and the inability of the federal government to handle a crisis in any sort of measured or logical way was on full display.

I haven’t come up with a new or interesting angle on Covid-19 to write about this evening. That’s been the thing I’ve been most worried about since I started writing these missives more than six months ago. How can I make this one subject fresh and impart fresh insights without getting awfully repetitive. I think I generally do a good job but there are times, like this evening, when the pandemic has dropped to a dull roar out there in the world and I can’t think of much of anything to say about it without going down a path I’ve trod before. New things are published routinely and there are constantly shifting battles and skirmishes between the population and the microbe so that’s unlikely to last. The thing I’m looking for is what’s going to happen later this fall in response to the outbreaks traceable to college and university reopenings? For the most part, the students won’t be overly effected but what’s going to happen to the populations of college towns and institutions in close proximity to colleges such as hospitals and elder care centers? There’s a well recognized pattern. Population behavior changes. Case numbers reflect that change three or four weeks later. Mortality statistics reflect that change another month or so after that. We’re about a month in to fall quarter. Cases are rising in places like Utah driven by University exposures. What happens a month from now? What happens when flu starts circulating? I am keeping my fingers crossed on flu season. As a goodly percentage of the population are being careful about viral exposure, this will interrupt seasonal flu transmission as well as Covid-19 and hopefully keep the flu season on the lighter end.

I haven’t told a story for a while so I’ll end up this evening with one. This one goes back to the summer I was 22. I had graduated from Stanford and was to start medical school in the fall. As a graduation present, my parents gave me a plane ticket to Europe, a second class Eurail pass, a knapsack and some traveler’s checks (remember those?) and told me to go have fun. I had never been off the continent before and was uncertain when I would be again so I was determined to see as much as I could squeeze into my eight weeks as I could. (Fourteen countries by the time I arrived back in the US, exhausted and fifteen pounds lighter from all the walking and cheap eats). About a third of the way through my jaunt, I had taken the train from Paris to the French Riviera and then, after a day or two, onwards into Italy. One Sunday in July, after touring Rome for most of the previous few days, I realized I had a relatively free day as I still had not made it to the Vatican museums and they were not open on Sundays so I decided to take the train down to Naples and visit Pompeii. I caught the first train of the morning. Five minutes after we were to depart, there was an unintelligible Italian address over the PA. Much groaning and everyone detrained and headed over to the second train of the morning and reseated themselves. (I hadn’t a clue what had been said but I could follow the crowd.) Forty minutes later, the same thing happened and the swelling number of irate Naples bound passengers detrained again to board the third train of the morning. This one actually departed and off we went around the bay.

Naples with the Bay and Mount Vesuvius

I arrived in Naples later than I had anticipated, toured the museum and then boarded the local train that headed to Pompeii. I made a mistake with this train and ended up getting off one stop too early. (Apparently the stop labeled Pompeii was not the stop for the ruins) and I headed down the road thinking I was in one place when I was, in fact, in quite another. When I realized my mistake, I thought, oh well, and, having taken orienteering in Boy Scouts, that I should be able to get where I needed to go by wandering down the country lanes as long as I kept Vesuvius on my left. Off I went and after about half a mile, passed an Italian farm house where a huge extended Italian family were having Sunday dinner in the courtyard. They leapt up excitedly at the strange young tall blond and obviously lost young man wandering past their compound and soon, I was being dragged in and invited to share the meal. They spoke not a word of English and I not a word of Italian past Prego but we finally found some common ground in French and were able to roughly communicate for an hour while I was offered several sorts of pasta and what I think was veal. I thanked them for their hospitality and departed with one of the sons who looked to be about fifteen who escorted me to the right road towards the entrance to the ruins.

Pompeii and Mount Vesuvius

I had a lovely (if somewhat warm) afternoon wandering through Pompeii, and as the sun was going down, headed off to the correct train station to take the train back to Naples. When I arrived in Naples, I was hungry again so I found a little seafood restaurant right on the harbor where they were frying up the catch of the day so I ordered the special (which contained mussels, octopi, seahorses, a couple of kinds of fish and who knows what else) and a bottle of the house wine. It was lovely watching the sun set into the Mediterranean and I kept eating and drinking and then I suddenly realized I had finished off the entire bottle of wine by myself and it was starting to hit. I stumbled to the train station to get a seat on the overnight back to Rome, found myself with a few hours to kill before boarding, and promptly lay down on the floor of the train station and sort of passed out until I was roused by a not overly friendly carabinieri. I was able to get to my feet, produce my ticket to the train, and stumble in the right general direction so I managed to avoid a trip to the drunk tank, get on the train, and more or less pass out again until it pulled up to the station in Rome. By that time I had sobered up, taken a couple of aspirin, had a cup of coffee and headed off to see the Vatican thoroughly hung over. I quite enjoyed the Vatican other than the Sistine chapel. Every time I tilted my head back to look at the ceiling, it would make the headache worse. The moral of the story. Don’t visit buildings with famous painted ceilings when you’re hung over.

September 26, 2020

Scylla and Charybdis

Today, I was either a slug or a sloth or perhaps some sort of hybrid. It took me something over three hours after waking up to actually get out of bed and I’ve had two additional cat naps so far and I may be heading for a third. I think my lizard brain has permanently switched from hypervigilance in the face of danger to a state of chronic play dead and conserve energy for further perils to come. I sometimes really do feel like I’m slowly being ground to fine powder between the Scylla of Covid-19 and the Charybdis of Social Isolation and have to remind myself that no matter how horrible things seem to be, I have a roof over my head, food in the pantry, a job that continues to pay me, and a large supportive circle of friends who remain part of my life even if we can’t be together in the usual ways.

I started these posts two and a half years ago in the face of personal tragedy as a way to help myself puzzle out thoughts and feelings and reinvent myself for a new phase of life. I assumed they wouldn’t be of much interest to anyone but I quickly got a response and a loyal readership, especially to my anecdotes about some of the odd things that have happened throughout the course of my life. I started to write those as it was dawning on me that I had aged into being an elder in the traditional sense. The elders are those with the life experience to understand the human condition and to translate it into forms palatable for consumption, originally around the campfire, and then later on in poetry, prose and song that could transfer collective wisdom generation to generation. They are the story tellers. My stories, without Tommy in my life, no longer had a home and were going to die with me if I didn’t start telling them in some form and this seemed as good a way as any to send them out into the world.

I assumed that these posts would revolve around the areas of my life in which new stories might arise… theatrical endeavors, travel, encounters with new and interesting people. But six months ago, all that changed as the whole world shifted and I started to write more and more about Covid-19 and its effects on the health care system, my personal life, and the world at large. And thus, the Accidental Plague Diaries were born. It just happened. I didn’t set out to do it. When I first started my Covid-19 posts, I assumed that the institutions that have saved us from serious trouble with infectious disease in the past would swing into action and that the whole thing would likely be over in six months or so, at least in terms of writing. Now, I can clearly see my own naivete. There is no clear end in sight at this point – and my posts on the subject are now at book length.

Everywhere I go, when I see people whom I haven’t seen for a while, they bring up my writing and how it has helped them make sense of a non-sensical world and how they are grateful for the combination of trying to stick to fact and trying to navigate a centrist position through the hysterical hyperbole that informs reporting on the subject on both sides of the political spectrum. I don’t know what to say. I’m immensely gratified that people like these essays but I hope they realize that I am as lost and confused in modern life as they are and that sitting down a couple of times a week to let my fingers dance over the keyboard is more about educating myself than other people. If I can find the words for difficult concepts that others can understand, then I know I’ve gotten things straight in my mind. And if I can get it together in my head, then I can pull it together to make it through the next day, the next week, the next month…

We’re now at seven million cases of Covid-19 in the US. We were at six million only three and a half weeks ago so we are in no way getting the pandemic under control. It’s now the third highest cause of death in the country (superseded only by cancer and heart disease). The long term effects on those who recover remain completely unknown. There are tantalizing glimpses of why it is so serious in some people and essentially asymptomatic in others. If those could be figured out, we might be able to figure out protections for the more susceptible and let the unsusceptible get on with life but we’re a long way from clear understanding. Life is beginning to return to pre-Covid norms in other parts of the world (but reporting in US media is spotty as it becomes more and more concerned with election politics) but those areas have robust public health programs not undermined by politics with authority to implement tried and true public health measures.

There’s a piece of me that wonders if part of the predicament we find ourselves in comes from the Boom generation’s refusal to accept elderhood. I’ve written before about how Boomers refuse to consider themselves as old, even though the leading edge is now in their 70s. I use the Cher scale at work. Cher was born in 1946, the first year of the Boom. I have my med students rate patient age based on Cher – Cher + 3 years, Cher – 2 years to help them understand just what a demographic watershed that year has proved to be. Part of the reason that the Boom has always felt young is that the generation above them, the Silent Generation, has smashed all actuarial tables in terms of living long healthy lives. Many of the cohort now in their 80s and early 90s remain with us and in quite good shape. The Boom, having always had stable elders to look up to, thinks of themselves as young in part because of that generation who have always been old to them. (Old is always fifteen years older than you are).

Cher ( born 1946 – Baby Boom) and her mother Georgia Holt (born 1926 – Silent Generation)

There is a lot of speculation as to why the Silent Generation have lived such a long, healthy life. The one that I think is the truth is known as the semi-starved rat hypothesis. This is a phenomenon first noted in rats, but replicated over time in many other species including primates. If you take the young of a species and calorie restrict them, it extends their life span. The Silent Generation was young during the Depression/World War II years. They didn’t starve but weren’t able to glut either. The long lived Silent Generation have helped keep the Boom from embracing their own aging and mortality and, as the Boom have been the political and economic power generation of the last thirty years, they haven’t developed a generational empathy for aging. What does this have to do with Covid-19? If the Boom can’t be old, then they can’t be in danger from things that happen to old people and therefore those things need not be worried about and policies that might help older people aren’t as important. This is being played out in very real threats to the ACA and Medicare which a shift in the makeup of the Supreme Court is not likely to help.

That’s enough for this evening. Going to go back to working on transforming my dining room into a movie studio for Zoom theater projects and have some left over Chicken Korma.