September 3, 2022

The acute Covid infection is over. It’s been a week now and all that’s left is a bit of a stuffy nose and a feeling of significant fatigue that leads me to needing a nap and ten hours at night rather than my usual seven. There’s no fever, no myalgias, no feeling sick. I hope the fatigue clears itself up over the long weekend and isn’t going to settle into some sort of post viral chronic fatigue. Ain’t nobody got time for that. But what will be, will be and I’m pretty good at reading my body and what it needs. I still haven’t heard much from my dueling employee health departments on when I can actually return to work. I’m hoping Tuesday, but who knows. I may be stuck teleworking another week… or two… or three… It’s hardly ideal but I can at least stay caught up to a certain extent, at least on the UAB side. The VA decided somewhere in the last six months to revoke my telework privileges over whatever arbitrary unfiled form so there’s not much I can do there until they clear me for duty.

So how have I occupied my last few days of confinement? I’m working on the final edit of Volume II of these Accidental Plague Diaries and if all goes well it will be out by the end of the month. I’m working on my lines in a prayer of being off book when I get back to rehearsal this next week. I’ve done some clean up around the house. I broke out the Xbox and realized I’m just no good at Grand Theft Auto V. I’ve read most of The Once and Future Witches which I quite like, other than some rather ham fisted political allegory. Just the usual things a sixty year old man does when left to his own devices at home for a number of days.

I’ve been living with a ghost. Binx, my new cat, absolutely refuses to have anything to do with me or Oliver, my geriatric cat who seems to live mainly on my bed these days. I know he’s here in the condo. Food disappears. Poop appears in his litterbox. I occasionally hear him late at night or catch a glimpse of him out of the corner of my eye. I figure one of these days he’ll figure out I’m not that scary or dangerous and he will start coming out of his hidey holes more often. I’ve found a few more he’s utilizing – behind the washing machine, on one of the bookshelves behind the foreign language dictionaries – he’s going to run out new ones soon. There’s only so many possibilities.

This evening, I ventured out. It’s been more than five days so under current CDC guidelines it’s OK as I have been asymptomatic and afebrile more than 24 hours as long as I keep a mask on (which I did). The opera chorus got together to sing Libiamo from La Traviata at the wake for one of our own who died a suicide a few months ago. I had known my colleague for a very long time. He was a physician like myself, although a generation younger. He had sought me out early in his medical school career as I was one of the very few out gay male faculty at the time and I helped him as a gay man in a homophobic profession through his med school years. He eventually went away for residency for a while and then came back to Birmingham about two years ago when he joined UAB as junior clinical faculty. He attended my church, sang with me in the church choir and the opera chorus and we were always friendly.

When someone commits suicide, especially someone who seems to have a happy and functional life, there are always unanswered questions. The what ifs. The did I miss somethings. Having lost a number of friends to suicide over the years, all I can say is they’re fairly useless questions. We can never really know the interior lives of another, even those with whom we share intimacy. I lived for well over a decade with both Steve and Tommy and never completely understood what they were thinking or how they would react to a given situation. There were always surprises. That’s part of what held the relationships together. There were new discoveries and hidden facets there to be found.

The gathering tonight was a party in a local nightclub/bar, hosted by his fiance (it was the place where they had been planning to have their wedding reception) and it was very much a festive wake. Music, dancing, food, drink and celebration for the fact that he had lived and touched all of us. Despite the surrounding gaiety (much of it literal), I was melancholy. I was having flashbacks to Tommy’s memorial of four years ago. Tommy’s affair was more sedate and had far fewer hula hoops in evidence but had the same air of festivity combined with sorrow for a life cut short. I suppose, at least for the next few years, any memorial I go to for a younger person is likely to jerk me back in that way. The memorials for older people who have passed in their eighties or nineties that I’ve gone to haven’t affected me in the same way. They’re much more of a bravo for a full life well lived.

As I read through the Covid news digests that I receive regularly in one form or another, I wonder if we’re about to head into another surge with the fall and if that is going to lead to more lives cut short, especially younger ones with so much yet to accomplish. US life expectancy has plummeted nearly three years since the beginning of the pandemic, from 79 to 76. Got to remember what that number means. Life expectancy from birth is the calculated actuarial statistical average length of life of the cohort born in that year. Babies born in 2019 could look forward to an average life of 79 years. Babies born in 2021 could look forward to an average life of 76 years. The last time there was this precipitous a drop was in the early 1940s when World War II killed a lot of young people; for it is early preventable deaths that have the most effect on the number. A person that dies at 30 loses about 50 more years of life than someone who dies at 80. And Covid continues to kill young healthy people.

The government of South Africa has a very robust wastewater monitoring program. They take sewer samples (as we all shed virus into our toilets when taking care of business) and find the coronavirus and genetically sequence it and map out the various subtypes that are turning up week to week. They were the first to identify omicron through their diligence last fall. They’re starting to find some new variants in their recent samples. Whether they are more contagious or virulent remains to be seen but when I hear of reports from there, my antennae go up.

On the good news front, both Moderna and Pfizer have had their bivalent vaccines approved for use (Pfizer for 12 and older, Moderna for 18 and older). The bivalent means that there are two different targets, one for the original Covid and one tailored specifically for omicron. Both vaccines are now being manufactured and are working their way into the supply chain and may become available quite soon. Check with your pharmacist. You can get it if you have had a recent Covid infection as long as you’re fully recovered. You can get it if you have had either one or two boosters prior. It appears to work best if there’s roughly a two to three month window since your most recent booster. So, if you had a booster in July or August, I would wait a few weeks. If you had it earlier than that, go ahead and get it ahead of fall. The more I see of the disease and the unknowns, the more I believe that you can’t have too many boosters. There have been hundreds of millions of doses given in this country with minimal problems and it’s certainly best to have as much immunity in place as one can. I’ll be marching out to get my bivalent booster within the next few weeks as I had my second in April.

August 30, 2022

Vintage engraving of a scene from the Charles Dickens novel David Copperfield. It is much better as it is! llustration by Fred Barnard

Covid Chronicles – Tales from the sickbed day #3. I wish I could tell you I was dying like the heroine of a Victorian novel, all pallor and white linen and the soon to be bereaved weeping in the hall, but no such luck. I’m feeling relatively normal, just tired and a bit under the weather. I never had a fever this time around, just a horribly stuffy/runny nose and a bit of a cough and that general feeling of unwellness that tends to accompany viral infections. I’m just keeping my fingers crossed that the fatigue clears itself up in the next few days and doesn’t settle into any sort of long Covid pattern. That’s the only thing that scares me at this point – some sort of prolonged post-infection syndrome that keeps me from living my life on all eight cylinders the way I usually do. To try and prevent that, I am adhering to a five day quarantine here at the condo and puttering through various projects. I can’t completely duck work. We’re so short staffed in geriatrics that I had to drag myself out of bed yesterday by 8 am and do my UAB clinic work from my laptop at the dining room table through various telehealth means. Supposedly we have new hires with clinical responsibility coming in but in the meantime, it’s all hands on deck as the demands for clinical service grow in an environment with shrinking resources and collapsing systems. I think I know how an 18th century midshipman felt as the sailing vessel headed into a gale.

Besides my usual work, I’ve managed to get a number of chapters read in two different books I’m working my way through, binge watched the first half of The Sandman on Netflix, completed a project for one of the non-profit boards on which I serve, and started working on the lines for my next stage appearance. I had nothing on my theatrical calendar for the fall and then the part of Bobby Dwayne Dillahunt in a play called The Hallelujah Girls fell into my lap. It’s one of those ensemble comedies calling for a number of women of a certain age which are popular at the moment. I call them descendants of Steel Magnolias, Crimes of the Heart and Sordid Lives. They usually involve a bunch of Southern women with interlacing friendships getting caught up together in a project or event – hijinks ensue. In this one, one of the women has bought an abandoned church building and is turning it into a day spa ‘Spa-dee-da’ with the help of her eccentric friends. I play her old high school boy friend, now a contractor who ends up doing the repair work around the place. Others include the head injured music teacher who loves all the holidays, the befuddled town clerk with the deadbeat son and a thing for bad romance novels, the acerbic manicurist, and a priggish mama’s boy. It should be fun, especially as we’re performing in an actual church auditorium.

The process of having to rearrange life for quarantine has been cumbersome. I have to deal with two different employee health departments at UAB and the VA who have very different rules regarding when clinical folks may be on premises again for patient care. While my formal quarantine is up on Thursday afternoon, it doesn’t look like I’ll be allowed back at work until the Tuesday or Wednesday after Labor Day at the earliest. In a normal year, with Labor Day weekend free, I would head down to Southern Decadence, an annual gathering of the LGBTQ folk in New Orleans, but I don’t want to push my luck or overdo it with just recovering from Covid so I think it will be wise not to do any such thing. Tommy and I would go to Southern Decadence fairly routinely if we didn’t have anything else on the calendar for Labor Day weekend. We’d do all of our usual antiquing and gallery hopping and then add in dancing at the street party on the gay end of Bourbon Street, cheering on the parade, and drinking entirely too much. I seem to remember an afternoon of one too many hurricanes at Pat O’Briens. Fortunately nobody got sick although we were both a little wobbly as we made our way back to the hotel.

I’m trying to think of a good Tommy in New Orleans story. We would go two or three times a year for a long weekend and we had this idea that when we retired, we would get a little studio condo down there so we could come and go as we liked. One of many dreams that will never be. It was very much our city together because of the food and the art and the music and we never grew tired of it. We made friends with a number of the artists and gallery owners in the French Quarter. We had our favorite restaurants from casual (The Gumbo Shop) to fine dining (Bayona). We liked to explore interesting little shops out past the Garden District and in the Marigny. One trip, we went to mass in the cathedral at Jackson Square and Tommy was inspired musically by the Latin and decided that he wanted to write a musical setting for the mass. This led to a trip to the Catholic bookstore for a missal and various mass translations, and to a couple of music stores for some scores of a couple of the lesser known Requiems and other sacred music. I was pretty sure he would put about five weeks of intense thought into the project and then move on. He was like that. He would become enthusiastic about something and throw himself into it and if it didn’t hold his attention, move quickly on to the next idea. The ones that held him, like wigs, became part of his daily life. The ones that didn’t created piles of paper and notes to be filed away, to be pulled out someday. I have some of these in my various bins of ephemera that I am way behind at sorting. Roughly six months before he died, Tommy was making diligent plans to return to school again. He was interested in M Div programs with an emphasis in sacred music and hymnody. If he had lived, would he have entered one of those? Completed it? Would that mass have actually begun to take musical form? Unanswered questions due to a life cut short.

Since announcing my current infection to the world, I have heard from any number of friends who are also currently battling Covid. And a number of my VA colleagues all came down with it at the same time I did making me wonder if that’s where I caught it. The Joint Commission was at the VA this past week doing their triennial survey. It would be ultimate irony if they were the source of this particular cluster. Someone should call up the surveyors and see how they’re doing.

I wonder if this is where modern life is heading? Boosters and infections. Get a booster to your Covid vaccine that’s tailored to the most recent variants and get sick anyway once or twice a year with a couple of days of misery until either unknown complications, long Covid, or your own advancing age takes you out. It’s too soon to tell. We’re still less than years into this even though 2019 feels like a couple of decades ago. In the meantime, you know what to do. Don’t make me repeat myself.

August 28, 2022

Round two. I suspected something was up last night when I woke up a couple of times feeling not my usual self. When I got up this morning with myalgias, a runny nose, and a mild sore throat, I suspected the worst and got out my handy dandy federally funded home Covid test and sure enough, the pink line appeared and I spent the next few hours getting hold of everyone who is depending on my over the next five days to let them know alternative arrangements would have to be made. I’m assuming this is locally acquired omicron. I flew last Tuesday and that’s sort of outside the window of getting sick on early Sunday morning. God knows I’m running around enough places these days trying to keep all the balls in the air that I could have picked it up practically anywhere. It’s a sharp reminder that we’re not out of this yet no matter how busy we may be or what responsibilities we may have.

I apologize to anyone I may have encountered in the last couple of days to whom I may have transferred virus. I’ll be keeping my mask on for the next couple of weeks just in case any stray critters are still lurking in my nasal passages. All I can say is that this bout doesn’t seem to be anywhere near as problematic as my last encounter with omicron eight months ago. That one felled me for a couple of days. This one just feels like a bad cold and, in normal times, I would be making plans to work normal hours this next week. I’m not allowed to go in to either UAB or the VA until I am cleared by their employee health departments so I’m switching all my clinical work to telehealth this next week and I’ll become a disembodied head on someone’s iPad in clinic. We’re too short staffed for me to loll around the house with bad television. I will go to bed relatively early tonight and try to get some decent sleep before the morrow.

We’re rapidly approaching the end of a fiscal year. Why fiscal years are based around October 1, I haven’t a clue but it does mean that a large number of tasks need to be completed in clinical medicine in order to close the books on fiscal 2022 and begin reeling in the numbers for fiscal 2023. Crossing this arbitrary boundary is going to change a number of things regarding the pandemic, mainly concerning federal funding. The federal dollars for immunizations, medications, testing, and other public health measures more or less run out with the new fiscal year and there’s been no motion in congress to continue these programs, likely due to pandemic fatigue and a general societal feeling that it’s over (even though it’s not – we’re still losing about 500 people a day nationwide and the numbers, while trending downward over the last month, are still way above what they were in the spring). In practical terms, what that’s going to mean is that if you want any additional boosters or test kits after the first of October, it’s going to cost you, or your health insurance which can set whatever coverage rules it chooses within federal guidelines.

Because that’s what we do in this late stage capitalistic society of ours. We monetize everything. If it can’t be harnessed in some way to create profit for some owner of industry, it must be worthless or, if it has obvious value as part of the commons, it must be brought down to size or destroyed through the manipulation of public opinion. (The current wars on public education and public libraries over idiotic ‘save the children’ issues come immediately to mind). What will a Covid booster cost on the marketplace? Hard to say. The federal government is playing Pfizer/Biontech and Moderna roughly twenty dollars a dose for huge bulk orders. The prognosticators are expecting the price to increase to about forty dollars a dose when the government is no longer the sole customer. By the time that goes through various middle men and administrative fees, I imagine boosters will have a cash price of about a hundred dollars. That may be reduced dramatically if we have another more virulent variant and insurance companies run the numbers as to what it will cost them to take care of an increased number of seriously ill patients and they may drop the price significantly in order to encourage more people to be boosted. But this is all pure speculation at this time.

Assuming we stay around five hundred deaths a day (and a certain percentage – somewhere between 15% and 40% depending on whose numbers you believe) of those are in individuals who have been vaccinated and boosted. Most of the vaccinated who die are either quite elderly or have serious underlying health conditions (in other words, my patient population). This is similar to what one finds with influenza. The difference is in the absolute numbers. Flu tends to kill about 20,000 Americans a year. In a really heavy flu year, it doubles. Covid is on track to kill nearly ten times as many if what we are starting to see now is the endemic pattern. If we as a society want to make the decision to bear that burden as part of living, just as we do at all of the other causes of death that we shrug our collective shoulders at, we can. But it doesn’t have to be.

I think we’re falling into our usual myth of control. Americans accept shockingly high risks regarding activities that we think we exert some sort of control and understanding over (driving, high fructose corn syrup, nicotine, alcohol) and are averse to risks we think are outside of our purview (alflatoxin in peanut butter, Alar on apples, cyanide in the Tylenol, shark attacks, lightning strikes). The early pandemic was clearly in the latter category. Anyone could get sick. We weren’t certain how it was being spread. Healthy people were rapidly becoming seriously ill and dying. Now with vaccines and a certain amount of natural immunity, especially after the huge omicron surge of last winter, it’s starting to feel more and more like the former. Yeah, I could get it but it’s not going to be that bad.

Perhaps the most serious issue with the turning of the fiscal year is going to be the drying up of US funding towards international efforts to get vaccines to poorer countries. We often forget, this isn’t a local disease, this is a world wide human disease and any population that is not granted immunity can become a pool in which the virus can grow and mutate. Perhaps our problem is that we’re trying to use the 19th century nation state as the model for solving 21st century problems. Pandemics, climate change, population migrations. All of these things are going to require transnational solutions.

If you’re over fifty and haven’t had a second booster, go get it before the end of the fiscal year.

August 24, 2022

CHICAGO, IL – MAY 16: Passengers at O’Hare International Airport wait in line to be screened at a Transportation Security Administration (TSA) checkpoint on May 16, 2016 in Chicago, Illinois. Waiting times at the checkpoints today have been reported to be as long 2 hours. The long lines have been blamed for flight delays and a large number of passengers missing flights completely. (Photo by Scott Olson/Getty Images)

I am back in the Southeast but haven’t quite made it back to Birmingham. I’m getting older and wiser so when I had a flight from Seattle that didn’t get in until 8 pm, I decided it was best to spend the night in Atlanta and drive back today rather than to brave I-20 after a travel day. I looked forward to sleeping in, but my biological clock is a bit screwed up so I woke up at 5:30 AM local time, but that doesn’t mean I have to get out of bed at an early hour. So here I lie, listening to the muffled sounds of an Atlanta freeway outside the window. I am not getting on the road until after morning rush hour which, knowing traffic in the ATL, should be around 10 am.

Yesterday was a travel day that once again showed the lingering effects of the pandemic on society. I got up relatively early, had breakfast with my father, and headed out the door about 8:15 to catch the light rail to the airport, about a five minute walk. Due to construction, only every other train runs through downtown to Sea-Tac so it was a bit of a wait but I ended up at the airport at 9:30 AM, plenty of time one would think for a 11:30 AM flight on a Tuesday. The departure terminal was a zoo. A lack of Delta baggage and ticket agents meant that the line to drop off bags snaked 100 yards down the concourse. Only two of six stations were manned (and I seem to have been behind a large number of extended families who spoke little English ) so nearly 45 minutes to accomplish that chore. Then into the TSA line, another 45 minutes due to a shortage of TSA agents. I made it to my gate just as my boarding group was called. It’s a good thing there were no transit delays. I was worried about ATL this trip. SEA was the problem.

It’s going to be quite some time before all of the issues with services recover from pandemic related effects. And it’s not going to sit well with a population used to instant gratification. I don’t know what all of the causes of the current bottlenecks are but I can guess. Workers who have died or become disabled from Covid and its complications. Workers who are not seriously ill but who are continuing to quarantine as they should when infected. Workers who have had to leave jobs as the caregivers for children or the elderly within their family systems died and they have had to step up into those responsibilities. Corporations that have not adjusted salary scales for new realities making some jobs simply unattractive. Early retirements. Vacancies in better paying jobs and workers moving up leaving the more menial positions open with fewer entry level employees available due to demographics and anti-immigrant sentiment. Workers unwilling to face the public day after day given the decline in civility and increasing abuse they have to face. The same trends are leading to airport lines (inconvenient but bearable) and the inability of me to get services lined up in a timely fashion for my patients (which will lead to people getting sick and dying when they need not).

For some reason, while waiting in yet another queue, I was inexplicably reminded of my grandfather. John Bertrand de Cusance Morant Saunders was a man of short temper who had no time for the inconveniences of the world. When faced with something like a delay in travel, he would bluster and look around for someone to blame and then let them have it if he could identify a convenient target. He was usually polite but between his imposing physical size, his British colonial accent, and his force of personality, he usually got what he wanted. He mellowed a bit late in life, especially after driving his car into a ravine at the age of 83 in what, given my personal experiences with him behind the wheel, was likely a fit of road rage. He was not seriously injured and he continued on for another five years after that particular incident. When he finally did pass on of natural causes at the age of 88, he left instructions that he be cremated and his ashes interred with my grandmother.

Melrose Abbey

There was a slight problem with this. No one in the family was quite sure where my grandmother was. She was a Scot from Dumfries who grew up and spent most of her young life in Edinburgh, which is where she had met my grandfather (he was in medical school, she a practicing physician). When she died, my grandfather made arrangements for her cremains to be returned to Scotland and buried there. He would not let the rest of the family in on the details but let us know that he had her buried in a cemetery in Melrose. Melrose is a lovely little town, site of the ruins of Melrose Abbey (mainly destroyed in the 16th century wars between England and Scotland). Why he would put her there, we do not know as there were no family connections to the town. Her family were buried in Dumfries, on the opposite side of the country.

She died and was interred in 1976. In 1983, my cousin Jenny, while on her semester abroad made her wat to Melrose and combed the cemeteries looking for our grandmother’s grave. No luck. I followed on my European jaunt in 1984. I too checked every cemetery in town and inquired at the town hall. Still no luck. My parents and my aunt and uncle, on various trips to the British Isles in the late 80s also had no luck. My grandfather was approached but didn’t want to talk about it (he had since remarried). He died in December of 1991 and Steve and I headed up to Seattle for the Christmas holidays that year. While we were there at my parents house, UPS rang the bell and handed me the box with my grandfather’s ashes in it. All I could think of was to call over my shoulder to Steve ‘Grandad’s home’. He wasn’t amused.

Grandad’s box lived in my mother’s shoe closet for the next year or so while my mother and aunt tried to figure out just what had happened to my grandmother so that he could be sent to join her. This involved a number of letters to local authorities inquiring where human cremains sent internationally some sixteen years before might have ended up. We did find out that she had indeed been buried in a cemetery in Melrose. The reason none of the family expeditions had been able to find it was that my grandfather had neglected to purchase and install the headstone as he had claimed. My grandfather was eventually sent over and laid to rest with my grandmother. My mother and aunt had the last laugh though. In Scottish tradition, a woman, when she marries, does not lose her own identity to her husband and family so the marker that was erected reads ‘Sacred to the memory of Alison Jean Maxwell-Wood MD and to her husband John Bertrand de Cusance Morant Saunders MD’. I haven’t been back to Scotland since it was erected but I will eventually go and pay homage. They, for better or worse, are part of what made me who I am.

August 20, 2022

I was a voracious reader as a child. I pretty much taught myself to read between 3 and 4 and was pretty solid by the time I entered kindergarten, having graduated from picture books to chapter books. I started in on adult literature around age 10 and anything that was left lying around I was likely to pick up and try. I don’t think my mother was amused when she found me reading Kurt Vonnegut’s Breakfast of Champions at that age or Mario Puzo’s the Godfather a year later. My mother was, however, relatively shrewd so she figured out that if I was going to read adult material at a young age she was going to guide me and soon she was handing me paperback editions of various classic novels and modern literature for me to read and discuss. By fifth or sixth grade I had worked my way through Jane Eyre, Wuthering Heights, The Count of Monte Cristo, The Three Musketeers, A Tale of Two Cities, Brave New World, 1984, and Auntie Mame among dozens of others.

One of her selections for me was Richard Llewellyn’s story of a Welsh coal mining community, How Green Was My Valley. I don’t think anyone reads it much anymore but the film version with a child Roddy McDowall in the central role is still played on Turner Classic Movies as it was a Best Picture winner back in the early 40s (now chiefly known as the movie that beat Citizen Kane). I read the novel several times as the child protagonist of roughly my own age, the themes of the tight knit family and community being ripped apart by forces beyond their control, and the degradation of the landscape by the byproducts of industry all spoke to my still developing mind. I hadn’t thought about the book for years but today, while wandering the streets of Seattle, it came back to me in full force.

The city of Seattle I grew up in peeks through here and there but the city that is now is unfamiliar. Landmarks have been bulldozed, the rapid increase in population has led to more and more single family homes being replaced by multiunit dwellings, usually cheaply manufactured and ill maintained, the parks and green spaces have been allowed to deteriorate. The city just feels dirty in ways that it didn’t in the past. There’s less care of private dwellings and yards. There’s graffiti everywhere. The streets are full of pot holes. There’s probably very good socioeconomic reasons and stresses behind this that I’m not fully briefed on, not having lived here for thirty five years. But as I was musing on this, I had a sudden recollection of the last line of that novel I read nearly fifty years ago: “How green was my valley; the valley of them that are gone.” It’s a brief sentence that combines the ideas of you can’t go home again with wariness of childhood nostalgia. So I guess that’s where I’m at. Feeling on one level that I am home and this is where I belong and on another level that it’s moved on without me and that Birmingham is where I need to be.

Not much has happened in the few days that I have been here. The weather has returned from Alabama heat and humidity to Pacific Northwest room temperature and breezy. I attended a birthday party at one of the parks on Lake Washington this afternoon and looked out over the blue waters thinking of my endless childhood summers at the Laurelhurst Beach Club where we all spent our time digging in the sand, swimming in the lake and flinging ourselves off various diving platforms. The crows in the trees were eyeing the picnic goodies and the ducks from the lake were intent on my Cheetos. (I gave in and fed them a few. I know you’re not supposed to but I’m a sucker for a soulful glance from any sort of animal). I did not swim.

The Laurelhurst Beach Club

My talk to the residents of my father’s senior living facility was a success. I’ve figured out just the right balance of stand up, story telling, medical information, and common sense to hold a senior audience for ninety minutes. I just hope they all buy a copy of the new book when it comes out. I did meet my editor/publisher briefly and we should be on track to have it finished and available by the end of September. At that point, I will take a little break and start thinking about Volume III of these Accidental Plague Diaries around New Years. I am hoping that will be volume the last. If enough people will get their boosters and the virus doesn’t have a a particularly nasty mutation in the next few months, we may be at the end of the pandemic and firmly into endemic territory by the end of the year. We shall see.

Tomorrow, we have a gathering of the clan at my brother’s house so we can all catch up with each other for a few hours. Then I have one more day of unstructured time before returning back to the Southeast on Tuesday. I haven’t decided what I’m going to do with Monday yet. Something will present itself, it usually does. In the meantime, to bed. I have more sleep to catch up on.

August 18, 2022

Time to shift focus away from Covidland and back towards itinerant wanderings for a few days. I haven’t wandered far off my usual beaten path, just off to Seattle for a few days to see the family. I try to get up here about twice a year but pandemic fallout of various stripes has made that a bit more difficult over the last couple of years. Anyway, I am ensconced at my father’s senior living facility, after having partaken of the special Roaring 20s dinner they were having this evening to celebrate the 13th anniversary of its opening. My parents moved in during its first year so my father is among the original cadre of residents that remain. The dinner was good as was the Manhattan cocktail that accompanied it. My father, at nearly 90, had two and was a bit wobblier than usual but obeyed my strict instructions of not to fall over.

This was my first cross country flight in eight months, the last one happening just as the omicron wave was beginning to envelop the world. Flying has changed a bit. The FAA no longer requires masking on planes or in airports. In Atlanta, there were very few masks in evidence other than on employees where they seemed mainly to be decorative chin straps. In Seattle, there were more – roughly 5% as compared to the 0.5% in Atlanta and far more were worn correctly. If I return from this trip with a Covid infection, I’m going to blame ATL although there’s really no way to know.

The trip went smoothly in general, unlike my last major flight with it’s nine hour delay. Round trip from Birmingham to Seattle was roughly $1,000 more than round trip from Atlanta to Seattle so I decided to fly out of Atlanta, driving over last night after work and spending the night in an airport area hotel. The drive was uneventful until I hit Atlanta around 10 PM, just in time for a monsoon which led to minimal visibility on the interstate and an interesting time had by all trying to negotiate all of the lane changes between I-20 and I-85 in downtown Atlanta. I survived, went to bed, slept in, and then made the short hop to the airport this morning. I allowed an extra hour or so due to all of the travel horror stories of the summer but things seem to have quieted down as ATL was calm and it didn’t take any longer than normal to check bags and clear security. The plane was on time, the entertainment system worked, and (per usual) I slept about half the way. On the Seattle end, no delay at baggage claim, and a brisk walk to the light rail which stops three blocks away from my father’s building.

Tomorrow I sing for my supper by giving a talk to the residents on geriatric issues. As I’ve been showing up regularly for over a decade, I long ago exhausted most of my usual community focused lectures so these days I just put out a call for questions the week before I arrive and make it an ‘Ask Me Anything’. The usual things that come up are specific questions on medications, medical marijuana and the octogenarian, how to stave off dementia, issues with the functioning of the health system and the like. I do my best but occasionally I get thrown a curve ball like ‘Why can’t I live to 125?’ I like giving talks to general older audiences. They’re one of the few groups that actually listens to what I have to say as they’re actually living with the real issues of aging, be they medical or social. My least favorite group to speak to is physicians. In general, they tend to think that because they are physicians, they are already omniscient and as geriatrics doesn’t deal with fancy new drugs or equipment or miracle cures, it’s not worth paying much attention to.

https://vimeo.com/40516254

I’ve learned from thirty five years of public speaking on professional topics how to read the room. Whether my audience is with me, or checked out. When to go off on tangents. When to insert a joke. When it’s safe to insert a macro on a topic so that I just go through it by rote and don’t have to think much. I suppose it’s a skill. I tend to get pretty high marks on evaluations when I teach (except by physicians) so I must do something right. I figure even if I formally retire, I’ll probably keep that piece up. I’m hoping to develop some new talks out of The Accidental Plague Diaries at some point. And there’s still the idea of it becoming some sort of performance monologue piece of some type but that’s going to take a very skilled director to take that material and shape it in such a way that it plays theatrically. If that ever comes to fruition and is published and someone besides myself plays it on stage, I suppose I’ll get to sit in an audience some day and watch someone I do not know interpret my life. That will be an odd feeling.

The only thing of note on the Covid front was Monday’s announcement by the FDA that they were going to approve an omicron variant specific variant this fall and that Moderna’s SpikeVax would be getting a nod shortly (it has been approved in the UK). People are asking me, if they have not yet had a second booster, if they should get one or wait. As one can get a booster thirty days after a previous one and as there is no calendar yet as to when the new omicron booster will actually roll out, I’m suggesting that people go ahead and get a booster now and then also get the omicron booster when it becomes available in a couple of months. I got my second booster in late June and will get my omicron as soon as it becomes available. Likely October but anything is possible.

I seem to have brought the weather with me as Seattle is in the mid 80s today and humid (yuck). At least my dad’s building has air conditioning which is usually in short supply around here. It’s supposed to cool down over the weekend. I look forward to that. I am still on Central Time so it is now past my bedtime so I am now going to sign off. My Manhattan is draining my energy…

August 14, 2022

I’m confused. And, if I’m confused, I imagine many of you are as well. Once again, the national public health system is changing its guidelines but without offering clear and concise reasoning behind these changes so that we all can make the wisest choices for ourselves and our families. This has been one of my biggest beefs throughout the whole Covid pandemic – poor messaging. Under the prior administration, it was deliberate for political purposes. Under the current administration, it appears to be due to a lack of marketing acumen which can allow for the necessary information to be reduced to easily digestible concepts and then given to all of the various media outlets in a consistent fashion. I am no fan of Fox News, but the federal government could learn a thing or two from them. They’re masterful at this sort of work.

Anyway, I have done a little poking around into the new CDC guidelines and some reading on what else seems to be happening these days in Covidland so I’ll do my best to clarify what all this means as I see it. First off, our late summer BA5 omicron surge appears to be waning somewhat. The number of new cases reporting daily has been slowly dropping and, at current trends, should be back under 100,000 a day by Labor Day. The number of people in the hospital and the ICU also are slowly descending (roughly 50,000 and 5.000 respectively at the moment). The only indicator that has been creeping up is the death toll which is nearing 500 a day, well over double what it was a couple of months ago. This is probably the usual lagging indictor phenomenon where the death rate rises 4-6 weeks after the case numbers start to go up. Will these numbers go back to the lows of late spring? Will numbers really start to peak in the fall? Who knows. Tune in tomorrow…

When one looks at the CDC guidelines, it’s clear that their ultimate goal regarding the pandemic at this stage is not to prevent all disease and transmission but rather to prevent serious disease that requires hospitalization. The agency is smart enough to recognize that mild disease from which one can recover at home is likely to simply be an endemic part of our lives going forward. They understand that the acute care health system, as battered as it has been over the last few years, is in difficulties and that the most important thing for society is to preserve its functioning so that it can take care of all of the other non-Covid related needs we have, especially in light of the rapid aging of the population due to the demographic position of the Baby Boom. I think we just need to keep that lens firmly in place while scrutinizing what the agency has to say. The major problem with this approach is that it does not take into account different risk stratifications for different populations; when that happens, higher risk subgroups are more likely to bear the brunt of disease morbidity and mortality.

The current CDC guidance on quarantine/isolation is to remove the requirement that someone who was exposed, but not sick, should isolate for five days in order to break transmission chains. No one was really doing this anyway, at least not in recent months, and I suppose that they feel the risks to society from excess quarantines and short staffing were worse than the risk of potential transmission. They still request quarantine for five days from initial symptoms/testing positive with an additional five days of total masking. This is all well and good, but there is some evidence that BA5 remains infectious on day 5. The CDC making this recommendation means, of course, that employers can require workers to come back to work after five days, even if they might transmit to coworkers. It will be interesting to see if there is a spike in workplace transmission as compared to general community transmission. There are also social justice concerns as lower paid workers are more likely to have jobs needing in person contact while higher paid workers may have work from home options. There is no requirement under CDC guidelines that there be a negative test to ‘clear’ someone. PCR tests in particular can read positive for days after the ability to transmit has been lost. I don’t know if this is a good or a not so good thing.

The CDC continues to publish weekly data by county on whether transmission locally is low (masks not needed), medium (masks should be worn indoors by those most at risk) or high (everyone should mask indoors in public). These numbers are not generated based on the risk to an individual being exposed but rather on what transmission rates are likely to do to the local health system in terms of generating serious cases which will require hospital or other acute care. Therefore, they are affected by such things as vaccination rates in the population, statistical analysis on the amount of native immunity present from previous waves, numbers of hospital and ICU beds available etc. Jefferson County Alabama, is currently in the ‘high’ level. I don’t think the local population is reading the CDC website however as I don’t think I’ve seen a lot of masks recently at the grocery store. We’re still masking at work and at church so I’m not worried. King County Washington, where I’m travelling shortly, is in the low category. There’s no CDC readings for Delta Airlines jumbo jets travelling between the two.

The most American piece of the new CDC guidelines is basically that guidance should be tailored to the individual and the individual’s understanding of risk. That’s all and good, but as a public health strategy, it will open up a lot of subgroups to higher risks of infection or reinfection and that in turn is going to mean continued cases, continued rise in long Covid cases with completely unknown sequelae in the future, and the potential of putting the elderly and those with compromised immune systems in harms way. Fortunately, we do have a decent weapon in the arsenal with the oral antiviral Paxlovid which seems to be quite effective against omicron and helps prevent cases from advancing to the point that hospital care is needed. It’s now widely available and it may be why the current wave hasn’t been worse.

What does this all boil down to? First, get your vaccines and boosters. Fully vaccinated at this point means at least one booster and, if you’re over fifty or have a chronic illness, I’d go get that second one and not wait. Yest, there’s supposed to be an omicron specific one in the fall but who knows when that will actually be in widespread distribution. I’m planning on taking each and every booster that comes down the pike as those unknown long Covid issues (and long Covid seems to strike 15-20% of those with an infection and the more infections you have, the more likely you’re going to get it) are not something I want to learn about first hand. Second, if you do get sick, get tested and, if positive and symptoms are anything above minor cold symptoms, get a prescription for Paxlovid. If you’re without insurance and can’t afford that trip to urgent care, head straight for the pharmacy. Under the current FDA rules, pharmacists can prescribe and dispense without physician authorization. Third, when indoors with others I’d read the room and put your mask on if you think there’s a chance someone there could expose you. Fourth, you know the litany – wash your hands, use common sense, stay home if you’re sick with anything.

August 10, 2022

Sad adult woman sitting on dark home corridor floor.

I went to a birthday party this past weekend. It was low key, mainly people of my generation (mid 50s to mid 60s) and a mix of folk who had known each other for decades and newer acquaintances. Once the usual topics of conversation such as entertainment and politics had been exhausted and we moved into the more personal, nearly everyone had the same story to tell. They were exhausted. Some were taking FMLA or other time off from work. Some were devising retirement plans. Some were trying to figure out how they were going to be able to keep up their usual professional pace without dropping in harness. This was an upper middle class professional bunch, working in health care, education, ministry, the not for profit world. And every single one was feeling the same.

I fit right in there with them. I’m running out of gas. I’m not quite to the coasting on fumes stage but it probably wouldn’t take too many further reversals to push me there. I’ve been thinking a whole lot about what’s causing this. I think just blaming the pandemic or the viciousness of our current political moment is too facile an answer. I think it’s something a bit deeper and a bit more primal. I think we’re dealing with an enormous amount of unrealized and sublimated societal grief. And if there’s one thing that I’ve learned from the last nearly forty years of my life in medicine and as a double widow, grief will always out. It may be transformed into other emotional states through circumstance or force of will but it will continue to rocket around your brain and your life until you acknowledge it and identify it and deal with it and grow around it until, while it remains a part of you, it is no longer the defining part.

What is grief? The dictionary defines it as ‘deep sorrow, especially that caused by someone’s death’. But, again, I think that’s a bit too simplistic because grief can happen in many circumstances that don’t involve death. One of my most acute episodes involved my finishing up thirteen years of higher education. I’d made it! I didn’t have to go to school or training any more! I was, to my knowledge, the first person in my medical school class to receive a faculty appointment at a major university. I had to grieve the loss of a linear way of living from educational milestone to educational milestone, neatly laid out like a treadmill and adapt to a life where there was no longer a road map. It took me about a year and a half to do that.

I think grief is what happens when the reality of our current circumstances differs from our imaginings and planning and expectations of what those circumstances should be. Death, of course, changes everything, especially the death of a spouse or other close companion. The mind can’t really conceive of the future without that other important person being a piece of what’s to come and if they are irrevocably removed, there’s a huge cognitive dissonance. But the same thing happens with more minor traumas and disappointments: the need to cancel a planned vacation, the inability to attend a social event or milestone celebration such as a wedding or graduation for someone important to our lives, the expectation that American society will rise to a challenge and act for good and instead, in many ways, does the opposite.

Two and a half years of pandemic has ripped well over a million Americans out of the social fabric from Covid through death. Each one of those missing people has left a social circle bereft with traditional mourning grief. Some people have only lost an acquaintance. Others have lost multiple family members. Hundreds of thousands of children have lost a custodial parent. Hundreds of thousands of aging parents have buried a child. But what of those who became seriously ill but did not die? I take care of a few of them. I have people with long Covid whose bodies were so ravaged that they will never resume normal activity again. They’re alive but grieving the trips they’ll never be able to take, the hobbies they’ll never be able to pursue, and their spouses and families are grieving the huge alterations in their own lives due to their loved one’s care needs. (I’ve been there – having a seriously ill person at home is no fun). Then there’s those who have recovered from acute Covid but who now have long Covid symptoms which are poorly understood and which no one really knows how to treat. They too grieve the loss of their past health and function and face an unknown future.

Then there’s the years of cancelled and postponed societal rituals. For me, this included the inability for my family to have a proper memorial after the death of my mother, the cancelled theatrical opportunities, the inability to make music as a choir, the lack of group dinners out, cast parties, or drinks with colleagues after a particularly stressful work day. Many of these things have started to return in a somewhat modified form but all of those missing events and interactions has each left a lingering trace on the grief pile and that must be felt and addressed. And those missing threads in life’s tapestry are causing all of us to become more detached from each other and part of the reason why so many of our social institutions – health care, education, cultural opportunities – seem so shaky.

Perhaps the biggest contributor is how the pandemic has laid bare the deep political and social divisions we have. I don’t care which side of the fence you’re on, every one of us is looking at the American political landscape, riven by distrust, if not downright hatred of the opposition, egged on by a media ecosystem that cares only about clicks and revenues which are best fed by maximum conflict, and wondering where is that ability we have always known in the past for Americans to all pull together for the common good in a crisis and will we ever have that again? That’s a huge loss of faith and certainty in how the world should be and when that’s added on top of the deaths and the disappointments, it’s a recipe for disaster.

I’ve learned about how to cope and lessen grief over time – and there’s really only two things that work: time and other people involved in your life. Antidepressants and other quick fix pharmaceuticals usually don’t help much. You have to develop the coping mechanisms and put in the time. What are mine? Well you’re reading one of them. These essays and the books that have come from them are perhaps my most obvious constructive response to my personal grief. I find that the actual patient care piece of my job and the time I spend face to face with patients where I can use my skills and my empathy and my ability to simply listen gives me renewal. The piece of my job that interfaces with administration and the system…. well that’s another story. I think this works because so many of my patients are now in their late 80s and 90s. They have living memories of a worse time: the Depression and World War II. They survived. They developed resilience and coping skills. Look up the elders in your life and listen to them. They can teach you a lot about how to deal with today.

I know I’m being a bit of a negative Nellie with this particular post, but I’ve learned through these writings that when a thought like this is rattling round my brain, best to get it out. I’ll sleep better and have a bit more energy tomorrow. Unlike today when I fell asleep on the couch in my voice teacher’s living room waiting for my lesson, despite the very loud scales from the lyric baritone coming through the wall. As I told my voice teacher, I was an intern. I can sleep through anything.

August 6, 2022

We haven’t run the numbers for a bit. Where are we? About 100-120,000 new cases of Covid being reported daily in the US. This is about four times the low spot of late spring when we were down to about 30,000 cases daily and about a tenth of the peak of omicron this past January when we were at nearly a million new cases a day. Is the current number accurate? Probably not as health departments are not as timely or as exacting with their data reporting and because the majority of home test diagnosed cases aren’t reported and counted correctly due to all the barriers that stand in the way of that data collection. Deaths are going up again. We’re up from about 300-400 deaths a day a month ago to about 650 deaths a day nationwide. That’s nowhere near what we had earlier in the pandemic but it’s still a significant increase over the last few weeks, likely reflective of the increase in cases as omicron BA 5 continues to spread with its pesky habit of getting around our various immunities, both natural and vaccine derived.

Assuming that we stay even at roughly 650 deaths daily, that’s nearly 20,000 deaths a month or about 235,000 deaths a year. That’s enough to enshrine Covid as the third leading cause of death in the US for some time to come, bested only by cancer and heart disease (both about 600,000 a year) and roughly ten times the usual flu death rate which usually hovers somewhere between 20,000 and 30,000 annually. So, if Covid is here to stay in an endemic fashion, it’s still a problem not to be taken lightly and my best advice to everyone is to keep getting those boosters as they come down the pike, just like you keep getting flu shots. I’m not convinced that we’re at the end of the road yet. I still think we’ve got a nasty little surprise or two coming.

Has the availability of Paxlovid, the antiviral drug combination which if taken early in the infection, made a major difference in the mortality and morbidity statistics? I honestly don’t know. It certainly hasn’t hurt. There’s a bit of misinformation about Paxlovid floating around out there. First off, it’s not a prophylactic. If you go to a wedding and you find out later that the person across the table from you had Covid and decided to come any way, taking the drug won’t protect you from infection. It’s only for those who are actually actively infected. If you are infected and you’re young and healthy and your symptoms are mild like a bad cold, should you take it? It won’t hurt but it’s probably not necessary. It’s probably best used by those who are starting to get slightly more symptomatic such as fever or worsening cough, especially if they are at risk for severe complications from age or from other underlying health issues or immune deficiencies. For it to be helpful, it has to be taken within four or five days of the start of symptoms and it’s a five day course. It’s standard dosing unless you have kidney function issues requiring a lower dose. It doesn’t have a lot of side effects. There is some talk about Paxlovid rebound – a worsening of symptoms following finishing a course for a few days, but it’s unclear if this is a real issue or not. Will I take it if I get infected again? Won’t hurt, might help, can’t think of a major reason not to.

The problem with Paxlovid, indeed with all medications within American health care, is that the general population thinks of them as magic. Feel bad? Take a pill and presto changeo the miracle happens and you’re back to normal. The problem is that health, disease and pharmacology are a lot more complex than that. (That’s why pharmacy school is a four year program after college). Drugs are controlled doses of poisons – substances designed to alter your physiology in one way or another. They don’t do the same thing in all people. One of the dirty little secrets of pharmacy is that pretty much all drugs don’t work in between 5-25% of people because of genetic variations in physiology. They don’t do the same things in the same person at different times in the life span due to alterations in body composition over time. They can interact with each other in highly complex ways that no one understands. There has never been a controlled trial of a human being with more than three medications circulating in their system at once. It’s too complicated to study using those sorts of rigorous scientific methods so when someone takes ten, fifteen, twenty-two different medications daily, we haven’t a clue what’s actually going on. We’re just making our best guesses.

I’m going to reduce four years of pharmacy school down to a couple of paragraphs to help explain some of these concepts. There are two basic things to consider. Pharmacokinetics and pharmacodynamics. Pharmacokinetics are the movement of drugs through the body and pharmacodynamics are the body’s biologic response to the drugs once they reach their destination. Pharmacokinetics are affected by four basic processes. The first is absorption. Most drugs are administered as pills and enter the stomach and pass into the intestine for digestion. The chemicals are then taken up across the intestinal lining and enter the blood stream. As the gut is one of the earliest body systems on an evolutionary scale, it works pretty well most of our lives and absorption doesn’t change a lot with age. There are some exceptions. First, some pills come with capsules and coatings that require stomach acid to properly disintegrate and a lot of older people, due to changes in the stomach and reflux, take a lot of antacids which may keep this from happening properly. Second, there are some specific categories of medicines not taken up as well as the transport systems in the gut deteriorate with age – these include positively charged ions such as iron and magnesium and vitamin B12.

Our second pharmacokinetic system is known as distribution. Drugs, like other chemicals, either prefer to dissolve in water or in fat/oil (hydrophilic or lipophilic). The body has both of these available. Water in the circulation and lead muscle tissue and we all know about fat. As we get older the proportion of fat to water tends to increase meaning that hydrophilic drugs have less volume to dissolve in and so their circulating concentrations go up and the lipophilic drugs have more volume meaning they are going to stick around longer in the body and clear less effectively leading to much longer half lives. I always had a problem understanding this when I took second year pharmacology in med school so if you have no idea what I’m talking about, you’re not alone.

Lastly, we have metabolism, the changing of drugs from one form to another, usually by the liver, in preparation for either use by the body or to become an inert form or a form which can be cleared from the body – something that slows with age and, of course, excretion, where the drug leaves the body either from being moved from the blood stream into the urine through kidney function (declining with age) or by the lower part of the GI tract. Paxlovid is subject to all of these processes as much as any other drug. It is eliminated in the urine so in those with renal dysfunction, it doesn’t cross through the kidneys quickly enough leading to toxic buildup which is why it must be administered in lower doses. It also interferes in the metabolism of several other common drugs and those drugs often need to be held while taking Paxlovid. Your pharmacist can advise you.

As one gets older or develops health conditions where you’re on routine medications, one of the best things you can do for yourself is choose a single pharmacy to fill your prescriptions and make friends with your pharmacist. Their scope of practice is quite broad and they are the experts at catching interactions between medications and other medications related problems, but to really do it, they have to know you and your whole med list. When you’re filling things at three different pharmacies, no one is able to see the whole picture and catch things early. With the number of patients I see, the complexity of their medical problems, and the numbers of medications they take, I rely whole heartedly on the pharmacists I work with to help keep me on the straight and narrow, or to at least keep me from killing too many of them.

And there you have it. I’ve just saved you $80,000 in pharmacy school tuition. Hopefully you’ll use some of that cost savings to take care of yourselves and buy a little gas for the car so you can go get your boosters as they become available.

August 2, 2022

Steve having a bath with Patrick Flanagan

Binx, the new cat, emerged from wherever he’s found to hide in this condo to stare at me for about three minutes, and then he turned tail and ran back to his safe space. I’m not exactly sure where that is. When I discover one, he appears to abandon it for somewhere else so he hasn’t been back in the fireplace, behind the bins of of cleaning supplies in the hall closet, or squeezed between the washing machine and the wall. The condo isn’t that big and there’s only so many possible places so I suppose that as I discover each one in turn, lowering his number of undiscovered hidey holes, he may eventually decide I’m not that bad and actually come out and join the fun. As long as there’s evidence that he’s eating, drinking, and using the litter box, I’ll let him make up his own cat mind in his own cat time. Oliver, the other cat, who is now about sixteen, appears to be ignoring him so I don’t expect any real issues.

I’ve had cats most of my adult life. I would, in may ways, rather have a dog or two but the odd hours I keep and my tendency to disappear from home for a couple of days at a time when working on both work and theater projects just precludes giving a dog the time and attention it really needs. Maybe after I retire. Steve and I started with cats back in 1993 when we moved from our 1200 sq foot condo to our 2700 sq foot house. Patrick Flanagan was the first. He was an orange tabby rescued by a friend from a feral litter under a nearby house. In Steve’s researches into the history of our condo (the top floor of a late Victorian house in midtown Sacramento) and our newly purchased house (an Arts and Crafts bungalow several blocks away), he discovered that both buildings had been owned, at one point by a Mr. Patrick Flanagan and so the cat was named in his honor, and because his ginger fur meant he was probably Irish. We then discovered that the modern day Flanagans of several generations later were living across the street and we became good friends. Patrick was joined by a second cat, Big Al (named after Allan Owen) for a while but he did not last long due to his unfortunate habit of spraying everywhere.

Binx in Hiding

When we moved from California to Alabama, Patrick came with us. He did not appreciate the four days in the car that it took for us to drive cross country. He would lay splayed out on the floor of the car not moving and then, when we got to the motel, would crawl up under the blankets and hide for an hour before coming out to use the litter box and eat and drink. He eventually got used to the Aerie and was Steve’s constant companion during his long illness and helped keep me sane after his death. When Tommy arrived, a few years later, he brought his two cats with him, Shadow, a gorgeous Himalayan with Siamese seal point markings and Willie, a small grey tabby. Willie developed diabetes and one or the other of us was always having to race home to give him an insulin shot during the first year of our living together. He eventually died of complications of the disease.

A few years later, we got Archie, who was sort of a buff color with pointed Abyssinian ears. He was a trouble maker. That brought us up to three which we thought was a good number. Then Patrick died after a long life and we went looking for a third. At the adoption room, we found a pair of litter mates, long haired and gorgeous who we decided to take as a set, Oliver, a dark gray and Anastasia, an off white. We became a four cat household. Anastasia was very much the princess, serene and aloof while Oliver hated everyone and only turned up for meals asking for more. Over the next fifteen years, Shadow, Archie, and Anastasia all left for cat heaven after long lives leaving me only with Oliver (who changed his behavior to become a loving little fur ball after he became last cat standing) and now Binx. Oliver is about sixteen. Binx is less than a year so I assume I’ll be down to a single cat again in a couple of years unless someone else gifts me one. I have two requirements: fixed and litter box trained.

Anastasia being a princess

So what does this litany of cats have to do with viral pandemics? A lot. Our pets help sustain us during our dark times. They help us meet our need to be needed when we’re separated from others. They offer unconditional love and acceptance. Their antics amuse us. The provide some unpredictability. In this last few years of pandemic, especially those of us who live alone, have needed the feeling of companionship that a dog or a cat can provide. This is leading to a bit of a problem now that the world is becoming more open. People acquired dogs and cats out of immediate emotional need a couple of years ago and they don’t have those same needs now. The responsibilities of pet ownership, however, are still there – and the expenses. Food, vet bills, boarding and all the rest. There’s been a significant uptick in dogs and cats abandoned or surrendered to shelters. The current inflationary spiral putting a strain on household budgets hasn’t helped. You can get rid of a pet for cost savings much more easily than a child.

I can’t help but wonder, as certain forces in our society seem to be determined to undo all of the progress made over the last seventy years regarding the place and opportunities for women, if the people behind those forces wouldn’t like to see, or at least tolerate, a return to the days when couples sold their excess children that they could not afford to rear or abandoned their infants at the crossroads for childless strangers to pick up and informally adopt. We seem to be monetizing everything else in America, why not human life. It seems a natural end game. I don’t want to wander too far out in the weeds so I’ll leave this topic with my basic philosophy. I believe in a society where every child is wanted, loved, and nurtured. I believe in a society where children are regarded as the greatest investment we can make and where education is paramount and appropriately funded for all. I believe in a society that makes sure that babies are born healthy and develop into healthy children – for that’s where healthy adults come from. To me, the most important public employee in the US is the first grade teacher. That is the individual who will either instill or destroy a love of reading and learning that will last life long. And we all know what the pandemic has done to the education system and what the parents empowered by the social changes of the pandemic have been doing to teachers who try to teach concepts such as empathy and sharing and how to view different backgrounds and experiences to the young.

Enough of felis felicitas. We will return to our regularly scheduled programming next essay. In the meantime, wash yo hands, get yo boosters, love yo pets.