Welcome to the 8th edition of Andy’s plague diaries. I have no idea how many there are going to be before it’s all over. I’m just going to trust that it remains in double digits. I remain healthy. My social isolation/soft quarantine to work and home only continues and trepidation mounts as Birmingham alternates between thunder storm and warm and steamy. It’s as if it were late May already. The weeds in the garden are having a field day but it’s been too wet to go out and do anything about them. Maybe it will dry off some by the weekend. My yard people are still showing up but I have told them if they need to be off to take care of kids out of school, it’s OK. Same with my housekeeper. And I am continuing to pay them both. I’m not that guy…

The first lappings of the tsunami of Covid 19 are starting to hit the foundations of UAB. On Friday, there were three cases in the hospital. Today there are 45 with more coming in. If the social distancing and other measures that have been put in place locally are effective we should start to see a leveling off in another week or so. What’s happening today reflects the social behaviors of roughly two weeks ago, just as it was recognized that the virus was here and starting to spread in the community. The city of Birmingham and Jefferson County have been fairly proactive. The state has not. What I fear most locally is that the exurbs and rural areas, filled with people who get all of their news from ‘conservative’ media outlets, have no idea what’s waiting for them and when things get rough they’ll turn to the Birmingham medical system for help. Alabama, for political reasons, did not take the Medicaid expansion offered by the PPACA and over the last decade, a number of rural hospitals have closed and services outside the urban cores are tight, at best. I’m already starting to hear stories that the emergency departments in the rural hospitals are starting to look like war zones and will soon be overrun.

I cannot save the world nor can I save people from the macro forces of politics and economics. I learned that lesson a long time ago. All I can do is work as best I can to try and protect my patient population in any way I know how. My whole career has been about saving one person, the one in front of me, at a time. That’s all I’ve ever been able to do. At the moment, that’s been through shifting most of our work to telephonic in order to keep people with the chronic disease burdens of age away from a hospital or clinic building where the acutely ill will also be. It’s working so far and we can temporize in this way for a month or so, but eventually we’re going to have to work out a way to see and examine people safely. We have some ideas, but one major set of problems at a time. It’s a good thing I’m relatively creative and used to thinking outside of the box at moments like this.

I asked at the end of the last entry for people to send me ideas for things to tackle as I write. One friend asked me to talk about how to deal with the very frail and demented elders in this current situation. Many of them live in senior living and the managers of such institutions, have quite rightly locked the buildings down to keep traffic in and out to a minimum to try to keep the virus from spreading within their vulnerable populations. When such measures are not taken, you get what happened at Lifecare of Kirkland, outside of Seattle, which rapidly became one of the ground zero centers of the outbreak. The approach to ones elders depends on their cognition. Those over the age of 80 or so who are relatively intact are going to have living memories of the Depression and World War II period and will have an innate understanding of what bad is and the kinds of rapid changes a society must sometimes undergo in order to protect itself. My father is 87, born in the depths of the Depression and World War II was the background of his childhood. Germany invaded Poland when he was six, Pearl Harbor was the week of his ninth birthday, and the war ended when he was twelve. He’s quite philosophical about where things are. He’s a bit bored being stuck in his apartment in his senior living facility in Seattle as he’s a naturally gregarious sort but he gets it. His generation has a few things to teach us all about surviving bad times. Ask and listen. (And I’m sure he’ll chime in in the comments if he feels the urge).

If you have a cognitively intact parent or grandparent stuck in senior living, call them. Get them to tell you stories of their lives. The role of the elder is the role of the storyteller and the keeper of collective wisdom – let them pass it on. If they have problems hearing, try FaceTime or Skype. If they don’t have a smartphone, see if one of the staff will lend his or her phone for a conversation. Many older people don’t do well on the phone because they need the visual cues from the shape of the face for the brain to process language correctly and video chat can really help. Working with the cognitively impaired is harder. They can’t process all of the rapid changes happening around us. All they will know is that spouses or children have suddenly stopped visiting. Their realities and brains are different than ours and they don’t have to be made to inhabit a world they don’t understand. If you’re talking to them on the phone, ask them to explain what’s going on. Their brains will create a narrative that makes sense to them, even if it’s far from reality. It’s OK to go with it. It’s OK to tell white lies. It’s OK to shine them on and change the subject. The best thing to do if they start perseverating and getting repetitive is to get a different brain pattern going, king of like pushing the needle on a stuck record (a metaphor that’s going to go right over the heads of everyone under thirty five). If they have a snack nearby, tell them to eat it (taste bud stimulation). Have them turn on the TV (visual stimulation). Start singing something or reciting a familiar hymn or childhood poem – lyric and song are stored differently in the brain and can sometimes push people into a new pattern quickly.

I’ve seen some heartwarming and heartwrenching displays of love around these lockdowns. Spouses of decades visiting by coming up to the window of a room. Children singing in the garden to their great grandmother. Just don’t forget your friends and family members, just as frightened as you, just as unable to move freely as you, but with a much bigger concern regarding mortality than you likely have.

As for the suggestions of the lieutenant governor of Texas that were published yesterday, I have a modest proposal for him…

I went for a five mile walk today. It was lovely weather for such. Cloudy, a hint of mist in the air, cool without being cold. The relatively mild and wet winter we’ve had means that the pastel season is in full swing – fresh spring green leaves on the trees, azaleas, forsythia, and red buds in bloom. The daffodils, grape hyacinths, violets, spiderwort are all coming up in profusion. There was also a lot more bird song than I’m used to. I don’t know if that’s due to more birds in the trees, a reduction in ambient noise as we all stay in, or if I, in the current situation, am just more conscious of the simple things. I’ve always been a big walker – from childhood on, and it’s one of the things I can still enjoy in my semi-isolationist state. Just have to be careful to to touch things like park benches.

It’s been an uneventful weekend and today is day eleven of work then home – lather, rinse, repeat and cut all other activities out in an attempt to stay healthy until such time as I am really needed by the medical system. I’m apprehensive, but not particularly worried about myself. I’m far more worried about patients, friends, family. Assuming I don’t get sick and die (small, but real chance), I’ll come through all of this all right but the early retirement with lots of travel is unlikely to happen the way I was planning. Those who enjoy my travel diaries may have to wait for a while. I did get in one piece of theatrical fun: The Politically Incorrect Cabaret has made a PSA about staying home and I provided the tag at the end (they could shoot it from my front lawn without my having to get close to anyone.) It’s due out this evening and I’ll post it when I have it. It’s kind of fun slipping into the Ansager, even for a couple of minutes but I can’t do the makeup anywhere near as well as Tommy could and it’s really hard to do when you’re getting blind as a bat without glasses.

I talked to my father this afternoon. He was very interested in the concept of ‘flattening the curve’ and just what did I think of that. He has, quite rightly, noticed that the area under the two curves in the standard diagram that is being shared around is roughly the same (meaning the same number of people become ill in both trajectories) and that the flatter curve means that the disease is present over a longer period of time. This led to a discussion of lies, damned lies and statistics. I had two take home points for him: First, the flatter curve may last longer but is less likely to overwhelm the medical system meaning that those who can be saved will have the resources to save them. Plus, all the usual medical issues we cope with are going to happen whether Covid 19 is here or not and, if the system is swamped, there’s no way to care for them leading to excess all cause mortality. Therefore, the flatter the curve, the better, at least as far as my brothers and sisters in health care are concerned. The second is that those curves suppose normal distribution and, with a new disease process, it’s impossible to say if that will hold up or not. There are a whole lot of variables, mainly unknown.

The people I am most worried about at the moment are the health care providers. The health system, with its just in time ordering mantra and financial disincentives against stockpiling is incredibly low on protective equipment and, as most of these products come from outside the US, N-95 masks, gloves, clean protective gowns and the like are in short supply. Within days, they are going to be sent in to care for the ill without the necessary protective gear and they will catch it and fall ill and some will die, completely unnecessarily and on the altar of short term profit for the owners of the system. It’s the moral equivalent of the World War I commanders ordering the young men of Europe out of the trenches and into charges against machine gun emplacements. It makes me incredibly angry and incredibly sad to know I will soon be hearing about the deaths of cherished colleagues, done in by the complete political and economic failure of the system that should have been there to protect them.

It’s back to work in the morning. No clue what the day will bring. Two weeks ago, there were no cases in Alabama, I had just finished successful performances of the Mozart Requiem and was looking forward to opera staging rehearsals. A lot has changed. A lot more is going to change. Where do we end up? I just don’t know. Looking at the history of various disasters, usually societies end up transforming themselves for the better after something cataclysmic. Perhaps this is nature’s way of reminding us not to get too fossilized in our thinking or institutions.
I’ll continue writing every other day or so. If you have something you want me to address in these plague diaries, drop me a note and let me know.

In a different life, I’d be on stage, roughly half way through the opening night of Massenet’s Cendrillion at Samford University’s Wright Center. But a burgeoning viral pandemic had other ideas and that process came to a crashing and premature halt about ten days ago. I’ve now spent more than a week either at work or sequestered away from the world in hopes that I don’t get infected with Covid 19 at a time when I might either become a disease vector for the frail elders for whom I care, or may have to serve as part of a reserve unit for the hospital doctors that are more than likely to fall ill from their front line duties. Those of us who normally do ambulatory care are transferring the majority of our work to telephonic, trying to minimize our contact with others, and stay healthy for the time we will be needed.

When I began these long posts at the time of a tragedy of a more personal nature, I had no idea I was going to end up as some sort of 21st century plague diarist. While I think I write rather well, I have nothing on Boccaccio or on Camus (although his plague was fictitious in nature). I tend to use more words than are needed and my syntax is sometimes arcane, at best. But these essays are essentially brain dumps written in a single pass without rewriting other than to fix glaring spelling mistakes and not massaged and edited into something that they are not. Like the rest of the world, I’ve had a lot of my assumptions about life come crashing down around me in the last few weeks. I feel relatively optimistic about the ultimate outcome (history shows we tend to do rather well after a major crisis passes), I am quite concerned about the more short term issues of how we hold our institutions together under incredible strain, especially in this country when half the country seems to be living in one reality and the other half in another.

Alabama entered the triple digits of diagnosed cases today (that’s up from single digits last weekend) and they’re starting to turn up at the hospitals A lot of planning by a whole lot of very bright people has happened over the last two weeks so we should weather the initial surge well. The biggest immediate issue is shortages of PPE (personal protective equipment) for the front line doctors, nurses, techs, respiratory therapists etc. who are going to be exposed over and over again. Our societal decision to treat health care as an industry like any other (one which manufactures patient/provider ‘encounters’) had led to a business model where you keep no excess inventory and order ‘just in time’ so you don’t have to pay to store, discard outdated supplies, or staff unneeded hospital beds. The side effect of this, of course, is that when there’s an instantaneous nationwide demand, it’s not possible to ramp up quickly. The beds don’t exist. The supply chain buckles. There’s a shortage of trained staff. Some of my craftier friends who sew have already started on making cloth masks to donate when the stocks are depleted. It’s better than nothing.

The local authorities have gotten more serious as the week has gone on. We’re not on full lockdown but most shops are closed. All food establishments are carry out only. Gatherings of more than ten people are strongly discouraged. I have a couple of friends working as grocery clerks who are just about to call it quits on the human race as they try to deal with panic buying. Fortunately, my local Piggly Wiggly has been sane and relatively well stocked. For those of my friends who have suddenly found themselves unemployed, most groceries are hiring. Not the most glamorous of jobs but essential and likely to provide steady employment for the duration. I personally shouldn’t need to go to the store for about a week. I’m pretty well stocked and, as one person, I don’t eat that much. I did have a major score today when I found a liter jug of hand sanitizer in Tommy’s wig studio, so now I’m stocked up on that.

I’ve been looking at the differences between Western and Asian societies and their approach to containment. China has nearly stamped it’s original epidemic out. South Korea’s is beginning to come under control. It never really took off in most of the other Asian countries despite early transmission through travel routes. Meanwhile, we and Western Europe continue to rocket along. I think at least part of this comes from a fundamental difference in our conceptions of who we are. Western thought, starting in the post Renaissance period with Cartesian dualism and then expanded by the Enlightenment thinkers, places all emphasis on the self. I am who I am, you are who you are. We are individualists at heart. We will come together for the common good, but we do it as individuals. Many Asian cultures, which developed without those changes in philosophy still use the community, the tribe, the family as the unit of existence rather than the individual. If one conceives of oneself as being a part of a larger collective, collective action for the good of the larger group is easier. I think they understood the need for individual behavior change in a deeper and more logical way than we can with our ‘no one can tell me what to do’ ethos. I hate making these kinds of generalizations because I’m always afraid I’ll end up stereotyping people and if I’ve offended anyone, it’s unintentional, it’s just me trying to process big ideas in inadequate words.

I figure our next big hot spot will be Florida, thanks to young people refusing to give up the beach and crowded theme parks that were relatively late to close. It takes about two weeks from the introduction of the virus in an area for the rate of cases to become majorly noticeable so I’m thinking next weekend should see a surge in the sunshine state. I saw an interesting article earlier today on the manufacturers of a smart Bluetooth thermometer that can upload your temperature to your home computer or to a hospital information system. Apparently, all those temperature readings, stripped of any identifying data, go to a central data bank and the company can look for trends. They usually see a hot spot of increased temps a couple of days before a flu or other viral outbreak and are better at predicting where flu is circulating than the CDC – another use of big data systems. According to this report, Florida is starting to light up like crazy, far more than most of the rest of the country.

I wonder what Steve or Tommy would have made of all this. Steve would likely have alternated between mild hysteria and laughing over YouTube videos of middle america emulating WWF smackdown in the toilet paper aisle. Tommy would have been miffed at the shutting down of the music and theater world, and then gotten out some new music to learn, gone to work in the garden, and gotten out the sewing machine and a mask pattern and gotten to work, all the while with a big ‘I told you so’ on his lips. Tommy had a keen eye for the fissures and fallacies of American society and was very much a realist about the rot at the top. If Tommy were still alive, we’d be arguing about the politics of it all, but after that was done, we’d still love each other and head off to bed to watch Star Trek with a bowl of ice cream. That’s the hardest thing at the moment for me. Just having to be on soft lockdown by myself. I’d go stir crazy if it wasn’t for the age of social media which allow me to feel somewhat connected to my communities.

I’ll try to keep this up roughly every other day and post interesting or informative news pieces in between. If anyone has a topic they’d like me to ruminate on, feel free to let me know. Going to have that bowl of ice cream now.

It certainly seems that we’ve all been slapped upside the head these last few weeks with two basic truths. First, humans aren’t special. We’re just one of many species struggling to exist on this blue ball teeming with life and mother nature is in charge. We may like to think we’re exempt from the natural processes that govern the way the world works but we’re not. Second, Americans aren’t special among humans. As the stress of the pandemic and societal shut down grinds inexorably on, we’re starting to recognize that forty years of hollowing out public good for private profit might not have been the best of ideas and that our tools for responding to this situation aren’t anywhere near as robust as they are elsewhere in the world. The last week or so may have seemed surreal to many of us, but it’s only the beginning. This is not something that’s just going to go away in a week or two. We’ll survive. We always do. Humans are a hardy species and pretty darn ingenious when we put our minds to it and this isn’t the first nor will it be the last tough spot we’ve been in. I read somewhere that sometime during the Cro-Magnon era, the human race was down to eight breeding females (determined from sequencing mitochondrial DNA) and we made it out of that tight spot.

In some ways, the economic catastrophe looming over us all is worse than the health catastrophe. And that’s probably what got the federal government to finally wake up. They weren’t terribly concerned about the safety of ordinary citizens (a failure of the first magnitude as that’s the most basic job of government) but they’re awfully concerned about the preservation of wealth, especially in the hands of those who run our institutions. I foresee a lot of changes coming because of this particular dynamic but whether those will be in the direction of an authoritarian cracking down by the power holders or a more equitable future for ordinary citizens is difficult to discern at this point. Maybe both. Maybe neither. Maybe some unknowable third way. I read a meme somewhere that we’re back in the roaring 20s, starting off with a pandemic, the bars are closed, and Wall Street is crashing.

If nothing else, I think we’re starting to recognize who’s really important in our society. As a doctor, I signed up for a job that I knew might include a time like this and where I might have to take on personal risk to benefit patients. It doesn’t bother me. It’s part of the calling. If you don’t have that ethos, you don’t belong in medicine. But people like grocery store clerks didn’t sign up for what they’re doing at the moment in terms of keeping shelves stocked for a populace that seems to have lost its collective mind over toilet paper. And they’re not the best compensated of individuals. Think of those that are really helping us get through theses days: Everyone involved in the supply chain – clerks, truckers, railroaders, port workers, warehouse workers. The people we turn to if we’re cooped up at home are the artists: the writers who provide us with books. The actors, directors, and myriad technicians that create movies and television. The musicians that lighten are hearts with song. We’ve been underfunding the arts and culture for decades in our society and it’s time we stop that because collectively, they are our soul but we only seem to understand that in times of trouble. And don’t get me started on the teachers – underpaid for years. With most of the country being thrust into home schooling, when the schools do reopen, I can see mobs of angry PTA parents marching on the local school district demanding better salaries and working conditions now that they’ve figured out what teachers actually do.

At my job, the people I’m saluting are the behind the scenes folk. The cooks and serving line people that make sure there’s a hot lunch in the cafeteria so I can keep going. The custodial staff who are doing double duty disinfecting. The IT people who make sure the computer systems work the way they need to. My receptionists who are fielding calls from frightened and confused people with a smile. My nursing staff who give a damn on a very personal level about the well being of our patients. It’s easy to elevate a doctor up on a pedestal but there’s a whole team of unsung heroes around him or her that allow the job to be done.

With three days of work, we’ve managed to get ambulatory care in geriatrics shifted away from bringing people into a clinic in a hospital environment to a telephonic based system where we can still provide care. We’re open for business. We will see people in person to keep them away from the emergency department but most routine care will be done through either phone or video chat for the next few months to try and keep our patients safe and out of harms way. I can’t say I like it because I’m a toucher and a hugger with patients (sometimes it does more good than any pill I can come up with) but desperate times call for desperate measures. Anything we can do to keep my peeps from falling seriously ill is OK in my book.

I’m pretty fried when I get home in the evening. It would be nice to have someone to unwind with other than the cats but I’m still being pretty rigorous with my social distancing and will likely be so for a while as I don’t want to be a vector carrying disease to vulnerable populations. I had my first outing other than work in nearly a week this evening when I stopped by the Piggly Wiggly on my way home to pick up a couple of things for the fridge. Sanitize hands before going in. Don’t touch face. Try not to touch anything other than products I’m buying and the basket. Most things were well stocked other than bread and I wanted a loaf. The bread aisle was completely cleaned out but I wandered over to the deli and found a few loaves of specialized brioche bread in an out of the way corner that had been overlooked. Score! And I happen to like brioche. Sanitize hands again in the car. Get home and scrub. My current wash hands song is The Ladies Who Lunch – last verse. May Elaine Stritch forgive me.

Spoke to the mortgage people today. Everything is in place to close on the new condo in a month as was planned. I told them I was fine if force maejure caused a delay. Even if I close on time, I foresee certain issues in the practicalities of moving so I may have possession but it may be a while before I can move and occupy it. We shall see. I can use more time to sort and downsize but that’s not a task I really want to do alone and at the moment, I’m a little leery of having a lot of people traipse in and out and undo the work I’ve put into keeping myself semi isolated.

Everybody continue to be well. I’m going to try and write like this every couple of days for a while, touching on the age of Corvid 19. I thought about going back to the chapters I’m working on for my book about the aging Baby Boom but I’m thinking that may need to wait until new realities take shape. I will try to get some new movie columns written though. MNM’s voice gets stronger in my head when the chips are down.

OK stream of consciousness time. This is my first world wide viral pandemic so I really am not sure how I’m supposed to feel or to react. If anyone knows, please send me a message and in the meantime, we’ll continue to all muddle through together and make it up as we go along. Our society, which has escaped most bad things for about 75 years, is learning what bad is very very quickly and it’s coming thicker and faster than I think most of us can actually absorb which might explain some of the stranger posts I’ve been seeing on social media over the last couple of days. I have great faith in America and Americans. When tested, we usually rise to the occasion. I have a lot of hope for the Millennials in particular – if you believe in the four generation cycle of American history, they occupy the same place as the World War II generation and we’ve had the Depression and Pearl Harbor rolled into one over the last two weeks.

I feel, at age 57, like I’ve been drafted and am preparing to ship off to war. The enemy is coming, implacably and inexorably. It is microscopically tiny, impervious to usual weaponry, and no amount of drilling or stripping of field rifles is going to help. The weapons are going to be maintained supply chains, good hygiene, availability of medical care, and necessary equipment. The home front can contribute by staying home. This will all rip a giant hole in our economic lives but we’re all in this together and on the other side, we may need to rethink our social priorities a bit. I don’t trust the gerontocracy of the federal government to handle post pandemic life terribly well. They’re not the kind of flexible thinkers who adapt to new norms. I think, as communities, we’re going to be a bit more on our own than we’re used to and have to be prepared for that.

Today, work was mainly about planning. How do we switch most of our clinic work from face to face visits to telephonic visits? Who can be pulled from outpatient to inpatient duty to cover all the usual medical issues if the inpatient docs are all either busy with Covid 19, under quarantine, or ill themselves? I last did inpatient ward duty in a previous millennium, so i hope I’m pretty low on the list. We’re all stepping up to do our part without complaining. It’s what we signed up for when we decided to go to medical school. It’s just a particular bill that’s coming due. Same thing tomorrow with the VA part of my job. And then, on Wednesday, we’ll figure out the hospice piece. One of the most interesting problems to surmount is how to deal with the myriad rules from the medico-legal-financial complex such as Medicare or HIPPA. They aren’t suspended until they’re suspended and working within those constraints makes things a bit more difficult than they might be otherwise.

My much older patients, those over 90 who survived the Depression and World War II and have clear memories of them, are fairly philosophical about the whole thing. They’ve seen a lot and they know that death lies in wait for them, just outside their field of vision. It’s my younger patients, the cusp of the boom who still believe in eternal youth and immortality that are struggling the most with the reality that this is not something they can wish away and that affluence or influence are not protective. For the most part, they’re taking my basic advice of good hygiene and staying home but, no matter how vigilant, I’m pretty sure I’m going to lose some of the familiar faces I’ve been taking care of for decades. I have a number of people I’ve had since I first arrived in Alabama – in their 70s then and in their 90s now and together we’ve seen social changes, health catastrophes, major improvments in function, widowhoods, and all the other little triumphs and tragedies that make up life. I learned how to say good bye in the 80s with HIV. I’ll make it through this.

We’re roughly ten to eleven days behind Italy in terms of the population disease curves which means we’re about three or four days away from the time when they locked the country down. From my latest news reports, they basically have started to do that to the SF Bay area and the Seattle area and I expect most urban areas will be that way by this coming weekend. How long? I don’t know. I have enough food in the house for me and the cats for about a month if it comes to that. I’m writing to my mortgage people this week to tell them that if closing needs to be delayed on the new condo, fine with me. I’ve never tried to complete a real estate transaction during a pandemic. I can’t imagine they have either. All of this has made me in no hurry to get to work sorting and packing. I came home from work after a not overly busy day and immediately fell asleep on the couch trying to play Words with Friends.

Everybody be well – use your downtime to clear your heads and practice a little zen or tao of letting the times carry you along instead of fighting against them. And keep a vigilant eye on your politicians. Some of them are itching to use this as their Reichstag fire moment to rush new policies through while we’re all distracted and prevented from protesting en masse. Watch out for your neighbors, your friends, your communities. We’re going to need them in coming months. I’ll try to keep these musings up every couple of days. If you’re a latecomer to my circle and being at home makes you bored enough to want to explore all these posts of mine, they’re archived at http://lifetheuniverseandeverything.blog

It’s late at night and I, like most of the rest of the world, am sitting up late wondering just what’s to become of us all over the next few weeks. I’m not worried about physical health per se. The virus, if and when I catch it, isn’t likely to do much more than put me in bed for a week (I have a couple of risk factors for complication,but in general my health is pretty good so the odds are definitely in my favor). I’m worried about other things. I’m worried about becoming a vector for all of my frail elder patients and transmitting virus to them in a subclinical phase. I’m worried about getting sick and being put on quarantine at the time when doctors are going to be most needed. (My ICU skills are rusty and several decades out of date but I remember the basics). Therefore, I’ve decided to do the most responsible thing I can think of and pretty much either go to work or stay home. No eating out. No going out other than for walks or into someone’s house where no one is sick (I have to do that anyway as the housecalls part of my job). It’s going to be quiet and a bit lonely in my off hours but it’s the one thing I can do when not at work that can help my older friends and my friends with chronic health issues. It will likely also help me in the coming weeks if we succeed in flattening the curve by making it less likely that I will be exposed in my profession and less likely that I will be called upon to do things way out of my usual scope of practice.

As I’ve got more time on my hands than I had anticipated and as I am as full of angst about all of this as the next person, I’ll probably write a lot more of these meditative posts in the coming weeks than I had been. People tell me they help them process and understand various complex issues but they’re really about me trying to make sense of things myself and I’m happy for anyone who wants to to come along for the ride. This whole Corona Virus Crisis has been fascinating for the intellectual part of my brain and it makes me head down weird rabbit holes via Google and Twitter as I try to learn more about what’s really happening in Italy or in Seattle. The emotional part of my brain, however, is having the heebeejeebies as my overactive imagination, Taurus stubbornness, and library full of books keeps creating various apocalyptic scenarios. It probably doesn’t help that I’ve been binge watching The Walking Dead. No, Corona Virus isn’t going to create any mutated zombies nor is it going to off most of the population but I’m over identifying with our heroes as they try to make sense of a world turned upside down. Think about it. Would you have believed this past holiday season we’d be where we are prior to Easter?

The family in Seattle are all fine, I’m checking in fairly frequently. Like here, much of the usual life of the city is shut down. My sister’s tattoo business is booming as college kids on unexpected break come in for more ink. My brother is learning the quirks of on line instruction for high schoolers. My father, whose building is on lockdown, is getting a bit bored. We haven’t made the final decision to postpone my mother’s memorial, currently scheduled for April 26th, but my guess is that will have to happen. My sources in the medical world of Seattle say things are holding up so far. The biggest issue is lack of personal protective equipment like gowns and gloves for health care workers. Some hospitals are down to less than a week’s supply and with all of the problems in the world, the usual supply chains are disrupted. I’m continuing to keep my ear to the ground so I can pass things along to both UAB and the VA which might be helpful as we continue to prepare around here.

I have this high minded ideal that I’m going to spend my extra alone time doing constructive things like working on my Rosetta Stone German, reading improving literature, and cleaning out all the drawers and closets in preparation for moving. What did I actually do today? Spent way too much time on line reading up on the latest CV news. Answered emails, texts, DMs and the like from various friends – my general advice for everyone is pretty much the same. Wash your hands, stay out of crowds, don’t go out if you don’t have to, don’t get on an airplane unless absolutely necessary. Caught up on my progress notes from last week, answered a bunch of calls from the hospice I medical direct for, took a constitutional for exercise, watched three episodes of the Walking Dead, and downloaded the most recent version of Civilization for Xbox and started to learn its ins and outs. (This one is VI – II remains my favorite). The big adventure for tomorrow is the laundry.

Of course I remain in escrow for the condominium purchase and have to get moved at some point. It’s a little tough to plan all of that when you’re not sure if the country is going to go into lockdown for a few weeks. I was going to hire a professional pack/move company for the move but I’m thinking I’ll take that money and hire my actor friends whose income is disappearing as the gig economy shuts down and who will need the dollars for rent next month. It strikes me that will be worth a few broken dishes and some scratches in my not very expensive furniture. The one exception would be the piano. I’ll have the piano movers do that. My futurizing brain is creating all of these scenarios where I won’t be able to sell my house or where changes in the health care system lead to me losing my job and the whole thing becomes a financial bloodbath but, compared to the other issues we’re all facing, that’s minor.

The day I’m most reminded of at the moment is late October of 1999. Steve and I were on St Martin at a resort with several hundred other gay men when hurricane Jose came barreling down on us. The day the hurricane struck there was an incredible sense of anticipation in the air. Everything had been canceled (which didn’t stop a couple of hundred queens drinking every drop of liquor in the resort) and after noon the wind started to pick up getting stronger and stronger. The deep sea birds, albatrosses and the like appeared out of nowhere, hovering over the beach and looking out to sea in the direction of the storm. The land birds fell quiet. It was an eerie calm. Steve and I went back to our room as darkness fell, the electricity went out and the rains began to pour around 10 PM. As we were in a cheap room, not ocean view, we were spared most of the weather and did not have to spend the night hung over in a bathtub like a couple of guys of our acquaintance. This weekend has that same anticipatory feel – I just hope that everything’s lashed down tight when the storm hits.

The feeling of dread is no better after forty eight hours of rather unbelievable news from all quarters. I feel like I’m trapped in one of those movie scenes where someone is hurtling towards disaster and everything switches into slow motion while our hero tries to prevent the crash/murder/gory accident/breaking of the irreplaceable clue, usually to no avail so we can set up the third act of the story. It’s just that things have switched into such super slow motion that it takes hours and days to get to the next chapter rather than twenty seconds.

It has become pretty clear to me, and to most of us who work in medicine and public health, that governmental entities have failed in a rather spectacular fashion when it comes to dealing appropriately with the corona virus rapidly sweeping the land. The one thing that encourages me about all of us this is the stepping up of private and public entities to stop the mixing of too many people in too confined a space for the near future. Social distancing, which seems to be public health buzzword de jour, is the one thing that we as ordinary folk can do to protect our fellow citizens by making it harder for the virus to leap from person to person. The corona virus is new to humanity. None of us has immunity. Even though it’s not likely to cause serious consequences for most of us, it’s still going to be very problematic for a small subset and if that small subset all gets sick at once, our health system will look like that in Northern Italy within a month. 2.5% seems pretty small until you realize that 2.5% of 330 million people is roughly twice the population of the state of Alabama.

As a gay man who survived the 1980s,I am not in the least surprised that the federal government is playing politics while peoples lives are at stake. Been there, done that. And when the LGBTQ community figured out that they were considered a disposable population,they rallied and saved themselves by creating community organizations and services that still endure. Communities are going to have to do that again, looking out for each other and not expecting a federal white knight to come riding over the hill to the rescue. The federal track record over the last couple of decades has been pretty dismal – Katrina and Maria in Puerto Rico come to mind. The canceling and closing down of life is painful and difficult but it is the one thing we can all do in the fight. Most of us aren’t virologists. And this is an enemy you can’t fight with your stockpile of AK-47s. Viruses don’t care about your bank statements, your passport, the color of your skin, your religious beliefs or anything else. They only care about replicating and moving on to the next host. I’ve heard more than one state official here make reference to some sort of godly intervention that has so far kept our caseload down. In my cosmic view, god is the god of viruses as much as of humans. Maybe s/he is on their side this year.

The closing down of society includes me. The opera has cancelled both the annual gala which was to be this Friday evening (to be rescheduled at a later date) and the actual opera itself which was to be performed next week. The plan is to carry the production forward to 2021 and reassemble as many of the cast and staff as possible at that time. It may be a good thing that Birmingham is to be spared the sight of me in full drag as one of ‘les filles d’altesse’ trying on the shoe at the end of Act IV. Ah well, there’s always next year. This, of course, frees up the next couple of weeks considerably so I suppose I’d better start my downsizing sort a bit earlier than I had originally intended. Who am I kidding, I’ll binge watch a couple of things on Netflix, read a few of the books in my tsokundu pile, and take some nice walks now that the weather is warming up.

We’re open for business at work, of course, but everything is a bit skewed as we all prepare for the unknown. A month ago, Italy had a handful of cases and now its health system is on the verge of collapse. Will we follow that pattern? Our transition of our health care system over the last few decades to a health care industry has demanded that the system become lean and mean and operate at pretty much all beds full during normal times to maximize profits. This means there’s not a lot of excess capacity for an emergency. It doesn’t make money to have extra beds sitting around unused or to pay staff who aren’t on the edge of overwork. If the worst happens and the ventilators are all occupied, I’m likely to have to spend a lot of time having a lot of very difficult conversations with patients and families. Can I do it? Yes. Do I want to? No. But it will be necessary work and I just hope I have enough of a reservoir of kindness and compassion from which to draw to be up to the task should I be handed that particular cup.

I had pipe dreams this last year of retiring at 62. I haven’t had the heart to check my retirement account balances after hearing about the carnage on Wall Street over the last week or so but I have a feeling early retirement is now off the table. At least I had a meeting with my financial people in January and reallocated everything into a new portfolio to begin minimizing my risk now that retirement is starting to look me square in the eye. It’s all monopoly money and numbers on a spread sheet at the moment anyway and we’re all in the same boat.

I have found, quite possibly, the worst film I have ever seen on Netflix so I’m going to finish it up and then MNM is going to have a field day with her column tomorrow evening. There’s a new column due out in a day or two and this one will follow that. You’ll have to stay tuned to find out what it is and what she thinks about it.

Be well, eat right, get some sleep, steer clear of large crowds and, above all, wash your hands. Holmes and Semmelweis were right.

Time for a long post to make sense of all my existential angst. I’m sure all of my brothers and sisters in health care professions are feeling it too, watching a viral pandemic unroll in front of us in real time. We know far too much about the possible ramifications of where the corona virus may lead and it’s tough to walk the knife edge between the hopeful news that the majority of us will weather an infection without too many ill effects and the despair that a sizable minority may suffer and die but also might bring our wobbly health infrastructure down with them. I live in a state without reported cases… yet. Does this mean it has not yet reached us? It is here and circulating but among untested populations? What is the correct amount of societal change and social distancing to put in place at this time locally? Is it better to over react and cause major disruptions and financial hardships or is it better to wait until there is proof positive that such measures might have an actual mitigating effect? People come to me because I am a doctor with some training and all I can really say we can’t treat it, we can just support someone while they heal themselves. Wash your hands, avoid sick people, use common sense. There are some estimates that pretty much the whole human race will be infected within the next few years. Most of us will make it. Some will not. The mitigation factors won’t prevent the spread, it will just slow down the rate of spread so that society has the resources to care for the sick while they recover.

I have a number of risks personally. I’m over fifty (I find that hard to believe sometimes but it’s true). My health is pretty good, but not perfect and I have some chronic disease burden which tends to accumulate in all of us with time. I’m a doctor. The price I pay for societal respect and a decent salary is the expectation that I will put my body on the line in this sort of situation. I’m used to being coughed and sneezed on, to catch whatever the viral crud de jour is, which rarely lays me low enough to miss work. If I get something this winter (and I’ve been pretty lucky so far), do I get tested? Stay home for days throwing clinical schedules into havoc? When I get viral bronchitis, as I do every few years, it tends to linger with me for weeks and weeks. Does this put me more at risk? If the virus becomes endemic and my hospital becomes flooded with patients and it’s all hands on deck, do I brush off my rusty critical care skills and volunteer for extra shifts to spell exhausted colleagues? Will my hospital be able to cope? My frail elder patients, many of whom I have taken care for decades and who trust me implicitly, are most at risk. How can I protect them? This disease has the possibility of profoundly altering my professional life for the rest of my career. What will that look like? Can I really prepare?

My family, of course, are all in Seattle, epicenter of the US infections. Seattle seems to be running about ten days to two weeks behind northern Italy in terms of case load. The Italian health system is buckling and it’s not some third world system, it’s as good and robust as our own. Will Seattle look like that in three weeks? My 87 year old father’s senior living facility is on lockdown. Everyone in their own apartment, no visitors, meals on trays. My brother found out today that an infected child had been running rampant through the high school at which he teaches for several weeks. So far, so good and everyone is fine but will it remain that way? I am scheduled to go to Seattle in six weeks in order to attend and speak at my mothers memorial. Will it have all blown over by then? Will the whole region be on lockdown? We’re all playing it by ear and will, of course, reschedule as necessary. A lot can happen in six weeks. Six weeks ago, corona virus was but a whisper of a problem someplace in central China.

This was probably not the time to enter a major real estate transaction, what with volatile markets and interest rates so I’m sitting here thinking ‘Oh lord, I’m not going to be able to sell my house and I’ll be saddled with two mortgages’. But that decision was made before current events started to take shape and I will roll with the punches. I never seem to have a lot of luck with real estate transactions. I guess I should be used to it by now. I’m going to start the process of cleaning out the week of the 23rd so anyone who wants to help, let me know and we can sit and sort through the detritus of Steve, Tommy and my lives while listening to Sondheim CDs. Sondheim is always my go to in times of trouble just as Jerry Herman is the best for house cleaning.

On the good news front, performances of Mozart’s Requiem with the Alabama Symphony Orchestra and Chorus went very well this last weekend. I’ve always loved the piece (ever since seeing Amadeus with my mother at the Guild 45th theater one evening) but this was the first time I’d had a chance to sing it. I used Tommy’s score from his last time singing it and it was comforting to have all his little handwritten notes and IPA symbols staring up at me while singing a mass for the dead. I think he would have appreciated that. Tommy never feared death. He was as matter of fact about it as he was everything else. His motto was you live, then you die. Rehearsals for Massenet’s Cendrillon are going well and it promises to be great fun. Once that’s over, nothing theatrical for some weeks while I clean out, pack, and move.

We haven’t had societal wide bad in the USA for about 75 years so I think the thing I’m most afraid of is what happens to us and our society if certain structures start unraveling. Will we turn to each other and help each other overcome and rediscover ourselves as one people of many creeds, colors, and beliefs, or will we let the stresses exacerbate our factionalism becoming more distanced from each other than ever, perhaps violently. No one under the age of 80 has really known a society without abundance, choice, freedom of movement and if those things start to disappear, all sorts of unforseen issues may start to arise. As the old curse goes, ‘May you live in interesting times’.

I’m sitting here nursing a sore shoulder on the right. Last week, suddenly, my subscapularis went to spasm for no particular reason and has continued to give me trouble ever since. I’m doing all my usual tricks but I assume it’s going to resolve itself when it feels like it on its time, rather than on mine. We live in such an over scheduled, over committed world that the least little thing throws a monkey wrench into plans with cascading effects. I haven’t had to modify much of anything yet, but one never knows, does one.

I am wondering if this is my body’s way of saying the stress level is a bit too high (registering now roughly 14 out of 10 on my patented stress-o-meter). It wasn’t too bad with the work stuff and the theatrical stuff, but then I had to throw moving into the mix and between the racing around collecting things up for the mortgage people, dealing with all of the little real estate things, looking around the house and recognizing that I have to either pack or purge everything in it over the next six or seven weeks, and it just becomes a bit overwhelming. I haven’t really started the P and P thing yet. I have to get into the new condo with a tape measure and make a floor plan and start figuring out what’s going to fit before I do anything else. I’ve also got performances of Mozart’s Requiem in two weeks and Massenet’s Cendrillon in four. I have bowed out of the play I was going to do in March/April as something absolutely had to give in order for me to maintain sanity.

The moving decision feels right and I know a few months from now, when I am settled and happily opening boxes and asking myself ‘Why do I own this crap?’, everything will be fine. It’s just the actual physical move that’s got me in a tizzy. I did it four years ago and survived so I’ll survive this one to. I have to keep reminding myself of one of my favorite Sondheim lyrics. (There’s a Sondheim quote for everything): “I chose and my world was shaken; so what? The choice may have been mistaken, the choosing was not. You have to move on.”

I’ve been very quiet this weekend. Every time I sat down, I nodded off so I took that as a sign that I needed some down time. I wasn’t completely a sloth. I did complete all I need to do for my income taxes and will have that in to the accountant on Wednesday. I also managed to watch a film and will shortly get back to MNM columns. I haven’t written one in over a month. Every time I try to do so, it just won’t flow. I think it’s because I set her up to get involved in a production of Cabaret. Her world usually parallels mine in some way. I just wasn’t expecting my experience with the show to be as profound as it was and I think my emotional reaction to this production is what’s blocking moving forward with her story. I figure I either have to reverse courses to something else quickly or I have to figure out how to channel that emotional energy in some different way.

We’re in the process of planning my mother’s memorial service in Seattle, the weekend of April 25th (which is, of course, in the middle of moving time for me – a few days away from that maelstrom is probably a good thing). Any of you in the PNW who might like to attend, send me a PM and I’ll make sure you get further details as they become available. Last I heard, Sunday afternoon was the most likely time but various things are still up in the air such as venue availability. I’ve been asked to write and deliver the family piece of the eulogy. I haven’t started it yet, but I’m thinking about how to strike the tone that pays tribute to her as an individual with a strong personality and a wicked and very British sense of humor. It was she who introduced me to such things as Monty Python.

All sorts of people have reached out to say they will help with sorting and packing and moving which is incredibly kind. I will have a local moving company do most of the packing and carting of things to the new digs. The sorting may require some help. I have donated all the contents of the wig studio to Red Mountain Theater Company. If they will come in the next few weeks and pack that all up and take it away, that will free up a place for me to start hauling things that I won’t take with me but still have useful life. I figure I let me theater friends paw through it and carry away what they want and then whatever’s left can go to Goodwill or Lovelady. Better call RMTC this week and make those arrangements.

I wonder what Tommy thinks of me selling his house? I told his family this last week. They didn’t think much one way or the other. Tommy is one of the reasons I want to move. It was bought for Tommy based on his wants and needs and everything about it has something to do with a past that’s cherished in memory, but no longer exists in a practical present. I think he would approve. Tommy was always looking forward to the next project, the next phase of life, the future. He had next to no sentimentality and rarely looked back. He always found that unimportant.

And just like that, life turns on a dime and all of a sudden you realize that you’ve just complicated your life and added another stressor. I’ll be moving in late April/early May. Relax, I’m not quitting my job or leaving town. My plan for some time has been to downsize into a condo I can stay in until I’m 80 with minimal supports. I was going to do this next year or the year after, but the right unit became available, interest rates are good and Forest Park is hot right now so I should be able to get a good price for my current house. Therefore, Arlington Crest, here I come. My offer has been accepted and we’re heading into that fabulous time of arranging mortgages and inspections and all those other escrow things. Fortunately, having just done this four years ago, I’m feeling relatively calm about the whole process. The only thing that’s scaring me is the actual physical business of moving and all that entails.

The condo, is about two thirds the size of the house so not everything can go so I have to start thinking about what goes and what gets rehomed. Once I know what I’m keeping, I’ll let my young local bohemian friends in need of decent furniture know and they can come get things. I’ve been cleaning things out some since Tommy died but I have a lot still to do and a symphony concert, an opera, and a play to ready while doing this all. I may be looking for volunteers to help me with what remains so if you’ve ever really wanted to help me go through closets and filing cabinets, now is your chance.

Am I sad to be leaving this house? Not really. To me, it’s always been Tommy’s house. He picked it out and we set it up to suit him and the kinds of things he liked to do. I’ve always felt like a bit of a squatter in it, especially since his death. My husbands have always been the ones who called the shots on domesticity so it’s been well over three decades since I lived in a space that was purely mine or about me and I’m kind of looking forward to that. The condo has a view, a private terrace, two bedrooms, a study, and a fairly up to date kitchen that I’m likely not to use. It has a handicapped accessible master bath, high ceilings, and new floors. I feel good about the decision. But it will need to be painted. I am not a Richard Tubbs taupe kind of guy.

The last move I made by myself was in the mid 1980s when I moved into the apartment I lived in during medical school with a rotating series of roommates. It was a large apartment. The small building in which it was located obviously had no idea what to do with the basement so they just made the whole thing into one unit. As it was dug into the side of a hill, it was kind of dark but that never bothered me. It was walking distance to the med school, had decent parking, and was big enough for me to spread out however I wanted. When I moved out of it in 1988, my friend Mark Sandberg and I moved me down to Sacramento in a U-Haul. Mark was an incredibly talented musician whom I had gotten to know during my med school days. My last hurrah in Seattle theater was a production of Sondheim’s You’re Gonna Love Tomorrow at the Cabaret de Paris at Rainier Square downtown. I directed, he music directed. Sondheim was kind enough to give us permission to rearrange some of the material and do a few extra numbers. He even set us a copy of his manuscript to Country House from the London production of Follies which had recently opened to use (so as far as I know, we had the American premiere of that song). Mark was a brittle juvenile Type I diabetic. He suffered a stroke in his 20s not long after I moved to California which robbed him of his ability to play the piano. I only saw him once more, that next spring when Steve made his first visit with me to Seattle. Shortly after that, another stroke took his life.

Steve was around for all the various Sacramento moves. (First apartment to second apartment, second apartment to condo, condo to house) and, of course for the big one from California to Alabama. Tommy was around for the quasi-move when we redid the old house and for the major one when we came down the hill. Now I don’t have anyone to plan with and fight with and procrastinate with and I’m not sure how I feel about that. I have the resources now to hire people to pack and unpack, and this is, if life goes according to plan, the last move I will make until my nieces pack me off to the home in my dotage but it still seems like a bit of an overwhelming undertaking without a companion at my side. I suppose I could go out and find one next week but needing someone to help move does not strike me as the way to begin a lasting relationship.

I have been tired and cranky and not doing much of anything for the last week. I think it’s post show syndrome. The amount of psychic energy expended doing Cabaret for three weeks drained the well and it’s just going to take a little bit of time to fill it up again. It’s put me behind on various projects although I did manage to pull together everything for the taxes this past weekend. I better get a nice fat refund to pay for moving expenses.