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(ALMOST) EVERYTHING YOU SHOULD KNOW ABOUT COVID-19

There is a lot of misinformation and bad advice circulating regarding the COVID-19 pandemic. I’ve tried to provide pertinent and useful information in this blog post. But before I begin, I want you to do two things:

DON’T PANIC
DON’T BE STUPID

Panicking in a crisis does no one any earthly good and often makes things worse. This is not the zombie apocalypse, Outbreak, The Stand, Contagion or The Walking Dead. It’s not even The Hot Zone, a book and miniseries based on the discovery of an non-human primate Ebola virus in Reston, VA in 1989.

We can get through this by helping each other, not by being a selfish asshole hoarding toilet paper, or going out to restaurants because Devin Nunes told you to. Follow current recommendations and guidelines to minimize the risk of getting it or giving it to someone who is at greater risk of dying.

Now, back to our previously scheduled PSA

What is Coronavirus?
Coronavirus is a family of RNA viruses – chunks of genetic material in a protein capsule – that infect human respiratory tracts. Coronavirus, like the more well-known rhinovirus, respiratory syncytial virus (RSV) and parainfluenza, often cause nothing more than a common cold.  It is so named because there are spikes on the surface that make it look like a solar corona. Click here to see an electron micrograph.

Where did it come from?
Coronaviruses are “zoonotic” – transferred from animals to humans. Bats provide a reservoir for coronaviruses and spread them to other animals. SARS was thought to come from civet cats in Guangdong, China, while MERS was transmitted by dromedary camels in the Arabian peninsula before spreading to other countries. (MERS resurfaced in Saudi Arabia in October 2019.) SARS-CoV-2 might have originated from an outdoor wet market in Wuhan, China. Neither the Chinese nor the United States developed it as a bioweapon.

How is it spread?
Coronavirus, like other respiratory viruses, spreads among people through droplets from coughing or sneezing which are then inhaled. It can also spread when hands contaminated with virus touch eyes or nose, or someone else’s hands.

The incubation period (time from contact to developing symptoms) is 5-7 days but can be as long as 14 days, the rationale for a 2-week quarantine. People who carry the virus can spread it even though they feel fine. Health officials estimated a lawyer with COVID-19 in New Rochelle, NY, had contact with 50 people before becoming ill.

No one is sure how long the virus survives on surfaces like countertops, handrails and boxes, although study results published in the New England Journal of Medicine on March 17, 2020 found coronavirus lasts longer on plastic and stainless steel than on copper and cardboard. When in doubt, wear gloves and wipe it off!

VIDEO: Amanpour & Co. Infectious Disease Expert Dr. W. Ian Lipkin Discusses How Coronavirus Spreads

If coronavirus is common, why should I worry?
Viruses, like bacteria, can mutate into more deadly forms. The virus causing the current disease, COVID-19, is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Yes SARS (Severe Acute Respiratory Syndrome 2003) and MERS (Middle Eastern Respiratory Syndrome (2012) were both “novel human coronaviruses,” meaning they hadn’t been seen in humans.  The difference between coronavirus causing a cold and SARS-CoV-2 is like the difference between the E. coli in your intestine and E. coli O157:H7. The former keeps your digestive tract healthy while the latter caused severe illnesses and deaths in people eating contaminated hamburger (1993), “organic” spinach (2006) and Romaine lettuce (2019).

Isn’t it just like getting influenza?
There have been an estimated 34 million influenza infections in the United States over the six-month 2019-2020 season with 375,000 hospitalizations and 22,000 deaths. But we have a vaccine and herd immunity for influenza, so the death rate is about 0.06%. There is no vaccine for COVID-19 and there won’t be one for 18 months or more. COVID-19 is more likely to kill people over 60, those with chronic illnesses (diabetes, asthma/COPD, heart or chronic kidney disease), and anyone with compromised immune systems (cancer, HIV, genetic disorders), regardless of age. The youngest death was a 21-year-old Spanish soccer player with undiagnosed leukemia and coronavirus.

As of March 17, 2020, there have been 197,320 cases of coronavirus and 7,950 deaths around the world. (Source: Worldometer Live Update-Coronavirus) That doesn’t sound like much until you do the math, which gives you a death rate of 4%. The New York Times reported C.D.C.’s worst case scenario:

“…Between 160 million and 214 million people in the United States could be infected over the course of the epidemic, according to a projection that encompasses the range of the four scenarios. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die….”

Take a deep breath and don’t panic. England got through WWII with “Keep Calm and Carry On,” not, “OMG, it’s the apocalypse and I’m going to run out of toilet paper!”

Related: USA Today What does the coronavirus do to your body?

How do I keep from getting COVID-19?

  1. Wash your hands, often! Wash them for 20 seconds, the time it takes to sing “Happy Birthday” twice or recite the Star Trek intro. Hot water isn’t more effective than cold or warm water, so don’t scald yourself.
  2. Use hand sanitizer if you’re out and don’t have soap. Antibacterial wipes are good for public surfaces (shopping carts, handrails).
  3. Don’t touch your face. That is going to be really hard for most people. Cajun hand sanitizer will make you remember not to touch your face!
  4. Although it’s better than using your hand, I don’t think coughing or sneezing into your elbow is a great idea. Get a small pack of tissues or stuff some in a zip-lock bag and keep them handy when out. Use them and toss them in the trash. And use hand sanitizer afterwards.
  5. Stay away from crowded places like subways, commuter trains and airplanes unless absolutely necessary. Many businesses are making their employees work from home.

If you need catchy music to grab your attention, then watch this Vietnamese PSA.

Should I wear a mask?
In general, no. Regular surgical masks stop droplets, which is helpful but won’t filter out viruses. If you are healthy and out in public, you don’t need one. N 95 respirators, masks that can block 95% of particles down to 0.3 microns, are used by people exposed to dust and other small particles. Health care N-95 respirators are a subset, specifically for health care workers. They need to be fitted to be effective and are a bitch to breathe through.

You should wear a mask if:

  • You are a health care worker.
  • You are coughing or sneezing.
  • You are sick and need to leave the house
  • You are sick and can’t isolate yourself from healthy housemates

Why should we practice “social distancing?”
Because health officials want to avoid an exponential increase in coronavirus cases by “flattening the curve.”  (If you don’t understand exponents, you weren’t paying attention in algebra class and I don’t have time to explain them! Just think “increasing really fast.”) We don’t want a lot of people getting sick in a short period of time and overwhelming the health care system. It is better to spread out those illnesses over many weeks or months.

Protecting the vulnerable – those who are elderly or have compromised immune systems – is the single best reason for keeping your distance from other people.

How is COVID-19 treated?
Like any other viral illness there is NO cure. One treats the symptoms whether cough, fever or full-blown respiratory failure requiring mechanical ventilation. Influenza is often treated with oseltamivir, which shortens recovery by 1 to 2 days. Remdesivir, created from a molecule developed ten years ago, may be the best drug to treat COVID-19, but it’s only in the testing stage and it isn’t a cure.

Eating garlic, drinking bleach or colloidal silver, breathing hot air from your hair dryer, taking Vitamin C or zinc, snorting cocaine or masturbating will not protect you from COVID-19.

Related: Buzzfeed News list of coronavirus hoaxes

What should I do if I feel sick?
If you just feel crappy with mild to moderate viral symptoms – cough, fever, aching – call your healthcare provider. DO NOT go to the Emergency Room without being told to!  They don’t want to see your sorry ass for something that is not life-threatening and will just have to run its course.

However, if you are having chest pain or enough difficulty breathing that your lips are turning blue, or you feel as if you are drowning, GO TO THE EMERGENCY ROOM IMMEDIATELY!

Should I be tested?
Not unless a qualified healthcare worker thinks you need to be tested. There aren’t enough tests right now.

Where should I go for information?

  1. The Centers for Disease Control
  2. Your state’s Departments of Public Health
  3. Harvard Medical School’s Coronavirus Resource Center

DON’T PANIC. DON’T BE STUPID. BE CAREFUL.

Coronavirus illustration © Can Stock Photo / feelartphoto

Christmas Cheer

This is the first Christmas since my teens that I haven’t been completely annoyed by the whole thing. Oh, I still rail at the commercial where the Yuppie scum couple celebrate with $100,000 worth of new trucks, or how we’re supposed to think love means buying your spouse a high-end luxury car. But I don’t feel the usual sense of dread mixed with despair.

And I’m not sure why.

Maybe it’s because

  • The weather has been sunny with temperatures in the 50’s, like December in Arizona, instead of cold and gloomy with slushy streets and bad drivers.
  • Peg hasn’t had to do the Death March to Christmas in three years, and we’re going to a 6 p.m. Christmas Eve Mass instead of the 11 p.m. “Midnight” Mass.
  • I’m no longer working for a heartless corporation that doesn’t give a shit about its people, and I’ve been doing something I find far more fulfilling.
  • I’ve been off all month since surgery and I actually have time to enjoy things like wrapping gifts and making cookies, rather than the last-minute blitz to get it all done.
  • I’m too old to be raging at the materialistic “gimme gimme gimme” of the season.

Whatever the reason, something changed. I’ve been pondering my inevitable mortality and prioritizing. As a kid I felt bad for not having much, then I felt guilty as an adult for having more than others. I’m still painfully aware of the divide between the haves and have nots, but I can’t fix it. I can only do my small part to make the world a better place for others, however fleeting that may be.

It’s often said, “The days are long, but the years are short.”  At my age the days are short and, the years are even shorter. Giving and getting stuff isn’t important; friends and family are. Cherish those around you who you love, as you never know which one of them may not be around next Christmas.

© Can Stock Photo / zatletic

(Almost) Free at Last!

I’m now semi-retired.

Even though I feel like I’m in my thirties mentally, I feel like a dinosaur next to physicians that are my kids’ ages. (Aaron would probably say, “Yeah, a T. rex!”). After 36 years, delivering babies is like riding a bicycle, but I started riding that bike when obstetrics was a Schwinn 5-speed I bought in high school. Now that bike is made from exotic materials costing thousands of dollars and requires an engineering degree to operate, even though the destination hasn’t changed.

I was ambivalent about leaving hospital practice when I started writing this, but I’ve gotten used to the idea of maybe never delivering another baby. Letting go has been easier for me than it would be for those whose identities are inextricably tied to their professions. I’ve become increasingly skeptical about the direction health care has taken; I’m more than happy to pass the baton to the next generation and wish them luck. They’re going to need it.

However, I am not just sitting around watching Matlock or yelling at kids to get off my lawn. I’ve been doing health assessments for seniors for the past two weeks and it’s been a fine experience. If nothing else, I’ve gained an appreciation for seniors and insight into what is to come.

Fifty years ago, we didn’t see people in their eighties or nineties. The seniors I knew as a kid were grey, wrinkled and tired.  Most people, especially those who did manual labor their entire careers, retired at sixty-five and had a few good years before dropping dead from a massive heart attack or a stroke. I was shocked to discover LBJ was only 55 when he became President and died at 64, my current age.

But by 2020, the percentage of people over 65 will have doubled since 1950, from 8% to almost 17%.  Ten years ago, people 80 and over were the fastest growing population segment. More people are working well into their 70’s and 80s, often out of necessity but sometimes by choice.

So, I’ve been driving around the Heartland making house calls. I have a rolling case with the equipment I need: a scale; an automatic blood pressure cuff; an ophthalmoscope; a pulse oximeter; a reflex hammer and a penlight; gloves; a 10g monofilament diabetic neuropathy tester; and company paperwork.

The people I’ve seen so far have all been warm and welcoming. They seem genuinely happy to talk with me and are far more relaxed than they would be in the intimidating confines of a physician’s office or a hospital room. The evaluation takes about an hour, longer than the fifteen to twenty minutes allotted to primary care visits. Several have remarked “This is the most thorough exam I’ve ever had!” I can only see six to seven people in a day and no practice would be able to survive at that rate, so it’s a nice service to provide.

While I’ve seen a few people my age, most of them are mid-seventies to early 90s.  Despite chronic illnesses and the infirmities of age, they don’t complain. Yeah, the back hurts and getting around is tough, but any day one wakes up above ground is a good day.

One of my clients on the first day lived in an assisted living facility. I passed a group of women around a table in the hall on my way to his apartment. One of them noticed my white coat and asked in a loud whisper, “Is that a doctor?”  The gentleman was a 93 year old veteran who still drove his own car and liked to play games on his computer. He’d been retired for 27 years, lived by himself, and still had more energy than I do some days.

An 89-year-old man learned keyboards when he retired at 62 and now plays for community events. I asked him what kind of music: “Swing, country, jazz, blues…”  He pointed to his keyboard and microphone, sitting next to his treadmill. He gave me hope that I might be more than a mediocre piano player before I die.

A couple of the men were still running their own businesses. A man in his mid-70s needed a new computer monitor and snagged a 43” UHD TV for four hundred bucks just before I met with him. Another man, 80, had rental properties to check on later the afternoon I visited him. I called a few days later to make sure he’d gotten his blood pressure rechecked and he recognized my voice.

“My blood pressure was much better. Thanks for calling me!”

I saw a couple for my last visit of the day near the end of the second week:  A 99-year-old man and his 92-year-old wife, who both looked like they were in their seventies. They were still relatively active; they’d been waiting for better weather so they could start working in their garden.

The husband went first. I confirmed his identity, entered his medications into the record, and then started with a long list of standard health history questions, which includes asking about past alcohol use.

He became a little defensive and said, “I never drank that much. When you’re Italian, there’s always wine on the table.” 

Sensing his unease, I replied, “My late father-in-law, Mike, was from the South Side of Chicago. After the war, he and his buddies used to crash Italian wedding receptions because the food was great, and the women loved to dance.”

He brightened up and replied, “We used to get trash can lids and bang them together in the middle of the night. People would throw money at us to get us to go away. They never threw quarters, though, only nickels and pennies.”

The conversation became a little more somber when I talked about Mike’s war experience.

“Mike was a tail gunner in a B-17.”

“Was he in Italy? If he was in a B-17, he must have been in Italy. I was the crew chief on a P-38, that fighter with the machine guns in the nose. We flew in the Ploesti raid in 1944.” The memory angered him. “Someone ratted us out; the Germans were waiting there for us.”

I was surprised to talk with someone who knew of that campaign, but I shouldn’t have been since he and Mike were born the same year.

“Mike was on that raid, too! Their plane had been hit pretty badly and they were going down. He’d been injured and his harness was shot up, so the bombardier, David Kingsley, put his own chute on Mike, dragged him to the bomb bay doors and told him ‘Put your hand on the ripcord and pull it once you’ve cleared the doors.’ He went down with the plane and Mike spent three months in a Bulgarian P.O.W. camp.”

Before I left, he showed me a large frame on the dining room wall with pictures of him and his buddies standing in front of their plane. “You know, it’s sad. We can’t get any of the younger guys to join the VFW or the American Legion. I guess it’s not that important to them.”

I started my career bringing lives into the world. Ending it by working with people on the other end is rather fitting, I think, and just as rewarding.

© Can Stock Photo / 3D_generator

Fat Chance

January – the month when millions of people engage in that time-honored bald-faced lie known as the New Year’s Resolution. “This year I promise I will exercise more, get in shape and lose weight.” (I resolved to get this posted in January, and you can see how well THAT worked out!) It’s about as successful as when my sister-in-law vows to give up throwing F bombs for Lent. One year she made it to 4:30pm on Ash Wednesday; usually she doesn’t make it out the door. Most people have given up on their resolutions sometime between January 12 in Australia and January 17, known as Ditch New Year’s Resolution Day.

Losing weight is one of the most common New Year’s resolutions but often remains an exercise in futility. The New England Journal of Medicine acknowledged the problem in the January 1, 1998 issue, noting ”the vast amounts of money spent on diet clubs, special foods, and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted.” Twenty-some years later the weight loss industry rakes in over $60 billion a year but only about 5% of dieters manage to keep from regaining weight.  Most of the Biggest Loser contestants regain most of their weight over time.

So how did we become so obsessed with weight?

In 1901 Dr. Oscar Rogers, Chief Medical Director of the New York Life Insurance Company, reported that overweight men had a 35% higher death rate. Insurance companies latched onto this finding and assumed the obese presented a higher actuarial risk. Rogers also discovered overly tall and underweight men suffered a higher mortality rate, but conveniently left out those data.

In 1930, Louis Dublin, Metropolitan Life Insurance Company’s vice-president and statistician, linked obesity to long-term illnesses – heart and kidney disease, diabetes, atherosclerosis and stroke – and obesity became permanently stigmatized. The obese stood accused of a variety of psychological disturbances, including depression, gluttony, homosexuality, laziness and anxiety.

Met Life published “ideal” weight and height charts for men and women in 1959 and 1983, but they were based on very sloppy data obtained from white collar people who could afford life insurance policies. Some of the data were self-reported; men over-reported their heights and women under-reported their weights. Dublin’s body frame sizes – “small, medium and large” – were arbitrary. No one considered muscle mass and physical activity; by these measures, many highly trained athletes would be considered overweight.

I’m six feet tall with a “large” frame. The Metropolitan Life Weight Chart for Men says my “ideal” weight should be 164-188 pounds. This is what I looked like in 1991: 175 pounds with a 34-inch waist.

I looked pretty good, right? Well, I was in my 30s and had lost 35 pounds because I’d stopped eating for days at a time when I was going through a painful divorce. Over the next few years I gradually gained most of it back, stabilizing at 220 pounds. I gained another 40 pounds from job stress eating in the late 1990s; my weight fluctuated between 260 and 270 pounds for the next fifteen years. A few years ago, I dropped below 250 pounds, but that was the result of two relatively severe respiratory illnesses. I could eat or breathe, but not both.

The hysteria over obesity was compounded in 1993 when two public health researchers, J. Michael McGinnis, MD and William H. Foege, MD,  published “Actual Causes of Death in the United States” in The Journal of the American Medical Association, from which the media erroneously concluded “obesity kills 300,000 people each year.”  If one bothered to read the article, one found the authors reported “diet and activity patterns,” not obesity, per se, contributed to mortality.  The authors cautioned “no attempt was made to further quantify the impact of these factors on morbidity and quality of life,” and the “numbers should be viewed as first approximations.” 

McGinnis and Foege compared the National Center for Health Statistics’ (NCHS) list of the most common causes of death – heart disease, cancer, strokes, accidents, diabetes, and others – with factors that contributed to mortality, such as tobacco, alcohol, guns, cars and the aforementioned diet and activity patterns. The NCHS found almost twice as many people died from accidents as from diabetes; however, no one suggested we had a national epidemic of stupidity or clumsiness.

NCHS
Causes of Death
Annual
Deaths
   McGinnis/Foege
Contributors to
Mortality
Annual
Deaths
Heart disease 720,000   Tobacco 400,000
Cancer 505,000   Diet /activity patterns 300,000
Cerebrovascular disease 144,000   Alcohol 100,000
Accidents 92,000   Microbial agents 90,000
COPD 87,000   Toxic agents 60,000
Pneumonia/influenza 80,000   Firearms 35,000
Diabetes 48,000   Sexual behavior 30,000
Suicide 31,000   Motor vehicles 25,000
Liver disease 26,000   Illicit drug use 20,000
HIV 25,000      

ARE THINGS REALLY THAT BAD?

Data from the NCHS and other sources suggest the answer is “no:” 

So why is it so difficult to lose weight and keep it off?

For decades physicians told us if we all just ate less and got more exercise, we’d all look like Adonis and Aphrodite. If you were fat, it was your own damned fault because you were gluttonous or lazy.  Researchers have only recently started admitting that weight gain is far more complicated than “calories in – calories out.” Weight regulation is a complex interaction of genetics, environment and biology, and long-term weight loss is nearly impossible for most of us.

The magnitude of genetics’ role in obesity isn’t entirely clear, but we know susceptibility to “common obesity” involves multiple gene variants, first identified on chromosomes 16 and 18. Studies of familiar relationships found the correlation for BMI in identical twins is twice that of fraternal twins and decreases as genetic separation increases: siblings, parent-child, spouses, and adopted children. Pick your parents carefully if you want to look like a cocaine waif your entire life without the drug risks.

Thousands of years ago, when we chased our dinners across the savannahs (or ran to keep from becoming some critter’s lunch), humans adapted genetically (so-called “thrifty genes”) to hang onto whatever calories they ingested as a hedge against times of famine. Western civilization has brought us a surfeit of food along with soul-sucking jobs that have most of us sitting on our butts for 8-10 hours a day (more if you factor in 2-hour daily commutes in large cities). Our bodies have not adapted to this relatively sudden change.

The Pima Indians of Arizona provide an extreme example of environment rapidly overwhelming centuries of a lifestyle that had kept a genetic propensity for obesity in check. Robert Pool, in his book Fat: Fighting the Obesity Epidemic, described the Pima this way:

“When the white settlers first arrived, they found Indians straight out of a Frederic Remington sculpture. The bodies of the Pimas were thin and sinewy, their legs chiseled by regular running, their arms strong from the bow, the war club and the plow. Today the Pimas are fat. Not just chubby or overweight, like the average American couch potato, but obese.” (Pool, p. 140)

A century and a half after being consigned to a reservation, the Pima have gone from being fierce warriors protecting the weak to a tribe devastated by high rates of diabetes, obesity and kidney disease. Their life expectancies are fifteen to twenty years shorter than the average American. Much of this appears to be the result of a sedentary lifestyle and a diet that has changed from a high-fiber, low-fat, low-calorie diet to one with a lot of empty sugar calories and triple the fat content.

Our own lurch towards diabetes and obesity appears to be linked to the low-fat craze that started in the mid-1970s. “Fat is the enemy!” “Carbs are good for you!” The food industry capitalized on this, producing a large range of low-fat foods, which we all gobbled up – and got fatter. Decades later, we learned the sugar industry started paying off researchers in the 1960s researchers to blame fat for obesity. Ironically, European countries with higher-fat diets had lower incidences of heart disease.

While it’s convenient to blame genetics and environment, biological mechanisms don’t help much. Researchers debate whether there is a single “set point” or multiple “settling points,” but most people who’ve lost weight will tell you how their bodies will fight like hell to get it back. Columbia University’s obesity researcher, Rudy Leibel, compared energy expenditures of twenty-six obese people with static weights, averaging 335 lbs., to those of twenty six normal weight controls. As expected, the obese required more calories than the normal subjects to maintain their weights. (Calories per day/weight (lbs.) = calories per pound)

However, when the obese lost significant weight (about 115 lbs. each), they required FEWER calories than expected to maintain their weights. Their metabolisms slowed in an effort to return to their original weight. Kevin Hall, a researcher at the National Institutes of Health, found the Biggest Loser contestants’ metabolisms remained low even after they started to regain weight.

What should you do?

First, weight alone is a poor indicator of overall health. Jim Fixx, the man who got America running, died of a heart attack in 1984 while jogging in Vermont. Dana Carvey, a perennially skinny guy whose genetically high cholesterol levels (familial hypercholesterolemia), has required four angioplasties to stay alive.

On the other hand, in 2002 the San Francisco Chronicle did a story on Amanda Wylie, a 250-lb. aerobics instructor in San Francisco who had a black belt in boxing, did yoga and the splits, and could probably wipe the floor with me. That same year, Jennifer Portnik, another obese but physically fit aerobics instructor, sued Jazzercise for refusing to sell her a franchise. She opened her own business after being certified by the Aerobics and Fitness Association of America, and Jazzercise dropped its requirement for skinny instructors.

Steven Blair and others at the Cooper Institute for Aerobics Research, found that skinny couch potatoes were at greater risk of dying than men – skinny or obese – who maintained cardiovascular fitness. Exercise isn’t going to make you lose a lot of weight, but it’s great for your heart.  So, go take a walk, find a physical activity you like, and minimize couch time.

Recently (February 13, 2019) Samantha Bee took on how media and physicians stigmatize fat people in a Full Frontal segment called “Thicc not Sick.” (I was appalled to find out news outlets refer to stock footage of the obese as “guts and butts”). Twelve years ago, a genetically scrawny medical school classmate badgered her husband into losing weight (I didn’t think he was terribly heavy). I found a Facebook photo from last year. He’s back to his original weight and still looks pretty good.

Realize diets don’t work in the long term because they are merely a temporary change. Anyone can lose weight eating 800 calories per day, but are you willing to do that for the rest of your life? Probably not. Your metabolism will adjust to compensate for the weight loss, rendering permanent weight loss an exercise in futility for most of us.

There is no single, optimum diet for everyone, so find what works.  Peg and I have a low-carbohydrate, high-protein diet, but she can eliminate carbs more easily than I can. My blood sugar will plummet in an hour or two if I don’t have a little carb with my meals. (That, and I get really ugly.) The best thing you can do is eat a relatively healthy diet and give yourself rewards in moderation.

Finally, I think the unrelenting stress of our jobs presents the greatest risk to our overall health (Midwestern winters run a close second). Obstetrical nurses often live on chocolate because they don’t have time to eat while working on chronically understaffed units. Corporate America learned how to squeeze more work out of fewer people for less money and they dare not squawk. “If you don’t like it, you’re free to leave and we’ll find someone who is more of a team player.”

Misery loves company. We’re stuck with work but socializing outside of the workplace and fostering supportive relationships will make life a lot easier. And wine. Everything goes better with wine.

Bookends

Many of my generation came of age with the music of Simon and Garfunkel. They provided a poetic and intellectual counter to the shallow, mass-market Top 40 hits on AM radio and the raucous, sometimes angry but certainly eardrum-shattering music of the late 1960s, which now we quaintly refer to as “classic rock” with the same disdain heaped on “your Golden Years.”

I listened to their Bookends album recently during a flight from Portland, Oregon back to Chicago. I hadn’t listened to it for at least two decades; I’d been trying to shed my sensitive side for a more curmudgeonly and safe persona.

I’m now ambivalent about Simon and Garfunkel. Yes, the music was poetic unlike anything I’d ever heard, but it could also be depressing and insistently New York City, an unfathomable existence to someone raised in the desert and then the Midwest. These are Walden’s “mass of men leading lives of quiet desperation.” People who read Emily Dickinson and Robert Frost while pondering if both God and the theatre have died; living in dingy, walk-up flats with noisy radiators and even noisier neighbors. I often imagined a grainy photo of Paul Simon in that black overcoat from the Sounds of Silence cover, walking on a rainy spring day near the Berlin Wal at Checkpoint Charlie past a sign saying “Eintritt Verboten” (Entrance Forbidden).

Bookends is one of Simon and Garfunkel’s more depressing albums, if such a thing is possible. America is a song of lost hope which, for some inexplicable reason Bernie Sanders chose as background for campaign ads. Did no one even listen to the lyrics?

“’Kathy, I’m lost’, I said,
Though I knew she was sleeping.
‘I’m empty and aching and
I don’t know why.’”

Sheesh.

The next song is “Overs,” a song about a relationship waiting to die:

“Why don’t we stop fooling ourselves?
The game is over…

…We might as well be apart.
It hardly matters,
We sleep separately.

And drop a smile passing in the hall
But there’s no laughs left
‘Cause we laughed them all.
And we laughed them all
In a very short time”

The first side of the album ends with “Voices of Old People”, followed by “Old Friends/Bookends.” The voices are those of elderly people – presumably New Yorkers, possibly Jewish or Italian – kvetching about their infirmities and resigning to their fates; they are waiting to die in a nursing home, in their adult children’s homes after a stunning role-reversal, or alone in a tenement, waiting to be discovered when the body starts to smell. I was a teenager then and now, fifty years later, we’ve vowed not to “go gentle into that good night,” but instead take Zumba classes, pursue the dreams we postponed as responsible adults raising families and acquire gonorrhea and chlamydia in retirement communities for “active seniors.”  It’s no longer “terribly strange to be seventy.” We’re more like the lecherous old lady in the Playboy cartoons. Mick Jagger is still prancing around the stage and we’re 35-year-olds in our minds, wondering what the hell happened.

I’d completely forgotten “Mrs. Robinson,” which brought back a whole bunch of bad memories of cinematic dysfunctional adult relationships – Doctors’ Wives, Ordinary People Carnal Knowledge, Women in Love and The Graduate – and those I observed in real life. The bar in the Robinson’s house, well-stocked with liquor and the kitschy “Bar” light in the corner, symbolized the emptiness of their relationship.  He was the successful, country-club-and-Cadillac businessman; she was the restless, neglected wife who could buy anything but what she really needed. It reminded me of an old girlfriend who lived in tony Glencoe, IL. The expansive house on an enormous, well-manicured lot obscured the psychopathology within.

Paul Simon reflected on American’s need for heroes in “The Silent Superstar,” a piece the New York Times ran the day after DiMaggio’s death as “subconscious desires of the culture.”

“Where have you gone, Joe DiMaggio
Our nation turns its lonely eyes to you…
…What’s that you say, Mrs. Robinson
Jolting Joe has left and gone away”

At The Zoo” is the only uplifting song and it’s uncharacteristically humorous. Paul Simon adapted the lyrics for a children’s book in 1999. Who wouldn’t love this?

“…The monkeys stand for honesty
Giraffes are insincere
And the elephants are kindly but they’re dumb
Orangutans are skeptical
Of changes in their cages
And the zookeeper is very fond of rum

Zebras are reactionaries
Antelopes are missionaries
Pigeons plot in secrecy
And hamsters turn on frequently
What a gas, you gotta come and see
At the zoo…”

 

Sometimes I miss the music, but not the emotional vulnerability that came with it. Time to put this genie back in the bottle for another 20 years, eh?
All music/lyrics © Simon and Garfunkel

Paul Simon, The Silent Superstar. New York Times March 9, 1999, Accessed October 11, 2016.