Bacon on the Bookshelf

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In the Dog Days of August…

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In the dog days of August – and the double-dog days of Covid 19 – we seek solace where we can. You might find me eating Jeni’s Buttermint ice cream or watering the flowers obsessively. My older daughter and I have been watching a lot of Grey’s Anatomy while she recovers from a tonsillectomy, but I’m thinking we could have made a better choice. “It’s okay, Mom,” she told me, when I was in tears mid-afternoon; “the babies live most of the time.”

Real life double-doctors Louise Hanson and Wally Smalley lifted my spirits – and I think they’ll make you smile too. I’m so happy to share their lives and perspectives today! 

Louise and Wally, married 26 years, met in med school at Vanderbilt. Wally had grown up in Kingsport; Louise in Mobile and upstate New York. Wally has served veterans his whole career, currently as head of Gastroenterology at the VA hospital in Nashville. Louise is the head of Student Health at Vanderbilt. 

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Hi Louise & Wally! Wally, did you know that you had agreed to this interview?

Wally: Does it really matter?  I do what I’m told!

Good man! How has your summer been? What’s the highlight so far? 

Wally:  This summer it has been a blessing to have Hannah (rising senior at Princeton) and John (rising sophomore at Duke) around to distract us from the complexities of working through the pandemic. 

Louise:  This summer has been a mixed bag – I am so happy to have the kids home, but I do hate that a global pandemic has ruined their plans for exploration this year.   We both have continued work as usual with strict precautions, but at home we have been quarantining and social distancing since March. For a natural introvert such as myself, that part of it has been fairly tolerable for me and I do get human interaction at work, which is nice. I do miss seeing friends, going to restaurants and things like movies/concerts/sporting events. The highlight of our summer has been the excitement of building a screened-in porch across the back of our house – something we’ve thought about for a decade and finally decided to do!

Any low point you can share in a public forum?

Wally:  I miss choir. Outside of work and family my greatest joy comes from choral singing. This has been my biggest part of my non professional life since college. My friend John Tarpley and I refer to our time with the choir at Belmont United Methodist as our therapeutic “scream therapy” time. There is nothing like singing in the midst of others and feeling the resonance of other voices resonate in your chest and forehead. (Except for basses – we could always use a bit less bass.) Missing this time with other singers is really difficult and I am afraid that it’s going to be another year before we can really do it with any real integrity.

Louise:  My happy place is the beach or any activity outside. Unfortunately I sustained an injury that prevented me from even doing these outside things that are allowed in the pandemic! After a lifetime of sports – paddleboarding, ice skating, skiing, hiking, golf, etc etc. I’ve never had a broken bone or had stitches. Unfortunately, carrying laundry down dark basement stairs changed all of that. I fell in May, ripping the front of my shin off, ultimately requiring a skin graft surgery to heal the wound. I’m now 13 weeks into my injury and still only functioning at about 60-70%. I’m thrilled to say that I walked the dogs and golfed 9 holes this week – a huge accomplishment even though it felt like I’d run a marathon!

How are your kids doing? Your extended family? Winnie and Paco?

Louise:  The kids are amazing and handling the pandemic with grace, humor and maturity. We’ve had a lot of fun with them here, binging TV shows, walking the dogs, playing games, watching our new porch come together, etc… My mom lives here in town and we see her often, which really helps with her sense of isolation. Protecting my mom is one of the many reasons our family has been so strict about our approach to quarantine and social distancing.    

Our dogs are loving having everyone here since March! Hannah will be here in the Fall doing on-line classes and hopefully return for in-person classes at Princeton in the spring. John moves back to Duke for the Fall and then likely will be here in the spring unless things improve. So the dogs will have somebody in the house every day for an entire year! That is a first for them!

Wally:  John and Hannah have been home since March. Even during their spring semester we started a ritual of watching the nightly news together – usually as  a side dish to our nightly carryout. It seems our kids are becoming pretty savvy consumers of what they see in the media and understand that things are almost always more complicated than what can be presented in 30 minutes. 

There are differences of opinion and perspective in our family. But at least least the kids tend to trust our 65 years of medical experience and some scholarly work when it comes to the pandemic.

They have been good sports about how COVID has affected their college lives.

On the day that you’re answering these questions, what have you done? What do you wish you’d been able to do?

Louise:  I have been doing a few errands to help John get ready to return to college! In a perfect world (no pandemic that adjusted John’s school schedule, no injured leg), I would be driving back from a trip to the beach that was originally scheduled for last week!

Wally:  I was mostly napping.

I wished I had dug out a better drainage system for our front gutters. 

Non aspirational I know, but true.

How has the pandemic affected your medical practices?

Louise:  At Student Health at Vanderbilt we have been caring for COVID patients since March, which has required a total re-do of our operation – staffing changes, physical locations (sick vs well), services delivered, telemedicine, etc…  It’s been a huge challenge but my team is amazing and has done a great job.

Wally:  This is deja vu for me.

In my senior year in college there were reports of a new syndrome that was killing gay men in San Francisco. Early during medical school we were using the term AIDS. During my fourth year of medical school (1984) the HIV virus was discovered.

AIDS/HIV changed the landscape of internal medicine training in the 80’s and early 90’s. Most public hospitals where some of the most prestigious training programs were established were overwhelmed. We were mostly treading water with this disease.  There were only a very few viral diseases that could be treated. 

In addition there was a lot of political and cultural heat with only a little light with HIV in the 1980s. 

When I was the Chief Resident at UVA (‘88) we hosted a speaker from the NIH who came to talk about a new drug – AZT – that actually had anti HIV effects. Standing room only. After the talk I took the speaker across the street for a gyro and fries. While Tony Fauci had lunch with the other chief and myself he shared some great stories about our boss with whom he had trained  at Cornell many years previously. There is nothing like sharing war stories of dealing with a grumpy, uber-professorial Chairman that would resonate with me more.

By the mid 90s we had much more effective therapy. Now HIV – while very serious – is like many of our other chronic diseases. With access to care it can be successfully managed.

Now here we are with COVID. In four months we are at the point we were with AIDs after a decade.

The science is tough enough. There are crazy amounts of cultural and political noise.

It is deja vu. 

At least Tony Fauci is around.

Doubters should take him out to the College Inn in Charlottesville for a vanilla shake and gyro.

By the way – when I taught the required course in Epidemiology and evidence-based medicine for VUSM this was my first slide:

“Science is a consensus.”

Just so we all know – it ain’t true till the editors at JAMA, NEJM, Lancet, etc think it might be true. 

It’s not a bunch of facts. It’s a lifestyle.

How are your colleagues doing, generally? Your patients? 

Louise:  My colleagues at Student Health are exhausted and afraid for their safety – this all comes with the territory while caring for COVID patients, but they are holding up well under the pressure. I am most worried about my friends who work with the most ill patients or in the hospital COVID wards. The mental and physical exhaustion (from wearing all that PPE for long shifts) can be overwhelming. I am lucky that most of my patients are under age 30 and generally healthy – our patients with COVID have all done well overall, which I’m so grateful for.  

Wally:  My colleagues are anxious to get back to seeing patients. 

We are starting to worry that some folks with important problems might not come to see us.

Routinely in GI we diagnose cancer in about 1/100 cases. That’s a little bit more than once a week in our lab.

In April – when we severely limited visitors – only very high risk patients came to see us. We diagnosed cancer in about 1/12 folks.

Once a day. The “you have cancer” talk.

Tough conversations already.

Really difficult phone conversation with the family members who are sitting outside in the parking lot because they cannot come into the building.

We are figuring that part out now – sometimes family has to meet you in person and we are doing this now.

On the other hand we all have finally started using virtual care (video and tele).

Many medical problems are readily handled in this very patient-centric way.

We think it is cool. Millennials think “duh”.

Are you concerned about what the fall and winter may bring?

Louise:  I am very concerned about the fall and winter – the inevitable arrival of influenza and other viruses, while also having an ongoing coronavirus pandemic that is poorly controlled. I hope there will be an effective coronavirus vaccine that is effective that may help turn the tide. I am trying to be hopeful but also realistic. I suspect things won’t feel even close to normal again until late spring or summer 2021.

Wally:  We are going to have at least one more lap.

Even with a really good (> 90% effective) vaccine.

We are not going to run out of ventilators like in NYC but there will be a continual strain in the healthcare system and more importantly the greater society.

What gives you the greatest pleasure right now?

Louise:  I love being with my family and especially love outdoor activities – as I’ve recovered from my injury, being outside is such a healing tonic for me – getting back on the golf course a bit, hiking, walking the dogs. Once I am fully recovered, being on water of any kind is my happy place. I love to paddleboard or kayak on the rivers and lakes in our area and hope to get back to it before the fall weather is upon us.

Wally:  Thinking about napping on a nifty screened in porch in 50 degree weather.

Yes, I am dreaming about napping.

It is what 60 year olds do.

If you find yourself in a bad mood or bad frame of mind, what do you do? (Me personally? I take it out on my spouse.)

Louise:  My mood can be sour/sad/frustrated and if I strap on my shoes and walk my dogs, I come back feeling 100% better. Fun upbeat music from my youth or college years will do the same – Squeeze, Beatles, Billy Joel, etc – will do the trick.

Wally:  I am a nervous eater.

I can have a full dinner, turn on CNN and eat an entire box of Cheerios. (True story. More than once.)

My family and diabetes doctor now have forbidden me to watch CNN.

What are you reading/watching/listening to? We all need recommendations!

Louise:  I just finished Cheryl Strayed’s “Tiny Beautiful Things”, which I loved. 

I also recently read Anne Tyler’s new book, “Redhead by the Side of the Road”, which I found slow and hard to finish! I’m also re-reading a few books that I read 25+ years ago while in the fog of medical school or residency. I read every day but in those days I would read a paragraph and fall asleep, so I’m not sure I retained as much, so re-reading old John Irving classics and one of my all time favorites “The Secret History” by Donna Tartt has been so fun.  

We are re-watching The West Wing on Netflix with the kids and that’s been great!  I’m also watching The Americans, a TV series about Russian spies embedded as American families – I highly recommend it!

Wally:  As you know the last book I read was “Harriet the Spy”. Totally character driven.

I also have enjoyed watching The Americans.

I am listening to Bocelli, Pavarotti, Gedda and Wunderlic (screaming tenors). In the car I can hang with them. At home or at church – not so much.

Has the pandemic changed you? Has it changed how you will live the rest of your life? 

Louise:  Hmmmm that’s an interesting question! I feel like I’ve been preparing for a pandemic for my entire life – I’m the freak who has reeked of Purell for decades and who has always pressed elevator buttons with my elbow. My family laughs that suddenly everyone else in the world is finally catching up to my insane behaviors!  

But seriously – at my worst moments, this pandemic has made me very afraid and perhaps too aware of how vulnerable we all are. But on my better days, this awareness has brought even more appreciation for the simple things that are so important, such as enjoying time together as a family. This is the part that I know I’ll continue to carry with me after the pandemic ceases to be the leading story on the news every night.  

Wally:  I feel like I still enjoy my work and am in a position to influence policy making and practice locally and nationally.

Weezie is really excited that I am washing my hands more. Really if you married a gastroenterologist you can’t have high expectations.

What’s your best advice for staying sane in the Time of Corona?

Louise:  Laughing out loud and being silly is a great distraction – we can always rely on John or Wally to show us a blooper video or a SNL skit that will get us all giggling.  Our most recent giggle-fest was reading the Amazon reviews of the Haribo Sugar Free Gummy Bears – none of us have ever heard Wally laugh so hard…  

Wally:  Enjoy the basics… Family. Food. Frequent naps.

And let’s finish up with speed dating! 

Favorite beverage in the Time of Corona?

Louise: Diet Coke, so cold that it burns the throat.
Wally: Diet tonic water. Feels sophisticated for a Methodist preacher’s kid.

Favorite basketball team even if it brings ultimate evil onto the court?

Louise: You know I have no choice on this one (even if I did teach 2 yr old Hannah to scream “boo Duke”….)
Wally: Duke.

Favorite child in the Time of Corona? Favorite spouse?

Louise: 1. Any child that does the dishes or laundry.  2. Any spouse that rubs my feet.
Wally: 1. Any child who says “yes, I think you are right”. 2. Spouse : Ditto.

Favorite comfort food…

Louise: Homemade vanilla ice cream with Heath bites (we bought a Cuisinart tabletop ice cream maker that is so easy and fun – highly recommend).
Wally: Sauerkraut and sausage. (And a night by myself on the couch in the basement.)

If I could go anywhere in the world right now, safely, I’d go to…

Louise: Maui
Wally: Watauga lake

If I could, I’d rather travel to the past – or the future…

Louise: The past – when the kids were 6 and 8 – such sweet days filled with innocence, fun and adventure. I enjoyed it thoroughly then but think I’d treasure it even more with a “do-over”.
Wally:  The future is going to be filled with gee whiz moments. I promise.

If I could eat at any restaurant in Nashville right now, safely, it would be…

Louise: Epice
Wally: Barcelona

I’m really tired of…

Louise: Science and data pushed aside for political reasons
Wally: Ditto. Science is a consensus, you know. Hmmm maybe I would like more consensus in general.

I’m really grateful for…

Louise: So much time together with the kids at a time when they’d normally be flung to all corners of the Earth!
Wally: Could not say it better. The silver lining of the Pandemic.

 

Thank you for the good company and the good cheer today, Wally and Louise! Xoxo

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