CK's Journal

There have been several recent conversations re PTS (just post-traumatic stress; no PTSD; no disorder). I have had a difficult time trying to decide whether to post this on FB. Several people have been reluctant to read it and I have been surprised by other reactions. But it’s not about reaction; it’s about reality.

Memory is a funny thing. Witnesses often see different things. I want to document what (to me, at least) are some astonishing facts. I asked someone else who was there if my recollections are accurate. “Sure.” First is that some people actually tried as hard as they could to kill me.

At DMZ. This is the only photo I have of myself at the time. Too busy for pictures

I understand that they weren’t trying to kill me as an individual or a human being with my identity. They didn’t know me and nobody said, “I want to kill that guy” (except the occasional sniper). They wanted to kill me and everyone I was with. We wanted to kill them too. That’s what everybody was there for. Crazy. All these actions involved unit/group (from squad to regiment) efforts, though occasionally a firefight would be more personal.

But here’s the thing: when bullets snap close by your head or when a mortar round hits very close or a bullet hits the man next to you with a smack and he grunts, it feels very personal. It could hardly feel more personal.

I know for a fact I’ve been shot at by:

• 152mm howitzers at Gio Linh, a small firebase at the DMZ where the shelling was intense and Khe Sanh, a large firebase where I was before it was surrounded and things got intense. I can’t even think of a word to describe the sound they make coming in close. A lightening quick screaming loud whir? The explosion is like a huge clang. These were the same caliber cannon that Russians are now using in Ukraine, though it seems likely the explosive is now more powerful and the barrages far more sustained.
• 122mm rockets at Dong Ha, a base with an airstrip just south of the DMZ. These were impacting kind of randomly, and it was a big base, so not a big sweat to me.
• 82mm mortars in the Hill Fights outside of Con Thien at the DMZ, also on Operation Deckhouse at DMZ. I was with 1^st Bn, 9^th Marines in the Hill Fights and the fighting was very intense. In Deckhouse I was with 1/26. The third night we were dug in in an old NVA (North Vietnamese Army) position and unfortunately for us, the NVA already had the position zeroed in with mortars. I was asleep beside a trench when the first rounds hit really close and I felt like I levitated into the trench and bounced back up and I could see the mortar muzzle flashes and I gave them two full belts/200 rounds even though someone was shouting “Cease fire! Cease fire!” I just kept cranking and the mortars stopped.
• 40mm RPGs at end of Deckhouse and probably other times. I was riding on the back of a tank. I was facing to the rear, kind of dazed from a 4-5 day battle I mistakenly thought was over. It was like I saw something flying through the air and I saw the driver of the tank immediately behind us about 20 meters away his head exploded and his comm helmet and it was like a radio exploded. At the same time the tank I was on was hit and then the tank with the dead driver rammed us and we were taking what they call “heavy small-arms fire.” We fought our way out of the ambush.
• 12.7mm machine guns near Khe Sanh and the Hill Fights. I was on a helicopter coming out of the Hill Fights and Bang! We were hit and the chopper spun several times and hit the ground hard. We were taking fire and set up a perimeter and returned fire and then another chopper touched down to take us away and some men wanted to get right on that chopper and get out of there but a couple of us disregarded them and went back to the chopper and pulled off the dead Marines from 1/9. I was really pissed that they wanted to just leave the dead men.
• 7.62x39mm machine guns, AK-47s and SKSs (everywhere). They all had AKs at the DMZ where we fought the NVA. I think around Danang where we fought Viet Cong there were more SKSs.
• Bouncing Betty mines and IEDs, especially at “Dodge City” near Danang. When a bouncing Betty is triggered a projectile shoots up and explodes at about waist level. Probably what killed D____ my assistant gunner. The night before when we were digging in he told he knew he was going to die. That’s why I let him carry my gun the day he was killed – I figured it would give him a better chance at beating fate or whatever. A love gift.
• Agent Orange here and there.
• One strafing run by US helicopter gunship, 7.62mm machine guns near Dodge City. We had just assaulted a trench and were resting beside the trench when the chopper strafed the trench (not having gotten the word that the VC were gone and we were there), but he missed. Another time at the DMZ a Puff (the Magic Dragon) with Gatling guns (7.62mm) firing drifted too close, which just about stopped my heart.
  

  My gun at DMZ

I was lightly wounded by shrapnel near Dong Ha. I’m a walking miracle.

Third and last radiation treatment…

“Shrink and disappear, little wretch!!!” Message to the tumor from my niece, Mary.

The way it went for me: Jean drove us in the van to Dublin where the Kaiser radiation oncology unit is. The first time in Dublin we got there early, had a snack, hung out in the van, and went to the cancer center. The second time we took a sandwich and went to a park that Jean found via google and had a picnic and a nap with a cool breeze playing over us. The third time was like the second. I love it so much that Jean likes picnics and naps together like this. ♥

I’m on the tray

At the cancer center I check in, wait a short while (meanwhile, Jean was running errands, walking), and they take me back, through the corridors, through the massively heavy 4” thick door into the room. I lie down on the plastic mold of my shoulders/torso (made on the previous planning visit) on the plastic tray and grasp the handles over my head. The radiation therapists move me in small increments until several bony landmarks of my body are aligned with the machine that will beam the radiation into my body, into the tumor. They leave the room and it’s just the machine and me. The plastic tray and I slide into the machine and I’m lying still, breathing however it is I’m breathing (it seems a little fast to me) and there are beams of light (red and blue? I’m not sure) and some things like appendages – to my left a flat thing, a blank plastic rectangle about 24” x 14” and to my right, a round thing, maybe 22” across with a ~8” glass square in the center like a window and there’s a third thing like a rectangular box and those three things slowly, silently rotate around me, sometimes it seems on different axes. So I lie there, very still and after about 15 minutes the machine powers down and the plastic tray and mold and I slide out. The RT is there. “Do you need help sitting up?” “Yes, thank you.” Experientially, it seemed like nothing happened except a little discomfort. Actually a lot happened. Beams of seriously high energy that breaks the DNA of the cancer cells and thus their ability to replicate/grow/spread.

The first time I was irradiated one of the radiation therapists and I talked for awhile. She told me that school for radiation techs takes about two years. School for radiation therapists is an additional 1.5 years, so 3.5 years to be there, getting it all right every time. I used to teach that part of being a patient was literally giving your body to another person/people and that trust was essential. True. The therapist was helpful to me – moving me a little farther along in the process of integrating these new realities, becoming little more connected. I felt like she was a truth-teller. Can’t do any better than that.

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For about 6 or 8 months I took Phana for weekly chemotherapy infusions and related at Presbyterian and MD Anderson. At Presbyterian when someone finished a course of chemo they rang a bell and everyone clapped. “They’ll never ring that bell for me,” she said.

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Phana and me, 30 years before she passed. Sigh.

Even caught early, with good odds of surviving it’s still realistically pretty heavy shit to have lung cancer. I feel almost dramatic when I say that, but you know, it is pretty heavy.

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Route 66

Many years ago I had a patient who had triplegia as a result of a radiation injury. He walked into the hospital and came home paralyzed in three of his four limbs. He lived with a prostitute and some other people in a shotgun house on the frontage road of a freeway. (A shotgun house is a cheaply built house, narrow, one room after another so that a shotgun fired through the front door would clear the whole house.). There was a bedpan and they put him on it and because the people in the house didn’t know anything and he couldn’t feel anything they left him on it for a couple of days. I got there and we got him off, but the blood supply to the tissue at his sacrum had been cut off for several days and over the next week or so, he developed a large, deep decubitus ulcer at his sacrum. I kept it as clean as I could with some help from the woman. She was a heavy drinker (they all were) and that and the nature of her work meant that she was gone or indisposed a lot. She was a nice person and I dug her, but she wasn’t dependable.

Several times when I was there the man was watching a TV program about sewing called Sew What’s New, which seemed odd since the program was hosted by a man all tricked out in pastels and lace and the live TV audience was all older white women and the patient was from streets, maybe pimping the woman, who brought her tricks through his room and on into her room. The ulcer/infection went into his bone and he became septic and died.

Way up into the alpine… rock, snow, ice, air.

A year or so later I saw the woman on the street. We talked for awhile. She still seemed nice and she still had that unpleasantly sweet alcoholic smell.

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My friend Joyce had 10 radiation treatments a year or so ago. Plus some other stuff. She’s doing fine. No evidence of recurrence. I know I’m getting off lightly, so far.

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David and me backpacking in Grand Canyon

When I was in my early 60s I began to look around, thinking about what I would do with the rest of my life. One answer was already clear: I would continue backpacking as long as I was able. The more time I could spend in the wilderness, the better. Wyoming’s Wind River Mountains became my place. I was in the Titcomb Basin four times, along the lakes, to the foot of the glaciers, in the alpine. The alpine, higher than any tree can grow, like magic to me. The Cirque of the Towers, the Highline Trail, Jean Lakes, Knapsack Col, Twin Glacier, snow, ice, rock, milky glacier run-off water, air, tiny alpine flowers, on and on. Also Big Bend, Sangre de Cristo Mountains, New Mexico, and more.

Another answer was to keep on traveling as long as we could. A typical trip was tickets from Dallas to San Francisco to see David to Hong Kong to Hanoi and 6 weeks later return from Bangkok to HK, SF, and home to Dallas. During that 6 weeks we’d ride buses, trains, and planes to Sapa, Hue, Saigon, Phnom Penh, Luang Prabang, Chiang Mai, Bangkok, etc. After Leslie passed away, Jean and I traveled to NYC, Barcelona, Granada, all over Wyoming, Colorado, and of course, California.

The Atrium Obscurum crew, meeting before the gathering

Sonic Bloom in Colorado

I also reconnected to my hippie roots through connecting to psychedelic medicine and to the psytrance scene. Talk about blessings! Try taking this in: I’m sitting with Jeff, my best friend since the war in Vietnam – we’re by a dirt dance floor somewhere deep in a forest in East Texas. We’re rolling very, very strong, I’m sitting next to a man I’ve loved since 1966, the music is loud, people dancing, dancing, I’m dancing, the stars above, pounding music through the night, into the day, and into the next night, and along the way I took the music in and was experientially connected to the psychedelic trance scene. The connection deepened over time and I joined Atrium Obscurum, a crew that was putting on forest gatherings in Texas. I went to gatherings in Texas, Oklahoma, Colorado, New Mexico, and Arkansas. Sometimes I taught classes on the end of life, PTSD, and psychedelic medicine. It was an amazing time in the reality of the global underground.

http://ckjournal.com/psytrance-trance-trance-culture

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When I finished my course of radiation, the nurse asked if I wanted to ring the bell. I said, no thanks – in tribute to Phana and because (so far) I’m getting off very lightly.

From our deck – Mt. Tam in the distance

“I think you need a haircut,” Jean said. Usually I respond, “No, I’m good for another few months.” This time I said, “Good idea,” because I like the idea of getting ready for radiation; to do it in a ceremonial way, including trimming my hair and my beard, taking care with what clothes to wear, praying to do it well.

The next day would be the “planning appointment” at radiation oncology. I knew there would be a CT and I would get some tattoos to guide the radiation team when it’s time irradiate me. It felt a lot like I would be going out on a long patrol that would start that next day and end sometime in the distant future. Like most other patrols, there would be casualties – some would die, some would be wounded. I was hoping it still ain’t me.

If that simile isn’t clear enough, it’s like this: let’s say it’s a patrol or operation with 100 troops going out/100 patients getting this sort of treatment. 85 of the troops will make it back/85 of the patients will be fine. Of the 15 troops who don’t make it back, some will die and some will be wounded. Of the 15 patients who are not fine, some will die and some will have further treatment, which will likely be increasingly difficult. Pretty good odds in the world of lung cancer.

There were elements of flashback to the planning appointment. When I was working in hospice and with refugees, I had associates who were in radiation oncology and I’ve spent many hours with refugees and others (including my Mom) in the waiting rooms and cancer treatment areas in Parkland, Presbyterian, Baylor, and M.D. Anderson. So a waiting room with sick people was familiar territory. As usual I felt a kinship with the people who worked there, regardless of their roles. We’re all playing in the band.

Some years ago in Old East Dallas I came across a woman with a ghostly sort of appearance. She had advanced cancer and a difficult past. I helped her with various things, as did my mate in the streets, Martin. One day…

I was taking her to radiation oncology at the county hospital (Parkland Memorial). I’d arranged for a translator from the Multicultural Center to accompany us to explain palliative radiation, which is kind of a difficult concept for someone who doesn’t speak much English. I had the woman in my truck and we went by the center to pick up the translator. I went in and in the conference room I found 3-4 people – including the translator – folding origami cranes. The director of the center told me the translator couldn’t come with the lady and me because they had to fold the cranes for an event at the area peace center. I was literally dizzy with rage. But I didn’t say anything – just left.

Radiation oncology was down the usual endless series of subterranean hallways and doors with little signs saying things like D-1572. The waiting room had the usual complement of sick, pale people. I stayed there while they took the lady through the double doors into the treatment area. There was a little TV on a little table in a corner and Mrs. Doubtfire was playing in the VCR. I’d never seen it before and to me it was one of the funniest things I’d ever seen, which was weird, because I was in a very unfunny place. So I was trying not to laugh, but I finally did. Hard. It seemed to be okay.

Ultimately the lady went back to her home country to die. She took a good stash of dilaudid with her. I hope it was enough.

Before she left, she and her daughter took me to a kind of blue-collar buffet for a thank you/goodbye dinner. It’s still sweet and poignant to me.

This radiation oncology unit where I am now is not the same as the one where I saw Mrs. Doubtfire. They move me through the process professionally, efficiently, and in a nice way. No six hour wait! The oncologist has brilliant credentials and experience. What more could one ask for? We’ll see how it all turns out.

It’s a new world (5/12/2022)

Here we go, into a new world, the world of being a patient with cancer. I am not a cancer patient; I’m a person (or patient) with cancer. Given the type of cancer I have and other factors, there is a high likelihood that I’ll be fine after treatment.

I’ve studied this world, gone into it many times with others, and taught about it for a number of years. I tried to teach people about the lived experience of being a patient with cancer. What is it like to be put into this world? I taught that it is a new reality. And so it is.

But I’ve never been here as a patient. I imagine that the reality for me is not as radical as it is for some people. I am not suddenly thrust into thoughts/perspectives of mortality and suffering.

History (4/20/2022)

A few years ago a CT for something else showed the presence of a nodule in my right lung. (“Nodule” = tumor <3 cm in diameter; tumor >3 cm = “mass.”) Subsequent imaging has shown steady growth of the nodule. It is now 2.9 x 1.3 cm and has changed in character as well as size – to the extent that the tumor board at my HMO is confident in initiating treatment for a primary adenocarcinoma of the lung. A PET scan showed no other suspicious lesions or nodes, so there is likely no metastasis. Treatment will include a biopsy to confirm the diagnosis, but it’s pretty much guaranteed to be accurate.

What does it all mean?

The fact that this is a less aggressive (than small cell or large cell) primary lung tumor with low likelihood of current metastasis is very good bad news. Treatment will be surgery (lobectomy) or radiation (stereotactic body radiation therapy/SBRT). In both cases, treatment is focused only on the tumor and adjacent tissue vs. systemic (chemotherapy) or a wider field of radiation (full lung). Two and five year outcomes show success rates for SBRT comparable to surgery (~85%) in cancers of this type.

The tumor has not been staged, but I assume it’s stage 0 or I (in situ).

I used to begin introductory lectures on cancer by saying, “There are well over a hundred known tumor types/malignancies and within those types and the cases resulting from them are countless variations.” The basic types of lung cancer, for example, include (1) non-small cell (adenocarcinoma, squamous cell, large cell [of various types]), (2) small-cell (several types, most notably oat cell), (3) mesotheliomas, (4) chest wall tumors, and (5) lung tumors that are distal metastases from other primary tumors – breast, for example. There are other, less common lung cancers.

All of us have knowledge or experience related to cancer in ourselves or someone we know or knew. But that doesn’t mean we know much about another person with cancer or about cancer in general.

I’ve spent much of my life involved in some way with people who have cancer and I’ve tried to live a life informed by these experiences. It’s a little weird to have cancer, but here we are. I count myself as very lucky.

Mistakes, bumps in the road, and lesson learned

Mistakes were made. The main one was that the doctor who told me on 4/13 that I have cancer forgot to refer me to the next step – radiation oncology. So there was a delay in the referral being made despite several messages from me to the surgeon and primary care doctor. I also had a pulmonary function test on 4/18, but couldn’t get an interpretation of the results until 4/25 or 4/26. It was weird being unable to get any response from the surgeon or primary care doctor. I finally talked with radiation oncology to learn that I had not been referred. I talked with the radiation oncologist on 4/29, 16 days after referral was supposed to be made.

The lesson learned was that I have to actively be in charge of my care and it is necessary to quickly follow-up on everything.

I wrote this to the surgeon on 4/25: “This delay is intolerable. I don’t know the legal definition of patient neglect, but neglect and disrespect for me as a human being are my lived experiences of this situation.”

Biopsy day (5/10/2022)

Got to Interventional Radiology at Kaiser on-time at 0830. Lady at front desk (Shirley) was warm and nice. I had the notion that she appreciates that this is potentially more stressful than some other procedures. The admitting nurse asked the usual questions and did a good job of starting the IV (a little more blood around the site than I expected, but there was also the fact that they planned on using my blood to plug the wound in my lung, so it just may have been a slightly bloody action). The nurse and I had some things in common and had a nice conversation.

I rode the bed through multiple double doors to the procedure room where I met several of the people involved in the procedure. The doctor explained what would happen and asked if I had any questions. I answered no, but told him that my wife asked that they spare as much of my chest hair as possible. I wondered then and now what his internal response was. I imagined that he could have been thinking, WTF, we’re here to biopsy a tumor (this is as serious as cancer) by sliding a needle between his ribs and into his lung and the patient is talking about his chest hair. Yes, and here is why: how I live is as important to me as how long I live. Sex and intimacy are important parts of how we live and Jean likes my chest hair. I’m not giving up a single thing unless I have to.

They asked me if I can put my arms up over my head. Okay. Then they asked if I minded them securing my wrists with my arms up like that. Okay, I said, “We must be in California ‘cause it’s getting a little kinky here.” Somewhere along the way they gave me versed and fentanyl.

I don’t remember what happened next until I was in the recovery room. We’ll see what the biopsy shows. As expected, adenocarcinoma of the lung (5/13/2022).

So, here we go.

Sourdough pot bread, 2022

12 years ago I posted a recipe for no-knead pot bread from NPR. It’s “pot bread” because it’s baked in a pot. Below is that recipe adjusted for sourdough (recipe for making sourdough starter at end). Original post is here and NPR article is here.

12 years ago Leslie was alive and well; we were in Dallas; There was 12.5” snow in Dallas that February; I was teaching end-of-life care and community health at Baylor; Leslie and I were both working in the Agape Clinic; Leslie, David, and I traveled for ~7 weeks in Asia (Hong Kong, Hanoi, Hue, Saigon, Phnom Penh, Battambang, Bangkok, Chiang Mai), and more in 2010. Those were some days! (see original post link above).

Good, dense crumb. Toast from this loaf is superb!

Now Leslie has passed from this earth; I’m in Berkeley, married to Jean; it’s sunny and cool here – and Dallas about to get some seriously bad weather; I’m retired and pretty tired, too; doing a little gardening, more baking, some writing, quiet life; in the past year Jean and I have traveled to Dallas, Bolinas, Point Reyes, San Francisco, La Honda; we’re about to hit the third year of this pandemic. These are some days!

No-knead pot bread: I made a summary (below) because the NPR article uses a lot of words. But I recommend you read NPR as well. I use a ceramic pot with top to bake in. I tried Le Creuset (heavy metal) but it scorched a little, so maybe bake at slightly lower temp if in metal?

4 cups/20 ounces/567 gm flour (3 parts all-purpose, 1 part bread flour OR some variation on 20 gm rye, 60 gm whole wheat, 487 gm all-purpose)
2 tsp salt
¾ tsp instant yeast OR ~50 gm liquid sourdough starter
2 cups ice water (if using sourdough, dissolve the starter in water and then add the ice
1 teaspoon honey or barley malt syrup
(if making cheese bread) 1/2 – 3/4 pound Monterrey pepper jack cheese cut into ½” cubes. Eatzis uses jack cheese. Cheddar gives too much oil for my taste. Gruyere is good, but expensive.
Olive oil

Stir dry together, then vigorously stir in ice water
Oil top, cover, fridge 8-12 hours
In cool room let rise 8-10 hours. The longer this rising, the more sour the taste. See end of post for other ways to increase the sourness
Stir. If making cheese bread fold in cubed cheese after stirring

Oil top, let rise until ~doubled
Fold using oiled rubber spatula until mostly deflated

Cover, let rise until doubled (2-4 hours)
The cheese may seem to come to the surface of the dough during rising, fermentation. I just push it back into the dough as far as my finger goes.

Preheat oven and bowl to 450 – lower the middle rack 1st
(Go fast – carefully) wipe small amount olive oil to inner hot pot
Dough in – use oiled spatula
Slash dough, spray water generously, put top on pot

Bake 55 minutes with top on***
Top off, reduce heat to 425
Bake 20-25 more minutes
*** some recipes call for ~ 25 minutes with top on and 55 minutes with top off

Making sourdough starter (from Tassajara Bread Book – my first baking book from sometime in the early 70s). You can also start with dry starter from several internet sources or best of all, use starter from a friend. If you start with dry starter, you have to use the dry to start your own starter which can be either a batter type starter or a firm starter.

2.5 cups flour (I used 1 cup all-purpose, 1 cup whole wheat, ½ cup rye – rye tends to have more of the requisite microorganisms)
2 teaspoons honey or barley malt syrup
2.5 cups warm water

Combine and let ferment for at least 5 days, stirring daily. A longer ferment yields a more sour starter. To maintain batter status, the starter should be replenished with 1:1 flour and water every time you use it. Or just add flour to generate a firm starter. Store in refrigerator. Feed every 1-2 weeks.

Increasing sour taste (from experience and truesourdough.com)

• Use whole grain vs white flours, especially all or part rye flour
• Stir longer, more vigorously
• Stir or knead the hooch (brown liquid that may come to top) back into the starter
• Longer ferments at cooler temperature
  

  Whole wheat sourdough from Tassajara – baked another time

• Use dry starter vs. batter starter. The above recipe yields a batter, but decreasing hydration is easy – just add more flour to the batter
• Use smaller amounts starter in recipes (I don’t understand why this one increases sourness)
• Use warmer (not hot) water
• Feed starter less frequently

Happy baking!

Bread makes itself, by your kindness, with your help, with imagination running through you, with dough under hand, you are breadmaking itself, which is why breadmaking is so fulfilling and rewarding.

Edward Espe Brown in the Tassajara Bread Book

A few days ago I posted: “The virulence, transmissibility, and vaccine resistance of the omicron variant is unknown, but it seems to be a fast-mover and is a reminder to be as safe as possible…” Now we know. Omicron is a very fast mover, anyone can infect anyone, cold weather is here, more people are sick (53% increase in cases over last 14 days in California), the variant causes illness ranging from mild to severe, California and New York have new universal mask mandates, so on and so forth and so, dear ones, here go again. We’re tired of this pandemic, but too bad; it’s not over.* Here is one functional way to approach the coronavirus at this (omicron) stage of the game:

The vaccine + booster (the new “fully vaccinated”) is like a slice of magical Swiss cheese laid on top of you. Protection against severe disease is pretty good, but not 100%. AND even fully vaxed we can still carry and transmit the disease – thus infecting others and promoting the virus’ ability to further mutate.

A second slice of that cheese (the masking slice) on top of the first slice cuts the number of openings considerably, but still not completely (though highly effective against any variant).

Add a third slice (the social distancing slice) and there is hardly a hole in the protection. Good air circulation is essential to social distancing.

Frequent hand washing helps.

This “targeted layered containment” concept is taken directly from Michael Lewis (2021). The Premonition (pp. 92-93). WW Norton.

* Covid has killed >5,000,000 people worldwide and the U.S. leads the world in recorded deaths and cases (800,000). Trump’s crime against humanity.

Mr. Natural says, “Take heed.”

We’re tired of this pandemic, but too bad; it’s not over. Here is one functional way to approach the coronavirus at this (omicron) stage of the game:

The vaccine + booster is like a slice of magical Swiss cheese laid on top of you. Pretty good protection (how effective against omicron is not yet known), but there are those holes, so the protection is incomplete. A second slice of that cheese (the masking slice) on top of the first slice cuts the number of openings considerably, but still not completely (though highly effective against any variant). Add a third slice (the physical distancing slice) and there is hardly a hole in the protection. Frequent hand washing helps. This “targeted layered containment” concept is taken directly from Michael Lewis (2021). The Premonition (pp. 92-93). WW Norton.

The virulence, transmissibility, and vaccine resistance of the omicron variant is unknown, but it seems to be a fast-mover and is a reminder to be as safe as possible. As with the currently predominant delta variant, it is likely that anyone, vaxed or unvaxed can be infected and can infect others.

Mr. Natural says, “Take heed.”