Dear Curtis

I was thinking about the last time I saw you. You pulled up in front of my hotel in Santa Monica with the Merlin and the Bike Friday in the car. We rode down to Manhattan Beach, then back up to Santa Monica, where we froze while eating at a sidewalk cafe. Los Angelenos have this thing about hanging out outside, even being in a desert where it’s freezing as soon as the sun goes down. Not to mention that we were in sweaty bike clothes. Neither of us knew you would die before we ever saw each other again. It was a good last visit. I remember the ride, but not what we ate.

• 

• 

Merlin image from Bicycle Czar, Bike Friday from Bike Friday

I was in town for a workshop led by Dr. Roy Meals (see “About Bone” in “blogroll”.) I’m back in touch with him and he makes me remember you. By the way, while I enjoyed the chance to ride the Bike Friday, the Merlin was one of my dream bikes and I secretly wanted to ride it.

I was living in San Francisco during the last great plague. I lost my boss and my job to that one. It was hard to see Jim wasting away. The last time I saw him, he was blotchy with Kaposi’s Sarcoma and barely clinging to life.

So now we have another plague. This one kills a lot faster, but kills a lot fewer of its victims. When the 1980s plague hit, we weren’t sure how it spread and people tended to avoid each other (or at least certain others) until we knew. This one requires that we avoid each other because it spreads so easily. But like that other one, we’re still learning. We were first told it spread only through droplets and not aerosols. Oops, turns out that was wrong and it can hang in the air longer than we thought. Turns out the virus can live on surfaces long after the droplets have dried.

When you got a cellphone and started calling me on Mondays, we stopped writing letters. I missed that. Since I don’t have your phone number in the afterlife (nor do I know that there is an afterlife), I’m back to writing letters to you. In the children’s book “The Mole Family’s Christmas” (by Lillian and Russell Hoban), Delver Mole decides to write a letter to Santa. He doesn’t know where to reach him, but knows that Santa comes from up, so he decides to send the letter up. In the same vein, I don’t know where to send this, so it’s going to the internet, the 2020 version of up. If you want to hear the story, I recorded it on a CD for my nieces, since they were blind and unable to read. (My kids also got copies, even though I could read to them in real life.) I could maybe send it to you via the internet. The CD also contains my all-time favorite read-aloud story, “Little Tricker the Squirrel Meets Big Double the Bear” by Ken Kesey (yes, that Ken Kesey).

This plague has gone viral. It spread worldwide in less than three months. As of April 2, there were only 18 countries not yet reporting confirmed cases. Does that mean they don’t have the disease? Or that they don’t have testing? “Confirmed cases” is an interesting concept. Since we can’t test everybody, and it is cold and flu season as well as allergy season, we don’t know who has this disease. Some people have suspicious symptoms and don’t get tested. Some people have suspicious symptoms and tested negative (but the false negative rate has been reported as increasing with each day after onset, and ~30% on day ten for nasal swabs per Wikramaratna, et al [worse for throat swabs].) Dr Gary Procop of the Cleveland Clinic calls false positives extremely unlikely. We could talk about Sensitivity and Specificity and Odds Ratios and the like, but overall we lack data to draw any strong conclusions about the tests we have.

There is some reluctance to test, as that would show more people with the disease and possibly lead to greater panic. Criteria for testing vary – my PCP said I didn’t meet criteria, my Employee Health Department said I did. So we don’t know a lot. When people die during the pandemic, but have not been tested, they are not identified as having died from COVID-19. We don’t use up test kits on the dead. If people are getting better, we don’t test them. If people are surviving at home we don’t test them, as bringing them in to testing centers risks spreading the disease.

So every day we see charts with logarithmic curves of the increase in cases; and those curves surely underestimate the numbers. We see daily numbers, not rounded, which makes us think there is a level of precision which is not actually there. Despite that, we’ve crossed the ½ million threshold in the US and are approaching the 2 million mark worldwide. We’re over 100,000 deaths. All of these numbers will be higher by the time you see this.

We’ve lost famous people and unknown people. I’ve already written about John Prine and embedded several of his songs. I read this tribute today and it made me cry again. It contains a link to Roger Ebert’s review of Prine from 1970.

Much of the world is in some level of quarantine. We don’t like to use that word, so here it is called “Safer at Home”. Only “essential” businesses are open. That means I go to work (hospitals are essential). Grocery stores are essential; though I used to go to the corner store almost daily and I’ve been there once this month. When I go to the co-op, I drop >$150 at a time so I can minimize the number of shopping trips. Restaurants are not essential, but can sell take out. Most of them have “no contact” pick up methods. They set the food outside and you pick it up. Pizza places have “no contact” delivery. They call to tell you when they are leaving it on your doorstep and you pick it up after they leave – same with Meals on Wheels. In some states, gun shops are considered essential. I don’t even want to comment on that. It is like living in a Twilight Zone episode.

Our only president likes to call this the “Chinese Virus” (and he has this weird way of saying “China” – it almost sounds like he wants to say “vagina”, like Austin Powers talking about his character “Alotta Fagina” (itself a parody of a James Bond character name).

https://ytcropper.com/cropped/7z5e94cf0b09b7c

https://ytcropper.com/cropped/c65e94cfb8cd252

Were you still around and not sheltering in place, you would get to see American racism first hand again. Folks would blame you for this disease, even though you were born and raised in L.A.

I don’t remember if I’ve told you about the president. He inherited a real estate fortune and frittered it away. He may be the only person who managed to lose money running a casino. He has declared bankruptcy for more businesses than most business owners will ever own. He was the star of a reality TV show with the catchphrase “You’re fired!” He likes that phrase so much that he regularly fires cabinet members, press secretaries, and other senior officials. He uses Twitter to do it. Almost all in his administration have the word “Acting” in front of their titles. You can’t make this shit up.

By the way, the rest of you can read this. Curtis was a friend in LA; the last person with whom I kept up a snail mail correspondence. Since he’s not around to read my letters, that falls to the rest of you. Since he’s no longer on earth, I’ve explained a few things that may be obvious to the living. Another letter to him can be found here.

Stop that train!

The Death Ride (billed as Death Ride Resurgence this year for the 40th anniversary) has been canceled. They said “postponed”, but for an annual event to be postponed for a year sounds a lot like canceled to me. So I don’t need to train for it, I can just ride. I am scheduled to ride a century in September, but that’s now a long way off and it is not at high elevation. If anyone needs a room in a mountain inn in July, let me know.

My workplace is incredibly supportive in this time of stress. In the lobby today, I saw these words of inspiration:

While we’re being inspired, and have no place to go, how about some more entertainment? Cab Calloway defines cool. The Nicholas Brothers have moves that would hurt just to watch, if they didn’t make them look so easy. If you’ve never seen this, you must. If you have, it’s time to see it again.

I love watching the tenor player

The Fleischer Brothers taught the world a lot about animation. Their animated Calloway is almost as smooth as the real thing.

Calloway’s moves might remind you of someone 50 years later.

Louis Jordan may also remind you of stuff you saw decades later that you thought was ground-breaking at the time.

So that’s it for today. No words of wisdom, no tales of epic rides, just some artists from the past that you oughta know about if you don’t and you need to revisit if you do.

Embarrassment

I’m embarrassed to be from Wisconsin.

I was once proud of my home state. Wisconsin, admitted to the union in 1848, abolished the death penalty in 1853. Milwaukee was run by the “Sewer Socialists” virtually from 1910 to 1960, and was one of the most well-run cities in the US as a result. Infrastructure was built and the city was maintained. The Progressive Party rose to prominence under the leadership of Robert M “Fighting Bob” LaFollette, who founded The Progressive magazine in 1910. That magazine is still published in Madison to this day. Superior WI was, arguably, the center of the Consumer Co-operative movement in the 1920s and we have long been a center for farming cooperatives and banking cooperatives (credit unions), housing the world headquarters of the credit union movement; AFSCME (The American Federation of State, County, and Municipal Employees) was founded here in 1932.

Senator Gaylord Nelson was the driving force behind Earth Day in 1970. Russ Feingold was the only US Senator with the sense and the courage to vote against the USA PATRIOT Act, recognizing its dangerous attack on civil liberties. (Among other things, it required libraries to turn over the borrowing records of patrons, and then lie if asked if they did so. As a result, our mayor ordered our library system to destroy all records as soon as books were returned, so if the FBI came looking, there would be no records to turn over.)

But we are now the laughingstock of the nation, if not the world. In 2010 we elected one of the least-qualified governors ever to serve. In 2011, he pushed through Wisconsin Act 10, which effectively ended collective bargaining for most public employees (and explicitly ended it for employees of the state’s largest hospital). Had the Democratic State Senators not left the state, the law would have been passed less than a week after its introduction, before anyone knew what it contained, and with no debate.

He survived a recall election and established the blueprint for the least-qualified president the US has ever seen, a man who similarly survived impeachment. I will simply call them “They Who Must Not Be Named”.

And now we have become the only state stupid enough to hold an election at the height of this pandemic; the only state to hold an April election. A special session of the state legislature to consider delaying the election was gaveled in and out of session within seconds. While we are under a “safer at home” order, in which all but the most essential activities are actively discouraged, we held an election.

Granted, one can (and should) consider an election an essential activity, though time was not of the essence in the way that it is while securing food. An attempt to change the election to all-absentee was quickly shot down. The US Supreme Court intervened to prevent an extension of the deadline to mail in ballots. Mind you, many who requested ballots before the deadline did not receive them by Election Day and were therefore disenfranchised unless they chose to risk infection by going to the polls after requesting absentee ballots (the requesting of which was strongly encouraged by local governments). Absentee ballots require a witness’ signature. An Executive Order waived that requirement, as the governor recognized that a person living alone and sheltering in place can’t get a witness. After ballots were submitted, the Sate Supreme Court struck down that ruling, nullifying those ballots – but since the ballots had been cast, it was illegal for those voters to vote again in person, even if they were willing to risk going out.

The city of Milwaukee was so short of poll workers that they opened 5 of 180 polling places. Lines extended for blocks. A chart was published by NPR noting the anticipated peak of COVID-19 deaths in each state. At the time, Wisconsin’s peak was expected to be April 15. Will we now have to plan for a second surge from the community spread resulting from the election? We won’t know for a week if we set a record for low turnout

Voter suppression is well-known to help Republicans. Donald Trump has even warned that Democrats want so many people to vote that, if they prevail, we’ll never elect a Republican again. Think about that. He says his party’s only hope to stay in power is voter suppression. Democracy is to be avoided at all costs. We knew that, based on the ALEC-written voter suppression legislation passed in state after state, but he said it out loud.

Regardless of the outcome, there are bound to be lawsuits. One of the statewide measures was the election of a Supreme Court justice. The incumbent was appointed by He Who Must Not Be Named. His judicial philosophy could be summed up in his opinion that slavery and affirmative action are morally the same. If the conservative justice is elected and the election contested, will the Supreme Court step in to uphold the result to save its own? Will he recuse himself, or vote to uphold his own election? There are no recusal rules nor written code of ethics to guide the State Supreme Court. There is such a code for all other judges in Wisconsin, but the Supreme Court justices are allowed to decide for themselves. They are above all that, apparently.

So now you see why my pride has changed to embarrassment.

Here’s what the cool kids are wearing these days; at least those who work in hospitals. Shopping for groceries after work today was a lot like work – gloves and mask, just no face shield. Awareness of where your hands have been is paramount. Driving to work (so I could use the car to shop) I found myself reacting emotionally to the various COVID-19 stories on the news. Preparing for “the surge” is stressful, but others are actually facing death. It took another shot of John Prine to make me realize…

I don’t have it so bad.

What’s the score?

My local newspaper (the handling of which is deemed a low-risk vector for infection) interviewed a medical ethicist (whose work I know and respect) about the allocation of resources in a time of scarcity.

In other words, if there aren’t enough ventilators to go around, who gets one? How do we decide? I suddenly feel old. My mind totes up the score. I’m over 65. That’s bad. I rode my bike across the country at 65. That’s good. I have asthma. That’s bad. My asthma is well-controlled; requiring no medication in years except for once last month. That’s good. I work in health care. That’s good, for being someone who should be saved. That’s bad, for being someone who can stay home and stay well. I’m not just resting on my laurels as someone who rode across the country a couple of years ago. I rode the Horribly Hilly Hundreds last last year and am scheduled to ride the Death Ride this year. That’s good, isn’t it?

In other words, I don’t want to die yet. Most of us don’t. While I accept death as part of life and as something that will happen to me, not just everybody else, I don’t want it to be now, as part of this pandemic.

But this keeping score is scary. I don’t want to think about whether I deserve to live more than someone else. What’s the difference between a person with diabetes, coronary artery disease, and COPD; and a healthy person with no chronic diseases, but paraplegia? What about someone with quadriplegia who already uses a ventilator? Disability is not the same as chronic illness. Living with one or the other is not the same as dying.

There is a disability rights movement called Not Dead Yet. They have grappled with these questions for years. Their website contains a link to a paper from the Disability Rights and Education Fund addressing the question of rationing care. Not Dead Yet lists two primary goals: 1) opposing the legalization of assisted suicide and; 2) ensuring that withholding or withdrawal of life-support is truly voluntary.

On the other side of the assisted suicide debate are Death With Dignity and the Hemlock Society (which no longer exists. The death of the organization is chronicled by its founder here). They look at the notion of being able to choose the time and manner of our own death if we have a terminal condition. Not Dead Yet is concerned about the slippery slope of assisted suicide becoming euthanasia, and about the idea that some have more right to live than others.

While these questions are separate, they are often seen as intertwined. By “these questions”, I mean: 1) prioritizing care, 2) assisted suicide, and 3) euthanasia. Peter Ralston talks about the word “confused” as “fused with” (“con” from the Latin word for “with”, and “fuse” “to blend as if by melting together”). While I find no evidence that this is the literal root of the word, it is useful, when we are confused, to see if we are melting together things that we could tease apart and look at separately.

“I can’t think for you, you’ll have to decide…”

Some questions are easy to answer. If the disease has a choice between taking me or taking one of my kids, take me. I may have more to offer the world, but not as much as they do, with potentially 40 more years to do it in than I have.

Some questions already have rubrics. We have a scoring system in place to decide who gets a new liver when one becomes available. We may not always like the outcome, but it seems to work. In the same way, ethicists can design a rubric to decide who gets the ICU bed or the ventilator. We just don’t have the luxury of time in which to figure it out.

“Cross contamination” – what does that look like? Check out this Facebook video.

This is even better if you listen without watching.

Since I had trouble finding his name, I want it out there: J-L Cauvin.

Exile

My wife works from home. As her work is confidential and involves talking, I am exiled for the day. I was forced to go for a long bike ride. A popular route since I was on training wheels is to the town park in Paoli. Usually I refill my water bottles there. Not today. I wasn’t going to since I didn’t have a way to disinfect the handle, but that wasn’t an option.

The pump don’t work cuz the vandals took the handles.

The handle may have been removed to prevent spread of infection

Social distancing was easy. There was no one out there. I rode past a bunch of loons out on the lake. They are also adept at social distancing. Ducks hang out in groups, but loons are introverts. Only once did I see two close enough to get them in the same frame. After the ride, I went home to get the “real” camera and went back to take pictures. Loons are wily. They dive to hunt and may pop up anywhere. They tended to stay away from me when I had the camera out. If I quietly moved down the path to get closer, one would pop up in the spot I just left. If I focused on one in the distance, another would pop up right below me. After I put the camera away, I swear one popped up directly below me and looked me in the eye.

Social distancing is easy when there’s no one out there.