Bless your own damn bike.

This Sunday should be The Blessing of the Bikes at Vermont Lutheran Church. The minister is supposed to bless our bikes and we’re supposed to eat a pancake breakfast that can’t be beat, with the first taste of this year’s maple syrup, and mediocre church basement coffee.

Vermont Church

But there are no group rides, and there are no church basement breakfasts, and there are no crowds of bicyclists having their bikes blessed whether they believe in such things or not, because it’s a beautiful day for a bike ride and the road up to the church is great and the minister is a funny guy and the church members lay out a great spread.

And tonight should have been the first Wednesday Night Potluck of the season, which means Dave should have made his famous asparagus and I should have baked the first rhubarb pie of the season and we should have sat by the stone wall, sipping a beer and watching the sun set over my favorite stretch of road as we watch the last riders struggle up the hill on County F, our adopted highway.

But instead it was a solo ride, and I climbed that hill into a 20 mph wind with no leaves yet to block the wind or mar the view of the barren fields. And I got home just ahead of the rain and I drank wine with takeout Laotian food instead of beer at a picnic.

And it’s all because of this damn virus. And our State Supreme Court, in its Infinite Wisdom (and infinite is no different from nothing), has decided that the Safer at Home order is null and void, that the Director of Health and Human Services has no authority, and the state and all of its businesses are henceforth allowed to return to their pre-COVID state effective immediately, and we can gather in crowds as big as we want, and share that virus freely, because we are Americans and we are Free, and they trust business owners to Do the Right Thing because we know that business has our Best Interests at heart because what’s good for General Motors is what’s good for America and the god of quarterly profits must be appeased by human sacrifice and Give Me Liberty or Give Me a Virus that doesn’t really cause any symptoms and we only have 15 cases and that’ll be down to zero in a few days and when spring comes it will miraculously disappear and what’s a hundred thousand or so deaths among friends and we don’t need no stinkin’ rules.

The court ruled that the order wasn’t an order, it was a rule, and an unconstitutional rule at that; because this is Wisconsin and out constitution says we are “endowed with certain inalienable rights, and among those rights are the rights to life, liberty, and the pursuit of drunkenness in a crowded bar.” So folks bellied up to the bar in large numbers within hours and you can’t drink beer with a mask on so of course no one wore masks. I shouldn’t complain because crossing county lines to get drunk in bars is what makes my livelihood. I should be in those bars, making sure everybody has their keys and that they understand that the faster they drive the less their chances of getting caught by the cops for drunk driving. The trauma unit has been quiet the past two months.

But the county I live in decided to pass its own rule within hours, so we still have safeguards here. They just end at the county line, so like in the old movies where the bad guy just has to cross the county line to escape the cops, this virus just has to escape this county and is then free to wreak havoc but that’s okay because it’s all China’s fault so it doesn’t matter if we’re irresponsible because it’s all China’s fault.

Hero to goat

Today three of my patients discharged to hospice. Another died in the hospital. I saw one person with a broken arm and dislocated shoulder. Finally back in my element, I was able to help someone; someone who is going to go home, get outpatient therapy, get better, go back to work. This is what I like about trauma and orthopedics – I have useful skills to offer and my patients get better.

It was only a few days ago that hospital workers were being hailed as heroes. Now we are surplus labor. Due to the uncertainties of the novel coronavirus and questionable planning by senior management, I will soon be out of work. The press release said that senior management would take a temporary 20% pay cut, middle management 10%, and hourly workers would see no cut. A nurse manager informed me that the CEO’s salary is $1.7 million. I am unable to verify this. If that is correct, his reduced salary for 8 weeks will be less than $210,000 – how anyone can be expected to live on that, I don’t know. What didn’t make the press release hit the fan the next day – a 33% cut in hours for hourly employees, with a “choice” of how to take the hit. Two and a half weeks without pay in the next eight weeks. (An update referred to this as “non-requested time off”.) (Like everything else COVID-related in the hospital these days, this could be inaccurate by the time you read it.) If my retirement funds hadn’t taken such a hit this winter, it would be Johnny Paycheck time:

One of my co-workers said she came down with “anal glaucoma – I can’t see my ass working here anymore.” The hall monitors asked the usual: “Self-monitoring? Any new symptoms?” I said, “Yes, I’ve come down with new symptoms – a deep disappointment in, and resentment of, senior management.” She checked the list and said that wasn’t on the list of symptoms, so I could go to work. My daughter in law pointed out that this was actually an acute exacerbation of a pre-existing condition – “he’s been presenting with disappointment in and resentment of upper management for quite some time”.

Another Modest Proposal

President Trump announced his desire to study the effect of injecting or ingesting bleach, rubbing alcohol, or other disinfectants to treat COVID-19.

He may be onto something here; he just didn’t think it through all the way. In related news, hundreds of people crowded onto the state capitol grounds in Madison WI (as they have at other state capitols this week) to protest the governor’s “Safer at Home” order and call for the immediate “re-opening” of the state. This seems like a natural population on which to test my hypothesis.

What if, instead of treating COVID-19, we were able to prevent it? My hypothesis is that 100% of people treated prophylactically with injected bleach will not contract COVID-19.

We would first have to test all of the protesters to ensure that no one is already infected. That would rule them out of the study. We could divide the remaining protesters into an experimental group, to be injected with bleach, and a control group, to be injected with normal saline. We would then measure the rate of infection with COVID-19 after 2 weeks and after a month. I hypothesize that none of the experimental group will be found to have COVID-19 on either of those tests. [Editor’s note: the author further hypothesizes that none of this group will live to the first follow-up, and will die of other causes, but that is not the dependent variable we are studying here.] Granted, this is a convenience sample and not necessarily representative of the general population, but some might argue that is actually the beauty of it.

Mole Poblano

A couple years ago I mentioned a story for another time. That time is here, so here is another story from the past, this one in Mexico.

I was working for a low-income housing co-op in Santa Clara, CA. On the side I was the Northern California Director of APSNICA (Architects and Planners in Support of Nicaragua). I quit the co-op job so I could move to Nicaragua and work full time, where we were building housing on cooperatively-owned cattle ranches.

I knew my Spanish was too rusty to live and work there, so I stopped off in Mexico for a refresher course at Cuauhnahuac, where I had studied Spanish several years before. I had three weeks to get up to speed. I brought my APSNICA slideshow along. As a self-imposed final exam I would present my 45 minute program in Spanish to the school. I had done it dozens of times in English, but this would let me know if I was ready to live in another country and work in Spanish. (I passed. Since I made up the exam, I got to grade it.)

The school placed students with families so we would be exposed to the language for more than the 6 hours/day we would spend at school. I was placed with a family with several children. The whole family slept on the living room floor to free up the bedrooms for students. One of the kids had had polio when he was younger. At 14 he wore a metal and leather long leg brace, which he took off to play basketball. A hoop (or maybe it was a literal basket, I don’t recall) was nailed to a pole in the street outside their house. Bad leg and all, he beat me more than once. (He called the game “basket”, as in – ¿Quieres jugar basket? -[“Do you want to play basketball?”]- but when he scored, he yelled – ¡Canasta! -[“basket!”])

I had a roommate, who was soon to start medical school -coincidentally in my home town. He said he wanted to be a family practice doctor and wanted to work with low-income clients who were not native English speakers. He knew that med school would present temptations to go into lucrative specialties and he wanted an experience to anchor him so he could resist those temptations. He would spend a few months volunteering in a clinic in a tiny mountain town in Puebla (home of Mole Poblano). A stint at Cuauhnahuac was first on the agenda, so he could talk to his patients.

We became fast friends. I was initially impressed by the maturity of his plan. I quickly remembered what I was doing at that age and how offensive it was when people were impressed by my maturity. I kept my mouth shut.

I went off to Nicaragua and Ken went off to Zacapoaxtla. We agreed to meet and travel together when I finished work. In those days, the only communication available was snail mail. International mail traveled at a snail’s pace. I wrote to Ken with a plan and date that I could arrive. I didn’t hear back.

I took a series of buses to get to Zacapoaxtla. I was the only gringo around. I found a clinic but no one was around. I found a hotel. When I went into the restaurant across the street for dinner, I was asked if I had come to town to see Ken, there being no other reason they could imagine a gringo being there. I said yes and that I had gone to the clinic but couldn’t find him. She told me he didn’t work in this town, but in the next village up the road, Tatoxcac.

After breakfast the next day I started up a narrow road winding through the mountain. I kept passing others walking up the same road, only to have to pass them again later. I learned that there was a path that left the road at every switchback and cut straight through the woods. The walk back down the mountain was much faster.

I made it to the little clinic. It was open but empty. I wandered through and then back outside and saw someone waving to me. The doctor walked up and asked if I were Steve. She said Ken was out of town and would be back the next day. She asked where I was staying and we made a plan for Ken to meet me for breakfast at the restaurant across from my hotel (the one that already knew who I was).

We had breakfast and hatched a plan to conduct a Mole Poblano tour. We traveled by bus from town to town throughout the state of Puebla, eventually getting to Puebla (the capital) itself. We ate Mole in every town. We ate in restaurants big and small, more and less fancy. We concluded that the best Mole Poblano was in a little village where there was a large open courtyard with big picnic tables. Surrounding the courtyard were individual open-air kitchens under a corrugated tin roof held up by poles. Whichever one you sat nearest fed you. The one we chose had two items on the menu – pechuga (breast) and pierna (leg). Either was served in a clay bowl covered in sauce and accompanied by a stack of tortillas. If you ran out of sauce before you ran out of tortillas, they refilled your bowl (no more chicken, just the sauce – but that was the best part). If I dug out my journal I could probably name the town. I could maybe find that market if I found the town. That’s not the point. The point was that we had a really good time eating a lot of really good food and had a great tour of the state in the process. And if we did it again, we might find the best mole somewhere else.

Ken went on to med school, became a family practice doctor, married another family practice doctor, went to work for a community health center (interestingly, the one which took over the clinic where I had volunteered in the 70s), eventually became Medical Director, and is now the CEO. I think his plan worked.

Fraud

I watched the “One World: Together at Home” concert, with all of the artists recorded at home. I felt like a fraud. Everyone was lauding the heroic frontline healthcare workers risking their very lives. Yes, I’m a frontline healthcare worker. Maybe I’m in the second line. I dress funny nowadays, but mostly I just do my job. I don’t really do anything heroic. Maybe it’s like the old joke about the definition of a Yankee (the closer you get the more specific and nuanced the definition). Or the notion of a “war zone”. In the 1980s, many people in the US considered all of Central America to be a war zone. When you got to Central America, the war zone was in Nicaragua. When you got to Nicaragua, it was the Matalagalpa region. When you got to Matagalpa, it was out near Muy Muy and Matiguás. Where I worked, between Muy Muy and Matiguás, it was over the next ridge. I never saw the war zone.

I’m no hero. But it would be nice if the wall-mounted hand sanitizer dispensers actually had hand sanitizer in them. It would be nice if I hadn’t worn the same single-use mask for three weeks (and counting). It would be nice if I were allowed to wear an N-95 respirator if I saw a COVID-19+ patient – but those are reserved for the ICU and IMC patients. Since I work in an IMC (intermediate care center), I should be careful what I ask for.

Treason

This is not a word to be tossed around lightly. But Our Only President first asserted absolute power, then said that the authority rested in individual state governors, then tweeted LIBERATE MICHIGAN, where he doesn’t like the governor and where a shelter in place order is active. I don’t know about you, but I remember a lot of National Liberation Fronts. The point of that word was to overthrow the existing government. So when Trump tweets that we should “liberate” a state (Michigan isn’t the only one, and your state may be next) at a time when a demonstration has been called in that state (and who is organizing and funding those demonstrations?) we all know what he means. Sure, he can hide behind the words and claim he just wants to ensure our constitutional freedoms, but we all know what that word means.

Think about that. We have a president advocating for the overthrow of government – not the federal government, but individual states. He may not be technically committing treason, since he’s not advocating nor attempting to implement the overthrow of the US government; but he is advocating for the overthrow of governments within this country and there is news that funding is coming from people within his government, if not from him personally. We have a president who claimed absolute authority. Then he realized that absolute authority is accompanied by absolute responsibility. Since he has already said, “I don’t take responsibility at all”, he may have figured out that he didn’t really want that authority, as he has spent his career blaming others for his failings. As soon as he relinquished that authority, he began attacking those who took it on.

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.

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.