Tonight (Friday) is awards night at Cycle America. Each week we have the opportunity to present an award to a fellow rider. I wrote the “script” and today I found and made the physical award. But the ceremony will go on without me. The meeting about tomorrow’s ride will go on without me. I am eating dinner sitting on the ground outside my tent. Amendment: they moved the meeting outside (for me? to mitigate COVID risk in general?) Tomorrow would be century #4 for the week. My bike will ride on the roof of a van and I will ride, masked, with the Trail Boss in that van. I was able to present The Dread Pirate Roberts award to a rider whose strengths, like those of The Dread Pirate Roberts, are myriad. While he may seem intimidating, he is a hero. He stopped by my tent and offered to pace me all day. I’m not young and stupid enough to accept, risking the rest of my summer for one day.

I know I have a friend here…the one who brought me dinner. I know she’s not the only one. I am writing through tears. The tears and accompanying snot are contaminated. Tomorrow we ride to Missoula, MT for a rest day. It is a hard 100 miles. I will be riding it in a van. I won’t be staying in the dorm with the other riders unless Greg finds a spare room for me to occupy alone. I will probably spend the rest day in a hotel, ordering room service or takeout. Can I do laundry? Addendum: turns out I can stay in the dorm and share a room with another COVID + rider.

I rode EFI (every fucking inch) in 2018. There is nothing to prove. I can take some solace in the fact that I climbed a mountain pass with COVID-19 and that I kept up with a 24 mph paceline. I have the sense to realize that riding tomorrow would risk the rest of the trip. If I take two days off, I may be able to get back on the bike next week, depending on how much this knocks the stuffing out of me.

Greg offered the option of flying home – ending my trip, or flying home and coming back later, or spending a week in a Missoula motel and catching up with them. Or I can take two days off and see how I feel. I’ll take door #4.

I knew this was a risk. I haven’t been maskless indoors with anyone other than my immediately family since February, 2020. I got through multiple tours of duty on the COVID units of the hospital – but I was always protected. I have a large supply of N-95 masks with me. The supply looks smaller now that I have COVID. Early in the pandemic I wore masks for weeks after airing them out overnight. I’m not sure I want to do that with masks contaminated on the inside.

Yeah, I feel sorry for myself. Yeah, I’ll survive this…at least I plan to.

(Saturday) I’m waiting for dinner to be delivered and will go to bed soon after, as I never got a nap today. The restaurant delivers beer so I will drink a toast to the MGHS class of 1971, celebrating a COVID-delayed 50th reunion. I hope they don’t spread COVID among them. It’s not fun. It takes (and took) only one selfish and inconsiderate person to create a superspreader event. I verified with that person that they are the source. They didn’t say so in so many words, but made it crystal clear. They didn’t seem concerned, but are going home today. I am expecting a rolling infection through our ranks. People are taking more precautions now, but it may be too late.

After a frustratingly long day dealing with the healthcare system, I received my antiviral medication at a local drugstore 10 minutes before closing time. I just took the first dose. The nurse I spoke with also recommended multiple supplements. The anti-viral drug was free. The supplements cost $65. It took a half hour to walk there and an hour to walk back.

I saw the innards of Cycle America as I rode in the COVID van with the Trail Boss. We were the last to leave our overnight stop and we picked up the first water stop after verifying that everyone had passed through. The person riding shotgun checked off each rider as we passed them – we also check in at lunchtime and the end of the day. Watching scenery was, in some ways, easier, as we didn’t have to keep our eyes on the road. The river was running high and fast.

Tomorrow (Sunday) I rest. See you down the road.

I am in a dorm on a university campus. Ironically, this is the worst internet and cell service yet. The post failed to upload overnight. Maybe it will at some random time today.

Guinness vs Bartlett

Once there was an employer that provided annual “Employee Appreciation” gifts. At first, these were items such as camp chairs, Thermos bottles, fanny packs, coolers. Then a new sheriff (CEO) came to town. Before she eliminated those gifts entirely, the last one was a tiny leatherette notebook with an equally tiny pen.

Unsure what to make of this, one employee used hers to record quotations (hence Bartlett) from patients. Alas, the book was lost to posterity in one of our numerous office moves. (In our latest office move, we are each allotted 32 inches of desk space – so much for social distancing – as we sit shoulder-to-shoulder and back-to-back along a series of long tables, facing a wall in a windowless room, that make us look like telemarketers in a call center.) Lest it sound like we are making fun of patients, we will provide herein a couple of quotations from doctors – eminently better to make fun of…but are we making fun of them, or celebrating their wisdom?

An attending physician, known to be tough on her residents, once told the assembled group, “There is no ‘I’ in team – but there are three ‘U’s in Shut the fuck up!”

A patient had been in the hospital for weeks with complex abdominal injuries. His nurses knew his needs and his day-to-day changes. An overnight resident became alarmed and ordered a barrage of unnecessary tests in a CYA move. The next day a senior resident, letting him know the importance of asking the experienced nurses for input first, said, “Just because you’re smart doesn’t mean you can’t be a fucking idiot!”

A surgeon friend was invited to join a sewing circle. She was told it was a fun group, they met in a bar, it would be low-key. She agreed to check it out. She went to a meeting and they asked her to introduce herself and say a few words about her sewing experience. She said, “I don’t have any experience sewing, except with flesh.”

Guinness is famous for his book of World Records. We keep informal records in our heads. The legal limit for blood alcohol level in most states is 0.08%. Evidence of impairment has been shown at 0.03%. We have had drivers come in at >0.50%, or more than six times the legal limit – a level that would be fatal for most of us, and a level that requires some serious training to reach without dying. These were no amateurs. [We normally measure alcohol intake in terms of “standard drinks”. This would mean 12 oz beer, 5 oz wine, or 1.5 oz hard liquor – these are estimates, as not all beer is 5% alcohol, not all wine is 12%, not all hard liquor is 80 proof. I have met drinkers who measure their intake by the “handle”. A “handle” is a 1.75 liter bottle – so named because of the handy handle to make pouring easier. I guess you could say “A handle a day keeps withdrawal at bay.”]

from (images are not to scale)

The human bladder holds an average of 500 ml. A patient who was unable to urinate on his own had a catheter placed which immediately drained 2.5 liters (more than a giant Coke bottle).

A normal blood glucose level is around 100 mg/dL. I have seen from the teens to over 1000.

A human normally has 24 ribs – there are a few variations. Some will have cervical ribs @C7, some will have lumbar ribs @ L1, some will lack a rib at one end (T1) or the other (T12). Most of us have 24. Flagel, et al (Surgery, 2005) found that “half-a-dozen ribs” are “the breakpoint for mortality”. In other words, if you break 6 or more ribs you are at significant risk for serious complications. (Four in the elderly, per a subsequent paper.) I saw someone who broke 22 of them and survived.

And finally, we can’t talk about healthcare without talking about COVID-19 and profit. While we’d like to think that vaccine development was a humongous humanitarian venture, the truth is a bit murkier. When it was suggested that the vaccine “recipe” be shared widely to enable faster and cheaper production, Pfizer CEO Albert Bourla called that “dangerous nonsense”. (He will make $24 million this year – a 16% raise over 2021, which was a 17% raise over 2019. [Ed. note: That sounds like dangerous nonsense to me.]) BioNTech (co-producer with Pfizer of their vaccine) forecasts a 2021 profit margin of 77%, while Moderna’s profit margin was 70% for the first nine months of the year (figures from Oxfam). The lowest estimate for profit from the vaccine seems to be in the neighborhood of 30%. (Compare this with the average grocery store profit margin of 2%.) The British Medical Journal (Hawksbee, et al, 2022) found that drug company profits have consistently surpassed other market sectors for the past 70 years, and have jumped during this century. Vaccine sales have largely gone to developed countries, the ones that can afford the high price tag, while less-developed countries have lower vaccination rates.

And so, I enter my last week of work. Is healthcare a basic human right, or the most lucrative profit center? (1)

Say Goodnight Dick.

Before embarking on my soon-to-end career, I took a course called “Labor in Literature and the Arts”. For that course I wrote a series of poems about work (including delivering newspapers, selling concessions at football games, driving cab, plumbing). After several years working in healthcare, I realized I had not yet written about that endeavor. I decided to do something about it.

Fast forward a dozen years. I was looking for some old photos on a seldom-used hard drive. I came across some poems about health care that I’d forgotten about. I’ll reprint some here so that you can forget about them, too.


Surgery is better than medicine.
That’s why surgeons get paid more than physicians.
If I give you a medication,
You have to keep taking it.
But if I cut something out of you,
It’s gone forever.
But then maybe you’ll have to take
Some medication.

I used to be a plumber.
I could be a vascular surgeon.
It’s the same work,
But it pays better.
It’s usually cleaner
And doesn’t smell as much,
But that’s not always true.

I can use a snake to clear a clog
But in your arteries we give it a different name.
I can replace your pipes
And if I were a surgeon I wouldn’t even have to
Know how to solder.

I used to be carpenter
But now I’m an orthopedic surgeon.
The tools are pretty much the same
But smaller and prettier.
I love stainless steel and titanium.
The work is still the same
But I get more respect.
I get paid ten times as much
And no one complains about the bill –
Not to me, anyway;
No one wonders if I’m worth that much.
No one complains about the materials cost
And asks me if I could use something cheaper.
No one tells me they can get a hip for less at Menard’s
And asks me if I can install that one and only charge for labor.

Alphabet Soup

There is a poem waiting to be written
But I don’t know how to write it.
I’ve been in this hospital for ten years.
There are stories to tell
But I still don’t know how to tell them.

You come in with a medical history written in code.
The we ask you what’s wrong
And make a diagnosis.
Diagnosis means telling you what you just told me,
but saying it in Greek and Latin.
Just because I can recite your symptoms in another language
I get paid in 6 figures. 
Well, not me
But someone like me.

We still don’t know how to fix it.
We can give you some drugs.
They’ll make some of the symptoms better
But only as long as you keep taking them.
The drugs will cause some other symptoms
But we have a drug for that.

We don’t use the word “drug”.
That’s how you know I’m not really a doctor.
If I were a doctor I would have said
Drugs are what you take.
Medications are what we give you.


Bare Necessities

Growing up, I was taught that the necessities of life were food, clothing, and shelter. Going to work, I found those definitions changing. This is another story alluded to in an old post – “a story for another time”. Here we are, in another time.

So what are the bare necessities in my book, and how did I find them? My first full time job was in a restaurant – preparing food for people. My first “career” was in a grocery co-operative – providing basic food via the Willy Street Co-op. I was pretty sure food counted as a basic need.

After 10 years I left the co-op and moved to Northern California, where I was Maintenance Director (then Financial Manager and General Manager) of the Twin Pines Co-operative Community, a community of 79 families that jointly owned an 80-unit low-income housing co-operative (the 80th unit was a rental reserved for an employee and I was the sole renter for part of my time there). I learned that the Silicon Valley was not filled with Yuppies. Before it became the Silicon Valley, the Santa Clara Valley was The Valley of Heart’s Delight, a vast area of fruit orchards. Now I knew why the supply of apricots had dried up back when I was in the grocery biz – the orchards were being ripped out for factories, office buildings, and housing. (The apricot supply has since recovered somewhat.) There were people who worked in those factories and were the secretaries in those offices and who fixed the fancy cars of those over-priced engineers. They were the people I worked for, and they needed a place to live. Yup, housing made my list.

I’d always had a side job or two. While at Willy Street I was a volunteer programmer at WORT-FM, a listener-sponsored community radio station. I was a patient advocate at the Near East Side Community Health Center, and I was the local representative of FLOC (the Farm Labor Organizing Committee, a farmworkers union started in the tomato fields of Ohio – they later merged with the UFW). In California my side job involved co-operative housing in Nicaragua.

In Nicaragua I found that the Matagalpa River (where we cleaned up after a work day) was also where everyone did their laundry and drew their drinking water, as well as where towns discharged their raw sewage. We found a mountain spring, had the water tested, built a dam and a pipeline, and supplied pure water to the houses we were building. (Fred Colgan deserves the lion’s share of the credit for that.) While we weren’t big enough to set up a sewage treatment program, we dug outhouses so sewage from our little community would not go straight to the river.

When my second visa expired I moved to San Francisco and became a plumber (after a side trip for the Mole Poblano tour, o quiere decir La Vuelta de Mole Poblano). It was pretty clear that clean water and sewage treatment made the list of bare necessities, so I made my living doing that. I mostly did residential service work, but also some remodeling and work in bars and restaurants. I used to tell people that my job involved hanging out in gay bars at 9 o’clock in the morning.

Life being what it is (and a story that I probably won’t bother telling here unless shelter in place lasts a really long time), my plumbing career came to an end. I became a college student and then an occupational therapist. Before I became a patient, I had never heard of occupational therapy. My sister (a Speech and Language Pathologist) defined occupational therapists as the people who come up with a simple commonsense solution to a problem; a solution that seems obvious in retrospect. Then she’d realize that she hadn’t though of it. When people ask me what the difference between a physical and an occupational therapist is, I sometimes say the PT’s job is to make sure you can move around, and my job is to make sure you can do all the things you want to move around for. It is a job that varies widely depending on the setting you are working in; and the lines between what I do and what my PT partner does are sometimes pretty blurry. (If you really want to know the gritty details, I have a 13 hour online course for you. Someday I may be able to do it live again.)

I saw firsthand how much access to healthcare depends on money, and how the US, unlike most industrialized countries, lacks a healthcare system. (I work in a hospital that provides care to all regardless of ability to pay – but that doesn’t mean they don’t get billed later, and it clearly affects the care they get after discharge.) Other countries have a healthcare system. We have an insurance system. Healthcare was now clearly on my list of bare necessities.

A common thread running through these, and made clear by our shelter at home situation, is community. I realized I had found my personal definition of the bare necessities: food, housing, water and sewer, healthcare, and community. I hope my list is complete because I’m closer to 70 than to 60 and I probably don’t want to start another career now. I’d like to pretend I had the forethought 50 years ago to build a life based on the necessities and pretend that my life and career trajectory was planned. Never mind, I don’t even want to pretend that. This was a case of going where life led me, then looking back and seeing what the path looks like. Or, as Robert Hunter said:

There is a road, no simple highway, between the dawn and the dark of night…

Le Tour de France/La Vuelta a España/Il Giro d’Italia

The French tour has been postponed and is now scheduled from 29 August to 20 September. The Spanish tour is still scheduled from 14 August to 6 September, but there is talk of moving it to the fall. The Italian tour is being run in a virtual format and the real version may be moved to late fall. The World Championship is also scheduled in the same timeframe as the rescheduled tours.

I think the only answer to scheduling anything right now is “Who knows?” I know of one cycling event scheduled for June that is still scheduled and another in July that has already been canceled.

Stay safe out there…ride alone and enjoy the scenery.