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.

Shorts!

Today was the first day warm enough to ride in shorts. Wednesday was the first Wednesday Night Bike ride of the season. In 26 miles I saw 12 other riders – 6 going the other way on the road I was on (scattered over the 26 miles) and 6 seen in the distance on other roads. Social distancing seemed to work here. There were those who chastised the organization for not canceling its rides. Being a rather anarchic organization, they decided to trust us to do what is right. I think we did pretty well.

On Thursday I rode with two friends. They made me ride behind them, 10 feet downwind at all times. Since I work in a hospital and they are sheltering in place, they figured they had a better chance of catching it from me than vice-versa. A reasonable thought, even if I wear a mask and face shield at work, wear scrubs that get carried home in a sealed bag and washed separately from all other clothes, and wipe down door handles, Purell dispensers, the time clock, keyboards, refrigerator and microwave doors, stair railings, flush levers on toilets…several times per day at work. A housekeeper told me we ran out of the Purell that comes in bags to go into wall dispensers. The homemade stuff from the hospital pharmacy is too thin to go in there. I suggested we thicken it with cornstarch. He was amused but didn’t think it would work. I suggested a wine reduction sauce. He didn’t think that would work, either. The trouble with alcohol without aloe or other moisturizers is that it dries your skin, leading to cracking and openings for icky stuff (that’s the broad scientific term for bacteria, viruses, molds, and fungi) to enter the body; in other words, an opportunity to make things worse instead of better.

I spent the afternoon in a recorded webinar about therapy with COVID-19 patients. It helped to convince me not to volunteer, being a frail old man with asthma and therefore susceptible to unfavorable outcomes like death. A major focus was on seeing the non-COVID patients more often than we usually would, to help them recover faster and discharge home instead of to a rehab center where they are once again at risk. Each morning I pass through a gantlet of nursing staff to show my ID and assure them that I have been self-monitoring and I have no new symptoms.

This will be my first 100+ mile week since before surgery. The coots and loons are in town, a brief stopover on their semi-annual commute. I saw an egret today. The robins and redwing blackbirds are back in large numbers. I saw 11 hammocks hanging over the lawns behind the Lakeshore Dorms this afternoon – I thought the dorms were closed and the students all gone – but this must be where they are housing the students who have nowhere else to go.

Bike by Bill Davidson, photo and 30 years of miles by Half-fast Cycling Club

In honor of my bikes turning 30 this year, I’ve been riding the old and trusty steel steeds and the carbon fiber bike has remained hanging in the basement. The Bruce Gordon is seeing heavy commuting duty and a couple of rides in the countryside. The Davidson came off the trainer and has accompanied me for the past two days and 60 or so miles.

Better Safe than Sorry?

Relations between people on bikes and people in cars are frequently strained, even though most adults who ride bikes also drive cars. What is that about, and what can we do?

Maynard Hershon is a writer about bicycles and motorcycles. Back in the 80s he wrote an essay for the California Bicyclist which changed the way I ride. I haven’t been able to relocate that essay, but I’ll put my own spin on what I remember of/learned from that essay and what I’ve learned in the intervening years.

When someone in a car cuts you off when you’re driving, you think, “What an @sshole!” When a bicyclist rolls through a stop sign when you’re driving, you think, “Those d@mn bikers!” What does that mean about us? First, we notice aberrations, not the norm. We don’t pay any attention to people doing what is expected of them. We pay attention when they don’t do that. Like the kid in class who never raises his/her hand is never noticed, but the kid who acts up get attention. So we don’t really notice all the cars that don’t cut us off and all the bikes that stop at stop signs. (And here someone is thinking, “no bikes stop at stop signs.”)

But there is something else going on here. We live in a car-centric society. Without consciously realizing it, we consider the driver of a car to be an individual, because driving cars is what we do. We consider the operator of a bicycle to be representative of a class, because that’s what they do. I can speed in my car, and I’m just an individual @sshole, but if I roll through a red light on a bike, I’m one of them, and they never stop at red lights.

But, guess what? Someone has studied this. Dave Schlabowski , former manager of the Neighborhood Traffic Safety Program in Milwaukee, has wrtten extensively on the topic. He notes that “people riding bikes are more law-abiding than people driving cars.” Dave has revisited this topic and found a high incidence of speeding by motorists. How many people actually drive at or below 25 mph in a 25 mph zone? Not many. He cites another study (which I can’t find right now) that indicated that people tend to break laws that are convenient for them to break and where the consequences are minimal. Thus speed limit laws seem to be the least followed by motorists who break the law, and stop signals are the least obeyed by bicyclists who break the law. In Idaho, the law allows bicyclists to treat stops signs as yield signs and red lights as stop signs.

Version 2
Spring is coming late this year. This is all that’s blooming in my yard so far. Something was needed to break up all this text. Good thing I got the photo when I did. This crocus is now buried under 4 inches of snow.

Back to Maynard: the essence of his essay was that, if we are going to be seen as representing a class when we ride bikes, we should represent ourselves the way we want to be seen. Before I read that essay, I rolled through stop signs and went through red lights when there was no traffic. I didn’t know about the “Idaho stop” at that time. Now I make it a point to stop and, especially, to signal my intention and then stop and yield to pedestrians in crosswalks. I’ve been known to move a bit to the left to make it harder for a motorist to blow by me and through the crosswalk. I’m still amazed by how many pedestrians are surprised to see a vehicle obey the law and yield the right of way to them.

My daughter makes a joke that no one seems to get. “Question: What do you call it when you kill someone?” Answer: Murder. Question: What do you call it when you kill a bicyclist with your car? Answer: An accident.” It isn’t funny, but it does appear that if you want to kill someone, that’s the best way to get away with it. The Des Moines Register studied 22 fatal car-bike crashes. The most common penalty (the mode, in statistical parlance) for drivers found at fault was $250. The joke actually stems from the article below.

Daniel Duane, in the New York Times, found that “studies performed in Arizona, Minnesota and Hawaii suggest that drivers are at fault in more than half of cycling fatalities. And there is something undeniably screwy about a justice system that makes it de facto legal to kill people, even when it is clearly your fault, as long you’re driving a car and the victim is on a bike and you’re not obviously drunk and don’t flee the scene. When two cars crash, everybody agrees that one of the two drivers may well be to blame; cops consider it their job to gather evidence toward that determination. But when a car hits a bike, it’s like there’s a collective cultural impulse to say, ‘Oh, well, accidents happen.’ If your 13-year-old daughter bikes to school tomorrow inside a freshly painted bike lane, and a driver runs a stop sign and kills her and then says to the cop, ‘Gee, I so totally did not mean to do that,’ that will most likely be good enough.” (NYT 11/9/2013)

What does this mean to me? Whenever possible, I make eye contact with drivers. I figure it is harder to kill someone who is human and not just an obstacle. I try to communicate with other road users. I try to use clear hand signals (and no, the one consisting of an extended middle finger doesn’t count) and talk to people. I wear bright clothing. That way, if you hit me, I figure you were aiming, not that you couldn’t see me. I try to remember that you’re not an @sshole, but you weren’t paying attention. I was once wearing day-glo pink when a texting driver almost ran me down. I yelled to get her attention. She said, “I didn’t see you.” I (not so calmly) pointed out that I was wearing bright pink and of course she couldn’t see me while looking at her phone.

In honor of our unseasonably cool weather:

Next time: a look at some specifics of bike safety.

And finally, on the way home from a meeting Wednesday night, I heard a loon on the lake – the first I’ve heard this year. Our lake in on their annual commuting route to and from the north woods. For those who have never heard one (and those who want to hear it again), here is a Common Loon (from Peter JH, recorded near Ely, MN):