The Ghost Bike of Billthy

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https://en.wikipedia.org/wiki/Ghost_bike

This is a ghost bike. If you’re looking, you will see them around cities marking the places where cyclists have died. Car crash fatalities have crosses, piles of flowers, pictures, and ribbons memorializing a life lost on the road, and cyclists have this.  It’s simple. Just an old, busted bike, chained up at the scene of an incident, spray painted completely white.  They can be found worldwide, wherever cyclists die, and there’s a cycling community in mourning. People say it’s to raise awareness for drivers, to help remember to share the road with bikes, but people who don’t ride often don’t understand, or care, what the bikes are for.  For me, they stand as a bleak reminder of how vulnerable cyclists are, that a car doesn’t have to be fast to be deadly, and that friends can easily die tragic, preventable deaths.

 

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Photo c/o Austin Horse, in Philly, halfway through his ride to D.C.

This is Austin Horse. He’s a New York City bike messenger, adventuring cyclist, winner of a few world bike messenger championship races, and based on all accounts given by mutual friends, a decent human being.

 

Once upon a time he had another friend that was named Bill. He was also a New York bike messenger, as wild and scrappy as his long beard, which had helped earn him the nickname Billthy. He had a serious case of bikelust, and was cherished for his presence at the back of the RAGBRAI pack that cycles across Iowa every year. He was a brother, an uncle, a father, a friend to many, and also, by all accounts, a decent human being.

One day, Bill woke up feeling ill. He dealt with it, as most grown ups do, but he didn’t feel any better. At this early point in the story, he could have gone to see a doctor, received some medicine, and been fine.  Or maybe had a yearly check up, where the doctor would’ve told him he couldn’t heal without treatment.  But he didn’t see a doctor, or have physicals because he couldn’t afford them. He took a risk, and assumed that like whatever maladies he’d experienced before, it would eventually go away.  Instead it became worse, and then unbearable.  Bill finally went to the hospital, but it was too late. What had started as an ulcer had perforated, then turned into sepsis, commonly known as blood poisoning. At 52 years of age, on February 1, 2015, Bill died.  From an ulcer.

If you met Bill you might think he was an uncommon person, but stories like his have become so common to me that it holds no surprise.  DC messengers I worked with have also died young from treatable conditions that went untreated, cancers that weren’t detected early enough, or chronic conditions that weren’t properly cared for.  These weren’t bad people. Despite whatever personal baggage they may or may not have had, they worked hard and were usually willing to drop what they were doing and run a package. Even if the whole city was under a foot of snow and even the US Postal Service was closed.  Typical of bike messengers and other working class people, Bill couldn’t afford preventative care because he was uninsured, even with medicaid expansion, and even with subsidies in the marketplace.  For many in this position, survival does not allow sick days, because hourly pay is how food finds its way onto their table. Illnesses come and go, but the need for income remains the same, especially if you’re living paycheck to paycheck, hand to mouth.

Austin thought Bill’s death needed a ghost bike. He was a cyclist, and this was a tragic, preventable death, common to many messengers, and it warranted some public awareness.  But where would it be displayed? There was no crash sight, or landmark to place the blame.  So Austin decided that in honor of his friend, and to advocate for universal health care that might have saved him, to make Bill’s ghost bike mobile.  Instead of a random ghost bike, he would bring Bill’s actual bike which was already white.  He would ride it from Bill’s home in Brooklyn, in his hand, by his side, all the way to Washington D.C and up to Capitol Hill.  Austin and Bill’s bike rode the stretch all this week, while the senators were debating  behind closed doors legislation that would affect the future for millions of Americans like Bill. He took the bike and Bill’s story to the people in congress, hoping to remind them that what they’re creating is not just a bill. It’s a way to change people’s stories. It‘s a chance to give them life.

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Image c/o Austin Horse, In Brooklyn, starting out toward DC

Austin is an experienced cyclist, but riding a long distance in this way is no small task. Any amount of riding with your hand on someone else’s bike is awkward.  I’ve ridden bikes that needed repairs to a shop about a mile from my house. It was unpleasant. It threw off my balance and slowed me down.  I’ve also ridden the distances Austin traveled each day. It hurts. Not just in your legs, but in your palms, your wrists, your back, and your butt. Being able to let go of the handlebars to sit up and stretch your wrists and wiggle your back is just about the best thing ever. Being able to have both hands on your own handlebars to adjust your weight or get out of the saddle is probably the only thing that might feel nicer.  You can’t do either of those things if you have one hand on someone else’s bike.  

It was a noble gift to Bill’s memory, to take a piece of him back out on the road, and to share his story with people who don’t understand what it’s like.  Often we make this debate about penalties, taxes and money spent, but we leave out the friends we’ve lost, and how they suffered. 

There are definitely problems with the system now. It costs more than a monthly house payment to insure a family like mine, even with my husband’s employer subsidizing it.  At different times my husband or I have remained uninsured because we’re healthy, and it was cheaper to pay the penalty and for the occasional doctor’s visit than it was to buy insurance.  But through that I’ve watched my husband go to work with chronic back pain for months at a time, and suffer through things like strep throat and the swine flu without antibiotics. Even when we are insured,  the polict we had was so crappy it would only pay for something if you were about to die.  Even though the bill was created to help people like us, I feel people’s frustration with the Affordable Care Act. 

I’m fine with fixing the problems, looking at the legislation again and even repealing the parts that don’t work, but not with forgetting that all people need affordble health care.  How many people have to die from small complications before we are willing to negotiate around this issue? I wish I was wise enough to speak into the future and calm everyone’s fears about the possible solutions and how they might work best for our country. I wish I could say, beyond a doubt, what measures we needed to take to ensure that greed and corruption won’t triumph at the expense of the vulnerable and less fortunate.

I know we all have our strong opinions about what should be done, and that there are no perfect answers, but the answer can’t be nothing, nor can it be looking back to the time before the ACA with fondness, when millions more were uninsured.  This is not just a bill, it’s people’s stories and so we need people like Austin out there, sharing the ones that people can no longer share for themselves.  Because it’s friends and family like Bill who are lost in ferocity of this battle.  

It has not been effective for us to yell, argue and growl at one another, while we forget that we are capable of empathy and understanding. We need more stories. So we can understand about the family who’s son was saved from addiction and mental illness because it was an ACA provision to include substance abuse treatment.  So we can hear about the family that is already swamped with insurance payments, and dreads a trip to the ER because they have no room in their budget to also pay down the deductible. Tell people this story, or your story, or the story of your own friends. We need them. That’s what the debate should center around, because nobody ever sold the child to save the farm and because we need to find a way to treat something as simple as an ulcer.

A documentary clip of Bill in action…May he rest in peace.

 

How to Create a Crisis

Edmund was such a bratty kid the first time I read The Lion, the Witch and the Wardrobe.  I loved Lucy, since I was a girl her age, but his relentless effort to embarrass her only made him half villain.  What I found repulsive was his ignorance to temptation; he didn’t even try to defend himself against White Witch. How could a person so shamelessly seek after evil, trudging through snow with no coat, to sell out his siblings for candy?  I understood that he represented me as a sinner, but I couldn’t bear being lumped in with someone so oblivious to an evil plot.

That same feeling is rampant where I live in the Appalachians. People’s resentment builds as heroin bashes away at the infrastructure of rural life. It’s not that they’re unfamiliar with addiction, or the depression that leads people to it. They’re just tired of the unrelenting pain the heroin version brings, and of lacking the resources to fight back.  People wonder, why can’t these addicts just say ‘no’? They did DARE in school like everyone else, so how could they be so helpless against such an obvious evil?  Maybe if addicts just thought about their choices, money wouldn’t be wasted on Narcan, social services and jail.  Someone in a crowd will always suggest we save our resources by just letting them overdose and die.  It’s callous and simplistic, but people are so annoyed that heroin is even an issue.

It took 30 years and raising 4 little boys for me to appreciate Edmund as a universal character.  My boys didn’t see him as a spiteful bully, but as an emotional little boy, frightened by the war and annoyed by his seemingly perfect siblings.  As a parent I was finally able to see the wounds caused by circumstance, separated from his parents and scared for their safety.  Every day I referee squabbles created by a child who’s been squashed by his place in the birth order, trying to undo the resentment that it brings.  Adding to Edmund’s plight, he’s sacrificing joys he’s been entitled to since birth- sugar, chocolate, even new shoes and socks.  He wasn’t wandering Narnia seeking fortune or dominance, they just found him cold and lonely in the woods with an unsettled heart and offered themselves as solutions.  All it took was a small choice of food, and suddenly his greed was insatiable. 

The enchanted treats perverted Edmund’s character similar to the way heroin would.  The more of the treat he ate, the less remained of his virtue.  Reality became distorted to the point he could no longer decipher the good from evil, or truth from lie. His disposition became increasingly combative, even when he was obviously wrong.  Of the Turkish Delight, Lewis says, “…anyone who had tasted it would want more and more of it, and would even, if they were allowed to, go on eating it until they killed themselves.” His greed for it left Edmund with an empty container, making promises he couldn’t keep, to a woman he couldn’t trust, all to dominate his siblings and live in a fantasy.   We scoff at people who fall prey to addiction, the same way we do at Edmund, but truthfully we know more about this scenario than we’d care to admit.  

The creation of today’s Heroin crisis is rooted in the same oblivion as Edmund’s.  He didn’t know that the Witch’s treats were enchanted.  He’d probably eaten Turkish Delight before without feeling the urge to sell his soul, so why should he suspect danger? The Witch may have been exuding evil, but it was just candy.  The increase in heroin use today is attributed to the mass abuse of OxyContin that began about 20 years ago. The pill was first marketed as non habit-forming, and for a decade doctors were encouraged to prescribe it to anyone with chronic pain.  It didn’t matter if you were prescribed pills from your doctor or bought them on the street, the lie was pervasive and convincing: there have been studies, it’s not habit forming, it’s FDA approved for all your pain.  Maybe we should have been more wary, but doctors prescribe all kinds of drugs that heal and help, so why should this be different? Even after 1000’s of years of experience with opium and its derivatives, we never stopped to question if these claims were true.

In the time that it has taken OxyContin and its generic oxycodone to rise and level off in popularity, our culture has seen an abundance of fraudulent schemes fail. Our economy imploded as the housing market crashed.  Record breaking athletes almost all turned out to be bogus, and our olive oil was fake.  We wanted so much, we even ruined kindergarten in an attempt to have smarter kids.  Ignoring fraud and then being horrified at the consequences is just about our new national pastime.  It’s in this way we know Edmund and the addicts on the street. We know them through our blinding greed.  

The story of how we legalized drug dealing reveals that greed as the real epidemic, and our opioid abuse as a symptom of it.  It would seem, according to the arrest records, that the White Witch villain of this story are the people operating pain clinics. To an extent this is true, Jeff and Chris George were like this, They were twin brothers from Florida who were both housing contractors and felons, but from 2008 to 2010 they owned and operated the U.S.’s  largest chain of pill mills, profiting $40 million in just two and a half years.  They hired desperate doctors who were bankrupt, either literally or morally, and told them if they wrote a lot of prescriptions they could make $2 million a year.  As soon as patients realized how easy it was to obtain drugs without getting arrested, their business exploded.   People drove down by the van full from as far away as West Virginia and Kentucky.  Each patient needed an MRI (done for $50 in a trailer behind a nearby strip club) and a clean cup of urine (didn’t have to be yours), but as long as someone followed the procedure they could go home with a month’s worth of pills.

Since pain is relative and mostly invisible, you can’t prove someone is lying, which made it difficult for the DEA to build a case. It wasn’t until the brothers violently threatened people that agents were allowed to wiretap their phones and prove the clinic was a sham.  At any point before that, the George’s certainly could have walked away with a fortune, but when recounting the story they said their love for profits and power became insatiable.  By the time the clinics were shut down and everyone involved was arrested, the DEA estimated that 20 million doses of oxycodone had been prescribed, an average of about 10,000 per day.

Most doctors, however, were less villainous than the Witch and as blinded as both Edmund and addicts alike. Dr. William Hurwitz, star of the documentary “Dr. Feelgood: Dealer or Healer”, had an impressive resume compared to the George brothers.  He was educated at Columbia and Stanford, and then volunteered with the Peace Corp in Brazil. When he came back to the States, he specialized in chronic pain, became an expert in the field, and opened his own clinic in an affluent D.C. suburb.  His patients were people whose pain was so crippling they were unable to do basic things, like walk or get out of bed. They were grateful for his support, but traditional treatment involved multiple types of surgeries and therapies in addition to some meager medication.  It was a long, expensive road with lined with tiresome insurance battles, and no promise of relief.  Everyone was desperate for an easier answer to the problem of chronic pain.

In 1996, sales reps from a company called Purdue Pharma showed up in doctor offices across the country, and a ‘hallelujah’ rang out.  They promised their new pill, OxyContin,  was the first non-addictive opioid, thanks to its fancy, new time release capsule. They wooed doctors during special conferences at fancy resorts, and cited a few loosely applied studies to substantiate their claims.  At these conferences they promised even a primary care physician could prescribe it safely.  It’s so harmless, people could use it after a tooth extraction.  Purdue trained its sales team to ingrain the message that the risk of addiction was “less than one percent.” They even made up a term to describe skeptics: ‘opiophobic.’

Hurwitz was so enamored with the idea of the pill that he became blind to its power. After years of repeated appointments with little progress, his patients were finally happy, and he was overjoyed. “It’s like a miracle from heaven,” they’d tell their friends.  They can go back to work, walk without a cane, and play with their grandchildren again.  But soon they would become tolerant and ask for a higher dose, and Hurwitz became as addicted to prescribing OxyContin as they were to taking it.  He started to ignore signs that his patients were abusing the drug.  When a nurse would point an addict out, he claimed they still felt chronic pain, so who was he to deny them relief?  If a patient ran out of pills before their prescription ended, Hurwitz would assume the patient was developing a tolerance and increased their dosage.  After two of his patients overdosed and died, the DEA opened an investigation. His abundance of patients taking abnormally large doses led them to shut his practice down.  Soon after the medical board revoked his license, and eventually he went to jail.

Even after losing everything, including his marriage and career, he still thought OxyContin was the answer for chronic pain.  When they interviewed his ex-patients, ones who were lucky enough to have recovered from their habit, they all regretted their addiction and understood how needing the pills had made them suffer more.  Hurwitz showed remorse for the people who had died, but was unwilling to assume any blame. He was sad that people had taken the drug incorrectly, mostly because it ruined the chance for others to use it for relief.  In his post jail interviews, he still did not feel that large doses, extended use, or increasing tolerance had anything to do with creating epidemic addiction. He shows we can be greedy with excellent motives, and what’s scary is that will blind us all the same.

Closer to the White Witch in this story is Purdue Pharma.  In the early 90’s they were still a small company, whose primary product was a painkiller called MS Contin given mainly to dying cancer patients. It was profitable, but the patent was about to expire, and with it’s limited market it wouldn’t be able to compete with its generic versions. The company needed something new to keep them afloat, preferably something with a bigger market so they wouldn’t be in the same position ten years later. OxyContin, was their answer and chronic pain patients would be their market.  Soon enough, its popularity turned them into superstars, and opioids became a billion dollar a year industry in just a few years.  Today their reach is global, and the Sackler family who owns the brand, is the 16th richest in the nation according to Forbes.

It’s unclear what their original intention was other than trying to stay in business. Did they create their product to help people or did they know they had found a way to legalize heroin? Probably the truth is somewhere in between.  By 2000, people began to realize that OxyContin actually was addictive, and started filing lawsuits.  In 2007 The U.S. Attorney General’s office took up the case, and Purdue Pharma pleaded guilty to criminal   ‘misbranding’, for mislabeling theb drug, fraudulently promoting it, and marketing for an unapproved use.  They paid $635 million dollars in fines to stay out of jail, which was the biggest pemalty at the time, but has lost its meaning compared to the $35 billion in revenue that ; earned from OxyContin to date.  Several other affected places have successfully filed for damages since, including Kentucky, New York, Ohio, West Virginia and Canada.  Most recently the town of Everett, Washington has filed a new lawsuit, this time claiming the company purposely fueled the black market in order to increase profits.  

Why did it take almost a decade for Purdue to admit their guilt or do anything about it? Could they really not see that their product was destructive? Their actions have created a state of unending winter without Christmas for large chunks of our country, just like in Narnia. As satisfying as it would be to see every CEO responsible in jail, it’s difficult to judge where the distinction between evil intention and ignorance lies.  The CEO’s themselves were so caught up in the success of their product, it’s possible they didn’t understand the long term consequences of their actions.  Even once the effects became undeniable, they were still too blinded by profits to admit the pill was causing problems.  29 claims for damages were fought off before a single case was settled.  With bank accounts growing into the billions, their morals became more polluted than those addicted to the drug they were selling.

When Peter confesses that he was partially to blame for Edmund’s actions, Aslan doesn’t deny it.  The contributing sin is in my soul as much as it is that of addicts, over-prescribing doctors and Purdue Pharma’s.  Living with four little boys helps me see how deeply embedded in our human nature greed is.  Every day begins a new challenge to shepherd them through their desires, trying to teach them to see others needs before their own, and to be content with what they already have.  Everything else, from their friends to our junk mail, teaches them they need more: more activities, brains, ambition, muscles, toys, fun, food, gifts and then also more money, to pay for it all.

In the aftermath of OxyContin we find ourselves like Edmund, standing alone in a frigid castle, desperate for hope and lamenting the greed of our actions.  Heroin addicts may receive the worst of our scorn, but those that can find recovery are the most blessed, for they’ll have seen their sin clearly enough to be freed from it.  Unfortunately, the epidemic of greed pushes us to behave like headstrong teenagers.  We suffer the consequences for a while, but when they’ve run their course, we’ve learned nothing.  If freedom is to be found, we must see our problem as clearly as an addict at rock-bottom, with an awareness of the disasters we’re causing, humility to admit our imperfection, and acceptance of contentment with our reality.

After Purdue Pharma was convicted, their profits and the rates of pill abuse continued to increase for 3 more years.  Even with the landmark court case, opioids were not a top news story in 2007, or listed in the top 10 headlines for any year before or after.  Most headlines were about elections and their related issues, the war on terrorism, sports or celebrity gossip.  The housing crisis and the ensuing recession have been a top story almost every year since 2008 because of the mayhem it caused, but opioids have devastated almost as many.  It’s estimated that 7 million have struggled with dependency since the release of OxyContin, many cases resulting in death.  On the surface this seems about equal to recession unemployment or foreclosures, but the statistic grows exponentially when we realize that addiction is a family problem.  For every dependent person counted, there are several more suffering the consequences, like kids in foster care, babies in withdrawal, and/or relatives spending a fortune on their loved ones in rehab.

After such a traumatic experience, you would think we would make an elaborate effort to keep history from repeating.  Some progress has been made; OxyContin now has a tamper resistant coating, and databases have been formed to track prescriptions and prevent abuse.  Doctors now have strict guidelines for prescribing opioids for chronic pain. Rates of abuse have leveled off, but at the same time so have profits.  Instead of being satisfied with the money that’s been made, there is now a global campaign for OxyContin, using the same misleading and aggressive marketing techniques that proved so successful in the U.S. In a terrifying quote from a promotional video, the company claims, “We’re only just getting started.” 

After we finished our trip to Narnia, the boys and I read The Blessing Cup by Patricia Polacco.  It tells the true story of a poor Russian Jewish family that had been gifted a beautiful  tea set for their wedding.  The set came with a note saying, “Anyone who drinks from this will have blessings from God. They will never know a day of hunger. Their lives will always have flavor. They will know love and joy and they will never be poor.” The mom pours the family tea in it every week, while reciting the blessing, and pointing out all the ways it has come true. Though they are meager peasants, fleeing persecution, fighting off pneumonia and living as refugees, they believe her.  The persecution has given life flavor in the form of crazy stories and new friends who help them along the way.  They may not have always had enough to eat, but they were never hungry for love.  They may not have had sufficient money to provide for their needs and yet they were still rich in family, even in through the three generations the tradition continued after the first blessing was recited.  

May we, as individuals and a culture, have that blessing too, that we can preserve one another for generations. Let us be so full of contentment and thanksgiving that we could clearly see the temptation set before us.  The heroin epidemic probably won’t be a catalyst for lasting change. History would indicate that it won’t, since our policies created this same exact problem when heroin was released by Bayer Pharmaceutical in the early 1900’s.  But it might, and we should pray that it will.  For now, our power against the greed is in choice as individuals to be satisfied, and our ability to teach our kids, friends, and neighbors to do the same.  May these values be the heritage we cherish above all, not ease, fortune, power or fame.