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Remembrance And Rules For Cyclists And Motorists

This third installment of “Cycling Wednesdays” comes as a guest post from Rachel Fagerburg. Rachel is a dear friend, mother of two young children, fellow cyclist, and wife of a teammate. She is famous in this area for her talent as a race announcer. I am grateful for her words:

On May 19, my husband and I joined thousands across the globe to honor cyclists who have been injured or killed while cycling on public roadways. With 1,000 participants at the first ride in 2003, the Ride of Silence has grown to a worldwide event raising awareness of the tragedies that can occur between motorists and cyclists. My husband and I rode in honor of two people we were privileged to call “friend.”

Bob Jordan was admired for his powerhouse strength at the races. Personally, I admired him for his expedient departure from a race at its conclusion. I recall watching his red two-door sports coupe as he left the race venue with the race bike dangling out of the trunk. He loved racing, but his actions spoke measures about how much he loved his family. He wanted to get home after the races and be with them.

Several years ago in a suburb of Indianapolis, Bob Jordan found himself in the windshield of a car being driven by a young lady. A son, husband and father was lost that day. The young lady was in route to her high school with plans to walk across the stage and clutch a diploma. Instead, she found herself at the scene of an accident where she killed a man without intention. Bob ran a stop sign. He died at the scene.  

Originally from Evansville, IN, Darryl Benefiel was a member of the racing community for years. Darryl was our buddy. He house sat for us. He helped tile our front porch. He watched our son for us. We dined with him often.  He was a good friend. Darryl left Louisville in 2007 and eventually settled in California. His visits and phone calls contained tales of the California life style that was so different from that of the Midwest. He loved living there, working there, riding there.  

On July 23, 2009 Darryl was riding down a California road when a motorist made a left hand turn into a subdivision directly in front of him. The speed at which Darryl was traveling was such that he could not avoid hitting the car. Darryl died at the scene.

The engine strength of any vehicle is more powerful than the strongest cyclist. Yet there is a necessity to beat the cyclist to the red light just meters ahead. Get ahead of, impede the progress of, ignore the cyclist. The cyclist is a nuisance to the motorist. Then there is the cyclist who loses all sensibility in the heat of an interval (or in midst of the Tuesday rivalry ride). During the intense moments of the workout, the cyclist will convince himself that training (or the weekly World Title) is more important than the rules of the road. I make no claim of innocence here. I have done the Tuesday night ride. I have experienced the adrenaline rush. I get it. It’s good stuff. At the end of the day, a bike ride on the road is still a risk regardless of intensity.

As I write for the infamous blog, I still grieve for my fallen friends. My heart hurts for their families and the motorists involved. I miss Bob. I miss Darryl. Races are not the same without them. In a perfect world, society would appreciate the laws of science and respect the laws of the road. We would co-exist in harmony. In the case of the cyclist versus the vehicle, the vehicle wins every time. More importantly, everyone involved loses. There must be more consideration on both sides of this debate.

The father of my children and love of my life is riding on the roads. Aside from the loss of a child, my greatest fear is that he is the next tragedy. The common citizen is not educated in the rules of the road, cyclists included. Being aware of one’s responsibility as a motorist and a cyclist is a first step. Adhering to those laws is the greater responsibility. In closing, I decided to post the rules of the road (as a post-script below) in accordance with the Kentucky State Drivers Manual. Be safe out there.

Thank you, Rachel.    – JMM

Rules of the Road

A cyclist must:

  • Use hand signals to communicate actions to other vehicles.
  • Obey the instructions of official traffic control signals and signs. Stop at stop signs and for stop lights just like a motor vehicle.
  • Operate a bicycle within posted speed limits or at a rate reasonable for existing conditions.
  • Ride a bicycle on the right side of the road with traffic.
  • Yield to pedestrians in crosswalks and on sidewalks. Give an audible warning before passing pedestrians.
  • When riding at night, operate the bicycle with a white light visible from the front and a red reflector or light visible from the rear.
  • All slower-moving vehicles, including bicycles, shall drive as closely as practical to the right-hand boundary of the highway. Extreme caution should be used when moving out into the center of the road to avoid road debris, to pass another vehicle, or to make a left turn.
  • Ride on a bike path adjacent to the roadway, if one is provided.
  • Never ride more than two abreast so as to interfere with the normal movement of traffic.

A motorist must:

  • Share the road with bicycles.
  • Before passing a cyclist, look to see if there is loose debris on the pavement that might cause them to move into the center of the lane. Pass a cyclist only when it can be done safely, and allow 3 feet between your car and the cyclist. Realize the air turbulence your vehicle can create at high speeds or in windy weather. Give the cyclist extra room if your vehicle has extended outside rearview mirrors. Return to the lane only when you are safely clear of the overtaken bicyclist.
  • Look for cyclists. Because of their narrow profile you will need to develop your eye-scanning patterns to include bicyclists.
  • When you are turning right after passing a cyclist, leave ample room so you don’t cut him off when you slow for your turn.
  • When opening your car door, check behind for cyclists.
  • Remember, bicyclists are not special and privileged. They have the same rights, rules, and responsibilities as all other highway users.

*This blog post was originally published at Dr John M*

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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