Thank God For Helmets

Hi everyone,

In the gloaming on Friday night, I rode my bike over a metal bracket on the Farmington Canal Trail, crashing hard, bruising my ribs and calves, and knocking my head on the pavement. Thank God for helmets. I got up, adjusted my light, and tried to ride, but my front tire was flat, so I limped home, four miles in the dark, listening to Ezra Klein, Derek Thompson, and an audiobook to pass the time.*

Many summers ago, when I was 16, I took a bike trip with other high school kids, from Lake Champlain to Nantucket. We camped outside, swam in ponds, filled our water bottles from roadside streams (not recommended), grilled hot dogs, and tried things I still haven’t told my mom about (we were supervised by a twenty-something who was no more mature than we were). We hauled our clothes, tents, and sleeping bags; slogged up mountains; and sped down hillsides, slicing around curves as the wind howled and blew back our hair.

We didn’t wear bike helmets back then, and it didn’t occur to us that we should. That year, 1979, was the first season the NHL required new hockey players to wear helmets. Seatbelts weren’t mandatory, and only about 10% of people used them. Bikers wore caps like these:

I survived the New England trek and many helmet-free rides to Shea Stadium; Cunningham, Flushing Meadows, and Alley Pond Parks; and best of all: down Queens Boulevard, across the 59^th Street Bridge, and up 3^rd Avenue for a slice of Ray’s pizza.

Within a decade, I began medical school. It was the height of the AIDS pandemic, but few people wore gloves to draw blood or place IVs, and I was taught that gloves made it harder to find vessels and easier to stick yourself. We learned procedures using the time-honored “see one, do one, teach one” method, and we subjected unsuspecting patients to our novice LPs, central lines, and “eses” (thoras, paras, and arthros). We made huge decisions independently: as a fourth year student, I pushed lytics on a patient with a massive PE, who survived because of and/or despite me. Attendings were theoretically available, but hardly more present than grownups in Peanuts.

We missed out on supervision, made mistakes that wouldn’t happen today, and assumed responsibility before we were ready. Training was exhilarating but dangerous, like riding helmet-free down a mountainside.

Today, many of us take safety culture for granted. Pharmacists intervene before we mix incompatible drugs, nurses question dubious plans, and we call timeout and follow protocols and Care Signature Pathways. Residents edit interns’ orders, and attendings hit the brakes before we skid off the road

I’m aching after my bike crash; my ribs, legs, and ego are bruised, but I’ll be fine with Motrin and time. Most importantly, because of my helmet, my brain is intact, which might not have been true if I’d crashed 45 years ago. In the same way, because we’re careful, your patients, and you, are safer than ever.

Enjoy your Sunday, everyone. My new helmet just arrived, and I’ll be riding again later this week, once my bike’s back from the shop. Today, I’ll be climbing East Rock.

Mark

*Why I didn’t call Gabrielle to pick me up is a topic for another Note

P.S. What I’m reading:

• How A.I. Can Use Your Personal Data to Hurt Your Neighbor By Maximilian Kasy
• The French Secret to Healthier Eating By Julia Belluz
• When I’m Sick of Doomscrolling, I Turn to This Poem By A.O. Scott
• ‘You Are All Terrorists’: Four Months in a Salvadoran Prison By Julie Turkewitz, Tibisay Romero, Sheyla Urdaneta and Isayen Herrera. Photographs by Adriana Loureiro Fernandez
• The fragile intelligence of GPT-5 in medicine By Rebecca Handler, Sonali Sharma & Tina Hernandez-Boussard
• Ken Burns on America's origin story: "The most important event since the birth of Christ" By John Dickerson
• The evolution of bacteria By Kevin Blake