My nurse removes the needle from my port and I gather my things to leave the infusion suite. Thankfully, it was only saline solution today. I am prepping my kidneys for a return to chemotherapy next week.

As I head to the elevator, I notice that there are three women waiting. They are the same women who had briefly entered the suite looking for the lab room. One of them needed a blood test. As I stand there, they suddenly start laughing because they realize they have forgotten to push the button; they were all busy talking. I smile behind my mask.

When the doors open, they go in first. Although they don’t really go to the back of the elevator, I enter and turn to face the door because it’s a little tight. As I make the turn, I catch a glimpse of one of the women who is closet to me, maybe 60 years old, whip off her mask like a woman kicking off her heels the second she gets through the front door of her home. Comfort can’t come fast enough.  They continue chatting.

I’m still looking at the door, my body is frozen, but my brain is on fire.

“We are in an elevator, inside a medical building.” I think to myself. “there is just no benefit of the doubt that I can give.” I am astonished by her choice.

As the elevator grinds down to the first floor, part of me wants to say something, but I don’t. I have seen too many of the videos on social media now. The ones where a maskless customer walks into a store and is stopped with a request to put on a mask. The customer goes from zero to 500 in a nanosecond. They are outraged that this request could apply to them.

I don’t want a confrontation. We are standing way too close to each other. When the doors open, I bolt out of the box, practically tripping on the metal edge.

Hours later, I am still reviewing the incident in my mind and I realize that there is something tugging at the peripheral of my brain. I was so focused on the mask removal, I had missed the bigger picture. Elevator Etiquette 2020. Was there such a thing?

I try and remember whether I saw signage while standing there, guidelines about entering an elevator in this COVID era. I just don’t remember. I’m pretty sure I didn’t see any floor markings on where to stand once I was inside.

I dig around for some information. Although volume of foot traffic plays a larger role in taller office and residential buildings, Elevator Etiquette at any level does exist. Here are several suggestions:

1. Wear a mask
2. Limit the number of riders to 3 or 4.
3.  Enter the elevator and stand in either a checkerboard pattern or at all four corners.
4. No talking (it can propel particles)
5. Only face forward

Interestingly, some studies suggest that elevators may not be a vehicle for transmission of the virus.

The following is an excerpt from an ABC News article dated June 15^th by Dr. Hassel Lee:

In March, during a COVID-19 outbreak in a busy 19-story building in Seoul, the virus spread almost exclusively between individuals working on the same floor. The authors of the case report that even with considerable interaction between workers on one floor with those on other floors, the virus did not appear to spread vertically through the building.

“This argues that elevators are not a hot spot for transmission” said Dr Todd Ellerin, director of infectious diseases at South Shore Health in Weymouth, Mass…

…”Time is our biggest risk reducer”, Ellerin said. “The short time people spend on elevators together will mitigate against large amounts of transmission.”

I am reassured by this duration comment. My exposure couldn’t have been more than 30-40 seconds. However, Anna Durrani points out in a May 26^th Realtor.com article:

“Elevators are typically pretty cramped, and you could be walking into a contaminated space.

“You don’t know what happened on the elevator before you got on,” says Dr. Jeffrey Siegel, a professor at the department of civil and mineral engineering at the University of Toronto and an expert on indoor air quality.He says someone could have coughed or sneezed, or there could have been a car full of people talking, which means there’s a concentration of particles/droplets in the air. That could lead to COVID-19 infection.

To demonstrate this data, I happened to recently catch an interview where Bill Nye The Science Guy slams an open baby powder bottle on a surface. The powder escapes, shooting up high and expanding outward. It floats. It doesn’t drop to the floor. This is what happens after a cough or sneeze.

This hadn’t occurred to me and my mind returns to the woman who removed her mask. It sounds like she had potentially put herself at risk more than anyone else. The fact remains though that one of the three is receiving medical care. If they continue sustained contact, at least one, if not all, moves to an exponentially higher level of risk. Is the removal of the mask for comfort worth it?

Moving forward, I will now be hyper aware when I enter an elevator. In fact, if I see more than one or two people waiting, I may wait for the next one. Better yet, I’ll take the stairs. I’m learning that riding in elevators with a diminished immune system, literally leaves little room for a mistake.