Mangione reportedly had personal frustrations with medical care for a bad back. He resided in a co-living space in Honolulu, and R. J. Martin, the commune’s leader, told The New York Times that Mangione suffered from persistent back pain that made sex impossible. Back pain is a nightmare, but it’s unclear what form of it stopped him from having sex while apparently leaving him free to stalk and kill a man and ride away through Central Park on an e-bike.