The sound of animals in distress - the great Botswana Rescue Adventure

The sound of animals in distress - the great Botswana Rescue Adventure


Animals in destress have a unmistakeable urgency to their sounds and movements. Impala will run for fun, with a fast, agile, bouncy step. But when they are threatened, their gate takes on an entirely different profile. They signal to each other with an audible and disquieting hiss. It turns out people in distress are no different. We were tracking lions. Or, rather, Gee our venerable guide was tracking them while we bounced along in our safari vehicle encouraging the hunt. The sky was cloudless and, save for the occasional range of trees, we could see planes of grass and mash for kilometers in every direction. We stopped to look for tracks. Across the marsh we saw a group waiving —not an entirely unfamiliar site as we’d encountered other safari-goers during some of our game drives. Only this group was waving with urgency.

Our diesel engine clattered to rest. We heard them screaming help! Please help us! Help!. One was waving something shiny, all of them had their hands in the air, moving wildly. They never stopped shouting.

I hope it’s a vehicle emergency and not a medical emergency. We all agreed we needed to go to them. Gee, in what would become a hallmark trait of the day, didn’t rush. Instead he quieted us and said he needed to make a plan.

We can’t just go to this place. It’s all water from here to there, he explained. Gee, a native of the Okavango Delta, took off his shoes and climbed out of the truck. Nick, will you come too? I hopped out, followed by my dad and we trodded off over a kilometer of ankle-deep marshlands.

By the time we were close enough to see the faces of the distressed wavers, it was clear they were all sobbing heavily. We’ve been out her for four days, the gentleman said through sobs and a non-native-english-speaker accent.

That hit us hard. 4 days!

By then we’d taken in the scene. They were a family of self-drivers, people who rent a 4x4 decked out with roof tents, shovels, camping gear and food. Only their 4x4, a converted Toyota truck, was buried nearly to the doors in a muddy bog. (Along our trip, we’d remarked on how fun self-driving seemed.)

We tried hard the first day to get it out but once it got so stuck, we were scared we’d lose the truck; it was our only safety. I tried to walk out one day, but there were too many hippos. We’ve been sleeping in the cab at night. He and his wife were still a bit teary, clearly frazzled and, above all, concerned about their two young boys.

This is going to be fine! Gee is always cheery. We’re going to get you out today. Gee is always timely. I’ve been driving here for 15 years, I know how to do these things. Gee is always confident.

Botswana Rescue

Their truck was too buried to be driven out, even by an experienced driver. Once the differential and under-mounted spare tire are buried, there’s too much drag. Gee and I debated the merits of axel lockers. I defered to him, knowing my own track record for getting stuck. Gee grabbed their Hi-Lift jack —a staple in any well-equipped 4x4 (I keep one mounted to the front bumper of my ’73 Land Rover). We improvised a base out of some wood and plastic and began lifting the rear corner of their truck out of the mud. We need lots of logs, small, straight logs. Gee sent us scouting.

The family had been using a nearby rock as their daytime base of operations. They’d hung water bottles in the only tree near the rock —a smart move, light reflects through the bottles and can be seen by planes. They also kept a fire going. The father took a bucket from the front passenger seat and emptied it into the grass; thankful it would be the last time for that chore.

We grabbed all the 3–5" diameter straight logs we could from their firewood pile and began stuffing them under the rear wheel of their truck. We did the same for the spinning front wheel. But it was no use.

Botswana Rescue

Gee trudged back to his converted Toyota Land Cruiser —the safari vehicle we’d been nearly living in ourselves for the last nine days. He carefully drove it as close to the mud hole as seemed safe. The rest of our party climbed out, carrying our provisions for high tea. They joined the family at their rock and setup for tea and rusks.

Gee and I joined the tow strap from the stuck truck to Gee’s tow strap. The father asked me to drive their truck, having understandably lost some confidence in the whole ordeal. I climbed in and signaled to Gee that I was ready. I expected a strong tug. I didn’t expect the tow strap to snap. We tried again, knotting the broken tow strap back around itself. Soon Gee was also stuck.

Botswana Rescue

The marsh was deceptive. In most places, a few inches of water covered a hard-packed sandy floor. There were reeds and grass covering the ground, so it was difficult to tell where the water was deep and where it was simply damp ground. On more than one occasion, moving around the stuck truck, I went knee, or thigh deep. I could drink this water and be fine. It’s very clean, very clean, Gee told us. This, and axel lockers, may be the only points on which Gee and I don’t agree. The water was brown and murky and not without the occasional dark, fast-swimming shadow.

Don’t worry, he chuckled, we just need logs. Lots of logs. Gee never loses his cool. He unbolted his own Hi-Lift jack and began lifting the back corner of his truck. Using his bare feet, he manipulated the logs into place and tucked in a thick rubber mat for more traction. Gee never complains. Twenty minutes later, we repeated the process for the opposite front tire. Gee gave it a shot and began rocking his truck back and forth. Not enough logs, he laughed as he said it and made himself a cup of coffee. We are getting out of here today, do not worry. He punctuates each of the last three words for effect. Gee never stops laughing. So, we jacked up our trusty safari truck, stuffed more logs in watery holes, and tried again. Nearly an hour later, Gee’s truck was again free. (I’d also earned Gee’s confidence to use the Hi-Lift jack on my own. I feelt accomplished and proud.)

Botswana Rescue

While Gee and I had been working to free his truck, my dad and the father of the stranded family were doing the same to their stuck truck. By now, I estimated, there must be a veritable forest’s worth of wood under each tire. Gee took a different angle, avoiding the deep ruts and holes from our previous attempt. Look at all the logs, * he pointed into the water, we’re not the only ones to be stuck here*. Gee giggled.

I climbed back into the stuck truck and jammed the stick into reverse. I was careful not to gun the throttle. If you go too fast, you just dig deeper. That’s the theory at least. Once I felt the tow strap tug the truck, I forgot my training and stomped on the the accelerator. This time, the truck moved! It lurched backward; I heard the sucking sound of the tires breaking free of their deep ruts. There was also cheering and clapping.

Once we were free of the mud bog, I tucked the truck in behind Gee’s Land Cruiser. We high fived. We patted backs. We cracked opened local Hasana beers. Gee had a coke. Ok, here is the plan, I have the plan, Gee announced. Gee is proud. I am going to drive across this marsh. Then, I will come back and drive you out. Do not follow me, ok? Gee is laughing between each word. We finished our beers, climbed into our safarimobile and started recounting the story of the day. We inched forward, Gee tried to keep the truck in the ruts, where the hard-packed sandy bottom was preferabe to the muddy holes. Halfway across the bog, we began to sink. Gee is undaunted.

Botswana Rescue

Do you think it would help if we pushed? My aunt, Phyllis, isn’t one to shy from a challenge. (A Dawson axiom, often said about my grandmother, is anything worth doing, is worth doing to extreme.) Before Gee could answer, Phyllis rolls up her pants and is finding a good hand hold near the spare tire on the back of the truck. Soon, we’re all out of the truck with our hands and feet hunting for traction. Gee throws it into gear and we start pushing. It sinks down, the back right tire spinning in a muddy socket.

Now, we’re old hat at this. Base, jack, logs, rubber, repeat. We tackle the spinning front tire. I sink one of the truck’s spare tires into the mud as a jack stand. Where’d you learn that trick? Gee asks me with a hint of surprise.

This isn’t my first rodeo, I’ve been stuck lots of times before. On previous drives I’ve told Gee all about my Land Rover and 4x4 adventures. But I’ve never really gotten myself unstuck before… Gee lets out a belly laugh and keeps jacking the front of the truck. Logs, rubber, repeat.

We reassume our positions behind the truck, feet digging into the sand, water up to our knees. You know, if this wheel spins, we’re all getting covered! Jineen is right, we all know it, and we all laugh. This is adventure. Well, it is to us. We haven’t been living in the cab of our truck for four nights. Before we try again, Gee reassures our new friends: I have a radio, I’ve been in touch with three other rangers and my other truck… (our support team is back at camp with their own well-equipped Land Cruiser)… we’re getting out of here today. No worries. No worries! Again, he punctuates the last words.

Our safari steed is in gear, the diesel engine is ticking over slowly, forceably, with much more torque than us petrol drivers are used to. We’re pushing. It’s moving. The logs beneath the tires are cracking and snapping as the Land Cruiser lurches forward freeing itself from the muddy suction of the bog. A few of us can’t keep up, and a few others keep pushing, running behind the truck. In another 30 seconds it’s across the bog and back on to dry land. (Dry land, interestingly enough, is mostly sodium bicarbonate washed down from natural deposits from Angola.)

Insert more cheering and another round of cold Hasana lagers.

Gee sloughs back to our new friends and instructs me to drive his Land Cruiser around the dry road to the other side of the marsh. I’d like to think this is what it’s like to be called up from the minor leagues. I knock the mud off my boots, climb into the driver’s seat, and find first gear. *Ok gang, no more lions, we’re rescuing Europeans today." Not many laughs, but I’d like to think I’d still make a fine Okavango Delta guide. By the time I drive the Cruiser around —after you’ve mastered Delta vehicle rescue, you can shorten it to Cruiser —Gee had piloted the selfdrivers’ truck to dry road. We invited our new friends back to our camp for lunch.

Nearly five hours after seeing and hearing their destress signals, we caravanned in to Camp Xakanaka (ch-Ta-Ka-na-ch-Ka). Open, one of our porters, stood with a tray of iced bush tea. Today’s special touch was a rim of candied sugar and a slice of cucumber. A second table had been added to our camp dining area. Matchsticks on the tablecloth spelled “welcome”. There were more tears, lots of recounting of events and another round of Hasanas.

After lunch, Gee and I drove them to the main gate of the Moremi game reserve. Gee gave them a map and very specific directions to Maun. They’d decided to abandon the rest of the their selfdrive adventure in favor of a warm shower and hotel bed; and I can’t say that I blame them in the least. We hugged, exchanged contact information, and they were off.

I don’t know how we can thank you, the father had said over lunch.

You’d have done the same for us, we said. And it wasn’t just a line. We’re not so different from the animals. Hearing the urgency and fear in their yelling that morning triggered something more primal than the word ‘help’ on its own. You really would do the same for someone else. We’re one big herd, us humans. We take care of each other. And when real stakes are on the line, we drop everything to help each other. Every other animal we saw in Africa behaves the same way (except hyenas, they’re apparently pretty big assholes).


I don’t know what I’d have done if I were part of that family. Four days is a long time to spend lost, alone and stranded in the Botswana bush. Heck, it’d be a long time to be lost and alone in the Appalachian mountains. I was hiking a few years ago on the Appalachian Trail and came across a search and rescue mission in progress. Someone had been missing for 12 hours and there were 5 teams out looking for him. There are real dangers to being stranded in the wilderness and make no mistake about it, the Southern African bush is among the most dangerous places on earth in which to be stranded.

I would have lost my cool. Many times. Every day. I’d have hurt myself trying to take my frustration out on something like a jack or tire or bumper. I would have been tempted to break (literally) rule number three: never leave your vehicle.

Gee, on the other hand, never lost his cool. I learned four important lessons that day:

  1. Never lose your patience. It took us five hours to get both trucks unstuck, multiple times. You jack, you dig, you collect logs, you place them, and you try again. You move 2 feet. You repeat the process. You have high tea. You get wet and muddy. You keep repeating. Then you get free. Don’t fight the process, just keep your cool.
  2. Don’t travel alone in a dangerous place without experience. Even then, you probably shouldn’t be alone. Two trucks can help each other in ways no one truck alone can.
  3. Be prepared. Boy scouts know it, soldiers know it, grandmothers know it. Our new friends didn’t have a satellite phone (we were 5 hours from the closest village with a cell tower), they didn’t have a flare gun, a signaling mirror, nor an airhorn. Would any of those things have shortened their stay? Maybe, maybe not. But one of Gee’s constant reassurances was: I have the radio, I can always call for more help if we cannot do this. But we can do this. Don’t worry. Don’t worry. The radio is a lifeline to other people. Gee never had any reason to panic because if it really got worse, he could call for more help.
  4. Trust your instincts. On many counts, the stranded family made some really smart choices based on instinct. They kept a fire going on the nearby rock. They never left their truck and knew to keep it safe too. It was all we had, they said. They knew if they were to burry it further, it might not run, then they might have been in much worse shape (temperatures ranged from 30s at night to 90s during the day). They also knew it wasn’t safe to walk, even though our camp was only five 5km away. Between us and them were several pods of hippos, a pride of lions and almost certainly a leopard and many of the aforementioned asshole hyenas.

Anthem's blank space - diminishing returns on cyber attacks

I remember when I first read about Chef Thomas Keller’s attentiveness to the law of diminishing returns. The idea is simple, with each bite, you get a little less enjoyment out of whatever it is you are eating. Some of Keller’s most famous dishes are only one or two bites. Leave ’em wanting more, he says. Well, as it turns out, the same is true for hacking.

The more it happens, the less we care.

In 2014 nearly everyone was hacked. Home Depot was hack. Target was hacked. Sony…well you know about Sony.


Celebrities are also a popular target. Jennifer Lawrence smartly said anyone who sought out photos of her was effectively abetting the hackers. By the time Taylor Swift was hacked in early 2015, the general reaction was…well…rather ho-hum.

News broke this week about the attack on insurance giant Anthem. It could be misconstrued as flippant, or know-it-all’y, but I think my reaction could best be summed up thusly:


It’s not that I don’t care, or that I’m not sympathetic - I do and I am. I’m just not surprised. So much of healthcare data secured by obscurity — think: fake rock hide-a-key. And, inside any give healthcare organization, hundreds if not thousands of people have access to datastores. Sure, there’s some notional security and there are, sometimes, audit trails. But it may simply be unrealistic to expect sensitive data, in the hands of large corporations, to ever be completely secure.


After the Sony attack, security researcher Steve Gibson remarked on his Security Now podcast on the challenges of securing Sony. Gibson suggested it would be nearly impossible for anyone to secure such massive, interconnected, multi-platform infrastructures. The same is undoubtedly true for large healthcare organizations.

Not to sound all Eyeore about it. I’ve just accepted that my health information, once it leaves my body, is vulnerable to attack. But here’s the good news — maybe no one cares? Sure none of us want our social security number and birthday circulating around. It’s an inconvenience and financial risk. But did anyone really care that Taylor Swift was hacked? Maybe the law of diminishing returns means we, as a society, are bored of hacks. And once we’re board, and there’s no real threat, then the target for the hackers is greatly diminished.

God, the homeless man

I mean, why not? Lets have a shot…this is how it begins. Sitting alone at the corner seat of any given bar, you’re a target. Drunks, kids, other tipsy singles, bar bets; these are, reluctantly, my people on a Saturday night. This isn’t my scene. *Oh how do you know [The Owner?*]" Like it matters. Boarding school’s a helluva drug. I tell my story about knowing The Owner of the resturant. Tabs are settled. I leave.

On my way home I step over God. At least he introduces himself as God, and frankly who am I to refute his claims?

God, as it turns out, is living on the porch of a condemned building.

Reaching for some cash, I ask him if there’s anything he needs. A hot sandwich would be nice. Granted, it took us three times before I understood him. He doesn’t have many teeth and even if he did, he was shivering so much they’d be chattering away. I told him I’d be right back.

I went into the pub next-door and ordered a large flatbread pizza-like thing…to go please. I had a beer while I waited; I fit in with this crowd, standing there in my collared shirt and corduroy pants. I was one of 100 other people wearing an expensive British hunting jacket.

When the bartender handed me the flatbread pizza-like thing, I said: “I’m going to give this to the homeless guy next door, do you want to come with me?” Sorry, I have to work… She probably thought I was nuts.

I went back and sat with God, who later said his real name was Duffy. He ate feverishly between shivers and coughing fits. He told me about knowing Dolly Parton —You do know who Dolly Parton is right? The famous singer? I knew who Dolly Parton was. He told me about his lady who gave him the mylar blanket, the kind marathon finishers get after a race. She had to go to California, but she wanted him to have the blanket. According to his lady, the blanket would only make warmth for a few days. Then it was no good.

A limo bus pulled up, dumping a slue of well-dressed, well-lubed post-holiday-party goers outside the pub. Duffy and I sat there and kept chatting. Honestly, I’m not entirely sure what he said most of the time. His speech wasn’t exactly of the Oxford dialect.

Some twenty-somethings walked by and shouted. That’s going to be a cold night! Their laughter suggested it wasn’t so much an observation as a condemnation. I shouted back: “Why don’t you give us your coats‽” No reply.

I realized I’d been there for over an hour…sitting slumped on the porch of a condemned building, cussing about life and generally acknowledging the awe-inspiring Dolly Parton with God, or Duffy. The line of sloshed party goers looked impatient. Maybe their heels were too high or their expensive British hunting jackets weren’t quite as warm as advertised.

I gave Duffy, who never asked for anything other than a hot sandwich —which I didn’t exactly deliver —the $100 bill I keep behind my license. I’ve carried it for five or six years. It’s the in case of emergency hundo I keep in my wallet. Turns out, I hadn’t needed it yet. He was nonplused. He reached in his pocket and pulled out a faux gold Pokemon talisman, proudly announcing I’ve got plenty of real gold, it ain’t money I need…but I’ll keep this…thank you.

I was freezing and had a long walk back. We said goodbyes. I got up off the dilapidated porch and made my way over the fallen pickets which once cordoned off a rather pathetic front yard. As I cut through the line of party goers I imagined their reactions. One of those bums has an expensive British hunt…wait, he’s not a bum, he’s one of us! They probably didn’t think those things at all. That’d be narcissistic.

Things that matter: Wikipedia

Screen Shot 2014-12-02 at 7.56.38 PM Every year I donate to Wikimedia, the parent organization of Wikipedia.


First, Wikipedia is more accurate than you think.

Secondly, it is the tth most popular website in the world and the only site in the top ten which is fundamentally about collaboratively generated knowledge.

But the most important reason I donate to Wikipedia is that for many patients it is the first stop. It is the place where you find the terms which lead to the people and the communities and the research. It's the most important collection of free and open information the world has ever seen and that is surely worth a few bucks a year.

Improving community health with more people and less cost

I've been wrestling with the uncomfortable realization that most of the innovation efforts in healthcare really just incremental improvements. Sure, we're making wait times in the ED shorter, and we've made the imaging centers look like fancy hotels. We're also making seriously and important strides at reducing harm and improving quality. But these are all just incremental improvements. They are iterations on the same thing. A new way to register, round or operate on someone are still the same basic things we've been doing forever.

To be fair, that may be perfectly ok. And, it is certainly noble to improve quality, reduce harm and make experiences more humanistic.

Hold that thought in your minds along with this: In ever design session I've been a part of for the past two years, providers and patients alike all want one thing — more people.

We are dying for more human contact in healthcare. We call them navigators, ambassadors, concierges. We want them to help us get appointments. We need them to help advocate for us when we cannot advocate for ourselves. We want them to be our scribes because...well, because EMRs. We want more people so we can have more time to spend with patients. And we've gotten to the point where we hire them to help us decipher our healthcare bills.  

I've been trying to reconcile how we might have our cake and eat it too. How can we have more people and simultaneously less cost? Or —and here's where some patented thought technologies come in to play —what else could we do with all the expensive people we already have? 

You see, while we're busy craving more bodies, we're also getting much better at moving things out of hospitals which are notoriously expensive, dangerous and hard to operate. Inpatient stays are down. Surgeries require less and less time in the hospital. We've moved a lot of things to outpatient settings. So what do we do with all the people we're committed to employing?

It seems some wisdom from a trip to Africa inspired the folks at City Health on exactly how to crack this nut. I really like the idea of community health workers. Now add on the idea of using our existing healthcare workforce as community health workers. Wooohhaaa!

But Wait, you're shouting. Where are you going to get these people, Nick? We're staffed so lean already. Right, but are we using our people wisely? By being ready to redeploy hospital employees, especially when we know utilization is going to continue to decrease, feels like smart planning to me. Plus, hospitals are already set up to take in payments from payors and redistribute it in the form of income to employees.

Here's the deets from NPR:

Thats how the idea for City Health Works was born. Kaurs husband, Dr. Prabhjot Singh, partnered with Kaur to get the project off the ground. The pair raised about a million dollars from three sources: The Robert Wood Johnson Foundation also a supporter of NPR, the Robin Hood Foundation, and Mt. Sinai Hospital, where Singh works.“


We really need an ambassador, somebody that really understands the clinical environment, but is deeply embedded in the community- Prabhjot SinghSingh says a lot of the people he sees in his clinic at Mt. Sinai are in really bad shape. "People youd expect to see in the hospital. People you couldnt imagine are in such a late stage of illness," he says.


Its this population City Health Works really wants to help. The idea is to get patients to the clinic before they get so sick, and then help them stay out of the clinics going forward."We really need an ambassador," he says. "Somebody that really understands the clinical environment, but is deeply embedded in the community."

via An African Village Inspires A Health Care Experiment In New York : Shots - Health News : NPR.

Best. Run. Ever

Untitled I'd like to tell you the best 3.2 miles I've ever run was my 5K PR. I should probably at least say it was the last three hellish miles (plus that nasty point two) of a marathon. But no, it was tonight's run.

"Look, Nick, the MRI shows some early arthritis and your meniscus is funky, but I don't see anything majorly wrong...if you are pain-free, then let's try running and see." That was the call from my doctor at 4:33 PM today.

I've been worried I wouldn't come back. I've been worried I wouldn't still enjoy running. What if I don't still love it and want to do it? What if I can't even run a mile?

Questions answered:

My pace and heart rate were all over the place. But hey, don't call it a comeback, right?

It felt like flying. No, I'm a pilot, I know of flying. It felt even better. It felt like the first stress-free, decompressing, I'll-be-ok moment of the last three months.

Tonight, my knee is still tender. That's ok. I celebrated with loud Springsteen and quinoa for dinner. It'll be a long road back, but it's nice to know the feeling is still there.


When they turn up the dials...

So this happened today: I got this text from a friend in New York City:













And I'm all like, "woah! That's huge! Is that for real, yo?"

So I tweeted:


And Uber tweeted back:

And here's the official site: Bringing_House_Calls_Back_with_UberHEALTH___Uber_Blog

So healthcare peeps, when we look at our bi-annual marketshare reports and ask "where'd the volume go?", remember this moment. This is one of the best examples I've seen of desire path meeting population health delivery. Remember Push For Pizza!

What pizza apps tell us about healthcare consumerism

Fact: in the early days of the web, Google was born and it was almost a service for ordering pizzas via fax.  Fact: a recent study showed that the number one thing people want an app for is....wait for it... ordering pizza. 

Fun link: Push For Pizza ... this is a real thing.

What does this tell us about the world (besides our love for pizza)? When we know what we want (pizza), we want to literally push a button and have all the rest —ordering, payment, delivery —taken care of for us. Uber did it for cabs. Netflix does it for movies.

Maybe it's time for Push for Doctor?*


*Yes, I know there are lots of home health and house call apps. But are any of them as dead simple as Push For Pizza?


Diagnose Nick's knee (part 4)

Diagnose Nick's knee (part 4)


Well, it's that time of the year again. Time to diagnose knee and leg pain. Step right up folks and spin the wheel.  

Symptoms: mild to moderate knee pain during running, transitioned into acute pain in leg.

Studies: Bone scan showed bone growth in lower femur, suggesting fractured femur.

Theory: Knee issue cased change in gait, resulting in fractured femur.

So...what's the cause of the knee pain? Meniscus? Tibial plateau fracture? Age?

View the MRI series as a video here.

touching my brain - from MRI to 3D print

As a proof of concept, we started playing around with going from an MRI to a 3D print. It turns out the process is pretty straight forward once you cobble together the right collection of software tools. For an ambitious first print, we used an MRI of my ocular orbits where one of the sequences continued a nearly complete image of my entire head. It took the printer 72 hours to render a slice of my head from my left hear to about a third of the way through my skull.

Here's the coolest part. I can touch my own brain. See those little wrinkles and those raises and gullies? Those are mine. That's my brain. Sitting in my skull. I can run the tip of my finger over the profile of my actual brain, as it sits between my skull and it's protective layers.

The pictures don't do justice to the feeling you get when you start running your fingers over the surface of your own brain. It's stunning!


2014-09-29 13.24.31

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My grandma was a Maker

My grandmother, Grace, passed away nearly a year ago. She was a maker and hacker, although she wouldn't have used those terms, her whole life. Everything was a prototype. If something didn't quite work right, she'd go to her tractor shed or basement and find some parts and improve it. Her meat grinder had a suction cup stand she robbed from another appliance. She was always gluing, duct-taping or screwing one object to another. When her dexterity became limited, she started modifying household items.

She wrapped these salt shakers with rubber bands to improve their grip. They are still on the farm's kitchen table. I think of them as a monument to her ingenuity - how she saw the world and objects.


MedX 2014 and the Ghost of Tom Joad

Well the highway is alive tonightBut nobody’s kiddin’ nobody about where it goes I’m sittin’ down here in the campfire light With the ghost of old Tom Joad

Springsteen - “ghost of Tom Joad”

When talk moves to action, the world changes.

This isn’t a new revelation. People whisper their discontent and then someone speaks it out loud and then two or three people shout it.

And then someone does something.

Throws a rock, refuses to move, demands to be included…

This year’s Medicine X was the barracks for a new army. An army fighting for one of the most important social justice movements in the United States - the movement towards participatory medicine.

Participatory medicine is about the right for patients to be at the center of their needs, to pull in providers, designers, pharmacists, inventors, apps, hackers, makers, therapists, artists and caregivers of their choosing to build something which works for them.

MedX 2014 was a convening of healthcare stakeholders who have collectively moved past the point of debate. Should patients be included? - it’s not a thing this group needed to discuss anymore.

Instead MedX 2014 was full of people - patients, doctors, administrators, designers, makers, doers of things - who were busy…well…doing. MedX 2014 was a gathering of freedom fighters; crusaders fighting for a new social justice of inclusiveness.

I don’t often quote song lyrics. It can be sophomoric. But in this case, I find Springsteen’s Ghost of Tom Joad stuck in my mind after MedX 2014.

Now Tom said “Mom, wherever there’s a cop beatin’ a guy Wherever a hungry newborn baby cries Where there’s a fight ‘gainst the blood and hatred in the air Look for me Mom I’ll be there Wherever there’s somebody fightin’ for a place to stand Or decent job or a helpin’ hand Wherever somebody’s strugglin’ to be free Look in their eyes Mom you’ll see me.”

Well the highway is alive tonight But nobody’s kiddin’ nobody about where it goes I’m sittin’ down here in the campfire light With the ghost of old Tom Joad


HOWTO for hospitals: host a live MedX viewing for patients and staff

UntitledI've written before about Stanford's Medicine X event. It's a rare breed - a conference to which I feel a deep emotional connection. Those of us closely connected to MedX often say its where magic happens. I don't know any other event like it; with it's energetic empowered ePatients, innovative partners like IDEO and an anchoring academic medicine focus.

I remain convinced it is the most important event healthcare executives are not attending. Look, I get it. Payment changes are coming, volumes are down, we're all scrambling to get on top of HCAHPS...who has time?

Then again, how can you afford not to be a Medicine X? Why are we sitting in meetings to talk about raising patient satisfaction scores when the top ePatient minds and participatory medicine speakers are convening in a few short weeks?

But, I'm aware not everyone can drop what they are doing. So if you cannot make it to Palo Alto in September, my suggestion is to register for the Global Access Program - it's a free way to view the conference live over the internet.

Here's my HOWTO for hospital leaders:

  • Register for MedX Global Access
  • Get a large TV or projector + good audio system
  • Wheel the TV or projector into your cafeteria or lobby
  • Launch the stream
  • Invite patients, families, staff, leaders and medical staff to come watch

Easy, right?


It's kind of strange...

20140717-123824-45504335.jpg These two people are sitting inches apart and yet they are a world away.

Seems like a strange way to work...

[spotted from a hotel's conference room last week]

Design for yourself

I did't train as an engineer or anthropologist —two of the more common pathways into design thinking. In fact, I found the language and tools of design after I was well into my career in healthcare.

I'm aware I'm not a seasoned designer, but not always sure I know what I don't know...I am, as Noel Burch would say, consciously incompetent.

Lately, I've been working on my relocation to DC. I've had to sort through finding a place in a city I don't know as well as I thought I did. And then there are all the moving pieces (pun marginally intended) of orchestrating a move.

Then it occurred to me: be your own design subject. I re-approached the entire process by first interviewing myself. I asked myself questions like:  selfwhat kind of place do you want? What should it be near? What do you dislike about your current place?  I made post-its with my must haves, wants and dislikes. Those post-its turn into trial runs of hotel nights in various neighborhoods to practice commutes and check out restaurants; in other words, prototypes.

This weekend, I applied the same process to coordinating everything about the move.

The lesson for me, and perhaps other designers: take time to design for yourself.

collaboration > litigation - Tesla opens its patents

Elon Musk, the C.E.O. of Tesla, opened up all of his patents. “Tesla will not initiate patent lawsuits against anyone who, in good faith, wants to use our technology,” he wrote in a blog post. Tesla’s competitors can now freely take advantage of its batteries, chargers, or sunroofs.


Musk isn’t entirely an altruist. Tesla makes electric cars, and will only succeed if the entire electric-vehicle industry succeeds.

via Why Elon Musk Just Opened Up All of Tesla's Patents : The New Yorker.

Meet Barb

shoppingActually, I don’t know her name. But we’ll call her Barb. She, or rather the waterproof luggage carrier on her car caught my eye when I was walking my dog, Ippa, this morning. It was a shiny new contrast to the rather old, worn-in four door to which it was attached. Barb was asleep in the front seat. Later, when I was on the last stretch of my morning run, I thought about Barb, asleep in her car. I thought I should go the other way because, well, it’s kind of a bummer and I was in the zone. Then I though really? You’re sucking wind and you think that’s hard? She’s sleeping in her car! I decided I’d go see if Barb was awake.

We made eye contact and I slowed to a jog and then stopped. “I’m getting coffee and a bagel,” I announced, “can I get you something too?” She was sheepish a first, and shrugged to indicate an inaudible yes. I asked her if she’d like anything else.

“I’m a vegetarian,” she told me.

“So am I! That’ll make this easy. Give me 10 minutes, I’ll be right back.”

I returned from the local coffee shop with a bagel, side of hummus and some black coffee. “I’m actually vegan, so I don’t put anything in mine, hope that’s ok?”

“Fine by me. I never ate meat, I guess I care for animals too much,” she said. “And I raised my two girls that way too. But I dream about milk. I jokingly say, I’m a milk-aholic..” She was standing in the street in her bare feet, outside of her car-turned-home as I took off to finish the rest of my run.