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It's a fine line between living for the moment and being a sociopath.

Patricia B McConnell: For The Love Of A Dog.

Pema Chodron: The Places That Scare You

Daniel Wallace: Mr Sebastian & the Negro Magician

All paths lead to the same goal: to convey to others what we are. --Pablo Neruda

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Location: Oxfordshire, United Kingdom

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Monday, April 15, 2013

Mongolians say "Spring has many faces."

Yesterday, it was sunny in Ulaanbaatar, with a diamond-cutting blue sky, and air so warm the river ice broke open to clear water for the first time this year.

This morning, I swept back the curtains to a complete white-out of driving snow.

The Mongolians say "Spring has many faces."

The Finns say, "There is no such thing as bad weather; only inappropriate clothing."

Monday, January 21, 2013

The Mink Malgai*

1 measure Bailey's
1/2 measure Vodka
1/2 measure Courvoisier
Splash Kahlua
Small scoop of good vanilla ice cream
...in a tumbler

Best accompanied by banana bread.

*"Malgai" is Mongolian for "hat"

Sunday, December 09, 2012

New Grass: Sleepy Man Banjo Boys

For different reasons, this is for my mother, my father, and Margot.  Watch it all.  The power break at the end of the second song is just beautiful -- whether that kid is 10 or 100.

Saturday, November 17, 2012

An Ulaanbaatar reminder of a Canadian memory

I am reminded that I like winter mornings.  I haven't lived with many since a grumbling youth in Canada, a youth that railed against morning.

But here they are again, in a long string, those mornings that have a little blue to their light, and the promise of idle hours of tea and books and not going much of anywhere, because it's too damn cold outside.


Sunday, November 11, 2012

Once more, with Heart

One of my secret dorky music indulgences, entirely sentimental and wholly authentic, is the 70's rock band, Heart.

They were no more a part of my growing up than dozens of other bands.  But where so many others have fallen away into sweetly impotent memory, Heart has somehow grown in power and significance for me.  I never would have predicted that, 30 years later, I would exalt Ann and Nancy Wilson -- the sisters who founded and fronted the group -- as among the most personally inspiring figures in rock and roll.

Yet, every 18 months or so, I find myself hours into a refreshed immersion in both the music and the energy of the women who made it.  I sit -- as I have done tonight -- watching them on video, listening to the power chords, beguiled by the physical commitment, and reverberating with the declarative high notes. Nancy is perhaps the most compelling female rock guitar stage presence ever (albeit among an admittedly, and sadly, small field), and Anne dishes out one of the most gripping rock voices of her generation -- the bastard child inheritor of Janis Joplin and Aretha Franklin.

I just sat here and watched six different live performances of the song "Crazy On You", back to back.  They were recorded 25 years apart. But, each time, at exactly the same point in the song, my whole body shivered.

I cannot watch the Wilson sisters without thrilling in the beauty and power of their brand of femininity.

"We didn't want to be the girlfriends of the Beatles. We wanted to *be* the Beatles."  Nancy Wilson

Tuesday, September 11, 2012

Big Lovin' Easy-Bake Oven

For my beloved friend, Bill Stuart, who died yesterday.

I am in Ulaanbaatar burning candles for you, Bill Stuart. On the other side of the world, Billy-Bill, there are candles lit for your insanely beautiful life.

Ours was a bromance. We smoked cigars, drank Kickin’ Chickin’, and talked about cars, women, God and symbolic interactionism.

I preceded you in grad school by a year. Then spent the next year learning from you.

You proved to me that humility and a big personality are not incompatible.

Your faith, your love, your patience, your silliness, your selflessness, your indefatigable, incorrigible, irreverence all schooled me.

You once offered that you admired me. I told you that was all kinds of the wrong way ‘round.

You wrote love on every surface around you, and on every soul you crossed with your smile. You loved on everyone. Everyone. And every now and then you'd let us kiss your head.

I adored watching you become Dr B, and then watching Dr B become mentor, inspiration and example. But I also adored that, to me, you never stopped being Big Lovin' Easy-Bake Oven.

But there was never greater joy, in my love for you, Billy-Bill, than watching you become husband and father -- proof to anyone who ever needed it that even the largest love can grow a thousand fold.

All these people you touched, Billy-Bill, we know how to live this life a little deeper 'cause of you.

God damn I loved you.

Peace for all time, beloved friend.


Sunday, September 02, 2012

Thrilled by death's demography

Some weeks back, in the throes of the Mongolian elections, I caught myself walking the empty evening hallways of our Ulaanbaatar offices relieved that the dead man was Filipino.  And relieved that he died in his sleep.

I was, for a moment, that person who forgets what loss means, and so had lost myself.

I manage communications for a mining company.  Slow news days are good days.  When I heard someone died at the mine site, my first two thoughts were, "How did he die?" and "Where was he from?"

The best outcome for the head of communications would be a death from natural causes, in bed, with no-one else around.  Even better would be a foreigner -- meaning anyone not Mongolian.  A foreigner's quiet, unremarkable death would pass virtually unreported.  A Mongolian death, under any circumstances, would be fodder for speculative conspiracy stories for days, maybe weeks.  A death on the job would shake the organisation to its core and raise plenty of questions about international expertise and standards: purported benefits that come from working with a big, global mining company.

The middle-aged Filipino man had a heart condition.  He was simply still and cold in the morning, when his friends came to rouse him.

And I felt super.  Dodged a bullet and all that.  It took me longer than I like to admit to focus on the other part of his story.

That there was a woman in the Philippines who last saw him get on a plane to Mongolia to go to work, and who would never see him again.  That he would never again see or hear or smell home, and the people who loved him enough to make it his home could never say goodbye.  That his last day had nothing in common with any of the ways he might have imagined it: among mostly strangers, in a strange place, with not even a morgue in which to lay waiting for what would come next.

My team and I took a moment's silence in our morning meeting, the following day.  Because he was one of us.  And, even more, because he was someone else's.


"I'm afraid I don't have a Lama on my org chart."

A few days ago, I wrote that, without irony, in a serious corporate email.  

Forty-eight hours later, I had a Lama on my org chart.

Job title: Spiritual Advisor.

True story.

This has now topped, in the ridiculous stakes, that time a few years back when I managed doctors.  Yeah: me, I supervise a Buddhist Lama.  

Capitalism takes some strange turns.

Tuesday, August 07, 2012

Office quote of the day from the heart of the Mongolian mining industry

"The cost of wild ass has been excluded."

Not kidding.

Sunday, June 03, 2012

Important message to every little girl in the world

It has now become my experience that, if you wait long enough, someone will eventually give you a pony for your birthday.

It only took me forty-five years.

The horse's name is Sarel, which means both Grey and Wolf.  I don't know how to begin to express my gratitude to my team for their extraordinary gift.

Sunday, May 13, 2012

If this is Mongolia, why are all the signs in Russian?

Whilst I sometimes pride myself on how many countries I've visited or lived in, it's a sign of just how un-worldly I am that I was surprised to find, upon landing for the first time in Ulaanbaatar some months back, that all the signs are in Russian.

Which, of course, they're not.  They're in Mongolian, a language that is nothing at all -- not even remotely -- like Russian, nor anything like Mandarin Chinese.  The language of the Mongols shares nothing in common with either it's northern or southern linguistic neighbours.  So, then, why do all the signs in Ulaanbaatar look like they've been ripped off 1970's Moscow store-fronts?

The Mongolian language has a rather idiosyncratic historical relationship with writing.  Ghengis Khan was illiterate, himself, because, well, there was no Mongolian writing before him.  During his conquests, however, he encountered this interesting technology by which words could be frozen on paper, and he immediately recognised its value for law-making, governance, and administration.  Not content to adapt the written language of another people, he commissioned a writing system to be developed for the Mongolian language.  The result, based on a Uighur script from what is now western China, was an alphabetic system, meaning that it had different letters for consonants and vowels.  That distinguishes it from so many other Asian languages that are either phonetic, like Japanese hiragana, or symbolic, like Chinese characters and Japanese kanji.

It's strikingly beautiful.  To the western eye, it might seem to have visual elements of both Asian writing and Arabic calligraphy.  Although Genghis never did learn to read or write, he vigorously promoted the practice of writing and documentation, which flourished under him, and thereafter throughout the Mongol empire.

But none of the signs in Ulaanbaatar are in this beautiful script.  They all look Russian.  Which they're not.  They're Mongolian.  But they're written in the same alphabet as Russian: Cyrillic.

Cyrillic isn't nearly as beautiful as Mongolian, but it's readable -- at least the sounds can be made out -- by many more people.  It was introduced into Mongolia in the middle of the 20th century when Mongolia came under the protection (or control) of the Soviet Union.  For the same reason Ghangis wanted a writing system -- ease of administration -- the Soviets imposed their alphabet on Mongolia.  And Mongolians have been writing in Cyrillic ever since.

The signs don't make any more sense to a Russian speaker than they do to me, but the Russian has the advantage of knowing roughly what the foreign words sound like.

Mongolian sounds are a whole 'nuther story.  It's genuinely hard to describe what Mongolian sounds like to my anglophonic ear without coming across as, at least, condescending and, at worst, insulting.  It's a sound unlike any I've heard before in my life.  I speak a little Chinese, a little Japanese, and smatterings of romance languages.  Mongolian, however, sounds to me like something from another planet.  As well it might, since it was the basis for Star Trek script writers when they came up with the sounds Klingons make.  Think what Klingons might sound like making romantic small talk, and you've got my hearing of Mongolian.

Do blonde camels have more fun?

The people of the Gobi desert call them "white" camels.  They're more blonde -- or very light tan -- but they are distinctive and rare.  It is good luck to encounter one.

The more I see of these bactrian beasts, the more fond of them I grow.  They look like something that might arise as the love child of Dr Seuss and George Lucas.  Especially the babies.

Photo credit: Taylor Buonocore, from the back of a Land Cruiser piloted by a very amused driver who humoured the dogged photographer despite the camels being, to him, like so many squirrels.

Thursday, April 26, 2012

Don't work. Be hated. Love someone.

Enjoyed this very much.

Sunday, April 22, 2012

The Reason We're Here

Blue rocks and big trucks.


On the road from Dalanzadgad to Khanbogd

Firsts, this week:
Drinking camel milk
Eating dried camel curds
Drinking salted tea
Hearing the horse-head fiddle accompany the Mongolian long song
Driving across the Gobi desert, from Dalanzadgad to Khandbogd

Australians could be forgiven for thinking that the Gobi looks like a slightly less red version of the outback.

My intrepid driver, Tsevenbaatar, who has a rather eclectic taste in pop music.  I should correct that: He was not my driver; I was his passenger.

Camels grazing in the Gobi.


Ulaanbaatar: Deel Or No Deel

You could describe Ulaanbaatar as a polluted post-Soviet mining boomtown in the middle of a desert.  And you’d be pretty right.  You could also call it the capital of one of the most historically successful people in the world and the centre of what is currently the hottest economy on the planet.

I’ve been living and working here for just a fortnight.  Last week, the ex-President of the country was arrested on corruption charges and neo-Nazis showed up at my office, while Lady Gaga and Jessie J thumped from the open windows of massive SUVs.  There is no way of describing this town in terms that make sense to those of us who’ve always neatly presumed that nations are either “developed” or “developing”.  This week, I have crunched on dried camel curds with a man wearing a traditional deel (pronounced "dell"), and also dined on fresh-off-the-plane Australian seafood with a woman wearing an Alexander McQueen dress.

There was also an unexpected dinner with a former finance minister: a man whom the Soviets threw in prison for distributing hand-typed copies of Solzhenitsyn, who has since published the Encyclopedia Britannica in Mongolian and is now personally translating Bill Bryson’s A Short History of Nearly Everything. He pointed out that Mongolia only has about 400 laws. His point was that that’s a whole lot more than the United States had when it was only 20 years old.

It’s a country in the midst of defining its modern self, and idiosyncratically making it up as it goes along.  How history fits with modernity is in flux.  It turns out, for example, that the neo-Nazis who dropped by my office are an officially registered NGO, albeit a heartily tattooed and leather-clad NGO.  The xenophobic politics are familiar, but the swastika is culturally nuanced in a place that was never touched by the Third Reich.  The only historic anti-Semitism in this country occurred when Russians were killing other (Jewish) Russians in the pogroms.  And then you have to go through the looking glass: The swastika is, of course, a revered Buddhist symbol when you turn the pinwheel the other way, and the oppressed minority in Mongolia were the Buddhists, whom the Soviets killed by the thousands. So the same symbol that makes us queasy in the west is a symbol of an oppressed minority, here.  And, um, also the symbol of the neo-Nazis.

As a result of this real-time sense-making – or, in some cases, nonsense-making – it’s a place of fast-forward cultural appropriation.  The signs are all in Cyrillic – so look Russian to ignorant foreigners like me -- Chinese goods dominate, French luxury products confer status, American and British culture are everywhere, and the most numerous restaurants are Korean.

But not everything is shifting.  If American identity harkens back to individualistic cowboys, and all Australians are, deep down, the Man From Snowy River, then this country isn’t that far distant from us.  It’s a vast, unfenced wilderness whose people, no matter how city-bound, all have nomadic hearts on horseback.  Just what that means I don’t yet know.

Sunday, April 15, 2012

A day in Terelj, outside Ulaanbaatar

Sunday, April 08, 2012

In transit to a chosen unknown

I am in Seoul, Korea. But, really, I am in that nether-world so familiar to international transit passengers, and so incomprehensible to anyone else. My body, my mind, my heart are all unsure of themselves. They seem grumpy with each other, not to mention the human condition. Everything enervates them. Me.

I am traveling from London to Ulaanbaatar. Seoul is my way-point. Chasing the clock and hurrying the sun, I am in Seoul in the mid-afternoon, having left London last evening. Fortunately, the day is bright, blue and, as far as I can tell from inside the hermetically sealed chamber that is Incheon Airport, warm. So, while my eyes protest the assault of the sun streaming through the glass walls, my mind is grateful for the jolt. My body isn’t trusting anyone: not about the time, not about anything.

Seoul was, the first time I came, the most foreign place I had ever been. I found the smells, the food, the habits and the regard for me as a foreigner all more alienating than the unknown people, language, culture and history. My first thought on emerging from the plane, today, perhaps 17 years later, was simply, “It smells the same.” I wonder if, visiting Mongolia when I am in my 60s, I will step off the plane and think the same thought.

Thursday, April 14, 2011

No day in court for our sense of right and wrong?

The NY Times headline caught my eye: "In Financial Crisis, No Prosecutions of Top Figures".

It is a question asked repeatedly across America: why, in the aftermath of a financial mess that generated hundreds of billions in losses, have no high-profile participants in the disaster been prosecuted?

Of the many things about the US that makes me shake my head, these days, this is a symptom of one of my deepest worries: namely, that we seem to have lost our deeply felt allegiance to desire for justice. Instead, we bury justice in an argument about politics, policy, ideology, and partisanship. Or just say that justice is some other bureaucracy's job.

Lying has become ok. Fraud has become ok. Getting away with it has become ok. And not just in the financial mess, but across so many issues.

I wanted the "change I could believe in" to include a Federal Government that took its sense of right and wrong to court.

I'm not seeing it.


Monday, March 14, 2011

Hierarchy of Argument on the Internet

Sunday, March 06, 2011

Royal Grandson Grins

I've been pretty bummed, in recent weeks, about the state of the planet, the state of democracy, and the state of the United States.

So, simple, heartwarming moments have been particularly welcome.

...like this photo, of a grandmother and her grandson simply grinning at each other in a circumstance that one might have expected would normally demand more decorum.

Saturday, December 04, 2010

Disney workers fight for a living wage

Disney's got a long history of being a magical place for its customers and a nightmare for its staff. The videos in this BoingBoing post give the behind-the-scenes Disney "cast members" a chance to share their stories of their working conditions, and the stories are just sad. The vids are part of the PR campaign that Disney's workers' union is waging to try to get what they consider a fair deal.

I find this kind of thing to be an indictment of the way some corporate executive teams practice shareholder capitalism. It's not a system that has to screw workers to succeed, so why is it so often practiced that way?

Getting away with the lowest wage bill you can is economically rational, but it isn't moral, and in the long run it probably isn't good business. Watch these videos and see if it leaves you with a good feeling about Mickey Mouse and Toy Story. That's brand damage you're feeling.


Monday, September 27, 2010

Pop music for dog lovers

OK-Go does it again. Fully fabulous.

Sunday, August 08, 2010

In case your battle cruiser breaks down

It is absolutely freaking delightful that San Diego allowed the trolley signs outside the ComicCon venue to be translated into Klingon.

Saturday, August 07, 2010

Sexiest Car Ever?

1935 Alfa Romeo 6C 2300 Jankovits Spider

Hat tip to Surfing With The Alien.


Sunday, August 01, 2010

Overheard after a sumptuous meal

Flame-Haired Angel: "I will lie in bed tonight like a beached whale."

Hubbin': "And I will nibble on your blubber like an eskimo."


Tuesday, July 06, 2010

I'm just a teenage ukulele player

How can you not love these guys?


Sunday, June 27, 2010

Gentle, joyful noise

This strikes me as combining all my favourite elements of bluegrass, jazz and chamber music.

Gawande's Commencement Address at Stanford Medical School

I've read two of Atul Gawande's books. Both times, I've turned the last page and wished I could pop the book in the post to my oldest friend, Chris, one of the best men I've ever known and a deeply talented surgeon. I know how much he'd enjoy them. I imagine him sharing with Gawande a similar viewpoint on medicine and humanity. It's a perspective we could use more of. Chris hasn't been in this world for years, though, so I'll keep reading Gawande and hoping others do, too.

The original of Gawande's commencement address to Stanford Medical School, delivered earlier this month, is up at The New Yorker.

* * *

Atul Gawande gave the commencement speech at Stanford’s School of Medicine last week. Here is what he told the graduating class.

Many of you have worked for four solid years—or five, or six, or nine—and we are here to declare that, as of today, you officially know enough stuff to be called a graduate of the Stanford School of Medicine. You are Doctors of Medicine, Doctors of Philosophy, Masters of Science. It’s been certified. Each of you is now an expert. Congratulations.

The experience of a medical and scientific education is transformational. It is like moving to a new country. At first, you don’t know the language, let alone the customs and concepts. But then, almost imperceptibly, that changes. Half the words you now routinely use you did not know existed when you started: words like arterial-blood gas, nasogastric tube, microarray, logistic regression, NMDA receptor, velluvial matrix.

O.K., I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.

Since I graduated from medical school, my family and friends have had their share of medical issues, just as you and your family will. And, inevitably, they turn to the medical graduate in the house for advice and explanation.

I remember one time when a friend came with a question. “You’re a doctor now,” he said. “So tell me: where exactly is the solar plexus?”

I was stumped. The information was not anywhere in the textbooks.

“I don’t know,” I finally confessed.

“What kind of doctor are you?” he said.

I didn’t feel much better equipped when my wife had two miscarriages, or when our first child was born with part of his aorta missing, or when my daughter had a fall and dislocated her elbow, and I failed to recognize it, or when my wife tore a ligament in her wrist that I’d never heard of—her velluvial matrix, I think it was.

This is a deeper, more fundamental problem than we acknowledge. The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. Worse, the fear is that the knowledge has grown beyond our capacity as a society. When we talk about the uncontrollable explosion in the costs of health care in America, for instance—about the reality that we in medicine are gradually bankrupting the country—we’re not talking about a problem rooted in economics. We’re talking about a problem rooted in scientific complexity.

Half a century ago, medicine was neither costly nor effective. Since then, however, science has combatted our ignorance. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses—13,600 different ways our bodies can fail. And for each one we’ve discovered beneficial remedies—remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we’re struggling. There is no industry in the world with 13,600 different service lines to deliver.

It should be no wonder that you have not mastered the understanding of them all. No one ever will. That’s why we as doctors and scientists have become ever more finely specialized. If I can’t handle 13,600 diagnoses, well, maybe there are fifty that I can handle—or just one that I might focus on in my research. The result, however, is that we find ourselves to be specialists, worried almost exclusively about our particular niche, and not the larger question of whether we as a group are making the whole system of care better for people. I think we were fooled by penicillin. When penicillin was discovered, in 1929, it suggested that treatment of disease could be simple—an injection that could miraculously cure a breathtaking range of infectious diseases. Maybe there’d be an injection for cancer and another one for heart disease. It made us believe that discovery was the only hard part. Execution would be easy.

But this could not be further from the truth. Diagnosis and treatment of most conditions require complex steps and considerations, and often multiple people and technologies. The result is that more than forty per cent of patients with common conditions like coronary artery disease, stroke, or asthma receive incomplete or inappropriate care in our communities. And the country is also struggling mightily with the costs. By the end of the decade, at the present rate of cost growth, the price of a family insurance plan will rise to $27,000. Health care will go from ten per cent to seventeen per cent of labor costs for business, and workers’ wages will have to fall. State budgets will have to double to maintain current health programs. And then there is the frightening federal debt we will face. By 2025, we will owe more money than our economy produces. One side says war spending is the problem, the other says it’s the economic bailout plan. But take both away and you’ve made almost no difference. Our deficit problem—far and away—is the soaring and seemingly unstoppable cost of health care.

We in medicine have watched all this mainly with bafflement, even indifference. This is just what good medicine is like, we’re tempted to say. But we’d be ignoring the evidence. For health care is not practiced the same way across the country. There is remarkable variability in the cost and quality of care. Two communities in the same state with the same levels of poverty and health can differ by more than fifty per cent in their Medicare costs. There is a bell curve for cost and quality, and it is frustrating—but also hopeful. For those getting the best results—the hospitals and doctors measured at the top of the curve for patient outcomes—are not the most expensive. They are sometimes among the least.

Like politics, all medicine is local. Medicine requires the successful function of systems—of people and of technologies. Among our most profound difficulties is making them work together. If I want to give my patients the best care possible, not only must I do a good job, but a whole collection of diverse components must somehow mesh effectively.

Having great components is not enough. We’ve been obsessed in medicine with having the best drugs, the best devices, the best specialists—but we’ve paid little attention to how to make them fit together well. Don Berwick, of the Institute for Healthcare Improvement, has noted how wrongheaded this is. “Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence,” he says. He gives the example of a famous thought experiment in which an attempt is made to build the world’s greatest car by assembling the world’s greatest car parts. We connect the engine of a Ferrari, the brakes of a Porsche, the suspension of a BMW, the body of a Volvo: “What we get, of course, is nothing close to a great car; we get a pile of very expensive junk.” Nonetheless, in medicine, that’s exactly what we have done.

Earlier this year, I received a letter from a patient named Duane Smith. He was a thirty-four-year-old assistant grocery-store manager when he had a terrible head-on car collision that left him with a broken leg, a broken pelvis, and a broken arm, two collapsed lungs, and uncontrolled internal bleeding. The members of his hospital’s trauma team went swiftly into action. They stabilized his fractured leg and pelvis. They put tubes in both sides of his chest to reëxpand his lungs. They gave him blood and got him to an operating room fast enough to remove the ruptured spleen that was the source of his bleeding. He required intensive care and three weeks of hospital recovery to get through all this. The clinicians did almost every single thing right. Smith told me that to this day he remains deeply grateful to the people who saved him.

But they missed one small step. They forgot to give him the vaccines that every patient who has his spleen removed requires, vaccines against three bacteria that the spleen usually fights off. Maybe the surgeons thought the critical-care doctors were going to give the vaccines, and maybe the critical-care doctors thought the primary-care physician was going to give them, and maybe the primary-care physician thought the surgeons already had. Or maybe they all forgot. Whatever the case, two years later, Duane Smith was on a beach vacation when he picked up an ordinary strep infection. Because he hadn’t had those vaccines, the infection spread rapidly throughout his body. He survived—but it cost him all his fingers and all his toes. It was, as he summed it up in his note, the worst vacation ever.

When Duane Smith’s car crashed, he was cared for by good, hardworking people. They had every technology available, but they did not have an actual system of care. And the most damning thing is that no one learned a thing from Duane Smith. For we have since had the exact same story occur in Boston, with an even worse outcome. Indeed, I would bet you that, across this country, we miss the basic, unglamorous step of vaccination in probably half of emergency splenectomy patients.

Why does anyone receive suboptimal care? After all, society could not have given us people with more talent, more dedication, and more training than the people in medical science have—than you have. I think the answer is that we have not grappled with the fact that the complexity of science has changed medicine fundamentally. This can no longer be a profession of craftsmen individually brewing plans for whatever patient comes through the door. We have to be more like engineers building a mechanism whose parts actually fit together, whose workings are ever more finely tuned and tweaked for ever better performance in providing aid and comfort to human beings.

You come into medicine and science at a time of radical transition. You have met the older doctors and scientists who tell the pollsters that they wouldn’t choose their profession if they were given the choice all over again. But you are the generation that was wise enough to ignore them: for what you are hearing is the pain of people experiencing an utter transformation of their world. Doctors and scientists are now being asked to accept a new understanding of what great medicine requires. It is not just the focus of an individual artisan-specialist, however skilled and caring. And it is not just the discovery of a new drug or operation, however effective it may seem in an isolated trial. Great medicine requires the innovation of entire packages of care—with medicines and technologies and clinicians designed to fit together seamlessly, monitored carefully, adjusted perpetually, and shown to produce ever better service and results for people at the lowest possible cost for society.

When you are sick, this is what you want from medicine. When you are a taxpayer, this is what you want from medicine. And when you are a doctor or a medical scientist this is the work you want to do. It is work with a different set of values from the ones that medicine traditionally has had: values of teamwork instead of individual autonomy, ambition for the right process rather than the right technology, and, perhaps above all, humility—for we need the humility to recognize that, under conditions of complexity, no technology will be infallible. No individual will be, either. There is always a velluvial matrix to know about.

You are joining a special profession. Doctors and scientists, we are all in the survival business, but we are also in the mortality business. Our successes will always be restricted by the limits of knowledge and human capability, by the inevitability of suffering and death. Meaning comes from each of us finding ways to help people and communities make the most of what is known and cope with what is not.

This will take science. It will take art. It will take innovation. It will take ambition. And it will take humility. But the fantastic thing is: This is what you get to do.

Collapsible Cool

You see a lot of cool, crazy, wacky, beautiful stuff on the web.

But how's this for genius design, in the form of a "Why didn't I think of that!?" idea, delivered as a save-the-world-and-make-money-at-the-same-time proposition.

When industrial designers get it right, it can be awe-inspiring. Geekily awe-inspiring, but still awe-inspiring.

I hope this guy gets really, really rich.

* * *

Collapsible Shipping Container

It's made of a fiberglass composite and weighs 75% as much as a standard metal container.

It folds down to 25% of its expanded size.

The composite is more resistant to corrosion than the steel it replaces, is easier to clean and it floats.

Making it results in 25% of the carbon dioxide generated by manufacture of its steel counterpart.

Collapsed containers can be bundled together in groups of four, allowing ships to load far more quickly and cutting time spent in port.

The Cargoshell, invented by Rene Giesbers, a heating-systems engineer from the Netherlands, "can be collapsed or opened in 30 seconds by a single person using a forklift truck," according to an article in the March 6, 2010 Economist Technology Quarterly.

Hat tip to Book Of Joe.

Saturday, June 12, 2010

Astounding reunion with an old friend

This makes me feel an estraordinarily diverse range of emotions.

Saturday, May 22, 2010

MBAs and Entrepreneurs

A month ago, I blogged an article and a clip about why MBAs often make crappy entrepreneurs. Here's another great article, with a fantastic catch-line:

“The top third of the class works for the middle third of the class at companies started by the bottom third of the class.”

Are MBAs necessary for start-ups or VC?


Sunday, April 18, 2010

What makes a leader? A lone nut.

“The first follower is what transforms a lone nut into a leader.” Derek Sivers

Saturday, April 17, 2010

Why MBAs often make crappy entrepreneurs

"VCs don't give a shit about your PowerPoint deck."

...from Stu Wall's excellent, brief article on why MBAs often fail at entrepreneurship.

Then, once you've read it, if you find yourself yelling "Yeah!" at the screen, you might also enjoy watching this:

Sunday, April 04, 2010

I'm 42. I think I need to get out and do something this good.

Tuesday, March 02, 2010

Wonderful, beautiful, stupid, ingenious, giddy...

OK Go does it again.