The Tartar Steppe (Buzzati), book review

Is it like “Waiting for Godot?” Is it Triste? It’s great, but what is it?

Triste.

In a past life, I have vague memories of learning French. And I learned there is a word in French that does not translate to English. Triste: the idea of sadness with an indefinable quality (I think).

I feel this, having finished this book. How I found this book, is now lost in my past history, some other book referenced this, and I thought at one point: “I must read.” now, having spend time on/off for 10 years (I first shelved this TO READ in 2012), I have come to the end of the book.

How do I feel? After a decade of pursuing the completion of reading?

Having binged my share of Netflix, HBO, Prime TV shows and movies, I can say that It is not an action flick. It is not a military triumph. So what is it?

I don’t really know.

It feels a little like “Waiting for Godot”: we are sitting, waiting for something, just around the corner, it peeks, and then disappears. Tantalizing.

I’m reading/listening to a different book: Mythos right now by Stephen Fry (hilarious), and Tantalus, one of the old gods, was punished by having tremendous thirst, and water, right THERE, just out of reach. Yes, it feels like that.

It feels a little like Ambivalence, with a capital A, for someone, indecisive, torn between two ideas, two worlds, two things one MUST do, and yet. Just hold, just one more day. Perhaps tomorrow. Like a person staring at their cigarettes, despising them, desiring them, not quite ready to quit smoking.

It feels a little like wanting, desiring, deserving.

How does he do it? Evoking these emotions, without speaking them. The words, the images, beautiful.

The action: a man joins the military. He is sent to the Fort, a desert frontier, facing the North, from where no one expects an attack to come. One hopes for glory, for action. Day after day, year after year, unexpected drama, tragedies, but the expected / not expected attack? Nothing. And when Something Looms, through the telescope, one believes: “it is too much to hope for.”

And the end? Realization, surprise, mostly at oneself.

What.

Writing about it really doesn’t do it justice. Will this review be oblique enough to evoke the mood, the triste, the indirection of the narrative? You must decide.

The Classics: what Copernicus teaches us about dogma vs revolution

I am a collection of contradictions. I alternate between hedonistic Netflix binges and an occasional classic book (Ptolemy, Copernicus, Kepler). What contradictions do you embody, and what has it taught you?

Son brought this book home from his sophomore year at St. John’s College in Santa Fe. You know the school has its bona fide’s when their faculty have written, edited and published the definitive modern editions of these classic books.

This was a fun read. I started with Ptolemy, and the geocentric worldview he championed about 40 CE, and followed some of the geometry proofs (having studied Euclid too many years ago). I watched him build his ‘epicycles’ (circles upon circles) to explain the progression and retrograde motions of the 5 visible planets.

Retrograde: here’s a bonus term for those of us no longer into astrology: it is the apparent reversal of the motion of planets gradually migrating across the sky. From the newspaper, I recall reading statements like ‘Mars is retrograde in Capricorn’ and thinking ‘what hocus pocus is this?!’ Now I know that it means Mars is migrating in reverse direction and it is positioned inside the constellation of Capricorn in the sky. It makes a little more sense descriptively, but I still don’t buy that astrology foretells my future as a result.

Clearly, says Ptolemy, the only rational view of the heavens are that they are concentric spheres. The proof is that with his excellent math, he can predict the positions of the stars into the future.

1400 years later, Copernicus thinks deeply and has an insight (how, though, did he have that insight?). I love books, like Lavoisier’s on Chemistry, where the author lays out his stepwise experiments and failures, and gradual reasoning toward the invention of the concepts of oxygen and hydrogen…

Nevertheless, Copernicus lays out the groundbreaking and heretical thought that the Earth is not the center, and that the sun is the ‘center of the world.’ Heliocentrism. He has to tread gently, as he is shattering what has been accepted by scholars (and the Church) for over one thousand years. (What do WE accept that has been true for 1000 years?)

In his introduction Copernicus gingerly states that both he and Ptolemy have explanatory systems that predict planetary motion successfully. But, the heliocentric model is SO MUCH SIMPLER.

So, how to explain why Mercury and Venus have a much smaller range as they move across the sky night after night, and Mars, Jupiter and Saturn seem instead to span the entire sky? Ptolemy has to jump thru hoops and invent weird epicycles to make sense of this, and yet Copernicus sweeps away all that complexity by saying Earth is itself a planet with an orbit BETWEEN Venus and Mars. Thus the ‘inner planets’ behave differently from the ‘outer planets’ based on Earths own orbit and ‘overtaking’ the orbits of those outer planets. And all the epicycles fall away. It is one of the most ‘ohhh’ beautiful moments in the history of science.

Devastatingly, he draws out what Ptolemy’s epicycles requires planets to do (spirographic pirouettes through space, ridiculous when you look at it that way).

Cool read, even if this aging person is too lazy to revisit Euclid and plow through the math. The thinking, the paradigm shifting, the worldview challenging. That’s fun. Next up, Kepler and Galileo.

CMIO’s take? The world makes sense until someone comes along to up-end it. The instigator proposing the change often is faced with the sharp end of sticks and pitchforks. As Machiavelli told us, change is so difficult because proponents of any change are, at best, lukewarm, while detractors have ALL THE PASSION IN THE WORLD. Copernicus faced this. I have faced this as well, by developing APSO notes, and advocating for Open Notes and Open Results. Whatever change you’re working on, take heart. We tread this road together.

My Gratitude Letter (to Dr. Fred Platt), and why you should write one too

Learning to write a gratitude letter is worthy exercise, for both the writer and the recipient. There are surprises here …

In our wellness work, we learn surprising things about ourselves.

First, that expressing gratitude benefits both the giver and the recipient, in terms of mood and overall health.

Best of all, giving gratitude, unlike carefully wrapped, commercially-obtained holiday gifts, is FREE.

One particular activity worth noting, is the GRATITUDE LETTER.
Here’s how to do it.
Write a letter to someone for whom you are grateful, and tell them why.
Make an appointment to see them in person.
Read the letter out loud to them.

The research tells us that both the giver and recipient receive a months-long boost in mood from that event.

WHY DO WE NOT DO THIS ALL THE TIME?!

Reader, I did this last week. I’m here to tell you how it went. One of my mentors is Dr. Fred Platt, author of many peer-reviewed articles and books on Physician-Patient Communication: Field Guide to the Difficult Patient Interview, and the Annals of Internal Medicine’s Words that Matter series, including “Let me see if I have this right …“. In later years, he wrote poetry.

He helped me get started in academic medicine, in teaching medical students, in learning how to be an excellent communicator, in being a better doctor, a better colleague, a better human being.

Now, decades later, his health declining, I wrote him a letter, made an appointment, and drove to see him. He only had the energy for a 30-minute visit, but loved the letter enough to have his wife and I read it to him twice.

Not a dry eye in the house.

I will miss you, Dr. Platt. Thank you.


November, 2022

Dear Fred

Thank you for the chance to tell you how you’ve changed my life.

I met you at the Bayer Institute CPC Workshop: Clinician-Patient Communication to Improve Health Outcomes. You facilitated a group of 16 junior faculty in Internal Medicine in 1997, and taught me, among other things, Reflective Listening: “So, it sounds like you’re having some belly pain, and it is going down to the right side, and you think it is … gout? Do I have that right?”

I learned about Ideas, Feelings and Values, and it changed my life. I became a Bayer-certified Communications Facilitator to follow your footsteps.

You took me under your wing, you re-ignited my passion for patient care, and gently taught me tools for difficult conversations: “On the one hand you think … On the other hand I worry …”

You co-founded Foundations of Doctoring at University of Colorado. Our initial trials at teaching communication in lecture halls met with abject failure. 160 students at the first lecture, and only 5 come to the second one.

We repeatedly redesigned the course until it really sang: 1 standardized patient, 4 student learners coaching each other, and a facilitator guiding ILS: Invite, Listen, Summarize. I use and teach these tools today to incoming students.

You generously asked me to co-author numerous communications papers, published in several journals, including the series WORDS THAT MATTER in the Annals of Internal Medicine. We discussed a number of delightful cases, including the case of the patient who ate too many pies at work, and wanted to claim workman’s compensation, prompting an outburst from my resident.

For this computer-geek doctor, you taught me compassion and connection and relationship-building. These are my guiding principles to this day. In my national travels and talks that I give in the Informatics world, there are few who have had a mentor like you.

I am proud to teach your ideas that words matter, communication matters, relationships matter.

I’ve learned over the years, that I have an internal Judge voice, who sounds suspiciously like my father, and an internal Sage voice, who I call Fred.

I am so grateful for your teaching, your counsel, your collegiality, and your friendship.

Thank you, Fred.

With Love
CT Lin
Chief Medical Information Officer, UCHealth
Professor of Medicine, University of Colorado

 

Door-dash ride along, a parent’s and informaticist’s view

Ever wonder what the gig economy is all about? What is the experience of drivers, interacting with restaurants, with traffic, with the AI-in-the-cloud, with customers?

My son recently turned to this service to make some cash prior to his upcoming trip. Wonder of wonders, he offered to let me come ride-along for a few hours on one of his outings.

Finally! a chance to see behind the velvet curtain! Is there a Wizard in Oz controlling things?

We spent about 4 hours together, including the dinner rush.

What did I learn, as a parent and an informaticist?

Gas is expensive

at $5 and eats (pun intended) into any profit margin. Food delivery is particularly hard right now, but I can’t imagine it is much easier or more lucrative even with less expensive gas.

This is hard work.

Even four hours is a lot of work, I can’t imagine doing this for more, and day after day. Even my son, after a couple weeks of doing this, notes that “this could be an occasional supplement to someone with an existing job, but I can’t see doing this full time for the few dollars it brings in.”

It is good to go online

and learn tricks from others. I haven’t done the surfing, but it sounds like there are youtube videos for strategies on how Dashers can make money. For example, “don’t take every offer that comes to you over the phone.” Some deliveries only offer a couple dollars for 2-3 miles of driving, working out to about a dollar a mile. From what we believe of the algorithm, if a driver turns down a delivery, the next driver gets a slightly higher offer. IF that is the case, it is the responsibility of drivers to look out for each other and decline overly cheap delivery offers! (see: Fight the Man!).

The informaticist likes end-users who educate themselves to improve their own workflow and experience.

Traffic is terrible

and some drivers have lost sight of their humanity. I occasionally see bad behavior on the streets when I’m driving, but spending 4 hours driving around the city, gives you a concentrated view of your neighbors. The pandemic has done something to our vehicular civility. People honking at folks driving the speed limit, people swerving and gunning their engines to get 1 or 2 spaces ahead in traffic, emotions running high while operating multi-ton vehicles. A dangerous workplace.

The informaticist understands strong emotion and unhappy end-users who act out at times.

Sometimes little physical tweaks

help provide better service. Having a shopping bag that is insulated keeps the food hot a little longer on your drive from the source to the delivery. Wearing comfortable clothing, having a phone with charger (a task-horse! Receive delivery offers, map your drive, text your delivery recipient that you are on your way, take a photo to prove you left it in the right place), and even better if you get good gas mileage.

The informaticist enjoys seeing work-flow tweaks that improve outcomes.

The smells are free, but it costs you

One bad side effect of driving food around, is that the food smells eventually get to you. Maybe not when you start, but a few hours in and inevitably you’ll get hungry. Uh-oh. Those fries … fast food places sure have dialed in the sensory experience. Other times the food is NOT to your preference, and you can’t get there soon enough to let it go. On the other hand, you get to learn where people like to order from, and you’re likely to find some new places to eat (we found bb.q, a relatively new Korean barbecue chicken place in Denver: cool)!

Don’t forget the drink(s)

The algorithm is smart enough to remind you to pick up drinks; having several moving parts to the order (not just the food bag, but also drink(s) and secondary items complicates the process and increases risk of error, so some reminders are built in. Also, some restaurants are on the app and can also call you back if you miss something.

Error-anticipating and error-correcting. The informaticist smiles.

Don’t be greedy. Or, maybe be greedy.

Apparently some gig economy workers run Door Dash and also Uber Eats and sometimes also Uber and Lyft AT THE SAME TIME, just to increase their chance of picking up more offers and staying busy. I can’t imagine the cognitive load (and increased danger) that entails whether stationary or while moving.

Separately, the app will sometimes try to package deliveries together (hey! if you drive another block, you can deliver a second request from a nearby restaurant, want to?) I can see the algorithm trying to lower costs and combine trips within a restricted time-block and geography-block. Kind of like the ‘traveling salesman‘ math problem. Except different.

The informaticist likes the math, hates the multi-tasking.

The attention economy

This usually refers to advertising, social media, how they are all now optimized to capture your attention and keep it. See: Made to Stick, The Shallows, Reality is Broken. Also see: every social media app on your amazing phone.

In this case, how does the algorithm capture you? It tells you “hey, you’re not accepting enough of these offers”. The little joyful “ping” of a new offer keeps us on the edge of our seats waiting to see what pops up next. It is HARD to quit driving at the time you set yourself. “I’ll just do one more, maybe the next one will be the big score!” Like Pavlov’s dogs, we could literally salivate when awaiting the next reward.

The informaticist likes “sticky” design, but only when used for the greater good.

Sometimes the little social tweaks can improve tips

My son learned to use the optional “send a message” tool. He would use it to tell the recipient that he had picked up the food and was on his way, with an ETA. “Hi Betty, Joe here. I’m on my way! ETA 10m” He even worked out exactly how few letters it would take to send a friendly note, with his name included, hoping for a better tip. And it would work, most of the time!

Informaticists like social engineering nudges when used for good.

Fight the man

Not all algorithms are looking out for the front line worker. “Fight the man!” becomes “Fight the code!” It is disappointing that gig economy algorithms have no allegiance to their drivers. No “company loyalty” engendered here: it seems that the algorithm is testing “how low will you go?” Here’s an offer to pickup from McDonalds for $2 to drive 2 miles to deliver. Want it? (no). or, Pickup from Applebee’s for $3 to drive 4 miles? (no). How about pickup from Korean fried chicken for $6 to drive 3 miles? (YES).

Sometimes it is not busy and you have to decide whether to take the lower paying deliveries because THERE IS NOTHING ELSE. But then, is that better or worse than just parking and having your engine off, saving gas, waiting for the next one?

Sure the algorithm has to make money for its Master-in-the-sky, but surely we can take care of our front-line workers and set some sort of regional minimum wage? Deliveries at $2/mile are helpful, but when it is $1/mile, it works out to less than minimum wage, and recipients do not often tip.

Hmm. Can the informaticist learn from game theory to improve user engagement in our common purpose? And are there principles of respect for front line workers in the design of artificial intelligence algorithms that make life better for all, not just the corporation?

Be grateful

when a son or daughter volunteers to let you come along to do something crazy like this. I’m aware these opportunities will not always be there.

The informaticist yields to the parent: YES, the parent says. I’m grateful.

Creativity DOES NOT come from our laptops

For all the great mind mapping tools out there, for all the shiny new apps that covet my attention, when it comes to creative thinking, designing things, or brainstorming a new talk, paper is it. #whyinformatics #hitsm #hcldr

Here are some examples:

Designing my Failure Resumé talk

Designing my AI talk

Designing my Sprint talk

Attending the Stanford Design Thinking for Social Systems

Of course, you should know that it is never this clean, never this simple. You don’t see the crumpled sheets, the trash can overflowing, the angry scribbles, the hair torn out and the yelling into the void. No, you don’t see it.

I’ll give John Cleese the last, inspiring words on this.

We don’t know where we get our ideas from. What we DO know is that we do not get them from our laptops.

John Cleese

City Scooters: an informatics viewpoint

A colleague and I were recently making fun of tourists and others riding the city scooters around Seattle and other large cities. Nearly no one was wearing helmets, they’re zipping in and out of traffic, going up against SUV’s and 16 wheelers. Just asking for it. Now, it is true that Seattle has some the best bike lanes around, with dedicated ‘green lights’ just for bike lanes, to improve safety. It IS a bike friendly town.

As an aside, my son and daughter, when they were 9 and 11, were riding their Razor scooters to the park, when I overheard them:

S: my scooter has a turbo boost to go fast.

D: oh yeah? My scooter has jets.

S: So, my scooter shoots out flames

D: Well, my scooter has apps, and I can download anything and plug it in to make mine better.

Wow, kids of the smartphone age.

I thought of my children, while I hopped on this scooter, downloaded an app to unlock and pay for a day of scooting, used Google maps to find the Art museum, used Yelp to find a good chinese noodle place, and Weather to see if I needed a rain jacket. All from one device. We are living in the future, folks.

So I’m humbled to report, dear reader, that I stooped to try one myself. I have returned from that ‘undiscovered country from whose bourn no traveler returns’. Hmm. Not exactly, but you get my meaning.

Seattle Chinatown gate

Here are some quick personal observations.

$ a city scooter is a nuisance – Some folks ride the scooter on the sidewalk, endangering pedestrians. Then they ride the scooter down wrong way streets against traffic endangering themselves. Often though, they ride in the many bike lanes, merging easily with bike traffic and other electric motor powered personal transport. It even looks harmonious!

$ a city scooter is a danger to the rider. There’s no way I would ride one. Okay maybe once. Okay, I’m pretty tired after my bike ride yesterday and maybe I could try it. At least it will be an interesting blog post. Hey this is scary. Hmm. Good design, my first ride is speed limited so as to protect the newbie. Wow, after a half mile of starts and stops I’m getting the hang of this and can’t wait to unlock a full speed ride. Zoom! Full speed second ride! This is a blast!

$ A city scooter is an app. The founders of this idea realized that their potential customer base is THE ENTIRE CITY of people who have a smartphone and need to get somewhere. With a QR code, snap a pic, set up an account, and in 3 minutes you’re on your first ride. Clever.

Museum of pop culture. Where are the ukuleles?

$ a city scooter is transportation disambiguated. I’m here in Seattle for an organized bike ride later, but don’t want to put my nice bike on the street with a lock. This is a great alternative: scooters on many street corners with an app-map to show you the nearest. Then, when you arrive, park (safely) and leave it.

$ a city scooter is micropayments. Even better with a day pass. $7 per ride or $21 per day, up to 6 rides. Cool. It’s like you own a fleet of scooters all over town.

$ a city scooter is a network which grows in value with more nodes. And Seattle supports several! not only are there Link scooters, but Lime scooters and bikes, and several other brands of mobility. Unlike the first generation of e bikes that required charging and locking stations, these can be left any where for convenience as long as they don’t obstruct.

$ a city scooter is an information highway. Interesting to think about what data is reported in real time, what adjustments leadership and management need to make to redeploy, fix, recharge, see where the scooters are needed and ‘rebalance’ their locations.

Seattle art museum

$ a city scooter is modular. The components of the network are easily swappable. Riders will report issues, the scooter will tell when the battery is low or needs repair. It is self-repairing as a network.

$ a city scooter has to gain popularity while promoting safety. After my second ride I received a mandatory quiz: which scooters are parked legally? What are the relevant city laws that apply to me? And yet there is the need to grow the business, so ‘helmets are required’ but a photo proof of a helmet is not required. ‘Photo proof of parking correctly’ is required. Hmm.

$ a city scooter has soooo many customers: the city government, employees, riders, the driving and waking public, shareholders. it is interesting also to think about how many city regulations had to be addressed and met, how the public perception must be managed, how the pricing and profit models have to continually be tweaked. Is there ‘surge pricing’ like with Uber? How do you balance all these demands and make a profit? What are the guiding principles?

Well, you recognize this one

$ a city scooter shrinks a city. This is perhaps my most profound observation. After the first nervous scoot, I had a face-splitting grin the entire time I was riding. Kick start, push the thumb lever and ZOOM I could see the city literally shrink in size as I rode. Blocks whizzed by, hills flattened, and I was master of the domain, blending into bike lane traffic with all my best friends. From Pike Place Market to the Space Needle and Museum of Pop Culture to the Seattle Art Museum to Biang Biang Noodles and back to the hotel. So easy.

CMIO’s take? Multi-dimensional thinking like this is common in healthcare informatics. I enjoy thinking, feeling, and working through hard problems like this. Do you? If so, come join our ranks! We and the larger healthcare industry need your brains and emotional intelligence.

CMIO teahouse menu

How can tea improve clinical decision support? How does it help change organizations? Are you kidding?

Links to some of these teas:

CMIO’s take? Those of you who have worked with me know that one of my favorite things is to have 1:1 meetings in my office and serve tea. Taking inspiration from my spouse who enjoys throwing cocktail parties and creating a fanciful drink menu, I recently put together a CMIO’s teahouse menu. I hope you enjoy it.

Here’s your moment of zen – cactus images from Arizona

Here is the “burr in my sock” or “pebble in my shoe” that bad EHR design can become. In another context, this is can be beautiful.

Found this in my sock in the middle of my hike.

The only way to hike in Tucson in the fall is starting at 630am and being done before 9am.

CMIO’s take? Be present, get outside, take a breath.