To Sleep, Perchance to Dream? Aye, there’s the rub…

Image linked from Quanta Magazine

https://www.quantamagazine.org/sleep-evolved-before-brains-hydras-are-living-proof-20210518/

QUICK, which Shakespeare character gives this famous speech (that I dutifully memorized in high school)?

“…To die: to sleep;
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to, ’tis a consummation
Devoutly to be wish’d. To die, to sleep;
To sleep: perchance to dream: ay, there’s the rub;
For in that sleep of death what dreams may come
When we have shuffled off this mortal coil,
Must give us pause…”

Yes, thank you, Hamlet.

Back to the Science:

I have always understood from my neuroscience colleagues, that humans (and animals) need sleep because our powerful multi-processing brains need downtime to repair, rebuild, consolidate memories, and even allow a pseudo-lymphatic system to remove waste.

Now, it seems, that brainless hydras and jellyfish exhibit sleep behavior. So, if we needed sleep before we needed brains, WHAT IS GOING ON?

Another fact: as life evolved, we had guts before we had brains, so is that a hint?

The article linked above is a fascinating dive into neuroscience and makes you question what you know. The best kind of writing.

TikTok Crowdsources a Parkinsons-friendly Pill Bottle

The better angels of our nature also exist on social media.

https://www.theverge.com/2021/1/23/22244673/parkinsons-tiktok-crowdsourced-pill-bottle

I love stories like this. Jimmy Choi has a TikTok page where he documents his athleticism. He also has Parkinson’s Disease, with an uncontrollable shaking in his arms. At one point, he complained about how difficult it is for people with Parkinsons to take their medications; the shaking often completely spills the pills from the bottle.

As a result, a community of TikTokkers began brainstorming and then modeling and then 3-D printing an innovative pill bottle design that ensures only ONE pill is dispensed at a time.

Read on!

CMIO’s take? Having access to the brain power and creative energy of the world, via communication technologies like TikTok and other Social media tools, is, I think, a wonderful antidote to our recent experiences, and the best expression of humanism. How can we design to augment this, the better angels of our nature?

Covid Vax Status, and Our Mental Health Status

We have a monthly Epic Provider Newsletter where we share system updates, and I send CMIO Update paragraph to my colleagues. Here is my update for this month:

With our next Epic system upgrade this week, Covid Vaccine status is now in the patient Storyboard! This is HUGE. It is now instantly visible when opening the chart, if/when the patient was vaccinated. This should help with rapid patient assessments and counseling, since the Covid-19 Pandemic Crisis now morphs into Covid-19 Ongoing Management. Possible Vaccine Statuses include:

  • Unknown (instead of ‘unvaccinated’ we know lots of vaccinations are not in our system; this prompts us to ask)
  • Dose 1 complete (if a 2 dose vaccine)
  • Dose 2 overdue (if late for second)
  • Vaccinated (XX date) if within last 2 weeks
  • Vaccinated

This is a nice improvement in our EHR.

IN PARALLEL, in discussions with colleagues this week, there is a sense that we are emerging from the pandemic. However, the prevalent emotion is not necessarily “relief”. Some say that they feel a sense of PTSD, or symptoms of exhaustion. In my mind, I feel like we have just finished running a sprint and are ready to stop and lie down.

BUT NO, there is no time take a break, it is time to resume the marathon of our regular healthcare jobs. 

We spent the last 15 months putting aside our burnout, putting aside our lives, and putting EVERYTHING into fighting this crisis, hoping to extinguish it.

Now, we put down our crisis tools, and look up and see … no end in sight. There is no way we are all collectively taking a year-long vacation, and our psyche’s are just realizing, now it is back to our regular, difficult jobs.

So, what is YOUR Covid Recovery Status on the grid below?

from: Responder Stress Continuum, via CU Anschutz Psychiatry presentation

We are starting to use this Stress Continuum Model to assess ourselves, and each other. More than ever, we need to take care of ourselves, and each other.

CMIO’s take? I hope all of you DO find a way to ‘take a break’. Although it is not a celebration, we SHOULD recognize that we stood on the front lines of an astounding moment in history. I am proud to have stood with all of you.

Navigating Open Notes and the Information Blocking Rule: an AMA innovation panel discussion

AMA Physician Innovation Network Avatar
from the AMA-Assn.org website

https://innovationmatch.ama-assn.org/groups/ama-physician-innovation-network-public-area/discussions/navigating-open-notes-and-the-information-blocking-rule

There are a whole bunch of Open Notes experts (and also me!) on a panel this week (ends tomorrow!) discussing Open Notes experience in regards to the Information Blocking federal rule. Come join us! Ask challenging questions! See what others have done! Lots of discussion on the pros and cons, the pitfalls and the successes.

“The unattainable best is the enemy of all the available betters” @Bill Burnett

You have more than one life in you. Lets ideate THREE 5-year visions. Do this exercise to generate creative possibilities. — Bill Burnett

In my clinical practice this week, I met a patient with whom I discussed this idea: he was a senior administrator in an academic institution, highly accomplished, well respected, and yet quite miserable at work and at home, feeling trapped.

It made me think back to Design Thinking principles, and creative approaches to hard problems.

Having been to the Design Thinking for Social Systems short course at Stanford, I’ve been working to apply this thinking at work and at home. I posted last year on my enthusiasm for design thinking as a process and approach to creativity and innovation. I came across Bill Burnett’s online video which prompted me to dive back into the material again.

A couple of books to recommend.

Designing your life by Bill Burnett and Dave Evans. More about applying design thinking principles to your life.

Bill also gives an overview in his great Stanford TEDx talk.

Creative Confidence by David and Tom Kelly. A history and principles of design thinking by some of the originators

Designing for Growth by Jeanne Liedtka and Tim Ogilvie. A practical book for application of design thinking. See also the Field Guide.

It made me think of myself, my work, my home, and how “designing your life” might be an exercise we could all apply with immense benefit. Join me?

CMIO’s take: What are you waiting for?

Big data graphics: NYTimes – Every Building in America (and Ed Tufte)

In informatics, we often are faced with big data sets and how to make this data comprehensible. Here is an example from cartography. Beautiful graphics, highly usable. We can aspire this “data density” in our own graphics.

My favorite book crafting great information graphics from data, is of course Edward Tufte’s Visual Display of Quantitative Information. He talks about data density, sparklines, lots of cool stuff. AND he has an online course. I have been his disciple for years, and have ALL his books.

The only thing better than gathering and making sense of big data, is being able to explain it clearly to change minds and behavior.

My Failure Resumé (a talk)

What lessons can we learn from CT Lin’s failures?

Thanks to the Colorado Chapter of HIMSS (Health Information Management Systems Society) and to Bonnie Roberts and Rich Morris for co-hosting my presentation.

Based on my recent Failure Resumé 1 pager. Here are some personal stories, life lessons, and 3 exercises to help you build a failure-tolerant future.

With, of course, a bonus ukulele song at the end.

CMIO’s take: Have you written a failure resumé? Are you building a failure tolerant future? Let me know in the comments.

The Narrows at Zion Canyon: a visual travelogue

In November of 2020, my son and I toured the Southwest US. One of our stops was at Zion Canyon National Park, where we were excited to experience the Narrows. It seemed a great way to escape the pandemic and get away. Spend a few minutes on the journey with us!

Driving, we arrived late in the day at Zion lodge, in darkness. We saw this improbable sight outside our cabin in the morning: canyon walls rising thousands of feet overhead, just outside our door.

We had rented dry suits from Zion Adventures, and laid out our clothing that evening for the hike ahead. In case you’re wondering about the hyperlinks, no this is not a paid post. Just a joyful recollection of an aging parent…

Double boot liners, grippy-soled rubberized river boots, an impervious suit with rubber-gasketed pants and sleeves, and a huge diagonal waterproof zipper across the chest. Hard to wrangle but exciting! We felt like spacemen. We wore several clothing layers underneath.

Normally the Narrows is a super-popular hike through the spring, summer and fall. We had thought that with the pandemic and with wintry November weather, we would have no trouble booking a shuttle ride from the Lodge in the park up to the entrance of the Narrows, 3 miles away. Suffice it to say, plan ahead. Fortunately, we found a last-minute shuttle option with seats remaining. Whew, disaster averted. Otherwise, the lodge had offered us “bikes to rent and ride up there, suits and all.” That would have been more adventure than I needed.

We walked the paved path for the 1st mile. Giddy and nervous, we passed a number of casual hikers who stared at our gear, our dry suits, our 6-foot wooden walking poles, our backpacks. Here, with the residual heat deep in the canyon, the last remnant of fall colors contrasted with the snowscapes outside the park.

And then: the pavement ends. Into the stream! I can feel the cold water sloshing around inside the boot. Hey! my feet stay dry! I don’t care about splashing because I’m sealed in up to my neck, and my backpack has a dry sack inside with food and water. The cyanobacteria poisoning warnings do not deter us. Upstream we went.

Did I mention the incredible geology? We feel puny in its presence.

I was surprised at the grip of these rubber soled river boots. Crunching upstream over large and small rocks was easier than expected. Where was all the slipperiness, the unstable rocks, the twisted ankles? The equipment smoothed that away. I grinned at my son; this was a blast. The water depth was up to a foot and the going was not hard. The current ran a couple of miles an hour.

As we saw fewer hikers, the enormity of the cavern became apparent. At one point, it appeared that the walls were maybe 3 football fields tall, 1000-feet-high sheer walls of stone. These walls plunged right down into the river with no shore or beach to speak of.

From there the river got deeper and faster. In about an hour and a half we arrived at the fork to observation point on the right, with photographers set up to catch the changing light in the canyon. Then we took the left fork to “Wall Street,” presumably named for the impressive sheer walls narrowing in.

At times, the water rises to the hips. Some hikers with only waterproof pants turn back. One couple raised their jackets, exposing bare midriffs to keep their clothes dry, and gamely walked through the first deep crossing. That must have been cold, with the water at 40 degrees. It is sunny, but also snowing.

At a rock outcropping, we paused for lunch. We find a few larger boulders, unpack and have our bagels. Suddenly ravenous, we savor the calories, noticing snowflakes drifting down 1000 feet into the canyon. The light is peculiar: in shadow, with sunlight bathing the Canyon just around the curve, blue sky overhead. It looks like indoor light because of all the bounce and reflection.

This is our turn around point. We rest, recharge, hear the stream burble, feel the snowflakes, our hunger sated, snug in our dry suits, we smell the fall giving way to winter.

It feels – cold, but I’m sweating from effort. The canyon appears unforgiving, but we have supplies and equipment up to the task. Flash floods and cyanobacteria poisoning are a risk, but we have mitigated them. Unlike more extreme adventure-seeking adrenaline junkies, this is the degree of risk and adventure I’m ready for.

It is time to head back. Downstream, like downhill, would be quicker. My main concern was balancing Seeing with Photography.

There is the disappointing idea that the more photos one takes, the less the brain experiences. Or maybe not. Yes, there’s more to show off when you get home, but were you really present? Or did you just line up and frame the shot? But, if you don’t take photos, how interesting is your blog post later? #FirstWorldProbs.

I tried to do both. Who knows.

Downstream was a pleasant splash. Yes, it was 1.5 times easier and slightly faster. There was little resistance to swinging the shins through the water as it flowed with you.

There are great speedway-sized curves to this river, as the millennia of water microscopically carry away molecules of rock every day. The views are magnificent.

It is a hike that promotes mindfulness. Your focus is required for not-stumbling, for pushing upstream, for awakening your senses. The constant, echoed river babble precludes idle chatter.

It is: exploration, sightseeing, photography, companionship, escape, reflection, effort, appreciation for dry-suit and photographic technology, wonder, mindfulness, pure sensation, focus, curiosity, pride of offspring, joy. All at once. Each in turn.

We emerge from the river, dripping and yet perfectly dry. We make our shuttle home.

A perfect day.