Review: The Emerald Mile: The Epic Story of the Fastest Ride in History Through the Heart of the Grand Canyon

The Emerald Mile: The Epic Story of the Fastest Ride in History Through the Heart of the Grand Canyon
The Emerald Mile: The Epic Story of the Fastest Ride in History Through the Heart of the Grand Canyon by Kevin Fedarko

My rating: 5 of 5 stars

Another of those books picked up off the coffee table at home: “Hey, who’s reading this?” And the daughter has found time … to READ. For fun.

Well, it’s a parent’s prerogative to borrow the book, take it on trips out of town, and generally be a nuisance, so I devoured this book. I’m not much of a white-water enthusiast, but I have purchased a seat on a few commercial floats and have enjoyed myself. My most memorable was a 3-day raft trip on the Rogue River in Oregon.

It was my last year as a primary care internal medicine resident at UCDavis in Sacramento. I was plowing through my final rotations as a trainee, looking forward nervously to being a full-fledged physician. As such, I had sought out a month-long rotation at a small internal medicine practice in Auburn, California, a reasonably rural town where Internal Medicine’s scope of practice is much broader than that in a metropolitan area with lots of specialists. A couple dozen surgeons and internists had cohered into a tight-knit community. I enjoyed my stay, found ways to be helpful, and began to relax: turns out I had learned enough in my 12 +4 (undergrad) +4 (med school) +3 (residency for internal med) years of schooling (twenty-three!) to be seen as a physician and be treated as a colleague by such a community.

It was with great surprise, that near the end of my month rotation, that my preceptor offered me a spot on their 3-day rafting trip through white water in Oregon. One of the surgeons had to cancel and I was to be the beneficiary. I rushed to my local Sacramento dive shop to rent a wet-suit for the trip, neglecting to mention that I was headed to Oregon. It was an oversight that I would come to regret.

So, 23 physicians set off on a sunny Wednesday, drove all day to our hotel, met our outfitters, and headed out to dinner to carbo-load. In the middle of the night, to our dismay, one of our number awoke with severe right lower quadrant abdominal pain. With a plethora of surgeons and internists, the differential diagnosis of his pain was a hotly debated topic. Nearly everyone palpated his abdomen, and eventually, his brother was elected to drive him an hour into town to be seen in the small ER there for a possible appendicitis diagnosis.

We suited up at our launch site, still talking about his misfortune, when the brothers showed up with huge grins. Turns out as they arrived in the ER, someone had a massive BM, which completely relieved the pain. Seems that excessive carbo-loading isn’t always the best idea.

We launched in 3 large rubber rafts and a couple of inflatable kayaks and proceeded to have a blast of a time. No pagers, no one on-call, great story telling, great meals, fantastic scenery, great friendships. And bailing. lots of bailing. And I volunteered for it all. You see, my wetsuit was the 1/4 inch-thick variety, intended for relatively warm water, not the much thicker version that Oregon weather and whitewater called for. Consequently I spent a large portion of that trip in teeth-chattering, drenching cold, looking for SOMETHING to do to get warm. I became Bailing-boy.

Near the end of the trip, our final overnight had an actual functioning sauna, and I spent enough time in that tiny shack to finally unclench the jaws, loosen the knots of muscle and return to the land of the living. Even 25 years later, I think fondly of that trip AND that warming hut.

But, I digress! The Emerald Mile is a fantastic read, and an instant throw-back for me to those days on the river. It is a dramatized documentary of the personalities among the renegade dory-drivers, the law-abiding dam-builders and the adventurers along the Grand Canyon. The ‘Emerald Mile’ was the prototype and the most famous among the wooden dories that the best river pilots would take down the Colorado River. It tells the story of the quasi-illegal speed run that 3 men in a wooden boat took down the 240 miles of Colorado river within the Grand Canyon, a legendary trip that took less than 2 days at flood stage, when the average guided tour for that distance could take 3-5 weeks.

The people you meet in these pages become your friends, your co-conspirators, your co-defenders of one of the greatest engineering feats in the world. This would be enough, but the lyricism of the writing elevates this to a book that embodies the spirit of the southwest.

Favorite Quotes from the book:

“We are three quarters of a mile in the depths of the earth, and the great river shrinks into insignificance, as it dashes its angry waves against the walls and cliffs, that rise to the world above; they are but puny ripples, and we but pygmies, running up and down the sands, or lost among the boulders. We have an unknown distance yet to run; an unknown river yet to explore. What falls there are, we know not; what rocks beset the channel, we know not; what walls rise over the river, we know not.”

–John Wesley Powell, 1869, about the first exploration of the Grand Canyon.

Page 50. “On May 24, 1869, 10 men in 4 wooden boats plunged down an unknown river through the heart of the last blank spot on the map of the United States. 99 days later, and just shy of 1000 miles down river, six men and 2 boats emerged. They had run through 414 rapids and portaged or lined another hundred. In the process, they enabled America to take full position of this last, hidden landscape feature, while simultaneously laying the foundation by which that same landscape would eventually turn the tables and take possession of Americans who would fall under it’s spell.”

Page 81. “…the color of the river when it was rinsed in the morning light, the little tendrils of perfume that ascended from the brittlebrush flower just before the rain arrives, the quiet music the boat hull made when moored inside an eddy at night.”

“The place seemed to transmit a shattering reminder of the insignificance and irrelevancy of human affairs when set against the twin pools of deep time and geologic indifference.”

Page 110. “For a minute or two, you would find yourself drifting on a flat and glassy cushion of serenity as the current slowly gathered its speed and heft beneath the bottom of your boat and you drifted towards this thing that waited, invisible, just beyond the horizon. It was silent during those minutes, the only sound being the creak of your oars in their locks and the dipping of the blades as you made a few micro adjustments in the hope of putting your hull squarely on the one tiny patch of current that would insert you through the keyhole in the cosmos. Then in the final seconds, you would start to hear the dull, thunderous roar, and you would see the little fistfuls of spray being flung high into the air.”

“This, perhaps, was the most riveting moment of all, because by now all of your decisions had been made-you had done your homework and saw the point of balance between instinct and analysis, listening to the data flowing from both your brain and your gut, and know you were well and truly committed. This thing you were running down had no brakes, no rewind, no possibility of a do-over. You would ride the surge of your adrenaline and surf the watery crescendo that was about to explode before you, and you would accept the consequences, good or bad, along with whatever gifts or punishments the river was prepared dish out…And if you were lucky, you might navigate to a place that would enable you to glimpse, however obliquely, a bit of who you truly were.”

Page 299. “What Wren was doing, in effect, was performing an act of supplication, a plea for hydraulic clemency, hoping the river might condescend to allow the Emerald Mile to surf through the chaos on the shining fortitude of her own righteousness.

No dice.”
CMIO’s take?

Carbo-loading: not always a good idea.
A float trip and unplugging from the world? Great.
Reading about the deep history of places near and far? Priceless.
Having seen the Grand Canyon merely from the south rim, I must return. Armchair travel can be good, but make sure that real-time travel is in your plans as well.

“We have an unknown distance yet to run; an unknown river yet to explore.”

Epic Poetry for the hearts of men and women: both River-rats and Informaticists.

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Robot parade


Robot Rail

Robot Parade, from “They Might be Giants” (Youtube link, 1.5min song)
The robotic revolution is upon us.

At UCHealth, our multi-million dollar robot train allows us to run the top 50 types of test results as “stat.” This means when the blood arrives in the lab,  it takes about 10-15 minutes, tops to run the blood test and report it into the Electronic Health Record so that doctors and nurses can act on that information.

This robot combines with a fancy multi-channel pneumatic tube system that spans across multiple buildings, and transports blood samples drawn from patients in our Cancer Center, about a quarter mile away. Furthermore, our nurses print pre-barcoded labels specific to the patient and the request lab order, so there’s no mix up during transport.

The 3 technologies together make it so that from lab draw to test result is typically less than 30 minutes. Compare this to the “old way” of human transporters who walk around between buildings every few hours collecting specimens, and lab technicians who run tests in batches, by hand, with lots of err0r-prone human transcription. You’d be lucky to see an 8am blood test return a result by mid-afternoon.

This is amazing on many levels, and so few people know about it. I bring students, residents and colleague down for a show-and-tell tour any time that I can.

Our lab technicians simply transfer the pre-barcoded tubes from the pneumatic transport canister to the robot intake rack. An articulated arm with camera spots the tube, grabs it, scans the barcode, puts the tube in a carrier slot on the railroad, and sends it down the track to the right machine in real time.

Once at the machine, the centrifuge has 6 slots. At busy times, all slots fill up quickly and the spin begins. If there’s a backlog, additional tubes are re-routed to an alternate machine to start a new load in-parallel. If there aren’t enough samples to run a full load after 5 minutes, water-filled tubes are selected automatically to fill empty slots and the centrifuge runs. Brilliant!


Sometimes tubes are needed in separate machines with different processing needed. The robot is smart enough to split off and label “daughter tubes,” pipette out the right quantity, and send each one to the right destination.

At the end of the line, lab tubes are stored in the automated Stockyard for 3 days in case of needed “add-on labs.” The seamless interface between the EHR and the lab system allows ordering physicians to be reminded “Do you want to add your new order to the existing specimen?” If yes, the robot retrieves the blood, runs it back up the railroad, processes the new order, with no human intervention.

This ONE IDEA has saved 30,000 repeat lab draws on patients, in ONE MONTH, at our University hospital. Astounding. Faster for doctors receiving important results, cheaper for the lab, one less “stick” for patients.

A true win-win-win.

CMIO’s take?  So cool. I wish =I= could ride the railroad. Or maybe it is time to retire and take up model trains. Does your organization have one of these? Or maybe you were a model train enthusiast? Let me know.


Terrible, mediocre, fantastic. 


In a surprise event, our Anschutz Medical Campus in Aurora, Colorado announced an amazing art exhibit comprising Rodin sculptures, Monet,  Renoir, and various other paintings, drawings and sculptures from a private collection. I discovered this in a small news blurb, left my office, and walked down the street to the single-room art gallery in the Fulginitti pavilion.

I spent some time picking my jaw off the floor. Then I took my sketchbook out and begin trying to capture some of what I saw.

Edgar Degas


What’s terrible is how infrequently I stop to smell the flowers. What’s mediocre is how poorly I draw. What’s fantastic is putting aside all concerns and focusing on one painting for half an hour.



Claude Monet


A few years ago, I very much enjoyed art exhibits AND I wanted to stretch myself, BUT I was afraid of being criticized, THEREFORE I silenced my inner critic and started sketching.



See what I mean?


What’s important is NOT the finished piece (thank goodness), but the experience of spending quiet time really LOOKING and SEEING and BEING PRESENT. It is incredibly peaceful and rewarding.

CMIO’s take:  Slow down, you move too fast. You’ve got to let the morning last, now …

Let me know if you’ve experienced something like this.


Doodling. I recently gave a talk at the Health Evolution Summit conference in Dana point California. It was a humbling experience, as I was expecting to give the standard PowerPoint presentation, and was told: “no,” that instead, I would be out on the lawn in front of the wind and surf and be giving a talk on a flip-chart.

This provoked a great deal of anxiety, and prompted ego- and personality-rebuilding. Then I thought of my sister’s book recommendation “The Doodle Revolution.” And so I took my story, boiled it down into symbols, and give a talk, which was not unsuccessful.

Turns out, googling any concept attached to the word “symbol” allows you to see what other people have used for symbols, such as for “strategy” or “manager” or “project manager” or “consensus”. Try, for example, googling “consensus symbol.” Well, at least it starts the creative juices flowing.

I challenge any of you to understand my chicken scratch doodles and interpret them into a coherent narrative. The good news is, I’m no longer afraid that my terrible chicken scratch will be criticized. I know that it will, and it’s still helpful to me and to my audience. I’m learning to get over myself.

For those of you interested:

  • The “upside down spaceship” in the corner is really a handshake symbolizing “partnership”
  • “…and…but…therefore” comes from a previous blog post on storytelling*
  • The elephant is a reference to slow moving, large academic medical centers
  • The drowning man refers to Healthcare organizations in the age of acceleration
  • The USB symbol refers to technology companies


CMIO’s take:  What are you waiting for? Get out and doodle! OR, if you’ve doodled successfully (or even unsuccessfully), let me know in your comments!

…and…but…therefore (Thanks, Randy Olsen!)

image from the nytimes dot earth blog

“…and…but…therefore” I spoke about briefly on a previous blog post on storytelling.

To remind you, in case you’re interested, Randy Olsen’s book Houston, we have a narrative introduces the world to his astounding idea, that “…and…but…therefore” is a concise way of summarizing an entire story in one sentence. For example, one way to interpret the Wizard of Oz story could be:

“…the story of a little girl living on a farm in Kansas AND her life is boring, BUT one day a tornado sweeps her away to the land of Oz, THEREFORE she must undertake a journey to find her way home.”

Read the book; this is just a taste of the great ideas there-in.

Here’s a counter-example of non-story-telling that illustrates why “And-But-Therefore” is better than most scientific or business write-ups and summaries, that end up being a list of facts “And-And-And.” Can you imagine the Wizard of Oz being an And-and-and?

“Once there was a girl on a farm AND there was a tornado AND she found her way back home.”

I find myself saying “So what?” — I probably wouldn’t read that book.

The NYTimes “dot-earth” blog is a fan of Randy’s as well. Also a worthwhile read.


CMIO’s take:    What is YOUR “…and…but…therefore” story?

Review: Doodle Revolution

Doodle Revolution
Doodle Revolution by Sunni Brown

My rating: 5 of 5 stars

I like drawing on white boards. As an introvert, I often delay making comments during meetings. Sometimes I doodle in my note taking (which I’ve started to do more on paper, moving AWAY from Evernote, or OneNote or other online phone-based or laptop-based tools; more on this another day). This book has emboldened me to take my not-ready-for-prime-time doodles and put them up in public (or at least on white boards in committee meetings).

What I do like about meetings is hearing viewpoints, especially those well-thought-out points. I like noodling on them, considering alternatives, categorizing parallel conversations, and problem-solving in my head as the meeting progresses. I’m not one to jump in with both feet and steer things, as I like watching things evolve.

Sometimes meetings have a good leader, or a good participant, who will actively steer the conversation toward a concrete and productive resolution, and I am happy to keep quiet, and if it is a team-member, I give them kudos for a well-run and productive meeting.

Sometimes, we get together and the wheels start wobbling, and threaten to come off the bus. People are arguing, stating points of view repeatedly, or adding new topics when existing discussions aren’t even clear yet, and soon we have 4 or 5 buckets of discussion and we’re talking past each other. I used to hate these meetings, which sometimes ended up with “seems like we need another meeting to resolve this.” In recent years I’ve learned that I can step in, and make a summary statement, when I feel like most of the viewpoints have at least been initially aired. Then my favorite part begins.

“So, it seems like we have 4 buckets to discuss. First, the timeline for this change, second, that not all participants are in agreement, third that the software isn’t really ready to handle 2 special conditions, and fourth that the proposed mobile version just does not work at present. Are there any other buckets I have not considered so far?” This usually shuts everyone up, while they consider that SOMEONE has been listening and not just yammering. I enjoy this. Then I play air-traffic control: “OK, so lets start with bucket 1 and defer the others for a moment. Can we agree that the timeline should have a kickoff on March 12? That part seems straightforward. OK?” And then parse the discussion down into buckets and walk through them one at a time. This works reasonably well.

Well, having read this DOODLE book, I find that we can kick this up a level. I do enjoy a good doodle when brainstorming at home, but this book is empowering, and breaks down doodling into component ideas. Practice shapes! Here are some ideas for organizing frameworks with convenient sketch-equivalents! How to draw a simple expressive face! how to draw a human and not be (too) embarrassed about it! How to represent lots of ideas visually! How to group and link ideas so that everyone can follow (or add their own ideas)!

So, now, I’ve taken to standing up during the middle of meetings and heading to the white board while others talk. I don’t LIVE-SKETCH like I’ve seen YouTube videos do of important discussions, but I can sure draw and crudely illustrate my buckets. I’ve found that people start gesturing at the board during the rest of the meeting, that some get up and make additional helpful marks, and we can come up with better ideas with a shared vision. Only a few weeks into this change, and I can say it has made my work life better. Maybe even helped the organization.

CMIO’s take:

  1. Learn to Doodle. Use it. Enjoy it. Join the revolution. Clarity needs all the friends it can get. For in-person meetings, there’s nothing better to cut through the noise.
  2. I’m interested in hearing from colleagues: how can we effectively doodle during online Skype or Zoom or other web-based meetings? I’ve not found a good answer to this question. Perhaps: set up a blank powerpoint slide, share your screen, and sketch (poorly with mouse)?

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Review: Algorithms to Live By: The Computer Science of Human Decisions

Algorithms to Live By: The Computer Science of Human Decisions
Algorithms to Live By: The Computer Science of Human Decisions by Brian Christian

My rating: 4 of 5 stars

As we inevitably accelerate towards the technological Singularity (thank you, Vernor Vinge!), I see algorithms popping up more frequently not only in my work-life, but also in daily life. Or maybe I just think of daily life more in terms of explicit algorithms. Perhaps like George Costanza “My worlds are colliding!

We read this book for our Clinical Decision Support book club at work. Wow, you say, how Geek can you be? Yes, guilty as charged. However, I find that every chance I have to participate and prompt others to read outside of their usual sphere or their narrow focus at work, the more creative and thoughtful my colleagues are, and so am I (bonus!).

“Algorithms to Live By” is a collection of narratives about how these logical structures invade our daily lives. The some chapter titles are illuminating:

1. Optimal Stopping (when to stop looking), otherwise known as the “secretary problem”, or when to stop interviewing candidates because the likelihood of finding someone better is too low.

2. Scheduling (deciding what to work on). This was a helpful discussion about multi-tasking and the cognitive overhead of constantly having to re-orient yourself around a new problem to solve (that is, DON’T MULTI-TASK, it’s a MYTH). Also, how to decide which items to work on first (first in, first out? Shortest completion time? Longest completion time?

3. Caching (forget about it). How to decide what to forget, or evict or throw out, given space limitations? How to arrange your work, your files (your home?) so that frequently used items are easily found? I used this to explain why I leave my clothes laying around instead of hanging them up neatly. “I’m just caching for efficiency, honey. I’m going to need that again pretty soon!” See? Book club can be useful.

Lots of other fun topics in here. Lots of ways to take what is essentially a way of designing computer programs, and applying it explicitly to our own lives.

My family constantly makes fun of me for trying to optimize their lives (because, of course, MINE is already optimized). My daughter’s neologism on this is “Dad is always trying to optimize Humans. He is always trying to Hume-Optimize.” This has gradually devolved into shorthand: anytime I make a suggestion to improve the lives of my loved ones, the simple retort is “Don’t Hume-optimize me.”

CMIO’s take? As long as you recognize that “Hume-optimization” is a double-edged sword, you will be okay. Sometimes thinking about algorithms at work, or in cases where a friend or colleague is ACTUALLY asking for advice (listen carefully, if indeed this is the case), then, yes, go right ahead and make suggestions. On the other hand, in those FRAUGHT situations when the venting of a friend or colleague or family member is purely about venting, and not at all about problem-solving (be it oh-so-tempting), then beware: Hume-optimization is NOT WELCOME HERE. Voice of experience.

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