Toys R Us GallowayCole Galloway with a rehabilitation patient and her recently modified car.

A couple of blog posts ago, I introduced the Maker Movement, a growing community centered on the idea that we can build physical solutions ourselves. Today, I want to introduce you to one of the best examples of Making in action, and that is Cole Galloway and his Go Baby Go campaign.

Galloway works in physical therapy to get children with physical disabilities mobile. The problem? Motorized vehicles for rehabilitating children’s mobility can cost as much as $20,000 and often involve long waiting periods. Galloway got inspired through trips to “Toy R Us” to try something different. He now modifies toy cars such as those you can pick up at a toy store to become vehicles for these children. The cost: $89 and most modifications can be done in an hour with his team. Children who could barely get around can now do what children naturally want to do, move!

Galloway’s case illustrates some important principles of making: First, that the best solutions are often conceived by those on the front lines, who know best the contours of the problem. Second, making is impatient in a healthy way. Making challenges the assumption that meaningful solutions must be expensive and take a great deal of time. Third, and perhaps most important, the solution is carried out in a community, patient centered way. The modifications to the cars are carried out by clinicians but also by parents and community members.

So if making is so wonderful why don’t we see more of it? Why aren’t all of us creating great physical solutions like this everyday? I think we are conditioned by the notion of expertise, the idea that we can only be good at one thing and must be consumers of everything else.There is also a certain inertia that must be overcome to create, but those who overcome this inertia are always struck by the possibilities. And word is getting around . . .

Making can in fact become a way of life. This occurred to me through an unusual path, an online karaoke app! Going back to my musical theatre days, I love to sing and discovering this app has been a revelation. The goal of this application is to promote online musical collaboration across the world. You can sing one part of a song with full accompaniment and leave the other part to be filled in by anyone else on the app, anywhere in world. One night, I recorded half a duet and woke up to find 10 new complete duets from singers who joined in from China, England and Mexico. Aside from the variety, I have never encountered such a unique blend of talent. Music made for mass media consumption must, I think, make certain stylistic concessions to be broadly palatable. But this music can be as creative, raw, spontaneous and yet high quality as it aspires to be. I don’t know if I can call this Making, because it is not strictly speaking tactile and may not be solving a pressing physical need, but the philosophy of making seems to be at work. Recording music is democratized, lack of proximity is eliminated as a limiting factor, and there is a genuine sense of community. Something beautiful can be created every day.

Where else could this go? Well, I’d like to leave you with some resources as you consider ways  you can discover your own potential for making:

  1. Parents may want to check out MakerKids.com which describes itself this way:

    “We are one of the first and only makerspaces for kids in the world.We run programs and camps on topics like Minecraft, 3D Printing, Videogame Programming with Scratch, Robotics Inventions using Arduino, Electronics and Remote Control Robotics.”

    2. The organization Maker Faire holds maker events across North America. One of the best ways to start getting into making is simply to get inspired, to see what people are doing to trigger your own ideas. For more information on maker events and ideas, you can check out, MakerFaire.com which includes event information, a magazine and further resources.

    I think one of the most important questions that Making asks is “What are you waiting for?” And it doesn’t ask this question in a sensationalized, infomercial kind of way but as a question with real tension, that makes us challenge assumptions about perceived obstacles. How do we justify NOT doing anything? The big three reasons are:  I don’t have enough time. I don’t have enough money. I don’t have enough expertise. Making proposes that all three of our grandest excuses are, in fact, hackable.

     

 

DJSanta

Photo Credit: Mp3Jam.org

I’m a sucker for Christmas. There I’ve said it. I tried not to start singing Christmas songs this early, but failed. The result is this duet (click below) that I recorded with a wonderful singer by the name of Niecy, whom I have never met (by the magic of technology, we recorded this duet, 1000 miles apart!). My Kenyan blood is revolting against the descending temperatures, but there is always song . . . Enjoy!

 “Baby It’s Cold Outside” via Smule Listen to my cover of “Baby It’s Cold Outside” via Smule: http://www.smule.com/p/431427151_199190488

Embrace

Photo Credit: EmbraceGlobal.org

I have never considered myself a DIY, use my hands to fix stuff sort of guy. I have always assumed that inclination was part of a different personality type. I am more naturally drawn to ideas, language, music, abstract science concepts and other things you can’t hammer a nail into. But in coming home this week from an interesting event called #wemakehealth I was forced to challenge some of my assumptions. #wemakehealth is an example of the “maker movement” a growing group of people from professions as diverse as medicine, business, design, and technology united by a common purpose, to make everyone into a maker.

So, what is a maker?

I understand it to be anyone who decides that she will not wait for a solution to handed down, but will get her hands dirty and build one now. And that is physically build it.  One speaker referred to it as “democratizing engineering”; an example would be the people who helped develop a warming blanket (known as Embrace) for premature babies in developing countries; this simple device is saving multiple lives where incubators are not available. The idea for this blanket emerged from a graduate school class assignment . . .

So what assumptions does this movement challenge?

That most of us can only be consumers of something someone else has made.

That if you’re not naturally “crafty”, building things is not really for you.

That you need tremendous background in design and engineering to build something from scratch with your hands.

I think we can agree that most things are more interesting to do than to watch. Yet, we somehow accept that other people who are more talented, educated etc must do all our building for us. This doesn’t mean that we suddenly have to try building complex computers. In fact, many incredibly useful objects are quite simple in their design (that warming blanket). I feel like the perfect messenger for this message precisely because I didn’t grow up trying to fix things and build stuff. And yet, in medicine, I was strongly drawn to surgery. There is something undeniably fulfilling about physically fixing a problem and being able to look upon your work. When I was given the chance to close incisions on the babies we were operating on in Kenya, I would look over my work the next day on rounds and if the wound was “clean, dry and intact” it was a tremendous source of pride. I often side with those who argue that we are born creative but have creativity educated out of us, and conclude falsely that it is the reserve of a select few. Now, I also wonder whether if there is something fundamentally human about building, making physical creations. The creation may be a meal, a painting, a creative blood pressure monitor, but it’s something. Perhaps, we were not made only to consume or roam the halls of the abstract, however enticing. Making is also key to progress in healthcare where so many structures, devices, procedures and processes remain opaque. Can we make something better ourselves? Can we stop waiting? Incidentally, #wearenotwaiting is the hashtag for the NightScout project, comprising a group of parents who came up with a creative way to remotely monitor their diabetic childrens’ blood glucose levels on cellphones . . .

So, to explore these ideas further, I am starting a brief blog series on making. I’ll bring in voices from the maker movement as well as practical ways to explore your own potential as a maker. If can I do this, trust me, anyone can!

Teenage Brain

Photo Credit: KindredMedia.org

I am still learning to decipher “Teenage-ese”

A widely spoken dialect, worldwide

Yet unique to those who have roamed the earth

For 13 to 19 years.

The first mystery is the vocabulary of this ancient tongue

It seems that there are only 7 words: “Uh-huh” “Nothing”

“Good” “Not” “Much” “Video” and “Games.”

As for tone, there appear to be two notes: low mumble and mid-range mumble

Excitement is hard to detect, shrouded in ambiguous grunts and mutterings

Unless a wrong is perceived, and then suddenly

This language acquires profound expressiveness

Through the boldly and repeatedly expressed phrase “Come on!”

Flowing conversations are not a traditional part

Of Teenage-ese oral traditions.

Long

Silences

And

Pauses

Seem integral to the communication style,

Creating regular tension with

Parent-ese, a language that insists

On constantly clear and emotionally appropriate communication.

And so, it is tempting to give up on Teenage-ese.

Grunts, groans and monotones

Fall prey to suggesting apathy.

But every so often, like the King in

“The King and I” who constantly exasperates his wife,

Teenage-ese succumbs to “something wonderful”

A single vulnerable phrase slips out despite

The best efforts of the native speaker.

An “I love you” evades the security system and tunnels underneath

The protective barbed wire of the teenage psyche.

If you are blessed

To catch this moment, grab it.

Security will soon catch up with the errant words.

And incarcerate them once again in the teenage brain.

And the mystery of Teenage-ese begins once again . . .

First Flight

Posted: October 12, 2015 in Ann Arbor, Nature, Poetry, Woods
Tags: , , , ,
First Flight

Ann Arbor, Sunday afternoon . . .

You thought I missed it

The moment when you broke away
Summoned by the season.
You trusted your entire journey
To a gust of wind
And you were right:
You were gently carried from the top of the tree
To your forerunners
On the forest floor
But so many of your friends
Took this flight unwitnessed
No wonder to guide their landing.
But you, I watched
From beginning to end, in awe

spelling-mistake-1

Photo Credit: TalentCode.com

Everything was going according to plan. I was putting the final touches on the latest revision of my clinical research paper when I caught something. It couldn’t be?! I had made a big mistake and substituted one bit of information for another, erroneously. All the subsequent analysis that my team and I had done was no longer applicable. It was a horrible, sinking feeling. I looked through the records to see how I had missed this error for so long. I put the pieces together, came up with a plan to fix it, and then had to write the humbling email to my team. I was direct. I explained my error, apologized for making it, and offered a plan to correct. And then I waited for their response . . .

Within minutes I heard back. The neurosurgeon leading our team simply thanked me for being honest, having integrity and for attention to detail. The rest of the team echoed those sentiments and they were repeated in subsequent messages. We were to present the data as is.

Truth matters. Even in a cultural setting in which the prevailing current of thought may favor what you can get away with or how skillfully you can bend the facts, the simple truth matters. My mistake, while real, was also interpreted as being attentive to detail when caught. The very thing we think could jeopardize our progress, can instead be a stepping stone. In a year and half, I will be making significant decisions about patients as I start residency. I will not always be right, but I can always be forthright. I owe my patients and colleagues that.

So if like me, you make a big mistake, here is what I have found works professionally (but I would argue makes sense for personal situations as well):

  1. Address the mistake in a timely manner
  2. Admit to your role in clear and active terms (not “an error was made” but “I made an error”)
  3. Have a plan to address it (even if a different plan is used; this shows initiative and further commitment to the project).
  4. Execute the fix quickly but thoroughly and circle back to your team.
  5. Reflect on how the error happened so as not to repeat it.

I feel for the medical personnel of Doctors Without Borders who had endure a bombing that killed 22 people this week in Afghanistan. The US government  said it was a mistake; DWB argue otherwise. What is the truth? We don’t know yet. But here is why developing an ethos of truth is so critical. One day, it’s a research paper, the next someone’s life is on the line. The seed of our decision making is planted long before we make the high stakes decisions. Will we be ready?

Daniel Coyle in his insightful article, How to Make Better Mistakes, refers to a study with an unusual result: Harvard Business professor, Amy Edmondson, studied a series of hospitals and found that the top hospitals reported TEN TIMES more errors than the bottom hospitals. In actuality, the hospitals were making about the same number of mistakes but top hospitals were proactive about reporting them. How did that help? That transparency created a safe zone and culture in these hospitals where employees still felt free to create and innovate without fear. The fearful approach of hiding errors because of consequences creates an atmosphere where the brain retreats and is paralyzed. Coyle puts it this way, “mistakes are not a verdict, but information to be sifted over.”

Errors should be avoided, of course, but if you have blown it, you are in good company. Of course, there will always be those who try and capitalize on our errors, but the principle is still worth it, even with temporary difficult consequences. Most of the time, though, people respond positively if given the chance. I still remember facing another actor on stage who had completely forgotten his next line (something every actor has faced) which was “What’s going on in town?” When I recognized his blank look I immediately said, unscripted, “You must be wondering what’s going on in town?” He lit up with recognition and said, also unscripted, “You read my mind!” Audience didn’t notice a thing and the play moved on smoothly. We had a good laugh about the whole thing backstage. Most of the time, people are gracious about our admitted errors because ultimately they recognize themselves.

Mephibosheth

King David was on a serious streak of military victories when he stopped everything to ask an unusual question: “Is there anyone left in the house of Saul, that I may show kindness for Jonathan’s sake?” At a moment when he was riding this wave of conquest, David chose to ask about if there was an opportunity for kindness. He went on to take care of Jonathan’s son Mephibosheth (say that fast, three times) who was lame in both feet. And by take care of, he gave him all of grandpa (Saul’s) land and invited Mephibosheth to dine with him everyday for the rest of his life. He used the words “always” and “continually.” Do we use those words when we give or otherwise act in an altruistic way? I think, instead,  we say things like “I’ve done my part.” If I’m honest, I typically think about what is a reasonable contribution, go ahead with that and give myself a little pat on the back for my generous act. Or when helping someone who is going through a tough financial patch, we say something like “I’m helping him until he gets back on his feet.” Both statements sound perfectly fair, but they also imply a limit on the generous act. Once I give my part, that’s it. Once you are back on your feet, the bank is closed. But what was interesting in David’s story was that the person he was helping was lame, in both feet. This medical fact is mentioned twice in the story. There would be no “getting back on his feet.” And that was fine with David. He simply wrote a blank check and said “You shall eat bread at my table continually.”

But today, giving blank checks makes us nervous, so we rationalize our limits on giving by saying things like “I only have so much money or time or energy” or “If I keep giving, I am enabling so and so’s dependence” or  “What about my turn?”or “This relationship is one-sided” or “I’m being taken advantage of.” And for each of these statements, there is probably a reasonable story to back up why we may  stop giving. But are we even following the rule enough to introduce these exceptions?

What if we stopped counting? What if we gave “continually” sort of offers? What if we dropped our expectation of reciprocation and gratitude and simply offered those we work and live with a permanent seat at the table? What if we just gave free refills no matter how many times we’re called to the table? I imagine a freedom from constantly assessing whether everything is balanced and fair. I imagine a different kind of impact as generosity makes people take notice, but continual generosity makes people change. Will things be unbalanced? Probably. Might we get more than our fair share of work? I think so. Will we even get taken advantage of? Very possibly. But perhaps  the point of David’s story is that we can let even that go and simply eat together at the table. And perhaps the question, then, is not “Have I done my part?” but “Have I done my whole?”

Theatre_Masks

Credit: Prince George Speech Arts and Drama


The email started with “Congratulations” and then five minutes later I received a text that began with “Sorry to let you know that” The first was an educational/career opportunity, the second was a loss in the family. I felt alternating excitement and sadness and was reminded of an acting exercise I used to do with my students in which for ten seconds they had to pretend that their partner was their long lost twin, and then that their partner was an immediate physical threat. The point of the exercise was to demonstrate that Theatre is about the extreme moments in life. Intense good or intense bad. There is not, to my knowledge, a play that has succeeded on the premise of brushing one’s teeth or sorting laundry. The moments we remember most in life also fall into one of those two categories. The Great. The Awful. And yet, what do we do when these happen so close to each other? To offer a medical example, how do I break the news to a patient that mom made it but baby didn’t, or the other way around. We talk a lot in medicine about breaking bad news, but what about breaking mixed news?

I think the answer may be found, in part,  back in the acting exercise. The exercise worked best when there was no hangover from the previous situation. When the actors inhabited the physical threat fully or the wonderful possibility of meeting a long lost twin fully. It worked, even if the switch was sudden. When faced with mixed news, I think we’re tempted to gloss over the part that makes us uncomfortable. We rush over the good news because we don’t want to seem insensitive or feel guilt about seemingly not empathizing with  the closely accompanying bad. Or we gloss over the bad because it’s hard and then strike a false cheeriness based on the good. The result is this emotional no man’s land in which we are not present because we are more concerned with what we ought to be feeling than what we are actually feeling. One of my favorite scriptures is “mourn with those who mourn” and “rejoice with those who rejoice”. There is no caveat for inconvenient timeframes or close proximity between events. All anyone expects or really needs whether it is a patient, friend, or a family member, is that you honor that particular moment, joy or pain, fully. Have you noticed how sweet the first laugh is after you have just talked about a tragic experience? We are most alive in those moments allowing for truer connection. And so, I will celebrate the good news in the first email and mourn with my family members for the bad news in the text that closely followed. May I honor both moments . . . .

ipad-typewriter

Photo Credit: AskmePC web design

“I was made for the library, not the classroom. The classroom was a jail of other people’s ideas. The library was open, unending free.” Ta-Nehisi Coates, Between the World and Me. I read these provocative words today while on a literary get-away to Barnes and Noble. I don’t know that I agree with Coates’ characterization of classroom as a “jail” as I actually find listening to other people’s ideas stimulating, but his challenge to chart one’s own path in seeking truth and knowledge, the “library path”, is important.

In Between the World and Me, Coates describes the vibrant yet turbulent tale of the African American experience in America. His whole book is written as  a letter to his teenage son with his best thoughts on how to live with dignity as a black man in an imperfect America. With my own son having just turned 13, I was interested to hear his thoughts. One question I wonder about is how to prepare my son for a environment in which race is still a controversial issue without making race color everything he sees.

It’s an unfamiliar challenge for many of us Generation X immigrants from Kenya, because we did not grow up with race being such a throbbing undercurrent to daily life. I am, in fact, biracial and grew up thinking it was quite natural to have a Scottish mother and a Kenyan father. It meant chapati and Scottish soup all in the same week and a common national fanaticism for football/soccer. What was not to love? I also grew up with a black (Kenyan) President, learning black (Kenyan) history.

I will pause here to say that in Kenya, we also had to learn the history of EVERYWHERE else as part of our highly ambitious 8-4-4 educational system at the time. When I say history of everywhere, I mean it. Basically if something had happened in the past, anywhere, whether that be in Northern Mongolia or Nebraska, we had to know it. But I’m not bitter . . .

What struck me about Coates’ words is how much change, of any kind, depends on our willingness to challenge the various scripts in our lives. I once tried to change the tired script and perception of Africa for my students as a vast “country” full of war, famine and poverty, but delightful animals . . . I decided to walk all around downtown Nairobi with my sister taking pictures of less familiar images, skyscrapers, fancy restaurants, malls. My mission was dramatically cut short when a few of our law enforcement officials detained me, quite concerned that I was taking pictures of multiple buildings, a suspicious act even at that time in a world of terror attacks. I was released once the confusion was cleared up, but it stuck with me that changing a narrative is not easy. It demands persistence, stubbornness, courage.

***

I started a new phase in my medical journey this week as I began my Masters in Clinical Research, a 2 year leave, before returning to complete and graduate from medical school in 2017. My research will mainly be in Neurosurgery, exploring the following topics:

1. The effectiveness of electrical stimulation in treating nerve injury.

2. A rare complication of brain aneurysm rupture treatment, known as PRES.

3. Patient costs of Pediatric Neurosurgical care in Kijabe, Kenya

I will also be working with Pediatric faculty on data visualization and bioethics projects. The bioethics project will involve analyzing the differing experiences of minority and majority pediatric patients in our University Hospital when facing difficult medical decisions.

Research, either personal or professional, is unique way to change the script; you can use hard earned data to challenge nonsense. I look forward to that challenge.

For today though, I am glad I could walk into a  room full of books, choose the knowledge I would seek, and create a script on the spot. Whether the original script is a skewed conception of Africa, a narrow view of each other by race, or medical treatments with flimsy support, some scripts were made to be changed . . .

notice-and-wonder-thumbnail1

Graphic credit: adventuresincommoncore.blogspot.com

This may come as a shock, but not every moment of parenting is filled with heroic deeds, warm hugs or high fives. There are tasks we parents do that won’t be making it to the big screen any time soon. One of those tasks is the parent-teacher meeting. It’s probably a good thing that this event won’t be a summer blockbuster. Not sure how many people would go and see the movie “Parent-Teacher Meeting: Goals Defined!”

And so it was that I drove over to my son’s school and sat down in his Math class, looking forward to meeting his teacher, but expecting a fairly generic description of the goals for the term ahead. But Mr. M surprised us all and instead whipped out a Math word problem for us to solve. But instead of jumping straight to a calculation, he got us to ask two questions “What do I notice?” and “What do I wonder?” This is the approach he takes with the students because of a growing revelation in education that many students do not know how to effectively approach verbal problems. They leap to calculation before really  understanding the problem. Asking what you notice and what you wonder first relieves you of the pressure to instantly be right and simply allows you to take in the information and process the problem in a non-linear way.

If there is one feeling you have in medicine, it’s the pressure to be instantly right. Even now, while I’m on research leave, I felt I needed to be correct when asked what I thought of the results I had just assembled for one of my research projects. But interestingly, my research group leader  used almost identical phrasing to Mr. M, the math teacher. She simply asked, when we were looking at the data tables, “What do you notice?” We are evaluating the literature to determine the effectiveness of a certain modality for treating nerve injury. I noticed that one muscle group seemed to improve much more than the others with this treatment. Why? (What do you wonder?) Could it really be that you can approach an 8th grade Math problem and a Neurosurgical research article with the same two questions?

And if so, where else could those questions be used effectively to solve problems?

What if spouses took the time to notice and wonder about each other? On second thought, there is probably a lot of noticing and wondering that goes on already “I notice you’ve walked onto the carpet with dirty shoes” “I’m wondering which couch you’d like to sleep on” but what if these questions were asked from a place of renewed curiosity and possibility?

With parents and children.

With employees and employers.

With ourselves.

We can get to the point where everything is about bottom lines and definitive answers. We stop noticing and worse, stop wondering. At that point, innovation is stymied, relationships stagnate and personal growth is stunted.

I first broached this question on Twitter earlier this week. As it happened, I have a mischievous friend who responded with a few notice/wonder questions of his own. I will leave you with one of his cheeky creations . . .

What do I notice? I can’t feel my foot

What do I wonder? If this crocodile will let go soon . . .