Saturday, July 20, 2013

Graduation day, Cambridge

DSC09418I walked into town yesterday, summer finally arrived and the streets filled with people.  I hadn’t realized it was graduation day for the 2013 class: a couple of the MBE students ran over to shake hands and we caught up about their next steps in life.

It reminded me of the same date, 7 years ago, when I walked to the Senate house to receive my diploma.  It was one of the happiest days of my life: the accomplishment, ceremonies, the perfect people to share it with.

DSC09409 (1264x1083)  DSC09433 (1800x1393)

DSC09419  DSC09415 (1800x1316)

I called my father to reminisce about the day and about how special it was for us to share it with him.  We laughed about his experience with the punts, the College dinner, the drinks with the dons.  The world was so filled with optimistic possibility.

Friday, July 19, 2013

Coming of age

We have no preparation for getting old: We’re always young and then suddenly we’re not.  There’s some psychological way in which we identify ‘old‘ as ‘other’.  

And then there’s that shocking moment when we realize that we have crossed over, we are perceived as ‘other’ by all those young people who can’t imagine they will ever reach our age. 

   -- Jennifer Egan, Studio 54

I’ve never felt ‘Old’.  I have my health and energy, my parents are still alive, my children are grown but I‘m not a grandparent.  While  friends prepared for retirement, I leaned into life.  I’m only as old as I feel:  ‘forever young.

But, as Egan notes, events can quickly assert reality.  For  me, the question crystallized talking with colleagues last week.

The next ten years of your life could easily be the last ten years of your life.

How do you want to spend that time?

I came to Europe in search of new opportunities, a better life, a fresh start.  A positive vision, it offered scope for living remarkably, enhancing my work, my relationship, and my lifestyle.  And, over eight years, I achieved a lot of what I’d hoped for. 

But life has veered seriously off-track, and driving myself and others  along the same path won’t work, especially as my 60’s horizon approaches.   How do I want to spend that time?  I’ve reached out to family and friends to talk, evenings of pub chats and flickering Skype conversations.  Personal essays by Oliver Saks, Matt Long, Elizabeth Spiers, Randy Pausch, Clayton Christiensen and others add perspective. 

And I’m coming to understand that I won’t be satisfied by attaining goals, gathering things around me, then withdrawing into retirement.   The important, lasting feelings will come, instead, from the journey:  the life I live, the people alongside me, and the stories and laughter that we share together. 

It’s “How we did things” rather than “What I did”.

In some ways, it feels like a classic ‘coming of age’ tale.  The literary genre  focuses on the transition from youth to adulthood, steeped in maturation, acculturation, loss of innocence, growth of wisdom and worldliness.  But those themes are equally relevant to a transition to becoming ‘older’.

As I have.

Ten years ago,  I turned to Europe in search of  the life I wanted.  

The next ten years must be spent living a life I can love and  share.

Thursday, July 18, 2013

Clare’s Mongol Derby

ClarePeople say that I’m lucky in life, but I know I’ve been lucky in people.   Again and again, I’ve seen the extraordinary things that can happen when capable people make positive choices and take affirmative actions.

So in that spirit, I’m pleased to recommend your support for Clare Twemlow’s upcoming participation in the Mongol Derby.  (CamNetwork)

It’s a remarkable event, a 1000 km horse race at speed for two weeks across the Mongolian steppes.  The scenery looks absolutely stunning, broad grasslands and rolling hills, still dotted with nomadic herders.  The racers ride classic Mongol short horses that are bred for life in the wilderness, but it means that riders must take care with the animals as well as with the harsh environment.  She’s allowed 5kg of the-mongol-derbypersonal effects, and has to keep the horse’s heart rate within limits throughout the race. 

A bit of background: Clare is a Chartered Accountant who has been CamStent’s CFO for 5 years and is a partner in New Wave Ventures (London).  She leads our finances and fundraisings and has been a wonderful co-director and friend as we built the business.

You can follow her journey on Facebook and on the event blog;.

‘wish her luck,, and please consider making a donation to Spinal Research.

Wednesday, July 17, 2013

Understanding medical stories

A&E ArrivalWhen a patient is brought to the A&E (Emergency room) by ambulance, the patient is quickly transferred to a waiting bed where a team of doctors and nurses begin treatment, stabilizing the patient, ordering tests, and starting treatments.  It’s a familiar scene from television dramas (and, unfortunately, to any parent).

Less visible is the rapid transfer of patient information from the ambulance to the hospital: the history, vital signs, and procedures during the initial encounter  on-scene with the medics.  We’ve gotten much better at transmitting demographic and device data ahead of the patient’s arrival.  But data alone is not enough.

Kyle McClaine, MD, talks to John Gold from Plainfield Ambulance outside of the entrance to the Backus ED. On Monday Dr. McClaine, who works in the Backus Emergancy Department,  will be presented a prestigious statewide award for collaboration with Emergency Medical Services in the communityWatch closely, and you’ll see the medic and physician have a brief conversation about the patient during the handoff.  They are sharing a structured story, explaining the incident’s circumstances, the treatment rationale, the observations that give meaning to the charted measurements.

Long ago, I led a research project to capture and interpret these narratives: we combined a voice recorder, transcription software, and medical language parser to try to extract the “facts of the case” from the narrative.  The technology was too crude for more than a proof of concept demo and a patent, but I’ve always had a soft spot for the idea.

Historically, machine transcription and translation based on linguistic rule-based approaches has always been fragile and unreliable.  I remember reading to Dragon for hours, training it with prepared texts and hoping it would get smarter.  We took a license to MedLEE, an expert system that extracted clinical concepts from medical texts.

DSC09383 (1500x803)Today, transcription and translation software uses statistical approaches that sidestep the whole question of structure and meaning.  Given a snippet of spoken or written text, computers simply search vast libraries of paired ‘voice-text’ and ‘native-foreign’ documents to find a match. 

As the libraries grow, so does the accuracy of the process.  Like any ‘big data’ project, the process needs well-curated content to get started.  But as it grows it can ‘learn’ and improve itself through simple removal of inconsistencies (cleaning our errors) and recognition of similarities (colloquialisms and metaphors).

The growth of medical information systems means that vast libraries of  ‘medical narrative-patient chart’ pairs are available.  Although held behind patient privacy walls, Vitalsde-identified data should be useful in developing better systems that mimic the human process for extracting the ‘facts of the case’ from the stories that medics tell physicians in those first moments at the doorway to the hospital. 

It may add an important dimension to understanding the simple ‘flow sheet’, the chart of vital signs data and medications over time.  Medical stories can explaining why things happened alongside the simple ‘what’ .

Tuesday, July 16, 2013

Balancing the days

OaksLast week was epic with tech failures.  My GPS, mobile phone, internet connection, and finally my computer itself all bit the dust on four sequential days.  Most could be remedied with some time and patience, but the computer issue was potentially catastrophic as I didn’t have a current backup (please make yours now).  Thankfully, the local repair person was able to image the hard drive and recover the data, and a new netbook should arrive tomorrow.

This all left me with a bit of extra time at the weekend, and the weather continues hot and sunny.  So I went down to the local pub to enjoy a pint, finish a novel, and admire the glowing sunset.

My replacement mobile phone rang.

An hour later I took stock.  45 minutes of misery from a former business partner, two follow-up calls to make sure he was contained.  The sun had set, the evening was lost, the beer was warm(er), and my stomach was in more of a knot than bt faultusual.

More than anything, this transition typifies the insanity that my life has become.

It was never a conscious choice.  It’s the result of many small choices made over the past six months.  Each was ‘temporary’; each was well-intentioned.

But, collectively, they are destroying the life that I came here to live.

Researchers note that the very traits that make people like me thrive as entrepreneurs are the ones that undermine our ability to say ‘no’.  I can set and reach lofty and significant goals.  I can adapt and fix things when they go wrong.   I can juggle priorities and work harder, longer, when I must.

sbb  2Your businesses will consume  every moment you offer them and then ask for more, I’ve advised my University class.  A Cambridge colleague told me the same the next morning over breakfast: it’s time to start committing to fewer choices.  (“Dinner parties are mere rituals; but you invite a man to breakfast because you really want to see him,” notes the FT, insightfully illuminating the virtues of 8 am conversations).  A US colleague shared the steps he’s taken towards balancing work (less) and family (more), with pictures.

I know that it’s definitely time to tame the beast...

It starts at home, where life refracts most personally and I have the most control to make situational and aspirational changes.

I still can’t sleep past 5, but I don’t engage with work before 8:30.  The cool quiet hours fill around the village, house chores, reading, and writing.  I’ve rescued plants to container gardens, repaired the apartment.  The thin high Duckscry of the neighbor’s new baby is becoming routine; mine are calling for job and college advice in the morning rather than late night.

Evening I’m brushing up skills, mainly Dutch and dinner for now.  Three tries to get the irregular verb right; three evenings over duck breast and potatoes until I got the right textures.  Get out to exercise or in for a show, share a long talks with friends over wine, make plans together, then seek fitful sleep by midnight.

This needs to evolve towards much further towards more balanced normalcy, and I know it’s a journey.  But I’ve made it stick for a week.

‘and the calls do stop coming when I stop taking them.

Sunday, July 14, 2013

Village suppers and ‘selfies

Our group gathered in the summer twilight at 6:15 sharp, everyone dressed up a bit, some clutching carry-all’s of food.  Comparisons were made of the weather, the people, the changes from previous years.  And with a crunch of gravel and the clicking of canes, we were off.

‘Another summer supper in the village.

I’d contributed a Key Lime Pie this year (very little was returned, thank goodness) and progressed around four homes for courses and conversation.  Barrington is a small community, filled with long-time residents, tightly knit.  These large social occasions are always filled with stories, gossip, and catching up: if I enter with the right spirit , then the evening likely turns out well.

A core topic among the men seemed to be Retirement.  Several folks were approaching 60 and making plans for how their lives would change.  Those with means talked about plans for travel, boats, grandchildren, and consulting; those without focused on pensions, health, grandchildren, and crafts.  Both groups were looking forward to the changes.  It’s a funny conversation to have, both distant and close to my own circumstances.  I certainly allowed that there were things I’d rather be doing, though we laughed about when.

In a way, it’s identity again, and the ways that people define themselves by the things and activities that they build around them.  Comfortably, that amplifies things that give them the most satisfaction, along with play for aspirational longings.

The Guardian published a piece in a similar vein on the rise of ‘selfies’, self-portrait snapped with a camera-phone.  “It's about continuously rewriting yourself. an extension of our natural construction of self.  It's about presenting yourself in the best way… an aspect of performance that's about knowing yourself and being vulnerable."

In fact, ‘very similar to the public presentation and positioning during the village supper.  Taken in that light, the generational difference comes down to a distinction between social suppers and social snapshots.  Is either less real to the community of friends?  Either less effective in creating a persona?  No, as long as it’s accepted by the individual and the group.

But the article concludes with a cautionary note, relevant to both suppers and selfies: the illusion of ownership.

You can manipulate your own image as much as you like. But the truth is that once they are public, you can never control how other people see you.”