business travel is about being ok with being alone

I woke up this morning at 4:30 AM to find my hotel bill slipped under my door with a note that said "Thanks for staying with us - please leave your key in your room!" I marveled then, as I have for the past two days, about how the entire hospitality industry has designed itself for business travel. But as I got on the plane this morning and was catching up on emails and articles, I read this Penelope Trunk piece that resonated with me about being lost.

I am feeling lost. Maybe not completely lost. But at least a little. I've had some big conversations over the past three months. I've been pushed to a lot of limits. I'm still figuring out what all of it means in the context of my work and my life. To be fair, my work is my life. And I'm not complaining. I genuinely like what I do, both in the office and outside of it. We are lucky if we have work that is both meaningful and challenging to a manageable capacity. I find meaning in what I do, and I am challenged by it (some days, more than others).

Yesterday, for the first time in my life, I drove to a restaurant and asked for a table for one. I made it a point to not have a single telephone conversation through my entire meal (Greg, I promise, I really didn't). I wanted to focus on the silence, on my own thoughts and how I would interact with my environment. More than myself, though, I was baffled with the ease that the waitstaff handled the situation.

It's amazing to me that the entire hospitality industry operates on two modes - family travel and business travel. As someone who traveled with my family a lot as a child, I never understood (or had any visibility into) how things are designed for business. Anyone who has spent an appreciable amount of time on business trips - both alone and with coworkers - can appreciate this. From the time I checked into my flight (online), dropped my bag off, went through security at Hartsfield, got on the plane, landed in Manchester, picked my bag up, rented a car, and checked into my hotel, I spent maybe 6 and a half minutes talking to someone.

Business travel is about making things faster. And the way to make things faster is to automate. It's the culture of business, translated into the culture of hospitality. To check out of my hotel or return my rental car, I didn't need to talk to anyone at all. Which is fine, at 6 AM, when I'm barely functional anyway, but still remarkable. I'm not sure that I want that culture to dominate my life. So I need to reevaluate my work being my life.

Traveling alone for business is so transient. There's nothing, except well-documented American Express bills, to remind people that you were there. There's so little interaction between people. It's kind of disconcerting, the fleeting nature of it all. Yesterday's experiment at lunch was a good learning experience in how I deal with being in social situations alone. But it was a more powerful reminder that we are social people, and we need interaction to be grounded and un-lost. It's hard to feel grounded when the culture of business takes over your life.

One of the things that I do when I travel is take pictures of my feet. I started a few years ago, in 2007, to focus my camera when I had multiple focal distances I was shooting. I used to post the pictures with the caption "I was here." Over time, through long trips and short ones, I've started doing it to ground myself - literally. So here's my shot from Manchester, NH this morning.

Manchester, New Hampshire - I was here.

So here's my attempt at un-lost, for now. I write. I take pictures of my feet. I try new things. I make the flight attendant take the banana from my breakfast tray away. And I admit to myself that while maybe I can handle eating lunch alone, I'll call my coworkers when I get back to the office and make some Amici plans.

she would give her life to preserve that kind of trust

(Dr. Muhammad Yunus and myself, bright and early this morning... please do not reproduce without permission)

I dragged myself out of bed at 6 am to attend a small lecture and meet-&-greet with Muhammad Yunus this morning. My academic background is in both biomedical engineering and development economics, and Dr. Yunus is a huge force in poverty eradication. The Grameen Bank is wildly successful, and incredibly simple. He spoke for a little more than an hour, off the cuff, and had some really great stories to tell. One of the most vivid, though, was about Grameen’s vision of having 50% of its borrowers be female.

When they first started in the 1970s, Yunus and his students went to the villages themselves. He would wait outside under a tree and his female students would go inside and talk to the village women. When the students had a question, they would come outside, discuss with Dr. Yunus, and go back inside to the women. For years, the women were so reluctant to borrow money. They heard things like, “My husband deals with the money.” and “I’ve never even held money in my hands.” and “I don’t know what a bank is.”

Imagine – how do you explain to an illiterate village woman who has never held money, what a bank is?

Furthermore, how do you explain this to a woman who, all her life, has apologized for the fact that she was born a woman? She has been called a drain on her family, she has never gone to school, and she is expected to manage a household with whatever she is given by her husband. Her life is not her own doing. This is the culture, the history, the circumstance that surrounds her life. How do you peel back the layers of fear and convince her to take a chance… on herself?

It took six years of convincing women like this for the Grameen Bank to achieve its 50/50 goal. That is, in the grand scheme of things, a very short time, but imagine giving six years of your life to walk around villages and convince women to build a better future for themselves and their families. That is no small investment. Yunus, when reflecting on the achievement, said this:

“A woman comes to the bank after days, weeks of pondering. Can she do this? What if she fails? Her family will forever hold her responsible, blame her for any mistakes. But she knows she wants a better life for her children. So she takes this sum of money - $30, $40, $45. It’s a larger sum than she’s ever seen. For some, it’s the first time she’s ever held money in the first place. That woman is reduced to tears by the amount of trust that someone has placed in her. And she would give her life to preserve that kind of trust.

Repeat that story 8 million times, and you will understand what Grameen Bank is all about."

A call to those of us who have been lucky enough to “win the lottery of birth” - It is possible to eradicate extreme poverty in our time. It is possible to improve healthcare in the developing world. It is possible to stamp out disease, to ease suffering, to empower women. All of these things are achievable. They require us, though, to take chances. To peel back layers of fear. It’s not about making money. The Grameen Bank is profitable. It is not charity. It is a business. But the goal is not to win the game of business – it’s to solve the problems in people's lives.

A woman came back into the Grameen Bank several years after she repaid her loan. She had built a successful enterprise in her village, and had managed to send all of her children to school. That particular day, Dr. Yunus was in the bank, and she came by with her now-grown daughter. This woman could have asked her daughter to stay at home and help with the business while her sons went to school, could have pulled her child out of school because she needed the help. But she didn’t. Her daughter was now a practicing doctor in a city in Bangladesh. These two women stood side by side. They looked the exact same, except the difference in age. And while he was talking to them, he couldn’t help but think – one woman, illiterate, uneducated, took a chance and made some sacrifices. The other woman became the product of those chances and sacrifices, and was now given the chance to save other peoples' lives. Her mother could have done everything that her daughter got to do, if only society had given her the same chance.

the first sense a human fetus develops is the sense of touch

The first sense we rely on as adults is typically sight. But the first sense that God (or nature, or insert other terminology consistent with your belief or nonbelief here) gave us was the sense of touch. The first sense that children trust is their sense of touch (followed closely by their sense of taste, it seems). So why do we lose sight of that as we get older?

(a little time in PowerPoint and a few stock images later... )

Or does it? We tend to believe things that we see, but I don’t think we take into account how touching something shapes our thoughts. This is true with people we encounter – there is research showing that supportive, nonsexual touching makes people more productive, comfortable, and secure with their teams (in a workplace context). From Peter Bregman:

In a study led by Mathew Herstein, an associate professor of psychology at DePauw University, pairs of students who didn't know each other took turns using touch to try to convey a specific emotion like gratitude or sympathy. The person touched was blindfolded and yet accurately identified which emotion the touch intended to communicate between 50 and 78 percent of the time.

With objects, things that we touch can change our internal response - people who hold hot beverages feel more generous than those who hold cold ones. People who sit in hard chairs drive a harder bargain than those in soft chairs. And the more you touch something, the more valuable it becomes in your eyes.

When I think about it, this should affect the design choices in the project that I’m currently leading. My new device has to interact with both a nurse (for placement and removal), and a patient (as it dwells on their skin for days at a time). We have to choose materials that convey strength to a nurse, but comfort to a patient... two very conflicting emotions. It’s nontrivial, even for medical devices. Although the push is for evidence-based medicine and clinical research, nurse and patient perception are hugely important elements of quality of care. Our perceptions impact us more than our realities.

live the questions now

"I beg you, to have patience, with everything unresolved in your heart and try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don't search for the answers, which could not be given to you now, because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even realizing it, live your way into the answer."  - Rainer Maria Rilke

Twelve stressful (but fun!) weeks later, life has demanded that today I ask the right questions and try and live my way into the right answer. It's the hardest design challenge I've been faced with yet.

nonobviousness in device design

I always have reservations when I open an email on a Sunday from my work address. That being said, this FDA presentation showed up in my inbox today from our VP of R&D about medical devices being connected to the wrong attachment, resulting in some pretty nasty consequences:

(as a product of the US Government, none of this material is copyrighted - its use and reproduction is encouraged)

At first glance, as a medical device engineer with a significant clinical background, this seems ridiculous. Connecting a nasogastric tube (used to feed patients when they aren't capable of eating and need significant nutrition) to a Foley catheter (used to drain the bladder of urine)? A feeding tube connected to a tracheostomy port? By a trained nurse?


But as I look closer, some of these aren't obvious to me (are they obvious to you?). And if they're not obvious to someone who makes the stuff, I can't imagine anyone that would have an easy time with knowing how to place each and every component that surrounds a patient in a hospital bed. In the hubbub of a hospital room, with patients, doctors, family, and the scores of other people that are involved in healing, it's not always easy for someone to glance at something and know exactly where it goes and how it connects. And that is terrifying. Some of these actions have killed patients (well, when you're pumping milk into an infant's lungs...). Others have led to gross deformity and reduced quality of life.


The onus is on us, as designers, to make things as obvious as possible. Don't assume that a nurse is trained on your device. Don't assume that a doctor has read the Instructions for Use. They might have been trained on a different procedure, or be familiar with a different device. Assume nothing, and make it as difficult as possible for someone to use your device incorrectly. Don't make standardized luer connections on the end of everything just because it's cheaper to manufacture - it's also easy to connect a standard luer to pretty much anything... including things you don't want to connect to. A second molded component is worth the cost if you can save a patient's life.


In general, it's a good idea as a designer to never rely on your instruction manual. Most people (myself being the exception as I am a user's manual disciple) don't take a second look at the instructions that came with a product. And why should they? Instruction manuals are famous for being wordy, detailing features that we'll never use (but cited in our decision to buy the product), and overly complicated. They're written in technical (and legally manipulated) language. If you're in a developing or foreign country, the translations may not be perfect, and nor do you really care about reading through them. And when you have a critical patient in front of you, an instruction manual is about the last thing you have time for.


A design should limit people from doing what they shouldn't do - "designed incompatibility." It should be difficult to do things with a device that lead to nondesired outcomes. It should be damn well near impossible to do things that would cause someone harm.


Oh, and don't go walking around the hospital connecting random tubes together.