the soft bigotry of low expectations

I can't remember where I first read that line. Maybe it was The Audacity of Hope, or Freakonomics. Maybe one of the painfully dry books I force myself to read, like The Paradox of American Power or maybe Guns, Germs, and Steel. I think President Bush said it in a speech once (or maybe it was President Obama...). The soft bigotry of low expectations.

Two days ago I had coffee with a very good friend of mine not far from where this picture was taken.

Covington Square. This is in front of more than one store. Gotta love working in the rural South.

We talked a little bit about stereotypes. Not for long. I'm not good at talking about stereotypes. Mostly because I haven't felt discriminated against too many times in my life. A few cases, for sure, but not enough to know right away when I'm being discriminated against. I'm a racial and religious minority in a conservative, Christian part of the country. I'm a woman in a male-dominated industry and profession. But John is a successful and talented software engineer for a high-profile startup in San Francisco. And he's black.

Last week I wrote about defying people's expectations. Working a lathe as a 5' 2" Indian girl wearing pink heels. Engaging in a Milton and Faulkner discussion group as an engineering major. Leaving cheerleading practice to tutor someone in calculus. But I've found in my life that those aren't the biases that bother me. It's the small things - having someone assume that I will quit working in three years to get married and have children. Assuming that I can work on a Sunday because I'm not going to church.

We don't live in the days of segregated stores, but that doesn't mean we don't discriminate. Real diversity isn't about race anymore (although our attitudes about race are still deeply ingrained). It's about socioeconomic status and life experiences. Malcolm Gladwell makes obscene amounts of money talking about this in Blink - about how we expect people with certain backgrounds (and yes, certain looks) to behave and perform a certain way. And how those expectations can shape how we treat someone - from people we hire, to people we fall in love with, to people we elect as President.

I love this line so much, the soft bigotry of low expectations, because it illustrates a perfect point. You don't need a plaque that calls out the color of skin to exclude or offend. We do it through the things we say, and sometimes the things that we don't. We do it when we ask a woman we've just met how many kids she has, and asking her husband what he does for a living. Sure, it might be a fair point, but by doing it, we've made an assumption about what's important to someone because it fits our model of what's important to us.

design lessons i learned from the sunscreen song

Lately I've been doing a lot of research about designing clinical interactions. Specifically, in how clinicians can interact with patients to boost healthcare outcomes. It strikes me how similar it all is to happiness research (The Happiness Project was this week's travel book). Designing smart interactions is like designing a happy life:

1. We're happier when we have meaningful relationships in our lives. A doctor-patient relationship in which both parties contribute to the conversation leads to better health outcomes and more patient satisfaction.

Also, did you know that the best predictor of loneliness is the number of female friends you have? Male friends don't make any difference in the loneliness statistics; it's because women are easier to open up to. This might make a great case for why people prefer female doctors.

I also find this sort of worrisome, because I have few female friends.

2. Patients are more likely to be compliant when there is a clear link between action and result. Feedback is a core tenet of interaction design. It's frustrating to receive instructions from a doctor, follow them meticulously, and not see the intended result. Since health is individual and outcomes are not guarantees, we should design devices to facilitate this kind of feedback as best we can. And related...

3. We shouldn't compare our outcomes to those of others. You can replicate treatments, but you can't guarantee outcomes from patient to patient. We're all different, and it takes different things to make each of us healthy. We've all  heard the crazy stories of the man who lived to be 90 smoking a pack a day, and the perfectly healthy marathoner getting metastasizing cancer. Our science is unique; that's what makes us works of art. Similarly, keeping up with the Joneses doesn't make you happier, because the things that make you happy are different.

4. Experiences make us happier than things. Visiting someone in the hospital is much more meaningful than sending flowers.

A great line in the book is "there is no love; there are only proofs of love." This isn't unlike Khalil Gibran's line in The Prophet, "Work is love made visible." Or Covey's idea that love is a verb, not a feeling. Proactive people treat love as an action. But I digress.

5. People who are grateful for what they have and appreciate their lives the way they are have shorter recovery periods and a higher quality of life. So much so that the American Heart Association has counseling programs for stroke sufferers on positive thinking.

Basically, these are all things I learned from the Sunscreen Song (it's here if you haven't heard it). It's easy to overcomplicate clinical design and positive interactions with bells, and whistles, and features. But there are no secrets to happy, and no secrets to healthy, either.

Get to know your parents; you never know when they'll be gone for good. Be nice to your siblings - they're your best link to your past, and the people most likely to stick with you in the future.

Being nice to my brother on Rakhi, many moons ago.

Understand that friends come and go, but with a precious few, you should hold on. Work hard to bridge the gaps in geography and lifestyle, because the older you get, the more you need the people you knew when you were young.

I'm thankful for the kind of friends that bridge gaps in geography and fly into town just to have dinner (thanks, friend!).

Read the directions, even if you don't follow them.

Don't waste your time on jealousy. Sometimes you're ahead; sometimes you're behind. The race is long, and in the end, it's only with yourself.

Maybe you'll marry; maybe you won't. Maybe you'll have children; maybe you won't. Maybe you'll divorce at 40; maybe you'll dance the funky chicken at your 75th wedding anniversary. Whatever you do, don't congratulate yourself too much, and don't berate yourself. Your choices are half chance. So are everybody else's.

Dance, even if you have nowhere to do it but in your own living room.

Enjoy your body; use it every way you can. Don't be afraid of it, or what other people think of it - it is the greatest instrument you will ever own.

Learning something new at Circus Fitness class.

Writing closing sentences has never been a strong suite of mine. It just feels awkward. But I love the ending to the song, which circles back to the research ("but trust me on the sunscreen"). So I'll circle back to the research:

The findings here are tentative and in need of replication. Until then, including empathy in the clinical encounter has little potential for harm and has positive influences that extend beyond the medical consultation. A “connection” also enhances continuity and builds a foundation for relationship-centered primary care within the patient’s medical home.

defying expectation (why do engineers wear ugly clothes?)

This morning I checked into Hartsfield an hour before my flight. After finding a parking spot (which proved to be more difficult than you'd think), getting my baggage squared away (I'm carrying a Chatillon gage and some other assorted medical-devicey-things), and getting through security with time to spare, I found out my flight had been moved from the T-gates to concourse E. So, still with time to spare, I made my way to the other end of the airport, and to the gate with 15 minutes left, only to be told by a Delta gate agent that they had given my seat away and I couldn't board.

Let me recap for a minute: I had time to check my bags, go through security, get through a gate change from one corner of the airport to the absolute farthest point, and still made it in time to see people on the jetway boarding the flight. And couldn't get on.

So basically I spent the morning waiting in line, on the phone with Bard Travel, emailing Hertz, and dealing with the general annoyances of rebooking flights and cars to obscure cities and small airports.

OK, vent session over.

I also spent the morning people-watching at the world's greatest airport. Over lunch, I met a man who runs a logistics company and he asked me, as most people do, what I do for a living. I told him I was an engineer, and he laughed. As most people do. He told me I didn't look like an engineer.

This is not the first time I've heard this. Once, when Iris and I were at an ICU visit in Fort Lauderdale, the nurse told us that when he heard he would be hosting two engineers, he was expecting "two old white guys."

We are about as far from two old white guys as you can get.

It doesn't really faze me. Or at least, not any more. I've grown up doing things that people don't expect. I grew up listening to emo and country.

With my dad (Happy Father's Day!) on senior night at Parkview.

I was probably the first Indian cheerleader at Parkview High School. We'll say that I was, because who even knows how we would every verify that. One time I skipped an AP Comparative Government exam to go shopping. I was Student Body President of a student body that is only 30% female. I get french manicures and operate heavy machinery.

OK, a Dremel isn't heavy machinery, but I don't have pictures of myself operating the band saw.

When Frank told me I didn't look like an engineer I laughed. I told him sorry that I wasn't wearing ugly clothes. I don't know why engineers have a tendency to wear ugly clothes. If I were married, or wealthy enough to have my own photographer, I would post photos of outfits, like Anh does on 9to5chic. I love her, because she works in the old-boys-club of the medical device industry and makes it a point to not look frumpy or old fashioned.

I don't know that we always realize how important our expectations are. Expectations color our perceptions, and no matter how unbiased we try to be, our perceptions shape our realities. This is especially true if you're a woman working in a male-dominated industry. When men dress well for work, it's seen as dressing well. When women dress well at work, it's seen as trying to leverage their looks to get ahead in their careers. When I was at Georgia Tech, I would read blogs about the perception gap about women and men in high positions. I showed up to meetings in pants suits because I didn't want my legs to communicate that I wasn't capable of doing my job.

I did all my headshots in pants. No exceptions.

At some point in the past two years, I stopped caring. Not because I didn't have to, but because, like Penelope says, I'm over it. Other people have fought that fight for me, and I can move on to bigger issues. Whether or not a man thinks I'm as intelligent and as capable of doing my job isn't dictated by my hemline. I've proven my point.

And now I wear a skirt and heels to work almost every day.

Because there's nothing wrong with wearing pretty clothes to the clinic or the lab.

I was going to make this a post about how unexpectedly nice the Delta agent who rebooked me was, but now I'm tired. And I'm on a flight to Manchester, NH and my bags are en route to Burlington, VT by way of JFK. And I haven't figured out why engineers wear ugly clothes. And now this post is about me, pretty clothes, and how not to be afraid to tell someone that I'm good at something because I'm a girl.

I wish I remembered her name. I would write to Delta about how she was the third agent I talked to, and all of them acted like they were too busy to do the job of finding me a new flight. I defied her expectations and walked across two concourses to get to an open Delta desk. She defied my expectations too, and rebooked me without a fuss. 

i just bought a cheese plate on an airplane

... and the lady sitting next to me is looking at me like I'm crazy for pulling out my American Express to pay for food on an airplane (I had to write that sentence last because she's taken to observing my screen with great care as I type).

Maybe it is crazy. I don't know. Everyone I work with thinks that I live a ridiculous life. Rafting trips on weekends. Conference calls from ski slopes. It'll change when you have a family, when you have kids, they tell me. But whatever. I spend money on things that matter to me. On my ideal life (of the moment) On gorgeous and satisfying experiences (which, by the way, make you so much happier than things).

A pretty incredible place to have a swim.

A pretty incredible place to have a conference call.

We tend to be attracted to people who are like us. We like friends who are like us. We also are influenced by the people who are around us, to a greater degree than we realize. I have friends who appreciate my love of experiences because they're willing to participate in them with me.

So when we get together, we partake in amazing experiences. Money can't buy happiness, but money can buy experiences that change your perspective and enrich your life.

At the National Mosque in Malaysia.

Holding a baby gator in the Bayou.

From the Tiffany What Makes Love True website (see tip #8... well, actually, read all of them):

Light the Candles.
Use the good china. And crystal.
When you are together put style in your life.
This is part of living well, together.

There's so much design inspiration in a life well lived. 

The floor of Auntie Nat's Cafe in Kuala Lumpur, Malaysia.

I'm living as close to my ideal life as I can. Putting style into my life. Living well. And happily eating my cheese plate.

commitment, to the problem you want to solve & the life you want to lead

Lunch on Friday in the Financial District. We were sitting in a gorgeous courtyard, full of marble and light and San Francisco sun. I asked Charlie if he ever gets sidelined by the perception from inside a company that consultants come in uninformed about and uninvested in a company's goals and culture, suggest swooping changes and then leave the actual implementation - the hard part - to someone else.

Sure, he said. But that's what happens only when the tasks haven't been well-developed. When a company hires a consultant without knowing what problem they're trying to solve.

This isn't so different from product development. I get frustrated with how often requirements change. Of course, time changes things. Patients change. Procedures change. Technology changes. But what can't change is our commitment to the problem that we were originally trying to solve. That's the easiest way to kill a good product idea before it hits the market.

You can't design to a moving target.

Don't get me wrong. You can design to accommodate change. You can design with a vision of how that design can change. What can replace it. Apple's the classic example of companies that develop products with multigenerational product strategies. But the point is, commit to something. A set of requirements that may not last forever, but that last for right now and give you something to work towards.

Commitment is a whole separate topic. It takes courage. We're so afraid of it. We're afraid of what might happen if we commit to one thing and miss out on ten others. This is true in product development. This is true in life.

Thomas living his ideal life in Napa Valley.

I was reading Unclutterer yesterday when I came across this post. Erin's post is like Covey's second habit: begin with the end in mind. I think the hardest part of being young is realizing that it's ok to change your mind as you get more information. That the ideal life right now doesn't have to be the ideal life forever, that your life has its own multigenerational design strategy. What shouldn't change is your commitment to live according to the things that you value. 

options from awful to worse

Saw this at Hartsfield-Jackson earlier this evening:

I'm not sure which is worse....

Would you rather have your body imaged as if you were naked... or felt up?

I've had trouble writing lately. Lots of ideas, not enough clarity. I haven't slept enough (not getting enough sleep is basically like being drunk, all the time). Off to sleep on another cross-country Delta flight...

five years ago i worked in the emergency room

One of my new goals is to learn everything about core body temperature in the ICU. Why it’s taken, how it’s measured, when it’s used. What information it gives a clinician and how they can use that information to drive clinical interventions. It goes without saying that I’ll be spending some pretty significant time in the hospital over the next several months.

Five years ago this June, I worked in a hospital. Grady Hospital, specifically, in the trauma center. Grady is one of those classic inner-city hospitals you hear about. It’s the largest trauma center in the Southeast, and the only Level I trauma facility within 100 miles of Atlanta. My first day, we intubated a woman shot in the mouth during a work scuffle (she lived). My last day, we watched a chief resident attempt a full thoracotomy on the way to the elevator for a man who had been shot in the chest with an AK-47 (he died).

I was technically a Research Associate. We were supposed to be running four studies for PIs at Emory – interviewing patients, coordinating with pharmacy, observing procedures, the like. Honestly, I don’t remember doing much other than talking to the homeless people about their smoking habits (one of the studies) and waiting for two hours by the bedside of a man who had a seizure while driving so we could measure the extent of his head injury (another study).

What I do remember learning that summer was how little of being a doctor is treating a patient’s condition. Instead, and especially in a place like Grady, it’s about demographics, socioeconomics, and psychology. And paperwork, too.

You do more for a patient by helping them find a job with a decent wage than you do by prescribing anti-depressants. Or by reducing sodium intake instead of prescribing lasix in patients with CHF. Or just by sitting at the bedside with an elderly homeless woman who has thrown herself off a bus to get a place to stay and a person to talk to.

I always meant to be a serious blogger about device design. I think I write about design like James Altucher writes about hedge fund trading (he doesn’t). That summer at Grady was for my medical school dreams what this blog is about my life as a designer.

Five years ago, the day before my birthday, I was at the hospital late. I was scheduled to leave at 8, but at 7:15, we got our first LifeFlight call. A peds case, but no details. In the hospital, “peds” case can be anything from a few months to 18 years old. Half an hour later I rode up to the roof with another research student and a PA, a stretcher and an excited silence between us.

The next day, my 20th birthday.

I don’t remember what actually happened. A helicopter landed. A boy, bigger than I was, was pulled off the board and onto the stretcher. We ran back to hold the elevators for the trauma team on call. I remember pointing out that he might be a candidate subject for a design research study, but quickly dismissing the thought as we took a separate elevator back to the trauma bay.

The details came slowly, from quiet conversations at the nurses’ station and the residents’ orders to the pharmacy. He was 15, spending the holiday weekend at the lake with family. He played football at the local high school. He was a good student.

He had attempted suicide.

His parents came in, having driven from the lake, about 45 minutes later. I vaguely remember the attending dismissing the first and second year residents minutes before they walked in. It’s hard to understand what to say to a parent whose son has just attempted suicide when it’s your first week on the job at Grady’s ER. I remember standing in the corner of Trauma 2, peeking into the next room, thinking that he was just three years younger than I was, and yet we were so far apart.

It's a patient privacy violation to take pictures of patients in hospitals, but this seemed fitting.

I think about that night a lot. About the look on his parents’ faces when they walked in to that trauma bay. About the promise of a young man’s life – a young man who hadn’t yet learned to drive, or been to the prom, or filled out a college application. About the life that lay ahead of me at 15. About all the things that I had yet to do and see and experience.

Sometimes, when I am in the hospital doing design research, I think about how all the technology in the world can’t save you if you don’t nurture the soul inside you. That all the diagnostics in the world can’t tell you everything that’s going on inside the human body. Design becomes practical to me in that moment. Hope becomes visible. We become human.

i'm not sure what city i'll wake up in on friday

Of all the posts I've written, the one that I've gotten the most emails, most comments, and most feedback on is the post about business travel. It's interesting - I'm not a professional business traveler. I'm not a consultant (I'm not sure if those two are synonyms, but I do remember when I was little and someone asked me what my dad did, I told people he was a professional traveler).

Actually, my travel schedule - both business and personal - is the opposite of a consultant's. It's really erratic and pretty unpredictable. In the years since college, I've started traveling (usually alone, sometimes with friends or coworkers) at least once a month. It's Wednesday, and I'm still not sure what city I'll be in at the end of the week.

I think - think - that this is El Paso, Texas.

I think you can tell a lot about a person's professional personality by the way they handle two things: email and travel. In terms of email, I'm a nazi. Almost nothing stays in my inbox for more than 48 hours - it gets read, sorted, forwarded, or otherwise dealt with. It's a habit I developed in college, and I've found that it's one of the most effective ways (for me) to get things dealt with.

Travel is a bit more complicated. I think if you travel often, the goal is less to maximize your time and more to make your life feel normal. I have a friend who dealt with a year of constantly being on the road at the age of 18 by playing putt-putt in every city he visited. My boss finds a bar in every airport he goes through. And I take pictures of my feet and read entertaining posts from Penelope's blog about life-disguised-as-work-advice (which is true even for travel - people are more lost, both literally and figuratively, when their travel plans are their own doing).

I'm pretty sure this is why hotel loyalty programs were invented. Staying at the same hotel, or the same type of hotel, gives us a sense of normalcy. A sense of our stay not being so transient. When Kimpton calls me to greet me by name and give me information on a city two days before I arrive, I feel like someone knows my story and remembers that I was there.

If you look at my DISC profile, most of you could probably guess that I'm a classic "I". I'm also a high "C". Meaning, I prefer knowing to not knowing, and (some sort of) structure to waking up in a different city every week. I have to continually find ways to keep myself grounded when I don't know where I'm going to be.

It's hard to handle frequent, unpredictable travel with grace (one of the best ways to learn about someone is to travel with them to a place that neither of you have been before). Everyone has their own way of dealing - whether or not they check bags (I always do, even though I make sure it's small enough to be a carry-on), what airlines and hotels they choose, which airports to connect through. But the more telling aspect of our personalities is how we deal with our bags being misplaced, or an incorrect hotel reservation, or what we do with our spare time in an unfamiliar place. It's not an easy balance when you're jet-lagged, drowning in email, and in a city far off the map that you've never seen before.