Ten things I hope my kids see the end of

Father’s day gave me an excellent chance to reflect on what being a Dad means.  Today’s world is filled with turmoil, so it’s easy to lose sight that the next generation will, in fact, have it better than today.  Here are ten things that I hope my kids see the end of in their life and give hope for a better world.

1. Going to the pharmacy. As a pharmacist, it might seem a little against self-interest to put this on the list. The fact of the matter is that our current system of medication delivery is old fashioned.

“I’m going to write on a piece of paper what I think you should have, and then you drive over to this other place to see if they have it for you and how much it might cost.  Yes I know, you’re sick but this will possibly make you better and who doesn’t want more responsibility when they’re feeling unwell?”

This one has my money back guarantee.  It will happen in my kid’s lifetime.  Amazon is already looking very actively at this space and filed for pharmacy licensing.  Additionally, CVS just announced they are making a play into the medication delivery market.  Many pharmacy benefit managers already require home delivery for refills.

It is still unclear what pharmacists and pharmacy technicians will do with this change in business practice.  There are plenty of opportunities to provide better healthcare service and value, but it depends on how quickly the profession can pivot.

2. Drive because they have to. Autonomous cars will not happen overnight, just as the first automobile wasn’t adopted   The comparison to horses and cars seems fair here.  They will become the primary transportation for short distance travel, but it will take time for society to adapt to it.  The technology is nearly ready so the move to self-driving will begin soon.  Also, it seems highly probable that my kids will live in a generation that does not own cars.  With autonomous driving, it does not make sense to have transportation that people are not actively using.  Transportation as a service is likely to be the future, with services like Lyft already announcing their plans to offer a subscription-based marketplace.  Additionally, manufacturers such as BMW, Porsche, Volvo, and others are currently offering vehicle rental services that encompass all costs of owning such as insurance, maintenance, and payments.

3. Buy a house through a realtor. Like pharmacy, the landscape of the property sales service is changing.  Heavy hitters with lots of support (g., Zillow, Redfish, Opendoor) are making plays in this market.  The next generation will be more comfortable making this decision outside of ‘normal’ home purchasing channels.  Online market changes provide an opportunity for competition on pricing and fees.  Ultimately, this will translate to lower prices on housing transactions. Buying a house should be an easier process with better visibility on what people can afford, and their total costs.

4. Live on Earth. Mars may not be a livable planet for colonization in the short term, but over the next generation, there is likely to be the opportunity to live outside of Earth.  SpaceX, Blue Origin, ULA, and others are all providing competitively priced space transport with goals to go further for cheaper.  It is difficult to estimate when this will translate to transport of civilians, but with the proper influence, it should happen in the next 20-30 years.  Once space-based transport becomes routine, we’ll see players we haven’t heard of yet moving into the space housing market.

5. Remember trivia. There are a lot of different ways this could materialize.  In its most complex form, companies like Neuralink are working to build a direct machine to brain interface that would allow humans access to everything in the digital world instantly.  That’s an incredibly complex task given how laughably little we understand about the human brain.  A more likely solution is a progression of augmented reality and digital assistants.  Siri, Google, and Alexa are investing vast amounts of money and effort to better predict your needs and answer your questions.  While the interface today is mostly a speaker on your phone or in your house, we will see over the next five years migration to augmented audio through headphones and augmented vision through glasses or contact lenses.  During the next generation, facts, like who invented the cotton gin, will not be necessary to learn in school because they are readily available at any time.  Instead, education will redirect to accessing and processing information.

6. See kids die from cancer, malaria, or starvation. Of the top ten, this is the biggest dream on the list.  It’s embarrassing that we can’t fix a problem like starvation.  Look at the other items on this list, and it’s hard to believe we are struggling to get food to everyone who needs it.  Malnutrition goes hand in hand with this problem and is a rampant problem throughout the world.  Obesity is a worldwide epidemic, and this is not just the fault of the people who eat.  We need to do better with food.

Efforts to eliminate Malaria are making significant progress through various mechanisms.  Vector control (i.e., killing all of the mosquitoes) is my personal favorite, but vaccination, chemical treatment, and bed nets are all effective measures in reducing the burden of this disease.  Shout out to the Gates Foundation for their considerable work in this area.

Childhood cancers seem like the hardest nut to crack.  We’ve made tremendous strides in some forms of cancer, and I hope that through advanced genetic research and genome editing we will be able to finish off this disease once and for all.

7. Work a position they don’t like. People generally choose what job they go to every day. I hope that my kids understand their power in this decision and make a choice to be happy in work and life.  A familiar refrain is that each person needs to find a work/life balance in their time.  The fact is, your work is part of your life and should enrich you.  Similarly, if you are not bringing your life to your work, the people you are working with are missing out on the best part of you.  You are not too different people, so trying to separate them will cause anxiety and not relief.

8. Be limited by their environment. How amazing is it that we live in a world that is so mobile? It’s possible to communicate with people around the world easily and quickly.  Similarly, there is almost no border they can’t cross or place they can’t go.  Today’s connected world is different from any generation before it and will make us a better civilization.  The next generation will learn from cultures previous generations never experienced and will gain inspiration from places others have never been.

9. Be afraid to speak what they feel. The hashtag #fakenews has done a lot in the last two years. While it has undoubtedly given a platform to some people with questionable motivations, it has also given rise to the ability for everyone to question what they hear and what they choose to believe.  At the very least it has given people the freedom to decide what is important to us.  Over the next generation, facts will become even more available without the filter of any media source.  Through this process, we’ll watch as people begin to communicate what is important to us as humans.  The #metoo movement is an excellent reflection of this assertion of values and will only expand as everyone has their voice heard.

10. Have top 10 lists define them. As awesome as lists are, reading “10 ways to find happiness” or “how to be a better person” is not going to fix anyone’s life.  My generation made these lists popular, so hopefully the next can do a better job of finding ways to find satisfaction internally.



Racecar on a Rocketship

I’ll be honest. The title of this blog is just an excuse to use a palindrome. Very few would consider a Tesla Roadster an actual racecar. It’s squarely in the sports car realm, but nowhere near racing at Daytona or Indy. Since I’m being honest, I have to confess that this isn’t my first go at writing this blog. Hours of thinking and a couple of drafts have brought me to a point I’m practically blocked. The Falcon Heavy launch is a lot to consider when you try to wrap your mind around it. I settled on the idea that I wouldn’t be able to recap everything into one entry, and thought it best to first describe the experience.

I’ve followed SpaceX for the better part of their existence, from multiple launch failures out in the Pacific Islands, to their first successful Falcon launch, to some landings – and RUDs (rapid unscheduled disassembly) -aboard Of Course I Still Love You, the autonomous drone ship. Witnessing the launch of Falcon Heavy and the remarkable tandem landing of two first stage rocket cores was a once in a lifetime experience for me.

I’ll skip over the 8 hours of waiting: waiting to get into the park, waiting to get to the viewing site, and waiting for the launch delays due to high upper-level winds. Suffice to say, we waited a while, although there was always an excitement in the air that made it bearable. I imagine it is a lot like the audition portion of American Idol, only for nerds. They kept us fed, and we received some sweet SpaceX swag to keep us happy in the interim.

Our launch viewing area was from a spectacular vantage point at the Saturn V/Apollo museum on Kennedy Space Center (KSC). KSC was great! During the wait, I was able to explore artifacts from multiple Apollo, Gemini, and Mercury missions – including space suits worn by Jim Lovell (who apparently prefers you don’t refer to him as Tom Hanks) and Alan Sheppard.



Also in this museum is one of three surviving Saturn V rockets. The Saturn V probably deserves its own blog post. It is impressive beyond belief. I put it up there with aircraft carriers as things I can’t believe that man can build.

The museum, along with some great food and beverages provided by KSC, was enough to keep us from being too stir-crazy. The time leading up to launch made it clear that I was one of the amateurs here. Tens of thousands of dollars worth of camera equipment adorned the site, and people were discussing periapsis, Hohmann transfers, and all kinds of other orbital dynamics factors. My thoughts included, “So if this thing explodes, what are the chances I can catch a piece of the spaceship?” and, “No seriously, will this thing hit us?” While our seats were great, they were clearly intended to be in the safe zone. In fact, I didn’t bother taking any video of the launch because I knew the professional cameras would all do a much better job, and it would allow me to live the moment.


Our view of the setup. Falcon Heavy is far to the left on the skyline.

Also, to keep us entertained, there was a fabulous presentation about the Planetary Society from Bill Nye, The Science Guy.

It’s hard to explain how the launch felt to an observer. In the moments leading up to ignition, everyone in the audience was in a borderline euphoria over what was taking place. Once the final ten-second clock started, we were practically screaming the countdown. At zero, the rocket ignited. The white steam cloud at ignition was massive and erupted from underneath the rocket. Although flames started right at zero, it seemed forever before the spacecraft began moving vertically. Once it did though, it was gone!

A few seconds after Falcon Heavy cleared the tower, the sound wave of the ignition hit us. The wave’s force something even a studio with the best equipment cannot reproduce. It was loud, for sure, but not make your ears bleed loud. I was comfortable without hearing protection. The volume was comparable to a rock concert. The percussion, however, was unlike anything I’ve ever felt. You could genuinely feel your lungs and stomach vibrating. Moments before the launch, we received an important message that we needed to move “at least 20 feet away” from the Saturn V center. The warning was because KSC was unsure what the shock wave would do to this building, made with a significant amount of glass. The glass windows on the Saturn Center shook to the point it seemed inevitable they would break.

And like that, the rocket was off. We watched it as long as we could, and as intently as we could, but the moment passed by so fast it seemed like it almost didn’t happen Quickly, the side rockets were peeling off and doing their flip to return to KSC. We could see these burns and then the rockets falling out of the sky like grains of sand. From our vantage point, we also had a live stream of the SpaceX feed. In real life, it looked even more identical than on TV. At one point, I believed the feed was just showing the same image twice since several of the thrust corrections seemed to be perfectly synched.

By the time the landing burn arrived, every person was on their feet to watch. Interestingly, the rocket that was slightly further from us took just a moment longer to ignite for the landing burn. It seemed to me, in that instant, that one of these rockets wouldn’t be coming down softly. Unfortunately, a building between our vantage point and the landing zone obscured our view slightly. We all saw the same image as you, but the euphoria was unique. Just after landing, the sonic shockwaves from the re-entry reached us. The set of six booms – think Back to the Future – were loud and seemed like celebratory fireworks. I’m told that when SpaceX first successfully landed a Falcon 9 rocket, Elon Musk, SpaceX CEO, thought it had exploded because of the sonic booms following the landing.

Initially, we were in the dark about if the third rocket core successfully landed. It wasn’t until later in the afternoon that we learned it touched down gently in the ocean, at about 300 miles per hour. Overall, the launch had gone exceptionally well! I would describe it like Christmas morning as a kid. You look forward to it for so long, you build it up in your mind, and you think of all of the presents you might get. Then, before you realize it, all of the gifts are open, and you’re on the way to Grandma’s house, with next Christmas seemingly an eternity away.

Beyond the sheer accomplishment of launching a private rocket of that size and power, it is hard to overstate the importance of this endeavor for the future of humankind. The Falcon Heavy launch is significant, not because of what it accomplishes scientifically, but the enthusiasm and hope it inspires to reach incredible accomplishments.  That’s really the bigger point we should be looking at from this historic event.

A lot has already been said and written about the theatrics of this accomplishment.  Most are supportive, but there are a some who criticize Musk as satiating his own ego by sending an expensive car into orbit around the sun.   Some also assert that the money would have been better served to provide power to the people of Puerto Rico, or clean drinking water to Flint.  I can’t argue that those are not noble efforts.  Indeed, they are needs that must be met.  I would argue, however, that Musks efforts achieved something much longer lasting than fixing either of these problems.

In my lifetime the Earth will reach a population of 10 billion people.  Already, we lack sufficient food and water to indefinitely sustain the population.  Coupled with global warming and depletion of natural resources, the next generations face some of the most remarkable problems in history.  To that end, Musk ignited – if you’ll pardon the pun – a renewed scientific curiosity in the world that may be our only hope for continuing as a species.

Consistently, NASA and Apollo astronauts reiterate the space race with the Soviet Union was one of the greatest technological sparks of any generation.  Undoubtedly, without President Kennedy’s aspiration to put a man on the moon before 1970, we would not be where we are today.  My hope, and I believe the hope of Elon Musk and Bill Nye, is that the advances we are seeing from SpaceX, United Launch Alliance, Blue Origin and others will inspire a new space race.  Feeding not only into finding a better understanding of our universe, but also amazing solutions to the complicated problems facing our world.



Wouldn’t we all like to feel like this about our accomplishments?


Inpatient Innovation

This past week was South by South West (SXSW) in Austin.  During the event there was a challenge by the University of Texas Dell Medical School to come up with innovative ideas to transform healthcare.  There are some amazing ideas and you can read about them more on twitter #healthhive or @dellmedschool.  I wasn’t at SXSW, but the challenge started my creative brain working.   Here is one idea worth considering.

Increase engagement for hospital INPATIENTS!  There is lots of talk about opening outpatient medical records so patients have access to their care plans.  This is a good idea.  Unfortunately, it has been side-tracked and slow to develop because of barriers.  First, outpatients are busy.  We have work, kids, church, and other social obligations to take care of.  All of that adds up to less time to decipher an outpatient record, or figure out access.  Second, outpatient records are technically complex.  You’re combining multiple sources from geographically disperse areas and different platforms.

Now think about these problems in an inpatient context.  Most patients and their families have a massive amount of unused time in their hospital rooms.  We’ve improved patients’ satisfaction by giving them restaurant style menus and on demand TV.  We haven’t capitalized on the opportunity to use this time to get them involved in their care.  Let’s give patients tablets with their medical records, copies of radiology reports, lab results, and lists of their medications.  Sure, most people will not have the medical literacy to understand every detail, but isn’t that what we’re trying to improve?  This is our opportunity to get patients interested in increasing their medical literacy.  In addition to technical resources, we have disease educators on staff who can reinforce information or answer questions regarding the data patients are reading.  We have a captive audience, let’s teach them.  Let’s encourage them to ask questions while they are in our care.

Today, if you order an item on Amazon here is what happens.  Instantly you receive an order confirmation.  Followed shortly by a status e-mail through which you can track the package through the system.  The application will update you every step of the way through delivery confirmation at your doorstep.  Why can’t the same happen in the hospital setting?

During consultation with the provider a patient asks for “something for pain”.  The provider verbally agrees to write the order.  As soon as the order is written the patient receives a notification.  Now the patient has an expectation of what they will receive as well as a chance to confirm this is what they agreed on.   Additionally, it provides the patient with confirmation that they are being cared for even when a provider is not in the room.  Next, the patient will receive a notification that the order has been received by the pharmacy and is processing, processed, and ready for delivery.  All of these can be paired with expected transaction times.  Finally, when the nurse receives the medication to the floor or removes it from a medication cabinet, the patient is notified that the medication will be to them shortly.

If one thinks about the primary causes of medication errors, we can see that many of them have just been mitigated by making the patient an active participant.  All accomplished simply by providing the patient more education and awareness.

Of course there are hundreds of opportunities to increase patient visibility.  What’s the wait time to get to MRI?  Why is my nurse not answering the call button? Is she in a different room?  When is my provider planning on seeing me today?  When do I need to order lunch?  When will lunch be to my room?

Sure the white board in each patient’s room is nice, but we have much better technologies we can provide the patient to fully engage in their care.  These technologies are accessible today and the barriers which persist on the outpatient side are reduced with in house care.  If we can review, purchase, and track pillows from Amazon, we can do the same with healthcare.

What the comet landing teaches us about life

I’m sure at this point you are all aware of the historic moment in space last week. With the European space agency (esa) landing a robot on a comet, we reached another significant milestone for human innovation and determination. The mission was incredibly complex and required extreme accuracy. The best analogy I’ve heard is that this mission was similar to throwing a baseball around the earth 193 times and hitting the strike zone.

It was a mission that took ten years. Ten years. And that was from launch. There was undoubtedly years of planning ahead of that. So someone, somewhere, started a project 20 years ago to land on a comet. Think about that level of dedication. Do you have a singular goal for 20 years from now? Are you willing to plan it for the next 10 years before even beginning the execution phase?

Some goals are great for the start now attitude. If you want to lose weight, start now. Find financial stability? Start now.

Some are bigger. Do you want to have the next Amazon or Facebook or Tesla? Maybe some planning is in order. I’m not saying waiting ten years is required, but do you have the patience if it takes that long? And what if, once you start, it takes ten more years?

Don’t get me wrong, I’m a wildly impatient person at times. I love quick results and get frustrated without them, but some really great payoffs, life changing payoffs, only come after time.

Point 1 – Great change and great accomplishments can take time and patience. Sometimes patience before you can even get started.

Now are you ready for the really bothersome part? Philae, the lander, worked for less than 3 days after landing. Don’t get me wrong, this is a huge success. The landing itself was beyond comprehension, and we received some great data from Philae to review. What’s bothersome is that 20 years after a dream, the actual mission was less than a long weekend. I can’t imagine the void left in the people working on that mission. They have chased it for so long that the elation when the device landed must have been overwhelming. Now that Philae is asleep, and the euphoria is ebbing they must be psychologically drained. We experience that after our team wins the Superbowl. I remember feeling that drain after my eldest son was born.

It was a moment I spent months preparing for, and was one of the most special moments in my life. I had failed to prepare for the idea that while the moment would be special, it would be a lifetime of work after that moment that would actually make the difference.

Point 2 – If you focus on one moment as your goal, prepare for a letdown when you get there.

Similar to ESA, who will now pour over the data from Philae for years, the mission isn’t really over once you hit that goal.

For those who haven’t kept up with what I’m working on lately, my wife and I have helped to launch a plant of Church Unlimited in San Antonio.  More info can be found here or like our Facebook page. My wife and I have invested in creating a campus in San Antonio for over a year. We planned for months, and I can guarantee that it has been in the heart and mind of Pastor Bil Cornelius for much much longer.

We had our first meeting just over a month ago, and 250 people joined us to launch this new campus. It was a huge milestone, and it would have been easy to be let down once that marker was reached. Just like with the lander or raising my oldest child, some of the most important work happens after you reach the goal.

Point 3 – A goal takes maintenance and work, even after you reach it.


Point 4 – Embrace the mission after the goal, so you don’t get letdown by reaching the goal.

For those who are building their dreams I hope this helps to plan what will happen in the future. You are unlimited by what you can achieve.

thank you to my pharmacy techs








For those who don’t know, October is American Pharmacists Month.  While I am happy to take this opportunity to pat myself on the back for being an awesome pharmacist, I’d be remiss if I didn’t spend some time talking about the fantastic pharmacy technicians I have worked with.  In fact, I should have done this sooner.  Navy pharmacy technicians are the finest in the world, and I would say that I have worked with some of the best of the best.  The photo above was shot just last week at an awards ceremony where one of my previous pharmacy technicians was recognized as the top senior technician in the Navy.  Mr Vogel came to me as a new technician straight out of school.  Now with a number of duty stations and advancements behind him he is recognized as the best in the Navy.

Mr Vogel (now HM1 Vogel, but then HN Vogel) is just one example of the high quality medical experts I’ve had the pleasure of working with.  I won’t list them all out for their privacy, but you know who you are.  My technicians from Corpus Christi (my first duty station) who helped me to grow as a leader and helped me learn the Navy system and those in Rota who performed well beyond their experience, thank you. A lot of leaders have said they learned more from their staff than the leader could have ever taught, but for me this is especially true.  Exceptionally brilliant technicians challenged me at every turn, with thoughtful questions and innovative ways to do things.

One particular trait I found in the technicians I have worked with, is the desire to always find a better way.  Part of that comes from each of our own desires to make life a little easier, but, more often than not, these technicians were seeking to provide a better experience for our clients.  I know that the nursing and physician staffs would agree that the pharmacy technicians have made the difference in the treatment of our patients.  They have been attentive and helpful; even when they didn’t necessarily want to be making that IV in the middle of the night.  The knowledge and skill sets of these technicians has rivaled many pharmacists, and the technicians’ ability to apply it daily saved lives and made people healthier.

There have been some bumps on the road, but the pharmacy team stood strong.  I have always admired my pharmacy technicians’ resolve when things went wrong.  Whenever the going got tough, the team would band together and cover extra hours, or work harder to get the job done.

Working pharmacy is a difficult job.  You hear a lot about what’s going wrong, but don’t get many compliments when things are going right.  I can tell you over the course of my career we have filled 10’s of thousands and probably 100’s of thousands of prescriptions together.  The number of compliments rarely outweighed the number of complaints, but take that number into account when considering the undertaking.  Each  technician should be proud of the work accomplished and the accuracy, efficiency, and attitude with which he or she accomplished it.

Many of these outstanding individuals have gone on to other tracks in life.  Civilian careers, entrepreneurship, or schooling.  To those technicians, thank you for serving.  You have done a great service for your country, and the Navy is better for your service.  For those who are still with the Navy, continue to do great things and show the world how great you are.

You, pharmacy technicians, have made me a better leader and I’m thankful for what you do.  Keep up the great work in whatever you do. I can’t wait to work with you again!

alright we need to talk about this time travel thing

I spent some significant time the other day, talking with my wife about the impacts of time travel.  I’m not sure how the conversation started anymore, (Isn’t that how most great conversations start?) but we ended up discussing the impact of changing history, and how it would affect the future.  Luckily, she is married to a trained theoretical physicist, with advanced degrees in time theory.  (Sidebar: I took physics I and II in college.)

To be clear, this is only my opinion, but after considering it thoroughly, I’m convinced that I may have developed a new theory on time travel that will soon be galvanized in text books.  Given the impact of this discovered theory, it was clear that I must immediately construct a half-cocked blog post that may be read by dozens of people.  (I’m assuming that Science magazine will just plagiarize it from my blog for their next edition.)  My intent to document this revolutionary idea in the annals of history with a dedicated blog post was backed by the steadfast support of my wife. “You’re not going to write about this for your blog, are you?”

With that cleared up, here’s my earth-shattering hypothesis in one statement: it’s not the magnitude of the change you make; it’s how long ago you made it.  Did that just blow your mind?  In advanced physics, we’d write that as mind = blown.  I know that the more scientific among you will require a scientific proof.  I could provide that to you, but instead here are some colorful examples.

First off, for this to be at all possible, we have to accept that time travel into the past is possible.  Now, there are a number of things in physics which say this might not be possible.  I think that if we can believe that Arnold Schwarzenegger can travel through time as three different robots, with three different personalities, and then later actually in real life become governor, then time travel is the most reasonable part of that scenario.  So, we’re assuming a person can travel back in time.  Point proven.

We also must assume that time is linear, for this example.  In other words, if you changed something in the past, then it could impact things in the future.  There are people who believe that changing the past will create a separate parallel universe, which will exist along side the universe that existed before the person went back in time.  These people are wrong.

So, now that we’ve got the ground rules established, here are the two scenarios that prove my theory:

1.  You go back 25 years, and invest in Microsoft. (Is that far enough back that they’re still relevant? (Don’t laugh, Apple people – you’re next.))  You make a reasonable investment that would today make you quite wealthy.  Unfortunately, by that action you’ve taken the stock off the market, and, therefore, prohibited someone else from buying it.  So now the person that would have been rich, will not be rich.  Instead they will end up working for living, which means that your Dad couldn’t get the job that person occupied, which means that he couldn’t buy your Mom an engagement ring, which means they didn’t get married, which means you weren’t born.  You see the large amount of effects there?

2. Now imagine if you went back to yesterday, and made a massive investment in a small cap stock that went up 20% miraculously, overnight. That would be a much large impact than your modest investment of 25 years ago, but the outcome would be the same.  A lot of money would be yours today.  What didn’t happen was the time to allow 2nd and 3rd order effects to occur.  Sure, you can assume you have somehow changed the future, but that future hasn’t happened yet, so who cares.   Unless you’re one of those people that believes that the past, the present, and the future all exists simultaneously.  Of course those people are wrong.

So with that, I think I’ve conclusively proven that it’s not the magnitude of the change that you make; it’s how long ago you made it.  I’ll gladly accept my Nobel prize at the committee’s earliest convenience.

P.S.  Anyone with a movie example that can prove my theory wrong gets an honorable mention in my blog.

P.P.S Don’t even bring Back To The Future into this.

P.P.P.S Especially Back to the Future 3.  That movie was terrible.

P.P.P.P.S.  This is the most fun I’ve had writing a blog in a while.

why ebola scares me (hint: it’s not why you think)

It’s not the ridiculously high mortality rate of Ebola that scares me.  It’s not the fact that health care workers are contracting it simply because they’re doing their jobs.  It’s not even the extremely long latency period before symptoms develop.  No, it’s something much more benign, but critically important.

The media has been doing an “exceptional” job of covering the Ebola “crisis” in America.  (I put those two words in there as sarcasm.)  The media has been doing a great job of scaring the public with Ebola, and it’s not a crisis as they have defined it.  There is a public health crisis here on two fronts, but not as reported.  First, the people in Liberia and on other African fronts are truly in a crisis.  Their substandard public health system and the lack of a pre-planned world response to this type of outbreak have set them substantially behind the curve for being able to contain the disease.  The number of deaths and suffering are unacceptable from a human perspective.  Additionally, the lack of public understanding on this issue will lead to second and third order effects in this area.  For example, there is already evidence that food prices are escalating, due to many of the key routes providing medical and humanitarian supplies being cut off.  That is a crisis.

The second crisis is here in America.  We are missing a prime opportunity to prepare for a real health crisis.  (Side bar: Get your flu shot.  More people will die this year of flu in America than Ebola.  I’ll take bets.)  While the American public is being bombarded with images of men in white bio-hazard suits and talk of isolation chambers, we are missing the chance to educate the public on measures that will help in a legitimate pandemic.  The transmission of Ebola is extremely limited (as far as infectious diseases go).  While we have seen diseases with limited transmission have huge impacts before, they are nothing compared to impacts that could strike us in a situation such as the 1918 flu.  Otherwise known as the Spanish Flu, this pandemic wiped out an estimated 8-10% of the young adult population.  For perspective, WHO says the death toll for Ebola today is about 4,000 (an undoubtedly low estimate,given that so much of the affected population is hiding their disease).  The devastation in 1918 was up to 100 million dead.

So what’s the difference between the 1918 influenza and Ebola today?  Most importantly: transmission.  1918 influenza was absurdly communicable (transfer from one person to another.)  Transmission of Ebola today only occurs with contact of bodily fluids.  It is not airborne like the 1918 flu.

Here’s why I’m worried about the the crisis in America.  We’re not using this limited transmission disease to emphasize precautions and hone our response in preparation of a larger pandemic.  Hand washing and isolation techniques are the fundamentals we should be teaching.  While social isolation is overkill for Ebola (handwashing is always important), this is an opportunity to educate the public on a plan for a large-scale highly-communicable pandemic.   We should be teaching our steps for addressing this type of situation.  We’re not closing the borders for Ebola (right call by the CDC), but what situation would need to occur for us to consider that step?  We’re not shutting down schools in Dallas (the #1 impact we can have on preventing highly-communicable disease spread), again this is not something we should do for Ebola.  We should, however, be communicating to the public when we would close them in a pandemic.  I assume that medical facilities are testing their own response plans, but that’s probably something to be emphasized as well.

I understand the public’s desensitization to these alerts.  We’ve had swine flu, bird flu, and any number of other pandemic threats in recent past.  Unfortunately, it’s just a statistical likelihood that we will have another large scale pandemic.  If anything, these previous alerts have shown us how ill prepared we are for a larger outbreak.  The CDC and federal government should use this opportunity to test their communication techniques, and improve their response strategies with the general public.

If you’re interested in reading up on public health preparedness, I suggest The Great Influenza by John M Barry as a fantastic read.

making a sweet rock wall for your garage

For those who don’t know, I’m a huge fan of rock climbing.  I’ve been climbing since I was about 10, and have climbed all over the world.  I really enjoy it as a way to focus and relieve stress.  Probably the thing that’s most appealing to me is that there are no excuses on the rock: you can either climb it or you can’t.

Now, none of this means that I’m a good rock climber.  I’ve climbed some fun stuff, but nothing particularly earth-shattering for grade.  I’m by no means an expert, in that probably the most difficult I can climb is 5.10.  For those who are unfamiliar with rock climbing, vertical climbing difficulty is measuring on an interval scale.  It’s rather subjective, but generally, experienced climbers can consistently rate how difficult a climb is.  It’s hard for one to understand how it scales, but if you want to know more you can check out the wikipedia entry.

Despite my lack of extreme talent in climbing, I am good at teaching and know the safety of rock climbing well.  Since it has been such a passion for me, I want to help my kids enjoy this hobby as well.  They’re all quite excited about it whenever we go out on the rocks, and are actually pretty decent climbers.  They have a problem with the heights, but their mechanics are pretty good.  My daughter can almost certainly outclimb me, and my oldest son has very good technical ability.

To further encourage their interest, I decided it would be fun to build an indoor climbing wall.  I’m not going to step-by-step it here with all of the technical details, but I’ll provide some basic guidance, in case others want to try it.  If you’re looking for more advice, please let me know and I’ll be happy to help.


First thing you need is a clear space.  It’s hard to get an idea of scale in this picture, but it is about 10 feet between the saw horses on the wall and the corner.  Floor to ceiling is 12 feet.  If you don’t have a finished garage, this is a much easier project, as you can anchor your framing directly onto the wall studs and ceiling joists.


Here’s the wall framed out.  I anchored a 2×8 to the wall and ceiling, and used joist hangers to support the 2×6 frame.  Took a considerable amount of work, but the completed project is rock solid.  I tried to push this off the wall and couldn’t.  That’s good, because it hangs 3/4 inch sheets of plywood off of it, which aren’t light.  Also it’s going to be holding people, so I wanted to make sure it couldn’t come down.


I am not using a rope and harness system, so my wife and I made this crash pad.  We used 5 foot width fabric and made a 5′ x 10′ x 1′ pillow case.  We then bought foam scraps online.  Below is the photo of what the foam comes shipped like.  On the right is a package that hasn’t been opened.  The pile is what happens after you open the package.


After the pillow was done, I drilled, anchored, and hung the plywood.  This is a painful process, as you end up drilling a lot of holes and spacing them is tedious.  Once is done, though, it’s a simple process of bolting your holds on, and you’re ready to climb.  Here’s the first complete assent.


The kids love it that, once you complete a new route, you get to give it a name.  The first route on the wall was “Hard Fall.”  I rated it at 5.7.

how Ari Fleischer attracted 25,000 new twitter followers in 1 day

Ari Fleischer. You’ve probably heard of him, but can’t remember where.  He was the White House press secretary under Bush 2 from 2001 to 2003.  A short stint to be sure, but I can only imagine the pressure of that job.  Most notably he was the press secretary for President Bush during the terrorist attacks committed on September 11, 2001.

This year on the 13th anniversary of the attacks, Ari took to twitter to give us an epic piece of history.  In a full day of play-by-play, he took us behind the scenes of the president’s staff on 9/11.  It was truly history, and if you haven’t seen it yet, you can check out the string here.   What was also remarkable was that he increased is exposure on twitter by over 25,000 followers (that was just the 10 hours I was paying attention.)  Reading the content, it was easy to see why he increased so substantially, but I think there are some fundamentals here if you want to increase your own readership.

First, what he said was timely.  Everyone was thinking about September 11th, so it was a topic people were interested in looking at.  More than that, he gave real time updates, which corresponded to the day.  Almost like live-tweeting an event that happened 13 years ago.

Second, he offered a unique point of view.  This was a look at the day I hadn’t seen before and was something I wanted to incorporate into my understanding of that day.

Third, he offered regular, original content.  I used to think there was nothing original on the internet. (Sidebar: How close are we to a point where every combination of words has been expressed somewhere?  Could be an interesting theoretical math problem.  How many combinations of words are there?  Given the amount of unique content published daily, at what point would all word combinations be exhausted?)

Fourth, he made it suspenseful. The readers were always waiting for the next post to hit their timeline.  I followed the account closely throughout the day, and was amazed how many instantaneous favorites and re-tweets he had.  People were watching for his content.

Fifth, he didn’t overwhelm the readers with too much content.  New followers could easily go back and catch up on what he had already said.  You can be sure he had tons of thoughts and editorials he wanted to add in, but he was good about keeping it to facts, and that allowed readers to stay engaged.

In case you haven’t read my blog before, there are two things that I really like: lists and applications.  The list is now finished, so it’s time for the application.  Very few of us can share the inside experiences of the most powerful person on the planet, but we all have our own point of view.

Additionally, we all have a topic that is timely.  Maybe you’re a techy and you want to write about Apple’s new line up.  Maybe you are in medicine and would like to write about costs of care, or how little patient contact time you get.  Regardless of the subject, we all have things that people will want to engage on.

I know that not everyone is seeking to rack up thousands of twitter followers, but I believe we all get some enjoyment out of engaging with others on topics that are important to us.  If that’s you, give it a try.  Take the subject matter expert (SME) role on something you care about.  You’ll probably be surprised at the engagement you get.

The Overwhelming To-Do List

Sunday is usually an overwhelming day for me. I have lots of stuff I want to get done, and zero motivation to do it. I can typically write it off as a day of rest, and, now that NFL is on, spend the day in front of the TV. Today, however, I felt an overwhelming anxiety to get a lot of stuff done. One of those things was to write a new blog post. I have a few topics in the queue, but felt it appropriate to put my to-do list on figurative paper and show you how I (ideally) manage it.

This isn’t some amazing new technique for managing one’s to-do list, so don’t think I’ve got some magical answer. This was a method I learned a long time ago. In fact I want to say I learned it from Seven Habits of Highly Effective People, but I could be wrong.  Regardless, I find it helpful to alleviate stress of getting things done.

Step One: List everything I want to get done. This is the mental expulsion of everything I feel I need to get done.  No particular order here, just getting things down.

-Mow the lawn

-Clean the house

-Finish my secret project (more on this later)

-Clean the garage from my project

-Study for my BCPS exam

-Write something for my blog

-Call my parents

-Watch church (my church is being built, so I watch online in the mean time)

-Play Minecraft on Xbox with the kids

-Shower (yes I have to write this down on a Sunday)

-Read a book

-Watch NFL

-Take stuff to Goodwill

-Figure out a sewing room for my wife

-Find missing LEGO parts for the set wife and son are building

I have more, but I’ll stop there for purposes of the blog, and your sanity.

Step Two: Sort them by priority

At this point, I need to put them in order.  I use the three I’s for priority: Itinerary (do they have to be done today?).  Importance (what do they mean to me?). Impact (what do they mean to others?).  Here’s the listed sorted and numbered:

  1. Watch Church
  2. Call my Parents (freakishly, the phone rang as I typed this to the list and it was my parents, so I can cross this out)
  3. Clean the garage (I want my wife to be able to park the van inside again)
  4. Play Minecraft with the kids
  5. Write a blog post
  6. Mow the lawn

I’m stopping with priority ranking there.

Step Three: Ignore everything not in the top 5

I numbered to 6 because #2 accomplished itself and #6 might not happen because it’s been raining.  I figured with these two taken care of, the remaining four can be accomplished.  I didn’t prioritize the remaining because they’re bonus items.  If I get them done great; if not, then that’s fine too.  They aren’t critically important at this point, and, therefore, I don’t have to do them.  Tomorrow, I’ll rewrite the list and those items might still be on it.  If they’re more important tomorrow, then they’ll move up the list.  If they’re not more important, then I shouldn’t feel guilty for not doing them.

Step Four: Accomplish the top 5

Logical right?  “Do first things first,” is the saying.

Step Five: Do something I want to do

I thought about putting step 6 in this spot.  The efficient thing is to do step six before I do step five, and you can change it if you want.  The reason I put “Do something I want to do” here is because having fun is important to one’s mental health.  My life can’t just be a checklist of necessary tasks.   Life is supposed to be enjoyed.  There’s plenty of time to have fun in life.  I’m scheduling it in my life after my top 5, so I remember it’s always important.

Step Six: Plan for the future

This doesn’t have to be complicated, and can be a lot of fun.  I treat this like my dreaming time.  It can be as simple as planning out a vacation, or next weekend’s activities.  It can be as complicated as mapping out a process for work.  This is important time to develop things that aren’t urgent.  Ideally, you’ll spend more time here than you do in your top 5.   Top 5 is stuff you have to do.  This time is for things that aren’t urgent.


It seems like I should have seven steps (it’s my favorite number), but I only have six.  That’s going to have to work for now.  I’m applying this to a Sunday, but I try to use it most days.  I’m always working to apply it more efficiently.  On work days, I use it in duplicity.  I have a six steps for work, and a six steps for not work.  I find this really helpful for getting things accomplished in the day, particularly at the end of the day when you don’t want to feel guilty about leaving work on time.

I encourage you to try the same steps in your day to day life.  I guarantee as you apply this you’ll be more productive, and you’ll relieve yourself of guilt from not getting things done.