I hiked over one of the world’s highest mountain passes in a four-week journey, offline, without plans. This blog describes people I met, life in the Himalayas, altitude sickness (and rescues), and methods I used to develop mindfulness that allowed me to overcome a decade of suffering from chronic pain. It began in the town of Besisahar and ended in Beni Bazar 28 days later.

The hike was part of a longer backpacking trip through Nepal and India, where I arrived in Kathmandu, learned basic Nepali phrases, then traveled through both countries without plans, adapting each day based on people I met and lessons I learned.

I’ve traveled this way for 30 years, flying into one country and out of another. This trip was different because I had a goal to hike without pain medications. Doctors at the Veterans Health Administration had prescribed pain medications to me for over nine years to postpone surgeries that have low probabilities of relieving pain. The meds treated symptoms, but my mind became sluggish and it was difficult to make wise choices for long-term health. And, as I would later realize, something had been going wrong with my mind that reminded me of when I first started noticing symptoms of physical diseases, mistaking symptoms for being sore from exercising or stiff from sitting at a desk. Similarly, I was now noticing slips in my mental capabilities, especially with simple math and remembering details even when I made a conscious effort to do so.

I share a few techniques I used to develop mindfulness throughout blogs about this trip, hopefully helping others.

The trail

I took a bus from Kathmandu to the village of Besisahar, being dropped where the dirt road ended and a hiking trail began. I had a backpack with two months worth of clothes. I carried a day’s worth of food and water, a few books, a camera, and a Frisbee.

The trail cut into the sides of mountains, crossing rivers with suspension bridges swinging hundreds of feet in the air. Two people could not pass on the narrow bridges, so we’d coordinate who went first. Goats, cows, and buffalo used the bridges; I gave right-of-way to anything with horns, and played with anything that was cute.

Sleeping & eating

I carried a day’s worth of food an water, knowing I’d find more on the trail. The trail goes through villages, passing people’s front doors. Most families offer simple beds and dinners to travelers. Their ancestors had done the same thing to Tibetan traders for generations.

Most villages don’t have schools. Some do, and nearby villagers walk the trail for hours to reach them. There are not medical services. Poverty is common, and the area was recovering from a recent civil war that killed 19,000 people and displaced 200,000. Foreign aid doesn’t reach them. Despite these challenges, the Himalayan people are kind, industrious, hard-working, and peaceful. Himalayan people say, “what is there to do?” as a way to be present in the moment and only worry about what is within their control.

Part of what’s in everyone’s control is our kindness towards others. Nepali culture encourages compassion, shown by how kids would run into the street to greet me when I approached a village. They’d clasp their hands, bow, and say “Namaste,” the Hindu word for “I see the divine in you.” I’d clasp my hands, bow, and wait to feel the sentiment before returning the word, “Namaste.”

Feeling compassion and speaking truthfully makes everyone happier. Imagine if our culture encouraged pausing to seek compassion for a person before saying, truthfully, “I hope you’re well.”

The poorest backpacker is wealthier than these kids can imagine, and many share treats. A consequence is a that kids start seeing backpackers, most of whom are caucasian (white), as sources of things rather than as people. They don’t say Namaste, they shout, “Money! Chocolate! Sweet!” You can’t see the divine in each other with a hierarchical relationship, so I gave the most valuable thing I have, time.

Many Himalayan families had been in travelers’ photos, but had never used a camera or seen their own picture. I lent my camera to kids, letting them learn by playing with it. They’d take photos of their parents, show them, and try again with new button combinations. In return, they’d teach me Nepali words for what they saw. This is co-learning, a powerful tool for connecting with students.

Kids took many of these photos, letting us see the world through their eyes.

People

I was hiking uphill each day, gaining 400-500 meters of elevation. Each night got colder; before going to bed, I’d huddle around kitchen fires, learning to cook Himalayan food while talking with families.

Most guest houses were people’s homes, and they juggled family duties while preparing our dinners. One host, Narme Llama, was a third-generation Tibetan with newborn twins. He had a warm smile, had learned four languages, and helped take care of his new daughters while running his business.

I arrived at the end of season without tourists, so a bed was free. A meal cooked over their wood stove was 200 Rupees ($2 U.S.). Ginger tea was 60 Rupees. They saved money to send their older daughter to boarding school in the nearest city, two-days away, for $15/month. They were lucky to save $2 per month, which would have to support them in old age. There were no schools nearby, and all jobs were physical labor that didn’t need an education, but Narme-Llama valued education. He realized their government wouldn’t build roads, schools, or hospitals in rural areas, but was grateful for his family and the values installed by his grandfather that helped make their exile from Tibet and independence in the Himalayas peaceful, despite being viewed as unwelcome refugees. Images of Buddha were on the walls; the Buddha taught how to seek your own happiness, because no one else can do that for you.

Sometimes a guesthouse would have other backpackers, or travelers with a guide, and we’d share time around a fire learning different perspectives on the world.

Some travelers had smart-phones with translation apps and solar-chargers, allowing us to communicate with almost anyone. Even tiny villages had WiFi; people couldn’t get toilet paper, but could browse the internet. Our world could be moving towards a global democracy, where people solve problems rather than politicians, or we could could be moving towards replacing democracy with “dataism.” (Read “Homo Deus.”) Wherever we’re going, 7.6 billion people using smart-phones will get us there faster.

Elevation

I hiked uphill 4 to 8 hours per day. Trees became rare, and snow-capped mountains became common. Tibetan prayer-flags highlighted mountains I’d eventually cross.

At higher elevations, people from poor castes walk downhill to collect firewood each day, walking back uphill to sell it. Tourists use more firewood than the local ecosystem can resupply; to balance this, the government agency overseeing this area has encouraged gas stoves. The alternative was burning yak-dung, which isn’t as smelly as you’d imagine, but I wouldn’t try it at home.

Mules resupply villages with gas tanks and food that can’t be grown in high elevations.

Democracy

Every few days I’d walk into a town, which is larger than a village and serves as a trading center. Towns had comfortable guest houses and supplies for backpackers, such as Snickers candy bars.

In the town of Manang, we had to wait four days because all guest-houses in the region were full of people from Kathmandu, who had traveled to vote in the national election. In Nepal, people must vote in the town they’re registered, usually where their ancestors were born. This was Nepal’s second election; their democracy was new, and followed a ten-year civil war that had divided the people between the poor and wealthy.

Nepali soldiers patrolled the streets, enforcing a curfew with guns rather than logic. Nepal uses their soldiers as defense, police, and national park protection. Until the civil war, they were the only people with guns, and without checks-and-balances they abuse their power in rural areas. I believe this will change now that Nepal has a democracy; I’ve never had a gun pointed at me in a country with a functional democracy.

The curfew didn’t affect our stay in Manang because there was nothing to do at night, especially when temperatures were below freezing. We’d walk up and down the street then return to our guesthouse to get warm around a yak-dung fire.

The guesthouse where we stayed was decorated for what the owners imagined a typical traveler would enjoy. Their home look like a rustic version of a 1970’s television sitcom; for some reason, they assumed that a typical traveler expected a Tiki bar. We’d sit under the Tiki bar, heating our tea in steel mugs on the yak-dung burning stove.

Frisbees are surprisingly useful for meeting people. One of our group used my Frisbee to prepare wild herbs he had found hiking in the lowlands earlier on the trip.

We spoke with local families about the election. Most people didn’t understand the differences between political ideologies, they simply hoped for a better life. The communist party overwhelmingly won elections in rural areas. In cities, the status-quo remained. Their new democracy would share government decisions between parties. Regardless of this year’s outcome, it’s a step towards more people having a voice in their future. They celebrated with parties in the street.

Silence

After the elections, I started hiking through remote areas. My head hurt from spinal injuries, my hips hurt from arthritis and inflammation, and the screws in my ankle caused the bones to throb with pain. But I did not experience worry, anxiety, stress, or suffering. I walked silently, concentrating on being mindful.

You see more wildlife when walking silently. Some, like this yak, are not subtle. Others are easily missed; there are at least four mountain goats in this photo:

And at least two in this photo:

Altitude

Many people do not get altitude sickness. I’m not one of them.

This photo was taken from the window of a shelter, where I stayed for three nights to recover.

For almost a week, I had been hiking at over 3,400 meters (~11,000 feet), gaining 300-500 meters each day. I had a headache and craved oxygen. My body fought two needs: deep breaths to get oxygen vs. tightening my windpipe to keep out the cold, dry air. I have asthma, and my breath “wheezed” on steep sections of the trail.

When you’re emotionally detached from discomfort, you’re able to differentiate between transient discomfort and symptoms of altitude sickness. At 4,880 metres (16,010 ft, ~ 3 miles) I realized that my headaches and dizziness were signs of trouble, so I descended to a shelter at 4,540 meters.

I stayed in a small room with one window that allowed cold wind into the room. I laid awake for hours, trying to stay warm as ice formed in my water bottle. It was -17 degrees by 2am. My heart was pounding at 124 beats per minute, more than twice my normal resting rate. Every muscle in my body was tense, sending blood to vital organs. I couldn’t descend; in daylight, it was six hours down a narrow and dangerous trail to the next shelter. I concentrated on relaxing until my jaw unclenched, which led to my teeth chattering at 124 beats per minute. I had preferred a clenched jaw.

By sunrise, my pulse was down to 80 beats per minute. I didn’t move that day, and by that evening my pulse was ~ 60 beats per minute, still more than my normal resting rate, but reasonable considering I was 3 miles high.

I acclimated by hiking to higher elevations during the day, descending to sleep at night. On one of these hikes, I found an emergency satellite phone. Three years prior, almost 400 people were trapped at this location by a surprise snowstorm; 42 died, and 175 suffered frostbite. I was not reassured by the satellite phone, which was made from a coffee can and something that looked like the dish-drying rack by my sink at home.

I’ve sumitted mountains all over the world, and frequently rock-climb in the Sierra Nevada mountains, where the amount of focus for each motion makes you not notice almost all other thoughts or feelings. This requires concentration; your mind is sluggish from high altitudes, low oxygen, and physical exertion, and it wants to be anywhere other than the present moment. Hiking above 17,000 feet can require 10 to 15 seconds of focus per step, requiring 6-8 hours of unbroken concentration. For me, I also must remain aware of the nature of pain in my body. For example, the metal screws in my ankle can wear into the bone, leading to a risky situation if I can’t walk effectively, and my normal headaches must be continuously evaluated to ensure it’s not progression to severe altitude sickness.

If you think about how difficult it is to concentrate on something unpleasant, you have an idea of the real challenge of high-altitude hiking, which is maintaining that level of focus for 6-8 hours per day for several weeks.

Here’s my metaphor for being mindful while hiking, which applies to anything in life. You’re the pilot of a bus, a driver with passengers, navigating a road with other drivers. You are the pilot, and the bus is your body and the passengers are your thoughts. The road and other drivers are external situations often out of your control. In other words, you’re in control of piloting your bus and maintaining it’s well-being, and sometimes you must pilot your bus on and rough and bumpy road despite deflated tires, weak shock absorbers, pain from screws in your ankle, pain from spinal disease. Your passengers are loud and all talk at once, like kids on a school bus shouting things that may or may not help you. They constantly tell your about your deflated tires, weak shock absorbers, pain in your ankle, pain in your neck; they warn you to look out for other buses even when the risk is negligible; they worry about where you’re going or question where you’ve been; they ask about work project you need to finish, wonder what other people in your life are doing, and talk about other aspects of your life not relevant to the immediate situation of piloting your bus over a rough road with weak shock absorbers and the potential to get a flat tire. But, some of those voices are telling you when to rest, ensuring your headache is not a symptom of life-threatening altitude sickness, notifying you of potential risks to avoid such as slippery ice or a possible avalanche or another driver on the road out of control, and other things critical to your safety at the moment. Your challenge is to acknowledge the voices of all passengers while maintaining focus on piloting the bus; you acknowledge pain, worry, anxiety, fear, and even joy or elation while concentrating on being in control of your bus.

When you pilot your bus 6-8 hours per day for several weeks you begin to recognize that you can listen to passengers while being detached from them, to acknowledge without judgement, and to make choices based on what’s important for your safety and peace of mind regardless of the condition of the road, your tires, or other passengers sharing the road.

I had been focused on piloting my bus, which required ten seconds for each step, for six hours when I saw a tea shop.

Seriously. I shook my head to ensure I wasn’t mistaken.

A cheerful entrepreneur had brought gas stoves and tea to a shelter at 17,900 feet. I paid $1.50 for a cup of hot tea; I would have paid a hundred.

Over the next few hours, his hut saved someone’s life.

I reached the summit, sat down, then got up as I realized something was wrong with one of the four other people. She was suffering severe altitude sickness. Her eyes were rolled back into her head, her breathing was in brief gasps, and her pulse was more than 150 beats per minute. She was in shock, and it was likely that pressure was building insider her brain.

None of us spoke the same language; we carried her into the tea hut while her guide was trying a satellite phone to call help. Over the next few hours, we kept her warm in the tea shop while preparing a helicopter landing zone. We carried her and her bags onto the helicopter, which would prioritize getting her to a lower elevation, and then to a hospital.

The helicopter cost $10,000. It was a private service, and the patient’s guide received a commission for calling it. The tea shop entrepreneur made $1.50. Three years ago, when the storm trapped 500 people here, local people dug through snow without concern for how they would get paid. There’s no right or wrong, just facts. Mindfulness is being aware of facts, but differing judgement until those facts are necessary to make a decision.

When the helicopter left, I was alone again. I started walking down the other side of the pass.

Mindfulness & a transformational moment

I had been so focused on the rescue that I hadn’t felt pain or symptoms of altitude sickness. I started to notice the pain again. Descending steep trails is harder on your joints than hiking uphill, and my head and joints screamed with pain. People become addicted to temporary relief from pain, either from medications or by pouring themselves into their work, so more doctors are recommending mindfulness, which can allow someone to become detached from discomfort while maintaining mental clarity.

When I had descended enough to reduce the effects of altitude sickness, I stopped to eat a Snickers candy bar. It was the first food I could hold down in 24 hours; at that moment was the most delicious thing I had ever eaten. In the time it took for my teeth to break through a peanut, all discomfort faded. I had no thoughts, just awareness. The sky was brighter, the air cleaner, rocks more beautiful than before I began taking that bite. This experience lasted for a month, and, to a lesser extent, remains now that I’m home. I’ve tried to share the continued experience throughout my blogs; this one remains the most challenging to describe because few people have that experience therefore it’s difficult to relate.

I had read writings from the historic Buddha who described the feeling of Nirvana, complete peace, as “all that needs to be done is done.” That’s apt, but only for people who have experienced that before. For me, it applies because I’m a person who takes several months off at a time to backpack or travel without anything else to do. But it was more than that; I truly and deeply understand many things now that became clear in that brief moment that lasted the time it takes to bite through a peanut.

First, a little background on me: I’ve taught physics, among other topics. But, I don’t have a physics degree, I enjoy physics as a hobby, and have had the opportunity to apply my understanding in medical research and aerospace engineering, and a lot of my free time is spent trying to deepen my understanding of the overlap between theories of relativity, quantum mechanics, gravity, and time. I can pass any exam, test, or conversation about physics because the people who write exams or test or have conversations about physics are simply repeating the words, not understanding the concepts, and definitely unable to apply them. But I did not truly understand what it would feel like to ride a beam of light in the eight minutes it takes to reach Earth from the sun; what it would be like to ride the gravitation wave that recently passed through Earth and originated 130 million light-years away; why my body disintegrates as the laws of Entropy ensure will happen to all of us.

The Buddha said that there are only four truths, and that Nirvana is seeing them. One of the truths is that we all will grow old, get sick, and die. That’s entropy, which is also the foundation for surprisingly recent explanation of life on earth beginning and, possibly, the arrow of time. I wouldn’t realize that part until reading books by Carlos Revelli. But, sometime between the moment I started biting through the peanut and before the peanut broke apart in my mouth, I gained a deeper level of understanding about the works of Einstein, Hawking, and many other physicists. I also gained a deeper understanding of what the Buddha taught, and how it applies to mindfulness and wisdom. I wrote about the books I read on this trip that contributed to that understanding in another blog.

I eventually learned that mindfulness can be permanent, but takes as much concentration as hiking at high altitude. The same concentration that allowed me to hike over the Himalayas without suffering from pain, the same focus that allowed me to assist in a helicopter rescue without noticing pain or worry, is possible in our daily lives without external motivation. As the Buddha said, peace comes from within. Over the next two months in Nepal and India, and the following six months back in the United States, I’d learn that, for me, being mindful while piloting a bus on a challenging road is easy compared to piloting a bus in daily life. The moment I transformed while eating a Snickers bar allowed me to feel mindfulness for many weeks, so I had evidence that it was possible, which gave me the conviction that I could learn to make it permanent.

It happens that Buddhist philosophy on meditation and mindfulness are useful tools in a deeper understanding of what these words mean. Just like memorizing physics words or formulas doesn’t ensure understanding, using words or citing philosophers doesn’t ensure understanding, and hearing words does not mean you’ll understand what you don’t practice, just like hearing someone describe riding a bicycle doesn’t mean you’ll be able to ride a bicycle without practicing yourself.

I decided to practice the methods with an open-minded approach (ha!) to see if I could understand mindfulness on the same level I understand physics. I had an advantage, I had experienced it. The focus and concentration on my body and mind’s reactions for a couple of weeks, combined with my attempts to practice yoga and meditate for the year before, had led to me experiencing what could not be denied: I could become detached from physical discomfort and mental worry, I could understand things on a deeper level at a rate faster than words allow, and that these feelings could be maintained over weeks if not longer, including a lifetime.

This is explained by how our brain connects neuron cells to other neuron cells to form complex patterns of association, creating present experiences based on a combination of past experiences and expectations for the future. This was famously seen in the experiment with Pavlov’s dogs. Does that name ring a bell? (Ha!) Pavlov was a psychologist who noticed that his dogs began to salivate when he conditioned them by ringing a bell before serving food; over time, they would salivate with only the bell, without smelling food or being near dinner time. Mind and body, perceptions and situations, thoughts and feelings, are inseparably linked and those connections are difficult to distinguish. Our discomfort or worry in a moment are almost indistinguishable from a complex network of past experiences and expectations that combine to make us salivate at the sound of a bell. Almost. I learned to distinguish the two on a daily bases, just as I learned to acknowledge all voices on the bus in a way that was detached and allowed me to pilot the bus despite bad tires and an icy road. What could be conditioned could be unconditioned through practice.

Einstein would often talk about detaching himself from conditioned thoughts that were obstacles to seeing reality. The Buddha’s final words were, “All conditioned things are impermanent. Practice diligently.” We don’t understand physics or our minds by reading about them, we must concentrate and practice diligently until we can ride our bicycle or pilot our bus effortlessly.

I walked downhill for a few more hours, found a guest house, and enjoyed the sunset. The sunset was beautiful because of ice crystals forming in the air; the lenticular clouds coming from mountain peaks indicated pressure was building and snow would arrive. Two days later, it began snowing on the mountain pass I had just summited, and it was raining in the areas of where I would spend the next two weeks. I started hiking through the rain, going off-the-beaten-path and into the Kingdom of Mustang.

Other blogs share key experiences during this trip through Nepal and India. Too much happened to list every detail, but many come out at appropriate times with friends. One’s worth mentioning here: On the hike down the other side of the Himalayas I stumbled across a small house that advertised itself as a bed-and-breakfast and Dutch bakery. It had American wild-west photos on the walls, and images of galaxies and quotes on astrophysics. The owners were a Dutch physicist and Nepali Buddhist; the physicists had hiked this route 20+ years before, fell in love with a Nepali woman, and lived with her in this remote town. He loved American western films, and decorated the home to look like a saloon from the California Gold Rush, which was near my home in San Diego, California. Of course, I stayed there. We spoke all day and night about physics and what the Buddha taught, realizing that insights of Einstein and Buddha were simply applications of geniuses applied to the tools they had available, physics and the mind.

Many of my side-stories are interesting in the context of main stories in these blogs. If you and I meet, I hope we spend enough quality time together to share stories.

Continue to:

Or, jump forward two weeks:

6 minute read.

In 1986 the space shuttle Challenger exploded, killing the crew and a high-school teacher that had trained with the astronauts.

The explosion originated near an O-ring gasket that sealed rocket fuel. The gasket protected a known design flaw that could expose fuel to fire. NASA’s purchasing department had bought the O-ring based on expectations of warm conditions at the launch-site in Florida. The launch was delayed until January. A rare cold day lowered temperatures below the specified rating of the O-ring, decreasing its ability to seal the design flaw. The incomplete seal led to leaking fuel, which led to an explosion at takeoff.

The explosion is shown in this video. An important aspect of Risk Management is alluded to at 1:30; NASA had been under pressure to launch on that day.

I’ve simplified the situation because I wanted to focus on the need for risk management standards and transparent communication. Engineers had warned of the risk, but NASA didn’t have processes linking risk analysis with purchasing and launch-team decisions. In fairness, it would be hard to see the significance of an O-ring, which emphasizes that Risk isn’t just about the part, it’s about what happens if that part fails, and the hazardous situations that would have to align for that failure to occur.

The international standard for risk management is ISO 14971, which was updated in 2007. If it had been available in 1986 the Challenger probably would not have exploded and the astronauts and first teacher in space would be alive. If we could travel back in time, this is how modern risk management would have looked for NASA and the space shuttle team, with ISO 14971 sections (in parentheses)

Plan

A risk management plan would have been created by before doing any work, when the team is not under pressure (3.4). The team would document what other risk management documents are required and who’s responsible, acceptable levels of risk, priorities for how to reduce risk, how to monitor assumptions, and how to update and improve the plan based on new information.

Brainstorm hazardous situations

A diverse team would have ensured understanding of intended use of the space shuttle and it’s parts, including the o-ring (4.2). They would have listed high-level hazards, including “The space shuttle could explode if fire reached the fuel tank” (4.3). The team would brainstorm sequences of events that could lead to hazardous situations (4.4). For example:

The launch date could be postponed from a warm month to a colder monthThe weather in Florida, where launch occurs, could have an unusually cold day where the temperature drops below o-ring specificationsThe o-ring could “shrink” due to the cold weather, becoming unable to seal the pathwayThe launch team could not know the risk of cold weatherAfter takeoff fuel could be exposed to fire, causing an explosion

The hazardous situations would be documented and updated based on new information (4.4). I believe it’s advantageous to document the sequence of events, too.

Estimate risk levels

Risk would be quantified for each hazardous situation (5). Risk is the combination of the severity of an event and the probability of that event occurring (2.16).

Risk = Severity X Probability

Teams would assign numbers to severity and probability, multiply them together, and the result would be compared to pre-determined acceptable risk levels in the plan (3.4). In this example the severity of an explosion is so high that risk control would have been required.

Risk levels would be documented and continuously improved based on new information.

Control risks

The team would have prioritized risk control (6.2):

Improve the designAdd protective measuresAdd warning labels, instructions, or procedures

For this example, options could have included:

Improve the space shuttle design, such as eliminating the path to rocket fuel.Add safeguards to reduce risk, such as changing the o-ring specifications to be resistant to cold weather.Create procedures to reduce risk, such as a policy for the launch team to delay a launch if the temperature is below 40 degrees.

Risk controls would be verified and documented (6.3), and the hazards document would be revisited to ensure all hazards were addressed (6.7) and new hazards were not introduced. Any residual risks would be evaluated to ensure the benefits outweigh risks (6.4, 6.6).

Monitor for effectiveness

The risk management plan would be continuously improved using real-world data to adjust risk assumptions. For example, current, real-world information about probability assumptions would have been adjusted. There are two probabilities in risk analysis:

P1 = the probability that a sequence of events will occur

P2 = the probability that the sequence of events will result in harm

P1 must be proactively researched and documented because hazardous situations are rarely recognized or reported. For example, it’s possible that other space shuttle launches had the same sequence of events but had not exploded because of slight differences in temperatures or air currents between the leaking fuel and fire. Many other teams of astronauts may have unknowingly come close to a similar explosion, but this wouldn’t be known if we weren’t monitoring P1 assumptions. P1 is proactive risk management that reduces P2.

P2 is reactionary, resulting from deaths or catastrophes.

Please focus on P1.

Link risk management to all department policies

All departments would fall under risk management, and the risk plan would be referenced for all decisions. In the space shuttle example, information from design engineers would be fed into a risk management policy used by purchasing, manufacturing, and the launch-team.

Links within an organization and monitoring and improving a plan are known as the “process approach” to risk management. Modern quality system standards require risk-based decisions in a process of continuous improvement.

Documents

All risk management work would have been documented (3.5). The final document would have been be a trace-matrix ensuring all hazards are addressed by risk control, and that work was carried out according to a plan. This would have allowed subsequent teams to continuously reduce risk by adjusting probabilities based on new information, adding newly identified hazardous situations, and using state-of-the-art risk analysis methods.

Standards

Lessons from the Challenger explosion are part of current, international standards for quality control and risk management. The most common international standard for quality management is ISO 9001, and the standard specific to medical devices quality systems is ISO 13485, which is the foundation of a new audit method, the Medical Device Single Audit Program (MDSAP). They require that quality systems function as a risk-driven process of continuous improvement, which is also emphasized by the FDA quality system requirements and the European Union medical device requirements (EU MDR). All use the concepts prescribed by ISO 14971:2007, Risk Management. and the supplemental version for Europe, EN ISO 14971:2012.

Regulatory requirements are emphasized by a MDSAP diagram showing Risk Management as the highest level of guidance for companies.

Practical application

In the case of the case of Challenger explosion, it’s obvious in hindsight how a series of disconnected processes led to harm. What’s less obvious is how to apply risk-based decisions into your existing quality systems. I give an examples of how to apply risk management to decisions in purchasing, vendors, and supply chains in another blog, That’s not a knife! How to make risk-based decisions, which uses another phenomenon from 1986, the film Crocodile Dundee, about an Australian crocodile hunter in New York City, as a fun way to learn risk management techniques.

Risk management requires a corporate that culture understands and applies the concepts. These consulting companies can help your organization continuously improve.

MaetricsLNE G-MedMDI Consultants

Summary

Consulting companies can help you continuously improve.

Please share

Risk affects all of society, and the more people who think in big-picture concepts the safer our world becomes for everyone. Please share this article if you think others would benefit.

Parting thoughts

The space shuttle Challenger explosion was a rare event that in hindsight had preventable sequences of events. History has many similar examples, such as the , the , and every . These events are often referred to as “” because of the book “,” which emphasizes that we can’t predict outlier events but we can build robust systems resistant to their impact and able to adapt to changes.

But, no amount of quality-control and mathematical modeling can replace humans working together and communicating effectively. In the case of the space shuttle example, individuals struggled to have their voices heard. To improve your company, focus on culture, communication, and transparency.

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8 minute read (4 if you ignore one part).

This article is to help anyone who would like to improve their electronic search skills. Over the past couple of years, I’ve noticed a wider range of people unsure of, or unaware of, search techniques I take for granted. To cut to the chase, read these two articles from Lifehack.org and Lifehacker.com

LifeHack for internet searchesLifeHacker for keyboard searches (any document)

Or this list of search operators from Google’s support site.

Or, Scroll down to the video tutorials below, because before I give search tips I’ll write why I’m doing this. I won’t put much time into editing it; as Mark Twain said, “I’m sorry I didn’t write a shorter letter, but I didn’t have time,” so scroll down to the techniques if you’re not interested in my ramblings. I’ll indent my missive. so you can more easily scroll down to my tutorial.

I used to be surprised how few people new how to efficiently find information on the internet, or within long documents, until I read an article that 90% of people don’t, according to research by Google employees. (I’m not making that up. To verify that statistic, JFGI.)

All joking aside, these techniques are important. But surprisingly few people are good at it. I have, unfortunately and regrettably, been sarcastic to the point of being cruel when joking about internet search skills when people, including clients, have asked how I “know so much” (their words, not mine).

I realized I was being hurtful after helping a local nonprofit with a wide range of things, helping them help at-risk kids in our community find free and fun resources for education. When they asked how I “knew so much,” I replied, “The internet, just like we’re trying to help the kids learn how to do!” I thought I was attributing my knowledge to publicly-available sources of learning, for which I’m grateful, but the looks on their faces indicated that they felt stupid. Ouch! That’s especially cruel considering that they were trying to help under-served kids in my community, which is a euphemism for kids living in poor neighborhoods, often from multiple generations of poverty, obtain an equitable education.

That story is a primary reason why digital search skills is important; when the majority of teachers in under-served aren’t efficient at using the internet or searching electronic documents for information, they are perpetuating an archaic education system where the teacher gives “facts” for kids to memorize and regurgitate on tests, missing the point that the future of education, and the future for these kids to change their situations, depends less on “facts” and more on what they’d like to accomplish, how to access, critically analyze, create, and use information that helps your team obtain their goals.

This approach to education is part of “Project-Based Learning,” where kids are coached rather than taught, starting with a common goal that teams try to achieve, similar to how the real-world works when a project-manager leads a team, or an inventor starts a new company and hires people who haven’t learned the new invention yet, or a civic leader wants to coordinate community action. In other words, we start with a goal, and learning occurs along the way, sometimes guided by a person who doesn’t know all of the information but is good at embracing ambiguity and adhering to a general process rather than a rigid formula.

This is also key to the Next Generation Science Standards, NGSS, which are new science standards for over 20 states that focus on observing phenomena and learning through observation, research, and experimentation. Again, information is no longer valuable; what you can do with existing information, and the process for discovering new information, is education for the future.

It’s worth noting that NGSS introduces “engineering” as a core science, which, like internet searches will be challenging to teach if the teachers don’t understand it themselves, or aren’t comfortable embracing ambiguity and being a “co-learner” with students.

If you’re interested in helping provide equitable education, find schools in your community that could use your help helping kids, especially under-served communities. To find them, JFGI.

Finally, to the point of the bad joke earlier (“which one?” you ask), if you doubt anything, or would like to confirm something before repeating to to others, it’ critical to have effective internet search skills. If more people had these skills our society wouldn’t be plagued with “fake news,” and we’d all be happier and at peace, discussing what we’d like to accomplish and how we obtained information rather than arguing over what to do about inaccurate information.

For me, it continues to surprise me how, as a consultant, I end up answering questions available, for free, on the internet in less time than it takes to review my consulting contract. I started subtly incorporating search-skills into my workshops, mixing teams for group-work to distribute skills, and noticed that people seem to learn quickly without realizing they’re learning, but only when starting with a team-centered goal, similar to project-based learning.

As your first goal, what does JFGI mean? As a hint, one answer is the Jewish Federation of Greater Indianapolis. Neither is it the Jacob’s Financial Group, Inc. Neither are what JFGI means in the context of this article, though several of my friends refer to the Jewish Federation of Greater Indianapolis when someone asks an easily-answered question. The point is, words are weaker than context, so use the context of what you’re looking for, and why you’re looking for it, to help you phrase searches or navigate results.

Search any document or web page

Please, please, please learn to use cntrl+F on a personal computer (PC), or cmd+F on an Apple computer. When a document or web page is open on your computer, simultaneously press the “control” button and the letter F on a PC, or the “command” button and “F” on an Apple computer. This will open a small window to Find any word, symbol, or combination of words or symbols. You type what you’d like to find, our computer will list them, or highlight them, and take you to them. Smart phones have similar features.

Personal Computer:

Apple Computer:

Practice:

use cntl+F to find every time I wrote “JFGI” in this articlefind every time I wrote the phrase, “search for phrases”

For more keyboard tips, read LifeHack for keyboard tricks.

Search the Internet

Don’t rely on Google. Try Bing,Yahoo, or DuckDuckGo. As a society, if we all use the same source of information we may become biased towards incomplete or inaccurate information, more so than we already are.

How to choose words or phrases to search

This is a genuine and useful skill that will become better with practice. There’s no “shortcut key” for rewiring your brain to think like a computer search engine, but it happens so subtly that you’ll eventually take it for granted. In other words, it’s not like a golf score or bowling handicap where you can track progress, you simply get faster at it, with results closer to what you really need. To get started, watch this video, or read the text below it, or both.

Here are basics:

Use quotation marks to “search for phrases.” In this example, typing search for phrases would return search results for all combinations of those words, but typing “search for phrases” would return results for the one phrase you needed.

Conversely, if you want random combinations of words, not just the sequence in which you type them, don’t use quotation marks. In the previous example, search for phrases would be similar to for phrases search, and would show results from Yoda (just kidding, I am).

Use an asterisk (*) when you don’t know a word in a phrase, and Google will replace your * with probable words. For example, “Jewish * of Greater Indianapolis”

Use a hyphen (-) to omit words. For example, type JFGI -jewish to omit the word “Jewish.” (Whether or not you use capital letters is irrelevant to most searches.)

Use the word “site” and a colon (:) to search specific sites. For example, search for colon cancer in the government’s national cancer institute by typing colon cancer site:cancer.gov.

Combine techniques. For example, “colon cancer” site:cancer.gov

Use Google’s tips for refining web searches in Google, which, unsurprisingly, was the #1 ranked result from Google. They may seem obscure, but can be useful. For example, when I was designing medical implants by researching competitive products, used “cache:” to find files from sites that no longer available, perhaps because the owners had deleted them but didn’t know that Google ‘caches’ search results. I believe this is ethical (it was originally public information), and am sharing that information so you’re reminded that the internet is public, even for “secure” sites, and even after you delete something, so don’t upload anything if you’d be uncomfortable if someone saw it.

Practice

A great way to practice is using the internet to play Jeopardy! or any trivia game for random information, especially if it’s drastically different than your most common sources of information, which will exercise your search-engine skills more than doing what you already know. For example, Who was the childhood actor famous from the 1980’s television show “Different Strokes” and running for governor of California?

If you’d like to try a trivia game I wrote, try this game of Celebrity Jeopardy that I created to teach medical device regulations. I created it for a similar reason as the blog you’re reading now, to help people focus less on “facts” and more on the process of asking the right questions to find information, and using that information to achieve goals. If you used the internet, you could become an expert in almost any law or regulation, especially if you cross-reference that information with things you already know, called “lateral transfer,” which is a technique for, and indication of, deeper understanding.

Learn more techniques by, you guessed it, searching the internet. But, nothing beats practice, so I’ll reiterate that you’ll get faster and faster without noticing it. One day, people will ask you “how do you know so much?” and you can reply, “JFGI.”

Advanced Tips

Sometimes searching for images, even when you want text, can be more effective.The second tip is the reason for the first tip: understand Search Engine Optimization, or SEO.

Many web pages are great at Search Engine Optimization, SEO, which is a fancy word for they know how to show up in your searches more than they know how to answer your question. But, for some reason, they aren’t as careful with their images, so finding an image that matches your search and then going to that web site may help find information, especially specific information that is swamped with SEO-driven sites trying to sell you something rather than help you.

Watch this video to understand SEA, or read the following text, or both.

SEO is a reason most articles you find using text-based searches are written with the same words being repeated again and again, like:

So you are a Jewish person in Indianapolis, who wants to learn more about what a Jewish person can do in our city of Indianapolis? Or, you’d like to find greater knowledge about the Jewish faith, and perhaps you live in Indianapolis, or are a Jewish person who knows there’s no greater place to visit than the city of Indianapolis. Well, you’ve come to the right place, home of the Jewish Federation of Greater Indianapolis, a federation in the Indianapolis greater region, for Jewish people, in Indianapolis.

The first clue that this not a useful page, but is a page designed to rank high in SEO for a wide range of search styles, using any combination of Jewish Federation of Greater Indianapolis, including people who didn’t type quotation marks when searching for the “Jewish Federation of Greater Indianapolis,” or for someone who typed “Jewish Federation of * Indianapolis,” is that it assumed someone wanted to visit Indianapolis. I mean, come on.

The second is the phrasing. Legitimate sites don’t need all of that. In fact, many fake web site are generated by computer programs that mix up keywords from legitimate sites to gain viewers, which, unfortunately, increases their rank in search engines to get viewer “hits,” not to solve your problem.

For more advanced tips, JFGI.

Finally

Now, you’re ready for nerd humor, like this video where a guy looks up information asked as if people were typing on Google. Warning: it’s PG-13, which doesn’t mean to omit the number 13. If you’d like to know more, JFGI.

Harry Anderson passed away last month; my thoughts are with his wife, son, daughter, and family.

The following is unusual, but truthful. It’s how Harry “The Hat” Anderson helped me learn, and teach, design, entrepreneurship, and risk management.

7 minute read.

Harry Anderson was a television star on Cheers, Night Court, Dave’s World, It, and other shows for almost 30 years. He was most known as Judge Harry Stone on television’s Night Court, where his character was a kind-hearted prankster, magician, and fan of jazz music.

Judge Harry Stone was an iteration of Harry “The Hat” Gittes from television’s Cheers, where Harry was a good-natured con-artist and magician.

Harry’s career jump-started in 1983 when he appeared on the famous comedy show Saturday Night Live, apparently shoving a needle through his arm.

Today, I use Harry’s Needle Through the Arm routine in workshops for medical device companies, teaching them how to comply with Risk Management and European Union Medical Device Regulations in ways that balance patient safety with innovative products.

Risk (this may get “Hairy” 🙂

I use Harry’s needle-through-the-arm routine in corporate training for medical device development on Reducing Risk As Far As Possible and applying Risk-Benefit Analysis, concepts that are often confusing. I believe the needle example explains the “point.” (ha!)

During the Saturday Night Live performance Harry fumbled while looking for the instructions to his trick while he had a needle stuck through is bleeding arm. This “stuck” in my mind (ha!) as a way to illustrate the concept of designing products that don’t require written warnings to protect people. The international standard for medical device risk management, ISO 14971, requires three priorities for reducing risk to patients:

Make the design inherently safeAdd safeguardsProvide written instructions or warnings

New regulations in Europe require that each medical device prove that the highest level of risk reduction were applied. Harry’s needle-through-the-arm represents a real-world challenge in healthcare, accidental needle sticks, that helps explain why these priorities are enforced.

Healthcare workers would get stuck by needles that had been in contact with patient blood, which resulted in transmission of diseases. Some of those diseases included life-threatening viruses such as HIV. Written instructions were ineffective at protecting healthcare workers, and it was difficult to make needles inherently safe because it must be sharp to penetrate patient skin. Innovative companies found cost-effective ways to add safeguards to needle after government regulations for needles required more safety, and those companies excelled in the market. Companies that didn’t innovate lost in the market. In all cases the reduced risks benefited society.

If an innovative company improves needle designs to be inherently safe, which is priority level #1, then that would become state of the art and society would once again benefit. Similarly, all medical devices are now required to “reduce risk as far as possible,” but companies struggle balancing cost effectiveness, innovation, and applying risk control. I provide guidance in a full article on risk management that uses more analogies from Harry and other 1980’s pop-culture.

Design & Education

I saw Harry perform his Needle Through the Arm on television’s Saturday Night Live in 1983. I wanted to replicate it so I started brainstorming how it could be done, prototyping ideas, and testing them in front of audiences. I’d repeat this process until audiences enjoyed the trick and my presentation.

Over the next few years, Harry performed a total of eight times on Saturday Night live, including when he opened the show by saying the

I would repeat the same process with each Harry Anderson skit: brainstorm, prototype, test, improve, repeat. This process is how I teach design, and is the basis of engineering design and the method of Next Generation Science Standards, NGSS, which include Engineering Design as a core science, the same as Physics or Biology.

Engineering Design is now a requirement for kids from Kindergarten to 12th grade in 22 states, but that doesn’t mean we know how to teach it yet. I’ve used Harry’s magic to help students learn design and innovation at two universities, a public high school, and in several countries; teaching teachers how to lead project-based learning where kids learn-by-designing, where the teacher is a coach, encouraging iteration and providing hints to overcome obstacles. I’ve also started incorporating the design process into my consulting on how to apply government regulations in ways that create more innovative designs.

Many of Harry’s magic effects were mechanical innovations, and even later in life, famous and wealthy enough to retire, he maintained a workshop to prototype ideas for the joy of observing a product evolve. Imagine that instead of reading text books to learn the mathematics behind mechanical engineering mechanisms students prototyped ways to swap cards or dollar bills when you activate the mechanism arm by dropping your pants on national television and moving the trigger connected through your pants, coat, and sleeve.

We loose some of our most creative students because they don’t fit traditional education models. New education standards like the NGSS are trying to improve education for all students, moving away from memorization, job training, and competitiveness towards critical thinking, design, and teamwork.

In hindsight, it makes sense that minds Harry Anderson was dyslexic, and had to find non-traditional ways to earn a living after high school.

“My high school teachers were always asking me what I was going to do. Cheers’ was my first acting job, but it was basically the character I had developed on the street,” he said. “That’s now I made my living, hustling drinks in bars and quarters on the street.”

Harry published a book sharing his good-natured con-games, “Games you can’t lose, a guide for suckers.” His”cons” were usually plays on words, but were often based on mathematics and probability, which is a more engaging way to learn the concepts than traditional teaching methods. I use those concepts in both high school classrooms and corporate workshops to help students learn math by practicing applications rather than reading concepts.

Harry wrote Games You Can’t Lose with Turk Pipkin, a writer for Night Court and other shows and movies. They co-founded The Nobelity Project for “bridging gaps in education at home and abroad.” It turns out that a many celebrities, athletes, and entrepreneurs are dyslexic, and also had to find non-traditional ways to earn a living that didn’t depend on written words.

Entrepreneurship

Entrepreneurship uses a similar process as designing: brainstorm, prototype, test, improve, repeat. Like design, entrepreneurship can’t be taught but it can be experienced. Almost every successful entrepreneur or inventor has more stories of failure than of success.

Magic and designing magic tricks is an ideal way to make iterative design fun, remove the fear of failure, and enforce the public speaking skills necessary to communicate with diverse people. Performing for real people develops skills that lead to other opportunities, like Harry discussed on television’s Late Night with Johny Carson, who was also a magician.

All of my classes incorporate some form of entrepreneurship, even if only how to communicate complex topics confidently. Innovators benefit from the iterative design process, getting a product closer to what is useful to a larger market, and everyone benefits from the hands-on skills and mathematical concepts that result from prototyping. I incorporate how to patent ideas and ways to build a business, which, like design, comes more from practice than lectures. As an example, rather than taking tests one of my Design Engineering classes created an online company that sold products they designed and continuously improved throughout the course using the process of brainstorm, prototype, test, repeat.

Combining all of Harry’s influences on me

My first medical device job had been with a start-up company founded by the original inventor of needle safety features, a serial entrepreneur who continues to invent products and start companies. In our interview he wanted to see how I brainstormed new ideas; by then I had designed or invented dozen of magic effects, starting with Harry Anderson’s 1983 Needle Through the Arm. I got the job, learned from mentors, invented medical devices, co-founded companies, retired, taught, and now consult on all of these things while incorporating my childhood love of magic.

In lieu of payment, I will exchange my service for corporate donations to non-profits or benefit-corporations that provide equitable education. Some of the work funded hands-on engineering laboratories in inner-city middle schools, and programs that incorporate community service into design engineering courses. I also perform magic shows for corporate events and private parties under the same arrangement.

I enjoy the work I do and feel gratitude for the good luck and influences that helped get here.

This is leading to my point.

A common theme in regulations I teach is “linked processes,” a concept that’s complex and difficult to apply in large organizations or government policies; I use Harry as a metaphor for linked processes, that we’re all connected by our words and actions in small but measurable ways. A lot of my luck and opportunities can be tracked back to seeing a guy in a hat apparently shove a needle through his arm on Saturday Night Live in 1983. Harry’s influence had ripple-effects that continue to help me help others.

I was fortunate to share a few drinks with Harry and his wife in their magic shop in New Orleans. We performed magic and discussed our love of the city and people who live there. I wasn’t consulting then, and I probably wasn’t self-aware enough to piece together the series of events that led to my career, so I didn’t share the positive ripples he created.

I don’t have the writing skills to convey what I’d like to say or to summarize my thoughts in one point. Maybe it’s that I was happy to see him doing what he loved, performing magic, 35 years after I first saw him on Saturday Night Live.

Or, maybe the point is that everything we do influences others in ways we may never know.

There are probably many points I could make from this article, and maybe one day I’ll have the skills to express them. If I do, it’ll unlikely to happen from luck, it would probably happen from the process of brainstorming, prototyping, testing, and improving.

Maybe that was the point.

For now, there’s no point, but I’m enjoying practicing writing while reflecting on influences in my life that have brought me joy.

Rest in peace, Harry Anderson, aka Harry “The Hat” Gittes, aka Harry Masters, aka Judge Harry Stone.