Best Practices Every Medical Conference Should Embrace

(I rarely do a list post, but could not help myself today (blame it on my daily reading of @Cracked…)

I often attend medical conferences and hear about the best practices applied within medicine, but I rarely hear about best practices applied to the medical conference itself.  In a world of often shrinking budgets and limited bandwidth, we must choose carefully which conferences we should attend.  Embracing some of the suggestions below can make an event a must attend inspirational and renewing moment in our lives and careers.

1.     The standing table, lounging chair and the walking meeting

I recently returned from a wonderful roundtable discussion on clinical trials in Indianapolis.  We had great conversations about open data and patient participation.  The only bad part of the meeting was the back pain I began to suffer after sitting for a few hours.  I am among the ever-growing group of people who work at standing desks.  So staying seated is a special kind of agony.  Fortunately, I am also without a modicum of decorum and had access to my huge suitcase, so I made a standing table MacGyver style during the meeting.       

Some conferences already provide standing tables around the back of the room and I say kudos to you!  Health 2.0 is one, but if you know of others please give them a shout out in the comments section.

On the flip side of the coin of attendee comfort is the lounging couch.  As we invite more and more patients to medical conferences it behooves us to remember, many attendees are listening while in pain.  I applaud the all the conferences that offer a cool down or comfort room where attendees can recline.  But sadly, such rooms rarely have access to the content feed of the live sessions that are ongoing.  Medicine X is the first conference I have attended that offered lounging couches to any who needed to rest while taking part in the live event.   It was rather epic to see that level of inclusion.

Another great addition to the conference venue is the walking meeting.  My friend Ted Eytan, MD introduced me to this gem.  Don't feel your conference has to be contained within four walls.  Go "on the lam" in a official capacity and have some of your breakout sessions outside while walking.  It is incredibly refreshing!  

2.     Inviting e-Patient Scholars and Patient Advocates

The ePatient movement is really expanding.  More and more patients are taking a hand in their own medical futures and helping shape health policy.   Their questions during Q&A sessions often change the direction of the conversation of the conference itself. Their keynotes and panel speeches help other attendees to express their own personal health stories.  Many of these patients and advocates have very strong social media profiles and their live-tweeting of events has exposed conference conversations to the wider world.  Look no further than Medicine X to see the enormous potential of e-Patients to spread the content of a conference.  

“But where do I find such e-Patients?” I often hear in response. Well @speakerlink is a great place to start looking for potential attendees and speakers.  Another avenue is participation in online discussion groups on Facebook, twitter and LinkedIn.  The future in medicine is "Patients Included." 

3.     You must list your #hashtag on Symplur

I can talk about the power of twitter to spread your conference message until I am blue in the face, but without analytics to support my point it is only so much hot air.  Thank you Symplur Hashtag project for providing proof of the power of conversations.  For free.  I ask conference managers to please to list their conference hashtag on Symplur.  Symplur will archive those tweets for easy access and provide  analysis of the day.  Your data will add to the ever-greater haul of big data available for analysis to determine trends within healthcare. If you do this prior to your conference it is a great tool for pre-promotion.  (If you wait till the day of the event attendees like myself will often do it for you, but don’t count on that as a back-up plan)  

It is a win/win situation.   Now all those ePatients can tweet and spread the conversation and you have proof of the level of spread.  You just have to focus on how to fund those e-Patient Scholars.

4.     Crowdfunding at the Medical Conference

Hosting a medical conference is expensive.   It is somewhat terrifying to know you have to come with thousands of dollars to make your vision of a conference a reality.  Even a conference run on a bare bones budget will cost about 25K.  Sponsors are great if you can get them (thank you Cerner!) and a well established conference often can.  For the rest of us crowdfunding is a godsend.  I personally have worked with both @medstartr and @Healthtechhatch for crowdunding in the conference world.  We focused the crowdfunding effort on travel and lodging scholarships for e-Patient scholars.  Working in partnership with a non-profit in line with our conference mission was a great help in securing funds.  

But the power of crowdfunding attendance to enable participation in continuing medical education is not limited to conference organizers.   E-Patient scholars and patient advocates should consider this route to cover their participation expenses in health conferences and classes that do not offer sufficient scholarship options.  A proof of concept is our dear friend @AfternoonNapper who has done so much for the role of the patient in the world of medicine.

5.     Traitwise surveys are the way to go.

So how many of you look at that after-conference response survey in your email in box and whoop with joy?  I bet very few of you do, unless it is a @Traitwise survey.   Not only does Traitwise have a pleasing graphic interface and font selection not reminiscent of the early 1990’s, their surveys are fun.  They keep you in the loop and informed on how your response fits into the greater data set of the conference.  And after you complete your conference survey, you can keep going, filling out survey after survey for the good of mankind.  One of my fellow e-Patients did exactly that after the Partnership with Patients conference.  They broke the record for most answers in one session with over a thousand.  (Another reason you should invite e-Patients: We are very giving people.)

6.     Teach attendees how to live-tweet

One of my favorite quotations is probably misattributed to Sen. McCarthy:  “Beware of Artists they mix with all classes of society and are therefore the most dangerous.”  Yeah, artists specialize in mixing it up, but to do that they need a forum. 

Nowadays Twitter is that forum, for artists and everyone else.

If you are running a medical conference for the good of your attendees and the wider world of medicine, you have several goals.  You want to break even.  You want people to have an enjoyable time.  But most of all, you want people to walk away inspired to make this world a better place.  In healthcare, many individuals feel they do not have a voice in policy discussions.  I am not just talking patients here.   I have spoken to a great many doctors and nurses who feel like they have worked to make a better system for 20 years without sufficient progress.  They are discouraged and feel alone.  I challenge all of you conference planners to get them live-tweeting, to help them realize there are hundreds, even thousands who think as they do. 

I have attended two conferences wherein the conference planners designed an entire webinar around teaching attendees how to live-tweet.  One of these events offered a webinar and 1-800 number support to walk attendees through the entire process.  The conference organizer

offered raffle items at the event that attendees who live-tweeted were eligible to win.  So many new twitter voices joined a wider conversation due the efforts of one conference planner. 

Do you want your conference to live beyond the after-conference survey?  Do want your attendees to act upon the content they absorbed?  Then help them tweet; help them discover the voice they always had.

Remember, online the Q&A never has to end and the microphone is accessible to everyone. 

"Healing Through the Pain"

I met Courtney Mazza many years ago as a fellow preschool teacher at CCBC.  She is beautiful person overflowing with kindness.  My husband and I sat beside her and her husband at many school events. Courtney was one of the wonderful people who stepped forward to help watch the children when Fred was sick.  In the years hence she has helped so many times.

In 2011 when I first decided to create The Walking Gallery, Courtney said she was willing to paint.  After me, she has painted the most jackets in the gallery.  This month she is presenting a show at the MOCA Gallery, (Georgetown) 1054 31^st St NW, Washington DC.  The show is called “Healing Through the Pain.”

This show features paintings created by Laurie Tylec, John Paradise, Tom Hill, Roger Anthony and others.  I have several pieces on display with these other wonderful artists.

On Friday November 15 will be a screening night. The mini doc on The Walking Gallery will be shown for the first time.  This film was created by the amazing Ben Crosbie and Tessa Moran at Eidolon Films.  I hope many of you will be able to attend!  Thank you Courtney for all you do!

Here is the program for the night:

THE PROGRAM [Note: This event WILL involve nudity* (at least one female model; optionally others of all sexes)]

6 - 6:30 Meet the Artists & curator Courtney Mazza

6:30  Work of Walking Art: Danyell Truesdale will be body painted with UV paint

7:30  Screening begins:

• The Walking Gallery (world premiere)--documentary featuring founder and lead artist Regina Holliday, and second lead artist and D.C. liaison Courtney Mazza

• 73¢--a mini documentary of Regina Holliday painting the mural that changed her life as her husband died; 73¢ at 5001 Connecticut Ave., D.C.

• A documentary of Roger Anthony tattooing

• Clips from A Painted City, by Caitlin Carrol, featuring D.C. muralists Regina Holliday & Byron Peck

• A documentary of St. Elizabeth's art therapy with the criminally insane, designed to improve self image and inspire confidence in these outliers to society

THROUGHOUT THIS EVENT, licensed massage therapist Rebecca Menso will be offering guests healing massages on site.  Clothing is OPTIONAL!

FOLLOWING THE SCREENING:  Roger Anthony will tattoo live onDanyell Truesdale, Walking Art--featuring CRACKS, attesting her struggle with her mother's crack addiction.

Launch

This is the painting “Launch.”  It is my third painting onsite at Health 2.0's annual conference. This year Health 2.0 was held Sept 29-October 1^st, 2013 and I love painting at Health 2.0.  There is a kind of frenetic energy that fills the air.  It is a unique passion fueled by the panicked reality of a start up and copious amounts of caffeine.

This painting is split between two canvases and represents division.  Division of conferences, as this week of focusing on health was divided between Stanford’s Medicine X and Health 2.0.  Matthew Holt runs Health 2.0 with his partner Indu Subaiya and Larry Chu runs Medicine X.  I am a friend of these two leaders and both are members of The Walking Gallery.  I happily attended each event, gladly hugging each host in a joyful greeting. I guess they must be one degree of separation from a hug.

But there is more division than overlapping conferences.  I almost named this painting “Intestinal Sky.”  Look at those looping guts of storm clouds rolling in.  Yep, a $#!* storm is coming.  We are in a time of great change.  Meaningful Use is marching through its Measures and ACA is being implemented.  Yet, as I sit down with my friend Kolya, I plot and plan a future where he can work to the full extent of his amazing mind and frail body.  In times like these, the fantasy of care for all seems so very far away.

The divide goes deeper, as I paint the Government enters shutdown.  Then great minds are taken from us as Farzad Mostashari, Lygeia Ricciardi and Claudia Williams must leave the venue and abandon their mission.  Farzad’s last speech as National Coordinator is stolen from him by machinations of a divided house.  Deven McGraw offers to lay bare their testimony before those gathered and the ONC staff slowly walks away.

I hear about Killer King Hospital from Sajid Ahmen CIO of Martin Luther King Jr. Community Hospital.  I hear him speak of a hospital that showed so little care for its patients that a patient died in the ED and the janitor cleaned up around their body. I began to paint a hospital that was antithesis of its mission.



Sajid explained that the facility is to re-open in 2014 with a new vitality and mission.   Yet, I paint it as it was but now adorned with a construction tape “Under Construction for 20 years.”  I write this because I hear that phrase at venue after venue, “It takes 15-20 years to create change in Healthcare.” 

I scream no!  I say cut through the tape of obstruction and demand change before others die.

So here at Health 2.0 we storm the barricades.

We mount our smart phones and ram them straight through the digital divide.   We can follow the rallying cry of Jamie Heywood’s “Patients Like ME is still here!” Or we can the share the brave stance of Alex Drane as she tells us to talk about death and Engage with Grace.  We can listen when Susannah Fox tells us to never forget paper and pencil are also data capture tools. We can cry when Susannah bravely reminds us: caregivers are the ones who wipe.

In this crowd there may be those who could care less about a dental app that can create better pricing through price transparency.  But I care, as I know that there are people who die from a simple tooth abscess for the want of affordable dentistry and perhaps brighter can change that. 

The division stops here.

This is the third appearance of Ramin Bastani from the Unmentionable’s Panel in a Health 2.0 painting. He has re-launched Qpid.me as Hula.  Here Ramin opens his zipper app with the woman who once slapped him when he inquired about her STD status.   Ramin, like Jamie, is still here.  He is still hopeful.  He still plans to change the world. He still has the charisma and energy that he had three years ago.

You know what else he has? He has three years of research on data access and a deep understanding of privacy legislation in 50 states.  Add to that a steely determination under that charming smile.

Ramin is dangerous.

Alex is dangerous.

I am dangerous.

We will tell you the truth and we will do it with technology.

You want to know the best way to deal with a divide? A bridge is really helpful, but at Health 2.0 we are shifting the earth itself beneath the feet of the leaders in healthcare.  

Reporting out from #CHC13

The opening day of the Cerner conference was a wonderful day!

I was honored to meet with Ross Martin, MD from AMIA and member of The Walking Gallery for a quick breakfast.  He told me about the speech that he delivered on Saturday.  I was happy to hear about it as I noticed the twitter stream blew up with positive feedback.  Ross wove technology together with his family patient story in an inspiring presentation that they will talk about at Cerner for years to come.

At lunchtime I met with the wonderful Matt Dunn who often tweets from the Cerner handle.  We had a wide-ranging conversation that covered children’s literature, professional organizations and the future of health informatics. 

As the day progressed, I saw more and more tweets using the conference hashtag: #CHC13.  At 4:15 I met Brian Carter from Cerner and a fellow member of the Walking Gallery.  We headed over to the convention center to sit among the hundreds gathered to hear four visionary keynotes.

Daphne Bascom introduced the night’s speakers and set the inspiring tone of the session as she used the conference motto: “It starts with me.” She reminded us anyone could be a change agent.  Our first speaker was Sajjad Yacoob, MD Chief Medical Information officer of Children’s Hospital Los Angeles.  Sajjid mentioned how it was very important to think about system design goals long before you ever involve a vender. He also emphasized focusing on the baby in the bed rather than the tech in the cloud.

Next up was Brian Yeaman, MD Chief Medical Informatics Officer from Norman Regional Health System in Oklahoma.  I was pretty excited to hear him speak as I grew up in Oklahoma and most my family still resides in the state.  He reported out the success of the state Health Information Exchange using the new moniker “Global Medical Record.”  I think that is rather a catchy title. He also spoke to us about the tornadoes that caused such havoc this past year.  He explained how their hospital’s electronic health records coupled with the ease of data exchange allowed for providers to better care for patients in the aftermath.

Next up was Jonathan Bickel, MD Director of Clinical Research Informatics, Boston Children’s Hospital.  Dr. Bickel explained the power of algorithms to predict the paths of hurricanes and discover patients suffering from domestic abuse.  He also pointed out the data set available for EMR use was better than clinical trial data as the data pool was far more diverse.

The last speaker was the amazing Rebecca Onie, co-founder and CEO of Health Leads.  I had the honor of seeing Rebecca present at TedMed in 2012.  She is a big proponent of addressing root causes that make patients suffer.  If a patient needs food to address a state of malnutrition then food should be able to be prescribed.  If a patient is returning to the ED due to asthma attacks brought on by a cockroach infestation in the home, the health system should be able to help remove the pests that are causing the root problem.  I love Rebecca.  She is my kind of disruptor.

That was the first day of the Cerner Conference and I was so glad to be there.           

Returning to Cerner

Returning to Cerner

In a little less than a week, I will return to Kansas City to attend the Cerner Health Conference 2013.  It has been a year since my last visit when Cerner hosted the Partnership with Patients conference.  People in the wider world of patient advocacy are still talking about that amazing event.  For one weekend last September, Cerner’s educational building became a social media hub and epatient epicenter.  We even trended on twitter in Kansas City.  It was the kind of event that stirred hearts and minds.   

This year I will do something very different at Cerner.

I will not paint.

I will not speak.

I will not moderate sessions of a patient conference.

Instead, I will blog and live tweet.  I, who have so long endorsed social media as a powerful voice in and of itself, will stick my courage to the testing place and prove that the online voice is just as powerful as any orator.  Cerner is paying me as a keynote speaker, but my stage will be the internet.

I look forward to seeing old friends and hearing new thoughts.  I look forward to returning to the company that gave me my first speech with listening ears and a questioning mind.  I shall tweet to @Cerner and with the hashtag #CHC13 and spread the word about innovation and new products in Kansas City.  I will report debate.  I will bring with me the questions that I hear at so many conferences regarding EMR systems.  I will listen eagerly for answers, for I have never regretted attending a Cerner event.  I cherish the knowledge I have gained while listening to those so willing to teach me when I was just known as Regina, the widow of Fred Holliday.  Now I may be known as Regina the founder of the Walking Gallery, but I will listen to the wisdom of the staff at Cerner.  Cerner invites patients to sit at their table.  I can think of few venders who can claim the same.

Now, I must admit it will be quite odd for me to sit back and focus just on writing when traditionally I do two or three things at once.  But I think that this event will be an exciting one as things are rapidly changing in electronic health records as the measures of Meaningful Use march forward.

Cerner Health Conference 2013 takes place October 6-9^th and I will be there on the 6^th and 7^th.  Due to a prior commitment I can stay no longer than those days, but I am sure that those hours will be sufficient to report out current Cerner projects.  Happily, I will be able to chirp in with follow-up questions while on the road as @cerner is one of the most responsive corporate twitter accounts within health care.

So dear friends and faithful readers, wish me luck, and follow me on twitter as I explain HIT content and health policy from Kansas City.    

   

Time to Leave the Island

This is #NHITweek, that would be National Health Information Technology Week, to the twitter illiterate.  I had the honor and pleasure of painting once again in the great hall of Health and Human Services as some amazing people from ONC, The Office of The National Coordinator for Health Information Technology spoke at a meeting entitled “Consumer Health IT Summit.”

So much has happened and many things have changed in the four years that ONC has worked on Meaningful Use and consumer engagement.  These changes were visually manifest in the fact that half of paintings in the room were worn on the backs of jackets rather than hung on the walls of these hallowed halls. 

Members of the Walking Gallery showed up in large numbers! Keith Boone, Casey Quinlan, Don Fluckinger, Matthew Holt, Donna Cryer, Mary Anne Sterling and Nick van Terheyden were some of those who walked wearing their powerful stories on their backs.  It also made my heart glad to see so many past and present federal employees wearing their jackets at an event at HHS.  Todd Park, Lygeia Ricciardi, Joshua Seidman, Peter L. Levin and Farzad Mostashari all wore their jackets while talking about the future of medicine and technology.

It was a lovely day because I designed the gallery so this kind of visual storytelling could become part and parcel of any health policy dialog. In the past, Individuals have questioned my decision to paint 236 jacket paintings basically for free.  I responded to them saying I designed The Walking Gallery this way so even federal employees could tell their stories.  The gallery accepts all who wish to walk, the gallery jackets have no monetary value and the walker wears them to at least three events of their choice per year.  All of these rules were designed to allow reporters, providers, patients and federal employees to be part of this movement toward truly humane healthcare.

I asked Farzad if he would join us in the gallery several times before he acquiesced last year.  Farzad is an amazing leader in healthcare and would not do anything that would be considered out of bounds in his role as a federal leader.  I assured him that I designed the Gallery so men and women such as him could join.  (I even had an opportunity to talk the ethics lawyers at HHS and they assured me I designed The Gallery in such a way that federal employees could participate.) Last year at a similar consumer meeting Farzad removed the jacket from his back and I painted it on the spot.  

This is Farzad’s jacket: “The Three Stages of Meaningful Use.”

In this painting, Farzad stands wearing his famous bow tie with a smile on his face as three waves shaped like the letter “M” descend upon him.  This represents his life’s work at ONC and his guidance of the implementation of a truly “Meaningful” Use.  In his hands he hold’s a blue button in a pose of reverence.  Last winter Farzad shared with us the story of his Thanksgiving.  After the meal was finished, Farzad asked his parents if they would like to see their blue button data.  As they were on Medicare, Farzad was able to log on and get the download in its raw form.  Then he remembered the presentation by Bettina Experton about I-Blue Button app by Humetrix.  So he called her on Thanksgiving.  She answered his questions and Farzad used i-Blue Button for his family.  The next day his father’s eye hurt.  They could have gone to ER but Farzad knew full well the chance of seeing an on call ophthalmologist in the ER on the day after Thanksgiving was slim to none.  So they used ZocDoc and were able to get an appointment that morning.  When Farzad’s dad saw the doctor he was able to bring up his medical record on his smart phone because of i-Blue Button.

This week at this consumer event Farzad gave us his last words of wisdom as he prepares to leave office.  He told us we were the misfits.  We were the ones who were early adopters or rode our bikes to work in a city of automobiles.  We would have to spread the vision of HIT and consumer empowerment to the wider world.

So I began to paint “Time to Leave the Island.”

In this painting a Blue Button doubles as the Island of Misfit Toys from the classic stop motion animation Rudolph the Red-nosed Reindeer.  The Text “All Misfits Welcome Here” is inscribed upon the button.  Farzad springs “out of the box” and fist bumps with Leon Rodrigeuz (as a polka dot elephant from OCR, Office for Civil Rights).  Leon told the crowd about the support OCR would provide in helping patients access their records and re-affirmed the OCR’s stance that data withholding from patients is just as bad as illegal disclosure. 

To Farzad’s left in the painting is and elf version of e-Patient Dave holding his granddaughter.  Dave treated us to a fast-paced speech that encapsulated all of the strides in the participatory medicine movement these past four years. He ended on that most important note; getting to live, getting to hold this child was why we do what we do.   To Dave’s left a doll version of Lygiea stands with a smile on her face and a Blue Button on her lapel as she helps patients enter the ongoing dialog.

Above the island flies the plane that could not fly, now bedecked with a streamer saying “Checklists Patients Included.” The alludes to both Atul Gawande’s campaign in the wider world of health to embrace the use of checklists and Lucien Engelen’s campaign to improve patient inclusion in medical conferences.

Around the island patients fly or swim propelled speedily along with hashtags on twitter. They are spreading the messages from this day around the world. 

I finished the painting as Farzad closed the day.   I take his advice to heart.  We misfits need to fly into the world of business, research and pop culture.  We need to open minds and hearts.  I know so many of us will miss Farzad heading ONC, but I for one can’t wait to see what he does beyond the island. 

Finals

Surely, you remember those days.  The sleepless nights filled with cramming knowledge into tired minds preceded days of testing.  We walked around in a caffeine-fueled daze; our pencils sharp prepared to fill little bubbles with darkness or scrawl endless essays.

And so it went, through junior high and high school.  The finals would come, time and time again. We would be tested.  We would pass or fail.  And if we passed, there would be more tests.  College finals were a little different; we would download the content of our minds in essay fashion into a little blue book.

I hated to write in a blue book, as my handwriting is abysmal.  But beautiful or not, everything I knew was laid bare for my professor to see.  I would pass or fail based on what I had managed to impart between these blue pages.

Do you know Peter L. Levin?  If you follow health policy matters, you might know he led health record innovations at the VA.  His official title was Senior Advisor to the Secretary of Veterans Affairs.   He was the executive sponsor of the Blue Button personal health record.  He worked with White House on technology initiatives under both presidents George H.W. Bush and Bill Clinton.  He co-founded a semi-conductor design firm.  He is the co-author on 50-plus articles on wide ranging topics from GPS to engineering to cyber security.

But most all, Peter is a professor. 

He joined The Walking Gallery in his favorite tweed jacket.  He usually wears this jacket once a week and has for the past ten years.  This is Peter as himself.  All titles and accomplishments aside, Peter is a teacher and he cherishes those around him.

This is Peter’s jacket: “Finals.”

In this painting, Peter stands beside a rolling lecturer’s chalkboard.  He is telling the class about the wonders of the Blue Button.  In front of him and sitting on a desk is a member of his team: Jim Speros, Special Assistant to the Chief Technology Officer in the Office of the Secretary of Veterans Affairs.   

What is the Blue Button?     

A few years ago, there was a meeting convened by the Markle Foundation.  In that meeting attendees were talking about how important it was for patients to able to easily access their medical record.  Someone said, “Why can’t there just be a blue button you push and you get your data?” 

Blue Button was born.  The U.S. Department of Veteran Affairs adopted it first.  It is a clickable icon that allows a patient to download their personal health records in a digital form from a secure website.  The VA, Medicare and Tricare offer this service to thousands of clients. In June of 2012, a White House meeting convened proposing an expansion of Blue Button to other agencies, venders and insurers.  Many organizations pledged to adopt this needed innovation. 

The Blue Button does have its detractors.  This button allows for a data dump in a pdf or ASCII file.  The data is not organized in a way that is easy for a layman to understand but is human readable. 

The data down load reminds me a great deal of my old blue books.  It isn’t pretty, but it is the information needed to pass the test.  And when we talk of patient data access this test is about life and death.

Peter stands at the chalkboard lecturing to the class.  He smiles as looks around the room.  But he stands at a rolling chalkboard and everything can change in an instant.  Have you ever lectured using one of these boards?  They are double-sided.  They are designed to easily flip over, allowing the instructor to write on the either side.  Such boards will surprise you.  I have found myself writing furiously on such a board only to watch it spin and turn.  My writing will be replaced by another lesson.  And so we go from Blue Button to blue alone.

Blue is such an important color.  For much of history, the color was synonymous with darkness.  (Only recently, and only in America, do we sometimes associate it with healthcare.)  Every new artist learns the lesson of blue when mixing color.  To have the blackest black, the deepest shadow you must add blue.  So we have sorrowful music and call it the Blues.  When people fall into depression, we call it the Blues as well.

In this picture Peter holds the hand of his uncle Ronny.  They grew up together as though brothers, with Ronny only ten years his senior.  Peter loved his uncle Ronny and watched him battle with depression and mental illness through adolescence.  Then Ronny died from cancer in his 20’s. 

To the far left of the painting a young girl stands. That is Amanda Andrews on her first day of second grade.  She seems so happy here.  She seems so happy in so many pictures over the years.  But in the summer in her 16^th year of beauty and youth, Amanda killed herself.  Her mother Kristen Andrews, is a friend of mine on twitter and works for Kaiser Permanente.  She was at work at the time.  She was in a meeting about health as her daughter died.

In the foreground on the far right is Misha Head.  I had the honor of being Misha’s supervisor at the toy store Barstons Child’s Play for a number of years.  Misha had the best laugh.  It would fill a room with joy.  Often that laugh would hide a deep well of sorrow.  Misha moved away from DC and decided to go back to school.  She wanted to dive back into the world of blue books and chalkboards.   But one day the well of darkness within her grew greater than her laughter.  She killed her herself 2011.

Finally we have Jim.  Such a nice man, so kind to all of us in every meeting I have attended in on health policy. He sits upon the desk prepared to speak to us, prepared to move boulders out of the way of progress.  Jim had such a nice smile upon his face to hide his sorrow.  Peter was his friend and Peter was his supervisor.   Jim killed himself last fall.  Peter never saw it coming.  Just as Kristen could not imagine she would lose her daughter during summer vacation.  Just as I cannot believe I will never hear Misha’s laugh again.

We sorrow, and then wonder why they did not share their deep despair with us.  Why do we live in a culture where we can talk of Blue Buttons but not blue feelings?