I wrote Exposures while I was a first-year medical student back in the early 2010s. It won the Marguerite Rush Lerner Award for Creative Writing in 2012.



She was thin with short, dark hair. Sharp nose, high cheekbones, and a crescent tear around her closed, right eye. Her breast tissue had deflated into the consistency of old newspaper. Her body had darkened with the absolution of formaldehyde. In silence, we unwrapped her linens and hauled back sheets of crackling, thick plastic wrap.


She had no tan lines. She had no evidence of a wedding ring, of jewelry worn often, of hair dye. She painted her fingernails. Left hand only.


The professor swept his fingers over a thin white line above her private parts. This scar just superior to the pubic bone meant a C-Section.


A chart on the wall said she had died of "alcohlic cirrhosis of the liver," a strange typo. We had no evidence that she had lived a good life. She had died, and she had given over her body to us. I had no idea what was to come, the things we were to remove from her, how I would stare at the imprint of the heart on the lungs, long after we had cut it away and put it in a bag at her feet.





In the days when I was still deliberating whether or not to apply to medical school, my friend announced that he had a heart murmur. He was a person who buried nervousness with bravado.


Do you want to hear it? he asked.


He took his stethoscope out of his backpack and handed me the earpieces. He lifted his shirt and slipped the stethoscope underneath, exposing a naked belly on an expectedly thin frame. My head was pulled near his stomach, the rubber of the stethoscope stretched taut. He said, Listen.


I didn't hear it. I laughed at the awkwardness of my proximity. He leaned forward, held his breath, and repositioned the stethoscope. Connected, I too came closer.


The sound of the murmur faded into my ears. I didn't yet understand the concept of systole and diastole, the snap of the regular heart rhythms and the natural split of S2. But I could hear a rushing, turbulent noise, almost like the gentle whooshing of an ultrasound machine, slipping in between the beats of his heart.


Since then, I have had an odd attachment to heart murmurs. Perhaps because of the strangeness of that first listening. In the same way that a word is defined by its nascent associations, murmurs to me will always represent the gift of exposure. Although eventually knowledge may become routine, it is the first uncovering that sows it to your mind. It is that awkward revealing that brings every other instance into stark color.





There was a congenial man, a kind neighbor, firm with his children, who had long since grown. He smiled at us. He believed in the greater good of educating medical ingénues.


The exposure was deft and intentional but without swagger. This was not a magician, throwing back a cloth, to reveal a surprise vacancy. This was the doctor who we, with a mix of reverence and pride referred to as Our doctor and Our teacher. He lifted the corners of fabric and dropped them. He pinched them and shifted them with veteran haphazard. To him, this was no longer exposure. It was another object in a series of objects. But I failed to seem as unabashed at the sight of a stranger's genitals.


I performed a full physical exam on the 40-something male. It was my first full exam. While I palpated and auscultated, his heart rate jumped to a twice-normal rate. I did not notice. At the end, our doctor handed me a long strip of paper, patterns of the man's heart carved out in dark ink. I could not read an EKG, but I could see the section of abnormality, the sudden onset of ventricular tachycardia.


He handed it to me with pride. We made light conversation and moved on. But the dark spikes, uncountable, pointed to all the things I couldn’t see. I put it in my pocket. I would keep it there until it was washed and crumpled, weathered, too tattered and torn to read at all.





There is a profound sadness in the doctor-patient relationship; in the oddness of our sudden connection with strangers, the disproportionate formality of it all, and the brevity incongruent for a relationship of such intimate action.


This is clearest to me in the act of surgery. I am stilled by its methodical communion. The surgeon places her fingers into the incision, seeking landmarks of which I am ignorant. The intentioned movements of her finger create a temporary bulge in the patient's skin. No one will ever touch this woman with such intimacy. She did not know that she would be the subject of a proximity not allotted to parents, to siblings, to lovers. A strange relationship in which she is temporarily a canvas.


If the woman is a sculpture, the surgeon is Pygmalion. She may touch her patient's incision later, still seeing a thing she crafted with her own hands. But a statue is no longer an object once it has come to life, even if that life depended on your intense prayers, the particular angle of your blade. Even though the surgeon touches this woman more intimately than her family ever will, even though she heals her in a way that her closest friends cannot, this surgeon and the patient will forever be strangers.





I interviewed a man who'd had a difficult life: a survey on lifestyle choices and access to medical care.


I had sat in lectures on the importance of connecting with patients. I held a strong belief in the bonds between people and the healing power of honest words. The man sat before me and I lost my voice. I lashed myself onto the bones of the questionnaire.


When was your last medical appointment?


Have you ever had high cholesterol? High blood pressure?


Do you drink?


The man hesitated only briefly before telling me that he had consumed alcohol, in the past, but no longer. I felt suddenly suspended, a tightrope walker leaning into a taut line. I could ask for more as easily as I could ignore the slight revealing he had given me, the edge of this curtain removed. It was certainly safe to ignore the brief ruffle in the tamped-down edges of his life. With every second, it was already settling, and settling closed.


When you used to drink…


His drinking had been a result of a traumatic event. Someone died. He survived. The vacancy widened. He spent a lot of time in the graveyard. He fell asleep next to the precious remainders of what used to be. I did not have to ask. While I listened, he lifted and pinched at the corners of his own life until it lay there, exposed.


As we examined the life he had led, silence took us. The speaking and revealing had settled something in the both of us. There was an unexpected sense of calm, like a pond after the plunk of hefted rocks: the renewed flatness of the water, transparent, the untrodden path of a thousand stones beneath.





When we first unwrapped her body, I had promised myself that I would to suture her together in the end, replace the organs we had removed, put things back where we had created unnecessary vacancy. I intended to close her body, re-wrap the gift she had given us and give it back to her family whole. But we had taken out tissue and made large, uneven incisions. Some skin had dried to the texture of stiff leather; other parts had been lost or thrown away. I imagined a thousand black stitches criss-crossing her body, a monumental task. I told myself that this new mutilation was no more charitable than leaving her as she was. But I was compelled, in the very least, to close the freshest cut. The cleavage of the saw down the center of her face, cutting between her eyes and her nose and exposing unseen sinuses beneath.


I fumbled with the halves of her skull, pressing them together behind the flaps of scalp. There was nothing left inside, now that we had removed the brain. Nonetheless, I pinched her cheeks together and began to sew. Her face slowly reassembled, held together just beneath the skin. Her chin, then her mouth and nose. She had no teeth left. Tiny black stitches materialized on her forehead, post-mortum beads of sweat.


Later, long after I exited the lab and left the smell of formaldehyde behind, I still thought of her. Just as her face had been exposed to me, so were the faces of all people, wide turbinates and deep sinuses, the enclosed brain that, if removed, would leave dura flapping like shirt tails in the wind, a strange new nakedness.


I felt a sudden vacancy; the unfamiliarity and permanence of this vision. When confronted with a classmate, discussing our shared experiences in bodily deconstruction, I had nothing to say. I saw not a nose but the nasal concha, not the cheeks but the zygomatic arches and the maxillary sinuses. So instead of looking at that face, I looked at my feet, thinking of the things that had been removed from me, and the things I had gained.

The Hippocratic Oath for Technology

First, do no harm

Several years ago, I left Yale Medical School and moved to work at a hardware startup in San Francisco. I went from dealing with emergencies surrounding human life to dealing with emergencies surrounding money. In some ways, it was relaxing. The stakes were lower. We were distanced from vulnerable people, from patients I could accidentally infect with germs in the cracks in my fingernail polish, people that I could devastate with a harsh word or clumsy turn of phrase.

But at the same time, I felt uncomfortably far from people. I had been training for a profession that was deeply integrated in the emotions and needs of others. Now, I was in a profession where the dominant philosophy was keeping people at a distance, understanding users through surveys and A/B tests, and replacing in-person conversation with messaging platforms.

Me on a panel about narrative medicine, during school. Photo Credit: John Curtis

Me on a panel about narrative medicine, during school. Photo Credit: John Curtis

When tech entrepreneurs heard that I went to medical school, they were excited to tell me about their new app that would replace doctors, replace physical exams, or replace therapists. I never felt comfortable having these conversations. As an industry, tech was distanced from people, and it was trying to widen that distance with every new app.

Tech can try to escape from human emotional connections, but we build them, whether we mean to or not. We see it in the recent efforts of Facebook to try to better account for misinformation and negative feelings, the exposure of the addictive nature of apps and smartphones, and the news that more screen-time might affect development. Standing at a distance from the people we serve does not make them feel fewer emotions or cause less psychological fallout. It just makes it harder for us to see our own negative impacts.

A machine slanders several social groups and becomes a center for hate speech. An algorithm meant to protect users from toxicity make it harder for them to be heard. A company takes out a patent to reconstruct our lives based on eavesdropped buzzwords, we let machines read to our children, our political systems are influenced by bots and foreign agents behind screens.

Tech is powerful and dangerous, but it can also be helpful, enlightening, life-saving. So what do we do?


The Hippocratic Oath for Technology

Tech is an industry, and so is healthcare. But physicians, while working within a system that pursues profitability, stand steadfast in choosing to do no harm. Although users do not have to trust hospitals as a business, they do have to trust the doctors that have direct impact over them every day.

As technologists and engineers, we must understand the relationship we have with our users. We must first, do no harm. We must guard the well-being of our users over all else, and design for positive rather than negative impact. We must understand what impact means, not simply in a company-wide or technology-wide sense, but in the larger system of people, emotions, and society.

We must re-apply the Hippocratic Oath to our own work (and especially consider particularly that bit on privacy).

I'm taking my own oath now. I'll remember it, while designing, coding, making roadmaps, onboarding users. Richard and I will repeat it to ourselves as we put together the Happy Robot Company, my first real return to healthcare-adjacent fields with everything I’ve learned from technology. It's my hope that this will keeps me closer to people, to my responsibilities, and to the impact I have on their lives.

Here it is again, in case you missed it.


The Hippocratic Oath for Technology (Based on the 1964 Hippocratic Oath)

I swear to fulfill, to the best of my ability and judgment, this covenant:

  • I will respect the hard-won scientific gains of those technologists in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
  • I will apply, for the benefit of the user, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
  • I will remember that there is art to technology as well as science, and that warmth, sympathy, and understanding may outweigh the technology-based solution.
  • I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a user’s recovery.
  • I will respect the privacy of my users, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life . If it is given me to improve a life, all thanks. But it may also be within my power to worsen a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
  • I will remember that I do not treat a chart of growth, but a vulnerable human being, whose experience may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the user.
  • I will prevent harm to users whenever I can, for prevention is preferable to cure.
  • I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
  • If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of bringing technology to those who seek my help.

Paired Objects: A Framework for Recreating Presence in Connected Devices

Family, friends, and significant others. When separated, we miss the ineffable feeling of being together. Presence-- the feeling we experience when we are near a loved one-- is spurred by memories, habits, and mental models. It is distinct, memorable, emotive, and difficult to recreate.

Presence is distinct from communication. Many couples speak fondly of activities that promote presence and shared experience over information exchange-- watching movies and shows, reading on the couch, falling asleep together. Filled with positive associations for loved ones, presence can be a calming force.

While constant communication transmits information and helps remind us of loved ones, it does not recreate presence. Texting with mom or video chatting with a significant other still isn't the same as sitting next to them at the dinner table. The realism and ubiquity of online communication is improving, but we continue to miss our loved ones.

The Internet of Things may provide us with new ways to reach out to loved ones, in the form of connected lamps, pillows, bracelets, rings, stuffed animals, and more. The success or failure of these devices will hinge on their ability to recognize the difference between communication and presence. When creating objects for distance relationships, designers will achieve greater success for both their products and their users by focusing on presence. Here, I overview the potential pitfalls of objects that attempt new forms of communication and a potential framework for refocusing these objects by recreating presence.


Communication Objects: Examples and Pitfalls

Families and couples note the importance of clear and unambiguous communication in supporting a relationship. This kind of communication can lapse when loved ones are separated, and modern interfaces sometimes underscore the tensions caused by ambiguity and misinterpretation. Who initiates calls? Who texts more often? Are you doing something else when you're on the phone? When and why do you call me?

Some connected interfaces provide us with new forms of communication for our loved ones. We can send light, sound, and haptics on command. Blogs hail these interfaces as innovative supports for long distance relationships and separated family members. However, when we send a flash of light, a particular sound, or a vibration on command, we are sending a signal with a recipient in mind. This is communication, and it is subject to the same tensions as texting and calling. ("I tapped my wristlet, but you didn't tap yours.")

In fact, communicating through these new interfaces may run a higher risk of increasing relationship tensions. We have developed tacit rules around the synchrony and asynchrony of phone calls, emails, and texts. However, there are no social guidelines for when and how to acknowledge a blinking lamp or vibrating wristlet. Remember: clear, unambiguous communication is important in maintaining relationships. Interfaces that present communication with no established rules run a higher risk of damaging the bonds they were built to reflect and maintain. In response to this challenge, many campaigns and products that began as communication objects have gone silent or pivoted to reduce ambiguity.


Presence Objects: Examples and Framework

Objects that focus on presence over communication have existed for years: wedding rings, gravestones, locks of hair. Presence can temper the anxiety and scorekeeping of modern communication, so an interface that recreates presence is ideal in helping separated loved ones feel closer. It also poses far less risk than one that introduces ambiguous communication. A presence object powered by the internet works with the same principles as presence objects in the unconnected world. Both recreate the presence of a person by strongly activating surrounding emotional memories.

Wedding and engagement rings, a classic unconnected presence object, outline presence by referencing habitual emotional memories with a comforting exterior. Like many presence objects, rings are a token for a particular memory and symbol of a relationship. As such, the timing of use, exterior, input, and output reference the missing loved one and the surrounding relationship.

The engagement or wedding ring uses a memory hook-- a strong, grounded emotional memory-- to recreate presence. Although over time the ring becomes a symbol for the marriage itself, the presence created early on is centered around the wedding or engagement event, a strongly grounded memory reinforced by emotion, storytelling, and social structure. In a mirror of the partner relationships they reference, rings have personalized exteriors, are often matched, and often worn continuously. They are unobtrusive and provide the memory hook in a natural, ambient way.

Increasing numbers of connected products are targeted at relationships, some of which promote presence over communication. These objects often have ambient inputs and outputs, and attempt to recreate presence by activating strongly associated memories. This framework is the same that is used in classic, non-electronic objects. Take, for example, this hypothetical system of connected pillows:

In the case outlined above, that memory hook used to recreate presence is the moment that the user falls asleep next to their partner. The moment is fairly easy to access, as it has been locked into the user's emotional memory through repetition and habit. Body heat is a strong sensory component of this moment, and it is used as an ambient output in this device. 

Other examples include Pillow Talk, which relays heartbeat between sleeping partners, and Patch of Sky, paired lamps that show the color of the sky in the location of a loved one. The memory hooks, habit, timing, inputs, and outputs of these objects can be charted and compared, as below:

These objects recreate ambient presence. They do not attempt to transmit communication of any kind. Given the dearth of presence objects and the wealth of communication methods, I believe that creating more presence objects will better support separated loved ones in the Internet-connected world. However, it is also possible to create hybrid objects if communication can be moved into recognizable channels with established social rules (see: Toymail) or channels oriented to later self-reflection or storytelling.

Going forward, I expect to see increasing numbers of connected objects targeted to paired relationships. Hopefully, this framework is useful in increasing presence in IoT to support family, friends, and significant others across the globe.