By Christopher Nemeth
Richard Irwin Cook was a software engineer, anesthesiologist, researcher, and thinker. None of those terms captures his character as fully as “radical.” Richard Cook was a radical in the truest sense of the word: going to the root of what concerned him. This led to a constructive discontent. He was impatient with quick fixes that were conceived and implemented without any understanding of the underlying problem. He disdained those who acted without understanding and those who acted to create the appearance of doing something responsive.
Faced with so many instances of this, he saw how absurd it was to funnel time, energy, and money into fruitless pursuits. The physical evidence of this was his lab door that was festooned with cartoons by Gary Larson. They included a particularly appropriate one in which the Devil is saying “C’mon, c’mon—It’s either one or the other,” while holding a pitchfork to the back of a sad soul considering two doors marked “Damned if you do” and “Damned if you don’t.”
Richard Cook could have chosen a more comfortable path and accepted an honorific title and adulation. Instead, he took the path of honesty, answering only to the toughest critic: himself. That required courage to stay the course, call out absurdity, and pursue what he knew was right.
He saw what others didn’t, even though the evidence was right in front of them. How information technology (IT) is a mismatch for clinical care, including simple infusion device interfaces that hide hundreds of states that no clinician could fathom. How patients who are less sick are bumped from an ICU bed for a sicker patient. How artefacts such as the resident sign-out sheet and Master Schedule for anaesthesia staff assignments could serve as a “way in” to gain a grounded understanding of that complex, emergent domain. How medical organizations perform as a system, and deal with adverse outcomes that insightful investigation can improve. How all sharp-end operator decisions are made under uncertainty and in effect are bets about the future that are based on their understanding of the current situation. How “technical work” influences the provision of care, even though it is widely dismissed as simply “the way we do things here.”
Richard was able to publish in some venues and those works endure. What we can take from his example is more of a challenge than it appears to be. Following his example requires his intellect, courage to call out absurdity, and to forsake the need for recognition.
In the seven years I was a member of his lab, every day was an adventure; quirky, revelatory, and never dull. His vision enabled me to sharpen my own and seek the root of what matters.