# My story in brief:
I was apparently born in Jeanerette (Sugar City), Louisiana 
a week before Christmas 1949 the second son of a young Methodist minister, Raymond Elvin Pierson, from a chicken farm two miles out from Kinder, Louisiana and his wife, Martha Shull, from a hillside farm alongside a roadless creek outside of Mary, Kentucky.
37.661103,-83.5374863 Mary, Kentucky Mom's childhood home on Little Bloody Creek, near Mary, Kentucky BOUNDARY 36.5524308, -86.0666424 BOUNDARY 39.0569339, -80.4198559
30.51094, -92.85587 Grandma's Farm, 2 miles north of Kinder, LA Grandma's Farm, 2 miles north of Kinder, LA BOUNDARY 30.9678949, -89.9121094 BOUNDARY 30.9302063, -95.5151367
29.9191562,-91.6737999 Jeanerette, Louisiana Jeanerette, Louisiana BOUNDARY 29.9391679, -93.0541992 BOUNDARY hint
By my memory we were a happy family for the first five years or so, and later became an increasingly troubled family. I was a happy and curious kid who could always depend on his mother and who early on learned the joy and safety that can be found in books. My mother would take me every week to borrow as many books as was allowed from the small library in a corner of the basement of the court house in Crowley, Louisiana. Reading became my reliable escapism with side effects, with a delayed pay off. Reading became a parasympathetic place for healing and growth—removed from the trauma that was to consume the family.
I began earning pocket money in the fist grade. I began selling onions I planted in our garden and later added selling holiday and greeting cards door-to-door and later mowing yards.
Possibly the deciding moment in my life took place outside our kitchen door at 806 South Avenue H, in Crowley. My mother had promised me for almost a year that I could take swimming lessons at the local outdoor pool. The day I was to begin lessons my mother and father had an argument in my presence about my attending. My father said no, my mother said yes. He won. I had never seen them disagree before. I was eight or nine years old. The consequence of their disagreement was improbable, though I did not know it then. At that moment I simply saw that they were unreliable sources of truth—the people that I depended on without question were undependable. At that moment I understood that I was on my own when it comes to deciding what is true. I never looked back. I never accepted their authority again, ever. Nor anyone else’s. The insight and conclusion was simple and irrevocable and odd for an eight year old. It was not an act of willfulness or passion. It was the click of a mechanism—simple, obvious, and complete.
30.2047841,-92.3707877 Childhood Home Crowley, LA Childhood home in Crowley, LA
My interest in learning at school was stirred up by an elderly sixth grade teacher at Eastview Elementary School, in Connersville, Indiana. She simply listened. She showed an interest. Nothing more. Nothing more was needed. School was enjoyable from then on.
I began delivering newspapers in the early hours of the morning during my seventh grade year and continued until my senior year of highschool. This meant that I spent my Saturday mornings collecting from my customers.
Eighth grade science class in Evansville, Indiana sparked an interest that was supported by a teacher who seemed to have few interested students. High school was the usual mess caused by puberty and 2500 confined adolescents. In my junior year I became certified as a lifeguard, in spite of my poor ability as a swimmer. My parents moved to New Albany, Indiana the summer before my senior year in highschool and I happily stayed behind, living in the basement of the parsonage of my Dad’s replacement and working at Burnett Park Swimming Pool. I had met Larry Mackey in the eight grade when we moved to Evansville, Indiana. We were to become best friends. Larry was then and is still the smartest person I have ever met—really—math, science, sports, family—the whole ball of wax. I never saw him study in highschool. 4.0. He did study in college and graduate school. Got the best job in America for an analytical chemist, at Proctor and Gamble in their research facility. He has more patents than anyone in the history of P&G.
I was not that smart, but the reading paid off and I finally learned how to study in the last three weeks of my first semester at Indiana University, in Bloomington. I had begun university with a declared a major of English and intended to become a writer, but 1967 was a difficult year for the US.—Height Ashbury in San Francisco, Vietnam War, riots, students killed, universities shut down, including Indiana University. I was good at science. Medicine seemed a more reasonable profession as it seemed that we might soon find ourselves in a barter system and I was not confident that people would trade chickens for short stories.
I had several jobs to support my self, including selling encyclopedias door-to-door in Kentucky and Tennessee, a coat checker in the “largest student union in the world”, cleaning the stairwell and burning the trash in exchange for a 5’ by 12’ basement room next to the stairs, houseboy in a sorority—with my own large room, access to the kitchen and my dog Shagafur—a poodle who attended my first year of medical school with me, teaching chemistry, physiology and anatomy to undergraduates, summer jobs as labourer on pipelines in Washington and Alaska.
Premed courses, the study of medicine at Indiana University School of Medicine with internship and residency at Parkland Memorial Hospital in Dallas were intensely interesting. During the last two years of medical school in Indianapolis, I worked every 8th night in the largest ER in Indiana. I loved it—what fun. I did a residency in Internal Medicine as preparation for a career in Emergency Medicine. Summers, my final pipeline work was on the Alaskan Pipeline which paid off most of my school debt. In 1980 I moved to Bellingham Washington a week after Mt. St. Helens erupted. The drive up I-5 ruined the paint on my car.
The practice of Emergency Medicine in Bellingham for eight years was interesting and rewarding. I trained EMTs and Paramedics, bought a 40 foot sailboat, spent eight years learning the boat and how to sail, set off in the “Patriot II” for the South Pacific. From 1988 until 1992 I spent half of each year working and half the year sailing. This was a permanently cure from the American Dream of retirement. I had retired and it ain’t what it is cracked up to be.
Next, I want to go a little slower and a little deeper into a seminal event that occurred in 1987.
Kip Funkhouser died. I had never met him until the paramedics delivered him to the emergency department shortly after he drove his friend’s new high powered motorcycle off Chuckanut Drive into a large tree trunk at a high rate of speed. Driving Chuckanut I would look for the scared tree for years afterward. It has healed and cannot be found now. Kip was wide awake. Helmets work. But the first chest x-ray revealed bruises already forming in his lungs, along with multiple rib fractures. His pelvic x-ray looked like porcelain dropped onto cement. Either of these injuries carries a high mortality. In combination... I had called for a surgeon and anesthesiologist as soon as he arrived. The OR was prepared. Several large bore IVs started. Intubated with positive pressure ventilation. He survived three days—getting worse day by day. His highschool classmates came to see him every day. Several were in the emergency department shortly after he arrived.
At that time Trauma Systems were a new thing, organized in only a very few large cities. We needed one. There is a “golden hour” between massive injury and the operating room. If it takes longer than an hour, mortality increases dramatically. Small hospitals in small communities cannot keep a trauma team in the hospital waiting for the rare case. There are not enough surgeons for the metropolitan approach to work in small communities. We reinvented the trauma system so that it worked. It took three years from Kip’s death (as it turned out unpreventable even with a trauma system) until we had a functioning trauma system with trained staff, surgeons, and anesthesiologists. We created what I think was the first level 2 rural trauma system in the US. This thing we built from passion and enthusiasm saved many lives every year and still does. The Whatcom County’s trauma system should be dedicated to Kip Funkhauser.
These kinds of lived stories, peopled, and passioned with fears and hopes, raise in us possibilities for new and better worlds. Such stories can pull and push us repeatedly toward some overwhelming question, like Eliot’s Prufrock. But unlike Prufrock, we choose to act, definitively, against the odds and the embarrassment of inevitable failures which are only rites of passage.
This was another **turning point** in my life (after the others: library in Crowley Court House basement, parents disagreement on the back steps, 6th grade teacher, Larry’s friendship, riots in ‘67, selling encyclopedias, and now this—building a system from scratch that worked without me.)
From there we went on to create the fist community wide electronic medical record and secure intranet in the US—completed in 1995 before the World Wide Web. The first community-wide inclusive medical delivery system with a local insurance company, and one of the first community wide medical system improvement coalitions. All well and good. Interesting stuff. Intense. Then in 2001 Mary Minniti and I led one arm of a multi-year Robert Wood Johnson Foundation grant to “Redesign American Medicine.” Due to Mary’s leadership we invited patients to participate in all aspects of the program. This experience changed my life, my point of view, my point of reference. Until then I had seen the health system from the vantage point of an emergency department attached to a hospital. This is a powerful vantage point for understanding the medical system—the injury and illness system. It is not a useful position to understand the “patient’s” perspective and certainly not a useful position to understand the system of health and wellbeing. For the record, a weakened health system feeds the medical system with people who have become ill early or needlessly, making the medical system ever larger and more dominating. After this “Pursuing Perfection” program ended, I was given a year to design an innovation program for PeaceHealth. Naively, the CEO, Alan Yordy, required that the innovation center be self-funding in the start up year. It was like telling your heart or liver to get a job. I left PeaceHealth on good terms a year later, when Alan decided PeaceHealth did not need to innovate. (Mr. Yordy lost his job a few years later as the effects of his serial mistakes accumulated.)
I did need to enact a new design—a community-based system of innovation . I had to. My privilege had to be repaid. I had learned too much to pretend ignorance or to deny the potential. All that led to this book, and this life.
P.S. There are three wonderful daughters and a divorce in there as well, but those are other stories.