It was fascinating for five reasons:

Price

I like preventative health checkups, often called “executive health screening”, where they run every test and inspect every part of you. Hearing, vision, heart, blood, bones, lungs, skin, stomach, etc. EKGs on the treadmill, ultrasound inspecting your organs, X-rays, MRIs, whatever. They run you through all these tests in six hours, then specialists analyze the results.

15 years ago I did one in Bangkok for $500, but now that same package at the same hospital costs $1500. A similar one in Singapore was around $2000. Cleveland Clinic in Abu Dhabi, two years ago, was $5000. Last month in Bangalore? $80.

I needed neurosurgery to remove a schwannoma from behind my knee. It would cost $14,000 at home in New Zealand, but only $2000 at a top hospital in India.

Medications that cost $50 in New Zealand or $100 in America are only $2 in India. After my surgery, they prescribed a bunch of stuff to keep the pain and infection away. Fulfilled at a local pharmacy, everything all combined cost about $8.

Need a private consultation with a specialist - like a neurosurgeon or dermatologist or cardiologist? $10. You just tap an appointment in their app, pay instantly with your phone, and that’s it. Which leads to the next point.

Speed

In New Zealand, my regular GP’s next availability is in six weeks, and to see a specialist takes three to six months.

At the Indian hospital, when I tried to book an appointment in advance, they were confused. “Just come in”, they said. I tried to explain that I’m coming from abroad for this major surgery and can’t stay for long, but their answer was the same. “Just come in.” So I flew there with no appointment.

The top specialists - some of the best in the world - are available within hours. I showed up at 7am and made appointments to see four specialists at 8, 9, 10, and 11.

Sometimes when meeting with one, like a spinal specialist, he’d refer me to another, like an oncologist, and I’d see him within 30 minutes.

One says I need an MRI, so within a couple hours I’m getting my MRI, then back the next morning for the specialist to review the results.

Skill

For this neurosurgery, I was kind of scared, wanting to make sure I picked the best surgeon. Assuming they’ve all had the best education and are working with the best equipment and facilities, how can I know who’s best?

I learned that what you want to see is volume. Who’s recently performed this procedure the most? And where you find those surgeons? At the busiest hospital!

We’re used to using price as an indicator of quality, so our instinct says that the $20,000 surgery in Switzerland is better than the $2000 surgery in India, but the rule of volume disagrees. Pick a popular hospital in a major Indian city, and you’ll be in the best hands.

After much research I chose Sakra World Hospital, but ended up at Manipal Hospital. Why?

Adaptive Systems

I love watching how they drive in India. It’s not orderly. But neither is water flowing in a stream. It flows around obstacles. Everything is opportunistic, selfishly taking the effective path, exploiting available gaps. It’s natural.

I made my appointments and showed up first thing in the morning at Sakra World Hospital for my full day of tests. But they said, “Our systems are down today. Come back another day.” So I took a taxi to nearby Manipal Hospital and did everything there instead. I never went back to Sakra.

When I arrived at Manipal, the coordinator said I can’t do it today. But then a different coordinator called my name, and I did everything that day, no problem.

Later that week, the surgeon scheduled my surgery for 6am. “6am? Wow!” “Yes. 6am. Bright and early.” “OK, doctor. See you tomorrow at 6am.” “Yes. 6am. OK. See you then.”

I showed up at 5am, checked in for the 6am surgery, changed into the gown, and waited. Nobody came. I asked a few times, but nobody knew where he was. After four hours of waiting, I walked out and made an appointment with a different surgeon, and that went great.

Many little things are like this, and it somehow all works. You flow around the obstacles.

Bangalore

They used to say it’s the Silicon Valley of India. But it’s so much more.

Mumbai and Delhi used to be the place to be, but now Bangalore is where it’s at. Artists, writers, scientists, hackers, painters. A creative, ambitious culture, on par with San Francisco, and nice weather too. It has that exponential energy that comes from the brightest minds being in one place.

The awful infrastructure is the only deterrent, otherwise everyone in India would be here.

But for me, it’s emotional. This is the place where I have the dearest friends.

Giddy Alicia, wry George, cranky Komal, calm Bindu, and swooning Karuna had me laughing to tears, over and over again, happier than I’ve been in years. We tease each other in that endearing way that old friends do, even though I haven’t known them that long.

Alicia and Komal cancelled their other plans, came to the hospital on my big surgery day, and sat by my bedside, chatting with me for seven hours. It was really meaningful.

I already have a local phone and bank account in Bangalore, and I’m planning on moving there as soon as I can.

I mention this at the end, because if it weren’t for my attachment to Bangalore, I probably would have chosen Medanta Medicity in Gurugram. But if you need healthcare, and you want to meet some great people, search the web for a list of top hospitals in Bangalore, and show up, ready to flow.

Oh and yeah, I’m fine and fully recovered and all is well.

Original at sive.rs/inflow

Apparently it was intriguing, because since then, it’s been my most frequently asked question: “How’s your house going?” I didn’t think this would interest total strangers, but enough people have asked, so here’s the story.

I hope you can apply it metaphorically to your own projects or life choices.

It starts with a maxim:

All buildings are predictions.
All predictions are wrong.

How do you build without predicting? Defer decisions. Start using what’s there. Discover actual needs.

When you catch yourself thinking “We’ll need this,” stop and say, “Let’s find out what we really need.”

A fabled example: They built a new park and argued about where to put the walkways. Around the edges? Through the middle? The winning answer:Open the park with no walkways. After a year, look where people have been walking. Find paths where the grass is worn away. Pave there. Don’t predict.

I’ve preached that idea for decades. Then a few years ago, I bought a piece of land for dirt cheap here in New Zealand - just 30 minutes away - and applied that idea to building a home for me and my son.

How do you build a home without predicting? By living in an unfurnished, unfinished place, adding only what you’ve proven you need or want.

It’s a fun philosophical experiment, testing what you really need.Especially when costs are high, it raises the bar on that word: “need”.

(Note: I will say “I” and “my”, but my teenage son was very involved in most of these decisions, and loves this place even more than I do.)

My land is an off-grid forest valley with a creek running through the middle.No buildings, no electricity or services. Just land. So I really started from scratch.

For two years, before building anything, we spent time there in all seasons, finding our favorite spots. We built a path through our forest. Twice, we came face-to-face with a wild boar.

I slept outside, so I know I need a roof, walls, and great insulation - about 4 by 8 meters. I bought a used, pre-made, well-insulated 4 by 8 cabin. Because they were on a clearance sale, I bought three more, so now we have four adjacent cabins for four purposes:

1. for sleeping

2. for me (where I spend most waking hours)

3. for him (where my son does whatever he wants)

4. for storage or future living.

I love the isolation of purposes. When I go into my cabin, it’s time to work. When we go into the sleeping cabin, it’s time for bed.

I slept on the floor, so I know I need a mattress and blankets. I bought a mattress and blankets and started living there.

I tried living without electricity, then planned on going solar-only, but I decided to get fast fiber internet. Since I was digging a trench for the fiber optic cables to run from the road to my house, it made sense to get electric service.

These ideas are from the book “How Buildings Learn” by Stewart Brand. For 20 years, it’s been a huge influence on my code, my life choices, and now on building my home. If you find this fascinating or crazy, go read that book.

It makes a powerful point about water:

“Water consumes wood, erodes masonry, corrodes metals, peels paint, and expands when it freezes. It warps, swells, discolors, rusts, loosens, mildews, and stinks. Houses deteriorate from the bathroom out.”

Heeding his warning, I made a rule of no water inside. Anything with water stays outside the cabins.

Outdoor showers, I’ve always loved, so now it’s all I’ve got. A simple hose shower that runs the water through a heater. Uncovered, so at night I shower while looking at the stars.

Outdoor kitchen, holding an umbrella while cooking in the rain, proved I needed a roof. Thin walls and a floating roof so the wind can circulate but keeps away the rain. Wonderful except in winter, but a few minutes of cold hands are worth it for no fumes or smoke in the home.

Outdoor bathroom, can I handle that? I tried peeing outside for a month and it was fine. I built the same structure as the kitchen. It’s actually really nice in there in a rainstorm. Got a composting toilet instead of flushing, which saves a lot of water.

Remember, my land is “off-grid” so I have no water supply, and no wastewater service. My only water source is collecting the rain from my roof.Gutters and tanks, and good water filtration. Later I added a reverse osmosis water filter for drinking.

Another nice thing about having the cabins, kitchen, and bathroom all separated, is that it keeps you going outside almost every hour. It snaps you out of your thoughts and into the real physical world of trees, birds, wind and weather. Every night at dusk, the owls start their beautiful “hoo-hoo ... hoo-hoo”.

This is a cold dark valley so I wanted a sauna for sanity, pleasure, and health.Glenn Auerbach from Sauna Times designed a great little two-person sauna for us. Now it’s my nightly ritual: Hot sauna, 82°C for 21 minutes, then shower, then bed. Coming straight from the sauna makes the outdoor shower more appealing on cold nights.

I hate hanging laundry, so I got a washer and dryer. But I’m happy to do dishes, so no dishwasher.

Do I need hot water in the sink? I went without it for a year, and found I never needed hot water - only cold or boiling. So instead of an expensive water heater, I keep a kettle by the sink for dishes and tea.

And no built-in appliances - only portable, for easy changes. I design for maintenance, not appearances, so all conduit and pipes are exposed. Nothing hidden. That said, I planted privacy bushes around the perimeter, since, y’know, I like to shower naked.

The story continues, but that’s enough. For each choice, like where to put lights, the process is:

1. Try to do without it. Stop here if possible.

2. Try a cheap portable fix, like a flashlight or lantern. Stop here if possible.

3. Test a simple flexible solution, easy to maintain and change.

We’ve been living here full-time for a year and it’s really ideal. It feels like custom tailored clothing. Instead of generic “one size fits all”, it’s a house that perfectly fits our unique preferences and values.

A neighbor came by for the first time and really hated it, getting all upset and yelling, saying I was crazy for not having his preferred comforts.

I love that this home feels wrong for others, and just right for us. (Kind of like my software and other life choices.)

It’s a fun ongoing experiment and reminder to challenge all predictions.

Original and comments: sive.rs/fit

You don’t really want to do it, but don’t know how to say so on the spot.

You avoid confrontation, and say OK.

You regret it, and later think of how your ideal eloquent self should have said no.

I felt the pain of this, over and over again. Then I finally figured out a solution that’s worked wonderfully for years.

I took an hour to write a really nice “no” in advance. Considerate, but decisive. Not too long, but not too short. Generalized and versatile for all situations.

I saved it on my computer and phone, to copy and paste. Now as soon as I get an unwelcome request? Tap-tap-tap. COPY-PASTE-SEND in three seconds, and it’s out of mind.

No anguish. No discomfort. No resentment. No procrastination.

It feels rude to reject so quickly, but I know this refusal is the kindest I could have written. Yet it took three seconds to send. And I can use it over and over again. Amazing.

A few people have written back saying it was the nicest “no” they’ve received.

Next: I memorized the gist of my text to use in-person.

It’s so handy in those high-pressure moments where someone is looking you in the eyes, asking you to do something, and awaiting your answer. No problem! You have it memorized and ready-to-go, even when unexpected. You can be kind but decisive on the spot.

I won’t post my text here, since it needs to be in your natural voice. But here’s my outline, in case it helps:

1. a clear “no” right away

2. gratitude, since I’m honored by my value implied in the ask

3. explanation that to stay focused on a bigger “yes”, I’m saying “no” to everything else

4. good wishes, and if my situation is temporary, an invitation to ask again next year

Four sentences is enough. Nobody wants verbosity here.

Original post: https://sive.rs/n0

But today I realized something more profound: Each of my biggest life-changing moments came from a single sentence deep inside a book.

#1 : Island by Aldous Huxley

This is a novel about a British man who shipwrecks on an island with an ideal culture. The natives are role models of mental and emotional health.

While rock climbing, someone says the instructor used to be her physics teacher. The British man is surprised, so she explains that in their culture, it’s healthy to switch jobs every two years, ideally to something the opposite of what you’ve been doing.

I was 22 years old, two years into a job. The first year, I learned so much, but the second year was just comfortable.

After reading that one sentence in this little novel, I quit, and that was the last time I ever had a job.

#2 : Doing Music and Nothing Else by Peter Knickles

I was 23 years old, trying to be a full-time musician in New York City, making an average of $100 per gig.

I went to a weekend seminar called “Doing Music and Nothing Else”. The workbook said there’s an organization, called the National Association of Campus Activities, that hires entertainers to come perform at universities, for $1000 to $5000 per gig.

I was determined to get into that scene, so I joined the organization, and spent a couple years working hard to crack it. I eventually mastered it, playing at 300 colleges around the country.

With the money from those shows, I bought a house.

#3 : Personal Development for Smart People by Steve Pavlina

200-something pages into this book, it said that to keep learning, we need to be surprised. For example, read books about subjects you know nothing about. Or ideally, it said, move to a place far away, very unlike home, so that you’ll be surprised every day.

This hit me hard. I was comfortable and successful, inside my expertise, and rarely surprised.

So in the name of learning and growth, I took the book’s advice to an extreme. I forced myself to leave America forever, to live around the world for the rest of my life.

#4 : How to Get Rich by Felix Dennis

As I was selling my company for $22 million, I saw this book in a book store, and read it for pure entertainment.

The author made millions pretty early, then spent another thirty years pursuing more and more, amassing $800 million. But he used himself as a cautionary tale. He had huge regrets. He said those decades of pursuing more only made him miserable, and if he could do it all over again, he would stop at $30 million, to spend the rest of his life planting trees and writing poetry.

I was at a crucial point. I was about to pursue the path of a serial tech entrepreneur, using the proceeds from my first sale to launch a bigger thing. But I respected his perspective, followed his advice, and haven’t worked for money since then.

----

I have more examples like this, but these are the biggest.

And this is why I read books carefully, all the way to the end, looking for another sentence that will change my life.

Original post: https://sive.rs/4s4b

Twenty years ago, I lived in Los Angeles. Talking with an old friend that’s still there, I said it’s the nicest place I’ve ever lived, and why. She said, “Oh wow. You haven’t been here in a while. It’s not like that anymore.” She said my description was like looking at an old photo from 1999.

Last year I went to China and loved it. So clean, polite, efficient, and all-around nice. A German friend said I’m crazy because “China is filthy, rude, noisy, and awful - with everyone spitting and pushing.” I asked when he was there, and he said 2002. Ah! But that place is long gone. It’s not like that anymore.

When someone speaks of a place, you have to ask, “When?” Geography is four-dimensional. You can’t know a place - only a place as it was at a time. Where is bound to when. Unless you are in a place right now, you can only speak of it in past-tense.

I was born in America, but the last year I lived there, George Bush was president. So I’m not from the current place, though it has the same name.

Like Doc stepping out of a time machine. “I’m from here, but not this here!”

I used to describe myself as American, but that’s becoming less true with time. I’m from the America of the 80s, 90s and early 2000s.

But that place is long gone. It’s not like that anymore.

Original post: sive.rs/4d

Wikipedia says a “netizen” is someone who actively contributes to the development of the internet, not for personal gain or profit, but to make the internet a better place.

I’ve been online since 1993. In 1993, the only way to connect a Mac to the internet (unless you were at a university) was to buy a big paper book on TCP/IP networking, to get the floppy disk inside the back cover that had the MacTCP drivers with SLIP and PPP, so you could connect a dial-up modem to your computer.

Imagine what kind of nerds go to that trouble. That’s who was on the internet in 1993.

It was an amazingly helpful place. We used the web, Usenet, FTP, and email mailing lists to share what we knew. All of this was plain text. Images didn’t really come until a year later.

I was running a recording studio at the time, and I couldn’t get my hardware to sync, so I posted my problem in a Usenet forum, and the next day a man from Trinidad taught me how to fix it.

In return, I shared what I had learned about how to copyright your songs, trademark your band name, and get gigs at universities. The U.S. copyright and trademark office was years away from putting their forms online, so I bought a flatbed scanner and scanned their paper forms, sharing them on my website. Wired magazine and many forums pointed to my website as a helpful resource for musicians, since it was the only place online to get these forms and instructions.

There was no advertising, and no talk of money. I met someone who said he wanted to make money online, and I tried to explain to him that that’s not what the internet is about. It’s a free helpful place where everyone contributes and benefits from others’ contributions.

I wasn’t naïve. I’m not trying to sound pure-of-heart. It really was the culture and vibe at that time.

Slowly the culture around me changed, so now it seems I need to explain my strange behavior — why I don’t monetize everything like everyone else. I’m just a product of my place and time. 1993 shaped how I think of the internet, and I’m keepin’ on in that original spirit.

Like picking up trash where you walk, even if the rest of the world is full of litter. You keep doing what you can to make things better.

Now my netizen contribution is to…

1. answer emails from about 10,000 people per year

2. run NowNowNow.com, and

3. keep sharing everything I can on my site.

Original at https://sive.rs/netizen

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Come back and review your journal often, so you can remind yourself of your decision, reasons, vision, and plan.

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