Invention favors the prepared mind

Bezzerides' hydration monitor

I used to think inventing was an act of sheer will, systematically working a problem. But after listening to one of our hospital investigators disclose an invention — a hydration monitor — I think the key quality is having a mind that’s able to receive.

Vassilios Bezzerides, a clinical fellow in the Cardiovascular Program at Children’s Hospital Boston, noticed during his daily routine that it’s often difficult to determine whether a patient is properly hydrated. Measuring electrolytes or other markers in blood or urine can provide a good gauge, but they involve cumbersome sample collection and can produce false alarms.  There’s also a quick noninvasive method: placing gentle pressure on the fingernail until it turns white, then timing how long it takes for the finger to regain color, indicating the capillary refill time. In a dehydrated patient, the color returns more slowly because capillary refill time is increased. But this test is crude and its interpretation highly subjective.

Late one night, Dr. Bezzerides was checking on a sleeping patient. Not wanting to disturb the patient by turning on the overhead light, he instead observed the color change in the patient’s finger using a tricolor LED flashlight. He noticed that the color in the finger was completely washed out by the white light — the finger seemed to disappear, but slowly reappeared as blood flowed back into the capillaries. He realized that one of the wavelengths making up the white LED was being absorbed, and that he might be able to image the capillary blood with a bedside tool that took advantage of this phenomenon. If he made a device that put pressure on the patient’s finger, then captured the reflection from appropriate wavelengths of light, maybe he could measure capillary refill time in a quantitative fashion, with an actual number readout.

On his kitchen table, he jury-rigged a prototype, testing it first on his own hand and demonstrated that it could effectively measure capillary refill time. He then performed a pilot study with a diverse population of children and showed that it can be used in a busy clinical environment, in children with all skin pigmentations.

His device will have applications not only in the hospital, but also at the bedsides of assisted living patients, and among athletes, who can measure their hydration on the go and optimize fluid intake during rigorous activity. Most importantly, this test could be used in developing countries with a high incidence of dehydration caused by gastrointestinal infections, especially among children. A hydration device could effectively triage patients, allowing limited staff to focus on those who need immediate attention.

What struck me about this story is how Dr. Bezzerides stumbled upon this profound idea as if by accident. There was an element of passivity involved. He was aware of the unmet need, but did not come up with a solution until a particular set of circumstances presented themselves.

It may seem easy or obvious, but it takes a great deal of skill to be a good receiver. If a catcher awaits the ball with a closed fist, even a perfectly aimed ball will bounce off his hand.

Receiving requires vulnerability and trust, traits that are not common and are difficult to assume. A good receiver hopes and trusts that the gift will come, without knowing when or how, maintaining a posture of readiness so that the gift will not pass by unnoticed If Dr. Bezzerides had been more cynical, less open, and his intellect less prepared, he might not have had a patent pending now.

I wonder what might be possible in my own life if I were willing to receive. There may be innovations all around me: maybe all I have to do is unclench my hand.  By practicing the art of receiving, maybe we can all be more innovative in what we do.