In Memoriam

I've had a hard time picturing an ECRI Institute without Dr. Nobel. He was such a force of nature and had his strong hands on so much of our operations. It's sensible to ask how we can figure a way forward without him. But among Dr. Nobel's many gifts I think that the most important was how he was able to impart his knowledge and wisdom, entrepreneurial spirit, and sense of purpose to so many individuals. That definitely applies to ECRI Institute. Visitors to ECRI Institute are often amazed at how many staff have worked here for decades. We're also proud of our many colleagues who have come back to the fold after working elsewhere. We stayed or returned because we believe in the amazing mission he started nearly 50 years ago. And, although we are sad that Dr. Nobel has passed away, we are so confident in what he has taught us over the years that we feel well prepared to carry on.

As I am winding down my final days as ACCE President, I feel honored to have represented ECRI Institute and, in effect, Joel Nobel in this role. The Clinical Engineering profession owes Dr. Nobel a huge debt of gratitude. He literally got us off the ground and has been our guide for nearly 50 years through the services he ran and provided at ECRI Institute. Just like the legacy that he left with ECRI Institute, ACCE's membership is filled with those who were influenced by and learned from Joel.

I am also very confident that ACCE has a strong future. A big part of that comes from what many of us in ACCE were taught by Joel. It's that we should do it for the patients, do it well, and do it with honesty and integrity. If you would like to learn more about Joel Nobel and his legacy, click here for an ECRI Institute tribute. ECRI Institute will be organizing a formal memorial event in Dr. Nobel's honor sometime during the fall of 2014. I'll be sure to keep the ACCE community informed about this and any other memorial-related activities.

Thanks for all you have done Joel. And thank you for your support, mentorship, and trust. You were one of a kind and will always be Clinical Engineering's icon!

I have to laugh to myself for the trust Joel placed in each of us as such young ages. In only a few years, many of us found ourselves presenting keynote speeches on his behalf at national and international scientific and medical sessions, and most of us had little more than a Bachelor's Degree and Dr. Nobel's say-so to back us up. As he sagely told me while calming my jitters before one of my first national debuts, "Just stick to what you know, Elliot, and don't let anyone draw you onto their turf. You know more about that product than anyone else in the nation, so stick to your guns."

I have to admit that Dr. Nobel was never easy to keep up with. He seemed to sleep but a couple of hours a night, and regardless of your medical, engineering, scientific, or legal specialty his habit of endless reading and his sharp, critical mind ensured that everyone needed to bring his or her "A-game" when you talked to him. Holidays and vacations seemed of little interest to him unless tied to a working mission or project, and the concept of retirement seemed unfathomable. Dr. Nobel never, ever sat still, and tracking him down around the globe was a challenge until the end! Not sure most of us would trade our own lives for his, but that was a choice that afforded him the constant cultural and scientific renewal and impact that made him tick.

I still hearken too many of the rules and explanations in that Employee Handbook, even though I've not been an employee at ECRI Institute for 25 years. Pearls like "a non-profit organization is not like most other corporations" as he tried to make it clear to everyone that ECRI's public mission and integrity took precedent over profit or rewards. Firm guidelines about spending funds as frugally as if they were your own personal money regardless of the situation, and incredibly restrictive conflict-of-interest and disclosure rules for each and every employee are today embedded in IRS and FDA guidelines and their peers around the world. I, and the non-profit organizations that I lead strive to live up to those requirements each and every day!

When I talked to Dr. Nobel as recently as last year, he had lost none of his missionary bravado, focus, or acuity, and his global treks were only limited by the wear and tear of travel. No country was too small, and no slice of society was unworthy of his time and attention. Unfortunately, though blessed with a brilliant mind and visionary perspective, his solid, stocky body turned out to be less robust than his intellect. Though I probably had close to a foot of height advantage over him, he was never less than a giant in my mind. I am sure that I won't be the only one to remember him that way, either!

You will certainly read of Dr. Nobel's accomplishments in the future, but I can tell you first hand that most of the accounts will be humble re-telling of a legacy that did -- and will continue to -- improve healthcare around the planet in remarkable and important ways. In the early days, half or more of the medical devices his engineers tested were at best mediocre, and many were a threat to life and/or limb. Today, though, most such testing reveals good-to-excellent products in the US market that are differentiated on features, price, and preference. That is quite an achievement, and it was won one year at a time relying on Dr. Nobel's commitment to "The Discipline of Science." and "The Integrity of Independence." That is the current marketing byline that the ECRI Institute that Joel founded, and it speaks volumes about the organizations ongoing mission.

Personally, few will know of Joel's wry humor and bent towards practical jokes, and few will know just how far he would go to help a younger engineer or physician develop a successful career. I owe him a huge debt of gratitude for his training, discipline, and visionary leadership, and can honestly help say that Dr. Nobel helped shape my career and life.

There are probably several other hundreds of my peers around the world -- younger and older -- who will have similar recollections and feelings, and I hope they all eventually say their piece. To me, early in my career Joel was like a second father, and leaving him and ECRI to expand my own career was not an easy decision for me to make in 1990, but he knew, too, that it was time for me to move on, and his friendship and support for me and many others proved to be unending. Farewell my dear friend. We will all miss you, but many of us will continue to do our best to honor you courage, vision, and insight. Honor and respect are due. Rest in peace, good Samurai, and soar joyously into the winds and in our memories for eternity.

ECRI went on to validate ambulances and the equipment carried in the ambulance. Many of today's standards (called KKK) for EMS equipment and vehicles were developed by ECRI and Dr. Noble reaching out to assure appropriate technology and patient care everywhere a patient was treated. Electrical safety testing, defibrillator, laser and ESU output testing, receptacle testing, medical gas testing and many other functions we do today he helped develop and standardize for our profession. Equipment databases as well as standardized descriptions, testing protocols, etc. were all developed by ECRI during hospital biomedical early years. Projects many of us work on today to properly manage technology from pre-purchase through surplus - technology management of medical devices - was developed and proven domestically and internationally under his guidance at ECRI. Work we do today to assure compatibility between medical devices, systems and facilities was something ECRI started educating biomeds about in the 1980's. Laser safety, operating room fires, the list goes on and on of work he directed and mentored at ECRI that is now practiced daily to improve patient safety.

The biomedical profession has lost some of our foundation with Dr. Joel Nobel's passing.

Joel was probably the first real genius I met...though there were unquestionably others on his team (who remembers Guy Knickerbocker?). As it is with so many great geniuses, I soon learned Joel had idiosyncrasies that would forever make him an icon and a legend. Many of my past and current ECRI friends will remember some (or most) of the following:

• always wearing OR "greens" and with his flak jacket serving as an overcoat...He didn't like to go out of the "lab" often and it was probably 2 years when he and I did a speaking engagement together and he was forced to wear a jacket and tie.
• equipping the company Toyota Cressida wagons with survival gear and supplies...complete with machetes
• conducting an interview from under his desk with a flummoxed job candidate (who didn't get the job)
• having telephones installed in the bathroom stalls
• driving around the office campus in his full sized farm tractor
• dropping in on orientation for a new group of technicians to give classic career advice (which though humorous now, I can't repeat)
• hiring a violinist during one holiday period to stroll up and down between our cubicles to play holiday music
• on one holiday giving each member of the staff a smoke alarm and on another, a fire extinguisher (practical gifts which left no doubt as to his concerns for our safety)

I will miss Joel. I will miss the idiosyncrasies that endeared him to us and the genius that inspired us. I loved him for all of it and I will be always be grateful to him for giving us the extended ECRI family...a family whose talent was synergistic and that continues to grow to this day.

Joel...you left this world a much, much better place. Who can aspire to more? Thank you and God speed.

Ironic, coincidence? I prefer to think of this evening's musings as a brief whiff of the spirit of God that in some way made me aware of the respect I owe to the invaluable encouragement to excel in finding the truth inculcated in me by my boss, Joel Nobel.

Joel said, "If you don't know the answer to a question, say that you don't know but you'll find out the answer." This and many more guiding principles have enriched my life.

The morning I returned to work after the funeral of my father in 1974, Joel sat beside me at my desk, offered his condolences and shared his thoughts on memories of the death of his father and the importance of persistent memory of those we love. Whenever I see a schefflera plant I think of the kindness of Joel and the ECRI crew who sent one to my mother as a token of their sympathy.

Joel was perceived by a few of us engineers at ECRI as a mentor. Over the years I have come to conclude, however, that mentors have a limited duration in that role. You take and apply the best of what a mentor has to offer. At some point down the road, however, you begin to question some of the perspectives, judgment, and guidance from the mentor. This is appropriate: you are learning. You further learn from observing the mentor's mistakes, as well as from your own mistakes. After about ten years though, if you are lucky enough to have had such an extended association, the mentor has largely run his or her course in that role and morphs into a peer sounding board and reviewer. Such was the case between Joel and me. I value tremendously my having known, worked, debated, played, and traveled with him.

I last spoke with Joel on July 1, 2014, to discuss a speaking invitation from Saudi Arabia. Since that time, just three weeks ago, I per chance encountered a first-hand historical anecdote about Joel's MAX Cart. While performing an accident investigation at a Delaware Valley area hospital I worked with the risk manager. She has been to ECRI many times for risk management society meetings. During my investigation she commented on the MAX Cart displayed in our lobby. She knew that Joel had invented it and asked about him. As a nurse in the late 1960s and early 1970s she stated that she had used it five times and successfully resuscitated all five patients. This is likely one of the few medical professionals who remember having used MAX. She commented that it functioned marvelously for resuscitation and quipped that she felt competent enough with MAX to give instructions on its use, if such training was still needed! I had meant to tell Joel about her experience and comments on the lives saved, but did not get the chance. I wish that I had.

In 2013, Joel received an extraordinary and touching email letter from the aging wife of physician who had been a medical resident at Pennsylvania Hospital with Joel in the mid 1960s. Joel shared the email with just a few of us. The woman had worked at the hospital at that time. She commented in her letter that of all the residents, Joel was "the only one that stuck with me because of your intentions to make it a better world for human beings." She went on saying "I remember your lunch time doodles of MAX and a rescue helicopter. You were so determined to use your life, heart, intellect, and talent to make a difference for humanity." Many other compliments and praises were in her email, including "So proud I am of you."

Joel indeed made a difference for humanity and he had much to be proud of. The world of healthcare is a demonstrably better and safer place because of him.

So, it has come to this. To Dr. Joel J. Nobel—I leave you with the opening of the First Aphorism of Hippocrates: "Life is short, and art long; the crisis fleeting; experience perilous, and decisions difficult." You experienced it all, sir.

Farewell, my friend.

Peace.

Like Joel, I was privileged to be a recipient of grant funding in the 1970s from the W.K. Kellogg Foundation to develop one of the shared service programs that played a part in the early years of clinical engineering. It was an interesting time to be in the business and it was exciting to be a part of that small group of Kellogg beneficiaries that became known as "the founding fathers". Although I suppose we were all peers, Joel's statesman-like manner always moved him to the head of the line. He was a natural leader as well as an excellent and very articulate spokesperson. For me, his most memorable contribution was the testimony he gave to the Senate Subcommittee on the proposed Medical Device Amendments of 1973 in which he completely blew away the possibility that the "microshock" phenomenon "invented" by Dr. Carl Walter and famously publicized by Ralph Nader in The Ladies Home Journal was a significant threat. He did that by testifying (in part) that:

"Bogus statistics on electrocution in hospitals have been proclaimed and republished without end – or confirmation – for five years. Many millions of words have been written about microshock and many millions of dollars spent to avoid it. It is obvious, however, that we still know nothing of its real incidence…."

This dramatic declaration marked the beginning of the end of that very important first period of overblown concern about electrical safety.

Joel was an ardent student of classical military strategies and one of his favorite stories was about the workaround that was used in his day by the surgical residents in the downtown Emergency Rooms in Philadelphia where a fair number of street gang casualties were received. They were not allowed to carry any kind of side arm, so - he would explain - they used to keep one or two bottles of saline on the shelf above each of the gurneys to provide them with some means of self-protection. Then, with his impish smile, he would add that - to keep the record straight - if they ever had to use one, they would enter into the patient's notes that 500ccs of saline had been administered supra-cranially.

It was my privilege to know Joel Nobel. He was an inspirational mentor and I will miss him. Thank you Joel! You made this world a better place.