Is Your Heartbeat Off, or Blood Sugar High? On the Road, You Can Keep Track

A new batch of apps and pocket-size medical devices that work with a smartphone or smartwatch are changing travel for people with serious medical conditions.

The devices allow people with heart conditions, diabetes and epilepsy to discreetly check up on themselves in airport terminals, in train or bus stations, in hotels or even as they travel, sending out information and alerts to doctors and caregivers. In effect, they are helping to create a virtual support and safety net.

A device is helping cardiac patients like Nicholas LiVolsi, 40, a graphic designer who noticed several years ago that his heart kept beating irregularly after flights.

His cardiac electrophysiologist, Dr. Daniel Frisch of Thomas Jefferson University Hospital in Philadelphia, recommended an additional monitoring measure beyond the standard electrocardiogram (or EKG or ECG), which requires lying on an exam table and having electrodes stuck to his chest, arms and legs to obtain a dozen views of the heart. The device, KardiaMobile, developed by AliveCor using artificial intelligence and approved by the Food and Drug Administration, is a personal EKG monitor that looks like a pack of gum and has two sensors.

Patients place the $99 device close to their smartphone, rest their forearms on a flat surface and put two fingers of each hand on separate electrodes. It records a medical-grade EKG in 30 seconds, telling users whether they are in normal rhythm or atrial fibrillation, and stores the results as a PDF on the smartphone. It also allows users to add a note for their doctor. The results can be uploaded to the doctor by subscribing to a plan.

“You could use it anywhere,” Mr. LiVolsi said. “I always carry it with me when I’m away just in case I need it. It’s easy to use and puts all of my EKG readings on the cloud so Dr. Frisch can review them when needed.”

The device, he said, “gives me peace of mind.”

Dr. Frisch, who carries Kardia in his pocket for demonstrations, said it’s “very useful for me to see what a person’s heart rhythm is at the time of symptoms, or for people that have vague symptoms, to figure out what their heart is doing around those same time points.”

He said he also encouraged patients to contact him with questions or concerns after they read their own results. “Feedback is part of the deal with wearables, and it’s a new paradigm that we have to embrace,” he said.

The Apple Watch Series 4 also has F.D.A. clearance for both its irregular heart rhythm alert and its ECG, which operates with an electrical heart sensor. Users take an ECG by placing a finger on the digital crown for 30 seconds. Electrodes in the crown and in the back crystal work in concert. Afterward, a user can add symptoms and generate a PDF. But there’s no option to automatically send the result to a doctor.

Dr. Frisch said the quality of recordings from the Kardia and the latest Apple Watch were very similar and provide a single view of the heart that is “an approximation” of the standard EKG. But Kardia is coming out with a new device, the KardiaMobile 6L, which Dr. Frisch said would allow doctors to view the same heart rhythm from six different angles. Users rest the 6L on the bare skin of either their left knee or their ankle and hold it in place with two fingers for 30 seconds.

Diabetics, too, have new devices that can help them monitor their blood sugar.

“The most painful part of diabetes is the finger stick,” said Kathleen Weaver, 59, of Dallas, a dog owner and handler who trains beagles and travels frequently for competitions. She said she used to have to test her blood up to 10 times a day. Now she wears a Dexcom G6 continuous glucose monitor, which doesn’t require drawing blood.

Its sensor remains attached to the skin on her abdomen for up to 10 days, and she also uses an insulin pump. The Dexcom transmits glucose readings every five minutes, and connects wirelessly to a reader device or via an app to her smartphone and smartwatch and sends her alarms when her blood sugar goes high or low.

She said the biggest advantage of the Dexcom was not having to “let blood every time you need to go check the numbers, and then it does check the numbers a lot more often.”

Since her medical devices are hidden beneath her clothing, Ms. Weaver said, she can be discreet when she wants to know her number. “I can say, ‘Hey, Siri, what’s my blood sugar?’”

Her endocrinologist can see the data stored in the cloud to determine how much insulin she should have throughout the day. Her insulin pump has to be programmed manually. When traveling, Ms. Weaver said, she uses an app to message her doctor.

Dr. Bithika Thompson, the director of the diabetes program at the Mayo Clinic in Arizona, said the F.D.A.-approved wearable monitors — including the continuous glucose monitors and flash monitors like Abbott’s Freestyle Libre, a 14-day sensor worn on the upper arm that can be read by a reader or smartphone — had “revolutionized diabetes care.” They make it easier for patients, especially those who are insulin dependent, to measure what’s happening with their blood sugar — where it is at the moment and where it’s going.

“It allows for better blood-sugar control because you just have so much more information for which to make the decisions,” Dr. Thompson said.

Wearable devices like the Apple Watch contain motion sensors (including an accelerometer and gyroscope) and have GPS capabilities that can provide a person’s coordinates to emergency responders. Apps developed by medical researchers to help travelers manage medical conditions gather this data along with heart rate measurements.

Mary Kate O’Donnell, 29, who has lived with epilepsy for more than a decade, said she worried that the stress of flying would cause a seizure on a plane.

“No matter how frequently I fly, I have this intense fear of trusting two complete strangers with my safety and simply hoping for the best, which can then cause a seizure during the flight,” she said.

Ms. O’Donnell, who lives in Manchester, Conn., has been using EpiWatch, an Apple Watch app developed by Johns Hopkins Medicine as part of a continuing study to help patients detect and track their seizures, missed medications and other triggers. When a seizure is imminent, patients participate in responsiveness tests and then complete brief surveys afterward. Seizures are logged as they occur so doctors can review them later. And participants can set the app to automatically contact a designated caregiver when they initially report a seizure or if they fail to respond to an alert from the seizure detector.

The goal of the app is to help patients gain more control of their seizures and their lives, said Dr. Nathan Crone, a neurologist at the Johns Hopkins Comprehensive Epilepsy Center who created the app with a colleague, Dr. Gregory Krauss. Dr. Crone said he hoped the project would “allow people with epilepsy to privately and discreetly share more detailed information about their condition with their doctors so that treatment decisions can be made more quickly.”

Ms. O’Donnell said that when she felt the onset of an aura, which can be an unusual feeling or movement that might be a harbinger of a seizure, she checked her heart rate on the Apple Watch. The higher her rate, the closer she is to having a seizure.

“When I feel my wrist buzz, I know I need to find somewhere to lay down and someone I can tell that will understand,” Ms. O’Donnell said. “If not, the app will text my emergency contact for me. That is my solace.”


Letter of Recommendation: Bird Feeders

If I had been toeing the mire before the trip, the darkness threw me over the edge. Over the next few days, as I began a free fall into despair, I was surprised to find a quiet comfort in the birds flitting about my friend’s window. Suddenly, I grew envious of his yard, a seeming prerequisite for a feeder. Then it occurred to me: I am not the first apartment dweller with this predicament. I opened Amazon, where I’d been browsing for light-therapy lamps, and discovered feeders that could be attached to our apartment windows with suction cups. “I bought myself a Christmas present,” I told my wife when I arrived at my in-laws’ house.

When we returned to Brooklyn, a house-shaped plexiglass feeder and four pounds of Deluxe Treat birdseed were waiting. We thought the birds would find the feed in a day, maybe two. One month later, the feeder was still untouched. I visited online forums thinking I might find a solution. Instead, I found guys from the upper Midwest swapping recipes for bird feed rendered from deer fat and peanut butter. (I stopped reading at “I don’t boil the deer fat; I hang the rib cage full of the scraps.”) Somewhere, though, I had heard to spread seeds around the feeder, so I placed a handful on the windowsill. Three days later, my wife texted me a picture of a blue jay. More soon appeared. So did sparrows, nuthatches, cardinals, mourning doves and a single red-bellied woodpecker. Within two weeks, I was ordering 20-pound bags of birdseed, Eastern Regional Blend, and filling the feeder’s trough daily.

Initially, it was the sheer novelty that caught my attention. My phone couldn’t compete with a woodpecker eating two feet away. Then I started to actually notice the birds, the peculiar rituals and particular charms of each species. I saw the nuthatches creeping down the window frame vertically, like awkward thieves, and dashing in for single sunflower seeds. The fat, insatiable mourning doves gorging themselves on white millet. The cardinals loitering shyly in the pear tree, waiting for them to finish.

The novelty has faded over time. But the beauty of the birds continues to draw my attention. In the tableau of blues gridded across the jay’s wing and tail, I see patterns of a Mondrian. More than once I have begun to scare away greedy doves only to stop short at the gleam of iridescent plumage. In these moments, and in the daily routine of filling the feeder with seed, I forgot my anxieties.


Electric Chargers for the Home Garage

Formula E racers used to swap out cars when their batteries were drained, but that’s hardly an answer for your daily commute.

And while additional high-tech roadside charging facilities will make electric driving more practical, it’s the availability of convenient home charging equipment that persuades many vehicle buyers to go electric.

“Home is the main charging location for most E.V. owners,” said Gil Tal, director of the Plug-In Hybrid and Electric Vehicle Research Center at the University of California, Davis. “Even in California, more than half of the E.V. owners are not using any out-of-home charging infrastructure. They are O.K. with just plugging in at home.”

Over 80 percent of electric vehicle owners charge at home, the Energy Department says, adding that “charging in a single-family home allows you to take advantage of low, stable residential electricity rates.”

Three methods of charging cars’ lithium-ion batteries are in use: Level 1, using a standard 110-volt outlet; Level 2, an upgrade to a 240-volt outlet; and DC fast-charging, which uses direct-current electricity. However, owing to the high cost and complexity of DC equipment, home use is typically kept to Levels 1 and 2.

Level 1 charging, with the plug-in cord that is standard on electric vehicles, can replenish the battery of some limited-range electrics and hybrids — like the Chevrolet Volt or Fiat 500e — overnight.

For cars with larger batteries, Level 1 is painfully slow. That category includes models with a range of over 200 miles, like the Chevrolet Bolt, the Nissan Leaf Plus, the Kia e-Niro, the Hyundai Kona Electric, the various Teslas, and most coming models. Charging a depleted battery for these would require days.

Level 2 devices, at 32 amps, can add about 25 miles of range per hour. Thus, a depleted 60-kilowatt-hour Bolt battery can typically be fully charged in 10 hours. A drained Tesla 100-kilowatt-hour battery will take about 14 hours.

Level 2 charging requires aftermarket equipment that operates on 240-volt AC household current, like some air-conditioners or other large appliances. A 32- to 40-amp charger sells for about $600, with feature-laden smart chargers topping $1,000. Portable chargers that provide about 16 amps of current are offered for less than $300, but as amperage and price go down, charging time goes up.

Level 2 chargers meant for outdoor installation are hard-wired to a 240-volt source. That will add $500 or more to the cost. Chargers for indoor use can be plugged into a 240-volt outlet. This might be the best choice for an owner with a 240-volt outlet in the garage, but installing one will cost about as much as hard-wiring a charger to the breaker box.

Most electric vehicle owners don’t drive over 200 miles on a normal day, so the battery isn’t fully drained by evening. In that case, refilling it on a Level 2 charger can take just a few hours. If the daily commute is only 20 miles and that mileage is rarely exceeded, the Level 1 plug-in might suffice, as would a portable 16-amp Level 2 charger. It gets easier if the office provides some charging stations.

Level 2 chargers for home installation are compact, and most have an 18- or 25-foot charging cord, so the vehicle doesn’t have to be parked next to the unit. More expensive Level 2 smart chargers can be switched on or off with a cellphone and programmed to charge when electricity rates are lowest, though many electric vehicles now come with firmware and apps that offer similar abilities with a basic charger.

Asked what improvements in home charging we might see in the years to come, Mr. Tal said Level 2 technology was reasonably mature. However, he does anticipate a market for chargers powered by solar panels that generate DC current, no complex inverters needed.


You’re Not Paying Attention, but You Really Should Be

Welcome to the Smarter Living newsletter! Every Monday, Tim Herrera emails readers with tips and advice for living a better, more fulfilling life. Sign up here to get it in your inbox.

I know, I know, we’ve all heard it before: Technology is making us blind to the world around us. In 2019 this is a well-worn cliché, an idea we lump in with “Back in my day” musings and “TV rots your brain” rants.

But really … it’s kind of true?

To wit: Earlier this year, The Times reported that the “time we spend on our smartphones is interfering with our sleep, self-esteem, relationships, memory, attention spans, creativity, productivity and problem-solving and decision-making skills.” Cool, great, good stuff.

I’ve always been one to extol the virtues of constant connectivity — in this very publication, no less! — but taking time for yourself away from everything to engage with the world around you is an invaluable, yet underused, way to cope with modern life. (If you’re unconvinced, read The Case for Doing Nothing, one of my favorite Smarter Living stories.)

O.K., you’re probably thinking, but how do we actually go about this? It’s one thing to believe that we all should slow down, but what are the practical steps to do that?

To find out, I called up Rob Walker, author of “The Art of Noticing.” In his book, Mr. Walker writes: “To stay eager, to connect, to find interest in the everyday, to notice what everybody else overlooks — these are vital skills and noble goals. They speak between looking and seeing, between hearing and listening, between accepting what the world presents and noticing what matters to you.”

Again, much easier said than done. So what can we overstimulated, under-focused navigators of the modern world do to notice better?

“On a deeper level, it’s just about trying to carve out and give yourself permission to have this time where you’re tuning into things, listening to your own curiosity and seeing where that leads you,” said Mr. Walker, who writes a workplace-advice column for Lifehacker. “We don’t have a lot of space for that in the culture now.”

He added: “If you’ve got a spare moment, someone wants it.”

Part of what plays into this issue is attention management. Everything around us demands our attention, so the way to fight back is to pay attention to what you care about, and to care about what you’re paying attention to, Mr. Walker said. Is it truly worth your time to obsess over feuding YouTube stars, or whatever is trending on Twitter? Maybe it is, maybe it’s not — but you should know the answer.

To be clear: This advice is not the same as advocating for an “unplugged lifestyle,” a silly idea that is an impractical solution to a practical problem. Rather, the point is to notice your surroundings, to be mindful of the world you’re navigating, and to give yourself permission to slow down and just … observe.

For example, Mr. Walker said one of his favorite ways to slow down and notice the world is the personal scavenger hunt. This is when, during a mundane errand or task, you spend time looking for something that no one wants you to look at. Headed to the store? Walk to every corner of the building and just see what you see. Off to the doctor? Stay off your phone in the waiting room and — in a non-creepy way, of course — notice the people around you. It’s these simple, low-stakes activities that can open up the world. The idea is that during these moments of intentional downtime, you’re focusing on what you are doing, rather than focusing on what you’re denying yourself. There will always be time to check Instagram, but how many chances will you get to observe and be mindful of the world?

[Like what you’re reading? Sign up here for the Smarter Living newsletter to get stories like this (and much more!) delivered straight to your inbox every Monday morning.]

Another of my favorite tactics Mr. Walker suggests: Record 10 metaphor-free observations about the world this week. This is deceptively simplistic: Who couldn’t look at 10 things this week and write them down? The trick is the no metaphors hook. You’re just noticing, not comparing, analyzing or referencing. You’re forced to slow down and truly contemplate the world around you, rather than passively breezing through it.

Remember: It’s looking vs. seeing. Hearing vs. listening. Accepting what the world presents vs. noticing what matters to you.

“There’s nothing more important than the stuff you notice that no one else does,” Mr. Walker said. “That’s where every single innovation begins; that’s where all creativity begins. It’s honoring what you notice, what you tune into and what you care about.”

How do you slow down to take in the world? Tell me on Twitter @timherrera.

Have a great week!

— Tim

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Tip of the Week

This week I’ve invited Anna Codrea-Rado, a writer and the founder of FJ&Co, an organization that supports freelance journalists, to give us some tips on working from home with a spouse.

Pardon the humblebrag, but my partner and I are the poster couple for the future of work.

I’m a full-time freelancer and he’s a remote worker. When I tell people we work from home together, they usually wonder how that works. I wonder how sharing an office desk with a stranger works, but hey.

Unlike other homeworkers who find themselves battling loneliness, our challenge is sharing the home office in a way that’s both productive and healthy for our relationship.

The secret is being as unprofessional as possible. We use the fact that we’re a couple, rather than co-workers, to our advantage.

Unlike bosses who come over to my desk to ask me something at the worst possible moment, I can tell my spouse where to go when he interrupts me.

Being unprofessional also means there’s no need to grandfather in the worst aspects of office culture at home. There are no sad salads in our house: We take lunch breaks seriously, and take turns making home-cooked meals.

There is one area where we do have to be hyper-professional, however. We always check if the other person is in a virtual meeting. You do not want to accidentally make a cameo on a video conference in a compromised state of dress.


Opinion | Scaling Wokeback Mountain

The young lawmaker went further, implying that the speaker was putting the Squad in danger, asking why Pelosi would criticize them, “knowing the amount of death threats” and attention they get. Huh?

A.O.C. pulled back and said she wasn’t calling Pelosi a racist. But once you start that ball rolling, it’s hard to stop. (You know how topsy-turvy the fight is when the biggest defenders of Pelosi, who has endured being a caricature of extreme liberalism for decades, are Trump and the Wall Street Journal editorial board.)

The A.O.C. crew threw down the gauntlet in a recent opinion piece in The Washington Post by The Intercept’s Ryan Grim. He wrote that when Pelosi and other Democratic mandarins try to keep the image of the party centrist, they are crouching in “the defensive posture” they’ve been in since the Reagan revolution.

Corbin Trent, a spokesman for A.O.C. and co-founder of Justice Democrats, the progressive group that helped propel her, told Grim: “The greatest threat to mankind is the cowardice of the Democratic Party,” with the older generation “driven by fear” and “unable to lead.”

Message: Pelosi is past her prime.

Except she’s not.

And then there’s the real instigator, Saikat Chakrabarti, A.O.C.’s 33-year-old chief of staff, who co-founded Justice Democrats and Brand New Congress, both of which recruited progressives — including A.O.C. — to run against moderates in Democratic primaries. The former Silicon Valley Bernie Bro assumed he could apply Facebook’s mantra, “Move fast and break things,” to one of the oldest institutions in the country.

But Congress is not a place where you achieve radical progress — certainly not in divided government. It’s a place where you work at it and work at it and don’t get everything you want.

The progressives act as though anyone who dares disagree with them is bad. Not wrong, but bad, guilty of some human failing, some impurity that is a moral evil that justifies their venom.


Self-Segregation, School Pride, Classism: Sharing Your Memories of Busing

Peter Hornbein described the impact that busing had on his life as “profound.” He wrote: “I found and made friends from different races and backgrounds; yet I also observed acts of racism and nativism.”

The racism he witnessed was both covert and overt, but busing “opened my eyes to the impact of systemic racism,” added Mr. Hornbein, who is white and went to George Washington High School from 1968 to 1971.

Mr. Hornbein remembers a friend from elementary school who identified as Chicana. She “put me in my place in seventh grade when I boasted about how I was a third-generation Coloradan,” he wrote. “She noted that her family had been in Colorado since the time when Colorado was part of Mexico.” That same friend, he added, was taunted by other Chicano and Latin students who were bused in from other schools and who spoke Spanish when she did not.

“Through my interactions with my friends of color, I came to understand that, although we Jews had suffered because of racism, nativism, and anti-Semitism, we had become white,” Mr. Hornbein wrote. “We served an economic purpose in this country, but always had the ‘promise’ of assimilation. Other populations of color never had and still do not have the promise of assimilation; they are and will continue to be oppressed.”

Smith Elementary School (Denver)

Traci Hailpern, 47, attended Smith Elementary School from 1977 to 1980. She was a minority in her school, but not in the way one might think. For Ms. Hailpern, who is white, busing changed the way she saw the world. Here’s what she had to say:

“Despite the prevalence of nearby schools in my Denver neighborhood, I was bused across town for first through third grades. I remember overhearing my father complaining about this, but not understanding why. All I knew was that I loved my teachers and made a lot of new friends.

“It wasn’t until high school when I fully understood that I was a minority in my high school, and that’s what my father was so upset about. By this time, I was so fiercely loyal to the diverse set of friends I’d known since I was 6, that I found myself on defense, often arguing with my father about his misguided opinions. These racially-charged debates continued throughout my adult life until he passed, but I can’t help but think I made a difference in helping him see the world through the eyes of his blond-haired, blue-eyed minority daughter.


Why Wouldn’t My Doctor Tell Me What Treatment to Get?

I am hesitant to report him, because I am the one who reported him 20 years ago, and the blowback was terrible. Name Withheld

It’s awful but, alas, not at all surprising that you suffered as a result of reporting this man’s behavior 20 years ago. Fortunately, it hasn’t stopped you from recognizing that you may need to do something again. My impression is that colleagues and friends are often too embarrassed to undertake the hard task of trying to intervene with people who are dealing with alcohol and drug abuse. Like driving, medical practice is not best done under the influence. And in both cases, the consequences of our failure to intervene can be disastrous for third parties. But I think two issues need distinguishing here. If this doctor’s drinking problem puts his patients at risk, he needs to be reported to the state medical board. If you think that the patients are fine — as you evidently do — but that he’s a danger to himself and to others on the road, what’s needed is an intervention by his family or friends. Given your history, that probably doesn’t mean you.

As a physician administrator, I have to manage physicians. Recently I had a conversation with a doctor who had been employed for many years by the health system I work in. He told me that our health system promised to market his practice, hire him partners and several other things that have not taken place because of market realities. These promises were made years ago, by other administrators, and in some cases when the health system was under different leadership. How dutybound am I to uphold others’ (sometimes unrealistic) promises? The commitments that this physician related were not part of any contract, just what he came away feeling that he was promised. Name Withheld

I can’t give you legal advice. But two things strike me. First, it would appear that, for years, this physician has been denied what he says he was promised and that, for years, he has stayed on the job despite this. Second, the promises were never formalized in writing. To be sure, that an agreement wasn’t written down doesn’t invalidate it, but you can wonder about how much weight to give his claims: Were these outright promises, or were they in the whiffier managerial realm of Things We Hope to Do? All you have is one man’s say-so.

Your own primary obligation is to the health system you help administer. An organization can certainly incur obligations that extend beyond the tenure of any particular manager. When someone’s expectations have an unclear basis, though, you can’t be obliged to compromise the organization in order to fulfill them. But here’s a thought: Maybe some of your colleague’s requests would be worth implementing. Could they have been promised to him because they would have been beneficial for the overall health system? Why not consider telling him that you’d need more evidence to act on those earlier offers, but that you’re always willing to work with him to develop his practice in ways that would be good for patients and the health system as well as for him? Looking forward is often more productive than looking back.


A Reckoning With the Wars He Has Known

Does Ackerman really think Abed’s grass-roots Syrian movement parallels the United States’ ocean-crossing, false-pretext invasion of Iraq? I doubt it, based on the other things he writes. And whose “democratic ideals” were at work in Iraq — American grunts’? Decision makers’? Ackerman doesn’t clarify.

Mostly, though, he deftly evokes resonances and contrasts. As Syrians process their war, he processes his. He seeks out old comforts to recapture a sense of safety (in his case, skateboarding). He metabolizes death differently when he first witnesses it as a parent, “with the same eyes that looked at my daughter.” He recalls shaving his beard after combat to reveal a self both new and old, like a rebel fighter I once saw leaving Syria with a tanned face and a pale, newly exposed chin.

He meets a self-described jihadi, Abu Hassar, who fought Americans like him in Iraq. Across the language barrier, they pore over a map of Iraq, tracing “places and names” they both know: Haditha, Hit, Falluja. They share, as does Abed, the irreplaceably intense feeling — through the ups and downs of what began as a greater enterprise — that you would do anything for your comrades.

Like a trail of bread crumbs pointing to a destination it doesn’t quite reach, Ackerman’s account offers clues to the complex relation between his wars and Syria’s. It’s not just that his Iraq mission was ill conceived and, unlike Abed’s homegrown revolution, a foreign adventure. The Iraq war was precisely the reason the United States had such a poor hand to play in Syria, and the American “wake of destruction” set the stage for the Islamic State’s takeover of swaths of Iraq and Syria.

But Ackerman’s business is “show, don’t tell”; rather than declare these points, he reveals some in snatches of conversation. He tells the jihadi the Iraq war was “a bad idea,” though he felt compelled to join. As President Obama weighed striking Syrian government forces after a 2013 chemical attack, a veteran tells Ackerman that if Marines were sent to Syria, he’d protest the way John Kerry did over Vietnam, but “on the other hand, someone’s got to stop what’s going on over there.” Ackerman touches on Iraq hangover as a factor holding Obama back.

A year later, when the Islamic State takes over Falluja and veterans ask, “Was it all a waste?,” Ackerman can’t engage his emotions. “Instead,” he writes, “a memory”: gearing up for Falluja, the stillness inside the armored vehicle, and then, “the back ramp drops.” He is in combat, as if it were today.

This episode, the defining horror and high point of his life, is detailed again in the last chapter, a recognition that it can’t really be integrated into narrative or analysis. He interrupts the orderly official praise of his Silver Star citation with his chaotic impressions at each moment: memories of comrades who died, he believes, in his place; the strangeness of enemy fighters up close; the admission, startling from a Marine, that “when we killed them it felt like murder.” We are left with the puzzle of how he and others — Americans, Syrians, Iraqis — can function, sometimes heroically, amid such terror.


How the Department of Defense Bankrolled Silicon Valley

These same factors prevailed at other aspiring tech hubs, notably Route 128 outside Boston, which housed several iconic firms, including Wang and Polaroid. Yet California eventually bested Route 128, and not just because the state had a clear edge when it came to winter weather.

The sources of its success, O’Mara contends, had to do with a host of regulations and legal decisions that governed how firms in the Valley did business. Foremost among these was California’s longstanding prohibition on noncompete clauses. This made it easy for employees to job-hop and share news of the latest innovations without fear of reprisal or recrimination. The turnover was staggering at Valley start-ups compared with established corporations such as I.B.M. on the other side of the country. But the creativity unleashed in the process left other regions far behind.

No less important was the passage of the Immigration and Naturalization Act of 1965, which unexpectedly led to an influx of newcomers, many of them skilled in the technical fields that are Silicon Valley’s bread and butter. Between 1995 and 2005, more than half the founders of companies in the Valley were born outside the United States.

But this was a later development. At first, Silicon Valley was the province of white guys in white shirts and crew cuts working for defense contractors and chip makers. They created what O’Mara memorably describes as a “profanity-laced, chain-smoking, hard-drinking hybrid of locker room, Marine barracks and scientific lab.” These men happily voted Republican, and had little interest in California’s counterculture, much less its increasingly visible feminist movement. As O’Mara notes, Silicon Valley’s gender imbalance dates back to a time when “girls and electronics didn’t mix.”

This is one of O’Mara’s strongest narrative threads: the casual misogyny that has defined Silicon Valley from past to present. She manages to bring the few women who did succeed to the forefront, most notably the programmer and entrepreneur Ann Hardy, who battled systemic sexism even as she wrote the code for many of the first computer time-sharing and networking applications built by the company known as Tymshare.

Men otherwise rule O’Mara’s book, even if, as the 1970s arrived, they increasingly came from the ranks of the phone phreaks and “longhairs.” They included Nolan Bushnell, the charismatic founder of Atari, whose band of merry nerd-bros smoked weed and made game controls shaped like breasts; the “Steves” — Wozniak and Jobs — whom one early capitalist, appalled by their lack of hygiene, described as “renegades from the human race”; and Jim Warren, the math professor and impresario who founded the West Coast Computer Faire in 1977 and published the influential, if offbeat, publication known as “Dr. Dobb’s Journal of Computer Calisthenics and Orthodontia.”


A Balkans Cycling Trip: Great Scenery! Ice-Cold Beer! And Bats and Land Mines?

My four friends and I rolled our bikes to a bar one sunny afternoon near the town of Zitomislici on the banks of the emerald green Neretva River in rural Bosnia. We stopped at Neretvansky Gusar, as the bar is called, to restock our water supply. There was only one problem: “I only have ice-cold beer,” apologized the longhaired proprietor, Nikola Bevanda, who prefers the nickname “Svabo,” slang for “The German.”

We looked at each other, and simultaneously dropped our bikes. A few minutes later, cans of cold beer in front of us on the outdoor picnic table, Svabo appeared, a half-empty bottle of off-brand Canadian whisky in hand, and the impromptu party was officially on. “It’s all rock ‘n’ roll,” he said. “That’s my life’s motto.”

Little did we know at the time that “rock ‘n’ roll” would be our motto, too — only much more literally — for this bike ride. It was the beginning of a three-day, two-wheeled journey through Bosnia. My four friends and I were pedaling the Ciro Trail, a two-year-old bike path that follows an old railway line from Mostar in Bosnia and Herzegovina to Dubrovnik in Croatia. When I’d heard the 100-mile trail is flanked by fields still littered with land mines, past abandoned villages, lifeless since the Balkan conflict of the early 1990s, and old railway stations, some of which have been converted to hotels and restaurants, I knew I had to do it.

The combination of recent history and Bosnia’s stunning natural beauty was appealing. As I told people about the upcoming trip, some friends were so intrigued they invited themselves along: Kim Barker, a reporter for The New York Times; Caroline Trefler, a guidebook editor; and the brothers Vedran and Darko Perojevic, owners and chefs of the Dubrovnik restaurant Azur. Ms. Barker and Ms. Trefler arrived fully prepared for the ride with proper equipment. The brothers Perojevic, having lugged fold-up electric bikes to Mostar for the ride, were decidedly less so. And I, the organizer of the trip, could have packed more than a few T-shirts, a baseball cap and swimming trunks. One aspect that helped, though, is that Ms. Barker, Ms. Trefler and I rented bikes from the Dubrovnik-based tour operator, Epic Croatia, which offers reasonably priced mountain bike rentals and a transfer (with the bikes) to Mostar so we could do the trail just one way.

And so here we were, one hour into the ride, and already off the bikes, imbibing Svabo’s ice-cold beer and taking turns wading into the cold Neretva River. It may have appeared counterproductive, but not racing through the trail was the point of it: We’d hop off the bikes when the spirit, or a beer-selling bar owner, inspired us to do so.

After a tour of the interior of the bar — the walls were crammed with a seemingly incongruent set of images of everyone from Jimi Hendrix to Marilyn Monroe to the Virgin Mary to the famously mustachioed Croatian crooner Miso Kovac — we were ready to recommence the bike ride. As we rode off, Svabo yelled, “Remember: it’s all rock ‘n’ roll.”

We were cruising through the town of Surmanci when we hit the brakes for an outdoor market. We were about four miles from the town of Medjugorje, where in 1981 six children claimed to have had a vision of the Virgin Mary, and the town has since been a major stop on the pilgrimage route. Surmanci was close enough to the holy village to get into the act of selling pilgrimage souvenirs. Women called to us to part with our money for beaded bracelets, images of the Virgin, and wooden crosses. “Lady!” they yelled repeatedly at our female companions. “Lady!” Kim bought a few knickknacks to give to friends back home. And she also acquired the nickname “Lady” for the rest of the trip.

After sleeping in the comfortable but no-frills Motel Jelcic in the unremarkable town of Capljina that night, we began day two by pedaling past sleepy villages and across rusty iron-lattice train bridges. The path would often gently curve along a mountainside, revealing its former self as a train line.

The first train chugged out of Dubrovnik toward Mostar on July 15, 1901 to great fanfare. Dignitaries from the Austro-Hungarian Empire, rulers of this domain at the time, as well as officials from Dubrovnik, Mostar and other cities, were seated in carriages as the train was met with cheering crowds in each small town and village. For the first time, parts of the interior of Bosnia and Herzegovina were no longer isolated. But in 1976, the rail line was deemed no longer financially feasible by the then-ruling Yugoslavian government and shut down.

These days it’s mostly foot-powered vehicles that chug along the trail, thanks to an effort by local bicycling clubs on both sides of the border to do something with this unused stretch of trail, and to help bring tourists to a part of Europe few outsiders see. About five miles into the day’s ride, we came to a fork. The signposts indicated we could take the easier paved route or power through the uphill gravel trail that directly follows the old rail line. We opted for the latter and were rewarded with views of Hutovo Blato, a 29-square-mile nature reserve that is mostly made up of marshland and tall, dark green, pyramid-shaped mountains, part of the Dinaric Alps. Pedaling mostly uphill and on tennis-ball-size chunks of white limestone was the “rock” portion to the previous day’s “roll.” It wasn’t easy but we stopped frequently to admire the surroundings.

At one point, we encountered 20-foot-tall walls of white limestone. Someone with a sense of humor had spray-painted on the stone “Beware of bloody vampires” in Bosnian. Vedran translated it and we all chuckled and shrugged. But then a few miles later, we got the “joke.” As we turned a corner, an ominous black passageway awaited us. Vedran and Darko led the way, pushing their bikes into the erstwhile train tunnel before completely disappearing into the blackness.

About halfway through the tunnel, still completely black save for Caroline’s flashlight, we began hearing a cacophony of high-pitched, squeaky, chirping noises. And it wasn’t our bicycles. We all paused. I could feel my heartbeat speeding up. What kind of army of creatures were awaiting us? Caroline pointed her flashlight up to the ceiling and we all screamed at the sight: hundreds of bats swirling just over our heads. We’d roused them from their sleep and they didn’t seem happy. Vedran was trying to play it cool, as we pushed our bikes faster through soft bat guano. My tire inadvertently rubbed against his calf and he let out a loud, panicked scream. We all laughed, lightening the mood. After we trudged through the 400-foot tunnel, we took a breather, relieved that none of us had been converted to vampires. Or so we hoped. Back on the bikes, we crossed the iron Stangerova Cuprija bridge.

There were nine more bat-filled train tunnels to go, but at least they offered a relief from the overwhelming heat. Any time clouds eclipsed the sun, offering a brief respite from its rays, it felt like an event. We encountered a German cyclist, fully decked out like he was on the Tour de France, going the opposite way, and our ragtag group peppered him with questions: How many more tunnels are there? When does the trail become paved again? And from Vedran: “When is the next place we can get beer?” The German looked at us a bit derisively and said, “About 25 more miles, I guess.”

A couple of hours (and those 25 miles) later, we cruised into Ravno and checked into our hotel, Stanica Ravno, a former railway station that opened as a hotel last year. The first thing we did, naturally, was plunk down at the outdoor restaurant and order a round of beers.

That night, our last in Bosnia before crossing the border, we feasted on grilled meat and sipped local wine at the hotel restaurant, happy our adventure with the bats was over. The following day we began by having coffee at Gostinica Zavala, a former train station that is now a restaurant. Inside was a black-and-white photo of the day the Ciro Train first pulled through the village of Zavala in 1901. The railway was flanked with hundreds of people cheering as the train chugged by. We cheered that the path in front of us was mostly paved and relatively flat.

Darko would occasionally stop to pick things off trees and plants on the side of the trail — sour cherries, hibiscus, mulberries, oregano — and offer it to us. A perk of traveling with a chef. We followed the long, gentle curve that stretched along the side of Popova Polje, one of the largest valleys in Bosnia. Here the road signs began to change from the Latin alphabet to the Cyrillic. We were now entering Republika Srpska, a quasi-autonomous strip of Bosnian-Serb land that was the result of a compromise that ended the Bosnian War at the Dayton Accords in 1995.

Just after passing through the village of Hum, a haunting hodgepodge of grazing cows and abandoned 19th-century buildings, many of which were in a state of disrepair (and where apparently about 10 people still reside), we began seeing ominous signs on the side of the trail brandished with a skull and crossbones and the word “MINE” written in Cyrillic. Then we came upon a group of guys, some wearing what looked like bulletproof jackets, standing around smoking and chatting. It turns out they were part of a Bosnian team from Norwegian People’s Aid, an N.G.O .that locates and defuses land mines.

The group’s leader, Nerven Stonic, said, “We’re trying to rid this area of land mines with the hope to open it up to tourism — making it better for people like you to ride through.” That’s when Vedran asked if they had any water. “If we did,” Mr. Stonic said, “we’d certainly offer it to you.” Vedran responded, “How about an ice-cold beer?” Mr. Stonic laughed and said, “That would be great, but in our line of work, it would be seriously questionable if we drank alcohol on the job.”

The guys picked up their metal detectors and went back to work and we picked up our bikes and pedaled the last five or so miles before reaching the Bosnian-Croatian border. In the now-abandoned town of Uskopje, we went by the old railway station, now populated by cows. They watched us bike by, seemingly unfazed by our presence, and then, in the town of Ivanica, we reached the border, experiencing that odd feeling of being on a bike sandwiched between revving automobiles.

After a quick stamp of our passports, we coasted down a steep paved path that delivered us right into Gruz Harbor in Dubrovnik. We sailed past the former railway station, where the Ciro Train first made its inaugural journey, and right into the bar at the new craft brewery, The Dubrovnik Beer Company, where we had one last celebratory ice-cold beer. “It’s all rock ‘n’ roll,” we said, and clinked our pint glasses.