The Five Angels of the Reconstruction
(or: How a Bunch of Non-Doctors Will Save the World of Sleep Medicine as We Know It)
By David E McCarty, MD FAASM (…but you can call me Dave)
20 August 2025
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“Obstacles are those frightful things you see when you take your eyes off your goal.”
--often attributed to Henry Ford
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FIVE ANGELS TO SAVE US ALL
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Prologue: A Landscape in Ruin
Walk with me for a moment. Picture the world of Sleep Medicine as a great city once meant to shine—a place of promise, where weary wanderers might finally find rest.
But somewhere along the way, the boulevards cracked, the bridges crumbled, and the citizens were herded into separated silos with locked doors, each with its own language and set of norms…each silo seemingly unaware of—or perhaps even hostile to—the goings-on in other silos…
…patients coming and going in chaotic bouncing patterns…lost…trying to find their way…like some sort of hideous human pinball machine.
We see many seekers on the wayside…providers and patients alike…battered and bruised and broken…tossed to the side…”used up” by the machine of modern medicine…answers nowhere to be found, chaos all around.
…Cue scratching record sound effect as the gloomy music stops. Let’s talk!
What happened, Life Fans?
How did this thing we’re all experiencing called Health-Care turn into such a turbulent fragmented disconnected mess? Who’s to blame for this entity with no name, this problem we all suffer from, this malady that I’m calling in my mind Fragmented Healthcare Delivery Syndrome?
Somewhere along the line, our fair city lost track of the notion that people are not labels. That’s the first tragedy. The second tragedy is that our very healers find themselves hunkered down in ever deepening silos, unable to hear each other, unable to act together. The third tragedy is that everybody’s so busy putting out fires that nobody is talking about this.
That’s why I’m writing this essay. I wanted to talk about this!
Help is on the way, you see. I can see it!
In the distance, we see a glimmering light, and within that light: movement.
See, the story doesn’t end here, Life Fans! Out of the fog, into this fractured city, we see five unexpected guides—not physicians, not titans of sleep science, not pioneering capno-centric breathing physiologists--but thinkers and seers from other realms. They arrive like mythic allies, each carrying a distinct lens, each riding on a golden beam of light.
Together, they form what I’m calling the Five Angels of the Reconstruction.
So: let’s have a roll-call! Who is this Dream-Team, anyway? Ladies and gents, I give you: Mary Douglas, Jiddu Krishnamurti, Eckhart Tolle, Dave Snowden, and Stanley McChrystal.
The Five Angels of the Reconstruction.
And they just might save us all.
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Angel One: Mary Douglas – The Anthropologist of Boundaries
Mary Douglas, British anthropologist, wrote her canonical masterpiece Purity and Danger back in 1966, and it’s still considered foundational reading even sixty years later. It was that influential. On its surface, it’s about ritual cleanliness, pollution, and taboo. But if you listen carefully, Douglas is whispering to us something profound about what it is to be human.
Human beings, everywhere, cannot stop labeling. And this, it seems, is where all the fun begins!
Douglas showed that every culture, everywhere, creates systems of purity (that which is acceptable) and danger (that which is other). We divide the world into categories—clean/unclean, sacred/profane, in/out—not because reality demands it, but because we crave the order it provides. It makes us feel safe. “Dirt,” she wrote, is just “matter out of place.”
And so it is, in medicine. The Apnea–Hypopnea Index (AHI) is a perfect Douglasian label: below five, you are “Normal.” Above five, you are “Abnormal.” At thirty, you are “Severe.”
Easy-peasy-mac-n-cheesy!
But life does not live in these tidy boxes. The tired schoolteacher with an AHI of 4.2 is no less exhausted for having scored below the threshold…and has no reason to investigate whether or not his sleep clinic scored RERAs, so has no context for what this labeling means. In our fragmented city, perhaps the system dubs him “Normal” and sends him on his way to find salvation elsewhere.
Douglas helps us see why this happens…and helps us make peace with it. Labels give us the illusion of control. They tame the relentless ambiguity. They protect clinicians from the terror of uncertainty. But labels also exclude. They blind. They cast suffering patients into the category of “Other,” in this case meaning “not worth further inquiry—not my job.”
Mary Douglas is the first Angel of the Reconstruction because she helps us understand the humanity behind this foundational root flaw--our endless love affair with labeling and categorization—and with this insight comes forgiveness, of ourselves and others, for our own siloed-thinking adventures.
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Angel Two: Jiddu Krishnamurti – The Seer of the Bird
If Douglas explains the why of labels, the late mystic speaker and writer Jiddu Krishnamurti explains the cost.
He told the story this way: “The moment you tell a child the name of a bird, the child will never see that bird again.”
In other words, once you call it a sparrow, it is no longer wings, song, and flight—it is just…a sparrow. A dead label. When we see it out of the corner of our eyes, we might not even look at it again—it’s just a sparrow…we might passively think…I’ve seen one, seen ‘em all…
This is the tyranny of labels. It’s what happens when the sleep study returns “AHI 4.2: Normal.” The patient’s fatigue, their daily suffering, their broken dreams—vanish behind the word “Normal.” The bird is gone.
Krishnamurti warns us that every label kills a little bit of lived reality. His voice is vital here because he reminds us that what’s lost in translation is not trivial—it’s everything.
Jiddu Krishnamurti is the second Angel of the Reconstruction because he holds up the mirror: our patients are the birds we’ve stopped seeing.
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Angel Three: Eckhart Tolle – The Sage of Presence
If Douglas showed us the trap & Krishnamurti showed us the loss, enter Eckhart Tolle to remind us of the way back.
In his best-selling breakthrough guide to spiritual enlightenment The Power of Now, Tolle speaks of the mind as a tyrant—always abstracting, analyzing, labeling…acting very Purity & Danger-like if you want to get right down to it! But beneath the noise of thought is something more profound: Presence. What he calls the Power of Now.
Presence is the art of meeting the world without the burden of categories, without the narrative of past and the anxiety of things to come. It is to dwell in the immediacy of breath, heartbeat, awareness. It is to feel the creative vibration of life as it unfolds.
Applied to Sleep Medicine, Tolle’s wisdom is a revolution. It means that when a patient sits across from us, our first duty is not to tally their indices and to tell them what to do… but to be with them—to listen, to feel the Now of their exhaustion, to let their personal narrative breathe, to help them discover their way forward.
He reminds us that healing begins not with labels, but with presence.
Eckhart Tolle is the third Angel of the Reconstruction because he restores our orientation: the cure is not always to be found in the abstractions of the mind, but sometimes in the receptive heart of the moment.
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Angel Four: Dave Snowden – The Cartographer of Complexity
Enter Dave Snowden, the Welsh Complexity-Sensemaking researcher who gave the world the Cynefin Framework. Cynefin (a Welsh word meaning “habitat” or “place of multiple belongings”) is a compass for decision-making. It maps the world we navigate into five domains, and each domain requires a different set of navigational skills. In Snowden’s world, the five navigational spaces are: Clear, Complicated, Complex, Chaotic, and Confusion. Let’s get into it!
In the Clear domain, problems are simple—like recipes, or self-managing an uncomplicated ankle sprain. In the Complicated domain, problems are solvable by experts, like flying a 747 airplane, or sewing up a difficult laceration.
But the Complex domain is different: cause and effect can only be known in retrospect. Patterns emerge, but you cannot predict them. The only way forward is to probe, sense, and respond. It’s an investigational effort, requiring real-time discovery.
Sound familiar? That’s Sleep Medicine, with a cherry on top.
The beast we all walk around calling Sleep Apnea lives deep in the Complex forest. Each case may have different mixtures of obstructive vs central apnea physiology. Each flavor of Sleep Apnea (OSA & CSA) has many moving parts. Moreover, Sleep and Wake may be disrupted by a million and one other sources—there may be trauma, circadian misalignment, polypharmacy, comorbidities, social stress, medical challenges, more than one primary sleep diagnosis…even beyond the Apnea, it would seem, there are many moving parts!
Snowden’s work gives us permission to say:
OF COURSE CPAP is not a one-size-fits-all answer!
OF COURSE the AHI is not sufficient to capture the whole shootin’ match!
OF COURSE the patient has to be part of the decision-making team!
Make no mistake, Life-Fans!...Sleep Medicine is not Clear, not Complicated—it is COMPLEX! And Complex problems require different tools, investigational tools of co-discovery, safe-to-fail experiments, narrative sense-making, scaffolds for curiosity.
This is exactly what the Five Finger Approach and Five Reasons to Treat are: tools that enstructure curiosity without collapsing mystery.
Dave Snowden is the fourth Angel of the Reconstruction because he gives us the map to navigate the forest.
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Angel Five: Stanley McChrystal – The General who Teaches Teamwork
Finally, we meet Stanley McChrystal, the fabled U.S. Army General who led the Joint Special Operations Task Force Command in Iraq in the early 2000’s, and helped defeat a very slippery enemy called Abu Musab al-Zarqawi. At the beginning, McChrystal faced a major problem: his force was highly trained, hierarchical, siloed—and it kept losing to their adversary-- al-Qaeda in Iraq—a team which was decentralized, adaptive, and fast.
McChrystal’s breakthrough was to create a Team of Teams: a networked organization built on shared consciousness (in other words: “we all understand this complexity the same way and we speak the same language”) and empowered execution (in other words: field operators were the decision-makers). Silos were broken down. Information flowed laterally. Everyone had context; everyone could act.
If you think about it, here in the trenches of clinical Sleep Medicine, we could use a healthy shot of this potion! Our silos—sleep medicine specialists, airway focused dentistry, traditional oral appliance therapy providers, primary care, the patient’s personal lived experience—are locked towers. They don’t talk, don’t share, don’t listen. Patients fall between the cracks and often find themselves navigating our fragmented city alone, with no map.
McChrystal shows us that the answer is not to perfect the silos (he learned that complexity is always too big for one silo to handle), but to weave them into a living network, bound by shared consciousness and lateral connectivity, a method which aligns perfectly with our Crows Teaching Crows ethos: knowledge shared laterally, peers empowering peers.
General Stanley McChrystal is the fifth Angel of the Reconstruction because he shows us how to rebuild the team of medicine into a living organism of collaboration.
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Wonder-Quints Powers, ACTIVATE! (The Five Angels Together)
Five Angels. Each thinker, an icon in their own right. Put them together, and the pattern emerges:
Douglas – shows why we fragment.
Krishnamurti – shows what’s lost in the fragment.
Tolle – shows how to recover presence.
Snowden – shows how to navigate complexity.
McChrystal – shows how to rebuild collaboration.
They are five lenses, five compasses, five allies. Each alone is powerful, but together this team of Super-Friends offer the blueprint for what I call the Reconstruction—the rebuilding of Sleep Medicine not as a siloed machine, but as a living, adaptive, narrative-based network of healing.
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Epilogue: The Reconstruction Begins
And so, dear traveler, here we stand at our own Bay of Narrative. Our Five Angels have spoken. They have given us language, presence, compasses, and networks.
The task before us is not easy. We must resist the tyranny of labels. We must learn to “enstructure” curiosity without killing the bird. We must practice presence, probe complexity, and weave teams out of silos with a shared understanding for the complexity we face.
But the journey is worth it. Because at the end of the day, this is not just about Apnea. It is about the reconstruction of medicine itself—into something more humane, more humble, more whole.
And the irony—the sweet, delibulous irony—is that it took a bunch of non-doctors to show us how.
I dunno…
(cue Dad joke)
Feels like a story worth high-fiving about!
Kind mojo,
Dave
David E McCarty, MD FAASM
Longmont, Colorado
20 August 2025
Further Exploration:
Snowden, David J. “Sense Making in a Complex and Complicated World.” Emergence: Complexity & Organization 6, no. 1–2 (2004): 46–54.
Douglas, Mary. Purity and Danger: An Analysis of Concepts of Pollution and Taboo. London and New York: Routledge, 2002.
McChrystal, Stanley, with Tantum Collins, David Silverman, and Chris Fussell. Team of Teams: New Rules of Engagement for a Complex World. New York: Portfolio/Penguin, 2015.
Tolle, Eckhart. The Power of Now: A Guide to Spiritual Enlightenment. Vancouver, B.C.: Namaste Publishing; Novato, CA: New World Library, 2004.
McCarty, David E., and Ellen Stothard. Empowered Sleep Apnea: A Handbook for Patients and the People Who Care About Them. Pennsauken, NJ: BookBaby, 2022.