By David E McCarty MD FAASM (but you can call me Dave)

13 November 2025

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“A shared body of narrative forms a substrate for identity, ethics, and, yes, communication.” —Dave Snowden, Complexity Theorist

(2019, April 23). Patterns of Narrative. The Cynefin Co.
Retrieved from: https://thecynefin.co/the-patterns-of-narrative/

"The role of the leader is no longer to command but to create an ecosystem in which the team can thrive…it takes shared understanding to empower execution."
—Stanley McChrystal, General, US Army, Ret.

Team of Teams: New Rules of Engagement for a Complex World.
New York: Penguin, 2015.

“It’s kind of fun to do the impossible.”
—Walt Disney.

Quoted in: Barrier, J. Michael. The Animated Man: A Life of Walt Disney. University of California Press, 2007.

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The last time we chatted, it was from the vantage point of a memory framed in golden light—Disneyland 1976…

…and all the stuff that that place got right…

…a curated tour of an eighth birthday celebration at the Happiest Place on EarthTM serving as a springboard for discovery about what’s going on in our current healthcare environment pertinent to Sleep Medicine…a place my cartoonists’ brain keeps seeing as a nightmarish version of that memory…a place I called THE FRAGMENTIEST PLACE ON EARTH (TM).

Here in this strange place, we start to notice that the real suffering isn’t the long lines or the broken animatronics or the confusing signage, though all of that can grind a person down. The real suffering is harder to define… a sort of meta-suffering. It’s the ache that comes from not knowing how to move through a world that refuses to agree on the basics.

We speculated that our park has three foundational questions…three simple queries that should have been settled long ago, but somehow never were, because the answers evolved divergently.

What is Sleep Apnea? Why should we treat it? What else could this be?

That’s it. Three doors. Three lenses. Three entry points that might allow alignment to the same landscape.

And yet the entire clinical amusement park has never agreed on the answers—I’m lookin’ at you, AASM 4% AHI CPAP Slingers!…I see you, Airway Focused Dentists!!!…Finger guns and Jazz-Hands, AAO Orthodontists who don’t even believe they are participating in the production!

The park’s a mess not because any of us deliberately designed chaos. It’s a mess because no one ever stopped to build the common language required to make coherence possible. The fragmentation wasn’t intentional. It just accumulated, the way clutter accumulates when nobody claims ownership of the junk drawer. One day you pull it open, and it hits you: this is no longer a drawer. This is geological strata.

We’ve been living inside that drawer.

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Walt Disney envisioned his amusement park with a different instinct, a different goal, a different intention. He understood something about human experience that we, somehow, forgot. He believed that a park—any park—needed a unifying ethic. Something simple. Something binding. Something that cast a spell strong enough that families could wander freely without thinking, Is this safe? Who’s in charge? Does anyone here know what they’re doing?

He took four simple principles and put them everywhere—not as slogans or background decor but as operational ethics. He called them THE FOUR KEYS: Safety, Courtesy, Show, Efficiency. He baked them into the DNA of the place so deeply that even now, decades later, they still shape the visitor’s experience in a way that makes parents smile, children beam, and executives scratch their heads.

In Part II of this series, we discovered something humbling: Disney’s Four Keys weren’t just clever operational ideas for a theme park. They were mirrors of our own four principles of medical ethics: beneficence, non-maleficence, autonomy, justice. We saw that each of Disney’s KEYS maps to one or more of these ethical principles, depending on which aspect of the patient’s experience we were talking about.

I made the argument that Disney’s “Safety” Key--in a medical setting--maps to all four medical ethical principles at once! I’m quite certain we can have a solid discussion for each of the other keys, and I’m hoping to do so at some point.

My point here: once you see that alignment, you can’t unsee it. This is not just a neato sparkle on show-biz, something for theatre-kids and thespians. This is speaking to our very identity as healthcare providers. And that forces a reckoning: when our amusement park fragments…when the cardiologist says one thing and the dentist says another and the pulmonologist says something else…we don’t just confuse patients—we violate the very ethical principles we pledged to uphold. Our lingua franca falls apart.

Our park becomes hazardous.

Not intentionally. Not maliciously. But structurally. Culturally. Systemically.

The fragmentation itself becomes an ethical failure.

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Engineering Teamwork

In his groundbreaking book Team of Teams, Stan McChrystal taught us something essential about complexity: when you face a fast-moving, emergent threat, you need two things.

(1) A shared understanding of the system.

(2) Lateral connectivity with decentralized decision making.

Those were the ingredients that turned a failing organization into a functioning one during his experience commanding the Joint Special Operations Task Force in the early 2000’s, in their campaign against Al Qaida in Iraq. Not more rules. Not tighter control. Not a bigger manual. Just a common picture of the battlefield and a network of teams empowered to speak to one another in real time.

Through that lens, the vulnerability of our FRAGMENTIEST PLACE ON EARTH ™ becomes painfully obvious. We don’t have a shared picture of the system. We don’t have a common map of the amusement park. We don’t even have shared language. And without that, lateral connectivity collapses. Each land becomes its own micro-kingdom. Each specialist becomes their own narrator. Each patient becomes a pinball ricocheting between interpretations.

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What Would Walt Disney Do?

Our FRAGMENTIEST PLACE ON EARTH ™ doesn’t have to be that way. And, in truth, the tools for something better already exist.

Disney had Foundations Training and the Four Keys as a common language to the park. At Rebis, we are finding tremendous success with our common language of discovery: the two collaborative complexity co-discovery tools from the Empowered Sleep Apnea project--the Five Reasons to Treat, the Five Finger Approach.

These tools are practical, narrative-based, collaborative patient-centered complexity deconstruction-tools: lightweight, intuitive, communal, portable. Designed for lateral connectivity. Designed for field teams. Designed—just like Disney’s Four Keys—to restore coherence.

Taken together, these tools help flesh out the answer to the three foundational questions that unify the park.

What is Sleep Apnea? An empowered response is that the beast we all walk around calling “Sleep Apnea” is a complex and fluid combination of obstructive sleep apnea (OSA) and central sleep apnea (CSA). Both “flavors” of Sleep Apnea have “many moving parts” that must be individually unpacked for each patient. Because there are many moving parts, there is no “one size fits all” solution and a team approach is often beneficial…

Why should we treat it? An empowered response is that every patient must discover their own personal reasons that Sleep Apnea should be addressed…it helps to have a structured conversation…on the ISLE, there are Five Reasons to Treat to be explored…every patient must decide if their own Reasons are valid enough to justify action…

What else could this be? Every person with the diagnosis of Sleep Apnea has a story, and every story might be the end result of multiple underlying problems. The Five Finger Approach guides narrative-based exploration…the structure allows and invites iterative review, and every patient can assist with their own investigation…

The full map. The full storyline. A coherent, ethical foundation for the entire amusement park, supported by every attraction in the park.

I’m pretty sure that’s what he would have done.

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Walt Disney understood curiosity. He understood awe. He understood that people learn best when they feel safe enough to wonder. Adventure Thru Inner Space didn’t dictate belief. It invited the rider to explore. It gave people permission to enter their own inner worlds with a sense of play. And in that play, learning happened. Trust happened. Transformation happened.

If Walt were here—really here—if he wandered through our fractured amusement park with the same squint he once gave Tomorrowland, what would he do?

A confession: I have no idea! I can’t tell you exactly what Walt would have built. We talked about the fun poetry of viewing a person’s birthdate through the lens of numerology, and how Walt’s birthdate resolved to a ONE, architect of worlds, titan amongst mortals.

I’m no “ONE”. I’m no Ayn-Rand-Atlas-Shrugged titan of industry. As I’ve revealed in prior essays, I’m a FIVE—a storyteller, a humanizer, a crow flying overhead trying to point toward the breadcrumbs of fellow travelers before they get eaten or blow away in the wind.

But when I squint, I see the outline of what he might have done...

My guess is: he’d start with the narrative. He’d need the narrative to ground the story in what matters. The story is everything.

I’m betting he’d build an attraction that answered the Three Questions in order, so that the geography would lead the way. He’d walk visitors through the landscape, so they could experience it, in real time, fueled by their own curiosity: here is what Sleep Apnea is…here is why you might want to treat it…here is what else it might be.

No coercion. Just curiosity.

As far as personnel, he'd make sure everybody in the whole attraction had their stories straight about the three questions, I guarantee it. I’m pretty sure that would take place in his Foundations Training.

And then, I’m pretty sure once he got that sorted, he’d do something nobody else would think to do:

I bet he’d build us an island.

That’s it! He’d make us an actual island experience—narrative, immersive, coherent—where providers and patients could explore the entire landscape together. It’d be designed the way he designed Disneyland: not as siloed kingdoms competing for attention, but as a unified story world tied together by shared principles, shared language, shared ethics. A place where every cast member, no matter their role, holds the same map.

A place where narrative is the bridge.

A place where curiosity is the engine.

A place where patients are co-explorers.

A place where complexity isn’t reduced—it’s honored, revealed, and navigated.

A place where the amusement park finally becomes whole again.

Life-Fans, this is what the whole essay series has been trying to say: it’s been an attempt to name the fragmentation, name the meta-suffering, and then, mercifully, offer a way home.

Ski the path, not the trees.

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Walt Disney left us clues. The Four Keys remind us about heart behind our precious Principles of Medical Ethics. Adventure Thru Inner Space left us awe and the curiosity to explore.

Stan McChrystal left us structure for engineering social change.

Dave Snowden reminded us about the practical magic of narrative.

Now we step onto the ISLE. Not as tourists. Not as experts. As co-creators. And the Five Finger Approach and Five Reasons to Treat give us a living method by which we can enjoy our exploration...

See, Life-Fans, if we get it right, this fractured park—our park—might finally become a place where people explore safely, curiously, together. A place where healing is the natural outcome of coherent design.

A place worthy of the people who trust us enough to walk through the gates.

That’s the bow. That’s the ribbon. That’s my story.

And the future?

The future is now.

SO: What would Walt Disney do?

He’d probably say: “Welcome to the ISLE. Prepare to be delighted.”

Kind mojo,

Dave

David E McCarty MD, FAASM

Boulder, Colorado

13 November 2025

David E McCarty MD FAASM is the Chief Medical Officer at Rebis Health, and the co-creator (with Ellen Stothard PhD) of the Empowered Sleep Apnea project.

What Would Walt Disney Do?--Part III: “Welcome to the ISLE”

What is Sleep Apnea? Why should we treat it? What else could this be?

“What Would Walt Disney Do?” Part II