No one's more wired than Vanessa Gonzalez. A poised 13-year-old in t-shirt, shorts, pink socks and a charm bracelet, she's a VR expert who's mastered Starbright World, a 3D virtual Eden with real-time video conferencing.
She's navigating Starbright World now, via a Pentium-based workstation. Around the screen is a whimsical frame with pictures of wooden Tinkertoys and the logos of Starbright's corporate partners. A small video camera is perched to the right of the monitor. Vanessa wears a headset, and conversations are audible throughout the room. The sound quality isn't great, but the speech is clear.
Vanessa's hair is fuzz-short because of chemotherapy she's having for osteosarcoma, and she's hooked to an IV pole with three drip bags - two clear and one yellow. A monitor on the IV flashes numbers: 10.0, 13.0, 7.4. Before Vanessa has settled at the Starbright terminal the monitor beeps, and she checks it calmly. "I need to get plugged in," she says.
The Starbright Paediatric Network, which includes Starbright World, aims to connect children who are hospitalised for long periods or who must return repeatedly. It links children like Vanessa in Palo Alto, California, with others in Pittsburgh, New York, Dallas and elsewhere, who come for chemo- therapy or organ transplants, or who have chronic illnesses.
Vanessa is sitting in a small windowless "rec-tech room" at the Lucile Salter Packard Children's Hospital at Stanford University. Although ultimately there will be Starbright stations that can be wheeled to children's beds, for now the necessary DS3 (equivalent to T3) wiring has been installed only here and in the main playroom.
Vanessa, represented in Starbright World by a helicopter, is "just churning around" until - in Cave World - she meets a fish, denoting a user at a Pittsburgh hospital. In text, they agree to switch to video conferencing. The Pittsburgh fish turns out to be Rachel, who's 17. (Names and other identifying details of children at the Pittsburgh hospital have been changed.) Asthma has put Rachel in hospital. The screen shows her sitting slouched in the playroom. In a corner of the screen, a smaller image shows Vanessa, as Pittsburgh sees her. "What are you guys doing?" Rachel asks. "Anything exciting?"
"No. Not really."
"It sounds like a normal hospital."
"Very," says Vanessa dryly.
A child using Starbright World these days is often ringed by observers - product developers, medical experts, hospital public relations people, parents and reporters like me. Still in beta testing, Starbright is courting publicity. So are the four corporate partners who have made this broad-bandwidth network possible - Intel is contributing workstations and its ProShare Video System 1.9; UB Networks Inc. is supplying local-area networking; Sprint. is providing DS3 lines; and Worlds Inc. is contributing the virtual reality space.
The kids navigate one of the most advanced video networks on the planet - an unequalled package-bundling real-time video conferencing with a series of real-time multi-user 3D virtual worlds. The kids get top-of-the-line Pentium machines (32 megs of RAM) with ATM lines (133 bps or more). As the project brings diverse state-of-the-art technologies together, the corporate partners are avidly watching this almost perfect - if costly - test arena for broadband networking.
Always hovering nearby are "child life" specialists, hospital employees whose job it is to make patients' lives more tolerable and who act as educators, helping children and their families adapt to hospital life and medical procedures. At hospitals with Starbright World, child life specialists also become technical support people. For them, Starbright promises a way to lure depressed children out of their rooms, to show a child with a rare disease that there are others in a similar condition and to make some part of hospital life an exciting and enviable experience.
This multimillion-dollar project was organised by Starbright, a self-styled "entrepreneurial charity" that is a sibling foundation to Starlight, a conventional charity granting wishes to critically-ill children. Starlight's co-founder, Peter Samuelson, is a Hollywood producer (Revenge of the Nerds, Tom & Viv) who had begun to feel that Starlight left sick kids miserably entertained. He describes visiting one hospital and asking a nurse how a boy in traction could change channels on the black-and-white wall-mounted TV. "We have a remote control," replied the nurse, fetching a ten-foot-long bamboo pole. Samuelson says, "The poor kid was supposed to lie in bed and poke the button with it!"
Samuelson reacted by starting two programmes: Starlight Express, media rooms installed in paediatric hospitals, and Starlight Express Fun Centres, VCR-PC-laserdisc-video-game combos on carts that slide over a child's bed and that have been distributed to more than 1,000 hospitals.
Off-the-shelf software used in those two programmes "was having a very good effect on the kids," Samuelson says, but "I began to wonder what would happen if we made software focused on kids' needs." He enlisted the help of Steven Spielberg, the 300-pound gorilla of the entertainment industry, who agreed to chair the new Starbright Foundation, and to make a seven-figure donation.
Out of their ambition - to combine Southern California's entertainment industry with paediatric medicine and new interactive technologies - came the remarkable combination of benevolence and marketing that is the Starbright Paediatric Network. The corporate partners get a chance to test-market new technology on a real-world population in an unquestionably philanthropic way. Some are deploying technologies previously restricted to business markets. (Will children accept them?) They are forming valuable alliances with the other corporate partners and with the entertainment industry. Thus, Worlds Inc. programme manager Kevin Ugarte remarks, though some think it's insane for a start-up like Worlds to invest in a huge project like Starbright; the programme not only connects the company with bigger corporate players and lets it learn to work with children, but also acts as an intense idea generator.
In addition, those who actually go into hospitals seem deeply struck by the human value of the endeavour, almost startled by the genuineness of the Good Deed.
As for the children, they get a break from the grimness and tedium of institutional routine. And they communicate with other sick children in powerful, unprecedented ways.
Rachel and Vanessa decide to go back into virtual reality and explore Cave World. Instead of talking through text, they carry the audio with them, a favourite technique. They go into Tropical World, a gorgeous land of palms, low mountains and pools. Entering a rainbow, they whiz to Sky World: flocks of high-heaped cumulus, one holding a classic Mad King Ludwig castle. Colette Case, a child life specialist at Vanessa's end of the line, suggests they visit the Build Your Own Zone, where users can create structures. They descend into the BYOZ through a tornado, but can't find each other visually.
"We're gonna fly above and see if we can see you guys," says Rachel. "What are you near?"
"I'm by the wall with flames of fire on it," says Vanessa.
But the BYOZ is such a tumult of walls, midair waterfalls, big-eyeballed plants, cubes and staring green aliens that it's not easy to locate the wall of flames.
Finally they cut the connection, meet in Tropical World and go through a gold sliding door to arrive back in Cave World, a mysterious dim green streaky maze. Rachel remarks, "I've never really been in the cave. This girl Marie, like she's always in the cave. Oh wait, here's Marie!" Marie walks up to the terminal in the Pittsburgh playroom, and Rachel points to - and introduces -the helicopter on the screen. "This is Vanessa - in California."
Shortly after joining Starbright's board, Lee Rosenberg, a senior vice president at the William Morris Talent Agency and a founder of Triad Artists, arranged a large lunch meeting in 1993 for paediatric specialists, members of the entertainment industry and representatives of companies like Brøderbund and Microsoft. It was designed as a brainstorming session to find solutions to emotional and physical problems confronting critically-ill children.
The brainstormers came up with 25 projects. Seven, with various corporate partners, are in development, including Star-bright, which has raised several million dollars. General Norman Schwarzkopf was drafted to head a campaign to raise US$60 million (£39 million) more.
Everyone has agreed not to specify how much Starbright costs: "multimillions" is all that they'll say. It's obviously not cheap. The more than 100 high-end PCs supplied by Intel, for example, retail for around $6,000 each. Worlds Inc. has devoted up to eight people at a time to Starbright. Sprint is supplying and maintaining seven DS3 connections, more than any of their corporate customers have.
Vanessa, Rachel and Marie switch back to video conferencing. They go through introductions. Marie, 14 in a few days, is there from Vermont because "my liver numbers went up. As you can probably see, I'm a little bit yellow." She sounds weary. "They're probably going to do a transplant." An ebullient 12-year-old, Emma, squeezes in next to Marie. She doesn't want to talk about illness, though she does want to know how long Vanessa's been in.
"This is my second day so far."
"This is my first day here," says Emma. "I come here a lot though."
"Me too."
Starbright fundraisers didn't simply ask for big donations; they asked for the creation of an unprecedented network, specifying what they thought would help sick children. The corporations they approached hesitated. "We knew that Spielberg was capable of having a great dream; we just didn't know if it was implementable," says Avram Miller, Intel's vice president for business development, who finds new markets for Intel processors.
Roel Pieper, CEO of Tandem Computers Inc, parent company to UB Networks, agrees. "It was a risky endeavour. We didn't know if we could get all the ATM technology to work, we didn't know if we could get sufficient performance for the ProShare video conferencing, we didn't know if we could get sufficient acceptance from the children on the 3D graphics."
But the project had great allure for the corporate partners: it's R&D with an unbeatable PR angle. While such a partnership could happen in the strictly for-profit world, Miller says corporations alone would be unlikely to tackle a project with sick kids.
"It's the kind of thing that Steven Spielberg, who is a storyteller and has a relationship with children, can do," he says. "If we proposed this, we would have been viewed as being very invasive. A bunch of geeks, people in white coats (although I don't think any of us have white coats), not really caring about the kids, but wanting to instrument the kids and treat them like objects. I don't say we would, but I think that's how we would have been perceived."
Steven Spielberg, content provider extraordinaire, lured the sponsors, lured the big donors, lured the reporters. Just his name has lured the shy kids online, as child life specialists hold out the prospect that kids might run into Spielberg - in the form of his avatar, E. T. ("Running into Spielberg" is no mean achievement; weeks of phoning didn't get Wired an interview.)
The director's own Starbright experience drives home the cost of this technology. He only got a Starbright terminal in March. Since a DS3 line would have cost perhaps $50,000 to install and $7,000 to $8,000 a month to run, an ISDN line was installed in Spielberg's office. He gets 7 to 8 video fps, instead of 15, and a quarter-second delay, but all features offered to kids are there.
This compromised rig is itself a bit of a beta test; it may show whether Starbright's projected Phase 2, in which Starbright kids will get access from home, probably over ISDN lines, will work.
Half a dozen hospitals are participating in Phase 1: Lucile Packard, Mount Sinai Hospital in New York, Children's Hospital of Pittsburgh and hospitals in LA and Washington, DC. (As this article went to press, a Boston hospital dropped out of the programme and Children's Medical Centre of Dallas went online.) As new hospitals are added, Starbright looks for more donors.
Emma, Marie and Vanessa turn to the subject of hospital playrooms and activities. "A lot of crazy stuff goes on here," says Emma enthusiastically. "Somebody sent us these!" She jams a figurine against the screen. "It's made from a peanut and it's got a top hat on. Isn't it neat? I'm all the way in Pittsburgh and you're all the way in California. Is it dark there yet?"
"No."
"We're going to show you Rachel painting the windows," declares Emma, a media natural. She rips the video camera from its Velcro mount and carries it around, showing Rachel standing on a chair painting snowflakes. "She said Hi! Rachel, don't fall off! She said she's already in the hospital!"
Children in isolation during bone-marrow transplants give perhaps the most striking example of the sorrowful conditions Starbright is meant to alleviate. They live in a small, sanitary room for four to eight weeks, seeing few, certified-healthy visitors. Their strength is low and their spirits are apt to be lower. Severe mouth sores make it painful to talk on the phone. Child life workers on transplant wards ache to get isolation rooms wired.
Such patients got Starbright its highest-profile fundraiser; when Norman Schwarzkopf was first approached by Samuelson and Spielberg to raise money for Starbright, he declined. Though he'd worked with camps for sick children, he was involved in so many charities that he didn't want to take on another. Then, after a fundraising event at a Florida hospital, he visited the children's ward. In the transplant unit he found Heather, a child he knew from one of the camps. "She was lying there in the bed in the fetal position, totally isolated from the entire world, with no companionship whatsoever," Schwarzkopf says. "What she wanted to talk about was camp and the one time when she'd been allowed to just be a kid. I suddenly realised that if we could have Starbright World in that room with her, she wouldn't be isolated, she'd be able to escape. So I called up Starbright and said 'OK. Where do you want me to start?'"
Emma, Marie and Vanessa discuss birthdays and favourite authors and then get onto the subject of brothers - how many, how old, how tolerable. Marie and Vanessa have serious complaints, and Emma joins in - just to be companionable. When Marie says that brothers are always in your face, Vanessa answers emphatically, "Tell me about it. It's true. They never leave you alone."
"They're always in your business," says Emma.
"And they never come see you in the hospital!" exclaims Marie. "They always have excuses."
This produces heated discussion. "My brother comes every night," says Vanessa. "Except he comes and he doesn't spend any time in the room, he's always outside playing."
After the kids in Pittsburgh - in a later time zone - say good night and log off, Vanessa's younger brother arrives. He asks to see Starbright, and they sit at adjacent stations. She shows him how to enter Tropical World and take the rainbow to Sky World. "It's cool," he says. "Neat graphics."
Both Palo Alto workstations are represented in VR by an avatar in the form of a helicopter. (Later, kids will have individual avatars.) "That's me?" asks Vanessa's brother. "I don't get it. Oh ... we're connected? I can see you?"
They explore Cave World, hunting for a huge stone face whose square mouth is a door that takes two people to open - so Vanessa has never been through. The environments are designed to foster cooperation, as Worlds producer Tamiko Thiel explains: "A lot of the therapeutic work with these kids is to get them to come out of their shells, come out of their concern with themselves and their sickness and start socialising again." Together Vanessa and her brother open the door and come out in the sky.
Video conferencing is the first thing many kids want to try. Colette Case, a buoyant young woman with short dark hair who is the Starbright coordinator at Stanford, says she's astounded by the children's candour in video conferencing. "They tell each other just everything. We sit there in awe." But when she asks Vanessa, "Do you think you guys would talk differently if there weren't people watching you?" Vanessa gazes at Case and slowly nods, nods, nods.
The corporate partners are eager to see how they use it. For decades, video conferencing has been just around the corner, yet its use is confined to the business market. (Picture phones were just too expensive.) But now, they say, it's really around the corner. PCs make the difference, says Miller. Instead of buying a new system, users will need software and a $50 camera for their PCs. "By the end of the decade, it will become unusual not to be able to communicate in some form of video communication from your office. It's going to be explosive." (The latest version of ProShare retails for around $1,000.)
Robba Benjamin, president of Sprint's multimedia unit, agrees. "The features and functionality that we're giving the Starbright children are the basic features and functionality of the 21st-century phone." Starbright, as a test market, provides a way for Sprint to explore new markets, to look not at productivity in a business setting, but at what people like to do, at uses they consider improvements in their lives.
Yet one of the important features of Starbright is that kids don't have to be seen. In fact, some kids refuse the option. One child hooked to an oxygen tank said he preferred not to be seen.
Pieper of Tandem Computers wants to examine the possibilities of a network without ProShare, to find out whether video is critical or a frill. It's a key question. Ordinary phone lines would suffice for the virtual worlds and for text and voice communication, while ProShare takes a lot of bandwidth to give decent video quality. ProShare is why Starbright runs over DS3 lines (equivalent to 672 voice telephone lines), and why it is so expensive.
"You've got people who believe that the real issue of getting a network to become a conferenc-ing system is voice-driven, and there's another group that says it has to be image-driven," says Pieper. "We don't know. We truly don't know."
Justin Lamarche is in the BYOZ when he meets a blue bear in a green t-shirt and shades. The avatar represents Susan Prosser, who does tech support for Worlds out of Seattle.
Prosser and Justin know each other well. Justin is twelve, and he's wearing a black motorcycle t-shirt and purple shorts. The effects of chemotherapy show in his shorter-than-crew-cut hair. He is at the Children's Hospital in Boston and will soon go into isolation for a transplant operation. A rare smile reveals his tremendous dimples.
Prosser and Justin communicate in text superimposed on their avatars. They agree to head for Tropical World, where Prosser saw a Pittsburgh fish and a green car, the avatar for New York's Mount Sinai Hospital.
The trip from BYOZ to Tropical World takes time, because in the transition between worlds, there's a pause while the new one is loaded into memory. As Justin travels, he and his child life specialist, Paula Johnson-Grenier, dis- cuss a drag race he just ran with some other kids. Johnson-Grenier has a serious demeanour and honey-blond hair. She is insisting, in the nicest possible way, that Justin ought to confess to cheating. "I just pressed a little Alt," says Justin, with what looks like pleasurable reminiscence. Two nurses in hospital blues appear in response to a fit of beeps from Justin's IV monitor. Justin questions them. "You going to hang my bag now? I have to go back to my room or can you do it here?"
A nurse replies sympathetically, "I think I can do it here - are you busy?"
"Yeah. We're too busy to talk to blue coats around here. We only talk to white coats," he teases.
"Snob!" she exclaims.
Justin returns to discussing the race. "I kicked their butts!"
Starbright World isn't meant to be a cinch to navigate. "You can either take the time to explore it yourself or you can ask some other kid and say, 'Hey, show me around,'" explains Thiel. "That's different from existing computer tools, where the whole idea is to be able to do something faster and easier."
Indeed, the most popular place in Starbright World, the BYOZ, is also the hardest to navigate, the chewiest - and the one that grants users the most control and most clearly bears the traces of their presence. In the BYOZ, you can move things or build things and everyone can see what you've done. At first, two tricks got kids out of the BYOZ - using a portal in a checkerboard pavilion, or going to desktop level. Then a kid at Stanford found out how to move - and hide - the portal, leaving other users to make baffled runs at the place it used to be. Another kid went to the desktop and started changing things at the pixel level. Next version, desktop access was cut off and the portal was nailed down.
Thiel says some media people are so smitten by video conferencing that they ask if virtual worlds are necessary. "'Couldn't they just have the videoconference and that would be the same thing?' The answer really is No. It's pretty weird if you just all of a sudden telephone someone that you don't know and start talking to them. You need some sort of context, some sort of shared experience."
She tells of watching two boys using the system, "an older, bigger, really sort of bullying kid and another, much smaller, very quiet kid. The older kid said, 'OK, you know the space better, how about if you show me around?'" She gloats a nerdly gloat. "The younger, quieter kid was the expert!"
"Always, the fear is that giving kids (or adults) computers will make them retreat into themselves and become less human," Tamiko Thiel says. "The Starbright space has been designed to socialise kids."
By the rainbow in Tropical World, the Pittsburgh fish hangs in midair, pouting powder-blue lips. It faces the Mount Sinai car, which races its wheels. Justin calls them, but gets no reply. The bear - Prosser - sends a message to Justin, suggesting they switch to video.
When they do, Justin says with apparent sincerity, "I think you should fix your hair; it's sticking up." Prosser runs a startled hand over her hair and blanks the screen, undoubtedly discovering that her hair is fine. Justin sniggers.
The picture returns, and Justin describes a sign reading "HI BOSTON" that he and Johnson-Grenier built in the BYOZ, which Prosser wants to see.
"It's over by the racetrack. When you first come out of the rain- bow you should see it. It has big letters."
Justin abruptly hangs up to try to get through to New York. Later, he finds Prosser again in the BYOZ, and she types, "so where is this sign you spoke of".
"do you want to see the sign brat" He turns to Johnson-Grenier and asks, "I'm getting better at typing, huh?"
Justin agrees to show Prosser the sign if she begs.
"please oh please show me the sign Please mr Pony sir"
"well all right brat"
They set out, and Justin exclaims to Johnson-Grenier, "Let's try to lose her!"
Justin changes his style depending on who he's talking to, says Johnson-Grenier. He teases people his own age, eases off with young- er kids. Starbright has discussed having monitors in case one kid harasses another. "But they're all pretty sensitive to what other kids are going through, because they're going through the same thing," says Ugarte. "I've never witnessed a malicious moment."
"I came into it with a some-what idealistic idea of what we were going to do and have been brought down to earth," Ugarte adds. What brought him to earth? "The day-to-day things that these kids go through and how amaz-ingly they cope with them. We're giving them another tool to help them cope. But we're not saving these kids. These kids are saving themselves with everything they can."
One small study conducted at a Los Angeles hospital measured the pain medication taken by children who used Starlight Express Fun Centres. The children were patients who could self-administer small doses by pressing a button on a pump. The study, which Starbright points to with pride, found that children not only used less medication when using the Starlight Express trolleys to watch videos or play games, but also used less in the periods immediately before and after using the trolleys.
The first decrease is thought to be due to anticipation, the second to a lingering distraction effect. Starbright representatives, from Samuelson to Schwarzkopf, say the drop in pain medication use was between 50 and 80 %, depending how the data are interpreted.
The children said they preferred controlling their pain with video games to using medication, which usually has disorienting effects and may depress the immune system. (While it's rare for this to happen with children, the medicine can also be addictive.)
Unfortunately, the Starlight Express study is not an impressive model. It looked at only 28 children, and there was no control group. Because of limited availability of the trolleys, the kids could use them no more than two hours a day, and the study didn't look for a decrease in the total amount of medication.
When Starbright World gets out of beta, a massive medical research programme - to include control groups and to be much larger - will look at its effects on use of medication, length of hospital stay, and frequency of "positive outcome," according to Dr. Mel Marks, who oversees the health applications and research component of the Starbright Foundation.
"These major investments in technology and resources are going to have to be justified extremely carefully by the most rigorous measures of outcome," Marks says. "We want to be careful not to divert millions of dollars to what is right now an experimental technique."
What if Starbright can't show health benefits? "We have "Apple" computers now, where the children can do their schoolwork or play games," says child life specialist Johnson-Grenier. "I could never claim it decreases their use of nausea medicine or something, but I certainly think it makes their stay in the isolation room better."
Asked about the importance of measurable health benefits, Schwarzkopf exclaims, "I don't care whether there are measurable benefits!" Calmly, he reviews the hoped-for advantages, but adds, "I gotta tell you, all that sounds good, but as far as I'm concerned, if we can just cause one child to be relieved from the terrible suffering that they're going through, it's worth every nickel."
In Justin's HI BOSTON sign, each letter is on a separate block, each in a different typeface.
"I like this sign," Prosser types.
Paula Johnson-Grenier warns Justin that it's time to log off. As a nurse takes his blood pressure, he finds Susan Prosser's bear avatar in the BYOZ and types "brat are you going to be here tomorrow"
"maybe maybe not depends on how nice you are to me"
"do you want me to beg" He turns to us. "Watch what I say if she says yes!"
"It may help" Prosser responds.
"i forgot my standreds are to hi" he grins hugely and types, "brat"
Urgently struck by an idea, Justin tells Johnson-Grenier he'll pretend to be her. "this is paula what time do you want to talk tomorrow and work some kinks" he types.
"I am flexible what's better for you" comes the reply.
After consulting Johnson- Grenier, he types, "200-400 500-800"
"ok I'll be hanging around the tropical world" types Prosser.
"see you then brat"
Susan McCarthy is the co-author, with Jeffrey Moussaieff Masson, of When Elephants Weep.'