About Gale · September 2026
Jodi Patton carried her dying mother's records by hand, then spent a decade moving records between institutions. "We almost never moved them to the woman they were about."
Ten past three A.M., and I am lying on my mother's couch in Las Vegas with the sheet kicked onto the carpet and my hair wet at the neck.
My mother keeps the thermostat at seventy-eight, because her heart no longer pushes enough blood to her hands, and I blame the house.
Down the hall her oxygen machine hums and clicks, hums and clicks, a sound I hear on most nights when I rarely sleep.
On the coffee table is the binder, three inches thick and colored tabs for every place that holds a piece of my mother: the cardiologist, the lung doctor, her family doctor, the hospital on Charleston, the pharmacy, the home health agency, the insurance company, and the hospice.
This is supposed to start on Thursday if they get what's needed: her last echocardiogram and the list of medicines from her discharge. The hospital says it faxed both, and the cardiologist's office says it never received them. At eight o'clock I will call again.
I worked in hospice, and I know which nurse to ask for and what a release form needs.
"Jodi? You up?"
"I'm up, Mom."
"Is it cold in here?"
Her last weeks
I
At 8:02 A.M. On hold with the heart doctor's office.
The cardiologist's office picks up at 8:02, puts me on hold, and plays the same twenty seconds of saxophone until 8:31.
My mother watches from her recliner with a cup of coffee she will not drink. She keeps her Medicare card in a sandwich bag with her library card and a folded twenty, and she does the crossword in pen.
While I wait she reaches over and fixes the piece of my hair that falls forward. "You need a color," she says.
When the receptionist comes back she tells me what the hospital told me yesterday, in reverse.
They will send the echo report to the hospice once the hospital sends it to them, and the hospital will send it once its records department has a signed release. The records department accepts requests by fax, by mail or in person, and answers them by mail, in five to ten business days.
The hospice starts Thursday. On my third call to the hospital, a woman in medical records offers to fax the report again, to the number on file, which belongs to a cardiologist who retired in 2011.
So I drive. I take the binder and a form with my mother's signature on it, and I sit in a plastic chair in a basement office for an hour and forty minutes until a woman behind glass slides eleven printed pages under the window.
The discharge list says my mother takes a water pill at the dose from before her cardiologist doubled it in October, and a blood-pressure pill she stopped in September. I know this because I have a photograph of every bottle on her dresser, on my phone, in an album I have named Mom Meds.
Nobody else has that album, not the hospital, not the cardiologist, and not the hospice nurse who comes on Thursday, who will sit at the kitchen table and copy the bottles out by hand, one at a time, the way I did. Each of them has a place for my mother, and not one has anywhere to put a daughter, so I have become the place.
I know how to do this. I have lined up eighteen four-year-olds at a preschool door, and I have kept forty women on the same count in a Jazzercise class at six in the morning; a substitute is teaching my classes this month. None of it makes a fax arrive.
That afternoon, on hold with the insurance company about a hospital bed, I look up and find my mother watching me.
"Tell me again what it is you do up there," she says.
Jodi's jobs on one axis, one bar each, in four lanes. Teaching comes first: preschool teacher at the Kahle Community Center, September 2002 to June 2004 1, then her Jazzercise franchise, August 2006 to December 2016 2.
Titles and dates are as she lists them on her profile, read September 23, 2026 3; the Chief I title is from a January 2020 state letter 4.
A program specialist in medical programs 8; from May 2017 to February 2019, school-based services and free care, tribal liaison and tribal health centers 9,10; from February 2019 to March 2020, chief of medical programs 11; a January 2020 letter lists her as Chief I of the Medical Programs Unit, a chief within the unit, not head of Nevada Medicaid 4. On the separate track, two acts of government: CMS's free-care letter, December 2014 12,13, and Nevada's plan amendment for children's services at school, effective September 1, 2019, a state filing that does not name her 14.
Hazel Health, director of health plan partnerships and government relations, March 2020 to May 2022 15; 1upHealth, under three titles, May 2022 to today 3,16. On the teaching lane, an adjunct post teaching marketing research at the University of Nevada, Reno, January 2022 to January 2026 17.
In Carson City, working for Nevada Medicaid, on the other side of the fax. The fax machine, I learned in my first month, was not a failure of the system. It was the most reliable part of it.
I worked on school-based services and free care, the rules that decide whether Medicaid pays when a child is seen by the nurse at school, and I was the state's liaison to tribal health centers. By 2019 I was a chief in Medicaid's medical programs unit, and I had learned how a state decides what it will pay for, and how often the paper it decides on arrives late, or at a retired cardiologist's number.
In 2020 I went to Hazel Health, which Bill Nguyen founded to put a doctor or a therapist on a screen in the school nurse's office, and I spent two years persuading health plans to pay for it, to reach, as I put it then, over two million students 18. A child could see a pediatrician between math and lunch. The visit went into Hazel's record, a bill went to the plan, and a note went to the child's own doctor if we could find one. The parent got a text.
Since 2022 I have worked at 1upHealth, selling the country's largest health plans the software that moves records between them and everyone else, the modern replacement for the fax. I have called myself "the connective tissue" 19. It took me years to see what I was connecting. We moved the records from institution to institution. We almost never moved them to the woman they were about.
Each office has a place for my mother, and not one has anywhere to put a daughter (an advocate), so I have become the place.Jodi Patton
II
In the last week of her life my mother asked me for one thing, and it was not another phone call.
The hospice nurse arrives on Thursday at ten, sets her bag on the kitchen table, sees the binder and says, "Oh, you're one of those."
She is kind and quick, and she copies my mother's bottles out by hand from my photo album while my mother tells her that her roots need doing. An aide comes to bathe her twice a week, and a chaplain calls. Everyone is good at their job, and everyone leaves, and the binder stays on the coffee table with its tabs.
On Sunday night my mother wakes at two and cannot get her breath. I sit on the edge of her bed with the phone on speaker, and the nurse on the hospice's night line, who has never met her, asks me what her cardiologist said about the water pill.
The answer is in the binder, behind the blue tab, on a page the hospital printed wrong. I read her the right dose from a photograph. By three my mother is breathing easier and I am in the kitchen with the sweat drying on my back, telling myself it is the thermostat.
On Monday morning I am at the kitchen table on hold again, thirty-eight minutes into the insurance company's saxophone, when she calls me from the bedroom. I go in with the phone at my ear.
"Put the phone down," she says, "and sit with me."
I hang up on the insurance company. I sit. After a while she asks me to set her hair, and I find the pink foam rollers in her bathroom drawer, the same ones from when I was six, and she tells me I am rolling them the wrong way, under, not over. I roll them her way. The phone rings twice on the kitchen table, and I let it.
My mother died on the Wednesday before Thanksgiving, in the afternoon, in her own bed.
The following Monday the hospice office called to tell me the echo report had come in by fax, and to ask whether I wanted it for my records. I drove over and got it, and put it in the binder, behind the tab for her heart.
My own nights
III
Ten past three in the morning, the heat came back, and this time there was no thermostat to blame.
I am awake with the sheet kicked onto the floor and my hair wet at the neck. The thermostat says sixty-six. I am fifty, and I do the arithmetic I do most nights now: the fourth time this week, the second tonight, and a meeting at nine with a health plan in which I will feel my neck go red.
I have spent my career moving other people's health records. At ten past three in the morning I cannot find my own.
The labs from my last physical are in one portal, the note saying what they meant is in none of them, and the phone on my nightstand knows more about this night than any doctor I have.
It has my heart rate by the minute, with the jump in it, and my sleep in broken bars. It could hold my records too. Apple's Health app can pull them in from many health systems, and it is a remarkable piece of work; I have been close enough to the plumbing to know how hard it was to build.
What it cannot do is put any of my records in front of the person who decides my care. The night lives on my phone. The decision lives in a chart I cannot write in, at an office that closes at five.
At my physical that spring I tell my doctor about the nights. She listens, and she is kind, and she tells me it will pass.
I ask about hormone therapy, and she says a lot of women don't do that anymore.
White women, 31.4 to 5.8. Hispanic women, 13.8 to 2.6 21.
In AARP's research, 15 percent of women had tried hormone therapy for their menopause symptoms, and nearly half had treated them with supplements 22. American women spend more than $13 billion a year on menopause symptoms, by AARP's estimate, and more than $10 billion of it goes to nonmedical treatments such as supplements 23.
The Menopause Society says hormone therapy remains the most effective treatment for hot flashes and night sweats, and that it should be considered for women younger than 60, within 10 years of their final period, with no medical reason to avoid it 24. I was fifty, and my periods had not stopped.
Hot flashes and night sweats last a mean of seven to nine years, the society says, and more than ten for a third of women 25. Lying awake, I did the arithmetic on that too.
IV
The new online menopause service, billed as guided by women, asked about my mood before anyone asked about my nights.
So I went looking, the way women do now, on my phone. The new entrants in women's health had soft colors and same-week video visits, and in some of them the first thing I met was not a clinician but a form.
Little interest or pleasure in doing things.
Feeling down, depressed or hopeless.
Trouble falling or staying asleep.
I answered all nine questions honestly, at midnight, in bed. The screen told me my score, eleven, in small grey type, and moved me on to shipping, because the page I booked from had a shop, and I had put a supplement for what it called hormonal balance in the cart. The visit the next afternoon was about my hot flashes, and nobody mentioned the eleven. A month later the form turned up on my insurance statement as a line of its own.
Nobody ever told me what my answers were for.
The PHQ-9, a nine-question depression questionnaire, redrawn from its published manual. Each of its nine questions asks, "Over the last 2 weeks, how often have you been bothered by" a problem, and each is answered in four boxes scored 0 to 3 26,27. No permission is required to reproduce it 28.
The manual pairs each band of scores with a proposed treatment action: 0 to 4, none; 5 to 9, watchful waiting; 10 to 14, a treatment plan; 15 to 19, active treatment; 20 to 27, immediate treatment and, if impairment is severe or treatment is not working, expedited referral 29. In the original validation, a score of 10 or more flagged major depression with 88% sensitivity and 88% specificity 30.
Pooled across 44 studies of 9,242 people, 24.6% scored 10 or more, against 12.1% who had major depression on a diagnostic interview 31.
My eleven sat in the band the form's own manual pairs with a treatment plan. I got a box.
I don't blame the clinician on the screen, who had a short visit and a template.
The questionnaire costs nothing to reproduce, but giving it can be billed, and one practice-software vendor calls that billing code one of the most underutilized opportunities in mental-health practice 33.
Across 16 trials, depression questionnaires used on their own appear to have little or no impact on how clinicians find and treat depression 34. In adult Medicaid in 2024, the median state recorded depression screening with a follow-up plan for a positive result for 2.0 percent of enrollees aged 18 to 64, a claims-based rate that can miss screening done but not coded 35.
That spring I did for myself what I had done for my mother.
I made a binder, and this time it was mine.
I downloaded my records from every portal I had, and I had five; most American adults now have more than one 36. I read the research the way I used to read policy at Medicaid, all of it, at the kitchen table, with my own numbers from the phone beside each finding.
I found a nurse practitioner who treats menopause and nothing else, and I brought her one page: my nights, my numbers, and the Menopause Society's statement with a line underlined.
Before I left, Julie asked what I wanted to hear about, and she wrote it down in my words: if I am not sleeping through by June, I want to hear from you, not the other way around.
For the first time in my life, a clinician had written down what I wanted.
In June I slept to the alarm.
Nobody ever told me what my answers were for.Jodi Patton
What we are building
V
Our stories are about a woman's health journey supported by facts, by science and research.
My mother's binder and mine sit on one shelf in my kitchen now, and between them they hold everything I wanted from the health system and had to build by hand.
Gale is built from what is in them, and from what neither of them could do.
This summer, in a draft I have not published, I admitted a mistake I had made for years, which was believing that the record was the answer 37. My five portals had not changed my nights.
The page my nurse practitioner wrote had. A chart records what happened, and what helps at ten past three in the morning is a page that says what happens next 38.
What we are building is the rest of the binder.
The colored tabs become a care team, your doctor, your therapist and the nurse who treats your menopause, each of them one tap away, and one tab is for the daughter you name to speak for you.
In ten years inside this system I never saw a record with a tab for the daughter. The Mom Meds album becomes data that belongs to you and stays on your phone, not in a record at a health plan or a hospital, and leaves it only when you send it, with your permission for each visit 39. The line I underlined in the Menopause Society's statement becomes the research, all of it, kept current and set beside your own numbers.
No questionnaire you answer becomes a line on a bill, and there is no shop to sell you supplements for extra, add-on revenue.
For my whole career, owning your health data and being cared for were two different things. The data lived with you, or with an app, and the care lived in a chart you could not reach.
Gale is built to be both at once: your records on your phone, the research beside them, and the people who treat you a tap away, working from the same page you are.
In the first of our stories, Dana, 51, logs one number most evenings, how many hot flashes bothered her. Her nurse practitioner, Julie, wrote down what she wanted to hear about, and when it comes true, Dana's phone says so, in Julie's words, with Dana's numbers:
GALE · NOW
Julie asked to hear if your hot flashes came back after the taper.
Your log: 1 to 3 a day in the month before your last change. 6 a day this week.
Book 20 minutes with Julie · Thu 4:30 or Fri 9:00 · $75
This message is from Gale's software, not from Julie.
In the second story, two years on, Dana is the daughter. Her mother, Ruth, is dying at home under hospice, too tired to hold her phone, and Dana answers her cards for her. In September Ruth told her oncologist what she wanted if the pain started waking her, and Dr. Reyes typed it into her note word for word:
GALE · 7:10 AM · Dana, for her mother
Pain has woken your mother two nights running. In September she asked that her team hear when it did.
Her words, with Dr. Reyes: "If the pain is waking me up, I want something done about it. I don't want to wait until the next appointment."
This message is from Gale's software, not from Dr. Reyes. The sentence is your mother's.
VI
I knew what Gale had to do and could not write a line of it. Bill Nguyen had been studying to teach grade school.
The question people ask me, reasonably, is the one I asked myself: if you are the expert and the patient, how do you build it?
I had been the daughter and the patient, and I knew the system from the state office to the health plan's data center. I had sold software for years and never written a line of code.
Bill had, for thirty years. He has been building companies since the start of DotCom in the 1990s, and he sold Lala, his music start-up, to Apple 40. Through Hazel, which he co-founded in 2015 41, and the work around it, he has helped, by our own count, about five million students reach free physical and behavioral health care at school.
He has also built things that broke. Color raised $41 million before its app launched, and within 30 minutes of the launch, he has said, he knew: "Oh my God, it's broken."
When he started his AI company, Olive, in the fall of 2024, he was studying at Sacramento State to become a grade-school teacher 42. I started as a preschool teacher, and we have talked about that more than about almost anything else.
Since then he nurtured what became the future of AI (covered in the WSJ, Semafor, Vanity Fair, Fast Company and even the Times of London.)
Gale is written from this cluster, this alchemy of Bill's ideas and by tens of thousands of AI agents that keep working after he has gone to bed (which isn't much.)
A day from noon to noon, one square per commit to Gale's 14 repositories between June 1 and September 23, 2026: 6,454 in all, from 203 in the 5 p.m. hour to 352 in the 9 a.m. hour 43.
1,543 commits, 23.9% of them, landed between midnight and 6 a.m., against 25% if they were spread evenly 43.
The hours after midnight look almost like the hours after noon anyway.
Gale's first commit, on June 2, 2026, went back to the same children whose school care I had worked on at Medicaid. It was a study, on synthetic data, of whether school-nurse visits, billing records and attendance together could flag a child's mental-health risk earlier than any one of them alone 45.
By June 14 the project had its name 46. The plan for menopause care in Gale's iPhone app was the first thing I approved as a founder 47, on August 9, we became co-founders 48.
VII
The motivations always existed but the technology arrived in waves with each frontier AI model.
We are Jodi and Bill, Gale's founders, and we have a commercial interest in you believing this 49.
One of us carried a mother's binder and then spent a decade inside Medicaid, school health and the plumbing of health plans, learning exactly where the fax goes missing. The other has sold a company to Apple, put doctors in schools, broken things in public, and built the cluster Gale is written on.
Either of us alone would still be describing Gale. The two of us together, with the AI agents, made this a reality ready for care today.
We can already promise what we will not do: we will not hand you a questionnaire without telling you what it is for, and we will not sell you supplements.
Our trilogy, our stories, begin here, with the first: Tell Me If It Comes Back, a woman's menopause, one night at a time.
Jodi's family story, her mother's last weeks and her own menopause, is told in her voice, with details condensed and conversations as she remembers them. Her jobs, titles and dates are as she lists them on her LinkedIn profile, read September 23, 2026 3,15,10; the Nevada title comes from a state letter of January 2020 that lists her as Chief I of the Medical Programs Unit 4. That she worked in hospice rests on our own confirmation 6. "The Time In Between" is an unpublished Gale draft bylined Jodi Patton, and the mistake she names and the chart she sets against what happens next are from that draft 50,37,38. Her profile still lists 1upHealth and no Gale role 3.
The two cards are reproduced from our stories Tell Me If It Comes Back and Awake Enough to Talk, and each story's own receipts say which parts are built. That your data stays on your phone and leaves it only with your permission for each visit is from the third story, Ask Me Why 39. No real woman has used any part of Gale; it runs on synthetic data until it can legally hold real health records 51.
Jodi's jobs are drawn from her LinkedIn profile as read on September 23, 2026 3. Hormone therapy use is from Yang and Toriola's analysis of the National Health and Nutrition Examination Survey, 13,048 women past menopause from 1999–2000 to 2017–March 2020, drawn on a ratio scale, where equal slopes are equal proportional falls 20,21. The questionnaire is redrawn from the PHQ-9's published instruction manual, whose site says no permission is required to reproduce it 28,29; the accuracy at a score of 10 is from the form's original validation 30, and the share scoring 10 or more against the share with major depression is from a pooled analysis of 44 studies 31. The billing-opportunity line is from a therapy-practice software vendor's billing guide 33. The AARP figures are AARP's own 22,23.
Measured on September 23, 2026 from the main branch of each of Gale's 14 repositories, June 1 to September 23, 2026, with each commit's time converted to Pacific time 43. A commit counts as AI co-authored when it carries a Co-Authored-By line naming a Claude model, so 91.2% is a floor for AI-assisted commits and says nothing about who wrote each line 44.
AI agents working for us, Jodi and Bill, did the research and drafted this story; we edited it and we stand behind it. We are Gale's founders, and we have a commercial interest in you believing this 49.