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Dr. Darrell White's Personal Blog

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Archive for June, 2011

A Eulogy I Didn’t Get To Give

It hits me on Tuesdays, Thursdays, and Fridays. Well, many Thursdays and Fridays, but it hits me pretty much every Tuesday, especially around lunchtime. That’s when my friend Ken and I would get together.

It’s funny, huh? I mean, Tuesday and all. You know… the whole “Tuesdays with Morrie” thing. I never really noticed that Tuesday thing until it was over. Tuesday was just the day that I usually operated, that I was usually done in time to hit the gym and then spend some time with Ken. Amy had mentioned last year that Tuesdays were a hard day for her since she had to work all day, and she wondered if anybody might be free to hang out. Tuesdays just happened to be good for me.

Some of my extended family and some of my other friendly acquaintances questioned whether this would be a good idea, at least for me. “Why would you spend so much time with someone, become a much better friend, when you know that they’re going to leave you? Won’t that just increase the heartbreak?” I always responded in pretty much the same way, that as far as I can see you can never have enough friends, even if a particular friendship has a pretty clear “expiration date”.

There’ve been lots of articles in all kinds of places recently, the Wall Street Journal, the New York Times, men’s and women’s magazines, about the fundamental differences between friendships between men and friendships between women. The “Reader’s Digest” version of these differences goes something like this: women have friendships that are face-to-face. They bond through shared feelings and emotions. Men have friendships that are shoulder to shoulder. They bond through shared experiences. All of this is probably true. If I look at my friendship history I would say that these descriptions are probably pretty accurate, at least for me.

Really good friends, the best of friends, probably have a friendship which includes both strategies. I think this is how it was for Ken and me for 22 months. The shared experiences thing was limited due to the extraordinary circumstances involved, of course. We hung out in the gym a little bit, enjoyed a few rides with the top down, and did the “guy picking out his new car” thing together. But mostly what we did was just hang out over lunch or over tea, thinking and talking about lives past and lives to come.

(Shrugs). We were just friends.

Now, I’m sure you’re wondering, what’s the point? Why am I sitting here listening to this guy in a bowtie talk about 22 months of friendship that were laid on top of 10 or so years of being friendly acquaintances? Fair question. (Smiles. Shrugs.). I think it kind of circles back to the way I answered those family members and friendly acquaintances so many months ago, a tiny lesson for all:  you can never have too many friends. 22 months or 22 years…you can never have enough friends.

Look around you. Take just a minute to look around you in the room of life. Look at the people sitting right next to you. Look at everybody else in the room. How many friends do you have? Real friends. People for whom you would change 18 years of your weekly pattern in order to cram in as much time as you possibly could with them, doing whatever. Not many, eh? Me either, frankly. 22 months or 22 years, shoulder-to-shoulder or face-to-face, a friend is just worth it.

Ours was a very private friendship. I don’t think Ken’s kids really knew what to make of this guy showing up every Tuesday, and I’m pretty sure that Amy felt that her Tuesday request had gone a little overboard! I’m not an awkward guy, a guy prone to social discomfort, but I admit to not really knowing how, or if, I should remain connected with Amy and the kids. At best we remain friendly acquaintances as we were before, and I apologize if my absence, caused by this awkwardness, is puzzling or uncomfortable. Honestly, I don’t really know how to play that. I AM open to suggestions, though! (Smiles)

In the end, as the doctor in us both expected, we ran out of time. Those well–wishers who were concerned about me in the beginning were absolutely right; I am heartbroken. I do miss Ken. I do miss my friend. But those well–wishers were also wrong because I am now MORE than what I was 22 months ago because of our friendship. In many ways we are, at least in part, a sum of our friendships. Through the lucky happenstance of my schedule and the generosity of his family, I got to be Ken Lee’s friend for 22 months.  It doesn’t matter when in life you get one, and it doesn’t matter how long you get to keep them, you can never have enough friends. I guess THAT’S why you’re here listening to this guy, just to hear that little message from me. And from Ken.

It hits me every now and again, especially around lunchtime, and especially on Tuesdays. 22 months of Tuesday’s. The 22 months when I had one more friend than I have today. 22 months that I would do over in a heartbeat, just like we did, even knowing how much it was going to hurt.

You can never have enough friends.

Sunday Musings 6/26/11: Thinking about work.

Sunday musings…

1) Oahu. Shout out to the CF Kids crew, including Lil’bingo, presently toiling away in Oahu.

2) Coca. Shout out as well to Coca Crossfit which hosted “The Heir” and his dad for a WOD. Doing Crossfit with your kids…priceless.

3) The sun. An apparently fictitious orb that fills the daylight sky and warms the earth beneath it. Not seen in Cleveland, Ohio for about 6 months now.

4) A college degree. Funny juxtaposition of “articles” in the Sunday papers this morning. There’s a long article on the “riches” of a college degree and a classic Doonesbury comic with college education competing with Google search. Funny, but enlightening, too.

Why do we go to college? Why did we EVER go to college? Back in the day, say when Grampbingo became the only member of his family to go to college, a degree was a ticket off the factory floor or out of the coal mines. Pretty clear pathway, and rather clear alternatives, but the college degree was still not all that terribly too common; lacking one did not preclude most job pathways except some professional ones. Indeed, the 50′s, 60′s, and 70′s were probably the heyday of vocational training and schools dedicated to that.

Fast forward to the present. Why do we go to college? Well, EVERYBODY seemingly goes to college now, and that seems to be pretty much the most accurate, albeit least instructive answer. But why? What is it that a significant number of kids are receiving while in college that prepares them for whatever? What do they gain in school that makes them better workers when they land their first, second, or even third jobs?

To be sure there are adult fields in which college is truly necessary. You know, like medicine, most engineering, teaching, stuff like that. But for many (most?) of our young people what they get out of college, and what employers get when they are done, is 4 (or 5, or 6) years older. The Al McGuire theory: the best thing about freshman is that they turn into sophomores.

After crushing his adversary with sub-second Google searches in the Doonesbury strip Zipper is asked the same question I posed above, why go to college? “Well, to party. That hasn’t changed.” Indeed.

5) Working. Work to live, or live to work? Is what you do who you are? I’m a doctor, that’s what I do in my day job, but is that what or who I am? Do I live, exercise, eat and sleep so that I can go to work, or do I do my job so that I can do that which otherwise makes me…me?

It’s not that simple, of course. Some jobs do, indeed, take on or become in some ways who we are. Sometimes this is truly a good thing, a kind of blessing. It’s that way for a bunch of Crossfit trainers, frankly, and it’s very much that way for the overwhelming majority of people who do what I do in my day job. It can be a not so good thing, too. It seems to me that there are an awful lot of folks who allow their job to define them, allowing it to be the walls of the silo in which they view themselves and from which they view the world around them.

In these situations the minutiae of the workaday world can take on a wholly outsized importance, usually on the negative side. Petty jealousies and insignificant, unintentional snubs can acquire manufactured importance and drive focus away from the task or customer at hand as the walls of the silo collapse ever inward. “Live to work” and “what I do is who I am” can be so inwardly focused that it’s not possible to do what you do well enough, because face it…what most of us do necessitates an OUTWARD focus. We have customers, clients, or patients, and doing our job means extending the focus on THEM rather than us. Manufactured importance begins to trump real stuff. Like doing your job.

Live to work; work to live. I think part of this is just a version of the classic “what do you do?” story. You know the one: if you ask someone “what do you do?” and they are from anywhere other than California, they will tell you what JOB they do. Ask most Californians, however, and you will get something along the lines of “I’m a poet” or “I like floral design” or ” I surf” or “I mountain bike.” Stuff like that. These folks go to work, do their job, and it seems to me often do it better, with quantifiably less focusing on the minutiae of their job and how THEY feel about their job…and then they go skiing.

Live to work? Work to live? What do you do?

I’ll see you next week…

Posted by bingo at June 26, 2011 6:35 AM

 

Sunday Musings on Father’s Day

Sunday musings (Father’s Day edition)…

1) Definition. Father. Answer below.

2) CDC. Physicians are little more than paid observers. Doctors are adept at pattern recognition. The best among them are tuned in to nuance, able to see not only the pattern but any tiny anomaly, however small. Anywhere.

I was in church this morning with my original nuclear family, celebrating Father’s Day as well as my Dad’s 80th birthday, when I notice a wrinkle in the pattern. The priest and all of the Eucharistic ministers snuck into a corner of the altar and used surgical disinfectant prior to giving Communion. Sort of like just before I enter the OR. Never saw that before.

I don’t know about you, but that kinda takes away a little of the mystery and majesty of the transfiguration, dontcha think?

3) Father’s Day. My brother, sisters and I joined Grambingo this weekend to surprise Grampbingo for Father’s Day and his 80th birthday. We are seriously fortunate to still have him. For goodness sake, all this bleating about how terrible American health care is would come to a screeching stop if the sheep just met my Dad. Bypass in 1985. Diabetes that he ignored for years. Kidney cancer in 1994. The guy is a walking scorecard for our healthcare system.

Says here it’s up to par.

4) Fatherhood. Are you a Dad? What are you doing today? I’m having a weird Father’s Day, at least for me: I haven’t seen any of my kids yet. Father’s Day for me has always been a day when I had permission to fully engage in the business of being a Dad, and it’s strange to not lay eyes on my gang yet. (“The Heir” will pick me up at the airport).

Here’s the part where the definition comes in. All it takes to father a child is viable genetic material that makes a journey of some sort or another, and joins up with someone else’s genome. Heck, nowadays neither someone even has to be present. Indeed, the coldest, most clinical definition of “father” requires no clicking of the “add location” button at all.

Not much that’s warm and fuzzy about that, eh? That, of course, is exactly the point. Father’s Day is about celebrating those among us who have actively engaged in the participatory sport of parenting. BEING a father requires connection, and in general the more the better.

On the front end of this safari to Rhode Island I had dinner with a friend who just moved back to Little Rhody, mostly to be closer to his daughters. Not a perfect move for any aspect of his career, nor all that great for his personal life, but nothing short of spectacular for his role as a father. He is simply more THERE now. I should have told him how proud I was of him for that part of his move, but I think he knows.

We probably can’t change today’s name, maybe “Dad’s Day” instead of “Father’s Day,” but in a nutshell that’s my actionable definition of “Father”, one who is active in the pursuits associated with being a Dad. Little League practice instead of 18 holes; another soccer game at 0800…in the rain; ice cream cones at that little shack instead of beers with the guys at the game.

Being a Dad is hard work to be sure, but it’s also good work. We can, and should, choose this whenever we get the chance. Grampbingo did, and that’s why it’s 1:30 and I’m still 3 hours from my first hug from my own kids, as I give my own Father a bonus weekend to actively be my Dad.

So Happy Father’s day to each one of you Dads at the Crossfit table. And Happy Father’s day to Dick White, my Dad. How lucky I am to still be able to say that.

I’ll see you next week…

Posted by bingo at June 19, 2011 10:33 AM

 

The Surgeon Has No Clothes

I stand by the side of the road, wide-eyed in amazement, alone despite the fact that I am surrounded by other spectators. We are watching a parade, a great spectacle to celebrate the apparent dawning of a new age in cataract surgery. One after the other they pass me, the great and famous experts, the Emperors of ophthalmology. Each one sits upon a throne surrounded by bags filled with the coin of the land, the thrones built upon the newest fashion, a femtosecond cataract laser. The rest of the crowd is dazzled; they stand in silent awe as these men with such magnificent reputations usher into the kingdom the latest fashion.

I blink once. Twice. I cannot believe what I am seeing.

Over the millennia there have been thus far three truly revolutionary advances in cataract surgery (a cataract is a clouding of the natural lens in our eye). The ancient Egyptians, and for all we know Ancients of many other sorts, “cured” cataracts through a procedure known as COUCHING. Using a thin bamboo reed the “surgeon” punctured the eye and simply pushed the opaque lens into the gel–filled open cavity in the middle of the eye. Not terribly elegant, but if the eye did not become infected it actually dramatically improved vision in the days of the Pharaohs. This was the original cataract surgery.

The advent of very fine suture material and magnifying glasses brought with it the development of intracapsular cataract surgery. The eye was entered through a large sterile surgical incision and the cataract was removed as a whole. After the incision was closed with these rudimentary sutures it was necessary for a patient to remain stationary, her head held still by sandbags for a week. As barbaric as this sounds today, this procedure, along with cataract glasses, dramatically improved both the safety and the visual results of cataract surgery. Revolutionary change number 1.

Intracapsular cataract surgery was followed by extracapsular cataract surgery, the procedure made necessary by the creation of intraocular lenses. These tiny implants, less than half the size of a dime, are implanted in the capsular bag left behind after the inner workings of the cataractous lens had been removed; think of it as filling an empty grape skin. Better vision, greater safety, and with the addition of mechanical assistance extracapsular cataract surgery also brought efficiency and speed to cataract surgery. Clearly superior, the extracap supplanted the intracap, and during a time of transition both procedures received identical financial coverage from all forms of health insurance. Revolution number 2.

What followed next in ophthalmology was probably the predecessor of all that we have come to know about the intersection between commerce and care in American medicine. A certified genius who was so sure that he was right that he simply did not care what any of his colleagues– indeed what any ophthalmologist at all–thought about him or his invention, introduced  phacoemulsification. Charles Kelman discovered that you could remove a cataract of any size through an extremely small incision by first dissolving it inside the eye with high–frequency ultrasound. Kelman was initially viewed as a heretic, and early adopters of phaco technology were scorned by the ophthalmic orthodoxy. In response they marketed phacoemulsification as the superior procedure that it was, further enraging the establishment by becoming wealthy and famous through the efficiency and efficacy of this surgical revolution.

Once again, during the time of transition from extracapsular cataract surgery to phacoemulsification, both procedures were treated equally in the eyes of health insurance, and every patient’s surgery was paid equally with either technique. Revolution number 3.

As phacoemulsification gradually ushered extracapsular surgery into extinction in the 1980′s there began an era of relative tranquility in the world of cataract surgeons. There was very little to distinguish one surgeon from another save for gross incompetence, a complication rate so far outside the norm that it could not be ignored. How could this be, you ask? Well, all of the intraocular lens implants during the initial part of this era were essentially the same. Each lens development, each evolutionary step however big or small, was quickly adopted by the overwhelming majority of surgeons, and pretty much every cataract surgery patient received a state–of–of the–art implant for her surgery. The SURGEONS surely knew who among them was better. They knew who was faster, slicker, more elegant, and dramatically less likely to have any complications whatsoever. But even the most astute patient was incapable of knowing the difference between a 20-minute cataract surgery and a five-minute cataract surgery, one plodding and clumsy, the other elegant and quick, so powerful was this new technology. Every cataract surgeon in America could, and did, look their patients in the eye and say their outcomes were essentially the same as every other surgeon; they, themselves, were just as good as every other cataract surgeon.

This happy time of peace, love, and tranquility came to a screeching halt in 2003 with the introduction of an implant called the Crystalens. Here, for the first time, the cataract surgeon was able to give his patient excellent vision at any and all distances WITHOUT WEARING GLASSES. The problem, though, was that the Crystalens was actually rather tricky to insert. You really DID need to be more equal then your surgeon peers in order to get this extraordinary outcome. Not only that, but the implant was almost 10 times as expensive as what now became known as standard implants, it required roughly 3 times as much work preoperatively and postoperatively to achieve this outcome, and all of a sudden there was a very clear division between cataract surgeons. There were those who did what became known as premium surgery because they could, and there were those who didn’t.

Surgeon Emperor’s rode on their thrones through the throngs of what once were their peers, adorned with wondrous capes and crowns they so deservedly wore for they were truly better surgeons, and they were paid more to do this premium surgery. For you see, a great change had occurred:  the health insurance companies did NOT view these new implants as equal to those in present use, and in their wisdom they allowed patients to pay with their own money for these more expensive lenses. This they did, though not in great numbers, just enough that it started to become clear that some surgeons were more equal than others. This was not a true revolution in cataract surgery itself, only the economics of cataract surgery.

So here I find myself, one of these Lesser Surgeon Emperors of the premium implant era. I stand among the crowd as this very small group of self–proclaimed Greater Emperors glide by, pulled along on their grand femtosecond chariots. They are declaring, loudly and to anyone who’ll listen, that laser cataract surgery is the fourth great revolution in the long history of cataract surgery. “It’s more accurate,” they declare. “It will make cataract surgery safer!” They cry. “It’s the next, mandatory step in premium cataract surgery. It’s well–worth every penny of the additional $1000 the premium cataract patient will pay,” they state as they preen on their perches.

I blink as I stand there. Something’s not quite right. The rest of the crowd cheers these magnificent creatures but still something seems wrong. A better, more accurate and uniform capsulorhexis (the initial opening into the cataract)? That doesn’t seem to be a problem with premium cataract implant surgery today, at least in the hands of the best surgeons. Better sealing wounds to decrease the number of post–operative infections? Again, the busiest, highest volume, best cataract surgeons already have the lowest infection rates in America. A simpler, more reproducible and accurate limbal relaxing incision (a technique to treat astigmatism)? Well, I HAVE heard that an inability or unwillingness to handle astigmatism IS a barrier to implanting premium cataract implants, but that doesn’t really seem to be much of a problem for those surgeons who are successfully using them now.

I blink once again and then it hits me: the Emperor Surgeons have no clothes! They are parading right in front of us, declaring the femtosecond laser the proverbial silk purse to be utilized as part of a premium service, carried only by those cloaked in the finery of the court as they have been told by the industry courtesans.  Femptosecond laser cataract surgery is a revolutionary step, but it is a premium service like the Crystalens, and is properly utilized only by Emperors.

They are right but they are also so very wrong.

Blinded by the hype, blinded by the glow of their reputations, by the industry courtesans as they wave their empty clothes hangars, the naked Surgeon Emperors are trying to MISS the fourth great revolution in cataract surgery, because femtosecond cataract surgery is not a silk purse, it’s actually just a better backpack! Femtosecond laser cataract surgery is the technology that reestablishes real equality among cataract surgeons. It is not the scepter of the Greater Surgeon Emperor, it is rather the butter knife of the common surgeon.

Think about it. The best cataract surgeons in America are not having any difficulty making a proper capsulorhexis, and they are obtaining over–the–top outstanding outcomes with literally every single type of intraocular lens available. These are not the men and women who are having outbreaks of endophthalmitis (a total eye infection) because of poor technique creating their incisions. We are not seeing an epidemic of untreated astigmatism in the population served by these extraordinarily talented surgeons, especially in those eyes that have received a Crystalens or other premium lens implant. The femtosecond laser as a necessary, mandatory tool to improve the outcomes in THIS group of surgeons performing premium service cataract surgery? Please. The incremental improvement in outcomes will be infinitesimally small in this group, and I will go out on a limb and say that any of the Emperor Surgeons in the parade who are truly among this group of noted surgeons would tell you just this.

No, femtosecond laser cataract surgery is the next great revolution in regular, garden-variety, standard implant cataract surgery performed by the middle–of–the–Bell Curve cataract surgeon. Here is a quick story to illustrate my point. An 80-year-old man had cataract surgery performed in his right eye by one of the most deservedly famous cataract surgeons in the United States. Perfect incision. Perfect capsulorhexis. Limbal relaxing incisions that reduced astigmatism to 0. Every single aspect of the operation that would have been impacted by the femtosecond laser was performed flawlessly. The outcome? Not so great, actually. The patient had a poorly positioned implant causing blurred vision, which was not discovered for approximately 9 months due to postoperative inattention. This caused him to be greatly unhappy with his result and ultimately causing him to seek another surgeon for his left eye even after the blur was fixed.

This new surgeon simply could not be more different from the world famous surgeon. A very kind and gentle soul with a lovely and caring bedside manner, he was at best deeply buried in the middle of the surgical Bell Curve. The outcome? Not so great, actually. A poorly done capsulorhexis prompted him to default to a much older lens implant, a clear technological backward step, and a surgical problem that would clearly be prevented with the use of the femtosecond laser.

So my friends, the femtosecond laser actually IS the fourth great revolution in cataract surgery, but the Greater Surgeon Emperors are failing to see that, like intracapsular to extracapsular, and extracapsular to phacoemulsification, phaco to femtosecond is a revolution for the masses. The femtosecond laser will make an average cataract surgeon a good one, a good cataract surgeon a very good one, and a very good cataract surgeon potentially a great one. It will do very little for the outcomes of the already great cataract surgeon. Oh, there may certainly come some new type of implant where the outstanding surgeon will require a femtosecond laser in order to properly use it, but as of this moment that particular widget doesn’t exist. The femtosecond laser is a technology looking for a use, an investment looking for a market. Will it find its place only with the Emperors, those who should be leading, now instead just riding behind?

The greatest of Emperors lead.  If I am right, if this is actually a technology which will make regular cataract surgery safer and more predictable, Surgeon Emperors and their industry minions should be pounding the streets of Washington to make this fourth revolution just like its predecessor: available to all. They should call it as it is, the average surgeon’s pathway to greatness. They should lead on behalf of every 80-year-old man who deserves a perfect capsulorhexis and a perfectly created wound to go along with his most modern standard implant. They should lead their surgeon brethren on behalf of their people. The greatest among these Emperor Surgeons will see nothing that is negative happen to them if they fight to make femtosecond laser cataract surgery just the next revolution in every day cataract surgery.

I blink. I wait for one of these Emperors to put on some clothes, get out in front, and lead.

 

Transition, 2.0: “The Heir” Graduates From College!

My oldest child Dan, known around my Crossfit buddies as “The Heir”, has reached a very significant milestone. On June 4th in front of his Mom and Dad, sister, brother, and grandparents, Dan graduated from college and I couldn’t be more proud. It’s an inflection point. Call it Transition 2.0. I wrote a little bit about graduations when Megan, “Lovely Daughter”, graduated from high school in 2008. Here’s an excerpt:

 

“The next stage. “Lovely Daughter” graduates from high school tomorrow. Now, in our family this would not typically be a very big deal, not a very big step. We are very fortunate chez Bingo, and by and large we try very hard to realize this good fortune. It has been for several generations not a matter of whether you graduated from high school but what you did and where you went from there. This was certainly the case with “The Heir”.

But “Lovely Daughter” had challenges that could not be foreseen, a difficult battle with illness that continues today, one that prevented her from attending school as a “regular” student for the better part of two years. With the assistance of Mrs. Bingo and others, but largely through the force of her own will, “Lovely Daughter” has been able to leave the darkness behind and live in the light (although, to be sure, the darkness lurks behind, always in the mirror, always there). Despite not being in school those years she will graduate on time, with her original class, 4.0 grade point in hand, and move on to her next step in college.”

 

Dan, on the other hand, was quite ready to move on to college some time in the Spring of his sophomore year in high school. Frankly, there were times that his Mom and Dad were ready for him to head off to college around then, too! Seriously, Dan is so bright and so able that it is always really just a question of ‘what’ and ‘when’ he will move on to the next great adventure, the next triumph. Maybe that’s why this whole college thing seemed to go by so very quickly. I mean, really, wasn’t it just last year that we were moving on from Jr. High to High School? Choosing all-boy parochial vs. public? And c’mon…I’m SURE it can’t have been more than 2 or 3 years ago that Danny (he was Danny back then!) was pulled, kicking and screaming and ferociously clutching the steering wheel of the mini-van on the way to kindergarten. Right?

Man, it all went so fast.

I tried to hold on to each precious moment. Really, I did. Even whacky stuff like lacrosse in a monsoon, I told myself I’d miss it when it was gone. Pay attention! Pre-school to grade school; grade school to middle school; middle school to high school; college to, well, who really knows? I really DO remember the graduations, each one of them. I was there for each of them, for Dan and Megan and Randy, both physically and mentally. As fast as it’s all gone I can make it slow down by playing the “tape”  of each one back in my mind.

It goes so fast, you know. All of it. It makes me wonder why people are always in such a rush to get to that next place, whatever that next place might be. Kids in such a hurry to grow up. Parents in such a hurry to have the kids grow up. I don’t get it. Even when it was tough–face it…this parenting stuff is nothing if not tough–I never really got the whole hurry up thing. Heck, it’s FUN to be a kid rolling in a big ‘ol mud puddle, and it’s fun to be the parent hosing said kid off after shooing him back outside after he fouled the front hallway. You just don’t get to DO that stuff after awhile.

I tried. Really, I tried to take it all in. To be OK with wherever and whenever we happened to be. You know, to be just fine with the graduation at hand and not so much into what was going to lead up to the next graduation. How’d I do? Man, it all went so fast, I’m sure I could have done a better job at it.

We are not promised tomorrow. If tomorrow comes we are not promised a “good” tomorrow. If we lead a virtuous life, whatever that may mean for each of us, we hope that our efforts will translate into a “good”, or at least “better”, tomorrow. Or not.

All we have is graduation today.  And every today has something, some thing little or big, that makes it a good day. Each of our privations, every challenge can be borne if we realize that there is some one thing, or some several things, that are good in each day. What we hope for is tomorrow, and that tomorrow might be as good, or better, than today. But what we HAVE is today. In the end, that’s all we ever have.

There was a time when I awoke each day and checked to make sure that I was still the father of a daughter. EVERY day was a good day. There’s nothing particularly special about this today, about Saturday June 14, 2011, except that this was the day we had, and it was Dan’s college graduation. Transition 2.0, but a day to cherish all on its own without too very much thought about transitioning to “what”. And I was there. Really, really there.

What’s good for you today? Who’s special to you today? Did you tell them? Do they know? You may not have a tomorrow you know, but if you are reading “Random Thoughts” you DO have today. You don’t have to be a parent for this to be so, but I’m here to tell ya, the today’s go reeeeeally fast. You slow them down by letting yourself be there, today. Because as fast as they go, there are really only two kinds of “todays”, good ones and great ones.

And man, they go by so fast.

Rational Self-Interest

At the root of behavioral economics is a rather simple concept: people will tend to make choices based on rational self-interest. Given the rules of any given situation, most people will behave in a manner that results in either some benefit for themselves, or one in which they are least likely to suffer some unpleasant consequence.

I first came upon this concept in the fascinating book “Non-Zero” which seeks to explain social evolution through the prism of game theory. But it was Alex Tabarrok’s introductory lecture in Econ 101 that best illustrates both the definition of rational self-interest and some of the unforeseen consequences that arise when one doesn’t remember this rule.

In the early to mid 1800′s Great Britain was suffering from the inconvenient combination of too many criminals and too few jails. In earlier times this would not have posed so much of a problem—the worst of the criminals would simply be hanged. This being a more enlightened age, however, made this an untenable situation, one that needed a more genteel solution. Enter Australia! During this time of expansion in the British Empire (despite those rascals in North America), the powers that be realized that the government was long some land just past Africa. Thus was a new nation born, populated by the misfits and miscreants shipped out of England, out of sight and hopefully out of mind.

This whole penal colony thing turned out to be pretty good business for the merchant marine industry in Great Britain. Ships were hired and captains engaged to deliver the human cargo to Australia. Indeed, large sums of money were paid to both the ownersand captains of the ships to deliver the prisoners alive, new citizens in the ever-expanding United Kingdom. After all, if your not gonna execute them at home, it made sense to get some benefit from keeping them alive;  colonizing yet another corner of the globe seemed a fair trade for avoiding execution.

A funny thing happened on the “road” to Australia: most of the prisoners died en route, and those who survived the trip arrived very much worse for the wear. This confused the British officials since they were paying top dollar, hiring only the best captains and working with the most reputable shipping companies. Both crew and cargo, human and otherwise, seemed to make the return trip with no difficulty. Fearing that this was an issue of economics the government officials increased the fees paid to the captains, theorizing that this would incentivize them to deliver the prisoners alive.

Alas, ‘twas not to be. Despite the enhanced payments the majority of the prisoners continued to die en route.

After some years of this pattern a rather low-level functionary in Australia took it upon himself to interview the surviving prisoners upon arrival. They told tales of incredible deprivation. Weeks upon weeks of rations that were below sustenance level. Horrid sanitation below deck where the prisoners were housed. Terrible beatings inflicted upon any who protested. Interestingly, all of these things seemed to WORSEN after the fees for passage were increased.

It turns out that the issue really was one of economics after all. The captains were given funds to pay the crew and to provide provisions for both crew and captives. They were paid UP FRONT! Any money left over went to the captain, and if he was smart some to the crew. No only was there no incentive to deliver their cargo alive, there was actually a strong DISINCENTIVE to do so. The less money spent on keeping the prisoners alive and well, the more money left over for the captain and crew.

Rational self-interest. Ugly? Yes. Inhumane, for sure. But irrational? Not hardly.

I know you are wondering, how is it, then, that Australia isn’t simply a huge landmass still populated only by its Aboriginal citizens? Well, armed with the knowledge that prisoners were not being fed, given exercise, or treated for any maladies that might arise, the business model of populating the penal colony was turned on its head. The ship shipping companies and their captains were given the equivalent of working capital sufficient to supply ship, crew, and cargo with the necessities to arrive alive and well, and wages were paid upon successful delivery of healthy, living prisoners to their new homes.

Voila! Problem solved. The expansion of the British Empire was saved by understanding the concept of rational self-interest.

So what’s the take home message? In most circumstances one can analyze the actions of the participants and gain a more clear understanding of why they behave in a particular manner by seeking to understand their actions through the prism of rational self-interest. For example, it always amazes me when business owners are surprised when their employees always turn out to be sick the exact number of sick days they are allowed each year.  It is certainly in the business owner’s interest for them to work if they are healthy, but when you turn that on its head and think about the worker…

Heroism and other forms of altruism do exist; they’re just really rare. People do stuff that looks crazy on first blush, but when you dig a little deeper it’s usually nothing of the sort. It’s usually rational self-interest that you simply missed.

For Whom Do You Sing?

We are all, in one way or another a one man band.

For whom do you play your music? Whatever it is you do, whatever it is you have to offer, it’s really no different from the street corner musician, is it? You may be part of a little band of musicians, but let’s just say it’s your music for the moment. For whom do you play and why?

Do you play for an audience of passersby, each there but for a moment, only to hear the smallest dose of what it is you have to sing? If you’re to get a coin in your case you’d best be at the top of your game for that moment, and you’d best be playing your very tip top stuff. Indeed, you are likely to play a very limited repertoire in that scenario, eh? Kind of like the salesperson in a big commercial gym, armed with a stress-tested script with little opportunity to ad lib, but capable of successfully performing that script better than others and thereby achieving a measure of success. Some coinage.

Or do you rather play for a much smaller audience, one that lingers to hear the greater range of your catalog? The person who represents that tiny percentage of aficionados who not only UNDERSTAND your music, but have actually been trying find it, whether they knew that or not. This kind of music can be kinda messy, an experiment in expression, and it may not prompt all that many people to pause at your corner as they stroll through the iTunes of their lives. Indeed, even those who DO pause may find your music too difficult, too much of a challenge, too long in the ‘sinking in’ to appreciate. You get excited to have an audience only to be brought down when they walk on.

This sounds a bit more like Crossfit. The music of Crossfit.

(N.B. I read something from Seth Godin that mentioned the metaphor here.)

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