Gene's Joint

Gluttonous thoughts on T-day

Man, I ate too much  <burp>

Seriously, I think I ate so much that I gave myself gastroesophageal reflux and couldn’t go back to sleep. Well, at least I’m not alone . . .

It turns out that the average American consumes 4500 calories on Thanksgiving day. Just to put that into context, my basal metabolic rate is 2564 kcal per day so I probably consumed close to double my basal metabolic rate yesterday.

Its crazy to think what kind of country we are in America where the day after stuffing yourself, most Americans will actually wake up early to line up to go shopping for Black Friday specials. Although I suppose you don’t even have to leave your living room anymore these days with all the internet shopping that is available.

Behavior change is definitely tough. I wonder if my latest “get thin fast” scheme is going to work. This time, I am going to try portion control while on the interview trail (smaller portions more frequency throughout the day). Who knows how that will go? Likely it will go the way of my last 90 attempts.

Economic Transition and political progress in China

We had a speaker back in January Minxin Pei from the Carnegie Endowment who offered some interesting rebuttal to the theory that economic progress will lead to democratic opening up. He argues for the political elite driven political system in which economic progress actually inhibits political progress. First he cites the
negative correlation between econ success and democratization because it legitimizes authoritarian governments. Citing the history of 70 democratized countries only 5-6 have been rich countries most have been poor.
Today China practices selective repression maintaining an elite force of 250k-500k riot police to suppress uprising and Internet police and what he calls social cooptation. This last point is very interesting that points out that China has learned from overthrow of authoritarian regimes (and Tianmen) is by social elites not by peasants so the gov is actively coopting urban intelligentsia into its ranks by maintaining a technocracy in powerful gov positions and benefits for academics. It’s pretty sad that they have been so successful using this basic principle is the more you have to lose the less you willing to shake the boat.
Question: is this sustainable? Pei doesn’t think so for several reasons. Everything depends on maintaining high rate of econ growth, corruption and inequality are key structural weaknesses and hypocrisies in the system (no inheritance tax, no unions, no capital gains tax). Authoritarian regimes cannot coopt everyone in the elite class so people will be left out and constitute new source of change. New middle class and civic activism are becoming politically active for environmental issues, corruption won’t challenge directly but will eventually show that cccp is incompetent inproviding healthcare and environment may be the entry points for Chinese society to become more empowered. He believes the change is coming in the next 10-20yrs. Very interestingly, he pointed out the vulnerabilities of China to any political transition or democratization given its imperial system of enforcing rule on Tibetans and Muslim ethnic groups that fundamentally do not want to be a part of the Chinese state. When China transitions to democracy, it will fall apart. At that point if Taiwan will break away as well and war will likely ensue.

Finally, I thought an interesting comment from the crowd was that of a professor who pointed out that industrialization has historically weakened democracies in the West as well including Europe and the US further reinforcing the thesis that economic progress does not lead to democratization. What do you think?

Life line exercise

Finally back at Tuck! Whew . . . makes me wonder why exactly I’m doing this residency thing

Speaking of introspection, I am taking a course called Leadership Out of the Box at Tuck which is about the developmental journey that leaders take where we study bios of leaders we admire as well as undergo some soul searching. Perfect class for me: high on interest and low on work!

Anyway, Prof B had us do an exercise in class where we all drew our own life lines with time on the X axis and happiness on the Y axis and noting transitions in your life where things went up or down precipitously. Mine was quite interesting. One of the key takeaways was that in my mind, I was happiest in my life when I was 12 right before my parents moved us to Taiwan. All I remember from that period was not feeling self conscious despite being a rather “portly” child, feeling self confident as I was one of the top students in my elementary school and in Jr high as well and most importantly having a lot of energy and happiness being surrounded by friends and family and having all a kid could ever want. The crazy thing is despite the other highlights in my life, I cannot say that there has ever been a period where I have been that happy with perhaps doing premed in San Francisco and being at Tuck in this fall term coming close to that.

So what does that mean? Does it mean that I was forever scarred by the move to Taiwan? Or as Dr. B would say it, is moving to Taipei a “defining” moment in my inner journey to become a hero/leader? What is clear to me is that some of my current behavior as an adult in which I prefer to be comfortable and lazy as an adult, be mothered in relationships, be mentored by father figure types relates directly to this period in my life where I was the “most” happy.  Does this mean I am forever to be defined by this moment so far in my past? Or does it mean I need to resolve some inner psychic conflict to move on? I guess that’s what the rest of this class and this life is all about.

Anyway, highly suggest doing the exercise, it may sound froofy but it actually does make you think about and visualize your life thus far a bit!

Decisions, decisions

So anesthesia it is! Like most decisions in my life, I waited till probably the last minute and took the path that as my dad says “opens up” more opportunities. Anesthesiology has a little bit of everything that I’ve liked about medicine and still gives me the opportunity to keep my hand in business. All while being a bit more lifestyle friendly than EM or medicine.

Just finished turning in my ERAS (that’s the common app service for residency programs) application so we’ll see if programs agree with me that anesthesia is the right fit!

A strange feeling

Its strange, for the first time in med school, I am feeling a strange sense of contentment and happiness these last few days on anesthesia. Part of it, I’m sure is getting out before 3pm every day which has been Sah-weet! Then again the adult anesthesiologists get out at 4p which is not bad at all either. But beyond the hours, just feeling like I have more energy (working out every day this week), confidence (intubated successfully twice today!) and curiosity (been motivated to read about 1.5 hrs each day this week). Its been really quite nice. Plus being back in NH when it is sunny and just doing my own thing has been really great. Eating when I want, sleeping when I want, having some extra time to study or work on my business. All of this has really made me quite happy . . . aaaahhhhh, anesthesia it is . . .

Morning break

This is the first time I’ve EVER hear those two words spoken to me.

Working pedi anesthesia with Dr JC today. Been amazingly relaxed but enjoyable. Makes you wonder why more people don’t do anesthesia. It’s like one part reassurance, two parts gas and meds and a healthy dose of observation and being careful. Got to intubate a couple of times and started some good ivs on the kiddos. Even got to play some candyland with one of my patients. Not bad, not bad at all . . .

So far after one day of anesthesia, I love it. The overall culture of anesthesia is great, nice people, smart, contemplative but very keyed into the need to treat the clinician right (ie not work 40 hours straight w/o sleep routinely). I also like the idea of shutting down the patient, supporting their vital functions and then starting them back up. Its totally the kind of thing I liked about critical care. Plus thinking about physiology and pharmacology, two of my fav subjects in med school is pretty nice. Finally, reassurance is a big deal in anesthesia and kind of jibes well with my personality.

Finally, I have to say that the combination of having a good day, working with good people and getting out at 3pm really energized me today. I went to the gymn, shopped and cooked dinner, even wrote in my blog! Now how is that for a medical specialty, one that adds positive energy instead of sucking it all away!

Back in Medicine

Wow, been a while. Just finished up a medicine subinternship where they told me that I was “rusty” . . . hahaha, so much for trying to do both business and medicine eh?

Still, it was pretty  to take care of patients again. The high points of seeing patients get better and go home to the lows of telling a patient he has cancer and has weeks to months to live.

Ah medicine, its wonderful taking care of patients, but you’re usually too tired to give  a crap.

The bad news is that I don’t think I did very well on my subinternship. The good news is I think I can safely rule out internal medicine as a specialty, hard to be passionate about a specialty where you are paid by your notes so you end up spending most of your time typing and making other people see your patients so they can type notes too.:)

In all seriousness, the system is pretty broken, tests are too easy to order, thinking and teamwork are discouraged and the patients too often get care that they did not want or need and may be bad for them.

On that lovely note, I’m back to business next week working for a consulting firm in Boston . . . more later

Flowers from my apt in Paris!

I’m in Paris!  Just had some baguette with Roquefort cheese and a couple of crossaints . . . mmmmmmmmm

The view from my apt, nice flower eh?

We won VCIC!!!

The Tuck team composed of four other Tuckies and myself are Venture Capital Investment Competition New England Regional Champions!

Whoo hoo!

http://www.vcic.unc.edu/

A few old posts

Here are a few old posts that I put on my iphone but haven’t uploaded

On Self Motivation 11/1/08

Lately, I’ve come to realize that the two times in my life where I have worked hardest and performed best were

1) in medicine where not working hard might kill someone

2) j&j where I followed an effective leader whose vision I shared, there was promise of high impact, prestige and to top it off I was compensated well

On Professional/Personal goals 11/3/08

New realization – goal is to be happy and the way to be happy is to be productive and this should be the goal Not productivity or networking or brand names for their own sake Eg maybe I want to be able to veg and do nothing sometimes and for that being an entrepreneur is not compatible perhaps I don’t want to be so passionate about something that I can’t sleep or have to be hypomanic and instead should just be employee #1 What makes me happy -social recognition & prestige -learning -mentoring/teaching -being excited about an opportunity not everyone else sees -being included (languages) -being comfortable -newness freshness -seeing what’s around the corner -self insight -connecting with people (talking to Paul and patients) -being appreciated/knowing I helped someone else -spontaneity -being part of something bigger (democracy in china)

I could never be the doctor patients want me to be Vc have not returned money Hedge fund quickly Two times to get in after Bschool and after Ceo

I need external motivators like threat of tests or embarrassment is it bc I’m not motivated or need to find what motivates me.

Do medicine for the right reason, being a better businessperson may not be one.

Christine’s observation 12/16/08

Christine said something quite interesting to me today. She observed that I really spoke about my time at jnj very fondly and that it’s rare to find a job you really like working with a great Boss for good pay. I told her two reasons it’s not totally ideal basedon geography and trajectory may be a bit slow but with great work life balance but that might be a cop out. Maybe it also lacks some prestige of working for a Mckinsey or the excitement of starting something new. In being a great balance of things maybe jnj just doesn’t have that sense of mystery and excitement that really gets me going?

Consulting for the summer 2/12/09

Finally got the “covetted” consulting job today but found myself wondering if that’s really what I want to do or not. Is it really a “positive” as in something I do because I love it? Or like Harold in white castle am I just lying to myself? So if not consulting then what really gets me up in the morning? Is it patients getting better? Is it the prospect of an exciting new business I’m building? Is it money? I guess looking back on the last few years I would say the general trend is that a few things really “activate” me and the rest is wanting to feel comfortable and safe. The things that have excited me tend to fall into a general pattern of being generally cool things that are innovative or clever and help people such as microfinance or things like my way village. The duration of the excitement varies and medicine has definitely been the most exciting of the bunch. It can definitely be enhanced by good management. In many ways JJDC was a sweet spot for me in terms of productive work that was interesting lucrative and helped people. The ability to also have ownership over it would be wonderful as well. The other factor here of course is prestige and feeling like I have to be better than others or in a position of strength, knowledge, insider, clubbyness.

Somehow I think the desire to work for Mck comes from this feeling of not being good enough. On the other hand the desire to be better and to excel also comes from this. So one question here becomes do I need to always have a boss? Someone to impress, someone to pat me on the back and tell me what a good job I am doing?

Yes and no, I guess I can get excited but not consistently, one reason I hedge all the time is because I keep looking for more interesting and prestigious things that are more clubby that can allow me to occupy that position of strength and give me that sense of confidence that I lack.

So who am I then? It seems that on both levels both in my personal life and professional life I am constantly seeking safety and sense of security both in terms of someone who can take care of me and who I can be a baby with as well as a job that at least on the surface can communicate to others what an impressive person I am.

So what now? Do I try to change all this? Understand it by getting a psychiatrist? Or do I just accept it and optimize who I am? Is there something I am missing here?

Crazy idea 3/5/09

I had a crazy idea today about drug compliance and starting a business which takes commonplace food and herbals habits and uses them to improve compliance with pharmaceuticals. Kind of like cough syrup or antibiotic lollipops for adults.