On Balance and Efficiency


My research focuses on the immune system and specifically how inflammatory diseases such as Crohn’s disease, ulcerative colitis, or sepsis can be targeted with specific therapeutics. In contrast to cancer, where the goal is complete eradication of the cancer cells by whatever means necessary, or infectious diseases where complete stasis or death of the offending pathogen is key, therapies involving the innate immune response in inflammatory disease implement a goldilocks principle- too much inflammatory response and an inflammatory disease results, yet a total suppression of inflammatory response also leads to inflammatory disease resulting from an expansion of pathogens against a weakened host immune response. This is intermediate therapeutic zone is much more difficult to design therapies for and determine what the optimal level of response would be. Yet this is how much of life works- at an optimal intermediate between two extremes, with either extreme seen as unhealthy. The ideal would be to have both: an immune response that is robust against pathogens but is self-limiting, in effect not just finding a happy intermediate between the two but strengthening both the aggressive response to invaders as well as the attenuating factors downregulating inflammation.

I have always found the term work-life balance to both mask the real problem as well as cause confusion about what both work and life entail (as an aside Schrodinger’s essay “What is Life” is certainly a worthwhile read). Certainly we need balance in life. Certainly we need to work. And certainly everyone is in favor of life over the alternative. However calculating the minutes spent in an occupation or hours spent at home is surely a poor way to measure either as well. And as great as “Rent” is, love isn’t a terribly concrete way to measure anything. We live in a unique time in human history where our occupations can be our passions and not merely the basis for sustaining life. I enjoy research and medicine, and much of the large quantities of time that I spend working on either could be thought of as a sort of recreation in that it is interesting and non-arduous. However you certainly need time for family and “life” as well. The importance for both work and life is being present in both. What is interesting is that when many people refer to needing down time or “life balance” this is more of a way to say they enjoy time on the couch being entertained as opposed to being intentional about the human interactions between family and friends that we value so much. At work many people avoid thinking about how to push the envelope occupationally and instead escape to pleasant day dreams about their life outside of work. In running there is the idea of junk mileage, that is miles that you run but that don’t necessarily help you become faster or more in shape. Getting rid of “junk” hours both in work and in life is critical. Innumerable “junk” hours can be spent at work without making progress or with family without building relationships or caring for one another.

To find success in work-life balance both work and life must be pursued with intentionality, curiosity, and enthusiasm. Often the balance between work and life is not between work and life, but between efficient use of the time we have and a squandering of that which has been given to us.

On New Transitions


One of the struggles many new companies have is the transition from a scrappy startup to an established and respected company. This has been notable in the news as Uber has now made repeated attempts to change and establish itself. For companies, this means the transition from impromptu meetings, a general lack of structure, and a pace of work that, while doable for a year or two, is not sustainable for decades. Many people have great ideas in their garage; very few people are able to take their great ideas and organize a sustainable company around those ideas.

Although different than companies, in some ways our lives are very similar. Many people begin with creative ideas and high hopes for changing the world around them. However the transition from idea to instrumentation is the burial ground for many commendable pursuits. The transition from spectator to player is key. Whatever pursuit you are thinking of, whether that be a sport, a hobby, a new invention, a business idea, the beginning of a political career, or any number of things, the first step onto the field is key. Often the thing holding us back from becoming a player is complacency and a fear of a new experience. Often the first step does not have a high opportunity cost. Instead the cost is a bit of comfort to establish a new identity. Growth is embracing the discomfort, digging in for the long haul, and deciding that whatever we are pursuing is ultimately of greater value and worth than the comfort we are leaving behind. 

Changing For A Better Story


“The man who views the world at 50 the same as he did at 20 has wasted 30 years of his life.”

-Muhammad Ali

Like the proverbial frog slowly brought up to a boil, we are often immune to gradual change. Asked how we are different from yesterday most of us could not see many differences. Even at a week or a month much of who we are may appear the same. Looking back from year to year we can begin to detect the changes. How was I different last year? Five years ago? Ten years ago? As Muhammad Ali notes, the answer must never be “no different”. An essential component to being human is the constant changing of our core selves. The best stories, whether fiction or non-fiction, movie or book, are those in which the characters change, become people their former selves would barely recognize. Take your favorite story, Harry Potter, Lord of the Rings, Star Wars, the Hunger Games, or any other. The most compelling aspect of that story is the dynamic nature of the main character, watching them morph and change as events unfold. Take your own story, your life. How have you changed? How have I changed? Have we changed in a way that makes a great story? Or are we mired in a static bog of routine and comfort? The great news is that the end of our stories has yet to be written and the opportunity for change and growth waits.

A Beginning, A Middle, An End


A beginning, a middle, an end. These are essential components of nearly all of our experiences. The beginning exciting and invigorating. The middle often repetitive, even monotonous. The end bittersweet and nostalgic. This cycle, these three elements are what imbue every undertaking with meaning and purpose. Whether in education or business, recreation or occupation, at the personal level or at the national level, we function best when these elements are well defined. The repetitive nature many careers take. And the later years of contemplation and reflection before final goodbyes are said. We see this in trips, the excitement while packing and traveling, the rhythm of being away from home, before solemn farewells and departures.  We see this over the course of lifetimes, the learning curve of being a child, a student, and a young member of the workforce. In the movie “In Time” where unending life can be bought for the right price one of the main characters observes that although the body can live forever, the mind cannot. We were made to have a beginning, a middle, and an end.

And there is a blessing in that. We understand poorly the process of aging, why the body breaks down, why even with the optimal lifestyle a hard ceiling to longevity exists. Likely within the next 50 years much of this mystery will be unraveled forcing us to ponder what we might do with an end postponed. Would we use our time differently? Invest in the planet and environment more? Harbor less ill will (grudges accumulated over centuries would certainly be oppressive)? Yet in our current state we must do what we can with the time we have. Making the most of our opportunities and our relationships.

On Being Nothing


The admission, and also the celebration, at the center of Christianity is that “I am nothing.”  The human bend is to strive to be something, a desperate plea that “I am something, I am someone.” Much of our daily lives is consumed with that pursuit. In career it is to demonstrate you add to the company or team. In society it is to demonstrate your skills are valued and add to others. In relationships it is to know you matter to the other person. Christianity reverses this. It accepts that we are nothing and even at our best fall short of being something or someone. Importantly it accepts that we are in so far over our heads that we need a savior. That our best strivings and a lifetime of good deeds and effort will still see us short of worth. There are two general ways of recognizing a need for a savior- looking inward and looking outward. When we look inward, a realistic self-evaluation (and this is often the most difficult, as Richard Feynman said “The first principle is that you must not fool yourself, and you are the easiest person to fool.”) we see a degree of selfishness, angst, anger, discontentment, insecurity, and loathing requiring us to look away. When we look outward we see the brokenness of the world, both natural and human derived, that destroy our hopes for a better world. Looking both inward and outward the brokenness is apparent. Instead of looking for distraction or a stubborn refusal to admit defeat, the Christian must joyfully embrace this defeat admitting brokenness and a desperate need for a savior. at its essence, being a Christian is a simple progression: (1) making an observation of brokenness both in ourselves and in our world, (2) accepting that at our best we are incapable of being the someone or something we desired, and (3) looking to a savior who can fix the brokenness inside and outside.

Complexity and Gratitude


The more I understand the human body, all the organs and tissues, all the complex interactions between systems and cells, the more I am amazed not at how terrible disease is (and disease is terrible), but how often things go right in the body. It is amazing how often all the systems come together to allow simple actions like breathing, stretching, walking, and thinking. Take none of this for granted. Every moment, every opportunity should be seized and enjoyed with great gratitude. 

Read, Think, React


The common trend we see in the online community contains one step: React. More than a handful of times I have seen posts on social media in which the person acknowledges they have not read the item they are critiquing yet immediately following that admission they proceed to provide a uniquely, and by their own admission, unqualified, analysis. Ignorance is a luxury that we as a nation, we as a global civilization, cannot afford. We ourselves cannot be afford to be ignorant, nor can we afford to allows others to continue in ignorance simply because they do not have the means to invest in education. Either the solution to this problem or the cause of the problem will be the internet. The internet provides a solution in that it enables access to a vast amount of information. However, there is virtually no filter on the quality of information online and often the effort to fact check and think critically about the information presented is time consuming and difficult. However this time and effort is what is required to maintain democracy and forward progress. Each person must synthesize their own thoughts from what they have read instead of parroting popular taglines. Contrary to what many political systems attempt to persuade us of, one does not simply decide whether they are on the right or the left. Instead one must think about each important issue and decide on that issue what they believe. Instead of a one movement reaction, we must move intentionally to inform ourselves and formulate our own ideas. This is the cost of democracy. Democracy is not guaranteed and there are certainly a multitude of people waiting to take it away. An educated and informed population refusing to buy into partisan lines must be our defense against this. Read. Think. React.

Learning, Doing, Teaching


Academia, as well as life in general, is a strange mix of learning, doing, and teaching. The true innovators are those that are able to balance all three. Learning must come first. Hone your craft, incorporate new techniques and new knowledge. Then do. Create and cultivate. Finally pass on your knowledge and skills to those behind you. Bring them alongside you and motivate them to become excellent in their own rite. In the past I’ve done a lot of learning, a fair amount of doing, and some teaching. The more I do and teach, the more I realize how incredible the teachers and mentors are that are able to both teach and do simultaneously. Attendings (Supervising Physicians) are tasked with both maintaining patient care at a high level as well as teaching the residents and medical students who are training under them. The best attendings meld the two together seamlessly using patient care to train residents and utilizing residents to accomplish patient care. This is true in many areas of life. In research, in business, in education, those affecting the most change are those leaders who can teach and do together. Those to whom teaching is doing and doing is teaching. Learn. Do. Teach.

18 Hours


I recently came across a quote by Gary Vaynerchuk, an entrepreneur and innovator. Noting that everyone has 24 hours in a day and six hours a day is required for sleep, each person still has eighteen hours each and every day to spend however they so choose. For those that need seven hours of sleep that leaves seventeen hours, still a sizable chunk of time. Most people wake up, work, and then have the evening hours to themselves. For those younger people, this time often is open with time for socializing and entertainment. For those with families often much of this time is spent engaging in family activities, doing chores, and preparing for the next day. Certainly there are phases of life- with young children, during an illness, etc- in which the evening or early morning are packed full, however this is the exception instead of the rule. Much of the evening and late night of the modern adult is filled with entertainment. Movies, books, TV shows, video games, browsing the internet, and social media. In most cases these activities do not build strong social ties (yes, even social media) or generate productivity in another way.

They say that if you love what you do vocationally you will never work a day in your life. While this is not purely true, there is certainly something to be said for have work that you love. When I am on a project I enjoy I think about it constantly- while walking in, while eating, while running, and while walking home. Much of the evening time (between 7pm and 1am), is spent working on those projects because they are entertainment in and of themselves. This is the goal, to have your work be so engaging and have such a purpose that it can be your entertainment. Regardless of your work, whether you find the 9 to 5 enjoyable or not, the 7 to 1 is yours to create and do whatever you would like. Don’t waste that opportunity.