Challenging Authority

 In light of my reading on decision theory and the human biases leading to errors, it has led me to think about my relationship with authority.  In the past in my career, I have been accused of not properly respecting authority.  I have always felt that authority should be challenged rather than blindly adhered to.  As a senior engineer, it is my job to assure the best decisions are made.  Since human error is inherent in decisions, those decisions should be questioned.  Additionally, technical authority is bestowed on individuals as a responsibility, not as a position or a reward or a right.  When questioned, those in authority should be considerate, not insulted.  

I'm sure there are those who would wish I would shut up and do what I was told.  That was never going to happen.  I have been silenced by my health.  My hope is that others will take up the cause and continue to challenge authority to make things better.

Forgive the rant.  This has been on my mind for quite some time.  Naturally, authority should be challenged in a respectful manner.  I have always attempted to do so.

Book Review: The Undoing Project by Michael Lewis

 Hi all,  I'm still here, though given the amount of sleep I require, it doesn't seem like I'm here as much.  I did read one book that was quire remarkable, and I recommend it for everyone.

The Undoing Project by Michael Lewis is a biography of two psychologists, Danny Kahneman and Amos Tversky and the work they've done together on decision theory and the natural mistakes made by humans that can impact those decisions.  

Lewis starts trying to show how their work is important.  Lewis uses NBA General Manager Darryl Morey as an example and all the trouble he has experienced trying to determine if players from around the world would make good NBA basketball players. 

The book then goes and looks at Kahneman and Tversky's lives, from their births during and after the Holocaust, through their roles in the military fighting for newly-independent Israel, to their initial academic postings at Hebrew University, where they began their work together.  Most of this work consisted of finding room somewhere and talking through various questions for hours.  They then came up with questionnaires on human choices which they gave to their students, but also to expert economists throughout academia.  Results showed it didn't matter if you were an expert or not, everyone is subject to a set of biases which are best described through a set of heuristics, or rules of thumb.  

These results also showed that people are not naturally rational or logical in their thinking.  For example, people are often biased by context and the narrative surrounding a given situation.  One of the more memorable was the 'Lynda problem.'  A narrative description is given of Lynda showing her to be of liberal mind and interested in women's issues.  The questionnaire then asks which is more likely:

a) Lynda is a bank teller

b) Lynda is a bank teller and a member of the feminist movement

A large majority of people chose (b), which is ridiculous when you think about it from a strictly mathematical perspective.  Clearly, (b) is a subset of (a):  all feminist bank tellers are bank tellers.  (a) should be more likely just because there are more bank tellers than feminist bank tellers.

While all the material on decision theory and biases is interesting, it can be overwhelming to the reader.  I suggest one reads (or listen to on audiobook) the book like a novel, letting the psychology wash over you, getting the general gist but leaving the details for another time.  The book is interesting on a number of levels:  how Kahneman and Tversky came up with their theories; their relationship while building up the actual material; and the personality differences between the two academics -- Kahneman was clearly an introvert who wanted to solve interesting problems versus Tversky, an a-type personality who wanted to prove the theories were right.

Having finished this great story, I plan on learning more about decision heuristics, as documented in Kahneman's later books, including Thinking Fast and Slow.  I think this material is critical for decisions throughout business and life.  I would recommend a similar course of learning for my friends and colleagues.  Michael Lewis' book is a good way to 'easy yourself into' the topic, while being a good interesting read

Song of the Beautiful Journey

 My son Ethan sent me the link to this song.  He said the words expressed how he felt about us now as we move through these last days of my life.  In listening the song, I felt that, at least for me, it spoke to the almost 28 year journey I've had with my wife Stacey.  I also picture this song playing as we walk the backstreets of Sanibel Island before Hurricane Ian.  

I have posted the lyrics below.  Thank you Stacey for the wonderful journey.  Not every day is this beautiful, but more are than not and I wouldn't have it any other way. 

Here With Me

Watch the sunrise along the coast
As we're both getting old
I can't describe what I'm feeling
And all I know is we're going home
So please don't let me go, oh
Don't let me go, oh-oh-oh

And if it's right
I don't care how long it takes
As long as I'm with you
I've got a smile on my face
Save your tears, it'll be okay
All I know is you're here with me
Oh, oh, oh, oh-oh-oh-oh-oh

Watch the sunrise as we're getting old, oh-oh
I can't describe,whoa-oh
I wish I could live through every memory again
Just one more time before we float off in the wind

And all the time we spent
Waiting for the light to take us in
Have been the greatest moments of my life

I don't care how long it takes
As long as I'm with you, I've got a smile on my face
Save your tears, it'll be okay, ay, ay, ay, ay, ay-ay-ay-ay

Yeah, if with me
Oh, oh, oh, oh-oh-oh-oh-oh
I can't describe, oh, oh

Sorry, There are no Re-Takes

 It's Okay to have a bad day or make a poor decision.  Just don't do it on one of those days you are taking a test to determine where you will be binned (and thus how you are treated) for the rest of your life...

This happened to my mom a few days ago.  I am so sad, mad, and frustrated but there is nothing I can do about it.  As you may know, my mom fell and fractured her hip.  She was taken to the hospital where they operated and inserted a pin between her femur and hip bone.  They start physical therapy in the hospital, but once the patient has medically recovered, the patient must be transferred to a different facility for rehabilitation where one works towards having the skills to be home again.  In an 'acute rehabilitation' center, the staff works with 4-6 hours a day teaching the body how to walk and perform basic functions.  Focus is on the rehab.  If one is not able to do at least 4 hours of rehab, a patient is released to a 'skilled nursing facility' where they only work rehab with you 2 hours a day.  Focus here is on basic care.

The day (and days) leading up to the transition, my mom made a poor decision.  Although the nursing staff at the hospital explained that pain medication, particularly Morphine, should be used as a tool to manage pain, such that one could work on physical therapy (and meet the 4 hour minimums for acute rehab).  Based on her lifetime of experience, mostly dating back into the 1970s when it was common practice to be heavy-handed on pain meds essentially putting patients into a semi-stupor, pain meds were to be avoided if she could tolerate it.  So, where the average patient was using measured doses of morphine at targeting times, my mom was taking the occasional Tylenol.  Results were predictable.  She could not participate in physical therapy at the hospital to indicate she could meet the 4 hour pre-requisite.  So, poor decision leads to bad day leads to poor outcome.

My mom is now headed to the skilled nursing facility where their rehab staff will work with her two hours a day.  If life were fair, there would be some opportunity to work her way up to more rehab hours, possibly transfer to an acute facility, and eventually work to get home.  Life is not fair.  She can do rehab for those 2 hours but no more.  The facility only has staff to support the two hours (maybe less since staffing in elderly care has been in crisis since COVID).  The rehab folks may prescribe exercises and more walking outside the 2 hours.  However, she won't be allowed to do any walking independently (i.e. without qualified staff) due to safety concerns and regulations.  Also, there is no additional staff to be with her during these times.  There may be some ways to positively impact the situation if family were physically present and willing to strongly advocate for her.  Unfortunately, I am her only son, located several states away, and have terminal cancer.  

What other binning decisions are based on one-time only tests on a given day?

Update:  My mom settled in to the skilled nursing facility.  She is 'sort of'' taking our advice on the pain medication, though she still refuses morphine.  My mother-in-law drove up from VA to check the facility out.  It appeared clean and well organized.  Her overall assessment was that it was 'fine.' The team of nurses will do weekly evaluation on Tuesday as to my mom's progress.  Within 3-4 weeks, they will make decision on what's next - long term care (i.e. nursing home) or go home (if she is mobile and can go up and down steps).  Meeting the 'go home' criteria would look miraculous from where we are now.  

My Left Turn - Leukemia

My Left Turn

As Fall turned to Winter in 2022, my life took an unexpected left turn.  I began having inflammation in various part of my body - my neck, my back, my shoulders, even my eyes.  What was strange was that the pain would be one place one day and somewhere else the next.  What was going on?  I scheduled numerous doctor's appointments trying to figure this out.  What was more frustrating was I couldn't even get certain tests or specialist appointments until deep into 2023.  I woke up on New Year's Eve and my feet, knees, and hands had all swelled.  My wife Stacey decide that enough was enough and carted me off to the emergency room.  They ran a lot of tests showing nothing, but the ER doctor did not like the looks of my blood tests.  She consulted with an Oncologist and had me admitted to Mary Washington Hospital.  In the meantime, my hands and legs continued to swell such that I could no longer walk nor even get myself to the bathroom.  I spent the worst weekend of my life waiting to get a bone marrow biopsy while having to be changed what seemed like hourly.  Once done, the biopsy confirmed I had Acute Myelomic Leukemia.  At the advice of the Mary Washington Oncologists, I transferred to University of Virginia (UVA) hospital in Charlottesville, one of the top hospitals in the country dealing with Leukemia and bone marrow transplants.

What is Leukemia?

Leukemia is a cancer of the blood.  There is no 'tumor' and the cancer resides within the blood and inside the bones and bone marrow where blood is produced.  Rather than normal blood, Leukemia produces something called blasts.  Left untreated, it will compromise one's immunity system such that some outside infection will kill you.

Science does not know what causes Leukemia.  There is some thought that one is born with it and at some point it is activated.  At the same time, there is no statistical evidence that the disease is genetic, passed from one generation to the next.  Leukemia just happens to some people - a left turn no body wants.

If you want to read more about Leukemia, I suggest you start here.

My Path To 'Cure'

I had some great doctors at UVA.  The best was the lead Oncologist, Dr. El Chaer.  He would only come talk to us when he had something new or worthwhile to say.  Day-to-day, this drove my wife and I nuts.  But, in retrospect, I appreciate it.  The quality of our fewer conversations was incredible.  The process for Leukemia treatment is highly individualized and tailored to the specifics of the disease as characterized by analysis of the biopsy results.  That analysis was performed by the Mayo Clinic and fed back to Dr. El Chaer.  More information flowed back over time as more was known.

The process started with a round of 'infusion' chemotherapy.  The goal here was to kill off most everything in my bone marrow, bringing my immune system down to nothing.  They then wait a week, take another biopsy, and go from there based on results (is cancer gone, almost gone, still there).  I was quite successful in this stage, eliminating ~98% of the cancer.  I also managed to avoid any major infections while my immune system was down.  My hemoglobin/platelet production picked up quite quickly, allowing me to go home from the hospital on 1 Feb, after a month in the hospital.  Normal course would have me meet with Dr. El Chaer in clinic to determine the next step.  I intervened before that, but let's not get ahead of ourselves.

There was some other work that got done in the hospital and I don't want to minimize that.  I entered UVA essentially bed-ridden, my legs, feet, and hands swollen and unable to operate.  They gave me medicine to drain off the swelling but getting to move around on my own was work.  The nurses would not let me just go on my own.  The fear of me falling was great.  Still I managed to progress from getting out of bed and sitting in  a chair, to moving around the room with a walker, to being able to get into the bathroom on my own (that was a big one).  I also managed to balance without the walker and get up and down consistently.  I cannot thank the Physical and Occupational Therapy staff enough for helping me push past both real and perceived limitations and being a capable human being again.

Genetic Markers and Tendencies

Using latest enhancements in both oncology and genetics, doctors are able to characterize an individuals Leukemia based on genetic mutations found from the bone biopsy.  These mutations indicate tendencies for how the Leukemia will behave over time.  My results came back with 6 mutations (average patient has one or two).  Of those, three were particularly bad.  The gist is that my Leukemia is nasty and has statistical tendency to come back even after treatments (chemo, bone marrow transplant, etc).  

Having mutations as I do essentially dictates an aggressive treatment strategy.  Thus, to fight it one should plan for multiple rounds of chemotherapy, both in- and out-patient, as well as bone marrow transplant.  This amounts to three-year battle if there are no set-backs.  Of course, mutations would dictate set-backs are likely.  So, as options were laid to me, best chance of success was to throw all my chips on the table against less than favorable odds.  I could be less aggressive, but that made odds even worse (in my mind a waste of time and resources).

The other option was to stop the active treatment, manage my pain and discomfort, and accept death when it comes.  This comes with the advantage of spending my time with my family vice in and out of hospitals while maximizing my quality of life for my remaining time.

Decision Factors

As I faced the decision of way forward, the following were factors:

•     Although my life has been far from perfect, I have no regrets and no 'burning' goals I need to meet.  I have endeavored build the foundation in my children for them to become productive and happy adults.  Aside from enforcing those teachings/efforts, I don't see anything drastically different that needs to be done.
• I cherish the relationships and resultant experiences I have had across my 58 years of life.  Though I have many small threads of incompletions and relationships I've not cultivated as best I could, nothing bubbles to the surface as a major incompletion - I can comfortably go to my grave today feeling I've said all I have to say.  This goes not only for my peers, but also with God.
• My life was coming to a major  cross-road in 2025 anyway.  That year marks a) my 60th birthday along with various retirement and Social Security eligibilities that come with reaching that age, b) 20 year anniversary with the Government and eligibilities that come with that, and c) my daughter's graduation from High School transitioning Stacey and I into 'empty-nesters.'  In my mind this would bring a major career transition.  I planned to enhance my technical skills, take job in commercial software development (no Govt. contracts, minimal bureaucracy, no denial  of technology due to stupid rules, and flexibility based on what I as an employee wanted and actual product needs of my employer). and work mostly from home, wherever I chose that to be.  You can throw that out the window if I am doing chemo -- no time, no energy, and all income feeding the medical bills.  So, I really have to accept that future is now dead.
• Lastly, what are the long term repercussions, financial and otherwise, of courses of action.  Medical events are the number one cause of bankruptcy in they US.  A small car accident with six month hospital stay will destroy the average family's finances.  Yes, I have medical insurance.  However, even having to pay 20% of $1M will wipe out an entire year of my salary.  Having state of the art treatment from UVA is great, but each time some doctor entered my room, there was a 'cha-ching' somewhere.  These costs don't go away when I die and they don't care if treatment is successful or not.  I could easily eliminate my children's opportunity for an education by putting on my armor and going to war with my Leukemia.  Why should I be such a burden only to die in failure two or three years from now?
• As Stacey walked the halls while visiting me at UVA, she had two occasions to overhear cancer wives begging doctors to stop the treatments and let their husbands have peace.  In the first few days at UVA, the social worker signed me up to have a volunteer who had similar Leukemia experiences to mine come talk to me for encouragement.  They never darkened my door.  Doctors quoted me plenty of statistics but evidence of success, to my engineering brain, was paltry.  Preachers will expound all the time how God will give miracles.  If they were that common, they wouldn't be miracles.  

With all this I have decided to forego any additional treatments, put myself under hospice care to keep me comfortable as I approach my death.  As you are reading this, I realize you are putting it through your own filters and reaching conclusions different from mine.  I just put this forward as my reasoning and decisions.  I am not right but am comfortable in my decisions.  I just wanted to document my process.

I plan to write more blog posts on more general and philosophical topics as I try to put my life into some kind of perspective.  Thanks for sharing in my journey.

Dan 

Writing as a tool, not just documentation

 

I listened to this podcast several weeks ago and got an insight into a better way to look a writing. Maybe it will motivate me to write more blog posts. I spend so much time on my job writing to convey what I know. In the course of writing it, I always need to go back to source material or Google to refine the ideas. In doing so, I am improving my understanding. The idea in this interview takes this a step further: Write about something you don't understand, employ different areas of your brain, and come to understanding of that topic. Below is partial transcript of podcast with the relevant topic. I encourage you to listen to the whole thing and then write down your own opinions about it.

From Re:Thinking with Adam Grant Podcast, Season 1, Episode 8, October 11, 2022- How Celeste Ng Writes Fiery Prose: Apple Spotify Transcript

Celeste Ng: I always write from a place of not understanding versus I think some of what you're talking about where, especially in the non-fiction world, you research, you learn about something, you understand it, and then you write about it. Right? To share that, for me, it's almost, it's almost the reverse. There's something that's confusing me. I'm like, “Why would somebody do that? How did you get yourself into the situation? Why are you like this?” And writing for me is my way of figuring out what that is. And so by the end, when I've finished writing, then I have figured out what it is it, it can't go the other way for me. And I think that's one of the big differences between my process and sort of what you're describing.

Adam Grant: I think that a lot of people see writing as a vehicle for communicating ideas. But it's also a tool for crystallizing ideas.

Adam Grant: So often I find that what's fuzzy in my head becomes clear on the page. And that when I try to write down, you know, an inkling, it could become an insight, or in some cases, I'll see the gap in my knowledge or my logic, or when I'm trying to spell something out in writing, I have to articulate my assumptions. I have to address counterarguments, and I guess I think a lot about the observation of how can I know what I think until I see what I say.

Adam Grant: Or until I see what I write. And I think we, we do enact our way into our thoughts through writing. And I guess one of the things that makes me curious about is I meet a lot of people who say, “I'm not a writer”, and therefore they don't write. And it's kind of like saying, “Well, I'm not a public speaker on stage, so therefore I don't talk”, right? It’s like, wait, you're, you're missing the point that writing is a tool for thinking, and if you wanna be a better thinker, you should write more often. It sharpens your reasoning. What do you make of that?

Celeste Ng: writing is a way of thinking and that many of us, when we go to high school, you're taught to do it like you know, you should have your whole ideas, and then you basically just dictate them to yourself and write 'em down on the piece of paper.

Celeste Ng: Whereas I think it's much more what you said. You articulate something on the page and it crystallizes something that you hadn't been able to say. Or you write down what you think you know, and then you read it over and you go, “Well, but wait, what about this?” And you start to make it more complex. And so that was one thing that I really tried to teach them that, you know, they would write a draft and they'd be like, “I'm done.” And I'm like, “No, no, no. This is your thinking through, right? This is where you're starting to think.” Um, so I, I, I really agree with you on that. I really think that writing is, it's odd because it is both the skill you are trying to get, and in order to get it, you have to do it. Right? It's this thing that you learn to do. By doing it.

Adam Grant: Which is a paradox. I think I, I've watched a lot of people get away with… Well, let, let, let's put it this way. I, I've seen too many people get away with faulty logic because they’re charismatic speakers. And one of the things I love about putting ideas on a page is, is it forces ideas to live or die more on their merits, right? As opposed to how they're presented. And I think so often you find that, that somebody who's a captivating talker, uh, struggles to articulate their insight on the page. And that doesn't mean they can't write. For me, it means that their unclear writing is a sign of unclear thinking, and they should stop using their charisma as a crutch, and, you know, force themselves to articulate ideas in a medium that doesn't benefit from, you know, their elocution or whatever skill is allowing them to be persuasive interpersonally.

Celeste Ng: Yeah, I think that's true because, you know, personal charm is real. Right? And like you said, if you write things down on the page, you take one of those variables out of the equation, you take away the variable of whatever your personal charisma or your, you know, your dramatic reading, whatever it is, your flare. And the, uh, you know, you can still certainly do a lot of pyrotechnics with your prose, but in some ways it, it takes away that layer of performance. And the other thing is that I think unlike something that is heard, like a speech, what's on the page is experienced at the reader's own pace. You can read it, and then they can read it again. Right? And they can read it again. And if they keep reading it and they're like, “I don't think you're saying what you think, you're saying.” They caught you. Right? And so in a way, like you say it, it kind of separates what you're saying from the act of saying it. It separates it from time and it has to hold up on its own.

Achieving Your Objectives in 3, 2, 1

 I spend a lot of time reading articles by 'thought leaders.'  It is even more cool when a friend and colleague publishes an article of that caliber.  Please check out Noam Oz's article using techniques he learned in Ju Jitsu in one's career and projects.

Achieving Your Objectives in 3, 2, 1