What a neurosurgeon can learn from a beer brewer: The dangers of playing it safe.

It’s odd the places you find concepts that bring your life and goals into focus.  I never thought the founder of Sam Adams —Jim Koch—a guy whose name I didn’t even know, would say something that changed my perception of what’s at stake in choosing a career path (full disclosure: I am biased against Sam Adams because I don’t like their beer much, and if there’s one thing I have impeccable taste in, it’s beer). I came across the story as told by Jim Koch in the podcast, How I Built This with Guy Raz. 

Jim tells the story of how he finished business and law school and got a great job at a firm called Boston Consulting Group (BCG). The pay was high and he flew first class to important meetings with important people, but he came to the realization that he did not want to do the job the rest of his life, and if he didn’t want to do it the rest of his life, then why do it tomorrow? So he quit that job and decided to…brew beer?!

His reason for leaving that great job is fascinating, he says:

I left it because staying there was very risky. Leaving it was not risky. And it’s the difference in life between things that are scary and things that are dangerous. And there are plenty of things that are scary but aren’t dangerous, and there are things that are dangerous, but not scary. And those are the things that get you.

He goes on to give an analogy in climbing. Rappelling down a rock wall is scary because you are jumping down a huge cliff, but it’s not dangerous because you are held by strong ropes and a harness. On the other hand, walking down the side of a mountain on a sunny day with blue skies around you is dangerous, but not scary. It’s prime weather for an avalanche that could easily kill you, but the beauty of the day lulls you into a sense of security. He elucidates further about his great job:

Staying at BCG, was dangerous but not scary, and the danger there, the risk of it, was continuing to do something that didn’t make me happy, and getting to, you know, 65 and looking back and going, “Oh my God, I wasted my life.” That is risk. That is danger.

As I look for a job after residency, I think a lot about this idea, that there are things that are perilous, but do not raise alarm. The job choice all residents face out of residency is private vs academic. I won’t go into the differences, as I’m sure most of you reading this know,  but I’ve always leaned academic.

I have been fortunate to train at a great neurosurgery program with wonderful mentors who have excelled in academia and are master surgeons. The thing about mentors is they make you want to follow in their footsteps, to do what they did because they are inspiring people. I like the academic side of medicine. But it’s a regimented path that requires discipline, dedication, and persistence to be successful. It doesn’t leave a lot of room for other pursuits. 

I don’t have any illusions that if I decided to pursue academic neurosurgery I would eventually be the chair of a renowned department or the president of one of the neurosurgical societies. Heck, right now, I’ve applied to more than a couple of academic positions and I can’t even get an interview. But academic neurosurgery is a clear path to pursue with well-defined goals and milestones. It doesn’t seem scary at all to me.

Pursuing a career in global health, on the other hand, seems quite the opposite. I worry about how Joy and I will raise our daughters in a different country (how will they be educated? what risks will they be exposed to?), how will our finances work out (where will our funding come from? our retirement?), what if we fail (what will job prospects look like then?), and many, many other things from dying from some strange virus to not having access to good beer (it’s the little things after all). 

But when I sit in the quiet moments, late at night when I am honest with myself, it’s taking the defined path, the one that doesn’t FEEL risky, that I am terrified of looking back on and saying “Oh my God, I wasted my life.” 

Trying to think about my life from the perspective of my 65 year old self is an insightful exercise. I imagine myself at the end of a career at a major academic neurosurgery program, I’ve mentored a lot of young surgeons, done interesting cases, I spend my day mostly doing the surgeries I like, and writing the papers I want to write, etc. When I think about that, I still find this nagging part of me that feels, well, unfulfilled. I don’t mean to disparage people who do this; I have benefitted immensely from people who found this was the right path for them. I also acknowledge that there are inspiring people in academics who have successfully pursued global neurosurgery projects (Dr. Haglund at Duke comes first to mind), but something in me just seems to say it’s not the right path for me. I also worry I could be diverted or distracted or not be able to devote enough time to my main goal.

When I think about dedicating my career to trying to improve neurosurgical care and education, as well as learning how people are already providing this care around the globe in resource-strapped settings, I get excited with the kind of feeling you get when you are clicking up the first hill of a roll-a-coaster held down by a harness. It feels scary, but people are there doing it with you and others have done it before you. When my 65-year-old-self thinks about looking back on that life, he has a deep satisfaction and peace.

I can’t say completely why dedicating a career to improving care in resource-limited settings has become my version of a life well-lived. I think it’s partly because I was raised in a Christian home, and the aspect of that upbringing that rang truest to me was that a life well-lived is one in which you gave up some comfort of your own to provide comfort for others less fortunate than you. That principle has stuck with me when a lot of other parts have faded.  And I’ve come to realize I’m not really choosing a career between private practice and academics; I’m choosing between the defined and undefined, the well-trodden path versus my own unique one. 

When it comes down to it, the things I worry about in working in global health are mainly logistical, not dangerous. Lots of missionaries have raised and educated kids across the globe. There are ways around the financial concerns. Strange viruses could pop up anywhere. And I can always home-brew. But the chance to pursue a career that you feel lines up with a truth you intrinsically and inexplicably hold regarding what gives your life purpose and meaning, you only have one lifetime to make that happen. The more I think about that, passing on it, or pursuing it only half-way, is the real danger. 

~ Josh

4 Replies to “What a neurosurgeon can learn from a beer brewer: The dangers of playing it safe.”

  1. Cheers to following the path that makes the most sense to you. The world does need you more than the Ivory Towers in academic neurosurgery do.

    One issue, though, could be funding. You can command a high salary here, and working a few weeks or months a year stateside can more than fund your extended trips overseas. Locums or a part-time gig could be a way to provide for your family’s financial future while also self-funding your medical volunteerism.

    I have seen physicians ask for donations for every last thing they need overseas from churchgoers in a poor area. And I’m thinking to myself — and probably shouldn’t be typing this in public — work a month of locums and all these money issues will be taken care of.

    Cheers! (with a non-Sam beer of your choosing)
    -PoF

    1. Thanks so much for reading and commenting, POF! In fact, we agree with you wholeheartedly. We are happy to explore and highlight the myriad of ways that humanitarian physicians fund their projects, but for us personally we have leaned heavily towards self-funding using some of the strategies you discussed. We frequently discuss exactly how to structure this between the two of us. One or both of us may very well end up doing locums.

      Your input is much appreciated!

      By the way, I am a huge fan of the Sam Adams Cream Stout.

      Joy

  2. Josh,

    Not so long ago I was looking for heroes who had lives I’d want to emulate in international health. A few I spoke to might help you understand how it could work for you are based out of the horn of Africa.

    Dr. Rick Hodes (rickhodes.org) trained in medicine at Hopkins an works with kids with profound spinal deformities, among others. He has a program with with Dr. Boachie of HSS in NYC. Since Dr. Boachie is originally from Ghana, they perform surgeries there and have a one of a kind rehab program for the postoperative period. He’d have some pretty challenging cases as well as some insight on how to make it work, and his life has been dedicated to the sick destitute in the horn of Africa. If you do spinal cases, I imagine this would be a real challenge.

    Dr. Einar Eriksen is a Norwegian born general surgeon who brought the plastics/burn program to Yekatit 12 Hospital in Addis Ababa, and most recently worked at the Korean Hospital in Addis. He’s a missionary physician doing meaningful work in a desperately needed specialty that would otherwise be extremely remunerative in the West. He raised his family there and would have additional insight into what that might be like.

    Wishing you both luck in forging a nontraditional path,

    CD

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