Category Archives: Figure Stuff Out

We’d like to think of ourselves as the sum of our prior experiences, learning and growing over time. As it turns out, we do not accurately remember our experiences. What we identify as our own “experiences” are not experiences at all but memories. What end up as memories tend to be the outliers of those experiences.

In the words of Nassim Nicholas Taleb, these are black swan events.  But black swan events do not just apply to large organizations or countries; they also occur in our everyday lives.  Our experiences compete for space in our limited memories, and we remember the black swans.  Since the events we forget do not simply reside in memory as gaping black holes – like the retinal blindspot, the brain simply does not perceive the forgotten events, it may then be suggested that black swan experiences shape who we are.

Thus, it follows that to live a fulfilling life, one should optimize on the quality and number of memory-worthy experiences.  It means to take frequent vacations, see new places, but it also means to attempt a wide array of extra-curricular activities, learn a few things about areas outside of our expertise.  It means surprising our lived ones with something special spontaneously so they too can share some of these memories with us.

“Science has eliminated distance,” Melquíades proclaimed.  “In a short time, man will be able to see what is happening in any place in the world without leaving his own house.”

 

– Gabriel García Márquez, One Hundred Years of Solitude (1967).

As a college student I thought medicine is just a vast combination of facts, then medical school taught me that it was more complicated.

In medical school I thought that radiology is just about pattern recognition, then residency taught me that it was more complicated.

In residency I thought that the health care crisis is just a problem of not enough money, then business school taught me that it was more complicated.

In business school I thought that informatics is just about customizing to user needs, then working on a project taught me that it was more complicated.

But after being wrong so many times, I find myself continue to simplify complex concepts in my head. Maybe we’re built to do that. If I knew how complex medicine is, I may have gone into another field.  If I knew how difficult radiology is, I may have applied into another specialty.  If I knew the full complexity of healthcare informatics, I may have waited years before launching into a project.

Maybe it’s how society moves forward – by foolhardy people acting on oversimplified versions of the world.  Although the person who jumped in without understanding the complexity of the world might frequently fail, the person who held back would always fail no matter how much complexity he appreciates.

On the sitcom Friends, first-time pregnant Rachel sees an obstetrician for ultrasound, nods her head and smiles as the monitor shows her future child.  Then, she returns home and exclaims, “I don’t see it!”

Radiology trainees struggle with the fear of “not seeing it” as well.  As a radiograph, MRI or ultrasound displays on screen, at first we just see nothing.  Then, there is the proverbial sinking feeling in the chest as we slowly come to the realization that something is amiss.  Something doesn’t look quite right – except we don’t see it.  It can be intensely frustrating, resolved only by a supervising radiologist pointing with a finger, and we think, “ah, I knew I saw something.”

There is something about that initial sinking feeling when we see something is wrong without consciously knowing why.  It shows that we are now aware of our ignorance (as opposed to unaware – which is infinitely worse).  It’s the strange category of unknown knowns, where we don’t yet consciously know something that we can already pick out.

It is a sign of learning.

Gently lit by low wall lights and candles on the table, slow pentatonic music in the background, my girlfriend and I brushed off the speckled snow on our coats and sat down for our highly anticipated dinner at a local sushi restaurant one evening.

What caught our eyes on the menu were rolls topped with House Special Sauce.

There is something about a restaurants’ “secret sauce,” the exclusive special dish that makes them particularly appealing, that is counter-intuitive.  After all, commercial sauce-makers are known for – well, sauce.  Mayo mayonnaise, sriracha chili sauce, and Heinz ketchup are all popular because they are backed by large R&D funding, tasting tests, and marketing.

So why would anyone not choose a time-tested favorite and go for the house special sauce?  An independent restaurant has but a single percentage of the resources of a large conglomerate.  They are outmatched in almost every way.

It’s David versus Goliath.

But sometimes we favor the underdog, the adventure of the limited, the David who did defeat Goliath. We believe something may be better because it is limited in quantity or limited availability.  It is a secret, and secrets are good.

We convince ourselves that independent “specials” can sometimes end in a pleasant surprise.  We try the homemade potato chips over Lay’s, or the hole-in-the-wall eatery out in the suburbs over Applebee’s, or house special sauces over Kikkoman’s sushi sauce.

Every time we make such a decision, we implicitly take the risk that things can work out the other way – that the homemade chips can end up soggy and soaked in grease, or the hole-in-the-wall may serve thawed frozen fish fillets.

Or the house special sauce may end up being a concoction whose off-center flavor profile fully explains its limited availability.