A Violent Encounter With Transparency And Other Adventures In Biotech Fund Management: My Unofficial Investor Letter 2017
Reliable Deli is on the north side of East 54th Street, midway between Park and Madison. It has a rust-colored awning with white lettering, with a string of Christmas lights strung around its edges that blink on and off year-round. I've gone there four or five times a week to take out breakfast or lunch for the past 8 years. It's a bustling place, one of those places where you can get hot food, cold food, toothpaste, batteries, boxes of cereal, sandwiches, wraps, spicy Korean chicken, fake crab meat, and real duck. Deep metal pans under heat lamps. Sneeze shields over the buffets.
You get the idea.
Reliable has two tall glass doors that can swing in or out, like saloon doors, only much thicker and much heavier. One day this summer I must have had difficulty deciding which way I wanted to open the door so I just walked into it as if it wasn’t there. Right knee and forehead met the thick, thankfully shatterproof glass while I accelerated from a standing start. I bounced off the door, shook my head back and forth like a puppy hearing itself bark for the first time, while soaking up the collective concern and secondary embarrassment of everyone inside.
The staff sprung into action. A small stack of clean napkins was quickly applied to my forehead. A first aid kit appeared, its contents probably long expired. A heavily accented New York voice repeated over and over: “Get him to an emergency room. He needs an MRI. I'm a nurse. I know”
I had no intention of going anywhere except back to my office across the street. I felt okay. I am not a stranger to concussions, having suffered one while ice skating with my son years ago, and I somehow knew that the door had enough give to have not made my brain rattle around inside my head. The skin on my forehead, however, was not so fortunate. Just to left to the midline on the mild frontal bossing over my eyebrow there was a terrific gash, the result of the impact followed by a little bit of a smush and tear. I folded the stack of napkins to hide the soaked-through part, applied pressure again and this time successfully exited Reliable Deli.
I was quite a sight in the elevator, going back to the office, holding a white plastic bag containing the styrofoam container with my lunch in one hand and the other hand pressing the folded stack of bright napkins against my forehead. Thirty minutes later I sat in the exam room of a nearby urgent care center. A half hour after that I am back on the sidewalk, having replaced the paper dinner napkins with a folded stack of sterile gauze pressed against my forehead, dismissed from the Urgent Care Center and directed to the nearest emergency room. (“Too deep. And you need an MRI.”) I stood on Second Avenue, left hand against head, right hand holding cell phone, speaking to a helpful representative of my insurance company, who reassured me that as far as United Healthcare was concerned, I could choose between the equidistant emergency departments of Cornell Medical Center and NYU Medical Center, confident in the knowledge that my co-payment, deductible, access to care for the rest of my life, and future list of pre-existing conditions would be the same.
I went north to Cornell. “I used to work here,” I said over and over, eliciting a flash of semi-interest from the security guard at the door, the triage nurse, the admitting nurse, the intern who took my history, the attending who retook my history, and the volunteer whose job seemed to be to observe me for any signs of rapid cognitive decline.
I turned down the MRI and was content to let the intern place four interrupted stitches (it may have been silk or vicryl but I forget) into my forehead, although I was offered a plastic surgery consult. At that stage in my training, I could have thrown those stitches in my sleep. The intern’s handwriting was good so I figured his hands were steady.
I returned to the office with a bandage wrapped tightly around my head, returned to the ER a few days later to have the stitches removed, filled out a nice evaluation online about the quality of my treatment at the hospital, and ignored the monthly solicitations for donations that came for the rest of the year.
The next day, I was a celebrity at Reliable. Breakfast was on the house, as was lunch. The cashiers, the short order cooks, the stock guys all greeted me with warm smiles and curious glances to the scar on my forehead. Menus were taped on the glass doors at eye level.
I made a point of joking about the incident and repeating over and over again that I had been careless and preoccupied and stupid and that it was my fault. And that I was fine, no crazier than before, no ringing in the ears, and certainly no intention of talking with a lawyer.
After a few weeks, the menus came off of the glass doors, and the customers of Reliable Deli were again trusted to use their hands or back sides to enter and exit. The scar slightly to the left of the midline just above my eyebrow faded away. The Intern, who by now has rotated to the Intensive Care Unit or to one of the med-surg floors, had done a good job. Whatever acute or chronic damage that my brief violent encounter with the glass door may have caused will forever remain undetected by the MRI scan that I refused to have done.
Every semester, as my students get to know me better, their questions get more and more personal. Towards the end of each semester I get asked wisdom questions, about success and happiness. I’m no expert, but I do think that humility and the ability to laugh at yourself are good places to start. Also: the fund did just fine this year.
David Sable MD
writer, teacher, fund manager and retired reproductive endocrinologist