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 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.
(A speech I gave to the American Fertility Association in 2000.)
In planning to speak about advances in the field of assisted reproduction I have two conflicting images in my mind: the first is filled with impressive slides and graphs, detailing what is new in ART and, more importantly, what is coming. The second, and more real, is the disturing and disquieting image of a detached doctor, close in proximity but miles apart from the hearts and minds of his patients.
I spend many nights staring at the ceiling, thinking about the two challenged that face RE's. The first and obvious challenge is pushing closer and closer to the holy grail of our field, that of a reliable, predictable procedure with low risk and consistent outcome, one that is easy enough to place on an actuarial table so that insurance coverage becomes not only an easy ethical choice but an easy business choice as well. We have taken many steps in that direction over the past few years, and we can be justifiably proud of the development of ICSI, blastocyst transfer, single sperm freezing, preimplantation genetic diagnosis, assisted hatching with fragment removal and cytoplasm transfer.
But to inch closer to where we need to be, to the only truly acceptable set of goals for our science, we need to find some huge pieces of the puzzle. In the short term, we need a better means of assessing whom we can help and whom we cannot help. Two years ago I wrote an internet piece on FSH testing and our means of assessing eggs, in which I lamented the limited means we have to counsel many of our patients on what we can do for them. Every RE who will speak to you today knows that it is far easier to counsel an auditorium full of 500 couples on their chances of a good outcome than the one couple who sits across your desk.
In the longer term we need to better understand what makes some eggs, and some sperm, "good" and others "not good" and find ways to either rejuvenate those with lesser potential or make new eggs de novo. Now there are people, none of whom probably need this type of technology, who get uncomfortable with this type of talk. Some of these bold steps might need to use "cloning" technology. And we all know that anything that needs cloning technology, or even brings us to the possibility of speaking about the need for cloning technology, or even makes us think about the need for cloning technology should be banned and outlawed and never spoken or thought of again. Or should it?
A thirty one year old woman sits in my office, a survivor of leukemia or lymphoma or some other disease whose treatment left her not only infertile but menopausal. She and I discuss the very real and wonderful possibilities of her onceiving through egg donation, and we both silently say thanks that we live in the year 2000 and can offer this possiility to her. But what of the undeveloped option of using her "own" eggs? But did we not just say she has no eggs? And since women are born with all the eggs that they will ever have, how can we even think about or talk about using her own? Well, why don't we make new ones? Now, thankfully I have already passed my reproductive endocrine boards so if any board examiners are in the audience I cannot be blackballed, (at least I hope I cannot.) But let's for a moment propose for one of our long term goals the development of techonology that allows us to not only swap the nucleaus (and therefore the genetic material from my patients' eggs to donor eggs) and therefore make new "good" eggs but to swap a brand new nucleus from a stomach cell (yes, I know it has twice the needed number of chromosomes and is **gasp** technically a clone cell) and then zap it with electricity or an enzyme or two so that it DIVIDES and becomes.... a new egg. And my lovely thirty one year old patient can now have her own babies.
But we have used cloning technology! We have stepped onto the slippery slope that will lead to an Orwellian nightmare of genetic engineering and online ordering of blue eyes and perfect skin and high SAT scores. Or maybe we have just refined a technique enough to allow my 31 year old to have her own babies. And if, in so doing, we have allowed 41 year olds to have their own babies more rapidly and with higher percentages, than I am all in favor of that too. And if it allows us to say to our patients with really high FSH levels who cannot respond to stimulation regimens or to women whose endpometriosis has aged their ovaries by an extra two decades to have their own babies then that's a good thing too. But but but... if you can take the cell from a woman's stomach and make an egg with her chromosomes and she can get pregnant and have a baby when before she could not, could you not take the nucleus from a man's stomach and make an egg for him too? uhhh,, yeah. So we're perfecting a (**gasp**) cloning technology and we're allowing men to have eggs and we're supposed to let this just happen, knowing full well that we have stepped onto the slippery slope that will lead to an Orwellian nightmare of genetic engineering and amazon.offspring.com etc etc etc....
No, we are finding ways to help couples to have babies where before we could not. In 1995 we started larger scale use of preimplantation genetic diagnosis for the detection of abnormal numbers of chromosomes. If I can manage to deliver some reasonably well matured eggs to Dr. Cohen's lab, and he can grow the resulting embryos for three days and deliver one good cell from that embryo to Dr. Santiago Munne, then Dr. Munne can tell me and my patient and her partner the likelihood that that embryo will have an extra number 21 chromosome, or only one X and no Y chromosome, or pass on Muscular Dystrophy. We can also do, with pretty much 100% accuracy, sex selection.
With the enormous amount of information that we will soon have from the human genome project we may be able to greatly reduce the risk for breast cancer within a family, or the risk for diabetes. But this uses a technology that allows accurate sex selection, which as you all know, is a step onto a slippery slope that will lead to Orwellian nightmares of.... oh forget it.
The point I am trying to make is that there are enormous opportunities to help people and locked inside some of our more "dangerous" technologies. The challenge is not to suppress the technology, or to outlaw it; the challenge is to use it well. Just as we can choose to use a sharp object to remove a diseased appendix we can use a fluorescent in situ hyridization probe to prevent the passage of disease. And we can use intracellular manipulation to help families have babies.
That's the future-- now what about the present? A long time ago I wrote an article called "Reflections of an RE." It probably should have been called observations of an RE because that's all it really was, but a lot of my patients read it and commented on it. I had noticed certain periods during infertility treatment that tended to recur one patient to the next-- I called them emotional crisis points. They are pretty obvious: a first failed treatment cycle with injectable medications, a painful diagnostic test, that sort of thing. In discussions with my patients after that, we looked at another side: strategies for infertility treatment survival. To finish my talk today, I would like to share some of the lessons I have learned from my patients.
Ten tips for surviving your IVF cycle
1. Take yourself off the hook. Recognize that there is nothing you can do the will screw the process up. Entry fee to the "I screwed up my own IVF cycle" club:
2. Don't sweat the small stuff. Realize that there is no one right way and that a minor deviation from what happened last time can still be ok. There are a hundred valid ways to overlap lupron and the birth control pill. 10,000 units of HCG is probably 5000 more than you really need, so if a tiny drop dribbled down the side of your rear end it will not make a difference.
3. Lower the bar. Remember when you thought that your Algebra II final exam was like your final grade in Life? Your IVF cycle and its outcome are extremely important and you have invested tremendously of yourself in doing it. It is not everything though.
4. Repeat after me: the limitations are in the technology. If my IVF cycle cannot use your eggs, the problem is my IVF procedure, not your eggs.
5. Be as stressed as you want to be. Recognize that a major dose of stress is unavoidable during your treatment cycle. Don't try to deny it away and don't let its presence become a further source of stress for you. Look stress in the eye and keep it in its place.
6. Speak your mind but keep your composure. Remember "please" and "thank you" and if you page your doctor in the middle of the night, preface your question with, "I am really sorry to disturb you." Don't do this for the doctor. Do it to show him or her, and the rest of the world that even though you are going through IVF, you are dealing from strength.
7. Win both ends of the IVF cycle doubleheader. The greater goal is pregnancy and children, but a short term goal is to beat the evil treatment itself. Infertility treatment can chip away at self-image, can rob of us our positive self-image and cause us to question some of the more important decisions we have made as to how we run our lives. Let your actions show the world that you will not let the uncertainty turn you around. (h/t to Jackson Browne)
8. Let yourself be amazed at how well your spouse is putting up with everything. Be over the top in the way you support your spouse. Say nice things to your friends about him or her within his or her earshot.
9. Don't save up the love and attention. It is not going anywhere.
10. Take a crayon and draw a picture of yourself getting a progesterone injection. Make yourself look really silly. Take another crayon and draw a picture of whatever sperm collection technique you employ. Make everyone look really silly. Next take another crayon and a piece of paper and draw the head nurse talking on the phone. Give her really big hair and a cartoon balloon coming from her mouth and make her say, "blah blah blah blah blah blood and ultrasound" and make her look really silly. Next take another crayon and draw a picture of your doctor doing an ultrasound while you, the patient lie on the table with a thought balloon in which you hit him or her over the head with the probe. Make yourself look really powerful and make him or her look really silly. Then hang the pictures on the refrigerator with magnets.
The most impressive part of the advances in reproductive technology is the way IVF patients channel their strength and determination into grace, humility and humor. The rest of us can learn a lot from you.
A couple of decades back, a senior surgeon handed me a scalpel, addressed me as doctor, and told me to make my very first incision. My hand and the knife then hovered over the patient's abdomen like a helicopter over a traffic accident before finally taking a timid swipe and barely scratching the skin. My colleague waited patiently for me to shake off my nervousness, and a couple of hours later, the patient and I—an intern—were both in stable condition in the recovery room.
Now I sit at my desk—a grid of PowerPoint slides on one computer monitor, my course outline on the other. I am a novice again, midway through the 28 lectures that I will present this spring. Only for the moment, I'm doing a lot of staring and very little PowerPointing, and the prospect of teaching an entire course for the first time seems far more daunting than performing surgery. Medicine is a teaching culture. Second-year students show first-year students how to throw square knots, interns give impromptu seminars on fluid management during quiet moments in the intensive care unit, and bow-tied internists happily demonstrate the secrets hidden in the patterns of filling and drainage of neck veins to the first orderly or flower-cart pushing volunteer who happens to walk by.
I left medicine a few years ago but continued to teach: an occasional hospital grand rounds where I had trained or lectured to science or business students. Now I agonize over decisions that experienced instructors take for granted. In a few weeks I will teach my "Entrepreneurship in Biotechnology" students the 10/20/30 rule of effective presentation: 10 slides in 20 minutes using a 30-point font. Of course, my first lecture has 33 slides, but I rationalize that the first few are throwaway office hours / grade consists of / last day for drop-add types. Lecture two has only five slides so far, but I need to leave time for student presentations. Each presentation should last one minute, followed by two to three minutes of discussion. Four minutes per student unless the discussions get detailed and deep—but what would be wrong with that? Nothing—but what if the discussion is superficial and belabors the obvious? Or what if there is no discussion at all, just the kind of sinking silence that happens in comedy clubs when the comedian completely loses the audience, and everyone knows that he can't win them back but also knows that he has to try and that they have to sit through it?
Tonight I struggle with week one. The slides are unformatted black on white, with a little line at the bottom with the course number and "Columbia University GSAS" in small font. The slides appear in neat rows across the screen, but their concepts and ideas somehow remain hidden—the presentation a puzzle with all the pieces the same shape and no clues as to their correct order. One of the business-world clichés that I will relate (though not necessarily endorse) is that a presentation needs to be delivered 25 times before it makes sense. I am unwilling to sacrifice coherence for my first 24 semesters, however, so I devise different practice methods. Most often, I lecture to two dogs in an otherwise empty room. Weeks one and two are almost ready, but week three is not even close.
My students-to-be are an extremely smart group: a mixture of undergrads, masters, and Ph.D.s in the sciences, hoping to cram as much of a business education as they can into one semester. I worry about letting them down. I focus on them and try to anticipate their expectations. I stop polishing my delivery and start listening for clarity. Suddenly the teacher's block breaks, and a few of the slides almost jump off the screen and beg to be moved elsewhere. Quickly, week three is almost clear—its transitions logical and its conclusions evident.
My process is evident as well: course outline on one screen, slides on the other, practice out loud in an empty room, dogs optional. Listen for what your students will hear, and make it logical for them to understand. Repeat as needed.
Ray Bradbury once said that living at risk is jumping off the cliff and building your wings on the way down. I used to think that cliff jumping was a young person's sport, but I still find myself walking along edges, blueprints in hand.
I arranged for BIOT 4180 to take their final exam on a survey site on the web. Half the class sat in front of me in Hamilton Hall; the rest took the exam wherever they wanted—dorm room, Starbucks, London. I activated the page at 4:00 and planned to close it two hours later. Not too pressured but not too easy. Every student had my email address and cell phone number if a technical problem arose.
I watched as the site tabulated the responses. The exam grew harder as it progressed but the percentage of correct answers stayed well above 90. As they had through the entire semester, my students exceeded my expectations.
The delivery log from my first night as an attending obstetrician lists two vaginal deliveries and a cesarean for a footling breech early in the evening, followed by my outcome code: HMHB—healthy mother and healthy baby. My role was to supervise the residents and the midwives. I remember thinking about the on-call room and sleep.
“Doctor Sable—in here. A shoulder.” Sleep would have to wait.
The room was old-fashioned, not one of those “birthing rooms” with flowered curtains and a foldout sofa. No, this was a real operating room. Thankfully. The shoulder was a young woman, first baby, pushing and breathing. The baby’s head was out.
And the baby was stuck.
At 4:45 the survey site instant messaged that it would terminate the exam in five minutes. A countdown clock appeared. I linked to technical support and typed “survey termination.” Technical support recommended I upgrade to “Pro” level for longer duration surveys in the future.
My phone rang. A little red circle appeared at the upper right hand corner of my computer mailbox: 2 messages. The countdown clock showed reached four minutes. The red circle showed 12 messages.
BIOT 4180 had 65 students.
Every oral board exam in ob/gyn includes a shoulder dystocia case, and every obstetrician can recite the steps: extend the episiotomy, press on the abdomen above the pubic bone, have the mother flex her hips and pull back on her legs, pass a hand along the baby’s back and press the front shoulder to an oblique angle, rotate the posterior arm in front of the baby’s chest and out.
Break the baby’s collarbone.
I muted the phone, googled “screen capture mac,” and email-blasted “Plan B coming.” I text-searched my hard drive for the words “final exam.”
A gown found my arms. Gloves found my hands. The apprentice midwife stepped aside and nodded. The baby was blue. I figured I had ninety seconds.
I extended. I pressed: nothing.
She flexed. She pulled: nothing.
I felt the back and rotated the shoulder, gently bringing the upper arm along to avoid fracturing it, just like the textbooks say.
The countdown clock read “0:25” by the time I had compared the draft copy of the final with what I had put on the survey site, updated it, cut, pasted, formatted it into an email (“Plan B as
promised”) and hit “send.”
I unmuted the phone.
I had never broken a collarbone, had never seen a doctor break a collarbone. I was one maneuver away from learning the hard way.
I felt for the posterior arm and gently passed it in front of the baby’s chest. The arm popped out. The back shoulder slid forward. The front shoulder slid under the pubic arch and the body landed in my hands. Blue face turned pink and the baby cried.
HMHB. Healthy mother. Healthy baby.
Sixty-five completed exam emails arrived, all completed within a time-adjusted two hours. My students, as usual, exceeded my expectations. I could only hope that I had met theirs.
Distracted by a report by an analyst I do not know about a company I do not own in an industry I do not cover, with Claudio Arrau playing Chopin in my head, oblivious to a truck backing out of a hidden garage, I felt the nudge of a fellow pedestrian’s shoulder just in time to look up and veer out of the way.
It’s a relief when unseen forces erase danger, reinforcing that child-like feeling that God or the government or some all-knowing future mentor exists, solely for my protection and guidance.
Of course before I reached Fifth Avenue the magical thoughts were gone and I knew that I had better keep either my eyes or my ears on the road ahead. So I clicked away the analyst report and let the music play.
I like Chopin when played on an almost out-of-tune piano half an hour before last call in an nineteenth-century Parisan tavern, drunken and romantic. My near collision with the truck coincided with the horn fanfare that transitions the Andante Spiniato to the Grande Polannaise. Soon after the piano returned: a sad song from the right hand balanced by ringing, triumphant chords from the left. The two themes danced around each other, sorrow and triumph; the pianist taunting us with almost-missed entrances and barely audible notes. The music floated to an inevitable conclusion of sprints up and down the keyboard, and grand chords that pushed open the revolving door to my building and made me smile. I arrived at work, chastened for my inattention but grateful that triumph and sorrow together can still equal joy.
Van Gogh and Prime Numbers, Manhattan Preschool Admissions and Long-Lost Love in the Netherlands: Investor Letter 2013
Before I summarize the 2013 fund performance, a brief anecdote:
Tarana was four.
We sat at the kitchen counter, admiring Van Gogh's "Starry Starry Night" on a computer screen. Using crayons and old stationary, we each drew our own versions. Although I stayed within the lines, Tarana saw and better captured the wonder of Van Gogh's swirls, and while we used the same crayons, her colors more closely matched his.
When we finished, I wanted to expand the moment, to create an experience -- one that she would remember (and that we could use to illustrate her creative early childhood when the time came to fill out Manhattan preschool applications.) I played and told Tarana about Don McLean's "Vincent" -- but that failed to make an impression on her, and reminded me how depressing the song sounded on the radio when I was twelve.
Tarana ultimately made it into a good New York City kindergarten, no clumsy help from me needed.
Regarding the fund: 2013 was a good year.
My thoughts about 2014? The number suggests stability. It is equidistant from the nearest two prime numbers, 2011 and 2017, and the two nearest sets of twin prime numbers, 1997/1999 and 2027/2029.
Volatility emerges when you dig a little deeper; 2014 sits far from the midpoint between the average of the prime number squares on either side. The average of 43 squared and 47 squared is 2029.
We won't know how predictive any of this analysis is until 2015 (a number whose prime factorization -- 5 x 13 x 31 -- adds up to 49, the square of a prime, a characteristic that I prefer to ignore for the time being) but it's as predictive of the coming year as any other macro trend I have heard of or read about.
So, to sum up--
2014: stable, but with an underlying instability that may take fifteen years to resolve.
Meanwhile, in August, at the Kröller-Müller Museum in Otterlo, the Netherlands, Tarana stood for a long time in front of "Country Road in Provence by Night," a painting that -- for reasons possibly related to something she saw or heard as a young child -- she seems to love as much as I do.
Which suggests -- to me anyway -- that even with a macro strategy based on primes, twin primes or squares of primes, something beautiful eventually happens when you share your stars, your swirls and your colors with someone you love.
To my dear friends and colleagues-- wishing you happy holidays and the best for 2014 (prime factorization 2 x 19 x 53.)
There’s a scene in “Night at the Opera” where Groucho checks into his little cabin on the ocean liner and then hears a knock on the door. A porter enters. Another knock. Room service. Another knock. Another. Five people, then ten-- all in the little cabin, and they keep coming.
Fall, 2007. I sat slumped on the couch, Tarana tucked lazily under one arm, Nikhil lying on the other side, the top of his head brushing against me. One window was cracked open and the air felt like leaves on the ground and smelled like pine needles in a campfire. It was a dark and rainy late afternoon, a ways to go before dinner. By now all four Marx Brothers were in the little cabin, surrounded by assorted plumbers, housekeepers, and lost travelers all repositioning themselves around suitcases, toolboxes and silver serving dishes with steam escaping from under the lids. More knocks on the cabin door, and more people: sea captains with monocles, women with bumpy blond hair parted on the side.
The scene reached a critical combination of too many people in too little space and the kids started laughing, and the laughter ratcheted up a little with each new knock on the door. The camera caught Harpo’s big eyes and nutty smile, the kids got on their knees on the floor to be closer to the screen. I forget how the movie scene ends, but I remember the black and white from the screen lighting their faces. Tarana laughed and bit her lower lip. Nikhil was catching the light in his mouth like a snowflake.
Our children fly past us, riding on a star. But every once in a while we get to ride along.
The arbitrary grouping of tens places our number system at odds with what’s real and true in the world. Suppose evolution had left us with four fingers instead of five, would we have adopted an octimal instead of decimal system? Would we count “one-two-three-four-five-six-seven-eight” while writing “1-2-3-4-5-6-7-10?” And would that convention be better, worse, or just different?
A couple of years ago I overheard a friend toss off the phrase “the difference between a first and second derivative” with a familiarity that made me jealous. I started reading books with titles like “Infinite Ascent” and “A Tour of the Calculus,” books about numbers. Not numbers of things, but numbers themselves: squares and square roots, series and patterns, the philosophy of zero and the inevitability of pi.
There are many truths buried in numbers, but the way we write them down obscures them. Prime numbers are real; counting on our fingers is not. Square roots are true in and of themselves, counting down from ten to liftoff is pure artifact.
I turned 49 yesterday. 49 shouldn’t matter. 49 is the last exhibition game before the start of the season, the dark theater before the movie, the vice-presidency of ages. Fifty – now there’s a momentous year. Fifty, as in half a century or a diamond anniversary or “sorry – I can’t break a bill that large.”
But the brave 50 is a fraud: five groups of ten, two groups of twenty-five, like one of those toys that changes from a truck or a plane into a robot. 49, on the other hand, is number royalty: a square of a prime number, part of the noble series 1-4-9-25-49.
The squared prime number series makes a lot of sense. Years go by too quickly now. The narrative breaks down: each year things are different but they’re not different enough. Are you better off now then you were a year ago? How can you tell what’s background noise and what will ultimately pass the “So what” test? Decades are pretty speedy too, and worse, they are inconsistent. Decade identity fizzles out over time: Teens and twenties are periods of tumult and revolution, of emerging identity, of atmospheric highs and fall and cut your forehead on broken glass in the parking lot lows. But the thirties don’t roar and the forties just…. happen.
Take the prime squared intervals, however, and it all makes sense. Sure 9 to 25 is huge but 25 to 49 is epic: we create families, make and lose fortunes, we matter. We fall, redeem, shine, disappoint, lose ourselves for months at a time in minutiae and emerge with perspective and the vaguest sense that wisdom and peace may ultimately be attainable.
Way too much for ten years to handle.
1-4-9-25-49. 49 is the last of the line, but that’s not a bad thing. None of us will make it to 121. 49 is the black belt of years: everything really starts from here.
(from March 2008)
David Sable MD
writer, teacher, fund manager and retired reproductive endocrinologist