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