Thinking Ahead

In my current state I have found myself constantly, almost obsessively, contemplating different aspects of a future visit that I had not thought about before. For example, I now always consider the physical entrance and exit to any locale I am headed. I am concerned with details and wonder, “Are there railings there? Are there steps at leading to the house? Where is the bathroom in the residence? How many people will be there? Do I know anyone that will be there?” These are just a few of the thoughts that race through my mind before I even step foot at my destination. Earlier this year, my thoughtful wife surprised me with tickets to a show by one of my favorite comedians Aziz Ansari. Even though I absolutely loved the show and found his performance extremely funny, getting to our seats was my nightmare scenario: we had to park very far away and had to traverse uneven terrain to get there. It was a sold out show with thousands of people attending. To make matters worse, our seats were in the top row of a large theater, and getting to our seats meant ascending up many flights of stairs. Stairs, as long as they have railings, are no problem for me; the trouble was that for these stairs there were no grab rails. Thus I had to go unsteadily and unsupported up multiple flights of stairs. Because we were late and everyone was already seated, I was contemplating having to grab onto one of the unsuspecting audience members in the event I had to steady myself or prevent a fall. Luckily, I made it up the stairs without falling, and we were able to enjoy the show. After the show we were able to find a stairway with railings, thus leaving the show, while still slow, was much easier. Now I tell you this, not because I simply want to recap for you a difficult situation I had to endure, but because I feel it highlights an important point: thinking ahead is very important and a skill that is vital to everyone, not only to those stricken with a brain tumor.

think ahead

If you examine any craft, whether it be music, art, or business, those with success in their craft have an uncanny ability to think ahead. For example, a novice chess player may think 1 or 2 moves ahead; however someone proficient at the game may think between 3-5 moves in advance;[1] a grand master could possibly for see up to 8 moves in the future; the top chess players in the world are known to sometimes map out entire games in their heads before the first move is made. It doesn’t take a statistician to see the trend here: increasing proficiency is directly correlated with how many moves ahead one can predict. This philosophy goes beyond the game of chess. The ability to think ahead leads to success in all fields. In medicine this is especially pertinent, as your physician often has your management plan mapped out in his or her head before even seeing you: okay, this is this patient’s second visit for back pain. Since we’ve tried some NSAIDs (non-steroidal anti-inflammatories), I think it’s time to begin trying some physical therapy. I’ll make sure there are no red flag symptoms[2] and prescribe physical therapy. They might push you for imaging (i.e. x-ray, computed tomography, magnetic resonance imaging), but there is no need for this yet. Imaging now would only result in exposing the patient to unnecessary radiation and increase health care spending. They might also push you for stronger pain relieving medications (i.e. opioids) but unless the pain seems almost unbearable there is no need to prescribe this. Remind them that these medications can have adverse effects, including death. This is not an uncommon thought that runs through a physician’s head before seeing the patient. Like with chess, thinking ahead is vital to the success of any clinician; a more proficient physician will have the ability to remain many steps ahead of the patient. In sports, fans almost believe the player to be prophetic in the amazing plays: does Roger Federer know that if he serves in a particular spot that his opponent will return the serve in this area, at which point he’ll run around his backhand to hit a forehand to win the point? How far ahead does he have the point mapped out?

The point here is that whether we like it or not, we should constantly be pushing ourselves to think further and further ahead. I believe that even in our daily lives the more we can think ahead, the more success we’ll have. For me this means plotting an entrance and exit strategy, for you this may mean planning out your shopping trip to maximize your efficiency.


[2] See my earlier post for a definition of red flag symptoms


One of the aspects of my work that always brightens my day is being able to see children. The only downside of having encounters with children is that they are often in distress (thus the reason for their visit). But many visits are ‘well child’ visits: visits where developmental milestones are assessed and vaccinations are given. These visits are typically filled with a smiling child’s face (that is until ‘the shots’ are given).

These highs come with the occasional low; in fact, since my return, I have only come close to crying once while in a patient room. This came after a six year-old girl told us that her mother’s boyfriend had sexually abused her. I hate seeing a child in any sort of distress- my heart sinks whenever I enter the room of a pediatric patient who is clearly sick.

The medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes.


Why do they give us so much joy? The scientific answer is that we’re designed to feel that way. It benefits our survival to think of children as precious. In evolutionary terms, loving them as we do causes us to protect them from any harm, leading to a propagation of us as a species. My superficial answer is that I see my sons (aged 8 and 2) in every pediatric patient. However, not only did I feel this way before the birth of my children, there are also countless others who do not or will not have children; thus my argument of seeing our children in others is debunked.

When I reflect on it more deeply, I realize it’s the honesty of children that I truly treasure. Kids will tell you what is on their mind; call it naiveté, but unlike us adults, they have yet to go through the long process of becoming an adult and being taught to censor many of their thoughts or words. This honesty can also be thought of as pureness. In philosophy there is a never-ending debate over our inherent values: one side believes us to be virtuous at the core, claiming that we are all born with inherent ‘good’ values. The opposite school of thought labels us as inherently ‘bad’; according to this theory we are all born with these hurtful tendencies. Personally, I subscribe to the former theory. I have never come across a trait that I disliked that couldn’t be traced back to a learned behavior. For example, I’ve yet to come across a racist whose beliefs spontaneously form. I can always trace their misguided beliefs to some experience that led them down this path. But regardless of where you stand on this debate, you’d be hard-pressed to find someone to argue against the pureness of a child’s mind. Whether or not their values are virtuous, they are always honest in what they say.[1]

That brings me to the topic of today’s column. When Linda Frevert (one of the leaders of the Epidermoid Society) told me that many of the EBTS members are parents of children who have been diagnosed with Epidermoid Tumors, my heart sank: deep inside I knew that children were afflicted with this condition just as adults were, but I had been somewhat in denial about this reality. The thought of a child having to endure a surgery of the brain or even the diagnosis of an Epidermoid Tumor is hard to fathom. The good news of diagnosis at a young age is that children’s bodies are incredibly resilient and fantastic at recovery. I’m sure there is a plausible scientific explanation for this, but the conclusion is always the same: kids bounce back from injuries better than adults. I liken it to a sand castle. If a piece of your sand castle is taken (or broken) while you are building it, who cares? You can just get more sand and rebuild the affected area. But, if your sand castle is already completely built and your sibling decides to break off a chunk of it, it can prove very tough to rebuild.

But my despair turns to hope when hearing of children afflicted with this condition. Yes on the one hand it is horrible to think of a child with an Epidermoid Tumor. On the other hand, their diagnosis comes now when they are best equipped to recover. I often wonder how my recovery process would be different if I had been diagnosed at a young age. Thus, this is dedicated to any parents who have to endure this diagnosis in their child: just remember that there is nothing you could have done to prevent this- it is postulated that the tumor begins its formation in the womb. Also know that diagnosis now is better than later as your child’s body is equipped to recover from this, and your child will heal. Sand castles broken while building it can be rebuilt, sometimes better than before.

[1] I am a big fan of stand-up comedy, and Louis CK does a hilarious bit on children learning to lie:


People often tell me I seem very patient and ‘laid back’. In fact, I devoted a whole article to the subject of patience and the importance of this virtue to my recovery. I do find myself becoming impatient. At times I find myself wishing I would awaken tomorrow with a normal gait and speech. I’ve come to the conclusion, however, that patience is the result of trust. When I am in a long line at the grocery store, it may seem to an observer that I am patiently waiting my turn, but it is actually trust that I am exhibiting. In this instance, I trust that the grocery store cashier is working the best he/she can. In my recovery, I trust that the team I chose (including surgeons, therapists, neurologists, and physiologists) is working to the best of their abilities, and have my interests at heart. Conversely, an impatient person may distrust the grocery store cashier or their physician believing their experience could (and should) be in more capable hands. The question then becomes, ‘What have these people done to earn your trust?’ I have no good answer to this, with my only rebuttal being that I trust in the system that has placed this person in their current position.

There is an economic theory called the Peter Principle. In essence, it postulates that in any company, people receive promotions until they are no longer effective at their position (thus no longer receiving promotions). The theory claims that this results in inefficiency in the company, claiming that all people are elevated within a company until it is deemed that he/she is no longer worthy of elevation, meaning we are all in a sub-optimal place in this company.[1] Why would I even mention this theory in an article telling you of the value of trust? Doesn’t this theory argue against trusting others? Besides finding this theory fascinating and wanting to share it with you, I also feel that in order to convince you of anything, all sides must be presented. Even though I find this theory intriguing, I believe that the promotions stop when it is deemed that someone is not only proficient at their position, but also that a change to this job would result in detriment to both the company as well as the individual themselves. Thus resulting in efficiency. In essence, unlike the Peter Principle, I believe that promotions stop because it is decided that these workers are doing a good job and that a change to their position would be detrimental.


Is trust like this genetic or learned? It is likely a combination of the two factors: a baby seems to trust everyone, making a case for the learned argument. However, this same baby might go through a phase of separation anxiety, showing his/her mistrust of anyone but their parent (usually mother), arguing for the inborn or genetic component of our mistrust. I would be delusional if I thought I could solve the centuries-old debate of genetic versus learned; but regardless of the origin of trust, I do believe we can make the conscious decision to think positively and optimistically of others. I am imploring you to trust more than you do. Realize that if you wish yourself to exhibit more patience, what you are actually asking of yourself is to trust more.



This past weekend I was lucky enough to be visited by two close friends from college, Ben Hall and Chuck Howe. I had not seen them since my surgery. In fact, the last I saw Ben was in 2007 during a trip to Puerto Rico, and the last time I had seen Chuck was before then at my wedding in New Zealand in 2005. Part of me was anxious at the thought of seeing my old friends and what they would think of my current condition. Yet there was another part of me that was so excited to see them again. Their visit was an uneventful, filled with retelling of old stories and updating of the whereabouts of former college classmates. While “uneventful” might connote “boring” to some, my ideal day is an uneventful one.

Even though part of me was anxious at the thought of seeing them, their visit reminded me of the importance of having such close friends. While this ordeal has clearly highlighted the value of family, it has also made me realize that I have underappreciated the value of close friends.

I realize that part of their reaction upon seeing me brought about thoughts like, “Wow, he’s worse than I thought.” These are people who would be frequent visitors to my tennis matches in college, and now, only 10 years later, I could not jog. Even standing upright proves to be a task. But I’d like to think after the initial shock of seeing my condition, they simply enjoyed seeing a friend.


Regardless of their thoughts I have come to appreciate the importance of having friends like them in my life. It’s unfortunate that it has taken a debilitating brain tumor for me to come to this realization. But I implore you, do not make the same mistake I have made. Don’t take your friendships for granted. Appreciate every friendship you have and nurture them. Friends love you for who you are. For them, your well-being is their first priority. Sometimes this means agreeing with the most irrational of explanations, but to them if this agreement results in an improvement (or maintenance) of your well being then this is what they will do. For example, if you’re friend said to you, “my dad’s idea makes absolutely no sense!” Even if you saw the logic behind this decision, you might agree with your friend, because he/she is, well your friend.  Your friend can also ground you, and will not hesitate to call you out any of your hair-brained ideas. “That makes no sense, Chris,” I’ve been told(in college after giving my roommates a bad explanation); even though a comment like that may hurt at the time, it could serve to stop you from making a decision or saying something that you regret for the rest of your life.

Cherish each and every friendship you have. When you find yourself trapped in a pit in the road it is your friends that will pull you out.


My return to the clinic has been separated into phases. The first phase of my return has involved my shadowing[1] different clinicians in the clinic. While all the clinicians that work there are extremely intelligent and have a fantastic rapport with patients, they each have their own particular strengths. As a resident physician, we are each assigned a mentor. These advisors meet with us about our test results, patient satisfaction ratings, and senior projects. When I was in recovery in the hospital, my advisor was in the process of changing positions at Michigan State University, thus I had to choose a new advisor. During my time in residency I had developed a close relationship with Dr. Kenneth Thompson, making him an easy choice as a new advisor. More importantly, even though he came across as gruff, I knew inside he had a big heart. I have been lucky enough to be able to shadow him during my return to clinic. Besides imparting his vast medical knowledge on me, he also often gives me his philosophical insight regarding my condition. On many occasions he has said, “Chris, if you step back and look at the situation, you have to appreciate the journey you’re going through.” I had never thought of it as a journey before. I began to reflect on what defines a journey.

Merriam-Webster’s dictionary defines journey as “something suggesting travel or passage from one place to another.”[2] By this definition, I have definitely been on quite a journey, at least figuratively. But we all go through our own journeys. Who is to say my journey is somehow more arduous than another’s. Life is a journey: someone who wakes up every day at 7:00 am to go to work then comes home to his/her children, eats dinner, watches the news, then goes to sleep is going through a journey, albeit different than mine. A journey results in you being in a different place than you started. Just as I am being put through a journey via my health, this hypothetical person also is going through a journey ending up somewhere other than where he/she started.


Our journeys make us who we are. Thinking our ending position is all that matters would be short-sighted, our paths to this position cannot be forgotten, and are as vital to us and our makeup as the end result. There is an old adage, “trust the process.”[3] It’s important where you end up, but what’s more important are the experiences that get you there.

[1] Essentially following and observing