Finance Is Not a Discipline to be Rigorously Studied
Transitioning from the world of competitive sports to the undefined realm of a university education was a strange experience. I was grossly underprepared for it. I went from being told what I was going to eat for breakfast to having absolutely zero structure in my life over the course of (literally) one week. Without much thought I ventured into finance, believing it to be “a domain where I could engineer solutions to intricate problems and effect meaningful change” … just like they told me in the career-day info sessions. Acknowledging I didn’t have enough “gift of gab” to wave my hands at a 10,000-foot overview PowerPoint about the three-phase implementation plan of whatever the thematic flavor of the year was… I decided to work in investment banking. I liked numbers anyway… so what the hell, why not?
My tenure within investment banking revealed that what I thought was rigorous analysis was really the translation of logical assumptions into spreadsheet form. Making things real and putting projections on paper was a necessary step in moving any type of project forward. Massaging the numbers was a way to bring ideas to life. Three financial statements and double-entry accounting were the rules, the spreadsheet was the playing surface.
Within finance I discovered a world filled with individuals yearning for purpose, striving to reconcile their ambitions with the quest for significance. This revelation transformed my perception of finance from a “subject of study” into a conduit for doing something useful. After all, finance in and of itself was a social construct – made by humans, performed by humans. The more I learned about this nebulous thing called “finance”, the more I realized it was something that couldn’t be studied in an analytically rigorous form. It was a tool, not a subject. I used to want to work at a quantitative fund until I realized some of the smartest people in the world worked at these institutions and they still struggled to outform an index. I didn’t see much utility in trying to be one of them.
I often interact with business grads, as I try my best to field inbound emails and LinkedIn messages from graduates of my alma mater: The Alberta School of Business . I always tell them the same thing… business isn’t an academic disclipline, it’s a conduit to get things you care about done. So figure out what you care about.
I came to crave studying something that could be understood with analytical rigor. For me, that became science and computer science. Admittedly, when I started medical school, I thought I’d leave finance behind. As I have moved from the classroom to the hospital, I realize I shouldn’t ever leave it behind. I can’t leave it behind. It is a tool I must and will eventually use.
Working With Patients is A Gift
Getting to work on medical wards is a true gift. Seeing some of the darkest corners of reality gives you the opportunity to experience raw human emotions. In my short time in the hospital, I have seen terrible things, but I’ve also seen incredible things – the kind of stuff that miracles are made of. Witnessing the passing of individuals serves as a frequent reminder of life’s transient nature and the insignificance of our daily worries when looked at through the scope of our existence. Our health is a true unifying force – the great equalizer – it can equivalate the most fortunate to the least fortunate. Healthcare has all impacted us in some form. For some of us it’s been mental health struggles, cancer taking a loved one, chronic conditions limiting autonomy, or watching old age cause our parents and grandparents deteriorate. Whatever it has been… we have all experienced it somehow.
I will never forget rotating on hematology and having an ICU doctor come and talk to a patient about his prognosis given his lymphoma diagnosis. Hearing the ICU nurses discuss the patient’s eventual death with his wife, son and daughter was haunting. The emotional turmoil of witnessing a loved one pass away is unbelievable. It has amplifying harm and it can take family members years or decades to recover. For some reason, witnessing the systemic therapy failures on the hematology ward left an enduring impact on me. I became simultaneously terrified and mesmerized by all forms of oncology. While diseases like cancer might never yield to complete conquest by therapies, advancements could enable people to live with dignity until they pass of old age.
I admittedly have days in the hospital where I ask myself… what I am doing here? But like clockwork, just when you think you are tapped out, you get to experience something incredibly humanistic, and it recharges you and keeps your engine running.
Quite Literally… Innovate or Die
It’s the difference between the daughter in the lobby outside the hematology ward with her head buried in her arms distraught after realizing her father is likely going to pass away, and the success story of the EGFR1 targeted monoclonal antibody therapy in lung clinic where I got to tell a patient his cancer disappeared off his CT scan while his young adult children were crying tears of happiness. The difference between those two scenarios is that in the ladder scenario the required therapy and diagnostic tools existed to make it happen. Patients will probably never meet the scientists and individuals who risked their time, livelihood and capital to make these advancements a reality… but the important thing, and only thing that matters, was that someone created those things and they worked. I recently read the book, The Emperor of All Maladies: A Biography of Cancer - by Siddhartha Mukherjee and included within is an old quote by Sidney Farber, a famous pediatric pathologist and whom the world-famous Dana-Farber Cancer Institute is named after. His words highlight my thoughts precisely:
“The [325,000] patients with cancer who are going to die this year cannot wait: nor is it necessary, in order to make great progress in the cure of cancer, for us to have the full solution of all the problems of basic research… the history of Medicine is replete with examples of cures obtained years, decades and even centuries before the mechanism of action was understood for these cures.”
In effect he is saying that very often a cure is often found before we uncover the granular step by step mechanism of action underpinning a molecular derangement. To me this quote reads something like – “dude… take risks, comb data, throw some spaghetti, try something new.”
Without getting too deep into it, the last three years of my education have led me to become increasingly obsessed with cutting-edge technologies like methylation data and whole exome sequencing, particularly within the context of urology and oncology. These molecular data sources offer profound insights into an individual’s genetic blueprint, shedding light on gene regulation and potential disease biomarkers. Whole exome sequencing zooms in on deciphering protein-coding regions, identifying variations linked to diseases and personalized treatments. Methylation data unveils epigenetic changes impacting gene expression and can uncover potential biomarkers for disease detection, prognosis, and treatment response prediction.
Integrating methylation data with whole exome sequencing opens doors to an insanely granular level of comprehensive patient profiling. This integrated approach unveils a deeper understanding of an individual’s genetic and epigenetic landscape, paving the way for targeted and personalized treatment strategies which can facilitate favorable outcomes.
Be Yourself, Not Who You are “Supposed to Be”
Within medicine, there is an “ideal doctor” archetype that is postulated during medical school. Roughly speaking, it looks something like an equivalent mix of a scholar, a humanist, an empath, and an educator. In fact there is an extensive document dedicated to this called the CanMEDS framework. My experience has been that medical school applicants, medical students, residents, and even staff physicians in their infinite wisdom and risk aversion dedicate thousands of hours towards developing their professional identity in accordance with this framework. While CanMEDS definitely has utility from a curriculum development standpoint, I personally think this is a futile approach to professional development, and it may even be stunting innovation. We should instead be ourselves and harness our diverse strengths to improve the medical profession as a whole. For some that is impacting public policy… for others it could be clinical care. I still don’t know what that looks like for me and I am trying to figure it out everyday!
Richard Feynman
- Richard Feynman (1918 — 1988) was a successful American theoretical physicist widely known for his enthusiastic teaching style
I had an extremely demanding hockey coach when I was younger, he told me anything worth doing was going to be challenging – I remember him telling me “if it’s worth it, it’s going to be hard, every week you are going to have three bad days… but as long as you have one good one, you should keep going.” The most important thing he emphasized was that “I controlled the only thing I could control” which was “having seven hard ones.” He taught me that the only way you can motivate yourself to do the “seven hard ones” every week is if you find your why. That meant finding the thing that allowed me to execute in the absence of external accountability. Now that means finding the energy for the “twilight zone hours” where you transcend the boundaries between reality and fantasy and work on those passion projects. I realized this “why” needs to come from something beyond accolades or money. For me, those fleeting moments of humanism in the hospital have been insanely motivating, and I hope it stays that way.