This is Jacko Podcast number, fifty six with ECHO Charles in me, Jocker willing good evening echo good eating. Silent screams and broken dreams, attics junkies, pushers and fiends Crowded spaces and sad faces, never look back as the police Chase us. Consumed slowly by chaos of victim of the streets hungry for college but afraid eat life of destruction. It seems no one cares a man child alone with burdens to bear trapped in life of crime and hate. It seems the ghetto We'll be my fate if I had

just one wish it would surely be. That God would send angels to set me free free, from the madness of a city. Wild. Free from the life of a ghetto child. And that is a poem written by a young. De Andre Mccullough, a criminal drug dealer who, when he wrote that part Palm, was due in time After being one of the main subjects in a book called the corner, which is written by David Simon and Edward Burns, which documents violent drug trade in Baltimore Maryland and that sort of

morphed into an HBO series that was called the coroner as well. Which paved the way for another series, which is called the wire It is just an outstanding Many serious that came out on HBO, but the wire is is fictional. Even those based on kind of the same situation in Baltimore, but the corners real, the book, the corners it gives a very clear, any very grim view at the life of drugs and crime, the inner city, namely in Baltimore, and I'm going to go back to the book now We can't stop it not with all the lawyers guns and money in this world, not with he'll to morality or righteous indignation. Now, crimes, summits or task forces or committees.

With policy decisions made in places that can't be seen from the lost corner of faith and Monroe no land. Sing. Victory in the war on drugs can be bought by doubling the number of beet cops or tripling the number of prison beds. No peace can come from King pin statutes and civil civil forfeiture laws and warrantless searches and whatever the hell else is about to be tossed into neck. Next year's crime bill down on fifth street. They know today as on every other day, the shop will be opened by midmorning and the town will be in the corners chirping out product names. As if the stuff is ST legal. The runners, will bring a little more of the package down in the fields. Will queue up to be served a line of gaunt passive supplicant stretching down the alley and around the block, Warner is rooted in human desire, crude and sir.

And immediate and the hard truth. That all the law enforcement a world can't mess with desire down at say it Monroe and every corner like it in Baltimore. The dealers in fields have one because they are Legion. They have one because the state of Maryland and the federal government having prison thousands and arrested tens of thousands and put maybe a hundred thousand on parole and probation roles and steal it isn't close to enough by raw, a graphics, the men and women of the coroner's can claim victory Baltimore alone, a city of fewer than seven hundred thousand souls with some of the highest recorded rates of intravenous drug use in the nation. They are fifty, perhaps sixty thousand strong, three of them M available for every prison bed in the entire state of Maryland.

The slingers, are manning more than a hundred open air corners serving up the product as fast as they can get it off. The south bound Metro, lighter and the fee means are chasing down that blast. Twenty four seven. In neighborhoods, with where no other wealth exists. They have constructed economic engine, so powerful that they'll readily sacrifice everything to it and make it mistake that engine is harming no slacking profit margins, no recessions, no bad quarterly reports, no lay offs, no naturalised unemployment rate, get it straight there just out here to sling and shoot drugs in drug market, in cities across the nation lives without any obvious justification are given deafened Through a simple self, sustaining capitalism

one or has a place for them. Every last soul, touts runners- gouts mules stick up boys stash dealers enforcers fiends, burn artists, police niches all necessary in the world of the coroner each is to be used, abused and ultimately devoured with unfailing precision. It's about the fiends, thousands of them who want that good dope. They need the way. Other souls need to breathe air. It's about the slingers, the young crews, working the package's all of them willing to trade on morality that they ve never seen or felt for a fleeting moment of material success. There working the package with them hidden knowledge that they will fall.

That, with we're exception, the money won't last and the ride will be over and six months or for or three violence violence is no longer the prerogative of the professional, but a function of imports ass, an emotion, the contract killers, and the well planned assassinations of earlier errors are mere myth. On these corners now the moment with generally comes down to some man child with her feelings. Waiving of three eighty, a thirty eight around spraying, bullets up and down the block. The accidental shooting of by standards, is now common place. Even fifteen year old hoppers have loaded thirty its hidden in the alley, the job

little better than a death wish and in the end, the corner best serves the hard core of the hard core. The junk yard dogs, with neither the time nor the inclination Sean for pity. The corner proves itself every day. It destroys. Everett touches and eventually the corner destroyed. The Andrea Mccullough, even though he received the second chance in his life and he actually got to play Oh small role in that series that came out on HBO the wire you get.

Mother jobs in the end, entertainment industry as well, but the coroner call them back in that guy. The Andrea who wrote that poem. He ended up of a when overdose, two thousand twelve at the age of thirty five now there's a reason on bringing all this up, and that is because have a guest tonight, a guess that is actually more possible. For this part gas than anyone get to that later? But his name is purity and he grew up. A boxer been a long distance endurance, athlete God his degree and medical engineering and applied mathematics and then got his doctorate as an DE from Stanford. And it is residency in surgery.

And the reason that I started off this whole talk about the corner is because he did that residency at a place called Job John Begins hospital, which is about three miles from the actual corner of fate Monroe Street, though we're zone- that's pictured in the book. The place where D Andrey Mccullough lived and were once was. In many ways still is just a part of life. Then Peter was at ground Euro in the war zone and saw more

darkness and suffering, probably than any person should have to and learned a lot from it and we're gonna get to that in a bit, but first of all Peter a tier welcomed. The shell. Thank you for having me, Sir glad to have you and finally and you grew up we'll get we'll get right into it. You grew up, tell us a little bit about just growing up. You grew up in Canada and I know you've covered. If it was you, they haven't, listened to The team Ferris Interview with you listen to what the three of us. Yet I think something distribute you can in those and get more details on. You know Peter background, but for those are just listen right now, you drop in Canada guess little little little little statement about that gap. A group in Tehran,

you don't. Immigrant parents so grew up a sort of in the wonderful lower middle class, not the best suburb of Toronto. It's wrong, like New York, has five boroughs. Four of them are nice. One of them is not grew up in the one. That's not so nice and meaning is just a dump nodded like it's you like a war zone or anything- and I have lived now in the United States for about half my life. So I high school in college was in Canada and then everything from medical beyond has been here, and I am now I dual citizenship, but how did that transition work? As you didn't you, you obviously yet applied mathematics degree, and then you worked in the civilian world a little while with that degree right so

my plan was always to do a Phd in aerospace engineering, and so I that's why I did mechanical engineering and applied math. That did the two things for undergrad got it and then was Sort of just in an almost about ready to go and start that Phd in Aerospace, and I had a just a complete change of heart and decided. I want to go into medicine, and so that What I do for a year then, was you gotta take this thing called the M cat, which of course I didn't have any the courses. Take it. So I had to go to teach myself. The chemistry and biology that summer took the M cat, for them still I times s what I do in the summer time I'll I'll teach myself chemistry biology, ass, I didn't I didn't do that well and then, and then I had to do was called a post back here where you go back and you are in the process

of applying to medical school without actually having the courses to get in. So if you get in its conditional and and so that year, because I already graduated- I just hot calculus side, you know was like a adjunct lecturer at the university and taught calculus, which I always enjoyed of inside taught couple years before it ends. That's why you wait and again in a medical applying and am getting my courses like. I forget what I hadn t or biology, and psychology biochemistry had to take a few prerequisites to get it because in engineering and math I'd never you have taken a single accord. In fact, the day before I took the M cat this, this is only gonna be honey from geeks who get biology so our care about a moment, but then I'm be made here, I'm studying for the M cat this summer, but there was a good s them the whole time. I'm studying I'm like you know. I can't believe how sloppy these textbooks. They keep confusing my hostess and my tosses like. Why can't I just Well, it the same way both times like the I didn't realize,

was to separate things right. My Aussies is when a cell separate operates in life, doesn't replicated DNA might houses when it creates an equal copy, and I literally not until the day before the M have realised that those are two separate things and that's how how clue? and I was going into this test It was a lovely reason. I knew that us helping one of my daughter study for their biology, something anybody who took any biology course should know that, but I hadn't taken any as a unit mescal you go there, let's have for years another four years ago, and then you get on with it, and now it's time to do your residency. So yeah do you get to pick where you're gonna go not sort of so it's a funny system called the match. System. So when you're in your beginning or fourth, your medical school by that point, you have to figure out what you want to do. Do you wanna be a surgeon,

be of an internet. You wanna be a pediatrician radiologist whenever you want to do cause all of those have different programmes, and then you have to apply to those programme. So let's say you wanted to do or the Peter surgery. You would send a trap location to all the author Peter Programmes in the country. Hopefully, you'd get interviews to a good number of em you'd go, do the interviews and then you would submit to a match system a rank order of the places you'd want to go in I'll put something on their that you don't want to take. So if you, if you intervene, if you applied to thirty programs, you got interviewed at fifteen and you like the ten. You rank those ten in order. Similarly, the programmes after they interview everybody do the same exercise. They do the leg and then a computer matches you one to one: that's actually pretty squared away

Yes, oh you, the only way you're going to guarantee you know where you're going is rank one programme and hope you get it. So, in my case, I, for I think I ranked five programmes and I ranked Johns Hopkins first for surgery, not because I wanted to live in Baltimore, though in many ways. I think it was a blessing to do so, but you know because at the time I don't know this is true today, but at the time it is probably the best general surgery training programme in the country, and that was a combination of two things. One is you had these kind of legendary surgeons there that had pioneered.

The most complicated? What are called her patio Billy Airy surgeries surgeons, bleed surgery of the pancreas in the liver of like that, but at the same time as you allude to it, was in a war zone and so the other aspect of training to be a good surgeon is having great exposure to penetrating trauma so trauma. You're. One of divide into blunt and penetrating blunt trauma is not often operative, so people that get hit by cars and things like that you know, ends up being more orthopedic. But if your general surgeon and you need to be able to cut open the chest in the abdomen and things like that- it's penetrating trauma. It's you want knife and gunfight, not that you wanted, but that's that's the training ground to be so and inserted Baltimore would have been probably in the top five. What you is this. Two thousand two thousand one year, two thousand and when you are what was the wars, the thing that slipped or he's gonna backward?

But what was the thing? A transition in your mind, were you all, the sudden one do medicine? Well, it's funny only have ever talked about this publicly So when I was in engineering school I in my second year I started doing some volunteer work and I thus the reason why is too complicated, but I started On hearing with some kids that were and in a shelter that had been abused says, it is a home for sexually abused, kids and academic twisted and sort of volunteering in a hospital. So I was volunteering at a hospital that had you know it was a pediatric cancer. Ward, so you would just start at Yale. You go up there and you can kind of hang out with kids and just play with them and stuff like that and so between had experience, and then I was still doing as volunteer work with these kids, who had been sexually abused. Lot of those kids were suicidal. So I also found myself in the hospital a lot with these kids after they attempted to kill themselves and

I think, somewhere in my senior year of engineering, I kind of had this. You know what the word is maybe I don't think it's an existential crisis is much too. Maybe a nervous breakdown by just a bunch of things were kind of going on, probably some undiagnosed psychiatric issues on my part, but I realized, like I love the engineering and math intellectually, but I'd theirs, emotional connection outside the joy of solving a problem which, by the way, is probably plenty enough, but I wondered there is something else that I'd be more interested in. That could scratch two inches right. It could scratch for the intellectual Ich but also may be an emotional edge, and so I spent the money many of my senior year. Thinking about was there's something else I ought to do, but I've been successful in

In my undergrad, so it was sort of a given that you know if you're going to graduate at the top of your class you're, going to go off and do the best Phd program. So, at the very end, when I inserted find to do that and I turned down a bunch of scholarships seemed a little odd that I would go and do Madison, but but that's really the reason it was. You know it's kind of this Tiffany. I had one day. Actually, while I was in the hospital and since we have had this axis really funny. We just moved it we're talking about earlier and no one of the things moving is great for his cleaning up stuff and actually found my essay that I wrote when I applied to medical school back and you know whatever ninety five. Ninety six agenda, in relation to go back and read. The story is its exact, the kind of how I remembered it right, which was like this moment. I had this sort of insight that we want to do so. So that's that's kind of it did that the series of events that led me to have that seemingly orthogonal change

direction. It ok! So now you go through that you end up. Do you get your accepted de residency? John John options? You show up there what what's that like? Well, remember when I I interviewed Hopkins for medical school as well. I was lucky enough to get in there for medical school and at the time I think Hopkins was technically the best medical school in the country. I think it was Harvard and Hopkins where the best to and Stanford was you know- maybe third. Fourth, fifth but I remember- and I interviewed there for medical school the end of the interview like I had to spend the night there, and so they put us up in the dorms for the men students which great idea you get to meet your upper classmates. Remember. I said that Friday night I said, hey I'm going to go, walk down to the harbor is like a mile and a half down the road they're like. Oh, no, you can't do that. I said what do you mean? You said you, you can't walk outside of the hospital.

And then they pointed out that on every corner there was like a booth with an armed guard, there's a garden full armor with an automatic weapons, and so I remember the time, thinking, yeah opera, we don't want to go here for Med school so and, of course, Stanford sort of for a guy who never been to California and who lived in miserable cold weather. His whole life as like it could have been. The hundred train medical school, I was still going there yeah. I have some actual stats it. I pull up so war zone. Two ninety three. There was forty eight murders. Hundred thousand people there's what's seven hundred thousand in the city. The next ties in two thousand fifteen, fifty five and in ninety ninety three again there's three hundred and fifty three homicides homicides almost one day, and so you don't have to put this in there. Just you know Your comment, a war zone, so when I was in remedy in two thousand and six

The one one eighty, which is the the ready First brigade me off, how's thousand six hundred soldiers, while we were there with them for six months, they lost sixty one guys so What I'm saying is now that doesn't count the enemy gash Tita, but it counts the friendly gas these that are showing up at our med centre right. So there you know your tongue, in three or four hundred, while you said one day about one today, ok so so you knew how bad it was when you got we'd better go out on a visit. I sort I knew it was dangerous, but but I think when I decided that you know for this, that sees of my life, you gotta sacrifice everything and you have to go to the place where you gonna get the best training, and I don't want to leave California, because you know four years in college

when you have for the first time was you know when you know you know what it's like I mean it was like. I don't ever want to leave this place, but also new. I just couldn't get that level of training on the West Coast and it was you know you base had to go to a place like hot, ends Bergmann weapons in Boston, maybe wash you Saint Louis, was can offer very similar environment. So then you know said, and I ended up ranking it First, they rank me first so away we go, we get lucky, it's a match made in Heaven and that's like kind of February of your senior year and then reality said sandwiches. You got sort of four months until you have to show up, and I was kind of like the oh shit moment right, like that. I really just signed up for this and a good friend of mine, who was two years ahead of me in medical school names, Brian Dunham he's now a pediatric head and neck your nose and throat surgeon at chop in Philadelphia. He was at Hopkins, which was at the time the best your nose,

a programme in the country and he actually recommended. I read this book the corner because and Brien's one of these guys, whose just now he's just he's like a renaissance man, you know like not always a great surgeon he's like a gifted artist leader has side job as medical illustration, like you can't believe what this guy can do, but he's introspective right- and he was he said, look you know, you're you're, going to sign up to be in this war zone and you're going to be taken care of people that it's going to be very easy to despise. So he said you need to read this book to gain a sense of their perspective, because very I guess it. You know what I saw at the time. I can remember the stats filling at the time that I was there. We averaged about sixteen penetrating traumas a day

Put that in perspective in general surgery. Your on call every second to every fortnight, so average about every third. It means every third night, a hundred and twenty times a year. You will spend the night in the hospital not sleeping waiting to take care of any trauma patient so of everything day and night. You know sixteen of these people are getting shot and stabbed. You're gonna have a lot of time in the e r in the tree. Ebay dealing with that and it's really easy to get jaded really quickly. It's fun for the first month and then all of a sudden every time somebody get shot, it's preventing you from sleeping, which when we're sitting here all well rested sounds like a very callous thing to say, but all of a sudden, you're sort of like dammit man like I can't eat, because the trauma Pedro just went off again to this day I still eat shockingly fast and drives my wife knots, which

I understand I said I think it's just a victim of you never know when you're going to have to stop what you're doing in that might be your last meal. Even I shaved quickly, because the word, to make it happen. As you got shaving primo over in the trauma, pager goes us, haven't you gotta run down half shaved once a year We are Democrats are not so stupid things like that. So so that was Brien's recommendations. I got the book immediately devoured. It found it to be the most depressing thing I had ever even read its head made more depressing by the fact that they pulled no punches, no names or changed every person. You re, about. You are reading about it in a completely uncensored, uncensored, unfiltered way and can you read it. You know, there's nothin happy about this book like you just finish it and you think. Yes, you have more empathy you understand where, where these folks are becoming from, but it's like, I don't

Aren't you finish that button go here's the solution? We need a six point plan. That's going to do excellence that's gonna. Why read that one excerpts we can't win, which is an awful thought and that's what that's the impression of book as you did, we can't win and I will add that that the way phrases it of being lick, it doesn't matter how many police, and whatever you do your gear going against human desire of the staff that you reiterated- and I remember very well from when I read this book. The first time was you, couldn't take every junkie and put them away if you took every federal and state prison bed in Maryland, you'd have three people for it. If you just looked at the users, never mind the guns, the money and everything that comes with it

so yeah. That's not a solution. Now, there's a second reason that nothing Brian New, because I don't think anybody knew that that book really hit home, which was it it it's it's per. It sounds tangential to the story, but it becomes highly related in at the beginning of the end of my third year, a medical school I'm going to the gym one day ride my bike. As always, do I get up together the gem I got my bike or to lock it up, and I was like back, really hurts like really hard, not like. Oh, it's a little stiff like something feels horrible, so I started walking down the steps. The generals, like not gonna, happen today. Like me, I couldn't I couldn't do any good time a shoot. So I just

back on my bike road road back to my apartment, told my roommate. I was like hey man, I'm going to go, lay it lay down upstairs the next morning. I woke up, I couldn't get out of bed and to make a very long story short over the next two weeks I completely deteriorated. You know I was at the point I could get in and go to the hospital, but I had to like have the nurses this back in the wild West days, where you could just forgetting thing you needed at the pharmacy. I get nurses or residence to inject toward all into me, which is a really strong and said. I could only sleep if I'm laid in an l shape over the nurses station, and if it wasn't get any better and then one day it pain, changed immediate. I realise in retrospect what happened. Ahern, aided disk had fragment, had broken off, so the pain in my back dissipated. But now I had this. What turned out to be a force enemy?

fragments sitting on my ass one nerve route. So now it felt like my left foot was being skinned from the by, but that was constant, so that was an unrelenting pain and it could only be sort of brought under control. If I could put my foot into a bag of ice, isn't I could make my foot go nuts and then I could take some pay medicine. So this one from other weakened in the dean of the Medical School, Sammy, Limp and through the hospice. It was wrong and I told them and drag me down to the ear we gotta MRI. Showed all of this now is in surgery the next morning. This was a son a night Monday morning, I'm in the o r. It turned into a disaster guy who operated on operate on the wrong side. So I woke up the left. She was still present, but now I had was called a foot drop on the right side. So foot drop is win the nerve that hold your foot up, which we take for granted when we walk. But if you dont have the ability to what's called Dorsey Flax, your foot would drop. You can't walk. You end up dragon, your toe. When you can,

tripping this story by me. We can spend three hours in the story. Is it so idiotic that the punchline is? I eventually needed many trips to the operating room, this guy refused to believe there is anything wrong with me. It took. Another amazing during urologist to actually intervene on my behalf and three months later I am, unable to walk, am unable to do anything, my mom actually to fly down from Toronto. To look after me and I'm sort of through you go through that the checklist rights others you ve ever heard of Elizabeth, Kubler Ross. I she's alive anymore, but she wrote a very famous book on these stages of dying and it goes through like anger and denial and finally, acceptance in the Andrea.

And so, if your bargaining like something that would make sense, if you and I'm sure you ve, got tired of that area and you ve probably watched it on really small scales yeah, you know like in combat. You might see these things over the course of compressed again dine with it with a cancer patient. You might see the stretched out over a year as, kind of going through this on my own right were initially it was like. Oh my god. What? If I don't finished this rotation on doing right now, it's called it, surgical said internship too to oh. What if I don't graduate on time to what? If I can't be a surgeon and then it was what if I don't walk ever again so somewhere along the way. Remember exactly when probably A month and a half into this, I finally caved in and started taking pain, medicine, I hadn't thought that's where the story was going to get some boy he's gonna get on the open up

and I had been so reluctant to do so initially been so stoic. You know just taking my ends, AIDS and Durham, even using Ben drill, which is a horrible pain medication, of course, but it sedates you through some of the pain, and so I know what our taking perquisite purkis at is its typically ten milligrams of Oxy codeine, so oxy oh down as the fast acting version and its stronger than say a vice or like it in his Tylenol Enhydra Codeine, immediate, acting but hydrocarbons, not as strong as oxy code on so Purkis at a stronger than Vike at him. They both have tylenol, it's just the opiate a stronger, and so you know, if you take a purkis at which have five hundred milligrams Tylenol in ten milligrams of oxy codeine. You not probably was taking. You know, Sir, taken two three four.

We're five six hours a day, you develop a tolerance and eventually either, longer acting version called oxy content, which is just a time released version of oxy co down. So then you would take that twice a day. So at my pique I was probably taken eighty LE grams of oxy content a day plus another hundred twenty milligrams of oxy code on. I just got rid of the tylenol altogether. You can just get straight oxy codeine and some about two hundred grams, a day of oxy codeine equivalent and again. If you know, if I took that today, I would just die you shot grieving, but at the time you do you build up this tolerance. But it also there was this point where I realized that I wasn't just taking it for the physical pain right and I think

since the single most important inside. I had that when, coupled with reading that book six months later was there, I think the single most important realization I ever had with respect to to this problem, which was at some when it was. I was just so depressed that I couldn't walk and I was so worried that I'd never to do anything again. That at least the drug gave me a high that took me away from that and so then it got to the point where I was just taking that drug all the time and I just stopped engaging like wasn't, engage with anyone anything and then I sort of had this realization that that was happening, and I was like I I want to stop so the time I was dating this girl. She was an aniseed you residents just four years old. They re just the coolest coolest person and I said to her. She was caught. Only one knew what was going on, because at the time even the doctors who are prescribing this like this just wasn't. I

those radar as a problem back then, I think today people would be like homeboys got two hundred milligrams Ex economy day. That's probably not good, but the time it was just like with like tick tax rights, so that women Emily killed like if I took two hundred milligrams with that that would really jack someone up. I would think I think if I took two hundred today, I would stop breathing, because that's how opiates kill you they repress base these inhibit the toy, DR that's. What, whenever, whenever someone overdose non hair when they just not breathing so yeah, I think two hundred would I don't know I'd have to look at the farm it actually highest. You want one so the gross aiding she she said you can't just stop right the withdrawal is so painful that you have the taper off. You have probably go on methadone and then you'd have to start some pretty potent anti depressants

like a male eyes or TCAS. You have to go on a drug like nor trip to lean, which is an enormous self kind of a crazy thing, and I was like yeah by think. I'm just gonna stop cold Turkey now, unlike alcohol. So if you took an alcoholic took some of whose drinking twenty alcohol Alcott beverages a day and the banana forever, and you see there they will die, they will get something called delirium tremens and they will die a horrible cardiac death. They will break into arrhythmia and they will die. So when we had our Alex in the hospital. Let's say we had operate on somebody who happened mean alcoholic. We were actually just put them on, and ethanol ivy, we weren't even trying to detox them. If we try to make sure they didn't die and go into these delirium tremens, but but Heroin and opiate is not like that. It is not physiology

strictly lethal to stop cold Turkey, it's just unbearable, and so I was like I'm going to do it so against her better judgment. I just stopped one day and she could not have been more right. It was the darkest I mean I can laugh about it now My life is a month, or at least I mean it was. I would just sit on a park bench for the whole afternoon, like complete flat, affect but it's all mental. It's not a physical, faint, northern physical stuff. Going on I mean, but, but now it's it's yeah, you're gonna? U you sort of like keynote opiates, make you it's like crazy. You get caught. Painted so there's like a reversal of a whole bunch of physical stopped at the biggest thing is the craving and the depression, and so the depression of coming off. This thing was brutal,

in many ways- and I dont tell that story to say will look at how special I am that I detox that's not the point at all. Had two things going for me that virtually no junkie has going for them right. The first is, I didn't, have a network but people around me that we're doing the same thing, I was sort of the only guy doing it so for me, to go and be around? My friends was to be run. People who weren't doing this. We always used to joke that. If you really want to kick a heroine, haven't you have to get a whole bunch of new friends You you don't get to decide. You're not do in heroin, then go back and hang with your friends are doing here when you need to watch trains botting to learn that the second thing, perhaps important thing is. I finally did connect with a doctor who was able to put me on the right path I had ended are going back to the operating room, probably path. It doesn't times over the course of the year to have that. They all these problems corrected, and then I found something else to fix it on which his physical therapy, so I started to, even though it didn't seem like exercise. It wouldn't seem like exercise that at the time it was the first activity

able to do? And so you know within six months I could like walk like a reasonable distance. Again and that's why I would be spending three hours a day at physical therapy just doing like the most trivial exercises: but basically the root cause of my depression was getting better. So that's really the only reason I think I was able to kind of detox office stuff, whereas I think for many people a it's not clear what the who causes or be it's not getting better. If it is clear, and so that's why I think it's really it's it's a bit. Little addiction and it seems like also year. You have a future. Right. You had a life you're in medical school, you're gonna, you! You know you re ass. I think my lot of these people that are drug addicts. What are they? They have no life that are looking forward to that is looking for TAT I salute, and so in February of that senior year, when I had to submit my rank list, we match in March and misspoke earlier I was still not functional perfectly like there was no way

in February of two thousand one that I could have withstood surgical residency, but I had to make a decision at that point which will I be ready on July first, and if I won't be, I should not submit my rank. I should defer a year set out a Europe medical school. Whatever and I remember that was a hard decision to make and I just gambled I was like you know what I'm going to be ready and I'm going to make it happen, no matter what, and so I submitted matched and then in addition to now reading the corner, to prepare for Baltimore and reflecting on my own sort of struggle with addiction, which was completely fresh. In my mind, I'm also like re having like it's my day, job and going through, like is an I most people take the last quarter med school off, but I didn't have the ability to do that now, because either I d go straight through till graduation day, because

missed so much time during my injury. So when I showed up in Baltimore a couple of days before July, first mean it still wasn't crystal clear to me that I could go. You know two days. That sleeping stand in an hour for eight hours. At a time, all those sorts of things at now asked one of things like this deprivation is people always obviously I take a lot of flak cause. I don't sleep a lot in and sleep. Deprivation. So what did that? Little? What's that like, when you're going through residency and you're, just saying you mean you there's days where you're going twenty four forty eight hours, no sleep, and how did that affect you? What did you think of that? What do you think looking back at it? What your opinion over now well, you know when I decided that there are going when the surgery I mean, I always I'm pretty in secure in general, must be put on the shelf Pritchett out on the outside, but always thinking of a gal it takes

how do I figured out, and so my my whole ammo and life is test the system hard. So when I was in medical school still deciding this, I figured well every Thursday night, I'm gonna pull on all night. Her in my room, standing up not allow myself to eat sleep, drink p. Do anything, I'm a stand at my ask for eight hours and practice suturing. Let us try to mimic what it would be like to be an operating room all night not be able to go p, not be able to drink mobility, and so I had little bit confidence I figured I can do this like. I can pull on all night or once a week. That's you know not the that's a good thing to do, but it was a kind of a confidence thing. So then you show up but there's no preparing for what you're in store for them, No, I got a point out. This is not the way it is any more. So in two thousand, I say like four

So labour laws came and exactly they a whole bunch of laws came in that we could spend hours talking about how it turns out the laws. Heaven Devon fix the underlying problem, but nevertheless habitual work requirement our stuff got six right, so you couldn't work more than eighty hours in a week or eighty eight, depending on a few programme, had an exemption and you couldn't work more than tat. Four hours consecutively and stuff like that, but by the time those laws really again I was already gone, and- and so I don't we know what it's like today, but I would imagine it's it's less demanding from sleep deprivation stamp.

But at the time there were no such rules, and you were at that sort of every second, every third or every fourth night call. But then your post call day, you would still work, so our mutual friend Kirk Parsley forces how we met. This is one of his favorite stories about me. He loves this story because it so crazy. So this is. July of two thousand, once I am I'm one month into being and doc right, an amount in every third night call rotation at this hospital called Bay View, which is about five miles from what we call the mothership, which has Hopkins, and it's out in, like EAST Baltimore, did a real crappy port town. But there's a real area, I hate saying, is bad and there are many good parts, a town at least back then in Baltimore, and so on so. I show up on a Monday at five o clock in the morning, so I buy.

But in my own bed, Sunday night so Monday morning, I show at five two round. We do our whole thing and that night I'm spoke to go home? So that's my office as culture swing day, you shop at five you'll be home, seven p m that night. If all goes well, you worked Europe fourteen hours and you Then you're better than then you get to come back the next day and then you're gonna be on call so the so we rounding that afternoon so and the What they did, this one of the senior residents says, hey so and so didn't show up. Further shift in the e are that the e are always staffs. Surgical resident full time and this guy just didn't show up and she's like and it's a seven p m to seven a m shift? Can you cover it, and you know this would be like if you ask the most junior guy, you know to do something like he eat. He'd, be picking his own ass to say yes, like he couldn't wait to do that. Right sounds

Hell, yes, I will do that so then I go down to the er and I work all night, seven to seven and then the next morning is now my on call day. So now, I'm seven a dot m crank in a way, bill that night and then I'm up all night on call. So and then it's now Wednesday and it's my post call day and I'm there till five or six p m basically been up from about four a dot m Monday, and it's now five or six p dot m Wednesday, and I get in my car to drive home and I have to make it. I have to go down this miserable street called Eastern Avenue to hit the eighty three to drive up to me, place and I'm driving along Eastern Avenue, which is like red light after red light after read like or stop sign or whatever, and every time I met a stoplight, I fall asleep. My foot pops off there,

such an eye. Star, like I am so tired. I can't even you know, handle Like the gradual, you know easing off the clutching the gas just to move up enough. I can't do it so finally, in one moment of lucid clarity, unlike you can't get on the freeway you're gonna die says, like what's the solution is like you, gotta get over and take a nap. So I pull over my car on the side of Eastern Avenue right in front of this park called Patterson Park which, at the time. I don't think I fully understood that that was an open air drug traffic market. So I got up here is the best browser, the logical thing to do would have been different, stayed in the car and take a nap? But I was like you haven't seen, sunlight and like days and it's the sun is still out like I'm gonna go nap in the park, so I get

the part. I mean green Scrubbs that are covered in a bloodstains, because I was too dumb to not change. I go laid down in the park. I take my page or often I clip it to my neck, and I set the alarm to let go off in one hour. Does ITALY Seven p m middle wake me up and I'll feel perfectly rest and not be able to drive home so laid out in Middle Patterson Park in the night. I know I wake up, it's like one in the morning two in the morning there's needles everywhere there is. I have like a bite on my arm that look like their from rats as their like nothing. I've ever seen before, like these bites all over me, and I'm just thinking myself like here, the only prevented me from dying, was how ridiculous the site was. You know something so strange like not enough so ass, I got the man. I get back in my car and drove home and when I tell Parsee story, he loves it because he's like that's the classic exam,

of how complete deprivation of sleep impairs your judgment There are a couple stories and residency where I had to do like those three night back to back the backs. Another time it happened, I remember was an o five. You feel like, though, ok driving a car can a boring right, stop lights. When you're, really tired, but there was something happens like bone. I feel like when that happens. I really like and lock on. There is almost no amount of sleep deprivation that will stop me from functioning and getting something done that important on task on time. Absolute. The truth is that I think Sir John, I think I think an adrenaline rush in the moment provide any amount of clarity and focus its necessary. The problem is very few. Things are life or death that way now, in your work, There were plenty of things, but in my world now- and this is the extra socializing hotel was in pray. My third year at this is my third year-

I was the same same sort of deal. I ended up covering for somebody and then covering for two people and two consecutive nights, and then it was my turn, but it was like three straight nights of not sleeping and it's a middle. And this guy comes in the e r, whose you don't got a really these gallbladder and in retrospect, should never come out that night, but a lot of times the dirty little secret surgeon. Want to operate at night. They can get better our time collectively, as opposed to waiting the next day. It's not emergent, so sure enough, we're in the middle of the operating room. Doing a laparoscopic gallbladder removal at two in the morning when we don't really need to be there too in the morning we could have slept and done it the next day and sure so so in her lap and removing the gall butters a two surgeon procedure. So there's the main surgeon which, because we're teaching hospital I'm the main surgeon, I'm actually doing the operation and enters the attending whose holding the camera and retracting for me son. You know, like I'm doing this and

yeah, that's a stimulating activity, but of course I've done a hundred of them. So it's not that stimulating. Why can't stay awake and I finally somehow managed to fall asleep on this patient, like I face plant in tune with patient, luckily it was laparoscopic surgery contaminate the surgical, but so even something as stimulating a surgery, because it would look if the guy's a order was bleeding rare. It I'm sure I know their dignity. I gladly, but in all you're doing is followed up with one ask all, but has no big bird yea. I wasn't stimulating enough to overcome three days of sleep tat. Did you Who did you figure out any tricks, any interference? I can t I wouldn't when I was going through seal training and even Mama whole career, and even to this day I take his eye, little power out of refund feeling that tired, I elevate my feet sleep for, like sixty eight minutes and it totally recharging did you do take power naps.

Aside from your power to argue our normal scares you killed. I did. I once took a power up in my car again same thing. I was like there's like eight o clock at night, got to the pool. I had a rule which was after you left the hospital. You never went home because I knew it. Went home. I wasn't gonna leave, so I would always go from the hospital to the general the pool or whatever I was doing- and on this particular night, I get there its eight o clock at night. I am so tired I'm not just like the father. You didn't want to go home just because you need going along with the three but found you didn't want to sleep, because you been awake for three days where each one of what? Why can't you wanna go and falls well, because I was really funny. A good friend of mine who, again couple years ahead of me, gave me interesting advice whether it was right or wrong? I don't know he said: look you're going to be tired, no matter what in residency dunks doing all the other things in your life, because you'll still be tired. Now I don't know that I was there. Advice, but I took an oath advice in my view, was I'm gonna continue

work out every day. I'm not on call, I'm mean it. You know, do all the stuff I want to do, and unfortunately, sleep always took the brunt of it so yeah, so it would be to the pool and so same thing. I got there Predicament, I was so tired. Was so nauseous liked. I couldn't suppressed the desire to vomit and as I am not going to account, if I puking pooled I'll kick me out, I will get This is not only worth tsars like just sit here for like thirty minutes and take a quick maps. The same thing took the pager at which normally could wake me clip. It here and was freezing assets like the winter. So I left not wasn't cold. But I really want to leave the radio on I'd like a dumb ass. So the car is off so alternate yours off radios. On what you know how to story ends, I wake up a two in the morning batteries dead, I'm in the middle the parking lot. I can add the call my girlfriend get jumper cables to get me out. That's one that governments become my wife and so

short answer now I didn't have a great strategy. I did have a friend who- and I never tried this, but he told me he would put coffee grounds in his eyelids, Apparently, it hurts so much that you close your eyes you know, I mean I would not bad, but I've told people s Don T, you know, do do a little bit of physical exercise. If you, she retired that definitely picture back out, there's gotta be some reality or some scientific reason for that happening. Does another thing you can do, but am so you're so gay. We know it socks, you're, not sleeping in your do, these patients in and how do you start to detach from this reality. That's around you so you're, not getting you know, give you eat. You said already liked, come the emotional involvement with people, but then, at the same time you said it didn't take long before you despise these patients that are common in

because they're interrupting her sleep, in bothering you that's all. Be lazy balance to trying to strike as a human being I mean, human beings are not meant to be dealing with sixteen puncture wounded day. That's that's not right! So what what happens in your brain? What happened in your mind? What did you notice about your mentality in this whole business ass time went on well what I notice so again Everybody becomes jaded, but most people do and where, where my senses jaded developed was actually towards, you know the patience of diabetes, the patients who had complications from being overweight, like when those people would show up with you know the absence in their foot in the middle of the night that needed to be debated, those people, I would get again pretty pissed at

amazingly the that what we hear these these trauma folks, like a kind of always maintained a soft spot in my heart for them and interesting Lee. You know it's it's it's easy once they die, you says what happens is like. What's a guy comes and has been shot, you have generally people who yet in the field don't make it in so so, but but sometimes this grey zone, where you know someone comes in whose basically dead, but because they had a little bit of a pulse on the way in the door like we're gonna, do everything we can but when those patients die like the room has to be turned over really quickly, which means someone's gotta come in, take the body put it in a body. Bag gather everything because you see these are criminal investigations or the police. Are there the housekeeping stew?

ass, a common and mock all the blood off the floor because, depending on where the gunshot wound was a gunshot one of the head, for example, tons of blood because the heads a confine space- and in that moment it's really easy to just immediately walk out that door, but I find myself, you know I'd sometimes like flip through their wallets right, and no invariably you'd, see something like you'd see a picture of a little kid. So you you see this guy who's huge, whose just been killed, he's probably twenty five and use like the six year old girl in his wallet and you eat, you'd start to sort of wonder what the narrative is right like was at his daughter. Probably did he know her? Probably did she know him, maybe not like you just don't know, and all of a sudden, that's better serves ass, a sort of humanizes. These guys and again. I think, because of my own understanding of what they were dealing with because of those sixteen penny trading. Traumas fifteen had to be drug involved when one way or another

and so everybody who were taken care of for the most part was some part of the cycle that being described in the corner. Now occasionally it wouldn't be mean that one of the examples that stands out that was, I would say so, like the top five saddest things I ever saw residency was July. First, two thousand to I just happen. Remember that day and this girl on her six, His birthday came in and she was just. She was just hit by a stray bullet in her neighbourhood. It was her sixtyth birthday, stray bullet from you know unrelated gang violence, hitter in the head and she's an example of someone who came in basically dead, but in situations like that, like you and I'm sure you can relate to that you're just going to do something, that's so beyond heroic. You want to do anything and ever To try to save her and, of course we couldn't so those apples were kind of rare, but the majority of the times. It's you, no executions for people who stole money. That's does those would be hard to see right cause you get these girl. You know this is like this.

Again, there are even the even the girl, the sixteen year old girl, she's part of a cycle too because that's a stray bullet, that's right! She's, an innate she's, a lousy neighborhood. You can almost guarantee that if this she lived in where she's living to get hit by a stray bullet like yes, she wasn't Lebanon. You know Rowan Park in went once did you would you ve seen family would family ever come in? Yes, it is two types of things going on right, so so that the biggest price Then we would have would be real gang on gang stuff because it became sort of feed for, loop rights of one guy came in and he was killed. You immediately knew the floodgates, we're gonna open, because there's gonna be retaliation that night. I don't remember that the police were pretty good about trying to

make sure that, like when someone came in it who was killed like if you weren't immediate family, you were not allowed there and they also tried to create a bit of a delay in letting that information out again. Maybe that wasn't that that that the most considerate thing to do, but their view is trying to let the violence dissipate the, The family stuffs hard in the hardest family are actually we had was with. It was without actually blunt trauma and it wasn't involving drugs at all right. This was a this was a boy he was fifteen years old. He and his brother There is older brother, whose preteen had picked him up after school. They were driving home and they were they had the right away. And a guy ran a red light and t bound them on the passenger side and this the fifteen year old boy, both of them in a separate traumas? But the older boy

men as an adult trauma, so he went to the adult side. I happened to be on pediatric surgery like I was the senior resident research Rita months, I ran a pediatric trauma, which is where the fifteen year old came in and that turned out the older they driving son was finding another scratch on his body. But this kid came in basically dead on arrival, though it wasn't clear why, but his pupils were blown. You know a little bit of a pulse. We did. You know, maybe thirty minutes of everything. Imagine double before, accepting the reality that he shared his aorta. So if a high enough force, We share the aorta and die Saxon. You basically bleed to death inside the wall of the aorta and that's why he died. And there is another example of how everybody disorder scatters after that, but you know his mom

is in a waiting room, wondering where her boys are, who could have an offender bender for all? She knows so, though those words I mean unquestionably the most difficult discussions ever because traumas, the one area where there is complete, surprise like it, it's tragic when somebody dies from cancer, it's even tragic when somebody dies during an elective surgical operation, which happens unfortunate from time to time, but at least there some heads up that something dangerous is going on, but this kid, like you know, said goodbye to him they went to school and never came back, and now she hears oh he's in a car accident she's in the hospital. Never imagining that he could be dead. And then you have to be the gotta goes in and say you know, I'm really sorry to tell you this, but your son is dead The EU is actually really interesting article written in the New York Times on this exact topic by so it's coming using store

so my mentor in medical school to this day, one of the closest mentors I've ever had of the gathering of Steve Rosenberg? So sixty Rosenberg is the chief of surgery at the National Cancer Institute. And he's got one of the luminaries in Munich therapy. So I did my postal with him at the age and, I actually spend time there in medical school, and actually he just call me yesterday of the blue women having a great catch up for thirty minutes, his daughter, his three daughters, his youngest daughter, is Naomi Rosenberg, whose arrive Didn't at in, I think, she's an emergency room dock at pen, it is also in a war zone in Philly, and she wrote a great peace on this. I would really we can link to in the notes or something maybe like the last three months about the difficulty of having to communicate to families when tragedies like this happen, which of course, you should see a lot of as well and fairly

and then that happens, so you do everything you can to save this, gives life and then you walk in you face the mother. You drop them devastating possible imaginable news on her here: go back to work Right, I mean don't you then have to isn't. Don't you gonna have to go work again now yeah that that night Particular that was that was our armament deeper while I was April of two thousand three when that boy died, and by the time near by the time we had declared time of death- and I had gone to talk to his mom- is prey like ten o clock at night in ivory spent an hour,

with her and, of course, its disruptive because you're in there, in your pages, going off, I got the e are calling me about this kid and got the icy you calling me about this, and you know and she's. You know I mean, like I sure, hope I never have to know what she went through, because I can't can't really imagine right. I mean she's hysterical at a level that you just like a movie. Doesn't do justice to that, like you, don't see that level of hysteria normally that would that was certainly like one of kind of the three or four that really upset me. The most I mean I, I had a real hard time gaddi I got lucky that night. I think that a night in european a pretty com night- I remember- I gotta properly- spent some time just alone in a call room that evening. You know and inform me that was it so that this is the awful thing here, as we tend to project. What's going on our own life into any situation, I I think I realise that pretty

really, and so I think in the case of that particular trauma, I saw in that boy my brother, my younger brother, and so I so I was dealing with two things in that moment. One was me from I own, and not not not. The immediate issue, which is this boy died. One is I'm imagining now like this could been me and my brother and high school like this. This could have in us and how tell your life changes after that. I thought his brothers life is never going to be the same The second was this was already after I had decided to leave medicine altogether, which was in June of two thousand and six, and this this trauma was like April of two thousand and six. I decided in March of that year that I was just going to finish that year and then leave so So the other thing it was sort of that I was struggling with, which probably makes us a little heavier than it needed to be, was.

As painful as this is it's a privilege to be this person, it's a privilege to be the guy who gets to try to save a life, and even when you fail that action you're going to have with that family, which I think is something Naomi wrote about in thy piece. It so important. It seems- trivial to us, because you have that interaction over and over and over again, but to that family it so important that will be with them forever and I think I felt that was a privilege, and so I think I realized like I'll. Never do this again. I'll, never again have that privilege to. Even if I fail to try to USA somebody to actually then be able to

I'm comfort that family and it sounds really weird and it's a very morose sort of thought to have, but all of those things I think in that particular example. You know made for a really difficult set of you know. Days and weeks at fault I went to his funeral is for patient. I ever went to a funeral of effort. Trauma patient certainly went to the funerals of patients. You got to know through. You know the people dying of cancer and stuff, but you know trauma patient like he just wouldn't think to go to someone's funeral that you've never known cuz. Like I never known that boy right, I stayed in touch with his mom for a few years and not surprisingly their life completely fell apart. You know: doesn't it make it that much worse, that you got this? U juxtapose the the kindest normal kid right who dies this random accident and then at the same I'm every night you're, you got people that are killing each other.

And your deal you're, seeing the results of that and you can't do anything about it. How does that also play into your your thoughts about hey here trying to save these people's lives and their out their killing each other for overnight, Over the street corner over this over that, did you go down that road mentally? Not there I'll tell the one time I felt really ethically, maybe ethically too strong a word, but just to be blunt mean the one time I was really pissed off that I was trying to save. Somebody's life was a guy that came in who killed his wife, killed his daughter and then put the gun in his under his chin and pulled the trigger and missed, so he basically blew off the side of his face and was still alive. His brain was completely intact.

Sky was going to survive after twenty three, you know face operations, and you know I'm take. Care this guy? In the I see you and I'm kind of pissed off about it actually right in, and maybe I should be right. Who am I to judge this guy? But, unlike you killed your wife, you killed your kid and you wanted to die. Why the hell am I putting anything into you know? Of course that is so. Ray slope, because in medicine were never supposed to play that role right, we're. Never we never play God people, some doctors, one like they're playing, but we never play God we're just there to do a job and on that day, timer thing. I got to want to do this job. I don't want it. I don't take care of this. Guy want the guy to die. Actually how do they? How do they have the address that we're going to medical school that hole we ve gotta covered outs, or is it just so underlining that the underlying theme of everything you do that by the time it on your. Is there not a resolution?

on the other ethic, clad ethics classes in medical school. They teach you that I am sure there are the fact that I can't tell you one thing about an ethics class. I took tells you it that whatever ethics, you, are going to be independent of whatever class your taking an knows you know today these pendulum swing from one end to the other. For all I know you know, half the curriculum could be ethics. Today I don't know but the short answer is, I think you know it's it's sort of it. In reality, but, as you know, if you're in a good programme and the one thing I'll say, I'm in as much as Hopkins was a brutal place to exist. The come roguery there was on believable I mean in other nickname, for the residents was the Hallstatt Marines.

Which again doesn't do justice to real Marines, but that was sort of the commodity right. It was like you would do anything for you rat. You know, that's why you always volunteered. It stay up three nights to help. Somebody else out, and so you know I had really great friends are in fact to this day, like some, my closest friends, people that I'm in touch with almost every day were were guys. I went through that experience with, and you could talk about those things with each other right. I mean you know you it was. It was ok to say, like I really wish this motherfucker would die because he's taking up a bed, he's costing the state, a million bucks, and I hate him- some are being able to talk about that. I think, makes it a little bit easier right,

We absolutely eminent any that's what happens in a military guys go through tough situations, tough battles and they avi they become closer going through it and part of the thing at bringing coastguards your talk about. What's going on as its happening and after it happens. What did you so a lot of time in this. This podcast. I say that this podcast here we talk worn. We talk about leadership and we talk about history but I find that the actual route of what the podcast becomes about is is really about human nature and what people what human beings are like was there, I'll give you both sides. This question Did you learn anything about people about human nature there? That was surprised. We positive.

And before you answer that one did. You learn anything about human nature. While you were there that was surprisingly negative. So I'll, give you one thing that I learned that I don't know that I would call positive or negative, but it was an observation that in retrospect seems obvious, but it never would have. I never would have thought of it before and to this day it still serves me well to understand it. So the object, different differs observation is that when you look at a significant illness. Like a a a a completely disruptive insult, you have cancer, you hear you have pancreatic cancer, which means you're going to die and you going to die soon. There are two types of families that come into that situation, so families that show up already fractured get blown apart fractures that

for our families. It show up already tight, become the tightest of any family. The same would be true when you see you know the kid that comes in. You know a burn victim kid that get burned badly on the fourth of July, and this gives you spend the next two months in the hospital you know as a couple that comes in with tension already in their marriage. They get splintered wide open if they came in and everything fine, they're gonna be there for each other, very tight or so so that was another, and I just saw over and over and over again- and I sought in probably even more vivid color when I was at the end I age because the two years I There, you know is mostly doing research, but you still had clinical responsibilities and sits here. You're basely, seeing patients who are coming to receive experimental therapy for cancer. So these are patients were all you know, otherwise, gonna die within six. Months and most of them are still going to die. Obviously, though, a subset of them, we can help but you're seeing

over and over again. So that was the first observation and then the second was that there were just a couple of residents who I couldn't believe how amazing they could be, who out ass. They could never sort of. Do the wrong thing said so that there are two residents in particular one? Really he was he ate. His name is crescent. He is now a he's, a transplant sergeant, the University of Michigan, amazing guy, and so Chris was two years ahead of me, and I mean he was like that that I would have done anything for, and I remember when I was leaving thinking to myself. You know I'm really glad I'm leaving, because if I stayed I'd know I could never be as good as Chris like that, like. How can someone be this good

and I don't mean like he can so this good and cut that out- I don't mean even medically human justice exactly as a human being. He is on a level I can't get and. You know, I don't know anybody else. You can get there either, but the fact that I can't get there is a little upsetting to me and I'm glad I don't spend the rest of my life chasing him, which of course pursued think of it. That way, because that's the nature being that guy is you he's just completely humble modest assuming guy- who just happens to be a god. It's gone back to the first point that you mentioned in it, something that I've heard people talk about as well. My body talk about Is you know that the whole idea of post, traumatic stress and all that and what war does to people and one

I happen to agree with his pretty similar. What you're saying that is going into the war right? If the person is got a good, stable mindset, and a good attitude in is appalling. The person in the years to come out of it with all the good positive things amplified they're, going to be more positive, they're gonna, be stronger, they're gonna be mentally tougher it The people that go into that are already somehow fractured. Those fractures are gonna, get worse through drama of combat. Again this is a broad generalization and there's definitely great guy that see things or do things at eight that it hurts and it takes a while to get through it, but There is also some guys you go. You know that I was stop when we showed up and now he's worse than it, and it's that pressure that opens up those fractures even even wider, and it's interesting that you got that you saw that with

we structures as well, but I could completely see how that happens. If that happens, right that happens in union need trauma. To make that happen, I mean where you get the financial trauma on a family if they're not tight, That'll make em blow up, whereas if their type you know What are some financial problems? They'll get tighter they'll buckle down, they'll save money together, they'll skip the movies start, although they joy Lookin, Rama, noodles together so that trafficking gin expose them. Fractures. That's why it's important to triumph He ate the most solid foundation. You cared with your family and with your own mind, so that when these traumas hit you dont get fractured, do the seals screen for that they try to, but like the story, so we had to take a psychological scream, isn't the ninety, so it wasn't like. We were super advanced on stuff, I'm going when I was going through boot camp. They gave us.

Psychological screening. For for our attempt to go to the seal training Ancillae a bunch questions and it was complete the sentence, questions and so would it was really obvious what wouldn't what would flag you for an end. So I made every answer we often boot camp and approved socked, and so every answer that I gave it just all about food. So, for instance, they they say complete this sentence. I hate when my mother rights it's pretty easy to this day. I hate when my mother shuns me in front of my sisters, and I work are not enough. All my answers were like you, I hate when my mother over cooks, this dick and doesn't put enough pepperoni notices that every answer I gave was about food

It was really easy. My points that was really is, if you were not a complete, even if you were, if you, in fact, if you were a psychopath, you would very easily say answer all the questions correctly and get through in there'd been plenty guys that made it through seal training that you knows there, some bad criminals. There's there's been a couple really heinous crimes committed by guys that we're seals, and just just as they are. Through. They got screen so yeah. They that a screening- but I wouldn't say it's the most effective they ve gotten better. Now you know in some this guy's a committed horrible crimes, it you know kind of inspired. This your teams to step up that screening process as much as possible to make sure they were not let guys through that are better ranged some way that are gonna. Do something here like that. You can already talked about these, but is there any other thing that that you are about yourself.

In that situation and an early. I don't really know too much about the where you and afterwards, the age You want to go into that a little bit, but what you are about yourself through this whole process? Obviously, you learn something because at some point you cited, you know what I don't wanna and want to do this minute. Those are those are some of the most interesting years of my life, and I repeat glad that I have my first kid till I was thirty five, which, on the one hand, you used to think long. So old, you know like I'm, not gonna, be I'm not gonna, be like the fifty year old grandfather right, But, on the other hand, it is a really good thing, because when I think about what was going on in my mid too late twenties, you know that the sort of really difficult decisions I have

make em in leaving medicine after being in it for ten years was a really difficult decision, especially to go and do something that had nothing to do with medicine. I mean when I left, I joined a consulting firm Mackenzie in company and I did credit risk modeling like I didn't, have a think. The fact that I was a doktor was like a liability. There was no. It was like starting all over again and life. So to get to that point yet, you I had to go through a whole bunch of stuff, so I think I mean I don't. I won't even know where to begin amounting. One thing I learned was so this fellow that I alluded to earlier Steve Rosenberg, who is again to this day, probably one of the most important men towards in my life outside of family members, just an amazing human being

rights are just kind of on another level, and I remember even asking him after being in his lab for two years, because member we had a couple of people in the lab who, I just didn't think we're that good. They really bugged me their existence, bothered me and I know I finally, after being allowed for two years, worked up the courage to ask him like how he is he's like this guy who's gonna win a Nobel Prize like he's changing the game, and yet we have a couple people. I kind of thought were bottom feeders like you, forget upset at them like ever I've never seen you get upset. If these people, how then he said you know Peter, I just

look at every body and I figure out at least one thing that they can do well and I just figured out a way to empower them to do that. One thing, even if they can't do the ten things that I would expect you to do. I remember thinking I understand in theory what you're saying I can't do that I can't tolerate mediocrity, so that was a huge thing that I learned and it never really hit home again until I was running a non profit, because if it wasn't Ohio mediocrity at Hopkins, writing you sort of had your pic of the vast residents there. Everybody there was the best of what they did. You're amazing nurses. Amazing residents are amazing: respiratory therapist, like everybody, there was like the best of their field right and then I gotTa Mckinsey same thing you ve got the best of the best all over again, but you know first

for five years are now running a non profit. Will all of a sudden. You don't get the best of the best anymore you your drawn from like the third pool- and I remember coming back to that which, as you know, what you're probably not cut out to do this. You have two choices: don't be a leader just be around dude or be a leader, but only with a players, this notion of, like you have the capacity to men toward the sea players and may be turn him into a b plus. They are like. I don't have those genes. Do is an anomaly that, like I will destroy the sea player. Mean too, but I will bury them in the ground and and become horrible human to them. So I also realise, like I can be a really bad person. If I don't, I don't respect the work that someone's willing to do to do. Did you or do you ever have to find a counter to that can I have your in the military and you and I working together, I like a Peter

gotta get you gotta get you you got it, like Rosen. Was it re? Rosenberg act like him began the military you're not get, Nay players. I mean you got some great icy initiatives. You got some great guys that are studied. Gets him. Ok, guys that are in the middle. You got some loser down at the bottom. Guess what you need everything one of go on regional and they all got to give you what you everything may can anymore. You create conflict with him in the more you are talking down to whom the less they're going to either the already is a sea level player a deal oval dwellings gather going down there, you're, not you don't make it any better. So that's it did you ever train correct that, or do you just go through as a you know what you realize that debts like a weakness? I wonder if I want to be clear, there are two attributes that you can you see, player in and I can cope with one, but I can't cope with the other, and I accept it fully. I can cope with someone who has a sea plus intellect such a feeling about the intellect,

the cpu, the computer. I dont need everybody to have the fastest cpu. I accept the fact that, like we, all have different sort of innate capacities took two to sort of process and do- and you know we all move at different speeds. I can cope with very ability, where I cannot cope with variability or maybe I'm just chosen, I dont want to is a cannot cope with very ability on intent, work ethic integrity like when you are. If you can't be in a player there actually dont want you in my life anymore, and I think I'm old enough now that I've just fuck it. You know, I'm not. To deal with it anymore. Life is too short and I'm not going to deal with sea players who fail on those metrics run. I don't care how smart you are, but if you can't show up and work your ass off, if you can't be honest, if you can't care, if you can't want to get better, I actually don't want you in my life, so you're right. I probably- and I think I am probably not cut out to be a leader, because I can't take this.

People who are failing on those metrics and work with them. Will you just need to be a leader of a very high performing team, not of a regular yeah yeah. I know I never had problems right. So when I was a resident in a residency is very hierarchical right. You know you ve got the med student, the sub by the intern, the second year resident the senior resident, the chief relative, the fellow the attending. I mean it it's it's as clear as day who's in charge any moment in time and as I'm going up through those ranks for the most part, I never really had difficulty. We are with the teams in any way, but I can add the luxury being Hopkinson everybody. There is the best men student, though the best the reason for the best Mackenzie same thing, you're dealing with the best of the best but yeah running a non profit. It was like a totally different world to me, and so I think the differences, a great leader could have succeeded in any environment. They could have done. They could affect out, like

The reason this person like acts, like a lazy sack of shit, is actually because of this, and you can like figure out a way to like touch them and help them out of that, and I was just like yeah, I'm not doing it that was so. That's that's going back to an age, and that was the first time you dealt with people. You must first, I'm sort of seen in a long term working environment like a couple people who weren't top agents and again maybe part of its culture and the government. At that point, and you get some staff people there may who you know in my part of the thing was just because De Rosenberg such an amazing guy, and he could get the best out of everybody that he might have had a greater tolerance for that. Thank the second thing I learned was. I would never be a world

class scientist. So when you go to an age, you really only going for one reason I mean I'm sure, there's some people to go there just to check the box and say I was at the end I age that wasn't why I when I went because data, bird, my hero when I was in medical school, I read his book called the transformed cell and I was like that book just now that book, along with it, book by Richard Fineman called surely you're joking, Mr Feynman became kind of two of the most important books. You know I read during you know my twenties and actually wouldn't date. Somebody, I wouldn't date, a girl until she read them I'm gonna wanna go into who, after after the park ass, you and I don't want to fulfil and count thinks you need help. So was so. I went to an eyelash because I was like look this house

I as my god him like her. I want to be like that right. My I want to be the best surgeon scientists that ever lived. And then I got there. I realized that surgery and science couldn't be more different surgery the ultimate immediate gratification like surgery, you get to fix the problem in hours. Science is a lifetime of work, a lifetime of failure. Before successes. In fact, one of the most remarkable stories from Rosenbergs Book, which of course I read well in medical school, but it wasn't until a decade later, when I'm living at that, I really understood why he was great and why I couldn't be great was,

from when he arrived at an age in nineteen. Seventy four, until he really had his first success, was about ten years. So for ten years everything he was trying was failing and every patient died. Every single person that showed up died until this one woman in nineteen, eighty four, when finally, they figured out how to do something called Interleukin too and they finally saw a cracked, the first piece of what has turned into a very long code that thirty years later, we are just starting to make really amazing traction on now think about that for a second. Forty three years ago, he started that job for ten straight ears. He just lost so remarkable, pick up every day for ten years and lose every day.

So what I realized was. Actually I don't have that intestinal fortitude. I cannot fail that frequently and still be at my best. The next day. Again. I hate admitting that could it sounds offers sounds like I'm a sock, and I guess I suck but, like I really like, I could be good, I mean I could go after easier problems to solve where you can, like you know, get grandson, you know just play the game and that's frankly, what most people do in this space. But if you wanna, like change the game, you want to change mankind, if you want to do something seminal, you to be willing to fail for ever, and I realized like. I don't I Ups again, it's not that I'm addicted to the wind. It's not like! Oh, I have to be told good boy, good boy, good boy, but I need someone. I need to know I have some control over. My faith was in surgery. You had some control over your fate, the other is.

Difference between the good surgeon in being about surgeon and its anti there's, not a Jew me, a good scientists at a great scientist, but in science you are far less and control of. What's going on then in surgery now you must have had some long term vision, hypothesis that he so was out there all he they believed he laid out. He said there are four things that have to be true. If we're going to ever figure out a way to get the immune system to fight cancer, these four things have to be true and if they're, not true It means the human immune system will never be able to fight cancer, and it took ten years just to figure out the first proof of concept interview So, yes, they had a couple of successes in mice where they had demonstrated. Okay, like at least in mice, you can do this, but in cancer biology you know you don't get terribly excited about doing stuff in mice for very long. It was a really famous italian cancer biologists to one's famously said. If you can't cure cancer, a mouse, you need a new profession,

That's that's pretty low hanging fruit. You gotta be old, jewish people, so. At that it was while you were there, that you decide, you don't want to go into medicine anymore. It s a hook, s complicated right. So then I didn't. I do you're still a cylinder Madonna residency. So what I said- and I went back to Hopkins to finish my surgical training, but then I decided you know what I think I might actually go into cardiac surgery which had always been interested, and so when I was in medical school, I was really torn between cancer surgery and cardiac surgery and you, don't need to go into cancer dreading. The real focus is gonna be on research, but you want to get you have to be involved in science and and surgery, whereas I thought in cardiac surgery. You know it's just pretty much the coolest surgery like it's the most technically demanding surgery. By far I should say by foreign, I think there are other things that are party on partake

but I was like I also came back in the mindset of you know what I'm just going to become like a great technician right, I just I loved operating in the heart is in one sense, the simplest organ in the body like it's really simple, to understand what is doing, and unlike the brain of the liver, where it's just like ten layers of complete, We want to know what's going on with the heart and when it comes to operating on it, you know it's all a mechanical problem. Like you know, this vow doesn't work of this pipe doesn't work. Oh this newcomer, but what sort of my concession of well, you know what you don't have to be the best surgeon scientists. What did you just be the best surgeon, because there you're more in control right? That's that's now, just a function of how hard can you want to work, and I was with those sugar right at my alley into then? How did that path and drifted? You don't want to do any this anymore. You know, I think, over the next couple of years I mean just a couple of things changed one was in. I was

getting frustrated with these patients and we're talking about earlier wasn't the trauma, patients that were again me. There is something else that was getting to me. That was much more frustrating, which was the entire system. It seemed like every thing we did was this last ditch effort to put incredible resources into a person's life at the very end, and we didn't really move the needle that much right. So it just seemed like a broken system on the other end of the spectrum there something else that did strike me as broken, which actually contrasts or contradicts a little bit of what I said earlier. I did feel that there was a subtle difference in quality of residence, Sir there's a guy Christianity whose, like the best resident that ever lived, I think good resident. I think there are some other really it raises, but there were others that just here they were good, but they weren't great and the thing about residency. That really bugged me and I think part of us was. I was watching my brother, who was a lawyer

So he came out of law school when I came out of medical school at the same time, and so I start residency when he starts this law practice. Are he joined like this law firm, and I remember seeing that it was a totally different world, like their promotions, seemed more merit based like they were. Up the ranks they got bonuses like all these things happen that were function. So my brother was like you know he was a breaking ever. Record of his law. Firm right, like nobody could work, is hard. Nobody could build as many hours like nobody could like crush it like he could and he was being rewarded for it either hating it. He left, he's now a public, He's prosecutor, rather so it takes a huge paper to grow and become a prosecutor, could actually really wanted to do. But the point is, he could have risen all the way up. That change, and I remember thinking and residence him like we all get paid the same, we'll take the same number years to get through it seems crazy to me, like there's no other system where this would be the case like I couldn't think of it.

A system where you just had this complete total lack of meritocracy it- was really hard to get fired from residency like I saw some real knuckle heads do some real stupid things I never actually saw anybody get fired, would not say you couldn't sure you could, but I felt like I was working a lot harder than was necessary, because I just wanted to be better and I thought TAT it still crazy. This is gonna. Take this many years to get through So so that- and I asked there's a whole bunch of things about the system structurally, that I thought were completely broken and then on the other side, I just felt like healthcare was completely broken as a system right. We have this,

I remember, the exact stats but you're gonna spend, like you know, fifty sixty percent of your entire healthcare dollars and like the last year or two of your life mean something asinine right and so the time my wife said to me. You know you are clearly upset about this system. I think you have two choices. You should either fix the system or leave it, but I think that what you're doing now is staying in the system and not changing it will probably not be sustainable, and so I think the toughest decision I ever made was at that point, because I'm thirty price, thirty, two thirty three of invested,

ten years into this and I'm thinking I wanna do over on a complete do over which you know. Everybody knows that the sun cost fallacy is called, the sun cost fallacy for a reason, but it's still a damn compelling reason to keep doing something so said, was I get. There was a super difficult time and you dont part you sort of failure, letting your meant. Down to a lot of people had invested a lot in me right Hopkins to taking me right here. I was like one of the six chosen ones. Only take six categorical is a year, so now you're going to leave that program, and there were, you know a couple of attendings. I become really close to who really believed in me and really sad, like you're, going to you're going to do something really special and then to Spanish. Maybe your doktor anymore, I'm just gonna go in southern Europe. Straighten Mackenzie was,

So what I wanted to do that you go back and get an mba, because I really want to do everything I miss the lot in medicine was I missed quantitative stuff like I, I missed math, I miss being an engineer, and a few times I tried to bring that into medicine. I got spanked right, so the one story- I I think I ve talked about this- maybe on a podcast before I don't think so. Pray, my first or second year, I'm in the ice you to gear this patient and this patients on a very, very toxic drug called gentle mice, and this is a drug that has to be dozed very carefully. So, if you give too much of it, you can destroy their hearing permanently industry there kidneys permanently, if you don't give enough of it, the bacteria that Trying to kill will kill them. So you're you're here a very narrow range in which to give the dose so there is no standard dose. It's not like. I'm just

a herons, only five milligrams of every twelve hours. Now it's taken first gas based on the patients body weight. So this many look grams per kilogram, give it to them in a measure, a level and then once the level, comes below a certain point. Give it again, I remember thinking it doesn't make sense Truly, we know enough about the kinetics of this drug that we could build a mathematical model to predict when to give it. So I looked up, you know a couple of papers, a couple of books, one night on call sure enough. I find like there's a very predictable alpha and beta decay, so I go for this drug, so literally in Excel. I build a model that uses a very simple differential equation and it needs a few inputs and it will predict the kinetic curve of this non like alright. Let's try it out so take one of my patients and the agenda Mason.

I do everything the standard way, but I plug my numbers into the model to see what my model have predicted this better and better, and the answer was unquestionably so now I start to give all com in the ideas like the next night, I'm like our I'm, actually start dosing the patient, based on the model which never put the patient in jeopardy, because you're always going to check the level before you doze, but you're going to do so at the exact right moment. That's how my model predicted like at four hundred and thirty one a dot m. This patient will nator, which means that's when you need to dose them for sure enough at like four in the morning, get the payoff the nurse to draw the patient's blood to confirm. They're just about to nator we're gonna Rideau Summit away. We go so next morning on rounds and in the I see you you round, is a big team. I'm presenting that this patient when my patience- and I start explaining that a case of the patient

if they're dose agenda Meissner for thirty in the morning in the attendance of award winning forthright in when we never dose gent at four thirty in the morning, we dose at seven a m, always unlike yea up at the patient, hid their nadir at four thirty care. You know, and so we got into this huge fight in line you know I almost got fired that wouldn't be fired by finding someone gets fired, idealism, gets fired and so mean that pissed me off beyond words right. It pissed me off that, like it just struck me as so anti intellectual. Let me My model wasn't perfect, we never know, but the fact that nobody even cared to say is there a better way to do this. That drove me that shit, crazy

and that's just one of many stories like that that happen through residency. Where I was like it's almost like. We want to live in the nineteen fifties here and so too you have that sort of pain of problem solving is not valued Least, didn't seem value to me was valued in the lab, but I had decided now not can be in the lab. So here are the Miss World were problem. Solving is not valued and I dont. Actually, I'm not a quantity more like I don't do math anymore, I'm really loved mass. So I started so tutoring kids in math. I made like a little bit of free times like it like Tudor High School, kids and calculus, just like my calculus on again missing, but it wasn't the same so so then I was like you know: maybe I'll go back and get an mba, so I looked into that didn't feel like I was already drowning in debt at that point in time you know you got med school debt is sort of painful, and you know residents of your making me the timer make him up. Thirty. Four thousand

you're. So it's united putting a dent in your two hundred thousand dollars that sort of thing so. So then I remember one night I was in. I was on call, and I was really pissed to be on call this night, and I you can relate to this better than I'll ever be a really good, because I'm sure this happened to you, your whole life, but my best friend from high school tells me in February he's getting married that August and I'm the best man so he's like does the data my way out for was like August fifth, it's Saturday, I want you to be the best man completely honour. So I tell my programme director in February. Can, I not be on call that day or the day before

I just need, and I need to be able to fly out of old, worn a Friday and come back on a Sunday and he's gay at it's no problem. I reminded three times no prop no problem upon sure enough call. Schedule comes out, among call scattered among all the day of the guys wedding, but you gotta be kidding, So it's two o clock that morning, I'm down in the EU are looking at a chest seat. He scan on a guy who I'm worried as it was called the dissecting a order and the radiological it you know. I I introduce myself and she's very nice and she's walks me through the cities and we just our suit shooting the breeze. Little benches desire you some kind of down tonight. What's up another guy, I'm Skype pissed off, among which I wasn't here bottle of wine and she's a guy I can. I can really I used to be in a surgical, residency myself, not like our really Chagos yea, I did my internship and surgery up at the university Seattle and I just hated it so much that I left and actually join us

company called Mckinsey. I worked there for two years, but then decide I want to come back to medicine, so I, but I wanted to do it instead of a kinder gentler way. So it's mine back you're doing radiology. I was like huh. What was his Mackenzie thing? I never heard of it Oh she told me all about it in like that sounds interesting. How do I apply? You know, and I was sort of the beginning of it, so she introduced me to some folks, and you know that I had to like study all over again cast it. The way they interview at these consulting firms is very specific and it's not you. You can be the smartest dude in the world if you show up- and you haven't thought through how to solve the case. It's like what are called these case interviews, Europe you're gonna flail, so you have to actually put in some like workin and studies. I got a bunch of books on case interviews and I'd, be sit in the trauma bay waiting for bodies to come and I'd be like reading. My cases case interview things before so that that's that was started at the transition, and then you walk. You walk out when you walk

they from medicine. You go into Sweden's medicine, specific, consulting soil against rooted to do that, because mackenzie- and I am sure this is true- of like Bain and Bc G, which are kind of the other two really big management, consulting firms. They recruit about a third of their consultants who, out of sort of what we call non typical or atypical, rather background, so people who have Phd these are JD's or Mds, but who didn't go to business school and then so they send you off to do business school that summer. They do. This thing called a mini mba, which was I mean it was like being a kid in the candy store again cuz. I got spend a whole summer school again, learning finance

like learning all of these things that for some people might seem kind of dry, but when you're like just dying to get back into numbers ass, like my god like you, I remember the first time we learn what was called the efficient frontier, which is basically the differential equation that describes you known investment philosophy I was like, like. I can't believe I'm doing this agenda. Leave it so so tonight we shot for orientation, I'm in San Francisco at this time, because I want you back, California sounds like San Francisco. Please so during the first drink during orientation week. I was approached by one of the staffers therein. They said hey. You know your background looks like you, ve done a lot of mathematics. I said yeah, they said well

You don't, we know, you're a physician and you're, probably here to work on your they all the medical teams are gonna. Try to grab you too, have you work on some biotech thing or whatever, but dumb. We have this banking issue. That is very important to some of our clients and it requires an ability to do so ass to calculus. Would would you be up for doing that and I was like of course, and so then you know that was basically the beginning and I never really stop doing that stuff. So so I know during was called credit risk model Which then, which started out run this thing called the Basel to accord, which was a type of that this was a regulation that came out in the MID two, thousands that required banks,

to hold a certain amount of capital against unexpected losses of banks, have a long history of knowing how to hold capital for expected losses, but they don't really know what to do for unexpected losses and in particular the problem that was damning was something called asset value correlations. So if you're a bank you you could have twenty seven lines of business, you do first mortgage. Second mortgage Otto student credit card, like you name it and the problem is nobody really understood how those assets correlated If your loss rate is acts in this, what's the probability that it impacts the last rate in tat. So where that, where the rubber meets the road is, if I can't make my house payment on probably not making my car painting either that's what nobody gonna realized everything window- oh yeah, yeah! So that turn into, as we were in the midst of that

because the banks used to leverage himself so much that they could well in in when the market crash. They weren't ready for that could handle it. You know it's such I mean it's like literally one of my favorite topics, actually, which I am sure your listeners don't get bored to tears on it. But personal all the best movie of all the movies that have like tried to explain. What's going on, the big short by far does the best job because it actually explains the the sequence of events that went that that took this from being just an isolated problem to a systemic problem. Most people miss the subtlety of how this thing ceased to be contained is cause technically. A housing crisis shouldn't have effected the global economy, so it was. These instruments called seedy owes that effectively alive.

This problem to become enormous, but at the time the bigger issue was. You know just a great example of hubris that exists everywhere, right, which is one we don't like. Looking at data that contradict our point of view and we're all guilty, because I'm guilty of this? I find myself doing it and I actually have now quite amused, I'm so attuned to it. Now that I'm quite him years like if I'm flipping through twitter I'll see a story that is key. ITALY, against how I feel- and I dont want to be and unlike the next one will be like exactly how I feel I want to read it and I'm like do look what you just did man you gotta, stop pull back, go assume you are wrong and keep going and try to figure out if you, but so so, at the at the banking level. I mean- and we know an error in the coal mine here. While there were many but into thousands early, two thousand and six to the mid two thousand sex.

We had when we were trying to tease asset value, correlations. One of the biggest problems we had is we couldn't. We only had ten years of data. The banks only had this data recorded for ten years. We didn't have losses to model, and I remember saying to like You know the controller at this bank, I'm like hey man like it's, going to be really hard to build you a model of losses, You don't have any historical losses. And he was away. That's mortgages. Mortgages can't lose money right. So that was- and we can laugh at that now, but at the time that was like not an unreasonable point of view. Right, like you, can't lose money on a first mortgage. Think about Europe, a twenty percent down. I hope for a hundred grand better shop with twenty you'd, better build a document. You have a job, you better do this, you better be that either there so you now

banks only on the hook for eighty on a home, it's been legitimately upraised for a hundred and you ve shown documentation so you're at least gonna pay. That thing down to seventy, such the worst case scenario market falls by ten percent houses. With ninety, you lose your job. Guess who still gets paid by the bank is still get their seven sure, if you're in the business of creating a second mortgage, you take a little bit more risk but There is no reason you shouldn't losing money on first mortgages, and so you fast forward a year well, especially because don't worry about the value the house gazettes can always gonna, go fetch her. So where did go? Well, that's where I remember. Even when I was in Baltimore one of my buddies casino, the residents railway, looking for a way to make a buck on the side right when you're making thirty forty year got it, you gotta, come up with the only saving graces you can't spend money by your clothes is free, urine, Scrubbs, all the time, you're kind of eating for free all the time, because you'd I eat off the patient's trays. Wherever

didn't finish. I'd like to go to the nurse's station and eat all this crap, so I didn't actually spend much money. Pens was like the only thing I wasted money on collect, Montblanc, so even through residency. I would still buy these beautiful pens, so so yeah. I remember one of my bodies being like dude. We cast our buying houses in Baltimore because, like they're so cheap and can get them with no money down. So you could buy a house for two hundred thousand bucks put like five thousand dollars down. That house goes up to twenty years. Just made twenty five cat, you may twenty k on your fine we're going all the way and no one does the math of what. If it goes down to one. Ninety you'd have lost everything right. So lucky I didn't get it only. Those sweetheart deals, although he time them right there, like people, did make a lot of money on those deals before the shoe fell. So when they win

when things started to become clear. So in early in early o, seven, it became clear sub prime mortgage is we're going to be a problem by August of O seven, a a very famous, then famous, analysed, Tournay Meredith. Whitney, I believe, is her name. I think she's at Oppenheimer called something that the time seemed. Raising she said. City group is gonna, cut its dividend next month, so for city group of huge one of the largest banks in that country to not pay a dividend for Q, three seemed impossible, but she done the matches. I guess there's no way there get their getting crushed unease mortgage backed securities and everyone is like she's, no she's talking about sure enough. Q three comes along city

that's its dividend, Chuck Prince the CEO of City gets fired, and at that point it's like God, damn pointing again. Everybody was still thinking. This is just a sub prime problem. It's an inch wide and yet a mild deep, but it's an inch why? While in a background we're working on another problem which is prime mortgages, that which everybody thinks is totally fine, that which has a historical default. Issue of less than half a percent, and we are seeing in the data the data that was right in front of this bank, the whole time, oh there's it. There's a tsunami coming your default rates, gonna hit for five percent, which in a sound like a lot ten times your default rate. It's gonna be actually higher than that, as we learn and your loss. Given a default is going up much higher, so loss is actually the dot product of probability of default and lost given default. You guys are my only to customers, probability you defaulted,

Fifty percent probability you default ten percent. If you default, you will lose out. Four thousand, so it's ten percent, two hundred thousand. I expect to lose ten thousand on you. If you default it's two thousand so two percent times. Two thousand a thousand. My total expected losses. Eleven thousand. So this is you? Don't you this eighty eight million times for every account you have and the model to predict buddy default and lost, even if all our enormous models that each have fifty variables in them. I should the pitied as the algae doesn't, but what people than real This is the loss given to falter skyrocketing. It was like in fact again at the level of just being kind of a math idiot like that to me was so amazing to watch right. It was like holy shit what these algae. These go there just like blowing what did you do Then you new ones the PD triggered meaning was the probability of default went out. It was it was,

Is going to become a non linear catastrophe and it turned out so November, fifteen Thursday November fifteen, two thousand seven was kind of a day like that was the matrix moment so I had a team great example. I was able to be a leader for once because I had an amazing team at a team in disco of four people at a team in India of four guys. We round the clock sixteen hours a day every day except Sundays, we took off and we would pass the model back and forth to each other. Amazing like it was it was. It was pure bless to be working that hard on this problem, and on that day we basically came up with for independent models that all predicted how bad this thing was going to be, and we presented it to the leadership of this bank and its really funny. I was a manager, so

though it may Kinsey. You have these levels like analysed, associate manager, junior partner partner director for a meeting of that stature, meaning you're talking to the entire leadership of the bank than this. Your partner would only be the one to predict, I'd be in the corner Can the Powerpoint in answering a question if piped up, because there's gonna be a technical question, but the senior partner would do all the talking but on that day we go into the meeting in the senior partners is Peter. You should present is- and I said, are you sure cuz, I'm like the third most junior guy in the room here and he said yeah two reasons why you're the only one who actually understand how all of these models work and to MRS the funniest thing he said he goes to because of all of your experience with cancer patients you're, going to be very good at answering hard questions, bad things happening while like okay, so I stepped in. I did my best to be empathetic and non judge men tall and like just as evidence fact, based as I could

This is what this has in this way. When you look at the run right model in the PD says this in the algae Dese. As this and the vintage model says this, and you know here then so finally, like there from the bank, says how much money Are we going to lose like she was kind? I cannot All good leader is she's. Just like just tell me the goddamn answer first, so I said I too think on my feet like pretty quickly about away to put it in terms. I said you're going to lose more money in the next eighteen months than you ve made in the last ten years. And see the Jacko answer to that question. How much money will we lose would have been all of it. That's

using you and me on Twitter, like I always have the best answer. Like always because I felt like a hydra, ok just picture and would like to see us, like the bank, hey Jack, of how much money Rio's all Peter one of three well start with your Ebay last year- multiply that by two of the three did it did they listen to you, we ve got a hundred thousand possible that is impossible to fathom years. Because I headed by this point left Mckinsey, but I stayed in close touch with that team and I reach back out too that senior partner who actually runs Dover, close with launched by mail from today's said: hey man, member all those models, yeah did we were we run.

We close and he goes. Oh, no. The models underestimated by a third- I don't like it seems like we kept trying to pony models down because they kept giving us he's answers and we were like, like there's no way they can be this bad and we're like. Oh, let's make this assumption more conservative and look do there's a month. You know in the end it was like. No, it was actually got bad, brutal. Seven. Now I remember I saw you tell a story, one time they turn it on Youtube somewhere, but you're talking about patient, you are working on. You can alluded to this earlier. Your pre diabetic or diabetic and you're sitting there going you gotta be kidding. Me because the day before you try to save them with life. That was you know, young kid and I was sort of was at the first time we started thinking about nutrition. As a in an earlier. You talked about hey. We do all this stuff at the end of life. It's always prevention to prevent someone from actually dying.

If we would have invested some of that money up front copies people are to eat We would be better off. Is that sort of where it came from or not at all, I mean I never made that connection at that time right. So at that time it was just what you describe. It was just a visceral reaction of I'm so angry at you. How can you not take care of yourself? How can you be sitting here so fat so diabetic? You know over and over again you come in here too. To have these alters debris

to have these things amputated, and you know how the story is going to go like just get it together. So so this was, I didn't, say those words, but that's how I m feeling- and so that's that's just part of like the thick, the callousness that develop towards that subset of patient. It wasn't until probably two thousand nine some out of medicine now, but I was becoming overweight and I was pre diabetic. I wasn't die but about pre diabetic, and I was you know that I was sort of come full circle right. That has a greater awareness. I do right I mean I'm swimming four hours a day, I'm following that goddamn food pyramid to the core, and I don't eat saturated fad, I'm like a car blowed like a ban. She like. Why am I? Why is all this stuff happening to me and such so then, when I went through my whole discovery process, a fairy mapped out

It was only then that I really thought back and reflected upon. You know the horrible way I had treated, not just that patient particular, but obviously many other patients like her. I remember her case specifically because it was probably like the absolute low point of my existence, so it may unfortunately, took me sort of failing on my own, because at least then I could say this isn't a well power problem. It's not like you! Don't care is not like you're, not trying your doing what you're told to do and your failing miserably so either you're an outline our or Maybe the advice is incorrect, so your eaten, what you're being told the your car, bloating and you're still getting fat email, at this time you're swimmin we're talking about before the park ass. You do an altar along swims dozens of miles worth of swimming which, by the way,

in seal training in basic zeal draining the longest. You swim is five and a half nautical miles, which is too statute miles which, in its with swim fins on so you're out there. In the end, you out there in the open ocean swimming twelve fifteen eighteen miles at a time and Your training for that working hard and your quote unquote: eating right because you're not eating saturated fat and yet you're getting fat. You go into the doktor, you get blood test and they say, oh by the way, you're pre diabetic and you just say yourself what is going on here and in truth be told, I was actually more pissed just from the vanity standpoint in fact the theme which I guess occurs not for those in the park. As echo is not those yardstick read it. I wish I could say like. Oh it didn't bother me to be fat. It did bother me to be fair. It really bothered me to be fat right. It bothered me. It bother me allotted

and so much so that actually want to get a gastric bypass, and so I will I wonder you like oh right now, when seventy five hours like private, to a five to ten percent. Once again- this progress dude I retorted council session. So I went to, I finally got my doktor to get me a referral to this guy named KEN Food Yoga, whose, like a very prominent, very accurate physician here in San Diego, so finally go to see food yoga I am sit in the waiting room and I think I told the story on TIM's pie, gas.

I don't remember telling I did tell it, but it is in bits in the book. It's in the annexes are tools that idea. So I, but in the spirit of assuming nobody listens, to reads multiple, so I'm in the waiting room, I'm finally waiting to see and the nurse comes out and before you go back to the clinic room like you have to get way. That's just part of the protocol right so like they call my name, so I walk up and I get on the scale and the nurse down with me, and it's like you know, whatever to ten and she's like congratulations, unlike what shoes, post surgery right firmly. No, I'm here to be evaluated for surgery, she like looks at me, looks out at the waiting room where everybody is four hundred pounds and, like doesn't say a word, but the look in her eyes is basically like what the hell is wrong with you.

You got serious, as you said, if you like, a reasonable, reasonable, very reasonable. You might want to check your reasonable ideas with me, because that is not a reason loggia. So you get done. You don't do that surgery, obviously, but what you like? I had no patients from me. What clicking your brain to use all the sunset here. Somebody houses happening. You remembered you're, a p class Instead, this I was going to happen. I acts are remember clear as day so September: seventh, two thousand nine. Did you. I thought I did like one of these long swims a year. You may do a bunch of short ones, a bunch of training, but how main events. My main event, this year was, I went,

Catalina Island and I wanted to swim from now allay out the Catalina. I had previously gone from Catalina to allay and was tough swim at a torn labour, so about six hours in which it became unbearable pain and you dont usually Of a head current in the Catalina channels of the San Pedro Channel, you noticing retrained out there the currants usually running from point conception. There are, I have to use a little bit of across current rate, very rare, to get anything back and forth and if anything, it's generally a little bit towards the island, and when I had swum for years earlier from Billina to allay it, took ten and a half hours, but that was only eighteen months after I learned how to swim. I was a much better swimmer in two thousand nine and

was going in the theoretically faster direction. To a great example, is expectations can kill you, so I'm expecting this to be like a nine hours, swim back and it really the only thing I'm thinkin about which is the worst thing you think about a marathon summit. You should never everything about how long this is gonna. Take, because you just you just say yourself from misery. Only real question has: could I break nine hours? I should be a break nine hours right so to make a long story short. I can close. This is a total disaster scenario. If he could steal appreciate this risk is Frazier stupidity. You never want to look anywhere when you're sweating, except down its very demoralising when you're in the middle, like, if you're in the middle, the channel You don't see land from the water level. You just need to start to less so

for you get in the water. You tell the crew and every I've crew chief for a lot of great swimmers. I mean it's. The big big crew asks the summer we Do you want what information do you want? Some start in the summit midnight at point the Sunday I said. Ok, I want to know when there are exactly ten miles to go and exert we four miles to would have it with the total distance of the swim. Well as a crow flies, its twenty one and if so, you don't have a current you're gonna twenty one miles when you do have occurred, you're gonna win more than that. So far ass. I said as I want to know when there's tend to go and forward ago, why tend to go you're just a little over half way. I'd like you to know that at Ford ago it's put your head down and swim for two hours. Don't do anything you're there so start the summit midnight says in September, so I forget what time the sun was rising back then, but I knew that I would have tend to go before the sun came up.

So in other words I knew that once the light was I was gonna, be inside the ten stretch and one of the most amazing things about somebody in the middle of shall ocean. If you got to experiences during training, is in the Pacific the Bio luminescence, how strong and so on a clear night, which I was always lucky to have. Every time I swam out I've done a lot of the channel swims everything I've been out. There have always been blessed with these clear nights, it so dark, because once you get out of allays light, under the water, to your hand, is coming down. You are seeing the Bio luminescence flare off your hands when you breathe You were seeing the stars. You can't tell the difference in so dark. You cannot see that it has been stars and viable luminescence, it's like being in this, using chamber, and so that's that that's the reward you get for swimming at night, which is otherwise incredibly lonely and then

The first thing you notice is the buyer. Luminescence gets harder and harder to see which means of the sons gonna be up in an hour in the sun comes up now. The sun's like up there I haven't heard anything and, unlike those guys, they forgot to tell me, I've got tend to go. That's ok, probably down to to go now, I'm swimmin I'm someone so like ten o clock and being facetious formulae. Eight thirty in the morning and the like tend to go us and because at that point I had no clue what the current was like, because a swimmer can't feel current right. Summers can only feel relative velocity, not absolute velocity, so you know that, coupled with the torn lay Brum coupled with like it, being over fourteen hours of swimming, and this very long story, because your question was a simple, but I remember getting on the boat

Aren't you remember my question was about more refugees arrive, asking about like when I finally decide doubts over here and Bio luminescence, a male okay. So this is the day. So so Federalist lend our guests acted the boat and they ve got like two burgers and to coax waiting for me- and I mean like I couldn't even those things quicker like the biggest juciest burgers you ever seen like the cokes I bid tasted so good right because you are your mouth is so salty. Alyosha really wants him a sweet and my wife did you not my wife hates. When I tell the story girl, she denies that she said it, but she completely said

she I'm just sitting there like ram. Remember that I think the Berger Fatty got like a? U S, a towel wrapped around my waist inhaling. I come to fishing burgers drinkin, my coax and she just looks at me and she goes again used in the sweetest way possible. She said you, you should probably work on being a little less, not thin house Let me is that lag behind as a way to just tell somebody you're gonna get a little fat while post fourteen hours swim get some. So now is the This time I had a coke. I've never met a ghost tat at all, yet frankly, at the time was just said, I M sure try an experiment allows like look at that time. I said thought it was just calories in calories out those religious, simple arithmetic and my view was our. I I can't do anything more.

On the calories outside. It's only a hundred sixty eight hours a week. I am not willing to exercise more than twenty eight of them so calories out. I don't get the change that anymore and Hey, I didn't really want change the calories insight cause, I hated being hungry. Every time I try to eat less. I would just be so hungry and know what to do it myself. So, like I'm trying experiment what, if it's, the type of calorie that might matter, should strikes me as not great for you, even though I can't tell you why I'm gonna stop having sugar, so that was my first experiments of timber of oh nine and that led to everything that comes since that time, which obviously ultimately lead to be coming back to medicines. One and that's why you're out now and and and by the way, listen at him TIM's, I guess what else should people listen to get all that nutritional information? The rest of the story, I think so,

yeah? Maybe a couple things a term I gotTA with Chris Crasser earlier this year, talked about longevity. A little bit. I've had won a debt prohibit, maybe alyosha probably get more nutrition and that there's an h, M C video. I did pretty like three or four years ago that once I can our long ago, pretty detailed in it yeah I've watched that, while the others are good, those are good. And again, if you had to kind of tell me Then we're gonna go was Mosebach S Ark and watch them that video. What would you tell him, you know what would you Tom to eat? Overall, you know I I generally dont like talking about nutrition because no ray. I will answer this question, but I anomalies preface it why I dont like I'd only talking about this,

need. Nutrition is kind of a pseudo science that masquerades as a religion for many people, and so I find it difficult to have a discussion about biochemistry when it so cloaked in emotion, religion and dogma. Now, that's on decide on have a strong point of view. I certainly do it's also involving point of view. I feel different today than I felt for five years ago, shall different that I felt two years ago and also my life is one big experiment right, so we were Jochen before I came in here. I've gotta glucose, Mere buried within me. At the moment, I've got like all these heart rate, very ability, things like everything, I'm doing actually meant to check out. She didn't experiment for I came here today are eight something, and I want to see how much it raised my blood sugar. When did you eat so I

eight this product that I've been doing some research on its called no k and oh W, like no foods- and I was in used to this product by one of my patients who said: hey PETE. I want you to kick the tyres on this a little bit it some its it uses a sugar substitute called AL. And it tastes amazing and apparently like it, doesn't raise your blood sugar at all, and I was like yeah I'm familiar with aloes. For for those. No aloes is a sugar that occur in nature, in very small quantities. That looks exactly like this sugar called fructose, which is for a trigger the sweet components. Sugar

with one small exception, but that one small exception carries with it. Some very important things, one it's not quite a swedish victims, it's about seventy percent of sweet, but by giving up a little bit at as you get a whole bunch of stuff in return. First, while it's not metabolize by the liver, which is the real problem of regos to you barely absorb it. So ninety nine percent of it or more or less excreted by the kidneys and three actually seems to lower blood glucose south this company. No foods is putting this like making stuff out of this but stuff. It is like Kirby like bread and waffles, and

fins and stuff. So anyone to make allowance for short him at this patients house and he's force, feeding, media things, which is really a my way of saying he's, left the bag open and I'm inhaling them. I hadn't he's idea. You gotta, you gotta, like tell me if this stuff's legit so make allowances already plugs me into the guide, the fifteen of the company, and he has sent me a bunch of this after just play with cause. He knows what I do, and so that's what I've been doing so today I normally don't eat breakfast. I worked out this morning and before I came here, I had a big piece of their toast covered, an almond butter and then two of their huge waffles covered with all butter and bananas. I made a big sandwich out of that, so the Allman butter, not gonna, have a huge by Sea MC response because it's got so much fat protein it, but the bananas should skyrocket, my blood sugar, if not to mention the two friggin waffles the size of my head and the peace, a toe so interesting. We set up

at nine o clock, but I ate those and I've been up since three thirty, but I didn't eat anything worked out from seven to eight, so, admittedly, there's a bit of a glycogen debt. So at nine, when I ingested, my blood glucose was sixty five and at its peak, which was one thousand one hundred and eighteen a dot m. It was up to ninety and its now down to eighty three. What would real waffles have done to you? I think they would have sent me to like one forty three huge pieces of bread, slash waffle with the full banana, so anyway, I've been doing his experiments all week, which is just a great excuse to eat the stuff. I'm com actually surprised, blown away so with all that said, was my advice from what people should eat in an eye,

he'll world everybody would have this thing embedded in them like I do. This thing is called decks. Contrary five, it's a continuous glucose, monitor the typically only is by people with type one diabetes and were now so easy people were type two diabetes wear them, but I was really completely lucky. When they sitting on an airplane next to a dude who happened to be in the watches, I'm into watches. We could talk about, watches I find out he's the ceo of the company that makes this thing thrust his history right, I'm like obsessed with the stuff so because the answer is this right. If you were a computer programme, I would say: Jacko eat whatever you want to eat, such that your average blood glucose remains below. Eighty five grams per deciliter and your standard deviation below ten milligrams per deciliter, so

inside out that into English, okay, so eat. In whatever way, your genetics and happy genetics permit you to such that your glucose levels stay low and the very ability stays low and those two things willingly. Were that you're insulin level stay loud. So what I'm trying to do is optimized for something called the insulin, a you see or area under the curve, and we can't measure that test. Clinically, I can measure that is put you in a house. Put a central line in your neck and sees me sample your blood every thirty minutes over the course of a day where you somehow act,

normally and every day, so that I have a time axis why access the israeli x axis be time the why access would be insulin, level and regenerate a curve and calculate the area under that curve, and we want that number to be as low as possible. So we can't do that outside of the research setting. So then the next best thing is: keep your average glucose as low as possible and the very ability. So you can have an average glucose of a hundred with low variability in that actually wouldn't produce that much insulin or you could have a glucose of hundred with high variability same average. Glucose higher variability is gonna, have higher insulin, all things equal, so just through empirical testing in myself over the past year and a half, I ve realized that an average blood glucose- and this thing tells me every time I hit click like it gives me my last fourteen days.

I just realized like for my average to be below eighty five and my standardization be below ten is like super dialed it. So what you can eat to achieve that varies tremendously by individual. You know there are some people who just disposal glucose remarkably, so that blood tests we're gonna do in you next week is going to be our best test at measuring that, and so so glucose disposal is, is most Leah function of the insolent sensitivity of the muscle, because the muscle is where we dispose of the majority of glucose, but it's more little more complicated than that right. Sleep impacts that right, so sleep deprivation makes us more insulin, resistance. Those have been experimentally demonstrated, even with two weeks of sleep deprivation, sellers, it's a small but very well controlled experiment. There was another Euro Chicago price six years ago. They took

small number subjects, like I say about eight subjects and for two weeks. Let them only sleep for hours a night and they did a very invasive task, although you guys, you make insulin, clamp at the beginning and at the end of the experiment, and insulin, sensitivity their glucose disposal deteriorated by fifty percent through and with no change in what they were eating, so so its highly variable right. So that's! Theoretically the answer on a practical level, I would say to answer: is this right? If it comes in a package, you're, probably better off, not eating it right? If your ancestors couldn't have eaten this even two hundred years ago, it's probably not worth eating. So if you just followed that advice, think about how many things you'd eliminate from your die

right. If you just took packaged foods away from your diet, ETA get notice, I'm agnostic, you wanna, be a vague and knock yourself. You wanna be the paleo man of the century. Go for. I don't give a shit. Ok, like I couldn't care less right, but if you can learn completed, hear those principles, your kind of going to be fine. Do you want me to if you're going to get seventy percent of the way there? You want to get eighty ninety hundred percent over there that it will then there's no simple answer now at that point you got to dial in and you got to go full immersion into. How do you tweak to your biochemistry how much protein timing of the meals. When do we fast mean all the stuff that is, is my world and maybe soon to be your world that that's that's it that's the stuff for which you cannot provide. You know systemic advice, but it is at the societal level or at the just the most basic level. Yet me think about that advice. If you dont, you don't eat sugar anymore.

You, won't eat, refined, carbohydrates, anymore, you're not going to eat. You know, process crappy foods anymore. What are you going to eat? You can eat fruits, you're going to eat vegetables, you going to eat meat you're going to eat ray. You know what kind of grains are you can eat? Well, you know your your gate. Oh you're not gonna, really eat these sort of refine crappy grains of people. You're gonna eat your your starches, I'm sorry, not great you're, starches, republican of uniform potatoes and rice. So again, I guess I just I sort of I think the reason only talk about nutrition anymore is, I don't find it to be it intellectually honest discussion anymore. I find it to be just a discussion of dogma rights so, if you're a low carb camp, your low carb camp, if you're in the whatever the vague in camp here in the vague encamped like there's that you can't even have a discussion about this stuff and at least not with most people size, you ever read the book of Diet,

I now saw what nonsense said where it that's the whole book really so interesting, fine to return. I want to check that out. I caught not going to open with essence. Its work since were over two hours right now, I said that you're, probably the most responsible individual for this podcast and because you originally through Kirk set me to do a pike asked with ten Ferris which set me up to do a pot gas. Would your Rogan, which was just all awesome and both those guys told me. I do my own pod gas, so anyone this listen, this pot gassed safe,

Peter for that. Actually they should thank her right began. Kirk was the man you know I mean Kirk is only to tell you but Kirk's, one of those guys were like he doesn't have to justify and ask right. So when he introduced me to you, you didn't have to explain he's just like I want you me, Jack, O Jack was my friend like that's good enough and so to me, like that's the measure of when life is good because I feel that way with all my friends like if TIM introduced me to summit like TIM's injuries me like a dozen people doesn't amazing relationships have come out of that right, and so you know, really. It was is very easy for me to desert it. Take Kirk on his word that, like jockers great then that's that's all I know you're gonna be a great guy and then similarly, like I could tell him like hey you, gotta be Jacko and anyhow TIM gets caught. Him quote pitched all day long errors, but you know he knows that I'm I'm not gonna, send him somewhat.

It's not you know, can we really interesting and going to benefit his listeners? Not just you know, whatever agenda that person might have, There now is awesome and that there really did. I mean the way TIM, the way TIM Advice is the way he was gonna release the pod cast a notice board unwelcome and he does nailed it. It was kind of ridiculous the way he understands that stuff and how helpful it was too. You know get nor book out there again, it's old and on all that, given all these people on board, and then you know that turn, this part gas, which you know he'd, be definitely has promoted the bog ass in a fantastic way along with Joe, so that both been awesome but again started with Kirk connected with you and then you can. I give you a term so I appreciate that- and I am speaking this part cast my almost silent partner over here that go Charles. If

somebody wants to support the past. How would you when they go out and do that here we split up question o o how'd, you richer back originally Think we ever really have a diagnosis. There were. Certainly Nothing on that day that I did that day. I ride my bike to the to the gym. I you know about the sins of my youth, you know I was really into martial arts. In addition to boxing, and I used to spend a ton of time. I was really obsessed with spinning backs kicks now that could on it or not. I, but I used to practice. Seventy five spinning backs with each leg every single day for probably about six years seven years. If possible, even though in theory is going back to get done correctly, should really not put any torque on the lower back. It's much more in your hips and technically the flexibility in the thoracic spine that the lumbar spine, but

God knows maybe reddish wasn't doing those things correctly. I did squat endemic really have a growing up. I d power lifting a sort of aside sport, but the innocently never hurt myself doing that. I rode crew for a year. I always always wonder if that was the most destructive thing. I did because in an ape man bout, its eight, your asymmetric when you skull your symmetric when you sweep you're not- and so I was like- I was a sweeper inside- must wonder if, like that's the most destructive thing, I ever did yeah and then need figures if you're asymmetrically, that your everyday life is asymmetric really does he have a little bit of over developmental aside

So I guess I never really known, but I take it really seriously today. In fact, you know jocker you'll dig this. Two weeks ago I created a video in New York with friend my name Jesse shorts, men and he's like. I call him the savant of movement skies like just like the kinesthetic man, and I wanted to put a video together of how do you train to train? How do you prepare your body to train? So it's basically three sections, it's what what what's the sort of dynamic while the this are of tissue preparation, how to prep in the dynamic prep it took us eight nominated me six hours to shoot this video it'll do be edited down into probably three ten minute videos and as soon as are done editing throw up on Youtube in my blog, so make sure you ve got a cop awesome, its Mean Jesse's, just he walks me through other exercises, but I get the sense like if I had done that stuff all the way.

I a point of order, her and luckily knock on which to this day I mean I never thought I able to squander left again after going through that year and my life. But amazingly, I totally fine and use a her needed this. Pop up, yes, it was an l, five s, one ray big her nation, but then for five centimeter fragment, broke off and then floats down the canal and I was sitting on the nerve rude and then I developed a few other problems after so I developed this thing called a facade, our throb bothy, which resulted in the feeling of having my test was torn inside I'm not even joking. That's just so. You son bearable he. I would imagine that some terrible, I don't recommend now well that, said: yes, we can talk about being talked talk about on it. I was Gregg and Terry.

And showing a number of China, the Warrior bars right. These are. These. Are dope and then then he is like. Oh yeah, like what else is there some goods on his good stuff? I've brought out that that that new pre work out, one which is good by the ever report on that, so now comes out, and then the crude oil comes out of this is good for this or we're talking about. Is this big table like all this up is not allowed to say for things that were bark of crude oil and the pre worker and three things. I care this does this? Does this and then I can step back of him like there were those guys with all our supplements talking about supplements dogma supplements which have never been in gringos yeah, we weren't such nice guys. This would be a real do. She conversation saw the kind of irony there is him saying that he's one having the do she conversation, but he is the nice guy. You get it. I guess so

what there or actually the second point there is on it is good supplement. So if you do talk about and while you taken up you're not having to do she conversation- and this is why our Joe Rogan talking today about like how hard it is when you stand comedian and you tell a joke and it just flat up if we just gotta, have a bell- and I think that is a matter of a millionaire where their railways do your mercy loud merciful, breath that was that had joking elements. But this is true in this part of the bigger point that are making also animals, the latter. It everything I say, even though you really much anyway the reason that it's not adieu, she conversation, here's the point the is because on it supplements the cruel all that stuff is actually good quality. It's not like. I'm a media give birth in all this stuff. It actually helps your performance anyway. So, in the event of you wanting on its tough and supporting this book is

while at the same time supporting yourself Granada on flashed Jacko ten percent off, secondly, to support Amazon click through Christmas is over, but we still need stuff ducky, whatever nice such if you want to support this part, guess just go to the website. Chalk apart, They'll, come click through the the Amazon banner link before you, dear shoppy. You can support, though so good will support all we hear you and chemistry sodium when you put a little piece of sodium. The water right makes this big commotions what kind of what the Amazon click through does. It seems like this little thing but applied properly. It makes Big back in the vodka support was, but you get three verify that doctor I will have to go

the Amazon click through. I tell Jugglery typically doesn't really understand. Does he doesn't know what sodium does when potassium or both? Actually now. That's always been a lie around us ensure not an I'm pretty sure I was actually very pretty sure. Goes a long way to go anywhere, Dickinson's I too the progress on Itunes, which seems obvious specifically that the pot guess it wasn t subscribe to, but- Some indeed also subscribe. If you have not already annual support the spot, just Google play stature also in the game here. Itunes here yet kind of unfair- that I don't think about that is much. You know when you have an iphone- or I don't kind of forget all the southern hunt over here to help him good thing, you're here on the spot caused you to. Of course,

working on putting more videos on their aside from the whole podcast. So some of those videos- and I have gotten like messages sane like those shorter clips- are helpful. They are rather listen to them, bought generating people wording, has been people that have been submitted to you on twitter gap, which excerpts are in high demand out there in the world yeah I ve been following now and in fact, to have em all like it's it's a process but yeah we're. And that's all subscribe. You too, we are working on that. We are at a collective does. Do you guys know about working with echo barriers, which is cool? Technically, you seem a little, but this will not work if both parties, young and exactly in the event of you wearing like what, like a t, shirt or something or hoodie jugglers store is called Jacko store

The url is Jackal Store Economics, Hata, a calculator watch you at the Ouse Gonna get to that. So you mentioned see. Now we got to change the subject, real quick, which I like by the way. Remember you were talking about your into watches. I was gonna shining one. You know what you're saying, but that is We appreciate that is red. The egg here does your incorporated this one back is what does it? Are calculator Wachovia? Actually, one of the first pictures I posted on Twitter was up before the enemy and it was like you know. Jack was always like or thirty a m between us at the castle, the castle school certain nineteen. Eighty four, eighty five that watch when I was a kid

like I would was only some yet for that only the cookies had the calculator one. Usually, if you had a watch used is the regular Cassio and the cook. It said the kelpie I had the first iron man did. You was black with like a little red trim on it. I asked word for Christmas. Parents got it for me, but I knew where they had presents so everyday after school. I would go into their room and I would take it out of the box and I would say I had set the time I would wear it. I would just hang out there and then before I go to bed I'd like sneak back put it and so like on Christmas, the hairs like I've been wearing a watch for among those you're what actually happen. You got a gun and want to do here. We got one actually got. I got Quite a few of you should have your own brand of watching we'll see how that turns out Nonetheless, I am proud of this calculator. What

to store, though jock restored no watches, but there are yet, but there are some cool my opinion. I think they're cool Display Nicholls Freedom. All these things chuckles head good, written in backward. Various layers through these shirts, not just like, ought picture, that's it. So if you like any of that stuff I'm not even saying go, buy stuff from Saint just go to the darkest order, can see if you like it. If you like it, you want then you by one and that supports the podcast systemic thing. There you go patches on theirs, well rash! Kurtz! Here! Do you know it? You didn't mention that you should have mentioned cause. Apparently, it's been pretty cool out there in the world laid on psychological warfare, yeah any mention at this time, but I mention it last time and in my everyday life and I use it so

psychological warfare, you use it, I use it every day when needed using. You can't use it every day. You know you can. Actually you can. I am August that you can use it every day, but the reason the whole reason that I was like a jack. What do you say? You know you're, ok, don't we need everyone are needed every day, but it varies. From season to seize it so like her if you are coming up against moments of weakness, we have method to get you over those hops year. Would it kind of like coaching a little bit because psychopathic yeah for sure he goes kind of the waiting room I played one of over a seven year old daughter, the other issues about to eat some candy or something calmer? Four minute, I player that one. You know that the snack time won't you.

The sugar coated lies. She was. She was pretty press, but would press me later in the evening. She was kind of saying it. Yeah see and that's was say where you explain its like courts, you're telling me to do this, so yes I'll, do it or not doing whatever, but you Spain's some some good stuff like tat to remember the news: Sugar coated lies and that's kind of catchy to suit sticks in your my voice, so you can buy them on Itunes. Yes, it somewhere else to write Google play. If you want it and also everyone that asked for an alarm tom to wake up. That's it! That's it is there now don't SK anymore beans. Good. I do to get that's like Clearing Klute, with your wife or whoever you sleep with you. I was gone some areas, feedback on that one, the air. What happens is the alarm goes off? If you have it set, there's gonna be my voice.

And ask me we're extending sound like there's some strange man in your room at four thirty in the morning you know she's gonna. We get lonely work at four thirty, eight, like now existing adjusting its just day. It's an album its. It is an album of tracks and each track talks about some moment of weak generally a moment of weakness that you have like there's ones to wake up in the morning. There's one to you what you'll feel I gonna Jim go to the gym theirs. Once you feel like it. I don't. I don't eat donor,

One element a plumber put this offer warm into procrastinate, no you're, not gonna procrastinate. So all the little moments of weakness that we all have is humans can be countered using psychological warfare he actually yet there is. There is actually to another one called by peaceful, like no more. It's basically like I'm not doing this idea. No more andred want downs good because it puts into words exactly like what you wanna think like you, because I always feel that, like our inner, how likely you know you gain in some way to emulate left, and you know why you're getting late and says liver different, but I cannot do drinking, is What we wake up had hung over you drinking anymore like that think, but you never really execute yeah. You know and it's perfect, could it sticks with the elections like No more and then the other one was up when you talking about We did it's called everyday living there, really the Monday lacquer down to see you

That also, if you want to get some tea If your tea drink or if you're, not if you drink or you can get some Jocko white tea, you can get it on Amazon, it's fully in stock. You all those days of being out of stock. I think we got them under control for now, and I make any promises. Cuz. Last time I made a promise. You guys went psycho from. I can make a promise, but you can get the dark YT. I figured out again it doesn't. It doesn't taste like tea, really it tastes like coffee and for a long time I was at a loss for words to describe what it tasted like, and I figured it out. I was responding to someone and I figured it out when it tastes, like that's pretty simple, the Jackal, weighty tastes like victory so you need to tree. I need a trademark rap. The fact that away tea table victory, both self gets

but that if you need to dead lived more, if you need to overhead squat more awaits, this will increase all those numbers beyond anything. You could have hoped for you can take it from a Jacko Mug says get after dawn that's good oversized by the way, yet Probably the not somebody somewhere. May the comment that it's not comically big raise, not a joke, yeah. I had now a clown. She knows it's big enough to you it's big, like a pair of work, Brutus biggest apparent what route it will? you in the ass or aid, so that big, if you haven't got the book extreme ownership, you can pick that up there. It's about leadership. It's about combat leadership. I'm gonna give my friend Peter about three copies of it.

Just to make sure he read it. So if he has to deal with any see players, you gotta step up his game of an arrow from higher outing free publication. That's right! I actually wish that we work that peat preferment would mean before the book came out. Hey here's! What the book is: ok, but still that's it! That's what you're, not my at the other participate our baggy. I was like yeah vip gear screening. They speaking of extreme ownership, we're having another muster. If you don't know what is check out the website. Extremely should not come. It's gonna be in New York City, so Everyone can come if you're on the EAST coast, no matter where you on the world, it's easy to get to New York and may Fourth and fifth, if you're a leader or you want to be a leader, come and get it, there's a or every level leaders. Air sea owes mid level managers every industry you can think after we people and manufacture

during its finance and construction in health and pharmaceutical and there's police there in fire and military in oil. And street and enters everybody all working on your ship talking about leadership, so they in upset it's gonna, sell out. We're moving in that direction quickly in echo hasn't even released his videos, yet cuz he's on hawaiian time. No, no, no you're, not working diligently and I'm going for quality nut. You know, you're, not gonna, put out any scrub material create once those videos come out. My feeling is gonsalvo quickly, so get there now sign up, For if you need a police or fire discount or military discount, or if you're going to bring a group of people, I think the biggest group we had the last one company was around sixteen people, don't want company or twelve people, but there's some pretty big numbers of companies that are showing up they're coming, come and get it Echo you gonna closing garments, my pleasure, no other,

Some comments think otherwise your pleasure beer, any closing comment. I would only echo echoes comments and that didn't even get planned and fill a keeper and if you want to continue these conversations with Peter on Twitter you're, Dorothy. I M D, what are your Facebook I don't know probably eating academy yeah. Ok, I will do my twitter is your most sweaters prominent and I've been paraded into doing something at Instagram. I just can't cope at the moment. The out there's a way to connect the two I've tried it. I don't like it. I do separately there. You don't really connect Twitter to the Instagram. I think it's the other way around this way to connect some of them. Somehow I just don't have pictures to show right there.

Don't you have a bunch of watches I'm going to watch the same watch every day passed show that ring how Europe's lack of pictures just some kind of one of my what my whole Instagram Stick became this like my blood glucose at every moment that critical and you can be in writing that you ate or something I guess you could just save that screen posted up that much work. It's work, it's hard labor to state that thing and press submitted the it actually has a little switch. You can make it go it's not that much work, for somebody that swimming eighteen miles to work the postman Degree Berkshire you gotta suicide I echo and I we are also present and accounted for on the entire webs on Twitter on Instagram,

of you gonna be looking around their facebook, he bore how we gonna be there. Echo is at echoed Charles and I am at Java willing and again how like to say, Peter phenomenon and on more imports for everything you ve done for me, which really the way it acted altogether. Get me through Kirk, the TIM fares, which was the book. Get me on Joe Rogan, which led to this podcast. It's been awesome so to you and to dock Kirk partially for introducing us Thank you and him for what you guys done for me. The men and women in uniform out their holdings line. Thanks for your service and yours, advice to the police on the corner- fighting Crime- The fireman fighting fires thing to keep it safe to the medical people in

medical professions, like Peter doctors, nurses physicians. Assistance E M tease all of you. Working to save lives. Thank you for your work It meant a service in its obviously a massive commitment when you hear about the hours- and the emotional trauma that it takes to go into any one of those industries and services, and to everybody else, s listening! Thank you! It's! nor communications, your questions, your participation, your feedback in

were spreading of the word that makes this possible end its. What makes this worthwhile so thank all of you for all of that then. Finally, thanks to all of you for getting out there in getting after it, so until next time this is doctor purity and ECHO and Jacko out.