With our scrubs in various phases of disarray, we heaped cubes of cheese onto our plates, collapsed into chairs, and reviewed the final details of a man’s life.
The surgical resident fastened her gaze to her paper, as if the printed words centered her. She spoke in monotone, as we must when we revisit images the mind cannot bear.
He was brought in by paramedics after being struck by a car at high speed. He was alert and protecting his airway upon arrival, but altered, with a Glasgow Coma Score of about 11. His heart rate was 150, and although he had a carotid pulse we couldn’t get a blood pressure. Then he became agitated. . . .
Despite the lexicon of detachment so fundamental to our training, the scene evolved for us in garish brushstrokes. We had all witnessed the suffering that played out beneath the bright lights of the trauma bay. We understood the visceral, irreparable, heart-breaking ramifications of each data point.
He was hemorrhaging. As his blood pressure dropped, so did oxygen delivery to his brain, and he became confused. His sympathetic nervous system kicked into overdrive. It squeezed his blood vessels, throttled his heart to a frenzied pace, and flooded him with panic.
She Held His Dying Heart
As the narrative progressed, her bottom lip quavered. He lost consciousness, she reported. Then, he lost his pulse. They performed CPR. They opened his chest in the emergency department (ED). They clamped his aorta, rushed him to the operating room (OR), and surgically explored his abdomen. A collection of blood, swollen and dark as an overripe pomegranate, welled up from his pelvis. They jammed gauze into each crevice, transfused blood, and yet still he bled. They massaged his heart between their gloved hands. Still, he bled. After an hour, despite every effort, his heart remained empty. Its stillness overtook the room.
When she finished her monologue, she raised her eyes. In them I saw the familiar grief, the mourning for someone whom she had touched so intimately, yet did not know. She had witnessed the passing of someone whom others called son, brother, mentor, friend, greatest love. She had witnessed the final surgings and heavings of his life, had fought to hem in their calamity, and yet she knew only those surgings, those sighs, those peaks and valleys on the monitor. As she held his heart in her palms and felt its feeble quiver, she could not see him scouring riverbeds for fool’s gold, or scrawling love notes in crayon to his first crush. She could not envision the road trip to Joshua Tree, the painting that misted his father’s eyes, the first dance with his wife. Their encounter had been violent and brief, a momentary gale. She was left stranded with the lack of him.
I understood this grief, as did all of my colleagues assembled around the table. Yet as I watched her, with her jaw set against the turmoil, I recognized something else.
“We didn’t have the right OR table,” she said. “I didn’t specify the OR table. Maybe that would have made a difference.” Then the tears came. “It’s my fault,” she whispered.
The Wages of Sin and the Work of Medicine
Her efforts to save his life were literally heroic. By the time this patient arrived in the ED, the acid concentration in his blood exceeded four times the normal level. His proteins had already unfurled from their compact configurations, and floated adrift among deformed blood cells. Hypothermia paralyzed his enzymes. His blood, thinned to the viscosity of water, could not clot. When paramedics rolled him into the trauma bay, he was already speeding into the presence of Jesus.
No special operating table would have averted his death. Yet, her shoulders sagged beneath the heft of her remorse. I watched her struggle to compose herself, and I knew she analyzed each minute, each decision, each word, each turn of the wrist, and felt their gravity. No words would assuage her guilt. Our shared framework was rooted not in the gospel, but in secular medicine. It was a philosophy that offered no vocabulary of atonement.
The wages of sin is death, and physicians toil in its preamble. Cancer, car crashes, widespread infection, organ failure — such catastrophes arise from our fallen state, and signify the terrible price of rebellion (Genesis 3:22–24). The suffering of the dying reminds us of the chasm between us and God, and our desperation for a Savior. Creation groans for freedom, patients groan in pain, and Christians groan as we await redemption of our bodies (Romans 8:22–23, 2 Corinthians 5:2–4).
Although mired in the groanings of our sin, healthcare providers operate in a system divorced from conversations about God. Ingrained in secularism, medical training ignores both the origin of illness and death, and God’s sovereignty in the process. We learn to analyze every data point, and to take personal responsibility for the rise and fall of those values. We study the intricacies of biochemistry, pharmacology, anatomy, and biology. We take courses in ethics. We surrender our needs for sleep, communion with family, nourishment, maintenance of our own bodies, all for the sake of the patient fading into the hospital mattress. When we take the Hippocratic Oath to “do no harm,” we admit first and foremost our capacity to inflict harm. The threat of inadvertently hurting people forever looms, stalking our thoughts like a phantom.
Meanwhile, the tension between human moral responsibility and God’s supremacy plays out around us daily. Patients die despite technology, expediency, and finely tuned protocols. Cancer recurs despite our declarations of cure. Sin churns and hums through every corridor. When we lose a patient, we consider our flimsy books, our hands that could not deliver, and we despair. We offer our report in monotone, while the full weight of our sin bears down upon us, stealing all breath, and sight, and hope.
Pray for Your Doctors
The physician suicide rate is twice that of the general population. This is no surprise. Without Christ, the daily fodder of medicine crushes the heart. Medical training mandates practitioners witness sin in graphic detail, yet the textbooks, instruments, and decades of study offer no context for forgiveness. Joseph understood God’s will at work in the face of evil (Genesis 50:20); medical training demands its practitioners confront evil, yet heaves culpability upon them.
Pray for your healthcare providers. When you go to your general practitioner’s office to have your cholesterol checked, or to titrate your blood pressure medicine, or if you are in the throes of chemotherapy, or undergoing surgery, or even struggling in the ICU, pray for them. While you pray for their skill and focus and knowledge as they care for you, please also pray for their faith.
Pray that they would see and embrace Christ, who shed his blood so that life may one day swallow up death (1 Corinthians 15:54).
Pray that they would see and embrace Christ incarnate, who took on the groans of pain and death in this life, to liberate us from death’s sting (Hebrews 2:14–15).
And pray that they may come to know God’s divine will always at work, even in the hospital, even within the clinic, even when their own meager hands fail to revitalize a lifeless heart.
Entrepreneurs can be pretty resilient.
Some of our favorite founders and some of the most successful companies suffered layoffs, down rounds, or went into the famed “cockroach mode.”
The simple truth is if you’re an early stage entrepreneur(or work with one) you have a better chance of failing than succeeding. Luckily, there’s a plethora of books and articles like this one that offer entrepreneurs the chance to learn from other’s mistakes.
The five stories below offer tactics that you and your startup can use to stay alive when on the brink of death.
While at Yale University in 1962, Fred Smith was racing to submit an economics paper on time. He hurriedly wrote a paper about an overnight delivery service in the computer information age.
He didn’t think much of it at the time, but that paper laid the groundwork for FedEx. In 1971, Fred Smith founded the company with his inheritance and over 80 million dollars in business loans(half a billion dollars in today’s currency).
Due to rapidly rising jet fuel prices, the economics in Fred’s paper weren’t holding up. After two years, the company was loosing a million dollars a month and on the verge of bankruptcy. Millions of dollars in debt, Smith was racing to raise some additional capital.
Smith employed the tactic that had been so successful for him — business loans. Even with a fleet of 8 planes and service in 35 cities, no one was picking up his deal.
After a particularly disheartening denial from General Dynamics, Smith realized he didn’t have enough money to fuel up his planes for next week. The company had already tried every scheme it could, including using pilot’s personal credit cards and uncashed paychecks for fuel.
That weekend, Smith impulsively took the company’s last $5,000 dollars and flew to Vegas.
Miraculously, Smith netted $27,000 dollars at the blackjack tables and flew back in time to fuel up the planes for next week. Roger Frock, an SVP at Fedex was flabergasted, saying, “You mean you took our last $5,000 — how could you do that?”
[Smith] shrugged his shoulders and said, “What difference does it make?” Smith used this momentum to raise additional capital, closing on 11 million dollars in the coming weeks.
Fedex turned its first profit a few years later and has been on the up and up ever since.
Read more about this incredible story in the book, Changing How the World Does Business: FedEx’s Incredible Journey to Success — The Inside Story
Most of you have probably seen or heard of ‘Snow White’. What you might not know is that the release of ‘Snow White’ saved Disney from certain death.
When video animation burst onto the scene in the roaring 20s, Walt Disney was known as the pioneer.
However, Disney faced multiple financial setbacks in the 20s and 30s. At one point, Disney lost the rights to his most popular character, without a clue of how to fill that void. By the early 1930s Disney was over four million dollars in debt.
With barely enough cash to finance the project, Disney released “Snow White and the Seven Dwarfs” in 1938. The blockbuster movie sprung the company out of bankruptcy and bankrolled the building of Walt Disney Studios in California.
Disney credits these hard times for his eventual success, saying, “You may not realize it when it happens, but a kick in the teeth may be the best thing in the world for you.”
Fortunately for struggling entrepreneurs, the takeaway here is that one killer idea can make up for a series of flops.
Wan’t to learn more? Read the rest of Disney’s story in Walt Disney: An American Original
In Howard Schultz’s book, Onward: How Starbucks Fought For Its Life Without Losing Its Soul, we learned that Starbucks, the green giant, almost tanked during the 2008 recession.
Starbucks was a little known bean roasting company until Howard Schultz, then Director of Marketing, went to Milan to attend a trade show. The show was unremarkable, but on his walks to and from the show, Shultz discovered, “the theater, romance, art and magic of experiencing espresso.” Shultz returned to the US and bought the Starbucks brand from the original founders in order to recreate the experience of Milano coffeehouses.
With this focus on experience, Schultz grew Starbucks from one location to 0ver 3,500. Schultz took a hiatus in 2000, with high hopes for the continued growth and expansion of the coffee company. In the next eight years, a much different story played out.
Shultz’s successors cared little for the experience, and expanded to thousands of cities and locales that couldn’t support the community atmosphere so vital to the chain’s success. Then the recession hit, and without the art and experience consumers refused to pay $4 for a cup of coffee.
Shultz felt like, “a former captain who could sense his ship slowly sinking,” and returned as CEO in 2008. He temporarily closed thousands of stores in order to re-train the employees and recreate the atmosphere.
Shultz checked his ego at the door, and reworked or replaced many of the strategies that he had implemented from the beginning. Schultz’s transformation of the company shows how humility and a fresh perspective are oftentimes more valuable than expertise and vision.
Loudcloud sold to HP for 1.65 billion dollars, but the compnay wasn’t always a smashing success. Ben Horowitz founded LoudCloud during the peak of the dotcom boom. When that wave came crashing down in 2001, Loudcloud’s millions in revenue disappeared overnight. Horowitz employed dozens of tactics, but the most important change he made was changing his own management tactics. When necessary, Horowitz changed from a “Peacetime CEO” to a “Wartime CEO.”
Horowitz says, “My greatest management discovery[…]was that peacetime and wartime require radically different management styles.”
Horowitz, through his own story, gives other entrepreneurs a guide of how to break with our normal, positive, peacetime tactics and be appropriately ruthless.
Management in wartime is about defining a mission and sticking to it no matter what. The wartime CEO will execute layoffs and eliminate all distractions. The great gift of Horowitz’s story is that Ben, a good manager and a good person, has to make tough calls again and again.
Many managers feel they could never deliberately undermine their competition, but Horowitz, through his own story, gives us that permission. His book, The Hard Thing About Hard Things, is one of the few resources entrepreneurs have for how to manage through wartime.
Through these tactics, Ben took his business from a few weeks from bankruptcy to millions in revenue and a successful exit. Read our Hardbound story for more on how he did it.
Chances are good you haven’t heard of GNIP. Their story fascinated me, and since the founders live in my hometown, I dug in and learned more. GNIP was founded in 2008 by Jud Valeski and Eric Marcoullier. The company mined social media data better than anyone, but that didn’t mean that they had a successful business on their hands.
This was the early days, before “big data” was even a buzzword. GNIP had racked up some amazing investors, with Brad Feld of Foundry group and a who’s who of Silicon Valley sitting on the board. But times were tough, and when the need for a Series B arose, not a single one of their investors was willing to step up.
The CEO at the time, Chris Moody, had a big vision. He saw a future full of social media data, and that GNIP could be “Grand Central Station” for it all. GNIP had built world-class technology to aggregate APIs and they were constantly getting approached by partners asking them to make one-off technology solutions to solve specific problems.
While these were the type of things that could have put some money in the bank, they were incredibly distracting for the engineering and management teams. Instead of working on these one-offs, GNIP focused on their vision and communicated it continually to their investors.
In the end, this focus on the vision saved them. Brad Feld ended up leading their Series B, and a year later, GNIP had an exclusive data partnership with Twitter. Four years after that, Twitter acquired GNIP for over 100 million dollars. I asked Chris Moody, Jud Valeski, and Brad Feld about how they secured that investment.
Brad said he invested in GNIP because of the vision, and Chris agreed. Jud, when I asked him, chuckled and said, “Yea, duh.” The talk that he was giving when I asked him is titled, “The Road to Hell is Paved With One-Offs,” and it’s all about sticking to the vision.
For yourself or the entrepreneur in your life, stick to vision. It’s why the company was founded in the first place.
Every company goes through hard times. As entrepreneurs it’s important to remember that you can get through this, and sometimes these hard times are the best thing for you.
When times get tough, do as others have done: Focus on the vision, seek fresh perspectives, lean in to wartime, ship a totally new idea, and do whatever it takes.