Losing the Track is Part of Tracking

From The Lion Tracker’s Guide To Life by Boyd Varty:

You must train yourself to see what you are looking for.

Perhaps the most concise description of radiology training.

“I don’t know where we are going but I know exactly how to get there,” he says.

Process > outcome.

I think of all the people I have spoken to who have said, “When I know exactly what the next thing is, I will make a move.” I think of all the people whom I have taught to track who froze when they lost the track, wanting to be certain of the right path forward before they would move. Trackers try things. The tracker on a lost track enters a process of rediscovery that is fluid. He relies on a process of elimination, inquiry, confirmation; a process of discovery and feedback. He enters a ritual of focused attention. As paradoxical as it sounds, going down a path and not finding a track is part of finding the track.

Uncertainty is part of life, but a search pattern helps.

Data-driven Personal Finance Takeaways

Some interesting passages and food for thought from Just Keep Buying: Proven Ways to Save Money and Build Your Wealth by Nick Maggiulli (a personal finance book with much more data behind its analysis than average for the genre).

On saving:

And one of the most common financial stressors is whether someone is saving enough. As Northwestern Mutual noted in their 2018 Planning & Progress Study, 48% of U.S. adults experienced “high” or “moderate” levels of anxiety around their level of savings. The data is clear that people are worried about how much they save. Unfortunately, the stress around not saving enough seems to be more harmful than the act itself. As researchers at the Brookings Institute confirmed after analyzing Gallup data, “The negative effects of stress outweigh the positive effects of income or health in general.” This implies that saving more is only beneficial if you can do it in a stress-free way. Otherwise, you will likely do yourself more harm than good.

That’s a counterintuitive claim: stressing about not saving enough does more harm than not saving enough.

On spending:

Researchers at the University of Cambridge found that individuals who made purchases that better fit their psychological profile reported higher levels of life satisfaction than those who didn’t. Additionally, this effect was stronger than the effect of an individual’s total income on their reported happiness.

For example, it has been well documented that people get more happiness buying experiences over material goods. However, what if this is only true for a subset of the population (e.g., extroverts)? If so, then we may be generating spending advice based on the 60%–75% of people who are extroverts to the dismay of introverts around the world.

I suspect Maggiulli is right to point this out. Just like scientists get annoyed when news media take a small experiment or a mild trend in the data and throw up a big bold headline, the idea that all humans benefit from the same things in the same sorts of ways doesn’t pass intuitive muster. For many people, I suspect there are probably plenty of high-impact ways to spend on some things and dumb ways to buy experiences.

On valuing an educational/career investment:

The proper way to find the current value of these future earnings is to discount this payment stream by 4% per year. However, there is a simpler way to approximate this—divide the increase in lifetime earnings by two. This will be roughly equivalent to a 40-year payment stream discount by 4% per year. I prefer this shortcut because you can now do the math in your head. Therefore, a $800,000 increase in lifetime earnings over 40 years is worth about $400,000 today.

Value of Degree Today = (Increased Lifetime Earnings/2) – Lost Earnings While things like taxes and other variables can affect this calculation, it’s still a simple way to check whether a degree is worth the cost.

Food for calculus when considering not just expensive degrees but also lengthy medical training or an additional fellowship.

On the health impact of debt:

For example, research published in the Journal of Economic Psychology found that British households with higher levels of outstanding credit card debt were “significantly less likely to report complete psychological well-being.” However, no such association was found when examining households with mortgage debt. Researchers at Ohio State echoed these findings when they reported that payday loans, credit cards, and loans from family and friends caused the most stress, while mortgage debt caused the least. On the physical health front, a study in Social Science & Medicine found that high financial debt relative to assets among American households was associated with “higher perceived stress and depression, worse self-reported general health, and higher diastolic blood pressure.” This was true even after controlling for socioeconomic status, common health indicators, and other demographic factors.

What makes buying a home even easier is if you can afford it. This means being able to provide 20% as a down payment and keeping your debt-to-income ratio below 43%. I chose 43% because that is the maximum debt-to-income ratio you can have for your mortgage to be considered qualified (i.e., lower risk). As a reminder, the debt-to-income ratio is defined as: Debt-to-Income Ratio = Monthly Debt / Monthly Income

Part of what makes mortgage debt less impactful to mental health is presumably the fact that mortgages feel universal and almost no one you are likely to know (at least early in your professional career) has the money to buy a house with cash.

Nonetheless, I suspect I will have a measurable well-being boost when mine is gone.

On why to invest:

In essence, by investing your money you are rebuilding yourself as a financial asset equivalent that can provide you with income once you are no longer employed. So, after you stop working your 9 to 5, your money can keep working for you. Of all the reasons why someone should invest, this might be the most compelling and also the most ignored. This concept helps explain why some professional athletes can make millions of dollars a year and still end up bankrupt. They didn’t convert their human capital to financial capital quickly enough to sustain their lifestyle once they left professional sports. When you make the bulk of your lifetime earnings in four to six years, saving and investing is even more important than it is for the typical worker.

Fund the life you need before you risk it for the life you want.

The conversion of human capital to financial capital is an excellent way of looking at/arguing for investing.

On being realistic about wealth:

For example, research in The Review of Economics and Statistics illustrates that most households in the upper half of the income spectrum don’t realize how good they have it…households above the 50th percentile in income tend to underestimate how well they are doing relative to others…even households at the 90th percentile and above in actual income believe that they are in the 60th–80th percentile range.

For example, you would need a net worth of $11.1 million to be in the top 1% of U.S. households in 2019. However, after controlling for age and educational attainment, the top 1% varies from as little as $341,000 to as much as $30.5 million. For example, to be in the top 1% of households under 35 that are also high school dropouts you would only need $341,000. However, to be in the top 1% of college educated households aged 65–74 years, you would need $30.5 million.

It’s incredibly easy to find some Joneses to keep up with.

On green grass:

But why does happiness start to decline in the late 20s? Because, as people age, their lives usually fail to meet their high expectations. As Rauch states in The Happiness Curve: “Young people consistently overestimate their future life satisfaction. They make a whopping forecasting error, as nonrandom as it could be—as if you lived in Seattle and expected sunshine every day…Young adults in their twenties overestimate their future life satisfaction by about 10 percent on average. Over time, however, excessive optimism diminishes…People are not becoming depressed. They are becoming, well, realistic.”

Part of the curse of medical training is to coincide with this natural stage of disillusionment.

Earning the Bare Minimum

From the (the free or inexpensive) The Almanack of Naval Ravikant: A Guide to Wealth and Happiness:

If you look at even doctors who get rich (like really rich), it’s because they open a business. They open a private practice. The private practice builds a brand, and the brand attracts people. Or they build some kind of a medical device, a procedure, or a process with an intellectual property. Essentially, you’re working for somebody else, and that person is taking on the risk and has the accountability, the intellectual property, and the brand. They’re not going to pay you enough. They’re going to pay you the bare minimum they have to, to get you to do their job. That can be a high bare minimum, but it’s still not going to be true wealth where you’re retired but still earning.

The problem with employment: “They’re going to pay you the bare minimum they have to, to get you to do their job.”

It’s always in the interest of the suits to pay you as little as they can get away with. It’s always in the interest of the hospital, the university, or the company to either pay you less, push you to produce more, or both. It certainly seems to be a very hard temptation to resist at the moment.

Speaking of retirement:

What is your definition of retirement? Retirement is when you stop sacrificing today for an imaginary tomorrow. When today is complete, in and of itself, you’re retired.

…one way is to have so much money saved that your passive income (without you lifting a finger) covers your burn rate. A second is you just drive your burn rate down to zero—you become a monk. A third is you’re doing something you love. You enjoy it so much, it’s not about the money. So there are multiple ways to retirement.


Lusting for money is bad for us because it is a bottomless pit. It will always occupy your mind. If you love money, and you make it, there’s never enough. There is never enough because the desire is turned on and doesn’t turn off at some number. It’s a fallacy to think it turns off at some number.

When it comes to helping people turn their jobs from just the income-generation game or the I-need-a-passive-income-side-hustle game, we need to move more industries (and here I’m thinking about healthcare) into more of a cooperative venture and less of a competition.

My co-founder Nivi said, “In a long-term game, it seems that everybody is making each other rich. And in a short-term game, it seems like everybody is making themselves rich.”

I think that is a brilliant formulation. In a long-term game, it’s positive sum. We’re all baking the pie together. We’re trying to make it as big as possible. And in a short-term game, we’re cutting up the pie.

The scarcity mindset sours the calling.

Atomic Habits

Atomic Habits was apparently the very best-selling book of 2021.

I don’t re-read books often, but James Clear’s entry is short and tactical, and it makes for a nice “get your head in the game” reset prior to a new effort (such as new year’s resolutions if that’s something you typically enjoy planning and then not doing).

Clear isn’t a scientist, but he did a nice job summarizing the work of others, particularly Charles Duhigg’s The Power of Habit and BJ Fogg’s Tiny Habits (though the latter’s popular book came later). It’s an example, like Yuval Harari’s wildly popular Sapiens, that synthesis, packaging, and storytelling are all considered valuable and certainly rewarded by the market (much more so than rigor).

Clear had a pretty solid newsletter for many years prior to the book, so he put in the time to generate some great quotes.

My two favorites:

You do not rise to the level of your goals. You fall to the level of your systems.

Every action you take is a vote for the type of person you wish to become.

I love the idea of identity-based habits. People love goals and are obsessed with outcomes. But not hitting your goals isn’t always a failure, and outcomes are often not within your locus of control. The inversion here we are affirming is of course the classic, “it’s the journey, not the destination.”

Habits are an effort to be the kind of person we want to be–internal validation–and not focused on outcomes that might happen as a result–external validation. That identity is more who we are and less exactly what we do.

From a post about residency interviews last year:

So much of your identity feels tied to your success in school, the match, and your developing career as a physician. But internal validation is always superior to external validation. You don’t and can’t control outcomes. You–at best–control yourself and your approach.

Perhaps we would do better to think of ourselves foremost as listeners or healers and less as a specific role like trauma surgeon or dermatologist.

What I Read in 2021

It turns out that this was the eighth year that I’ve kept track of at least the book-reading fraction of my entertainment consumption. It’s a practice I encourage, especially if you can jot down a few notes to yourself about your thoughts afterward (I read most of my nonfiction on my Kindle because of the very handy highlight feature, which helps). A fraction of those highlights typically then find their way into my digital brain archive and some eventually become posts on this very site. That and a new daily note habit are part of my ongoing fight against the forgetting curve.

Prior years here: 2020, 2019, 2018, 2017, 2016, 2015, 2014.

  1. Atomic Habits by James Clear (re-read this for pandemic new year inspiration)
  2. The Math of Life and Death by Kit Yates (I’ve long wished people were generally numerate, especially after reading the book Innumeracy in college. This pandemic has only made that desire stronger.)
  3. Derelict by Dean Henegar (This is a sub-subgenre of LitRPG called DungeonCore, where the main character is a sentient dungeon. This wasn’t very good, but the genre itself is sorta weirdly engaging, as if a tower defense game were a novel with lots of internal monologue.)
  4. Derelict #2 by Dean Henegar
  5. A Promised Land by Barack Obama (Obama is a good writer.)
  6. Quit like a Woman by Holly Whitaker (Alcohol culture is pretty toxic.)
  7. How I Built This by Guy Raz (origin stories of some modern unicorn companies. Honestly less interesting than I thought it would be.)
  8. Weird by Olga Khazan (also much less interesting than I thought it would be.)
  9. Exo Hunter by Jeremy Robinson (Everything this guy writes is a fast-paced romp. He has the page-turner plotting down to a science. This is one of the worst but still perfectly enjoyable.)
  10. Vagabonds by Hao Jingfang translated by Kevin Liu  (The Dispossessed [a Le Guin class] as if written by twenty-something year Chinese man writing in Mandarin in 20xx.)
  11. Happier by Tal Ben-Shahar
  12. God’s Eye Awakening by Aleron Kong (new series based on The Land; we’ll see…)
  13. On Writers and Writing by Margaret Atwood (meh, as far as writing about writing goes, I much prefer Ursula K Le Guin’s and Stephen King’s entries)
  14. Life Reset (#1) by Shemer Kuznits (another LitRPG, yes, but in this one, the main character is a monster, so there)
  15. Life Reset: EvP (#2) by Shemer Kuznits
  16. Life Reset: Hobnobbing (#3) by Shemer Kuznits
  17. Life Reset: Human Resource (#4) by Shemer Kuznits
  18. Life Reset: Conquest (#5) by Shemer Kuznits
  19. Infinite 2 by Jeremy Robinson (solid, but honestly Infinite [1] was probably better off on its own. That was a seriously fun book.)
  20. Range by David Epstein (If you ever feel frustrated that we’re all hamsters spending more and more time learning about less and less, this is the book for you)
  21. The Hobbit by JRR Tolkein (thought I’d return to the classic)
  22. Project Hail Mary by Andy Weir (super duper enjoyable book. This [not Artemis] is the real spiritual sequel to The Martian.)
  23. How to Take Smart Notes by Sonke Ahrens (the most academic of the recent takes on the Zetellkasten system of creating a repository of personal knowledge like those facilitated by recent apps including RoamResearch and Obsidian. It is also very repetitive and dry).
  24. World Tree Online (#1) by EA Hooper (enjoyable LitRPG; also nice that it’s a trilogy with an actual ending!)
  25. Demon Lord (#2) by EA Hooper
  26. World Tree’s End (#3) by EA Hooper
  27. Backable by Suneel Gupta (written by the brother of the much more famous Sanjay Gupta; meh; made it into some posts about medicine here and residency interviews here.)
  28. Adventures in Opting Out by Cait Flanders (thought this might be fun as a quick sequel to her first book, but it mostly wasn’t)
  29. The Emergency Mind by Dan Dworkis MD PhD (A book of mental models for decision making in high-stress situations [e.g. an emergency department]. Dan was actually the older brother of a close friend growing up. Super smart dude. Brief post here.)
  30. Israel by Noa Tishby (a very accessible whirlwind tour)
  31. Talking to Strangers by Malcolm Gladwell (It’s refreshing how willing Gladwell is to take the flip side of the coin he popularized in Blink. Brief post here.)
  32. Andrea Vernon and the Superhero Industrial Complex (#2) by Alexander C. Kane (not as good as the original)
  33. Vanishing Fleece by Clara Parkes (a story about modern American textiles; I find these types of memoir-ish deep dives to be oddly interesting. I knew nothing about yarn–until now.)
  34. The Practice by Seth Godin (truly half-baked)
  35. Ascension (The Beginning After the End #8) by TurtleMe
  36. Metropolitan by Walter Jon Williams (The world-building and characters in this book are extremely vivid.)
  37. City on Fire (#2 of 2) by Walter Jon Williams
  38. The Midnight Library by Matt Haig (This is one of those books that became extremely popular. I get why given the world we live in, but ultimately perhaps too tidy, dry, and predictable.)
  39. The Mayor of Noobtown by Ryan Rimmel
  40. The Village of Noobtown (Noobtown #2) by Ryan Rimmel
  41. Castle of the Noobs (Noobtown #3) by Ryan Rimmel
  42. Dungeons and Noobs (Noobtown #4) by Ryan Rimmel
  43. Noon Game Plus (Noobtown #5) by Ryan Rimmel
  44. The Blade Itself (First Law #1) by Joe Abercrombie (often held up as the best example of Grimdark Fantasy. This was really, really good in addition to being brutal.)
  45. Before They Are Hanged (First Law #2) by Joe Abercrombie
  46. The Last Argument of Kings (First Law #3) by Joe Abercrombie
  47. The Hundred Thousand Kingdoms (The Inheritance Trilogy #1) by NK Jemisin (I’m still not sure how I feel about this series.)
  48. The Broken Kingdoms (The Inheritance Trilogy #2) by NK Jemisin
  49. The Kingdom of Gods (The Inheritance Trilogy #3) by NK Jemisin
  50. The Awakened Kingdom (The Inheritance “Trilogy” #4) by NK Jemisin
  51. Mirrorworld by Jeremy Robinson
  52. Red Shirts by John Scalzi (Hugo Award winner; such a great sci-fi subversion; breaks the fourth wall and then beyond)
  53. The Amazing Adventures of Kavalier and Clay by Michael Chabon (a novel set primarily in the golden age of comics. Won the Pulitzer Prize and has been on my shelf to read for a decade. Truly excellent. Chabon is a master.)
  54. Shadeslinger (Ripple System #1) by Kyle Kirrin (I think this is really the last new LitRPG series I expose myself to for a while. All of these LitRPG series are essentially examples of a subgenre called Progression Fantasy, essentially stories focused on character growth like the shonen-style of anime that’s been popular for the past 30 or so years, and–in that way–they’re addictive and soothing at the same time, a balm for the mind in these troubled times.)
  55. Life Reset: Salvation (#6) by Shemer Kuznits (another series concluded!)
  56. The Hospital by Brian Alexander (a depressing tale of modern healthcare and small-town decline through the lens of a midwestern community hospital. Brief post here.)
  57. Everyday Vitality by Samantha Boardman
  58. What Happened to You? By Oprah Winfrey and Bruce D Perry MD Phd
  59. Greenlights by Matthew McConaughey (some interesting stories but almost painfully self-indulgent)
  60. Taste by Stanley Tucci (warning: will make you desperately want really good Italian food)
  61. Keep Sharp by Sanjay Gupta (synopsis: exercise, eat right, and don’t retire)
  62. Cytonic by Brandon Sanderson (Skyward #3)
  63. Will by Will Smith (even more interesting stories but even more self-indulgent)
  64. Black Sand Baron by Kyle Kirrin (Ripple System #2)
  65. The End of Craving by Mark Schatzker (I really found The Dorito Effect interesting as a look at modern food science, the flavorings industry, etc. I honestly don’t have the background to evaluate the claims this book makes about food additives. Could all be raving pseudoscience for all I know. I can at least recommend his first book. But clearly, in the words of Michael Pollan, “eat [real] food, not too much, mostly plants” would be better for all of us.)
  66. The Invisible Life of Addie LaRue by VE Schwab (This was enjoyable, with echoes of The Time Traveler’s Wife. I preferred the Shades of Magic, but VE Schwab is a solid writer.)
  67. Crying in H Mart by Michelle Zauner (though this is supposed to be a moving memoir about acculturation, assimilation, family, food, and loss, it mostly made me want to head to our local H Mart to re-stock my freezer and pantry because it’s been a while.)

I didn’t do a very good job keeping track of what I read to my son, but here are some of the chapter books and graphic novels:

  1. We eventually finished the 27-volume Magic Treehouse series and read the first five or so of the sequel Merlin Missions.
  2. Yeti Files by Kevin Sherry
  3. Cat Kid Comic Club by Dav Pilkey
  4. Rowley Jefferson’s Awesome Friendly Spooky Stories by Jeff Kinney
  5. The Magician’s Nephew by C.S. Lewis (I would really like to continue reading Narnia with him, but he’s more interested in Pokemon and Lego at the moment…)
  6. The Forbidden Power (Lego Nexo Knights: Knights Academy #1) by Max Brallier (honestly far better than it deserved to be)
  7. Glitch by Sarah Graley
  8. The first two volumes in this Pokemon novelization box set, which we are enjoying, um, asymmetrically.