How Punishing the Universe Can Be

Feb 2023

 

 

“Learn from other people’s mistakes because you won’t be alive long enough to make them all yourself and learn from them.”

Eleanor Roosevelt

 

 “Doveryai no roveryai means to trust but verify. Trust everything you’re told but then independantly verify everything.”

– Russian Proverb

 

I used to think when I was younger that the world was a very forgiving place. That when you made mistakes, you’d be able to just fix those mistakes because there was time on your side. With enough time you could fix anything. But what never occurred to me was what if the result of the mistake actually resulted in your death or running out of time and so you’d never get more time to fix the mistake. What if you didn’t know that at the time of making the decision.

You didn’t know that if you chose door X in this moment, you’d be fine. But if you chose door Y, you might die. And what if the mistake too was as a result of just not knowing enough information or thinking you had enough time to recover from something where actually you didn’t. Or that you thought you were more resilient than you actually were.

For example, a dangerous belief I think held by many young people is that by virtue of being young, they are also healthy. While this is usually true, it is not always true. Young people can get really sick and die all the time. In fact I think the internalised story told to young people about their inherent invulnerability is a sort of bedtime story designed to make young people feel better about how scary the world can be.

But it’s a disservice. Much of the world is actually just random. Sickness, death and so on is just as much self inflicted (eg smoking every day and then getting lung cancer) as it is totally random (eg being born with a genetic disease that causes lung cancer). Both examples result in lung cancer but one has causality, the other is random.

I’ve lived sufficiently long now that I’ve seen a lot of these sliding door moments. Some that ended very well and some that ended very badly. But I’m trying to learn to recognise more often when I see people I care about who are in them. To learn from the successes and mistakes of people I know.

I’m also trying to learn to recognise these moments and recognise when I’m in one of these moments. To make an educated guess at what might be behind each door. When if I go in one direction things will be alright. And if I go the other way, I could die. So I can choose to go the way of safety.

It’s not that death is probable in one direction, it’s that it’s possible. If something is possible, a non-zero amount of the time that happens to someone if the sample size is big enough. I make thousands of decisions per day but I want to start knowing which one of these decisions could walk me through a door with a catastrophic failure scenario on the other side of it.

So I wanted to go over a few examples from my life and try to analyse them at a high level for where exactly the mistake is and if there’s anything that can be learned from it. Here are the examples I’ve seen and what I think are the lessons that can be taken away. This essay is going to get very dark and this is the part where you can stop reading if you’d like to avoid that.

1. Always See a Doctor Immediately – Heads and Hearts are Fragile

My cousin in school had a really good friend who was once in a small car accident. The car was driving and then had to break very suddenly and hit the car in front of it. The damage to the cars was minimal. But my cousins friend was sitting in the back seat, she was thrown forward and hit her head against the back of the seat in front of her.

She was a bit dazed at first but seemed completely fine. Later that night she went to sleep and in her sleep, she died at 16 years old. Later it was discovered that when she had hit her head when the car braked, there was a very slight brain bleed that started and wasn’t picked up. Nobody, not even her knew it was happening and then when she went to sleep, she didn’t wake up.

There’s a couple of times in my life where I’ve seen some variation of this story play out. The second time was a friend of mine who got into a fight outside a McDonald’s in Melbourne. Some guy said some words to him, he said some words back and then the guy punched him in the head. He got back up, went home, went to bed and died. He was 21 years old. The guy who punched him was found guilty of murder and went to prison.

There’s 3 mistakes in this story. The first is that my friend could have ignored the guy and walked off, avoiding the conflict entirely. The second is not going straight to the hospital after he got punched. The 3rd is the friends he was with could have taken him to a doctor or a hospital but they didn’t. They thought he was fine and so they did nothing.

The third time my Dad’s colleague’s son was playing a sport and hit his head while jumping for a ball. He misses but lands badly on his head by accident. He gets up, seems dazed, gets looked at by his other team mates but seems fine. He’s speaking, he’s coherent, he’s walking, so they think he’s fine. He eventually goes home, goes to sleep and dies. He’s 25 years old. He’s literally seen hitting his head by a field of sports players and nobody does anything because he seems to walk it off. It’s because nobody knows that they should be doing something in this scenario.

What’s something important that happens in every one of these stories? The first thing is the obvious one, they all get hit hard in the head but then don’t go to the hospital. This is the biggest lesson, if in every one of these stories after they got hit in the head they went to the hospital. I think all 3 of them would probably still be alive. Even though they seemed fine and thought they were fine, they weren’t fine.

The second lesson that screams out to me is that the person always gets checked up on by other people before they leave. For my friend, people see him totally fine even though he’d just been punched. My cousin’s friend is in the car with her parents who see her when this happens. My Dad’s colleagues sons teammates check him before determining he’s fine. There’s a moment of intervention in all of these stories.

A moment where the person who checks them has a moment to instead of letting them walk away, take them immediately to a hospital. Where the underlying brain bleeds that are happening in each of these stories could have been found and treated. Saving their life, potentially. Nobody does anything when they see the person who has just his their head seeming fine. Nobody appreciates or understands the severity of what has just happened.

Here is another story that I strongly remember from one time when I was a teenager. There was a party and my Dad was running around a tennis court. He trips and falls and hits his head hard against the floor. So hard that I could hear it. I went over and helped him up with another of his friends, we sat him down and he seemed dazed.

I then immediately insisted we take him to the hospital to get checked up. Why do I say that? I think because I had been watching Grey’s Anatomy and in the episode they say to just always go to the hospital when you hit your head. But my Dad’s friends are there and they’re all adults and said it wasn’t necessary and that he was fine. They were the adults in the room and so I listened to them and we did nothing. Thankfully, my Dad was fine.

But I think about this story in the context of knowing the other stories now and I realise that it was a huge mistake to have done nothing. All of my Dad’s friends were wrong. They had a “she’ll be alright” type of attitude but this was stupid. It was just luck that my Dad hitting his head on the ground caused no damage. It could just as easily have caused the same damage that took my cousins friend, my friend and my Dad’s colleagues son.

What is a broad rule that should be followed is anytime you hit your head, you go straight to the hospital. Even if it seems like nothing is wrong, something could actually be very wrong and potentially life threatening. Head injuries should never ever be taken lightly. The reason I think nobody does anything is because it’s bothersome to go to the hospital. But it’s a huge mistake not to. This doesn’t just apply to your head, but also your heart.

I had another friend who one night had pretty severe chest pains. He just thought it was heartburn, took an antacid and then tried to sleep through it. But he was having a heart attack. By the time he realises what’s happening, he rushes to the hospital but dies on the way and they’re unable to resuscitate him. He’s 30 years old.

Why doesn’t he go straight to the hospital? I’m honestly not sure. But that’s a commonality here. A common thread is that people don’t want to seek help and go through the effort that it takes to do that. Even if it might save their lives. Hearts and heads should never be ignored. If anything is happening to either of them, it’s better to err on the side of medicine and go straight to a hospital. If they had gone to the hospital, they might be alive still.

I think it’s because of a mental error people make when it comes to a certain type of pain and the inconvenience associated with a hospital. Normally when people are experiencing pain, it ends up being nothing. But head pain or heart pain can have such a catastrophic outcome if nothing is done that if anything is happening to your head or heart, go to a hospital. If anything is happening really, go see a doctor immediately.

2. Second Opinions Matter – Don’t Ignore Symptoms

My Mum got diagnosed with breast cancer while I was in university. She catches it super early at Stage 1 but by the time she gets to surgery it’s Stage 2. She’s always been a bit of a hypochondriac, where anytime she’s a little bit sick, she sees a doctor – but this is a moment where that pays off big time and saves her life.

Growing up, my Dad actually makes fun of my Mum’s hypochondria sometimes and when I was a kid, I thought he was right. But now that I’m an adult I know that my Mum is right. Another way of describing this type of hypochondria is actually self advocacy. Which is a good thing to have because it means you seek specialist help for things and you don’t let symptoms go unchecked.

This means that if you’re ever unlucky enough to get sick, which happens randomly, you’re likely to find it early and improve your odds of survival. This is what she does. One day she feels a lump on her breast, she immediately goes to see a doctor who schedules a surgery and a biopsy. She doesn’t wait around, she feels something is different and seeks a second opinion immediately.

It’s discovered that it is breast cancer but it’s been found very early and she goes in for surgery to remove it. But it has spread to her left arm lymph nodes between the time of diagnosis and surgery and the surgeon has to remove those too, saying it’s done with sufficient margins and that the cancer is gone and she can start preventative chemotherapy.

But my Mum is a hypochondriac remember, she’s not satisfied by the surgeons view and she wants a second opinion that the cancer is actually successfully removed in the surgery. Because she’s convinced that she was lying on her side during the procedure, something she thinks may have caused the surgeon to overlook something. She gets into a fight with the surgeon, who at first tells her not to worry and that the surgery was a success and she doesn’t need to do another procedure afterwards or verify his work.

She strongly insists and goes to another surgeon who is a friend of hers and they go back in a few weeks later to do another biopsy. But this time they find traces of the same cancer in exactly the same spot. She was right. It wasn’t fully removed in the first surgery, the “sufficient margins” the surgeon thought he had weren’t good enough. The surgeon apologises profusely and tells her that patients like her are model patients because they self advocate for the standard of care.

What’s the lesson there? Mistakes happen, second opinions are important. But also self advocacy is important and seeking help early is important. My Mum spent a large part of her adulthood being made fun of for hypochondria but it’s the very thing that saves her life when she experiences a medical error. The surgeon made a mistake. Mistakes happen and everyone can make them. But you have to check.

She does 2 things very right, she gets treatment as soon as she knows something is wrong and then she doesn’t trust a surgeon telling her something is fine just because he’s qualified. She insists on second opinions. I think about this sometimes, what would have happened if she hadn’t advocated for herself. I don’t know many people who right after having a surgery would question the surgeons opinion and get a second opinion from another surgeon. But she did that and it probably saved her life. She gets the cancer completely out while still at the early stages.

This is something I juxtapose with another story. One of my wife’s cousin. He has irregular bowel symptoms and thinks nothing of it for 6 months. When he finally goes to see a doctor, has his symptoms misdiagnosed for IBS and Haemorrhoids. He plays this misdiagnosis game with his doctor for close to 18 months where he gets misdiagnosed, given all sorts of treatments from drugs and creams.

He’s told to make dietary changes, exercise changes, blood tests, all sorts of different advice such as to stop eating dairy and to take anti-inflammation drugs. But he keeps coming back with increasingly severe symptoms. He takes the doctors words at face value and never gets a second or third opinion by other doctors or specialists until much later.

When the pain gets severe enough that he nearly passes out one day, he reluctantly but finally sees a specialist gastroenterologist who schedules an immediate colonoscopy. During the colonoscopy he’s told that he has Stage 4 Colon Cancer. After a long battle with cancer, he passes away 2 years after his diagnosis at 32 years old. His family is absolutely devastated. It’s the pinnacle of tragedy. This is a young, fit, healthy young man who suddenly gets cancer and passes away.

What’s the mistake? I think there’s 3 hurdles that happened to get to that catastrophic failure scenario. The first is taking the doctor at face value who was misdiagnosing him and not getting multiple opinions on what was going on. Possibly even seeing a specialist immediately. The second? Time. He waits so long to seek specialist treatment that the disease has progressed so far it can’t be successfully treated anymore. The third? It’s a subtle but it’s actually an informational mistake because he doesn’t know any better than to get his symptoms checked immediately. Why? Because he never talks about them with anyone.

I’ll unpack them in reverse. People generally find things like talking about your bowels or breasts taboo and I think it’s wrong. I think societal decency is to blame here. Shame, the kind of shame that society throws on you when you talk about taboo topics. But people should talk about taboo topics openly more often. I think in my life every time I’ve seen someone do that in front of older people like my parents, they’re told not to because it’s inappropriate. So they learn not to.

But there are unknown unknowns that happen like this when you suppress the flow of information. When a kid grows up being told it’s gross to talk about their poop, they don’t know to talk about their poop when they get colon cancer. And it’s society’s fault that this happens. What’s the lesson? Encourage open dialogue, about everything, every topic is allowed, nothing is too inappropriate to be discussed. By doing that you reduce unknown unknowns.

The second mistake was time. Waiting too long to initially start seeing a doctor. This is a derivative of the same lesson as the previous dot point of waiting too long to seek help. The lesson is good to repeat. Go see a doctor immediately if anything is even remotely wrong or out of the ordinary. I don’t think seeing a doctor can ever backfire, it can only ever be helpful. The cost is worth the probability of removing the catastrophic failure scenario.

The biggest mistake in this story. Not getting a second opinion. A doctor is saying the disease is mild so it doesn’t enter his mind that it could be something life threatening and an early colonoscopy could save his life and he should ask for a second opinion or referral. Why? Because most people don’t know that a colonoscopy isn’t just a discovery tool but an intervention tool.

Early colonoscopy can actually prevent colon cancer completely by removing polyps before they have the chance to grow into cancer. But this is something most people don’t know. But somebody does know. A specialist knows if you just go see them and get that second opinion. You’re allowed to request an appeal in the legal system but why don’t people do it in the medical system? That’s the lesson, always appeal. Always get the second opinion.

3. Location Matters A Lot – Immunity Doesn’t Prepare for Unknown Unknowns

One of my Dad’s colleagues was once travelling from Australia to East Timor on a humanitarian mission. It was charity work to help with something while also visiting his family. Whilst there he caught a rare bacterial lung infection that has no cure and has become terminal. Completely accidentally by being in the wrong place at the wrong time and having the wrong immune system for the wrong environment, he caught a disease that effectively ended his life. Because it’s a perpetual lung infection, his breathing capacity has been significantly reduced. This is a person who used to be able to run marathons now struggles to climb up stairs.

This is similar to another story of a friend of mine who was a high flying corporate executive at an investment bank. She wanted to trade the corporate life to do what she thought was some good in the world; so she volunteered in parts of Africa to help with World Visions charity efforts. She spent 3 months there before contracting a very bad case of Malaria that left her permanently disabled with scarring in her heart.

There was a period of time where it was potentially life threatening but she ended up overcoming the worst of it and she survived with some permanent heart damage that may come back later in life. Her Australian immune system wasn’t designed to withstand the diseases in that part of Africa. The important part of the story is that had she had better quality treatment, the Malaria she had would probably not have been so dangerous for her or left her with any disability whatsoever. And that if she hadn’t been in that part of Africa, she wouldn’t have contracted it in the first place.

What’s the mistake? I’m not really sure exactly. My gut is to think that if a person has an immune system built for one environment, it isn’t easily able to be transported to another one that is more dangerous for that person. But having said that, you need people from wealthy countries to help poorer countries. So I’m not sure if that can really be avoided. It is a reverse tragedy of the commons where it is good for everyone if someone is there but very bad for the individual doing the work.

But I think there is a lesson in it that location and exposure to disease is really important and that we can underestimate the impact of some of it. If we are adapted to one particular part of the world, it is silly to think we can function the same way we would here in another part of the world. Especially when the jump is from somewhere like Australia to somewhere like Uganda, our immune system hasn’t grown up and adapted to the higher viral load of infections.

In both stories, a person from Australia underestimated how debilitating a virus caught in the local ecosystem would be to their Australian immune system and were left with permanent disability from almost fatal diseases when it couldn’t cope. This is a perfect example of reducing your risk surface area.

4. Drugs, Alcohol and Stupidity – Ingesting Poison Isn’t Cool

I had a friend who was a binge drinker. He used to drink himself unconscious almost every night of the week and would tell me it was the only way he could sleep. He’d been drinking like that since he was 18 years old to about 25 years old. He loved it so much that he felt like in many ways the alcohol completed him and giving it up was the hardest thing he ever did. But then about 6 years later, at 31 years old one night he had some chest pain, had a huge heart attack and died. They found out later that the years of binge drinking had damaged his heart.

Another story I had a really good friend who was one of the most brilliant tech entrepreneurs I’ve ever seen. He sold his first tech company at a young age and suddenly had more money than he had the common sense to deal with. He started partying hard, got a sports car, an expensive girlfriend and developed a drug habit. It started really slowly with smoking cannabis and then the occasional line of cocaine at a party which over the years developed into pills which developed into crystal meth and finally about 7 years after he first started taking drugs, he was using heroin.

After a year of occasional heroin use, he checked himself into rehabilitation and tried hard to get clean and completely drug free. It worked and he spent 2 years being clean and living a normal life before one day he suddenly had a brain aneurysm and died. The hard work of overcoming the addiction and getting clean and the years of being clean didn’t matter in the end, the damage was done. It’s hard to say conclusively that the drugs are what caused it but it’s straightforward to see the link.

I had heard about the gateway theory of drugs when I was younger, that when you try your first drug it often eventually leads to trying harder and more addictive drugs. I honestly thought that theory was silly until I’ve seen it play out with half a dozen friends of mine. It all starts the same way, with trying something really minor which they think they have control of. Then as they build tolerance, they move up the drug seriousness escalator.

I think it’s because when you get accustomed to the high you start chasing higher and higher highs. But as you get higher and higher, the fall back to the lows are so severe that you start to never want to not be high. Because the delta between the highs and lows are so large that the lows become impossible to deal with. But the problem is that these highs are causing a ton of damage to your heart and brain and body. Damage that will only appear years down the road.

What’s the lesson in both of those stories? I think there are 2 lessons. Don’t fuck around with addictive substances. They’re addictive for a reason. Addictive substances are something to stay away from but that is something which is obvious. Everyone knows deep down that drugs are bad but they do it anyway.

Why? Because I think people think they’re more capable and have more will power than they actually do. Acknowledging that is the first step towards not getting addicted to something. So I think the answer is to avoid the first ever use and to never start. There’s a reason why the prevailing wisdom is to not to ever smoke your first cigarette or try your first line of cocaine. Because it really is a gateway and people don’t understand or internalise the affect of the damage they’re doing to themselves.

Because of the second lesson, it doesn’t always work out that way, but in both the stories I’ve seen. Becoming a heavy user and then quitting didn’t make a difference. The harmful effects and damage has already happened resulting in both people to die in their early 30s. People are much more fragile than we think we are and the damage from poisonous substances is cumulative. It harm gets worse the more you do them.

Lessons and Patterns

These are some of the moments that I’ve seen in my life up to date. A pattern with all of this is that sometimes if you make the smallest most easily able to make mistake. A mistake that many other people would make in the same position. The universe can just crush you. It totally punishes you for that error. In chess, when your opponent makes an error, you can punish them for it. But in this sense, it is fighting with the universe for survival.

I think this model is fundamentally unfair. People are irrational beings who are prone to making errors. But implicit in how destructive an error can be is how fragile people are. We are much more fragile creatures than I ever thought when I was growing up. Probably because of our upbringing, from childhood we’re taught to make lots of mistakes and to learn from them and get better. Implicit is that we’ll still be around after the mistake is made.

But we’re not taught that actually sometimes an error can result in the universe crushing you. You can make the smallest error, the tiniest miscalculation and then the universe comes crashing down and punishes you for that error. And what if the mistake itself wasn’t even really a mistake. It was actually the thing that most people would do if they were in the same scenario. Or from not knowing some key piece of information at the right time.

So what might we do behaviourally to not repeat this? To learn a few core lessons and patterns.

1. Err on the side of medicine. For as long as there have been people, there has been medicine. Because people don’t like being sick and it’s been the collective pursuit of humanity to try and heal people and extend life expectancy by as much as we could. Because we’ve collectively decided that living is better than not living and medicine is the best way we know how to fix that. What this means is always go see a doctor and a specialist, early and often.

But also to get second opinions. Just because a doctor says one thing doesn’t mean you stop there. Go see another doctor as well. Second and third opinions are useful and nothing should be taken at face value because everyone makes mistakes. You can easily pick up on mistakes by having extra sets of eyes.

2. Avoid violence. Violence is just about the easiest way to accidentally get caught up in randomness. If you get into a fight and someone punches you in the wrong place, you could die. If you play a rough sport and you getting hit in the wrong place, you could die. So even if it means swallowing your pride and ego a lot of the time, you should never participate in violence. The downside isn’t worth the upside.

Because it doesn’t matter how good you are, it exposes you to negative outcomes. The corollary to this is if you’re in pain or get hurt, go to the hospital immediately. It’s inconvenient but if you do that you maximise your chances and wholly remove the path where you don’t realise how serious an injury it is and don’t seek help when it could be fatal.

3. Risk is real. The obvious companion to the previous one is to make big impact low effort decisions to reduce your risk surface area. What that means in practice is use a seat belt, wear a helmet, don’t smoke, don’t do drugs, have health insurance. Life is too fragile to fuck it up doing dumb shit. Especially when those things are addictive and they can hook you from the very first try. It doesn’t matter how cool you think you are, smoking is literally inhaling poison. Don’t ever start on them.

3. Limit exposure to disease and infections. Don’t unnecessarily expose yourself to forces beyond our control and understanding. One big category of that is disease. Even if we know how to treat a disease in Australia, doesn’t mean that same knowledge and medicine can be equally applied on the ground in Africa. Humans have worked really hard for many generations to build functioning cities with excellent healthcare. Being close to these hubs naturally improves longevity because of the quality of healthcare and knowledge that builds up around them.

4. Don’t fuck with addictive substances. Because overcoming addiction is exceptionally difficult and even if you do, often the damage is already done and there’s nothing you can do about it. You were doomed from the very first time you tried it. So if you avoid that very first time, you will avoid the problem entirely. Peer pressure, friends doing it, wanted to try the high, none of these are good enough reasons to get on the addiction escalator. Wilfully ingesting poison isn’t cool.

5. Existence isn’t guaranteed. Take small precautions with big results. One of the things these stories have definitely broken for me is the belief in the continuation of existence. Every day when you wake up, you take for granted that you will continue to exist. But suddenly I’ve seen that chain of continuation be broken a number of times. A lot of people I know and loved now have woken up one day and stopped existing. And that scares me to think it’ll happen to me someday, possibly unexpectedly and randomly. What can I do to prevent this from happening is the hope that by recognising the moments when a key decision can change an outcome, to make the right decision.