Setting the scene

There’s probably one in many good-sized organizations… “that guy.” Well, Chris has always been “that guy.” He has always been the odd man out, marching to the beat of a different drummer. He cares about different things, and does things differently to everyone else. It’s not always a bad thing, but it means that Chris is not representative of most Navy officers I’ve ever known.

Also, submarines are very strange places to work. Pack 130 men into a very small space for six months. Then mess with their body clocks by having them work on an 18-hour day (compared to a rational 24-hour day), with six hours on-watch, six hours training/maintenance, and (hopefully) six hours sleep… constantly changing so you never feel fully awake or (sometimes) even fully tired. The norms of human behavior just change when you’re out at sea.

When you’re confined for so long you get bored easily, and the way to be entertained is simply to fuck with people. You’ll do anything to get a reaction out of someone. Once you get that reaction, you know that whenever you get bored you can do the same thing and get the same reaction. Two of the most common ways we would use to get reactions from each other would be by playing off of fears of homophobia and general bad taste. In other words there was a lot of “grab-ass” and disgusting stories (and pornography); all of it to try and get a reaction from other guys on the boat. (Most everyone was immune to the usual “your mom” insults.) As long as you didn’t react you were fine; guys would stop trying and find other things to eliminate boredom.

I explain all of this because Chris just didn’t quite seem to fit in that kind of environment, and also didn’t recognize that people were fucking with him only because he would react. (And it appears that the same problems of not fitting in occured in Iraq, where run-ins with his superiors in Baghdad ended up getting him transferred to another command.)

Melodrama

Most importantly, only think of reading this book if you’re comfortable with melodrama. Below is quite a long quote, but I think it describes exactly what I mean:

Around the base of the statue [in France], the names of various writers, philosophers, and mathematicians from centuries past are inscribed. The names are those of giants like Descartes, Renoir, Sartre, Curie, Fourier, Newton, Shakespeare … every one a genius—someone who had changed the world! As I read the small chiseled names, it occurred to me that the names had been added after the statue was built; it was a work in progress! Encircling the monument, I realized with a sense of amazement that fully half of the space was left blank for more names to be added!

A sense of awe gripped me as the weight of that empty space set in, for in that blank space lay faith in the capacity of mankind—the most powerfully humanistic statement I had ever seen. A tear came to my eye as I stared at the beautiful emptiness of those bronze panels, wondering whose name would come next and what extraordinary thing that person would have accomplished. Then, just as quickly as this audacious faith in mankind had gripped me, the emptiness of another monument seized hold and dragged me down. My spine tensed, the hair on my neck stood on end, and I imagined myself standing once more at attention in the central rotunda of the Naval Academy. On the large memorial to our fallen alumni, several new names had appeared since my graduation, yet the vastness of the empty space seemed unchanged. On that massive wall with movable plastic lettering, the emptiness had become the most salient feature. I realized with a sense of horror that my life had been a pursuit of that emptiness. Until that point, I had struggled to control the things that would prevent the names of my classmates from appearing in that unbearable space. My faith in those white plastic names had dignified my pursuit! But at that instant, I realized that my quest had been hollow because of what lay within the emptiness of that godforsaken wall.

Instead of faith in the capacity of mankind, that emptiness chanted in an austere, commanding tone the insidiously pessimistic dogma War will never end … War will never end! WAR WILL NEVER END!!! “SHUT UP!!!” I shouted in anger at the cold, blackened wall. My voice echoed in the hall as though I were standing alone within a canyon. Suddenly tears were streaming down my face, my fists were clenched, and I howled, “I will not follow you anymore! You can’t have my life!” I sobbed, exasperated and purged. The albatross that hung from my neck broke loose and fell into the sea. I knew what sort of monument I wanted my name to be inscribed upon, and that knowledge carried me forward with a newfound sense of hope.

If you managed to survive reading that quote, you see exactly what I mean. If you couldn’t survive reading that quote, I would avoid the book.

Cheating in the Navy & on the Hartford

The biggest controversy to come out of Chris’ book was his accusations of wide-spread cheating on the Hartford. Overall, this is absolute horseshit. I don’t ever remembering receiving answer keys to any of my nuclear exams before the exam. And I’m pretty sure I passed mine on the first try.

What I think happened is that other guys on the boat recognized that Chris was struggling with the exam. (The book mentions it took him five times to pass it!) The choices for the Navy then are to either kick Chris off the boat and off of submarine duty, or to help him pass the exam so he can at least be evaluated in the context of actually doing the job. Some guys just aren’t good test-takers, but are solid nuclear plant operators. It appears that while Chris could barely pass a test and couldn’t lead a watch team, he could operate a reactor plant safely. In my mind, that’s much better than washing someone out of submarines, wasting a lot of the Navy’s time and money, when it wasn’t really necessary.

Chris extrapolated this to believe that everyone on the boat was receiving exam keys and cheating. That’s certainly not something I ever witnessed. What he experienced was someone who was a bit of a rock getting help. And after doing so, he proved that he could actually do the job.

Were the exams too tough? Possibly. But if that’s the case, I don’t blame the boat, I blame the Navy’s nuclear community and Naval Reactors for putting into place a system that sets unreasonable standards. Was it too each to cheat if you wanted? Yes, but unless the Navy develops Navy-wide exams and hold exams that are proctored not by the boat but by the squadron (the commander of ~5-6 submarines) the current system is the best there is.

Other Hartford stories

Did pressurized septic tanks spray in the galley? Yep, it happened. (Though it’s not as bad as it seems.)

Did Chris have some legendary run-ins with the crew? Oh, yeah. Perhaps the most legendary was the one he describes in Chapter 1, where one of the enlisted guys in the engine room wagged his genitalia near his face when Chris was leaning down to read some electrical meters. It was early in Chris’ tour on the boat and as he writes in the book, “I completely lost control.” That set the tone for a lot of his interactions with the crew for as long as I was on board.

At one point in the book he described how he had to call the senior enlisted supervisor into the engineering control room to enforce discipline. If you know how to lead a watch team, that never needs to happen. (You also learn what’s serious, and what is people trying to fuck with you, and how to ignore the latter.) You earn the respect of your team, and it sounds like Chris had difficulty with that.

Iraq

The problem I have with Chris’ description of his time in Iraq is that I’ve already read “Imperial Life in the Emerald City” and “Fiasco”. (Both of which I highly recommend, by the way.) He does capture the daily inanity of working as a junior officer on a major command staff, but a lot of this part of the book was a bit boring because it was just from his single-person perspective. It’s more personal, but very limited.

If you read “Imperial Life in the Emerald City” or “Fiasco” there are a lot of stories and perspectives from people across the government and military, and they are woven together into a compelling story that’s really powerful. Chris’ story is interesting, but doesn’t really add anything to the body of work about how screwed up the Iraq war had gotten.

Summary

Part of me really liked this book because it brought back a lot of memories of my time on the Hartford. Thinking back, this was a very formative period in my life, and it’s pleasant to revisit (some) of those memories.

But mainly I was really frustrated reading this book, because it reflects the perspective of an oddball outsider. In the grand scheme of history it might be useful for family history to be written by the black sheep of the family, but it doesn’t do much for accuracy of that family history. Those of us who were there know how to filter the author’s offbeat perspective and understand what’s behind it, but for any other reader it’s just not what I would call an full version of the truth.

It has been shown in an extensive world-wide study that a simple checklist used in surgery cuts infection rates, cuts death rates, and saves costs. It does all of these by substantial margins, everywhere they’ve been implemented. But so far only a minority of hospitals (Dr. Gawande mentioned 10 percent) have started using the safe surgery checklist, or any others, for that matter.

Yet today, the New York Times has an article titled “Results Unproven, Robotic Surgery Wins Converts.” Here are the most important quotes:

But robot-assisted prostate surgery costs more — about $1,500 to $2,000 more per patient. And it is not clear whether its outcomes are better, worse or the same.

[...]

Last year, 73,000 American men — 86 percent of the 85,000 who had prostate cancer surgery — had robot-assisted operations, according to the robot’s maker, Intuitive Surgical, the only official source of such data. Eight years ago there were fewer than 5,000, Intuitive says.

[...]

[O]nce a hospital invests in a robot — $1.39 million for the machine and $140,000 a year for the service contract, according to Intuitive — it has an incentive to use it. Doctors and patients become passionate advocates, assuming that newer means better.

[...]

And the robot is slow; it typically takes three and a half hours for a prostate operation, according to Intuitive, twice as long as traditional surgery.

So in this particular kind of surgery, a majority of surgeons quickly take up a new technology that has yet to show it can provide any sort of benefit! The same procedure is now slower and much more expensive. And the same doctors are resisting adopting a simple checklist (for little to no cost) that conclusively show improved results.

Not to make too much of a political situation here, but our health care system is clearly a mess. Doctors clearly don’t always know what’s truly important for their patients. I’m not saying surgeons shouldn’t use robots, but exhaust the easy, cheap, and conclusively better tools first! Use a damn checklist!

The result?

In one hospital:

• 10-day infection rate went from 11% to ZERO
• Prevented 8 deaths
• Saved $2million in costs

Across ICU’s in Michigan:

• In three months cut infections by 66%!
• Typical ICU cut infection rate to ZERO
• In 18 months, prevented 1500+ deaths
• In 18 months, saved $175,000,000

These are amazing results, and his book on checklists, “The Checklist Manifesto,” was recently published. Click below to order it from Amazon.

This book is inspiring, educational, engaging, riveting and fascinating. It’s extremely well-written, and is a fairly easy read. I’ve never written a blog post immediately after finishing a book, but I am now because not only is it GOOD, but this book is IMPORTANT.

Dr. Gawande led a huge study of a “safe surgery” checklist, a simple set of steps to be checked in each surgery. It was used and studied in eight hospitals: four in the developed world (US, UK, etc.) and four in the developing world (Tanzania, New Delhi, Jordan, Manila). Thousands of patients were studied for months before and after checklists were implemented. The results?

• Rate of complications fell by 36%
• Deaths fell by 47%
• Infections fell by nearly half
• Even in advanced hospitals in developed world, complications were decreased by one-third

I mean…. WOW! Cutting infection rates and death rates in surgery by half (with marginal differences between developed and developing countries) is simply incredible.

But here’s a choice quote from the book:

Take the safe surgery checklist. If someone discovered a new drug that could cut down surgical complications with anything remotely like the effectiveness of the checklist, we would have television ads with minor celebrities extolling its virtues. Detail men would offer free lunches to doctors to make it part of their practice. Government programs would research it. Competitors would jump in to make newer and better versions. If the checklist were a medical device, we would have surgeons clamoring for it, lining up at display booths at surgical conferences to give it a try, hounding their hospital administrators to get one for them – because, damn it, doesn’t providing good care matter to those pencil pushers?

Checklists are powerful, and not just for surgery. Gawande writes about data from investment managers and venture capitalists that shows that those that use checklists are much more successful than those that don’t. They’ve been used in aviation for 70+ years, ever since airplanes became so complicated as to be dangerous without checklists. The modern construction industry uses checklists to ensure their projects are safe and properly constructed.

I’m very familiar with checklists; operating a nuclear reactor in a US Navy submarine means you live with checklists in everything you do. But I accepted it without too much thought since we had no idea there was any other way of running such a complicated machine. It’s amazing to me that other complex professions don’t also use the same procedures.

Checklists are threatening to many people and professions. Using them implies that professionals don’t know what they’re doing, that they don’t have the ability to do their jobs. Even with the results described in surgery above, many surgeons still don’t use them. (Despite the fact that they continually prove to save patients’ lives, everywhere.) As Dr. Gawande describes above, if the same results were achieved through a pill or machine, doctors and hospitals would be racing to adopt them!

Dr. Gawande goes into real detail not only in what makes a good checklist and how to develop them, but also why they work. They work by simply making sure that key simple steps are accomplished, and by freeing your brain from concerning itself about the easy stuff (since the checklist will catch anything you miss). This frees the brain to think about the hard stuff, and able to deal with complications more directly. Good checklists also make communications easier, so that when things do go wrong, the experts involved can address them more directly.

Fundamentally, time after time, in study after study… checklists WORK.

Summary

This is a hugely important book, and I honestly can’t recommend it more highly, It doesn’t matter what industry you’re in, if you deal with or manage complexity, you NEED to read it.

If you want to efficiently improve your performance or your teams’ performance quickly and substantially, a checklist is your way to do it.

For those people that are reading this and have yet to take the GMAT, I have just a couple of simple tips for hacking the GMAT.

However, before all that, are you aiming to get into a top-tier school? Get a 700+ and you’ll be setting yourself up for success. You can certainly still get into top schools with significantly poorer scores. In fact, I’ve heard of a student who got into a top school with a GMAT score in the 400′s. (What happened in that case was the GMAT wasn’t at all consistent with the person’s CV/resume and work history. The interview clearly showed that the GMAT was an outlier; the person turned out to be a superstar.)

That said, the higher score you get the easier it is for schools to accept you.

Tip 1 – Challenge yourself

My first and most important tip is to really challenge yourself. If you really want to kick ass on the GMAT, forget 90% of the study books out there. Those are written for people who want to do above average on the GMAT, not kick ass. If you want to get that 700+, only go for the books that are trying to get you the mythical 800. Kaplan GMAT 800 is the book that I used.

Why do this? Well, instead of picking a representative sample of test questions, it only focuses on the really difficult questions. This is what you need to get comfortable with and master if you’re going to hack the GMAT. Forget your other study books; focus on the ones that challenge you.

Tip 2 – Prepare your body and mind

The second and final tip is to be very careful in the days before your exam. Get good sleep, and not just the night before the exam. Make sure your head is in the right place by getting good sleep consistently for a few days before the exam. Whatever you do, don’t be stupid and try cramming so much that you lose sleep the night beforehand.

So that’s it… my tips on how to Hack the GMAT. A good score won’t guarantee you entry, but neither will a bad score necessarily prevent it. But the better you can do, the easier it is for your chosen schools to accept you.

I’ve found it a great little book to keep with my bag as I ride the Tube into work. There are a lot of short but important thoughts that help remind me of what’s important in life and what I really need to be focusing on.

To be fair, it’s also clear it was written over 2000 years ago, so certain bits aren’t very applicable. Some of it is on the metaphysical side, some on the nature of physics, etc. But so much of it is a leader meditating on how to be a better person, and still rings very true today.

I’m going to periodically post quotes from this book; things that I find interesting or important. Perhaps you’ll find them as intriguing as I do!

Today’s closing quote:

Claim your right to say or do anything that accords with nature, and pay no attention to the chatter of your critics. If it is good to say or do something, then it is even better to be criticized for having said or done it. Others have their own consciences to guide them and will follow their own lights. Don’t be gazing after them, but keep your eyes on the straight path ahead of you, [...]

-Meditations, Book Five, #3

The Nine: Inside the Secret World of the Supreme Court

I bought “The Nine” a number of months ago as I browsed in a Washington DC bookshop. I’m fascinated by the Supreme Court, though I have zero interest in becoming a lawyer. (While I don’t have any irrational hatred of lawyers at all, it’s just not work that suits me.)

This book goes into really interesting detail about all of the recent Supreme Court justices. They each have really interesting personalities and approaches to the law. The book does a great job of really rounding out their personalities, with both positive and negative elements. But a couple of justices just don’t come out looking so well… Thomas and Kennedy in particular. Kennedy seems to be quite a shallow person, and interested largely in his image. Thomas comes off as a man obsessed by his critics, and quite isolated professionally.

Strangely I found myself fascinated by David Souter. He’s a man who seems very defined by his home state of New Hampshire. A life-long bachelor who still lives on the family farm/homestead, doesn’t use a computer or the internet, writes with fountain pens, and allegedly never even plugged in his television! (He wasn’t in attendance for Chief Justice Rehnquist’s funeral simply because no one could get in touch with him in time.) But underneath those personality quirks, he comes across as deeply devoted to judicial principles and stability, so much so that he seriously contemplated resigning after the debacle of the Bush vs. Gore decision in 2000. His role in landmark decisions such as Planned Parenthood vs. Casey is explored in much more detail that I have seen elsewhere.

What I found most interesting in the book was the balance of power issues, and how various blocks of justices come together to hash out agreements on opinions, and the diplomatic tactics used within the Court to make that happen. It’s really fascinating, and could itself serve as an excellent study in organisational dynamics.

Unfortunately the core of this book ends around the death of Chief Justice Rehnquist and the retirement of Sandra Day O’Connor. While it covers Samuel Alito and John Roberts, there’s little detail there as they had just gotten to the Court as the book was finished.

Overall, I highly recommend it!

Imperial Life in the Emerald City: Inside Iraq’s Green Zone

Most recently I read Imperial Life in the Emerald City. This book blew my mind! If you are at all interested in what the hell went wrong in the Iraq occupation, you MUST read this book. It’s only after this that I began to understand how many different ways the United States screwed up the aftermath of the original invasion.

This book details the year and a half or so at the end of the Iraq invasion and the beginning of the occupation; particularly the Coalition Provisional Authority. If the stories that the author tells were in a fiction book, it would be high black comedy. Unfortunately, they’re all true.

The crux of the problem that the author describes is an unyielding ideology. People weren’t selected because they would do an outstanding job; they were selected to go to Iraq because they had excellent Republican/neo-conservative principles. (Those that were extremely qualified but not reliably conservative were often prevented from these jobs.) This led to such things as a 24-year old recent university graduate (with no background in finance) being put in charge of getting Baghdad’s stock exchange up and running! WOW!

There are so many excellent vignettes of complete incompetence, but also of extreme competence trying to do their best in the environment of incompetence. It was a great read from beginning to end.

A while ago I read about this absolutely INCREDIBLE new bookstore in the Netherlands. (H/T to John at Brand Autopsy.) An old (essentially unused) church in the heart of this city was turned into the most incredible bookstore you’ll likely ever see.

The building hadn’t been used as a church for years. In more recent times it had been used for bicycle storage, of all things, which seems like an inappropriately poor use for a building of that significance.

Well, a bookstore has now moved in and really done a good job of melding a bookstore into the space and beauty of a good-sized cathedral.

These photos are fantastic.

[UPDATE]- More photos on the BLDG BLOG here.