Choices you make

After my first heart attack, I became conscious regarding my health and started regular medical checkups. When someone told me to include Lipoprotein A in my blood test as a marker for heart, I added LP (a) in the list. When I received report from my Path lab, my LP (a) was close to 50 while 20 was the upper limit. A high LP(a) of 50  meant that my heart was at a very high risk.

I met my doctor regarding this concern. My doc went through the medical records and prescribed Nicotinamide that will reduce my high  LP (a) levels. I remember when I had the first tablet of Nicotinamide, my body had a heat flush and for couple of minutes I thought I was in a steam jacuzzi. I googled on nicotinamide and found that while it was good to reduce LP (a), it could cause serious damage to the kidneys over a long run. I called my doctor immediately.

“Well Dr Modak, we have to make a choice between your heart and the kidneys”. I would rate your life risks to heart much more than the kidneys. We can manage kidneys later but for the next 5 years, let us work on your heart”. Although doctor was a good friend, I heard him like a dispassionate analyst – saying things as matter of fact.

I decided to research more on LP (a). I didn’t take Nicotinamide. I found that changing lifestyle could lower LP (a). This meant eating healthy and in time; sleeping well; doing exercises regularly and living just for the day i.e., manage the stress by not remembering past and unnecessarily worrying about future.

After 3 months of changing the lifestyle, I got my LP(a) tested once again. To my surprise, LP(a) had dipped to 9!. I went to see my Doc with a triumphant face. He was very happy to see my results. As I was about to leave his chamber he said “Dr Modak, all good now. Continue this lifestyle. But by the way, recent research has indicated that LP (a) is no longer a definitive marker for cardiac health. So don’t take LP(a) values seriously”. I was astonished to see that the very basis of making a choice was no longer valid.

Well, the episode taught me that life is about making choices. You have to decide which way to go. Making a choice can be a risk. Your risk appetite matters.

Many of us have been lucky to make choices in our careers. But there are several who don’t have that luxury. We make career choices based on our own liking, sometimes based on self-assessment of our capabilities, based on advice given by someone whom you respect, and many times based on financial and social considerations and constraints. Exceptional are those who think independently, are open to change and are rather adaptative, and in some cases even nomadic. They wander around in their careers till they realize their mission in life. One of the reasons, I love meeting with people and especially the youngsters is to learn about the choices they make in life.

Years ago, in 1990,  I remember I went to see an old friend in Virginia in the United States. He worked for SAIC. I saw him sitting outside the cabin of the big boss. We had lunch together and I could sense that he was very much respected and adored by his team. When I went to see his “big boss”, he spoke about my friend so warmly and said that he is the anchor of SAIC’s regulatory business. It was 5 pm when we finished our meetings. Sam (my friend) excused us and said that he will need to leave the meeting now as he has to be at the tennis court. The big boss and the team let Sam go. “Sam has his own life and we respect”. The big boss said.

In 2000, I went to SAIC to meet Sam as I was in Washington. I saw Sam sitting on the same desk as I saw him last time. I peeped into the glass door of the “big boss”. I saw some other face.

I told Sam that I was expecting him to be sitting inside as the “big boss”. Given his competence, popularity in the SAIC team, he certainly deserved the promotion. Sam did not reply. He just smiled and invited me for lunch with his colleagues.

I was really surprised why Sam did not get promotion. It must be so demoralizing I thought.

In the bistro, when Sam walked to the counter to get some beers for us, I couldn’t resist asking this question to John, his colleague.

“Oh Dr Modak, that’s not the case. Sam was approached by the management many times to take over the unit and become the “big boss”; but each time Sam turned down the proposal”

John saw my intrigued face. He added “Sam told us that he was happy to be No 2 in the organization because he could live life the way he would like to. No revenue targets, no administration and no politics. Sam hates all this baggage that one has to carry as the “big boss”. Today, Sam continues to get all the respect. And his appointment at 5 pm at the tennis court is never questioned”

So, that was Sam’s own choice. Was it right or wrong from his career perspective? – I wondered.

I told such stories to my Professor friend. He heard me patiently as usual.

“Dr Modak, let me tell you a story that I witnessed”. He lit his cigar.

Professor was with one of the well known astrologers. Every prediction that the astrologer made was accurate. This gentleman who looked like an old sage didn’t charge for his predictions and was away from any publicity. Everything about him was discreet. He lived in a small town in north India. Professor’s interest was to research how the astrologer could make accurate predictions based on study of the horoscopes.

There was a case of a young man who had fallen in love with a girl and had promised to marry her. He was there to show his and his fiancée’s horoscopes. His family has forced him to meet the astrologer to get his “clearance” and blessings.

The astrologer looked at both the horoscopes. He scribbled some calculations on referring to some tables that had positions of the planets. His face became serious.

“Well gentleman, you have a difficult choice to make. If you marry this girl, then your children will have serious health issues and in fact one of them may not live long. And if you let her go, then she will probably have a better life with someone else and you too. So, in the interest of both, I would recommend that you should not marry this girl”

I was now curious to know what the boy replied to the learned astrologer.

Professor did not answer and got up extinguishing his cigar.

When I insisted, Professor completed the story.

“Dr Modak, the boy did not budge. He said he had given his word. He married his fiancée and kept astrologer’s prediction a secret.”

“Dr Modak, we checked subsequently and found that astrologer’s prediction was indeed true. The couple did face challenges on the front of their children, lost one child. They faced these challenges bravely – and together.

Despite the odds, they are a happy couple today.

So hard was the choice. I wonder whether the choice was right. If you used the concept of greater good then the boy and the girl would have perhaps lived a better life with their partners. But then I leave it to you to decide whether the choice was right.

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