CHAPTER 1
From a Wide Angle
A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.
âRobert A. Heinlein, Time Enough for Love, 1973
When you meet Thomas Fogarty, the cardiovascular surgeon who invented a medical device called the balloon catheter, he has a wry twinkle and the affability of someone who has, since 1978, owned a winery in Northern California. He is not one of those wiry surgeons who appear to run ten miles each morningâalienatingly healthy and otherworldly in equal measure. He speaks in an Ohioan accent with wide-open Aâs and a cadence as simple and percussive as a one-drum musician in the New York City subway. It makes much of what he says sound like a punch line.
This is fairâDr. Fogarty is a pithy man. He possesses a childlike ability to see things as they are while also trying to make them better, as observant of the broad design challenges of modern medicine as of any single device. He speaks like a doctor, that subset of the population who can say, âHe died of cancer of the rectumâ the way someone else might say, âIâm going to the store to buy oranges.â Heâs not unfeelingâitâs his own father who died that way, when Fogarty was in grade school. He had already seen his father taken away to an asylum, straitjacketed, when Fogarty was about five.
Dr. Fogarty is part of that elite and dubious club of people who did something big in their youthânot the captain of the football team who threw the game-winning Hail Mary pass but a badly behaved, resourceful kid who invented a medical device that opened up the world of noninvasive cardiovascular surgery and that still saves three hundred thousand lives each year. Fogartyâs story springs from what I call a âwhole lifeâ approach. His insight came not from separating his work life and his leisure time, but from a wide-angle view toward the combination of both.
Growing up in the 1940s and â50s, Fogarty was never in terrible trouble, but he was a self-proclaimed juvenile delinquent who had to be either busy or supervised. When the teacher wasnât looking, he would jump out of the window to go fly-fishing. Not knowing where he had gone, his teacher would call his mother at her job, where she supported three kids by working at a dry cleaners, what Fogarty called âa sweatshop in every sense of the word.â So, in the eighth grade Fogarty got a job at the Good Samaritan Hospital in Cincinnati, Ohio. The sole reason he went to work there was that hospitals were exempt from child labor laws. He was only thirteen.
Fogarty started as a dishwasher in Central Supply, cleaning out stomach pumps for eighteen cents an hour. The cleanup job was so grim he invented a new dishwashing agentâmade from green soap, ether, and baking sodaâto cut the time in half. Much of the life of the hospital passed through Central Supply, providing Fogartyâs Venn diagram brain a chance to build up a mental encyclopedia of usable formsâa certain shape of scissors used in gastric procedures that could, if scaled down in size and changed slightly in angles, be used for eye surgery. Fogarty was observant, and the doctors let him sit in on a lot of things. By the time he was fifteen he had seen two autopsies. âThere were a lot of things you just learn without the intent of learning. You just make an observation and say holy cow.â
Already, Fogarty had a synthesizing mind and an impatience with a lack of action. He wanted to do things. Around the age of fifteen, Fogarty became a scrub technicianâan assistant inside the operating roomâfor a surgeon named Jack Cranley. Dr. Cranley had ten kids. Fogarty essentially became the eleventh. One of the main procedures in Dr. Cranleyâs surgical practice was the removal of blood clots. To retrieve a clot, a surgeon would have to make an incision the length of the blocked artery and open it up in its entirety. Sometimes patients died or had to have limbs amputated. Those who healed often bore long scars on their chests or legs. â[T]heyâd do an operation, which would take about eight hours, and then one or two days later, the patient would be back in the operating room, having his legs cut off. When you see that repetitively, you say, âThere has to be something better than this.ââ
Fogarty had always been a tinkerer and entrepreneur. As a child, he built soapbox cars and model airplanes so good he sold them to neighbors. He bought the model airplane kits for eighteen cents and sold the finished planes to other kids for seven or eight dollars. He was his motherâs personal handyman, fixing anything she asked him to.
Fogarty even worked part-time in a motorcycle repair shop that mainly serviced scooters. The manual clutch on a scooter had a problem when you dropped into a low gear: â[I]f you were going up hill, youâd lurch forward and suddenly find a certain part of your anatomy on the street, with the scooter about ten yards ahead of you. My idea was to smooth that transition. . . .â Fogarty and his friend invented the predecessor to the centrifugal clutch that is still in widespread use today. They wouldnât profit financially from the invention because the garage owner had a claim on their intellectual property through âshop rights,â something Fogarty would remember. (Later, when his mentor, Dr. Cranley, advised him to get an intellectual property attorney, he listened.)
Blood clots were a problem far worse than landing on the seat of your pants off the back of a scooter. Dr. Cranley challenged Fogarty to find a better solution, and so the scrub technician started experimenting. He was working with a urethral catheterâa piece of vinyl tubing like a tiny garden hoseâand the single pinky finger of a number-five latex glove.
He wanted to build a device that could, in a compressed state, be threaded through an artery past a blood clot and then expanded to rake a clot back, pulling it out through a single, much smaller incision. âI think I tried two or three other things that didnât work, but the minute that idea came to me, it was pretty clear it was going to work.â
By 1959, Fogarty was in his fourth year of medical school tinkering with the balloon catheter in his attic. He had just decided to become a heart surgeon. (As he explained it: â[Cardiologists] certainly do a lot now, but all they did then was read EKGs and pronounce people dead.â)
He imagined what the balloon catheter would look like, but his key challenge was that no glue of the late 1950s and early 1960s would make latex and vinyl adhere. Fogartyâs breakthrough was to tie the device togetherâwith the fly-fishing knots he learned while cutting school. âIâd always tied flies and made lures so it was just a natural thing.â
And so it turned out that a device that is still in use todayâsaving more than 20 million lives or limbs since it was introducedâcame into being not from specialized expertise or a large pharmaceutical lab, but from a Huck Finn propensity for jumping out of windows to go fishing during school and an imaginative leap from the domain of fly lures to the design challenge of adhesion.
The idea of a whole-life approachâthat your work and your leisure are not always separate, that necessity and luxury sometimes cross over, that the whole accounts for the success of the partâopens up broad questions about pathways to progress and habits of creative work. Thinking about your life as a whole ecosystem is the first step.
THE OBJECT AND THE ENVIRONMENT
In his 2005 commencement address at Kenyon College, the writer David Foster Wallace told the story of the fish:
There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, âMorning, boys, howâs the water?â And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, âWhat the hell is water?â
Economics assumes a world of profitable products. It is a world of fish, not water. Whole-life thinking models the world as the entire systemâtaking into account all of life underwater. The âfishâ can be anythingâa report, a number, a person, a productâseen in isolation, as if it is floating on the green screen of your life. This kind of object-based thinking can lead to an artificial separation of different spheres. It can lead you to judge what is important or unimportant prematurely and to miss out on the times a solution to a problem comes holistically from another area of life.
In his 2003 book, The Geography of Thought, the social psychologist Richard Nisbett recalls the origins of his graduate student Takahiko Masudaâs research. Masuda, a six-foot-two football player, arrived at the University of Michigan, there straight from his native Japan and wildly excited to take in his first Big Ten game. In the colossal and electrifying stadium in Ann Arbor, Masuda was shocked by what he perceived as the rude behavior of the people around them. In Japan he had been taught to âwatch his backââto be mindful of how his location in space affected other people. There in Michigan, fellow fans were standing up right in front of him with no awareness that they were keeping him from seeing the game. Masuda designed an experiment to see if he could isolate this cultural difference.
Masuda hypothesized that Eastern and Western audiences simply perceived the world differently. The Eastern view held up a kind of wide-angle lens of looking out for others and noticing the context; the Western view focused a kind of tunnel vision from the point of view of the actors themselves, the context taken as given. To test the hypothesis, Masuda gathered two groups of students, one from the University of Michigan, the other from Kyoto University. He developed eight animated scenes, each about twenty seconds, of life underwaterâreplete with fish, plant life, rocks, and bubbles.
In each scene, at least one âfocalâ fish crossed the screen bigger, brighter, faster, and more colorful than the others. After showing the individual research subjects the animations twice, Masuda asked the students to describe what they had seen. Both American and Japanese students homed in on the focal fish, mentioning them a roughly equal number of times. But the Japanese observers also made twice as many comments about the relationship of the focal fish to the background elements and, in fact, mentioned the background elements 60 percent more frequently than did their American counterparts. Americans were three times as likely to begin their description with the focal fishââThere was a big fish, maybe a trout, moving off to the left.â The Japanese were more likely to begin by describing the overall environmentââIt looked like a pond.â
In an object-based world, if you were shown a picture of the ocean below the surface, you might name a fish or an anemone, or a shark. In an environment-based world, you might describe the whole ocean. Profitability of a single product looks for the single focal fish. Sustainability and overall health takes in the whole environment. Creativity often does too.
Taking in a wide-angle view of possibility can feel less analytically efficient than just watching the fish. Keeping in mind the whole picture takes energy. In fact, in management consultant parlance, âboiling the oceanâ is a pejorative shorthand for taking an inefficient, unfocused approach. The water is vital; without it, the fish dies. Yet, looking away from the fish can feel risky and off point in an answer-driven and outcome-oriented culture that embraces the 80-20 rule as an article of faith.
The 80-20 rule comes from an observation Vilfredo Pareto made in 1906. He noticed that 80 percent of the land in Italy was owned by 20 percent of the population, and generalized the Pareto Principleâthat 80 percent of the gains come from 20 percent of the effort. This idea that focusing on 20 percent of the work can yield 80 percent of the outcome creates pressure to stay focused. âBoiling the oceanâ is a form of getting the 80-20 rule backward. Yet sometimes the important, world-changing work lives in what initially appears to be the inefficient part. The 80-20 rule helps you to execute well within the known world. But it also makes it harder to see enormous opportunities outside the frame of low-hanging-fruit efficiency, in the lake, not in the trout.
A life like Fogartyâs, where his breakthrough in science came from idle patches of his youth, is a reminder of how much the whole of your life matters. That makes it hard to moralize work as more important than leisure and by extension science as more important than art, or short-term profit as more important than a long-term investment that might at first appear to be fruitless. They are all connected. As Nisbett points out, the word âschoolâ comes from scholeâthe Greek word for âleisure.â The merchant traders of ancient Athens valued school for cultivating their sonsâ curiosity.
The further you get into adult life, the less often you get to indulge your pure curiosityâto swim around in the water without having to get somewhereâand the less often you have to master something truly newâto remember how hard and clunky that process is but also how fast you can learn. Making artâin any area of lifeâcan feel that way.
The question is how to start. How do you set up a process that eventually includes performance evaluation, collaboration with other departments or people, and coordination with structured goals? If you look at all the parts of your life as a landscape with hills and valleys and lakes and towns, the tools come from seeing how the pieces relate. Whole-life thinking begins with managing energy and time and then building in spaceâmental, physical, and managerialâfor exploration, observation, and discovery. Ultimately what you are doing is arranging the artistic composition of your life.
MANAGING ENERGY AND TIME
In their 2003 book, The Power of Full Engagement, Jim Loehr and Tony Schwartz m...
