A Learning a Day

I sprained my MCL a couple years ago. Two things about that experience have stayed with me.

The first: eighty percent of the healing happened in the first week. The remaining twenty percent took another three weeks. Sprains work like so many projects we take on — the first eighty percent comes relatively quickly. The last twenty percent is a different beast.

The second: I was fascinated by how the MCL was invisible to me until it wasn’t. Walking straight was fine. But any lateral movement and the muscle screamed. Even attempting a forearm plank — something I’d never have connected to the MCL — lit it up. I thought about this recently when I sprained my upper calf. Normal walking, no problem. The moment I tried to accelerate or push off, it announced itself loudly.

It never ceases to amaze me how incredible our body is. So beautifully engineered and so intricately interconnected that we barely notice it when everything works together. And the moment one part breaks down, the whole web of dependencies reveals itself.

There’s so much gratitude owed to a body that’s just quietly doing its job. We never think about it — until we have to.

There’s a sequence at the end of Court of Gold — Netflix’s documentary on Team USA’s path to the basketball gold medal at the Paris Olympics — that I’ve watched three times now.

France had cut a fifteen-point lead down to four. Victor Wembanyama was having a great game. The home crowd was starting to believe. And then Steph Curry took over.

He asked Steve Kerr to give him the ball at the start of the play (called “ear tug”). He knew what he wanted to do.

Three consecutive three pointers followed. Then, with fifty seconds left, doubled-teamed and fading back from well behind the arc, he launched a shot that French captain Nicolas Batum described as something only Steph could make from that angle. It went in. Steph turned to the crowd for the first time all night and made his famous sleep gesture — the game was done.

What stayed with me wasn’t the shot itself. It was Steph’s description of the moment. Missing was not an option. He’d made that shot before — thousands of times in practice. When it mattered most, he didn’t think. He trusted his muscle memory and went for it.

Dwyane Wade said it well: big players show up in big moments because they feel the big moment. They don’t run from the stakes — they tune into them. And then they let the reps do the talking.

For most people, high-stakes moments are when their worst shows up. For the best, it’s when their best does. The difference isn’t talent. It’s a combination of the practice reps and the willingness to trust everything you’ve already put in.

I went to bed recently knowing the next day had at least three potential issues waiting for me. One had already made a surprise arrival that evening. Another looked like a tricky conversation. The third could go either way.

I fell asleep with a simple reframe: the job description is to slay demons. If it were easy, anyone could do it. I woke up repeating the same thing.

All I did was create some space in the day to deal with each one separately. And it turned out — one conversation went better than expected, another was a nothing burger, and the third went smoothly.

Three lessons stayed with me.

The first: when things seem difficult, all you have to do is put one foot in front of the other and take action. The results aren’t guaranteed, but you’ll be on your way.

The second: I was reminded of the old saying — I have worried about many things in my life, most of which never happened. It’s so easy to spend energy on things that don’t deserve it. Worry less, act more. Easier said than done — but worth the effort.

And finally, the job is slaying demons. In our own small way as part of our own fascinating tale.

It is amazing how conversations about immigration are conveniently put on pause when immigrants are scoring goals in a World Cup, hitting clutch shots for the city’s basketball team, or winning gold medals at the Olympics.

I recently started building products focused on healthcare affordability in the US. As I was ramping up on a new space, the biggest question that sparked my curiosity was: how did we get here? This question is the inspiration for this weekly series chronicling the decisions, accidents, and breakthroughs that built the US healthcare system.

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By the early 1980s, a quiet crisis had been building in American emergency rooms.

Hospitals across the country were denying medical care to roughly a quarter million patients annually because they were uninsured or couldn’t afford to pay. The practice had a name: patient dumping. Private hospitals refused to treat patients who couldn’t pay. Ambulances were rerouted mid-route if a patient’s insurance didn’t meet a hospital’s standards. Women in active labor were sent to other facilities, even when doing so endangered their lives.

In Dallas, the number of dumping victims jumped from 70 per month in 1982 to over 200 per month in 1983. Physicians at Cook County Hospital in Chicago — the public hospital absorbing the transfers — started tracking what was arriving from private ERs. Of 467 transferred patients: 22% needed intensive care within 24 hours, 24% arrived medically unstable, and 9.4% died — compared to 3.8% of patients who hadn’t been transferred.

EMTALA passed largely under the radar — a four-page bill tucked inside the Consolidated Omnibus Budget Reconciliation Act of 1985. It barely registered until after Reagan signed it in 1986.

The law was simple: any hospital accepting Medicare — nearly every hospital in America — had to screen and stabilize any patient arriving at their emergency department, regardless of ability to pay, insurance status, or citizenship.

It passed with broad bipartisan support. The problem it addressed was one members of both parties found unconscionable. Almost nobody argued against the principle.

What nobody fully debated was the consequence.

The employer-based system covered working Americans. Medicare covered the elderly. Medicaid covered some of the poor. EMTALA, with one stroke, turned every emergency room into a guaranteed safety net for everyone the rest of the system had left behind.

The ER became America’s doctor for the uninsured.

Emergency rooms are the most expensive possible setting for routine care. A diabetic patient who can’t afford $15 a month for insulin doesn’t stop being diabetic. They manage without medication, deteriorate quietly, and eventually arrive in crisis — at a cost that can run into tens of thousands of dollars. EMTALA required the hospital to treat them. It created no mechanism to prevent them from getting there in the first place.

Between 1990 and 2009, ER visits per 1,000 population increased by 18%. Uncompensated care grew from $6.1 billion in 1983 to $40.7 billion in 2004. Those costs didn’t disappear — they were absorbed by hospitals, shifted onto insured patients, or passed back to the government.

EMTALA is one of the most humane laws in the history of American healthcare. People who would have died in parking lots lived. Women in labor received care.

And it became the most expensive patch ever applied to a system that had never decided who it was supposed to serve. Every unresolved question from the posts in this series found its way, eventually, to an emergency room.

The only approach that works long term is to deeply feel the pain of a mistake and use it to change how we operate.

First-time mistakes, especially those that are a mix of painful and fixable, are a part of life.

Second-time mistakes don’t need to be.

We systematically overestimate the amount of context people have about the matter at hand — the decision that needs to be made, the problem that needs to be solved.

Start by ensuring everyone is operating with the same context.

I recently got a traffic ticket for stopping a touch late at a stop sign — missing the line by two feet. Undoubtedly fair by the rule of law, but I felt aggrieved. It was a late brake, a spillover, at 8am on a quiet Sunday street without a soul in sight.

My subjective feelings aside, I noticed my “why me” reaction and sat with it for a moment.

Three years ago, I accidentally drove past a stop sign on a similarly quiet road. The officer was kind, understood it was a genuine mistake, and sent me on my way without a ticket*.

I’m pretty sure I didn’t dwell on that stroke of luck anywhere near as long as I dwelt on this one.

It’s easy to ask “why me” when misfortune strikes. If we find ourselves stuck in that loop, it’s worth reflecting on the many times good fortune came our way — and we never thought to ask the question at all.

*I was clearly due a ticket from a karmic perspective. :-)

Growing up, the game I watched along with my friends was cricket. And there was a familiar story about the Indian team — Sachin Tendulkar, the iconic batsman, would do well all the way to the finals, and then inevitably get out, and the team would fold. It took an entire changing of the guard before India became capable of winning in clutch moments.

It was hard not to see the parallel in this year’s NBA Finals between the Spurs and the Knicks.

The Spurs led in the first quarter of every game. Across the series, they outscored the Knicks by nearly sixty points in first quarters. And yet the Knicks won four out of five — because when it came to the second half, and especially the fourth quarter, they were a different team. By Game 5, down ten in the fourth, they went on a ten-nothing run and it felt inevitable. You just knew they were going to come through.

The Chicago Bulls had the same journey. Years of being unable to get past the Detroit Pistons before they finally summoned the ability to rise to the occasion.

There are really only two things that build clutch. Practice hard enough that it becomes second nature. And learn to embrace the big moment rather than shrink from it.

We don’t face NBA Finals. But we face big meetings, big weeks, big decisions. And in the long run, the ability to show up in those clutch moments that add up.

The difference in our perception of people we love is that we assume good intent. Every quirk, every friction — we interpret it charitably.

The wider we expand that circle of assumed good intent, the more likely we are to find community wherever we choose to spend time.

And it’s why love is a verb. Especially in relationships that have lasted a long time, it’s easy to forget to choose it. To fall into patterns where all we see are the quirks, all we feel is the friction. Reminding ourselves of the intent takes real commitment.

It is why it takes commitment and character to consistently choose to love.