EPILOGUE

THE ULTIMATE RISK

“Never test the depth of the water with both feet.”

—Warren Buffett

HEALTH CRISIS

Facing the ultimate risk keeps life in perspective.

Back in the 1940s and 1950s, doctors were like gods to us. More than a few of them thought of themselves that way, too. The old joke—“What’s the difference between God and a doctor?” “God doesn’t think he’s a doctor!”—must’ve been born in those days.

Doctors were privy to a vast amount of knowledge that was unavailable to the rest of us. Often they literally held the power of life and death in their hands. So it was natural, even comforting, for us to assume that there was a gulf of knowledge between doctors and ordinary mortals. Only with the advent of 24-7 medical databases and chat rooms on the internet have patients started to balk when a doctor tells them what to do—without deigning to explain why.

We’ve taken a healthy new level of interest in our medical care in the last two decades. About that time, I began to think critically about the quality of my health care. Since my dad, his brother, and some of his sisters had died of strokes, I started out by investigating my own vulnerability. I used a cardiologist as my family doctor. I didn’t realize that his training wasn’t as broad as what I needed.

At age sixty, I made an appointment with a general physician. In the course of his examination, he casually asked, “How often are you getting colonoscopies?”

“What’s that?”

He blanched. “You should have been getting them since you were fifty!”

When I asked my family doctor about it, he pointed out that my insurance would only pay for a simpler procedure called a sigmoidoscopy.

“How accurate is it?” I wanted to know. “What is the likelihood that this procedure can detect any problems?”

“Eighty percent,” he admitted.

“That’s not good enough for me,” I scoffed. “I’d never invest in such bad odds.”

The doctor sent me down the hall to his partner, who was a gastroenterologist. When I explained that I was sixty and had never had a colonoscopy, he recommended that I settle for a sigmoidoscopy, too.

“If I have a problem, what’s the likelihood that it would detect it?”

“Sixty-seven percent,” he sighed. “We used to think it was 80 percent!”

I scheduled a colonoscopy.

“Your insurance won’t pay for it!” the doctor warned, but I did it anyway.

When I awoke from the colonoscopy, he told me, “Congratulations! We found and removed a precancerous growth. So your insurance will pay for it after all!” I almost hit him.

Next on my list of potential genetic proclivities was cancer. I had lost my beloved grandmother to cancer. Since prostate cancer is the most common cancer in American men, after skin cancer,1 I asked my physician about taking regular prostate-specific antigen (PSA) tests.

In the mid-1990s, PSA tests were painful and not nearly as accurate as they are today. False positives were common, and they resulted in regular, painful, and perhaps needless exams. So my doctor recommended against the test. Still, I figured that I’d rather take unnecessary, painful exams than discover too late that I had prostate cancer. So I started looking for a doctor who was willing to give me regular PSA tests.

Luckily, I found the great Dr. Jim Puffer, an international authority on sports medicine who had served as the head physician to American Olympic teams. When I met him, he was the chief of the division of sports medicine in the Department of Family Medicine at the UCLA School of Medicine. I was grateful to have him as my doctor until the time when he moved to Kentucky to become president and CEO of the American Board of Family Medicine, the organization that supervises the certification process for all family practitioners in the United States.2 He saved my life.

Jim ordered annual PSAs for me. The first few took place without incident. But in 1999, he said he thought that I had prostate cancer, even though I had no symptoms. He sent me to a specialist, the fabulous Dr. Rick Ehrlich.

The only way to be certain that a cancer existed in those days was to take a biopsy with a needle inserted into the prostate gland at various locations to generate samples. Since some parts of the gland are hard to reach, cancer can escape sampling. Only through the insistence of Dr. Puffer and the relentless patience of Dr. Ehrlich did they, after many months, find the cancer. And it was aggressive.

I was terrified.

To me, cancer meant disability, then death. It was September 1999. I had just expanded my firm with new personnel and larger offices. We had just closed our first investment fund. If word got out that I had cancer, I figured that not only my most crucial investors, but my own employees would want to abandon my new firm! So I educated myself before making any rash moves.

First, I got two additional opinions of the biopsy results. Two of the top cancer treatment centers in the country confirmed the diagnosis. It was an aggressive prostate cancer. I swallowed hard and turned my attention to a plan of action. There were three general options: waiting to see if it got worse, treatment with radiation, or surgical removal of the prostate. (Procedures like radioactive seeds implantation were new at the time and were too unproven for me.)

Next, I studied my alternatives. Rick’s cousin, Dr. Skip Holden, was also an expert in the field. I met with him. He in turn introduced me to an expert on radiation therapy. At each stage, I gathered more information, educating myself about the nature of the problem and the possible solutions.

When I studied the outcomes of radiation therapy, I was shocked at the lack of statistically meaningful data. The main variables were the age of the patient, the grade (aggressiveness) of the tumor, the health of the patient, and the skill level of the people treating the problem. But the data sets were much too small to really evaluate the success rate for different mixes of the variables!

The surgery data was more reliable. Surgery outcomes indicated a small risk of death. In those who lived, the risk of impotence was more than 50 percent, and the risk of incontinence was 10 percent. Neither was attractive.

Then I learned that if I were to choose radiation and it didn’t work, it was unlikely that I could have a successful surgery afterward, because of the tissue damage. Unsuccessful surgery, on the other hand, could be followed by radiation. That made my choice clearer.

As I saw it, having both Dr. Holden and Dr. Ehrlich doing the surgery together gave me a big edge on the skill variable, which would hopefully help me avoid complications. My ever-devoted wife seconded my decision.

I was depressed by my prognosis. But she was her usual amazing self. We had been married fifteen years, and she was an unfailingly generous partner. “Do what’s safest for you. We’ll deal with the results.” And we did.

On a Thursday in mid-September of 1999, I had the surgery. After three days in the hospital, I went home. The next day, I was in the office, smiling at my nervous staff. All they knew was that I had had minor surgery just a few days before and was already back in action.

Thanks to the intervention of Rick and Skip, I had dodged a bullet. Little did I know, I would soon dodge a second one! But in the interim, my life returned to normal and my firm prospered. We raised a second fund only a year later.

About six months later, in April 2000, my PSA level suddenly bounced up to 0.3. The dilemma was that the PSA test wasn’t accurate for levels of 0.1 and lower, but at level 0.3, it represented some risk. Alarmed, I insisted that we use two different labs for tests every six months in order to reduce the risk of lab error.

By late December, however, my PSA was up to 0.6. This meant my cancer had not been contained in the prostate. There was a high likelihood that the cancer would now spread throughout my body, and I would be dead in maybe ten years. I still shudder to think of that moment.

Focusing again on the actions I could take, I started plotting my PSA levels on a graph. Sixteen months later, in August 2001, the level had tripled to 0.9. Yet, even at this level, no known test could determine the location of the cancer cells. Only after they had spread would their strength be high enough to find them, and by then it might be too late for any decent quality of life or longevity.

On September 10, 2001, while living under the shadow of a cancer threat, I spent the day in meetings at the World Trade Center in New York to kick off the marketing for our third fund. Had I booked the meeting for the next day, or stayed nearby instead of flying to Chicago that night, prostate cancer would’ve been the least of my worries. The next morning we were all confronted by the horrifying news of September 11.

Luckily for me, I flew out to Chicago from New York the day before to meet my partner Mark Holdsworth. Early the next morning, our sales meeting was interrupted by reports of the World Trade Center attack. Our next meeting was to have been at the Sears Tower, which was thought to be the next target. That meeting was canceled.

We were expected in Detroit that night, but the planes had been grounded all day and no travel options were available. We asked the hotel to extend us one more night, but they were sold out. New guests were due to arrive, though no one knew for sure, and the current guests wouldn’t leave their rooms. Fortunately, a friend managed to get us into his club, where we had dinner and watched the news.

The next day, we told our car service to drive us to Detroit. We dined in truck stops along the way. No one in Detroit wanted to invest in anything. The US stock exchanges had been closed indefinitely. So we chartered the last private jet left in Michigan and headed home. It was a tiny Learjet with two pilots who appeared to be in their teens. There was no food on board, except the two six-packs of beer we brought along.

We sat glumly in the back of the tiny plane and drank the beer. Before long, Mark, a six-foot-two athlete, rushed to the toilet in the front of the plane. Alas, that toilet had been designed for a dwarf. The ceiling was so low, he couldn’t stand to urinate. Trying to wrench himself around into a good position, he leaped out, faced the front of the plane, dropped his pants, mooned me, then slid back into the toilet sideways. I can still see those two giant, pale buttocks. I roared with laughter for the first time in a week filled with tragedies.

On the trip we decided that, since the climate had become far too uncertain for anyone to consider investing in a locked-up, seven-year fund, we would suspend marketing until early 2002.

Facing my own death sentence, I decided to evaluate radiation again. Radiation therapy consists of shooting high-powered waves into the patient’s body. If the waves are very strong, they damage healthy tissues and organs. If the waves are not very strong, they may not kill the cancer. In situations like mine, where no one knew exactly where the cancer cells were, the inclination had been to use lower-power radiation designed to damage a wider area. Luckily for me, a new process had been invented to address the problem.

Dr. Holden introduced me to Dr. Mike Steinberg and his wonderful new machine. It was a high-powered radiation generator that could focus the beam on small areas, while the patient was strapped to a metal plate that rotated on a three-point axis. Mike used sonograms to create a computer model of my interior, like a cad-cam drawing. He judged where the cancer cells probably were, then programmed the machine to zap them. I went through this process one afternoon a week for a month.

This time, naturally, I told my partners and my assistant what had happened two years before and what I was doing now. Since I wasn’t likely to become ineffective any time soon, they kept it all confidential and covered for my absences. Not much scares me now, after having gone through that. And I’m much more devoted to my health and fitness.

A certificate honoring the completion of my treatment.

To remove internal stresses and toughen a metal after it has been bent, a metallurgist will anneal the metal by subjecting it to intense heat and then allowing it to cool slowly. Afterward, it is all the stronger for it. Facing death was an annealing experience for me. Twenty years later, I completed four hours of major back surgery with the same stoic demeanor to focus all my energy on recovery. Mindfulness helps.

Mindfulness is a kind of self-control of the mind. It can be developed through concentrated effort over many months. Buddhist monks spend lifetimes mastering this process. The masters seem to be able to tolerate any environment simply by tuning their minds to a more comfortable state, while blocking out any intrusions. Mastering this state creates a feeling of relaxation in both mind and body, which practitioners call “the zone.” In the zone it is possible to send signals to different parts of the body, to raise and lower body temperature, direct blood flow, change heart rate, and relax cramps.

Dr. Lobsang Rapgay taught me many of these secrets of the mind. Dr. Rapgay had been a Buddhist monk in Tibet for about twenty years. Gradually, he rose to become a private secretary to the Dalai Lama. Then, some years later, he changed course. He came to the United States, earned a PhD at UCLA, married, became a father, and began a new career in teaching and counseling.

I’ll never forget my first session with him. He wired me to a computer and said softly (he always speaks softly), “Raise the temperature of your hand a few degrees.”

As skeptical as I was at first, I did learn to raise, lower, and stabilize my hand temperature. I was even able to alter my heartbeats, as well as to relax my body tension. These techniques helped me overcome claustrophobia, which was invaluable in my scubadiving activities. It’s remarkable how much we can control with our minds. I had Dr. Rapgay speak at the annual Tennenbaum Capital Partners Investor Day. Cultivating mindfulness can overcome dysfunctional investment behavior, like buying high and selling low, which behavior has a common root in anxiety about what everyone else is doing.

(left) H.H. The Dalai Lama inscribed this book to me at Dr. Rapgay’s request. It reads, “With my deepest prayers and blessing. From the Sakaya fully ordained monk, The Dalai Lama, June 3, 2011.”

(right) A leaf from the tree under which Buddha received his enlightenment.

Dr. Rapgay and I also discussed the interesting ideas formulated twenty-five hundred years ago by Buddha Shakyamuni, ideas about the brain and its role in life and death. Shakyamuni believed that rigorous training of the mind—mindfulness—was the secret to a good life now as well as in future lives. He also held that controlling the state of the mind at death is useful in providing a comfortable departure from this life. These classic ideas are well developed by His Holiness the Dalai Lama in his many books, as well as in the Tibetan Book of the Dead. As I understand it, terminally ill patients are more comfortable and may live longer if they practice mindfulness and if they are shown consideration, rather than the very intrusive life-extension treatments that are now common.

Physical exercise has become a key component of my effort to live a longer, healthier life. It not only strengthens your muscles, helps your balance, and reduces your weight, but it also releases endorphins to your brain, which helps combat anxiety.

Exercise theory has changed remarkably over the past ten or so years. My new trainers emphasize weight lifting, core strength, and proper function of the joints, with an assist from stretching and deep tissue massage. I now use a powerful machine called a deep muscle stimulator that breaks up adhesions and releases muscle spasms. Pro athletes train in these new ways now, and their accomplishments are more and more remarkable.

Professional athletes have many injuries. So have I: five knee operations (two of them total knee replacements), a rebuilt shoulder, and major back surgery. In college I was a cheerleader. We ended every cheer with a standing back somersault. Underrotation of a somersault is awful for your body. And, of course, if you hurt yourself in front of thousands of cheering classmates, you don’t let on. You just wince, get up, and keep going. I’m paying for that bravado now.

All the damage that we “weekend warriors” do to our bodies can be mitigated by proper exercise and stretching. Most doctors are taught about our skeletons, but not about our soft tissue (muscles, tendons, skin layers). Even when we find experts who do have the information we need, that is never enough. I learned the hard way to not just seek out diverse expert advice, but to force myself to follow it—that goes for nutrition as well. Obesity and diabetes are epidemics. Lowering the volume of my food intake and eating a lot of fresh fruits and vegetables are my antidotes. When I was a director of Jenny Craig, I attended their programs a few times and learned more about healthy ways of eating. If you’re going to live life like a Ferrari, treat your body and mind like you would a Ferrari.

Looking back on my long life’s adventures, I feel good about them. But lately a lot of my decisions are constrained by the actuarial tables. This depressing outlook is made worse by the increasing frequency of deaths among my friends. Do I have another five years to live? Or ten? If that’s the case, should I buy a new car? Build a new house? Does it make sense to keep skiing—especially skiing fast down World Cup slopes? I always have feared leaving this great life. I wondered what would happen to my favorite photos. And my cuff links. And my car. We can’t know till we get there, but it’s still possible, of course, that death is just another great adventure. No one can say for sure. Scientific evidence is lacking, but it’s certainly tempting to think that death isn’t the end. As an atheist, I don’t subscribe to the elaborate afterlife promises that most organized religions promote. Yet I do take heart in the possibility that our life energy may continue to live on after our bodies die.

Scientists believe that life originated about four billion years ago in hydrothermal vents in the ocean by a chemical reaction under very special circumstances that combined elements that are common throughout the universe. One of these elements, hydrogen, was modified so that it generated an electrical current. In combination with rocks and with other elements, including carbon and oxygen, this current kept flowing. Over billions of years, this electrochemical process evolved into a life form. Through the process of evolution, many species of plants and animals emerged, the most adaptable of which have survived.

Our brains are the likely repositories of this life force. We are considered to be clinically dead when our brains no longer seem to function, yet this life force might exist just outside the brain for a while after clinical death. Every year, forty thousand tons of cosmic dust fall on our planet. Its components find their way into our food supply as well as into our lungs. Comets have been found to contain the very chemicals that probably started the life force. One could say that our life force and our universe are common elements.

Maybe the interplay among living creatures, their departed life force, and the stuff of the universe is one integrated process that keeps everything working together. In which case, the end of this life may be nothing but the start of the next great adventure. We’ll all go on it.

THE LONG GAME

As I develop my new life in Puerto Rico, I find myself including many of the high-risk tactics and activities I’ve enjoyed so much success with in the previous eighty years of my life. And I confess: I haven’t changed much. Neither have my risk-taking friends. When I ask those—both in and out of business—about how they made their choices, they tell me that they:

• Selected great schools because they were attracted to the challenge.

• Enrolled in tough courses of study to push themselves to excel.

• Chose career paths notorious for high pressure because of high rewards.

• Made these decisions spontaneously, not as part of some grand strategy.

When I then ask why they continue to keep up such high levels of activity, even after they have already attained great success, they all have a similar reply: “Because I like it!” or “Why would I do anything else?” or “I love the challenge!”

Before this book, I had never taken the time to reflect on my life. If you’d asked me to describe it, I would’ve said it was a mosaic of glimmering pieces. In the individual moments in that mosaic, I was simply careening through my life at top speed, following the call of my intrinsically adventurous spirit. I never reflected on why I spent my life continuously on the edge. It just seemed natural to me. Only after I noticed that I was continuing this high-engagement style of life well into my eighties and (hopefully) beyond did I start to reflect on the forces that drive me.

If that drive has become an addiction, it’s not been either debilitating or self-destructive. In fact, my relentless drive has provided my family and me with a good living and has given me the opportunity to pass on useful benefits to society, as has been the case for my successful friends.

As far as I can tell, taking bold risks means the difference between living an ordinary life and an extraordinary one.3 And I’ve been determined to pursue the latter.

Life is one long adventure. Or maybe it’s a big tapestry of many adventures. Adventure stimulates our brains, leading us to push ourselves to the limits of our capacity. When we stay active, we absorb cultural, intellectual, physical, and sexual stimuli.

My own quest for adventure is never-ending. I’ve played the long game and, more often than not, it’s paid off. It’s been the same for all of the explorers, entrepreneurs, and high achievers whom I have had the pleasure to know and who have inspired me. The chemicals in our brains reward us with the most gratification when we take on risks.

We’re never going to stop. We’ll just take longer naps. Until the last one.