Mark Shrime | Living a Life of Meaning: Why Pursuing Purpose is More Important Than Happiness

Srini Rao

Mark, welcome to the Unmistakable Creative. Thanks so much for taking the time to join us.

Mark Shrime

Yeah, thank you for having me.

Srini Rao

Yeah, so you have a book out called Solving for Why, A Surgeon's Journey to Discover the Transformative Power of Purpose, all of which we will get into. But before we get into the book, I want you to start by asking what I think is very relevant given some of what I learned from reading the book, and that is where were you born and raised and what impact did that end up having on what you've ended up doing with your life and your career?

Mark Shrime

Yeah, so I was born in Lebanon, born in Beirut, back when horse-drawn carriages were a thing. A couple years after I was born, a civil war started in Lebanon. Actually, a year after I was born, it started in Lebanon. My father, who had spent some time in the US, did his PhD in Chicago and then worked in Dallas, Texas.

for Texas Instruments for a while, and then before moving back to Lebanon. So this war started, and he and my mother, he and his wife had two young kids at that point, and realized that it wasn't going to be a short flare up of hostilities as had been happening since the 1940s, but this might be more protracted. So they decided that they needed to move. And...

Honestly, of all the places that they could move to, there weren't a lot at that point because of my dad's prior connections in Dallas. That's where we ended up moving to in 1976 when I was two. And that's where I grew up. We moved into apartment for a few months and then into a house, which is still the same house that my family lives in. So although I am Lebanese and you know,

The friction of being a brown person growing up in Texas in the 80s and 90s was definitely there. I also grew up in Texas in the 80s and 90s.

Srini Rao

Well, the reason I ask that question, because I also grew up in Texas during the 80s and 90s. I grew up in Bryan College Station, and I usually have to say College Station, because unless you're from Texas, nobody knows where the hell Bryan is. Although Elizabeth Holmes has now made Bryan very popular.

Mark Shrime

That's true.

Mark Shrime

Right, right.

Srini Rao

But I'm curious to hear about your own experiences with that friction in terms of race relations, in terms of your own identity, sort of growing up. I'll share a story just to give you a backdrop. I remember in eighth grade, I didn't tell my parents about open house because you remember like eighth grade is where you start to suddenly become very self-conscious and it's kind of ridiculous to this day. I look back at it and I laugh and I remember my dad.

asked why I was like, because I'm embarrassed by your accents.

Mark Shrime

Mmm, yep, yep. Yeah, I hear that.

Srini Rao

What about for you? Like what was that friction of sort of dealing with, you know, your own culture, you know, which you're clearly from and the friction of growing up in Texas as a brown person during the 80s and 90s?

Mark Shrime

Well, I could talk about this one question for an hour. So let me answer it in a couple of different ways. I'll start by saying that I don't know what it was like for your family. My family was incredibly big on assimilation. When our wave of immigrants came into the US, there was less of this conversation around sort of cultural identity.

It was a mandate from my parents that we needed to speak like Dan Rather, like Peter Jennings, who I realized was not an American, but we needed to have that sort of accent. If we had any sort of Lebanese accent and or if we picked up any sort of Texas accent, we were corrected. We were told that we didn't need to speak like that.

Mark Shrime

I would bring to school lunches, you know, cream cheese and olive sandwiches, which by the way are delicious and everyone should have them, but were very weird in the 1980s. I'd bring those and I'd get, you know, I'd get made fun of for that at school. And at the same time at home, there's this push to be as American as possible. Where I went to, where I went to school from the sixth grade to the 12th grade was a very small old boys Catholic school.

in which I did not realize until later that I was part of the minority. There were 28 kids in my graduating class. There was one Chinese kid, one kid of South Asian descent, and there was me. But until I grew up and until this one particular event, which I'll tell you about in a second, happened, I really...

You know, we would go back to Lebanon and my Arabic is non-existent. My French at that point was terrible. So we'd get made fun of as kids for being too American by our cousins. But then we were being made fun of for being too Lebanese by the folks in Texas. What for me really solidified the feeling of otherness was when the first Gulf war happened.

Srini Rao

Yeah.

Srini Rao

Hmm.

Mark Shrime

I was late in high school at that point and I remember, so it was that night that we had the news, you know, it was all over the news, the bombing, the shock and all, all of that sort of stuff. The next morning, one of the guys in my class drove into school blaring as loud as possible from his car the song by The Cure called Killing an Arab. And that's when I was like, oh my God.

Like I am actually different. I am actually an Arab. This is an offensive song. This is a song about killing people who look like me and who talk like me and who have accents like my dad and my mom. And that was really the first time when this kind of facade of assimilation broke. And I can be fairly white passing. I grew up in Texas. I can pass. But that was what really sort of drove home to me that no matter how much I can pass.

I'm different. There are songs written about killing my people.

Srini Rao

Yeah. Well, you know, I think that, yeah, because I remember I never directly confronted racism, but I witnessed it like, blatant, blatant racism, like in the backseat of my, you know, friends, parents, cars, some of the things that would come out of their mouths. And I'm thinking to myself, and I have mentioned this before, these aren't like, you know, rednecks, these are highly educated, wealthy white people who came from like generations of wealth in College Station, you know, and

Mark Shrime

Mm.

Mark Shrime

Yep.

Srini Rao

I just, I remember thinking about that and thinking in a lot of ways, and I'm guessing this is probably the case for you as well. In one way, Indians were really fortunate in that we're kind of stereotyped as model minorities. You know, like it's like, oh, you guys are doctors, engineers, lawyers, and you're smart. You know?

Mark Shrime

Right.

Srini Rao

But when I saw like the attitude towards other races, I was like, wow, I cannot believe that I am here as a brown person sitting in the backseat of a car of a white person who was saying these kinds of things about black people only to then go to the country club with my friend, be served lunch by a black waiter. And the reason we were there is because a black kid got stabbed at school that day.

Mark Shrime

Right, right. Yes, yes, 100%. And it is weird as, so it's weird as a model minority, I suspect it's weird that Lebanese folks are also, because we tend to be whiter looking, people, I'll just say, it's my experience to this day now, you know, that people either know exactly where like by looking at me know exactly where I'm from, they'll be like, Oh, you're Lebanese, aren't you? Or have no idea where I'm from.

And so that's also allowed a little bit of the ability to kind of fly under the radar. But that also means that sometimes talking about the fact that I counted one year, literally 26% of the flights that I go on, I require extra security screening. Talking about that is people are like, well, but why? Of course, I mean, everyone does.

Srini Rao

Mm-hmm.

Srini Rao

Hahaha!

Mark Shrime

So there's this feeling almost that like we have to prove that we are being discriminated. Does that make sense? Prove that we are also being discriminated.

Srini Rao

Yeah, no, it absolutely does. Yeah, it absolutely does. Because my sister is very, very fair skinned for an Indian person, so she has the same issue. Like, it happens to her quite a bit.

Mark Shrime

Right, yeah.

Mark Shrime

It's a weird place to be. Yeah, it almost, and look, I'm gonna have to say this because I am an Arab, it's become particularly heightened with everything that's been happening in the Middle East right now, and sort of the Israel and Gaza conflict. It's just this like, these are people, again, as I said, who sound like my cousins, who look like my cousins, who, you know, and it almost,

It almost feels like I've got this duty to be like, hey, I'll wake up. This is happening again. It happened in the 90s. It's happening again.

Srini Rao

Well, so one of the opening things you say in the book, and this is what I wanna talk about in terms of, you know, being raised by Lebanese parents and contrasting it with what it's like being raised by Indian parents, because it doesn't sound very different from some of the things you read. But I think the thing that struck me most was the line where you said, I'm a surgeon who never wanted to be a doctor. So I gotta ask you, like, what was the advice that your parents...

gave you about making your way in the world.

Mark Shrime

Yeah, so...

Mark Shrime

I say this in the book also, kind of the glib version of this is that I am the firstborn son of an immigrant family. And as firstborn sons of immigrant families know, like we have three options, doctor, lawyer, or failure. And that's kind of glib. That's kind of the like 30,000 foot view. The conversation that happened with my family as I was going through college, I went into college. So, in high school.

I liked a lot of things. I liked the sciences, but what I really, really liked was linguistics. It's weird, it's odd for a high school student to love phonetics, but I really did. And so going into college, I thought I was going to be a linguist. And then I thought I was going to go into philosophy and I was going to go, I also loved music and I thought maybe music, music composition, things like that. The direct advice from my dad.

or the direction, probably a better way to say it for my dad was that I shouldn't go into a field whose only purpose was to perpetuate itself. And that's kind of how he viewed some of the sort of soft sciences and things like history, linguistics, etc. was that they existed only to sort of perpetuate themselves. And I needed to go into a field.

like medicine, like the law, he was an engineer, so like engineering that existed to do something concrete in the world. And that's how I ended up as a doctor.

Srini Rao

Well, so it's kind of funny because I think that, you know, I kind of rebelled against that advice probably because I was terrible at science. Like the funniest story I remember, you know, my mom telling me that she wouldn't pay for me to go to college if I didn't go to become a doctor. And I was like, just agree with her and go to college. Like, you're not going to become a doctor. We know that. But the funniest thing I remember telling her, only mom, I hate hospitals. I get sick all the time. And her response was, you'll develop immunity.

Mark Shrime

Yep.

Mark Shrime

Mm.

Mark Shrime

Yeah.

Srini Rao

Well, so I know that you went to Princeton as an undergrad from reading your bio. So I wonder, because I went to Berkeley, and I imagine there's probably a degree of this at a place like Princeton, too, where I feel like people's futures kind of are predetermined in so many ways, partially by the narratives they got from their parents, partially by the environment that they're in, because the pattern I...

saw and I only recognized in retrospect, it was like, these are the majors, these are the jobs that they lead to. And it would just get narrower and narrower to the point where like if you asked the average Berkeley grad, it was like, are you going to law school, med school, banking or consulting? That was kind of it. And I wonder if that was a similar experience for you at Princeton.

Mark Shrime

Yep, yep, exactly.

Mark Shrime

It was, I think it was a little bit at Princeton. It became much more concrete sort of after that. But it is true. So it's something like 95%. I majored in molecular biology. 95% of the people that came out of my major went on to medical school. And the fact is, after having these wranglings with my dad about which, I was gonna say specialty, which major that I could go into,

after I settled on molecular biology, which by the way, I loved, I think it's an absolutely fascinating field. But after I settled on that, it was like the path was predetermined. Most molecular biology majors, when I graduated at least from college, didn't stay in molecular biology or in the hard sciences, went on to medicine. And at that point, because I couldn't be a rock star or a linguist or a philosopher, I had no reason not to join them on.

So I got into medicine out of a sense of filial duty and because, well, once I was, once I'd sort of been kicked off on this path, that was just the next thing to happen, which, you know, as you know from the book, did not lead to a very joyful tenure in medical school.

Srini Rao

Well, so, you know, like, obviously, I'm intimately familiar with what it's like to be in medical school because of my sister and the amount of work that is involved. And the amount of commitments. Well, like, I wonder how in the world could you sustain the kind of effort and commitment required to even get through that, let alone become a surgeon when you don't like you hate what you're doing this much.

Mark Shrime

I get asked this question a lot and I think there's two not very flattering answers to it. The first is that I am stubborn as heck and I don't like to quit. And then the second, and I think these are related, is that I'm also deeply fearful, deeply terrified. One of the pros of being on a predetermined path, like you mentioned, one of the pros

most of these predetermined paths, lawyering, doctoring, business, engineering, they lead to a fairly certain success of some sort, right? And so to even consider jumping off that path is to consider jumping into absolute uncertainty, absolute risk.

So I'm terrified, fundamentally. I don't make decisions like that very quickly. I have friends who are much better at like, this idea could be amazing. And so they go for it. For me, it's this idea could absolutely fall on its face. So let me think about it for 10 years. And then in the 10 years, yeah, I'm stubborn. Like I don't like to have a challenge set in front of me and not do it.

So it was that. And let's be honest, I mean, the human body is fascinating. There are parts of medicine that are absolutely fascinating. As a theoretical construct, medicine is one, and honestly, surgery, I mean, I will say this, human anatomy is one of the most beautiful things you will ever see. So there is a joy that I was deriving from it. But the day-to-day was truly, like I was not aligned with it. And so it was...

It was a decade of kind of gritting it out because I felt like I had to I had to do it I couldn't I couldn't know

Srini Rao

Yeah. Well, you know, one other thing I wonder about, we had David Epstein here who wrote a book called Range, where he talked about people who specialize early in life. I'm guessing you may have read it based on just some of what you've written here. And I remember him saying that at 18 is a particularly bad time to be making such long-term decisions, because you're being asked to choose on behalf of a person that you don't know and a future that you can't predict.

Mark Shrime

Right.

Mark Shrime

Hmm.

Srini Rao

And there's sort of a tension here when it comes to medical school, because it's kind of like, if you don't make that commitment, like freshman year on, it's almost impossible, because it's such a long road. I mean, I have friends who took a year off and did that, but it was pretty clear they were headed to med school, right from the get-go. And...

The thing I always wonder about is, you know, we make these decisions, like I always, people will ask me, like I'll have family friends whose kids are going to Berkeley, they'll ask all these questions, and I'm like, listen, I was like, you don't have enough data points to make these kinds of decisions right now, and I can't tell you the answers to any of these things because you have to figure them out.

And yet in a lot of ways, the system is actually set up to make it challenging to get those data points. Like it amazes me. It's like people will say, Oh, I want to be a doctor. My dad, you know, teaches he's a, he's a professor. And he's like, these people are like, Oh, I want to be a cancer specialist. It's like this person has never set foot in a hospital. Cause you mentioned the day to day. And I know that like, if a lot of people saw the day to day, they'd be like, fuck this.

Mark Shrime

That's exactly right. And I think there is one other fallacy that I'm ashamed to say it took me about 40 years to come to grips with. And that is the fallacy that you have to make a decision for the rest of your life.

Mark Shrime

And it's that's you I mean you mentioned it that's the pressure that's put on us as we're as we're in college That's the pressure that's put on us in medicine again, you know in our third and fourth years as we have to choose a specialty Again, if you decide to sub specialize you keep making these decisions based on imperfect information Which I mean listen, that's what all decisions are all decisions are made under uncertainty. If not, it wouldn't be a decision

But you're making a decision with imperfect information and also the pressure that must be what you do for the rest of your life I think that's where the real the real pain point is because Look, I wouldn't be where I am right now had I not gone to med school and residency and fellowship So it has turned out to be good but it's only because finally after

few decades, I could let myself admit that the path that I was currently on was not what I wanted to do for the rest of my life. And I could change that path using the stuff that I had learned from previously. So I agree. I think the age of 18, the age of 26, not the right time to be making these sorts of decisions, but especially when there's that added weight that what you decide at 18.

you must still be doing it 65.

Srini Rao

Yeah. Well, I think that the other thing, you know, you mentioned that there's almost sort of a guarantee of success because I remember thinking like the career I chose, like the next step when you're doing something creative isn't obvious, right? Like the steps aren't laid out in front of you. And you're basically, you know, signing up for a profound uncertainty where nothing is guaranteed and anything is possible. And there are moments I remember thinking like the day that my sister got into med school, I was like, that meant that she would never again for the rest of her life worry about a paycheck.

Mark Shrime

Mm. Mm-hmm.

Mark Shrime

That's 100% correct. Yep, that's 100% correct. And that's what keeps us on, those of us who are in these sorts of jobs, that is a large degree of what keeps us on that path. I don't know how many physicians you've spoken to, nurses, people in the medical field you've spoken to. Okay, fair point. But even pre-COVID, there was already an exodus out of medicine because the American medical system

Srini Rao

I'm Indian, so probably more than I want to.

Mark Shrime

is not designed to benefit either the patient or the provider. And so the patients are bad done by because we have to see them in seven minutes and then make a diagnosis. And the physicians and providers are bad done by also because you didn't go into this to be a cog in a machine looking at throughput and making sure that you're seeing your patient every seven minutes. So there was already an exodus out of this, the exodus.

massively accelerated during COVID with a lot of people leaving the medical field altogether, either through early retirement or quitting or, unfortunately for many, succumbing to COVID. But then there was that uncertainty of, oh God, I just left the certain paycheck. And this particular stress

of I don't know what's anything and nothing could be next. This is a particular stress that I've never faced before as a physician. What am I going to do with that?

Srini Rao

So like, I remember my sister actually worked in a COVID ICU during COVID. Uh, yeah, I remember she sent a video. It was like, you look like Jack Bauer in a hazmat suit, like refusing a bomb. But she had, she mentioned a meme that was going around, like the joke was she's like, for the first time in history, their Indian parents were actually happy. Their kids are not doctors.

Mark Shrime

Ehh

Mark Shrime

Yeah, yeah.

Mark Shrime

are not doctors. Yep. I mean, it was a weird, weird time. It was a hard time to be in medicine or public health or anything in the related fields.

Srini Rao

Well, one of the things that you say is that we can measure success through tangible outcomes, promotions, money, children, houses, because this definition's simplicity is so alluring, its tendrils insinuate themselves everywhere. The problem with this monolithic definition lies not in the things it makes us pursue. There's nothing wrong with money, career, success, or fulfilling family life, but in the fact that unless these things are actually are why they end up feeling like a trap. Yet the

overwhelming majority of the population does exactly this. I mean, even though I have this unconventional career, I absolutely to a degree still think those are measures of my own success.

Mark Shrime

And listen, I don't know that I expressed it as well as I could have in that sentence. There is nothing wrong with those as measures of success. I would very much like to be able to pay rent next month. So as a measure of maybe not success, maybe it is simply a measure of stability. Again, there's nothing wrong with it.

The point in that sentence, the point in that chapter, even in that book, is that unless that is truly what you want to devote your 70 to 90 years on this earth to, then idealizing, lionizing those things as your barometer of being successful is going to lead you to make decisions that aren't necessarily consistent with what you actually want your 70 to 90 years to be.

There's an example I give when I give talks about this or when I talk to some of my clients about this. And it's, so the guy that hired me into my first job out of fellowship, a guy who's a work partner, I operated with him, we saw patients together, we would tag team into surgeries together. When I was deciding that I did not want to do medicine,

a full-time career anymore. Look, my first inclination with talking to him was like, gosh, you don't get it. You're pursuing X, Y, and Z. You're pursuing money or fame or whatever. But then the more I talked to him, I adore this guy, and the more I talked to him, the more I realized, no, wait a second. That actually is his why. Being the best surgeon that he can be, doing the best research that he can do, providing the best life for his family that he can, those truly drive him.

And so God bless him, more power to him for pursuing those things. I had realized at that point that wasn't exactly what drove me. That wasn't enough for me. And so that's what I'm trying to get at that sentence is that it perfectly fine for my partner to pursue those things because that's what he wanted to. There's no judgment in that. It's just that for me and for others,

Mark Shrime

that may not be what you're pursuing, it's just that the world tells you that's what you should be pursuing. Is that making any sense at all?

Srini Rao

Yeah, absolutely. Yeah, I mean, I think that one of the things that we overlook, even when, you know, we think about the things that our parents tell us that we disagree with is the role of context, like it took me years to sort of reconcile that my parents advice, based on the context that they were raised and made complete sense, they basically grew up in an environment where outcomes in life were binary, it was poverty or security, nothing in between, like they didn't, I don't think that they had the freedom to think about things like passion

Mark Shrime

Mm.

Srini Rao

purpose and meaning like we I think we kind of forget that is a very privileged position to be in to even have a conversation about this kind of stuff.

Mark Shrime

Yes.

Yes, without a doubt. Two really, man, what you just said right there, like again, two huge things. First of all, yes, it is absolutely a position of privilege to be able to even consider these things and to have even the look like let's just even say that being Americans, being like hitting bankruptcy.

is not anything anybody really wants to do, but even our systems have protections for people who hit that place. Bankruptcy is a legal protection. So just even the fact that exists is itself a privilege. And so yes, it's completely a position of privilege to be able to make career decisions based on that. However, it's also not only

the purview of people who sort of can make that decision. In other words, I think it's still a question that we should be asking ourselves anyway. Within the constraints that I find myself in, within the sort of the hand that I drew, am I constructing my life in a way that maximizes my chances of being aligned?

with what I want these 70 to 90 years to be. The other thing that you said, though, it was another thing I really struggled with is I was starting to get off my moving sidewalk, my predetermined path, which is, so a little bit of a story. Really the first time that I did any significant global health work was in 2008. And this one episode, when I say it's life-changing, it was truly life-changing. It literally like...

Mark Shrime

shifted the entire course of my life. So I took a year off after my first fellowship and traveled for a year and then worked for six months on a hospital ship in Liberia. And that work was the life-changing part. But what I want to talk about actually here is what happened before that. As I was debating whether or not to take this year off and then come back after it has sort of finished my second year, my second fellowship.

As I was making that decision, I talked to all of my fellowship mentors at that point and to a man, they were all men, to a man, each one of them said, don't do this. Don't do this. It will ruin your career. It will be a black mark on your CV. People will wonder whether you're a flight risk. People will think you're not serious about surgery, etc., etc. So this is the wrong thing for you to do. But then...

Once I finally made the decision that I was going to do that, basically every single one of them would corner me in the hallway of the ORs and be like, gosh, I wish I had done that before I had the mortgage, the children, the whatever, whatever. Gosh, I wish I had taken that time off. And I really struggled with that disconnect, that dichotomy, until I realized that what they were doing was exactly what you said. They were giving me advice based on

their successful careers and what they had gone through to get to the points that they were. So it was very well-meaning advice. It was very protective advice. This is one of our trainees. We want to make sure he succeeds. And so they were giving me advice based on their context, but it wasn't necessarily the advice that I needed or the context that I was living in at that point.

Srini Rao

Yeah, absolutely. Well, one of the other things you say is that purpose, meaning and contentment exist when Y is at the center and when we construct our paths to lead it, not the other way around. Can you expand on that for me and kind of explain that idea?

Mark Shrime

Mm.

Mark Shrime

Yeah. So there's a quote that anybody who kind of speaks in this area, it's in like all of our talks. It's a quote by Viktor Frankl. Frankl survived the Nazi concentration camps in World War II, and afterwards he wrote a book called Man's Search for Meaning. And in that book he quotes Nietzsche. And the quote is, I'm not even going to try it in German, but the quote is,

Mark Shrime

can bear almost any how. And what I see in this quote is a dichotomy, not a dichotomy, it's an ordering of why over how. You can bear almost any how if you have a why that you are bearing that how for. Where most of us, myself included, make an error

is that we flip that hierarchy. We prioritize our how over our why. So, you know, when I was in medical school and residency, that was the how, that was the what, that's what I was doing. I was on the path to be a doctor. And what I would say to myself at that point is some of the things that I said earlier on this podcast, which are very true, surgery is a beautiful thing to do. The human anatomy is beautiful. I absolutely adore the operating

And so I would try to shoehorn what was deeply inside me. I would try to sort of paper it over with rationalization and justifications and shoehorn it so that it fit the path that I was already on. So I'm subjugating my purpose to my path. But that's the opposite of what we should be doing. And true meaning, true contentment, I think only happens when we figure out what that purpose is.

And then we build a path to maximize our chances to achieve that purpose.

Srini Rao

Absolutely. One other thing you talked about is this idea of epiphany. And I really appreciated this. You said that epiphany looks nothing like it does in the stories. It comes with no fanfare, there are no trumpets, no angel choruses, no orchestras, no focus pulled cameras. And the thing that I think is so striking about that is that we are going to hear sort of, like we get a window into your story when somebody like you comes to my podcast or I'm on a podcast or I write a book, right?

So to your point, like we basically kind of leave out everything in between like the parts we don't see what Scott Velsky would call the messy middle. Like nobody sees that aspect of the reality. It's like you see the end result, but you don't see the work that went into it.

Mark Shrime

Mm-hmm.

Mark Shrime

Yeah, 100%.

Mark Shrime

We could talk a lot about epiphanies and I do think they're important. I think they're crucial in fact, which I'll say this briefly and I'll get to the messy middle part of it. We don't in general structure our lives to allow for epiphany. There's a theologian named Marcus Borg who talks, and he's not the first person to use this phrase, but he talks about the thin places.

places, experiences where the veil between the human and the divine gets just a little bit thinner. This is not, we're not talking about a church here. We're talking about that feeling that you get at an amazing concert, the feeling that you get when you're in the mountains, the feeling that you get when you're in a flow state. There is that slight thinning of that veil.

allow for that to happen a lot. In fact, we tend to structure our lives to almost, it feels almost intentionally to avoid that because these sorts of epiphanies kind of, you know, throw us off our horses. But then in the movies, in the focus pulled movies, that epiphany leads

right to the next thing, leads to the final sort of denouement and all of a sudden all as well, and I've, you know, we lived happily ever after. And that's not the case. And I will say this all the time, between the time of sort of my epiphany that I wanted to be working in surgery, in vulnerable health systems, that's what I wanted to devote my life to, or the next phase of my life

Mark Shrime

truly diving in with both feet, that took 10 years. And that took 10 years of stubbornness and fear and debating and gosh, talking my friend's ears off about whether this was a stupid decision. And that stuff, right, that stuff is not there when you do the, when you listen to the sort of 15 minute Ted talk or you watch the two hour movie. Those 10 years are not there.

Srini Rao

Yeah, absolutely. Well, there's something else you say in this section of the book, and that is that the safe life is fundamentally a self-centered life. Little more is likely to push us down a Tolstoyan spiral than a self-serving life focused on the pursuit of our own happiness to the exclusion of the other. The best way to serve humanity, the best way to create Einstein's life worthwhile is to walk with the other. Say more about that.

Mark Shrime

Yeah, I've actually struggled with this line in this section of the book since I wrote it because I don't know, I believe what I said. I 100% believe what I said. I also wonder if I'm being too prescriptive there. Again, to use the example of my partner at my first practice, his why was not necessarily mine. So I do struggle with how prescriptive I am.

how prescriptive I'm being in that particular passage of the book. That said, many of the things that you and I have talked about, the fact that I would like to be able to pay rent next month or that when your sister got into medical school, you said, gosh, she will never have to worry about when her next paycheck is coming. All of these things that we're saying, they are centered on us. And there's plenty of research that shows that sort of self-focus.

actually does, it serves us well in the short term, but it doesn't necessarily serve us well in the long term. And the only way to get ourselves out of that, the only way, at least I have found, to get myself out of my own head and out of my own anxiety about what's next, is to make sure that the choices I am making are fundamentally in the service of other people. That...

If nothing else, simply because it involves the other, that takes me out of that sort of self-centered spiral, that Tolstoy and spiral, that spiral which Tolstoy was in where he was like, at this point, what is the point of life? Why shouldn't I end it? Now, of course, he didn't at that point and he wrote a whole bunch of amazing things, but that existential crisis exists because...

or exists when we focus entirely on what's next for me, as opposed to how can I use this life to benefit other people.

Srini Rao

Well, speaking of benefiting other people, you had a pretty extensive section on poverty. And you said that's shockingly easy to view the poor as other as qualitatively different from us. It's shockingly easy to see their lot as a result of the choices they made choices. We're sure we wouldn't have made. And in doing so, it's shockingly easy to keep the poor at arm's length. We do our altruistic duty toward others and return safely to our lives. True poverty robs its victims of their seat at the table of humanity.

of structural evil and it survives because of an ethos of the other. And you know, like having traveled in India and traveled to developing countries, like I've seen like poverty at a level that most of us don't, like in the United States, like in America, you don't encounter that kind of poverty day to day. Like it's very, even if you see a homeless person, it doesn't, you know, look anywhere near what you see in these countries.

Mark Shrime

Mm-hmm. Yep.

Mark Shrime

Yep.

Srini Rao

Talk to me about sort of one, what we are not seeing, like, because I think most of our understanding of this is shaped entirely by people like you who come and write books and tell us about it. What do we not see? Like, what part of the reality of this is not made, are we not made aware of just by consuming media about it or just by hearing somebody like you talk about it?

Mark Shrime

That's a really broad question. And it's a good one. I think the... So what are we not seeing? To a degree, we are not seeing the poverty itself, the depths of poverty itself. We don't experience it. We don't have any correlate in our lived experience to even grasp what it's like.

And so just already because of that, it's easy to other somebody who's in part.

Mark Shrime

But also I think because of that, because we can other them, because we have no lived experience that is similar to that. And because we also are aware that we have struggled to get to where we are, irrespective of where we are, whether you're Warren Buffett, Bill Gates, or you or me, we've all faced struggles to get to where we are. So...

We think, rather, it's easy to think that, okay, I've struggled to get to where I am. It has been a slog to get to where I am. That poor person over there is not where I am. Ergo, they must not have struggled the way that I have struggled. And that, I think, is behind a lot of our rhetoric these days around poverty, around the unhoused.

basically around anybody that we other, around drug addiction, et cetera, that it is some sort of outflow of intentional choices that folks made. Instead of recognizing that birth is a lottery and I was born to a country that descended into civil war a year after I was born.

Srini Rao

Mm-hmm.

Mark Shrime

my father had a PhD and connections in the US and could leave. Right? So I won the birth lottery in a way that some of the patients that I now see working in say Sierra Leone did not win. And that has absolutely nothing to do with the choices that I've made or the choices that my father made. And it literally had to do with the fact that I was simply, I was handed a better deal when I was born.

There's a philosopher named John Rawls who does a thought experiment in one of his books. And I'm gonna butcher this and misquote it, so apologies to my ethics professors from grad school. But he would say, well, he would call it behind the veil of ignorance. Before you knew what lot in life you were going to draw. So,

before that birth lottery, if you were tasked with constructing a just world, what sort of world would you construct? And that question actually forces us to get out of the post-hoc, okay, now that I've drawn, now that I've won the birth lottery, oh, well, this feels fair, or that feels fair. And it forces us to get out of that, forces us to think, okay, if I don't know if I'm going to be Mark Shryme or one of Mark's patients.

Would I construct a world that makes things best for the worst off? Or would I construct a world that's similar to what we have today? And his point in this argument is that behind that veil of ignorance, you would absolutely construct a world that's best for the worst off because you have no idea if you're going to be in that. So it's even like self-serving to construct a world that's best for the worst off if you don't know where you're going to end up.

Srini Rao

Yeah, yeah, I mean, just hearing you talk about this, like, I, you know, I realized, like, you and I are definitely winners in the genetic lottery, like, as far as the birth lottery goes.

Mark Shrime

Oh, absolutely. Yep. Yeah, yeah, we absolutely we were dealt a good hand. I mean, it's our conversation earlier about privilege. Yes, we grew up brown in Texas. Yes, we dealt with racism. Yes, yes, all of those things. So yes, we struggled. Without a doubt, we struggled and we can and should talk about those struggles because the future generation shouldn't deal with the same racism that we dealt with when we were growing up. At the same time, we grew up in the richest country in the world.

we grew up being able to speak the dominant language in the world, etc. So we also have a lot of things that were just handed to us simply because of who we were when we were.

Srini Rao

Tell me about the Gary Parker rule. That was probably my favorite line in the entire book.

Mark Shrime

Yeah, it's so backstory. Gary Parker is a surgeon. He's a maxillofacial surgeon. He does head and neck tumors and head and neck reconstruction on the Mercy Ship, which is the organization that I have worked with since 2008. Spectacular surgeon, one of the best surgeons I've ever seen, but also just this eminently wise man. You devote your entire life to living on a ship and doing surgery in some of the world's most vulnerable countries.

you gain a lot of life experience. So, Gary was a surgical mentor initially and has become a dear, dear friend since. Early on in my time working on the ships, probably my second or third trip to the ship, we were sitting down and having one of those interminable, like lovely interminable conversations where you talk about everything from like religion to politics to relationships to whatever. And I asked him,

He'd made some very clear choices in his life that had led him to deciding to live on a hospital ship for 37 years. And I asked him, you know, when you make a decision, a big decision in your life, how do you approach it? What do you do? Now, you know, I went back to grad school after I decided that I didn't want to do medicine and my PhD is in decision science. So the Gary Parker rule has an official name. It's the...

the optimist or the maxi max criterion for decision making under uncertainty. But that's a mouthful. So I call it the Gary Parker rule. And what Gary's rule is for making big decisions in his life is he looks down the road 30 years at the best possible outcome of any of his choices. The best possible outcome of do I live on a ship or do I become a maxillofacial surgeon in California? Like what's the best possible outcome?

of these choices. And if one of the best possible outcomes just makes him shrug his shoulders and be like, nah, well, then he knows that that's not the right choice for him. Because he'll work his tail off for 30 years for the best possible thing to be a shoulder shrug. And that, first of all, blew my mind. That's actually the thing that made me finally decide to...

Mark Shrime

quit my US practice was applying that same rule to my own life. But it also blew my mind because it's not how most of us naturally make decisions. We, instead of being maxi max, let's maximize the best possible. We are maxi min. Let's maximize the worst possible. If we're going to fail, let's cushion that fall as much as we can. So instead of looking at the best possible outcome and choosing the best of the best, we look at the worst possible outcomes.

and choose the best of the worst. Totally turn my world upside down to think about my life in that way. The reason that we tend to be maxi-min instead of maxi-max though, is because maxi-max, the Gary Parker rule, is very risky. Because often when you're making these big moves, when you're aiming for the thing that, if it works out, will be the best, often if it doesn't,

the worst possible outcome is also down that path. And so we tend to avoid it. But that's, as I said, that's what made me decide that I, you know, I looked at my life as an academic surgeon. I was in Boston at that time, you know, 30 years down the line being an academic head and neck surgeon at a big city hospital somewhere in the US. And I would have seen, I don't know, you know, 100,000 patients at that point operated on like 30,000 of them and because I do cancer, you know,

of them would have survived and half of them wouldn't have. And then I'd retire with a nice house and a jaguar. And to me, that best possible outcome made me shrug my shoulders. And that was what finally made me make that decision of, okay, this path that I'm on, even if it works as well as it could, is not going to give me that passion, that purpose, that contentment that I'm looking for.

Srini Rao

Yeah. It reminds me of a story that I read. I just ordered this book. It was called LeBron Inc. And the opening sentence is about LeBron sitting at the table at Reebok when Paul Fireman, the CEO of Reebok, hands him a $10 million check. And he actually walks out.

And one of the things he acted, it's very, it's like, you know, it's articulating exactly what you're saying, because he said that you're looking rather than thinking about the first check, you should think about the subsequent ones.

Mark Shrime

Mm. Yeah.

Srini Rao

which ended up being worth hundreds of millions, both to him and to Nike.

Mark Shrime

Oh, that's amazing. Yeah, I have not read that book.

Srini Rao

Yeah, I mean, it's funny because they've Nike has made. I think it was Adidas or Reebok or somebody that I remember seeing a documentary about this somewhere where they wouldn't give him more. And in the first year, Nike made something like 100 million off that shoe. Yeah.

Mark Shrime

Wow, yeah. Yeah, I mean, nobody's handed me a check for $10 million, but it's the same principle. It's the same of like, what am I building towards? What is it that I want to spend my energies building towards? It is what the final check is. You're right, not the first one. Still, if somebody wants to hand me $10 million, I'll do it.

Srini Rao

Yeah.

Srini Rao

Yeah. Well, tell me. Yeah. So tell me about this. You say that a falsifiable goal opens the door to failure. We're tempted not to set falsifiable goals, but we forget non-falsifiable amorphous goals guarantee failure because success is undefined. Talk to me about that idea. Like explain that to me.

Mark Shrime

Yeah, so as you're starting to think about, you know, and this will apply to almost anything. In the book, it's in the context of thinking about what do I want to design my life towards and how do I make the first steps towards designing that. In the making the first steps, we tend to want to avoid setting goals that we can fail at. So I'll give you sort of just a very...

very mundane example from like New Year's resolutions, right? You could make a New Year's resolution that says, I want to get fit this year or whatever. I want to save money this year. And that has no metric to it that you can measure. At what point do you say, yes, I have succeeded. I am now fit or I am now I have now saved.

The other way to frame that decision is, I am going to go to the gym, whatever, three days a week, or I am going to put aside $10 a week. And those sorts of goals are falsifiable. You either did or you didn't. You either did or didn't put aside your $10 a week for the 52 weeks of the year. And we tend to avoid those sorts of things because we might not achieve that.

and we don't like failure. So instead we say like, I'm going to be better with money this year. And that will never fail that we will never fail a nebulous goal like that. But also we'll never succeed at that. We will never know if we've become better with money in inverted commas. So in the context of the book, this is in the in the idea of if you want to start making steps towards

this why that you have solved for, make those concrete steps. And not only make those concrete steps, this is, I think, a really something I'm super passionate about. Not just accept that you might fail at making those concrete steps, but actually actively court, actively woo the failure, set a goal that you won't succeed at initially. Because

Mark Shrime

I mean, because quite literally the only way to construct a life that is, as you have said, that is much more risky, that doesn't have success guaranteed, is to not just become comfortable with the fact that you're going to fail, but to be in a position where failure gives you a bit of a rush, gives you a bit of a like, oh, all right, well, I didn't do this quite well yet. But hey, look, this guy, this woman is doing it better.

I have a goal here that I can get to. So it's this difference between I am, I can't do this thing full stop versus I can't do this thing yet. And that yet opens up all sorts of possibilities. It acknowledges that the only way to get to that yet is to start in a place where you can't do this in the first place.

Srini Rao

Yeah, absolutely. Well, I love this idea of falsifiable goals because it basically means you're ruthlessly objective. So I have this custom chat GPT model that I built that plans my days for me. Like I basically just have it plan my tasks, I review my days with it, especially now that you can talk to it via voice. It's really crazy. But one of the things that I said is like, when we plan these tasks, I need you to write them in a way that we can be ruthlessly objective. So there's no question of like,

Mark Shrime

Wow.

Srini Rao

didn't. You know, like it's either yes or no. There's no gray area. And so I even write my daily tasks this exact way.

Mark Shrime

Yes.

Mark Shrime

Yeah, and I think it's the only, I mean, it's a terrifying way to do it. It almost feels, I don't know, like ruthlessly clinical to do it that way. But also the, there is a, there is a, a joy in realizing how many of them you did just accomplish. Um, yeah.

Srini Rao

Well, I think that the other thing you mentioned failure in it, it reminds me of something that Seth Godin has said, like over and over. He said, you know, before he starts any project, he was the guy who's written 17 bestselling books. The very first thing he says is this might not work. And I remember thinking about that. I'm like, why the fuck would you believe that you might fail? And I realized that the moment you say that it basically gets like it's a way of like detaching from the outcome.

Mark Shrime

100%. So I'm in the process, this is not a plug because this book doesn't exist yet. I'm in the process of writing a second book. And it's a similar but on a very different topic. And I sat down to write the proposal over December, over the holidays.

And this first book, Solving for Why, did fairly well. I was very proud of it. And I didn't want to be in a position where I had to be like, okay, the second book has to do better than Solving for Why. It has to be more sellable. It has to, whatever. And that freed me to just be able to sit in a coffee shop over the holidays and just write the stuff that I was passionate about. And honestly, if this second book never sees the light of day, I will be very sad. I will be very disappointed.

But also, man, I got to write that. I got to write 100 pages of stuff that I'm super passionate about, and that felt really good, without having to worry about, is this going to sell?

Srini Rao

Yeah, absolutely. So there are two last things I want to cover. One of the things you say is, jumping off the moving sidewalk is like taking a train in Varanasi. We're offered the Varanasi choice, focus on failures, doubts, anxieties, and routine, or find wonder. They're both there, wonder and failure. One keeps us odd, the other keeps us cowed. One makes the leap off the moving sidewalk worth it, the other just makes us want to run back to safety.

Um, and you know, having been to India many times and knowing I've never been to Varanasi, but I knew my parents were there and I've heard, um, and I, it just reminds me of my friend, Matt, like when I sent him a video of the traffic in India, he's like, his response was fuck that. He's like, I'm never doing that. He's like, oh my God, that would stress me out so much. And I'm like, dude, you live in this like bubble of white privilege. I'm like, that's not the way the world works. Like that is so not an accurate view of how the rest of the world is.

Mark Shrime

Yeah, yeah. Yeah, I mean Varanasi is a it is a mind-blowing city. You know, I've traveled a lot. India was one of the harder places that I've traveled. Because of the things that you the video that you sent to your friend Matt because there's just it's crowded. It's Hot, you know all those things.

Srini Rao

Yeah, India is what I describe as organized chaos.

Mark Shrime

It is in and barely organized even at that. But also Varanasi is an absolutely gorgeous city. And it's really just a matter of looking straight ahead at you at the dust, the dirt, the, the crowds, the traffic, et cetera, or looking five degrees up at the color of the buildings, the, the music, the sound, the, um, and you know, I, something similar to what I was saying early.

Srini Rao

Yeah.

Mark Shrime

on being a physician in the US was never my path. That doesn't change the fact that there is beauty on that path that I have been privy to and privileged to be privy to. The beauty of being in the operating room, the beauty of the dance of how an operating room works, like all that sort of stuff, it wasn't the path for me. But also jumping off the moving sidewalk has also led to, gosh, I don't die.

know if this job is going to last a year or seven or you know whatever and I have the choice and I don't always make the right choice but I have the choice to decide that I'm going to focus on the risk that I'm taking or decide that I'm going to focus on the potential beauty that I'm surrounding myself with and or hopefully creating.

Srini Rao

Well, let's finish with this one final quote, because I think this was just something that stood out to me so much given, you know, we have a podcast where we bring in experts on happiness, we bring in psychologists, everybody is like, you know, kind of perpetuating this, our Instagram feeds are littered with quotes about happiness. You say the pursuit of happiness can never be an antidote to the ethos of work, because we've literally evolved to lose the happiness game. Not only will we never achieve sustained happiness, but it gets harder each time for any one thing.

Mark Shrime 
Mm.

Srini Rao 
to make us happy. I love that. And I think that in a lot of ways that speaks volumes to sort of the general, you know, narrative of personal development literature and one of the flaws in it.

Mark Shrime 
Yeah, yeah, agreed. So actually, when the PR folks at the publisher were sort of working on the PR for this book, the first copy, the first version of the back cover or inside front cover copy had the word happiness all over it. And I pushed back really hard because happiness is not what we should be going for two reasons. One is the one that's in that line, which is that

We are evolved to have what psychologists call the hedonic treadmill. The first scoop of ice cream tastes amazing. The second scoop of ice cream tastes amazing, but not quite. And we have diminishing marginal returns on anything. So we are hardwired that we have to always pursue the next thing or more of the thing to get the same hit of happiness that we did the first time around.

So happiness as a goal doesn't work. The other reason I say this, and this is a little bit depressing sometimes, people don't like when I say this, building a life in pursuit of purpose does not always mean building a life of happiness. And there is some literature in fact to suggest that it is the opposite. That people who have lives of meaning, so eudaimonia, people who have lives of meaning

don't always describe their lives as happy. The obvious sort of paragon of this is a martyr, right? Joan of Arc would probably not have described her life as happy. She had a life of meaning. So there's a reason that in the book, I use the words contentment instead. And that's because, yes, like living in accordance with my personal lie has meant that I...

You know, I live in and work in and travel to very difficult places and not always the source of happiness, but always the source of contentment, of joy, of this contentment that I am living in accordance with what I believe I am here to do for the 70 years of my life.

Srini Rao (01:02:57.634)
Wow, well, this has been amazing. I love conversations like this, because literally you gave me a thousand things to write about, dozens of books to check out. So I have one final question for you, which is how we finish all of our interviews at the Unmistakable Creative. What do you think it is that makes somebody or something unmistakable? What do you think it is that makes somebody or something unmistakable?



Mark Shrime 
I look, I'm gonna go back to Gary Parker here because I wish all of your listeners could meet him one day because of all the people that I have had the privilege of meeting in my life, he is the one person who is probably living a life most consistent with what he feels like his calling is. And there isn't a single person who comes in contact with that guy who does not remember him. And so yeah, listen, I'm biased because this is what I write about. This is what I talk about is constructing lives in accordance with your why. So I'm biased into thinking that that's what makes somebody unmistakable. But man, like when you discover those people who truly have done that, it's really hard to forget them.

Srini Rao 
Amazing. Well, I can't thank you enough for taking the time to join us and share your story, your wisdom, and your insights with our listeners. This has probably been my favorite conversation. I've had one of them this year. Like, I just feel like you've given me so much to think about and hopefully for our listeners as well. Where can people find out more about you, your book, and your work and everything else you're up to?

Mark Shrime
Yeah, well first of all, thank you for letting me be part of this conversation. I, the questions you've asked have challenged me and made me think. So I really, and this has been a great, a great interview, a great podcast. So I have a website, www.markshryme.com. I'm also on Twitter and Instagram, at Mark Shryme. And yeah, my book is available wherever books are sold.

Srini Rao 
Amazing. And for everybody listening, we will wrap the show with that.