The Book's Purpose

• Prove that no one will reach his fullest potential by avoiding risk
• Present the “Best/Worse Analysis” (B/WA) as a formula for decision making
• Give personal examples integrating the B/WA formula in faith and work
• Explain practical ways one can implement the B/WA in his daily life

The Book's Message

We live in a society that is obsessed with safety and risk avoidance. Instead of embracing those risks that lead to greater success, we tend to run from them. If we choose to stay in our comfort zone, we will miss out on life’s greatest adventures, and we will never reach our God-given potential.

Which risks do we take? When do we take them? The “Best/Worse Analysis” (B/WA) formula provides a practical way to take calculated risks. By using this formula, we can learn to identify and live with acceptable risks.

The Bijani Twins

Reflecting on performing surgery on the Bijani twins, a feat which brought worldwide coverage, helps explain how to identify, choose, and live with acceptable risk.

The Twins’ Story

I will never forget my trip to Singapore where I first met the infamous Bijani Twins. Ladan and Laleh represented a true medical rarity. The odds of giving birth to conjoined twins are about once in 200,000 births. The odds of twins being conjoined at the head are about one in 2 million. Surviving beyond two years is rarely heard of. But the Bijani twins had reached their 29th birthday.

They had adapted to their environments and had become educated, productive citizens in their native Iran. Both had law degrees. But they were at a life-altering crossroads because Laleh wanted to pursue a career in journalism while her sister wanted to continue in the legal field. For their whole lives, whatever they did, whether going to the bathroom or to class, depended on the other’s cooperation.

The twins made contacts all over the world to find a surgeon to separate them. No one was willing because the odds indicated that one if not both would die. Finally, they located Dr. Keith Goh, who had successfully separated craniopagus twins. Dr. Goh contacted me to see if I would assist. At first, I thought the surgery was too risky and even recommended that it not happen. But once I met the twins and saw their determination to live separated lives even if the risk cost them their lives, I was willing to join the team. They said, “We would rather die than not pursue this if there is any chance we could be free to live our own separate lives.”

Weighing the Risks

On the day before the surgery, I told the twins I would pray for them before going to bed. I prayed for them, for the large team of doctors and staff, and for myself. I prayed for God’s presence in the operating room and for His strength and wisdom.

Before accepting my involvement in the surgery, I weighed the risks. Some of my colleagues warned me that my reputation would be at risk if the surgery failed. On the other hand, what if they did die and I did not participate? I would wonder for the rest of my life if I could have made a difference.

When I make major decisions, I go through an exercise of four questions that serve as the basis for this book: What is the best/worst that can happen if I do? What is the best/worst that can happen if I don’t? In the Bijani case, I felt an obligation to do everything I possibly could to help.

The Surgery

All through the surgery, we encountered one unexpected challenge after another. At one point, to me it became obvious that we should not proceed any further because the risks were too great. But when the twins’ guardian insisted that they would not approve of stopping, the surgical team continued.

At various stages, we saw glimmers of hope and reasons to be ecstatic. We were able to overcome number of unexpected challenges. Their two brains had become entwined over their 29-year lifespan. We began the tedious task of separating one millimeter at a time. The greatest challenge was stopping the bleeding, because as soon as we stopped one area, bleeding began in another. Without any warning Ladan arrested and could not be revived. About 90 minutes later her sister arrested as well, dying from uncontrollable loss of blood.

Was the Risk Worth It?

Never in my life do I want to experience the agony that I suffered on that day when the twins died. But was the risk worth it? Yes. Especially in light of the Bijanis’ request that they would rather die than continue to live conjoined lives. But in addition, there were many medical lessons we learned that would give us a better understanding for future surgeries. What we learned about the potential of the human brain was staggering.

Life is Risky

The Bijani twins’ case was not the first time I had to weigh the risks of performing a ground-breaking surgery. For example, I was approached to perform a hemispherectomy on a beautiful four-year-old girl named Maranda Francisco.

I warned the family that I had never attempted such a surgery; but after studying the procedure, I agreed to give it a try, knowing that it was extremely risky and that Maranda could very easily die as a result.

Despite the risks involved, my decision actually came very easily. If a person is going to die without the surgery (as was the case with Maranda), one has nothing to lose by trying. Thankfully, the surgery had a much better outcome than the Bijani twins’ surgery had.

Obsessed with Risk

Many people are actually schizophrenic when it comes to risk. Think about the irony. We idolize extreme athletes who perform death-defying feats. We cheer their successes as we cheer our heroes. On the other hand, look at the extreme policies every public school in America has to follow to make sure no child suffers an injury. Every swing set and set of monkey bars must be equipped with legally standardized cushioning to soften the blow of any fall. We stayed glued to the television to watch Fear Factor and Survivor. Then we turn our sets off and join the public outcry over the need to have greater safety standards.

Sometimes our obsession with risk ends up in the ridiculous mode. McDonalds must put on their coffee cups a warning that the contents are hot. You’re not supposed to tear the tags off pillows. Doctors must pay absurd amounts of money for malpractice insurance. Ladders are sold with warnings about falls. Halloween costumes include the disclaimer that the cape does not enable the person to fly.

Around for a Long Time

Risk has been around for a long time. Take a quick look at American history and you will learn about the early explorers to this land and the risks they took. The establishment of the democratic form of government was risky. What about the risk of detonating the hydrogen bomb? Risk has been a fact of life since the beginning of time.

The roots of probability theory can be traced to Blaise Pascal in the 17th century. His groundwork through time led to new fields of business such as risk management, insurance, and forecasting economic trends. These new endeavors culminated in the 70s with the emergence of a new science we call risk analysis.

Now we can spout off one risk factor after another. Alcohol is a factor in 44 percent of all accidental deaths. A child is 600 times more likely to be killed by a school bus than by traveling on a school bus. One is 400 times more likely to die from falling than to die by having something fall on him. And on and on it goes.

The bottom line? Everything in life is risky. Every day is filled with risks. The main issue is how we respond. How can we sort through all the information that bombards us?

The Truths About Risk

Which risks should we worry about, and which ones should we not be concerned about? Since so much distorted perspective abounds, how can we learn to make wise and reasonable decisions? The following eight principles will help.

1. Everything in life is risky. A study of daily newspapers across America revealed that about 47 percent of front-page articles dealt with some type of risk. Note the themes of some of the headlines on a single day: painkillers cause heart risk; pets increase eczema risk in children; and veterans have high risk of identity theft. With all the information that bombards our minds, it is easy to see how confusion can set in.
2. Worry increases with knowledge. One significant reason we tend to worry more today than people did one or two generations ago is that technology allows us to see firsthand some of the gruesome things that happen to people. People worry about flying. But the odds are greater of dying on the way to the airport than dying in a plane crash. One of the skills we need to develop is the ability to focus on those risks we can do something about. For example, most people think the risks of dying from a fatal heart attack are about 1 in 20. In reality the odds are 1 in 3. And those are odds that each one of us can do something about.
3. Many risks are not worth worrying about. Did you know 8,000 Americans are injured annually by musical instruments? Did you know that January is the most common month that people die? Sometimes even the experts provide conflicting reports. Worry never does anyone any good.
4. Eliminating all risk is impossible. People tend to believe that if a risk can be identified and measured, then it can be nullified. Zero risk, a concept that has been planted in our brains, represents a true disconnect from reality.
5. Our goal should be minimizing risk. The scientist responsible for developing the Saturn 5 rocket noted the impracticality of designing a valve that does not leak. Consequently, one must determine how much leaking can be tolerated.
6. Each person must decide on acceptable risks. Taking an aspirin can cause stomach ulcers. But a daily aspirin can also prevent strokes. Each individual must use his God-given brain to determine which risks to accept.
7. Every risk is not bad. There is an upside to some risks. Think how dull life would be without risks.
8. We will all die one day. The odds of dying from cancer are 1 in 500. The odds of dying while riding your bicycle are 1 in 130,000. The odds of dying by a falling meteor are 1 in 5,000,000,000. The odds of dying are 1 in 1.

Some people never take risks and end up doing nothing significant with their lives. Others take all the wrong risks and end up hurting themselves and others. In both cases these people never enjoy their God-given purpose in life.

Life Changing Risks

All through my life I have faced risks. Applying to Yale for college was a risk because I had enough money to apply to one college only. While at Yale, I took a huge risk by developing a relationship with Candy Rustin who later became my wife. One of the greatest risks took place in med school when my advisor suggested that I either drop out or take lighter loads. Instead, I chose a third option. I designed a new method of studying, which proved to be the turning point in my med school years. Three other risks deserve attention here because they helped shape my career.

The Risk of Thinking in New Ways

While observing a neurosurgical procedure, the surgeon explained that the most difficult part is locating the foramen ovale, a tiny hole at the base of the skull. Indeed, as I watched, the process became a trialand-error approach.

There had to be a better way. I spent some days designing a new approach that involved using an X-ray beam to line up through two points. At first, I sat on the idea because I was just a student. How would the doctors feel about my suggesting a new procedure? Eventually, I took the risk; the procedure worked, and the doctors were impressed.

The Risk of Weighing the Alternatives

During my fourth year of residency at Johns Hopkins, I faced a difficult dilemma. A teenage boy came into the emergency room with a head that had been badly beaten with a baseball bat. He would die without immediate surgery. Most of the neurosurgeons were in Boston for an annual convention, including my supervisor. The next protocol step was to call the faculty member in charge of all consults. After numerous failed attempts, I knew I had to make a quick decision because the boy was already comatose and deteriorating rapidly.

The physician’s assistant told me to go for it and I did. I waited for several days to see what kind of consequences I would suffer. But thankfully there were none. That young man is now married, has a family, and works as a psychologist in Baltimore’s public school system.

The Risk of Making Your Own Decision

Near the end of my residency a neurosurgeon from Australia invited me to come there and become senior registrar (like our chief resident). The opportunity would provide a wealth of experience, although it would extend my residency for an additional year. And since Candy was pregnant with our first child, we declined. But we were never at peace about our decision.

As we continued to weigh the pros and cons, we decided to accept the position. The year was fulfilling to say the least. Many of the surgeries I performed were extremely complex, thereby giving me experience I would have never garnered in the states. About a year after returning from Australia, I accepted the position of director of pediatric neurosurgery at Johns Hopkins, at the unheard-of age of 33.

The Best/Worse Analysis Formula

Whether it is deciding on career moves, knowing whether to accept speaking engagements, or discerning which cases to accept, I analyze the risk. How do I analyze risks and arrive at a decision? I use a formula that I designed called the Best/Worst Analysis (B/WA) formula. It is actually quite simple. “What is the best thing that can happen if I do this? What is the worst thing that can happen if I do this? What is the best thing that can happen if I don’t do it? What is the worst thing that can happen if I don’t do it?

The B/W A Formula Applied

These four questions have become my best friends when analyzing any risk that I face.

The Christopher Pylant Case

Four-year-old Christopher Pylant had been diagnosed with a massive, inoperable brain tumor. Every medical professional had given him a terminal prognosis. The parents informed me that they felt God had led them to Johns Hopkins and to me. They were not satisfied when I informed them that I concurred with all the other prognoses.

The parents pressed me to do something. But I couldn’t justify taking any action just because of the parents’ faith. I needed some rational justification. I wondered if there was any possibility at all that the mass was something other than a malignancy. At that point, I applied the B/WA formula to decide whether or not we should operate. Only one option provided any chance of a positive outcome.

There was nothing to lose by doing an initial exploration. Unfortunately, what I saw confirmed what everyone else had said. However, Christopher’s quick response and recovery surprised us all. The decompression we did at the back of his head evidently relieved a lot of pressure from the tumor. Further testing showed that the tumor had not yet penetrated the brain stem. After surgery, he made a remarkable recovery, finished his education, and is now a minister. This result would have never happened had I not used the B/WA formula.

Please understand that applying the formula does not guarantee a storybook ending. But it is unlikely you will have a worse outcome by implementing the formula.

“What a B/WA does guarantee is that you consider the various possibilities in a reasonable, logical manner before making any uncertain or risky decision.”

When Additional Wisdom Is Needed

In those cases for which the formula seems insufficient, try answering the basic questions of who, what, where, when, how, and why. Who will be most affected by the decisions? Who else will be affected? How will the decision affect me?

What do I need to know? What am I willing to learn? Many times other professionals will see that I am on to a good idea and will ask, “What can I do to help?”

The “where” question needs to be asked from three different perspectives. Your goals lead you ask, “Where are you going?” Your skills, thinking, and attitudes lead you to ask, “Where are you now?” And your preparation leads you to ask, “Where will you begin?”

The issue of timing (when?) is critical when performing the B/WA formula. What I might decide to do today I may never have decided to do 10 years ago. If anything has changed significantly over the past year, this might modify or even reverse your thinking.

It doesn’t matter which order you use to answer these questions. Frequently, the questions must be considered simultaneously. This, in fact, has been the case for me when dealing with the “how” question. How will we proceed with a surgery? How can we use multiple procedures to accomplish our goals?

The “why” question and the Golden Rule (which I try to follow) are closely connected, and they play a pivotal role in the decisions I make. I try to put the needs of others ahead of my own.

Integrating Faith and Work

God expects every believer to integrate his faith in the workplace. I don’t believe He ever intends us to cram truth down people’s throats. Nor does he want us to cower when opportunities arise.

An Imposing Audience

Probably my most formidable assignment was to participate in a panel discussion conducted by the prestigious Academy of Achievement. The subject was the relationship between faith and science. Past participants in this elite group include former presidents, Nobel Peace Prize winners, well-known CEOs, as well as world-renowned participants from the fields of arts, public service, science, and sports. I wasn’t sure if I wanted to reveal my spiritual beliefs before such an audience.

After applying the B/WA formula, I decided that the possibility of embarrassing myself before such an august group wasn’t as important as the opportunity for open and objective discussion on things that matter the most.

The main truth I wanted to portray in this discussion was that faith did not have to be anti-science. I tried to explain that science has many gaps that actually require a measure of faith to accept. Science and religion both require faith. Each person must decide where to put his faith. And whatever choice is made does not make him superior to those who choose a different path of belief.

My B/WA

Here is how I assess the risk of integrating faith in my medical practice. What is the worst that could happen? I could offend someone. And if I offend the wrong person, I guess I could be fired.

What is the best that could happen? I would be the same person and true to myself regardless of whether I am home, at work, or wherever. I can use my God-given abilities and talents in ways to edify others and God. If my motive is to please God in every area of my life, then I don’t have to waste a lot of energy worrying about how people might react.

What is the worst that could happen if I decide not to integrate faith and work? My life would be out of balance, and I would be at odds with myself. I’d feel like a hypocrite and would probably eventually have to make a choice either to abandon my faith or risk being more open about it.

What is the best that could happen if I decide not to integrate faith and work? Actually, there is no best scenario with this option.

Faith and Risk Go Hand in Hand

There is no way we can remove all risk from faith. But how to integrate faith and work is a difficult process for many because the risk sometimes results in opposition, injustice, and criticism. I often pray with my patients, but only if they ask me to. That is a much different approach than praying whether the family wants it or not. “There is something to be said for wisdom or discernment, and we can all reduce the risk of living out our faith at work if we use a little of both.”

It helps me to understand that any risk I take becomes more acceptable when I remember that God took a great risk when He decided to have a relationship with me. He doesn’t ask me to risk anything that He Himself hasn’t risked for me. This truth makes it easier, then, for me to follow the Golden Rule and to deny myself and follow Christ.

B/WA for Parents

One of the most difficult, yet significant, challenges known to man is being a parent. Every parent every day must make decisions on behalf of his children. Some carry more risk than others. The B/WA always comes in handy.

Driving Privileges

Let me tell one story that shows how this formula helped us make a family decision. Our third son, Rhoeyce, soon after he got his driver’s license, totaled our car when he lost control on a rain-slick road. It’s a miracle he survived the crash. We lectured him strongly; and he was humbly regretful. We had confidence in him. So we let him continue to drive.

Within a couple of weeks, he made another serious misjudgment when he rear-ended another vehicle~ two serious accidents in less than a month. At this rate, it wouldn’t be long before our family would have no vehicles to drive. Rhoeyce was very hard on himself. His confidence was badly shaken. He announced that he didn’t want to drive anymore. That sounded like a reasonable consequence.

But then we applied the formula. The best thing that could happen if we didn’t let him drive is that his odds for survival were better. The best thing that could happen if we let him drive is that he could learn from the previous two accidents and become an extremely good driver. The worst thing that could happen if we didn’t let him drive is that he might lose so much confidence that he would never want to drive again. The worst thing that could happen if we let him drive is that he could die in another accident.

Other parents may have reached a different conclusion than we did. But we let him continue driving. After factoring in his personality type, we believed that letting him keep driving would be a tremendous boost to his confidence. We told him we believed in him. Five years later he was still free from accidents and traffic tickets.

Parenting Issues

Let’s take a look at two random issues and learn how to apply the B/WA formula. First is the issue of school choice. Should parents be content with the public school system or should they look into private schools? Homeschooling and private schooling are skyrocketing in enrollment. Many parents choose this route because they fear for their children’s safety. A careful risk analysis would show that those fears are largely unfounded. Children have a greater chance of dying in an accident while traveling to school than being killed in some type of Columbine tragedy. If the motive is concern for substandard education in public schools, then that is a different story since 80 percent of sixth graders cannot locate the United States on a map.

Second is the issue of the spiritual considerations related to education. Do parents provide an educational environment that provides faith and values or do they send them to public schools where the education is becoming more and more anti-Christian? I made it fine in public schools because my faith was deeply grounded; my mother and my church saw to it.

That doesn’t mean you should go the public education route, however. Each parent must weigh the risks. But it is critical that parents not only protect their kids, but also prepare them for life in the “real” world.

Our National Financial Crisis

Our national debt continues to spiral out of control. To arrive at a solution certainly requires thinking outside of normal parameters. I believe we could eliminate the national debt by doing away with money altogether. (I’ve even presented this concept to the president.) Just as God established the tithe for all, the wealthy and poor alike, I believe nations would do well to implement a proportional template.

For this concept to work properly would require eliminating all money and credit cards. We could identify everyone by a handprint and a retina scan and perform all transactions electronically. We could set the tax rate at 10 percent (or 12 to 15) on all financial transactions.

There are many glitches to overcome, but think of the positive effects. One is the issue of fairness. Everyone would be taxed the same. The plan would eliminate tax incentives for corporations and the wealthy. Such a tax wouldn’t penalize the rich or patronize the poor. In war situations, the proportion could be increased. This system would eliminate our national debt because it would increase the tax base by about 30 percent. Think about what such a plan would do to drug dealers and organized crime, segments of society that operate on a cash basis.

Most congressmen and senators agree that my idea would work very well. But they admit that overcoming resistance from special interest groups would be difficult to overcome. Implementing this idea would require courageous leadership and a broad support from the grassroots population.

Special Interests

Some issues are so overwhelming that they can actually paralyze us. And when we don’t respond, we become complacent, a state which becomes an even greater societal threat. We all know that our government is being run by special interest groups. Our elected officials are now spending up to half their time raising money just to stay in office. We all know it’s a problem, but we don’t have a clue what to do about it. The very principles upon which our country was founded are at risk. We must never forget that the country exists to serve us, not to rule us.

Gambling

Americans are far too complacent about the devastating effect gambling has on families and individual lives. I know this problem is not going away anytime soon. But when I received an invitation to speak to a national convention of the gaming industry, I accepted. The approach I used was to talk about the potential of the human brain. Then I challenged them to admit that their industry was not just entertainment, but that it was actually ruining many lives.

I told them that I knew they were decent human beings who were not bent on destroying lives. Certainly, they wanted their customers to have fun. I just encouraged them to use their brains to come up with a better way to provide entertainment without all the negative effects. I suggested a type of card, like a credit card, whose limit was based on a person’s income. That way no one could spend rent or grocery money on the machines.

I am not naïve enough to think that all the conventioneers returned to Vegas or Atlantic City and immediately implemented my ideas. But I do believe that I planted many seeds in people’s minds that there could be a less harmful way of doing business. The brain is all you need to master any problem.