death – Pertinent Observations

The Ticket

In his usually excellent column for Mint on Sunday, Charles Assisi writes today about the time after he was told that his father was nearing death.

It is a brilliant essay, where he talks about the “ecosystem” that had developed in his house over the last 18 months when his father was bedridden, and how each part of this ecosystem reacted to this news of impending death.

The part that I could connect with, and which I want to focus on in this post, however, is about the friends and relatives who came visiting. Assisi writes:

Until out of no place a steady stream of visitors started pouring in. To put it bluntly, a farcical affair. All of them looked horribly solemn. I suspect mum may have called some friends and, unwittingly, they may have called everybody else.

This concept of visiting someone on their deathbed has come to be known in my family as “the ticket”. This follows a flippant comment my grandfather had made several decades ago, when he quipped after one such visit that he had “given his ticket” to the person on his deathbed and he (the person my grandfather visited) was now free to go!

And ever since, in my family whenever someone goes to visit someone seriously ill or old, the conversation alludes to whether the “ticket has been given”. And so “did you give the ticket?” or “I gave the ticket and came” have become standard phrases after such visits.

Of course, there are people who get offended by this seemingly flippant way of referring to the last visit to someone before their impending death. They think it is impolite and rude to talk about the ticket, as if it implies one person’s wish that another person were to die. But the ticket givers seldom make such wishes or judgment. Whether they’ve given the ticket is their assessment of whether the person on the deathbed will see them another time.

I also agree with Assisi that for the family of the dying, this constant stream of ticket givers can become an annoyance. The ticket givers think they’re doing a favour by visiting and possibly offering their solidarity. However, most people overestimate their own abilities in making other people feel better, and don’t realise that relatives of the dying are sometimes better given their space as they prepare for life without the soon-to-be-departed.

And so I remember when my mother was in the ICU (almost exactly seven years ago) when a bunch of relatives had come to the hospital, possibly to give her “the ticket”. And I’d gotten really pissed off because the hospital discouraged visitors to the ICU, and I’d to beg and plead with the nurses to allow these visitors to see my mother.

That day, I remember being rude to these relatives, and asking why they bothered coming. I also remember turning them away saying the ICU wasn’t taking any more visitors that day and they cannot see my mother (who had lost consciousness by then, so she would have no way to know these people had come). I’m sure they’d’ve gone back and reported that they’d done their bit to give my mother her ticket.

Not that she needed their send-off.

Sudden death and the discount rate

It’s six years today since my mother passed away. She died in the early hours of Friday, 23rd October 2009 following a rather brief illness. The official death summary that the hospital issued reported the cause of her death as “sepsis”. She only officially died on the 23rd. As far as I’m concerned, I’d lost her two Mondays earlier, on 12th October 2009, when she complained of extreme breathing difficulty and was put on ventilator in the ICU.

Looking back (this year’s calendar is identical to that of 2009, so memories of that year have been coming back rather strongly this year), I realise that the suddenness with which it all happened have left me with a deep sense of paranoia, which can be described in financial terms as a “high discount rate”.

Having moved back from Gurgaon in June of that year, my mother and I had settled down in a rented house in Tata Silk Farm (she didn’t want to go back to our own house in Kathriguppe where we’d lived until 2008). She had settled well, and living not far from her sisters, had developed a nice routine. There were certain temples she would visit on certain days of the week, for example.

And then suddenly one day in September she complained of breathing trouble (she took thirty minutes to walk from our then house to my aunt’s house, which is only a ten minute walk away). Initial medical tests revealed nothing. More tests were prescribed, as her breathing got worse. There was no diagnosis yet.

She started seeing specialists – a pulmonologist and her cardiovascular surgeon (she had had trouble with some veins for a few years). More tests. Things getting worse. And before we knew it, she was in hospital – for a “routine three day admission” for an invasive test. The test got postponed, and the surgery finally done a week later. She got out of the ICU and remained there for hardly two days before she complained of insane breathing trouble and had to be put on ventilator – the only purpose the 12 days she spent on that served was to help me prepare for her impending death.

In all, it took less than a month end to end – from initially complaining of breathlessness to going on ventilator. What seemed to be a harmless problem leading to death.

I realise it’s caused insane paranoia in me which I’m yet to come out of. Every time I, or a relative or a friend, show minor signs of sickness, I start fearing the worst. I stop thinking about the symptoms in a Bayesian fashion – by looking at prior probabilities of the various illnesses that could be causing them – and overweight the more morbid causes of the symptoms. And that adds paranoia and anxiety to what I’m already suffering from.

Like two weeks back I had a little trouble breathing, but no apparent cold. It wasn’t something that happens to me normally. A quick Bayesian analysis would have revealed that the most probable cause is a sinus (which it was), but I spent half a day wondering what had become of me before I applied Vicks and quickly recovered. When my wife told me a week after she reached the US that she had got a high fever, I got paranoid again before realising that the most probable cause was a flu caused due to a change of seasons (which it was!).

Another consequence of my mother’s rather sudden death in 2009 (and my father’s death in 2007, though that was by no means sudden, as he had been diagnosed with cancer two years earlier) was that I suddenly stopped being able to make plans. I started overestimating the odds of something drastic happening, and planning didn’t make sense in such scenarios, I reasoned. As a consequence I became extremely short-term in my thinking, and couldn’t see beyond a few days away.

There have been several occasions where I’ve left a decision (such as booking tickets for something, for example) until it has been too late. There have been times when I’ve optimised for too short a term in some of my decisions, effectively jacking up my “discount rate”.

I’d written a while earlier about how in case of rare events, the probabilities we observe can be much higher than actual probabilities, and how that can lead to impaired decision-making. Thinking about it now, I’ve seen that playing out in my life over the last six years. And it will take a considerable amount of effort to become more rational (i.e. use the “true” rather than “observed” probabilities) in these things.

Finite and infinite stories

Stories in books or movies are “finite” in that there is a defined end-point. Real life, on the other hand, has to go on.

Recently I started reading a book called “Finite and Infinite Games”. I’m barely through the Kindle sample, so can’t comment much on the book, but I want to talk about a related concept – finite and infinite stories.

An important feature of the story is that it is “finite”, and has a fixed ending. For example, if you take Lord Of The Rings, the story is primarily concerned with whether Frodo can destroy the ring by taking it to wherever it came from before Sauron can get his hands on it. Once either the ring is destroyed or Sauron gets his hands on it, the story is essentially over, and doesn’t concern about any subsequent events.

Thus, as you plough through either the books or the movies, you condition yourself to the story “ending” at one of these two finalities. And in this particular story, considering that both of these are epochal events, all characters have a horizon no longer than the time required for one of these two events to happen. In other words, most books and movies are “finite stories”, and efforts in those stories are optimised for such finiteness.

Real life, however, is different, in that it is “continuous”. Whatever happens, in most cases, life simply goes on, and hence you need to optimise for the long term. Let’s say, for example, that you are going through a tough time at work and want your current assignment to end. And while you are at it, you look upon your life as a story, where the success or failure of your current assignment is an epochal event. Consequently, you will use a strategy that optimises your performance until this epochal event.

And then this event happens. Let’s say the assignment is a success. Then, life has to move on and another assignment gets thrown at you. Except that you’ve thrown all you had at the previous assignment, and now have no energy left to deal with this one.

In that sense, real life is like an “infinite story” (though death adds a degree of finiteness to this). However epochal certain events seem, unless they are life-threatening, one ought to think for the long term and plan for beyond the event. For unlike in the books or the movies, the story never ends.

Analysts, competition and Wall Street deaths

Yet another investment banking analyst has died. Sarvshreshth Gupta, a first year Analyst at Goldman Sachs’s San Francisco office reportedly killed himself after not being able to handle the workload. Reporting and commenting on this, Andrew Ross Sorkin writes:

Some banks, like Goldman, are also taking new steps, like introducing more efficient software and technology to help young analysts do their work more quickly. And investment banks say they are hiring more analysts to help balance the workload.

I simply fail to understand how these measures help balance the workload. I mean having more analysts is good in that the same work now gets split between a larger number of analysts. However, that there are more analysts doesn’t mean that the demand for Associates or Vice Presidents has actually gone up – that might go up only with deal flow.

In other words, what the above measure has done is to actually make the organisational structure “more pyramidal” (i.e. reduced the slope of the “pyramid’s walls”). So now you have a larger number of analysts competing for the same number of associate and VP positions. I don’t see how it makes things better at all!

On another note, I wonder if the number of deaths among Wall Street analysts has actually gone up, or if they have only started being reported more in recent times, after Wall Street got into trouble. Based on my limited understanding, I think it is the case of the former, and I attribute it to the lack of choice.

Back in 2004, I attended a talk by a Goldman Sachs MD (who worked in the Investment Banking Division, which does Mergers and Acquisitions, IPOs, etc.) in IIMB where he told me about the lifestyle in his division. That was the day I swore never to apply to that kind of a role. Given that the sales and trading side was doing rather well then, however, I had a choice to take up another equally lucrative, but less stressful-on-lifestyle career. That I chose not to (in 2006) is another matter.

The way I see it, following the crash of 2008, sales and trading have never recovered and don’t recruit as many as they used to. That takes care of one “competitor” of investment banking division. The other “competitor” is consulting, but they don’t pay just as well. In fact, with banking on the downswing, the supply of quality candidates to consulting firms has improved to the extent that they haven’t had to raise salaries as much. For example, starting salaries of IIM graduates at top-tier consulting firms in India have only grown at a CAGR of 6.5% since the time I graduated in 2006.

What this means is that few jobs can match the pay of investment banking, and that reduces the number of exit options. A few years back, anyone who found it too stressful had the option to move out to another job that was less demanding in terms of number of hours (though still stressful) without a cut in pay. This option has expired now, with the effect that people soldier on in investment banking jobs even if they’re not completely cut out for them.

And then some don’t make it. And so they go..

Ban bathrooms

My grandmother passed away last Sunday. While she was fairly old (late eighties) and her faculties were declining, the immediate cause of her death was a fall in the bathroom. She fell about a month back following which she underwent a hip replacement surgery (at her ripe age). While she responded well to the surgery (an X-ray taken a day before her death shows perfect fit), the fall and the surgery made her considerably weak which probably led to her demise.

Two months back, her sister passed away. While she too was old (not as old as my grandmother, though), her demise too was accelerated by a fall in the bathroom.

One of my grandmother’s brothers has been in hospital for five months now, slipping in and out of coma. He was admitted into hospital following a head injury which happened because, you guessed it right, he fell in the bathroom!

Deaths due to falls in the bathroom are becoming an epidemic now. It is not wise on our part to lose so many of our learned and wise elders due to this trifling presence in our homes. It is important that the government take strong steps to curb this malaise of deaths being caused due to falls in the bathroom.

I have a simple suggestion – ban bathrooms. Once bathrooms have been banned, there will be no place left for old people to fall and die. Banning of bathrooms might be the singular lever that can help push up India’s life expectancy. I expect that the government take steps in this direction quickly.

PS: Past studies have shown that Indians suffer from an acute case of irony deficiency