Do you want to rule?
Do you see the problems in your country and know how to fix them?
If only you had the power to do so.
Well, you've come to the right place.
But before we begin this lesson in political power
ask yourself:
why don't rulers see as clearly as you?
Instead acting in such
selfish, self-destructive, short-sighted ways.
Are they stupid
these most powerful people in the world?
Or
is it something else?
The throne looks omnipotent from afar
but it is not as it seems.
Take the throne to act
and the throne acts upon you.
Accept that or turn back now before we discuss
The Rules for Rulers.
*somber music*
No matter how bright the rays of any sun king:
No man rules alone.
A king can't build roads alone
can't enforce laws alone
can't defend the nation or himself, alone.
The power of a king is not to act but to get
others to act on his behalf
using the treasure in his vaults.
A king needs an army, and someone to run it.
Treasure and someone to collect it.
Law and someone to enforce it.
The individuals needed to make the necessary things happen are the
king's keys to power.
All the changes you wish to make
are but thoughts in your head
if the keys will not follow your commands.
In a dictatorship, where might makes right
the number of keys to power is small
perhaps only a dozen generals
bureaucrats
and regional leaders.
Sway them to your side and the power to rule is yours
but never forget:
Displease them...
and they will replace you.
Now all countries lie on a spectrum
from those where the ruler needs few key supporters
to those where the ruler needs many.
This foundation of power is why countries are different.
Yet many keys or few
the rules are the same:
First:
Get the key supporters on your side.
With them, you have the power to act
you have everything.
Without them
you have nothing.
Now in order to keep those keys to power, you must
Second:
Control the treasure.
You must make sure your treasure is raised and distributed to you
for all your hard work
and to the keys needed to keep your position.
This is your true work as a ruler:
figuring out how best to raise and distribute resources
so as not to topple the house of cards
upon which your throne sits.
Now you
aspiring benevolent dictator
may want to help your citizens
but your control of the treasure is what attracts rivals
so you must keep those keys loyal.
But there is only so much treasure in your vaults
so much wealth your kingdom produces.
So beware:
Every bit of treasure spent on citizens
is treasure not spent on loyalty.
Thus, doing the right thing
spending the wealth of the nation on the citizens of the nation
hands a tool of power acquisition to your rivals.
Treasure poured into
roads, and universities, and hospitals
is treasure a rival can promise to key supporters
if only they switch sides.
Benevolent dictators CAN spend THEIR take on the citizens
but the keys must get their rewards
for EVEN IF you have gathered the most loyal, angelic supporters
they have the same problem as you
just one level down.
Being a key to power is a position of power.
They too must watch out for rivals from below or above
thus the treasure they get must also be spent to maintain their position.
The loyal and dim may stay by your side no matter what.
But smart key supporters, will always watch the balance of power
ready to change allegiance if you look to be the loser
in a shifting web of alliances.
In countries where the keys are few
the rewards are great.
And when violence rules
the most ruthless are attracted
and angels that build good works will lose
to devils that don't.
So buy all the loyalty you can
because loyalty
in dictatorial organizations of all kinds
is everything.
For the ruler, anyway.
Thus, the dictatorship exposed:
A king who needs his court
to raise the treasure
to keep the court loyal
and keep raising the treasure.
This is the self-sustaining core of power.
All
outside
is secondary.
Now a king with many key supporters has real problems:
not just their expense
but also their competing needs and rivalries are difficult to balance.
the more complicated the social and financial web between them all
the more able a rival is to sway a critical mass.
The more key supporters a ruler has on average
the shorter their reign.
Which brings us to the third rule for rulers:
Minimize Key Supporters
If a key in your court becomes unnecessary
his skills no longer required
you MUST kick him out.
After a successful coup
the new dictator will purge some of those who helped him come to power
while working with the underlings of the previous dictator
which from the outside seems a terrible idea.
Why abandon your fellow revolutionaries?
Are the old dictator's supporters not a danger?
But the keys necessary to gain power
are not the same
as those needed to keep it.
Having someone on the payroll who was vital in the past
but useless now is the same as
spending money on the citizens:
Treasure
wasted
on
the irrelevant.
And by definition, a dictator that pulls off a coup
has promised greater treasure
to those switching sides.
The size of the vault has not changed
so the treasure must be split among fewer.
A dictator that sways the right keys
takes control of the treasure
cuts unnecessary spending
kills unnecessary keys
will have a long and successful career.
Seeing the structure unveiled
you might be excited to get started
and control a country to the benefit of you and your cronies
or you might be exhausted
wishing to do good but seeing the structural difficulties
now turn to democracy for salvation.
So let us discuss
Rulers as Representatives.
You again might have grand dreams of the utopia you wish to build.
But
No man rules alone.
And never more so than in democracy.
Presidents and Prime ministers
must negotiate with their
senates and parliaments and vice versa.
And they all have their own key supporters to manage.
In a well-designed democracy
power is fractured among many
and is taken not with force
but with words.
Meaning you must get thousands or millions of citizens to
if not like you on election day
at least like you better than the alternative.
With so many voters and such fractured power
it's impossible to
as a dictator would
follow these rules and buy loyalty.
Or is it?
Of course not.
Don't think of citizens as individuals with their individual desires
but instead as divided into blocs:
the elderly
or homeowners
or business owners
or the poor.
Blocs you can reward as a group.
Democracies have wildly complicated tax codes and laws
not as accident but as reward for the
blocs that get and keep the ruling representatives in power:
Farming subsidies, for example
have nothing to do with the food a nation needs
but entirely with how key the vote of the farming bloc is.
Countries where farmers' votes don't swing elections
don't have farming subsidies.
If a bloc doesn't vote
such as younger citizens
then no need to divert rewards their way.
Even if large in number
they are irrelevant to gaining power.
Which is good news for you:
one less bloc to sway
and the treasure you give to your key blocs has to come from somewhere.
If you want long years in office
rule three is your friend in a democracy
just as much as a dictatorship.
You can't eliminate those who don't vote for you
but there is still much you can do.
Once in power
make it easier for your key blocs to vote
and harder for others.
Establish voting systems that reduce the number of blocs you need to win
the more rivals you get
very handy indeed.
Draw election borders to predetermine the results for you or your cronies
and have party pre-elections with Byzantine rules
to determine who blocs even CAN vote for.
Mix and match the above for even better power perpetuation.
When approval ratings couldn't be lower
yet re-election rates couldn't be higher
you'll know you've succeeded.
Now, enough with thinking about the citizens.
Even in a democracy
there still are very influential individual key supporters
you need on your side
because their money
or influence
or favors
keeps you in power.
While you can't just promise to give them treasure directly...
as a dictator would
...you can create loopholes for their investments
pass laws that they've written
or print get out of jail free cards for their actions.
Not a wheelbarrow of gold to the door
but contracts for their business.
You as ruler do have roads to build
or computers to maintain
or buildings to reconstruct.
No man rules alone, after all.
Or you could take the moral path
and ignore the big keys.
But you'll fight against those who didn't.
Good luck with that.
Corruption is not some kind of petty crime
but rather a tool of power
in democracies and dictatorships
but more on that another time.
So, accept the favors
sway the key blocs
and you will get into power
ruling with actions that look contradictory and stupid
to those who don't understand the game
privately helping a powerful industry you publicly denounced
or passing laws that hurt a bloc that voted for you.
But your job isn't to have a consistent understandable ruling policy
but to balance the interests of your keys to power
big and small.
That is how you stay in office.
Now with all this headache of being a representative
you may wonder...
looking at rule three
Why couldn't you skip all this bloc-building, favor trading nonsense and
just bribe the army to take power?
We must finally turn to:
taxes and revolts.
You must understand rule two
and how the treasure is raised and used
to hold a country together.
If we graph the tax rate of countries vs the number of key supporters the ruler needs
there's a clear relationship.
More democracy
lower taxes.
If you're sitting comfortably in a cushy democracy
you may scoff at this
but your fellow citizens who don't earn enough
don't pay income taxes and get rebates.
Bringing the AVERAGE tax rate down.
In dictatorships
this doesn't happen.
Dictatorships often forgo tax paperwork in favor of just
taking wealth directly.
It's common for the dictator to force farmers to sell their produce to him for little
then turn around and sell it on the open market.
Pocketing the difference at an unthinkably high equivalent tax rate.
So taxes in democracies are low
in comparison to dictatorships.
But why do representatives lower their take?
Well, cutting taxes is a crowd pleaser.
Dictators have no need to please the crowds
and thus can take a large percentage from their poor citizens
to pay key supporters.
But representatives in a democracy can take a smaller percentage
from each to pay their key supporters
because their educated, freer citizens
are more productive than peasants.
For rulers in a democracy
the more productivity the better.
Which is why they build universities
and hospitals
and roads
and grant freedoms
not just out of the goodness of their hearts
but because it increases citizen productiveness
which increases treasure for the ruler and their key supporters
even when a lower percentage is taken.
Democracies are better places to live than dictatorships
not because representatives are better people
but because their needs HAPPEN to be aligned
with a large portion of the population.
The things that make citizens more productive
also make their lives better.
Representatives want everyone productive
so everyone gets highways.
The worst dictators are those whose incentives
are aligned with the fewest citizens.
Those who have the fewest keys to power.
This explains why the worst dictatorships have something in common.
Gold or oil or diamonds or similar.
If the wealth of a nation is mostly dug out of the ground:
it's a terrible place to live
because a gold mine can run
with dying slaves
and still produce great treasure.
Oil is harder
but luckily foreign companies can extract and refine it
without any citizen involvement.
With citizens outside this cycle
they can be ignored
while the ruler is rewarded
and the keys to power
kept loyal.
Thus we live in a world where the
best, smartest democracies are stable
the worst, richest dictatorships are stable
and in between
is a valley of revolution.
The resource-rich dictators build roads
only from their ports to their resources
and from their palace to the airport.
And the people stay quiet
not because
"this is fine"
or even because they're scared
but because the cold truth is:
starving, disconnected, illiterates
don't make good revolutionaries.
Now a middling dictator without resources must
as mentioned before
take a large amount of wealth
directly from his poor farmers and factory workers.
Thus two roads won't do
and so he must maintain
some minimums of life for the citizens.
But keeping the work-force SOMEWHAT connected
and SOMEWHAT educated
and SOMEWHAT healthy
makes them more able to
revolt.
Now understand:
the romantic image of the people storming the gates
and overthrowing their dictator
is mostly a fantasy.
If you run a middling dictatorship
the people only storm the palace when
the army LETS THEM
to remove you
because you lost control over your keys
and are being replaced.
This is why after
"popular revolts"
in middling dictatorships, the new ruler is often
the same as the old
if not worse.
The people didn't replace the king
the court replaced the king
using the peoples' protest
they let happen to do it.
The very things a benevolent dictator wants to build
to cross this valley
take treasure away from the keys to power
and make the citizens more able to revolt
often ending in a stronger ruler
less likely to build bridges
and more loyal to his keys.
On the other side, the best democracies are stable
not just because
the large number of keys and their competing desires
makes dictatorial revolt near-impossible to organize
but also because the revolt would destroy
the very wealth it intended to capture.
The high productivity of the citizens.
Plus: those helping the would-be dictator in a democracy
know he plans to cull key supporters once in power.
That's what's a coup is.
So potential key supporters must weigh the probability of surviving the cull
and getting the rewards
versus the risk of being on the outside of a dictatorship
they helped create.
In a stable democracy
that's a terrible gamble:
MAYBE you'll be incredibly wealthy
but PROBABLY you'll be dead
and have made the lives of everyone you know
worse.
The math says no.
Being on the right side of a coup in a dictatorship
means having the resources to get you and your family
what the peasants lack:
Health care, education, quality of life.
This is what make the competition for power so fierce.
But in a democracy most already have these things
so why risk it?
So the more the wealth of a nation comes from
the productive citizens of the nation
the more the power gets spread out
and the more the ruler must maintain the quality of life for those citizens.
The less
the less.
Now if a stable democracy becomes very poor
or if a resource that dwarfs the productivity of the citizens is found
the odds of this gamble change
and make it more possible for a small group to seize power.
Because if the current quality of life is terrible
or the wealth not dependent on the citizens
coups
are worth
the risk.
When democracies fall
these are usually the reasons.
*Conclusion*
These rules for rulers explain not only why
some men are monsters
and others are merciful
but EVERYTHING about politics:
from war
to foreign aid
to political dynasties
to corruption.
All of which, we can talk about at another time.
But for now
you aspiring ruler
may be disgusted by the world of politics
and have decided to avoid it entirely
but you cannot
for rulers come in many forms.
Yes, Kings
Presidents
and Prime Ministers
but also Deans, Dons, Mayors, Chairs, Chiefs.
These rules apply to all and explain their actions:
from the CEO of the largest global corporate conglomerate
whom must keep his board happy
to the chair of the smallest home owner's association
managing votes and spending membership fees.
You cannot escape structures of power.
You can only turn a blind eye to understanding them
…and
if you ever want the change you dream about
there is a zeroth rule you cannot ignore.
Without power
you
can affect
nothing.
You may not like these rules
but surely
better you on the throne than someone else.
And who knows
maybe you'll be different.
*somber piano music, slowly fading*
For more infomation >> Az Uralkodók Szabályai (CGP Grey fordítás) - Duration: 18:57.-------------------------------------------
Brilliance, Baths, and a Rant - Vacation Vlog Part 1 - Duration: 10:50.
oh terrible lighting, terrible lighting
better lighting
hi everybody, I'm Amanda the G and I'm on vacation so
vacation vlog!
woooooooo
now you got sick
this is day one
it's Friday
and I actually went to work this morning, so it's like half of a day
but it's day one, we're going with it, day one!
I went
(dog claws clicking)
I went to the gym
(dog claws clicking)
I'm just gonna let him click
you're just gonna deal with it
who's crazy?
are you crazy?
then I filmed a video which I had wanted to film, but I was sick
and then
I went to Hobby Lobby, cause I thought I was gonna get stuff to recover this couch that I destroyed
in my basement
here's what I did
here's what I did to this couch
this is the couch that got stuck
up in the corner
when I was trying
to bring it down from upstairs
it's my old couch
that I hate
(quiet laughter) so
my plan was
to put more foam in it, make it like a double armed chaise lounge type of thing
and then recover the whole thing
and
I went to Hobby Lobby
because- oh god, don't die
um, went to Hobby Lobby because the fabric was on sale
it was like 30% off, and I was like, ok, I'll look at it
I'm not spending 70 bucks for frikin' fabric to recover a free couch
so instead, I got some stickers
and
I scheduled
to have my HVAC cleaned for the fall cleaning that I clearly postponed way too friggin long
to make sure it's not gonna kill me with carbon monoxide
ummmm so they're coming (laughing) this week
and
I also scheduled my home internet to come
so I'm going to actually have internet in my house again
which is weird cause I have not in years
but now
I'm gonna eat some food
and I'm gonna watch the Olympics
and I can't show you that
because I have a feeling if you broadcast the Olympics
even in a little bit, they're gonna be mad at you
day two and I have just gotten home, this lovely, lovely look
is brought to you by two hours at the gym followed by a walk in the rain
which wasn't raining at first, but now it's raining
so
yay good thing I wore my rain boots
and then I come home and I see this
and I'm reminded
of how much this closet sucks
there's shit everywhere
shit everywhere
in this closet
so now
I've decided that on my to do list
I'm gonna add fix that damn closet
and now you see why Amanda doesn't daily vlog
because one, my house is a fucking mess
and two
I don't do a lot of super fun shit (laughing)
my vacation is doing shit around the house
I'll see you guys after I take a shower cause this is gross
actually!
let's knock off the to do list
let's give the dog a bath
put the paws up, there you go, good boy
good boy, Ollie, good boy, mwah, mwah, mwah, good boy
good boy
that's a good boy, I know, I know
get the soap
good boy
good boy
good boy, good boy
who's a good boy?
who's a good boy?
who's a good doggie?
you're a good boy, yes you are
good boy
all done, water goes off
what a good doggie!
yes, you're good boy
yes you're a good boy, yes you are
oh what a good boy
believe it or not
that's like the least painful a bath has ever been
ever
and I've taken a shower now
clean
and we got one load of laundry in, and I'm about to do something that I consider brilliant
and hopefully you consider it brilliant too, and if you don't
oh well
it's not your house, it's not your stuff
deal with it
this comforter
is in a cover
and it keeps moving
and you have
sections of the cover
with no comforter in it
and sections where there's like a pile of frikin comforter
and also it's a pain in the butt to put in
and to figure out where things are going
so I've come up with what I consider a brilliant damn solution
I'm gonna put snaps in it
I'm gonna put em one way on the top
and another way on the bottom
and I'm gonna put a corresponding snap on the comforter on the inside
and then if I get a new cover, I just put four more snaps on the cover based on the top and bottom
and then I'll always be able to find the top and bottom
you just snap in all four corners
it should spread out easier
hopefully
that's the thought
and then it stays out, and then you have your comforter everywhere
instead of like my dog hogging all the comforter
yeah that's right, Ollie, I know what you do, you're a comforter hog
high 5
good boy!
that's his trick, he likes to high 5
you get a little pokey thing and this
and the pokey thing goes underneath
and this goes on top of the fabric
and then you hammer it on
snaps are on, laundry is in
and
second load of laundry is actually in now
and the first one's in the dryer
and hanging up in my bathroom because not all of it can be dried
and I am now going to eat
for the first time all day
and then I'm gonna edit
which is super thrilling
look
it's the Olympics- don't look!
it's classified
I'm just taking
my little
video file
and transferring it onto my computer from my SD card
it's super thrilling
(robot voice) robot vacuum take over world
the lighing is shit right now because it's, it's night time
I have my 6th
load of laundry in the frikin dryer (laughing)
because
I don't know, I waited too long to do all of this
but I'm gonna see
if my
plan
worked
cause now there's snaps on that
so
theoretically
you just put the mountains in the holes
since the mountains are on the top on the inner thing and the bottom on the outer thing
it should be easy
and there should just be simple
(music playing)
(maniacal laughter)
it's working!
it's all to each corner now
it's all to each side now
you just have to snap em and then fling it
it works!
day three
good morning, I have coffee
all the coffee is mine
I'm gonna wake up now
I'm gonna have coffee
and then
I'm gonna be super fun again and edit all day
(sizzling) breakfast yummmmmmmmmm
ok, now that I finished editing, I've moved that painting over there
just so I have room on my table
for insanity
also known as scrapbooking
I just finished 36 pages of scrapbooking
which if you scrapbook at all, you know how extensive that is
umm
that hacking is the dog
it's like
yeah, it's like almost 6 o'clock at night
um, this is the aftermath
on my table
which I clearly need to clean up
cause it's everywhere
and then there's more
um, more too
because there's never enough space
for all of this
day four
I'm exhausted
right now
because my alarm went off at 5:10
and I'm going to the gym
but
I planned on this
I planned on my alarm going off this early because I have to get
my run in
before
the internet people come
so we'll see how many
crazy people there are at the gym at this hour
also that's a Capri Sun
on my night table
because I got really thirsty in the middle of the night
and I didn't feel like getting a glass to get water
which I probably should've done, so instead
I got a Capri Sun that's in my fridge that was leftover
and it took me forever to get that stupid thing open
with that straw cause I didn't want to turn any lights on
I'm back from the gym, I just ran for like an hour
and then I went and stretched for a bit
so I did intervals, one on, er
one off, two on
whatever
um, and I just- I have my sock here because that's blood
um
I was like I think my foot's bleeding
about halfway through
yeah my foot's bleeding
in high school, my cross country coach used to get mad at us
and every time he did, he said that he would make us run until their feet bled
so Mr. Forbes
my foot is bleeding
it's like
seven o'clock in the morning
dog is still asleep
I gotta take a shower
and then get dressed and then move the TV
so that the internet people can get to the plugs back there
because for some reason in this house
the only place to plug in anything like a cable wire
or a cable for internet is behind where my TV is
three hours later, I finally have internet
well three hours after the guy got here
look my house looks actually kind of clean
but you wouldn't think that
because there was mud all over the place that I had to clean up
and then the guy asks for a towel to put under his shoes, and it's been raining
so it's like, ok, well I figured it'd be like water, it was caked in mud
so it's a good thing that I gave him a shit towel
that I don't really care as much about
but now
I still have to clean that towel
and I just did 7, 6? 6? 6 loads of laundry?
somethin' like that
the other day
and now I just made more laundry
so great
and I'm also kinda pissed off right now because
the guy
is talking to people his whole time he's here
which is fine
if you wanna talk to people on your little bluetooth headset, you go ahead and talk to people on your
little bluetooth headset when you're settin' shit up
but he's like trying to explain shit to me, and making phone calls, and trying to explain shit
and making phone calls, but just fucking deal with what we're dealin' with here, and then go make your goddamn phone call
also I heard him very loudly say outside and then
hush himself as he was coming in the door and then say very loudly in my basement
which by the way, sound carries like no other in this house
I can hear everything that happens
to complain
about the dog poop in my back yard
ok
first off
I work four jobs
I have no time
I'm taking a week off to stay at home to get laundry done
and cleaning done, you think I have time?
and then on top of that, it's fucking pouring rain
so I was gonna go out there and pick it up this mornin'
after I went to the gym
but it's fucking pouring down rain
I'm not doing it in the fucking pouring down rain
also, my dog just shits on the walkway because he's a jerk
so just go next to the walkway, it's fucking fine
and there's not even that much out there
he's like 'I'm gonna be sick'
blah, blah, blah
you wanna complain about me?
fucking complain about me, I don't care
complain about me all the fuck you want to
complain about my yard all the fuck you want to
but don't do it in my house
anyway
day four!
I have internet
and terrible lighting
and now I have to crochet more
and then get some other stuff done
and I have to go back to my to do list
back there
it's so hard to point
back there
and see what else I'm gonna do today
(music playing)
-------------------------------------------
Romina Power e Al Bano Carrisi: Loredana Lecciso? "Sono giorni molto tristi…", parla Barbara d'Urso - Duration: 6:47.
For more infomation >> Romina Power e Al Bano Carrisi: Loredana Lecciso? "Sono giorni molto tristi…", parla Barbara d'Urso - Duration: 6:47. -------------------------------------------
Anticipazioni l'Isola dei Famosi: naufraghi in arrivo in Honduras, ecco i nomi | M.C.G.S - Duration: 3:54.
For more infomation >> Anticipazioni l'Isola dei Famosi: naufraghi in arrivo in Honduras, ecco i nomi | M.C.G.S - Duration: 3:54. -------------------------------------------
Grayhill Touch Encoder | Digi-Key Daily - Duration: 1:08.
Grayhill's Touch Encoder simplifies the design and implementation of attractive, robust,
highly functional HMIs for industrial, commercial kitchen, medical, off-road and other challenging
environments.
It supports tap, swipe, and turn gestures, making it an intuitive interface for users
that can save space by replacing multiple traditional inputs.
The Touch Encoder combines a PCAP high resolution touch screen and rotating encoder in an IP67
sealed, IK6 impact resistant, and chemical resistant package.
The tablet-based development platform has a library of customizable widgets to simplify
development, and the integrated memory can store hundreds of screens.
The Touch Encoder has 32 positions per revolution and is rated for 1 million cycles, and is
offered with either a USB or CAN interface and multiple knob styles.
-------------------------------------------
REINHARD HEYDRICH - WikiVidi Documentary - Duration: 23:28.
For more infomation >> REINHARD HEYDRICH - WikiVidi Documentary - Duration: 23:28. -------------------------------------------
Cactus Coloring Book and Drawing for Children | Learn Colors for Toddlers - Duration: 4:44.
PINK
RED
YELLOW
PURPLE
PURPLE
ORANGE
PINK
PINK
BLUE
BLUE
GREEN
GREEN
YELLOW
YELLOW
-------------------------------------------
Racing Sports Network
For more infomation >> Racing Sports Network-------------------------------------------
TOME AGUA DURANTE LA MAÑANA EN AYUNAS POR 30 DIAS Y ESO SUCEDERÁ CON SU CUERPO! - Duration: 2:39.
For more infomation >> TOME AGUA DURANTE LA MAÑANA EN AYUNAS POR 30 DIAS Y ESO SUCEDERÁ CON SU CUERPO! - Duration: 2:39. -------------------------------------------
BuildingNY:NYStories - Robert J. Cerfolio, MD - NYU Langone Health - Duration: 28:14.
♪ [THEME MUSIC] ♪
>> NORTH HALEDON, NEW JERSEY.
>> PATERSON, NEW JERSEY, OH, I
LIKE BASEBALL.
I LIKE SPORTS.
I LIKE COMPETITION. A LABOR
AT THE AGE OF TEN. SWEEPING?
I WILL BE A DOCTOR BECAUSE
YOU KNOW, I SPAYED MY DOG.
YOU KNOW?
I AM GOING TO FIND THIS PROGRAM
UP AT THE UNIVERSITY IN
ROCHESTER, 242, YOU KNOW, DAD
WANTED ME TO BE A UROLOGIST,
YOU KNOW?
MAYBE I WILL DO CARDIOTHORACIC.
THEN I AM GOING TO GO TO
MEMORIAL SLOAN, BUT NO, I AM
GOING TO WANT TO GO TO THE MAYO
CLINIC.
THE UNIVERSITY OF ALABAMA?
A BOY FROM NEW JERSEY?
THIS GUY IS NOT A UNIVERSITY OF
ALABAMA.
HE WRITES BOOKS.
HE LECTURES.
HE TRAVELS AROUND.
HE DONE 18,000 SURGERIES.
I HAVE THE CARDIOTHORACIC
SURGEON FROM NYU LANGONE-
>> DIRECTOR OF THE LUNG
CANCER CENTER.
A LOT OF FANCY TITLES.
DO YOU WANT TO GIVE THE LAST
NAME TOO? DOCTOR-
>> ROBERT CERFOLIO.
>> THANK YOU FOR BEING HERE.
>> THANK YOU.
>> SO TELL ME ABOUT YOUR
GRANDPARENTS. HOW THEY CAME
OVER HERE AND HOW THEY CREATED
THE NAME CERFOLIO.
>> WELL, FIRST OF ALL MICHAEL,
THANKS SO MUCH FOR THAT
INTRODUCTION. THAT WAS GREAT.
I HAVEN'T HEARD IT DONE THAT
WAY?
WELL, I THINK, EVERYTHING GOES
BACK TO YOUR ROOTS.
EVERYTHING GOES BACK TO YOUR
CULTURE AND WHAT HAS BEEN
INGRAINED IN YOU.
SO MY GREAT GREAT-GRANDFATHER
ON MY FATHERS
SIDE WAS AN ORPHAN
AND OSTENSIBLY, THE LEGEND HE
WAS LEFT AT THE ORPHANAGE AT FEW
DAYS OF AGE.
AND THERE IS SOME HERB FLOWER IN
ITALY THAT IS NAMED CERFOY
AND FROM THAT THEY MADE UP
CERFOLIO.
>> SO WHEN DOES GRANDPA
COME OVER TO AMERICA?
>> SO ON MY MOM'S SIDE.
MY MOM'S PARENTS WERE BORN HERE.
BUT HER PARENTS CAME OVER.
ON MY DADS SIDE.
MY DAD'S MOM WAS BORN HERE.
MY DAD'S FATHER CAME
OVERLOOKING FOR HIS FATHER.
>> NOW YOUR DAD'S FATHER FIRST
OF ALL I THINK HE WAS INVOLVED
WITH BUILDING BRIDGES?
>> HE WAS.
GEORGE WASHINGTON BRIDGE WAS
A LABORER BUT LIVED IN NORTH
HALDEN, NEW JERSEY. THEY HAD
BEAUTIFUL HOME IN A GARDEN.
GIGANTIC GARDEN.
I MEAN 1,000 TOMATO PLANTS,
APPLE ORCHARD, PEACH TREES,
40 OR 50 OF THESE. WHEN I WAS A
KID I REMEMBER GROWING UP,
CLIMBING ON THEM.
>> SUBSEQUENTLY FROM BEING A
LABORER, HE BECAME A FARMER.
>> HE DID. THEY STARTED SELLING
THEIR PRODUCE
AND THOUGHT IT WAS EASIER WAY
THAN TRAVELING TO THE FOUNDATION
AND DOING ALL OF THE LABOR WORK.
>> RIGHT.
YOU WERE ALSO SAYING TO ME WHAT
WAS INTERESTING IS THAT BOTH OF
THE GRANDFATHER AND THE
GRANDMOTHER DIDN'T HAVE ANY
FORMAL EDUCATION BUT THEY BECAME
BUSINESS PEOPLE.
>> THEY DID. THEY
HAD NO FORMAL EDUCATION TO
THE FIFTH OR SIXTH GRADE WAS
AS HIGH AS THEY WENT.
THEY COULD READ AND WRITE.
THEY HAD A GREAT WORK ETHIC AND
OF COURSE, THAT'S THE MOST
IMPORTANT THING.
>> TELL ME ABOUT YOUR DAD?
THEN TELL ME ABOUT MOM.
>> MY DAD WAS ONE OF FOUR.
HE HAD THREE SISTERS.
HE WAS BROUGHT UP IN THE HOME
WHERE THERE WAS A LOT OF HARD
WORK, GRASS ROOT TYPE OF
MENTALITY. HE WAS THE ONLY ONE
WHO REALLY WENT ON. ONE SISTER
WAS NURSE BUT HE WAS GOING
ON TO COLLEGE AFTER THAT THEN TO
MEDICAL SCHOOL.
>> HE GREW UP IN NEW JERSEY,
IN NORTH HALDEN.
>> RIGHT.
>> HE WENT TO-
HE WENT TO CHICAGO MEDICAL
SCHOOL.
THAT IS WHERE MET MY MOM WHO WAS
NURSE THERE.
THEN, HE TOOK HER BACK AND HE
DID HIS TRAINING AND KINGS
COUNTY IN BROOKLYN.
>> HOW DID DAD DECIDE HE WANTED
TO BECOME A UROLOGIST?
>> WELL, HE WAS IN THE NAVY AND
SO HE SAW SOME OF THE DOCTORS
AND SAID I THINK I'M JUST AS
SMART AS SOME OF THESE
GUYS AND I AM NOT SURE HOW
THE SURGICAL SUB SPECIALITY OF
UROLOGY INTERESTED HIM.
HE LIKED THE FACT THEY WERE
DOING A LOT OF THINGS IN THE
BELLY, IN MULTIPLE AREAS OF THE
BODY AND THAT ATTRACTED HIM.
>> SO THE NEW JERSEY RESIDENT
WHO WAS IN CHICAGO, NOW COMES TO
BROOKLYN TO KINGS COUNTY THEN
SUBSEQUENTLY HE GOES BACK TO
PATERSON, YOU SAID, RIGHT?
>> TYPICAL ITALIAN BOY WENT BACK
CLOSE TO HIS MOM AND DAD WENT TO
FRANKLIN LAKES WHICH IS TEN
MINUTES FROM NORTH HILL.
>> AND WAS IN WAYNE HOSPITAL
YOU WERE SAYING TO ME.
>> SO THEY BUILT- FIRST HE WAS
IN PATERSON.
THEY LIVED IN PATERSON AWHILE
FOR TEN YEARS AFTER THEY GOT
MARRIED. MY MOM AND DAD.
>> YOUR FATHER IS 91?
>> MY FATHER HAD HIS 91st
BIRTHDAY.
HAPPY BIRTHDAY DAD IF YOU ARE
WATCHING.
YESTERDAY, THE 13TH.
>> WONDERFUL.
>> MY MOM IS 87 VERY, VERY
HEALTHY.
YEAH.
SO THEY GOT MARRIED AND WENT TO
PATERSON.
HE WAS ON STAFF AT THE PATERSON
GENERAL HOSPITAL WHICH BECAME TO
WAYNE AND BECAME THE WAYNE
GENERAL HOSPITAL AND LEFT
PATERSON AND BUILT A HOME IN
FRANKLIN LAKES IN '64.
>> NOW YOU SAID TO ME, YOUR
DAD HAD A HOME OFFICE, RIGHT
>> HE DID. IN PATTERSON.
>> WHEN WERE YOU BORN?
>> WELL, THE INTERESTING
THING IS MY MOM RAN HIS OFFICE
FOR 35 YEARS.
>> DID TELL ME SHE WAS HIS
OFFICE MANAGER.
>> YEAH.
MY MOM AND DAD WORKED TOGETHER
EVERY DAY FOR 35-40 YEARS AND
CAME HOME AND YELLED AT EACH
OTHER ABOUT THE WORK THEY DID.
I WAS BORN IN 1962 AND THEN WE
MOVED TO FRANKLIN LAKES IN '64
SO MY LIFE WAS REALLY ONLY IN
FRANKLIN LAKES.
>> WE HAVE A NICE BABY PICTURE
OF YOU?
>> NOT SO NICE.
THAT IS ALL GOD GAVE ME.
>> OKAY.
LET'S TALK ABOUT GROWING UP IN
FRANKLIN LAKES.
WE'LL GET TO THE JOBS BUT YOU
SAID TO ME FROM THE BEGINNING,
YOU WERE ALWAYS ATHLETICALLY
INCLINED.
HOW DO YOU GET, WAS DAD INVOLVED
WITH COACHING AND BASEBALL TOO?
>> HE WAS.
IT IS A SIMILAR PARALLEL BETWEEN
ME AND MY CHILDREN. HE WAS THE
ASSISTANT COACH OF OUR BASEBALL
TEAM AND THE ALL STAR BASEBALL
TEAM AND HE ALWAYS LOVED SPORTS
ALL FOUR OF US.
I WAS THE THIRD OR FOUR CHILDREN
ALL PLAYED HOCKEY.
MY OLDER BROTHER PLAYED HOCKEY,
BASEBALL, FOOTBALL LIKE I DID.
MY OLDER SISTER PLAYED TENNIS
AND SWAM. MY YOUNGER SISTER
WAS A SWIMMER, IN
GYMNASTICS, ALL VERY, VERY
ACCOMPLISHED.
>> SO TELL ME ABOUT YOU
GROWING UP?
YOU WENT TO PRIVATE SCHOOL, TWO
PRIVATE SCHOOLS, RIGHT?
YOU STILL, EVEN THOUGH YOU
WENT TO PRIVATE SCHOOL, YOU
STILL PLAYED IN THE COMMUNITY
SPORTS YOU SAID TO ME.
>> CORRECT.
WENT TO KINDERGARTEN TO THIRD
GRADE IN ENGLEWOOD, NEW JERSEY
THEN WENT TO MONTCLAIR FROM
FIFTH GRADE TO 12th GRADE AND
GRADUATED IFROM THERE.
BUT YEAH.
I PLAYED IN THE LOCAL TOWN
BECAUSE I WAS IN FRANKLIN LAKES
WHICH A DISTANCE FROM ENGLEWOOD
AND MONTCLAIR SO I PLAYED
LOCALLY ON THE BASEBALL TEAMS
AND PLAYED TENNIS AND PLAYED
BASEBALL, PLAYED HOCKEY.
PLAYED 100 HOCKEY GAMES A YEAR
ON A COUPLE OF TRAVEL TEAMS.
VERY INTENSE SPORTS.
>> NOW YOU SAID DAD WANTED TO
YOU WORK EARLY SO YOU GOT
YOU A JOB SWEEPING?
>> I BECAME A LABOR FOR ONE OF
THE CONSTRUCTION FIRMS ACTUALLY
IN PATTERSON.
MY FATHER HAD OPERATED ON THE
OWNER AND PRESIDENT.
SO I WAS DOING JOBS FIRST
PAINTING THEN SWEEPING THEN
ACTUALLY GOING OUT WITH CRANES
AND DOING MORE DANGEROUS JOBS
AS I GOT OLDER.
I DID THAT FOR FOUR OR
FIVE SUMMERS UNTIL I STARTED MY
OWN BUSINESS.
>> WHICH WE'LL GET TO IN A
SECOND.
IN YOUR BOOK, OKAY,
SUPER PERFORMING, YOU TALK ABOUT
YOUR LIFE GROWING UP AND YOUR
DAD TALK ABOUT SOMETHING WHICH
PROBABLY MAY HAVE INFLUENCED YOU
TO BECOME A PHYSICIAN, THE
SPADING OF THE DOG.
>> YES. MY FATHER TOOK
WHAT MANY THINK INTO HIS OWN
HANDS AND I THINK THAT GOES TO
ACCOUNTABILITY AND THE LESSON
YOU LEARN FROM THAT.
OUR DOG, OUR BEAUTIFUL DOG, A
LITTLE BEAGLE, NEED A HIS
HYSTERECTOMY.
NEEDED TO BE SPADED. RATHER
THAN GO TO A VET SINCE WAS
OPERATING IN THAT PART OF THE
BODY EVERY DAY. HE SAID HE
WAS GOING TO DO IT HIMSELF.
I WAS 12.
WHAT DID I KNOW?
HE GAVE THE DOG HIS OWN
ANESTHETIC.
WE BUILT THE BOARD WITH STRAPS
FOR THE PAWS.
WE DID THIS INCREDIBLE
OPERATION.
I REMEMBER ASSISTING.
THAT DAY CHANGED MY LIFE.
I REMEMBER THAT LIKE IT WAS
YESTERDAY.
I THOUGHT THAT WAS THE MOST
INCREDIBLE THING TO SEE MY
FATHER WHO YOU CAN SEE TAKE THE
GARBAGE OUT, HIT THE GROUND
BALLS NOW WAS DOING IN THIS
CREDIBLE OPERATION ON AN ANIMAL
WE LOVED. THERE
WAS NOTHING MORE SPECIAL TO
US TO THAN OUR DOG AND WATCH THE
DOG FULLY RECOVER FROM THE
OPERATION AND DO GREAT.
ITS WITH AMAZING.
>> TELL ME ABOUT THE
SWIMMING POOL BUSINESS.
>> SO I REALIZED THAT MY FATHER
WAS MAKING ME WORK TO LEARN
THE LESSON.
>> THERE AREN'T THAT MANY
CARDIOTHORACIC LUNG SURGEONS
WHO COULD SAY THEY WERE IN
THE SWIMMING POOL BUSINESS.
>> LET'S HOPE NOT AT LEAST.
>> RIGHT.
>> I SAID, I GOT THE LESSON.
I WANT TO START MY OWN
BUSINESS.
I THOUGHT IT WOULD BE SOMETHING
THAT WOULD BE FINANCIALLY
BENEFICIAL AND ALSO I LEARNED A
LOT MORE.
SO MY MOM AND DAD WERE
TOTALLY AGAINST IT.
THEY SAID, OKAY.
WE'LL LET YOU BUY A PUMP AND
VACUUM $150 IF YOU CANNOT MAKE
THAT MONEY BACK IN TWO
WEEKS YOU GOT TO GO BACK TO
CONSTRUCTION.
IN TWO WEEKS, I HAD FOUR OR FIVE
ACCOUNTS AND I GAVE THEM THE
MONEY BACK IN FIVE DAYS.
THEN, FLASH FORWARD FIVE YEARS
LATER WE WERE CLEANING 400
POOLES A WEEK AND MAKING MORE
MONEY IN THREE MONTHS OVER
THE SUMMER WITH THE LAST COUPLE
OF SUMMER.
>> HOW DID YOU DECIDE TO
CONTINUE?
SOMETIMES WHEN YOU'RE AN
ENTREPRENEUR AND YOU DO THAT?
HOW DID YOU DECIDE TO BE
MOTIVATED TO CONTINUE TO GO
TO MEDICINE?
>> WELL, I DIDN'T WANT TO
SPEND THE REST OF
MY LIFE SUCKING DIRT OUT
OF A BOTTOM OF A POOL BUT I HAD
TEN PEOPLE AT ONE POINT, NINE
OR TEN PEOPLE WORKING AT FOR ME
WHEN REAL REALIZED MY DAD TOLD
ME TO PUT MONEY IN RETIREMENT
FUND AND DO OTHER THINGS
THAT SEEMED COMPLICATED.
I STILL LOVED MEDICINE.
I KNEW SURGERY IS WHAT I WANTED
TO DO.
I WAS DRIVEN TO DO THAT AND BE
THE BEST AT THAT.
SO I KNEW THE POOL
CLEANING BUSINESS WAS SOMETHING
THAT WAS GOING TO END.
>> A GOOD WAY FOR THE SUMMER
WHEN YOU WERE IN COLLEGE. LET'S
TALK ABOUT WITH REGARD TO THAT.
SO YOU WERE ALL AMERICAN
IN HIGH SCHOOL ON A VARIETY OF
TEAMS.
HOW DID YOU DECIDE TO GO TO
ROCHESTER?
>> SO,
I WAS ALL AMERICAN IN FOOTBALL.
IN HIGH SCHOOL I WAS ALL STATE
IN THOSE THREE SPORTS. I WAS ALL
AMERICAN IN FOOTBALL, BASEBALL
AND HOCKEY.
BUT GIVEN MY SIZE AND STRENGTH
BASEBALL WAS GOING TO BE
THE ONLY THING THAT I WOULD HAVE
A CHANCE TO PLAY AT A COLLEGIATE
LEVEL.
THE UNIVERSITY OF ROCHESTER
WAS INTERESTED IN BASEBALL BUT
WAS ONE OF THE FEW SCHOOLS I
LOOKED AT THAT HAD THE 242 YOU
MENTIONED IT.
IT IS EARLY SELECTION TO MEDICAL
SCHOOL AFTER TWO YEARS OF
COLLEGE.
SO YOU DON'T GET INTO IT UNTIL
YOU ARE A SOPHOMORE IN COLLEGE.
I WAS LUCKY ENOUGH TO GET THE
WRONG LETTER AND THEY ACCEPTED
ME IN A GOT INTO MEDICAL SCHOOL
EARLY.
>> YOU GOT INTO MEDICAL SCHOOL.
YOU SAID TO ME I DIDN'T HAVE
TAKE THE MCATS.
>> I DID NOT. BECAUSE I GOT INTO
MEDICAL SCHOOL AS A SOPHOMORE
IN COLLEGE, I DIDN'T HAVE TO
TAKE THE MCATS.
>> YOU REALLY WANTED
TO PLAY BASEBALL, RIGHT?
THEN YOU HAD ACCIDENT?
>> SO, NO, I WANTED TO PLAY
BASEBALL.
SO THE BEAUTIFUL THING IS
ROCHESTER THAT ALLOWED THE
DURING THE BASEBALL SEASON TO
TAKE LESS OF AN ACADEMIC LOAD
LIKE MY SON IS DOING NOW DURING
BASEBALL SEASON, A LITTLE LESS
ACADEMIC AND I COULD LOAD UP
DURING THE NON-SEASON.
>> ONE OF THE FEW PEOPLE WHO
PLAYED BASEBALL WHEN YOU WERE IN
MEDICAL SCHOOL.
>> OH, YEAH.
MY FRESHMAN YEAR, I GOT INJURED.
I HURT MY ANKLE. SO I HAD
FOUR YEARS OF ELIGIBILITY
THE YEAR AND I WAS FIRST TEAM
ACADEMIC ALL AMERICAN I WAS A
FIRST YEAR MEDICAL STUDENT SO I
GRADUATED IN COLLEGE IN 1984 BUT
I WAS A FIRST TEAM ACADEMIC ALL
AMERICAN BASEBALL PLAYER IN 1985
WHICH IS UNUSUAL.
WE HAD TO PETITION THE NCAA YOU
KNOW, THEY SAID IT WAS FINE.
>> SO YOU CONTINUE AT THE
UNIVERSITY OF ROCHESTER AND AS
WITH PLANS TO BE UROLOGIST.
>> MY DAD IS STILL THE MOST
INCREDIBLE MAN IN THE WORLD TO
ME.
I WANTED TO BE LIKE HIM.
I WANTED TO JOIN HIM IN HIS
PRACTICE.
HE HAD WAITED FOR ME AND PRIVATE
PRACTICE DURING DIFFICULT TIMES
FOR HIS SON TO COME JOIN HIM.
AND I MATCHED AT NEW YORK
HOSPITAL WITH THE NUMBER
ONE RANKED UROLOGY
PROGRAM IN THE COUNTRY
BACK THEN, I GUESS IT WAS 1988.
>> BUT THEN, AS OPPOSED TO
GO THERE, YOU FIND SOMETHING UP
AT HARTFORD.
WHAT HAPPENED? THIS LITTLE
HOSPITAL ST. FRANCIS.
>> YEAH.
THAT DECISION CHANGED MY LIFE
IN SO MANY WAYS.
SO YOU DO TWO YEARS OF GENERAL
SURGERY AND FOUR YEARS
UROLOGIC OF TRAINING IF YOU
GOING TO BE UROLOGIST BUT THE
FIRST TWO YEARS AT NEW YORK
HOSPITAL DID VERY LITTLE
SURGERY. DID A LOT OF PUSHING
PATIENTS AROUND.
I MADE AND ARGUMENT TO THE
DOCTOR THAT I WANTED TO GO
SOMEWHERE THAT I OPERATED A LOT
AND I FOUND THEY DID THE MOST
OPERATIONS AS PGY1 AND PGY2
INTERNS AND SECOND YEAR SURGICAL
RESIDENTS.
ST. FRANCIS HOSPITAL IN
HARTFORD, CONNECTICUT AND THAT
IS WHERE I CHANGED MY CAREER AND
MET MY WIFE.
>> LET'S TALK ABOUT HOW
YOU MET YOUR WIFE.
>> YEAH.
>> WHO WAS A NURSE. OKAY-
>> SHE WALKED IN THE CAFETERIA,
THAT IS ALL SHE NEEDED TO DO.
>> WE HAVE A PICTURE OF
YOU AND HER AT THE EARLY TIME
WHEN YOU MET.
>> RIGHT.
>> THEN HOW DID YOU DECIDE
TO LEAVE UROLOGY TO GET INTO
CARDIOTHORACIC SURGERY?
>> MY WIFE WE'LL TALK ABOUT
LATER. BUT
I KNEW DURING THOSE FIRST TWO
YEARS I FELL IN LOVE WITH
CARDIOTHORACIC SURGERY, I'D
NEVER BEEN EXPOSED TO IT.
I SIGNED A CONTRACT WITH
DR. VAUGHN AND THAT MEANT A
LOT TO ME AND I WAS GIVEN A
POSITION TO STAY THERE BECAUSE
I WAS DOING RELATIVELY WELL AT
HARTFORD HOSPITAL IN CONNECTICUT
VERY GOOD GENERAL SURGICAL
PROGRAM AND I WENT TO NEW YORK.
DID MY YEAR OF UROLOGY.
I FULFILLED MY CONTRACT AT NEW
YORK HOSPITAL AND
SLOAN-KETTERING.
I SPENT TIME IN BOTH PLACES
ACROSS THE STREET AS YOU KNOW.
SO THEN, AT THAT POINT, I WAS IN
TROUBLE BECAUSE I DIDN'T HAVE A
JOB IN GENERAL SURGERY. THEY
OFFERED ME TO STAY THERE BUT
I'D DO A YEAR OF RESEARCH.
I SAID, LISTEN.
WANT TO DO CARDIOTHORACIC
SURGERY. I THINK
THE MAYO CLINICS THE BEST PLACE
IN THE WORLD.
YOU READ THE STORY IN THE BOOK
WHERE I KEPT CALLING AND FINALLY
GOT INTERVIEW AT MAYO.
>> TALK ABOUT THAT.
WHAT HAPPENED WAS, YOU CALLED UP
AND YOU KEPT IN TOUCH FOR TWO
WEEKS WITH THE CHAIRMAN OF THE
DEPARTMENT AND FINALLY, HE
ACCEPTED YOU THAT YOU SHOULD GO
THERE.
>> I CALLED HIM EVERY DAY FOR
TWO WEEKS.
SAYING I WANT TO COME IN AS
PGY3.
HE KEPT SAYING WE HAVE NO
SPOTS FOR PGY3 BECAUSE I'D
DONE TWO YEARS OF
GENERAL SURGERY, ONE YEAR OF
UROLOGY.
AFTER CALLING HIS OFFICE EVERY
DAY OR TWO WEEKS HE FINALLY
SAID, YOU'RE NOT GOING TO GO
AWAY AND INTERVIEW KNOW SEE
WHAT YOU THINK.
AFTER THE INTERVIEW THEY GAVE ME
A SPOT AT PGY4 BECAUSE I HAD
DONE ENOUGH CASES IN MY FIRST
TWO YEARS MORE THAN MOST.
>> WHEN DID YOU GET MARRIED?
>> WELL I ASKED HER OUT.
SHE SAID I WON'T
GO OUT WITH DOCTORS
SO NOW THE CHALLENGE WAS DOWN.
WE GOT MARRIED IN NOVEMBER OF
1990.
>> AT THAT TIME, YOU WERE UP
AT THE MAYO CLINIC OR-
>> WE WERE ENGAGED.
MY FIRST SIX MONTHS IN NEW YORK
WE GOT MARRIED IN CONNECTICUT
THEN I DRAGGED HER TO ROCHESTER,
MINNESOTA, WHERE WE HAD TWO-
>> VERY WARM.
>> REALLY WARM.
>> SHE IS FROM CONNECTICUT.
I'M FROM NEW JERSEY.
I TOOK HER TO ROCHESTER,
MINNESOTA AND THEN BIRMINGHAM,
ALABAMA.
>> HOW DID THE JERSEY BOY
GET TO BIRMINGHAM, ALABAMA?
>> AT MAYO I DID MY LAST YEARS
OF GENERAL SURGERY,
THREE YEARS OF
CARDIOTHORACIC, SPENT FIVE
YEARS THERE. MY FIRST SON ROBBY,
MY MIDDLE ALEX WERE BORN.
WE WANTED SOMEPLACE WARM.
THERE IS A REAL CONNECTION
BETWEEN MAYO CLINIC AND THE
UNIVERSITY OF ALABAMA BECAUSE OF
A GUY NAMED JIM KIRKLAND, A
FAMOUS HEART SURGEON.
THAT IS WHERE I WENT.
>> YOU'RE 34, RIGHT?
>> ABOUT THAT.
PROBABLY ABOUT RIGHT.
>> HOW DO YOU BUILT THE
CARDIOTHORACIC SURGERY AND
THE LUNG-
>> I WAS VERY FORTUNATE.
THE UNIVERSITY OF ALABAMA IS
A WORLD CLASS HOSPITAL WITH
GREAT PEOPLE.
I SPENT 21 YEARS THERE.
THEY ARE AND ALWAYS WILL BE MY
FAMILY.
THEY GAVE ME A GREAT OPPORTUNITY
TO BUILD. THEY GAVE ME RESOURCES
AND WE WERE LUCKY ENOUGH TO
BUILD REALLY ONE OF THE BEST I
WOULD SAY THE BEST LUNG CANCER
PROGRAM IN THE COUNTRY. NOW IT
IS AT NYU BUT IT WAS THERE.
>> WHAT HAPPENS WHEN THEY,
WHEN YOU PERFORM THE
SURGERY AND YOU HEAR ABOUT
YOUR WIFE?
>> YEAH.
THE DAY MY WIFE WAS HAVING HER
MASTECTOMY.
I SCHEDULED NINE OR TEN
OPERATIONS WITH PEOPLE WITH
CANCER.
AND SO I HAD VISITORS EVERY DAY.
WE OPERATED YESTERDAY HERE.
I HAD VISITORS IN ALABAMA.
I HAD VISITORS THEN, THE BREST
SURGEON TOLD ME SHE HAD DONE THE
LUMPECTOMY BUT THE SET IN THE
LYMPH NODE WAS POSITIVE AND
I WAS OPERATING AT THE TIME,
WHEN I GOT THAT NEWS WHICH WAS
IN A WAY DEVASTATING.
I TALK ABOUT THAT IN THE
INTRODUCTION TO THE FIRST BOOK.
>> SO LET'S TALK ABOUT IT.
SO BECAUSE, I THINK PART OF THE
BOOK IS AN INSPIRATION TALKING
ABOUT YOU AND YOUR WIFE AND
YOUR CAREER.
HOW DID YOU DECIDE TO WRITE
THE BOOK?
>> AGAIN, IT IS ALWAYS
CHALLENGING FROM THE CHILDREN.
I ALWAYS TOLD MY CHILDREN, THAT
I DON'T WANT TO HEAR YOU CAN'T.
I DON'T WANT TO HEAR EXCUSES.
I THINK AT SOME POINT I SAID
YOU KNOW WHATI SHOULD WRITE A
BOOK. AND MY SON SAID, DAD,
DON'T TALK ABOUT IT. DO IT.
AND I SAID, YOU KNOW WHAT?
FINE. I WILL.
NOW I HAVE WRITTEN THREE.
>> LETS A TALK ABOUT THE
FIRST ONE WHICH WAS WRITTEN A
LITTLE AFTER YOUR WIFE PASSED
ON?
>> YEAH.
ACTUALLY IT WAS ALMOST REALLY
DONE BEFORE SHE PASSED AWAY.
>> YOU SAY IN THE BOOK,
THE LAST CHAPTER WOULD HAVE
BEEN DIFFERENT.
>> IT WAS SUPPOSED TO BE WE
LIVED HAPPILY EVER AFTER.
SHE WAS THE LOVE OF MY LIFE.
I MISS HER EVER SECOND OF EVERY
DAY.
SO I WAS WRITING THE BOOK REALLY
ABOUT THE PROCESS OF IMPROVEMENT
AND THAT IT'S ABOUT PROCESS OF
THAT OUTCOME AND PREPARATION,
REALLY, REALLY BEING ENGAGING
YOUR TEAMMATES HAVING TEAMMATES
ENGAGE AND ALIGN.
>> THINK I THE BOOK IS A
SELF-HELP BOOK.
>> IT IS A SELF-HELP BOOK.
INITIALLY IT WAS CALLED
THE ATHLETICISM OF SURGERY.
BUT THE PEOPLE WHO WERE
PUBLISHING IT THOUGHT IT
WOULD BE BETTER CALLED
SUPERFORMING AT WORK AND HOME TO
SELL NOT TO ATHLETES OR
EXECUTIVES BUT TO EVERYBODY.
IT IS A SELF HELP BOOK BUT THE
LAST TWO OR THREE CHAPTERS IS A
LOVE STORY ABOUT MY WIFE WHO HAD
BREAST CANCER AND GOT
CHEMOTHERAPY FOR IT AND THE
CHEMO CAUSED LEUKEMIA.
SHE DIED OF COMPLICATIONS FROM
THE CHEMO THAT CAUSED ACUTE
LEUKEMIA AND GOT CHEMO AGAIN
OVER FIVE MONTHS AND PASSED
AWAY IN APRIL OF 2013.
>> ALSO THE BOOK TALKS YOU
ABOUT BRINGING YOUR DAD AND YOUR
MOTHER TO ALABAMA.
YOUR FATHER ORIGINALLY THE MAYO
CLING.
>> CORRECT.
MY DAD HAD, WE WERE ICE SKATING
ON THE ICE ONE CHRISTMAS.
WE WERE GOING BACK SOME YEARS
NOW.
HE HAD CHEST PAIN THE NEXT DAY.
I WAS BACK IN ALABAMA.
IT TURNED OUT HE HAD SIGNIFICANT
CORONARY ARTERY DISEASE.
I FLEW HIM TO MAYO.
I WAS IN ONE OPERATING ROOM.
HE WAS IN ONE OPERATING ROOM AND
HE HAD A TRIPLE BYPASS AND HE'S
DONE GREAT FROM THAT.
>> AND MOM ALSO HAD ONE.
>> MOM HAD ONE DONE IN ALABAMA
SO WHEN SHE HAD A CORONARY
STENOSIS. I FLEW HER TO
ALABAMA BECAUSE I WANTED
TO MICROMANAGE THEIR CARE.
THAT'S MY PERSONALITY.
>> YOU KNOW IN THE BOOK YOU
TALKED ABOUT AND IT IS TODAY,
WHEN WE WERE TALKING IN GENERAL,
YOU KNOW, SURGERY WAS MANUALLY.
THE WORLD HAS BECOME, YOU KNOW,
IT IS A QUESTION OF HOW PEOPLE
ADAPT AND ADJUST AND YOU BECOME
ONE OF A LEADING ROBOTIC
SURGEONS.
TALK TO ME ABOUT HOW THE MANUAL
AND THE ROBOTIC TODAY.
>> IT IS A GREAT QUESTION.
I THINK WE HAVE TO EVOLVE.
NOT JUST TECHNICALLY BUT
EMOTIONALLY IN EVERYTHING WE DO.
WE NEED TO EVOLVE AS PARENTS,
AS CHILDREN, WE EVOLVE WITH
TIMES.
WE EVOLVE WITH NEW TECHNOLOGY
BUT SHOULD EMOTIONALLY EVOLVE
AND BECOME BETTER LEADERS SO
WHEN I SEE THE ROBOT WAS GOING
TO PROVIDE BETTER CARE FOR MY
PATIENTS AND I AM CONVINCED IT
DOES
I KNEW I NEEDED TO EVOLVE INTO
THAT ALTHOUGH IT WAS DIFFICULT
TO LEARN.
>> THE QUESTION, EVEN FOR THE
PATIENT, THE PATIENT WHEN YOU
SAY I AM GOING TO DO ROBOTIC
SURGERY.
THEY SAY, IT IS A SURGEON WITH
THE SURGEON'S HANDS.
WELL, OK.
BUT I MEAN, YOU ARE USING THE
HANDS BUT YOU ARE USING THE
HANDS ON THE ROBOT IN
ANOTHER ROOM-
>> CORRECT.
I LOVE WHEN THE PATIENT HEARS-
THE PATIENT HEARS ROBOT AND
THEY THINK OF LITTLE GUY IS
GOING TO DO THE OPERATION WE ARE
DRINKING A CUP OF COFFEE
AROUND THE CORNER.
NO, NO.
AND NO.
THE ROBOT IS JUST ARMS THAT
ARE PUT INTO THE PATIENT
THROUGH LITTLE INCISIONS AND
THEN WE SIT AT A CONSOLE
AND WE MOVE.
THE DEFINITION OF A ROBOT, AND
I HAVE WRITTEN A FEW PAPERS
ON THIS,
IT IS SOMETHING THAT COPIES IN A
SLAVE-LIKE MANNER YOU THOUGHTS
OR YOUR MOVEMENTS.
AND THAT'S WHAT HAPPENS. THE
ROBOT DOESN'T MOVE UNLESS WE
ARE MOVING.
>>THE TEAM, THE REST OF THE
TEAM IS IN THE OPERATING ROOM.
YOU ARE IN-
>> I AM IN THE OPERATING ROOM
BUT NOT AT THE BEDSIDE.
I AM A FEW FEET AWAY SITTING
AT CONSOLE.
TEN MAGNIFICATION, THE OF 3D,
THE MOST INCREDIBLE VIEW
YOU HAVE EVER SEEN.
MY ASSISTANT, THE NURSE OR
RESIDENTS,
THE RESIDENT IS TRAINING AT
ANOTHER CONSOLE.
SO THE NURSE, THE SCRUB NURSE
AND THE PHYSICIAN'S ASSISTANTS
OR SOME HOSPITALS USE NP'S
ARE AT THE BEDSIDE PUTTING
PUT INSTRUMENTS IN FOR US.
>> HOW DID YOU GO FROM
CARDIOTHORACIC TO MORE
LUNGS?
>> WELL, I ALWAYS HAD MORE OF AN
INTERESTS IN THE NONCARDIAC PART
OF CARDIOTHORACIC, THE LUNG,
ESOPHAGUS, THE STINUM. I THOUGHT
THERE WAS BIG OPENING THERE.
IT WAS NOT BEING DONE VERY WELL.
THERE WERE NOT A LOT OF PEOPLE
DOING.
I MOST PEOPLE WENT INTO
CARDIOTHORACIC SO THEY
COULD DO HEART SURGERY.
I WAS ATTRACTED TO THE OTHER
PART. I THOUGHT IT WAS
TECHNICALLY DIFFICULT IN A WAY.
IT WAS MORE, A GREATER
VARIETY AND
I LOVE SURGICAL VARIETY.
THE NECK, BELLY AND THE CHEST.
>> AFTER 21 YEARS IN ALABAMA,
YOU LOST YOUR WIFE.
ONE OF YOUR SONS.
>> MY OLDER SON ROBBIE
WENT TO YALE. LEFTY PITCHER
THE CAPTAIN OF THE YALE
PITCHING TEAM. DRAFTED BY THE
DODGER BUT HURT HIS ELBOW AND
NEVER PLAYED PROFESSIONAL
BASEBALL NOW IN THE FRONT OFFICE
FOR THE CLEVELAND INDIANS.
MY MIDDLE SON ALEX WENT TO THE
UNIVERSITY OF ALABAMA AND THE
HONOR'S COLLEGE THERE WHICH IS
PRESTIGIOUS.
GRADUATED WITH HONORS AND THEN,
HE JUST FINISHED THE FIRST
SCREENPLAY AND VERY
ACCOMPLISHED AS WELL.
MY YOUNGER SON MATTHEW IS A
FRESHMAN AT COLUMBIA.
THAT ANSWERS YOUR QUESTION
BECAUSE I WAS COMING HOME TO THE
HOUSE THAT I BUILT FOR MY
CHILDREN WHICH AS
YOU KNOW AS AN ATHLETIC
CATHEDRAL WITH MULTIPLE SPORTS
FIELD AND A TINY GOLF COURSE.
WHEN HE SIGNED WITH COLUMBIA
OVER PRINCETON TO PLAY BASEBALL
AND I AM COMING HOME TO A
HOUSE FOR MY WIFE WHO IS NO
LONGER THERE.
SHE PASSED AWAY THREE YEARS
EARLIER. MY MOM AND DAD ARE
IN NEW JERSEY WITH FAILING
HEALTH, MY SISTERS IN NEW YORK,
MY OTHER SISTERS IN BOSTON,
MY BROTHERS IN CALIFORNIA
AND THEN NYU IS JUST A
WORLD CLASS METRO SIZED HOSPITAL
THAT I SHARED THE CULTURE WITH.
JUST A EASY DECISION.
>> WHAT ABOUT THE CANCER
AT NYU?
WHAT IS THAT PROGRAM CALLED?
>> WHAT I LIKE ABOUT IT.
NOT JUST A MYOPIC
VIEW OF BEING A SURGEON
BUT TAKING CARE OF A PATIENT,
A DISEASE PROCESS.
WHETHER YOU ARE DOING SURGERY,
CHEMOTHERAPY, RADIATION. THE
DIRECTOR OF THE LUNG CANCER
CENTER IDEALLY IS SOMEONE THAT
IS LOOKING AT PATIENT OUTCOMES
NOT THE SURGEON.
ACADEMIC MEDICINE CENTERS
ARE SILOED. YOU HAVE THE
DEPARTMENT OF SURGERY AND
DEPARTMENT OF RADIATION
DEPARTMENT OF ONCOLOGY.
AND IT IS SUPPOSED TO BRIDGE
THOSE SILOS.
>> LETS TALK ABOUT THE SECOND
AND THIRD BOOK. ESPECIALLY
SINCE I HAVE READ THEM.
>> YOU'RE THE ONLY PERSON IN THE
WORLD WHO READ THE THIRD BOOK
"INSPIRE" YOU HAVE THE ONLY COPY
HERE.
>> TALK ABOUT "INSPIRE."
>> SO "INSPIRE" IS MY BEST
BOOK AND THE MOST
IMPORTANT BOOK TO ME BECAUSE IT
TALKS TO EVERYBODY ABOUT HOW TO
LEAD.
I AM CONVINCED THAT BUSINESSES
THAT DO WELL, HOSPITALS THAT DO
WELL, FAMILIES THAT DO WELL,
IS FROM THE LEADERSHIP AND THE
CULTURE THAT ARE INGRAINED AND
EVOLVED AND INSTILLED.
>> WE'LL CONTINUE ABOUT
"INSPIRE". ALSO TALKS ABOUT
THAT YOU CHANGED YOURSELF.
THAT MANY YEARS AGO WHICH
IS SIMPLE FOR MEDICINE BECAUSE
THE, THE SURGEONS ALWAYS
SCREAMED AT THE RESIDENTS AND
THE INTERNS, OKAY?
YOU HAVE LEARNED TO BE
ADAPTABLE.
>> I STILL GET GIVE THEM A HARD
TIME. MORE OF A COACH.
IT DEPENDS. IN THE BOOK WE TALK
ABOUT LOVE LANGUAGE.
I TALK ABOUT COACHABILITY
LANGUAGE.
EVERYBODY HAS DIFFERENT LANGUAGE
THAT THEY RESPOND TO BETTER FROM
THE COACH.
THE COACH SHOULD BE ABLE TO
CHANGE THAT COACHING STYLE
BASED ON, IT SHOULD BE
PERSONALIZED TO THE STUDENT.
SOME RESIDENTS DO REALLY WELL
WHEN YOU YELL AND WHIP
THEM, JUST LIKE SOME OF MY
CHILDREN AND SOME DO BETTER
WITH ENCOURAGEMENT.
>> LET'S TALK ABOUT THE THIRD
BOOK. THE THIRD BOOK IS CALLED?
>> THIRD BOOK IS SOLVING U.S.
HEALTHCARE CRISIS WHICH I WAS
CHARGED TO DO AND I WAS
TALKING ABOUT, I WAS
TIRED OF WATCHING HOW PATIENT
CARE WAS BEING POLITICIZED BY
REPUBLICAN AND DEMOCRATS ARGUING
OVER NONSENSE INSTEAD OF TAKING
CARE OF PEOPLE WHO ARE DYING.
>> SOME PEOPLE ARE GOING TO ASK
YOU WRITE THESE BOOK, SPEAK
AROUND THE WORLD,
WE HAVE PICTURES OF YOU IN
INDIA, CHINA AND OTHER PLACES.
THEN YOU DO EIGHT TO TEN
SURGERIES A DAY ALSO?
>> WELL, IN ALABAMA, I DID 1,000
OPERATIONS A YEAR FOR EIGHT
CONSECUTIVE YEARS.
I DON'T DO THAT NOW.
EVEN MY LAST FEW YEARS IN
ALABAMA I WAS MORE ABOUT GROWING
A TEAM AS OPPOSED TO DOING THAT
MUCH SURGERY.
BUT WE HAD THE HIGHEST QUALITY.
WHEN PEOPLE SAID YOU COULDN'T DO
THAT MUCH AND DO HIGH QUALITY.
THE DATA SHOWS THAT IS NOT TRUE.
>> WHAT IS REALLY GOOD IS THANK
GOD YOU LEFT BEING A LABOR.
YOU LEFT A SUCCESSFUL SWIMMING
POOL BUSINESS.
>> I MISSED IT.
>> YOU BECAME A WONDERFUL
SURGEON, IMPORTANT TO THE
COMMUNITY AND AS YOU SAY, PEOPLE
HAVE TO ADAPT AND PEOPLE HAVE TO
DECIDE THAT THIS IS THE NEXT
CAREER AND IN THE BOOK YOU ALSO
MENTIONED EVERY SEVEN YEARS IF
YOU HAVE THE POSSIBILITY YOU
SHOULD ALSO.
>> YOU SHOULD REINVENT
YOURSELF.
EVERY FIVE TO SEVEN YEARS.
I AM NOT SAYING YOU GET A NEW
JOB BUT YOU SHOULD DO A 360 TO
SEE WHAT YOU DO WELL AND WHAT
YOU DON'T DO WELL.
SO MANY THINGS I DON'T DO WELL
THAT I NEED TO IMPROVE THAT
I WILL WORK HARD ON THOSE TODAY
AND TOMORROW.
I WILL GET BETTER AT THOSE
THINGS THAT WILL TAKE ME DOWN TO
A DIFFERENT PATH TO HELP
MORE PEOPLE HOPEFULLY.
>> SO IN THIS CAREER AND IN THE
LIFE PORTION, I THINK THE NYU
LANGONE AND YOUR PARENTS
BEING NEARBY.
YOUR SISTER AND YOUR SONS.
THANKS FOR BEING HERE TODAY.
>> THANKS SO MUCH FOR YOUR TIME,
MICHAEL. THANK YOU.
♪ [THEME MUSIC] ♪
-------------------------------------------
Cactus Coloring Book and Drawing for Children | Learn Colors for Toddlers - Duration: 4:44.
PINK
RED
YELLOW
PURPLE
PURPLE
ORANGE
PINK
PINK
BLUE
BLUE
GREEN
GREEN
YELLOW
YELLOW
-------------------------------------------
Nous buvons cette boisson chaque jour sans nous douter qu'elle peut causer le cancer du sein - Duration: 6:44.
For more infomation >> Nous buvons cette boisson chaque jour sans nous douter qu'elle peut causer le cancer du sein - Duration: 6:44. -------------------------------------------
Big Gummy Vs. Lil Gummy For more infomation >> Big Gummy Vs. Lil Gummy-------------------------------------------
cat_and_horse.mp4 - Duration: 0:41.
Hello there..
Why did tcha' active subtitles?
Turn them off.
Hello, What did i say?
TURN TH- o wait..
Umm... Ignore what you almost saw..
They're still spinning..
Now i'm sp- HEY, TURN TH- Ah.. you know what..
Screw it, i'm not saying anything.
...
...
bang bang bang
pfoo pfoo pfoo
Welp, bye horse..
r.i.p spinning horse will never be forgoten 1998 - 2020
-------------------------------------------
Republicans Stop Liberal Judges Dead In Their Tracks, Find Grounds For Impeachment - Duration: 2:36.
Republicans Stop Liberal Judges Dead In Their Tracks, Find Grounds For Impeachment.
Liberal judges in the past few years have taken unprecedented liberties.
Instead of making a decision based upon the rule of law, the U.S. Constitution, and the
Declaration of Independence, which is their sworn duty to uphold, they choose to make
up their own rules and regulations based upon their liberal agenda.
In the rust belt, liberal judges from a northeastern state supreme court made a horrendous decision
that directly attacks conservatives living there.
So Republicans there have had enough.
They have now found grounds for impeachment that should leave these judges stopped dead
in their tracks.
Philly.com passes along an example of how the party is doing just that.
Pennsylvania Republicans, furious that the state Supreme Court threw out the existing
congressional map and imposed one that stripped much of their partisan advantage, have been
talking about a stark response: impeaching the justices who ruled against them.
After a rank-and-file lawmaker, state Rep. Cris Dush of Jefferson County, raised the
idea a few weeks ago, the rhetoric has intensified.
This week, U.S. Rep. Ryan Costello of Chester County said the justices "should be impeached"
and U.S. Sen. Pat Toomey said the idea is worth discussing.
In short, the state's Democratic Party was feeling colicky about the prospect of having
their clocks cleaned in future elections.
To prevent that from happening, they changed the rules to ensure there would be nothing
resembling a fair fight.
State Republicans aren't going to take this one laying down, and they're hinting at
taking down these judges.
Talk about an epic response.
As of Thursday, no impeachment bill had been introduced.
But in the memo he circulated to fellow lawmakers, Dush contended the high court's ruling redrawing
the congressional map "blatantly and clearly contradicts the plain language of the Pennsylvania
Constitution."
We'll have to wait and see how this ultimately plays out, but it's at least encouraging
to see the GOP fighting back on this egregious overstep by Democrats.
Perhaps members of the GOP in the nation's capital can use this for some further inspiration
to do the same.
After all, they finally have a president in place that is more than happy to call out
blatant and ridiculous nonsense whenever he sees it.
what do you think about this?
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