“I’m a hustler, baby; I sell water to a well!”
For my first appointment with Dr Wagner (a reminder: not a real name), I flew from San Francisco to Munich. It was early November 2018. I was in equal parts curious and skeptical of taking my trip. I was following my physical therapist’s recommendation to visit Munich, but she knew the chief doctor through his book only. As I was researching the clinic ahead of my arrival, I had two goals: form an opinion of my own and figure out intelligent questions to ask once I arrive in Munich to patch up the inherent uncertainty of my prior evaluation.
Through personal intelligence work, I discovered an impressive array of famous people that had their treatment at the clinic. In addition to Usain Bolt I mentioned previously, the list includes Bono, Vitali Klitschko (who dominated boxing for a decade), and other star athletes from NFL, NBA. It was hard for me to imagine all these heavyweights would be collectively delusional to visit that place. On the other hand, celebrities are prone to questionable beliefs. Ask Tom Cruise about Scientology.
Why did I doubt the clinic in the first place? My intelligence work returned hints of highly controversial practices of the chief doctor and founder of the clinic. I found mentions of injection of extracts from young calf blood, rich in amino acids. I saw articles on goat blood injections. Or injections of shredded cockerel’s comb. Yep, you’re reading it right. I came across numerous stirs in the medical community, accusations of doping athletes with weird practices acting as a cover-up. Highly accomplished doctors and scientists were calling for the exclusion of the chief doctor from speaking at conferences. If there was an equivalent of firewalking in the world of medicine, I found it - I thought to myself.
Doctor Wagner called me into his office, and we started chatting. I wanted this meeting to be efficient, so I rehearsed both short and long versions of my medical history. What I tried so far, how my muscle tension was gradually and mysteriously getting worse. I came ultra prepared with notebooks detailing my tension scores, an old CD with MRIs, and any material I thought was relevant. To my surprise, the doctor wasn’t interested in looking at anything I brought. After a short greeting, our conversation went like this:
- I know what you have. We specialize in this problem here, and I think we can help you.
I don’t think I succeeded in hiding how taken aback I was. We continued:
- But doctor, we just met, and we didn’t even go over my diagnostics. We just talked, and you glanced over my posture.
- I know. You’re not the first one to be surprised. We have experience in cases like yours, but let’s take an X-ray to make sure I got it right. We have a high-quality X-ray in the room next door. Once you get the results, come back to see me.
I was increasingly confused. How come this doctor could know when others, often called world-class, couldn’t make any progress on the diagnosis? And what would be the point of an X-ray? I knew my bone structure was fine and I had a muscle problem. Everyone else was asking for an MRI. None of it made any sense to me. I was fighting the urge to jump to conclusions about my trip just yet.
I went to the X-ray room and had two scans taken. The first image covered my whole body standing with the arms up, a pose similar to what they ask you at the airport security scanning machine. The second one was also in the standing position, but the X-ray zoomed onto my pelvis.
I returned to the doctor’s room, and we resumed our conversation:
- Yes, you have a problem with your pelvic rotation. It stresses your lower back, and that’s the real culprit. Do you feel any pain in the lower back?
I thought about it for a second, and I remembered that I had strong tension in my upper back that Fabienne was battling in Basel. I didn’t recall any mention of lower back problems, and my confidence in the value of my visit lowered a notch again.
- I recall upper back problems but not lower ones.
- Yes, it happens. Sometimes you have muscle tension, and you don’t feel it, but that’s where your problem is in the lower back.
- Ok, but I have pain in my leg. In my adductor.
- These two issues are connected. Lay down, and I’ll make an injection that’s going to help you.
At that moment, I panicked. I recalled the controversies I read about, and our conversation didn’t dispel any of my concerns. Am I initiated to a weird cult? I was thinking to myself. The doctor explained that my sacroiliac joint (SI joint - where the tailbone connects with the pelvis) is stuck, and it’s one of the origins of my problems. I have many more, but we’ll focus on that one. He went on:
- I’ll make a small injection into SI joint with something that acts like a lubricant and will get your joint unstuck. It will make your pain and tension in the adductor go away temporarily. Just for a few minutes, so don’t expect miracles.
- How safe is it? I read some coverage on the internet - I interjected as diplomatically as I could
In my head, I didn’t believe it’s going to help me, but I was worried about the downside. Until I let something I don’t understand get injected into my body, my visit is fully reversible in consequences.
- It’s safe. We’ve been using these injections for many years. They’re not legal in the US, so many Americans come to us.
It was such a comically lousy reassurance that I thought a joke was hiding in plain sight. Only over many interactions ensued, I appreciated how the true experts sometimes are the worst marketing people on the planet. After covering a few more safety questions and hearing that these injections are, in fact, officially approved in Germany, I decided to give it a go. Still, I maintained my utmost skepticism of the positive effect of these shots.
I laid on my stomach and received the shots. No injections are fun, and these were particularly spooky. Half of it was just my psychology messing up my perception, and the other half was the genuine pain. After the shots, the doctor gently massaged the area around my tail bone and asked me to turn around and lay on my back. Less than a minute later, he started moving my right leg, where I had tension ranging from mild to severe for months on end. As the pain from the injection was easing, I realized my leg was moving freely. Bending up (knee towards chest) and down was effortless, and I had a full range of motion! A full range of motion. I hadn’t experienced it in more than a year.
It took a couple more moves to fully believe the drama of the injection didn’t fool me and the effect was real. I almost jumped off the examination table in excitement. It felt like someone had just removed the concrete shell wrapping my leg. It’s hard for me to put into words how it felt. It was a miracle. And I do recognize the boosting effect of low expectations going in.
So I was both ecstatic and confused. We injected something into a joint I didn’t even know I had in my body, and the adductor muscle lost its tension. None of it made any sense to me whatsoever.
I asked the doctor if there’s a simple explanation of what just happened. He went on to say that the immobility in my SI joint stressed the lower back. Specifically, it reduced the mobility in the lower spine as all these pieces are connected. The real problem was my lower back, where the nerves branch out of the spinal cord and reach their destination. Around that area, my nerve was slightly compressed, and that caused the tension. He immediately stressed that my discs are in great shape, so this is not a herniated disc problem that other doctors checked for when they looked at my MRI.
This explanation generated a torrent of follow-up questions. The two most pressing on my mind were how did it get started in the first place. How is it connected, if at all, to the semimembranosus muscle issues that I went to Basel to fix? And if the seemingly correct diagnosis was so easy to arrive at, how the hell had everyone else had missed it?
My time was up for the initial appointment, so I had to leave these questions unanswered and focus on the next steps. The doctor mentioned that I had muscle malfunction for too long, and there are many more complications we’ll need to correct. The higher-order bit for me was if I put extraordinary effort into treatment, could I get back to full fitness. He responded simply by saying that he thinks the chance for success is 80–90%. From his experience, most people with problems similar to mine recover. There’s the 10% of mystery cases where nobody at the clinic found a way to influence for reasons they do not understand. When I asked how long would it take, he said he wasn’t sure, but he hoped it would be fixed in a couple of months, probably by the summer (it was November).
If you, reading this, are thinking I was quickly becoming a convert, then no. But it was the first time somebody demonstrated an ability to influence my condition in a significant way in months. All my other attempts were closer to me desperately wanting to see a change than really experiencing it. To borrow a reddit crypto term, my past tries ran on hopium.
Back to planning. We agreed I would come back for a visit the next day, then return in a couple of weeks and stay a bit longer. I would receive a more comprehensive set of injections, and I would meet with an osteopath that the doctor described as someone with magic in his hands. I would also get a meeting with a physio and athletic trainer. It was a fully integrated clinic, and I was to get the full service the next time.
I can’t stress it enough: I was genuinely astonished by the whole experience. Maybe this place was special, but what could explain it?
To my great disappointment, the tension started returning about an hour after the injections, as warned.
Before boarding the plane back to San Francisco, I was on the phone with my friends from Zurich, the ones from my hiking story in part three. I was telling them about my visit to Munich. I said that I could relate the whole stay, minute by minute; I remembered all of it, and I took copious notes to make sure nothing evaporates. Yet, I couldn’t tell what happened. I simply didn’t understand it.
If they asked me whether I just got doped, I couldn’t tell. All I could say is that whatever happened, it involved needles, and it seemed to be working. They listened in awe and said they would love to hear more updates on this story. I can tell you that it was infinitely more entertaining to listen to it than to live through it. And then they told me they had a perfect recommendation for a movie to watch on my way back to the Bay Area. It was the 2017 Best Documentary Oscar winner, Icarus by Bryan Fogel. The main character is Fogel himself, who chronicles his exploration of voluntary doping to win an amateur cycling race. My friends knew I was an avid biker pre muscle malfunction saga, and the doping topic came up in our chat only half-jokingly. I followed the recommendation and want to pass it on now: go watch it. It has the right mix of an appealing premise, pure fun, and a sudden bent of the story that elevates the movie to the Oscar level. For me, it was triggering a special kind of emotion: I wondered how much the story of illegal vials I was watching is a story of my own, but I didn’t know yet.
I returned to San Francisco and the adductor tension returned in full force. Based on my notes from that time, I suspected the tension came from sitting on a plane for 11 hours. I was disappointed and in war mode. I immediately started thinking of how I can arrange my work life for the return trip to Munich. I thought about how transparent I should be with people at work, and I decided to opt for maximal transparency. In many ways, my story was the kind of crazy that people in Silicon Valley love hearing: I was taking bold risks for something worth it. I was playing to win.
A few days into my work life, I realized that my three-month-long sabbatical in Basel introduced a shift in office politics. I don’t want to go too much into details of it, but at the time, I was leading a developer productivity team that landed on what I thought was the wrong side of history. If there was a lesson to share, it is that in a fast-growing company, being priority number two equals to being a non-priority. I figured I had to change something, and I had this fascination with deep learning. I wanted to check whether the AI hype was real. So I decided to switch teams and work on machine learning applications. The catch: I had no idea about machine learning. I suspect, if anybody at work who had any say in my decision realized how little I knew about ML, I would never get the transfer approved. So I kept it to myself. Why would I want to make a risky move into an area I didn’t know and stack up against personal challenges? The reason was twofold. My private life was in pieces, and I hated the prospect of playing a losing game at work. Also, as a counter-balance to the daily fire drill, I wanted to have some long-term focus. My long-term bet was that eventually, I would figure out how to fix my health, and I would be in a position to do something ambitious at the frontier of technology. I had a suspicion the AI revolution was over-hyped and under-hyped simultaneously, and it’s not easy to sort this out without a first-hand experience.
Throughout this story, I highlight some life hacks I found helpful. I like to think of them as “positional” - they put me in the place I want to be. However, I firmly believe that once you’re in the right spot, you have to deliver. So when I got approved for the move, I ordered introductory books on ML (I recommend this one), signed up for a few classic online courses (fast.ai is very good), and went through all of them as quickly as possible (weekends). I didn’t foresee it, but my odd choice of moving from systems programming to AI brought an unexpected benefit. Unlike most machine learning people, I could rip the lid off the apparatus underneath and rearrange it the way I needed it. It came as a superpower later on and confirmed the old maxim that often, the outsized value sits at the seams of fields. More practically, I nanosized my ego. There was no grunt work I wouldn’t take at the time. A broken big data job? Gkk is on it. A spaghetti SQL query nobody remembered how it came about? My archeologist hat was on. Whatever moved important projects forward. I knew that after making a controversial move, not from a position of glory, I had to play on personal defense (didn’t come naturally).
Now, back to my health. As I mentioned before, I decided to opt for the maximum level of transparency, so I told my manager that my big bet on Basel didn’t work out, and I came back feeling worse. I had a plan b, and it involved this shrouded-in-mystery clinic that treated superstars from around the world, and I was lucky to get in. I was trying to sell this as an adventure as much as possible because I felt I needed the people who decided my fate to be strangely excited about the story. I wanted the people to think, “man, I admire this guy’s perseverance,” over “this guy is a walking source of bad news.” And I wanted myself to think it.
I was back on the plane to Munich. The plan I had this time was to understand how close to a reliable diagnosis we were. I had questions about the substance injected into my back. A week before Christmas 2018, I’ve arrived in Munich. My first appointment was with dr Wagner. After a quick assessment, he said my mobility did deteriorate compared to when I left his office the last time, but it was still a slight improvement over when I came first. I asked about the injections, and in his lighthearted way, he dodged my attempts to learn more. I knew I was in a losing position since our meeting time was limited. I concurred to receive the recommended cocktail and keep my questions for the next time. My notes from that day said I received injections in my hamstring, and I rated my pain at 5/10; I had small contractions in the muscle due to shots.
My work deal was that I would continue working remotely during my trips, so I dragged myself slowly to the public state library in Munich, suffering from pain as I walked. As an aside, people tend to recommend hotel lounges as good places for working remotely, but I found public libraries to be much better for focused work.
The next day I had an appointment with the physical therapist who worked on loosening up my muscles. Next, I met the Dutchman everyone at the clinic was raving about, describing him as having magical hands. Dirk (not his real name) introduced himself as an osteopath (it was the first time I encountered the term) and was flying in weekly from The Netherlands for rapid-fire series of appointments. Given I was still knee-deep in skeptic’s mode, I was very cautious about this jovial Dutchman.
After a quick intro chat, he told me a few problems he noticed as I walked into his office. I had “blockages” in my ankle and my knee that was causing a slightly awkward gait. Then he asked me to lay down, and he proceeded to manual inspection. He would gently touch my back and find particular points on my skin that, when pressed, would hurt unexpectedly hard. These were other “blockages” he found.
Remembering JP Meersseman and Michel from Zurich, who both used similar methods and claimed quick diagnosis, I remained unconvinced. Let’s see the complete list of identified blockages I saved in my notebook:
- blockage in my ankle
- blockage in my vein right below my knew (at the back of my knee)
- blockage in my hips
- blockage in my back, both lower and upper
For medically inclined: I wrote down in my notes I had blockages L4 and L5 in the lumbar spine area and C4 and C5 in the cervical spine area.
Overall, Dirk found 13(!) specific points to work on. Then we proceeded with manipulations similar to what a chiropractor would perform - unblocking my ankle through a very gentle pull resulted in freeing my calf. Literally, I could feel that all the tension in my calf was easing instantly.
Unblocking the rest of the points resulted in a better hip position, and amazingly, in better overall body position. I could feel the effect immediately too. And it was strong enough that my sense of balance was a little off. The tension in my adductor eased too, but the change wasn’t as noticeable.
The overall assessment was that I had a domino effect from one problem - adductor tension - triggering a whole chain of compensations and muscle strains in my body. Specifically, my right adductor tension was causing my body to compensate with hip rotation. I was “giving in” to the adductor’s pull by rotating right hip forward. It was an unconscious reaction and persisted as I was walking. That, in turn, induced tension in my lower back muscles surrounding the lumbar spine area. Next, these muscles would accumulate their tension and compress the nerves coming out of my spine. The compressed nerves would increase their passive activity levels and induce stress in my adductor. The catch? It was a closed-loop: the adductor tension would travel up the lumbar spine through a chain of compensations and back down through the nervous system. There was no natural way the body would find a way out of this. Waiting it out was not a tactic. It was the critical thing everyone else I worked with before had missed: you need to work on all loop elements simultaneously.
I can’t stress enough how vital the whole body view over my condition was. Many people looked at my problems and noticed the rotated pelvis or the tension in the lower back. But they saw it only as a symptom and not as both a symptom and source of my issues. Moreover, my back problem was getting worse while walking - the opposite of what you hear about spine health. If you had a wrong model of the condition as I and people I worked with had, you would perform interventions that were either ineffective or even actively harmful. It took me a long while to fully internalize how profound this detail was in solving the Engima of my muscle distress. I attribute the length to how counterintuitive the conclusions from the correct model were and how abset neuro-muscular view of sports injuries was in the mainstream medicine.
Undoing all these issues would take time but most likely was doable - Dirk concluded.
I left the office stunned. On the one hand, the chiropractor-like manipulations did help me. I wondered for a second if it was simply a placebo, but the effects were too stark. I had undeniably improved my range of motion. On the other hand, the process felt otherwordly. Dirk seemed to truly possess a sixth sense both in his eyes and his touch. I have seen dozens of physical therapists, chiropractors, and doctors by this point in my life. Noone had as quick and as deep a grasp of the human body. Yet, if you check a Wikipedia page on osteopathy, you’ll see that it’s considered pseudo-medicine. It doesn’t work according to randomized controlled trials.
As I mentioned before, an essiential aspect of navigating a highly complex medical condition is to remain self-aware. I tried everything I could in the department of conventional medicine, and I decided to see if there’s something to be found on paths less traveled. I didn’t know much about the history of medicine. I was a student of history of technology, and every time anyone had an original idea, there was strong pushback from the mainstream. Artists, including medical ones, never look good in randomized controlled trials. Still, you need some way to decide whether a particular avenue you’re exploring has the potential for the treasure down the road. Over time, I developed a method of sizing people. Whenever I’d meet someone who was supposed to help me, I’d pay attention to two things:
- Was I impressed with their knowledge of basics?
- Could they visibly help me in five minutes?
The first rule was about weeding out fakes who simply don’t know what they’re talking about. I haven’t met anyone in sports medicine who was good and wasn’t exceptionally well-versed with anatomy and muscle function. The second rule was about the validation of their method. I had noticed that the people who met the bar to help me would meet that bar in the five minutes of our interaction, even if in some small way. In all other cases, I would spend weeks listening that my issue is complex and I shouldn’t expect instant miracles. Yet, with more time, nothing improved. And you have only one life to live. I’ll come back to the duo of basics and fast results later on.
Right after seeing Dirk, I went to dr Wagner’s office. There, I received shots in my ankles and my lower back. My reservations about the needles didn’t fully ease just yet, but I increasingly felt the people I’m meeting are unconventional but not quacks. In my daily journal, I wrote that day:
I was in a hotel’s lobby slightly debilitated from injections I’ve received when a group of formally dressed, rowdy Germans rolled in with beers in hand and ordered a round of whiskey. It was a pre-Christmas party. I was deep into debugging some big data job, and I was trying to focus in the face of the loud chatter and pain from injections. Working across the continent, hustling, and having a cloud of doping over my head. How surreal my life is.
For the rest of my stay in Munich, I worked with physical therapists and athletic trainers. My training’s design was around the idea of undoing the damage caused by my mispositioned pelvis. The exercises were slow, methodological, and only from the outside looked easy. The theme of precision will reoccur throughout my stories, and I think that might be the keyword you’re looking for when dealing with a complex medical condition.
Before leaving Munich, I chatted with Dr Wagner about the next steps. He felt confident my condition is reversible but will require diligent work on my end. I felt like we were closer to an accurate diagnosis, even if I didn’t fully understand it yet. We agreed that I would commute from San Francisco to Munich every 4–6 weeks, and I would find someone local in the Bay Area with whom I would follow the athletic training protocols I would receive on each visit. It sounded like a brutal commute, but if it had a chance to help me and eliminate the pain, it would be worth it.
Early in January 2019, I hauled myself back to San Francisco and threw myself into the search for the local counterpart to my Munich crew. I collected leads from friends and coworkers of local physical therapy clinics and gyms. I practiced my pitch. It went like, “I have a rare sports injury and have a very detailed and specific training plan I received from a clinic in Munich. I’m looking for someone who would help me go over the program and watch my form. My form was essential”. I went on to visit a dozen of places, repeating my story. After a few meetings, I realized people treat me like a nut head. I talked about this mysterious condition they’ve never heard of, but it sounded like simple muscle tension. For example, I would describe how my calf tension originates in an ever so slightly mislocated ankle. The correct conclusion is: work on your stability. The most common reaction I received “you need to foam roll your calf”. Doh, if I haven’t tried that nine months and six doctors earlier.
Some people were happy to follow whatever plan I had because they billed by an hour anyway. But in reality the craftsmanship of what I needed was above their heads. I wanted to find a match as quickly as possible, so I developed a system. I would schedule as many different people per week, and I simplified my pitch. I skipped talking about the ready program but focused on detail about pain in my piriformis muscle (it’s a muscle in your glutes essential in walking and running). If I sensed surprise or confusion on the therapist’s face, I would apologize and say the session was over in the interest of our time. I walked out in the first five minutes, seven times. I would keep reminding myself that I had to cast a wide net by necessity, but they would give no medals for wasting time.
Finally, someone recommended Brandon Agawa. He was the first person I met that listened first and recommended second. He knew fundamentals and was curious about my condition and my seemingly crazy idea of commuting between San Francisco and Munich. We talked about the backstory, and I told him what I’m looking for: meticulous execution of somebody’s else plan. I wanted him to help me follow the exercises and watch my form, which was the most critical aspect of my training regime. The outcome we were looking for was a subtle reprogramming of my muscle function - reverting the accumulated miscoordination that inspired tension. Brandon and I got to work in earnest. We met 2–3 times a week and followed the program from Munich. For the first few weeks, everything seemed to be heading in the right direction. Until one day, during my exercises, something went off, and the tension started creeping in. Specifically, it seemed like we messed up hip thrusters. I left that training session limping from an adductor tension and with a strange feeling in my lower back. I returned a few days later, but the tension persisted, and we found no way to reduce it. We had to call it a defeat.
Fortunately, I had a trip to Munich coming up two weeks later, in late February of 2019, so we could take care of it. On my flight, my condition deteriorated further, probably due to ten hours of sitting. By the time we landed, the stiffness in my adductor had shot up. I left the plane in pain. An hour later, I was limping so hard that I couldn’t drag my luggage to the hotel’s lobby and needed staff’s help. Once I got to my room, I lay down on a bed, wept, and thought to myself, “it sucks to be me.” I was in my early thirties, and I couldn’t walk. The next day my friends from Zurich arrived for the weekend to see a Christoph Niemann exhibition and hang out together. I barely dragged myself to the museum, and then I had to excuse myself and go back to the hotel. They came to see me, and I couldn’t even keep the company. It sucked to be around me.
I visited the clinic right after the weekend. Dr Wagner and the athletic trainer’s diagnosis: I did my exercises slightly off, and I had stressed my lower back. It was the familiar drill for me: painful injections into my back and some athletic training. It did help and reduced my adductor tension. While at the clinic, I floated a more radical idea: what if I moved to Munich for an extended period? Even though my Basel trip turned out to be ultimately unsuccessful, I deeply internalized the value of tight feedback loops in exploring the medical maze. I wasn’t sure I would need to move (and combine the move with my work), but I wanted to know my options. Dr Wagner responded that it seemed far-fetched, unnecessary and that I should remain in San Francisco and finding a local physical therapist to work with.
I had a new set of exercises handed over to me and boarded the plane back to San Francisco. The February trip reinforced the sentiment that my condition was still acutely fragile. It was evident that an emergency hopping to another continent on every slip was out of the question. To keep me on track, I needed a local person to fix regressions. Brandon was a great trainer, but I needed a physical therapist. A good friend of mine shared contact with a mysterious physical therapist named Yann that used to work with Israeli and Georgian national soccer teams but likes to remain low profile. He came with glowing reviews from San Francisco locals who worked with him. We met with Yann a week later.
After a quick chat, Yann moved onto tactile inspection of my muscles. It had been only over a week since I returned from Munich, but my adductor tension was back in full force. It was painful, and at the same time, it was easier for Yann to understand my issue. He quickly pointed out that I had inflammation around the adductor’s attachment near my crotch (apologies for graphic detail); the muscle was stiff for so long that it caused strain and inflammation in tendons surrounding it. My Munich crew didn’t mention that detail, but it did help me understand why my pain was so localized. Yann continued by saying my condition is terrible and requires urgent action. “I can’t help you. It is too complex. If you think people in Munich can help you, work with them,” he said without any sign of subtlety.
He was about to leave. From his point of view, everything was clear. I felt he knew what he is talking about, so I thought I might leverage his network. I asked if there’s anyone in San Francisco or even the West coast in general who he could recommend to me. Yann answered that America excels in complex surgeries, but its physical therapy school is subpar. He went on to say that in his experience, the best traditions of physical therapy are in Australia, Germany, Holland, and a few other places I don’t recall anymore. He reaffirmed some of my findings: my condition is most closely related to soccer players’ injuries that the US doesn’t have much experience with. The treatment will require a complex interplay between doctors and a physical therapist. In the US, by the system’s design, you see the doctor once and then work with a physical therapist. They do not interact or work under a single roof. That’s fine for industrial-style healthcare of ACL (anterior cruciate ligament - frequently injured ligament in the knee) tears but not for artisanal issues like mine.
I was neck-deep in worries. If Yann was right, would that mean I have to move to Munich? The previously lurking concern took priority: I barely returned from my sabbatical in Basel. How could I explain this at my workplace? I pressed harder and asked Yann if anybody else local I could talk to, even if it’s a long shot. Yann gave me the phone number of his physical therapy friend that worked with San Francisco’s 49ers - an NFL team. I called that guy the next day, and after a brief intro, he said that Yann is the local special projects person, and if he was out, it’s over.
If you got that far in reading my story, you might guess what was next: I didn’t take no as an answer just yet. Before I rule out America as a whole, I decided that I will make a list of five more people to talk to. I spent my evenings researching the most elite sports clinics in the US. I was on the phone with people from Los Angeles, Rhode Island, and Connecticut. Despite rich marketing claims, I found people I spoke with to be overwhelmed with my story. Two of the places suggested I should visit them without much justification. By this point, I acquired enough puzzle pieces of my condition to triage unfruitful directions more aggressively. I called back both clinics and asked a simple question: do they have an experience of issues in the lower back manifesting as leg muscle tension?. They went into a defensive “we don’t do medical consultations over the phone.” I wasn’t asking for consultation. I was inquiring about a piece of particular knowledge. I instantly knew that visiting them would be a waste of time. And I had no time to waste.
Here I need to underscore the importance of a critical contradiction that you need to store in your head when dealing with a medical maze. You need to believe that there’s a way out, and at the same time, assume that ninety-nine percent of turns lead to dead ends. You need to blend an unreasonable optimism with a ruthless eye for any sign of lack of problem-competence fit.
For a short while, I planned to jiggle between San Francisco and Munich. The jiggling was over, and I needed a new plan.
The idea of moving temporarily to Munich was on. There were two severe constraints:
- I didn’t see a way work would let me move again
- I didn’t know how I would pay for the new treatment
You could say, why not quit the job? If that is not a good enough reason, then what is? It would exacerbate the second issue, but that wasn’t the actual blocker for me. The true blocker was that I was on a visa tied to the job. Me quitting meant I would have to leave the US immediately. An immigrant’s life at its finest. I still hoped I could stay in the US for longer (doing the first-rate tech was my dream), and losing my visa would undo two years of my life I invested into moving to the US. So I had to find a way to convince people to give me another go at the treatment.
Financing my new treatment was another obstacle. The Basel treatment depleted me financially, and even my tech salary couldn’t cover it. As I was thinking about this issue, I decided to adopt a mindset of an entrepreneur. I mentioned before how I found Horowitz’s business book to be the most helpful in making decisions and finding fresh angles. I decided to treat my recovery as a kind of startup and the Munich trip as one of the projects. I needed financing, selling some key people on the idea of letting me move, having some framework for thinking about risk and operational methods of organizing my time. And to be honest, it was a mind trick: startups are supposed to be hard so was what I was doing.
Through a pure coincidence, someone who wished me well in life was following my adventures from afar. Mike (not his real name) was a successful person in the Silicon Valley whose family member had a recent, serious sports injury. Mike was looking for a list of dos and don’ts and followed my raw notes. He enjoyed the unfiltered nature of my writing and said, as a rule, he prefers to follow people “close to the metal” on the issues he is interested in. He believed first-hand, specific experience beats platitudes.
When we met to talk about what I had learned in the medical wilderness, I said that my number one advice was to internalize Ben Horowitz’s “control your own psychology.” It was very likely the recovery would be longer, bumpier, and more lonely than any healthy person would anticipate. The other advice was to remind oneself that the health investment is a long-term proposition. I also mentioned I wanted to try the Munich people in full swing, but I worried about personal finances. Mike said he would like to see the other end of my story and offered a cheque. I was taken aback. My cultural upbringing (in Central Europe) doesn’t have a concept of accepting stranger’s money.
On the other hand, I knew I was talking to a highly thoughtful individual, so the offer wasn’t impulsive. He sensed my hesitation and told me to understand it as a long-term investment as he thought I’d do something impactful once health was off my plate. I said I would treat this offer as a last resort. I ended up not taking the money; the total cost of treatment was lower than I had anticipated. Still, the offer was vital in unblocking me psychologically: money wasn’t an issue anymore. I could go all in and move to Munich if I got the permission. I took a note to myself: if I ever find myself at the other end of the conversation and hear out a smart person with an ambitious goal, I will have an offer in hand.
The other problem to solve was getting the green light. I expected people at Stripe to be skeptical, and I knew what would lower my chances: vague talk. In a hyper-growth company, everyone is incredibly busy, having more things to do than hours within the day. The last thing anyone wants is to deal with us a homework-free request. So I first reached out to Dr Wagner in Munich to discuss the move. I floated the idea before in person, so I made it more concrete: I’d come for three months, intensely focus on the recovery, and return to San Francisco healthy and kicking. I was explicitly asking for open dates, starting as soon as possible. The response “there’s no need for such a drastic step, and we don’t do that kind of extended treatments. We can help you with an occasional visit.” Deep inside, I felt there was a notch of optimism too much. I had inflamed muscle attachments and could deteriorate any day so much that I would weep because I couldn’t drag my luggage to the hotel. There was no room for a leisurely pace.
As I was thinking of ways to move forward, I recalled this quote by the legendary founder of Hollywood’s legendary Creative Artists Agency:
Gentlemen, I’ve done many deals in my lifetime, and through that process, I’ve developed a methodology, a way of doing things, a philosophy, if you will. Within that philosophy, I have certain beliefs. I believe in artificial deadlines. I believe in playing one against the other. I believe in doing everything and anything short of illegal or immoral to get the damned deal done. - Michael Ovitz
My engineering background didn’t make it a habit to sell, or think that way. But sales mindset is what I needed. Here’s what I wrote to people in Munich:
I talked to people at the company where I work, and they recommended I come to Munich for focused recovery and return in a good mood. The company I’m part of is considered one of the best companies to be born out of Silicon Valley in the last decade. They value high-performance culture and thoughtful decisions. I’m lucky to have their support.
We agreed on April 15th as an optimal date for me to move. Could we schedule appointments for three months around that date?
The deadline was my own; it was the earliest I think I could pull off the move. The answer arrived quickly: “yes, we can see you but the first appointments free are the beginning of May.” A miracle was born.
You might wonder how come I turned around pretty clear “no” I got the first two times? I learned about this months later during a training session in Munich, once the stranger’s distance wore off. I heard, “yes, we were very skeptical of you coming, but your company told you to come, and you sounded serious about it.” And then that person continued, “We don’t do that kind of extended stays, but we were curious how would it go, and who this crazy guy is.”
I smiled inside and thought it worked like intended. The quote from Colin Powell was the inspiration for the specific angle I picked:
You’ll know you’re a good leader when people will follow you… if only out of curiosity.
Next, I needed to convince my manager that I needed to move. I launched my conversation with a preamble: my only personal priority for 2019 is to recover. Tech people understand yearly goals and priorities. Then, I said my best bet is people in Munich, as they seem to know what they’re doing. On my last trip, they said my case is more complex than anticipated, and I need to move to Munich for longer. I didn’t forget to add, “they treated people as famous as Usain Bolt and Bono, so this was an amazing opportunity to have their invite.”
My self-removal as an initiator of the whole idea was complete. During that conversation, I also made it clear I was adamant about moving, but I’d love to do within the employment options we had at the company. I thought about it a little bit and concluded that I was so miserable with the pain that I would have walked away if I didn’t get permission to go. The last thing I wanted is to be a drag for everyone working with me.
It’s a trivial observation but worth reminding: a line manager executes within a narrow lane, so it was the first step in getting the approval. I quickly understood that no rules or processes within the company cover my request; there’s no automatic way to approve it. The decision was inherently subjective and had to be escalated to the executive level. Feeling I’m about to trek unfamiliar territory, I consulted a very well-versed friend in big company life. Her advice was to watch out for not putting myself in a position to be fired, not because someone actively wants to fire me, but someone who never met me in, e.g., HR would have no other choice but let me go for crossing some line. That advice would be eerily prescient later on.
I appreciated my friend’s reminder of the risk, but I was on a search for a positive spin. Engineering training teaches you to stick to facts and maybe (in advanced case) systems thinking when making a decision. However, I believed that appealing to values is often more powerful. Where I worked, ambition and bias for actions were the two characteristics people valued. These two would be the tenets of how I would frame my request.
Fortunately, Stripe still had a muscle to move quickly, and I had the meeting with an executive scheduled soon. I repeated my pitch and added that I explored other options. I used what I described as an exponential escalation in my search for a physical therapist: I looked in San Francisco, California as a state, and the US as a country. I felt this was enough of due diligence before making my unusual call. Lastly, I remembered to stress a simple fact: I was moving to optimize for a fast feedback loop and not for the hours of treatment per day - i.e., my move wouldn’t interfere with my job. To my surprise, I got the approval on the spot. I couldn’t tell whether an angel was watching my back or everyone was just simply too busy and wanted to get me off their list. To this day, I don’t know.
Either way, my move was written.
It may seem that I was unquestionably confident about relocating to Munich. No, it wasn’t an easy decision. Let’s round it up: Munich people did seem to know something about my condition and how to affect it, even if temporarily. However, after each visit, I regressed in a flash, and Dr Wagner dodged questions about my treatment each time I raised them for reasons obscure to me. It was also an expensive way to spend three months. Still, this seemed like the best option I had at the time, and the status quo equaled misery. I remembered reading this quote from Jerzy Gregorek, a Polish weightlifter who won The World Weightlifting Champion title four times:
Hard choices, easy life. Easy choices, hard life.
The moment I recalled that quote, the decision had settled in my mind. It wasn’t an easy choice but the choice to be made.
Another thought that occurred to me was that I wasn’t choosing certainty but optionality. If the Munich magicians turned out to be unable to help me, I could cut my trip short, return and look elsewhere.
There’s the old truism on the importance of goals that serve as powerful propellants. My goal was to run 10km run and ride 100km on a bike, pain-free. When a few friends asked me why not just recover, I would joke I had a genetic mutation that made the word “just” absent from vocabulary.
Thanks to Nada Amin and Lyn Nagara for reading my drafts.