🪞Beware Cokeheads Creating Culture🪞
It's happened before
Hey,
Do you know when you hear about the same idea, person, or thing seemingly all at once? Well, that happened to me this summer with William Stewart Halsted.
Halsted is a fascinating character who made incredible contributions to society. But the lifestyle behind those innovations came at a steep cost. And not just for Halsted, but for many physicians and their patients today.
In this post, I’ll discuss how a leader’s lifestyle may have unintended consequences on the culture they create.
Stay clean,
Ben
🪞Beware Cokeheads Creating Culture🪞
Consider this: You start a new job. It’s in a stressful, high-stakes, life-or-death industry, but you knew that going in. Your job is meaningful, which you love. And it’s prestigious. So it’s all good.
Well, it’s all good, except that your boss is a maniacal genius, and he expects you to be a maniacal genius too. This boss is hard-charging, seems not to require sleep, and expects you to work upwards of 24+ hours a day with few or no days off. He checks on your work, whether it’s 2 pm or 2 am. He requires you to live at the office and punishes you if you leave. And for all these demands, your boss is bold, courageous, and innovative, changing the world right before you. And (as long as you stay on his good side) he gives you unprecedented responsibility and an opportunity to see your name in books that people will read for centuries. Everyone who works for him appears to be a total badass.
And, for a while, this fast-paced and rewarding work environment sustains you.
But this boss gradually becomes increasingly incoherent and paranoid, and you find your current workload unsustainable. One day you find out why. This boss is hopelessly addicted to cocaine.
Meet William Halsted, the father of surgical residency
If you were a surgical resident under William Stewart Halsted, the above scenario was likely your experience.
Halsted was, by all accounts, a tremendous achiever.1 Among other things, he’s widely credited with inventing surgical residency and, importantly for this post, the culture (and the current standards for surgical training) surrounding it.
What are the consequences?
Medical residency in the US is notoriously grueling.
I have many friends who went through it, and every single one talks about their experience as simultaneously the hardest and most rewarding part of their lives. Candidly, I’m a little jealous that they got to experience something so monastically chaotic.
But the culture created and modeled by Halsted comes at a cost. Sleep-deprived and overworked medical professionals make more mistakes, and the suicide rate among physicians is much higher than the general population.
The Learning
Creating a culture is one of the most difficult things anyone can do. It’s even more difficult to create a culture thoughtfully.
Often, culture is created by a leader who models behaviors (good and bad, healthy and unhealthy, sustainable and unsustainable). In Halsted’s case, his residents were celebrated for being bold and innovative. Unfortunately, it also meant that they were expected to match the energy level of a leader who was coked out of his mind.
If you’re fortunate enough to be in a leadership position, then be aware of the behaviors you model and the lifestyle that enables them. Maybe you can afford childcare that allows you to work long hours when your direct reports can’t. Maybe you have nonwork-related income streams that provide additional financial flexibility and independence. Maybe you have a spouse who manages all the domestic duties; maybe you don’t have sick kids to worry about (Halsted never had children of his own).
At a large enough organization, it’s fair to assume that your life situation isn’t like everyone else’s. That’s neither good nor bad, but taking it into account when working with others, and more importantly, modeling the behaviors that will establish your culture, is critical to avoid unintended and damaging consequences.
🙏Huge thanks to trauma surgeon and medical ethicist Dr. Allan Peetz for reading and providing notes on an early draft of this post.
Some of Halsted’s career highlights: invented modern residency training, invented surgical gloves so a nurse (who later became his wife) could handle antiseptics without pain, performed one of the first blood transfusions in the US (on his own sister, and he used his own blood. He operated on her immediately after the procedure and saved her life). His Wikipedia page is worth a read.