Searching for my brain surgeon taught me to think differently about my design career

TL;DR: develop a process for delivering excellent results.

Seth Jenks

Photo by Piron Guillaume on Unsplash

In June 2018, I found out that I had a large tumor about the size of a golf ball growing into my brain. It’s called a Vestibular Schwannoma (in times past an Acoustic Neuroma). I’m lucky. It’s “the best of the worst” — Not cancer, but it can be deadly. It’s a pretty rare condition (1:100,000) — especially for someone as young as myself. Mark Ruffalo had the exact same tumor in 2001. (Mark, let’s get together for dinner soon and exchange stories!)

So, this is pretty terrifying news to receive. Actually, “terrifying” doesn’t really do justice to the emotions that completely overcome a person when they receive news like this. There aren’t words for those feelings. There are a host of hazards and side effects in this situation. The possibility of death is low. But it’s not zero. I’d likely lose my hearing on my left side. And, there was a real possibility that the left side of my face would be permanently paralyzed. My wife and I cried a lot. I had to walk a couple hours a day in order to help burn off the anxiety and keep the feeling of dying off my mind.

See that white mass? Yup, that’s a tumor.

At this point, you’ll naturally want to evaluate all of your options — I certainly did. We ran my case past a few radio-oncologists to see if they’d be comfortable doing a much less invasive treatment. Because of the size of my tumor, and some abnormalities in my MRI It became clear that a procedure called a Translabyrinthine Craniotomy was my best option. After watching a couple of YouTube videos — and getting a little queasy — it was pretty clear to me that I wanted someone drilling into my head that not only knows what they’re doing but has had great results.

Because of where the tumor is located, it requires two surgeons — an Otologist (Ear Surgeon) and a Neurosurgeon. There are less than a handful of doctors in the region that perform this surgery. The doctor who diagnosed me had done about 100 of these. His neurosurgeon counterpart hadn’t done as many. Before meeting with the neurosurgeon we were told that he had a terrible bedside manner but that he was an excellent surgeon. As we met, it became clear to us that he was somewhat uncomfortable with the procedure. He said that working with the nerves in this situation is “like trying to peel away a piece of spaghetti crushed by a bowling ball.” The tumor splays and compresses the nerves as it grows. It’s extremely easy to damage them. This perceived lack of confidence — and bedside manner — was enough to turn us off to that team of doctors. We asked for a second opinion from the doctors at the University of Utah.

A few of the steps from the procedure that I underwent (Translabyrinthine approach). Created by: Robert Jackler (surgeon) and Christine Gralapp (artist)

As we searched for doctors that could perform this surgery I had the realization that they are a lot like basketball players. We were discussing their credentials and what their success rates were. We didn’t care for the most part what their bedside manners were or how much they tried. We only cared about their results and experience. I asked one of the University’s Neurosurgeons what he’d learned in the years since he’d started performing this procedure. I figured that he’d say something like “I’ve learned if you don’t use bone glue to fill up the semicircular canals you get better results” or something like that. He instead responded, “Well, we’ve got a really good process that we stick to and we have great results”. This was an unexpected response but opened up my eyes in a small way to his profession and why he’s one of the best neurosurgeons in the country. All of his life’s work lives in the process that he’s been developing. He spends his days teaching that process to his students and they, in turn, perform the procedures too. His value is not necessarily in his own skill.

The credentials were there. The success was there. They had humble confidence. This was the team of doctors we chose.

As I went into surgery in August I realized more acutely what this process is like. There are information and family history forms that you need to complete. There are things you need to do on the day of the surgery to be safe and make it a success: no blood thinners (including some vitamins) for 10 days before, no food after midnight on the day of surgery, wash with antibacterial soap before you show up at the hospital. As I checked in, changed into a hospital gown and was being wheeled back into the operating room I saw almost a dozen people preparing for me. Each had a job to do — a checklist to go over. Hundreds of choreographed actions needed to happen in order for this team of people — and me — to get excellent results. My surgery went off about as well as it possibly could have. They were able to remove 100% of the tumor and save my facial nerve.

Feeling pretty rough after surgery. Newly deaf in my left ear. My facial nerve froze up afterward so I couldn’t blink or move my left side, thus the clear eye patch to keep it from drying out.

So what does this have to do with being a product designer?

While in recovery, I had time to marvel at the dedication and care my doctors put into their work. I contrasted it to my own profession and how undisciplined I’d been with it. I sort of feel like I’ve wasted my life in comparison. I don’t really have a process or a system that I keep all of my knowledge and experience in. I haven’t written down a checklist or even committed myself to a product development methodology. I’ve tried to make my own way and I’ve gotten mixed results because of it. Sometimes things work out alright sometimes they don’t. I’m like a surgeon trying to remember all of the steps to a brain surgery off the top of my head or just winging it as I go. I could be a much better designer if I approached my career as a surgeon. “The results are all that matter.” I never had a mentor or a teacher to pass along a successful process — although I think it’s a good idea. It’s alright to practice my profession without a license (for now)

Your value is in the system you build for yourself.

Excellent results matter. This probably seems obvious but it’s really, hard to get right and get right consistently. It’s critically important for a surgeon to get a procedure right. Many times, someone’s life hangs in the balance. It doesn’t matter if they’re sick or depressed or if they had an epic fight with their spouse. They can’t let those things affect the results. We don’t think the stakes are as high in product design but they can be. Bad design decisions affect people’s lives dramatically. At Nav, bad design can be the difference between a small business owner getting the financing they need to make their business succeed. When you’re working on an app as large as Facebook poor design decisions can affect Billions of people. Hold yourself to a high standard. Your work matters.

So let’s say your results aren’t good right now. Why not? Is your visual design amateurish? Did you build a feature that was a failure? Do you feel like you’re moving sideways instead of forward in your career? Do you wonder why your team is dysfunctional? Not having a system… is a system. Your value is in the system you build for yourself. Some might consider it as being intentional about your career.

Here’s an example of how documenting a process is linked to your value. In 2013, I had the opportunity to work with Nate Walkingshaw on a startup called Cycleface — which was acquired by Strava later that year. He had a process that he’d developed called “Directed Discovery”. To me, it looked a lot like Steve Blanks idea of Customer Development — with a few notable exceptions. I remember Nate saying “I’m going to write a book about this.” I internally rolled my eyes and thought “sure you are”. (This is an example of why Nate’s been so successful and me less so, but that’s another article) Nate went on to refine his process at O.C. Tanner and shortly after at Pluralsight. He did write a book recently for O’Riley. Nate has created a lot of value at some big companies because he took ownership of a process and made it his own. Your process is a big part of the value you bring.

No process is perfect if they were, we’d all be out of jobs and robots would be building all the products out there. As I talked with several designers, they had varying levels of structure around a system. Some had nothing. Some have it documented in a 57-step-system that includes activities and deliverables. Some have a loose strategic framework that they follow. Others have a slide deck where they have their core process laid out. Others just have a list of “Tools in their toolbelt.” Some have literally written a book based on their system. Others just embrace chaos. All of these systems have validity. Each person is trying in their own way to get better results and make a bigger impact.

Your process includes your “Personal Operating System” or the way that you choose to operate at work. What is yours? I’d argue that it should include:

1) Trust (integrity, intent, capability, and results)

2) Focus (time management, flow)

3) Curiosity

4) Adaptability.

Paul Murphy at Intercom has an excellent deep dive on this. Additionally, learn what your strengths are, and incorporate those too.

What is your design process? Is it documented? Can you easily articulate the key points? Is it thoroughly documented? What’s worked for you and what hasn’t? Companies are quickly adopting design systems in order to standardize and improve their output. Do you have a personal “Design System” for your process? Can you update it? Add to it? Rely on it when you’re having an off day? If not, I’d start in the same way you learn to design in school. Copy the masters, then make it your own. There are several methodologies that you can choose from. Having your process written down is the first place to start if you’re looking to improve. In my experience this a key difference between ordinary and extraordinary product leaders.

To me, anyone that strives to apply themselves in order to improve or systemize quality results is a craftsperson and a leader.

Practice and refine your system relentlessly. Think and write down what worked, what didn’t and what you’re going to improve next time. Have a place for ideas that you want to try out. Have a place for problems that you can’t figure out. Make space to reference key ideas, articles, books, and videos. Have a place for your thoughts on why something worked and why it didn’t. Store documents that you’ve created or used that help you accomplish each step. I use Airtable for this myself. Commit to delivering impactful results and hold close the ideas, processes, and failures that get you ever closer to excellence.

For my surgeons, having a tested process and being focused on excellent results made a huge impact on my outcomes. Seeing their method and commitment to delivering the best results possible made me think differently about the focus, dedication, and ability I put into my own career. I want to be as good in my own way as they are. I hope you do too.

Author: Seth Jenks

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