Career Choices When Life Is Short

HBR’s fictionalized case studies present dilemmas faced by leaders in real companies and offer solutions from experts. This one is based on the HBS Case Study “Avi Kremer” (case no. 411022-PDF-ENG), by Joshua D. Margolis. The News: One Week After Diagnosis The leaders of GlobalScope didn’t typically shed tears in their weekly meetings, but this was an exception. Gil Lehner, one of the start-up’s four founders, had just told the others about his diagnosis: He had small-cell lung cancer, and while he planned to fight it with his trademark tenacity, his chance of surviving longer than five years was only about 18%. After a few moments of morose silence, Gil clapped his hands and sat up straight. “I’m not dead yet,” he teased. The young Israeli was perennially positive and refused to indulge his colleagues’ sadness for long. They had too much work to do. GlobalScope was a New York–based tech company focused on turning cell phones into powerful microscopes. Gil and his partners, all recent business school graduates, had secured their first round of funding eight months before and were poised to receive another soon. They were currently testing various plastic lenses that could slash the cost of the microscope while providing the most amplification available for a mobile device. “So let’s talk about the next phase of testing,” Gil said. He was the team’s scientific expert: He had a PhD in biology, and he’d worked at a health care company in Israel before studying for his MBA. Michael Shrock, the team’s finance chief, shook his head. “It just doesn’t make sense. You’re not a smoker. You’re barely 30.” “The doctors tell me I’m an unusual case. It’s very rare for someone like me to get this kind of cancer, but it happens. I’ve already talked to another patient my age.” Michael kept shaking his head. “Does anyone have any other questions before we get back to business?” Gil asked. “How’s Ruti doing?” Carly Gardos, GlobalScope’s technology chief, asked. “She’s handling it better than most new brides would. We’re Israelis, after all. She’s already got my treatment plan mapped out.” “So you’re going to stay here in the city? Keep working? Are you sure you want to?” Michael asked tentatively. “I haven’t thought everything through yet, but yes, I’m committed to you guys, and Sloan Kettering has some of the best oncology docs in the world. The chemo will be rough, but I should have plenty of time when I feel fine. So I’d like to keep everything else as normal as possible.” “You know, your health is more important than this company,” Carly said. Everyone nodded in agreement. “I know, but I think I can focus on both,” Gil said. “Now, can we please change the subject?” Labor of Love: One Month After Diagnosis Three weeks later, two of Gil’s friends, Arthur Kraus and Maya Hanley, both still in their second year of business school, invited him back to campus for lunch with David Johansen, the entrepreneurial management professor who had been their mentor on a group project in his class a year ago. Gil met his friends on the stairs up to David’s office. “Before you ask: Yes, the treatments are going fine. Yes, I’m fine. Yes, Ruti is fine. Yes, the prognosis is the same.” He smiled. “Of course, I probably won’t eat much lunch, but I can’t wait to hear about this big idea. What’s up?” “Let’s wait until we’re with David,” Arthur said, trying to match Gil’s upbeat tone. “We want to pitch it to you both at the same time.” When they knocked on his door, David opened it immediately. “Come in, come in. Have a seat,” he said as he ushered them in. “Gil, how are you? Do you know anything about this big idea these two are so eager to share?” “I’m in the dark too,” Gil said. “And doing fine on the other front.” “OK,” Maya said. “Here goes.” She explained that, inspired by Gil’s diagnosis, she and Arthur had started to look into the research on lung cancer and particularly why nonsmokers were getting it. They’d learned that, overall, lung cancer received much less financial support than other types of cancer. “There’s not a lot of sympathy when people think victims have brought the disease on themselves,” Arthur said. “Ah, so the view is ‘Smokers know the risks; they should bear the consequences’?” David responded. “Yes,” Maya said, nodding. “But we all know that’s not Gil.” “And even if I were a smoker, I wouldn’t appreciate the logic,” Gil said. What’s more, Maya explained, of the funds that were directed to lung cancer research, most targeted the much more common varieties. Donors and medical institutions seemed to think there were just too few people with small-cell lung cancer, relatively speaking, to warrant the investment. “But,” she continued, “we have a plan for changing that.” She passed identical folders to Gil and David. “We want to establish a prize to reward innovative ideas in this particular area.” She told them that a professor at Harvard had just completed a study showing that prize-based research initiatives not only raised awareness about lesser-known illnesses but also generated significant scientific breakthroughs. Often, the prize attracted scientists not currently studying the disease, who explored how their work might apply to the illness. “Our goal would be to fill the treatment pipeline with fresh ideas,” Arthur said. “Wow,” Gil said, opening the folder and scanning the proposal. “I don’t know what to say.” David, already reading the last page of the document, turned to Maya and Arthur. “I assume you’ve already consulted the professor who did the study?” They nodded. “The biggest obstacle will be raising the funds,” Arthur said. “We want the prize to be significant—a million dollars. And we want to offer smaller prizes for different areas, like one in biomarkers and one in treatment.” “Given the size of our academic community, you might start here,” David said. “And Gil could help as the face of the initiative.” Indeed, Gil was universally liked by his teachers and fellow students; from the moment he’d arrived on campus, they’d been charmed by his enthusiasm and generosity. “Assuming you’re both committed to making this happen, I think this would be an excellent postgraduate pursuit.” Arthur and Maya looked pleased; it was their last semester, and although both had job offers from consultancies, neither was excited about accepting. “Just remember, these types of endeavors are a labor of love, at least at the beginning. You shouldn’t expect to make a salary right away.” “We know,” Maya said. “But we want to do something meaningful. The consulting gigs will always be there.” “What about you, Gil?” David asked. “I know you’ve got a full plate with GlobalScope, and I imagine your treatment is going to take up a lot of your time and energy. Would you have the time to get involved?” “He wouldn’t have to,” Arthur said quickly. “I mean, we’d love for you to be involved in any way that you can, Gil, at least in a fundraising capacity. But we understand that you have a lot to focus on right now.” They all looked at him. “I’m 100% behind the idea,” he said, “and so touched that you guys would take this on. And I do want to get involved: If I’m not going to win this battle, I want other people to. But I’ll need some time to think about it. GlobalScope is at a critical stage, and I promised Ruti that I’d focus on this second round of chemo for now.” Arthur choked up as he tried to speak, caught himself, and apologized. “It’s OK. I seem to have that effect on people lately,” Gil said. They all got up to leave, but David asked Gil to stay behind. “I want you to know that I’m here if you want to talk—about GlobalScope, this prize, anything,” he said. “It’s strange,” Gil answered. “I thought I had it all figured out: the wife, the MBA, the start-up. I was in total control of my life. Now I’m not sure what’s going to happen next week, never mind in three months or three years. Most people have lots of opportunities to make important career decisions in their lives. I might have just one. I want to get it right.” “I thought I had it all figured out: the wife, the MBA, the start-up. I was in total control of my life. Now I’m not sure what’s going to happen next week, never mind in three months or three years.” Back Home: Three Months After Diagnosis Gil’s parents’ house on the outskirts of Haifa was packed. When his family had heard that he and Ruti were coming home to Israel for Passover, they’d all made time to see him. But Gil had insisted that there be no discussion of prognosis, treatment, cancer, or death, so the mood was lighthearted, even festive. A few hours into the party, Gil managed to escape to the backyard for a quick rest. His cousin Tomer followed. The two men had grown up in the same neighborhood and gone to the same schools; now Tomer was married with two toddlers and worked at a tech start-up in Tel Aviv. “You look good,” Tomer said to his cousin. “Not like I’m dying?” Gil joked. “You’d hardly know it,” Tomer teased back. “I actually feel good. The chemo sucked, but it has stalled the lesions for now.” “I heard all about it. It seems like any time you throw up, Ruti calls your mom, and your mom calls mine, and mine calls me. It’s a Gil Lehner phone tree. I know all about the trial you’ll start when you get back, too.” Gil laughed. “It’s nice to be loved, I guess.” “You also won’t be surprised to hear that your father asked me to talk to you,” Tomer said. “About moving back?” “I’m supposed to tell you to finish out this trial and come home this summer. Do the rest of your treatment here. Spend time with Ruti, your parents, the cousins, all our kids. You’ve got a support system here, and so does Ruti. In the grand scheme of things, family will help you a whole lot more than work will.” He paused. “Of course, I can’t for a moment imagine being in your shoes, so feel free to tell me to shut up.” “Don’t worry. Uncle Jacob beat you to the punch. He says he can get me into any clinical trial in the country and a part-time job at the Israel Cancer Research Fund. He laid on the mom-and-dad guilt a lot thicker than you ever could.” Gil paused a moment. “I have to admit that the thought of coming home is comforting, and I know I could accomplish a lot at the research fund. “You know, Ruti was adamant that I stop everything at first, too,” he continued. “Get through the treatments, then enjoy our life as much as we could. She wanted to travel around the world, just the two of us. But then she realized how much happier I am when I’m working hard. And work is really good.” He updated Tomer on GlobalScope, explaining that the company had made a breakthrough—it was producing images that were much clearer and easier to transmit via mobile. It had interest from the World Health Organization, and investors were clamoring to learn more. “So, if I stick with it, I could make some significant cash—if not for me to use, then for Ruti and my parents. Plus I’d be helping a lot of sick people who wouldn’t otherwise get care.” “I can see how you wouldn’t want to give that up,” Tomer said. “But there’s another option.” Gil explained Maya and Arthur’s project. They’d already raised $300,000 from business school alumni, and they’d been lobbying him to get more involved with fundraising so that they could announce the prize in the fall. “I like the idea of fighting this disease—not just in my body but on a bigger scale, and I think this prize could have a real impact.” “Is there a chance it could fund a breakthrough that could help you?” “Possibly. It’s impossible to know. Ruti gets excited about it when she talks to Arthur and Maya.” “Man, Gil, this is heavy. I know you said we shouldn’t talk about death, and I, for one, still believe you can beat this. But if it’s true that you only have a few years left, what kind of legacy do you want to leave behind? Do you want to spend them as an entrepreneur or an activist, or with your family?” What Would You Do? Some advice from the HBR.org community Gil’s legacy shouldn’t be determined by his fate or circumstances; it should be determined by Gil himself. He should keep working at GlobalScope and help launch the prize. That’s what will allow him to have a positive impact on future generations. Michael Ho, senior manager, Hutchison Whampoa Love, more than anything, will help Gil lead a happy and potentially longer life. He might choose his love for the start-up, working on the prize, contributing to research, or being with friends and family at home. Those are not mutually exclusive choices in the world we live in today. Varun Jain, MBA candidate, Kellogg School of Management I was a cancer victim at age 22, and I’d say he should find a way to balance all three things. That would help him get out of bed every morning and make an impact on society. It’s difficult to sit around and wait; far better to keep yourself occupied with things that give you pleasure and stability. Archana Dhankar, student, Army Institute of Technology, Pune, India Gil should dedicate the rest of his life to working on the prize while also spending a good amount of time with Ruti and his family. People rarely have an opportunity to make such a significant contribution to society, and Gil can fight the lung cancer battle for himself and for others. Sivakumar Palaniappan, founder and chief mentor, Mastering Mind Academy Should Gil keep working at GlobalScope, help launch the prize, or move home to Israel? The Experts Respond Ben Munoz is the founder of Ben’s Friends, an online network of patient-to-patient support communities for people with rare diseases. Gil should follow his cousin Tomer’s advice and move home to Israel. It all comes down to priorities, and his family comes first. This doesn’t mean he needs to stop working altogether. If his health allows it, I’m sure he can find creative ways to contribute to one of the ventures—the prize, the start-up, the foundation in Israel—or maybe even all three. But he should spend the bulk of his time with his family now. I speak from personal experience. In 2006, at age 29, I suffered a brain hemorrhage caused by an arteriovenous malformation. I was rushed to the hospital for emergency surgery. As I lay in the hospital bed that first night, wondering whether I was going to live or die, I was surrounded by my family. If it had been my time, it’s exactly what I would have wanted—I wasn’t thinking about work at all. Gil doesn’t have to choose one option, of course. In the wake of my health scare, I’ve pursued many paths. I’m currently a medical student at Baylor and an aspiring entrepreneur. I also run a nonprofit that I founded to help people like me—and like Gil—cope with their illnesses. During the two years when I wasn’t sure if I was going to survive, the only person I could relate to—who understood the anxiety, depression, and euphoria I was alternately feeling—was a friend of a friend who had the same condition. I decided to start a social network to help people with rare diseases to connect. It now has 35 different patient communities and is a destination for more than 50,000 people looking for support. No reasonable person would fault Gil for moving back to Israel to be with his family, and he may be able to contribute from afar. GlobalScope sounds as if it has a strong team in place and would persevere in his absence. His colleagues would undoubtedly be flexible if he wanted to continue to work from Israel. They’d miss him, but not as much as his family would. And he’ll continue to serve as an inspiration wherever he is. An occasional visit or teleconference with Gil would likely do wonders to lift his colleagues’ spirits during difficult times. The company would still be on the road to success, and his wife and parents could still benefit financially. I’m sure the team starting the prize for small-cell lung cancer research—Arthur and Maya—would appreciate anything Gil could do to further the cause as well. And he doesn’t have to sacrifice family time to make a difference: He’s most valuable to the fundraising efforts as the face of the disease. Through occasional in-person appearances and video messages from home, he can represent all those who would benefit from the research. Gil doesn’t have to drop everything immediately to move back to Israel. He should take his time finishing up projects with GlobalScope and securing the money to fund the prize. But he must be adamant about not taking on new tasks so that he can begin to make the transition home. Many might look at Gil’s situation and decide that he should focus on leaving a legacy—on making the biggest impact that he can. That thought crossed my mind, too, when I first read his story. But in my opinion, there’s really only one choice. No matter how much time Gil spends with his family, as he approaches the end, he’ll wish he had more. No matter how much time Gil spends with his family, as he approaches the end, he’ll wish he had more. Avichai “Avi” Kremer is the CEO and cofounder of Prize4Life, a nonprofit dedicated to the discovery of treatments and a cure for amyotrophic lateral sclerosis (ALS). Gil’s options are not mutually exclusive. In our globally connected world, it’s possible to live in Israel and still work for a U.S.-based business, making the occasional commute back and forth. This is what I do, and it works. But if Gil needs to choose one option, I’d suggest he pursue the start-up. It will make him happiest and offers the best opportunity to provide for his family after he’s gone. Gil, like all of us, has three types of responsibility. The first is a personal duty to himself. This is often called “fulfillment”—doing what will most satisfy him. The second obligation is to his family, especially his dependents—his wife, Ruti, and their kids, if they decide to have any in the coming years. Quality time together is important, but so is money. For a man facing death, wealth might seem insignificant (that’s why Shakespeare’s Richard III said, “My kingdom for a horse!”), but Gil may want to do as much as he can to ensure the financial security of his loved ones. The third responsibility is to society—to make the world a better place. Gil can make good on that commitment by either continuing with the start-up or pursuing the prize initiative, both worthy endeavors. The difference between Gil and an ordinary person is that he can’t meet his commitments one by one over time. With his hourglass running out, he has to choose. Right now, personal responsibility should be his priority: If he’s not fulfilled, he will be frustrated and unproductive, and that discontent will make his family and loved ones miserable, too. Gil knows that he finds his work at the start-up rewarding. Plus, there’s a financial upside, which helps him honor his responsibilities to Ruti. That’s why I think it’s the best choice for him. This case is based on my own story. In 2009 I was diagnosed with ALS—amyotrophic lateral sclerosis—commonly known as Lou Gehrig’s disease. It’s a degenerative condition in which muscles gradually atrophy, ultimately leading to complete paralysis. After lying in bed depressed for a few days, I decided that I was going to fight it. I got together with friends from my home country of Israel, along with classmates and professors at Harvard Business School (where I was studying for my MBA), and founded a nonprofit called Prize4Life. It’s similar to what Maya and Arthur are proposing to Gil. We provide $1 million prizes to researchers pursuing treatments and a cure for ALS. This was the path I knew would be most fulfilling for me, and even though my work kept me away from home for another three years, my loved ones applauded my decision. Also, money was less important to me because I didn’t have a family to support. No matter what Gil decides to do, my advice to him—to everyone, really—is to live every day to the fullest, be optimistic, and fill your time with work you enjoy. Back in 2004 my doctors gave me three years to live. That was 10 years ago. Working hard for something you believe in is the best treatment I know. Working hard for something you believe in is the best treatment I know.

Career Choices When Life Is Short

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