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One of the most compelling images in all of cinema (Fig. 1) comes from the Ingmar Bergman classic, The Seventh Seal [4]. The movie begins with a knight returning home from the crusades; upon his return, he’s met by the personification of death. It’s been awhile, and I don’t speak any Swedish, but in rough paraphrase, here’s what comes next…Fig. 1: Image from the Ingmar Bergman movie, The Seventh Seal, of the protagonist (Antonius Block) playing chess with Death. © AB Svensk Filmindustri (1957) Still Photo: Louis HuchAntonius Block (the knight): Are you here for me? Death: Yes. Antonius Block: I was hoping for a little more time. Death: Everyone says that. As they parley, the knight and death come to discover that they both enjoy playing chess, and the knight negotiates a deal wherein as long as he keeps the game going, he gets to live. The metaphor is evident enough: We all know how the game will end, but despite that, it matters how we play. This month’s guest in “A Conversation With …” has got game. And more importantly for purposes of this feature, he believes the lessons he’s learned from playing chess at a high level can be shared—even with those who don’t play—in ways that can help us perform better in high-stakes situations. Chess Grandmaster Maurice Ashley (Fig. 2) writes thoughtfully on the topic of risk and sacrifice in ways that will resonate with surgeons who, alongside their patients, need to make risk assessments every day. Mr. Ashley distinguishes between what he calls “sham sacrifices” (ones in which a sacrifice is sure to deliver a payoff) and real ones, where the benefit—in chess parlance, this is called “compensation” —seems plausible but is by no means certain. Having the insight to know when to make such trades is what separates the journeyman woodpusher from the best players in the world. In Mr. Ashley’s words, “Having enough compensation for a sacrificed piece is a judgment call based on knowledge of similar situations or a refined intuitive feel based on thousands of games played. Of course, compensation doesn’t guarantee that you will win the game, and if these intangible advantages don’t pan out then that extra material you gifted to the opponent could come roaring back It’s up to the player to decide if sufficient conditions have been met to take the chance on a risky move” [1]. This concept should resonate with every surgeon who has done more than a few tough cases.Fig. 2: Chess Grandmaster Maurice AshleyIn that same essay [1], Mr. Ashley made the point that the full spectrum of risk tolerance is represented among the best chess players in history. The same no doubt is true among surgeons. I’ve always been somewhat risk averse, but maybe I should reform myself. Mr. Ashley quotes Magnus Carlsen, the highest ranked classical chess player in the world at the time [5], as saying, “Not being willing to take risks is an extremely risky strategy” [1]. An old mentor of mine captured it differently when he opined about my risk aversion. He told me that I have an “ego problem”—in other words, he meant that by protecting my ego (in the Freudian sense), I was denying a subset of my patients the chance to get better. I hope he was not correct, but I don’t know; maybe he was. Mr. Ashley has shared his views on these topics and others in his recent book, Move by Move: Life Lessons On and Off the Chessboard [2], and he’s shared his approaches to in-the-moment decision-making in numerous appearances with CEOs, other professionals, and corporations. As our profession calls for us to “play chess with death” sometimes, I think you’ll enjoy—and gain from—what Mr. Ashley has to say about risk and sacrifice in the conversation that follows. Seth S. Leopold MD:Surgeons can be a pretty concrete bunch; some may not think in metaphor. And in particular, I think all of us know that harms arise both from being too risk-averse and too risk-tolerant. More than anything, we’re all looking for “just right.” What helps you find that sweet spot, particularly when the stakes are high? Grandmaster Maurice Ashley: There is no one-size-fits-all formula for calculating risk. Usually, one’s experiences dictate what type of risks one is willing to take. The most important initial guide is self-knowledge—only the person can tell when he or she is reaching the edge of one’s comfort zone and how much stress that produces. For me, I know from experience that losing will not destroy my ego or prevent me from bouncing back. For that reason, my risk tolerance is very high, and I get more of an adrenaline rush than a feeling of stress when I have to make high-stakes decisions. That said, assessing risk is not a question of whether you should take an irrational chance or gamble recklessly. A sober calculation must be made based on tangible metrics and historical precedent. If you are well prepared, taking risks becomes a lot easier. However, it’s only risk-taking when the numbers are not enough and a judgment call has to be made. That’s where the master lets go of fear and trusts the direction his or her intuition suggests to go. Dr. Leopold:You’ve had a long career in chess; many surgeons practice for decades, too. How has your approach to risk and sacrifice changed as you’ve gained experience? Grandmaster Ashley: Experience is our greatest teacher. I’ve failed many times, but I always make it a point to analyze those failures to see what lessons I can draw from them. In fact, that is the biggest secret to success—that humans learn best through trial and error. Those who wait until they know for sure what path to take are usually left in the dust by those who stumble three or four times but end up discovering the path ahead along the way. Dr. Leopold:What do you think of the observation one of my mentors once shared, that excessive risk aversion is an “ego problem,” and if it is, how might that help someone change his or her approach to risk? Grandmaster Ashley: I’m not sure what the definition here is of “ego problem,” and that would impact my response. If it means that someone doesn’t want to look bad if they fail, then that is definitely a real phenomenon. It happens in chess all the time where a grandmaster doesn’t want to look like a fool for losing a game badly, so they play the most mathematical way instead of taking any chances. That attitude stifles creativity, hampers growth, and limits new breakthroughs and insights. However, another way of looking at the ego problem is that someone may have been traumatized by a previous failure and just can’t tolerate the pain of losing. In this case, the challenge is psychological, and change has to happen in baby steps. The art is to take small—even minuscule—risks and slowly build up one’s capacity. Once again, it comes back to really knowing yourself and what holds you back in critical moments. Dr. Leopold:It’s been said that “self knowledge is always bad news” [3]. I don’t know if that is true, but I know that self knowledge can be hard to come by. Beyond the ego question, how do you recommend someone perform a self-assessment to know whether he or she is making decisions too conservatively or is tolerating too much risk? In chess, I would think that the outcome of the game tells you the answer, but in life, the relationship between our decision-making approaches and our outcomes can be much less direct and much harder to ascertain… Grandmaster Ashley: I disagree! Life is a much more brutal teacher than chess. Mistakes can cost lives instead of getting you checkmated on a wooden board. It all depends on the level of the stakes we are playing for—it could be something as trivial as the guy who takes a chance at rejection by approaching a pretty woman or as extreme as an army general taking risks that could result in dead soldiers on a battlefield. I do agree that there are lots of situations in life that are murky, because we are unable to profoundly feel or precisely calculate the level of risk in each circumstance. Knowing that there is a small chance of dying in a car crash is a difficult thing to put into context each time we get in a vehicle. In those everyday situations, we are at the mercy of the elements, but in a limited domain, the expert stands a better chance at assessing risk than a novice does. We know the areas where we are particularly skilled as opposed to those where taking risk is a fool’s game. Dr. Leopold:In your book, you share a story of a discovery you made about the power of the knight on the chessboard [2]. Your moment of clarity on something that seems fairly fundamental came some two decades after you learned the game, at a point when you’d already been playing at a high level—it was within 2 years of becoming a Grandmaster [6]. In that story, you talk about having “beginner’s eyes”—being ready to see things anew even that are in a sense very familiar—and that reminds me of an old concept in Buddhism called “beginner’s mind”[7]. It refers to receiving information without preconceptions. What helps you cultivate and retain this “beginner’s mind” (or, to continue to see through “beginner’s eyes”) even though you are anything other than a beginner? Grandmaster Ashley: I think the most effective way of cultivating a beginner’s mind is to teach kids or adult beginners. When we have been in a field for a long time, we think we know what we know. But beginners don’t have this repository of knowledge and experience; it must be taught to them. And the task of trying to explain something requires us to try to see the subject through the beginner’s eyes. It’s even better if you are impatient and don’t fancy yourself to be a great instructor. The challenge will force you to stretch yourself, and you may end up learning something new in the end. Another important way to cultivate the beginner’s mindset is to remain open to new ways of looking at things. I once received a revelation from a lower-ranked player I was teaching. An innocent question led to an explosion of insight. There is a story about a former World Chess Champion, Mikhail Tal, who would actually attend beginners classes to try to see chess again and again through a beginner’s eyes. Even the best chess players in the world are aware that we only know maybe 20% of what there is to know about chess, and that may even be on the high side. Try wrapping your mind around the size of the universe, and you’ll come to understand that you pretty much know a minuscule fraction of the knowledge that’s out there. Humility helps. Dr. Leopold:You were born in Jamaica, and your mother made what you’ve called a real sacrifice—one that “promise(s) no guarantee of a concrete return”—when she brought you and your siblings over to the US. There must have been something special in that house because all of her children went on to achieve competitive success at the international level: You at chess, your sister at boxing, and your brother at kickboxing. Many of your readers are parents as well as surgeons. While I think most of us don’t anticipate raising children who will compete at that level, I think we all want to raise resilient kids. What advice do you think your mother might have to help us raise children who can stay tough when life gets hard, and is there anything you’d add to or subtract from that? Grandmaster Ashley: My mother and my grandmother, who raised us, were very courageous women who taught us a lot about taking risks and sticking to things through the very end. Their tenacity helped us develop deep wells of resilience through tough times. I have to give a lot of credit to my dad, as well; he didn’t live with us, but we regularly saw him. He taught us to love various board games and we would play together all the time. The discussions over those often-heated games helped train us to make good decisions and to balance risk and reward. My advice to parents is to find ways to place your kids in as many low-stakes situations as possible where winning and losing are part of the process—martial arts, games like chess, athletics, competitive bowling, you name it. The discussions you have with them when they come home from these activities are the priceless lessons that will stay with them for the rest of their lives.