Blink: Chapter 4

He had that crisp voice, low to middle tones. Very direct. Concise. Confident, without a lot of icing on the cake.

Once he and I were in the jungle a few yards away from a river, and he wanted to reconnoiter over certain areas, but he couldn’t get the view he wanted.

After a battle, there would be a brief respite, then we would be back to training.

He was virulently anti-American.

In war game parlance, the United States and its allies are always known as Blue Team, and the enemy is always known as Red Team, and JFCOM generated comprehensive portfolios for each team, covering everything they would be expected to know about their own forces and their adversary’s forces.

The rogue commander was getting more and more belligerent, the United States more and more concerned.

In Operation Desert Storm in 1991, the United States had routed the forces of Saddam Hussein in Kuwait.

In the wake of Desert Storm, the Pentagon became convinced that that kind of warfare would soon be an anachronism: no one would be foolish enough to challenge the United States head-to-head in pure military combat.

Conflict in the future would be diffuse. It would take place in cities as often as on battlefields, be fueled by ideas as much as by weapons, and engage cultures and economies as much as armies.

JFCOM devised something called the Operational Net Assessment, which was a formal decision-making tool that broke the enemy down into a series of systems—military, economic, social, political—and created a matrix showing how all those systems were interrelated and which of the links among the systems were the most vulnerable.

They were given an unprecedented amount of information and intelligence from every corner of the U.S. government and a methodology that was logical and systematic and rational and rigorous.

They were given an unprecedented amount of information and intelligence from every corner of the U.S. government and a methodology that was logical and systematic and rational and rigorous.

“We looked at the full array of what we could do to affect our adversary’s environment—political, military, economic, societal, cultural, institutional. All those things we looked at very comprehensively,” the commander of JFCOM, General William F. Kernan, told reporters in a Pentagon press briefing after the war game was over.

This is why, in many ways, the choice of Paul Van Riper to head the opposing Red Team was so inspired, because if Van Riper stood for anything, it was the antithesis of that position.

From his own experiences in Vietnam and his reading of the German military theorist Carl von Clausewitz, Van Riper became convinced that war was inherently unpredictable and messy and nonlinear.

Then there were all these traders, these brash, young New Yorkers in their twenties and thirties, and I looked at the room and there were groups of two and three, and there was not a single group that did not include members of both sides.

Then, without warning, he bombarded them in an hour-long assault with a fusillade of cruise missiles.

Sometimes what was said and done didn’t quite work. But often it was profoundly hilarious, and the audience howled with delight. And at every point it was riveting: here was a group of eight people up on a stage without a net, creating a play before our eyes.

If you were to sit down with the cast of Mother, for instance, and talk to them at length, you’d quickly find out that they aren’t all the sort of zany, impulsive, free-spirited comedians that you might imagine them to be.

“We think of what we’re doing as a lot like basketball,” one of the Mother players said, and that’s an apt analogy.

The humor arises entirely out of how steadfastly the participants adhere to the rule that no suggestion can be denied.

Van Riper carried this lesson with him when he took over the helm of Red Team.

Once the fighting started, Van Riper didn’t want introspection. He didn’t want long meetings. He didn’t want explanations.

Recognizing faces sounds like a very specific process, but Schooler has shown that the implications of verbal overshadowing carry over to the way we solve much broader problems.

Something should have happened at that point: the fire should have abated.

In retrospect all those anomalies make perfect sense.

They were so focused on the mechanics and the process that they never looked at the problem holistically.

In one possibly apocryphal story, doctors once trained a homeless man to do routine lab tests because there was no one else available.

It’s a system with constrained resources. How do you figure out who needs what?

Lines that once were curved may now be flat or elongated or spiked, and if the patient is in the throes of a heart attack, the ECG readout is supposed to form two very particular and recognizable patterns.

A single bed in Cook County’s coronary care unit, for instance, cost roughly $2,000 a night—and a typical chest pain patient might stay for three days—yet the typical chest pain patient might have nothing, at that moment, wrong with him.

So he fed hundreds of cases into a computer, looking at what kinds of things actually predicted a heart attack, and came up with an algorithm—an equation—that he believed would take much of the guesswork out of treating chest pain.

But at the end of his scientific articles, there was always a plaintive sentence about how much more hands-on, real-world research needed to be done before the decision tree could be used in clinical practice.

Why? For the most arcane of reasons: If you are in a submarine at the bottom of the ocean, quietly snooping in enemy waters, and one of your sailors starts suffering from chest pain, you really want to know whether you need to surface (and give away your position) in order to rush him to a hospital or whether you can stay underwater and just send him to his bunk with a couple of Rolaids.

But Reilly shared none of the medical community’s qualms about Goldman’s findings.

Take, for instance, the hypothetical case of a man who comes into the ER complaining of intermittent left-side chest pain that occasionally comes when he walks up the stairs and that lasts from five minutes to three hours.

“Doctors think it’s mundane to follow guidelines,” he says. “It’s much more gratifying to come up with a decision on your own. Anyone can follow an algorithm. There is a tendency to say, ‘Well, certainly I can do better. It can’t be this simple and efficient; otherwise, why are they paying me so much money?”’

They feed the extra information into the already overcrowded equation they are building in their heads, and they get even more muddled.

“One of the things Brendan tries to convey to the house staff is to be meticulous in talking to patients and listening to them and giving a very careful and thorough physical examination—skills that have been neglected by many training programs,” Evans says.

“He feels strongly that those activities have intrinsic value in terms of connecting you to another person. He thinks it’s impossible to care for someone unless you know about their circumstances—their home, their neighborhood, their life. He thinks that there are a lot of social and psychological aspects to medicine that physicians don’t pay enough attention to.”