Case Study: Career Choices When Life Is Short

The leaders of MedPath 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 the team’s sadness for long. They had too much work to do.

(Editor’s Note: This fictionalized case study will appear in a forthcoming issue of Harvard Business Review, along with commentary from experts and readers. If you’d like your comment to be considered for publication, please be sure to include your full name, company or university affiliation, and e-mail address.)

MedPath 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 scientific expert on the team, having earned a PhD in biology and worked at a health care company in Israel before studying for his MBA.

Michael Shrock, the team’s finance expert, 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 turn back to business?” Gil said.

“How’s Ruti doing?” Carly Gardos, MedPath’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 where 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 since they did 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 the professor’s door, he opened it immediately. “Come in, come in. Have a seat,” David 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,” he said. “And doing fine on the other front.”

“Okay,” 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, the mentality of ‘Smokers know the risks; they should bear the consequences,’” David responded.

“Yes,” Maya nodded. “But we all know that’s not Gil.”

“And even if I were a smoker, I wouldn’t appreciate that logic,” Gil said.

What’s more, Maya explained, of the funds that were directed to lung cancer research, most targeted the much more common non–small cell variety. 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 Karim Lakhani, a professor at Harvard, had just completed a study showing that prize-based research initiatives not only raise awareness about lesser-known illnesses but also generate significant scientific breakthroughs. Often, the prize attracts scientists not currently studying the disease, who explore 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 as the face of the initiative could help.” Indeed, Gil had been universally liked by his teachers and classmates; 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 MedPath, 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. MedPath 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 him to stay behind.

“I want you to know that I’m here if you want to talk—about MedPath, 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.”

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 working 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 pre-empted you. 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. And work is really good.”

He updated Tomer on MedPath, explaining that the team had made a breakthrough—they were producing images that were much clearer and easier to transmit via mobile. They 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.” He explained Maya and Arthur’s project. They’d already raised $300,000 from business school alumni, and they’d been lobbying Gil 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 make 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 turns out to be true that you only have a few years left, do you want to spend them as an entrepreneur, an activist, or with your family? What kind of legacy do you want to leave behind?”


Question: Should Gil keep working at MedPath, help launch the prize, or move home to Israel? 

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