A Longterm Investor Looks Sudden Death In The Face — With Eric Markowitz

0:00A long-term investor stares death in the face and lives to tell the story. Today, we talk about what happened, what he's learned from it, and how it's changed his perspective on investing and life. That's coming up right after this. Welcome to Big Technology Podcast, a show for cool-headed, nuanced conversation of the tech world and beyond. I think it's going to be a fascinating episode for you, something different. As we round out our summer coverage, I want to bring you the story that Eric Markowitz has to tell. He's a partner at Nightview Capital, which is a long-term focused investment company and also somebody that I know from journalism circles.

0:36I've been a fan of his work for quite some time. And recently, a story he wrote about a health scare came across my timeline and just absolutely floored me, had me sort of standing in place for a few moments. And I thought it was important to get Eric's story to you. And so, Eric, I'm so glad to have you. Welcome to the show. Yeah, thank you, Alex. So let's start at the very beginning here. What happened to you in early 2023? I mean, we can start there, but I think it's actually probably even more practical to start what happened a little bit before that, which was in 2022. You know, I wrote about it in the piece, but for all intents and purposes, I was a fairly healthy, you know, mid-30s guy, married kid, working a job in finance and investing.

1:232022 was a really rough year. It was very stressful. and towards the later part of the year, I think that the stress started to really wear me down and all of a sudden in like January 2023, you know, just woke up one day and didn't feel right. I'd previously kind of been feeling fine, no major health problems, but the major symptom I was getting, which was very bizarre, was like an intense vertigo, dizziness and nausea, which I hadn't experienced before. You know, if you've ever maybe had a few too many to drink and you're sitting in bed that night and the room's kind of spinning. You know, that was the feeling, but it was constant and I don't really drink.

2:00So it wasn't related to that. What do you think it was initially like when that started happening? Were you like, I just need to sleep more? Yeah, I thought it was like maybe some sort of bug. You know, I told my wife, I was like, I just don't feel right. I'm just going to go lay down. And then it just kind of got worse and worse to the point where I was like projectile vomiting and pretty, pretty intense symptoms. So went to the hospital. They kind of initiated stroke protocol. So did an MRI of my brain. And the scan, as far as the radiologist read it, came back clean. So they, you know, the doctors were kind of a little bit confused, but said maybe it's something like an inner ear disorder, BPV.

2:35So, you know, it just got worse. So it was a constant state of just the room spinning, constant nausea, constant vomiting. I just couldn't keep food down. It was very scary, as you can imagine, where you just have this like intense vertigo. And for anyone who's experienced it, you know, it's, it's very unpleasant, bordering on terrifying and quite miserable. So when, when back to the hospital, stayed there for two to three days, I think three days, maybe, and still kind of like no answers, you know, they gave me fluids. That was primarily what, what happened at the hospital and was checked out.

3:11And the situation was kind of getting worse and worse and yet was discharged. I think with the idea being, we're not really helping him. We'll just see if he can get maybe a little bit better on his own. He's stable right now. In retrospect, you know, probably should have stayed at the hospital, probably should have advocated for that. But hindsight is 2020, of course. And again, like that initial, I think the key thing here is the initial scan was read as, you know, no problems with my brain. Fast forward, you know, a few days, then a couple of weeks. We live in Portland, Oregon. So we flew back up, which was kind of a harrowing experience.

3:48My father-in-law had to come. You know, I was wheeled onto the plane in a wheelchair. Couldn't really walk. Any sort of slight movement in my head just triggered like intense nausea, vomiting, vertigo. Got back to Portland, though, and went and saw a few more specialists. Everyone was kind of, you know, just very confused by it. I couldn't really explain it. I think going back because the initial scan, the radiologist read it as no problems. You know, at some point, I think this was like February, mid-February of 2023. So about a month passed. And at that point, I had lost about 35 pounds in a month.

4:26You know, I was kind of deteriorating, really couldn't get out of bed, couldn't sleep because any sort of like motion would just trigger intense nausea, you know, quite literally suffering. I mean, just really deteriorating. And I think like, you know, just taking a step back, like, this is just like a, it was just so bizarre because I had been pretty healthy up until that bite. You know, I hadn't really experienced any sort of like major health crisis. And for anyone who's gone through it, you know, especially when you have like an answer, there's that's, at least there's a path to some sort of treatment.

4:58But for me, because there was this sort of, you know, what in retrospect was a misdiagnosis, there was no real answer of what I should be doing. So the main kind of commentary from doctors until that point was just wait it out. Maybe it'll get better. My wife, who is amazing, who kind of kept me like literally alive during this period, like just bringing food, just scheduling doctor's appointments, just like literally getting me through the day, the physical side, also the emotional side, to her credit, really advocated for a second MRI. So a good friend of mine picked me up, went to the ER to do another MRI and, um, you know, came out of the MRI machine.

5:40And, um, you know, it's like, it's like the tap you never want to get. They were like, the radiologist wants to speak with you. So they put me in a little booth, they hand me a phone and I guess it's all, it's all done remotely these days. So the doctor on the other line just says, you know, you have to get to the ER right away. You have, and I think the worst use was a rapidly enhancing lesion in your brain on your cerebellum, which is your brainstem. I asked him what it could be. He was kind of hesitant to give answers, but basically said, it could be a range of things. It could be brain cancer, a brain tumor.

6:13It could be something else, but we don't know. And you posted the scan in the article that you wrote, I think, and it looks like this sort of grape that's just sitting there in your brain. Yeah. Like, right. So if you feel in the back of your head. It's your cerebellum, which is like your little brain. So I think most people know about the left brain, right brain hemispheres, but there's actually like the much older human part of the brain, which is the cerebellum, which is kind of like the air traffic control for your brain. I mean, so all visual inputs going on that go to your cerebellum, your cerebellum makes sense of visual inputs and also vestibular inputs.

6:46So your proprioception, your ability to get balance in the world. And yet it had like sprouted this pretty, you know, walnut sized or large grape sized growth right on my brainstem. So I went to the ER. And, you know, at this point, you know, I saw some neurologists and they kind of said, yeah, we don't know what this is, but you need to get it out immediately. The worst case scenario is it's a glioblastoma, which is brain cancer, brain tumor. And if it's in your brain, it means it's likely metastasized throughout your body. And I was told, you know, pretty much like six months, if it was a successful surgery.

7:23That's how much you can expect to live for. Alternatively, if it was something like an abscess, some sort of bacterial abscess, which is extremely rare and in some ways very unlikely, that was more immediately fatal because if it popped and the bacteria from the abscess would get out, it would go directly into my brainstem and mix with my basically the fluid that goes through your um your your spine and um you know it could it could be pretty fatal now when you hear this do you even have the capacity to like sit back and be like oh my god what's happening or are you feeling so bad at this point that the moment sort of washes over you yeah it's like a little bit of an out-of-body experience the the real like devastation for me was, you know, we had an 18 month old daughter and, um, just like the, what hit me was just not being able to be there for her.

8:19And it wasn't even guaranteed that you were going to wake up from the surgery. That's right. And it was unclear at that point, even, you know, who would do the surgery, which was another element to the story, which didn't, didn't put in the piece, but my like best friend who lives here in Portland, who I've known for since college, he is Ben Jacobs, the best man, you know, gave, he gave a speech at my wedding. So texted him, called him, forget exactly, but said, this is what's going on. And he said, let me call Zach. Zach being a high school friend of his that had recently moved to Portland, who had recently also finished his neurosurgery residency at Stanford and as a brain surgeon.

9:02And I had never met Zach, but because he was friends with Ben, we had kind of like in the weeks leading up to this, just had like tried to organize a poker game, but then I got sick. And so we never actually met, but I knew of Zach. I knew that Ben had this friend who was a brain surgeon. So Ben calls Zach. Zach was like in the middle of a surgery, but his, I guess Ben got his wife on the phone. And then his wife contacted Ben or Zach right after his surgery and said, you got to take a look at Eric's scans. So that day, Zach took a look at the scans and said, I'll do the surgery. And we got to do it right.

9:37We got to do it immediately. So the next day, I got prepped for surgery. That night, I actually, because I was in a different hospital and Zach had to operate in a different hospital, I was actually discharged, went home, grappled with this situation I was in, wrote my daughter a goodbye letter, very practically got things organized for my wife right so you thought that this could potentially be your your last night yeah yeah and you write in the piece what do you tell an 18 month old child the day before you die sure you tell them you love them but what else how do you cram a lifetime of knowledge into one little letter what did you write um i'm not really ready to share that truthfully okay i think it's like if we're gonna i'll probably start crying if i start talking about it so i will say that the letter is not finished and i continue to write it

10:35so go to the hospital get right for surgery do the surgery i mean the surgery itself is like highly risky um because you're operating in a part of the brain that um i mean within millimeters if there's like a mistake, you know, we could potentially just not make it through the surgery. So as far as I recall, Zach's initial plan was to actually biopsy the whatever was in there. And he kind of conferred with his partners and they very rightly made the decision. A biopsy was a little bit too dangerous because if it were to puncture this lesion and it was, in fact, an abscess, you know, it could puncture and that could be very dangerous.

11:19So in some ways, I think the more risky surgery, which is a full craniotomy, which is to go in, open up the back of my skull, they kind of drill a hole in the skull, cut out the skull and go in and actually remove it. Did that. And, you know, his initial impression upon seeing it was this doesn't look like cancer. You know, it's like this bizarre abscess. And so I woke up in the ICU. I remember, I mean, I vaguely remember this, but I do remember seeing Zach standing there. And, you know, my first question was, is it cancer? And he said, I don't think so. I'll never forget, but it was just like this odd, just feeling of like relief.

12:04But then also in like the hours that followed this uncertainty of, well, are they sure? You know, like the pathology hasn't come back yet. I mean, just the moment of waking up, like you write it in the story and it's so powerful. You say the anesthesiologist stepped into the room, count backwards, anyone who's had surgery knows this, right? Count backwards, 10, 9, 8, darkness. And you write, in my mind, I traveled a million miles and then a funny thing happened. I woke up. What was it like waking up? Um, first of all, I was under a lot of drugs. So, you know, anyone who's woken up from anesthesia knows you're sort of feeling a little bit high, quite literally.

12:50Um, but of ultimate like relief and almost in the, in the hours and the days that followed, um, a sense of euphoria, which I've been very like fortunate to talk with a lot of people in the last year or so. that have gone through these experiences. And there is this like survivor's euphoria that you feel. And I think I was beginning to feel it in that moment of, okay, I made it. Everything's different now. All of the like things that I thought were important before, I'm recalibrating what actually is important. And it's such a fascinating story because as you describe it in your story, you're a long-term oriented investor, always thinking about the long-term.

13:43And here you're like faced with the prospect of maybe there is no long-term, but in good news, it turned out that it was indeed, right? An abscess and that they cleared it out. Yeah. I mean, I'll get into the long-term thing in a second, but just to kind of close the loop on the story, it was like an episode of House. They took this thing out. No one could explain where it came from. You know, it was quite dangerous because if the abscess were to rupture or break or pop, it would likely, from what I understand, prove to be a fatal situation. Yeah. And so you were basically like looking death in the face from two ways, right?

14:19Whether it was cancer or an abscess. So like it's lucky it was an abscess, but not like, you know, a guarantee of getting through. Yeah. In some ways it was like the options were all bad, right? It was either some sort of brain tumor that was cancer. From what they suggested it could be, it could be something like a glioblastoma, a stage four. And that would be, even if I survived the surgery, then it would likely be, you know, less than a year, maybe six months to live. Because the cancer had likely metastasized throughout my body at that point. The other scenario, which would be much better, would be an abscess because I could survive that long term.

15:02But in the short term, that was actually much more dangerous because it could pop at any moment. Especially, I guess, when they're going and operating on it. Exactly. And so if it were to rupture mid-surgery, that would be very problematic. and you know later I would I would learn this but you know abscesses typically rupture after just like a week or two you know at that point it had already been in my head for you know over a month yeah I mean how did you feel once you learned you were that close just terrified it's the truth you know I don't think anything really prepares you for for this kind of situation it's profoundly shocking.

15:43It's terrifying. And, you know, like, like I said, I mean, it was mostly just this deep sadness, the potential for not even myself at that point. It was mostly for my family, for my wife and daughter. Yeah. You're lucky, man. Super lucky. And so what happened once it was out? In the weeks and months that followed, of it, I had to do like really intense intravenous antibiotics to begin with nine times a day. So I had a port in my arm and then I had a port in my chest. And after even I was discharged from the hospital, I would have to give myself injections throughout the day of these really hardcore kind of like just intense antibiotics that make the symptoms way worse.

16:29You know, it's almost as someone describes it as like kind of like chemotherapy. It just makes you super nauseous it kills everything in your body so you didn't feel instantly better um like the symptoms that you had no they remained even though the abscess was out yeah yeah and you know there's like a a piece of i mean there's kind of there's a it's funny it's like there's an old yiddish expression that i remember like my grandparents using called lock and cough which means like oh i need this like i need a hole in my head and it's like i have a hole in my head like i know that experience. They took something out.

17:02And so the most important thing is in the months that following, everything looked good. There's no recurrence. There's no hydrocephalus. It should be fine. I have residual symptoms, but they're manageable. I'm getting through them. The source of the infection was never located, which to this day, I get infectious disease doctors reaching out to me and like, how did this happen? No one knows. At one point, they scanned my jaw and found some sort of lesion in my jaw. So I had surgery, like a really intense surgery in my jaw to remove this thing turned out to be totally non-related. So we'll never know.

17:33So I think there's like a lot of uncertainty to it, which is part of the experience for me. I think the irony and maybe not the irony, but maybe, you know, just why this, this story is like, so like interesting that it happened is like, I had really based my professional and like kind of personal life around this idea of long-termism as a firm or long-term investors truly believe in the power of compounding i write about this in weekly newsletter like all good things take time um the whole sort of like i've been enamored with like the buffett ideology of just wait it out patience and yeah you write in the piece that you said i mean this is what you say here i was 35 years old out of time no more compounding no more long-term is long long-termism and by the way this is long-term like in finance, not like the long-termism as far as like AI risk.

18:27I don't think you can correct me if I'm wrong on that, but he wrote, hell, our firm's tagline that I wrote myself was investors focused on the future. And you quote the Warren Buffett saying that our favorite holding period is forever. Yeah. And it's, I mean, in retrospect, it's like, man, that is like a real level of hubris to think you have that. I think that we take this idea for granted, long-termism. It's a nice soundbite. And it's true to say that thinking and acting long-term is really, really important. But on a deeper level, it's not guaranteed. None of it is guaranteed. And so anything can derail the long-term at any point.

19:16And so for me, it was a real like wake-up call of, it's a real privilege to have a long-term mindset, to enjoy the fruits of compounding is a really lucky position to be in. I will be really lucky to have a 30-year career of compounding and to not really ever lose sight of that. Okay. I want to get into how your life has changed since, but I have to ask you a question that's been sitting with me since you talked to me about, talked to us about Zach. You really entrusted your, your life to, I mean, of course you graduated from Stanford, but I imagine a rookie neurosurgeon who a friend recommended that's bold.

20:01Yeah. There in that moment i think that there was actually quite a bit of comfort in knowing that there was a personal connection um but yeah i mean we're like mid-30s it was like yeah you could you could go with the guy who's like maybe been around or for 20 30 years doing it or like you say a rookie i think given just the time constraints it wasn't like i could shop around for a neurosurgeon right the reality was is that it was either zach or whoever was on call okay so good job going with zach zach's the man zach can go to the organ clinic if anyone needs back surgery or brain surgery yeah and you had a friend who texted you or told you as this was going on uh they said this kind of shattering event is showing up right on schedule it doesn't mean it will all be pleasant but it might be redemptive.

21:01It's the horrendous reset that's going to set you up for real creative synthesis for a real creative synthesis stage. So of course, like, you know, it only is applicable, you know, if you made it through and you did make it through it, thankfully. So I want to hear from your perspective, you know, one of the things that also stuck out for me from the beginning of this story was you described being healthy, but not really being healthy. I think I highlighted this when I was like taking notes on your story. This was the thing that really stuck out for me. You said, I wasn't living an entirely healthy, long-term oriented lifestyle, even though you were like a long-term preaching investor.

21:38I was constantly stressed at work. I had stopped exercising. I was glued to my phone and to the market. And in the months leading up to my condition, we were having a rough year and it was all I could think about. I dream about stock prices. I'd wake up in a panic and to underscore you right, despite the ideals of long-termism, I professionally and publicly promoted. I was in fact living a lifestyle that was just the opposite. I was myopically focused on the short term, on success, on the day-to-day. I avoided seeing friends. My marriage was becoming stressed. Things were unraveling. And I think there's definitely elements of truth of that.

22:17When I read it, it reflected in my life for sure. And I think that like, it's not a uncommon thing, I think, among people working today to feel these very same things. Yeah. So how did you look at that in retrospect after the health incident? Yeah, I think it's something that probably even as much as mental health gets talked about now, probably still isn't really talked about enough of, you know, how we actually in our day to day spend our time. I think if you're ambitious and you're motivated, it's very easy to fall into the sort of like success trap of staying focused on what's happening today.

23:05How can I optimize for today? How can I increase my output? How can I increase performance? And I think you see that it's online of this sort of intensity around optimization and performance. And there are elements that are important, you know, and I think really healthy. But I think for me and probably for a lot of people, it's easy to get a little too focused on those sort of like metrics. Right. Like the next performance review, the stock price, you know, in the quarter, the whatever. Whatever it is. Sales number for the quarter. Exactly. What happened today. Right. And I'm abstracting because everyone's situation and profession is different.

23:45But I think across like all ambitious mid-career, later career, whatever it is, like there's an intensity of success, whatever around the KPIs. And I think coming out of this experience, it's not that I have like a lower level of ambition. I think the ambition is still there to like really put up good numbers and succeed and like have our firm do really well and like for performance to be really good. those ambitions are still there. It's just maybe put into a bit more of a holistic perspective of how you go about achieving those things. And ultimately, maybe ironically, the more you subtract and the less intense you are, the greater potential for better outcomes.

24:37Say more about that. Yeah. So, so I think that like so many things in life, you can't force things, like you can't force relationships. You can't force, you can't force success. And I think looking back and not just in 2022, but like, you know, probably a lot of my professional life, there was a lot of like pushing, pushing, pushing to, to achieve. and it didn't give enough space for like actual compounding and good things to happen. And so I think that it's been a refocusing in a very simple way of like quality over quantity. So if I'm going to do something, spend a lot of time doing it, you know, really like high quality time doing something and same thing with relationships like really focus on important relationships high quality relationships and devote time there and then just cut out the stuff that isn't important now you you said like i think pretty definitively in your piece that you believe that the lifestyle that you were leading led to the health issue i think that there are so many studies about stress that reveal to me that we don't really fully understand how stress impacts the body, but we know that stress impacts the body.

26:00And I think from like a very simplistic level, I think that my immune system was shot. I think I was burnt out. And I think that, um, you know, the, that stress can kill and it's a little bit vague how it can kill, But this is one example of how I think it could, which is your immune system gets shot and then some sneaky little bacteria finds its way through the blood brain barrier in my case and becomes an infection and like the worst part. And, you know, stress also can just lead to other types of issues. I think sleep has become like a really super important, like cornerstone of recovery for me.

26:40And that's something that I've learned a lot about just in the last year and a half of like, if you're not sleeping, you, you literally like your, your brain is just not operating at like its full potential. Right. So what are you at? Eight hours? Yeah. If I can, I mean, we're back from another kid. Okay. So it's like, that's a weird. There goes the sleep. Yeah. So, yeah. Um, but it, you know, the, it's a long-term bet the next kid, right? Yeah. Yes. So yeah, I'm, you know, I think if you can get eight hours, like for me, that that's what works. I go to bed super early, but I think like all of these things matter.

27:18And I think anyone who has like preached, like they have the, the right, you know, formula is probably lying to some extent. I think it's, uh, I think it's an iterative process itself of like figuring out what sleep cadence, the food, um, stress levels. there's a there's a really healthy balance of both ambition but also just like not ambition whatever the opposite of ambition is just relax yeah just enjoy the moment yeah it is interesting it's like it you you were almost killed by the system effectively and you have decided not to disengage from the system but just to meet it on your own terms yeah it's like we're playing by my game by your rules now yeah yeah yeah and i i i mean that's part of the reason why i went public with the story is i think i think a lot of people kind of like feel like they're you know sort of trapped in this system right and and it's really it can be over overwhelming and you don't really have to play by those rules necessarily it's very freeing to realize you know life is very short and you need to buy a bus tomorrow and you can kind of i'm also like i should point out extremely privileged to be able to do any of these things right like financially socially like just where i was born just won the lottery by being born where i was um so none of this like i take for granted anymore and very grateful for it but for people who are like maybe in a similar position that I was, I just wanted to maybe be somewhat of a voice out there to say, look, I went through this really shitty thing.

29:03Um, and I think it was like, it happened because of my lifestyle. This is on somewhere. And, um, and coming out of it, I'm not like some, some genius who has like some incredible perspective. I, I, I really don't know if I have any wisdom coming out of this but i do have like a real grounding for what really like matters is is not what i thought it did necessarily uh one more question for you before we wrap from a personal finance standpoint i mean it is interesting like a lot of people just like save up but never really get a chance to see the fruit of all that saving like i've heard so many stories of like people who like you know rough life retire die in the first year of retirement um do you think any differently about the way that you approach personal finances now after having gone through this that's a really great question in some ways yes i i think like i think that inevitably i feel a little bit more averse to risk right and that's like a But that's a complex thing to say because that doesn't necessarily mean that, you know, oh, I go to all cash because I actually think that means like very risky to do something like that.