Economics to See, Wisdom to Live

Written by Joshua Banner | March 28, 2024

Fall semester 2023 started like most semesters, and Department Chair Dr. Donna Gilleskie was eager to lead a new group of economics majors through ECON 550: Advanced Health Econometrics. In this course, students get “their hands dirty” with real health data from large national surveys in order to empirically analyze a health behavior (e.g., expenditures on medical care, the number of doctor visits in a year, the number of cigarettes smoked in a month, the number of minutes of exercise in a week, etc.) or a health outcome (e.g., blood pressure, body mass index, mental health score) of their choosing. On August 28, UNC-CH experienced a health shock when the campus was locked down in the midst of a fatal campus shooting. While students returned to their course work a few days later, the impact of the event was still palpable.

Over the next two weeks, Dr. Gilleskie learned a little more about her students each time they interacted in class or during office hours. One student in particular, however, captured her attention. Joshua Banner sat in the front row. He asked lots of questions and was keenly – if not a bit overly – engaged. Suddenly, he didn’t show up for a couple of classes. Dr. Gilleskie received an email informing her that Banner had two weeks of university approved absences. A few days later, the Office of the Dean of Students alerted her that Joshua Banner had withdrawn from all courses.  Below, Joshua shares how he became acutely engaged with health data, literally getting his hands dirty.

I was walking down South Road on what I thought was my last FDOC at the University of North Carolina at Chapel Hill. It was a bit warm on campus – with nothing more than a few sweat stains to worry about – until I felt myself losing control. I had to sit down on the stone walls in front of the ROTC building before I fell flat on my face, terrified by how much of a fool I was making of myself.

One month later, on Labor Day 2023, I found out that I wasn’t out of shape or having a panic attack. I was diagnosed with a Right Occipital Lobe Arteriovenous Malformation (AVM) bordering the visual cortex of my brain. AVM is a malformation of arteries and veins and can cause a stroke or aneurism when located in the brain. Most 23-year-olds worry about interviewing for jobs, finding their new apartments, and maybe paying off student loans. I was suddenly in a different camp. I was diagnosed with a cerebrovascular and neurological disease that is found in only 1 out of 100,000 people. There is a significant lethal rate for this disease and a list of complications longer than the walk from the Dean Smith Center to Franklin Street. It wasn’t the most convenient timing for a monumental shift of focus onto my health as I was on a path to becoming a credentialed, independent man post-university. I was loving my classes, following great leads on potential job opportunities, and overly excited to walk in my Carolina Blue Gown for graduation that December.

The best kept secret about this nightmare was that I would find my purpose in life through the journey. It was both a fact-finding journey to inform my medical decision-making and a hills-and-valleys journey about life.

My medical journey took me to hospitals in Miami, Atlanta, Baltimore, Philadelphia, New York, and Cleveland. On all these stops, I was told that to cure my disease I would likely lose most of my vision and potentially damage other functions of my brain. The “elephant in the room” was that anything could go wrong when operating on the brain. Several neurosurgeons admitted that they were unable to confidently perform the surgery and recommended radiation therapy, which is expected to take 3-5 years to cure my disease. It was very tempting to give up. I had many thoughts of just choosing whatever treatment would be the easiest to get done immediately. I hated waiting. I was tired of going on grueling road trips just to be told my disease was “inoperable.”  My life was seemingly flowing down the drain.

As an economist and data scientist, my reaction – or approach – to this unanticipated struggle was very rational. Naturally, human emotions are experienced by everyone.  I inevitably experienced feelings of hopelessness, fear, and sorrow. However, the dominant school of thought that I employed throughout my 5+ month journey to get cured was quantitative and logical reasoning. I needed to put on my thinking cap because there were decisions to be made. I was given different opinions about the best medicine to treat my AVM, and I wanted to make sure I was going to be cured without losing my vision. Each doctor I visited gave me a similar spiel about what my disease is and the options to treat it, but they varied in their recommendation of which path to take. I was left clueless, and my spirit was in shambles after the first five or so visits. I ended up having nine more. No matter how many long drives it took, I was going to get the best treatment I could.

I needed to understand the potential outcomes of each treatment plan, to determine their probabilities of occurring, and to decipher how to value the multi-dimensional consequences of each medical alternative. I would ask the doctor to explain each risk or negative outcome (return on investment) that was possible with each treatment. I also asked about how each treatment could benefit me; both the probability of curing my disease, and also the time and quality of recovery.

I treated the characteristics (features) of each treatment alternative like random variables. For example, I labeled the “pain following a procedure” as an unknown variable p. I assigned a point value to the variable p based on how much pain was expected to result from each treatment. In calculation of the overall score (think utility) of a treatment option, I also assigned weights to each variable to define my own sensitivity to the category. I multiplied the variable Pain (p) by -2 to reflect the disutility I get from pain as well as how undesired it is. Admittedly, depending on the day, I played around with different values of the variables and the weights as my optimism ebbed and flowed. There were also characteristics of each treatment alternative that produced positive utility: a doctor’s experience with a given procedure and whether the doctor actively participates in all phases of treatment or allowed students to take control of integral parts of the process. Some factors were continuous variables, like the time of recovery, and some were binary, like whether the doctor had students assist him in the operating room or not. Importantly, the value of each alternative depended on my future lifetime utility. That is, I also had to ask (and think) about the cure rate (probability of success) of each procedure and my resulting health (based on either success or failure).

These data were so valuable for me: not only to support my decision-making process through rationality, but also to organize my thoughts and open avenues for me to ask my parents and doctors questions about various interactions or intricacies about the unknown experience I was about to undertake. I was able to inspect my own thoughts and truly determine what position I wanted to put myself in. It made me look at each pro (benefit) and con (cost) with a relative connection to other factors in the judgement process.

Both of my parents are doctors, and a life-changing illness was not on their list of worries about me as a young healthy man. I am so lucky to have parents who are physicians because they were able to connect me with their medical colleagues to find a doctor who would be able to cure my disease. I am eternally grateful for their ability to also decipher and translate for me medical terminology when we met with each specialist. Additionally, they could answer so many of my questions about how specific features of each procedure would impact my quality of life. Without my parents, there is no way I would have met the man who saved my life.

When I visited Brigham and Women’s Hospital in Boston, Massachusetts in December 2023, I was greeted by Dr. Nirav J. Patel. He had the brightest and calmest smile and spoke to me as if he was my uncle or someone I had known my entire life. He understands human psychology and how to treat patients like humans instead of statistics. But most importantly, Dr. Patel possesses skills unlike anyone else in the country. He can perform open brain surgery on complicated and high-grade AVMs with minimal to no side effects and has the greatest track record in the country in this regard. It really was a no-brainer (excuse the pun) to choose Dr. Patel to perform surgery on my brain; any other option would have felt wrong. I received my life-saving operation on Monday January 8, 2024, and was out of the hospital by the following Friday. I was able to walk a mile within a week. Today, I am cleared to skydive, scuba dive, or run a marathon. My abilities are truly unlimited by my disease.

Every night for five months after the diagnosis, I dreamt about what my life would have meant if it was to no longer be. What am I on this planet for, and how can I use my life story to create an impact? Presently, I am focused on sports analytics projects, performing/recording music, reading about history/philosophy and writing a newsletter on LinkedIn. I will be working as an Intern Project Manager this summer at Centene Corporation, a company that sits atop the medical managed care industry, specializing in Medicaid. I worked there last summer as well as a business analyst. I plan to return to Carolina in August to finish my final semester of college. I am actively applying to full-time opportunities post-graduation in December. I am on a trajectory that I never would have dreamed of had I not gained essential life lessons by staring death in the face and coming out more alive than I have ever been.

The most important practice I learned on this unexpected journey is to identify and appreciate the world around you. That is what it means to “love.”  This practice of identification and appreciation includes – and is most important when it comes to – your relationship with people. It functions in areas where you may not be strong. Lean on others to teach you; learn from them. In areas where you are strong, share your talent as service to the world. This lesson became clear to me because I was totally helpless to fix my health. Yet, what got me through was utilizing my strengths (critical thinking, numbers, personal relationships) to grow, and allowing others to help guide and support me when I was vulnerable.

Life doesn’t let you control what is thrown your way. There are an infinite number of circumstances you may encounter, both unexpectedly or by (active or passive) choice. It is your RESPONSE-ABILITY to RESPOND to the situation – especially those marked by adversity – with integrity and perseverance; to better yourself, your loved ones, and society as a whole. There will be times where you don’t feel like putting in work when you wake up or read that book before bed. When that thought races in the back of your head, and you feel guilty that you are missing an opportunity to grow, it usually means you are. Whether you align your identity with religion, art, athletics, history, academics, your profession, etc., use every day to turn your dream of that identity’s purpose into action. Remain grounded in the present, and use the past and future as guidance, but not as directions. If something will not be relevant to you in five years, don’t think about it for more than five minutes. Release that anxiety because you are here now, so make it matter.