Similar to many physicians, I am reasonably well educated in many areas, but I have never considered myself a mathematics expert. I have especially struggled with statistics but understand the basics enough to interpret medical literature. When I least expected it, the concept of exponential effect was presented to me, and it may become the most important mathematics principle for my long-term well-being.

After a 35 year career in academic medicine, I have now entered a period that I call the transition time when it is necessary for me to find other endeavors that give value and meaning to life. I have always loved clinical care, but it is the teaching of medical students, residents, and fellows that has given me the most enjoyment in my professional career and the one thing that I am now missing the most. This has caused me to reflect on my past career and attempt to determine whether my efforts to educate others in medicine have had a lasting impact.

As so often happens, it appears that the wisdom of youth of my 11 year old granddaughter has given me the simple answer to my question about my lasting effect on others. I recently had a discussion with my granddaughter about a mathematics principle she was learning, and she asked me to explain the concept of an exponential effect. I explained that an exponential effect, defined in a positive manner, means that something always has to be increasing and that the increase should be a relatively constant amount. She said that she did not understand this concept and might I explain it better. Being a physician and not a mathematician but being her all-knowing Zaide (Yiddish for grandfather), I had to think quickly so as to not embarrass myself and to maintain my lofty image in her eyes. I asked her to bring me her savings bank and counted out 500 pennies. I then gave her 1 penny and told her to give it back to me and that I would return 2 pennies to her. We repeated this exercise of doubling the amount each time and utilized all 500 pennies by the ninth exchange. This took only several minutes, but she then stated with a big smile that she now understood the exponential effect, thought it was very exciting, and that her Zaide was a good teacher.

At a later discussion, she asked me why there was a plaque placed in the entrance of the recently constructed high school in her community that had my name engraved on it. In her innocent manner, she was very concerned I may have done something wrong that made the school place my name on such a plaque. I related to her the story about how I had run for the school board in northwest Ohio with my commitment to raise millions of dollars to build a new high school. I told her I was elected to the school board, rose to become its president, and assisted in passing a tax levy to raise the necessary funds to build the new high school and that is why my name was on the dedication plaque. She asked whether it was difficult to run for the school board, raise the tax funds, and build the new school. I explained to her that it was but that I clearly was committed to this effort to improve education for all the students in the region not ever thinking that it might have a personal effect on my own family. She became very excited and exclaimed this was a great example of an exponential effect because of how many students had been and will continue to be affected secondary to all my efforts to improve education in her school district. All this had occurred prior to my granddaughter’s birth with no thought on my part that someday one of my family might attend that school and benefit from my efforts.

My granddaughter’s excitement over my exponential effect on the public school students of northwest Ohio started me ruminating about my 35 year career in medical education. I calculated that I had been involved with an average of 150 medical students per year rotating on obstetrics and gynecology clerkships, 24 residents per year in training, and approximately 100 fellows. This calculates to 5250 medical students, 840 residents, and 100 fellows for a total of 6190 doctors with whom I have had direct educational involvement. When I try to calculate how many people that they may have affected, the number, which I am not able to determine, becomes more than I can envision. As Henry Brooks Adams (1838–1918) the American historian and descendant of 2 Presidents wrote in his book, The Education of Henry Adams , “the teacher affects eternity; he can never tell where his influence stops.”

Now when I sit at my desk feeling sad and questioning the impact of my career, I look at the picture on my desk of my granddaughter pointing to the plaque at the high school with my name and then I begin to smile. My granddaughter has taught me that I truly have had an exponential effect. How about your exponential effect!