Audit Lessons from a Brain Tumor

Life teaches us unexpected lessons

I said to my wife, “Am I driving straight?” I felt as if I was weaving, not quite in control. I had been feeling dizzy and hearing clicking noises in my ears.

The mystery only increased over the next two years as I visited three different doctors. They stuck, prodded, and probed me–but no solution.

Frustrating.

Doctor Looking at Head Xray on blue

This picture is provided courtesy of iStockphoto.com.

Meanwhile, I felt a growing numbness on the right side of my face. So one night I started Googling health websites (the thing they tell you not to do) and came upon this link: Acoustic Neuroma Association. I clicked it. It was like reading my diary. It couldn’t be: a brain tumor.

The next day I handed my doctor the acoustic neuroma information and said, “I think this is what I have. I want a brain scan.”

Two days after the scan, while on the golf course, I received the doctor’s call: “Mr. Hall, you were right. You have a 2.3 centimeter brain tumor.” (I sent him a bill but never received payment–just kidding.) My golfing buddies gathered around and prayed for me on the 17th green, and I went home to break the news to my wife. I had two children, two and four at the time. I was concerned.

Shortly thereafter I was in a surgeon’s office in Atlanta. The doctor said they’d do a ten hour operation; there was a 40% chance of paralysis and a 5% chance of death. The tumor was too large for radiation–or so I was told.

I didn’t like the odds, so I prayed more and went back to the Internet. There I located Dr. Jeffrey Williams at Johns Hopkins Hospital in Baltimore. I emailed the good doctor, telling him of the tumor’s size. His response: “I radiate tumors this size every day.” He was a pioneer in fractionated stereotactic radiation, one of the few physicians in the world using this procedure (at the time).

A few days later, I’m lying on an operating table in Baltimore with my head bolted down, ready for radiation. They bolt you down to ensure the cooking of the tumor (and not the brain). Fun, you should try it. Four more times I visited the table. Each time everyone left the room–a sure sign you should not try this at home.

Each day I laid there silently, talking to God and trusting Him.

Three weeks later I returned to work. Seventeen years later, I have had one sick day.

I’ve watched my children grow up. They are nineteen and twenty now. My wife is still at my side…I’m thankful for each day.

So what does a brain tumor story tell us about audits? (You may, at this point, be thinking: they did cook the wrong part.)

Lessons Learned

1. Pay Attention to Signs

It’s easy to overlook the obvious. Maybe we don’t want to see red flags (I didn’t want to believe I had a tumor). They might slow us down. An audit is not purely about finishing and billing. It’s about gathering proper evidential matter to support the opinion. To do less is delinquent and dangerous.

2. Seek Alternatives

If you can’t gain appropriate audit evidence one way, seek another. Don’t simply push forward, using the same procedures year after year. The doctor in Atlanta was a surgeon, so his solution was surgery. His answer was based on his tools, his normal procedures. If you’ve always used a hammer, try a wrench.

3. Seek Counsel

If one answer doesn’t ring true, see what someone else thinks, maybe even someone outside your firm. Obviously, you need to make sure your engagement partner agrees (about seeking outside guidance), but if he or she does, go for it. I often call the AICPA hotline. I find them helpful and knowledgeable. I also have relationships with other professionals, so I call friends and ask their opinions–and they call me. Check your pride at the door. I’d rather look dumb and be right than to look smart and be wrong.

4. Embrace Change

Fractionated stereotactic radiation was new. Dr. Williams was a pioneer in the technique. The only way your audit processes will get better is to try new techniques: paperless software (we use Caseware), data mining (we use IDEA), real fraud inquiries (I use ACFE techniques), electronic bank confirmations (I use Confirmation.com), project management software (I use Basecamp). If you are still pushing a pentel on a four-column, it’s time to change.

Postscript

Finally, remember that work is important, but life itself is the best gift. Be thankful for each moment, each hour, each day.

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32 thoughts on “Audit Lessons from a Brain Tumor

  1. What a story! A lot to learn from it. The thinking process is the right one. I frequently use the AICPA hotline. It seems to me that one of the reasons for a bad audit is the ready-available and ready-to-use audit checklists, which are the audit programs. Non-real auditors believe that the “audit checklists” is all that is needed to complete an audit.

    • Armando, I call that the “cookie-cutter” approach (blindly following the checklists). Worse yet, many auditors just follow the prior year workpapers and don’t even read the audit planning checklists. The Hotline is an underutilized service. I recommend it.

  2. Thank you for sharing your story and your advice. You would make an excellent speaker at one of the ACFE and/or FALI conferences!

  3. Thanks Charles. It’s a great lesson to me and everyone else. The way you face and treat your life and all kind of professional experience sharing are priceless. May you all the best!

  4. Thank you for sharing this personal story and for how you relate it to auditing. Your approach to life and work is admirable and respected.

    I have to make a conscious effort not to be a person who only follows the cookie cutter audit plans or prior year workpapers. Forensic accounting courses have helped me ask questions and look at account balances in a new light.

  5. How interesting! I had the same type of tumor and had it removed at UW-Health in Madison by Drs. Baskaya & Pyle in 2012. I had wonderful results, and it sounds like you did, too.

    Great article! I like how you made the connection between your tumor and audits.

    • Alayne, so glad to hear your procedure went well. While I learned a great deal while going through the tumor ordeal (mainly spiritual), I can’t say I want to do it again anytime soon. It’s a daunting thing to go through. God bless and I hope you continue to do well.

  6. I also had a tumor in my head, mine was at the base of my skull, pressing against the brain stem. I never correlated the lessons I learned from my medical case to my audit engagements. I agree though with all four lessons since I most definitely have experienced each of them. I ended up traveling for my radiation therapy, but to MGH in Boston for proton beam radiation.

    I’ll definitely keep these points in mind going forward with my audit engagements. Thanks for your story and perspective!

  7. Thank you for sharing this story, Charles. What jumped out at me from your story is how we are challenged in the way that we give ourselves over to the experts. On the one hand, I can imagine some who might not seek expertise at all. They might notice some problems but not visit a doctor until it was too late. On the other hand, many would go to a doctor and follow whatever path of treatment that first doctor prescribed. What your story makes clear is how important it is for us non-experts to form our own opinions on the expertise of others. To form such an opinion likely involves wading into unfamiliar waters and having the gumption to decide that one expert seems more reasonable than another. (I think this is a general life moral. I’ll let you draw the audit implications!)

  8. Eddie, so good to hear from. Hope things in Florida are well. Yes, that’s the hard part, deciding which expert is right. And every expert thinks he or she is correct. It was God’s grace for me to see the right path. So thankful.

  9. A friend forwarded me your post. I also had a severe incident where I had to be my own medical advocate. 14 years ago this September I was diagnosed with a pancreatic tumor at Mayo Clinic in Rochester MN. Trouble was…the doctors in my home town had seen it 2 years previous and didn’t tell me until I got severely ill. By them it had grown six fold and they still didn’t want to do anything. Lucky for me, I have a DR brother who had worked at Mayo for 7 years and got me in. As soon as I got there, they took one look at my scans and told me to write letters to my 3 young boys because they were uncertain of the outcome. Well…,I’m a lucky person but everything you said in you blog is true. You have to be your own best advocate. It took me 13 years but after a disappointing job incident, I finally reflected on the many things that occurred to me over my life and wrote a short book that actually was published.

    Congratulations in your fortitude and health.

  10. I enjoyed your article. Although I am not an auditor, I am interested in the work and agree that sometimes coming in the “back door” may give you a different vision, approach, or answer. Thanks for the information.

    Charlene

  11. I agree listening to your experiences and parallels to auditing would make sitting through seminars much more interesting and relevant. I lost my brother to a brain tumor, you are truly blessed. Another insight is to not be afraid to take ideas and alternative positions from someone with no experience or education in the audit field. Just like you self diagnosed, you never know what a young accounting intern or clerk can identify just by asking simple questions.

  12. Thank you for sharing this story. It needs to be read by everyone whether they are an auditor or some other life form. The old definition of an auditor was “someone who went in after the battle and bayoneted the survivors”. The author of this article, God Bless him and his family, is a survivor. The checklist process did not spoil his attention to questioning results of a first inquiry and getting a second opinion.

    • Walter, thanks much for your kind comments. I am blessed and very much so. I think checklists can be helpful but many times they smothered creative thinking. And creative thinking is greatly needed in the audit field. We auditors should always be looking for ways to see the unseen–to think differently.

  13. I’m so glad you are healed! My brother had a very large brain tumor and was operated on. He now has life long cognitive issues to deal with.
    Ah, the AICPA Hotline. I found it very helpful but when the senior partner of the firm I worked for found out I called it he almost fired me. He said it was like ratting yourself out. To my knowledge nothing bad ever came of it and their answer helped us stay independent with an audit client.

    • Julie, I am glad I am healed as well. Sorry to hear about your brother.

      With regard to the AICPA hotline, I have heard the same sentiments from other firms, but I have never heard to the AICPA using such questions against a firm (and don’t think they would). I have found them helpful.

  14. What a beautiful story, and so true. Continue to be well and hope your life continues to be full of gifts.