Solving for Why

A Surgeon's Journey to Discover the Transformative Power of Purpose


By Dr. Mark Shrime

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From Mercy Ships surgeon Dr. Mark G. Shrime comes an inspiring memoir about finding the answer to life's biggest question—"Why?"—and about following that answer through remarkable, unlikely places on the road to fulfillment, purpose, and joy.

SOLVING FOR WHY chronicles one man's journey to find the answer to the biggest of all life's questions: "Why?" Following a traumatic car accident, Dr. Shrime—the child of Lebanese immigrants fleeing a civil war, who later became a successful practicing surgeon in Boston—found himself compelled to change the course of his life, determined to find meaning and satisfaction even if it meant diverting from America’s idea of “success.” Featuring stories, insights, and research from his own exceptional life and work, SOLVING FOR WHY is the story of Dr. Shrime's search for—and discovery of—lifelong fulfillment. 
Now a global surgeon operating on a hospital ship docked off the coast of West Africa and one of the few global experts on surgery in low- and middle-income countries, Dr. Shrime seeks to impart the wisdom of the lessons he’s learned over the course of his search for a life of true contentment. In the tradition of Dr. Paul Farmer's To Repair the World, Dr. Atul Gawande's Better, and Dr. Michele Harper's The Beauty in Breaking, SOLVING FOR WHY combines personal stories with deep, thoughtful research into the challenges of working in modern medicine in the 21st century and the commodification of work in America.
A story of discovery and transformation, SOLVING FOR WHY seeks to help readers answer the “why” of their own lives and ultimately find joy outside the status quo.


Chapter 1

He had not thought of himself as Other, as worthy of disapproval simply by virtue of being who he was. Well, of course, in reality, he was totally Other.


SINCE 2008, I’VE WORKED to bring surgical care to the world’s forgotten poor. I’ve done it from the decks of hospital ships docked off coastal countries in sub-Saharan Africa, from within excrement-painted hospital walls in the highlands of Haiti, and from the self-important ivory towers of academia. Why?

Because I’m a surgeon who never wanted to be a doctor.

Because I’m an Arab who grew up thinking Arabs were dirty.

Because I work in Africa, but I used to pray I’d end up anywhere else.

Solving for why has been a tortuous path; its hairpin turns changed my life. I hope my story changes yours.

Before I can tell you the things I learned on that path, and before I can introduce you to my traveling companions—both the welcome ones like worship and faith and wonder, and the less-welcome ones like anxiety and failure and doubt—I need to tell you my story.

I need to tell you how a kid who hated medicine and who was taught to hold himself separate became a surgeon enmeshed in the dusty beauty of the Other. And I need to tell you about faith lost and worship regained. Let’s get started.

I WAS A YEAR old the first time someone pointed a gun at me.

Backlit by a fierce Middle Eastern sun, he wore an ill-fitting, dirty uniform. Voices from the rabble of men he’d already forced out of their cars quieted. His vision narrowed to the six inches separating him, a one-year-old boy, and the boy’s mother. He held the gun that connected them against her head.

Would he have to shoot this woman? Would he have to kill her baby? Or would the father finally step out of his car?

Behind the soldier stretched a long, bloody story, half a century of fathers murdered at their children’s baptisms, of snipers and car bombs and barricades, of racism and nationalism, and of failing empires playing at geopolitics. A story of Othering. A story of setting ourselves apart. A story that was mine.

IT WOULDN’T BE THE last time someone pointed a gun at me. Thirty years later and seven thousand miles away, a man whose face I never saw pushed a double-barreled shotgun into my stomach. There was no fierce Middle Eastern sun that night. It was a moonless, late-autumn evening, the kind that folks in Texas live for.

The oppressive summer had begun to crack, letting in hints of the coming cool. Some houses had already lit their fireplaces; charred wood laced the air.

I had been at the hospital late that day, embroiled in the scut work of medical student life—unearthing patient charts, drawing blood, pushing beds, and scouring vending machines for anything that wasn’t Cheez-Its. When I finally collapsed into my boxy, used Volvo, rolled the windows down, turned the music up, and started the forty-five-minute drive to my mom’s house, I folded into a satisfied and tired calm.

In retrospect, I’d noticed the headlights behind me for at least ten minutes. My childhood home, where I lived for the first two years of medical school, sits in a nondescript residential neighborhood in Dallas, flanked by two-story strip malls, each anchored with unremarkable banks, grocery stores, and Tex-Mex restaurants. It’s easy to get lost in the almost-parallel streets, among featureless lawns surrounding single, off-center oak trees.

The man wasn’t lost. “Give me your money,” he said.

It would have been cliché if it hadn’t been so threatening. His voice was young, hesitating, reedy. His accent was distinctly non-American. He wasn’t far out of puberty.

His shotgun didn’t hesitate. He’d covered the stock with a towel. I could only see its twin barrels.

Would he have to shoot me? Or would I give up my money?

I pulled a confusion of receipts, credit cards, IDs, money, and keys from my pocket. Testament to his fear, he let me rifle through the jumble, picking out the cash and keeping the rest. Testament to my fear, I thought this was an excellent idea.

We stood in silence until he wised up, grabbed the entire wad, and drove off.

My computer sat plainly visible on my car’s passenger seat. I held the keys to the house in my hand. Inside, my mother, brother, sister, uncle, and young cousin ate dinner unaware. If he’d wanted, he could have done a whole lot more damage.

He didn’t. He would have killed me for eighteen dollars.

I LEARNED THREE THINGS early in my life. I learned to idolize work. I learned faith in absolute truth. And I learned to fear the Other—the foreign, the different, people like the man who robbed me.

All three were connected, and I had to unlearn each of them to solve for why. To explain them, however, I need to get into some history, because these three lessons are interwoven with a Lebanese diaspora of which my family is a part.

Thirty years before the robbery, under that Middle Eastern sun, more than eighteen dollars lay at stake. The history of the Lebanese Civil War is so complex that Robert Fisk’s 2002 account of it, Pity the Nation, spans 750 pages. At one level, however, the Lebanese Civil War was a religious conflict, pitting Christians, like my family, against Muslims, like their friends.

The Levant—Lebanon, Palestine, Jordan, Cyprus, and Israel—occupies a strategic post on the eastern shores of the Mediterranean, a position that has made it the site of a dozen conflicts since the fall of the Ottoman Empire. When allied militaries defeated the Ottomans at the end of World War I and divided the empire, the Levant proved particularly problematic. Initially, the British field marshal created a short-lived Occupied Enemy Territory Administration, whose rule was allotted to British, French, and Arab administrators. At San Remo in 1920, the Enemy split in two; Britain retained Palestine, and the French took what is now Syria and Lebanon.

Because of where it sits, the Levant has always been a pastiche of cultures, languages, and religions. The Arab conquest of the seventh century cemented Islam’s dominance, but large pockets of ethno-religious groups like Christians, Druze, Jews, and Kurds pepper the region.

This religious diversity is most pronounced in Lebanon.1 In 1956, in the Lebanon of my parents’ youth, 55 percent of the population was Christian, 44 percent Muslim, and the remainder a mix of adherents to Jewish, Baha’i, and other faiths.2 Although my family comes from the Christian sector, my mother grew up in a Muslim-predominant part of Beirut, and my father’s boyhood village was split evenly between Christians and Muslims.

Christian dominance in Lebanon’s demography is no accident. The French created the state of Greater Lebanon specifically as a bastion for Christians in the otherwise chiefly Muslim Levant. Most Lebanese Christians are Maronites, a denomination aligned with, but separate from, the Roman Catholic Church.i

My family is not. My parents grew up within the Melkite Greek Catholic Church, a smaller, Eastern rite sect that claims lineage from Antioch, the city where the word Christian was first used to describe followers of an itinerant Jewish carpenter prophet. Melkites and Maronites tended to view each other with mutual distrust and disdain.

Six years after the colonial powers conferred at San Remo, the Republic of Lebanon was declared, cementing the hegemony of its Christian majority. The three key government positions were constitutionally split along religious lines: the president was to be a Maronite Christian, the prime minister a Sunni Muslim (selected by the Christian president), and the speaker of the Parliament a Shia Muslim.

This arrangement lasted exactly one administration. In 1932, two Maronite politicians campaigned for the presidency, along with Sheikh Muhammad al-Jisr, Tripoli’s Muslim leader. Fearing he would lose to his rival, one of the Maronite politicians withdrew in favor of Jisr, precipitating a constitutional crisis. Lebanon’s French overlords responded by suspending the constitution, thereby keeping Christians in artificial power.3

Lebanon declared independence from France on November 22, 1943. When the last French soldier departed in 1946, he left a Christian majority in firm control of the country’s political system.

ALTHOUGH LEBANON’S NEXT HALF decade was mostly peaceful, this wasn’t true in the rest of the Levant. After Britain’s mandate over Palestine ended in 1947, the United Nations Partition Plan for Palestine split that country into two states: a consolidated Jewish state, and a noncontiguous Arab state whose borders approximated the current West Bank, Gaza, parts of southern Israel, Jaffa, and the region around Acre that borders Lebanon.4

Surprising exactly nobody, the partition plan proved unpopular. An intercommunal war between Arab and Jewish militias—which began a day after the UN passed the plan—became, after the declaration of Israeli independence in 1948, a cross-national war between Israel and the Arab states.5

Streams of refugees overwhelmed the northern border, settling in Lebanon and shifting its demographic and sectarian balance—a shift that threatened Maronite hegemony.

They wouldn’t let go easily, however. In 1952, Camille Chamoun, another Maronite Christian, became the country’s president. Toward the end of his six-year term, he intimated that he would amend the constitution, which did not allow sequential presidential terms, to try to stand for a second one.6

Amid growing violence, including a coup attempt by an Egyptian-backed group of left-wing Sunni pan-Arabists, Chamoun cunningly turned to the United States for help. Its new Eisenhower Doctrine had committed America to providing military and economic aid for any Middle Eastern country threatened by “overt armed aggression from any nation controlled by International Communism.”7 That became Chamoun’s play: his upstanding, Christian, democratic regime was being attacked by Muslim communists.

Fourteen thousand American troops landed in Lebanon for Operation Blue Bat. Skirmishes turned to clashes, riots turned bloody. And Pierre Gemayel appeared.

IF THERE’S ONE MAN whose philosophy of the Other infiltrated into my family, it was Pierre Gemayel. He and his Phalange militia played an outsize role in the ensuing civil war and in my family’s complex wartime hagiography. My parents hated him—and he, they say, hated the Melkites—but his nationalist ideas insinuated themselves into my family’s consciousness.

When Bashir, Pierre’s son and president-elect, was assassinated in 1982, the Christian Lebanese diaspora in Dallas sat vigil. A portrait of the slain man lay against the altar at a downtown church. My family paid its hushed respects. They had hoped Bashir’s aborted presidency would usher in peace.

What I didn’t know at that vigil—I was too young and too bored, the church too warm and too quiet—was that the man on the altar was no saint.

I didn’t know how insidiously his family had co-opted religion for political gain. I didn’t know that his father had modeled the Phalange after Italian Fascism. I didn’t know that the militia wore brown shirts and adopted Hitler’s straight-armed salute.8 And I didn’t know that they would avenge Bashir’s assassination by massacring 3,500 Palestinian Muslims at the Sabra and Shatila refugee camps two days later, all under Israel’s guidance.

Here’s what I did know. I knew that Gemayel had told us that Christian Lebanese were different. I knew that he—and my family—espoused Phoenicianism, a philosophy that taught that we weren’t Arab. Instead, Christian Lebanese descended from the Phoenicians.9 The same seafaring traders who developed the world’s first alphabet were our forebears—and not the forebears of Arab Muslims.

These are troubling assertions built on fraught history. They’re also how Pierre Gemayel consolidated power. He adopted them as a key plank in the Phalangist platform, using them to bolster a staunch nationalism. By setting his people apart, he could paint his enemies—pan-Arabists, leftists, and Muslims—as less than. Dirty. Other.

It worked. Gemayel and the Phalangists chiseled out a position of ethnic superiority, and we, while hating everything the Phalangists did, grew up knowing we were set apart. We had more in common with Europeans than with our darker Arab neighbors.

THERE’S SOME TRUTH TO Gemayel’s assertion of European and Phoenician identity. A small genetic study of ninety-nine Lebanese people showed that a large portion of our DNA traces directly back to Canaanite Phoenician traders.10 But intermarriage after the Arab conquest means we aren’t pure-blooded.

My mother’s family can also trace its lineage to an Irish merchant who came to the Middle East to ply his trade while Crusaders crusaded. And in Lebanon’s more affluent sectors, French education and culture supplanted Arab culture after World War I.

Her family comes from those affluent sectors. She was born in Beirut, the second-youngest child of a prosperous, landowning, Christian family. She and her six siblings grew up in French schools, living a life buttressed by domestic help and the trappings of wealth.

My father came from the other side of Christian Lebanon. The second-youngest son of an eight-person family in the northern Lebanese village of Fakeha, my dad grew up in the shadow of Roman ruins. He was educated at Arabic-speaking boarding schools. When he and my mother met, he had to learn French to woo her; she had to learn Arabic to understand him.

Their story was a personification of the divisions splitting this patchwork country, divisions that would come to a head a few months after I was born in 1974. In coastal Sidon, Camille Chamoun—the guy who convinced Eisenhower to send American troops into Lebanon, and one of Gemayel’s staunchest allies—decided to monopolize the fishing industry. His takeover was opposed by Maarouf Saad, a left-leaning, exceptionally popular Muslim politician with ties to Egypt and Palestine.

Chamoun offered Saad’s unionized fishermen higher pay if they’d break ranks and cross to his side. They refused. Saad responded with a general strike. He was repaid with a sniper’s bullet. He died within a week.11

Six weeks later, Pierre Gemayel attended a baptism in a Greek Orthodox church in East Beirut. Phalangists erected protective roadblocks outside the church. When a bus carrying Palestinian Muslims refused to divert around the roadblocks, the militia killed the driver. An hour later, as the baptism ended, two cars plastered with pro-Palestinian posters opened fire, killing the father of the baptized child and three of Gemayel’s bodyguards. Gemayel survived unscathed.

That was all it took. The powder keg burst. The fifteen-year civil war it ignited would kill 6 percent of the country’s population and would only end when Syria occupied Lebanon. Neighbors became enemies. The ethos of the Other that Gemayel had cultivated turned lethal, and many of the most brutal killings were committed by Christians.

ONCE THE WAR STARTED, a fair number of Lebanon’s Christians—especially those who were better-off and European educated—fled. My family is part of this diaspora.

After boarding school, my dad graduated with an engineering degree from the American University of Beirut and moved to the suburbs of Chicago for his PhD. For the rest of his life, he spoke bleakly about those grim Illinois winters, in no small part because he put himself through grad school working as a stevedore on Chicago’s docks.

He then moved to Dallas for a job with Texas Instruments. According to family lore, projects he worked on turned into antilock brakes and TI’s first calculator. He’d never tell you that, though. The man never spoke about his accomplishments.

He held three patents: one for an improved typewriter daisy wheel,12 one for a method for the confidential transfer of facsimiles,13 and one for a clock14 to indicate “the direction of a favoured place, such as Mecca, and… the hour of the various Islamic prayers.”

My dad was as inquisitive and entrepreneurial as he was taciturn. He worked hard and found solace in his garage woodshop. And he quickly tired of the Dallas dating scene. He decided his wife, whoever she was, still lived in Lebanon. So, he flew home.

He was thirty-one when he met my mother. She fell in love with his laugh.

They got married in 1972 and bought a house in a predominantly Muslim part of Beirut. By 1975, when a just-baptized infant lost his father to a firefight at a Greek Orthodox church, I was barely a year old.

Over the next year, checkpoints metastasized across the road between Beirut and Fakeha, a rash of semiofficial barricades, manned by a splintering constellation of warring militias. It was here that, under the Middle Eastern sun, and backed by nationalist fervor and an ethos of the Other, a soldier pointed his gun at my mother’s head.

We were on our way north, from Beirut to Fakeha. The first half of that two-hour drive went through Christian-controlled parts of the country. Our car passed unhindered.

Once we entered the Muslim-controlled north, however, we hit the checkpoints. At each, my father would leave the car, show his ID, open the trunk to inspection, and introduce the militia to his pregnant wife and one-year-old child. Lebanese ID cards listed the holder’s religion and denomination; they served as shibboleth, allowing safe passage through friendly checkpoints and harassment at the others.

After five consecutive stops, he got frustrated.

“Look, I just showed everyone my car,” he told the soldier.

“Get out,” the man replied.



There wasn’t a lot he could say. The soldiers knew this.

They also knew he had a pregnant wife and young son in the back seat. A second soldier trained his weapon at us.

“Get out or I shoot her.”

My dad got out. They confiscated his ID and herded him toward a dozen other men whose cars, wives, and families awaited them beside the road.

My dad never spoke about this episode, but to hear my mother tell it, his escape wasn’t guaranteed. Hours passed; more men joined the crowd. As the sun set, one of the militia asked my dad where he was headed.

“To Fakeha to see my mother,” he replied.

“Listen. Take it from me. Turn around and go back home.”

As he said this, the Lebanese Army opened fire on the checkpoint. In the chaotic churn, he ran.

Back to the car, back to his wife and child. And back the way he came. South, to the parts of the country where people looked, talked, and thought like us.

That night, the militia decapitated anyone left at the checkpoint.

MY PARENTS NEVER BELIEVED they’d leave Lebanon for good. My dad may have barely escaped execution, but, to them, this was all just another violent outburst between Christian and Muslim, between white and brown. They’d seen it before. It would be terrifying but short-lived.

But after the checkpoint incident, my father was now an ID-less Christian living in Muslim Beirut. They had no choice. When they packed their children—now two of us—into a plane flying west, they figured they’d be back in a year. Two, at most.

Along with their children, they also packed three ideological stowaways with them, the three ideas I’d have to unlearn. The most insidious is Gemayel’s ethos of the Other.

In Texas, my parents orchestrated an uneasy balance for their immigrant kids: weekends of homeschooled Arabic and French lessons in tenuous coexistence with a strong push to assimilate. They would chastise us when our English didn’t sound like that of Dan Rather, Peter Jennings, or Alex Trebek.

And we assimilated. Starting in the sixth grade, my brother and I attended an all-boys Catholic school run by Hungarian monks. My graduating class of twenty-eight had one South Asian student, one East Asian student.

And me. We were the diversity, but if you asked me in high school, I couldn’t have told you that. Until 1990, I was white.ii I had internalized Gemayel’s divisive philosophy. It fit with my new Texan home. And my family reinforced it—sometimes explicitly.

I had my first serious relationship in college. Adele is from Singapore; you’ll see her again in a few chapters, but I bring her up here because of what happened the day my parents first met her. Poor Adele—she had no idea what she was walking into when she ran into my family during their campus visit. Always the consummate hostess, my mother invited her to a very pleasant lunch that day. We got pancakes.

Things turned less cordial that night, after Adele left. In their hotel room, my parents handed down an unambiguous lesson in the ethos of the Other.

If we were to date, they told their three children, we had to adhere to a hierarchy of peoples. If we couldn’t find ourselves a good Christian Lebanese partner, white Christians were okay. East Asians like Adele were third best.

God forbade anyone else.

We protested. They told us not to be naive. They used to have friends across religious and ethnic lines, once. Then the war happened, and friends killed each other. The only people we could trust were our kind.

We’re all formed by—and have to unlearn—histories we don’t choose. My parents, who have since vehemently disavowed this hierarchy, were formed by theirs just as their history became part of mine.

LIKE EVERYONE ELSE IN Texas in August 1990, I watched, rapt, as America insinuated ourselves into the first Gulf War, injecting our armies into a conflict that didn’t involve us.

I watched as news anchors breathlessly narrated the full might of our air forces imposing our politics on a country that suffered—we were told—under a brutal regime. The short-haired Texan oil baron turned president assured us it would be quick and safe. We would liberate the Others (and their oil). We wouldn’t lose any of Us.

I also watched, rapt, as a classmate insinuated his red convertible into a prime spot in the school’s parking lot the next morning. His car’s stereo tore the August air with The Cure’s “Killing an Arab.”

Staring down the barrel at the Arab on the ground.

I can see his open mouth, but I hear no sound.

On August 3, 1990, I became Other.

My family’s Phoenicianism evaporated, and with it their insistences that we keep ourselves apart, their assertions that we were separate, purer, whiter, more European, and more Christian. The Arabs I’d learned to shun, the ones I’d learned to Other, were now me.

No matter how addicted I am to donuts, no matter how many times my parents corrected me when I didn’t speak Dan Rather’s English, I still got raw lamb with bulgur as a birthday cake.

It didn’t matter that my Arabic is terrible. It didn’t matter that my French is, at best, stuck in stilted language-lab phrases about finding the nearest toilet. My family has its own recipe for hummus as thick as my dad’s accent. The tenuous American veneer we’d built shattered that morning.

I had spent nearly my entire life in Texas. I stood for the Pledge of Allegiance. I could play Jimi Hendrix’s guitar-solo version of the national anthem. I went to church every Wednesday and twice on Sunday. I believed in the might and the right of America.

And I am an Arab. That August, my home attacked my people. Soldiers who talked like me attacked people who looked like me, and other people wrote songs about it. People who looked like my friends dropped bombs on people who spoke like my uncles. They annihilated people who dressed like my grandmother, people who lived in flat-topped houses and hung their laundry out to dry and slept on roofs under the stars on nights when the air was too hot and too still.

That August night, I became Other.


i Lebanon’s Maronites follow the teachings of a fourth-century Syriac hermit monk. The head of the Maronite Church, called the Patriarch of Antioch and the Whole Levant, is elected from within the Maronite religious without overt influence from the Roman Catholic Church. Upon his election, however, he requests—and is granted—recognition by the pope, who responds by making him a cardinal.

ii To be fair, in the eyes of the United States government, I still am. Although airport security takes a lurid interest in my bags every time I fly, the US Census specifically instructs people of Middle Eastern descent to check “white” on their census forms.


Chapter 2

Truth may be vital, but without love it is unbearable.


FINLAY GRAHAM CUTS AN imposing figure in Lebanon’s Christian history. He was also my best friend’s grandfather.


  • "Dr. Mark Shrime is one of the most remarkable humans I’ve ever met. I knew he’d write a wonderful book—I just didn’t expect to dog ear every page and underline so many wonderful thoughts that he puts so well onto the page. His curiosity pushes him to learn more about himself, the world, and why we are here and what we should be doing to live up to our potential. I loved this book and believe it will be widely read and remembered. And I’m so mad I didn’t think of this title first!"—Dana Perino, New York Times bestselling author of EVERYTHING WILL BE OKAY
  • "As I read, unable to put this compelling book down, I heard my heart echoing thoughts and questions that arose out of the pages. I discovered in each page a profound perspective and a provoking transparency. I will read it again and again."—Barclay Stockett, American Ninja Warrior
  • "I am not sure if I have ever read a book where the author was willing to bare their soul as completely as Dr. Mark Shrime does in this remarkable book. By sharing his life’s complicated journey, he will (or at last should) inspire the rest of us to take a good look at the 'moving sidewalk' of our own lives and figure out if we are going the right direction. I needed and appreciated this push."—Jean Becker, New York Times bestselling author of THE MAN I KNEW

On Sale
Jan 25, 2022
Page Count
272 pages

Dr. Mark Shrime

About the Author

Mark G. Shrime, MD MPH PhD FACS, is the chair of Global Surgery at the Royal College of Surgeons in Ireland and a lecturer in Global Health and Social Medicine at the Harvard Medical School. His academic pursuits focus on surgical delivery in low- and middle-income countries, where he has a specific interest in the intersection of health, impoverishment, and equity. Dr. Shrime graduated summa cum laude from Princeton University in 1996 with a BA in molecular biology. He received his MD from the University of Texas Southwestern Medical School in 2001, after taking a year to teach organic chemistry in Singapore. In 2011, he graduated with an MPH in global health from the Harvard School of Public Health, and in 2015, he received his PhD in health policy, with a concentration in decision sciences, from Harvard University. To date, he has worked and taught in Liberia, Sierra Leone, Guinea, Benin, Togo, Congo, Haiti, Saudi Arabia, Cameroon, Senegal, and Madagascar. When not working, he is an avid photographer and rock climber, and he has competed on Seasons 8, 9, and 11 of American Ninja Warrior.

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