Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for December, 2013

Resolution 2014: Love

Will you make any New Year’s resolutions this week? I probably will. Each year my list becomes smaller, but I am more successful in hitting the mark. Why? Probably because the list is small and therefore better thought out for one.

The other reason is “resolve”, the characteristic most necessary to achieving success in your resolutions. It’s a fancy word for commitment, or more precisely the conscious act of making and following through on that commitment. It’s infinitely easier to find  the resolve necessary to follow through on my resolutions if there are fewer of them for sure, but having taken a bit more time in coming up with them in the first place it also seems that my resolutions of late have been a bit more meaningful, too. Investing the time in the search for a meaningful resolution seems to reduce the time and effort it takes me to muster up the resolve necessary to see one through.

If you celebrate Christmas (or Hanukah for that matter) you probably did a bit of gift giving recently. Sure, some of it probably felt kinda like an obligation, but at least a bit of that gift giving was really more about the expression of love behind the gift. That’s the easy part, at least for me, expressing love. Whether on the gifting side or the giving side, once I gave myself permission to freely express love it really became pretty easy. Took a while to learn how to do it for sure, but with practice it became a natural thing, almost a default setting.  It was fun, too!

The receiving end of the gift thing is a lot of fun, too, of course. I mean–come on–who doesn’t like opening up gifts?! Lots of funny stuff around getting a gift, too. Think of all the funny “re-gifting” stories you have, or the last “White Elephant” party you attended. In the White house the philosophy of “it’s OK to say you probably won’t use that gift” became “REJECT THAT GIFT”! That got to be quite funny as we all tried to one-up each other in the outlandish ways we declined the gifts. Beth is still scarred from her first encounter, and she’s never had a single gift rejected!

Accepting a gift is really rather easy, it’s accepting the love behind the gift, accepting another’s love that’s a little more complex. Maybe you didn’t know how much they loved you. Maybe you are worried it’s conditional, the love, with strings attached. More often, though, the problem is that you aren’t really sure HOW to accept the love, or even if you are deserving of such a thing. That’s it, isn’t it? That’s really what you’re thinking. “They can’t possibly love me, love me that much. If they only knew the truth.” Or something like that.

Here’s the truth: they really DO know. And because of that they really, actually, truly DO love you. Most importantly there’s not even a little bit of a mistake here, and more than likely there’s not even the tiniest thread of a string attached. Not only are you loved, not only has someone in some way told you that, you deserve every little bit of that love. Really and truly. Resolve this year to believe that. Make your 2014 New Year’s Resolution to be openly thankful for that love, just like you are for that beautifully gift-wrapped present under the tree at Christmas, the one you would never reject.

Resolve to let yourself  be loved this year.

Happy New Year!

Musings at Christmas on Connecting

‘Tis the season. Home for the  Holidays and all that. Gatherings of all sorts, at home and away, as we make and re-make our connections in one of the best parts of the Christmas Holiday season. We send out a couple hundred Christmas cards every year, and I never tire of seeing the cards from friends and family as they pile up on our “card tree” on the counter. Those annoying notes and letters that accompany the cards? The family pictures? Love ‘em! In Gladwell’s universe my wife and I are “Super-Connectors”; this year I’ve been thinking about how we all connect in our modern world.

1) Twitter. Has there ever been a better example of the power of community interacting with the power of a technology than CrossFit HQ weblebrity  Pat Sherwood, his “Go South” adventure, and Twitter? Calamity or comedic pratfall, there to pick up the pieces were CrossFitters who have never set foot on U.S. soil, let alone Santa Cruz, all connected to Pat via Twitter. That was fun.

Twitter is “instant on/always on”. Kinda like a 140 character postcard from anywhere and everywhere, we take the pulse of our world (and others take our pulse for us). I’ve only made a couple of connections here, but I’m learning.

3) Facebook. Gotta admit, my entry into the world of FB was initially a rather cynical attempt to grow the business at my day job. That lasted precisely one day. That’s how long it took my Facebook page to be discovered by one of my CrossFit friends from the days when CrossFit.com had 1000 comments.

Boy, did THAT work out well for me!

There are all kinds of folks over there on FB who have read something of mine, or who know someone who did. I treasure each one of them. The really cool connections though, are the ones where FB has allowed us to grow what was probably just a handshake at the CrossFit Games or a quick hello at some event, and keep expanding something that would very likely be a nice little friendship if it weren’t for the hundreds of miles between us. Here’s hoping I get to shake a bunch of new hands, for real, in 2014.

4) Email. About 2 years ago I was invited to join this incredible email thread comprised of men like me who had spent some time at a particular tiny college in New England. The tactic used by the guy who launched the thread some 10+ years ago was quite simple: wish one of the guys a Happy Birthday and tell a story about his days in college or shortly thereafter.

Sometimes even tell a true story!

I’d call it a low-rent Facebook for old guys but for two important points: there are no pictures (I have no idea what 95% of the guys look like now), and it is quite private (we all know how that privacy thing is working over in Zuckerburgville, eh?). Not a lot of places for any of us to work through stuff with people who get you at whatever stage of life you might be in at the moment.

I’m connected there.

5) Hugs. ‘Tis the Christmas season in the Christian world. If ever there’s a time we seek to connect this is it. Planes, trains, and automobiles–or if you are Pat Sherwood a motorcycle–we move Heaven and Earth to get ourselves together. Not Facebook or Twitter or Email together, either. Nope, real live, honest to goodness, reach out and touch connecting.

I like to think of it as “hugging distance”.

On Christmas Day I will be in an airport, alone, heading to my ancestral home. Back to the primordial bed. I will leave my little, growing family in order to be with my parents in time for Christmas dinner. My siblings and I have hosted our folks in turn, each of us having the privilege of their presence every 4 years. Now unable to travel, in order for my Mom and Dad to connect, we four must go to them.

If you are very observant you might have noticed a couple of connections missing from my list above. Postal service and phone calls are how the extended Clan White has always communicated. Once upon a time Gram sent each of us a postcard every day. That’s every single day. Four of us. We called and talked on the phone, all of us. We still call and we still talk (you young’uns might have a fleeting knowledge of what that green “call” button on your texting instrument is there for) even though Gram and Gramp don’t really do the cell phone thing.  But the postcards have stopped.

Aged and bent, very nearly (but not yet quite) broken, my parents’ lives have shrunken to the point where nearly all that is left is that most intimate of connections, the one that can only be made by walking through the front door.

This is not one of those wistful “oh I wish” or “oh if only I had” posts. Our lives proceed as they will. As they have. As Rafiki would say “it doesn’t matter, it’s in the past.”  We connect and we disconnect. Sometimes quite deliberately, on purpose, and sometimes quite simply by accident. At any one time, though, we are connected to some someones, and our connections might still include a Mom and a Dad. Anyone who’s been here awhile and read any of my nonsense might remember my post around this time last year; it seemed quite unlikely that I would have another year with my Dad.  I travel on Christmas this year with one part sorrow at the leaving, and two parts surprise and joy at the destination. Against all odds I still have that front door to open, with TWO parents on the other side waiting.

One more time, to my great surprise and delight, “[W]e’re gonna get together then, Dad. We’re gonna have a good time, then.”

Merry Christmas.

 

The Value of Work

All work has value. Well, all legal work of course. Every job has value. There is a certain dignity that can be found in every job. Mop the floors? Someone’s gotta do it, and the rest of us should be thankful that someone did it. Digging up coal? Man, that’s a dangerous job. I think I read that 90% of Ohio’s electricity comes from coal. I’m warm today because someone went deep and came up with that coal.

Heck, even used car salesmen perform a job that has value. Seriously.

More to the point, especially at this time of year, is the value that is conferred on the person who has the job. Almost any job. You’ve got a reason to get up in the morning (or evening if you work graveyard). You have folks you are responsible for, and you are taking care of them. You are taking care of yourself. Taking responsibility. FWIW I would go to work on Wednesday if I had the magic lottery ticket on Tuesday.

In the Great Depression what everyone asked for was a job. Will work for food. I truly believe that this is still true for the most part today. People feel deep down that they need to work. When they have a job by and large most people work as hard as they can to do a good job. I live and work in the second most highly regulated industry in the U.S. (bonus points for knowing the first), and my income has been halved over the last 10 years or so. I still go to work, though, and I still work for the people who “buy” my services just as hard and in the same good faith that I did 10, 15, 20 years ago.

That’s my job.

Which brings me to the point: if you have a job for Heaven’s sake do your best. Work hard. If someone has given you a job work hard for her. Don’t’ let any resentments interfere with doing your best work. Everyone is underpaid; your boss thinks he’s underpaid, too. It may or may not be true, but when you are on the job it doesn’t matter. When you are at work is not the time to harbor or act on anything other than the job at hand. If you work for someone, WORK for him. Do whatever it takes to do the work well, to get the job done.

It’s not just that you owe it to her, you owe it to yourself.

 

Indulgence

‘Tis the season, eh? Indulgence at this time of year, at least in the Judeo-Christian world, is rather obvious. I WAM my nutrition all year so that I can eat pie at Thanksgiving and cookies at Christmas. Neither of which I weigh or measure, by the way.

There’s an aspect of guilt when it comes to indulgence. It’s more than just the occasional treat. An inch of dark chocolate on your Paleo Diet doesn’t really cut it, and if you consider that an indulgence it’s probably time to loosen up a bit. I was thinking that the ultimate First World indulgence is the un-timed hot shower, but anything that occurs on a daily basis probably doesn’t count either.

Uh uh…indulgence involves a certain sense of not only excess but also a bit of “I really shouldn’t”. Jay McInerney: “I find the shadow of guilt always adds piquancy to any indulgence. It’s almost more pleasurable, feeling slightly guilty.” As a boy raised Catholic by a mother who openly admired the way her Jewish friends raised their kids (producing what I’ve come to call “double guilt”), I definitely get the “shadow of guilt” angle to indulgence, especially with ones that only occur on rare occasions.

Others, though, indulge in ways both frequent and grand. Indulgence writ large, if you will. Take, for example, Lilly Bollinger and her approach to Champagne: “I drink it when I’m happy and when I’m sad. Sometimes I drink it when I’m alone. When I have company, I consider it obligatory. I trifle with it if I’m not hungry and drink it when I am. Otherwise, I never touch it–unless I’m thirsty.” Man, THAT woman knows how to indulge. Not much guilt evident, either. I’m sure my Mom wouldn’t approve, and I’m equally sure that Lilly wouldn’t care.

In a perfect world we would all be more like Lilly Bollinger, indulging on a daily basis in something that brings us pleasure with or without a side of guilt. The world, as I’ve said, is messy, no matter where it is you might live. Indulgence is what you make of it, and it’s probably a good thing that we have this Holiday Season during which we give ourselves permission to indulge a bit. Life is messy and hard–you’ve earned it.

[Raises flute]

 

Tarnishing a New Technology

The technology is fabulous. I mean, Femtosecond Laser Cataract Surgery (FLCS) is really, REALLY fabulous. It deserves a full roll-out. It is nothing less than the logical next step in a progression of medical treatments that extends back in time to the days of the Pharaohs and Cleopatra. Yet we debate its merits (Is it better? Is it safe?) in a sad and tawdry replay of the introduction of its predecessor technology, a chapter in the august history of ophthalmology that is still cringe-worthy among the vanishing actors still alive from that tragicomedy. That original sin, the denigration of the technique of cataract removal called Phacoemulsification (Phaco) by the establishment could at least stand on technical grounds;  Phaco 1.0 was rather rough stuff. Here we have no such ground on which to stand; the new technology of FLCS at launch is at LEAST as safe and effective, and promises to become more of both as it develops.

Why, then, my obvious angst?

The problem lies not with the technology but with the business model, and by extension how that is dividing the community of cataract surgeons. You see, what was really tragic about the the response of the ophthalmic community during the transition to Phaco for cataract surgery was the outright character assassination of those on the forefront of adopting Phaco by those still entrenched in the status quo. In my opinion the same is starting to happen now, only it is those who are adopting the new technology who are subtly smearing those who have yet to do so.

At the turn of the most recent century a company called Eyeonics (since purchased by Bausch & Lomb) and its CEO Any Corley ushered in a new era in cataract lens implants. With these new implants came an equally revolutionary new business model. Through the tireless work of Corley and his associates patients were given the option of paying an additional charge to add an UNCOVERED service on top of a medically necessary service that was otherwise fully covered by insurance. While the costs of the basic aspects of cataract surgery (remove the cataract; replace the removed natural lens with an artificial implant) would continue to be paid by health insurance (including, most importantly, Medicare), a patient now had the option of paying to add an additional service such as the treatment of astigmatism or presbyopia (the ability see up close as well as at distance) without the need to wear glasses.

Mr. Corley and Eyeonics did the grunt work of convincing the bureaucrats in what is now CMS that this was OK, and this  success launched some of the most vibrant technological advances anywhere in medicine. We now have no fewer than 6 “premium” lens implants, with at least another 6 in development. This is really exciting stuff and it is the direct result of the lobbying work done to create this new business model: extra charges for services that are beyond the basic, standard services necessary to accomplish the treatment of a medical necessity, in this case the removal of a cataract.

So what’s the problem? In a nutshell, the industry that has given us the FSLC is conflating this advancement in the fulfillment of the basic aspects of  cataract surgery (FSLC) with the provision of additional services that are not medically necessary (treatment of presbyopia). Indeed, such luminaries in my world as Eric Donnenfeld, Dan Durrie, and Steve Slade are on record as saying that FSLC is already safer than traditional Phaco, and that it already produces superior outcomes in ALL circumstances, specifically including the implantation of a standard lens implant. How then is this a “premium” service? Why is FSLC not being sold as the next development in the long line of successful improvements in cataract surgery for the masses? For Heaven’s sake, if FSLC is truly safer than what industry and industry consultants have taken to calling “manual cataract surgery” (despite the inconvenient fact that FSLC still involves some pretty tricky manual steps), how can one justify calling this a “premium, non-covered procedure” for which a patient must pay more? Seriously, pay more for safety? Pay more for better outcomes?

THAT my friends is the problem. In order to get what may turn out to be the safest surgery, for the first time in history patients must now pony up. Think about how this would play in, oh, heart surgery. “Well Mrs. Jones, your heart surgery can be done with the older technique and covered by your insurance, but for $2000 extra we can do the better, safer laser version for YOUR heart.” Nice, huh?

Our ophthalmic device manufacturers, including interestingly the same Andy Corley I previously lauded, have taken the easy route. Rather than “man up” and go before Medicare and the other insurers to justify a request for insurance coverage of the additional cost of what the podium speakers are calling a safer, better procedure, they have instead opted for the cynical, cowardly route of mis-applying the “Corley Rule” and having the patient pay. Worse than that, there is a very clear message coming from the podium (though not necessarily Donnenfeld, et al.)  and various editorials that those of us who have achieved stellar visual outcomes with spotless safety records are somehow now failing to provide our patients with the new “standard” if we opt to wait at this stage of development. Really. That’s what they are saying. Indeed, even some who are old enough to have been the targets of this kind of behavior in the 70′s and 80′s  say that out loud.

Listen, I get the excitement about a new technology that will probably win out as both better and safer. Heck, new often wins just because it’s new, or because people THINK it’s better and safer even if it’s not (read: Femtosecond laser LASIK  flaps vs. modern mechanical keratomes). I’m good with that. At 53 years of age I will almost surely perform FSLC for a significant part of the rest of my career once I begin. But don’t try to tell me that this is anything other than the latest step in a progression of procedures that began with “couching” in ancient Egypt. Don’t expect me to feel OK with the cynical decisions that everyone in the pipeline have made in order to avoid having the battle on insurance coverage for something they are already calling a “standard”. You simply can’t have it both ways. You can’t say that this is a safer surgery with better outcomes and then say that the regular Joe or Jane should reach into their pocket and pay EXTRA for the next better version of regular surgery that has always been covered by insurance, and then expect me to get in line and salute the “Jolly Roger” you’ve just hoisted.

The technology of the Femtosecond Laser Cataract Surgery is great. The cynical business model is not. Let’s not tarnish this wonderful new technology by repeating the bad behavior of the 70′s during the transition to Phaco by speaking ill of our colleagues who may not be as willing to jump on the bandwagon of a cowardly industry unwilling to do the right thing in support of of its own creation. It is our job as ophthalmic surgeons to demand that the device industry do the hard work to come up with a more appropriate business model if they want to sell their lasers.

As far as I’m concerned it is also our duty as colleagues to not forget the trauma we inflicted upon ourselves in the Phaco transition by smearing one group or another, however subtly or quietly that might be done. Both sides of this controversy must do whatever it takes not to repeat that tragic history as we move inexorably toward the universal adoption of the newest heir in the cataract surgery lineage. In general I’m a fan of our industry partners, but they created this issue by abdicating when it came time to support their invention.

It’s up to us to force them to own up to that and fix it.

What Do You Remember and Why?

Memory is a funny thing, isn’t it? My Dad has been sick; his short-term memory is now approximately 30 minutes, give or take. It’s exhausting to be the “reminder”, but worth the effort to quell the terror at the forgetting.

Did you watch any college football on Saturday? Ohio State vs. Michigan perhaps? The unprecedented ending of Alabama vs. Auburn? Memorable doesn’t quite seem to be adequate, but that’s surely what they were. Imagine for a moment you were there, on the field of play. Imagine the memories you’ll have.

Given my Saturday’s activity (glued to TV watching football) it’s not too surprising that I dreamed of football last night. It was a recurring dream, one that comes to me often, and one from which I always seem to awaken to start my day. My dream is like a classic NFL Films pastiche of all of my football FAILURES. That’s right, all of my lowlights in one continuously running loop, endlessly spooling until I finally, mercifully, wake up.

I never remember the good plays. From any sport at any time. Is it like this for you guys? Seriously, there is literally only one play from college I recall where it all turned out OK. Ah, but the misses? Those plays where I got burned, fumbled, missed the free throw, failed to get it up and down for the win? Those are burned into my brain as if by some cosmic branding iron. I wonder why that is…

Memory is a funny thing, isn’t it?

In my Inbox the other day I received a request to participate in a concussion study of Div. III football players. Some of my teammates received the request while others seemingly have not. This set us to the task of deciphering who did get the request and why. Opinions differ, swinging between GPA (those above a certain grade were solicited) and athletic prowess (those below a certain grade were solicited). All of which made for a spirited back and forth between men of a certain age who share…wait for it…memories.

Men over the age of 30 are well-known to have difficulty making new friends, at least friends as significant as those they made in their youth. I get this, especially when I realize that I really DO have good memories from my days as whatever version of athlete I might have been. They just don’t happen to be from the field of play, but rather from the locker room and the bus. Pre- and post-game meetings and gatherings. Watching the “big boys” play on Saturdays with teammates after our all too short season had ended. Gathering to parse the mysteries of the concussion study, so much like being back on a stool contemplating a new day’s fresh undergear, musing on the next generation telling their own stories of bonding and wondering if they will have what we had. What we have.

Indeed, I remember very little of yesterday’s CrossFit WOD. Little other than what the aches in my body tell me I must have done. Like in my days as a team sport athlete I do not remember a particular rep or the weight I used or my score. No, just like always and ever before what I remember from yesterday is what I remember from last week and last year and all the way back to 2006: I remember who I was with. I remember that being with them felt like winning.

I hope that they, as I do with teammates of yore, will remember it the same.

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