Random Thoughts from a Restless Mind

Sunday musings (theoretically speaking)…

1) Theory. Among the definitions of “theory” is: “an accepted hypothesis.”

2) String theory. No, no, no…not THAT string theory. I’m a pretty bright guy, but theoretical physics? Nope. Beyond me.

No, what I’m thinking about here is the string as a connection between individuals. We are about to have a most marvelous “string”, the Crossfit Games, and the level of connectedness we will encounter will be epic.

How so, you ask? How could this possibly be, how could I call this an “epic” connection of any sort, much less of the sporting sort, when we have just seen the Women’s World Cup, the Tour de France, and are about to see the Track and Field World Championships, among other athletic events? Simple. The string that connects most everyone through the Crossfit Games is none other than Crossfit itself.

Think about it. How many of those millions of people who watched the WWC play soccer every day? Those who watched Evans out-Trial Schleck on OLN, how many of them were on their bikes even once last week? Ah, but the Games…the people watching the Games will be planning their viewing schedule around their WOD and vice versa. We LIVE what we watch.

The string is so much shorter here; the connection is tighter.

3) Education theory. Get this…I just saw a headline that said “Master’s Degrees Now Required.” Whaaat. We’ve got literally thousands upon thousands of young people with degrees that have absolutely nothing to do with their job, and now some wonky educational theorist is opining that a Master’s is required? Talk about educational inflation!

There is a practical level of knowledge that is necessary for any job, and a practical level of excellence that accrues to anyone who continues to be a learner and gains experience in that job. Why do you think sergeants are so important in the military? Yes, there is certainly a need for a small number of individuals steeped in the minutiae of any field through extended time in the oven of education, but really, that number is small in almost all fields.

As if we aren’t warehousing enough young people in “going nowhere” educational tracks, doing little more than offering an extended opportunity to grow up and grow older (Al McGuire: the best thing about freshman is that they grow up to be sophomores), now we should park them in MORE school?

4) Chaos theory. Nope. I’m not smart enough to expound on economic chaos theory (actually, I DO understand it though), I’m talking about the chaos that each of us encounters in our daily lives. It’s always so…so…outta control, ya know. Chaotic. Almost random.

There are patterns, for sure, and you can plan according to a pattern you might discern, but eventually chaos reigns. Chaos rains down upon your plan, soaking the leaves of your decision tree and leaving a sodden mess of your space underneath. Then what?

Well, sometimes it’s all too much. Sometimes the rain of chaos leads to the reign of a flood, and everything in its wake is washed away. The simple fact, though, is that these epic floods are quite rare. The confluence of streams all running against your little rowboat is really rather uncommon. The chaos itself is always there; the trick, I think, is in always seeking the flow that’s positive. Flowing your way. Being a spectator to an interesting or funny flow that’s nearby but not pushing or pulling your little boat, and maybe getting splashed a bit by the happy foam of someone else’s whitecaps.

Chaos is as random on the up side as it is on the down side. Those fantastic confluences of positive forces that conspire to push you inexorably toward some un-imaginable peak, like a 50 foot wave you are riding tighter than anything Kelly Slater ever rode? Just as rare as the 1000 year flood. Nope, the trick is to see and seek those little streams of good, each tiny trickle of happy. Not a branch on your decision tree? Scr^w it! Get out from under the tree and get wet!

You’re ready to face the chaos. You’re a Crossfitter.

I’ll see you next week…

Posted by bingo at July 24, 2011 6:30 AM

I don’t feel so hot. No, that’s not quite right. I feel really lousy. Yah…that’s more accurate.

I’m really not much of a complainer, at least for a guy (women are much tougher than men in all ways). I go to work unless I simply can’t rise from bed and crawl to the shower. The entire staff, my family, and every patient who walks into my office feeds off my mood. No matter how I feel, how up or down I might be, on the outside it’s always a good day and I’m always feeling great. That’s the way it is, and that’s probably the way it’s supposed to be whenever you set the pace, and it’s certainly what’s expected of a doctor in the office. I get that, and that’s what I’ve done all of my adult life.

Except now. I’m feeling really lousy, and it’s so bad that I’m having a really hard time hiding it.

It’s partly physical, and it might be medical. No one, patient and doc alike, ever really thinks of the doctor as susceptible to human frailty of any type. Sick day? Yer a doctor…you don’t need any stinkin’ sick day! Just the same, there are a couple of things which just aren’t right. Sure, I’m 51 years old, and that might have something to do with this, but…

So what’s going on? Hmmm…my hands hurt. Pretty scary, eh? I’m an eye surgeon; the quality of my kids’ diet depends on the health of my hands. Nothing too big dealish right now, but just enough to engage my consciousness, oh, all day. And my shoulder, the one I hurt 3 years ago doing push-ups, it’s been buggin’ me after a little kayak rescue adventure on the 4th of July. It’s not really a new problem actually, and it still only keeps me from doing a couple of things I LIKE to do (play golf) and not anything I NEED to do (work), but it wasn’t getting any better, and for a few days it was a little worse.

The gym hasn’t been the sanctuary it’s been for me over the last couple of years. I’m a Crossfitter–we measure everything in the gym. I’m not making any PR (Personal Records) on repeat WOD’s (Workout of the Day) to speak of. In fact, if I’m really being honest here, my times and loads on repeat WOD’s are actually off by about 10% or so. Greg Glassman, the founder of Crossfit and a real, live, certified genius has postulated that measured fitness is a proxy for health. Indeed, he posits that Fitness EQUALS Health. I’m a huge Greg Glassman fan, but I really hope he’s not entirely right on this one.

Whaaaat! Is that it? Is that all this is about? A few physical dings after 51 years of being a knucklehead athlete? Not doing so hot in the gym? Ack, suck it up and quit yer whining!

(Laughing) Sure! It would be cool if that’s all there is! But there’s this little bump in my neck (probably just left over from a virus), and a general decrease in energy along with generally poor quality sleep. My tolerance for the little inconveniences in life is nil, and my ability to let the myriad little discourtesies that are directed at a doctor or a boss is at an all time low. A couple other vague and maddening symptoms that have turned me into every physician’s nightmare: the doctor as a patient.

Medicine of all kinds is the ultimate looking glass. Patient or doctor, you spend pretty much all of your time on one side or the other, and your perspective is irrevocably set by which side you started on. As much as we as docs try to empathize with a patient it’s simply impossible to do any better than sympathize, even if we have the exact same symptoms or diagnosis;  our experience is NEVER the same because we are doctors. We speak the language so our conversation with our own doctors is different, and our doctors nearly always treat us as colleagues first, patients second. We either receive a little lip service and a pat on the rump, or more likely end up with the “blue-plate special” work-up in which no stone is left un-turned, no opportunity to pet a Zebra missed.

Nope, it will likely turn out to be the result of the unrelenting grind of being a doctor who takes care of patients. The countless little cuts from folks who are involved in the “care” that make it more difficult to do your job. The incessant bleating in every media outlet about the “problem with healthcare” and the “problem with doctors”. The patient or family member of a patient who has received state of the art, best in class care and the best possible outcome, and yet finds it necessary to find something to complain about. It will likely be the endless weight of carrying the financial health of 15 families on my shoulders like so many other small business owners. It will likely come down to the blessing and the curse of having an out-sized work capacity and an under-developed ability to demand the same from others, to demand that they share the part of the load that is rightly theirs. Non-medical business owners have resources to call on in these situations, organizations like YPO, Tech, and EO. Docs? Meh, not so much.

Who watches the watchers? Who looks out for those who are tasked with looking out for others? Who is there to care for those who dispense care?

I know what you’re thinking. WAAAAA…what a crybaby! Send in the Whambulance and get this whiner outta here! Maybe. Perhaps. But you’d better have a bunch of those Whambulances on call, because when the doc does go down he/she never goes alone. Private practice or huge institutional setting, we are each an integral part of a complex micro-economic and social ecosystem. Set apart, but never truly separate. We never go down alone.

So, where to turn? To whom do I bring this? My own doc will undoubtedly rule out any and all illness as expected (but I’ll still end up with that CT of the neck). I have an image in my mind, a slow video of waves washing over a rock on the beach which sits at the mid-tide mark. It’s a substantial rock. Sturdy. Large. Not unattractive. Steady. I imagine  people walking by all day, every day, occasionally glancing at the rock, but mostly just peripherally aware that it’s there. A jellyfish in the surf or a crab underfoot might prompt a jump to safety; a daydreaming beachcomber might stub a toe, but mostly folks just don’t really think about the rock. No body notices that after years and years of twice daily tides the rock has started to show some wear. A tiny crack here. A little chip there.

I don’t feel so hot. High tide is nigh.

Sunday musings…

1) Google +. Facebook for big kids.

2) “Fortune knocks but once, but misfortune has more patience.” This one bears some contemplation.

3) Ninja mosquito. The monsoon season has just ended in Cleveland and we are now in the swamp season. Mosquitos the size of small hummingbirds now patrol the skies, as agile as any earthbound ninja. They apparently have quite a sense of humor, too. One bit me in the arse last night.

I’m pretty sure that’s the same one buzzing around laughing every time I scratch.

4) Roger Bannister. It’s the 40th anniversary year of Sir Roger’s epic athletic achievement, the breaking of the 4 minute mile barrier. His immediate reaction was to feel “as a flashbulb just after the flash; consumed and without further purpose.” Few know that he retired from competition 6 months after his historical run.

Fewer, still, know that Bannister was knighted not for his mile, nor even for his extraordinary career as a neurologist and teacher, but for his efforts in the 60’s and 70’s creating fitness programs for the everyday Brit. Indeed, he has often opined that the foibles and personal failures of famous professional athletes are among the greatest dangers to the fitness of the masses, discouraging the fans and presenting yet another speed bump in their path. Sir Roger became less and less a fan of professional sports as the business and the money became more and more the topic of sports conversation, elbowing aside the talk of athletic exploit, cold cash giving the cold shoulder to talk of training, of playing.

There’s a lesson here for us, I think, courtesy of Sir Roger Bannister, as our “Crossfit as Sport” takes off like the proverbial rocket. Crossfit the “Fitness program” is still primary. Ask Coach. I hear he’s spending way more of his personal time on fitness and health issues, stuff like drown-proofing babies, and not as much as you’d think on The Games and Crossfit competitions. Don’t get me wrong, I know he gets a charge out of the epic achievements of our top competitors, but I think he’s much more of the mind of Sir Roger when it comes to the nitty gritty of Crossfit (note: this is just my opinion; I’ve not discussed this with Coach).

If we all, each one of us, Crossfit HQ or John Q. Crossfit, takes just a moment to remember what Crossfit is for the masses, what it is for the vast majority of us who will never compete anywhere at all, we stand a much better chance of our future Crossfit “Roger” being more Sir Roger Bannister and less W. Roger Clemmens.

5) Summer reading. It’s also that time of year when every publication, blog, and foophy radio show comes out with a summer reading list. You know the kind, the ones with new books not to be missed, classics to catch up on, reads to expand your mind. All of it. I peruse them each year as we prepare for out annual sojourn to Cape Cod looking for the mind-numb for the drive, the hidden spot to escape whatever the “problem with Darrell” is this year.

Funny, but every list I’ve looked at this year just bores me to tears.

I don’t think my tastes have changed all that much, nor have I become any less inclined to branch out and test drive something new and different. Nope, I just think the stuff out there right now is just under- cooked pabulum put out to fill the dead air of summer. Kindle, Nook, Sony, iPad, or old-fashioned paper n’ ink, it’s all pretty much rubbish.

So what’ll I do? What will I pick up to fill the hours that otherwise gape before me like so many metaphysical (not to mention metaphorical) canyons? You know what? I think I’ll just read the last “Harry Potter”. Ya. That’s what I’ll do.

That’ll show ’em.

I’ll see you next week…

Posted by bingo at July 10, 2011 8:11 AM

Sunday musings…

1) Boomerang. An implement which when thrown returns to the thrower.

2) Boomerang. Hails from Australia. Wondering if Lil’bingo is planning on returning from his visit.

3) Boomerang. Nickname for children who return to the home of their parents after leaving for college (or life). Mrs. bingo and I spent the collective childhood years of the bingo progeny steeling ourselves for the inevitability of their permanent emigration away from Cleveland. All we hear is that Cleveland cannot retain its young, after all. “The Heir” left for college in Denver, and “Lil’bingo” left to explore Crossfit as a career with a first step in So Cal. Cleveland…SoCal…Cleveland…Denver…

A funny thing happened along the way to the empty nest, though: everyone wants to return to Cleveland! Go figure. “The Heir” seeks a job, looking only in Greater Cleveland, while he contemplates grad school. Lil’bingo talks only of his return home as he contemplates a CF career. Even “Lovely Daughter” has extended her acceptable landing zone only as far afield as Pittsburgh.

Go figure.

4.) Crossfit Crossroads. I’m stuck. Stuck on a plateau. Feels like some 3 months or so now. Does this happen to you at all? It feels like a Crossfit plateau, but it might in fact be a much broader one. I’m not sure.

Outcomes, the right side of the ‘black box’, are pretty stale at he moment. No PR’s. Actually, if I look closely, my WOD results on repeats is ~10% worse. Hmmm…why is that? Diet? Not much changed there in any real way. Same foods in the same volume; same alcohol intake, + or -. Pretty much Main Page WOD’s done on the same days and with the same volume.

Psychological? Attitude? I’ve noted a bit more difficulty making myself go to that ‘dark place’ where Crossfit intensity is found, for sure, but nothing has changed in my workout environment (workout alone in globo-gym 2 miles from house and office). Stress? The grind of my day job? Perhaps. Changing my venue, going to an Affiliate gym might be the solution.

Am I sick? Do I have some sort of quiet, real illness that I am presently unaware of? You know, the Crossfit definition of health is “Health = Fitness; Fitness = Health.” Is my gym performance a proxy for my health? Coach would look here; maybe not first, but he would certainly say to look.

Or is it simply that I am now 51 years old, and that I have run the course of what I can expect in terms of continual fitness improvements through everything that is Crossfit. Coach has opined in the past that one can expect 10 years of improved fitness no matter when you start Crossfit, but I think he also said this was conjecture, and he said it some years ago. The curve must eventually flatten under the weight of age. Is this just a particularly long plateau, or is this the last flat spot before the slopes are no longer ascending?

I’ve always found the plateaus more confusing than either the ascents or the descents. You?

I’ll see you next week…

Posted by bingo at July 3, 2011 8:06 AM

There are only two kinds of people in New York City: Targets, and people who hit Targets. At Bellevue we took care of the Targets.

It’s the first weekend in July. For most people in America that means the 4th of July and everything that goes along with that. Barbecues. Fireworks. Festivals and ballgames of all sorts. And beer. Lots and lots of beer. But in that curious sub-culture of medical education the first weekend in July means the first time on call for newly minted interns and newly promoted residents and fellows of all sorts. Everyone and everything is new, just in time for July 4th and its aftermath.

Funny, but I ended up on call for every 4th of July in my four years of post-med school training. I’m not sure which, or how many, of the residency gods I offended, but whatever I did I apparently did in spades ’cause I hit the first weekend jackpot every year. I have no memory of my first on call as an intern, but the “Target Range” was open for business those first couple of years at Bellevue, for sure! In fact, if memory serves, the phrase “Target” was coined that very first weekend of that very first year as an ophthalmology resident.

“Hey Eye Guy! We got a John Q. Nobody who got shot in the temple just standing on the subway platform. Says he can’t see. Whaddaya want us to do with him? By the way…welcome to Bellevue.”

Crowds and beer and heat and stuff that explodes. Welcome to Bellevue, indeed. Some poor schlub survives the bar scene after the parade, makes it through pickpocket alley intact, gingerly stepping over detritus living and otherwise, only to get shot in the head as the A Train approached the station in a random act of anonymous violence. The bullet entered through the right temple, destroyed the right eye, and wreaked havoc in the left eye socket before coming to rest against the left temple. Right eye gone and malignant glaucoma in the only remaining left eye. And there I was, all of 3 days into my opthalmology residency, backed up by a chief resident of similar vintage. Whoa…

There’s no way to avoid it. After all, med students have to graduate and residencies have to start some time. There’s just this unholy confluence of weak links in the system all coming together in time for the second (after New Year’s Eve) most difficult ER day in our big, academic hospitals. Get sick or injured on June 4th? Everyone’s on top of their game and everyone’s in town. July 4th? The fix is in, and the game is as rigged against you as any carnival game attended by a dentally challenged carnie.

As I sit here, an Attending on call for the 4th of July weekend, covering the ER and cowering each time the phone rings, the Tweets and Facebook posts heralding the arrival of a new crop of interns and residents send me back to Bellevue. Year 2, cursed again, covering the spanking new 1st year ophthalmology resident (was it Dave?) as he got his welcome “gift” from the ER. “Hey Eye Guy. We got a Target down here for ya. 10 year old girl. Some dumbass tossed a lit M80 to her and she caught it. Went off before she could get rid of it;  blew off her right hand and looks like her right eye is gone. You from NY? No? Welcome to Bellevue, pal.” Yup…there’s something about the 4th of July in every teaching hospital in the U.S., and just like everything else, whatever it is, there was more of it at Bellevue.

Only two kinds of people in New York, Targets and people who hit Targets. At Bellevue we took care of the Targets.

It hits me on Tuesdays, Thursdays, and Fridays. Well, many Thursdays and Fridays, but it hits me pretty much every Tuesday, especially around lunchtime. That’s when my friend Ken and I would get together.

It’s funny, huh? I mean, Tuesday and all. You know… the whole “Tuesdays with Morrie” thing. I never really noticed that Tuesday thing until it was over. Tuesday was just the day that I usually operated, that I was usually done in time to hit the gym and then spend some time with Ken. Amy had mentioned last year that Tuesdays were a hard day for her since she had to work all day, and she wondered if anybody might be free to hang out. Tuesdays just happened to be good for me.

Some of my extended family and some of my other friendly acquaintances questioned whether this would be a good idea, at least for me. “Why would you spend so much time with someone, become a much better friend, when you know that they’re going to leave you? Won’t that just increase the heartbreak?” I always responded in pretty much the same way, that as far as I can see you can never have enough friends, even if a particular friendship has a pretty clear “expiration date”.

There’ve been lots of articles in all kinds of places recently, the Wall Street Journal, the New York Times, men’s and women’s magazines, about the fundamental differences between friendships between men and friendships between women. The “Reader’s Digest” version of these differences goes something like this: women have friendships that are face-to-face. They bond through shared feelings and emotions. Men have friendships that are shoulder to shoulder. They bond through shared experiences. All of this is probably true. If I look at my friendship history I would say that these descriptions are probably pretty accurate, at least for me.

Really good friends, the best of friends, probably have a friendship which includes both strategies. I think this is how it was for Ken and me for 22 months. The shared experiences thing was limited due to the extraordinary circumstances involved, of course. We hung out in the gym a little bit, enjoyed a few rides with the top down, and did the “guy picking out his new car” thing together. But mostly what we did was just hang out over lunch or over tea, thinking and talking about lives past and lives to come.

(Shrugs). We were just friends.

Now, I’m sure you’re wondering, what’s the point? Why am I sitting here listening to this guy in a bowtie talk about 22 months of friendship that were laid on top of 10 or so years of being friendly acquaintances? Fair question. (Smiles. Shrugs.). I think it kind of circles back to the way I answered those family members and friendly acquaintances so many months ago, a tiny lesson for all:  you can never have too many friends. 22 months or 22 years…you can never have enough friends.

Look around you. Take just a minute to look around you in the room of life. Look at the people sitting right next to you. Look at everybody else in the room. How many friends do you have? Real friends. People for whom you would change 18 years of your weekly pattern in order to cram in as much time as you possibly could with them, doing whatever. Not many, eh? Me either, frankly. 22 months or 22 years, shoulder-to-shoulder or face-to-face, a friend is just worth it.

Ours was a very private friendship. I don’t think Ken’s kids really knew what to make of this guy showing up every Tuesday, and I’m pretty sure that Amy felt that her Tuesday request had gone a little overboard! I’m not an awkward guy, a guy prone to social discomfort, but I admit to not really knowing how, or if, I should remain connected with Amy and the kids. At best we remain friendly acquaintances as we were before, and I apologize if my absence, caused by this awkwardness, is puzzling or uncomfortable. Honestly, I don’t really know how to play that. I AM open to suggestions, though! (Smiles)

In the end, as the doctor in us both expected, we ran out of time. Those well–wishers who were concerned about me in the beginning were absolutely right; I am heartbroken. I do miss Ken. I do miss my friend. But those well–wishers were also wrong because I am now MORE than what I was 22 months ago because of our friendship. In many ways we are, at least in part, a sum of our friendships. Through the lucky happenstance of my schedule and the generosity of his family, I got to be Ken Lee’s friend for 22 months.  It doesn’t matter when in life you get one, and it doesn’t matter how long you get to keep them, you can never have enough friends. I guess THAT’S why you’re here listening to this guy, just to hear that little message from me. And from Ken.

It hits me every now and again, especially around lunchtime, and especially on Tuesdays. 22 months of Tuesday’s. The 22 months when I had one more friend than I have today. 22 months that I would do over in a heartbeat, just like we did, even knowing how much it was going to hurt.

You can never have enough friends.

Sunday musings…

1) Oahu. Shout out to the CF Kids crew, including Lil’bingo, presently toiling away in Oahu.

2) Coca. Shout out as well to Coca Crossfit which hosted “The Heir” and his dad for a WOD. Doing Crossfit with your kids…priceless.

3) The sun. An apparently fictitious orb that fills the daylight sky and warms the earth beneath it. Not seen in Cleveland, Ohio for about 6 months now.

4) A college degree. Funny juxtaposition of “articles” in the Sunday papers this morning. There’s a long article on the “riches” of a college degree and a classic Doonesbury comic with college education competing with Google search. Funny, but enlightening, too.

Why do we go to college? Why did we EVER go to college? Back in the day, say when Grampbingo became the only member of his family to go to college, a degree was a ticket off the factory floor or out of the coal mines. Pretty clear pathway, and rather clear alternatives, but the college degree was still not all that terribly too common; lacking one did not preclude most job pathways except some professional ones. Indeed, the 50’s, 60’s, and 70’s were probably the heyday of vocational training and schools dedicated to that.

Fast forward to the present. Why do we go to college? Well, EVERYBODY seemingly goes to college now, and that seems to be pretty much the most accurate, albeit least instructive answer. But why? What is it that a significant number of kids are receiving while in college that prepares them for whatever? What do they gain in school that makes them better workers when they land their first, second, or even third jobs?

To be sure there are adult fields in which college is truly necessary. You know, like medicine, most engineering, teaching, stuff like that. But for many (most?) of our young people what they get out of college, and what employers get when they are done, is 4 (or 5, or 6) years older. The Al McGuire theory: the best thing about freshman is that they turn into sophomores.

After crushing his adversary with sub-second Google searches in the Doonesbury strip Zipper is asked the same question I posed above, why go to college? “Well, to party. That hasn’t changed.” Indeed.

5) Working. Work to live, or live to work? Is what you do who you are? I’m a doctor, that’s what I do in my day job, but is that what or who I am? Do I live, exercise, eat and sleep so that I can go to work, or do I do my job so that I can do that which otherwise makes me…me?

It’s not that simple, of course. Some jobs do, indeed, take on or become in some ways who we are. Sometimes this is truly a good thing, a kind of blessing. It’s that way for a bunch of Crossfit trainers, frankly, and it’s very much that way for the overwhelming majority of people who do what I do in my day job. It can be a not so good thing, too. It seems to me that there are an awful lot of folks who allow their job to define them, allowing it to be the walls of the silo in which they view themselves and from which they view the world around them.

In these situations the minutiae of the workaday world can take on a wholly outsized importance, usually on the negative side. Petty jealousies and insignificant, unintentional snubs can acquire manufactured importance and drive focus away from the task or customer at hand as the walls of the silo collapse ever inward. “Live to work” and “what I do is who I am” can be so inwardly focused that it’s not possible to do what you do well enough, because face it…what most of us do necessitates an OUTWARD focus. We have customers, clients, or patients, and doing our job means extending the focus on THEM rather than us. Manufactured importance begins to trump real stuff. Like doing your job.

Live to work; work to live. I think part of this is just a version of the classic “what do you do?” story. You know the one: if you ask someone “what do you do?” and they are from anywhere other than California, they will tell you what JOB they do. Ask most Californians, however, and you will get something along the lines of “I’m a poet” or “I like floral design” or ” I surf” or “I mountain bike.” Stuff like that. These folks go to work, do their job, and it seems to me often do it better, with quantifiably less focusing on the minutiae of their job and how THEY feel about their job…and then they go skiing.

Live to work? Work to live? What do you do?

I’ll see you next week…

Posted by bingo at June 26, 2011 6:35 AM

Sunday musings (Father’s Day edition)…

1) Definition. Father. Answer below.

2) CDC. Physicians are little more than paid observers. Doctors are adept at pattern recognition. The best among them are tuned in to nuance, able to see not only the pattern but any tiny anomaly, however small. Anywhere.

I was in church this morning with my original nuclear family, celebrating Father’s Day as well as my Dad’s 80th birthday, when I notice a wrinkle in the pattern. The priest and all of the Eucharistic ministers snuck into a corner of the altar and used surgical disinfectant prior to giving Communion. Sort of like just before I enter the OR. Never saw that before.

I don’t know about you, but that kinda takes away a little of the mystery and majesty of the transfiguration, dontcha think?

3) Father’s Day. My brother, sisters and I joined Grambingo this weekend to surprise Grampbingo for Father’s Day and his 80th birthday. We are seriously fortunate to still have him. For goodness sake, all this bleating about how terrible American health care is would come to a screeching stop if the sheep just met my Dad. Bypass in 1985. Diabetes that he ignored for years. Kidney cancer in 1994. The guy is a walking scorecard for our healthcare system.

Says here it’s up to par.

4) Fatherhood. Are you a Dad? What are you doing today? I’m having a weird Father’s Day, at least for me: I haven’t seen any of my kids yet. Father’s Day for me has always been a day when I had permission to fully engage in the business of being a Dad, and it’s strange to not lay eyes on my gang yet. (“The Heir” will pick me up at the airport).

Here’s the part where the definition comes in. All it takes to father a child is viable genetic material that makes a journey of some sort or another, and joins up with someone else’s genome. Heck, nowadays neither someone even has to be present. Indeed, the coldest, most clinical definition of “father” requires no clicking of the “add location” button at all.

Not much that’s warm and fuzzy about that, eh? That, of course, is exactly the point. Father’s Day is about celebrating those among us who have actively engaged in the participatory sport of parenting. BEING a father requires connection, and in general the more the better.

On the front end of this safari to Rhode Island I had dinner with a friend who just moved back to Little Rhody, mostly to be closer to his daughters. Not a perfect move for any aspect of his career, nor all that great for his personal life, but nothing short of spectacular for his role as a father. He is simply more THERE now. I should have told him how proud I was of him for that part of his move, but I think he knows.

We probably can’t change today’s name, maybe “Dad’s Day” instead of “Father’s Day,” but in a nutshell that’s my actionable definition of “Father”, one who is active in the pursuits associated with being a Dad. Little League practice instead of 18 holes; another soccer game at 0800…in the rain; ice cream cones at that little shack instead of beers with the guys at the game.

Being a Dad is hard work to be sure, but it’s also good work. We can, and should, choose this whenever we get the chance. Grampbingo did, and that’s why it’s 1:30 and I’m still 3 hours from my first hug from my own kids, as I give my own Father a bonus weekend to actively be my Dad.

So Happy Father’s day to each one of you Dads at the Crossfit table. And Happy Father’s day to Dick White, my Dad. How lucky I am to still be able to say that.

I’ll see you next week…

Posted by bingo at June 19, 2011 10:33 AM

I stand by the side of the road, wide-eyed in amazement, alone despite the fact that I am surrounded by other spectators. We are watching a parade, a great spectacle to celebrate the apparent dawning of a new age in cataract surgery. One after the other they pass me, the great and famous experts, the Emperors of ophthalmology. Each one sits upon a throne surrounded by bags filled with the coin of the land, the thrones built upon the newest fashion, a femtosecond cataract laser. The rest of the crowd is dazzled; they stand in silent awe as these men with such magnificent reputations usher into the kingdom the latest fashion.

I blink once. Twice. I cannot believe what I am seeing.

Over the millennia there have been thus far three truly revolutionary advances in cataract surgery (a cataract is a clouding of the natural lens in our eye). The ancient Egyptians, and for all we know Ancients of many other sorts, “cured” cataracts through a procedure known as COUCHING. Using a thin bamboo reed the “surgeon” punctured the eye and simply pushed the opaque lens into the gel–filled open cavity in the middle of the eye. Not terribly elegant, but if the eye did not become infected it actually dramatically improved vision in the days of the Pharaohs. This was the original cataract surgery.

The advent of very fine suture material and magnifying glasses brought with it the development of intracapsular cataract surgery. The eye was entered through a large sterile surgical incision and the cataract was removed as a whole. After the incision was closed with these rudimentary sutures it was necessary for a patient to remain stationary, her head held still by sandbags for a week. As barbaric as this sounds today, this procedure, along with cataract glasses, dramatically improved both the safety and the visual results of cataract surgery. Revolutionary change number 1.

Intracapsular cataract surgery was followed by extracapsular cataract surgery, the procedure made necessary by the creation of intraocular lenses. These tiny implants, less than half the size of a dime, are implanted in the capsular bag left behind after the inner workings of the cataractous lens had been removed; think of it as filling an empty grape skin. Better vision, greater safety, and with the addition of mechanical assistance extracapsular cataract surgery also brought efficiency and speed to cataract surgery. Clearly superior, the extracap supplanted the intracap, and during a time of transition both procedures received identical financial coverage from all forms of health insurance. Revolution number 2.

What followed next in ophthalmology was probably the predecessor of all that we have come to know about the intersection between commerce and care in American medicine. A certified genius who was so sure that he was right that he simply did not care what any of his colleagues– indeed what any ophthalmologist at all–thought about him or his invention, introduced  phacoemulsification. Charles Kelman discovered that you could remove a cataract of any size through an extremely small incision by first dissolving it inside the eye with high–frequency ultrasound. Kelman was initially viewed as a heretic, and early adopters of phaco technology were scorned by the ophthalmic orthodoxy. In response they marketed phacoemulsification as the superior procedure that it was, further enraging the establishment by becoming wealthy and famous through the efficiency and efficacy of this surgical revolution.

Once again, during the time of transition from extracapsular cataract surgery to phacoemulsification, both procedures were treated equally in the eyes of health insurance, and every patient’s surgery was paid equally with either technique. Revolution number 3.

As phacoemulsification gradually ushered extracapsular surgery into extinction in the 1980’s there began an era of relative tranquility in the world of cataract surgeons. There was very little to distinguish one surgeon from another save for gross incompetence, a complication rate so far outside the norm that it could not be ignored. How could this be, you ask? Well, all of the intraocular lens implants during the initial part of this era were essentially the same. Each lens development, each evolutionary step however big or small, was quickly adopted by the overwhelming majority of surgeons, and pretty much every cataract surgery patient received a state–of–of the–art implant for her surgery. The SURGEONS surely knew who among them was better. They knew who was faster, slicker, more elegant, and dramatically less likely to have any complications whatsoever. But even the most astute patient was incapable of knowing the difference between a 20-minute cataract surgery and a five-minute cataract surgery, one plodding and clumsy, the other elegant and quick, so powerful was this new technology. Every cataract surgeon in America could, and did, look their patients in the eye and say their outcomes were essentially the same as every other surgeon; they, themselves, were just as good as every other cataract surgeon.

This happy time of peace, love, and tranquility came to a screeching halt in 2003 with the introduction of an implant called the Crystalens. Here, for the first time, the cataract surgeon was able to give his patient excellent vision at any and all distances WITHOUT WEARING GLASSES. The problem, though, was that the Crystalens was actually rather tricky to insert. You really DID need to be more equal then your surgeon peers in order to get this extraordinary outcome. Not only that, but the implant was almost 10 times as expensive as what now became known as standard implants, it required roughly 3 times as much work preoperatively and postoperatively to achieve this outcome, and all of a sudden there was a very clear division between cataract surgeons. There were those who did what became known as premium surgery because they could, and there were those who didn’t.

Surgeon Emperor’s rode on their thrones through the throngs of what once were their peers, adorned with wondrous capes and crowns they so deservedly wore for they were truly better surgeons, and they were paid more to do this premium surgery. For you see, a great change had occurred:  the health insurance companies did NOT view these new implants as equal to those in present use, and in their wisdom they allowed patients to pay with their own money for these more expensive lenses. This they did, though not in great numbers, just enough that it started to become clear that some surgeons were more equal than others. This was not a true revolution in cataract surgery itself, only the economics of cataract surgery.

So here I find myself, one of these Lesser Surgeon Emperors of the premium implant era. I stand among the crowd as this very small group of self–proclaimed Greater Emperors glide by, pulled along on their grand femtosecond chariots. They are declaring, loudly and to anyone who’ll listen, that laser cataract surgery is the fourth great revolution in the long history of cataract surgery. “It’s more accurate,” they declare. “It will make cataract surgery safer!” They cry. “It’s the next, mandatory step in premium cataract surgery. It’s well–worth every penny of the additional $1000 the premium cataract patient will pay,” they state as they preen on their perches.

I blink as I stand there. Something’s not quite right. The rest of the crowd cheers these magnificent creatures but still something seems wrong. A better, more accurate and uniform capsulorhexis (the initial opening into the cataract)? That doesn’t seem to be a problem with premium cataract implant surgery today, at least in the hands of the best surgeons. Better sealing wounds to decrease the number of post–operative infections? Again, the busiest, highest volume, best cataract surgeons already have the lowest infection rates in America. A simpler, more reproducible and accurate limbal relaxing incision (a technique to treat astigmatism)? Well, I HAVE heard that an inability or unwillingness to handle astigmatism IS a barrier to implanting premium cataract implants, but that doesn’t really seem to be much of a problem for those surgeons who are successfully using them now.

I blink once again and then it hits me: the Emperor Surgeons have no clothes! They are parading right in front of us, declaring the femtosecond laser the proverbial silk purse to be utilized as part of a premium service, carried only by those cloaked in the finery of the court as they have been told by the industry courtesans.  Femptosecond laser cataract surgery is a revolutionary step, but it is a premium service like the Crystalens, and is properly utilized only by Emperors.

They are right but they are also so very wrong.

Blinded by the hype, blinded by the glow of their reputations, by the industry courtesans as they wave their empty clothes hangars, the naked Surgeon Emperors are trying to MISS the fourth great revolution in cataract surgery, because femtosecond cataract surgery is not a silk purse, it’s actually just a better backpack! Femtosecond laser cataract surgery is the technology that reestablishes real equality among cataract surgeons. It is not the scepter of the Greater Surgeon Emperor, it is rather the butter knife of the common surgeon.

Think about it. The best cataract surgeons in America are not having any difficulty making a proper capsulorhexis, and they are obtaining over–the–top outstanding outcomes with literally every single type of intraocular lens available. These are not the men and women who are having outbreaks of endophthalmitis (a total eye infection) because of poor technique creating their incisions. We are not seeing an epidemic of untreated astigmatism in the population served by these extraordinarily talented surgeons, especially in those eyes that have received a Crystalens or other premium lens implant. The femtosecond laser as a necessary, mandatory tool to improve the outcomes in THIS group of surgeons performing premium service cataract surgery? Please. The incremental improvement in outcomes will be infinitesimally small in this group, and I will go out on a limb and say that any of the Emperor Surgeons in the parade who are truly among this group of noted surgeons would tell you just this.

No, femtosecond laser cataract surgery is the next great revolution in regular, garden-variety, standard implant cataract surgery performed by the middle–of–the–Bell Curve cataract surgeon. Here is a quick story to illustrate my point. An 80-year-old man had cataract surgery performed in his right eye by one of the most deservedly famous cataract surgeons in the United States. Perfect incision. Perfect capsulorhexis. Limbal relaxing incisions that reduced astigmatism to 0. Every single aspect of the operation that would have been impacted by the femtosecond laser was performed flawlessly. The outcome? Not so great, actually. The patient had a poorly positioned implant causing blurred vision, which was not discovered for approximately 9 months due to postoperative inattention. This caused him to be greatly unhappy with his result and ultimately causing him to seek another surgeon for his left eye even after the blur was fixed.

This new surgeon simply could not be more different from the world famous surgeon. A very kind and gentle soul with a lovely and caring bedside manner, he was at best deeply buried in the middle of the surgical Bell Curve. The outcome? Not so great, actually. A poorly done capsulorhexis prompted him to default to a much older lens implant, a clear technological backward step, and a surgical problem that would clearly be prevented with the use of the femtosecond laser.

So my friends, the femtosecond laser actually IS the fourth great revolution in cataract surgery, but the Greater Surgeon Emperors are failing to see that, like intracapsular to extracapsular, and extracapsular to phacoemulsification, phaco to femtosecond is a revolution for the masses. The femtosecond laser will make an average cataract surgeon a good one, a good cataract surgeon a very good one, and a very good cataract surgeon potentially a great one. It will do very little for the outcomes of the already great cataract surgeon. Oh, there may certainly come some new type of implant where the outstanding surgeon will require a femtosecond laser in order to properly use it, but as of this moment that particular widget doesn’t exist. The femtosecond laser is a technology looking for a use, an investment looking for a market. Will it find its place only with the Emperors, those who should be leading, now instead just riding behind?

The greatest of Emperors lead.  If I am right, if this is actually a technology which will make regular cataract surgery safer and more predictable, Surgeon Emperors and their industry minions should be pounding the streets of Washington to make this fourth revolution just like its predecessor: available to all. They should call it as it is, the average surgeon’s pathway to greatness. They should lead on behalf of every 80-year-old man who deserves a perfect capsulorhexis and a perfectly created wound to go along with his most modern standard implant. They should lead their surgeon brethren on behalf of their people. The greatest among these Emperor Surgeons will see nothing that is negative happen to them if they fight to make femtosecond laser cataract surgery just the next revolution in every day cataract surgery.

I blink. I wait for one of these Emperors to put on some clothes, get out in front, and lead.