Eye surgery paid well, interested me, challenged me, and rewarded me. But it did not ‘fit’ me. My selection of oculoplastics came as close to perfection as was possible within the choices available. It suited me much more than any other subspecialty of ophthalmology, or a general eye surgery practice. The field offered more room for creativity, more incorporation of esthetics, and (frankly) more room for error. If you operate inside an eyeball, precision counts above all else. A fraction of a millimeter can make the difference, in some cases, between success and functional blindness. The preoperative examination and postoperative care require equal attention to detail. With surgery around the eye, rather than inside it, you do not need to be so compulsive. There is more need for judgment and innovation, and less need for machine-like accuracy. That matched my skill set better.

The problem for me did not come down to dexterity. It had more to do with diligent attention to detail. That is just not my strong suit. Since I left medicine, doctors have diagnosed me with ADD (attention deficit disorder). Long before receiving the official diagnosis, however, I knew there were problems with forgetfulness and inattention. They say that ADD might be more appropriately named ‘selective attention deficit disorder’. I explained to the psychologist who administered the ADD tests that I never had trouble focusing during surgery, but that pre-operative preparation and post-operative follow-up involved a lot of details that caused me problems. She told me that my experience fit the classic ADD model. When the adrenaline surges through my system, I am capable of intense concentration. But when the pressure lessens, my mind wanders.

So working as a doctor of any kind (which in most fields requires keeping track of myriad facts and countless essential tasks), not just as a surgeon, usually stressed me out. I struggled constantly to make sure I did not overlook some crucial clinical finding, forget to order a vital medication, omit filling out the form for a key lab test, or fail to direct the patient to return for the proper follow-up. Relating this now embarrasses me. It is only in hindsight that the problem looks so clear. While in the field, I did not allow myself the luxury of admitting my weakness. I just powered onward, and did the best I could. Sedulous care was most exhausting and difficult while in training, because I was inexperienced, and few of my professors bothered to check up on us (surprising, isn’t it, that trainees were not watched more closely?). Once out in practice, I could do a lot by rote, and the staff I worked with quickly picked up on my need for others to help manage the details and paperwork. I did a fantastic job with diagnosis, planning, and surgery. But remembering all the countless peripheral components that go into taking care of patients never came easily. And relying on your helpers to catch your mistakes is destined to fail sooner or later.

I had talent as an oculoplastic surgeon. Patients were referred to me from wide areas, repeatedly by the same doctors. Some even told me my reputation was stellar. The errors I made were no more common, I don’t believe, than those of most other eye doctors I knew. But if you overlook a crucial detail, it looks really bad. If you perform an unnecessary operation, or decide not to operate when surgery would have been better for the patient, people may disagree. Nevertheless, they won’t look at you the same way as if (for instance) you operate on the wrong eyelid. (There: I revealed it—my most public and shameful mistake.)

So in a sense, losing my ability to perform surgery may have been a good thing in the long run. It certainly reduced my burden of stress. It saved more patients from being harmed by my ADD. Even though there were only a few times that my tendency to lose focus caused significant harm to those in my care, every one of those mistake haunts me to this day. Yes, it is easy to come up with justifications. For instance, I remind myself that all physicians make errors. My view has always been that the type of blunder reflects the individual doctor’s personality. Some people make mistakes because they refuse to recognize their limits, and take on cases for which they lack adequate talent or preparation. Conversely, some surgeons are too timid, and hesitate rather than accepting necessary challenges. Some rush, and make mistakes by going too fast. Some are terribly slow, and needlessly prolong cases, increasing the chances of infection or other complications. Not a few just have poor clinical judgment. And so on. My mistakes came from a genetic inability to keep track of details. Frankly, I don’t think my missteps were any more frequent or severe than those of most surgeons in my field, but errors of forgetfulness are glaring and impossible to explain away. And even though I have run all these tapes about how ‘everyone makes mistakes’ countless times in order to feel better about my errors, in the end there is no valid excuse for injuring patients.

In my day, and probably still, no one ran aptitude tests to help medical students choose the right specialty. I knew of doctors who made it all the way into a field like ophthalmology, where you simply have to have good depth perception, only to find out they had none. We were never assessed for manual dexterity. If you were a good student you could do whatever you wanted.

I liked the eye. The first time I looked at a human eyeball through a ‘slit lamp’ (the clinical microscope used by eye doctors; you know the type: you put your chin in a little cup while a bright light flashes in your eye), it literally took my breath away. I thought the eye was one of the most beautiful sights I had ever seen, like a faceted jewel or the most intricate flower. I once wrote a description of that first view; and I have made it available on the ‘MemoirShards‘ page of this site. That piece came out of the fact that looking at that first living human eye through a microscope stands as a landmark day in my life. The way the eye’s beauty thrilled me led me to be an eye surgeon. But it may not have been the best way to select a specialty.

My instinct told me to become a psychiatrist. When the time for choosing a direction arrived, I had yet to develop the mental health history I now have. There was depression in my background, but I had never been hospitalized, and never given medications. But both my mother and my sister had been through the ‘mill’, and the subject fascinated me. The brain held more intellectual interest for me than any other organ. (The retina, by the way, develops as an outgrowth of the brain. Studying its circuitry in graduate school laid the groundwork for my later connections within ophthalmology. It is not an exaggeration to say that the retina is actually a subunit of the brain.) I also had a natural facility working with psychiatric patients. They did not scare or repulse me, as they did some other students. I found them interesting, and their plights deeply touched me. I connected well with those on the psychiatric unit, and seemed to be able to bring them comfort.

But ‘eye surgery’ had more cachet. It paid better, seemed more technically sophisticated, and attracted more driven and competitive students. Always one to look for a chance to enter a contest and win, I couldn’t resist. Plus, the research in ocular cancer that I did as a medical student went quite well, and the eye surgeon/professor who guided me had an international reputation. He mentored me, complimented me, and persuaded me to enter ophthalmology. I ignored my ‘heart’, and my natural talents, and did the more impressive, ‘ambitious’, and expected thing.

What can I say? When young, we make poor choices. By the time I figured out my mistake, so much work and time had been devoted to becoming an ophthalmologist that it seemed like it would be stupid to switch. So I motored on, and chose the field within ocular medicine that suited me the best. I did well, got a lot of recognition, and actually enjoyed the work. But it never ‘fit’.

Worse, I knew going in that my family has a strong history of severe arthritis. The emotional stress of working so hard to avoid forgetting things, and the physical stress of operating as much as I did, led to a liability for my neck that it could not sustain. My spine failed me, and I had to abandon the career. That led to my psychiatric collapse, from which I have been recovering for a decade. I am now better, but permanently marked as a ‘mental patient’. And my body has been irreversibly scarred by the medications.

Sometimes I think this is my retribution for the mistakes I made as a doctor. If so, then I have paid my dues. The distress I experienced from the shabby way several mental health clinicians treated me, and the horror I felt watching my body get wrecked by psychotropic drugs, have been so great that I don’t think I need to undergo any more ignominy or torment to balance the scales. This feels liberating.

So I have a clean slate. The old me has been burned. The silly arrogance, stupid misdirections, careless errors, and exaggerated drive to win have all been incinerated. I am free. Crossing that wobbly bridge from a high powered surgical career to permanent psychiatric and physical disability took a long time, and nearly drowned me in regret, humiliation, and grief. But I am still here. Crucially, I have forgiven myself. I am still marching forward into the mists of fate, and have not jumped over the edge to avoid them.

This essay, this baring of my defects as a surgeon, would not have been possible ten years ago. Now that I have been so long out of the field, and can look back with objectivity, I see things far more clearly than I did at the time. And I no longer have a reputation to uphold. I can be honest. I did much good as a surgeon: most of my post-cancer reconstructions, for instance, came out exceptionally well. But the whole time I spent in practice, I lived in fear of that critical mistake. Now it is all in the past. As devastated as I was on that day I described in my last post, the day I knew that a decision during surgery had been dictated by pain rather than clinical judgment, the day I knew the only ethical choice was to stop operating, as frightened as I then was, I now realize that everything I went through had to happen for me to be released from bondage. Losing my career was inevitable for many reasons. For my sanity, for the benefit of those patients who might have suffered harm because of my ADD, for my neck, and for my enlightenment.

I hated the bottomless despair of the past ten years. It felt like hell to spend my nights awake in anxious terror, feeling the disgrace of my weaknesses and failures becoming public knowledge, knowing I had lost every shred of status and all sense of financial security, and eventually watching critical parts of my body get destroyed. But now I understand. I get the point of suffering. I know that life is not all about having things go well, about ‘winning’, about getting what you want. We are here to learn. Some of us are destined to suffer more than the average amount of anguish. In the end, if we survive, we have more empathy for others, and for ourselves, than we could have found any other way. My emotional privations and my public defeats brought me to what I consider a ‘wisdom’ that always eluded me before. They cleansed me and brought me peace.

This relief sculpture by Eric Gill reminds me of the best of Christianity. The purification by suffering, admission of sinfulness, and acceptance of divine forgiveness, are what I have needed to get to this point. Even so, I do not know if I consider myself Christian, although for a time after my ‘visions’, I most certainly did. Christ came to me in a concrete form, and rescued me from my torments. If I had been able to maintain my faith, I might have been spared the descent into hell that followed. Looking back, I suspect my soul needed a period of intense suffering to allow myself to accept absolution. I needed to pay for my mistakes as a physician with poor attention to detail, and atone for wasting my God-given talent by choosing a career based on ambition rather than a mission of helping others. Perhaps I needed to feel the sting of punishment before I could accept the tenderness of forgiveness. However it came about, on my best days I am serene, accepting, and grateful for the trials I’ve survived. What greater blessings can we ask from life?

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I am almost sorry about yesterday. What a discouraging post! I say ‘almost’ sorry, because my goal here is to be honest about what goes on in my world, inside and out. I don’t want to hide my moods; certainly not the positive ones, but not the depressed ones, either. If I don’t watch it, my text drifts into the arid desert of analysis and logic, and away from the messy emotional compost that nourishes my more heartfelt writing. Personally, I find too much issue-dissection boring. Life is as much about what the heart feels as what the brain thinks. States such as passion, affection, sorrow, euphoria, fury, and desperation often look disorganized and senseless. If I am to be authentic, and open about my inner experience, sometimes I will sound wretched. (Another reason I’m not too regretful is that I received such nice, supportive comments!)

My feeling life gets tossed about by frequent typhoons of sadness and despair. Although the cloudiness alternates with brighter moods, including pressured winds of optimism and plans that soar high above firm ground, I never venture far from the shade. Until recently I called my storminess ‘bipolar disorder’, and my bleakness ‘depression’. At this stage in my life I find it more helpful to consider myself a bit temperamental, mournful, and sensitive, but to pitch the illness concept overboard. Whatever you name what I’ve ‘got’, however, I am never long on an even keel, and I spend a lot of time in the stagnant duldrum of hopelessness.

So if I am going to write with feeling, which makes more interesting reading than pure logic, there will be times when things sound a bit unhealthy. Self centered. Whining. Self pitying and immature. I hope the less uplifting posts will alternate with essays that climb toward ecstatic observations on the spiritual underpinnings of biology, or pieces that animate the possibility of utter contentment in the face of chaos and loss.

I could make the decision to censor ‘ugly’ material out; I could make myself always sound spiritually fit and possessed of wisdom. But I have given this thought, and my goal in this blog is to tell a story of life. Not just my own history, though that forms the basis of most of my ideas, but the larger story of life as a damaged human being. An injured person may have days when everything ‘falls into place’. On such days every insult, each wound, and the countless pangs of grief, are recognized as openings rather than cuts. The awareness blossoms that such fenestration widens the eyes so they can see more beauty, and expands the heart so it can offer more love. But most of us with hellish memories also suffer times when the vision clouds over, and the heart cramps into a lonely knot of muscle, unable to accommodate more than the thinnest stream of blood.

Even Jesus, we are told, had moments of doubt in the garden of Gethsemane. My spiritual development is as close to that of Jesus (or the Buddha’s, or Gandhi’s, or Mohammed’s) as a flea’s heart is to an elephant’s. So for me, at least, perfect and perpetual equanimity remain out of reach. I suspect this to be true of all but the most determined and fortunate of those who are raised deprived, assaulted and hated instead of nurtured, protected and loved. When children suffer overwhelming losses, they grow up with infinite feelings of want. When they are attacked, they learn to expect the worst. And when despised, they learn to hate themselves. Such lessons take a lifetime to unlearn. On the best days, one gets blessed with a radiant comprehension of life and its full panoply of emotions. One understands that joy, love, anger, and grief are just different directions that the same wind blows. One feels the uneven but never-ending currents of time, space and fate flow like God’s blood through the mind, body, and soul.

But there will also be days when it all looks like a lump. At those times the injuries seem too great, the loneliness too imminent, the joy too sparse, for life to be worth living.

I have my saintly moments. But they are not as common as my darker days. I am not offering a cure in this blog. I am not presenting my path to recovery as a method others can follow and find salvation. That would be a lie. My path has not proven to be direct and unerring in leading me to peace. My commitment to well-being wavers, and sometimes I just break down and cry.

That is the story I want to tell. The entire canvas, including the splattered and shredded edges that often get hidden when one uses an elegant frame. This is my life nailed to a tree. It is not hanging in the Met, or bound in the rare books section of a major library. It is a mess. But it is sometimes beautiful, often interesting, and it is all I have to offer.

My aim is not to lead people to think I always view life as a precious jewel, which I certainly don’t. Or that I am living the perfect story of recovery, which will never be the case. I choose instead to present the days as they strike me, the ideas as they arise, and the emotions as they crash over my bow.

Yesterday I was a shipwreck. Today I feel more like the transom of an ancient wooden fishing boat I once found on the beach in San Francisco. The varnish had at one time been shiny, and the wood had formed part of a stout and working vessel. What I found had turned into a labyrinth of splinters and warps and cracks. The paint that once proudly announced the boat’s name could barely be deciphered. But that piece of wood had an elegance it had never known when it was still functioning as a beam across the stern of a trawling watercraft. Time and catastrophe had etched it with a fineness that it seemed to want to share with me. So I took it home and put it in my garden.

This is my transom. It is wrecked, and not all of it will be beautiful. But I want to share it with you. Feel free to place it in some corner of your garden. Let the moss grow over it, and let the ants move in. Or burn it and toast marshmallows. It is my gift to you and to the world, if you want it. It will not always be attractive, or even inspirational, but I will try to keep it authentic.

So I don’t apologize for whining, even though I’m embarrassed. Yesterday, I was a lonely and discouraged child. Today I am an inept but enthusiastic poet. I am sometimes enlightened. I am often discouraged. But most of all, I am alive. And good or bad, upbeat or down, this blog is helping me stay that way. I pray that it helps you, too.

(I modified this post on 2009 August 28, c. 07:30 PDT, primarily in the first paragraph, but I changed a few other spots also.)

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Wow! There are so many mental health blogs to read. It’s enough to make an insecure manic-depressive jump off a cliff. How can I possibly stand out in such a throng?

Oh well. I’m used to being put in my place. If this past decade had a purpose, it was to teach me humility.  Where once I could tell people I was an oculoplastic surgeon, all I can say now is that I have started a blog. Well, who hasn’t? I’m trying to show up in mental health circles on the internet. I read the successful blogs about the subject (I’d read less successful ones, but how do I find them?). Since I always think I have something to add, I post lots of comments. I keep plotting a direction for my own work.

As I write my comments, It seems inevitable that one of my insightful observations will attract attention, bringing readers back to my own site, but no luck so far. Maybe the comments aren’t all that insightful after all. Inevitability inevitably fails.

It’s not easy being a psychiatrically ill former physician (is it easy to be any kind of human?); I feel like people should take me seriously, just because I was once successful and my history is fairly unique (you’d probably agree if you knew even half of it). But in this society the question often is simply, “what have you done lately?” Watching my past glory fade into my current obscurity hurt for a long time, but not anymore. I now feel happy to be free of the pressure to compete. It is a pleasure to be an ordinary human, and not worry about trying to be better than others.

On the other hand, I would like my message(s) to get out. If I could get someone to listen, I think I have important stuff to say about mental illness and psychiatric care. Maybe my experiences would help others. Maybe they could avoid my mistakes, and reach happiness sooner. Nothing would please me more than having someone struggling with mental illness derive benefit from my history.

Believe it or not, I used to think it would be kind of cool to have a bipolar I diagnosis. So much more interesting than ‘mere’ depression. It pleased me when I started to come out of my manic psychosis/religious ecstasy and I realized that I was now officially manic-depressive. I had always read about bipolar artists and writers, and I was happy to join the club. Pretty naive, don’t you think? I now realize that many people are frightened and turned off by mental illness. I understand that it looks like weakness to others (even though I know it takes strength to survive the storms of emotion that come with bipolar disorder). I see now that it might have been better to hide my psychiatric problems. But I already  told everyone who would even half listen about my religious ‘delusions’, my hospitalizations, medications, and so on.

Since everyone around me knows the story, whether they wanted to or not, I figured I had nothing to lose by starting a blog. So what if the whole world knew my story?

It is now obvious that the whole world could not care less. There are so many bigger problems, more famous people, and better writers. Not to mention more than a hundred million blogs! (Or is it two hundred million?) What’s a poor former surgeon to do?

Keep writing. Keep hoping. Keep living.

I am prepared to fulfill my mission–to bring light to others with mental illness. But will anyone ever hear me? What can I do to make it happen?

Keep writing. Keep hoping. Keep living. My new motto.

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