Guamology Interview for World Peace, a Blind Wife, and Gecko Tails

I was interviewed about my book back in 2009 by Kel Muna, a film-maker, and host of the Guamology.com website. Since then, Guamaology has gone off-line, as Kel has become busy planning the Guam International Film Festival. I enjoyed the interview, and thought I'd post it here since Guamology is no longer around.

World Peace, A Blind Wife and Gecko Tails. It's such a great title. How did you come up with it? Did you have any alternate titles before settling on your final choice?

As I was having friends review the book, I'd ask them, "What is this book about?" and the typical answer was that because the pieces covered a potpourri of subjects, the title would have to be reflective of that. I also wanted the title to be a bit intriguing and memorable. Someone suggested that many of the pieces were about world peace, so that became the opening of the title. The blind wife and gecko tails are references to specific pieces in the book. I also wanted to give reference to our tropical location, and that's why I chose "Gecko Tails" as part of the title. My first thought for a title was simply, "Thoughts from an Island".

How does it feel to know that Blind Wife is required reading for sociology students at the University of Guam, where before Blind Wife it had been Mitch Albom's "Tuesdays With Morrie"?

Honestly, I'm a bit stunned. I'm always surprised when someone tells me that something I've written is meaningful to them. I receive the reflection papers that the students write after reading the book, and it's both rewarding and humbling to know that something I've written has in some way touched someone's life. "Tuesdays with Morrie" is such a powerful book. I can't really get my head around the fact that Blind Wife has displaced it from the reading list.

I understand that Blind Wife is a compilation of all of your most popular columns from the Saipan Tribune. When and how did you come to write for the paper?

I started writing for the Tribune as a columnist in 2004. I had wanted to be more disciplined in my writing, and I felt like having a weekly deadline would help. I also am a curious person by nature, and like to pull ideas from various places, so the column provided me a place to share the things I was learning or thinking about.

When did you get the idea and interest of turning your columns into a book? How long did the process take to put the book together?

The book came about as a result of panic. About a year before it was published, I decided to take more time off from work and write a book I had been thinking about for some time. I had given a series of talks on the subject of establishing unity in communities. People told me that I should turn that into a book -- "7 Habits of Unity" or something like that. So I took time off to write this book, but really didn't have a clear idea of where I was going with it -- the tone, the audience, the purpose. And because of this uncertainty I began to have all kinds of personal doubts and misgivings while trying to write it. I spent a lot of time just staring into past my computer screen into space. After nine months, I realized that the year was coming to a close, and I had nothing to show for it, and that I'd feel like a total loser if the year ended and I hadn't published a book. So, I realized I could pull together my columns, which were already written and which had been well-received in the community, and publish them. So this book came about because I wimped out at writing the other one.

Your writing style is very easy to relate to as well as reflective. Did you have a formal education in writing?

I got the same training that we all get by virtue of going to school. I didn't take any special writing courses or workshops. But I did have some terrific teachers who taught me the value of re-writing, and the need to read your own writing out load to make sure it makes sense and that it flows. One of my comparative religion professors had a journalism degree, and he emphasized the need to write clearly for a broad audience, even in a term paper. So, I think that's where the conversational tone of my writing comes from. I also believe in being authentic. Even though at times I write about some lofty principles (like being truthful 100% of the time, or not dwelling on the faults of others, or eating well and exercising daily) I know it's difficult, because I fail with the same struggles. I try to make sure I'm conveying that I know I'm on the same human level as my reader.

How did you decide on the number of entries to include in the book? Did an editor choose for you?

I wanted to have about 50 pieces, just because it was a nice round number. I went with 52, because that's the number of weeks in a year, so it's like a year of columns.

Your writing style and reflection of topics are uplifting and the overall tone reminds me of one of my inspirations, Seth Godin, a blogger who totally thinks outside the box. What is your source for inspiration when it comes to writing your entries?

I've never really thought about this before. I think my writing is just a reflection of me, my thoughts, my surroundings and my responses to them. So, in some way, the answer to the question of what inspires my writing is the same as what inspires my life. The biggest sense of inspiration for me is a conviction that the world is moving inexorably toward a fully integrated global society, and that the social structures of old are crumbling, making way for new paradigms, and ultimately for a spiritually rooted civilization. That's what I see when I see the current economic collapse -- the collapse of a system that was not based on sound spiritual principles, and so, it's collapse provides the opportunity for a new, more holistic one, to emerge. The source of this mindset and this perspective -- this overall optimism -- is my exposure the the writings of the Baha'i Faith. Check them out. They are revolutionary both in terms of social organization and human relations, and in terms of the individuals relationship to his or her own existence. www.bahai.org.

Do you get writer's block? If so, what do you do to get over it?

I do have difficulty writing at times, but I don't like to call it "writer's block" because that phrase formalizes the simple fact that at times, everything is difficult. It turns it into a monster. I mean, there are some days I don't want to go to work, but I don't call it "worker's block". That's just an excuse to stay home. "Sorry, can't come in today. I've got worker's block." The best way to get over difficulty writing is to write. It's that simple. As one writer has succinctly phrased the remedy, "ass to chair".

If you had to choose only one favorite entry from your book which one would it be and why?

That's a little like being asked, "of all your children, which is your favorite?" Because the pieces are so diverse, can I pick a favorite from a few categories? Of the serious pieces, my favorite is "Thoughts of a Father" which is what I wrote down while awaiting a diagnosis of cancer in my six-year old son. It was a very personal piece and a very raw reflection of the horrors and doubts of such an experience. Of the humorous pieces, the one that is my, and most people's favorite is "The Relationship Between Moral Health and a Blind Wife," which depicts a Saipan scene of the pitfalls of multicultural communication. Of the medical stories, I like "Sweet Sight" which depicts the drama of a blind man regaining his sight.

Tell us about your writing process. How do you find the time to write with a busy schedule/family life?

Most of the time, I'll write about something that has been on my mind for a while. It takes time for ideas to percolate. I start the writing process inside my head. I have a loose idea of what I want to say, but it really evolves as I'm writing. The act of writing is a sort of unveiling. I'm not sure at the start how it will turn out. The interaction between the writer and the page determines the end result. The page is an active participant, molding the writer's words as they emerge. At least that's how it happens for me. When do I find the time to write? When everyone is asleep. I also write on Thursday mornings. It's my operating room day, and in the 20 or so minutes between surgical cases, I'll pause and write.

You are a very respected ophthalmologist. I'm sure you could have your choice to practice anywhere in the world, so why Saipan?

Are you kidding? Because Saipan is the greatest place in the world! I'm living on a beautiful tropical island, serving people who need and appreciate my services. I live in a community that values human relationships, where my kids are growing up without fear. What more could a person want? One of my professional goals was to work in an under-served area, which is why I left the US after I completed my training. Sometimes I think back on the life I could have had -- working in an academic medical center, teaching, publishing scientific papers -- and all the prestige that comes from that. It can be seductive, but I truly believe that I'm in the setting that gives me happiness, which is much more important, ultimately than prestige.

How big of a role does Saipan play in your writing? 
Big.

How has your experience growing up as an Iranian boy in Kentucky contributed to your unique views on life? 


I think more than anything else (and I think this is common among many immigrants), it gave me the perspective of an outsider -- of someone who had to work to fit in, to be accepted. Immigrants were rare in Appalachia when we moved there in the 60's. People didn't know how to categorize us. It was still a time of racial tension, and here was this brown family -- neither black nor white, with strange accents, strange foods, strange religion, strange names, strange strange strange. I carried that sense or having to work to just fit in around with me through my 20's. But once I left the United States, I lost that sense of being an outsider. I think the ethnic diversity of Saipan, where there is no clear majority, is unifying. People are used to people of various colors, with funny names. Here, I'm no more a stranger than anyone else, and ultimately, I imagine many parts of the world will be like Saipan -- a true mix of cultures and peoples. Growing up in rural Kentucky also gave me a sense of appreciation for small towns and tight communities, which is one of the reasons Saipan resonates with me.

What future projects of yours can we look forward to?

I'm not sure. I've been on pause in terms of writing for almost a year. I'm trying to create more space and quite time in my life, and I'm very careful about the things I undertake. I'm contemplating writing some columns again, but not with the same weekly frenzy as before. I'd also like to get back to the "7 Habits of Unity" book, but I'm in no hurry.

Is there anything else you'd like to add?

This is my first interview by a famous film-maker!

Finally,

Our version of James Lipton’s/Bernard Pivo Questions (one word, or short answers please):

What does the Chamorro culture mean to you?

Search

Who’s your favorite local artist?

Greg Elliott

Do you speak Chamorro?

Some

As a person, what turns you on?

Contentment

As a person, what turns you off?

Poverty

What’s your favorite curse word?

Booger (my kids might read this).

What sound or noise do you love?

Laughter

What sound or noise do you hate?

The sound of surgical scissors removing an eye.

What profession other than your own would you like to attempt?

Stand-up comic

What profession would you not like to attempt?

Hitman -- boss is too demanding.

If heaven exists, what would you like to hear God say when you arrive at the pearly gates?

Welcome!

Patients Gone Wild and Healthcare Reform

(I'm blogging from the operating room.  Here's my Saipan Tribune column for this week.)

I recently had the opportunity to read President Barak Obama’s letter on Health Care Reform, dated June 3, 2009.  There is one paragraph in particular that jumped out at me, because it seeks to identify the “root cause” of rising health care costs.  Here it is:

“At this historic juncture, we share the goal of quality, affordable health care for all Americans.  But I want to stress that reform cannot mean focusing on expanded coverage alone.  Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach.  So we must attack the root causes of the inflation in health care.  That means promoting the best practices, not simply the most expensive.… That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.”

First, let me say, that I agree with the gist of the statement.  Rising health care costs are killing our economy (well, that and a few other things), and medical care can definitely be improved so that it is more cost effective.

But here’s the truth.  The single best way to reduce the cost of healthcare is to reduce the need for healthcare.  We are a sick bunch of people, and for the most part, it’s because of our own behavior – we’re all “patients gone wild.”  The majority of us are sick, not because we’re out doing healthy things and suddenly get struck down by some horrific disease.  No, we’re sick because we eat too much, sit around too much, eat the wrong foods, smoke, consume alcohol, and generally ignore the things that lead to good health.  We’re sick because of the wild and crazy choices we make.  The vast majority of healthcare costs in America and the CNMI are tied to chronic “lifestyle” diseases.  The top ten causes of death in the US include heart disease, stroke, diabetes, and cancer.  And every single one of these has been incontrovertibly linked to how we live our lives – whether it’s what we eat, what we do, what we drink or what we inhale. 

To a large extent, we’re digging our graves with our spoons and forks.  Last year, we spent over $20 billion dollars on cholesterol lowering drugs.  That’s billion, with a “B”.  If you had $20 billion dollars, and decided to burn a million dollars a day, every single day, it would take you 55 years to spend $20 billion!  Why is our cholesterol high and why does it need to be lowered at a tune of $20 billion a year?  High cholesterol is a major risk factor for heart disease and stroke.  Our bodies produce some cholesterol, but most of the problem comes from what we eat.  Only animals have cholesterol in them.  Vegetables have no cholesterol at all.  We’ve known for decades that the most effective way (and the cheapest way) to lower cholesterol is to lower our consumption of animal products – animal flesh, animal milk, animal cheese, animal crackers, etc.  But you know what? We’d rather not make that kind of change.  We’d rather pop a pill and keep eating whatever we want to eat.  And that’s $20 billion dollars we spend so we can do what we want to do, which is to eat lots of animals. 

The same is true for diabetes, which is devastating our community, and growing at an alarming rate.  We know that for most of us, the adult onset variety can be controlled, or at least hugely improved, with diet and exercise.  Yet we choose not to make these difficult changes.  We choose to eat what we want, and take pills and go on dialysis and lose our vision and our feet and our erections.  And we spend untold billions on the cost of care for diabetes and its related problems. 

A diet high in animal fat is also linked to a slew of cancers.  Pass the processed meat that starts with “S” and ends in “M” and rhymes with “PAM”.  Or just pass a burger or wiener or any other chunk of meat.  Alcohol consumption is linked to many cancers.  Pass a Bud (better make that a Bud Lite).  Tobacco is irrefutably linked to cancer.  But we can’t seem to manage to pass legislation to ban smoking in public spaces.  Pass the votes. 

I admire efforts to improve the cost-effectiveness of the healthcare we deliver, but I know that the “root cause” of the mess includes our culture of indiscretion, of consumption, of sitting around.  Any serious effort to fix the healthcare mess must include a change in our culture – what we eat, what we do, what we drink and what we inhale.  These changes won’t solve all the problems, but they’ll make a huge dent in the demand for and the cost of healthcare.  A major portion of the responsibility to “reform” belongs on our shoulders -- those who end up needing healthcare.  Reduce the need, and you reduce the cost.  It’s simple.  But it’s not easy.  We humans typically don’t like change.  Yet failure to change our behavior will result in more and more people needing healthcare every year, rising costs, and eventually, not enough doctors, hospitals or other resources to take care of so many sick people.  We’re experiencing the fallout right now, right here in the CNMI. 

Addressing our behavior needs move to the front and center in the public policy discussion on healthcare reform.  It’s a nut we must crack.

_______________________________________________________________________

David Khorram, MD is the co-founder and medical director of Marianas Eye Institute.  He is the author of the book, World Peace, a Blind Wife, and Gecko Tails, which is available on Amazon.com and at Marianas Eye Institute.  Dr. Khorram can be emailed by visiting www.MarianasEye.com, or by phone at 670-235-9090. © David Khorram, 2009.

Risk Factor for Swine Flu

What they're not telling you about Swine Flu

Here's a portion of an email I got from one of our public health officials, just to put things in perspective:

I am getting more than 8 Swine Flu "Updates" per hour.  Good grief.  This is a true epidemic, likely soon to be a global pandemic.  My guess is that we'll be in Phase 6 next week.  But the relatively minor human toll (low morbidity and low mortality) does not yet justify the resource allocation, nor the media attention that we have all seen.

We need to insure that we have a "measured response" that is commensurate with the real, not the perceived, threat.  And responding appropriately, in the face of media hype and patient worry and governmental involvement, is a real art.  I am hoping to hear your opinions on this.

In the past six weeks, Swine Flu has killed between 20 and 80 people.  More than 2000 have had clinically significant infections.  In the same time period, more than 40,000 people have died from routine influenza.  Millions were infected.  More than 40,000 died from TB just last week.  40,000 more died from malaria last week.

Jerks Die Younger

The next time some jerk is yelling at you for no good reason, you can smile, knowing that they'll be off the planet sooner than you.

A new study published in the Journal of the American College of Cardiology finds that people who are angry and exhibit hostility have a 19% higher risk of dying from coronary artery disease -- i.e. a heart attack.

The average person hopes that future studies will show an increased risk.

Sexualization of Young Girls

I was at the Thursday night street market, where every week on Saipan you'll find food vendors and live entertainment.  Tonight, a dance schools performed.  I'll tell you, it was a sad scene.  There were kids, girls, six, seven, eight years old, dressed like teenagers, with short skirts, makeup, and shin-high boots, and dancing suggestively to lyrics like "Let's make love, ooh, baby, let's make love."

When did this happen?  When did parents start looking the other way, and give their assent to the sexualization of their young girls?  It's like they all went out for a walk, let some stranger called  a dance instructor come into their house, and in the name of "developing talent" twist their kids into these vacant performers.  It disgusts me.  What happened to protecting innocence?  What are these parents thinking?  Do they think this is okay?  To have their young daughters thrusting their pelvises while lip-synching these overtly sexual lyrics?  I don't get it.

Nagoya City University Hospital

A few years ago, I needed some surgery that wasn't available on Saipan, so I was faced with finding a surgeon to undertake my care.  Part of the issue for me was that I wanted to get the care close-by, and being self-insured, I needed it to be cost effective.

My main four choices came down to Australia, Hawaii, Manila and Japan.  I visited one of the top surgeons in Sydney during a trip there, and I wasn't impressed.  I scratched Manila off the list pretty quickly.  I've had a fair bit of experience with patients going to Manila for care, and although one of the surgeons I've worked with there is good, I've found that in general, the delivery was not up to the standards I expect when sending a patient to a major medical referral center.  Sorry guys, but that's the truth.  I wouldn't go to Manila unless it was a last resort.  I'm sure many have had good experiences there, but seeing many of my patients return, I haven't been too happy with the quality of care they received.

Hawaii was an obvious choice because, well, it's US quality medical care.  The problems with US care is that it's expensive.  If I'd had the procedure in Hawaii, it would have cost me $10K.  If I had had insurance, my 20% co-payment would have been $2K, for an outpatient procedure.  So, I just held this option in reserve.

I started to look seriously at Japan.  In the world of medicine, Japan is one of the areas, along with the US and parts of Europe, that lead medical research and publish in medical journals.  I know the quality of care there is top-notch, and that the cost is reasonable.  I ended up finding one of the best surgeons in the world for my condition, and headed there for my surgery.  I was very happy with the quality of the care I received, and the cost was only $2K.  That included the surgery, and five days in the hospital, getting fed and watered.  The system of care in Japan is a little antiquated, and many expatriates in Japan complain about it for this reason, but as someone in the medical field and as someone who has experienced the care first-hand, I think that the care is on par with anyplace in the US, and even better than the US, it's cost effective.

After I returned, I tried to convince the powers that be to start looking at Japan as a place to send our medical referral patients from the CNMI.  It close, it's cheap, and the quality of care is outstanding.  It's taken a while, but finally the CNMI has a relationship with the Nagoya City University Hospital (NCUH), and we have liaison people on the ground to help patients navigate a foreign country.

Nagoya City University Hospital is an 800 bed medical center (CHC has 72 beds).   The first patient from the CNMI that went there was an infant, a few days old, who was on the way to Hawaii for cardiac surgery, decompensated while on the tarmac in Nagoya, and was taken to the NCUH where the pediatric cardiac surgeons did an outstanding job on a very complex surgical procedure.  Since that time, the relationship has deepened, and in the next few weeks, I hope to send the first ophthalmology patients there.  This should provide closer and less expensive care than is available in Hawaii, and  as high a quality of care.   I'm looking forward to using NCUH as a referral center.

Truth, Death, Unity and Classroom Cataract Surgery

Because of my book, I was invited to give the keynote address to the University of Guam during their faculty development day on Friday.  I just shared some thoughts that were on my mind.  I think in some way, the points I raised had to do with some of the anchoring principles of my life.  It was also an opportunity for me to try out some of the stand-up comedy material I had been working on, and most of the jokes got laughs.  Here were my key points.

1.  "Truthfulness is the foundation of all human virtues.  Without truthfulness, progress and success in all the worlds of God are impossible for any soul."  Before I really started to think about this principle in my own life, I used to "fib" so much to avoid embarrassment or to stay out of trouble.  Being committed to total truthfulness required me to change the way I did a lot of things, but it was a liberating process.  It's a pain, and I feel I sell out pretty easily at times.  But it's still one of the key principles that I think everyone can benefit from.

2.  We're all gonna die.  Really.  Remaining conscious of this truth on a daily basis helps lend clarity to life.  This can be done by bringing oneself to account each day.  "Bring thyself to account each day, ere though art summoned to a reckoning, for death unheralded shall come upon thee and thou shalt be called to give account for thy deeds."

3.  The motto of UOG is "Unity in Diversity."  Unity requires that as individuals we refrain from faultfinding.  The process of higher education gears us toward "critical analysis" which makes faultfinding a natural way of life.  Faultfinding is an intellectual activity that is quarantined to one's mind.  But the real problems arise when we mention the faults of others -- when faultfinding moves to backbiting.  It's endemic in our culture, and there is a need to establish "no backbiting zones" around our mouths, and even our ears, so we don't participate in this corrosive force.

4.  Cataract surgery brings vision.  Teaching brings vision.

The faculty were appreciative of having a speaker who wasn't there with charts and numbers, and as someone said, "we're all human, and it's nice to remember that at times."

Gory Eye Picture - Dermoid from Hell

This is a weird growth that some people are born with.  It's called a dermoid.  It can enlarge over time, as this one has.  (This guy walked in this week is in his 20's.  Time to remove it, don't ya think?)  You can see it has hair growing on it.  Sometimes there's bone and teeth and cartilage and other Frankensteinian components in them.   Growths like this that consist of tissue not normally found at the site are called "choristomas".   One choristoma made it to the big screen in the movie, "My Big Fat Greek Wedding," where the Aunt is telling the fiance of the lump that was removed from her back that had teeth and hair in it, and that it was the remnants of her twin that was never born.  It was a great scene, and a proud day for choristomas everywhere.

Often, ocular dermoids go deep into the substance of the eye wall, so despite it's "stuck-on" appearance, you can't just slice it off, (or lacking instruments, pluck it off), because you could end up with a hole in the eye.  So you have to have donor tissue available to patch up the hole at the time of surgery.  They occur in about one per 10,000 people.  

Happiness

"The fact is that without inner peace and wisdom, we have nothing we need to be happy. Living on a pendulum between hope and doubt, excitement and boredom, desire and weariness, it's easier to fritter away our lives, bit by bit, without even noticing, running all over the place and getting nowhere. Happiness is a state of inner fulfillment, not the gratification of inexhaustible desire for outward things."

~Matthieu Ricard

Gory Eye Picture

I'm amazed by how many people complain to me that I don't warn them that these pictures might give them nightmares and why don't I warn them of the graphic nature. What do you think it means when the title of the post is "gory eye picture," kittens?

Without further warning, here it is:

(photo credit)

I'm Back

Sort of... maybe... in a different way.

I've been in blogging rehab. Everything is okay. It's just that blogging was becoming a toxic force in my life. It was taking up way too much of my mental space. I was checking my hit counter every few hours, planning posts days in advance, writing things when I had nothing to write. And all for no clear purpose other than some narcissistic drive to climb higher in the blog rankings. It was pitiful.

I woke up and realized this, and one day, just quit. With the help of my family, I have been able to successfully withstand the pains of withdrawal, and I thank them for their loving support during this difficult time. I know that even writing this post is dangerous for me, since just a little sip has the power to strangle me in its clutches.

So, I'm not sure what the future holds. For now, I'm chilling out. I may post occasionally, when I'm compelled to share something I think is meaningful or profound, or to stay connected with family and friends in far-off lands. If you're from Saipan and you miss what you've been reading here, heck, call me up and let's go to lunch. You know how to get in touch with me.

The Bottom of the Economic Development Ladder

Here is my Saipan Tribune column from Friday.

***

How do we, who are having such bad economic times here, stack up compared to the rest of the world? Where are we on the world's economic development ladder? I don’t know much about economics, but these questions were recently asked of me, so I thought I’d find out. Economic development, as it turns out has a fascinating history. Economist, Jeffrey Sachs, describes a four step ladder, as a way of viewing the world in terms of economic development. The first step, which I’ll describe today, is not really a “step” because it’s not even on the ladder. It is “extreme poverty.”

Today one billion people – one sixth of the earth’s population – live in extreme poverty. This "bottom billion" is so economically destitute, that their very survival is at risk on a daily basis. Their lives are fragile. They live with drought, famine, starvation. Any small change can make the difference between life and death – a storm that wipes out meager crops, being struck with a simple disease, but having no access to medicine to treat it, late delivery of food – all of theses sorts of threats are very real, and can mean death to entire populations living in extreme poverty. If there is any income that comes into the hands of those in extreme poverty, it is counted in pennies per day.

For much of human history, the vast majority of the world’s population has lived in extreme poverty. Our ancestors struggled for their very survival, in a harsh world, with a fragile existence. Wealth, above extreme poverty, did not become accessible to common people until the mid 1700’s. It is only since about 1750 that humanity has climbed onto the first rungs of the economic development ladder.

Extreme poverty does not exist in developed countries. It is a condition that afflicts swaths of the developing world. Seventy percent of the extreme poor live in Africa. Ten to fifteen thousand of them die of preventable causes, like hunger, malaria, and dysentery every single day, day after day, year after year.

The tragedy of our times is that such dire circumstances affect one billion of our fellow men, women and children, in a world with such vast resources.

One of the goals of the United Nations is to wipe out extreme poverty by the year 2025, and to cut it in half by 2015. It requires commitment from wealthy nations, but I think it also requires awareness by the rest of humanity that such conditions exist and that solutions are available. The bottom billion require assistance to get on the economic ladder, to move from extreme poverty to just regular poverty. It is a small step, but the most important one in terms of the survival.

Marine Sting Photos Wanted

I got an email from Dr. Paul Auerbach from Stanford University Medical Center. He hosts the blog, Medicine for the Outdoors. He's looking for photos of stings from marine animals.

Thanks for your kind comments about Medicine for the Outdoors at Grand Rounds this week. You have a great blog. If you ever encounter a marine animal sting for which you need assistance, please let me know - I serve as a consultant to the Divers Alert Network for that sort of thing.

Also, if you get any good photos of stings, eye or otherwise, it would be wonderful to see them, as I am always on the lookout for images for the textbook Wilderness Medicine and other teaching purposes. If you allow a photo to be used in a book, it would be credited as you indicate.

Divers, if you get any good photos, let me know and I'll put you in touch with Dr. Paul.

Victoria's Secret to Include Free Safety Goggles with Thong Purchases

This is all over the news in the past few days. A 52 year-old woman in Los Angeles (where else?) is suing Victoria's Secret because while she was putting on her newly purchased thong, a piece of decorative metal flew from it and struck her eye. Her attorney states that it caused "excruciating pain" and that the injury was so severe it required "steroid drops" and that she'll be living with the effects of it her whole life.

Gimme a break. I treat corneal abrasions all day long, and I'll use steroids in about 25% of them, just to get rid of any residual inflammation after the abrasion has healed. It's no big deal.

Every abrasion has a theoretical risk of becoming a "recurrent erosion." The attachments of the corneal epithelium can sort of get weak after the abrasion heals, and there is a chance that during rapid eye movement of sleep (REM sleep), the epithelium will split open again, causing a few hours of pain. Of all the thousands of abrasions I've treated I've had one patient with recurrent erosions. It's most common with abrasions caused by paper and by fingernails.

I know what it's like. I developed corneal erosions after my son poked me in the eye when he was a year old. The abrasion healed over a few days (and yes, it was very painful), but then a few months later, I'd wake up most nights with pain from recurrent erosions. But guess what? You can get the recurrent erosions fixed. I had some laser treatment done on my eye, and I never had a problem again.

So, boo-hoo is what I say. I just can't understand the mentality that sues over a thong induced corneal abrasion. The woman and her attorney are giving interviews on the morning talk shows, including the Today Show. I'm sure she'll get a book deal, which will spill over into a screenplay, a night at the Oscars, and an action hero figure whose secret weapon is a lethal metal-firing thong that gets activated when placed on a wrinkled butt.

My Blog Knows Me So Well

Blogging really is a weird kind of sickness -- sort of like love. Bloggers will recognize themselves in this post by The Blog that Ate Manhattan, titled, I Love My Blog.

Gory Finger Picture

It's been a long time since I've posted a gory eye picture. Having had nothing gory to present, I'm resorting to gory finger pictures.

Remember that story about the guy who was wearing his class ring, and went up to dunk the basketball, but got his ring stuck on the rim? Not urban legend. Photos courtesy of this site. Dr. Ramona Bates, over at Suture for a Living, tipped me off to this story (pun intended).

Hiccups during surgery

Yesterday was my surgical day. My last case of the day, a cataract patient, got the hiccups during the surgery. Under the operating microscope, it was like a series of earthquakes. It made for an interesting few minutes until the anesthesiologist could give him enough sedation to put the hiccups to sleep. The patient looked great this morning, except that the hiccups woke up after the surgery and are still there.

Recovering from the Heat of Grand Rounds

I'm still recovering from all the work of putting Grand Rounds together. It was fun, but I needed to be away from the keyboard for a few days. On Tuesday, the day Grand Rounds was posted, I got over 1,000 visits to my blog, which is a testament to how well organized this carnival is. I'm still catching up with all the comments and email I received as a result.

The days are getting hotter here on Saipan. Although we have the most stable temperature in the world, staying right around 85F year round, the sun is HOT this close to the equator, and because of typhoons, houses are built of concrete, which are ovens. The utility is limping along, with power outages rotating around the island all day long to conserve the fuel supply. At the office, we have a generator, so we can keep functioning, but at the house we're in right now, no such luck. Last night, the power went out around 8 PM. I don't think it was scheduled because it was preceded by lots of browning out of the lights. It came on briefly around 10:30 PM, but went out again for the rest of the night. We slept in the sweltering heat, with damp paper towels on us to keep us cool.