“Always do what you are afraid to do.” -Ralph Waldo Emerson

TASK AT HAND: This week I’m thinking about success; specifically, the fear of success. Success, this nebulous and enigmatic concept, fascinates me in that it is desired and revered but, at the same time, can create fear and depression.

In a previous Sunday Surgical Scrub, I defined the achievement of success in one of two ways: either you spend your days doing what your love or you craft a life where you subsidize – with money, creativity or effort – time for that which you love (you can find the blog post here). In my opinion, there are no other acceptable definitions of success.

But where do the elements of fear come from when we discuss success?

Is fear just an apparition of objectives that have not yet been achieved? Or does fear and success represent a more complex interplay?

There are two aspects of the fear of success that we will discuss here. First, as the Emerson quote above states, there is a natural fear of the unknown. Success, usually in terms of achievement, represents a journey we have not yet completed. Consequently, a fear of unknown outcomes is a common reaction and akin to the fear of an adventurer seeking discovery. One should use this fear as a motivator for that which we desire, pursue and value.

The second aspect of fear in the context of success is more troubling and is applicable to instances where some success has already been achieved. Whether it be in business, sports, arts or simple hobbies, past success can confound further progress. The fear of success here is dependent on emotional factors where previous success leads to expected future success. The fear of not being able to “back it up” can leave us feeling like an imposter. This fear can cause us to shy away from opportunities which limits our ability for success. This can create stagnation and hinder our willingness to take on fresh challenges.

Stagnation breeds depression which creates paralysis.

How do you overcome the fear of success?

The answer, and I’ve touched on this with the Sunday Surgical Scrub before, requires a commitment to acquainting yourself with the energy and passion to move beyond this fear (check out this Sunday Surgical Scrub blog post here). Remember, worst case scenario is you don’t back it up and fail. So, what? There is no apocalyptic outcome here. There is no fatal end. You will still move on but maybe at a slower pace or in a more prolonged route. Take your task or objective seriously but realize that this fear is miniscule and let it not hold you back from that which you define as success.


MEDICINE & MACULA: Last week I played in the Beyond Walls Squash Week held at the Commodore Club in St Paul MN.

Beyond Walls is an incredible organization aimed at promoting academic excellence, healthy lifestyles and access to meaningful opportunities for all youth. It is a year-round scholar/athlete approach to youth development and out-of-school time for 6th to 12th grade students. It uses a one-to-one academic mentoring with physical fitness via the racquet sport of squash aimed at community engagement and college-readiness. You can find more information here.

I won the amateur A singles squash draw with a bevy of tough matches! I won this tournament in 2016 and was very excited to repeat in 2017. I’ll keep working hard and try for the three-peat in 2018…

In addition to amateur singles, there was a professional singles tournament, a pro-am doubles and an amateur doubles draw.

With sincere gratitude, I thank everyone involved for their energy in growing the sport of squash in the Twin Cities!!


GRATIS: “Courage is resistance to fear, mastery of fear, not absence of fear.” -Mark Twain


My best to you,

David Almeida

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“If I’m going to live, I want to live fully, very intensely, because I am an intense person. It would ruin my life if I had to live partially.”

Ayrton Senna (1960-1994), 3-time Formula One World Champion


TASK AT HAND: This week I’m thinking about passion and what it means to live days immersed in the strength of barely controllable emotion. Passion, as a source of energy, can be oppressed by the many tasks and distractions endlessly intruding into our lives. However, I have found that, being reacquainted with your passion is a revitalizing elixir of energy, focus and determination that cannot be neglected. Consequently, I have found three strategies to ensure that passion is a tenet not lost or neglected.

Passion in decision-making. When formulating decisions and employing strategies in your business or professional life, don’t neglect to acquaint yourself with your drives and desires. Some aspects are best decided dispassionately; but, similar to what we talked about last week with intangibles, core fundaments require a degree of enthusiasm, self-expression, and identity to fulfill the full potential of the decision in question. “Passion to a person is what gas is to a car. Without it, you won’t go anywhere!” (Alex Haditaghi; Softly, As I Leave Her). Many times, amongst decision options without major distinction, choosing the one best aligned with your passion will provide opportunities not previously foreseen.

Passion in your personal relationships. A personal relationship without some element of passion is mere acquaintance. Strive to consistently surround yourself with people who stoke the fires of vitality: those that challenge you, those that ask you to grow, and those that allow you to change. It reminds me of an Avett Brothers lyric: “I wanna have friends that I can trust, that love me for the man I’ve become not the man I was” (The Perfect Space).


Passion in your daily life. Finally, irrespective of your professional and personal endeavors, please commit to one act that you are passionate about each day. This need not be for more than a few minutes – but stay connected to that drive daily. Don’t lose this connection because, this connection, is very much a defining part of who you are.

When you look back – if you must – recall a life lived with passion! Days filled with this barely controllable emotion that allows you to create and touch the lives of others in fantastical and wonderful ways. Find passion and “Let us live so that when we come to die even the undertaker will be sorry” (Mark Twain).


MEDICINE & MACULA: Interesting study in PNAS that, after reviewing 9 studies and 2100 participants, found a consistent reduction in the clarity of people’s memory of their past unethical actions. The communication finds that people who acted unethically are the least likely to remember the details of their actions. That is, people experience “unethical amnesia”: unethical actions tend to be forgotten and, when remembered, memories of unethical behavior become less vivid over time than memories of other types of behaviors. Because of unethical amnesia, people are more likely to act dishonestly repeatedly over time. This important publication advances the science of dishonesty, memory, and decision making.


Check out the study here.


GRATIS: “A study can be made against invasion by an army; no stand can be made against invasion by an idea.” –Victor Hugo


My best to you,

David Almeida

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hand print identity

“In the social jungle of human existence,

there is no feeling of being alive without a sense of identity.”

Erik Erikson


TASK AT HAND: This week I’m thinking about the intangibles of strategy. We are well versed in the tangible data of decision making: spreadsheets, SWOT analyses, and projections. But today, let’s look at the intangibles – those aspects that are sometimes neglected when we devise a strategic plan .


Let me divert for a couple of sentences… In medicine, one of the ways we can describe a patient complaint is in terms of “quality”: how does it make them feel? Similarly, I adopt this same descriptor to strategy and have arrived at three distinct aspects of the quality, or intangibles, of a decision or strategy: satisfaction, opportunity lost, and identity.


Satisfaction. Good decisions need to make sense. Good decisions need to respect budgets and achieve objectives. Great decisions should satisfy. That is, they should provide adequate information or proof so that they are convincing. Extrapolating, effective decisions should convince stakeholders of its ascribed path. Try this next time you have a conflict or decision and are considering options. Ask yourself if the decision you have arrived at satisfies the need or problem at hand. At this moment, you realize: “The ultimate victory in competition is derived from the inner satisfaction of knowing that you have done your best and that you have gotten the most out of what you had to give.” (Howard Cosell)


Opportunity Lost. Most are familiar with the microeconomic concept of opportunity cost: the value of the best alternative forgone where, given limited resources, a choice needs to be made between several mutually exclusive alternatives (Investopedia). Assuming the best choice is made, it is the “cost” incurred by not enjoying the benefit that would have been had by taking the second best available choice. The latter can sometimes become arcane, esoteric, and neglected in strategy. I frequently use the term opportunity lost to highlight the fact that, in making a certain decision, what have you given up in turn? This is not simply the best alternative foregone, but all other options lost. In my opinion, this drives home the professional, personal and intangible consequences of the decisions I make.


Identity. This one is simple. The best decision available, if it does not identify with who you are, with what message your business is trying to convey, or leaves you with doubt about ethics, is a decision that is not congruent with your identity. Be careful with these! Decisions without respect for identity risk entering a path without direction. Actions without regard will leave you in an abyss; this void expands without reflection and consideration.

solo business man

As you continue to improve your personal and professional strategy, remember the power of intangibles to transform good decisions into great ones! Satisfaction, opportunity lost and identity are integral components to the quality of the decision you make.


MEDICINE & MACULA: Interesting study found that excessive stress can cause memory problems in women who had survived breast cancer. This study examined 1,800 breast cancer survivors and found that those with a greater level of physical activity had higher levels of self-confidence and less stress, and as a result fewer perceived memory problems.

If you didn’t know already, it seems the benefits of exercising regularly are practically limitless!

The study was published July 8 in the journal Psycho-Oncology. Check out the study here.



GRATIS: Check out our new paper: Bimanual pars plana vitrectomy for removal of a dislocated DSAEK graft from the vitreous cavity published in Retinal Cases & Brief Reports. We describe a new technique for removing dislocated grafts.

PPV K graft 1PPV K graft 2


My best to you,

David Almeida

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“There is only one success – to be able to spend your life in your own way.”

Christopher Morley


TASK AT HAND: This week I’m thinking about success; a nebulous concept that for millennia has eluded many. Last week, a friend asked me how I define “success” – not happiness, not satisfaction – simply success. This enigmatic question consumed a lengthy conversation that I believe worthwhile to revisit here.


I believe success occurs in one of two ways: either you spend your days doing what your love or you craft a life where you subsidize – with money, creativity or effort – time for that which you love. Furthermore, those we love and love us, are fundamental cornerstones of success. Our relationships with those we care about is absolutely critical: clichés like the influential who neglects loved ones is not success.


Let’s take this first part: do what you love. I am reminded of Mark Twain’s words: “The secret of success is making your vocation your vacation.” This is the ultimate achievement and what I regard as success – no qualifiers needed. Unfortunately, this exists only in a minority of cases. If you are lucky to have this in your life – cherish, craft and confirm it because, “when love and skill work together, expect a masterpiece” (John Ruskin). Now, success is filled with bumps, bruises and bile so never confound it with convenience, which actually tends to degrade your ability to grow.


But, what happens when the above is not the case? In my opinion, the majority of people aren’t lucky enough to love their career or job. This is an unfair reality of civilization. However, this is not a problem: what you then have to do – to achieve success – is develop a routine that allows you to constantly revisit that which you love. Dislike your job? No problem – this does not mean you can’t be successful. Find pockets of time, a circle of friends, actions and hobbies, a lover and family that bring you closer to success and that which you love. This could mean saving for a vacation, biking with a group of friends – it doesn’t matter – as long as you are on that byway which is intrinsically yours. As the quote above implies, success is singular to you! If you find yourself at odds with this goal, remember: “success is not final, failure is not fatal: it is the courage to continue that counts” (Winston Churchill). Continue to craft the life that finds in it your success.

As you move forward, don’t feel that you have to adopt my definition in any way. But, realize that you need to define this term for yourself – this is essential if you are ever going to achieve success.



business success

MEDICINE & MACULA: In line with our discussion, let’s move over to the business literature. Here is a case study driving the point that if the sole purpose of your business or career is to make money, you’re destined for mediocrity. Change your story so that meaning is first priority and money second.

Check out the study here.


GRATIS: Given today’s topic, I leave you with a few words from Frank…

“Regrets, I’ve had a few

But then again, too few to mention

I did what I had to do and saw it through without exemption

I planned each charted course, each careful step along the byway

And more, much more than this, I did it my way

“My Way” –Frank Sinatra



Go out. Find success. Your Way.

My best to you,

David Almeida

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