Sunday Surgical Scrub

“We should always be asking ourselves: Is this something that is, or is not, in my control?”– Epictetus (Enchiridion)


TASK AT HAND: This week I’m thinking about the illusion of control. This powerful mirage commonly creates a façade we believe to be actually present. While the desire for control may be real, in actuality, control is an illusion that can impair our judgement and create anguish and anxiety that does not exist.

How can we give up on the illusion of control?

The first step is to realize – you are not in control! You are not in control of the weather. You are not in control of what others think of you. You are not control of any external events. So, as the Stoics accepted long ago, you too must accept this as a means to fulfillment. All you can control is your reaction. Be honest, caring and genuine in the acts you put forth into the world but, beyond that, realize you do not have control.

The second step, which follows logically from the point above is, if you are not in control, then to worry is pointless. That flight delay, the toddler screaming from the next table, the insult from a disgruntled coworker – all inconsequential. By choosing to not worry about it, and to rather embrace that all you can control is your reaction to events, will liberate you from most of life’s torments.

The final step, in the process of letting go of this desire for control, is to come to terms that this process is not an apathetic one. Quite contrary – events may cut deep and personally injury you. This is ok. However, they need not consume you with resentment, fear and regret. The call to action is to be compassionate and honest in what you curate and create; however, beyond this, there is no need for control.


MEDICINE & MACULA: Thanks to everyone who regularly emails and contacts this forum with opinions, suggestions and criticisms. In response to recent comments, I will continue with regular postings of interesting patients similar to the images last week of Vogt-Koyanagi-Harada (VKH) disease.

Here is a color fundus photograph of a severely immunocompromised patient with viral retinitis. This shows the condition known as Progressive Outer Retinal Necrosis (PORN) secondary to herpetic virus infection.


GRATIS: “I can control my destiny, but not my fate. Destiny means there are opportunities to turn right or left, but fate is a one-way street. I believe we all have the choice as to whether we fulfil our destiny, but our fate is sealed.” -Paulo Coelho


My best to you,

David Almeida

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“Body language is a very powerful tool. We had body language before we had speech” -Deborah Bull

TASK AT HAND: This week I’m thinking about the body-words disconnect. The concordance, or lack thereof, between words and actions is a powerful revealer of motive. Congruence between what someone is telling you and how their body relays those messages speaks volumes to the truth, emphasis and purpose of the message. “Reading between the lines” and “it’s not what someone says, it’s how they say it” are popular clichés that remind us of the importance of the connection between words and mannerisms.

“The concordance, or lack thereof, between words and actions is a powerful revealer of motive.”

The first step in understanding the body-words disconnect is carefully listening to what people tell you. The words serve as the message. If you don’t carefully listen to the message, any further interpretation will be lost. You need to be cognizant of what someone is telling you. Next, survey their body language. This requires visual and auditory engagement in the conversation. Visual input (facial expressions, body movement and position) is as crucial to auditory input (words, volume, inflection).

“The first step in understanding the body-words disconnect is carefully listening to what people tell you – the words serve as the message!”

The simplest – and extremely useful – aspect of the body-words disconnect is as follows: listen to the words people tell you and, if the words don’t match their body language, consider an alternative meaning or motive. For example, comments “welcoming” of your opinion expressed with a closed body posture (e.g., arms crossed) would indicate a defensive stance.

“Congruence between what someone is telling you and how their body relays those messages speaks volumes to the truth, emphasis and purpose of the message.”

Another common example involves words evoking positive emotions, like joy or happiness, with incongruous facial expressions like frowning of the brow. A few years ago, Gill and coworkers presented an excellent summary of the strategy of many common facial expressions (D Gill, OB Garrod, RE Jack & PG Schyns, Facial movements strategically camouflage involuntary social signals of face morphology. Psychological Science 2014;25(5):1079-1086. doi:10.1177/0956797614522274). Here are a few key illustrations:

·       High dominance—wrinkling the nose and snarling the lips

·       Low dominance—raising and lowering the brows, showing dimples, stretching the lips, and lowering the chin

·       High trustworthiness—raising the brows, deepening the lines between the nose and mouth, and smiling

·       Low trustworthiness—narrowing the eyes, wrinkling the nose, dilating the nostrils, frowning, and parting the lips

·       High attractiveness—raising and lowering the brows, smiling and pulling the lips back in a slight smile

·       Low attractiveness—tightening the eyelids, wrinkling the nose, and pulling the lips open and back

The purpose of today’s Sunday Surgical Scrub is not make you an expert in decoding body language. Although this is an interesting skill set, it is obviously beyond a single post. However, the call to action is for you to be cognizant of the body-words disconnect and, when these two spheres do not align, look for alternative motives for the communication in question.


MEDICINE & MACULA: Here is a fundus color photo of a patient I saw recently with Vogt-Koyanagi-Harada (VKH) disease. VKH is a severe inflammatory condition with a myriad of ocular and systemic effects. The fundus photo shows circumscribed retinal edema with multiple serous retinal detachments.


The optical coherence tomograph (OCT) shows serous subretinal inflammatory infiltrates.


GRATIS: “Language is a more recent technology. Your body language, your eyes, your energy will come through to your audience before you even start speaking.” -Peter Guber


My best to you,

David Almeida

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“Everything that we see is a shadow cast by that which we do not see.” -Martin Luther King, Jr.


TASK AT HAND: This week I’m thinking about cooperation and lengthening the shadow of the future. Let me explain what this means.

In game theory, the prisoner’s dilemma – commonly evoked in strategy development – is an example of a scenario where rational individuals would do better if they did not cooperate even though it appears that it is in their best interests to work together.

The prisoner’s dilemma is as follows:

–       Two criminals from the same syndicate are arrested.

–       Each criminal is in solitary confinement with no ability to communicate with the other.

–       Prosecutors do not have enough evidence to convict either criminal on a major charge but hope to charge each with a lesser crime with a punishment of 1 year in jail.

–       At the same time, prosecutors offer each criminal a deal: testify against the other criminal and get off while the other gets convicted on a major charge and faces 2 years in jail. Or, cooperate with the other criminal, stay silent, and get 1 year in jail on the lesser charge.


Here are the possible outcomes:

–       If both betray each other, each of them serves 2 years in jail, on a major charge.

–       If both cooperate and remain silent, each serve 1 year in jail, on a lesser charge.

–       If one betrays the other but the other remains silent, one would get off free, and the other would serve 2 years.


It would seem, looking at the possible outcomes, that the rational strategy would be for both to remain silent and serve the 1 year in jail on a lesser charge. However, this is not the best strategy. Game theory purports that it is clearly in the best interests of the criminal to betray the other for the possibility of no jail time. Since betrayal always results in a better payoff than cooperation – irrespective of the other person’s choice – it is the dominant theory. Because you cannot assure that the other criminal will stay silent, your only choice is to betray. In fact, in the prisoner’s dilemma, mutual betrayal is the only strong outcome.

Where is the dilemma?

The dilemma occurs because mutual cooperation would provide a better outcome (only 1 year for both on a lesser charge) than mutual betrayal. But, this is not the rational outcome because, if you assume individuals act to maximize their self-interest, the choice to betray is preferred over cooperation.

So, what does this have to do with lengthening the future?

Shadow of the future is another basic game theory concept which states that we behave differently when we expect to interact with others repeatedly over time. At the prospect of having to interact multiple times, our behavior changes since we can now be punished or rewarded for previous choices. Our choices today are shadows on future interactions. If those criminals are loyal to their crime syndicate and expect to interact with that individual again, remaining silent becomes a significantly better strategy, albeit not entirely rational. This is a form of conditional retaliation strategy and favors cooperation.

How can we use this for our decisions, choices and strategies?

There is nothing wrong with working towards optimizing our self-interests; notwithstanding, be careful to not interpret the prisoner’s dilemma as always needing to solely pursue your best interests at one particular point in time. Assess the relationships in your decision and look for opportunities to lengthen the shadow of the future – look to cooperate and maximize value to others and support their interests as future prospects.


MEDICINE & MACULA: Many thanks to Clinical Ophthalmology for recently publishing our study, Epiretinal membrane and cystoid macular edema as predictive factors of recurrent proliferative vitreoretinopathy (Kunyong Xu, Eric K Chin, D Wilkin Parke 3rd & David RP Almeida).

You can find our study in the October 2017 issue here.

In it, we describe epiretinal membrane and cystoid macular edema as potential predictive factors for recurrent proliferative vitreoretinopathy. Early recognition and treatment of these conditions may be critical to prevent dreaded recurrent postoperative scarring and improve visual outcomes.


GRATIS: “We cast a shadow on something wherever we stand.” -E. M. Forster


My best to you,

David Almeida

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“A mind cannot be independent of culture.” -Lev Vygotsky

TASK AT HAND: This week I’m thinking about the interplay between culture and strategy. What would you prefer – advantages in culture or a superior strategy? This a question that comes up frequently when looking at organizational design and strategic plans. There are two considerations we need to discuss when contemplating this answer.

1. Culture Trumps Strategy. A superior culture has definite advantages over strategy development. Organizational excellence is akin to having a built-in mechanism for effective strategy. To be part of an organization that is grounded in metrics and principles of development is always preferred because there is an inherent advantage to set processes and practices. An example I commonly use is a take a football team. A superior culture is analogous to a strong playbook whereas a superior strategy can be compared to one dominant play. You can use that one play successfully but, in the long run, developing a playbook that is composed of plays for a myriad of situations that may be encountered is best.

2. Strategy Shapes Culture. The main reason why one cannot simply rest on laurels of culture is because, culture alone, is not enough for long-term growth and improvement. There is a necessity to continue to develop strategies for the challenges encountered. It is in these circumstances where well-constructed strategy has the benefits of providing you with an approach to a problem. Moreover, at the same time, this strategy allows you to shape culture. Contrastingly, fragmented strategy that lacks cohesiveness, can harm cultural identity.

When I surmise the idea of culture and strategy, I feel the need to stress the importance of culture over strategy. However, effective strategy is a powerful influence on culture. The final point that should come to light, and one I discuss in my book in several chapters, is that strategy does not exist in a vacuum. Thus, aligning strategy with culture is an excellent path to achieving goals and objectives.


MEDICINE & MACULA: Yesterday, Saturday October 7th, Dr Ed Ryan presented one of our recent studies at the 50th Annual Retina Society Meeting at the Fairmont Copley Plaza Hotel in Boston, MA.

Our study, Outcomes of Current Techniques for Repair of Moderately Complex Phakic Rhegmatogenous Retinal Detachment, compares scleral buckle, vitrectomy and combined scleral buckle and vitrectomy surgical techniques in retinal re-attachment rates in phakic patients.


GRATIS: Last Sunday, October 1st, I had the once in a lifetime chance to share the court with Mr Karim Abdel Gawad for a squash event hosted by Boast Squash here in MN! Gawad is a professional squash player from Egypt who reached World No. 1 in May 2017.

It was humbling and an honor to share the court with a fierce talent like Gawad. I had a blast and thankful to Gawad for having some fun with us amateurs!


My best to you,

David Almeida

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“Life is without meaning. You bring the meaning to it. The meaning of life is whatever you ascribe it to be. Being alive is the meaning.” -Joseph Campbell

TASK AT HAND: This week I’m thinking about the concept of “the meaning of life”. All discussions, thoughts and contemplations are essentially about the meaning of life. At the very core, discourse on any meaningful topic is by virtue an introspective survey of that which holds some meaning in our lives. Consider, “is there one meaning of life” or “is all life about meaning”?

Here is my answer: there are 3 meanings of life that should be pursued and need to be satisfied.

1) Meaningful Health. We need meaningful health. Without meaningful health, the pursuit of all other goals is hindered. There are two key components to this aspect. First, meaningful health is not perfect health. We all know many able body people with excellent physical health who have stalled in life. Contrastingly, we know individuals with serious physical limitations who live energizing and impressive lives. Second, meaningful health requires commitment to psychological and physical facets. Diet, sleep, reflection, exercise, recovery, stretching, etc. are all elements of meaningful health that require attention.

2) Meaningful Work. We require meaningful work. Purpose is the manifestation of meaningful work. We need work constructs that provide benefit to ourselves and others. This is one of the reasons why youth unemployment is a tragic economic problem. Individuals need the ability to purse interesting and valuable skills. Following, there is a real need for economic opportunity and societal activism to ensure we can contribute in a meaningful way to the growth of culture in both local and global senses.

3) Meaningful Relationships. All life is about relationships. Living is about family. Meaningful relationships, perhaps more than any other component discussed here, contribute most significantly to finding meaning in the lives we mold. Meaningful relationships – founded on trust, empathy, and selflessness – provide us with insight and opportunity for growth. Work towards meaningful health, contribute to mankind by means of meaningful work but, most importantly of all, seek out meaningful relationships to enlighten you.


MEDICINE & MACULA: Earlier this year we published a photo essay on intraocular foreign bodies in the Canadian Medical Association Journal (CMAJ). Entitled, Five things to know about intraocular foreign bodies (Kunyong Xu MD MHSc & David RP Almeida MD MBA PhD), here is a quick summary:

1. Risk of intraocular foreign body is associated with mechanism of injury.

2. Ophthalmic examination should include dilation of the pupil.

3. Imaging should be conducted promptly to diagnose and localize intraocular foreign bodies.

4. Antibiotics should be prescribed early to prevent endophthalmitis.

5. Patients with an intraocular foreign body require urgent referral to an ophthalmologist.

You can find the study here.


GRATIS: “Each man must look to himself to teach him the meaning of life. It is not something discovered: it is something molded.” -Antoine de Saint-Exupery


My best to you,

David Almeida

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“Even a happy life cannot be without a measure of darkness, and the word happy would lose its meaning if it were not balanced by sadness. It is far better take things as they come along with patience and equanimity.” Carl Jung

TASK AT HAND: This week I’m thinking about equanimity. Let me preface, without writing another sentence, that the secret anxiolytic elixir of life is equanimity. I don’t usually bestow such praise on any one quality but – in the case of equanimity – it is warranted.

What is equanimity?

Equanimity is not a virtue or emotion but instead a skill. Equanimity is the ability to remain stable and composed when under stress. Equanimity is the skill to exercise calmness in the midst of a storm; the faculty to remain balanced in a state of disequilibrium. Equanimity comes and goes but, as you will see below, is a competence worth cultivating because it is essential for navigating the choppy waters that we are sure to encounter. Without equanimity, there is a propensity to slide into reaction without strategy.

Stability Under Stress. Composure Amidst Concern. How do we go about cultivating equanimity? How do we strengthen ourselves to remain stable under stress? How do we exert control to remain composed amidst anxiety and concern?

The strategy I have found to yield the most benefit towards a state of equanimity is summed up as follows: “analysis without judgment”. Take any situation, especially those that cause you to have unpleasant feelings, and you will see that the negativity arises from the emotions we placate on situations. This is happening because, during our analysis of a situation, we judge. Consequently, when we judge, we attribute qualifiers like “good”, “bad”, “terrible” that ultimately spawn anxiety and fear.

Alternatively, exercise the skill of analysis without judgment as follows:

1. Analyze the situation or conflict.

2. Assess the relative consequences possible.

3. Decipher the relative impact of different strategies to a satisfactory resolution.

No need for anxiety, fear or pain in any part of this process. By taking away judgment, you remain with analytic faculties to work out a solution. You will notice that this allows you to remain composed despite chaos and disaster. There is a wonderful Tori Amos quote that I believe sums up this strategy well and I paraphrase to: “It’s okay when everything is not okay.”


MEDICINE & MACULA: Today, Sunday September 24, I have the privilege of walking with my wife Jasmine and my children Max, Leo and Paloma as part of the VitreoRetinal Surgery, PA (VRS) team for the Foundation Fighting Blindness VisionWalk.

Today is the 11th Annual Twin Cities VisionWalk to be held at the Lake Harriet Bandshell in Minneapolis MN. The VisionWalk Mission – Changing Lives One Step at a Time – speaks to the fact that since its inception in the Spring of 2006, VisionWalk has raised over $45 million to fund sight-saving research.

Great time walking with my family and the VRS team for a wonderful cause! Many thanks for everyone who participated!


GRATIS: “Never let the future disturb you. You will meet it, if you have to, with the same weapons of reason which today arm you against the present.” Marcus Aurelius (Meditations)


My best to you,

David Almeida

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 “Your first ritual that you do during the day is the highest leveraged ritual, by far, because it has the effect of setting your mind, and setting the context, for the rest of your day.” –Eben Pagan


TASK AT HAND: This week I’m thinking about the concept of a morning ritual. The morning ritual is the practice of having some set approach to the commencement of the day. The morning ritual is a strategy that will support a composed and successful mindset for the day. Despite the challenges, surprises and shortcomings that lie ahead, the morning ritual allows for preparation. From innovators to iconoclasts, found in teachers and thinkers alike, almost all individuals of genuine merit prescribe to some sort of morning ritual.

“Despite the challenges, surprises and shortcomings that lie ahead, the morning ritual allows for preparation.”

What is the morning ritual?

The morning ritual can take many forms: meditation, exercise, reading, journaling, nature walks, stretching, thought exercises are just a few examples. The overarching purpose of the morning ritual is to allow you a few moments of honest self-reflection. In reality, it actually doesn’t matter what your morning ritual is or how you do it; the focus is to have one that allows you to connect with yourself in a genuine manner. Over time, you can hone the morning ritual as a barometer of your willingness and preparedness for the uncertainties that await you.

“The overarching purpose of the morning ritual is to allow you a few moments of honest self-reflection.”

Now, it is important to note that this genuine willingness to look at yourself has much less to do with catering to emotional whims but rather, it is about curating strength in your ability to be ready for what lies ahead. The goal is to be poised and prepared for the traps and trickery that suffocate modern life. Bias, rationalizations, lack of self-control can rob you of effectiveness and leave you to act as a reactionary animal. Use your morning ritual for a measure of peace as you align strategy with execution.

“Use your morning ritual for a measure of peace as you align strategy with execution.”


MEDICINE & MACULA: Last week, I was a guest on the Cognified Marketing & Selling podcast with Joel Gaslin. If you haven’t heard of this podcast before, it focuses on marketing and selling by blending multiple strategies and techniques. I had a great time discussing some of my decision diagnosis strategies as applied to marketing and selling. No matter what your background is, I think you wil find this episode insightful and intriguing.

You can find the entire interview here via the iTunes link.

For other episodes, transcripts and other information, check out the homepage here.


GRATIS: “Every morning we are born again. What we do today is what matters most.” – Buddha


My best to you,

David Almeida

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“Hindsight is always twenty-twenty.” Billy Wilder


TASK AT HAND: This week I’m thinking about hindsight bias. In my opinion, this is one of the more comical fallacies for the degree of rationalization and inaccuracy inherent in its fabric. The hindsight bias, also known as the “knew it all along” effect, occurs when after an event has happened, we purport that we correctly predicted the outcome. However, the fallacy exists because there is no objective evidence for us having predicted the event.

Hindsight bias, commonly referred to as creeping determinism, is the basis for that feeling we get, “I knew it all long…”. For example, a patient presents with loss of vision and the eye physician diagnoses a retinal detachment. In summary, the doctor concludes, “I knew it! I had a feeling it was a retinal detachment”. Or take last year’s dramatic Super Bowl comeback win by the New England Patriots over the Atlanta Falcons. In various debriefs, you heard fans, players and commentators alike with phrases like: “I knew we were going to come back and win” or “I knew we could do it”. In reality, there was no way possible to predict this. Sports and medical diagnoses are areas where the hindsight bias has been extensively studied. You can find a nice summary here by Neal J. Roese of Northwestern University. Hindsight bias is a decision trap because it falsely supports our ability to predict events that cannot be predicted.

In an excellent commentary, from the September 2012 issue of Perspectives on Psychological Science, psychological scientists Neal Roese and Kathleen Vohs (you can find the article here) show that we bias and selectively recall information that confirms what we know to be true; then, we synthesize a narrative to describe this truth. If our brain has an easy time creating this narrative, then we interpret it to mean that the outcome must have been predictable and we identify with having correctly predicted it.

How does hindsight bias hurt us?

Hindsight bias is troublesome because it limits our ability for introspection. We all have a need for closure and a strong innate desire to make sense of events. Whether they be close relationships, world politics or natural disasters, we strongly want to establish some order and cause to events. This benefits our view of ourselves and the world. However, much – if not everything – lacks any sense or logic. Randomness runs rampant! Hindsight bias limits our ability to learn from events because, if we feel we correctly predicted them, then it follows that we must be in tune with the decision-making process  – which is untrue if this fallacy is present. Contrastingly, with honesty, as witnesses to our errors and miscalculations, we gain valuable insight and maturity in how we come to terms with external stimuli.


MEDICINE & MACULA: I was in Barcelona, Spain this week for the EURETINA 2017 Congress.

On Friday (8 September 2017), I presented a talk on our recent findings and techniques for proliferative vitreoretinopathy (PVR). My talk, Predictive factors for proliferative vitreoretinopathy formation after uncomplicated primary retinal detachment repair (David RP Almeida, Kunyong Xu, Eric K Chin & D Wilkin Parke III) looked at predictive tools for patients who develop this complex condition.

Many thanks for all the interest and international support!


GRATIS: “You can’t operate by hindsight.” -Max Baucus


My best to you,

David Almeida

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“Grit is living life like it’s a marathon, not a sprint.” -Angela Duckworth


TASK AT HAND: This week I’m thinking about grit. A trait commonly alluded to while, at the same time, rarely well-defined or understood. Most people identify grit as a requisite trait for success yet few can define its crystalline qualities. On today’s Sunday Surgical Scrub, let’s deconstruct the quality of grit and find ways which you can develop more of it.

What is grit?

Merriam-Webster defines grit as “firmness of mind or spirit” and “unyielding courage in the face of hardship”. In my opinion, the former definition lacks direction as it tends to imply “strength” without context. However, the latter definition is right on! Grit is the ability to withstand hardship without compromise to integrity, intuition and individuality. Grit allows your character to carry on despite conflicts and confusion. Without grit, you risk being swallowed by the tides of misfortune and disaster. Like the opening quote by Angela Duckworth, you can think of grit as the kind of energy and focus that allows you to push through the pain and fatigue of a marathon; having the dedication and courage to continue when all you want to do is quit.

“Grit is the ability to withstand hardship without compromise to integrity, intuition and individuality.”

How do I acquire grit? How do I get more of this ephemeral quality?

This is a question I am frequently asked. First, I do not believe that you are binary in this regard; i.e., you are either born with grit or not. To the contrary, grit can be pursued the same manner meaning in sought when faced with despair. If grit is the ability to maintain courage and withstand hardship, then surely discomfort is the surest path to this goal. 

How do you know if you have the necessary grit to face hardship? 

Start by reveling in instances of discomfort. If these occur, don’t retreat. Instead, maintain focus on your goals and ensure your objectives remain intact. When faced with a negative fury, brace and stay committed to what brought you there. See it through and you will find that it was grit that accompanied you across the finish line.

“If grit is the ability to maintain courage and withstand hardship, then surely discomfort is the surest path to this goal.”

I do not wish you calamity or disaster, but discomfort is ok. The call to action from today’s Sunday Surgical Scrub is, over the next week, look for instances of discomfort. Identify what makes the situation or scenario uncomfortable. Next, align the original motives that brought you there and make sure you see them through. Take joy in these instances and you will begin to find that discomfort is a challenge with positive consequence irrespective of a negative result.


MEDICINE & MACULA: It was fantastic to be an expert guest on The Don and Gino Radio Show and their new series, Interview With The Giants!

We discussed how to get uncomfortable, leadership and effective management strategies, Citrus Therapeutics and, of course, the effect of procrastination on decision-making. You can find the entire interview here.

You can also find the interview according to 4 topical segments via the YouTube links below. Many thanks again to Don & Gino!!

 Segment 1

Segment 2

Segment 3

Segment 4


GRATIS: Happy Labor Day and may you find joy in the celebration of hard work!


My best to you,

David Almeida

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“No work is insignificant. All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence.” – Dr. Martin Luther King Jr.


TASK AT HAND: This week I’m thinking about the old proverb, “work is worship”. It’s one that my parents taught me and one I echo frequently. However, it is also one that I commonly get dumbfounded and exasperated queries for. It is commonly questioned whether work is not merely some mechanical action relegated to a necessary compromise for material survival. So, on today’s Sunday Surgical Scrub, I will explain how I adapt this ancient teaching into a daily motivator.

1. Your work is about you. Work does not define you but, how you carry out your work, does speak volumes about your character. We need to remind ourselves that our work – whatever it may be – gives us a tremendous opportunity to develop ourselves. When you are working, you are working on yourself: your temperament, patience, equanimity, and problem solving. Therefore, this is why putting in a weak effort is so troubling. When you deny yourself effort and care in your work, you are placating a similar weakness in yourself.

“If a man is called to be a street sweeper, he should sweep streets even as a Michelangelo painted, or Beethoven composed music or Shakespeare wrote poetry. He should sweep streets so well that all the hosts of heaven and earth will pause to say, ‘Here lived a great street sweeper who did his job well” (Martin Luther King Jr.). To borrow more from MLK, simply put, carry out your work as the best possible reflection of who you are. This facet of emphasis supports improvement and the creation of a culture of excellence rather than the mere production of tasks and jobs. This is where work, and how you approach it, can facilitate a spiritual connection.

2. Work is work. Sometimes, work is just work. It can be painful and frustrating. This is ok. It does not mean quit your job. It does not mean you are a terrible person. It does not mean you have to replace coworkers. It means that, sometimes, work is work. Don’t deny this feeling but accept it. This provides calm during challenging times. Moreover, it is worthwhile to remember that, if you have the skill where you are paid for a task, then it follows that you should be able to execute certain functions despite frustration and fear.


MEDICINE & MACULA: Many thanks to New Retina MD for showcasing our publication on the cover of the July 2017 Mystery Cases issue.

Our case, The Adventure of the Upstate Traveler: A camper brings home an unintended souvenir from a camping trip (Robin Kuriakose, Lorna Grant, Eric Chin & David Almeida) will have you checking twice after going out in the woods…

Attachment of a deer tick to the conjunctiva is a rare event, with only a few reports in the literature. We report a unique case of tick penetration into the conjunctiva, specifically a black-legged deer tick (Ixodes scapularis). You can find the case here.


GRATIS: “The reason why worry kills more people than work is that more people worry than work.” –Robert Frost


My best to you,

David Almeida

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