• Life is Not a Dress Rehearsal

    Past Academy President William Tasman, MD, reflects on the innovations in ophthalmology during the 60 years before (1895-1955) and after (1955-2015) he graduated from medical school.

    As Irving Berlin wrote in Annie Get Your Gun “There is no business like show business,” and through the centuries there has been no greater contributor to the theater than the immortal bard, William Shakespeare. In Act II Scene VII of Shakespeare’s play, As You Like It, Jacques begins a monologue that compares the world to a stage, the people to players, and life to a play in which the seven stages of aging are portrayed. It begins as follows: “All the world is a stage,”and details life from “the infant mewling and puking” to “second childishness and mere oblivion.”

    While shaving one morning, I thought about this speech because medicine measures your years in practice from the year of your graduation from medical school. For me that was 1955, so I calculated that I have been doing this in one form or another for 59 years. Just to make the math easier I rounded 59 off to 60 and then, on a whim, subtracted 60 from 1955. This put me back to 1895.

    Like many present-day practitioners, I tend to think of major advances coming online during my professional lifetime, but that really isn’t the case. I was astounded when I looked back to 1895 and found out that’s when Wilhelm Röntgen discovered X-rays. There were very talented people working even hundreds of years before that, Avicenna, a Persian physician before 1000 AD, Ambroise Paré in France, a barber surgeon who ministered to the wounded on the battlefields of France and realized that ligating vessels when a limb had to be amputated led to much greater comfort for the patient than boiling the stump in oil. In 1747 Jacques Daviel took a giant leap forward in cataract surgery with extracapsular extraction.

    1955 itself was a pretty remarkable year. It was just one year after the first kidney transplant in 1954, which had been performed on identical twins. And I shouldn’t neglect to mention that 54 years before, Freud in 1900 was running around interpreting dreams. Of course, he had been preceded by Joseph of the many-colored coat in the Old Testament, who had quite a career when, having been sold into slavery in Egypt by his brothers, interpreted dreams for the Pharaoh.

    But back to the 1950s. That decade saw the clinical trial for retinopathy of prematurity, as well as the introduction of Rauvolfia, which had reserpine serpentina in it as a treatment for hypertension. And 1955 was the year oral contraception came along, as well as the Salk vaccine.

    Since that time, we have seen major advances in the field of ophthalmology, such as the Ridley implants, which were developed during World War II. Pasteur said, “Chance favors the prepared mind,” and Harold Ridley in Great Britain certainly had been thinking about intraocular lenses for some time when he cared for flight lieutenant Cleaver, known as “Mouse.” The fact that Cleaver got methyl methacrylate particles intraocularly after the canopy on his Hawker Hurricane was shot up, but no inflammation or infection, gave Ridley the idea that this would be a good material to consider for an intraocular lens.

    Of course, the next consideration is what is going to happen over the next 60 years. Technology has taken over big-time and I think the horizons are probably almost limitless. What do I mean by that? Could artificial vision be on the horizon? I think in some ways it is already here. A book that I read called The Blind Doctor is about one of seven children born to Polish refugees in Chicago in the late 1800s. He is born blind as were two of his siblings. I believe they must have had Leber’s congenital amaurosis, something for which there is now the possibility of obtaining some sight.

    Trying to imagine what will be coming down the pike in 60 years can be difficult. To quote Yogi Berra, “It’s tough to make predictions, especially about the future.” So rather than go further with this thought, I will quote now from a poem by Robert Browning entitled, “Rabbi Ben Ezra.” He begins that poem with these lines:  “Grow old along with me! The best is yet to be. The last of life for which the first was made.”

    And in keeping with that thought there is another line of Robert Browning’s from his poem on the Florentine artist Andrea del Sarto to be kept in mind. It has been applicable throughout the centuries, but perhaps not as elegantly stated. “Ah, but a man’s reach should exceed his grasp, Or what’s a heaven for?”

    So what does all this have to do with life is not a dress rehearsal? Probably not a lot, but if you have an idea or aspiration, pursue it and don’t put it off because you don’t know when the next opportunity will come. To keep putting things off or redoing them over and over may lead to no opening night at all.

    Editor's note: In a 2009 conversation with friend and colleague Paul Lichter, MD, Dr. Tasman reflected on his career in an oral history recorded through a partnership between the Museum of Vision and StoryCorps. View transcript [PDF].