EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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E W NEWS & OPINION 2 5 Author's note: The "powers that be," a numinous phrase, have granted my writing broad discretion regarding theme, topic, and content. I am blessed. For my muse is adamant that there must not be another expostulation of the Affordable Care Act nee Obamacare, another screed regarding t he Sustainable Growth Rate or one more stave on the essential tasks of the recondite meibomian gland. Having recently and irrevocably crossed my Rubicon, I ask you, dear reader, to permit me the following conceit. S ometime between 12:30 and 1 p.m. on a battleship gray day as Cleveland's December sluiced to winter's solstice, I signed papers transitioning the practice to my associate. I inked them on the ill-treated oak table that I bought second-hand from a business in Parma sometime in the summer of 1984. It was part of a grouping that included six chairs that had swiveled out of the set of Mad Men, a capa- cious credenza, an executive high- backed chair, and a desk upon which Dreamliners could land. The newer the doctor, the bigger the desk; insecurity and acreage are directly proportional. How, I won- der, did I move these boardroom Behemoths, another Good Book term? It was hot, they were heavy but I was young. Herniated disk surgery was years off. I—and the bank, the hospital or Physicians Resource Group—had owned my practice in part or total since May 1984. That's almost 30 years if anyone is counting. I no longer have a desk. This is good, all good. A medical practice is organic. It grows, learns, tests itself, faces chal- lenges, matures and ages. Many just end. With luck, a succession of young, clear-eyed professional kindreds will continue to foster its legacy beyond its founder's lifetime. In 1984, my practice consisted of a small rented office, its floor to ceiling window opposite the eleva- tor; it was in the bowels of the town's only multistory building whose frontispiece didn't have the letters "U.S." or the words "Hospi- tal" or "Bank" on it. A combination of mid-western pragmatism and Scandinavian spareness, it was ugly. It featured a dragon's scale, shake shingle exterior, a round recessed atrium skylight of Polyphemic dimensions and a small pillbox on its flat, generous roof that conjured notions of Area 51. My office was in the basement. This was euphemisti- cally labeled "LL" in the elevator but that seemed a bit pretentious. Symbolically, realistically, it was in the belly of the beast. But I was a private practice player on medicine's greatest stage. I was 33; I owned the telephone and the typewriter. Im- pulsively, I had invested in a sched- uling book that spanned three years. My practice would see its first pa- tient in a month. Selective memory serves us well. It shields and protects from recall the sleepless nights staring at the haunting hours' bedroom ceiling. It, like a jovial, slightly demented aunt, deludes and confabulates. Was I worried about money, making pay- roll? Of course not! I was com- mander of the Starship Enterprise, sitting behind the biggest, baddest oak desk in the cosmos. What could go wrong? Patients would come. They would come with their presbyopia and cataracts and tear duct obstruc- tions. They would sit patiently in the crepuscular light of one of my two exam lanes anxious to witness the diagnostic acumen of this spe- cialist oozing the sureness of newly minted board certification. They would marvel at his dexterity in handling those "gently used" Haag-Streits. And they would pay me for doing something that I loved, would do for nothing. And this, unfortunately, came to pass frequently. My first patient was the town's Episcopalian minister, the shepherd in residence at St. Paul's Church. My wife is Episcopalian. Her forebear, John Howland, made passage on the Mayflower, reportedly imbibed a bit too much grog—the potable water was putrid—and fell overboard in a storm only to be rescued. Having sired at least 10 children, Howland's genes are only slightly less pervasive in New England than those of Genghis Khan in Asia Minor. Intuit- ing how important word of mouth was to the success of my practice, I was most pleased to have this man of the cloth claim the distinction of being Invoice #1. Of course, I didn't charge him; the rent would have to wait. Ophthalmologists of a certain age nurture such risible tales. Remembering them makes it easier to get out of bed in the morning. Remembering them helps us con- front the inevitable. In 2014, after 30 years of chairing office meetings, feigning to listen to all sides of an argument, and making the final de- cision—period!—until the night's sleep demanded its amendment, I will now serve as another W-2 form in my old practice. I want it this way. I've seen too many promising partnerships go the way of the Kardashians. It is good. It is all good. I'll let you know how it works out. EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for more than 30 years. Contact information Noreika: JCNMD@aol.com by J.C. Noreika, MD, MBA Upon crossing the Rubicon J.C. Noreika, MD, MBA I nsights February 2014 13-25 News_EW February 2014-DL2-ALT-OIS-ad_Layout 1 1/30/14 10:08 AM Page 25