Eyeworld

EW NEWS & OPINION 16 May 2016 Insights by J.C. Noreika, MD, MBA Sir Richard Burton and Gertrude Bell's Victorian Age spawned an in- dustry promoting discovery and ex- otica. The Lost Generation witnessed the interwars' truce: Joyce's Leopold Bloom spent a day strolling around Dublin, Fitzgerald lazed in summer- time Cap d'Antibes, and Hemingway led safaris in Africa, Spain, and later, the Gulf Stream. Today, Paul Ther- oux, Bill Bryson, and Rory Steward have assumed the mantle of vener- ated writers such as Wilfred Thesiger and Eric Newby. Howard Markel, MD, once observed in the New York Times that "each year it seems that more and more physicians are putting aside their stethoscopes for word proces- sors." Populating the Times' Book Review, physicians Verghese, Gawande, the late Oliver Sachs, and Paul Kalanithi tell their tales of patients to patients. Amazon devotes a webpage to ophthalmology's own Robin Cook, who fuels read- ers' imaginations with timely thrillers. Is it surpris- ing then that England's Gavin Fran- cis, a medical polymath, has written a medical- ly themed travelogue? In Adventures in Human Be- ing: A Grand Tour from the Cranium to the Calcane- um, he almost succeeds in combining the genres. Unfortu- nately, his slim 225-page book offers too little to keep the clinician fully engaged and too much for the laity to assimilate. Travelogue of the human body J.C. Noreika, MD, MBA intraocular lens compelled similar perseverance of its pioneers. The chapter "The Shoulder: Arms & Armor" is constructed around a motorcycle accident victim presenting to Dr. Francis' emergency room with damage to his brachial plexus. The accident provides the framework for a discussion of bat- tlefield injuries. Over the millennia, war-induced mutilation has ad- vanced peacetime surgery. Military medicine historians study accounts of battles to demonstrate that casu- alties of the Trojan War and today's victims of domestic violence show traumatic effects best understood when arms are raised in defense, the forearms bearing the brunt of the attacker's violence. He also points out that as weapons became more powerful, mortality rates began to fall. Shells and bombs deal death less efficiently than stones thrown on the plains of Troy. After proceeding through the head, chest, upper limbs, abdomen, hips and pelvis, the book closes naturally with the feet and toes. Recounting Mary Leakey's discovery of 3 sets of footprints in Tanzania's ancient lava, Dr. Francis writes sub- limely of male, female, and infant human progenitors walking upright 3.5 million years ago as a volcano spewed ash. One of the footprints "pressed deeper into the ash with the left foot, as if carrying a baby, a burden, or even struggling with a limp." The obsidian imprint re- vealed it was raining. Dr. Francis' book is an interest- ing, easy read. He writes well, effec- tively blends diverse subject materi- al, and employs a clever essay-driven approach. Doctors are natural writers. A clinical history at its best exploits the tools of literature. The best doctors tend to be the best lis- teners, witnesses, and documentari- ans. With its formulaic binary drive for standardization, we hope today's electronic health record will not render this important legacy of the art of medicine as archaic as Hector's stones. EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for 35 years. Contact information Noreika: JCNMD@aol.com The book is divided into 7 sections and 18 chapters, each devoted to a specific part of human anatomy. In the style of Baedeker, he constructs the chapters starting at the brain and working downward, appends a pertinent clinical case and inter- sperses interesting vignettes culled from history, literature, art, and science. Unlike the best travelogues, he doesn't linger long enough to immerse the reader in detail intrin- sic to the subject. In the section designated "Head," Chapter 3's 13 pages are devoted to the eye. Dr. Francis reminds us that "there are few exam- inations more intimate: my cheek often brushes theirs, and usually both of us, through politeness, end up holding our breath." True when the direct ophthalmoscope was the instrument of necessity, the claim is mostly moot after the accession of optical coherence tomography. Quoting a mentor, he wryly observes that to other physicians, "ophthal- mology tends to be thought of as a blend of mysticism and the applica- tion of drops four times a day." Per- haps. In describing modern cataract surgery (while erring in the techni- cal subtlety of phacoemulsification), he endears himself to ophthalmol- ogists by proposing that they "have to be among the most dexterous of surgeons." Those who determine its compensatory value fail to recognize this obligatory competence. Historically, the Greeks thought vision possible because of the eye's indwelling divine fire. Homer, one of military history's first correspon- dents and an early travel poet, was blind. Milton and Joyce lost their vision. Glaucoma likely destroyed Jorge Luis Borges' sight; he referred to the eye as "the noblest organ in the body." Ironically, he headed Argentina's National Library, a blind man surrounded by millions of books who never learned braille. Some chapters succeed better than others. Using a case study to describe benign positional vertigo, we learn of the trials of Dr. John Epley, struggling to have his novel therapeutic approach accepted by otolaryngology's establishment in the 1980s. Effective in more than 80% of cases, his work awaited peer-reviewed publication for more than 10 years. Ophthalmology's contentious acceptance of the A review of Adventures in Human Being, in which Dr. Gavin Francis blends anatomy, clinical case reports, and historical, scientific, and artistic references T ravelogues have been a staple of literature since antiquity. Homer's Odyssey, Dante's Inferno, even Don Quixote's chivalric quest were about journeys. Marco Polo's peregrination along the Silk Road in 1271 begot translations that are still in print today. As empires expanded, travel became a staple of exposition. Unknown regions of Africa, India, and the north and south poles kindled insatiable curiosity among peoples bound to the land. Melville's Omoo, Typee, and his epic Moby Dick helped define America's Romantic period.

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