I was delighted to be the first cataract surgeon to implant the FDA-approved Alcon Panoptix Trifocal intraocular lens at the Wills Eye Surgery Center in Cherry Hill. Colleagues & ophthalmic device companies continue to inspire with new technologies.

Here’s an Alcon-produced patient-friendly video which explains the highlights of monofocal vs. multifocal / tri-focal lenses:

LEARN MORE ABOUT CATARACTS

A cataract is the clouding which occurs in the natural lens of the human eye. When we look at an object or enjoy colorful scenery, we depend on a clear pathway for light to travel from the outside world to the eye. Light and visual information travel through the cornea, pupil, and lens to the retina. The retina then sends this visual information to the brain.

Cataracts can cause multiple symptoms, including blurred vision, glare, halos, poor contrast and generalized visual discomfort. Patients may have difficulty driving, watching television, focusing on a computer, tablet (iPad, Kindle, Nook), smartphone, or reading. The haziness of vision may be similar to looking through a windshield during a rain or snowstorm. As cataracts progress, patients may feel that their vision no longer lets them enjoy common activities such as driving, watching television or walking safely.

More than 20 million patients in the United States have cataracts with an estimated 30 million patients affected by 2020. With the growth in our population and older patients leading active lives, cataract progression can result in a decrease in quality of life as well as the increase in the risk of falling, fractures, and depression.

Cataracts are treatable by cataract surgery, which is among the most common procedures performed in the United States. Dr. Goel is board certified and perform cataract surgery using the latest technologies and at the state of the art Wills Eye Surgery Center of Cherry Hill.

We often follow patients for many years while their cataracts are developing and until symptoms have an increased impact on daily activities. Patients are encouraged to learn about cataracts and watch our educational YouTube videos. We also use the latest lens technologies and can recommend the proper lens implant to replace the cataract once removed. Intraocular Lens (or IOLs) are commonly tailored to each patient’s eye health and visual demands.

Symptoms:

• Blurred Vision
• Glare/Halos
• Poor Contrast or Dimness of Vision
• Double Vision
• “I can’t see that small line at the bottom of the tv screen”

Visit http://www.reanj.com to learn more about cataract surgery options.  Or call the office at 856-795-8787 to schedule a cataract consultation with Dr. Goel.

 

 

I was inspired to create the talk, Growing Your Practice Through Collaborative Partnerships, after listening to podcasts and reading many leadership books in the last few years.

Through collaboration, you can amplify your strengths, shore up your weaknesses, save time and money. Shared authority, resources, and accountability between practices can help you achieve common goals that would otherwise be very difficult or expensive to accomplish.

In this session, I introduce numerous leadership and collaboration concepts to help ophthalmic and medical practices realize their full potential.

You’ll learn:

• The three behaviors of a collaborative leadership style, essential when forming partnerships.
• Common collaboration missteps that can throw your plan off track and how to overcome barriers.
• Leadership and partnership lessons from some of today’s business experts.
• Common themes among Collaborative Leaders, Level 5 Leaders & Serving Leaders.
• The essentials of OKRs – Objectives and Key Results (Andy Grove & John Doerr)

 

I’ve tried to maximize my commuting and leisure time and have discovered wonderful podcasts which help formulate mental models.  These include:

1. We Study Billionaires Podcast (Preston Pysh and Stig Brodersen)
2. The Knowledge Project (Shane Parrish)
3. Ted Talks
4. Naval Podcast (forgot to mention in talk!)

 

I reference many books I’ve read recently in this talk including:

1. Peter D. Kaufman (editor) and Charles T. Munger. Poor Charlie’s Almanack: The Wit and Wisdom of Charles T. Munger
2. Morten T. Hansen, Collaboration: How Leaders Avoid the Traps, Build Common Ground, and Reap Big Results
3. Jim Collins, Good to Great: Why Some Companies Make the Leap and Others Don’t
4. Kenneth R. Jennings and John Stahl-West, The Serving Leader: Five Powerful Actions to Transform Your Team, Business, and Community
5. Daniel Goleman, Emotional Intelligence: Why It Can Matter More Than IQ
6. Walter Isaacson, Benjamin Franklin: An American Life
7. John Doerr, Measure What Matters: How Google, Bono, and the Gates Foundation Rock the World with OKRs
8. Ray Dalio, Principles: Life and Work
9. James Clear, Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones
10. Spencer Johnson, M.D., Who Moved My Cheese?: An A-Mazing Way to Deal with Change in Your Work and in Your Life
11. Guy Spier, The Education of a Value Investor: My Transformative Quest for Wealth, Wisdom, and Enlightenment
12. Mohnish Pabrai, The Dhandho Investor: The Low-Risk Value Method to High Returns

 

I’ve enjoyed participating in the Wills Eye Hospital resident teaching courses on cataract surgery pearls & techniques.  With the 2-day course coming up this week — one on suturing and the second on basic phacoemulsification techniques — I wanted to share pearls and online resources.  This post is ideal for ophthalmology residents in training and colleagues engaged in lifelong learning.

I offer the following pearls for ophthalmology residents as they start the journey of cataract surgery:

1. Watch videos.  When I was a resident, I’d watch VHS tapes & DVDs of top ophthalmologists performing cataract surgery.  I enjoyed the calmness of watching world-renowned surgeons share their pearls on difficult cases (Howard Gimbel MD chief among them).  I visit CataractCoach.com daily and friend Uday Devgan, MD has created a cutting edge channel for cataract surgery pearls.
2. Watch surgeons in the operating room through the microscope AND from 5-10 feet away.  Learn to appreciate hand movements from a distance.  Focus on patient head positioning, surgeon posture and where senior colleagues rest their hands.
3. Make a list of every item you need for surgery.  Glove size, Microscope PD, routine and complicated cataract cases all use various instruments, etc.  Take photos of the cataract surgery phaco settings for sculpting, quadrant removal, etc. You may operate in different facilities and will want to give the OR team your preferred items.  Make a list of special items you want on-hand for difficult cases.
4. Also issues to make you as comfortable as possible.  Do you like lights on or off during surgery?  Music in background?  Is the surgeon chair comfortable and appropriate? Ergonomics is critical and especially during the early days of microscopic surgery.
5. Record all of your cases and watch back in real-time.  No fast forwarding allowed!  During my 3rd year of residency and early years in practice, I watched every case in real-time and often with my brother, Sonny Goel MD, a cataract & refractive surgeon.  I still remember the pearls of an independent observer as he reviewed my cases with me.  Be able to explain and minimize all time delays between steps and during the procedure.
6. Every second counts in the operating room.  If an OR team member needs to leave the room to get a special instrument, have the instrument on-hand for future cases.  I will not enter a room unless a Malyugin Ring, Vision Blue, and other special devices are in the room before I operate.
7. Start performing functions with your non-dominant hand.  Cataract surgery is a bi-manual technique and you’ll want to be able to use both hands easily during surgery.  I would try writing, shaving, etc. with my non-dominant hand as a resident.
8. Make copies of dictations from various cataract surgeons.  Surgeons have numerous techniques, and you’ll find surgery note dictations helpful as your style evolves.  Develop special templates for complicated cases.                                                 
9. Calculate your own intraocular lens powers.  I use 7 formulas to optimize & select the intraocular lens power.  This includes older generation formulas (SRK/T, Holladay 1, Holladay 2, Hoffer Q) and newer generation formulas (Barrett Universal II, Ladas, and Kane, currently free online).  I also calculate lens powers for in-the-bag, sulcus, and ACIOL before surgeries.  I use special colored sheets (red for right eye (OD) and light blue for left eye (OS)) as an added patient safety measure.

Here are some blog posts and videos on suturing and cataract surgery techniques.  I may add more links in the weeks ahead.  I hope this is a helpful start.

 

Suturing Pearls:

1. Uday Devgan, MD Basic Principles of Ophthalmic Suturing

2. Uday Devgan, MD Review: Basic Principles of Suturing with 10-0 Nylon

3. Mayo Clinic Corneal Suturing Techniques (Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6)

4. Christopher Teng, MD How to Suture Efficiently in Ophthalmology (no sound, but less than 2 minute video with text and great pearls)

 

Cataract Surgery Pearls:

1. Howard Gimbel MD – When I was a resident, an ophthalmology device company sent all residents a VHS tape of Dr. Gimbel performing 5-6 cataract surgeries, telecast live to an ophthalmology conference.  I watched Dr. Gimbel’s videos hundreds of times (for many years, every week and on the night before I operated!).  Here’s a recent video from on Effective Fracturing in Cataract Surgery.

2. Richard J. Mackool, MD – I visited Dr. Mackool at his Astoria, NY practice & surgery center twice early in my career.  The first time was in 2002 and the second in 2006.  Dr. Mackool is a brilliant ophthalmologist and cutting edge cataract surgeon.  His columns and surgical pearls have guided me for two decades.  His 2019 Mackool Online Fundamentals: Episode 1, Phaco Fundamentals is an ideal starting point for the busy resident and lifelong learner.  And in 3-D online!

3. Uday Devgan, MD – I love cataractcoach.com!  Here’s a link to his complete list of videos.  Start with his routine cataract surgery case here.

4. My guest submission on CataractCoach.com “Bleeding from a Pupil Expander!  Now What?” is here.

5. Lisa Brothers Arbisser, MD Routine Cataract Surgery (2012) here.

6. Dr. Takayuki Akahoshi performs 10,000 cataract surgeries a year.  Here is a case he performed on a grade V cataract using ICG (indocyanine green) and a pre-chopping technique.  This case had a Cumulative Dissipated Energy (CDE) = 9.86.  (Keep a personal log of your aspiration time, CDE, and fluid exchange throughout residency!)

7. This is an example of my cataract surgery technique video in which I describe each step of surgery in a patient-friendly manner (you’ll never look at an M&M candy the same again).

8. I also include a white cataract in which I used Vision blue here.

 

PS. A most successful suturing & phaco course! The Wills Eye Hospital Measey Ophthalmic Surgery Training (MOST) Lab is a game changer in ophthalmology microsurgery training. Congrats to colleagues and leaders for helping the next generation in the journey of #ProtectingSight & #EmpoweringLives. #BelievingIsSeeing

I will continue to add pearls & links to this blog post.  Please send me helpful links & comments below or via social media: YouTube | Twitter | Instagram | LinkedIn

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Ravi D. Goel M.D. is a cataract surgeon & comprehensive ophthalmologist at Regional Eye Associates in Cherry Hill, NJ.  He is also an instructor at Wills Eye Hospital. #ProtectingSight #EmpoweringLives #BelievingIsSeeing

A year ago, I experienced the collector’s thrill of a lifetime.  I started collecting documents related to Yale history in 2003 (around my tenth year reunion).  I’ve been fascinated with the Yale campus, architecture, traditions, societies, and college life since my first day of freshman year.  My original intention was to collect Yale-related historical documents — the interest grew to include Colonial, Civil War and US Presidential history — between my 10th and 25th reunions. I planned to gather documents “in secret” and make a single donation in honor of the 25th reunion.

As I soon discovered, the research time needed to curate each item in preparation for donation increased exponentially in the passing years.  As Google increased its offerings on Google Books, the opportunity to research and learn about the many authors and subjects in my collection became an obsession in itself.  I also realized that historical documents are best enjoyed when available to other researchers and scholars.  By 2008, I decided to donate my entire collection to Yale in honor of my 15th reunion.  After suffering a month of donor’s remorse, I enjoyed seeing documents available for research.  I continued to assemble documents and made additional donations during numerous reunions and events (in honor of the 15th, 20th, and 25th reunions, the 2011 conclusion of the Yale Tomorrow Campaign, and the 100th anniversary of Henry Roe Cloud’s (BA 1910, MA 1914) masters degree in 2014).

As part of my 25th reunion weekend, I shared my love of collecting with classmates during a Friday afternoon exhibit at the Gates Classroom, a newly renovated Manuscripts & Archives teaching space once devoted to the Gutenberg Bible.  The Gates Classroom is adjacent to the L&B rooms in Yale’s Sterling Library.  The first YouTube video includes a 12 minute impromptu overview with collection highlights from the May 2018 exhibit. (My college roommate & class treasurer recorded the speech with my iPhone and eventually gave me the hook!)

In the second video, I mention a 25th reunion gift to the Beinecke Library.  During the appraisal process, my appraiser discovered a rare manuscript leaf in the hand of famed author Frank Norris.  The Frank Norris and Conrad Richter letters from the Frederic Taber Cooper collection were displayed at the Beinecke Library throughout the 2018 reunion weekend.

(Corrections from 2nd YouTube video: Conrad Richter was awarded a Pulitzer Prize in 1951. Frank Norris died October 25, 1902 of peritonitis from a ruptured appendix. Regarding the number of Frank Norris’ The Octopus manuscript leaves known to survive, the University of California – Berkeley Bancroft Library finding aid states, “The Octopus: notes; character sketches; two leaves of the original manuscript; photocopies of four additional leaves.”)

After the Gates Classroom exhibit, many classmates approached me in appreciation of the opportunity to see the documents.  One classmate told me about his brother who collects Harvard memorabilia.  We’ve probably been rival bidders at many an auction!

Classmates also spoke about their own collecting interests, which led to many positive interactions.  And the Yale Library, Development Office, and University friends were most gracious to attend late on a Friday holiday afternoon.

For me, the Gates Classroom exhibit was the highlight of many years of the “wonderful illness” of collecting.  Very much appreciate the class, reunion leaders, and University’s graciousness.

Below is an inventory of items which were on display.  With thanks to former Head of Collections Bill Massa who prepared this inventory.  I also funded the digitization of my collection which is available on the Yale Library Digital Collections.

Selection of manuscript materials donated to Yale University Library by

Ravi D. Goel, Yale College Class of 1993, between 2008 and 2014.

Gates Classroom, Manuscripts and Archives, Sterling Memorial Library

May 25, 2018

#1   Josiah Willard (BA 1714) letter, 1719 Apr 20, to an unnamed recipient.  RU 1081. (** Willard was named one of Yale’s 30 most prominent graduates at Yale’s 300th Anniversary by the Yale Alumni Magazine in 2001 (one per decade which includes Princeton founder Jonathan Dickinson, Noah Webster of Webster Dictionary, US Presidents George HW Bush, WH Taft, and Bill Clinton among many).  Willard, then a 27 year old preacher, was captured during a turkey-expedition and skinned by Indians in 1723.  This is the only Willard letter I’ve been able to locate.)

#2   Timothy Cutler letter, 1736 Oct 8, to Sir Geflow Cambridge.  Cutler served as Rector (now President) of Yale College from 1719 to 1722.  RU 1081 (** The son-in-law of Yale’s 2nd Rector, 3rd Rector Timothy Cutler (Harvard 1701) was dismissed by a vote of Yale’s Trustees in 1722 after giving an Anglican blessing.  The details of this 1736 letter are extraordinary.  Mentions Maderia wine, the comments of Sir Isaac Newton, and procurement of books from a fellow at Eton College.  Also mentions Harvard, Cambridge, Oxford, London, many Cambridge professors and religious struggles in New England.)

#3   Jacob Heminway (BA 1704) quit claim, 1746 Apr 15.  First student to receive instruction at Yale, then the Collegiate School in the Colony of Connecticut, in Rev. Abraham Pierson’s parsonage in Killingworth (now Clinton).  RU 1081 (** This is only the 2nd known signature of Yale’s First Student that I’ve been able to find.  The other is at the Beinecke Library. See also Judith Ann Schiff’s superb profile of “Yale’s First Student” in the Yale Alumni Magazine (2004).)

#4   Eleazer Wheelock (BA 1733) agreement (early copy), 1777 November 9, with Mr. John Smith as Dartmouth College’s first professor.  Wheelock was the founder and first president of Dartmouth.  RU 1081. (** As I mention in the video, Dartmouth curators are unable to locate the original copy of the contract between Dartmouth and their First Professor.  My “Copy from the Original” may well be the only one which survives.)

#5   Horace Holley (BA 1803) letter, 1802 Feb 14, to his father Luther Holley.  RU 1081 (** Holley was an educational pioneer.  As a Yale student, he writes passionately about the Judiciary Act, Constitution, and future of the young United States.  My Holley letters have been quoted in James P Cousin’s Horace Holley (2016) biography.  And a Yale senior essay!)

#6   Edward Anthony Bradford (BA 1833) letter, 1833 Jun 17, to his mother Lois Bradford. RU 1081. (** I love this letter.  Members of this Yale class, which include William Russell and Alphonso Taft, founded Skull & Bones.  Salutatorian EA Bradford writes to his mother about 7th US President Andrew Jackson’s Yale visit. He states, “Jackson left town this morning for Hartford. He arrived here Saturday afternoon from New York + remained over Sunday, thus giving me a full opportunity to inspect him.  He was attended by Mr. Van Buren (VP) … (NY Governor) + other distinguished characters.” )

#7   Wyllys Warner (BA 1826) letter, 1843 Mar 17, to Aaron Kellogg about an indigent student fund. RU 1081.  Warner served as Yale’s treasurer (1833-1852) and Secretary (1858-1869). (*** I am proud to be a “financial aid kid” from Yale.  I have a lifelong appreciation of alumni & philanthropists who have supported financial aid across generations.)

#8   Yung Wing (BA 1854) letter, 1851 Jun 25, to Albert Booth (BA 1850).  Yung Wing was the first Chinese citizen to receive a degree from an American College.  RU 1081. (*** This document is mesmerizing in every detail.  Yung Wing writes about “the many disadvantages in which I labor.”)

#9   Yung Wing’s senior class autograph album.  Yb71 854y. Donated by Mrs. Violet Chan, 1955. Henry L. Hubbell’s album with engravings and autographs.  Yb71 854hu. Donated by Charles H. Small (B. Div. 1885).

#10 Heman Potter Babcock letter, 1860 Jan 22, to Tracy Peck, Jr. (BA 1861) with a hand-drawn Skull and Bones symbol.  RU 1081. (** Babcock had left Yale and was writing to Peck, then a junior, a few months before Peck was tapped for Skull & Bones).

#11 John Jacob Edic (BA1864) letter, 1861 Feb 2, to his brother.  Makes a brief mention of secession by Georgia.  RU 1081. (** Thomas Carolin Clay (1841-1897) is the student who left Yale.  He enlisted as a Private in the Liberty Independent Troop in 1862, which became part of Company G, 5th GA Regt. of Cavalry.  This letter is also quoted in a Yale senior essay which includes many more details of Clay’s life.  I forgot to mention that we were standing in Yale’s Sterling Library, named for Yale’s greatest philanthropist John W. Sterling & Clay’s classmate in the Yale Class of 1864.).

#12 Bound volume with a series of letters about Skull and Bones, Delegation of 1874.  RU 1081. (** My biggest regret from donating historical documents to Yale!  I wish I had kept for many more years and researched each item more thoroughly.  The letters include “Yours in 322 … Temple Fund … Bones,” and many key details of Skull & Bones history).

#13 William Howard Taft (BA 1878) letter, 1898 Dec 18, to Frederick B. Percy (BA 1877). RU 1081.  (The future 27th US President, then writing on US Court of Appeals stationery, laments being unable to attend a Yale alumni gathering in Boston.  Taft writes, “I do not doubt that night under the eaves of her ancient evening, Yale’s spirit burns brightly in the breasts of her sons …”  This handwritten letter is signed, “Yours in the Bones,” a detail missed by the auction house).

#14 Edward A. Bouchet (BA 1874) postcard, 1911 Aug 8, to James F. Alston.  RU 1081. For years Bouchet was recognized as the first African American to graduate from Yale College.  In 2014 evidence was found that Richard Henry Green was likely the first African American to graduate from Yale in 1857.  Bouchet remains the first African American to receive a Doctor of Philosophy degree from an American university—Yale—in 1876; he studied physics.  An online finding aid for Green’s papers is here. (** I remember this as one of the first Yale-related historical documents I ever purchased).

#15 Class of 1911 Scroll and Key photograph album.  RU 1081. (** From 1860 to 2020, there are about 160 delegations with photo albums.  With an estimated inventory of 2000 – 2400 volumes per society (160 x 15 = 2400 for Bones & Keys, and 130 x 15 = 1950 for Wolf’s Head), the Yale Library owns less than 30 for Bones, less than 20 for Keys, and 2-3 for Wolf’s Head (the rest are in Egypt).  Stay tuned.)

#16 Second piano parts composed by Reuven Kosakoff (non-graduate of the Yale School of Music), for works by Chopin, Heller, Mozart, Beethoven, Grieg, Gurlett, Schumann, Schubert, Mendelssohn, and Burgmüller.  MSS 130. (Kosakoff items were included in the Yale Gilmore Music Library’s recent exhibit, Musical Roots of the Elm City. Kosakoff’s papers are at the Klau Library, Hebrew Union College.)

#17 Composite photograph of members of the Yale College Class of 1910.  Henry Roe Cloud, first Native American to graduate from Yale College is in the center row, first photograph on the left.  MS 2008.  

#18 Typescript, 1915, of Cloud’s “From Wigwam to Pulpit:  A Red Man’s Own Story of His Progress from Dark to Light.”  MS 2008. See also Roe family papers at Manuscripts and Archives. (** This essay defined Cloud for generations. His 1950 NY Times obituary paraphrases the 1915 essay’s first sentence, “Dr. Henry Roe Cloud, a Yale graduate of 1910, who was born in a wigwam on the banks of the Missouri River …”  There is a Yale senior essay waiting to be told just from this manuscript.).

#19 Henry Roe Cloud letter, 1938 Feb 14, to “My dear Marion”, likely his daughter Elizabeth Marion.  MS 2008. (** See also a Yale Manuscripts & Archives blog post on this remarkable letter: Party Diplomacy: The Ravi D. Goel Collection on Henry Roe Cloud.  Cloud writes in detail about his travels in the snow to a lavish embassy party hosted by his Yale 1910 classmate Wang Zhengting, Chinese Ambassador to the US.  Of note is that the Yale 1910 class includes Robert A. Taft, who may have been instrumental in Cloud’s leading a Winnebago delegation meeting with 27th President Taft in 1912.  “Taft was a Yale alumnus and his son had been Roe Cloud’s classmate. Roe Cloud’s Yale connections provided him with access to political power and politicians which were not available to reservation Indians.” (Native American Netroots)).

#20 Dean Gooderham Acheson (BA 1915), address, 1962 Mar 31, “Real and Imagined Handicaps of Our Democracy in the Conduct of Its Foreign Relations.”  MS 2008. See also Dean Acheson’s papers at Manuscripts and Archives.

#21 Class of 1966 Skull and Bones photograph album.  Personal copy of Richard Warren Pershing (BA 1966), grandson of General John Joseph “Black Jack” Pershing.  Yeg2 R9x 1966 Oversize. (** See also my blog post on this item: Richard Warren Pershing.  A New York Times 2004 article explored in detail fellow Bonesman & then US Presidential candidate John Kerry’s reaction and struggles with his best friend’s (“Persh”) death.  History will judge this to be among the rarest Skull & Bones albums ever to come to private hands.  The only one I’m aware of to include a US Presidential candidate’s Bones photo in the public domain.  Through a FOIA request, a curator was unable to locate 27th President Taft’s album at the Library of Congress or in US Government holdings …  the search continues.).

Online resources:

1. Ravi D. Goel Collection on Yale (RU 1081), Manuscripts and Archives.
2. Ravi D. Goel collection on Henry Roe Cloud (MS 2008), Manuscripts and Archives. (See also my blog post of Yale’s 1st Native American graduate)
3. Ravi Goel Collection of Reuven Kosakoff (MSS 130), Irving S. Gilmore Music Library.
4. Ravi D. Goel collection of Frederic Taber Cooper, 1890-1913 (MSS 1132), Beinecke Library.  (See also my blog post on Frank Norris’ The Octopus manuscript leaf).

I recently donated a collection of documents related to American editor, literary critic and author Frederic Taber Cooper (1864-1937) to Yale’s Beinecke Library.  Cooper (Harvard AB and Columbia LLB, AM, PhD), was an associate professor of Latin and Sanskrit at New York University (1895-1902). He was also an editor of The New York Commercial Advertiser (1898-1904), The New York Globe, and The Forum (1907-1909). His NY Times obituary states, “It was while Dr. Cooper was editor of The Forum that it began to take a leading position in literature and changed from a quarterly to a monthly publication.”

Cooper profiles Frank Norris among fourteen distinguished writers in Some American Story Tellers (1911). In the preface, Cooper writes, “The late Frank Norris once wrote that in every child a story teller was born, but that the vast majority died soon after birth.”  Cooper features Norris as a novelist among a group who possess “the gift that makes them next of kin to the minstrel and troubadour, to the ancient fabulist, and to the forgotten spinner of the world’s first nursery tales, – the gift of holding the attention by the spell of the spoken word.” 

During the collection’s appraisal process, the appraiser discovered an unsigned document which he described as “Believed Frank Norris” manuscript related to his work, The Octopus.  He writes, “A highly important literary discovery: fascinating manuscript working draft from Norris’ epic The Octopus: A California Story, from Cooper’s files. Oversize sheet 10-1/4 x 15-3/4, with corrections also in Norris’ hand. Norris died the year after publication, at just 32, from a ruptured appendix. A major work in the annals of Western Americana and turn-of-century literature, here dealing with American free trade, and iron and steel tariffs!”

The Beinecke Library displayed three Frederic Taber Cooper items during my 25th reunion weekend. The label states, “an uncredited manuscript that may be a draft fragment of Frank Norris’s acclaimed 1901 novel The Octopus.” 

The display also included “surly” letters between Frederic Taber Cooper and then-future Pulitzer prize winner Conrad Richter.  

After the donation, I hired an independent researcher, Juliet Demeter, to photograph The Octopus related items at the UC Berkeley Bancroft Library (Frank Norris Collection of Papers and Related Materials).  

I am most excited to share the images below.  The Frank Norris manuscript leaf at the Beinecke Library appears authentic when compared to the known manuscript leaves at the Bancroft Library.

Infact, based on the Bancroft descriptions (leaf numbers 190, 213, 7), the document I donated to the Beinecke Library may well be leaf number 117.  (See the number notations in red ink in the upper right hand corner.)

Below is an image of a known manuscript fragment, which has a representative Bancroft Library stamp and leaf number “190” in upper right corner (Gift of Dr. Frank Norris, 1969).

Bancroft Library manuscript leaves 190 and 213 alongside Beinecke Library leaf 117.

The Bancroft Library collection includes negatives of The Octopus manuscript fragments from the Bohemian Club (San Francisco) and New York Public Library (leaf numbers not identified).  

I hope to get color images of the Bohemian Club and New York Public Library manuscript fragments for comparison in this most extraordinary inventory. (Also, Frank Norris was a member of the Bohemian!)  

In addition, I exchanged emails with leaders of the Frank Norris Society.  Frank Norris Society President Eric Link replied, “This is potentially a very exciting discovery, indeed.”

I hope that Frank Norris scholars will study & share insights into this fragment leaf.

Relevant links:

1. Ravi D. Goel Collection of Frederic Taber Cooper. Yale Collection of American Literature, Beinecke Rare Book and Manuscript Library. 
2. Frank Norris collection of papers and related materials, BANC MSS C-H 80, The Bancroft Library, University of California, Berkeley.
3. Finding aids for my collections at the Yale Library and Amherst College Library.

Patients are increasingly presenting to my office with difficulty with night vision, including glare and halos with nighttime driving.  I was delighted to post an article on the American Academy of Ophthalmology EyeSmart patient education site, which can be found here.

I’ve also included the article’s text below.

I remember the days you were both born and less than three months apart. You brought great joy to my brothers, sisters-in-law and our extended families. Now you are both entering college and I wanted to give you some advice. Having no children of my own, and hoping to one day have children, I thought it best to record some of my feelings.

I’ve had the joy of being a doting chacha (uncle). For many years I could watch you grow, attend birthday parties, participate in activities and then pass you back to your parents.  Uncles enjoy the best parts of parenting without the responsibilities. You have both grown up to become wonderful young adults.

Still in your teenage years and ready to take on the world. Having spent my own childhood obsessed with college admissions and watching your journeys I offer you the following advice:

1. The college experience is a privilege not a right. With online resources, college-level courses, podcasts and blogs, you could achieve a world-class education for free online. Appreciate that a university community enhances the learning experience.
2. Learn as much as you can in the next four years. Both from your professors and classmates.  You will be surrounded by mentors.  
3. Universities have vast resources available to you. Take advantage of them. Libraries are places to study and explore. The book you find in the stacks will have resources adjoining ready to be discovered. Google Books & Wikipedia are nice starts but originality comes from researching primary sources. 
4. Remember that borrowed & purchased books should not simply collect dust. Books are meant to be opened, read, and enjoyed. You may not read every book in the curriculum and you will be fascinated that your classmates “read that book in high school.” Learn at your own pace and seek help when you don’t understand concepts.
5. More than 25 years after graduating college, one of my biggest regrets is that I did not go to professor office hours often enough. You’ll be surrounded by world-class faculty and graduate students who have the skills to teach you outside the lecture hall.  Honor and respect them. Seek out your teachers for help. They are not there to complete your coursework. Rather, come prepared with questions and ask them to guide you in the journey of learning.
6. Learn gratitude.  Write to teachers, counselors and mentors to thank them for helping you along your journey.  A text message doesn’t count.  Put pen to paper.
7. Be careful not to judge yourself against your peers. You are now surrounded by many more classmates who have natural abilities which you do not have.
8. Remember that success depends on those who have grit.  Success and failure are both part of success. You cannot be successful in life unless you fail on occasion. The mark of success is being able to give your best effort, be knocked down, and still stand up and fight again. (Read Teddy Roosevelt’s In The Arena and watch my high school classmate Angela Lee Duckworth’s TED Talk before the first day of class.)

9. Surround yourself with classmates that inspire you. Find ways to avoid those who do not inspire you or take away from your learning & growth experiences.

10. Limit social media.  Every post you make will be reviewed by graduate school admissions officers and human resource departments.  Turn your phone into airplane mode, set an alarm for 30-60 minutes and then study uninterrupted. (I learned this from Shane Parrish’s wonderful Farnam Street blog & The Knowledge Project podcast.)

In four years I hope to be at your graduation. I hope that you will look upon these next few years as a learning experience. I hope that you will utilize the unlimited resources that are available to you.

If you need help, assistance, or an ear to listen to, I’m here for you. Your parents, siblings and extended families are here for you. You are surrounded by those who want you to succeed in life. Do not waste these next four years on stress, the loss of learning opportunities, nor regret.

Love,

Ravi Chacha

I graduated from college in May 1993 and went straight to my state medical school.  My student loan debt was $100k+ after 4 years (I missed out on the NYU College of Medicine’s remarkable tuition free initiative earlier this week). When I saw Troy Aikman’s tweet earlier today asking for a Twitter ophthalmology consult, I Googled the former Dallas Cowboys QB’s name and learned he signed an 8-year, $50 million deal the same week I had taken my anatomy final! (link)

I love Twitter and have embraced the American Academy of Ophthalmology’s hashtags #ProtectingSight & #EmpoweringLives. I also follow many ophthalmology colleagues, eye hospitals and ophthalmology related organizations.

I have the privilege of being an on-call phone consultant when colleagues have difficulty finding an ophthalmologist in their local communities (including the Great State of Texas!).  One friend who was then-president of the American Medical Association called me with a curbside question while managing patients in his ER. (Emergency Medicine colleagues know how to get the information they need to help patients with efficiency!) Ophthalmology is a visual specialty, and the patient history and clinical findings dictate management.

The American Academy of Ophthalmology has a detailed Preferred Practice Pattern for conjunctivitis management (link). A patient friendly guide is here. (“Pink eye,” or “red eye” are among the many descriptions for this acute or chronic condition.)

Acute conjunctivitis is a common ailment which affects upto 6 million people in the US yearly. Viral conjunctivitis is the most common cause, followed by bacterial conjunctivitis. The cost of antibiotics therapy for bacterial conjunctivitis alone is estimated to be $377 million to $857 million per year (Azari AA in JAMA 2013; 310(16): 1721-1730. doi:10.1001/jama.2013.280318 ). In addition, allergic conjunctivitis affects 15-40% of the population.

For Mr. Aikman (whom I have not examined) and patients with similar symptoms, I recommend ophthalmology consultation. Specialists consider the zebras of rare conditions when they hear the horse hoofbeats of common infections. In the absence of immediate ophthalmology availability I recommend:

1. Maintain contagious precautions – Wash your hands and your workplace frequently. Do not shake hands and avoid door knobs. Literally walk with your hands in your pockets. Take time off work and keep kids out of school as you may cause others to become infected.

2. Discontinue contact lenses (if you wear them) – With any pink eye or conjunctivitis, stop wearing contact lenses and throw away the current case and contact lens solutions.

3. Seek medical (preferably ophthalmology) consultation immediately – As the American Academy of Ophthalmology Preferred Practice Pattern alludes, there are numerous vision threatening conditions which need to be assessed in a timely fashion and treated immediately. Azari offers a helpful algorithm for clinicians and patients to approach suspected acute conjunctivitis:

The AAO Preferred Practice Pattern has a helpful high yield summary paragraph:

“The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis, primarily by educating the patient and family about proper hygiene. Infected individuals should be counseled to wash hands frequently with soap and water (as opposed to sanitizer only) and use separate towels, and to avoid close contact with others during the period of contagion. Avoiding contact with others is especially important for individuals in professions with high potential for transmission, such as health care workers and child care providers. While the exact length of the period of infectivity is variable, many consider 7 days from the onset of symptoms as the contagious period, because the recovery of virus from infected cases drops off after 7 days of infection.43 However, other studies have suggested that patients should be considered potentially contagious for at least 10 to 14 days.44,45″

Good luck to Mr. Aikman.  With his public stature, I hope this potentially contagious conjunctivitis can be limited from spreading to colleagues and fans.

And #FlyEaglesFly!

—-

Ravi D. Goel M.D. is a cataract surgeon & comprehensive ophthalmologist at Regional Eye Associates in Cherry Hill, NJ.  He is also a clinical instructor at Wills Eye Hospital.  His patient-friendly YouTube cataract surgery educational videos are here.