There goes the alarm! Long day ahead, so I'll just grab a bagel on my way out the door. What do I have this morning? At least 8 post-ops. Thank goodness for co-management, or it would be 40 and I wouldn't have time to make any money blasting corneas. Oh, I need to have Cindy call the keratome rep and tell him it's sticking! Cut a short flap yesterday, dammit. I'll probably get sued. Why oh why do I still do lasik on attorneys????

Well, lemme call Mike. "Hey Mike, my stocks are down again, thanks to that stinkin' newspaper article on lasik complications. I never hated the syndication of articles like I do these days. I'm getting calls from all over the country about this one. Yeah, just sell it all before they drop even further. I don't see any good news ahead for this industry. Thanks, buddy. Later."

Hmmm, gotta find out how many eyeballs I'm burning today. "Cindy, how many surgeries today? 24? Okay, I'll be there shortly." Hmmm, 24 x $5000. Okay, so $120,000 gross today.....that leaves me with only $90,000 for the entire day's work. Man, I need to talk to a marketing pro. Sales are down, and I am so close to being able to buy that yacht. I can't wait to surprise the wife with it. When she sees it, she'll stop giving me such a hard time about missing dinner every night. Oh well, gotta make my millions now, before more of those damned stories about complications come out and dry up the market even further. What's a little fuzzy vision, anyway? Most of them see far better unaided than they did before I lasered them. I can't believe the kind of money all of those ingrates are getting out of lawsuits against us. Millions!!! What kind of baloney is that???? I'm a great surgeon though. My patients don?t have complications. Well, a short or buttonhole flap once in a while, DLK rarely now, a little irregular astigmatism here and there? I have so many grateful patients. They hug me and kiss me and tell me that I'm a miracle worker. Well, not quite if you wanna know the TRUTH, but it sure feels good! Yeah, once in a while I have someone who's pissed off about their vision. I warned them though--told them there were risks. Not everyone can expect to have a perfect result. We'll fix up the bad ones with custom ablation, if and when it ever comes. Guess I'll call John and see how it's going with his FDA trial.

"John, how's the custom going? Done any mangled ones yet? Okay.....well.....let me know when you do. I'm anxious to start too. Got a lot of problems here with irregular astigmatism. See you at ISRS."

"Hello? Hey Cindy, what's up? Who? Oh, Mrs. Wesley. Uh huh. Uh huh. Yeah, tell her she needs to be seen this morning." Ah, great! Haze..... Well, it's probably just some edema or dry eye. Could even be another DLK. Crap. I hate those. Daily followups until it clears. Just more of my time down the drain. I hope she hasn't been on the internet again. That damned Surgically Altered Eyes group. What a bunch of idiots, trying to diagnose each other via a bulletin board! God help the man who damaged Don Ringleader's eyes and started this whole mess. Refractive surgery used to be no worries, mate. Now those self-appointed consumer activists are making our lives miserable! The lengths they will go to: websites, crashing seminars, whining to the media?. What do they want to do? Kill LASIK? Over my dead body! There aren't enough serious complications for that. LASIK is a great procedure. Sure, we don?t know the long-term, but heck, there's no guarantee that I'll be here in five minutes. Life is full of risks.

Later...

Yeah, it's shoot my laser time! Two more eyeballs staring at the lights. Stay on the lights, geek, while I burn, baby, burn. Okay, please God, let this one go well. He seems nice enough, but you never know who will turn around and sue you. The blade slices right on through...nice cut...snap snap snap snap...vaporize this cornea...plumes of burnt tissue rising up...fold the flap back over and rinse out as much debris as I can...a little smoothing....okay, all done! Phew! No problems. I don't need any more problems.

Next victim! Ah ha. My celebrity patient of the week. I have lasered the eyes of so many Hollywood stars. I am pretty damn good at this! Gotta double-check and triple-check my numbers here. If it goes well, this one might be willing to autograph her photo and let me hang it on the wall. Heck, maybe she'll even do an infommercial with me if I pay her enough!

Oops, my pager. Hang on a minute....."George, thanks for calling. I'm really concerned. We were so hoping that the new website would get the public away from SurgicallyRuinedEyes.org, LASIKNightmare, AskLaserJockeys and HornyToad's boards, and convince them that LASIK is safe. The first thing it did was increase their traffic tenfold! We should have seen that coming. Just mention the words "complication" or "risk" and you know people will be typing them into search engines. Well, do what you can. Emphasize that LASIK is safe and effective, and light-years ahead of what we were doing even six months ago. Nooooo, George, my complication rate is about the same as it was three years ago. I'm the best though, remember? This is about as safe as it gets. It's close enough?

Here we go again! Another pre-op who wants to ask me another bunch of lousy questions. "Do you sterilize your equipment? Of course. Do you use a new blade for each patient? Of course. How many cases have you done? Thousands upon thousands! What is your complication rate? LASIK is safer than driving your car!? I think it's time that I videotape myself answering all of this crap and just park these people in front of the monitor for a few hours so they can watch it after they watch the informed consent video. I am so sick of answering the same blasted 50 tough questions over and over and over again! I don't make any money by answering questions they've found on the stinkin' internet! I try so hard to hold my tongue and be patient with these people, but it's really getting old. Do they really think that if they ask the questions, they are preventing complications? Oh well, I guess if it makes them feel better and sells the procedure, it is another $5000 in my pocket.

What's this? Ms. Jones wants me to recheck her microstriae AGAIN??? Aww, she's not happy with her new 20/20 vision? Guess I'll have to explain to her that she is a very active focuser and that she needs to relax and enjoy her new natural vision. I wonder how many times I'll have to tell people that before I get to retire and move to Tahiti. That will be the life! No more whiners moaning about their starbursts and glare. No more worries about wrinkled flaps or ingrowth, or the long-term stuff like ectasia, regression or anything else these goons will present with in the future. It will be someone else's problem. Ha ha ha. I'm just about there. Buy the yacht, buy some more stocks and bonds (of course, none having anything to do with laser vision correction!), and I'm outta this game. The great thing about refractive surgery is that I'm guaranteeing my young colleagues future income. In a few years, regression will make enhancements so popular that the second wave of laser vision correction will hit. After all, after being given a taste of 20/20 without aid for a few years, no one will be happy going back to contacts or glasses!

I'm still amazed that we managed to get this far. Really, how many government-regulated industries can pull off having individuals with financial interests in approval be the ones to vote the approval??? Cracks me up that we get away with this stuff. We sure have beat the system on this one. Gotta love the FDA. A few bucks put in the right hands and you get what you want. It's so true that everything is for sale if the price is right.

Oh, my favorite cohort on line 2. "Hey, Jay!!! I sent that letter out yesterday. We've got to stop these guys from doing expert witness stuff. They are spoiling everything. Not only are they badmouthing our work as surgeons, but then they take the stand against us in court! Our own brothers! In fact, I fear that one of them is criticizing my own work today. Huh? Yeah, really. I did a minus 10 and his flaps crinkled up--too thin, you know the routine. I've tried relifting, suturing, everything and can't get the vision decent again. The patient told me he's making the rounds for second opinions and he's seeing one of the traitors this afternoon. I guess I'll offer to pay for repair with the surgeon of his choice and see if that prevents litigation. It will probably boil down to transplants, but then the patient should be fine. Nothing I should be sued over!?

Next victim?.I mean, patient! Hmmm, I think the lens on this laser is dirty. My ablations aren't as smooth as they should be. When was the last time it was cleaned? Oops, we're overdue. What happened here? "Cindy!!! Will ya take care of this please? Get this thing cleaned--set it up for next week." By that time, after another hundred or so surgeries, it will definitely be responsible for some poorer outcomes. Nothing too noticeable, I'm sure, but for those active focusers it could cause some complaints about their acuity. I don't like complaints. I'm tired of complaints!

I wish I'd bought the Tokiyaki laser. I would not have near the troubles I have had with this XLIS hunk of junk. I hear that the Tokiyaki jockeys are using them to clean up the central islands the XLIS makes. Boy, am I glad that I didn't have my laser used on my own eyes!

Okay...got a couple of complications here from other laser jockeys. Both with irregular astigmatism and decentered ablations. I never miss. What?s with these clowns that they can't aim their lasers properly? Well, I'll just go with the flow. "Your surgeon did a fantastic job. Your flaps look beautiful and you are healing nicely, but you must have moved during your surgery or you weren't looking at the lights..the ablations are slightly off-center. All in all, you really should be seeing better than you say you are. Let's try the chart again. Please do your best to read each letter...guess! Is it a P or an F? Come on---you have to be able to read something!! Okay, if this is your best, we'll stop here. I think your eyes are a little dry. You need to use drops every hour. Custom ablation is almost ready. We are already doing FDA trials, and soon we?ll be treating patients just like you! In the meantime, you can wear contact lenses and you'll be just fine. Give my office a call in about six months and I'll be able to fix you up. You can pay at the front desk and I'm sorry, but we don't accept any insurance."

Last patient! I'm gonna have to string this one along. I can tell that she is really getting annoyed with the ghost images and is thinking legal. "Hello, Ms. Smith! You don't think there's any improvement yet? Well, at eight months, you're still early in the healing process. Ghosting is normal this early on. Oh, you don't remember that from the informed consent form? Well, we cannot list everything imaginable on that form. There are thousands of lasik patients with a little bit of ghosting in an eye or two. It's perfectly normal after this procedure and will resolve on its own with time. You know, corneas heal very slowly and time is our friend here."

"Hmmm...your eye is looking much better from this side of the slit lamp. Are you sure your vision has not improved?? Well, let's give it some time...how about four more months? Then we'll know you're stable and we can evaluate enhancement surgery. I'm already doing custom ablation and I'm sure it will take care of all of your problems. Okay? See you then!" (He he, we'll be past the statute of limitations when I break the bad news to her that I cannot fix her.)

My buddies are starting to do quite a few PKs after LASIK. Good thing that corneal transplants are the most successful of all transplant ops. Only a 20% risk of rejection. Heck, they're almost as safe as LASIK and with more practice , they'll be even safer. Within a year or two, these people have correctable vision again and can just go back to wearing contacts lenses like they did before. No big deal. If they have to take time off work, they can relax and even travel if they want to. Even some of the worst damage from LASIK is easily fixed with a transplant! Makes me wonder why so many of these people with minor fixable complications claim to be depressed and flock to psychiatrists. Probably very unstable before they had surgery. I really should start doing some pre-op psychological screening to weed out the sue-happies.

What a great procedure. There have been a few cases of blindness, but we've done millions and the majority of our patients are very happy. We are the heroes of modern medicine!

Well, Porsche baby, let's hit the highway!! 24 zap-a-roosies today. Woohoo!! In these lean times for lasik surgeons, gotta love a $120,000 day. I'm so good!