Charles Kelman MD
Delivering the ASCRS Binkhorst lecture in 1989, Charles Kelman MD said: “I have always been a saxophone player wearing the mask of an ophthalmologist. Had it not been for my parents’ insistence I would have followed my own dream to become a musician.” Indeed, he once said that as a teenager his father caught him sneaking out of the house at 2am, hoping to run away and join Louis Prima’s band. Taking the saxophone away from the young man, his father said: “You can be a singer, you can be a composer, you can be a songwriter, you can play with bands, whatever you want. But first you'll be a doctor.”
So, the young Kelman went to medical school, but he never let dust gather on his saxophone case. While undertaking his residency at the Wills Eye Hospital, he said: “I was often late for rounds and could just as easily have been found playing a horn in south Philadelphia as cutting a suture in the operating room.”
Giving a speech on the subject of innovation, Dr Kelman looked at the various factors that lead to innovation. “The creative act is as close as we get to the divine. It is paradoxical, therefore, that society has always had a scornful attitude for those that possess that creativity; especially if it threatens to change the status quo.”
Listing a series of qualities inherent in creative people, he asked the following question: “What chances of acceptance would an applicant for residency have armed with a letter of recommendation which read: ‘This young man or woman is an independent type, who likes taking risks, playing around, experimenting and tends to make things very complicated. Nothing threatens him; he’s very self-assertive, unconventional, indifferent to disorder or ambiguity and is certainly offbeat. I highly recommend him for residency.”
Citing the discoveries of Alexander Fleming and Harold Ridley, he quoted Nobel prize laureate Albert Szent-Györgyi: “Discovery consists of looking at the same thing as everyone else and thinking something different.”
MOMENT OF ENLIGHTENMENT
Inspiration can come at the strangest time – think of Dr Kelman’s own moment of enlightenment. After two years and eight months working under a grant at the Hartford Foundation, which he had received for the promise of delivering a cataract removal procedure that would require no hospitalisation, Dr Kelman had been through a dozen different unsuccessful ideas.
Having let his hair grow long and his teeth get dirty, he took himself off for a cleaning. “In the dentist's office he used this device, an ultrasonic device on my teeth. I asked him what it was, and he told me that it had a high-frequency vibration and it flicked the tartar off the teeth without disturbing the tooth itself. I got very excited, I ran out of his office with a doily around my neck shouting ‘I've got it, I've got it!’”
He came back an hour later with a cataract and discovered that he could engrave lines on the cataract, without it jumping up on his finger, which meant that he could remove a cataract without it spinning up against the corneal endothelium. Thus, the idea of phacoemulsification was born.
The first procedure – which lasted 70 minutes – was a failure, as the cornea collapsed on the vibrating tip. Three years later he tried again, having incorporated an aspiration tube that prevented corneal collapse.
The surgery would go through further trials, not all of them clinical, largely due to the politics at play and a resistance to new methods. “The fact that its main proponent – me – was playing the saxophone and singing in the casinos of Atlantic City and appearing on the Johnny Carson show, did not help the cause.”
Having a creative mind was what drove Dr Kelman, be it with phacoemulsification or in songwriting and performing. Returning to his innovation speech, he said: “The creative thinker does not stress being correct, he stresses originality. And he accepts failure as a necessary expected part of the learning process.” Dr Kelman might have been thinking of Thomas Edison, who once said: “I have not failed. I’ve just found 10,000 ways that won’t work.”
This article is based on interviews with the late Dr Kelman broadcast in the Video Journal of Cataract and Refractive Surgery celebrating the 50th anniversary of phacoemulsification. View the video at http://bit.ly/Kelman50
