Howard Fine’s reputation precedes him. Whether you’ve seen him riding a motorbike around Hawaii or Alpine mountain ranges with Richard Lindstrom, or know him as one of the most influential and renowned ophthalmologists of the last half-century, he has shaped cataract and refractive surgery more than most. He has not only been a clinical investigator for nearly 50 ophthalmic products, but has also personally designed (or redesigned) nearly 40 ophthalmic instruments, and introduced almost 40 surgical techniques. His first degree – Engineering, from MIT – has certainly helped inform how he’s practiced and innovated in ophthalmology over the years. But there has been another external influence that has profoundly changed how he practiced ophthalmology: orchestra conducting.
How did you get involved with orchestras?
I’ve always been interested in classical music, but I was especially drawn to the conductor because he seemed to be bringing the music out of the orchestra and the vocalists. I always told my wife that I’d give everything else up, if I had that ability.
When I arrived in Eugene, Oregon, in 1970 to start my practice, it was the year of the city’s first Oregon Bach Festival. It started out as a symposium for conductors who were interested in learning from a world-renowned master conductor, Helmuth Rilling, who was representing the International Bach Academy from Stuttgart, Germany, and is viewed as one of the leading interpreters of Bach – he has memorized everything that Bach has written, and conducts without a score!
My wife and I have attended every Bach Festival (bar one) since 1971. Each year, in addition to concerts, there are classes, with the biggest being the master conducting class. Accomplished conductors from all over the world attend, and all are there to spend time with Helmuth Rilling. As a surprise birthday present, my wife arranged for me to become an auditor in that year’s Oregon Bach Festival master conducting class – no small undertaking: the class takes place over 14 days and each session lasts 9 hours.
The morning consists of a three-hour session where conductors and soloists are instructed pretty extensively by Helmuth Rilling. In the afternoon, there’s a full orchestra and chorus rehearsal, and in the evening there’s a concert, at which time Helmuth Rilling explains what Bach was trying to achieve, some of the interesting aspects of the music, what’s different about the music. A segment of the conducting class directs a portion of that evening’s concert – and the students in the master conducting class sit up on the stage during the rehearsal and the performance. So we get to look at the conductor, and we can understand what he’s trying to do and see how he works.
What really struck me as amazing was Helmuth. He was a superb teacher and communicator, never critical, and he always explained what was going on. The areas that he covered were all important; he always emphasized precision, control and clarity. He taught the mechanical aspects of conducting, which is an aesthetic as well as an athletic event: the left hand is used mainly for rhythm, the right hand for entrances and exits and emotion and other directions like higher, lower, softer, louder, faster, slower, longer, shorter. He doesn’t command or tell people what to do, so as much as he gives them an invitation to participate. And this is something that you really feel as he’s doing it. When he gets everyone on the same page – highly focused and intensely engaged – a musical masterpiece is the likely result.
How does this have parallels with your professional career?
My interest in conducting, and learning about it, had no relevance to my practice when I started – but I came to understand that it gave my practice a horrendously advantageous boost. I realized the surgeon is a conductor in the OR – and that there’s usually very little communication between the surgeon and his or her OR staff. It’s a strange thing, but surgeons really don’t spend enough time with their OR staff, who are akin to the musicians and the vocalists. I realized I wanted to be like Helmuth; to lead by education and explanation, and I wanted to invite my OR crew to participate in something that I thought was very worthwhile doing.
And so I educated them; I spent a lot of time teaching them about new techniques, new technologies, and why it was worth the effort to abandon some aspects of what we were doing in favor of something better. I spent a lot of time explaining what was difficult about upcoming challenging cases. My invitation to them was to provide the patient with an unusually good outcome.
Later, about one-third of my practice became “train wrecks” – difficult and challenging cases referred to me from all over the world. After a while, I was able to get everyone on the same page, highly focused and intentionally engaged, and we actually achieved better surgical outcomes – better than any I had seen published – and despite the fact that we were dealing with some of the most challenging cases from around the world. In fact, almost all of those sent to us were visually rehabilitated, and we had many young ophthalmologists from all over the world visiting our clinic to do fellowships with me on cataract surgery and implant surgery.
What overall impact has it had on your life and work?
I honestly believe my interest in conducting had an impact that no one could have anticipated. Helmuth Rilling has been a friend to me for many years now – and, in many ways, he changed my life. I certainly have favorite conductors, but what so impressed me about Helmuth was his emphasis on precision, control and clarity – all essential aspects of cataract surgery as well.
I am very much aware that the fine arts can have benefits to society that are unforeseen and unrelated to their original goals. Conducting certainly helped me a great deal in my career and resulted in the reorientation of my career from simply taking care of patients in my own OR to taking care of patients from all over the world. My OR crew loved being included in the entire process and gaining new knowledge on the way; it made them feel very much more engaged in what we were doing – and we were all thrilled with how well our patients did as a result. But it was a different setting than in most ORs, I’m afraid. To that end, I wanted to pass on the wisdom I gained from Helmuth (and conducting in general) in a lecture that I taught all over the world. I discussed the Oregon Bach Festival and my experience there, but mainly emphasized that you can create a masterpiece by conducting your own OR team.
George Beiko is Assistant Clinical Professor at McMaster University, and currently practices at St Catharine’s in Toronto specializing in cataract, anterior segment and refractive surgery. George also lectures at the University of Toronto.
