Turning Points

No life is without its turning points-the key is navigating them. In this episode, Neda Shamie, MD, recounts part of her life story with Gary Wörtz, MD, and shares how she has dealt with some major life-changing events. Find out what led Dr. Shamie down the path to becoming the successful ophthalmologist she is today.

Gary Wörtz, MD: Open, outspoken. It’s Ophthalmology off the Grid—an honest look at controversial topics in the field. I’m Gary Wörtz.

You play the cards you’re dealt … or so the saying goes. And, as we know, not everyone’s hands in life are equal. One colleague and friend has undeniably been dealt a challenging hand, although she would disagree… “I actually look at life events differently. I look at it as though it's rigged in my favor.”

That’s Dr. Neda Shamie. For those who don’t know, Neda was 9 years old, living in Iran, when the Iranian Revolution started. This marks one of her earliest “turning points,” as Neda calls them. We recently sat down to talk about this and other life-changing events that led Neda to become the determined ophthalmologist she is today and helped mold her truly optimistic outlook on life. Here we go.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Gary: This is Ophthalmology off the Grid with Dr. Gary Wortz, and today I am so excited to talk to Neda Shamie. Neda has been a dear friend for a long time, and I've gotten to know her just through meetings and just a lot of interactions professionally, and I've been found that there is so much more than meets the eye with Neda, and I wanted to invite her on the show to talk about her career, but more than her career, just what makes Neda Shamie tick. So, Neda, with that being said as a little bit of a preamble, thank you so much for taking some time out of your busy schedule to talk to me today.

Neda Shamie, MD: Hey, Gary. Thank you so much for having me.

Gary: I think that we might have initially met at maybe an ad board or something else, and we had a really funny experience at the TSA pre-check.

Neda: Yes.

Gary: Do you remember this?

Neda: Yes, I do remember.

Gary: And we were with Sam Garg, and he has TSA pre-check, and we didn't, and we were waiting in line for like an hour, and we actually made a bet that one of us, whoever got TSA pre-check first, would have to pay the other one $20.

Neda: That's right. Was it $20 or $100? I thought…

Gary: It was $20.

Neda: It was $20? I owe you…

Gary: And, just for the record, you have not paid up, so…

Neda: But, I have to say, to be fair, I've actually decided I enjoy the standing in the line.

Gary: It's all part of the journey, isn't it?

Neda: It's all part of the journey. You get to meet wonderful people, so…

Gary: There you go.

Neda: But I'll pay you the $20.

Gary: No, no, no. It's all good. It's all good. So, we've had some time to talk, like I said, in the background, etc, and I would just love to hear a little bit of your story about when you actually came to the US and sort of ... it seems like your life has been about some transitions. There's been transition points in your life. I feel like those are really interesting experiences that we can learn a lot from, so give me just a little bit of a background on your first transition, your first big transition to the US.

Neda: Well, there was a couple of transitions that really define my early life. When I was 9 years old, the Iranian Revolution occurred, where the Shah left the country, and the Ayatollahs came over, and it became the Islamic Republic, and, at the time, there was a huge kind of outflux of Iranians leaving the country in fear of what's to come. My father, who's a psychiatrist and actually who had trained in the US, found an opportunity for us to leave, so we fled the country and '79, '78 actually, and came to San Diego.

Gosh, I think I was in third grade or second, third grade. We went to a small area in San Diego, which was not very diverse and tried to settle, and about 5 months into us having moved to this small region, these hostage crisis happened, where Iranians were really villainized around the world because of what had happened, which was so terribly unfair, and we were ourselves horrified by it. We never thought that we would be considered part of that whole kind of genre of people who were anti-American, but I remember the day that the hostage crisis happened, the next day going to school. The kids wouldn't speak to me, the teachers would make comments, and my brother actually got beaten up by some of the older boys in his school.

Then probably the turning point for us was my 9th birthday in San Diego. We invited the whole class. It was like 3, 4 months. Again, it was just shortly after the hostage crisis, and not a single person showed up. We invited the whole class. Not a single kid showed up, and every time I tell this story I cry, and I'm crying now. What was worse is that the parents actually came and threw rocks at our house, and ... I can't believe I'm doing this. And egged our house and said, "Go home, terrorists." So, it was kind of funny because we had fled to the country to be safe, but we decided to go back because we didn't feel safe in the US. Now, we could've probably moved to New York, and it would've been different. So, we went back, and I'm sorry if I'm answering it too long. Is this okay?

Gary: No, no, no. This is so ... just keep talking. I think this is part of your story, and that's why I wanted to have you on the program.

Neda: Thank you.

Gary: ... because it's so powerful.

Neda: So, then we went back and we decided to just continue our life, even under the revolution, and my dad was actually a very successful psychiatrist, and he did okay. He didn't have any political ties, and we were kind of not really bothered by what was going on outside of our homes.

Gary: Can I ask a brief question?

Neda: Uh huh.

Gary: So, when you came back, were you looked down upon for leaving? Was there some sort of animosity, or not too bad?

Neda: I don't remember. I just had this sense of relief that I'm back home, and then, as I said, we continued our life, but then the Iran-Iraq War broke out, and with that there was a lot of danger for boys who were my brother's age. He was, at the time, 14, and, with the war, there were so many people who were lost, so many men who were lost in the war they started lowering the age of enlistment into the war, and it became ... it was 16 and then 15, and then it was just like just take the boys from school, and we're gonna take them to war for bodies, basically, just bodies to fight.

When a few of my brother's friends got pulled into the war, my father felt that that was quite unsafe for my brother, and so he decided putting together ... I mean, that's a story of its own. He decided to put together a medical file, a falsified medical file, to figure out a way to get him out of the country legally, and so he managed to do that through loops in his connections, and he left the country on the premise that my brother had…

Gary: A medical condition.

Neda: ... a medical condition, and we stayed behind, my mom and I, and then about a year later we left. So really, truly, I immigrated twice, but it was about when I was 12-and-a-half when I left the country and we stayed. But this story is not unusual. I mean, if you speak to Iranians who are my age, many of us had very similar stories of just living on the edge, not knowing exactly where we're gonna be living the next year and having to start all over again.

Gary: Yeah. I think that when I hear that, I grew up in Michigan, kind of Midwestern and kind of a simple upbringing, didn't have these transition points that a lot of people have gone through, it's so easy, I think, to just paint a culture, a people group, whatever, with a broad stroke. We've heard axis of evil, and it's so easy to think, oh, well yeah, those people don't agree with what we think, and then you meet people that you know and you love who are of that demographic or of that ilk, whatever you want to say, and you're like, life is never that simple, and I just cannot imagine the internal conflict of, oh, we're gonna leave, we're gonna come to America, we're going to have a place of refuge, and it be this horrible experience.

Not to get too political, but I think we're gonna be seeing those stories playing out more and more with a lot of the dreamers who face an uncertain future, etc, and I think that it's always important when we know people who have stories of, "Hey, I came here and this is what happened to me," it really helps us apply those lessons that life is not just people in boxes. Everyone has a story. Everyone has something that has really impacted them in a way that we can learn from, and I think that this is really important to unpack. What was it like ... go ahead if you have a comment. Go ahead.

Neda: Yeah. I think a point I could make is this has been a country of refuge for me and my family, and I am so grateful to be an American, so grateful that I had the opportunity to live here. About 10 years ago, I was invited back to Iran to speak as an ophthalmologist, and it was really an amazing experience for me as an Iranian to go back to my home country and as a scholar being treated like a scholar, but one of the interesting experiences was coming back to the US. For the first time, I truly felt like a true American.

Up until that point, I felt like, okay, am I Iranian, am I American, am I just a visitor in this country? But I really felt like an American because I felt like ... I saw my peers who are in Iran and the challenges they were facing, and I thought, the gift that I've been given simply by the fact that I was lucky enough to be part of a family who chose to come to America, and all the opportunities that have come my way, that year paying taxes was the most enjoyable just because I thought, I'm paying rent to live in a country that given me a future, given my children a future. How could I have any complaints about anything, really, for that matter?

Gary: Wow. So, you felt like you were coming back home when you came to America?

Neda: Absolutely. Yeah, absolutely.

Gary: Yeah. Isn't that interesting? I love looking at stories like this and the challenges, and I think that especially growing up you faced some times when life was not fair to you. For no reason of your own, for nothing that you did, life was very unfair. How do you feel like those experiences shaped you, or how do you feel like you respond when you feel like life is not fair, and do you feel like your experience early in life has in some ways molded your ability to overcome?

Neda: Well, I have to actually disagree with the notion that sometimes life isn't fair to you. I've always looked at it differently, maybe because of my dad. My dad is a quintessential kind of optimist. Nothing ever seems unfair to him. In life, he always finds the rainbow, and I have picked up on that, and I have to tell you, you may think, oh, life was unfair. We left the country. This revolution ... but, if it hadn't happened, I wouldn't be here. Right? I wouldn't be here talking to you, so I actually look at life events differently. I look at it as though it's rigged in my favor.

Gary: Wow.

Neda: I look at life, and this is a quote that I came across recently: Live your life as though it's rigged in your favor. I really felt like it resonated with me because that's really how I've lived my life. When things happen that cause transition in my life, sure, at the time it's challenging. But I look back and I think, gosh, thank God that that happened. Thank goodness it happened, because then I wouldn't be experiencing this other way of living, and if everyone really sees that and not look at it as being victimized, I mean, there are life events that most definitely thank goodness I haven't experienced, and I don't want to discount that, deaths in family or debilitating illness and such, but I haven't experienced any of those, thank goodness, but the events that cause you to change your ways or maybe paint a…

Gary: Grow, or yeah…

Neda: Grow, or paint a different picture of your life. Those are fun events in some ways when you look back on them in retrospect, because then it allows you live a different life and experience different things.

Gary: Man, that is so inspiring. We could just stop right there, and I think we would have some major things to chew on, but I want to dig further. So, you came back when you were 12 and you went through the, I guess, the normal-ish transition through middle school, high school, etc. When did you start having the notion that you wanted to pursue medicine, and, secondarily, when did ophthalmology come into focus for you as a specialty?

Neda: First of all, my transition through teen years was not normal in the sense that I didn't speak English, and…

Gary: I spoke English and mine wasn't normal, so ...

Neda: But maybe because I didn't speak English it was easier because I didn't have to…

Gary: Right. You had no idea what they were saying.

Neda: I had no idea that they were making fun of me or…

Gary: Right. Right. That's a gift, another gift.

Neda: It was another gift.

Gary: Another gift.

Neda: Thank goodness I didn't speak English. The question was when did I decide on medicine.

Gary: Right.

Neda: It's interesting. I started college actually interested more in arts and architecture. I was a painter growing up, so I really was kind of directing myself in the liberal arts kind of direction, but sciences were always my strength, and everyone I ever knew around me, because usually with immigrants they tend to hang out around their peers that they know, so my dad's and my parents' family were all physicians, and so everyone I ever knew were physicians. I never had really met an adult architect or an adult…

Gary: Painter, right.

Neda: ... painter or anyone like that, but I was driven in that direction, and yet I knew that my strengths were in medicine, or in the sciences, and then I met my husband, who at the time he was 2 years older than I, and very focused on medicine, and I was just intrigued by his focus, and he basically spoke some sense in me, which he has continued to do in the last 20 years.

Gary: Spouses are good at that, aren't they?

Neda: He said, "Listen. You're so good at this. You should just go do medicine. Don't try to fight it," and I think that's probably what led to me realizing that medicine was really in my blood and I was trying to fight it, and so I followed medicine. As far as ophthalmology, that also was another situation where I was talked some sense into. I went into internal medicine because I loved everything in medical school. I loved my orthopedic rotation, I loved my ophthalmology. I loved everything so much that someone said, "Because if you love every field, you should just do something general like internal."

Gary: Right. You can see everything.

Neda: You can see everything. So, I went into internal medicine and I was gonna do interventional cardiology, which again was trying to focus myself. About 2 years into my residency, I was admitting my 20th patient that night, and, all of a sudden, I got this flash forward of my lifestyle being calls and getting called in, and I overheard a girl on the phone next to me crying to her parents saying, "I'm thinking about quitting ophthalmology," and ... you don't know the story?

Gary: Now it's ringing. I remember this now. I remember this. You've told me this before. Yeah.

Neda: This is that whole attitude, you feel like life is rigged in your favor.

Gary: Right. Life is rigged.

Neda: ... but I thought, is this a message? And so, she was a resident at Jill Stein and she was quitting her residency about 2 years into it. She was my age.

Gary: Which never happens.

Neda: Which never happens.

Gary: It never happens.

Neda: Exactly, and I think maybe even in her case it didn't happen. I'm not sure exactly what happened to her. She decided probably to stay, but it kind of started a path for me where I revisited my interest in ophthalmology, which had been a late interest in medical school, and started applying around. I got into UC Irvine, and that was another kind of story of its own because they had a resident drop out as a second year, and I applied to that spot and there were so many applications. The secretary, when I called in, said, "Sorry, we've closed off the applications," and so I said, "Can you make an exception?" "No, sorry." I drove to Dr. Peter McDonnell's office, slipped my resume under the door, and left. And I thought, okay, well they closed it, but they didn't say they. They closed it to mailing in the application. They didn't close it to actually slipping it under the door.

Gary: You found a way.

Neda: I found a way, and thankfully I had impressive enough of an application that Dr. Peter McDonnell noticed my application and, actually, I got into that position, and so I took that one spot left, but there was something like 60 applications for that one spot, and so I was grateful for that. Life is rigged in your favor, I'm telling you. You have to tweak it a little bit. You can't just sit back and wait for things to happen to you.

Gary: I mean, it's such a hinge moment. Do you ever think about, all right, what if I would've just taken no for an answer? What if I would've just said, "Oh, application's closed and I'm just gonna stick it out and do internal medicine"? Is that in your DNA to just not take no for an answer or, I'm gonna just work this problem until I get ... I'm gonna see how far I can take this.

Neda: I wish I could say that every opportunity that has come my way I've approached it that way where I've gone all out. No. I mean, there is definitely ... you have to prioritize. If you said yes to every opportunity out there, you'd probably be kind of running around in circles. I think I have learned that if I really want something bad enough, then I do my very best so I don't look back and wonder. There's been many opportunities that I missed out on because I didn't have that attitude, and through my years I've learned that if I want something bad enough, I've gotta go for it.

Gary: Right. You bring up a really good point, and this is something we've kind of talked about I think in the past and with other guests on the show, is how do you achieve that balance? How do you achieve capacity in your life as a working mother, as a wife, as an ophthalmologist, as all the different hats that you wear? It can be exhausting and overwhelming on the best of days. Do you have a philosophy that you sort of run decisions through, where you say, "All right. This is how I'm gonna prioritize, how we kind of make time for the important things"?

Neda: Do I have a philosophy? No. I should. I should have a philosophy. I go with my heart.

Gary: Okay. That's a philosophy.

Neda: I go with my heart. Yeah. Most definitely, my children, my family are a real huge priority for me. I don't have to even think twice about it. When they need me, I'm there, and so that, I think, has been…

Gary: That's an anchor point for you, yeah.

Neda: ... kind of an anchor point for me, but obviously my work and what I do at work and my patients and all of that is also very high. It's up there, and those two are the anchor points. All the other stuff falls apart.

Gary: That's okay. That's okay.

Neda: Like home stuff, the roof falling on our ... Those things.

Gary: Air conditioning unit you said broke the other day.

Neda: Air conditioning. Yes. My husband would not be happy about me mentioning ... It broke the other day? It was like 2 weeks ago, and we've had this heatwave and…

Gary: I'm sorry.

Neda: ... speaking about life is rigged in your favor, I actually feel like it's been an interesting experience because now I'm really looking forward to it being fixed.

Gary: You're going to have a whole new appreciation for air conditioning.

Neda: I'm gonna have a whole new appreciation for it.

Gary: That's awesome. Let's switch gears a little bit and dive a little bit deeper into ophthalmology. Tell us a little bit about your practice and what is exciting for you right now in ophthalmology.

Neda: So, I was an academic ... well, actually no. Let's start back.

Gary: Sure.

Neda: So, after fellowship in cornea, I joined a small practice in Oregon. My husband was being recruited to Portland, Oregon, and we had a 6-month-old, and we moved to Oregon. I found the only position that really resonated with me at the time, which was less than ideal for me, was a small clinic called Portland Clinic, and basically I joined as their ophthalmologist. It was like a Kaiser model, and I did lots of cataract surgeries, but about 6 months into it, I thought, you know what, this is not for me. I want to use my cornea skills.

So, I sought out the cornea practices around, and Mark Terry, as you know, at Devers Eye Institute, was in Portland, and I knew of him at the time. He really was already involved with DMEK and endothelial keratoplasty. I reached out to him, and he was so generous and so kind. He said, "I'm not looking for an associate, but please come on by. We have meetings. You're more than welcome to come and visit. I'll show you the eye bank." So, I went and met with them, and I said, "Are you sure you don't want an associate?" He said, "I'm sure. I'm not ready for an associate."

Gary: I'm noticing a trend here, so yeah. Keep going.

Neda: Yes. And then I said, "Well, how about if I help with papers and articles or any project you have. I'd be happy to help," and he says, "Okay. Well, here's an article I was invited to write. Do you mind doing this one?" "No, not at all." So, I went ahead and wrote that paper and sent it in, and then that led to a couple other projects that he offered me, and I did all my time, and I was really not doing it to impress him. Really, that was not my motivation. It was truly a genuine interest in wanting to learn from him, but I think it kind of sparked him an interest in, what, this woman…

Gary: She's really talented, yeah.

Neda: She's talented, or she's…

Gary: Interested.

Neda: He interacted with me, and he thought, okay, it would be fun to work with her or that she seems like she would be an asset to the practice, so about 6 months later, I get a note in the office saying, "Dr. Mark Terry called. He would like to speak to you," and I thought it was about a patient, but I called him. He says, "You know, I've been thinking. Maybe that whole question about associate that you brought up last year, maybe we should talk," and so I went and met with him, and then the rest is history. I joined him, and really having joined him in practice and being his junior associate was a life-changing experience for me. It made my career because it infused this passion for innovation and corneal transplantation at a level that was incredibly advanced, defined by his desire to do the best possible, and that was also a turning point.

Gary: Life might be rigged in your favor.

Neda: No.

Gary: You were in Portland at just the right time.

Neda: But, here's the thing. I could've been sitting at that clinic and complaining about how this is not for me, but do nothing about it, which is what ... I tell my kids, "If you're unhappy, find a way out. Look at other options, and maybe if you're…"

Gary: Make your own luck.

Neda: Make your own luck. Make your own luck. Be open to opportunities because they are out there. You just have to look for them. I think it's important to. But sometimes, you may think you're unhappy and you look for other opportunities, and that has happened to me too, and you see, you know what, this is really wonderful.

Gary: Right. Life isn't so bad.

Neda: No, life isn't so bad. Like the air conditioning thing. We used to complain about how our air conditioning wasn't strong enough. I bet after it gets fixed, we'll be perfectly happy with it.

Gary: Right. Right. So, I think the lesson is be positive, evaluate your situation, realize it might not be as bad as you think, but also not be afraid to go out on a limb if something's really important to you.

Neda: Yeah.

Gary: Man, there is so much to that. It's fantastic. So, fast-forward us a little bit to where you're at now in our story. I guess you transitioned there back into academics?

Neda: So, we transitioned. So, Mark Terry's practice at Devers Eye Institute was academic private. The practice was highly prolific in publishing on the endothelial keratoplasty innovations that he had a big part in, and so it was a very academic practice, but we had fellows. We didn't have residents. It wasn't a medical school that it was affiliated to. My husband got then recruited to USC, and, with that, I also got recruited to USC, and the part about that that really drove us to LA was that our family lives in LA.

Gary: That's fantastic.

Neda: As happy as we were in Portland, and really probably the 6 years I spent at Devers Eye Institute, were really some of the most memorable years of my career, and I do sometimes look back, what if I had stayed, how my career would've been. I mean, everything has been wonderful, but it would've been a very different direction. So, we came to USC. We were a part of traditional academic institution, where I stayed for 5 years, and then things at Doheny Eye Institute at USC kind of took a turn and there was a lot of leadership change, and it just didn't seem like it was the right place for me.

I think the overlying reason, the main reason that I left ... I mean, my colleagues were amazing. I miss the medical students and the residents, but what I found was frustrating for me and possibly because of all the academic turnover and the leadership turnover, I felt like the momentum of growth, my personal growth as a clinician, as a surgeon, was slow, and I felt like my wings were clipped. Again, to be fair, things have changed at Doheny now, and it's much more stable, so in that situation I was at a place where it was very unstable and I felt like I could either stick it out or if the right opportunity comes, seek that, and the opportunity then came for me to join my friend Nicole Fram, who you all know who's amazing, as well as Sam Masket.

So, they are in private practice very close to where I was, and I felt like we were aligned as far as our approach to patient care a contributions that we'd like to make to the field of ophthalmology, and when things were, again, very unstable at USC, and I wasn't sure if there would be a future for me, I decided I would resign and join Nicole. I have to say, though, it's been hard in a sense where moving has not been as easy as one would think. Every opportunity has been wonderful, but if we had stayed in Oregon, I would've loved to stay at Devers Eye Institute. I think I would've been in a different place in my career, and it would've been in some ways better for me having stayed in one place and really growing within one institution.

Gary: Yeah, but at each stop-off, I'm sure that there are things that you have learned along the way, and life, remember, is rigged in your favor. We've proven that time and time again, so I'm not buying it. But I know how that feels to sort of have that place that you have a lot of fond memories and to kind of think back on that. That makes a lot of sense.

Now that we could just kind of talk forever, I do want to get maybe a probe or two or a little more insight into what is exciting you right now about ophthalmology. Are you most excited by corneal surgery? When you have your corneal cases, are those the cases that you are most excited about as a cataract, refracted cataract? What lights you up? When you look at your surgery schedule and you know you have X on the schedule, what is it that you are most excited about?

Neda: You know what? What I'm most excited about is the variety of cases, because when I was doing fellowship with cornea, for example, it was just PKP. With cataract was monofocal lenses. There was if you did an LRI was, "Wow, you must be a refractive surgeon." I love the variety. When I see my lineup and every single case is different than the other, to me, that just is so cool, and that's exactly what excites me is the fact that there's variety, and adding further variety. So, if you say what specifically excites me, I love my cornea cases. I look at my corneal transplants as an opportunity to really ... I look at it as, all right, I tell my patients, "Your eyeball is my canvas, and allow me to…"

Gary: Right. So, now we're coming full circle back to your architecture and art.

Neda: Yes, exactly.

Gary: Right?

Neda: It's so true. I love lamellar corneal transplantation because it gives me that opportunity to really try to recreate that stability of the cornea. That's really cool, but yeah, with cataracts, I still have ... sutured IOLs I love to do, and I'm learning a lot from Nicole and Sam. Their technique is amazing. I've done sutured IOLs for 12 years, but to do it their way is a great approach, and so I'm just excited about learning more, doing more, and being better. When I think I'm good enough, there's always a better way to do it.

Gary: Oh, I love that. Well, Neda, I think we'll just leave it right there. Thank you so much for sharing a little bit of your story. I know it resonates with me. It's gonna resonate with a lot of other people. We are very, very blessed that you decided to stick it out in this country, in ophthalmology, that you transitioned into becoming just a wonderful ophthalmologist. There's so much more we can learn from you, and I'm just excited to have you as a friend and a colleague, so thank you so much.

Neda: Thank you so much, Gary.

Gary: We can’t always choose where we come from or what happens to us along the way, but, as Neda shows us, we can choose our perspectives. I’d like to send out another thanks to Neda for sharing her amazing story with us, and I invite others to consider doing the same. There is a lot we can learn from one another’s experiences.

So, with that, thanks for listening to another episode of Ophthalmology off the Grid. Be sure to visit eyetube.net/podcasts and rate, review, and subscribe. We’ll see you next time…

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.