Dear Cyndy,

If I reply to your letter withing a few hours, it's not because 
I presume that anything I write can be of help to you, - but because
I can't stop thinking about your eye problem, and, as I've confessed 
before my letters to you are immediate reflections about what's on
my mind.

No, I was not, and am not critical, and will not be critical of any 
decision that you have made or will make concerning the diagnosis or
treatment of your eye problems. I'm sympathetic, and if I have thoughts
that might be helpful, I will write them to you.

If I understand correctly, you had cataract surgery with lens implantation
in both eyes. The left eye had developed macular degeneration which was
treated with injections to suppress neovascularization. A day or two ago,
you noted a change in vision in the better, the right eye. I don't know 
how well you are able to see with either eye at this time. I presume the
injection into the right eye was made in an attempt to prevent the
progression of the macular degeneration.

If I understand correctly, you are now in a position where you must decide
from month to month whether to permit the ophthalmologists to repeat the
injections. Of course, I don't know the answer. I have often found myself 
in analogous situations where I had to advise my patient whether or not to
proceed on a course of treatment where the outcome was uncertain. I would
confess to my patient that I could not predict the results. I would ask the
patient to imagine the worst possible outcome, i.e. that the eye was "lost", 
and ask the patient to meditate on his or her feelings in that circumstance.
Would he or she, if the eye were "lost", be happier if treatment had been given or
would he or she, if the eye were "lost", be happier if treatment had not been given.
I recognize that my reluctance to be a cheer-leader for all "advances" in
medicine and to exude confidence of success was a reason why my ophthalmology 
practice was relatively unsuccessful, (but it was also a reason why I was never
sued.)

I think often about Rilke's premonition, which he entertained already at an early
age, that just each of us needs to live his/her own life. so each of us needs to
die his/her own death.

O Herr, gib jedem seinen eignen Tod.
Das Sterben, das aus jenem Leben geht,
darin er Liebe hatte, Sinn und Not.

O Herr, gib jedem seinen eignen Tod.
Oh Lord, give each of us death of his own.
 
Das Sterben, das aus jenem Leben geht,
The dying which proceeds out of that life

darin er Liebe hatte, Sinn und Not.
which gave him love and meaning and despair.

I'm now inclined to expand this existential interpretation of death
to an analogous interpretation of disease, in that the disease may
also, and optimally should become integral to the spirit of him or her
who is afflicted.