Great Conversation With Susan Carlow

Great Conversations Section Editors: Meagan D. Seay, DO Rachel Calix, MD Great Conversation With Susan Carlow Meagan D. Seay, DO, Rachel Calix, MD, Kathleen B. Digre, MD R achel Calix (RC): Today, we have the privilege of speaking with Susan Carlow. Susan will be immediately recognizable to many of you as the wife of the late Dr. Tom Carlow, and an integral force in the growth and development of NANOS as we know it today. We’d like to extend our deep condolences following Tom’s passing in March of this year, 2021. The outpouring of sentiments from his colleagues has emphasized how respected and loved you both are in this community. Thank you so much for your willingness to speak with us today. We are grateful to gain insight into Tom’s rich life, career, and legacy. Can you first tell us a little bit about your early life? Susan Carlow (SC): Tom and I were both born and lived our early years just 3 miles from each other in a suburb of Cincinnati, OH. It is a big midwestern city with a smalltown feel. Kathleen Digre (KD): Your paths didn’t cross in high school? SC: I went to an all-girl’s Catholic school, and Tom went to an all-boys Catholic school, that’s the way things were in our community in the 50s and 60s. My new friends in high school went to grade school with Tom. We met at intraschool social events; he was 18 and I was 16. We dated for 2 years. After graduating from high school, I decided that I had a calling to religious life. Tom, of course, did not like the idea and advised against it. Being stubborn and determined, I proceeded with my plan. I joined the Glenmary Sisters, a newly established missionary order with young, talented, and dynamic women whose mission was to help the poor and disenfranchised people in Appalachia. Nuns make yearly vows of poverty, chastity, and obedience every year for 5 years. At the end of the fifth year, one can take “final vows.” I persevered for 5 years before becoming convinced that the vow of obedience to the dictates of unknown community leaders would be a bridge too far for me. That year I returned home, and Tom got the news faster than my bags arrived at Departments of Ophthalmology and Neurology (MDS, KBD), University of Utah Moran Eye Center, Salt Lake City, Utah; and Departments of Ophthalmology and Neurology (RC), Ochsner Medical Center, Jefferson, Louisiana. M. D. Seay and K. B. Digre are supported in part by an Unrestricted Grant from Research to Prevent Blind-ness, New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah. The authors report no conflicts of interest Address correspondence to Meagan Seay, DO, Moran Eye Center, Department of Ophthalmology, 65 Mario Capecchi Dr., Salt Lake City, UT 84132; E-mail: [e-mail]. Seay et al: J Neuro-Ophthalmol 2022; 42: 131-136 the door. We began dating and were engage soon after. In June of 1966, I finished my third year of college, Tom graduated from medical school, took his Medical Boards, and we got married. Immediately after, we left for Henry Ford Hospital in Detroit for a rotating internship. Tom chose a rotating internship because he wasn’t sure what specialty to go into, and he was leaning toward of all things, psychiatry or neurosurgery. I convinced him that psychiatry was not for him. He was attracted to neurosurgery because he liked the idea of what goes on in the brain and what goes wrong in the brain, but the actual tedious technical procedures and the early or middle of the night nature of emergency surgery gave him pause. That’s when he settled on neurology because it combined his love for anatomy, neuroanatomy, and problem solving. So, the natural third, and almost final, choice was neurology. The Vietnam War was raging on at this time, and Tom managed to get a 2-year assignment with the United States Public Health Service. After internship, we went off to Denver, CO, which was our first experience of the Rocky Mountains. It was a revelation for us midwesterners, and we promised ourselves that we would return. SC: Tom served 2 years in Denver during which time he researched neurology residencies. He applied to Stanford and University of Michigan and was accepted by both. He chose the University of MI. The big draw was Russell DeJong, who was the author of 1 of the great neurology texts. Unfortunately, the residency was toward the end of Dr. DeJong’s career, and Tom very seldom got the real experience of Russell DeJong. But all in all, he thought it was a good residency. The teaching staff was great, and excellent people were attracted to the residency program. KD: Were you there with family then in Ann Arbor for 3 years doing neurology residency? SC: Yes, we started the residency with 2 children, and our third child was born at the end of the residency. Michigan was a wonderful school. During residency, Tom realized that he loved neurology, but he didn’t want to be a general neurologist. A friend who lived near us in the University of Michigan married housing complex was a neurologist who knew Todd Troost. He suggested that Tom talk to Todd, who’s subspecialty was called neuroophthalmology. SC: Tom talked to Todd, and he definitely loved what he was hearing. Todd was working with Bob Daroff who had a research lab and was teaching fellows at Bascom Palmer Eye Institute. Tom would have loved to do a 131 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations fellowship with Bill Hoyt, but he was booked up for months. Dr. Hoyt also preferred to have his fellows have a designated university job at the end of their fellowship. And of course, Tom didn’t have any idea of where he’d go or what he’d do after a neuro-ophthalmology fellowship. SC: Bob Daroff and Joel Glaser accepted him for a fellowship at the Bascom Palmer Eye Institute (BPEI). In Tom’s estimation, it was the best year of his life. He didn’t want it to end; he just loved everything about the fellowship and neuro-ophthalmology. We became very close to Bob and Jane Daroff and Joel Glaser. Tom loved both of their approaches to neuro-ophthalmology. He did not want the experience at the BPEI to end! SC: The fellowship and his training at BPEI gave him lots of information and good experiences. One was Residents’ Day, which was a day of presentations and shared knowledge as well as fun activities, outdoor events, informal social events, and, of course, a banquet. That concept struck Tom as unusual, he said, “There should always be intense scientific and intellectual sharing and equally intense activities and socializing at medical meetings.” He took that concept to his next job and to his first neuroophthalmology courses and onwards to NANOS. SC: During fellowship, Tom began looking for a school, preferably in the Southwest, that wanted a neurologist, neuro-ophthalmologist. Joe Bicknell, interim chair of neurology at the University of New Mexico, was also a neurology resident alumnus at the University of Michigan; he knew some of Tom’s instructors on staff at Michigan very well. They gave good recommendations, and Joe invited Tom to interview for a position at the University of New Mexico. Tom went, fell in love with the desert and the mountains, and the offer Joe Bicknell made to have him run a Neuro-Ophthalmology section in the Department of Neurology was an offer he couldn’t refuse. KD: With three kids in tow! SC: Yes. [chuckle]. I was not able to join Tom for the interview and tour of Albuquerque. He loved the offer, the desert, and took the job and bought a house in less than a week. For a midwestern girl who only knew the green belt from Ohio to FL, the endless brown desert was breathtaking, and not in a good way. I quickly grew to love it as much as Tom, but best of all he loved his new job. KD: Your house at Juniper Hill was up at that time? SC: No, our first house was in the city, a very unusual modern house, that was the only modern house in the whole development. We both liked modern architecture, and he trusted that I would love the house too. SC: To establish himself as a neuro-ophthalmologist in New Mexico was more difficult than he ever dreamed. Most doctors in the community didn’t know what a neuroophthalmologist did. It was a slow process. He had to lay the groundwork for his practice by educating local ophthalmologists, neurologists, and neurosurgeons about what to look for in a patient and thus who to refer to him and when. 132 While trying to educate physicians about NO, he also missed his fellowship days and knew he too needed to continue to learn. So, he hatched what I called, a devious plan. He asked Bob Daroff who was in the continuous heat of Florida if he and Jane would like to come to NM for a ski meeting and if he and Joel would also ask Bill Hoyt, an avid skier, to join us and to lecture on NO topics and enjoy a ski meeting. The carrot and stick technique! They all agreed and that began the first University of New Mexico sponsored Neuro-Ophthalmology meeting (Fig. 1). The 3 of them were the core or the nexus of the first meeting. Ads for the meeting were put in the journals of Neurology, Ophthalmology, and Neurosurgery, as these were the specialists who, if informed about NO, would be making informed referrals to their local or regional practicing NO. If successful, this meeting would help solve Tom’s and other private NO’s referral dilemmas. KD: Wow! Were you involved in helping to put it on at that time? SC: No. After we settled in Albuquerque, from 1974 to 1979, while the children were in grade school, and Tom was working long hours I decided to indulge my love of painting and pursue a lifelong dream. I enrolled in a Bachelor of Fine Art program at the University of New Mexico. This is an Art History and Studio program which is the equivalent of a Masters in Art. While a Master of Fine Art is equivalent to a Phd in Fine Art and Studio. With Tom’s work schedule and the children’s schedule and then later in the late seventies with the addition of my NANOS responsibilities, I had to reduce the number of credit hours per semester, and my 3-year program morphed into a 7-year program. KD: At the University of NM? SC: Yes. I graduated from the University of New Mexico in 1981. That was the about the time that Tom was leaving his full-time position at UNM and joining a private multispecialty Ophthalmology group that had been his FIG. 1. Taken in 1993, one of the first meetings of the Rocky Mountain Neuro-Ophthalmology Society. (Left to right) Tom Carlow, Bob Daroff, Bill Hoyt, Joel Glaser, and Norman Schatz. Seay et al: J Neuro-Ophthalmol 2022; 42: 131-136 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations main source of referrals for many years. They wanted him to join their practice, while also seeing patients part time at the University. KD: Wow! Were you involved in helping to put it on at this time? SC. I became involved after the Jackson Hole, Wyoming meeting, 1979. From 1975 to 1979, Tom was at the University of New Mexico (UNM) and had a great secretary, Verna, she was an efficient typist, an energetic and fun-loving person, and UNM handled continuing medical education (CME) and advertising details. It was a natural easy fit and the first meeting in 1975 was a big success with 156 in attendance. It was such a success that most returned the next year and brought friends and peers. Doctors Hoyt, Daroff, and Glaser also happily agreed to return year after year, bringing with them other great lecturers. So, the meeting continued yearly with excellent lecturers, great venues, and fun activities, there was no need to continue advertising and the attendance numbers increased (Figs. 2 and 3). SC: Tom also kept adding new lecturers from around the country, most were former fellows of Hoyt, Daroff, Glaser, Thompson, and others and were themselves directors of fellowship programs. As they came to speak at the meeting, their fellows also came to participate. This created a snowball effect introducing more and more of the young and up and coming neuro-ophthalmologists to the meeting. SC: In 1979, 5 years after the first meeting, Tom was negotiating a contract with a private ophthalmology group and a part time assignment at UNM, 80%–20%, respectively. He knew he would lose his “free” UNM secretary and CME service. But more importantly, those who supported him in his efforts: Hoyt, Daroff, and Glaser suggested that it was time to move from a yearly meeting to a society, to incorporate and have Bylaws, and to apply for 501c3 nonprofit status. The new society’s name became Rocky Mountain Neuro-Ophthalmology Society (RMNOS). Bob Daroff, who did bylaw worked with the American Neurological Association, helped Tom with the arduous process of writing Bylaws for the new society. Those who wanted to attend the annual meeting now had FIG. 2. (Left to right) David Knox, Bob Daroff, Bill Hoyt, Susan Carlow, Joel Glaser, and Tom Carlow receiving distinguished service awards in the 2000s. Seay et al: J Neuro-Ophthalmol 2022; 42: 131-136 FIG. 3. (Left to right) Neil Miller, Tom Carlow, Susan Carlow, and Jack Selhorst. to join the RMNOS and pay yearly dues. This was important because the Society now had to pay for office equipment, an administrator, and for CME credit certification. KD: During this time, you’re raising your family, and then you become the person who’s in charge of helping Tom put on this meeting. SC: I came on the scene as a helper in 1979 and solo in 1980. Tom asked me to step in for a while to do what his secretary did, until the society could hire someone. Luckily, Verna helped me that first year because I had zero office or management skills. In hindsight, in 1979, office skills consisted of phone communication, typing, and file management. Sounded simple enough! So, from 1979 to 2001, when I retired from NANOS, office administration and office management went through a colossal revolution and so did my life! We started with a typewriter, a copy machine, and a phone. In the 80s, we moved on to a computer, a phone/ fax, and printer. Computers and their programs were a big challenge and an invaluable necessity since all our communication and business was done remotely. Email took over the world, no more faxes and snail mail, on to instant communication and the magic of attachments. As it did then and does now, these tools made NANOS function well. For me, it was a constant learning curve, not always a smooth curve since the pace and complexity of change and learning was so fast. I enjoyed the challenge, although trying to keep up was often frustrating. I had to learn administrative chores and new technology as fast as I could, which necessitated hiring local consultants from time to time for crash courses in 1 thing or another, like setting up a database for billing and current member status or learning desktop publishing in order to produce the syllabus in our home office or finding a local webmaster for our initial NANOS website. All in all, I got to work with many interesting and talented local experts who helped us make the home administrative office run with relative efficiency. 133 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations KD: Describe for us what it was like before a NANOS meeting because I just can’t even imagine how that must have been. Take us through what that was like for you and Tom, but for you, in particular. SC: It was a test of our marriage. We were alike in many ways and very different in many ways. Tom was a super type A personality especially when it involved his medical, professional, and NANOS spheres. So, producing the master copy of the NANOS syllabus, for example, always involved a final deadline and was a major headache for both of us and for different reasons! In the end, I think we both made personal adjustments that were mutually beneficial. Tom was president of the new society, RMNOS, from 1980 to 1992, so we had time to fine tune the process of working together and performing the chores of the administrative office. This was a trial run for the next phase of the Society, passing the baton to a new president, who would function from a distance. Jim Sharpe was the second President of the RMNOS; he and Tom spent a year together in Florida, so he was not only a friend to both of us, but a very respected peer and I might add a Canadian Neuro-Ophthalmologist. SC: Surprisingly, the first transition from a husband–wife administrative team worked very well. Jim was president from 1992 to 94; during that time, our membership and attendance continued to grow. The number of Canadians increased significantly too. Jim noted this change and suggested to Tom and the Board that the name RMNOS sounded too provincial and not inclusive enough. So, a new name, the North American Neuro-Ophthalmology Society (NANOS) was selected to reflect the changing dynamic and broader mission of the Society. During the early years especially during the time that I was managing the office, our presidents each brought something new and valuable to the table which enhanced and improved the fledgling Society. For example, Steve Feldon, our third president, had an MBA and encouraged business budgeting and investing and setting long-term planning goals. These were ideas and issues that we did not address early on. The talent, knowledge, and enthusiasm of our presidents and Board have truly enriched NANOS over time. As with the merger of Walsh with NANOS, it was the NANOS Board members who were also active in Walsh and of course Bill Hoyt, who made the transition both amicable and possible. KD: Plus, the model of having fun at the meeting. One of the questions was, would you say NANOS is doing what Tom expected? Is it doing what the members hoped? SC: I think it is, it is combining the best of all those worlds, the best of learning, of sharing knowledge, camaraderie and collegiality, and having fun, playing, bonding, and socializing. So, it still does all the things that he thought a society should do. Which is a testament to everybody involved with NANOS over the years? KD: Susan, tell us a little bit about how your family played a role in NANOS, too. Didn’t your whole family get involved? SC: November, December, and January were my busiest NANOS months and consequently our family holiday 134 celebrations were compromised. During those months, more time was spent at the computer and there was less time for shopping and cooking. I think the schedule bothered me more than the family. In the end, the family enjoyed the meetings, helped when they could, and loved the concept of the yearly ski meeting. It was a joint effort, and we all benefited (Fig. 4). SC: Tom and I both enjoyed site selection trips. Early on it was fun to pick a site that we thought would be enjoyable for all and that most times would afford the members opportunities to see new and exciting parts of the Rockies and the West. For example, there was Big Sky Montana which included a great side trip to snowmobile in Yellowstone National Park in the Winter. We all enjoyed that part of NANOS; it was a win–win for our family. We played together and so did the NANOS members. It all worked out the way Tom envisioned it. We have changed over the decades, as a Society we grew older and grew bigger; the old times just couldn’t continue. Ski areas are not designed for 400, 500 people. So, things have changed, but there is still the same spirit. Play, do something fun, go somewhere interesting, enjoy what’s available in that part of the world, have scientific sessions, and socialize at the same time. RC: How do you feel like your involvement has evolved over the last, say, 10 years? SC: I think the move to a management company was long overdue. Our management company now and the previous one had on-site people that were experts in every aspect of meeting organization, billing, budgeting, websites, publishing, and CME. It was in 2001 that the Board interviewed 2 companies and selected 1. The first company provided NANOS with a one-page contract; our daughter, who is a lawyer, advised us to use a more detailed one. She wrote up a ten-page contract much to the dismay of the management company. In the end, we discovered the value of “exit clauses” and “termination requirements” that proved invaluable to the Society. It was a learning FIG. 4. The Carlow family. Back row from right to left: Thomas P. Carlow (son) Ava Carlow (granddaughter), Anna Tannaz (granddaughter), Anthony Tannaz (grandson), Susan Carlow, Luke Carlow (grandson), Alex Tannaz (grandson), and Beth Tannaz (daughter); front row: Kathleen CarlowCarlig (daughter). Seay et al: J Neuro-Ophthalmol 2022; 42: 131-136 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations experience, and we made it in and out of the first company to a better place with or current management company. KD: People call you the “Mother of NANOS.” Did you ever see yourself as that? I mean, along the way, it sounds like you were working hard, supporting Tom, you had your whole family involved in making these meetings happen. But did you ever see yourself in that role? Would you do that again? SC: The “Mother of NANOS” expression probably came from Tom’s concept of NANOS as a family not a business or bureaucracy. He wanted the members to feel like family, cared for and respected. I was at the forefront of that vision; sometimes it did feel like a motherly activity. We both worried that a management company would not create the atmosphere that Tom wanted for NANOS. Mothers are always helpful and forgiving, and in Tom’s mind, management companies should do the same. RC: Well, NANOS has clearly been such an incredible achievement, and it’s impacting so many neuroophthalmologists, people who have been in practice a very long time and physicians like myself who are very new to this. In addition to that, what would you say you would consider your greatest achievements, yours or Tom’s or both of you together? SC: My greatest achievement is probably my relationship with my husband and our children. Tom worked hard; his days were long because he took an enormous amount of time with each patient, and I accepted that and liked the idea. SC: I supported his needs, his schedule, and all the demands of his work. I think the greatest achievement for us as a couple is that we made it work in the difficult times, when there were conflicts, we always tried to make it work, and that’s an achievement. My achievement was to make him happy and let him do the work he loved. It’s a simple achievement but sometimes it’s not that easy to achieve simple things. KD: That’s exactly right. How do you spend your free time? Did you get to work in your studio with your art and are you still doing that? SC: After I graduated, I was in several group art shows and made some sales. But marketing my art didn’t make me happy. So, when Tom said he needed some help I said, “I’d love to.” Maybe it was an escape from the business of art but working with him and the NAONS family was much more rewarding. KD: Tell us what you and Tom did in your free time. Once you gave the reins over to the management organization, you hopefully had some free time, right? SC: In his youth Tom did not have the size or strength to engage in the popular sports of his day like football or basketball; soccer and tennis were also not available to him. When we moved West in our twenties, we both decided to try everything we missed in our youth. We started with running—3Ks, 5Ks. Tom even managed to fulfill a “mini Seay et al: J Neuro-Ophthalmol 2022; 42: 131-136 jock dream”, the half marathon. As a family, we all hiked, camped, biked, and, last but not least, skied. We studied sailing and water navigation with our son and his wife who lived in San Diego. Culminating in a few sailing adventures in the British Virgin Islands and other Caribbean Islands (Fig. 5). We kept up with our kids (and the NANOS kids) for a while, until our runs slowly turned into leisurely walks and camping, fortunately, became cruising the world. We both were ready for that change. RC: Well, after all of these experiences, what would you say words of wisdom to young neuro-ophthalmologists or current NANOS member would be? SC: The neuro-ophthalmologists that I’ve met, and some I’ve gotten to know very well, are an extremely diverse and talented group with a very similar profile. Neuroophthalmologists are goal driven; they know what they love, what they want, what they’re going after. Their professional love is neuro-ophthalmology; it satisfies something in their make up. It satisfied Tom, satisfied his curiosity, his intelligence, and it satisfied his need to help people. So I think neuro-ophthalmologists are programmed to be wise. The beauty of your professional life is that you know what turns you on, what excites you, and you go after it and do it. And in doing that you help people, and you help your specialty grow and improve through your research and your FIG. 5. Tom and Susan sailing in the 1980s. 135 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations advancement of knowledge. That’s what I would tell you, but I don’t need to tell a neuro-ophthalmologist, because it’s in their DNA. KD: I think you’ve hit that one on the head. That’s probably very true. RC: I Think people are really going to identify with that and be flattered by that, and probably agree. [chuckle] KD: Susan, this has been wonderful! Thank you for sharing these details with all of us in your NANOS family, as you know, we love you to pieces, we have loved Tom to pieces, and we just are so grateful for all the work and sacrifices the 2 of you made early on to give us this organization that combines this real sense of family. Because 136 I really think NANOS has had a family kind of feel to it, and I really think it came from the 2 of you to give us that feeling that the mom and dad were in charge but that we would all get along and play well together and we’re in it together. SC: That’s what Tom envisioned for the meeting. It should be like a family: sharing, giving, learning, and having fun. So, if it still feels that way, I think he achieved his vision and that his vision is continuing onward. KD: But we have you and Tom to thank for setting it up in that way, because not all organizations are like this, and it’s really been great. So, I personally want to thank you, Susan, for taking the time to do this. Seay et al: J Neuro-Ophthalmol 2022; 42: 131-136 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.