Plan B
“If you don’t have a Plan B, you don’t have a plan.”
These words were quietly spoken by Jim McKinsey, Chief of Vascular Surgery at Columbia Presbyterian Medical Center. I had recently started working there to help develop Columbia’s Vein Programs. These words were uttered not because he was doing a fenestrated aortic endograft for a supraceliac aortic aneurysm repair and needed another option; for that procedure I am sure he always has a Plan B. This comment was made because the projector for the PowerPoint talk I was invited to give at a local restaurant to the vascular and interventional radiology attending physicians of Columbia wasn’t working. From an obscure backpack in the corner of the room he produced “Plan B,” his own laptop/projector so the show could go on.
Plan B is the plan. We spend our careers thinking about Plan B. A surgeon is taught from the beginning that one needs options when performing an operation. The steps to a successful procedural outcome are not always the same. Things get in the way: bleeding, adhesions, unexpected anatomy, etc. We begin an operation knowing where we want to end up but we don’t always take the same route getting there. The better surgeon always has options. We need to expand this concept to vein care, practice growth, and venous education.
We always need to be ready with Plan B when things change. This issue illustrates “Plan B Thinking,” Most of us understand that one component of post-DVT treatment is compression therapy. None of us would look forward to having a DVT , and certainly not at a young age. The story about Kelsey Miniark highlights her “Plan B.” Her Plan B was her option to the usual Plan A. We run this story so that we all can better understand how some of our patients deal with DVT . No one is the same.
Mark Meissner’s interview is a good example of Plans A, B, C, etc. Mark is a good friend and a lot can be learned from him. Unfortunately, his choice of socks needed to be upgraded. I recently sent him my Plan B for sock fashion update. Regarding venous disease, his approach and many plans have impacted most of us in the vein world.
By definition, “Rethinking Varicose Veins” is Plan B Thinking. Looking at something familiar from another perspective. The collaboration of what I have termed “The Triumvirate”--Industry, Venous Societies and Physicians--will give us another framework from which we can rethink varicose veins for the common good.
There are numerous examples of Plan B Thinking in this issue and most issues. NA SA was a good example of Plan B Thinking until someone decided that the little o-ring that sealed fuel from leaking didn’t need a Plan B. NA SA didn’t have a plan. The result of no Plan B: shuttle disaster. Let us learn from our examples like Jim McKinsey did. If you don’t have a Plan B, you don’t have a plan.
Steve Elias, MD, FACS, FACPh
Medical Director