RESIDENT’S DIARY
JOY AND TERROR
Leigh Spielberg describes how it felt when his attending
surgeon first left him on his own to carry out surgery
“T
his looks like I don’t know whether he left a pear,” I said the operating room because he to Dr van actually had something useful Ruyven, as we to do. Maybe he wanted to both peered test me, to see whether I could through the maintain my composure with operating microscope at the no supervision close at hand. next patient’s eye. He tried not Ceding responsibility to a to smile, but couldn’t resist. young cataract surgeon is a “Pear” or “P-E-A-R” is our step-by-step process. Once the acronym for “Perfect Eye for resident has repeatedly shown A Resident”. We use the term that she or he can complete as a subtle way to indicate a procedure independently whether the attending with a reasonable level of skill, surgeon would allow the attending moves further the resident to perform the away from the possibility of next phaco. immediately assisting should “Every single one looks something go wrong. like a pear to you today,” Dr The first step is to scrub in, van Ruyven said. This was but to observe the procedure true. As I neared the end of via the live-feed TV screen my third cataract rotation, on the wall. The next is to I really pressed to get as not scrub in at all, but to stay much experience as possible close, physically and mentally, during the last weeks of to the operating table. As supervised surgery. the resident progresses, the My goal was to do half of attending sits elsewhere in the the day’s 12 procedures each OR only occasionally focusing time I was in the operating his or her attention on the room – and more, if possible. resident’s procedure. He adjusted the During the previous days microscope’s pupillary in the OR, Dr van Ruyven distance to 65mm, which is had been very chatty with the my setting. Doing this is his nurses while I operated. This My goal was to do half of the day’s way of indicating that the was, at first, a bit annoying 12 procedures each time I was in the next operation was for me. and distracting, but I later operating room – and more, if possible Each patient who undergoes realised that it was the next a phaco in our department step in my training. during a resident’s third and final phaco rotation is informed This realisation was a pleasant one. It suggested to me that Dr ahead of time that a resident might perform their cataract van Ruyven trusted me enough to handle these cases. An OR operation. They are then specifically asked whether they agree. can be full of distractions – telephones ringing, instrument trays Most have no objection. rattled, personnel entering the room – and being able to maintain The attending surgeon, of course, treats those who do object. your concentration despite these interruptions is crucial. Although patients know that being operated on by a resident is a But when he left the room this time, for the first time, it was a distinct possibility, it seems that many prefer not to know, or at bit of a shock. ‘Is he going away? Seriously?’ One part of my brain least not be reminded of it during the operation itself. was ecstatic and the other panicked. I recalled the first time I The unknown aspect of the experience makes it pedalled my bicycle without training wheels and without support. quite frightening, and we all know that a frightened patient Joy. Terror. is not ideal. There was no time to think about that now. Autopilot. Two Allowing a resident to perform cataract surgery is a timehundred solo procedures had prepared my hands for this moment, consuming and, I imagine, stressful ordeal for the supervising but had they prepared my nerves? attending. Everything takes longer and becomes more Fortunately, a phaco isn’t too lengthy a procedure. On the complicated, even in the absence of complications. other hand, it can really get messy in a hurry. And yet, most But Dr van Ruyven isn’t the stressed-out type. He tolerates problems can wait a few minutes for an attending to return. I my continual pushing for experience, allowing me to do as regained my composure and all went well. I quickly got used to the much as possible. Then he seems to get bored and does some independence and responsibility of operating alone. procedures himself. After the last case, I saw Dr van Ruyven taking care of some But while I was creating the sideports on this case, I hadn’t more paperwork as I passed by his office. “Don’t worry about that expected him to announce, to no one in particular: “I’m going to stuff right now,” I called out. “We have a whole day in the OR my office to take care of some paperwork.” tomorrow. Time enough!” Courtesy of Eoin Coveney
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EUROTIMES | FEBRUARY 2015