The first day in ophthalmology clinic

The famous line from George Bernard Shaw’s “Man and Superman”-“those who can, do; those who can’t, teach”-is sometimes quoted to explain why certain of us choose a career in academics. Fortunately for many medical students, the head of medical student education in my medical school was both a doer and a teacher.

This professor was among the most famous leaders in studying and treating retinal diseases. But unlike a lot of people who rise to the top of their fields, he never lost his ability to relate to young trainees. He was an empathic person who was eager to work with intelligent and curious students who showed up with little or no knowledge about the eye.

I never envisioned ophthalmology as a career when applying to medical school, but Mark’s enthusiasm about the specialty was infectious and so I headed over to see this professor. We spoke and he told me to come spend time with him in his clinic.

Where it all started

On my first day in the clinic I met a delightful patient, a beautiful young woman with juvenile-onset diabetes who was several months pregnant. My professor told me that sometimes pregnancy precipitated the onset of proliferative diabetic retinopathy in patients like her, and sure enough a fundus examination revealed the growth of large neovascular fronds.

Even I, who had only practiced with my ophthalmoscope to examine the normal fundi of my fellow medical students and my sisters, could see these impressive bundles of vessels. The patient was concerned about her eye disease but expressed confidence her doctor would do everything to protect her vision.

We left the exam room and my professor told me that the patient needed a retrobulbar injection to numb the eye and then he would do a laser treatment that would make the vessels regress.

It sounded fascinating, and we walked to his office where he told his secretary (it was her first day also) he would like her to stay with the patient after the numbing injection to ensure the patient didn’t have a negative reaction.

He returned to the exam room with his secretary and me in tow. He explained to the patient about the injection and that his secretary would stay with her while the anesthetic took effect. He performed the injection, placed a gauze pad over the closed eye, asked the secretary to place her hand over the gauze while watching the patient, and explained that he and I would go to examine the next patient while waiting for the anesthetic to take effect.

We stood in the hallway outside the next exam room, discussing the patient we were about to see. Suddenly, we heard a loud thump from the room we had just left. We hurried back to find my professor’s secretary sprawled on the floor, her head cradled by our patient.

“I’m sorry,” she said. “Your secretary told me she felt hot and fainted before I could catch her.”

Happy endings

Like any good story should, this one ended well. Our secretary, who had never before witnessed a retrobulbar injection, regained consciousness in a few minutes and was no worse for wear. Our patient’s proliferative retinopathy regressed after her PRP and she enjoyed excellent vision while taking care of her healthy baby. She was grateful to my professor and I learned how ophthalmologists can positively impact their patients’ lives.

In the same play, Shaw offers this quote: “This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one.” This is how, as a medical student watching great teachers, I came to feel about ophthalmology.