Confident to lead

The view only changes if you're at the front of the pack, says Dr Leigh Spielberg

Leigh Spielberg

Posted: Thursday, September 1, 2016

Your lead dog has heterochromia!” I yelled to Ville Paavilainen, the Finnish vitreoretinal surgeon who was dog-sledding just behind me through the Alpine valley outside Chamonix.

The four huskies pulling his sled were right behind me, and I could see the lead dog’s eyes: bright blue OD and dark brown OS. But my dogs were anxious to keep moving and they almost pulled the sled out from under my feet, which would’ve sent me tumbling into the deep powder as they continued on their merry way.
We were all taking a break from the educational sessions of the Chamonix Retina Meeting, a new conference organised by Prof Peter Stalmans, a retinal surgeon at the University of Leuven in Belgium.

We had spent that morning in the hotel’s conference room and everyone seemed to appreciate being outside in the chilly mountain air, where we learned how to snowshoe, shoot air rifles and glide along the surface of the snow while each being pulled by four dogs that seemed to never, ever get tired.
The morning session consisted of a series of videos presented by experienced surgeons interested in sharing their trickiest and most interesting cases. As someone who had just graduated from a vitreoretinal fellowship barely two months earlier, I felt very lucky to have been invited to this small meeting of less than 60 specialists from across Europe and the USA. On the other hand, it takes a robust sense of self-esteem to watch videos of experienced surgeons performing complex surgery while one is still working on mastering the most basic vitreoretinal procedures.


After years of having only attended large, international conferences, the intimate and collegial feel of a small, highly specialised meeting pleasantly surprised me.
All attendees were staying in the same small hotel in town. Dinner together. Transportation together. Activities together. Which brought us to the outskirts of the famous French ski town near the Swiss and Italian borders. That evening, as we all walked up to dinner, up a snowy hill in the darkness, with a mug of vin chaud in our hands, Gregory Haverbeke, a Belgian VR specialist, asked me how experienced a surgeon I was.
“I just finished my vitreoretinal surgery fellowship in Rotterdam, where I did a few hundred procedures,” I answered.
“Not bad, not bad at all,” he said. It was dark enough to see the stars. “Can you remember the first time you peeled an ILM?” he asked.
“Yes, of course,” I replied, recalling the sheer joy of that moment. As with one’s first phaco, a first successful ILM peel isn’t something one ever forgets.
“Me too,” said Dr Haverbeke. “That’s the moment I felt like I joined the club.”
“The club?” I asked, intrigued.
“Yes, the club of vitreoretinal surgeons, worldwide.”
It was too dark to see his face, but I could hear from the way he said it that he was serious. Interesting.

Although I clearly remembered my first ILM peel, and was very happy when it happened, I didn’t experience, at that moment, the feeling of having entered a club. At that point, I still had so much to learn, so many more vitrectomies to do, so much to accomplish before I could start to consider myself a fully fledged retinal surgeon. Indeed, even after graduation, even with my diploma in hand and my title and licence official, I still didn’t consider myself part of “The Club”.
But maybe it was time to change my mindset. Maybe signing a contract to work full-time at Ghent University Hospital signified that I had arrived – or receiving an invitation to the VR-only meeting in Chamonix, and being recognised by my new peers as “one of them” was enough.

I decided it was Dr Haverbeke’s “I peel, therefore I am” moment which convinced me that I had reached that point. I became convinced that once we’ve learned how to perform macular surgery and treat retinal detachments, we ourselves are the ones who decide when we’re ready to belong to the club.
Being a good surgeon requires more than surgical skills. It requires good training, lots of practice and support from one’s colleagues. But above all, I think, it requires a powerful feeling of belonging, of inclusion, which allows you to be confident enough to make decisions during surgery that would otherwise lead to a paralysis of indecision.

Dr Haverbeke and I finally reached the dinner spot and I snapped out of my musings. As we walked in, I thought back to the heterochromic lead sled dog who didn’t even know that he had two differently coloured eyes. He would never know. But legend has it that heterochromic huskies are the fastest sled dogs. Maybe that’s why he was the lead dog, which is good because “if you ain’t the lead dog, the view never changes.”

Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University Hospital in Belgium, and can be reached at:

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