In the zone

[caption id="attachment_7223" align="alignnone" width="750"] Illustration by Eoin Coveney[/caption] A journalist from The New York Times recently asked Keith Richards of The Rolling Stones about performing onstage. “I was made to do it,” he replied. “Playing live, that’s the essence of what I do. As I say to (fellow Rolling Stone) Ronnie (Wood) when we go onstage, ‘Right, now we can get some peace and quiet.’ There nobody can disturb us. We’re invulnerable.” This is a feeling I recognise. Mind you, I’m not comparing myself to Keith Richards! But I can relate to the feeling of peace and quiet, when I do what I was “made to do”, or at least trained to do, which is to operate. Surgery is the one time when I can shut out the rest of the world and concentrate on what I’m doing. No one bothers me, and no one considers it unreasonable of me when I refuse to discuss anything unrelated to the procedure. When I started my current job as a vitreoretinal and cataract surgeon in the university, the nurses in the operating room would ask me questions about materials needed for tomorrow’s procedures. Or they would pick up my hospital phone when it rang, which is fine, but then would ask me if I would like to speak to the person on the phone, which I prefer not to. Interruptions have to be kept to a minimum. As well as that, during surgery, my own mind doesn’t bother me by interrupting itself constantly. In this digitally distracted age, in which there’s always something else I could be doing, or another task I should be doing, surgery time is surgery time and nothing else. The rest of the world is, at that moment, secondary. I have no obligation to anything or anyone else. From the moment the patient is sterile draped to the moment the eye is finally patched, the eye is my only focus. Concentration, confidence and perseverance During the procedure, I only hear my assistant next to me, the radio in the distance, and the voices of my surgical mentors, repeating their advice inside my mind. This isn’t to say that operating is all Zen all the time. My mind is not transported to a meditative state while I’m struggling to peel a diabetic membrane. It’s hard work and requires a great deal of concentration, confidence and perseverance. It can be dispiriting, sometimes even depressing. Oftentimes I feel the crushing burden of a patient’s hopes upon me. But sometimes I’m ‘in the zone’, and this might last for an entire procedure. For me, being 'in the zone' means existing in a mental state of focused concentration on the performance of an activity, in which I dissociate myself from distracting or irrelevant aspects of my environment. It happens when a confluence of factors occurs, all of which are necessary but not, in themselves, sufficient. For me, what’s required is thorough preoperative preparation for the case, a good night’s rest, an unrushed morning with a good breakfast, enough caffeine to stay sharp, but not too much, so I don’t get 'the shakes', a low-stress operating room preparation with motivated and efficient nurses; and my assistant, an ophthalmology resident, who has taken care of the details required between the planning of the operation and its execution. I cherish such days in the operating room, and I try to make them happen as frequently as possible. I often review the ‘Tips & Tricks’ section of my surgical journal to remind me of ways I’ve discovered to make a particular procedure go more smoothly. This might be silly, early-fellowship advice like: “Iris tissue is the vitrectome’s favourite food, so stay away!” to more advanced, subtle or nuanced tips regarding how to avoid the Argentinian flag sign in an intumescent cataract. But I can’t continually exist in a state of splendid isolation. The mood of an operating room is an important factor in the motivation of everyone present. In order to keep our spirits up, we maintain a healthy dose of humour. My assistants know that they can occasionally act as a sort of joking cheerleader for me during particularly easy steps (“Wow, you really injected that OVD like a champ!”) or more difficult ones (“Nice ILM peeling, that was your best so far today.”) Of course, the ultimate goal is great outcomes for the patients. All the rest is just details. A patient once asked me to pray for her. “Why me?” I asked. “I’m just the surgeon.” “Because your prayers are worth more than those of most others. Doctors are closer to God,” she replied. I don’t know whether that’s true or not, but I told her I would make sure to be in the zone when I operated on her. Dr Leigh Spielberg is a vitreoretinal and cataract surgeon 
at Ghent University Hospital in Belgium leigh.spielberg@gmail.com

Tags: surgery, training