The Gift

“Doctor, what would make you happy?” she asked. “I beg your pardon?” I replied, as I looked up from my notes. “I mean, what can I get for you to thank you for the treatment you gave me?” Ms Charlier was a 60-something woman whom I had treated several days earlier for a full-thickness macular hole. She was the friendly yet hyper-nervous type of patient for whom every bit of information regarding the pathology, treatment and recovery was both fascinating and terrifying at once. The type of patient who would never be able to make up her mind about whether she wants to undergo vitrectomy for a macular pucker (prognosis too unpredictable; natural history not too terrible), and would start hyperventilating in the examination room if told that she has a retina that needs to be reattached within 24 hours. A macular hole is the “perfect” pathology for this type of patient. As a semi-urgent, semi-elective problem, it’s critical enough that it has to happen soon, but not so urgent that the treatment plan (operate today or tomorrow) will cause the patient to faint. By some stroke of luck, I had correctly identified Ms Charlier as this “type”, and had helped her navigate the stress and confusion of her new problem. Mind you, the results of the surgery were not yet known; a gas bubble still filled the eye and an OCT wasn’t possible. The visual acuity was thus currently worse than before surgery. However, I had informed her about everything (possible subconjunctival haemorrhage, hyperaemia, mild ocular irritation, gas bubble, positioning, progressive visual recovery), so she was reassured. And so, her desire to thank me with a gift was not (yet) for the vision that she had recovered, but rather for the emotional support that I had given. In Belgium, the customary thank-you gift is a bottle of wine or champagne. The first time you receive this from a patient, the feeling is spectacular. You feel like you’ve exceeded expectations and have done what we all entered medicine to do. It also boosts your self-esteem, which, as far as vitreoretinal surgery goes, can always use a little boost. But, like the bubbles in champagne, it is fleeting, transient, evanescent, ephemeral. “A letter,” I said, rather unexpectedly. “I beg your pardon?” she replied, understandably. I had something in mind that had moved me, but she didn’t know what I was talking about. “You don’t have to spend any money at all. A simple thank-you note would be perfect,” I clarified. I was thinking about a specific thank-you note that I had received a short time earlier, a heartfelt message from someone who I had treated for a very dense, very sudden and unexpected vitreous haemorrhage. This is a favourite pathology of mine: with simple surgery, patients’ vision can improve from vague hand motion to 20/20 vision almost immediately. He had written a short, sincere letter that I keep in a drawer in my office. I have re-read it several times, and every time, it gives me more satisfaction than any other token of appreciation could. It is something that my children will read sometime, and it will undoubtedly make them proud. It will also help them understand why I might have occasionally missed their ballet performance or soccer game. The letter also makes me laugh. The patient who wrote it, a vibrant man in his 70s, had gone online to look for risk factors that might have caused the haemorrhage. Although it was in fact due to peripheral exudative haemorrhagic chorioretinopathy, which I informed him was nearly always idiopathic, he had become convinced that it was due to Viagra. So shocked was he by the haemorrhage and its temporary blindness that he swore never to take Viagra again. He was satisfied with this conclusion, but his wife did not seem to appreciate my inability to convince him otherwise. I don’t think she’ll ever forgive me for that. I tried my best to change his mind, but to no avail. I wish it could have been otherwise, but it’s nevertheless quite funny in retrospect. Vitreoretinal surgeons are not the public’s favourite eye doctors. That is clearly reserved for cataract and refractive surgeons, whose work is considered the next best thing to magic. Besides vitreous haemorrhage, floaters and the occasional astonishingly rewarding BCVA after macular hole, macula-off detachment or trauma, the results of a VR surgeon’s work are usually not as lovely as those after laser refractive surgery. Thus, thank-you gifts are neither frequent nor expected. Both we and our referring ophthalmologists know the value of our work, and that is more than enough. But I now know exactly what my answer is to the question, “How can I thank you?” And I look forward to reading what Ms Charlier will write. Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University, Belgium