A motorcycle diary

Concentration, know-how, and a small dose of insanity are all you need for a motorbike – or a career in surgery

Leigh Spielberg

Posted: Wednesday, November 1, 2017

Each ophthalmology conference represents an opportunity to rent a new motorcycle abroad. My editor here at EuroTimes, having heard that I was spending my EURETINA 2017 evenings cruising around the city streets and into the hills around Barcelona with a shiny red Ducati, asked me to write a piece comparing riding a motorcycle to working in the operating room. I eagerly obliged. What could be better, I thought, than writing about two of my favourite activities?

There are at least a dozen different classes of motorcycle, from the loud and shiny Harley Davidson-style cruisers made famous in the movie Easy Rider to the speedy Japanese racers; from the beautiful, roaring Italian street bikes to the big, on-road / off-road BMW sport tourers that you can ride from Paris to Dakar. Whereas buying a motorcycle is like signing up for a multi-year surgical fellowship, just renting a motorcycle is like doing a short observership in a foreign city: it allows you to get a sense of what a particular motorcycle is like, without having to get too involved.

There are several obvious similarities between riding a motorcycle and operating. Both are intense. They require a combination of concentration, know-how, and a small dose of insanity.

I’m pretty sure, or at least I like to believe, that I’m a better surgeon than I am motorcycle rider. This makes sense. Whereas I’ve only taken a few motorcycle training courses, I have the good fortune to have done a serious surgical fellowship. Operating is my job, my focus, the reason I go to work in the morning.

On the other hand, my time on a motorcycle is purely a leisure-time activity. Although I very occasionally ride my motorcycle to work, I prefer to save the privilege of riding for sunny evenings and relaxed weekends. I prefer not to associate work and riding with each other. I also don’t want to be stuck in traffic, rushing to get to the operating room on time. That’s when accidents happen.

Both on a motorcycle and in the operating room, it’s important to recognise – and respect – your own restraints in terms of skill and experience. Nothing is more dangerous than disregarding one’s surgical limitations and adopting a cowboy attitude. That’s how complications happen. But if these limitations are respected, and risks managed, things generally seem to work out fine. Just as I refer paediatric retinal surgery cases to my senior colleague and mentor, Fanny Nerinckx, I also don’t attempt to take sharp turns at high speed.

After all, you have to expect the unexpected. Back when I finished my fellowship and started off on my own, my father, also a physician, told me the following: “Always assume that the case you’re about to start is the one in which a complication is bound to occur.” The same thing applies when you go out riding. You can never really let your guard down.

And yet, when cruising down on a long stretch of highway, it’s easy to let your mind wander. How about during basic sculpting or cortex removal? It’s something we’ve done so many times that it happens almost automatically. But therein lies the danger: as easy as it may seem, maintaining your focus during these moments is crucial. A quick swerve of a truck into your lane, or a tiny fold of posterior capsule in the aspiration port – both can turn a smooth experience into a nasty surprise.

To lower all risks, you make sure all equipment is present, ready and in full working order. For example, I always test the phaco function before I make my first incision. I want to know of any mechanical problems first. On a motorcycle, having a problem with your brakes on the way down a mountain road is no joke. Being caught in the rain with worn-down tyres? Non, merci.

And what if something happens? It’s not only crucial to avoid complications, but also be able to manage them when they occur. Fortunately for our patients, complications in modern surgery can almost always be properly treated to avoid chronic problems. Just as the surgical equipment and techniques have improved drastically over the past 20 years, so have motorcycles become safer. Anti-lock braking systems and traction control on a motorcycle are comparable to phaco’s active fluidics and vitrectomy’s advanced IOP management.

Problems have become rarer with the introduction of all these advances. Nevertheless, quick reflexes are needed to correct a rear wheel that has lost traction on some sand or oil on the road, regardless of a
motorcycle’s technology.

On a lighter note, the funniest piece of motorcycle clothing I’ve ever seen has absolutely no comparison in the operating room. It’s a T-shirt, and on the back, it tells other drivers: “If You Can Read This T-Shirt, My Girlfriend Fell Off.”