Back to work
Maternity leave and lockdown have similar effects on out-of-practice surgeons
Staring down the microscope, I recalled the last time I’d done this; my last time operating in theatre had featured kicks in the abdomen without warning, 10 long months ago. That had been when I was pregnant, and now I was back in the operating chair again – free of any physical jabs, but suffering from some bothersome mental ones – this long out of practice, was I up to this? Quieting my mind’s chatter was essential. I found myself using a mental trick from my old handbook on skiing; you replace your train of thoughts with a simple mantra, which reinforces what you want to bring out in your form on the slopes. That allows you to better concentrate on your movement and stay in the present, or in my case, to better focus on my operating without worries getting in the way. Smooth and clean. These words can be repeated on loop, to be played over unwanted thoughts, making them less audible. Smooth and clean. My hands were able to take over then, when I calmed down – they remembered.
The cataract was on the dense side – denser than I’d estimated – the grooves needed deepening, and deepening again, as my cracking attempts had to be repeated. Patience – smooth and clean – go again. Finally, under the encouraging gaze of my Consultant – who was sitting in the corner of the theatre, watching the progress on screen – I cracked it. The rest went by quickly; suddenly I was sealing the wounds. It had been fine, my first case back was over. It turned out that what I had been reassured by mentors was true – getting back operating is not that bad.
My predictions about getting back to work after maternity leave have turned out different to what I imagined – I was not alone in being out of practice. The other trainees, and even the Consultants, had not been operating. The COVID pandemic had drastically reduced elective procedures for close to three months in my hospital, the Royal Victoria Eye and Ear Hospital in Dublin. So everyone could sympathise and understand what it’s like to get back into performing surgery, and to have to face down fears that you might have gotten rusty. Before that first Monday back I had gotten some excellent advice from ophthalmic surgeons who had taken maternity leave and been through it. Before your first theatre list – visualise the steps of surgery, write them down even. Close your eyes and see yourself proceeding through a straightforward case. Then when your operating day is coming up – practice with the microscope, remind yourself of the settings. Day of surgery – examine and consent the patients yourself, so you know what to expect. Don’t be afraid, you’ll remember how to operate, but do try to do straightforward cases on your first few theatre sessions. It sounds too simple, but it worked for me.
Another change – we work with masks on all day. The masks cause problems – to prevent fogging of the slit lamp or operating microscope, a lot of us resort to taping the masks down on our faces – not pleasant.
Sometimes when I’m examining a patient I’ll wonder why my view is poor; then I’ll see that the patient’s mask is up, and my 90D is beaded with condensation from their breath. So now I usually ask if they can pull the mask down just below their nose. The masks may cause more serious problems; on an evening on call I saw an elderly patient who had an intravitreal avastin for their macular degeneration, performed in another hospital, who presented to us a week later with a dense vitritis and tender globe – endophthalmitis. Theatre staff were quickly mobilised for a tap and inject. I had heard of increased infections in some units, and read reports of more oral flora-related endophthalmitis cases during COVID. Thinking about oral flora, and how dangerous a bite injury is, with a high likelihood of polymicrobial infection, it makes sense to me to be cautious about masks, which can direct a patient’s breath up to their eyes, when carrying out an invasive procedure like an injection. So when we do injection lists now, while the nurse and I kept our masks on, I have the patients lower theirs for the injection.
An added dimension to getting back to work, which I had not accounted for, is the sleep deprivation. Having an infant at home, one who still wakes to feed at night (a few times) does not make for restful sleep. I used to depend on my eight hours, or so I thought, but I am surprising myself with how functional it is possible to be on quite broken sleep. Someday perhaps, our baby might sleep through the night… Not yet. Getting babies to sleep can be trickier than cataract surgery.
Clare Quigley is a resident at the Royal Victoria Eye and Ear Hospital, Dublin, Ireland
Illustration by Eoin Coveney