Dr Leigh Spielberg is a night owl

Operating at night creates challenges, but also opportunities.

Leigh Spielberg

Posted: Tuesday, June 6, 2017



You’re not only here to assist me with this retinal detachment surgery,” I tell each resident when he or she first joins me in the operating room. “You also have a very important cheerleading function. By which I mean you can feel free to compliment whatever manoeuvres I perform. Especially if they go well – but even if they don’t.”
They mostly think I’m joking at first, but I insist, and they generally get the hang of it after a while. But many of them have never been in the operating room before, so they can’t be expected to know when something is going well and when it isn’t.
“Nice capsulorrhexis!” they’ll say, as the tear disappears under the iris. “Thank you,” I reply, as sweat starts to roll down my back. Sometimes they’ll comment on the equipment or instruments. “Ooh, robot lights!” I hear as I insert the twin light chandeliers near the superior limbus.
And finally, “I thought you’d never get that retina reattached!” they’ll sometimes say at the end, which makes me look at them over my face mask. “Um, I mean, of course I knew it would work out, um, eventually, sorry…” they’ll say, not sure how I’ll interpret it.
I don’t do it to hear what a great job I’m doing. I do it so that I know they’re paying attention, focusing on what’s going on in the eye instead of what’s going on in their mind. OK, maybe I do it a little bit to hear what a great job I’m doing. Just a little bit. Give me a break, though. Retinal surgery is hard work. I admit we don’t have to spend much time treating blepharitis, and that alone makes it worthwhile. But we do have to 
spend hours at a time bringing eyes back from the brink of blindness – at night.
I’ve been doing quite a bit of operating at night recently, which means that whichever ophthalmology resident is on call that night is my assistant. In all honesty, it’s not the most efficient system, but it gets the job done.
Although neither my wife, my health nor my lower back appreciate me operating after sunset, I tend to enjoy it. I’m not in a rush to finish my programme before the staff switches shifts. We’re usually the only ones working in the whole surgical wing, since the orthopaedic trauma and emergency Caesarean sections happen in another building. We have the place to ourselves.
The OR staff is generally in a good mood: they have the next morning off, especially if they can’t leave before midnight, and they are well compensated for late-night work. Sometimes I can see the moon shining in through the windows. Yes, my operating room has windows. Big ones! Which make for a nice view of the nighttime sky when the operating room is dark and the night is clear.
On the other hand, the longer the procedure progresses and the later it gets, the more I start to realise what a mess the next 24 hours will become. Typically, I’ll get home around 1am. Our cat then thinks it’s morning, and starts meowing. He wakes up Raphael, who’s four years old and is always looking for an excuse to get out of bed. But he won’t get up while I’m still up.
He’ll wait until I’ve descended into my first useful REM sleep before he wakes me to tell me that he’s hungry, thirsty, and wants to go out for a ride on his bike. OK buddy, back in bed. The whole world is asleep. “Except China! It’s morning in China!” he’ll reply.
But nighttime surgery is when I’m at my most creative, inventive, and adventurous. At night, necessity is the mother of progress. I did my first direct decaline-oil exchange in the middle of the night, because I couldn’t bear the thought of the retina detaching again under an air infusion. This is a tricky procedure, in which the intraocular pressure can easily jump above 60mmHg if one is not careful. There isn’t much room for error.
I don’t like the term ‘trial and error’, however. Instead, I would rather borrow a phrase from inventor Thomas Edison: ‘I have not failed. I’ve just found 10,000 ways that won’t work.’
I’ve certainly found many ways that won’t work: half a dozen ways not to try to remove silicone oil from the anterior chamber; many locations where not to make a retinotomy to drain subretinal fluid; certainly, a dozen ways not to peel the ILM on a detached retina. But this searching always leads me to the one or more ways that do work, the ways that will lead to an attached retina, the restoration of sight, a happy patient and a happy me.


Dr Leigh Spielberg is a vitreoretinal and cataract surgeon 
at Ghent University Hospital in Belgium

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