Erin NaPier and Brad Gundlach
Stein Eye Institute, UCLA, Los Angeles, CA
Dr. Nicholas Farber kicked off the session by leading everyone through a “square breathing” exercise to show how easily stress can mess with a surgeon’s hands. The panel explored the physical side of anxiety, specifically the “intention tremor” which attendings and trainees may have during high-stakes maneuvers. Dr. Royce Chen shared the importance of managing his physiology and addressed the possible role of pharmacologic aids such as timolol to help steady hands. He also shared a story of a how he coped with outcomes that are difficult and how his mentors helped guide him though this time. The panel agreed that staying calm in the operating room is a critical skill, requiring a mix of mental preparation, realistic expectation, confidence and, occasionally, pharmacologic help.
The conversation then shifted to the jarring transition from being a fellow to an independent attending, which many described as a period of “surgical loneliness”. Dr. Brian Do talked about how the sudden absence of a mentor at the side scope made those early cases feel significantly more stressful. To handle this, Dr. Malini Pasricha described a rigorous system of writing detailed notes to her “future pre-operative self” regarding patient behavior and clearly listing every instrument she needed before scrubbing in. She found that over-preparing for the routine steps helped her stay cool when case took a difficult turn.
The group also pushed for a culture shift in asking for help intraoperatively, something that is uncommon in ophthalmology. Dr. Kristen Nwanyanwu shared a particularly tough case early in her career involving a tractional retinal detachment where she eventually called in a mentor to help with the difficult peel. Having a second set of eyes didn’t just help the patient; it made the procedure feel more like a team effort and less like an isolated struggle. She shared that it was validating for a senior surgeon to admit that the plaque was likewise difficult. While many people shared stories of how critical it is to ask for help, the audience was reminded that offering help, or at least letting younger surgeons know you are available, was equally as important.
One member of the panel urged providers to keep a log of their surgeries because even though most people tend to replay the surgeries or outcomes that did not go well, they are probably far outnumbered by great outcomes. The panel wrapped up by reflecting on the emotional toll of surgery, citing a quote about the “surgical cemetery” to remind everyone that every surgeon carries their failures with them. Offering yourself some grace is just as important as the surgery itself.
