I asked to do theatre lists at Moorfields as part of my timetable. The medical retina fellow jobs are a bit odd in that the vast majority of the different rotations lack a regular theatre session. This might suit some of the European fellows quite well as they tell me it is rare for them to do cataract operations in any significant number during training and there is no requirement for specific numbers as our college demands.
My boss when I was an ST1 in Carmarthen said that if regular surgery was akin to flying a commercial Boeing 747 then phacoemulsification was flying a jet. Shorter, faster and a lot more stressful. I never forgot this and was worried that my hard won jet flying skills would atrophy in a pure medical retina job, hence why I am now sat scrubbed in a chair in theatre 8 at City Road, waiting for the patient to be wheeled in.
There was another reason as well. I thought it would be nice in future to reflect about the ‘time I operated at Moorfields.’ One of the biggest eye hospitals in the world. All that advanced technology and all the skilful staff. In future I could regale wide eyed audiences with all the wonders I had experienced operating in the most advanced eye theatres in Christendom. One of my Jordanian colleagues even went to theatres in order to take selfies of himself standing next to various bits of theatre kit wearing scrubs. He uploaded these pictures to his Facebook page and the comments, mostly in Arabic that I translated via Bing, would say how great he was and how skilled to be in such a place. I asked him what it was like operating there and he laughed and said he hadn’t done any operating, just gone there to take the pictures. That was the power of the place. Consecrated ground. I wanted to go on a pilgrimage.
The consultant, a genial man who was himself brought up in Wales, showed me around. It was a large complex and whilst it didn’t really look much different to the theatres I had been to before I surmised it must be the working practices, the ‘Moorfields Way’ that made it what it was. As I set up the microscope I realised it had no light output. None. There was a fault with the ‘otoflex bulb’ the monitor told me. I asked a nurse how such faults were usually fixed here. She started setting up a kit and a minute went by so I asked again. She told her colleague that I “wasn’t satisfied with the microscope” and a male nurse looked at me with some degree of suspicion. I told him I might be perfectly satisfied if it worked but there was no light. There was some confusion but eventually somebody worked out that a lead wasn’t connected somewhere and the problem was solved. As soon as it was solved I discovered the movements of the microscope were exactly inverted and if you wanted to go up and right you had to toggle your foot down and left. I was embarrassed I couldn’t work out how to right this so I asked the boss. “Yes that is annoying,” he said. “I find that difficult to get used to as well.”
There were quite a few surprises. The first time I asked for a cystotome, the purpose made instrument that is used to start the capsulorhexis incision, was one. The nurse looked at me as if I had sworn. “You want a cystotome?” I did. “A cystotome?” Yes. “Are you sure?” I was getting less sure that I did, even though every single other cataract operation I had ever performed in my life I had always used one. Eventually one was found and I could continue. The boss said afterwards that the standard practice was to bend an insulin needle with a pair of forceps and use that. He chuckled at my naivety in asking for precious items from the scrub team.
The biggest surprise was the turnaround time. I expected to be struggling to keep up with the frantic pace of cutting edge surgery at the biggest eye theatre complex in the country. But here I was sitting scrubbed in a chair waiting for the patient to enter. There was an itch in my nose and I cursed myself for having scrubbed so soon. My old boss in Newport always made a point of scrubbing up as soon as possible to make theatre move that little bit faster. I got the impression I could have been hammering on the door, been politely remonstrating with the staff or had a grand mal seizure and it would not have affected the speed of the turnover one iota. Mainly because I was the only one in the room and the whole place was like the Mary Celeste.
In trying to distract myself from my itchy nose I looked over to the computer. Rather oddly the first time I had tried to print the operation note it hadn’t come out. It turned out that the computer automatically sends all printouts to a place called Cumberlege Ward and if you had the indecency to want the printouts to emerge in the same theatre you had to manually change the setting each and every time. Failure to do so would send the information to the mysterious Cumberlege Ward that I had never visited. Perhaps it was a place entirely filled with hundreds of printouts. A magical land of operation notes with continuously whirring printers.
Eventually the list ended and I ventured to the consultant that my space age surgery experience had been less space age than I had imagined. I wondered why as consultant he didn’t demand better working conditions. He told me of his ‘inverse diva’ rule that the consultants in the smallest units were often the most demanding and difficult to please and that, well, Moorfields was at the other end of that scale. “This is no place for high volume surgery and advanced technology. It’s tough to operate here, but if you can then you will be fine anywhere else.”
So there was indeed a benefit to doing lists at City Road. A different sort of benefit but a definite learning experience nonetheless. One of the medical retina consultants, a straight talking Yorkeshireman, summed it up best of all after I told him about the experience. After laughing at my space age expectations, that is. “You’ll be able to leave here and if you find yourself in the middle of the Namibian desert with a plastic knife and an eggcup you could do a cataract operation with no difficulty at all. You know what you can say to people then who marvel at that?” I did not. “You can say ‘I can do surgery anywhere, because I’ve operated at Moorfields’.’’ And that is the greatest compliment anyone could pay their hospital, really.