The first time I attended the Congress of the Royal College of Ophthalmologists was now more than 10 years ago, though I still remember the excitement of wandering down the aisles in the exhibition hall marvelling at the stands and delighting in being handed pens, pads and brand new USB sticks and putting them all in the new heavy-duty congress satchel that I still use.

This statement dates my first congress quite considerably I have to admit, as nowadays fresh faced ST1 trainees wander down the aisles with a tiny cup of coffee from one of the stands collecting just a mint of some kind or a teacake or two, as everything useful has now been outlawed. Which is just as well, as you would have no place to store these precious items since congress has now done away with the useful bag as well.

One of the most vivid aspects of that memory is how easy it was to walk past the stalls, gazing in wonder at such exotic items as a radioactive probe uselessly used to treat macular degeneration, shiny new lenses I had no money to afford and phaco machines that looked and smelt like brand new sports cars. I could read the posters with a cup of tea and croissant with plenty of time to wander past them all. I knew nobody and nobody knew me; I was a pilgrim in a foreign land and time was plentiful.

The longer I did ophthalmology the more I recognised the famous faces and the next stage was spotting people you knew and trying to say hello should they wander past. I remember greeting Harminder Dua, Peter Shah and Peng Khaw, none of whom knew who I was but who to me represented an aspect of what was good and honourable in the world, and it said a lot about our profession that we could say hi to our heroes so easily and openly. Usually I delayed their progress for this hello for only a very short time as there were many vying for their attention and they were seldom alone.

“I knew nobody and nobody knew me; I was a pilgrim in a foreign land and time was plentiful.”

Progress through the aisles slowed again as I recognised important people from my own deanery, such that a short friendly conversation was needed if a certain distance between us was breached, lest offence be given. The posters were still the same distance away, but in practical terms they were getting more and more difficult to reach. The problem intensified as I did more jobs and moved around as there was now the phenomenon of meeting past bosses and colleagues, as well as present, and it did not do to offend anyone. I tried to work out the acceptable distance of passing without engaging on the way to the posters and reasoned it was about 10 metres if eye contact was made but could be as low as three if it were not. Sometimes I would hear a shout behind me calling my name and sometimes I would shout the name of a colleague who might have been, in retrospect, trying to escape my interaction radius by suddenly becoming captivated by an interesting sample of ocular lubricant on the stand nearby.

When I was a registrar proper I found more junior trainees treating me with the same polite respect with which I had treated my own seniors and a whole new chapter of social rules of engagement opened. I could not ignore them, just as Harminder Dua did not ignore me all those years ago, and he hadn’t the blindest idea who I was then (or am now). The posters were lost. Lost forever behind a sea of friends, colleagues past and present and important folk of all kinds. If I was an anthropologist I could have written detailed rules to that which I observed around me, as there was a culture absolutely deferential to hierarchy. In fact, I did come up with an ‘inverse distance’ law after I observed that the most important members of the college council travelled all the way around the edge of the display hall to reach a place rather than cut through the middle, presumably to avoid becoming bogged down in conversations. The people walking happily right through the middle were predominantly ST1s and ST2s, unless there was a critical mass of senior people walking in step. Four or more senior people walking through the middle in conversation would be mostly immune to being stopped and chatted to, unless there was an unexpected roadblock caused by a free coffee based opportunity or an accumulation of Novartis reps. Walking pace also appeared to play a factor, with a quicker pace being inversely proportional to the odds of being interacted with en route to the food. In that way, important Moorfields people could get across singly; head down walk fast and avoid any eye contact whatsoever. Like traversing London at night.

Samuel Shem’s House of God, so excellent in its description of the hospital hierarchy, illustrates the same effect by saying: “The House medical hierarchy was a pyramid – a lot at the bottom and one at the top. Given the mentality required to climb it, it was more like an ice cream cone – you had to lick your way up. From constant application of tongue to next uppermost ass, those few toward the top were all tongue. A mapping of each sensory cortex would show a homunculus with a mammoth tongue overlapping an enormous portion of brain.” The laws of traversing the exhibition hall floor were designed exactly to counter Samuel Shem’s pyramid metaphor. Being somewhere in the middle of the pyramid, I guess a person is licked against by those beneath as much as they lick others above, and are therefore by their very nature the most likely to get stuck between the Bayer and Spectrum stands on the way to the posters in a party of licking that nobody really wants but equally nobody knows how to stop. Perhaps if everyone put their tongues away at the same time everyone could get to the posters. Perhaps nobody actually wants to get to the posters and licking is what the whole thing is really about. A colleague with whom I shared this theory laughed and said “Of course licking is what it was all about. If you want to actually learn anything go to EURETINA. You get a proper conference bag there.”

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Gwyn Samuel Williams

Singleton Hospital, Swansea, UK.

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