Monday, August 17, 2015

The Loss of your Identity

Everyone is fearful of their online identity being stolen and hi-jacked, however what does one do when you lose your identity ?  Where does it go?

It happened to me about 8 years ago for the first time. I was not aware of what was happening, and attributed it to other factors.

I was operating at a new facility with equipment I had not used previously. Although the equipment was the same brand (a high quality preferred operating microscope) and the most commonly used for microsurgery, including neurosurgery, hand surgery, and eye surgery.

There were five cataract surgeries scheduled. The first two did not go well. After removing the cloudy lens using an ultrasound probe I attempted to place an intraocular lens into the space where the normal crystalline lens is located. It usually is placed in a space approximately 8 mm in diameter and less than 3mm in depth. It requires very fine depth perception akin to what fighter pilots must have to fly jets, and extremely fine motor control of one's hands  I cancelled my last three cases asking the operating room director to have the microscope checked.  

We all live in couldn't be that it was my "fault"  I had been operating since 1976 for over thirty years. I considered myself a better than average eye surgeon.  I was always an early adopter of new technology, and had good results, as evidenced by the numerous physicians who chose me to perform their cataract surgery. I had  been a humble surgeon, not seeking attention although on several occasions was interviewed by a national feature program on NBC news.  I never advertised, and after the program the demand for my services increased greatly. I remained current with new skill sets, travelling to take training courses.

The power of the media is enormous. I was a  embarrassed when my colleagues mentioned it and brought attention to my television interview.  I immediately regretted my acquiescence to being photographed and having a surgery broadcast (with patient permission and all personal identification of the patient masked for the broadcast).

I could feel the blood rushing to my head as I felt embarrassment at my sudden notoriety. Somehow or other I felt I had crossed an ethical line. I came from a generation where this type of activity was somewhat unethical and some surgeons have been warned or even had their membership in professional organizations suspended or removed.

I had agreed to the broadcast not for self-aggrandizement but as an educational message to patients how outpatient surgery which took less than an hour allowed a patient to go home immediately following surgery. Prior to this patients would remain in hospital or the outpatient surgery center for less than 2-3 hours, only long enough for the anesthesia to wear off.

Several other developments had occurred to allow this.  A technique allowing a 3 mm incision to replace a 10 mm incision to remove the cataract with a relatively new ultrasound probe that dissolved the cataract to be dissolved with ultrasound. Also the development of safe intraocular lenses and fine nylon sutures about the width of a spider's fine web which restored normal vision and immediately allowed normal functioning eye sight without glasses or contact lenses.

Egocentricity can be a dangerous personality defect for a surgeon. Denial also can be treacherous to a patient.  Self analysis and critique are essential. The first question that should run through a surgeon's mind must be 'did I do something wrong ?'   Surgeons  must be forward thinking and predict what may go wrong to produce a less than perfect result. I taught this to all my surgical residents as they began their careers.

Even after I was informed there was no problem with the operating microscope I pursued the thought that it was an isolated event. I chalked it up to a bad day. In the past I had cancelled surgeries if I did not feel up to snuff, with a cold or some other malady that might effect my performance. (prim um non nocere--first do no harm).

Losing one's primary identity is a serious event in a surgeon's life.  Most physicians primary worth is to help patients. The feeling is enormous and probably related to endorphin release, not unlike an addictive behavior or pleasurable activity such as jogging or other sports events. It often leads to depression and anxiety. Some physicians turn to substance abuse to compensate.

In my case it led to depression, even requiring treatment. If severe enough it may even be due to underlying emotional disturbance deriving from underlying psychiatric disease, such as bipolar disorder. However t hat is another subject.

Eventually my deterioration became self-evident and my cases were reviewed as my complication rate increased. Vitreous (the gel inside the eye behind the   lens should not be disturbed during cataract removal. The incidence of this increased to 50% of my cases. Still I lived in denial rationalizing this occurrences, as acceptable since I had dealt with this event in the prescribed manner....vitrectomy..a procedure. in  which the vitreous is meticulously removed with a special cutting device. All of the cases did well although their recovery was delayed. I felt pretty good being able to handle that complication. But why was  that occurring in the first place? (still in denial)

I had a series of cardiac events, one serious enough to require a four vessel cardiac surgery bypass. In the back of my mind I wondered if the surgeries and/or anesthesia had effected my fine motor coordination. I noted a slight intention tremor when picking up a glass of water....was that a tremor?? Nah...not me, I am fine.

Eventually I realized how fatigued i had become, missing  educational meetings, and in a  hurry to get through my operations. Besides fine motor skills and vision, patience is a necessity for any kind of surgery. Complications or difficulty during a case were never a problem for me to deal with. Now they became more than annoying.

My first cardiac event occurred when I was only 47 years old. My father and mother's family had a history of heart disease and my cholesterol levels were elevated requiring statin drugs which corrected it to normal levels. (but not me ?!)  Only fools tread where no men go)  I had evolved into my worst fear.

After all Dick Cheney continued to be vice-president as his heart condition deteriorated far beyond mine. Arnold Schwarzenegger continued as governor of California after his cardiac surgery. I prided myself how I had glided through angioplasties and open heart surgery...My foolish mantra was, " I am like the Timex watch, I take a licking and keep on ticking"  No one mentioned if it still kept correct time.

I was great at offering advice to others, but not myself. Eventually one night i awoke at midnight unable to move my right arm. I had a stroke.  Things became crystal clear to me .  I was aging. Today I am fortunate that my arm (brain) rewired and the paralysis is completely gone.  I have some balance problems and fall wit hout warning when I suddenly turn. I  fell down a flight of stairs twice rolling like a basketball and bouncing several times. I could not get up for about ten minutes.

I completely retired at age 67, my last year of practice was medical ophthalmology.  I still had a fantasy of operating...I was (and my patients even more fortunate that I was denied operating privileges) Thanks to my colleagues.  It relieved me of making my own decision.....a foolish thought. Age and wisdom are two separate qualities and not related,

I hope that this article helps young surgeons to look forward and plan retirement voluntarily rather than being passive as I had been.

I leave this message to my young colleagues as a final passing shot...Enjoy it as much as possible, it will eventually leave. And remember you are not just a surgeon, but a father, a husband, and very educated. Your intellectual skills are transferable.  Plan early to have a hobby or a second career.  Mine is health reform and health information technology, hoping to improve patient care.

No comments: