TASK AT HAND: This week I’m thinking about a dear friend and talented vitreoretinal surgeon colleague, Dr R Rishi Gupta. He has a new book – Reflections of a Pupil: What Your Med School and Ophthalmology Textbooks Can’t Teach You (But What Your Mentors, Colleagues and Patients Will) – and I’m very excited to present a selected excerpt from the book here. The book goes beyond facts and protocols and, as you engage each page, you discover the wisdom of a mentor and the essence of  the intangibles needed to succeed in medicine, in surgery and on our own journey. Enjoy!

DON’T LET THE FALL CRUSH YOU. During our lifelong pursuit of bettering ourselves in our craft, there are peaks and there are valleys. Never does this ring truer than during our training or first year of independent practice. Sometimes the valleys can feel really deep . . . really dark . . .and really lonely. After a particularly tough case that I took to heart, a mentor of mine saw that I was struggling. “Don’t let the fall crush you,” he said. “Your heart and head were in the right place. There are a lot of people who will need you. Don’t let singlesetbacks stop you from growing so you can help all those otherswho will need you.”

Medicine has come a long way, yet there are still many diseases and conditions for which we lack the technology or understanding to be able to heal our patients. In some cases, people present too late; in other cases, they present with something too complex for the tools we have at hand. There will be problems that we won’t be able to fix. There will be eyes that we cannot save. Although that does not sit well with any of us, we have to be able to accept that reality. For some physicians, this is more difficult than it is for others. We all take pride in our work and it is not easy for us to live through failure.

It is normal to feel grief when an outcome is not what we would hope for. I love this evocative quote from the French vascular surgical pioneer René Leriche: “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation of his failures.” Finding the time to grieve is important. Feel it. Be upset. Be angry. Be sad. Be frustrated. But then control and contain it. Break down the case with a colleague or mentor and take time to reflect.

During an OR day, we may need to compartmentalize and delay this emotional process and be ready to pick ourselves back up quickly in order to give our best for our next patient. Resiliency is an extremely important quality to develop. We owe it to our patients to be strong. Keep these two sayings in your back pocket for the inevitable rainy day:

1. When nothing is going right, go left!
2. Whenever I feel blue, I remind myself to start breathing again.

MEDICINE & MACULA: The book reviews have been outstanding! “The book brilliantly demonstrated the harmony of understanding basic facts of a patient problem balanced with confidence and experience” (Carol L. Shields, MD). “This should be required reading for every ophthalmology resident and fellow” (Charles C. Wykoff, MD PhD). “A superb piece of work that will certainly be an important resource for many years to come in the ophthalmology community” (David Sarraf, MD).

My favorite review comes from Robert L. Avery MD: “He [Dr Gupta] is certainly leading an examined life, and by relaying his reflections on both the good and the bad along his path, he provides useful insight to all of us, whether we are young ophthalmologists or not.” The necessity for us to look inwards – to dissect our core beliefs and biases – will always be a fundamental base of virtue and improvement.

Thank you Dr Gupta for an outstanding contribution!

GRATIS: You can get your copy from Amazon Canada here. For US customers, you can buy on US Amazon site here.

The website Millennial Eye recently featured Reflections of a Pupil as a “must have book for the beginning ophthalmologist”. You can read the blog post here.

My best to you,
David Almeida

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