Inside Ophthalmology

Back to work

Maternity leave and lockdown have similar effects on out-of-practice surgeons. Clare Quigley reports

Staring down the case. Then when your operating microscope, I day is coming up – practice with recalled the last time the microscope, remind yourself I’d done this; my last of the settings. Day of surgery time operating in – examine and consent the theatre had featured kicks in patients yourself, so you know the abdomen without warning, what to expect. Don’t be afraid, 10 long months ago. That had you’ll remember how to operate, been when I was pregnant, but do try to do straightforward and now I was back in the cases on your first few theatre operating chair again – free of sessions. It sounds too simple, any physical jabs, but suffering but it worked for me. from some bothersome mental Another change – we work ones – this long out of practice, with masks on all day. The masks was I up to this? Quieting my cause problems – to prevent mind’s chatter was essential. fogging of the slit lamp or I found myself using a mental operating microscope, a lot of us trick from my old handbook resort to taping the masks down on skiing; you replace your on our faces – not pleasant. train of thoughts with a simple Sometimes when I’m mantra, which reinforces what examining a patient I’ll wonder you want to bring out in your why my view is poor; then I’ll form on the slopes. That allows see that the patient’s mask you to better concentrate on is up, and my 90D is beaded your movement and stay in the present, or in my case, to better focus on my operating without worries getting in the way. Smooth and clean. These words can be repeated on loop, to be played over unwanted Illustration by Eoin Coveney with condensation from their breath. So now I usually ask if they can pull the mask down just below their nose. The masks may cause more serious problems; on an evening on call I saw an elderly patient thoughts, making them less who had an intravitreal avastin audible. Smooth and clean. My Quieting my mind’s chatter was essential. for their macular degeneration, hands were able to take over then, when I calmed down – they remembered. I found myself using a mental trick from my old handbook on skiing; you replace performed in another hospital, who presented to us a week later with a dense

The cataract was on the your train of thoughts with a simple vitritis and tender globe – dense side – denser than I’d estimated – the grooves needed mantra, which reinforces what you want endophthalmitis. Theatre staff were quickly mobilised for a deepening, and deepening again, to bring out in your form on the slopes tap and inject. I had heard of as my cracking attempts had to increased infections in some be repeated. Patience – smooth units, and read reports of and clean – go again. Finally, under the encouraging gaze of my more oral flora-related endophthalmitis cases during COVID. Consultant – who was sitting in the corner of the theatre, watching Thinking about oral flora, and how dangerous a bite injury the progress on screen – I cracked it. The rest went by quickly; is, with a high likelihood of polymicrobial infection, it makes suddenly I was sealing the wounds. It had been fine, my first case sense to me to be cautious about masks, which can direct a back was over. It turned out that what I had been reassured by patient’s breath up to their eyes, when carrying out an invasive mentors was true – getting back operating is not that bad. procedure like an injection. So when we do injection lists now,

My predictions about getting back to work after maternity while the nurse and I kept our masks on, I have the patients leave have turned out different to what I imagined – I was not lower theirs for the injection. alone in being out of practice. The other trainees, and even the An added dimension to getting back to work, which I had Consultants, had not been operating. The COVID pandemic had not accounted for, is the sleep deprivation. Having an infant at drastically reduced elective procedures for close to three months home, one who still wakes to feed at night (a few times) does not in my hospital, the Royal Victoria Eye and Ear Hospital in Dublin. make for restful sleep. I used to depend on my eight hours, or so So everyone could sympathise and understand what it’s like to get I thought, but I am surprising myself with how functional it is back into performing surgery, and to have to face down fears that possible to be on quite broken sleep. Someday perhaps, our baby you might have gotten rusty. Before that first Monday back I had might sleep through the night... Not yet. Getting babies to sleep gotten some excellent advice from ophthalmic surgeons who had can be trickier than cataract surgery. taken maternity leave and been through it. Before your first theatre list – visualise the steps of surgery, write them down even. Close Clare Quigley is a resident at the Royal Victoria Eye and your eyes and see yourself proceeding through a straightforward Ear Hospital, Dublin, Ireland