Challenges and Looking Forward

Dr Clare Quigley, herself a young ophthalmologist, surveys the world now faced by those who have been obliged to enter the vision care profession in the midst of a global pandemic and who must now continue their careers as the world begins to heal.

Starting out, the learning curve was steep. Picking up a 90D and attempting to puzzle out whether a retina was attached or not, I remember vividly. Staring at an anterior chamber, willing myself to spot cells that I knew I should see floating there, and failing to spot any. Facing a crying uncooperative toddler who had burst a liquid-detergent tab in their eyes and their tired, worried parents; making an effort to appear professional and competent but feeling intimidated.

I was learning on the job—watching the seniors to see how they did things and reading what was presented to me on call or in clinic. It was challenging. There was just so much to take in. In surgery too. Wet labs and Eyesi sessions certainly did help, but operating on a living eye attached to a human head was a world apart. At that point, at the start of training, the gaps in my knowledge and experience felt huge, though I was working hard at building a scaffold to bridge them.

Of course, I was never alone. With the other junior trainees, we learned together from our seniors. We especially learned from the Registrars, who were only a few years more experienced than us and yet seemed omnipotent, through our first-year ophthalmology trainee eyes. Registrars like Elizabeth McElnea, who methodically took me through the steps of phaco, and Emily Hughes, at my shoulder with encouraging whispers when I did my first full cataract surgery.

CHALLENGES—PREDICTABLE AND NOT SO PREDICTABLE Following that first year of training, the learning curve tapered to a more comfortable slope. Ophthalmology got more enjoyable the more familiar we got with the eye. But challenges were not over, as training continued. There are predictable challenges for us all. Licensing exams that include the whole range of topics in ophthalmology; exams that require reading dense tomes alongside recent publications to be sure to cover everything. We progress to tackling trickier surgical problems as our skills develop. Then, for many of us, there can be challenges taken on voluntarily, like starting a family while training, taking on a higher degree or a substantial research project, or moving abroad for fellowship training. Those things add another element to what already is a packed clinical schedule—requiring skills in organisation and time management in order to juggle commitments and deadlines alongside training requirements. Free time whittles away mercilessly.

Then there are the challenges that come out of nowhere. If you talked about a global pandemic two years ago, you would be laughed off as having an overactive imagination. The notion would have seemed more science fiction than a real-life risk. How everything has changed. Even now, we are seeing a fourth wave starting here in Ireland. The suffering induced by the virus and all the knock-on effects on the health service are immense. For long months, very little elective surgery was happening. Some patients did go blind, waiting for cataract surgery. For young ophthalmologists, our training aims, our target surgical numbers, became impossible to achieve. How to deal with that? For many of us who missed out on vital hands-on experience, training will take longer.

Other unannounced challenges arise for all of us during our training. I hope other health services do not experience a cyberattack such as the one we had in Ireland, that we are only now recovering from. On a personal side, too, we experience loss, or sickness, affecting our loved ones.

WHAT’S NEXT? How do we continue to learn and develop as young ophthalmologists in the current turbulent training conditions? The bottom line remains the same—our patients. We should use this time as best we can to maximise the benefit we can bring to them through our care—by developing fully as clinicians.

I would include in this too: developing skills in research and teaching. There is a lot to learn, and we can do this when we have our downtime from surgery, when elective lists are cancelled. Reading, listening to podcasts, watching videos. Working on research and audit. Many of us have learned how virtual clinics work, as well as their limitations. There is a substantial amount we can still do to develop as ophthalmologists and improve our performance when we can’t get into the operating room.

SMELL THE ROSES At the same time, we should not deny these times are a major source of stress. That slightly twee-sounding proverb, ‘Physician, Heal Thyself’, expresses an important idea: To be in any form to look after others, we must first ensure we are well. Taking time to get outside and spending time with family and friends (as much as the latest iterations of lockdown restrictions allow), is important. Those absolute basics, eating and sleeping well, are also vital.

Lately at the weekend, we get outside for a stroll. A short walk from our house takes us to the entrance of the National War Memorial Gardens. A tree-lined path winds downhill through the gardens towards the Liffey. Centrally, the park opens in a wide terrace, with pergolas overlooking sunken rose gardens. Roses of every colour are tended to there, their scent filling the air now, in summertime. Michael invariably tries to climb into the central fountain, and we move on as he protests. Rowers do their lengths in front of the gardens, traversing the Liffey up towards Chapelizod. We hit the local coffee shop and then go home. It’s the simple things that recharge depleted batteries at the weekend.

At this point, I am among the more senior trainees, nearing the end of training. I am the one who is helping the junior learn phaco. It makes me better appreciate the patience and judgement of the Registrars who taught me, when it is now me who is inviting the junior to sit in the operating chair. Teaching has its own learning curve, I am discovering. A Consultant is always close by, supervising, but I am now the one at the junior trainee’s shoulder. We are all learning, moving forward on the road to becoming Consultant Ophthalmologists. Even if that road is sometimes bumpy, we are on the way there.

Recalling the carnival atmosphere of the ESCRS meeting I first experienced in the Athens, the 2016 winter meeting, brings back warm memories. Running into friends at Dublin airport. Staying in an Airbnb far from the conference venue, figuring out how we could navigate the city. Discovering the breadth of sessions and the huge exhibition floor. Lunches and dinners, coffees and walks together around a beautiful city. We have all missed that. But we will do it again! Not everyone who wants to will be able to travel this year, if the international travel restrictions remain tight, but we will meet again.

Clare Quigley is a resident at the Royal Victoria Eye and Ear Hospital, Dublin, Ireland.