The Staff Who Steps Up

 Doing cataract surgery with a resident who is just starting out is surely a very stressful thing for the attending. The patient may not even belong to the attending - they're just here to oversee the care. But there comes a certain time when as an academician, as a teacher, you have to step up and be there for the resident.

I had a patient come to the pre-operative holding area one morning in preparation for his cataract surgery. Despite being told multiple times by multiple people to stop his aspirin a week before the surgery, he didn't to it. We always discuss with our patients, as residents, the use of blood thinners, primarily because in preparation for the surgery we give a retrobulbar block, the biggest risk to which is hemorrhage. But on aspirin, this risk is fairly low. And in the "real" world, a cataract surgeon may not even blink an eye about a patient being on aspirin.

OR, they change their game plan. Doing an anesthetic injection behind the eye (the retrobulbar block) is only one option for anesthesia. The other is simply using topical anesthetic with maybe a little bit injected into the eye. At my stage of training, many of my current attendings would have just cancelled the case - sent the patient all the way back home, only to have to reschedule and repeat the whole process, costing everyone more time and money.

But I was lucky enough to have an attending that day who stepped up. Everyone else would have cancelled the case. But he walked up to me, handed me the appropriate topical anesthetics and said, "We're doing this one topical. See you back there."

That about made him the best attending to do cataract surgery with.  I think.