• The Board Exam That Eclipsed My Front-Page Adventure

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    It seemed surreal: walking into a strange hospital in an unfamiliar city to be interrogated by strangers about one’s competence. After all the challenges I had conquered by then — most of them outside the rigors of medical school — I didn’t expect my ophthalmology board exam to hit me that way.

    At age 16, I had managed to get on a train and travel hundreds of miles to attend a college I had never seen. Later, I had listened to the head psychiatrist at my medical school tell the class that we were all smart enough but had signed up for the long haul of training that did not certify us as normal — au contraire!

    One day in training I had a triumphant moment, when the chief of medicine, after listening to the gathered doctors state their diagnoses on a complex case, agreed that I (a mere medical student), and he, did not know!

    Subsequently, I had sailed off as a ship’s doctor on U.S. Navy transport ships to take care of women and children, Turks, Greeks and Ethiopians. I had gone in an open boat, in heavy midwinter seas in the North Atlantic, on a rescue mission that made the front page one Sunday long ago.

    I then went from being saluted and addressed, “Yes, sir!” to life as a lowly ophthalmology resident whom others called, “Hey, you!”

    I was lucky enough to have a full graduate ophthalmology year taught by some of the top people of the time (Alfred Kestenbaum, MD; Arthur Gerard DeVoe, MD; Goodwin Breinin, MD; Ramon Castroviejo, MD; Arthur Linksz, MD; Conrad Berens, MD, et al). As a resident, I also enjoyed excellent personal mentors who helped me get broad clinical experience and much surgery practice. 

    Yet, here I stood, to face some widely known professors of ophthalmology, the top specialty of the world of medicine, to prove I was worthy of acceptance into that elite group.

    Yes, I was apprehensive.

    Two episodes stand out from that fateful day. Paul Chandler, MD, remains a giant figure in our field. He sat next to me on a bench, after I had examined a patient with a total retinal detachment and large hole in his retina. He talked quietly with me for a while and found out much about me, and at the same time taught me several things. From my high school days, I hated guys who said, “I enjoyed that exam,” but thanks, in part, to Dr. Chandler, this time I enjoyed that exam!

    My other experience that day occurred with Edmund B. Spaeth, MD, who was intimidating. He started off this confrontation supposedly about ophthalmic surgery by quizzing me about radiotherapy. It took little time to discern that I knew little about this, other than Castroviejo’s strontium 90 applicator for the limbus for pterygia.

    Then he says, in a sarcastic tone of voice, “Doctor, you are doing your first Kronlein operation for a suspected deep orbital tumor.” (Unbeknownst to him, I had actually done two and also had scrubbed with neurosurgeons on at least 20 craniotomies).

    He went on, “The instrument nurse hands you a long skinny alligator biopsy forceps when you have managed to get a fingertip deep into the orbit. You now feel two firm rounded structures — one is likely the tumor you seek and the other is the optic nerve. What do you do?”

    I was able to answer without hesitation, “I would close up and call my neurosurgical friend to do a frontal cranial approach to the orbital roof.” Doctor Spaeth put out his hand to shake mine and said, “Very good. You are the first of fifty to give me a proper response.”