• Memory from Residency: A Complication

    Written By: Linda M. Christmann, MD

    During my third year of training in early 1982, I was chief resident. I was in my retina rotation with the chairman of the department at the University of Texas Medical School in Houston, Richard Ruiz, MD. To this day, I consider Dr. Ruiz to be a fine physician, mentor and leader, whose vision established this training program.

    One Saturday, I was called in to assist Dr. Ruiz on an urgent scleral buckle.

    His reputation among the residents was intimidating at best, terrifying at worst. But, I never heard anyone question his skill during my five years with the department. He had always treated me like the gentleman I knew he was at heart.

    I treasured this, especially as a woman, at a time when women in training were rare in ophthalmology.

    The day did not start well for me. I had to settle my two children before I left, and had barely a moment to spare. Only a mile or so short of the hospital, I had a flat tire, and stopped to change it to the spare. I rushed into the OR just as the patient was going under general anesthesia.

    I clarified my late arrival to the “chief.” The surgery was proceeding as planned, and once the anchoring of the buckle had been started, Dr. Ruiz stepped aside and invited me to place two of the anchoring Mersilene sutures. I had done this before, but not with him looking over his loupes at me. The first suture into the thin myopic sclera went well – deep enough to hold, but not so deep as to perforate and drain subretinal fluid inadvertently. I was feeling better.

    On the second suture, however, I was not so lucky or so skillful, and was met with a flow of clear yellow subretinal fluid. I immediately spoke with Dr. Ruiz and he took over and finished the case flawlessly.

    At the end of the case, I was completing the operation report and cowering in the corner of the room, waiting to be chastised. In due course, Dr. Ruiz finished what he was doing, and walked over. He peered at me in his way that I remember today, and then looked me in the eye as I apologized, and said, “If you haven’t experienced that complication, you have not done enough surgery.” I was stunned by his kindness, and then flooded with relief. Thankfully, the patient did well, too.

    I have never forgotten that day, and have tried to emulate it many times over as a surgeon supervising surgical trainees. None of us escapes complications, and there are too few opportunities to be kind.

    Thank you, Dick.