The Hands That See

I remember the smell. Not of the operating theatre, that came later. But the smell of my grandmother’s kitchen in Baghdad, where she would sit by the window every afternoon, squinting at her prayer beads, counting them not by sight but by touch. She had cataracts in both eyes. Dense, white, like two small moons. She never got surgery. She said she could still see what matters, the shape of her grandchildren coming through the door.

I thought about her on my very first day assisting in cataract surgery at Al-Shafaa Teaching Hospital in Babylon in 2013. I was a junior resident, terrified, trying to hold retractors with steady hands while mortar rounds shook the windows two blocks away. The patient was a 70-year-old retired schoolteacher named Abu Kareem. He could not see his grandchildren’s faces anymore, he told us. That was his chief complaint. Not visual acuity. Not the Snellen chart. His grandchildren.

My attending surgeon, Dr Saad, did something I did not expect. Before the surgery, he sat on the edge of the patient’s bed, not beside it, on it, and held Abu Kareem’s hand. He asked about the grandchildren. Their names. Which one looks most like him. The old man laughed so hard he started coughing. Then Dr Saad said: “Tomorrow you will see that face again, inshallah.”

There was no femtosecond laser. No digital OR. The phaco machine was older than me. We had maybe three IOL powers to choose from. But Abu Kareem’s hand did not shake during surgery because Dr Saad kept talking to him, about football, about the weather, about his grandchildren. When the patch came off next day and Abu Kareem looked at his youngest granddaughter, he started crying. Then Dr Saad started crying. Then I started crying too, and I was just the resident holding the torch.

That moment changed something in me, though I did not fully understand it until years later.

When I moved to Germany in 2015, I entered a completely different world. Everything was precise, protocolled, efficient. The machines were extraordinary. Outcomes measured in microns. But something felt missing, and it took me time to realise what it was: it was the bed. Nobody sits on the patient’s bed here. In fact, there is no bed—just a chair that moves on a rail into the OR. The system is so efficient that sometimes I would finish a surgery and realise I did not know if my patient had grandchildren at all.

I do not mean this as criticism. I learned an enormous amount from European training, and I am deeply grateful. The precision, the safety culture, the evidence-based approach—these are gifts that my training in Iraq could not give me. But I carried something from Baghdad that no machine could teach: surgery is not just what happens between the speculum and the drape. It is what happens between two people.

Now, in my daily practice, I have made small rituals that are my own version of sitting on the bed. I always ask my patients one question before surgery that has nothing to do with their eyes. Sometimes it is about their holiday. Sometimes what they had for breakfast. One elderly Swiss lady told me she was nervous because she promised her cat she would be home by dinner. So I told her we will make sure of that, and during surgery when she tensed up, I said: “Your cat is probably already sitting by the door.” She laughed under the drape and her eye relaxed.

These are small moments. They will never appear in a surgical report. No AI algorithm will code them as a quality metric. But I believe they are the difference between a procedure and a healing. My grandmother never got her cataracts removed, but she taught me that seeing is not only about the eye. And Dr Saad, in a crumbling hospital in Babylon with equipment that would not pass any European inspection, taught me that the most advanced instrument we have is still our ability to connect with another as human beings.

I have been trained by machines, and I have been trained by people. The machines taught me how to operate. The people taught me how to care. And when I stand at the slit lamp today, somewhere between the technology that surrounds me and the patient before me, I try to remember: the hand that holds the phaco probe must also be the hand that can hold a patient’s fear.

That is the part they cannot automate. And I hope they never will.

Dr Chichan was awarded first prize in the 2026 John Henahan Writing Prize.

Applicants were asked to respond to the following prompt, without using any AI tools:

The digital OR, AI algorithms, and robotics notwithstanding, cataract and refractive surgery involve a human relationship between you and your patient. Please describe how an experience or experiences in your early training reminded you of the importance of the human touch and how this has inspired you in your clinical practice.