Heroics and magic

"Dr De Zaeytijd referred me to you, so you could peel the membrane from my retina,” said a patient to me yesterday. "Dr De Zaeytijd has saved my vision since she started treating me five years ago. But she said that now is the time for you to help her help me.” Julie De Zaeytijd is the medical retina specialist in our department at Ghent University Hospital, an excellent colleague who keeps the medical side of our department running like a high-speed train. Medical and surgical retina are distinct, separate subspecialties in Belgium, so a symbiotic relationship between the two is crucial to the success of both. So, Julie and I have each other’s numbers on speed dial. I call her when I need to know something. She calls me when she needs something to be done. I must admit, however, that I call Julie more than she calls me. I guess this is because there are more patients with macular degeneration, vascular occlusions and diabetic retinopathy 
than there are patients with retinal detachments, macular holes and trauma. “Look at this OCT with me, will you?” I ask, as we both open the images on our own computers on opposite sides of the department. We are separated only by the big new glass-enclosed atrium and waiting room. “I’m thinking anti-VEGF, followed by laser if necessary…” My favourite thing to hear Julie say: “Absolutely, that’s exactly what I would do.” But she’ll often offer a more nuanced approach, one based on the most recent research results in medical retina. I then add this information to my own treatment protocols, so I can avoid asking the same question twice. Although I call her more than she calls me, Julie views what I do in the VR department as a mixture of heroics and magic. She sends patients blinded by a macula-off retinal detachment or a dense diabetic vitreous haemorrhage. Six weeks later, the patients return to medical retina, their vision restored. Hooray! And yet, this skips the drama of the anaesthesia, surgery, postoperative care, daily drops and all the rest. By week six, it all looks just great. And thus, Julie has a very vivid imagination regarding my interventions: “And then the VR surgeon appears out of nowhere, takes the patient to the operating room and solves everyone’s problems, while we have to spend months or years injecting and lasering for a single line of improvement.” For both of us, I suppose the grass always seems a bit greener on the other side. We both have tremendous respect for what the other does, and this admiration is mixed with a bit of envy for what the other has achieved, for what the other can do to treat referred patients. Julie is a bit jealous that most of the problems she’s asked to solve take months or even years of dedicated follow-up, whereas a retina can be reattached in an hour or so. On the other hand, I envy her ability to make a difficult diagnosis, to recognise a single pattern among thousands, to be able to tell the difference between two different subtypes of retinitis pigmentosa with a quick look at the mid-periphery. It’s a great feeling to know that my own patients will be well taken care of when I refer them to her. “The pucker in your right eye is gone and it all looks very good, but your left eye is developing some problems due to your diabetes,” I’ll say, “so I’d like to refer you to the diabetes eye specialist for further follow-up and treatment.” I’ve noticed that introducing a colleague by mentioning their subspecialty field usually draws a blank stare. “Dr De Zaeytijd is a medical retina specialist” means literally nothing to most patients. Instead, I’ll say, “Dr De Zaeytijd is specialised in treating abnormal fluid in the retina, which is exactly what you have.” This works for all kinds of disease descriptions. “She’s a specialist in blood clots in the retina… a specialist of diabetes in the retina… a specialist for inherited diseases of the retina.” This kind of introduction distils everything down to the information that is most relevant for this one specific patient. It’s amazing what someone with seven years of dedicated study, fellowships and full-time attention to medical retina can realise. She can confidently identify diseases that most of us have simply not heard of since studying for the final exam of our residency training. I’m not sure whether I’ve ever said that to her, but maybe I should. And yet I know that she would answer, with her characteristic modesty, something like: “Yes maybe, Leigh, but I don’t think I could peel an inner limiting membrane to save my own life.” Dr Leigh Spielberg is a vitreoretinal and cataract surgeon 
at Ghent University Hospital in Belgium leigh.spielberg@gmail.com