‘You see the white debris covering the pupil? The operation did not go as planned.’
As with anything in life, sometimes medicine can go wrong. All treatments come with their own risks and benefits, and it’s the job of a doctor to weigh out the scales and decide if a certain drug or operation will benefit the patient, or harm them. For the patient above, their outcome was not so favourable.
She had originally had a cataract (a clouded lens – found behind the pupil), and so had been scheduled for an operation to remove it and replace it with a new, synthetic lens. For a cataract as mature and opaque as hers, this would have meant a significant improvement in her vision.
In the eye, the lens sits within the lens capsule. In removing it from this capsule, sometimes the back of it (which faces the vitreous jelly in the centre of the eye) may become ruptured – a posterior capsule rupture. This is a well-recognised complication of cataract surgery and unfortunately occurred during this lady’s operation. A chief concern is that the lens may drift backwards into the vitreous, and so the surgeon had pulled the lens fragments forwards into the anterior chamber: the space in front of the pupil.
This explained the curious appearance of the patient’s eye: there were shards of milky white covering all the pupil and iris, almost like a paperweight pattern. This was what remained of her original lens, displaced and broken apart. Whilst this meant the lens stayed at the front of the eye, the patient’s vision would be negligible until a further operation to try to remedy the damage. They were also now at increased risk of glaucoma, infection and and retinal detachment, making close post-operative follow-up essential.
Throughout medical school, I’ve always tried to seize the times where I’ve been wrong as learning opportunities. In a way, I think I came to see getting something wrong as a ‘good’ thing, as it easily highlighted an area to improve. This is all well and good when talking about exam grades or write-ups, but I think it will be much harder to gather myself after my first real clinical complications.
There is a lot more at stake than just my learning – the situations where I make the wrong decision for patients will be the biggest challenges I’ll ever come across. Luckily I’ll always be part of a team to support me, and I hope that through them, these errors will be as rare as what happened to this patient.