(1)
St. Johns, FL, USA
(2)
Helen Keller Foundation for Research and Education, International Society of Ocular Trauma, Birmingham, AL, USA
(3)
Consultant and Vitreoretinal Surgeon, Milos Eye Hospital, Belgrade, Serbia
(4)
Consultant and Vitreoretinal Surgeon, Zagórskiego Eye Hospital, Cracow, Poland
The robot never doubts itself nor has ego issues. Both can, however, happen to the VR surgeon; there are certain things that he must subconsciously keep in mind while other things need conscious reevaluation on a regular basis. Why the surgeon should periodically face himself in the mirror is best discussed before the need to turn to a psychiatrist emerges.
11.1 Self-Confidence Versus Overconfidence
Without proper belief in his own capabilities, the VR surgeon may be overcome or even paralyzed by the task ahead. Conversely, a complete lack of self-doubt can lead him to readily undertake jobs that he is yet unqualified for and then blame somebody else (or the circumstances1) when something does go wrong.
It is not easy to find the right balance between these two opposing extremes, yet this is one of the key ingredients in being a VR surgeon who can justifiably feel as satisfied with himself as his patients can with him. Those who during the training do not neglect the “only gradually” rule (see Sect. 2.2) have a higher chance of finding the right balance.
11.2 A Series of “Bad-Luck Cases”
No surgeon, and certainly no VR surgeon, has a 100% success rate. Even if he always does a superb, error-free job, nature interferes: the human body does not accept part of what took place during surgery and surely not all the time. If eyes with poor outcome cluster,2 it is not necessarily his fault, yet he eventually feels guilty and starts to doubt himself: maybe he has indeed erred.
As an example, Fig. 11.1 shows several possible outcomes in a person presenting with an EMP. In extremely rare instances, the patient may even die during surgery (see theAppendix, Part 2), and compared to this event the original scar on the macula is so insignificant that the surgeon seriously blames himself for offering/indicating vitrectomy in the first place.
Fig. 11.1
Possible outcomes after PPV for macular pucker. Not all potential options are shown here; see the text for details. Preop preoperatively, intraop intraoperatively, postop postoperatively, * compared to before the initial surgery
Occasionally an intra- or postoperative complication occurs and makes the patient’s final vision worse than the preoperative one (or at least prevent improvement). If there is an accumulation of such failures in a short period of time, however unrelated they are, it naturally suggests to the surgeon that he is at fault.
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