• Dr Mustafa Ali

“So, can you use a slit lamp?”

It’s the first question I was asked. And for a while it was the only question that mattered. Six years of medical school, two years of foundation training and a master’s degree were all weighed on a scale against this simple query. The foundational examination tool in all eye clinics all over the world. The place where I would spend all my working hours.

I started my first ST1 placement without having done a formal job in Ophthalmology previously. Much like some exotic tropical creature, I had seen a slit lamp but had never been close enough to handle one properly. My knowledge of it was almost completely theoretical, but I was assured that in time I would come to think of it as an extension of my hands and eyes. A light beam, a magnifier, a joystick to move it all, and more knobs, dials and twisty bits than I knew what to do with. As I held the joystick for the first time, it dawned on me that this was the start of an entirely new set of skills I would have to master. Skills that would forever separate me from the rhythm of life in general medicine. I had sacrificed the comforting weight of my stethoscope for the cold and alien heft of the contraption on the table in front of me.

As would be expected the learning curve was steep. Unfamiliar presenting complaints, unfamiliar treatment plans, unfamiliar diagnostic tests, the list could go on. Nobody can inject competence in you, you need to work for it. The first few weeks of clinics and shifts in eye casualty were predictably unnerving. To re-start from the bottom of the experience ladder after building up one’s workplace confidence is no small thing. Worse still is the ever-present fear that a mistake you make in diagnosis could mean deterioration or even loss of sight. Fortunately, the mood of the seniors en masse was always positive (no doubt in large part to the wonderful work life balance they all seem to enjoy). Any question I had was answered with a smile. Any tips or tricks I needed to be able to tame this beast of metal and electricity were taught with patience. “It’s ok, you’re only an ST1. Nobody expects anything.” The reassurance was comforting, but the need to prove oneself was chafing.

Weeks passed, eye casualty sessions came and went. Everything in the front half of the eye I could see with ease (obviously, given that it’s right there). The greatest challenge was using the handheld mini lens, hovering between my fingers and held in line with the light beam and the viewing scope, all to see that precious sliver of retina. I had been struggling with this skill the most, as I was told all juniors do when they begin this life. I can’t say what it was, whether it was just chance or if I had actually become more fluid with holding my lenses and manipulating the lamp. But one day the stars above aligned, just as my eyes, my light beam, my lens and the patient had aligned. And finally, I saw it – that elusive horseshoe shaped retinal tear. My retina was looking directly at the patient’s retina. Both our eyes were connected by a beam of purest light and the magic of physics. It was like a spiritual experience to be able to appreciate this connection and be in awe of this delicate organ – the only organ that can truly perceive light. I was euphoric, and also alarmed because I realised that we now had to send the patient for urgent laser retinopexy.

A world of new diagnoses had opened before me, and with it new challenges, new skills to master, and new ways to serve my patients. The road is hard, but it’s a joy to walk on.

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