I was travelling south on the train, sitting gloomily by the window, every mile taking me closer to London and the rigors of the examination. If successful, I would become a fellow of the Royal College of Surgeons, a vital step on the road to a career as a surgeon.
I reflected on the challenge that lay ahead. I was about to have my clinical skills assessed, face-to-face by examiners who were the most eminent surgeons in the land. The 70% failure rate was daunting; I knew of numerous surgical trainees who had failed, many of them far more experienced than I. Some had failed more than once. The range of topics on which the examiners could ask candidates was immense; anything from toenails to tonsils, from trauma to transplantation.
As it happened, my first case was straightforward. The patient was a man in his 40s, who had jaundice due to gall stones. I had treated many such patients in the past and knew that my answers were satisfactory.
“Reasonable,” said the examiner, grudgingly. “Now let’s see how you fare with something quite different.”
He passed me an ophthalmoscope and invited me to inspect a patient’s right eye. This was most unusual, for although the fellowship exam was wide ranging, problems with eyes were generally agreed to be too complex for general surgeons. Furthermore an ophthalmoscope is not an easy instrument to use and in this instance was made more difficult because the light in the room was quite bright, causing the patient’s pupil to be constricted. Opticians usually put drops in the eye, to dilate the pupil, before they attempt an examination.
Nonetheless, I was able to see the retina and had the most amazing piece of good fortune. I immediately knew, without the slightest doubt, exactly what the diagnosis was, not because I was a brilliant student, or because I’d read about it. It was simply that an identical case had been presented at an educational meeting at my hospital less than three weeks before.
It was a condition that follows an eclipse of the sun. The retina, the highly sensitive tissue upon which we depend for our sight, was swollen and inflamed. This was without doubt an ‘eclipse’ burn, a thermal injury resulting from the patient watching an eclipse of the sun. Just as the sun’s rays may be focussed by a glass lens and cause a piece of paper to burst into flames so, if someone looks directly at the sun, the lens in their own eye will focus rays onto their retina and cause a burn.
Although an eclipse of the sun occurs somewhere on the earth’s surface every 18 months, it only occurs in a particular locality every 50 to 60 years. This injury therefore is incredibly rare; one which the majority of ophthalmologists never see in their entire careers.
The examiner invited me to describe what I could see, which presented no particular difficulty.
I was most certainly not going to admit that I had chanced to be shown an identical case so recently!
“What do you think might have caused this problem?” the examiner asked.
Playing along, I replied. “May I have a look at the other eye, Sir?”
“Why would you wish to do that?”
“To see if it has a similar injury.”
“Let me tell you then,” said the examiner, not wishing to waste any time, “that the other eye has an identical problem. What do you think is the diagnosis?”
“The only condition that I know that can cause damage like this to both eyes is a thermal injury resulting from a solar eclipse,” I said.
The examiner was amazed. He could not contain his pleasure. He beamed with delight and actually shook me by the hand.
“Well done, young man. Well done indeed. I’m not supposed to tell you this, but you’re the only candidate today to have made the correct diagnosis.”
I had been most incredibly fortunate and later that day I found myself shaking the hand of the President of the Royal College of Surgeons and being informed that henceforth I would no longer be referred to as Dr Sykes, I had become Mr Sykes.
Definition of ‘Serendipity’ Looking for a needle in a haystack and finding the farmer’s daughter.
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