Paul was travelling south on the train, sitting gloomily by the window, every mile taking him closer to London and the rigors of the examination. If he was successful, he would become a fellow of the Royal College of Surgeons, a vital step on the road to a career as a surgeon.
He reflected on the challenge that lay ahead. He was about to have his clinical skills assessed, face-to-face by examiners who were the most senior and eminent surgeons in the land. The 75% failure rate was daunting and he knew of numerous surgical trainees who had failed, many of them far more experienced than he was. Some had failed more than once. The range of topics on which the examiners could ask candidates was immense; any thing from toenails to tonsils, from trauma to transplantation.
Horror stories abounded of examiners who deliberately tried to unsettle the candidates.
In this respect, his surgical consultant, Mohammed Khan had been extremely helpful. He had arranged mock vivas for Paul, and had warned him of some of the tricks the examiners were known to play.
If, for example, you were asked how to remove a patient’s appendix, it seems natural to commence by saying: ‘I would make an incision two inches long, in the lower right abdomen, centred on McBurney’s point,’ at which moment the examiner might comment, somewhat sarcastically, ‘don’t you think that the patient might appreciate it, if you anaesthetised him first?’
‘Yes Sir, sorry Sir,’ you might reply. ‘With the patient anaesthetised, I would make a two inch incision, centred over……‘
There could then be a further interruption.“Wouldn’t you put an antiseptic on the skin first, or are you deliberately trying to give the patient a nasty wound infection?”
‘Yes, Sir,’ you would correct yourself, trying to keep a cool head, ‘with the patient anaesthetised and having painted the skin with a suitable antiseptic solution, I would make an incision…..’
And so it would go on.
On the other hand, if in answer to the original question, you said, “with the patient anaesthetised, I would paint the skin with an antiseptic solution, wait for it to dry, put drapes around the operation site and then make an incision….” the examiner was likely to stop you in your tracks, saying, “yes yes, yes. I wouldn’t expect you to plunge your knife into a patient who was wide awake, would I?”
Similarly, if it became apparent to the examiner that you knew the answer to a question, he would move quickly on to a new topic, or perhaps go off at a tangent, “now tell me who McBurney was?” All the while, they were searching for a weakness in your knowledge. It was designed to unsettle you, to see if you could cope under pressure. To succeed, you needed to stay calm and avoid becoming rattled.
As it happened, Paul’s first case was straightforward. The patient was a man in his 40s, who had jaundice due to gall stones. Paul had managed many such patients on the ward and knew that his answers were satisfactory.
“Reasonable,” said his examiner, grudgingly. “Now let’s see how you fare with something quite different.”
He passed Paul an ophthalmoscope and invited him to inspect a patient’s right eye. This was most unusual, for although the fellowship exam was wide ranging, problem with eyes were generally agreed to be too complex for general surgeons. Furthermore an ophthalmoscope is not an easy instrument to use at the best of times 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, Paul was able to see the retina and had the most amazing piece of good fortune. He immediately knew, without the slightest doubt, exactly what the diagnosis was, not because he was a brilliant student, or because he had read about it. It was simply that an identical case had been presented at an educational meeting at his 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 any particular locality every 200 or 300 years. This injury therefore is incredibly rare; one which the majority of ophthalmologists never see in their entire careers.
The examiner invited Paul to describe what he could see, which presented no particular difficulty.
He was most certainly not going to admit that he had chanced to be shown an identical case so recently!
“What do you think might have caused it?” the examiner asked.
Playing along, Paul 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 the recent solar eclipse,” Paul said.
The examiner was amazed. He could not contain his pleasure. He beamed with delight and actually shook Paul 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.”
Definition of ‘Serendipity’ Looking for a needle in a haystack and finding the farmer’s daughter.
If you enjoyed this story, why not subscribe on the home page to receive all future stories direct to your inbox ( no ads – guaranteed )