Amazingly, or frighteningly, an ophthalmologist is only required to have a weekend course on LASIK in order to be certified to perform the procedure. There are no boards exams for LASIK. It is part of the reason that the "see how many procedures your surgeon has performed" can be useful advice. Of course, it is still possible to do a bad job thousands of times (I once had a haircut from a lady at Great Clips that made me look startlingly like Hitler even though she probably did a thousand haircuts that week), but it is a lot less likely. The reason I chose to spend a year with Dr. Durrie, is that I wanted to be really, really good at LASIK before I started doing it on my friends and family.
That still means that there was a first patient, though. I remember her very well. Dr. Durrie had a deal where patients could choose to let the fellow in training do their procedure and pay a little less than if he was doing it. It was a good deal because they knew they were at one of the best places in the country, and Durrie would only let good things happen to their eyes. Part of that assurance was that he would only let me do a part of the procedure that I was comfortable with, then do that a bunch of times, before moving on to the next part within my skill set. For that first patient, that meant that I got to "drive the bus."
"Drive the bus" is what Durrie called it when you put your foot on the pedal (the laser is fired by pressing a foot pedal with the right foot) and make sure the eye is lined up. The fact that there is an eye tracker that is unbelievably fast and precise means that lining the eye up is equivalent to saying "making sure the eye is underneath the laser." So basically, as long as the patient doesn't get up and walk around the room during laser, they're going to be doing good. But on that first laser procedure, it felt like the type of responsibility that Presidents must feel.
Durrie did every part of the procedure except that one 6-second moment where the pedal was pressed. I switched seats with him, looked at the eye (already perfectly positioned) through the scope, pressed the pedal and watched. I said, "fannnntastic, this looks greeeeat, you're doing greeeaat…" and in my head I thought, "WOOOAHHH!! AHHH I AM SHOOTING A LASER AT SOMEONE'S EYEEEYAHHHH!" There was a lot of adrenaline involved.
And that's what goes away sometime between the first procedure and the thousandth. The adrenaline. Alex Honnold, who climbs mountains without a safety harness (and who's videos make my palms sweat uncontrollably) had a quote in a 60 Minutes interview that was so good that I tried to write it down, but gave up because I couldn't read what I wrote with it being smeared together with sweat. He said something along the lines of his ability to do what he does well depending on the fact that there is no adrenaline involved. If there is adrenaline, it means something has gone wrong, because everything should be smooth and controlled.
No matter what we do, whether it is a salesman's first sales call, a singer's first performance, or a doctor's first procedure, the transition from good to great happens as we move from adrenalinized focus on the fact that we are doing something new, to controlled focus on the steps involved in doing it well.
Author: Joel Hunter, MD is an Ophthalmologist, Refractive Surgeon, and the Founder of Hunter Vision, a LASIK Orlando Clinic in Florida. A recognized and respected specialist in vision correction who has performed a countless number of refractive surgeries, Joel gives lectures across the country and trains fellow doctors in the newest LASIK surgery techniques.