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Residents & Fellows Corner | Jan/Feb '21

Adapting in the Face of Change: Twelve Lessons From an Unexpected Year

When life goes off script, take up a pen and write a new one.

After the death of Alan Crandall, MD, I cried all weekend. My response surprised me. This was a seemingly remote event—the death of a person I had never met, a colleague I had admired only from afar. Another colleague whom I admire greatly had posted on social media about Dr. Crandall’s passing. In the comments below his post were hundreds of touching eulogies, a clear testament to Dr. Crandall’s impact on those in our field. These remembrances moved me for many reasons, not the least because my own experience of losing a mentor was fresh in my memory. I had my dream fellowship, and then it unraveled.

People often think of life as a linear path, and sometimes it is. We set goals, work hard, and find people to help us along the way. However, there are some things in life for which none of us can plan. When I asked for advice on how to invest my time this year, a friend and mentor of mine offered little guidance. Rather, he referred to the COVID-19 pandemic as “a life-altering event” and “100-year storm” and encouraged long-range planning.

In the past year, I did not learn nearly as much about glaucoma surgery as I anticipated. Instead, I gained new perspectives that I expect to maintain for the rest of my career. I would like to share some of these lessons here, one for each month of this surprising year.

1. Come prepared. I began the year as a visiting resident in Albuquerque, New Mexico. From hiking through snowdrifts on the face of a mountain ridge to pulling hundreds of shards of glass out of a patient’s anterior chamber, I never knew what I would encounter next. I held my expectations loosely and prepared for a wild ride.

2. Keep swimming. At some point, I was exhausted. However, the cataract surgery teaching I received from mentors who were determined to see me comfortably chopping by the end of my rotation made every long night of Q2 call worthwhile.

3. Find your people. While visiting Albuquerque, I had the chance to observe local surgeons. The day I spent with Greg Ogawa, MD, watching him perform complex cases and brainstorming ways to improve upon the Yamane technique for intrascleral haptic fixation was among the most memorable of my residency training.

4. Be flexible. Shortly after returning to Pittsburgh, the global pandemic put an abrupt end to my cataract surgery training, just over halfway through my senior phaco rotations. I did not know when I would be allowed to operate again, but I redirected my time into research projects and found ways to mentor younger trainees.

5. Do it together. I started my busiest cataract surgery rotation when the spring shutdowns ended. Although trailing in numbers, I had coresidents who were struggling, too. My program director added 1 OR day each week, and I helped an overwhelmed surgery scheduler provide 2 full phaco days per week for myself and a colleague.

6. Keep challenging yourself. That last month of cataract surgery with my mentors in Pittsburgh was glorious. My program director let me do as many cases as he was able—high hyperopia, white cataracts, and all. I settled comfortably into horizontal chopping and welcomed every opportunity to try something new. My first month of fellowship was equally glorious, as I gained confidence in performing cataract surgery and adopting new MIGS procedures.

7. Be intentional. When one of my two mentors announced that he was leaving the practice, I was stunned. After carefully considering my options, I decided to take a gap year and try for another glaucoma fellowship the following year. Soon, I had a position lined up outside the Match as well as opportunities to learn during the current year.

8. Ask for help. I reached out to colleagues and mentors to ask for recommendation letters, seek advice, and renew collaborations. They were happy to help, and I soon found myself with more projects than time.

9. Comfort others. As I shared news of the year’s losses with colleagues, I learned that others were experiencing similar things. We supported and encouraged one another, and this helped all of us to weather our more difficult days.

10. Exercise gratitude. I have good friends around the world, amazing mentors back in Pittsburgh, and an awesome glaucoma family awaiting me in Indianapolis next year. There is much to celebrate.

11. Hold your head high. I learned the importance of acting with integrity and being true to myself. At first it was difficult to explain my position as an orphaned fellow, but I eventually learned to own my story and even have a sense of humor about it.

12. Take the scenic route. Many successful people take a nontraditional path. Traveling off the foot-worn trail can bring new insights and prepare us for a future we did not know to imagine!

Rikki Enzor, MD, PhD
  • Graduate, Ophthalmology Residency Program, University of Pittsburgh
  • Founding member, @masterthepressure, glaucoma education Instagram team
  • rikkienzor@gmail.com; Instagram @rikki.enzor
  • Financial disclosure: None