Dear Dr. Husney,
Thank you for agreeing to do this interview. Before I dive into the questions, I’d like to provide our readers with a little bit of background about how we know each other, and why I am so excited about the opportunity to partake in this conversation.
Dr Husney and I are both ophthalmologists that perform cataract surgery at the same surgery center in Brooklyn, New York. Our paths hadn’t crossed for several months. prior to us bumping into each other just a few weeks ago,
On the day we reconnected, I had just finished my cases and was about to head back home when I remembered that I’d left a plate of orange peels and a half-eaten energy bar in the surgeon’s lounge. When I popped in to tidy up, I noticed that you were actively reading (the Talmud?) and even taking scrupulous notes. I was pretty amazed that you were engaged in such a mentally rigorous exercise right before you were about to perform 30 cataract surgeries.
In fact, when I reflected on our brief encounter later in the day I realized that I was quite awestruck by your discipline, depth and concentration. It left me wondering how you process things and how your mind works. Not many human beings live with the same intensity and devotion, to both their religion and their craft.
With that brief backstory out of the way, let’s dive into the interview.
Q) First of all, would you consider yourself a person with a lot of intellectual and mental stamina?
Firstly, thank you very much for the opportunity to be interviewed, I must say that I am quite flattered. As for the stamina, I wish I could say that I did have much mental stamina but I feel like I’m a product of todays world of screens, and I get distracted quite quickly.
Q) Non-doctors and physicians alike often wonder how neurosurgeons and cardiothoracic surgeons can maintain their concentration over the course of such long operations. Performing a high volume of cataract surgeries must require a similar amount of stamina. How do you do it? What do you eat for breakfast? Do you exercise a lot?
I have the utmost respect for our neurosurgery and cardiothoracic colleagues among the other myriad of surgeons out there. To be able to do a single case for hours on end is nothing short of amazing. Getting closer to home, our retina and glaucoma surgeons also deal with longer and more unpredictable cases. As for cataract surgery, we have been blessed with a multitude of advances over the years cutting down our case time. So I find it easier to focus on doing 1 case for a few minutes than maintain concentration for a single case for many hours.
Q) Besides a tremendous amount of skill and stamina, doing so many cases in one day obviously requires a certain ability to cope with stress. Do you think this is something a person is just born with? Or, is it something that they can develop over time?
Your question brings to mind what my attending, Dr Reginald Camillo, mentioned to me in residency. I was blessed with phenomenal teachers in residency now that I can look back at it. When we started gaining some proficiency in cataract surgery, we obviously started to have an ego. That’s when he said, “You can teach a monkey to do surgery” He reminded us to stay humble and check your ego at the OR door. Dr. Camillo pushed me out of my comfort zone and purposely forced me to try new techniques. Dr Zabin–another one of my mentors– would tell us to minimize movements in the eye, “spend the least amount of time necessary in the eye”. To this day, 11 yrs out of residency, I feel like they are over my shoulder, watching and critiquing, trying to improve my performance. It is an attitude of always pushing to achieve more.
Q) How did you come to realize that you possessed this disposition? What motivates you to be so prolific? Be honest, is it financial? Or do you think a cataract surgeon needs to do a very high volume of surgeries in order to become a true master of his craft?
I believe that we have the best job in the world, we get paid to get patients to see better. It is a privilege to be allowed to operate on someone’s eyes. With cataract surgery it is a quest for maximum efficiency. Brook Plaza is such a wonderful place to operate, for the surgeon and patients alike. They have a certain efficiency built into it. I use them as a role model to show how I need to be more efficient in the surgery.
You don’t need to do a million cases to be a master. I think you just have to know how to do 1 case and be able to repeat that many times over.
Q) Ok, at this point, I’m going to expand the scope beyond just the clinical practice of eye surgery if you don’t mind.
As a orthodox Jew, religion is a big part of your life. How does religion inform your identity as a surgeon? Can you share some ways that practicing medicine turbocharges your religious identity or sense of spirituality?
There are many religious Jewish people in our field and I feel lucky to be part of this club. I wont lie, sometimes this is just a “job” examining pts and dealing with this and that. But every day there is always one pt where you get to see the “hand of god” in the office. A trauma patient who has a corneal scar just next to the central visual axis and not in it, so he has 20/20 vision. And in the OR, forget about it. How many times have I grabbed the posterior capsule with no repercussions. Surgery to me is the ultimate religious activity. You have no one to rely on but God himself to help you with the case.
Q) Are there certain passages / prayers that you read prior to surgery?
Although I should be praying specific passages during the surgery, I don’t. I know my Rabbi did tell me to…
Q) Is studying Torah like a form of meditation? Is it a form of gratitude ?
I don’t know if I would go so far as saying “I’m a student of Torah”. There are true giants in the Torah world and I am but a “passerby”. Since the Torah is the word of God, I feel that it is good practice to try and learn in a time when His help is really needed. The OR provides that because when there is down time (not so much due to working at Brook Plaza Surgery Center!) you really have protected time to learn. At home, it is quite difficult to find that “protected time” It is a much better thing to do than gravitate towards the phone (which I invariably do so often, unfortunately)
Q) MEDMIC is a bit of an “artsy” publication. Can you share a passage from the Talmud that you think has a bit of an artistic flourish or flair?
I like a tractate of the Talmud that talks about how to settle situations where someone suffers physical damages from someone else’s actions. The guilty party is required to pay for the injured party’s medical bills. However, the guilty party can’t say “I will bring you a doctor!” The injured person is given the opportunity to choose who provides their care. Why? The Talmud mentions that the guilty party could —if they had the opportunity to do so—bring a physician from far away, who may actually make things worse and “blind him.”
This was written thousands of years ago but it still rings true. I remember in residency, there were programs that would fly their residents out to foreign countries to learn to do surgery. The resident physicians can now “practice” without consequences. The authors of the Talmud knew exactly what they were talking about. When a physician does not have “skin in the game” he may end up literally “blinding someone.”
Q) What would you say to a cataract surgeon like me that only does 8-10 surgeries per day and looks at the OR schedule and sees that you’re doing 3 times as many cases. You do realize that this makes us feel inadequate (tongue-in-cheek)?
You should never feel that way. First, I rarely if ever do as many cases as you state. Second, the caseload does not equate to skill. My mentor, Dr. Camillo would tell us he would do 10 cases a day. Although I don’t know how many he does now, his skill set and speed dictates that he could do 100 before lunchtime.
Q) Ahem (clearing my throat) you only “rarely” do 30 in a day? Its pretty often, I see the OR schedule.
What would you say to a medical student who’s considering a career in ophthalmology? And more specifically, what might you ask them to determine if ophthalmology is a good fit for their natural proclivities?
I’m heavily biased, but every med student that tells me about what they want to do, I tell them to go to ophthalmology. I truly believe that ophthalmology is the best field out there. Hands down. Within ophthalmology you have so many sub-specialties that any personality can fit in.
Q) How do you stay positive when surgical complications arise? I personally feel like no matter how great a surgeon is, they will occasionally encounter strange anatomy or unforeseen conditions. Do you have a mantra? Or a particular knee-jerk strategy that you employ?
You’re only as good as your last complication. Ophthalmology is a very humbling profession because we can do 99 cases without any issues but we remember the 1 case that got away. In the beginning of my career I would be very down on myself, almost distressed and that would be a heavy burden to carry around. Now, I have learned that the best thing to do is to “live to fight another day” Don’t be a hero, there are many great surgeons with skill sets more advanced than my own who can probably fix it. Sometimes I just “close up shop” and send it out rather than try to go out of my comfort zone. It is better for the patient and for myself. Another great resource for complications has been watching videos from Dr. Devgan, the true “Cataract Coach.” He constantly reminds the audience that everyone will have complications as long as they operate. It is comforting to know that, because early in your career, you go to meetings and everyone shows you wild cases and you say to yourself, “Whoa I could never do that, this surgeon is amazing.” They never have any complications. Dr Devgan broke that mystery and shed light on the fact that everyone has complications.
Q) For me, one of my favorite things about ophthalmology is seeing a patient’s reaction on Post-OP Day 1 when I take the eye patch off and watch people’s facial expressions. Because of the volume of cases you do, I would imagine it’s not possible for you to see very many of your post-op patients. So then what is your favorite aspect of the job? What gives you the greatest sense of awe and gratitude?
I try really hard to see all pts POD 1. For some patients it’s a shlep but I feel more comfortable seeing how they are doing and giving them the instructions. It never gets old hearing patients say, “Wow, I see much better.” The best stories are from patients who mention what the surgery did to them “It looks like my TV is HD” or, “My house looks so dirty now! ” Or a recent one which is a new favorite “I look so ugly with all these lines on my face, why didn’t anyone tell me I looked so haggard.”
Q) If you were going to pick adjectives to describe what qualities help make a great surgeon what would they be? I think mine would be patient and meticulous.
I would say perseverant. The beginning of a surgical career is a very, tenuous time. Surgical complication rates are up, confidence is low. As long as you persevere and strive for perfection you will find success.
Q) Finally, is it possible to be a “mensch” just by virtue of doing 30 cataract surgeries in an afternoon? Does that somehow provide you with enough good karma to satisfy the “requirement”, or does one still need to be a good person to live up to the moniker?
I don’t think there is any correlation between that. I like to do a high volume of cases more from an efficiency standpoint. My ideal situation is a patient comes in, gets evaluated for surgery, booked for surgery and is on the table that week. I like to decrease any barriers for patients to have surgery so we have weekends available and we try to add patients on to the schedule as opposed to telling them “the next day we have an opening is for…” If a patient wants surgery, especially if their vision is impacted severely, I try to have them on the table the next time I go to the OR.
Q) How do you unwind after surgery?
I always mention that surgery is the easy part of the day because the heavy lifting is done by the staff. They prep the patients for the OR and anesthesia will get them relaxed. It is a perfectly controlled environment. Chaos ensues in other areas. The office always has its issues and at home we don’t have an anesthesiologist to put our kids to bed…
Thanks again Daniel. I think people will appreciate this opportunity to get a glimpse into the mind of such a prolific and pious surgeon.
Interview Questions by Eric Dessner MD
.