new m.d.
Practice and Experience in Phaco
Some things just take a while to master ... especially when they involve my left hand.

I'm not sure why I remember this, but I do. I couldn't have been older than 5 or 6, and there I stood, likely dressed in some ridiculous outfit arranged by my mother, in my older cousin Jack's backyard in suburban Chicago. I was given an old leather mitt, far too big for my little hand, and the contagious and abounding will of a cousin to play his favorite sport, in spite of a far less capable counterpart. I recognize this moment as my first attempt at playing baseball.  

It was only a game of catch, but at the time, a considerable challenge. The single most memorable detail of this momentous event was my complete inability to even approach any appreciable level of skill with my left hand, let alone catch a rock-hard baseball thrown directly at my vulnerable body. It would have been far easier to both catch and throw with my right hand, I thought.

Unfortunately, when Mr. Doubleday concocted the game, that wasn't what he had in mind. I watched in amazement as Jack adeptly caught the majority of erratically thrown balls right into his mitt — all with the use of his left hand!

From the Field to Surgery

Twenty-five years later, many of which were spent playing baseball capably, I found myself an ophthalmology resident, seated at the head of the bed of a patient who had the misfortune of blurry vision from a cataract. I had performed a number of manual ECCE procedures with a reasonable degree of proficiency, and was now poised to tackle the challenges of phacoemulsification. The instant the case began, upon the creation of a paracentesis, I experienced another one of those unforgettable moments. I could not get over how awkward it felt to make an incision with my left hand. In the words of Yogi Berra, it was "like déjà vu all over again." It was akin to playing doubles tennis with a scrub for a partner who couldn't pull his own weight — and the tennis club all out of other willing members.

The case was otherwise uneventful and went well, and the patient did fine. Phacoemulsific-ation, I found, requires a considerable amount of ambidexterity. With regard to personal skills, my degree of ambidexterity was somewhere on par with my ability to sing, play clarinet or whistle with my fingers, none of which approach any degree of respectability. Soon thereafter, I began to force myself to use my left hand for everything — eating, drinking, brushing my teeth and shaving. I persevered, and walked out of residency with outstanding training, solid surgical skills and overall good comfort level in the OR, but far from ambidextrous.

Surgical Skills are Cultivated

Last week, I watched my mentor, a lefty, as he zipped through his morning schedule of a bazillion cataract surgeries (once again, in the words of Yogi Berra, "You can observe a lot by watching"). As usual, he was pretty impressive. With ease, he tackled the small pupils, dense nuclei and fidgety patients as they wiggled around on the stretcher.

"What was that? The patient can't lay flat? I'll just stand," he asserted. If required, I bet he could do the case while standing on his head. He threw sutures and tied them off with little regard to which hand he was using.

Is this level of adeptness somehow amplified by being born a lefty, raised in a world of righties, and therefore unattainable to the rest of us? Had he been begrudgingly forced as a kindergartner to use his non-dominant hand because his classroom had a shortage of lefty scissors? Had the ridicule and censure of adolescence for writing like a contortionist driven him to abandon his left-handedness to be more like the other kids? Have these circumstances cumulatively made him ambidextrous, and in turn, a more gifted surgeon?

One can make that argument, but not all lefties are good surgeons. Perhaps, and more likely, operating is a little like baseball — the more fly balls you shag in the outfield, the better fielder you will become.

Howard Amiel, M.D., practices at Koch Eye Associates in Warwick, R.I. His e-mail is howard_amiel@brown.edu.