As I See It

On the shoulders of giants

Another ophthalmic legend passes.

By Paul S. Koch, MD, Editor Emeritus

The day I wrote this column, I “celebrated” my Sergeant Pepper “When I’m 64” birthday. As if that wasn’t enough, a big storm forced me to haul the little fleet of boats, which I keep moored in front of my house, onto dry land. And that made me sad. The season is over.

AUTUMN BRINGS INTROSPECTION

Also making me sad — the growing list of my teachers who have passed away over the last few months: Bob Sinskey, Dick Kratz, Norm Jaffee, George Waring. And others. All were known not only for their clinical investigations and their surgical skills, but also for their humor.

The newest name on the list is Jan Worst. He was one of the most outrageous, funny and innovative surgeons this specialty has seen. I was excited when I first visited him in Groningen, Netherlands, and I was honored when he visited me in Warwick, R.I.

A BEAUTIFUL MIND

It was at his surgery center, in a corner of the Ophtec factory, that I first saw intracapsular cataract surgery performed replete with a Freon can, fresh from the auto shop, and a blunt hypodermic needle. If he had an idea, he’d shout it out in Dutch to the device engineers, who’d have a prototype to try by the end of surgery day.

I was intrigued by the simplicity of using intraocular pilocarpine for miosis, and dumbfounded by his use of stainless steel sutures. His intraocular forceps were comprised of a small hypodermic needle, slid inside a larger one with a spring between them and bent tips on the end. His claw lens remains revolutionary. He wrote the definitive book on the anatomy of the vitreous, showing it’s not just a jelly.

The author, right, with the irreplaceable Dr. Worst.
COURTESY PAUL S. KOCH, MD

SURGEON AS ROCK STAR

My favorite Jan Worst story goes something like this. I was having breakfast at his house. He told me we were going to do surgery at a small hospital in Germany that day. It would take about an hour to get there. As it was already past nine, I asked him what time surgery was scheduled for. “Seven thirty,” he told me, and had another sip of coffee. Yes, he did mean seven thirty a.m. But no worries.

I panicked. I had agita. I could only imagine the furor, the hostility that would await us when we reached the clinic. I know the reaction I get when I am a few minutes late. What would happen when we were late by hours?

I did not enjoy the drive and I was scared to follow him into the lobby. A patient saw him first and jumped to her feet. “Dr. Worst!” she screamed in excitement. “Er kam!” Which loosely translated means, ‘OMG, he’s actually here. It’s him in person. I can’t believe it!’

As a group, the patients and their families stepped forward to greet him. They smiled, they shook his hand, they thanked him for being there. If selfies existed back then, the flashes would have been flashing.

Now, if I were that late to my practice it would have meant guns and knives and letters to the authorities. Here, patients recognized that while their surgeon might live according to his own clock, he was das genie, the genius. OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, RI. His e-mail is pskoch@clarisvision.com.