My Student, My Surgeon

Linda S. Costanzo, Ph.D.

 It was an ordinary Monday, except that the newspaper print looked wonky. I blinked and rubbed my eyes, but there was no change.

            I closed my left eye, and the print was normal.

            I closed my right eye, and there it was. Chunks of type were out of place, pieces of letters were missing, and lines that should have been straight were wavy.  

            Something was seriously wrong with my left eye.

As a professor at the medical school, I'd joked about having a faculty colleague for every body part. Stomach troubles? I'm on committees with gastroenterologists. Bone density issues? My walking buddy is an endocrinologist. Kidney questions? I teach with the nephrologists. Today, it was no joke. I urgently called Dr. K, an ophthalmologist colleague.  He offered to take a look right away.

My left eye struggled with Dr. K's battery of tests. When he presented the Amsler grid, my left eye was an unequivocal fail. There could be no positive spin on the wavy, broken lines in the center of the grid.  (The Amsler tests the function of the central portion of the retina, the macula.) The Amsler fast-tracked me (and my rising panic) straight to a retinal scan.

"The scan is conclusive," Dr. K said. "You have a macular hole in your left eye." I heard the catch in his voice.

            I'd never heard of a macular hole, so I must have misunderstood.

            "Macular hole," he said again, as matter-of-factly as he could muster.

            The rest is a blur. Something about a newly arrived retina specialist who could see me right away. Where's your husband? Is there someone you can call?

            In the span of five minutes, I'd gone from never having heard of a macular hole to needing a macular hole specialist. Too stunned to think strategically, I agreed to the new specialist. (I did wonder how young this guy was and whether "young" was good or bad when it came to retinas.)

My presumption couldn't have been more wrong. The new specialist was ancient.

            Ancient charged into the exam room, with no, "Hello I'm Dr. X," no eye contact, no handshake. He jumped right in.

            "The hole is big. If it's not fixed, you'll permanently lose your vision for reading. My surgery requires six weeks face down. The secretary will schedule you." He turned to fiddle with his computer -- apparently done with me.

            Meanwhile, I couldn't take my eyes off the dingy shirt cuffs hanging out of his lab coat. My stomach turned. This guy operates on patients' eyes?

            My radar for never-in-a-million-years-over-my-dead-body whirred loudly. Ancient would not be touching my retina.

            "I'll think about it," I lied.

            As I fled the exam room, he yelled at my back, "You'd be foolish to delay with a hole like that."

That night I tossed and turned. What's the best retina place in the country? Should I get names of specialists at Hopkins or Duke?

            In the throes of ruminating came the moment of clarity. I didn't need the next train to Baltimore or Durham to see specialists I didn't know. I needed “T”, my former student, now Doctor T --  a retina specialist in Virginia.

Years earlier, I'd been T's medical school physiology professor. At his graduation, he took top honors and stood before his class as valedictorian. The dean described him as "meticulous, scholarly, and rare." He said, "Doctor T is the physician I'd want to treat a member of my family."  In fact, T was already on every faculty member's secret short list of "students I'd trust to take care of my loved ones."

After graduation, T went on to a residency in ophthalmology and then to a fellowship in vitreoretinal surgery. Coincidentally, many years before my crisis, we were on the same flight to Chicago when he was en route to interview for that retina fellowship.

            We packed in several years of news on the flight.

            When we came around to "why the retina?" T glowed. "I was blown away when you taught about the photoreceptors in medical school. They're turned off by light? Then they reverse the signal to create images. It's brilliant!"  

            I've always loved the retina too for its backward mechanisms, but T's passion was off the charts. Of course his fellowship interviews would go well.

I located T as the head of the local retina institute. His staff expedited a next-day appointment.

            I heard his voice in the hallway. "Is Dr. Costanzo in Room 6?"

            Then he appeared. In a black turtleneck, he was as trim and elegant as I remembered, with flecks of grey now at his temples.  

            T beamed, "You look wonderful."

            I understood that his greeting had nothing to do with how I looked. It was a former student's tender acknowledgement of the professor who'd guided him through the uncharted waters of medical school. Now she was before him, on the other side of the podium, terrified and facing her own uncharted waters.

            He clasped my hands and said the only six words I needed to hear, "Don't worry. I can fix this."

            My breath steadied.  Whatever lay ahead, I knew that his word was good.  

T studied my retina with a high-powered microscope and described landmarks of the morphology.

            "Your optic disk is perfect. The retinal vessels have excellent branching. The vascularity is textbook!"

            "Perfect, excellent, textbook" were welcome words.

            Then, he came to the macular hole.

            "The hole is clearly visible. It is full-thickness. The break is all the way through the central macula."

            Those were the unvarnished facts that I needed to hear.  

T moved the microscope out of the way and sat face to face with me. He tented his hands under his chin, with fingertips lightly touching.

            "Here's what happened to you. In the aging process, the vitreous humor of the eye shrinks and pulls away from the retina. Normally, the vitreous releases cleanly. However, if the traction is too great, it tugs against the macula and can create a hole."

            T's step-by-step turned a seemingly random event (that was destroying my central vision) into something that made sense.

            "I'll close the hole with a vitrectomy procedure. That means peeling away the retinal membrane, removing the vitreous, and replacing it with a gas bubble. After the surgery, you'll need to spend five days face down. In that position, the gas bubble presses against the hole like a band aid. Now, ask questions. Take your time," T continued. 

            "What if surgery doesn't close the hole?" I started with the fear that superseded all others.

            "More than 95% of the time, the hole closes with current surgical practices. In the rare event that it doesn't close or that it reopens, I can bring you back in and redo the surgery."      

Reopens? (I hadn't thought of that.)

            Bring me back in? (I hadn't thought of that either.)

            T sounded calm, so I went on to my next concern.

            "I'm supposed to teach second year medical students for the next month. Can the surgery wait that long?"

            "The hole will get bigger during that time. But we'll still be in the window for full repair. I'd like to do the vitrectomy the day after your last lecture."  

            There was no mistaking his word choice. He said "the day after," not "soon after." There was some cushion, but there was also urgency.

            "What else worries you?" T continued, as if he had nothing else to do.

            I was quiet, but he read my mind.

            "Older procedures used slow-absorbing gas that required much longer face-down periods. Current procedures use 'fast gas' that closes the hole more quickly and with greater success."

            There it was. Like the best teachers, T anticipated the unasked question.  Ancient (and his 6 weeks face-down requirement) was apparently "ancient" in more ways than one.   

The vitrectomy was scheduled for a month later. That meant one month of watchful waiting, one month of obsessively checking my left eye's vision for worsening distortion. Each morning, I gave my left eye a "distortion score,"  as I waited and watched.

            I distracted myself with housekeeping details like ordering a "3-piece, luxury face-down package" from a vitrectomy rental company. The package included a massive massage-style chair, a table top adapter, and the ironically named "easy sleep." The rental company offered an open-ended return date "should the patient's face-down period need to be extended."

            The equipment was designed to position my head "face-down" so that the gas bubble inserted in surgery would press steadily against the macular hole.

            All of the equipment looked uncomfortable, but "easy sleep" looked impossible.

            Five days, I reminded myself, just five days.

With one week until surgery, I no longer needed to score my left eye. With both eyes open, my vision was so distorted that I couldn't see details. My husband's face was rearranged like Picasso's Man With a Pipe.  I couldn't read normal print, since large chunks of letters and words were missing. I couldn't read street signs or drive. The vision in my left eye was so distorted that my right eye could no longer compensate.

            The macular hole was worsening, as T said it would.

The final day of teaching was a marathon. I gave an 8-hour physiology review to prepare second-year medical students for their big licensing exam. Twenty-one years before, then-medical student T sat exactly where they were sitting. The next day, he would operate on me.

            I couldn't read, so I had to give the review entirely from memory. I felt physically sick and wondered if I was up to it.

             I'd printed a few notes in 72 point font and somehow made it through the 8-hour marathon.  

The day of surgery arrived. The busy work of check-in at the surgical center was a blessed distraction. I was escorted to the operating suite, where the nurse placed IVs and monitors and clamped my left eye open. As gruesome as the clamp sounds, it would keep my eye in position for the duration of the vitrectomy procedure. I would receive a fast-acting general anesthetic just before surgery was to begin.

            "Dr. T is on his way," the nurse said. A calm settled over me.

             Then, I heard his voice beside me. “Good morning, Dr. Costanzo. We're all set."

            He leaned in and quietly said,  "I slept well last night."  

            How curious that he told me he slept well. It must have been on his mind. Don't worry, he seemed to saying.

            T rested his hand on my shoulder. That's the last thing I remember before I went under.  

At home, after surgery, I alternated between the various pieces of face-down equipment, passing the time with audio books and family. I ate and drank haphazardly though holes in the equipment by aiming for my mouth and slurping. As expected, I slept poorly on "easy sleep," fearing that I'd accidentally roll over and dislodge the gas bubble.  

             For five days, I was face-down without a break. I could picture the gas bubble pressing against the hole and willed it to do its work.

            And I waited for the verdict.

On day six, the face down period was over and I cautiously raised my head.  The gas would be slowly absorbed, first forming a sliver of a horizon above the bubble. The sliver would give me the first sign of a successful surgery. Would my vision in the sliver be normal? Would printed words be intact, would lines be straight?  I endlessly checked for the sliver.

            Finally, after days of checking, there was a small horizon above the gas bubble. It was clear! I shifted my head to align the horizon with printed lines on a page. They were straight, unbroken, normal. It seemed that I would be ok.

On the day of my follow up, I walked through the doors of the retina institute light as air. After many pre-op and post-op visits, it had become a place of safety and comfort.

            There was even comfort in the familiarity of the patients' waiting room. How are you? How did your surgery go? Ah, today's your follow-up too.  A long-time patient of T's took a rosary from his pocket and pressed it in my hand. We wished each other good luck.

Waiting my turn, I overheard T talking with a patient in the adjacent exam room. Their voices rose and fell. The patient asked, "What will happen to me, doc? I'm so scared of going blind." T answered calmly, without jargon, "We'll monitor your diabetes closely. There are new treatments that can slow down or reverse your eye disease. Call me anytime."  This was my student, my surgeon.

T took a seat facing me. He leaned forward and smiled, "Here's today’s retina scan. The macular hole is closed. The dip in the center is symmetrical and smooth. The adjacent areas of photoreceptors look healthy."

            "I'm so grateful.....," I started.

            T lowered his head and folded his hands in his lap. It felt like minutes passed.

            Finally, he looked up and quietly said, "I was scared too."

In that moment, I understood the pressure he’d felt. The calm, competent surgeon with decades of experience was caring for his old professor. He had not anticipated the strength of feeling that would evoke. Now I understood his final words before surgery, "I slept well last night." The duty to protect me had been weighing on him.

            Teacher and student, full circle. Almost like family.

Linda Costanzo, 2026