Gladys Atto
Most people hear about my successful surgeries and assume that everything always goes smoothly. But that’s far from the truth. Complications arise, and sometimes things don’t go as planned. Today, I want to share one of the most humbling experiences I faced in 2020.
It started as an excellent day. I was in high spirits, ready to clear my list of scheduled cataract surgeries. But one patient, unknowingly, was about to change everything. He had been blind for years due to a cataract in his only functional eye—the other eye had been damaged long ago, though I don’t recall from what.
During the preoperative assessment, I anticipated a challenging surgery, but not nearly as difficult as it turned out to be.
A Complex Surgery Takes an Unexpected Turn
As expected, I struggled to extract the lens nucleus due to his poorly dilating pupil and posterior synechiae. For those unfamiliar with cataract surgery, the lens beneath the iris can only be accessed through an opening called the pupil. A fully dilated pupil makes the surgeon’s work much easier. But in cases of posterior synechiae, the lens surface adheres to the inner part of the iris, making removal significantly more difficult.
In my struggle, the posterior capsule tore—yet I didn’t realize it. This capsule holds the artificial intraocular lens in place after removing the damaged natural lens. Typically, when it ruptures, vitreous humor leaks—a jelly-like, stretchy substance that’s easy to spot. But in this case, there was no vitreous loss, making the tear undetectable.
Beginners often miss such signs, and adjusting the operating microscope properly takes experience.
Satisfied that I had removed the nucleus and thoroughly cleaned the remaining cortex, I proceeded to implant the artificial lens. But the moment I attempted to dial it into place, I saw it sinking—right into the vitreous cavity.
My heart sank with it.
Watching an intraocular lens descend uncontrollably into the vitreous is every eye surgeon’s worst nightmare—akin to watching a ship sink while being unable to intervene. The descent is swift, irreversible, and devastating. Though allowing it to sink is often the safest option, I still tried to retrieve it. I pleaded with it to resurface, but it was determined to go down.
A Moment of Deep Disappointment
I sat back, leaning on my stool, frozen for a moment. My heart pounded, my hands trembled. “What just happened?” I asked myself.
My assistant, sensing the shift in my body language, looked at me. “What’s the matter, doctor?” she asked.
“The lens has dropped,” I responded.
Lens drops require the expertise of a retinal surgeon to retrieve, and the nearest one was in Mengo, 500 kilometers away. My patient had never been to Kampala. He had no job, no transport money, no means for food—nothing. And the surgery itself cost over three million shillings. How was he supposed to afford it?
Despite the weight of these concerns, I reminded myself: “Gladys, finish the surgery first.”
I picked up the vitrector and began the anterior vitrectomy.
Owning My Mistake
I could have kept quiet. No one would have known. The patient was already blind; he wouldn’t realize what had happened. My assistant wouldn’t have suspected anything if I had stayed silent. But I was raised differently—taking responsibility was the right thing to do. And beyond that, I wanted him to see.
When the surgery was done, I removed my gown in haste and rushed to the hospital director’s office. I interrupted his meeting, knowing the urgency of the situation.
“Sorry, doctor,” I said. “I have a patient who needs an urgent referral to Mengo Eye Hospital.”
“What’s the matter?” he asked.
“I got a lens drop during surgery in an only eye,” I replied.
Being an ophthalmologist himself, he understood the gravity of the situation immediately and arranged for an ambulance.
An Unexpected Setback
I explained everything to the patient and his attendant. To this day, I’m not sure he fully grasped the magnitude of the situation based on his reaction. Regardless, we prepared them, and they set off with a nurse accompanying them.
But 60 kilometers into the journey, my phone rang.
The nurse sounded panicked. “Doctor, the ambulance tire has burst. We are stranded in Iriiri.”
I knew calling the hospital director wouldn’t help; it was the only ambulance available. The least I wanted was further delay.
So I reached out to Sightsavers. Within moments, they sent another car to rescue the patient.
A Grateful Ending
I contacted Dr. Lisbon in Mengo, informing him that my patient would likely arrive late at night. Without hesitation, Mengo Eye Hospital offered to perform the surgery free of charge for my sake. What should have been a three-million-shilling procedure was now completely covered.
To this day, I remain deeply grateful.
I had already been wondering how I could possibly foot the bill. At one point, I even considered calling my mother for a fundraiser.
The patient arrived at Mengo at 3 AM, and the retinal surgeon successfully operated on him the next day.
Five days later, when he returned to Moroto, he didn’t talk about his eye. Instead, he excitedly described the beauty of Kampala—the crowded streets, the towering buildings.
I just smiled, listening.
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