Throwback Series: A biopsy, a lesson, and the courage to speak up

In celebration of Ophthalmology Times’ 50th anniversary, leaders revisit a memorable “throwback” case from earlier in their careers. In this special series, they reflect on how evolving knowledge, techniques, and technologies have transformed the way such cases are managed today. Join us as we look back at pivotal moments in their professional journeys—and explore how far the field has come.

This episode centers on a first-year ophthalmology resident left to perform an urgent artery biopsy alone late on a Friday night. Faced with a patient on blood thinners and no assistance, the resident—Marguerite B. McDonald, MD, FACS, who is now clinical professor of ophthalmology, NYU Langone Medical Center, New York, NY; Tulane University Health Sciences Center, New Orleans, LA; and OCLI Vision, Oceanside, NY—learned a lasting lesson about communication, teamwork, and the courage to ask for help—no matter the hierarchy or circumstance.

“This is a case from way back in my career," she recalled. "I was a first-year resident in ophthalmology at Manhattan Eye and Ear. I was on call, and the culture there was never call your second-year resident or your third-year resident. Everybody was on call, but ‘do it yourself. You're a weakling. You're a fool if you call the person one step up.’ They made it very clear.”

Late on a Friday afternoon, the department chair ordered an urgent biopsy for a patient with giant cell arteritis. “The third- and second-year residents said, ‘Marguerite, you do it.’ I said, ‘I've never seen one done. I've never seen it.’”

Alone in an empty hospital with a patient on prescription blood thinners, McDonald proceeded with the biopsy. “There were no nurses, no one to help me. I had my little tray by myself, and it was catastrophic. It was, I mean, I got the biopsy, but there was blood everywhere," she said.

She eventually controlled the bleeding and completed the procedure successfully—but not without realizing how close the situation came to disaster. “I thought, you know, there's actually a chance this man's going to exsanguinate here.”

From that terrifying experience came a lifelong takeaway about professional integrity and patient safety. “If your gut tells you, don’t proceed, don’t do something, speak up,” McDonald said. “I should have said, ‘I don't care that it's Friday and that you have plans for this evening. One or both of you has to stay and help me.’ I'm just really lucky that man did not die.”