Equanimity under Duress

When Sir William Osler left the University of Pennsylvania’s Medical School (the first one in the USA, started in 1765) to begin his tenure at Johns Hopkins in 1889, he gave a speech entitled “Aequanimitas” which explained the principle of keeping calm and collected, equanimity, when a difficult situation is encountered. This was adapted by a great American surgeon, LeSalle Leffall, Jr, MD as “equanimity under duress” and this quickly spread to medical schools across the USA.

I first heard this phrase when I was a medical student at the University of Southern California from Edward Cornwell MD, a professor of trauma surgery, who had an incredible ability to stay calm, collected, and focused when treating the most serious trauma. At the time, the trauma surgery service at USC was treating more than 1000 gunshot wound victims a year in addition to the thousands of traumas from accidents and other causes.

Ophthalmology is far removed from these deadly types of traumas, but the principle of equanimity under duress applies across medicine and all surgical subspecialties. The case shown here is a great example: a very skilled and experienced surgeon has a terrible complication when performing cataract surgery on a young child. The IOL injector is not fully lubricated and the IOL is suddenly and forcefully injected into the eye where it pierces the posterior capsule. Now what? Can we recover from this complication and deliver a great outcome to this patient?

The answer is yes and Dr. Alexandre Grandinetti from Curitiba, Brazil shows us how. He keeps calm and collected and finishes the case with an outstanding result.

Click below to learn how to achieve equanimity under duress:


  1. The best internet cataract surgery educational site for both novice and experienced surgeons. A wealth of information. I look forward every day to opening the new video(s)

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