BLOG: The cost of what we leave on the table
I grew up in a conservative home. Not at all like what the word means today. We conserved.
Dad grew a large vegetable garden from seeds, not starter plants. Mom canned the tomatoes. One day I stayed home from high school to learn how to rebuild an alternator not just to save money but because why would you throw away a thing like that if you could just replace its brushes.
The first time I volunteered in a hospital during college, I visited a general surgery operating room and was shocked by how much was thrown away. Large plastic bags hauled away oversized table covers, drapes, unused sponges, and stacks and stacks of towels. Large plastic tubs protected disposable instruments and other products. Sharps containers filled quickly with vials of medication, as well as syringes and sutures, both used and unused. With time, the waste of a hospital became normal to me, even special because I thought it must be better for patients that we take no chances by reusing anything.
Then, as a senior resident, I visited an eye hospital in Armenia during the country’s poorest years and watched the senior surgeon do procedure after procedure without gloves because they did not have any. The same cloth gown was worn all day and then steam sterilized. In one OR, two patients had surgery simultaneously, and instruments were passed between the two tables after a rinse in ethanol. The same resterilized suture was used on patient after patient with a duller and duller needle until no thread was left. To my shock, infections were an extremely rare event, a fact I have confirmed with many repeat visits and patients I have followed personally.
Armenia is like many countries in its frugality. At Aravind Eye Hospital in India, the waste produced for a single procedure is about one-tenth that for a similar surgery in the U.S., according to one study. And their rate of infection is identical to the U.S.
In the Western world, medical waste today contributes disproportionately to the island of plastic floating in the ocean the size of two Texases. That should bother us caregivers no matter what side of politics we sit on, and we can make a difference.
Anne Marie Bonneau said it best: “We don’t need a handful of people doing zero waste perfectly. We need millions of people doing it imperfectly.” That is why I was so pleased to join in when David Chang created the idea of EyeSustain, a global effort now cosponsored by multiple eye societies that aims to educate and celebrate medical efforts to leave less on the table. Practitioners can participate by taking the EyeSustain Pledge. Hundreds have, but thousands more need to.
Fortunately, our medical industry colleagues also seem incredibly committed to downsize packaging, make products reusable and find ways to recycle rather than discard, maintaining their bottom line while filling our table with fewer items to throw away. And even regulators who previously seemed motivated only by patient safety at any cost seem surprisingly open to reducing waste.
Most of all, I am inspired by medical students and residents who bring such energy and capability to our EyeSustain movement. They may never change the brushes in an alternator, but they will help our world in so many bigger ways. Today, my surgical table is less full than it used to be, with more reusable instruments, a smaller drape and fewer trash bags at the end of the day. I know my parents would be proud, and even more importantly, my kids can be pleased that each year we surgeons are leaving less on the table.
Follow @DrHovanesian on X, formerly known as Twitter, and Instagram.
References:
- The surgical facility pledge. https://www.eyesustain.org/facility-pledge. Accessed Mar. 28, 2025.
- Thiel CL, et al. J Cataract Refract Surg. 2017;doi:10.1016/j.jcrs.2017.08.017.
For more information:
John A. Hovanesian, MD, FACS, an ophthalmologist specializing in cataract, refractive and corneal surgery at Harvard Eye Associates in Laguna Hills, California, can be reached at drhovanesian@harvardeye.com.
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