Connecting On a Different Level with the Surgeon

I have only recently truly appreciated the different depths of a given clinical teacher. People behave, and apparently teach, very differently in different environments.

So, yeah. Learning from someone in the operating room is totally different than learning from the same person in the clinic.

Pretty much lost the rest of my thoughts on this one. Don't know what happened.

Those Little Gray Spots

You know what's scary to me? Children admitted to a psych ward. I have always felt uncomfortable in that situation. But do you what is even scarier? A KID IN THE PSYCH WARD WITH GRAY SPOTS ON HIS EYES!!!! AHHHH!!!!

Allow me to clarify a little bit while giving a lesson on time awareness. There was a child (yes, admitted to the psych ward) who fell while jumping on the bed. (Immediately I think of my daughter's feigned attempts at singing "No More Monkeys Jumping on the Bed.") Now, I am only being a little cynical by wondering why psychiatric physicians aren't able to assess someone after s/he fell to determine if head CT scanning is needed. After all, I have several friends in the department. But why they have to call a family medicine resident to do the assessment is confusing, if not concerning. At any rate, one did. And this one, we'll call him Dr. Thybeorver, noted gray spots on the kid's eyes. But even he knew this was not likely to be urgent and could wait until morning. Although, he still recommended an ophthalmology consult which was not needed.

Apparently, someone else (the psych resident) thought 5AM was a good time. "Non urgent you say? Well 5AM will do just fine, then."

Blah. So I saw the patient and of course agreed, there were a few perfectly normal looking gray spots on this kid's eye. Had probably been there since birth.

I got so scared I about shit a brick.

You Sound Like Tom Cruise

The comments regarding my overly youthful appearance are always forthcoming. And I can't say they disappoint me - I would rather look ten years younger than ten years older than my current age.

Some have commented on a particularly soothing voice. I have had one attending say I sound like a radio announcer. Although, I will claim to have led a more straight and narrow path than the Ted Williams with the "golden voice."

What took me by surprise one day was a little black lady who told me I sounded like Tom Cruise. How she really knew what he sounded like is beyond me. Perhaps she saw in entirety his little freak out moment on Oprah one day. Never once did I get on my chair or desk and jump around though.

So that's it. I am an 18-year old radio announcer with Tom Cruise savoriness.  With emerging gray hairs. It just doesn't all add up.

Look, a baby tick!!

The VA clinic is a very busy place. There are distractions everywhere. The halls are lined with people and each of the rooms experience constant in and out traffic. But once you're in my room, you expect my full undivided attention. Likewise, I expect yours. There is already a sign on the inside of my door telling you of the importance of not talking on the cell phone while I'm in there.

But I didn't think I needed a sign for this. A lady, perhaps more accurately a less than well-kept female, was sitting in my exam chair. She asked me some question about her glasses prescription. I then proceeded to tell her why we couldn't give a new prescription at that time (certain conditions preclude giving a good, accurate prescription). I did not have her full attention; to this day, I'm not certain I had much of it at all.

She was too busy examining herself. I think she was doing everything possible short of stripping to find what was bothering her. Recall I described her as less than well-kept - stripping was not an option. Eye contact could not be maintained. Then she found it.

"Oohh - a baby tick!" she acclaimed. "I was wondering what that was. . ."
"That's great. Don't throw it on the floor, please."
"I'm sorry, Doc, what were you saying about my glasses?"

Okay. New sign. Here it is:

The Lady in the Scooter

I know I have made an Austin Powers reference in the past, but I couldn't help but smile to myself and again think of that silly man when I saw exactly what this title implies.

You all know this scene. In an attempt to turn his little cart around, he wedges it between the hallway walls, switching from forward to reverse gears repeatedly to move mere inches.

Well, a lady at the VA did a very similar thing. Lots of those folks have found themselves in a powered scooter for one reason or another. Some have also become quite adept at maneuvering through the hallway; others not so much. This poor lady found her self similarly wedged in the hallway, except the effective walls were patients in chairs, each fiercely protecting what toes they had left (diabetes runs rampant in the eye clinic).

So what if I chuckled? There wasn't much I could do to help.

Look Mia - A Video Tape

As residents, we make video documentation of most if not all of our cataract surgeries and anything else that may be done under the scope and worth recording. At the VA, the current recording systems use VHS tapes to record the material. I have heard a DVD system was once tried but worked miserably with poor quality. Hmm, I wonder. . .

While we could speculate all day about why that may be, that is not the point of this writing. The point is, look at those things. Finding them in the store means looking at the bottom shelf nested back in the corner somewhere. Finding a player means going into your back bedroom closet with a shovel and a trash bag. And while that just sounds like a murder scene, it's to rid yourself of other useless junk while you're at it.

She only knew that it was a tape and was probably best served by lying on the table. But that DVD? You bet she knows what to do with that.

The Chief Race

At the VA, we are kind of in this position where we are between real chiefs. We have had acting chiefs, or people working in the chief position though not officially named. The way I have seen it, there seems to be two people currently in contention for the spot. The reality is, I didn't think either of these two people would have wanted such a thing; one has a few very little ones at home to help tend to, and the other seems to get way too stressed out over the little things.

Regardless, the VA now has a new surgery chief. Which means the decision process has only just begun - even if it already had several months before with the interim chief. Each of our two candidates serves as an ophthalmology chief for a period of time. Then it seems a winner will be chosen by the surgery chief. It almost seems like a season of Survivor.

I haven't been asked to be on a tribal council yet, but I'm sure it's coming. Look for us on the next VATV Morning Edition.

The Value of Patient Positioning

I should first point out the fact that though I have rotated over the childrens hospital as of September first, I often have a backlog of blog entries to write. I have been averaging in the range of twenty at any given time. And since I have only been averaging about fifteen posts a month for the last three or so, well, you do the math.

One of my biggest mantras has always been about the importance of proper patient positioning during surgery or a procedure. Firstly, we do a lot of our surgeries on patients are still awake, perhaps just a little sedated. Of course, I do want to go into oculoplastics where there are more patients who are put under general anesthesia. At any rate, you want them to be comfortable so that they can lie there still for a good period of time.

Secondly, the person doing the surgery has to be comfortable. Imagine trying to do an entire surgical case straining your neck to see through the microscope or hunched over because the bed is too low to the ground. These situations make for a very unhappy surgeon at the end of the day and may even cause chronic back and neck problems.

So if there is one thing I always tell to people when I am teaching is to get everything set up so that everyone is comfortable FIRST, then you may proceed. And this goes for everything form an exam at the slit lamp to putting in a central line to doing an 18-hour muscle flap procedure.