Allow Me to Draw My Condition For You

It is no secret that some of our patients border on crazy. Fact is, there are psychiatrists to manage the crazy people. When a crazy person walks into my clinic I am not always sure what to do.

So one day this, you got it, crazy guy comes into my clinic room. He brings in with him a large bag stuffed to the max with categorized folders documenting in detail his prior physician visits. This, off the bat, is never a good sign, if not always a bad one. Seeing as I was new to him and he to me, he began at the beginning, some years ago. But it wasn't with words. It was with pictures. He had drawn out in detail the visual distortions he noted in his vision. Each complete with color coded documentation.

Right off he clearly doesn't understand how unimportant all this stuff is. Of course, he then proceeds to tell me that no resident in the past was ever capable of seeing his problem, only the retina attendings. "Okay," I'm thinking at this point, "this guy is in for it." Even from his story it was obvious he had categorized residents and attendings on opposite sides of a tall cinder block wall. He was missing out on key elements of the resident-attending relationship that are quite obvious to others.

"Look, any new problems today?" I asked
"Well if you'll give me a piece of paper. . ."
"I'll just go get the 'Retina Specialist.' Draw while I'm gone."

Drawing is a true art. But then, so is knowing how to cut people short in their graphic rambling.

Moving From a Frustrating Case to a Satisfying One

The best way to make use of operating room time, particularly in an specialty where operating days are limited to one or two (or three) a week, is to schedule all cases at that same time. Then you spend the morning going straight from one case into the next, hopefully getting yourself into a good routine. But as a learning surgeon, the inter-case variability may be significant.

One morning I was doing a cataract case during which it seemed like everything became ten times more complicated than they needed to be. Ultimately, the patient did just fine and in the end the surgery could easily be considered a success. But the path to that end was very rocky and difficult. This is never how you want to start the day; it seems to set everything else off pace and it can be very difficult to get back into a good rhythm.

Then my second case came rolled into the operating room. Somehow, things went just splendid - if not a bit longer than what an experienced cataract surgeon may take. Suddenly, it seemed as though the day was going to go okay.

Time to Take the Eye

An enucleation spoon, believe it or not

As eye doctors we have this goal through training that ultimately results in saving vision and protecting the eye. But there are times when instead of keeping a bad eye, the best thing we can do for a patient is get rid of the eye. This is a process called enucleation, and while it's a generic procedure name many specialties use to refer to removal, it means only one thing to all eye doctors.

We recently had a patient who developed an infection in the eye. I happened to be the one to see him first on his visit to the emergency room with severe eye pain and redness. The infection was obvious and he as admitted for treatment. Several things, including surgeries and injections into the eye, were tried to save his eye. But ultimately, the pain and discomfort of a now blind eye became too great.

Only after removal of the eye did he completely turn around and become his old, easy going self.

Regenerating Hope

 

You're Not in the Club!!

I may have mentioned before how there is a club to which certain oculoplastics fellowships belong. This is known as ASOPRS, or the American Society of Ophthalmic Plastic and Reconstructive Surgery.  What does membership mean? Perhaps a bit more prestige in the long run and maybe a better academic appointment if that is desired.

So here is the plan. I will first apply to the ASOPRS programs simply because the application deadlines for those are first - the match occurs this coming April. If/when I don't match via this route, I will then seek out the non-ASOPRS fellowships and apply to those who are willing to take on a fellow in 2013. It's basically about putting myself out there and seeing what grabs. They typically interview only 8 months prior to the start date.

The fact is, of all the people who apply for ASOPRS fellowships during this match cycle, only 50% or less will get a spot. The remaining half who don't match will consist of a couple different types of people. One type is the one who isn't terribly serious in the long run about oculoplastics and will ultimately decide to apply for a different type of fellowship. I used to be this kind of person - I thought if the plastics thing didn't work out, I would go the cornea route. But after much reflection, I decided I just wouldn't be overly happy doing cornea. The other type is the one who will reapply and find these other non-ASOPRS people. That's how both of my current mentors did it and they're both great at what they do.

What's to lose? And if a few years lapse between finishing residency and landing in fellowship position, so what?

That Question Wasn't Directed at You

So for those who visit regularly, you know I generally enjoy teaching - one of the big reasons my eventual plans are to enter as an academic surgeon. Having students around is usually enjoyable to me. But there are always those few students who are incredibly annoying. They come in several different types. And, hey, you can't expect everyone to like and enjoy everyone - it's just not reasonable.

We were all sitting in grand rounds one day. The third year medical students currently on the neurology/ophthalmology rotation came strolling in - late as usual, though not entirely their fault. Our grand rounds typically involve a lot of question asking of the residents - known affectionately in our field as "pimping." Although, the pimping at our program is pretty mild. At any rate, the questioner that day was not directing his questions openly; rather, they all started with, "Dr So-and-So, what is. . . ." This is all fine and dandy - it eliminates the type of silence where everyone is thinking: "Well, someone else will answer the question. I think. Do I even know the answer?? What if I'm wrong. Oh God, now I definitely won't answer. . ."

Well there was this medical student. Not even particularly interested in ophthalmology as far as I know. Any low-ball question that was asked to Dr. So-and-So, he was sure to blurt out the answer.

It didn't matter if he was correct in his answers. The temptation to slap him was overwhelming. I don't recall being like that as a student; I knew my boundaries. I think he will find himself having issues with this now and in the future.

A Dream About Failure

Anything surrounded by a lot of thinking and worry can be expected to be accompanied with dreams from time to time. The quickly upcoming stress of applying to fellowships has led to such a thing.

The other night I had a dream I was interviewing for fellowship somewhere in the Pacific Northwest (there are a couple potentials in the area). Through an arduous process of elimination, the applicant pool had been narrowed down to just me and another female applicant - a completely made up person in my head. Someone once told me that the faces we see in dreams should always be from someone we know; this is complete bollocks.

Anyway, she interviewed first and I second. At the conclusion of the interview, the physician (also someone I have never seen) across the table from me looked up and said, "I just don't think you're who we're looking for here." I exited the room only to find everyone applauding for the other applicant who of course got the position. I can't figure out who all these people applauding were. They weren't there when I entered the room, and why would they be so damn happy? I have never placed a lot on the "hidden" messages of dreams, but I mean what the hell?

On the upside, one of my fellow junior residents was there and was given (by the stranger interviewing me) a card - a free pass if you will - stating he would be granted admission into whatever kind of fellowship he wanted when it was his time to apply. Or, at least I guess this is an upside. Either that or a fat slap to the face.

A Tick in the Eye

In continuing with the tick theme as noted in a recent entry, I wanted to share this other tick story with you. Perhaps if I had gotten my sign up. . .

So this dude presented to the to emergency room (thank God it was during daylight hours) stating he has had something in his eye since the day before. He had been working outside and couldn't place anything as going into his eye. Naturally the emergency room immediately punted to us without an eye exam.

The eye looked pretty good at the surface. But further inspection with flipping of the lid revealed a moving target. Usually, a tick on the eye bites and latches on tight - much like skin. But this guy was moving, trying to avoid the giant approaching Q-tip. A single swipe and he was out of there.

Is there anything we can do that doesn't require the use of safety goggles?