What's That Smell?

For those who may not know, I have continued residency at the same place where I went to medical school, UAMS. In case you don't know, the only real thing UAMS is well known for is the myeloma institute. All moral issues aside, it is by far the most prominent myeloma center in the world - and that is not an exaggeration. Patients come from all over the world to see the specialists there.

What is myeloma? It is a malignancy of a particular subgroup of cells in the hematopoietic system. I won't go into any further detail other than to say the typical treatment involves a bone marrow transplant. This ultimately leads to prolonged periods of immune system suppression, which is how they often end up in our clinic or on our consult list - to rule out infection or bleeding within the eye.

Here's the problem. These patients, for reasons I don't know much about, have a very peculiar *bad* smell about them. I'm sure it's related to the cocktail of chemotherapy they have received, but I have no confirmation of that. Some people have likened it to the smell of sweet corn. I will never eat sweet corn smelling like that. And when they leave the clinic room, the smell lingers for quite some time. Whatever it is making the unique scent must be emanating from every pore on their bodies.

How do they do it?

Rules are Made to be Broken - Unfortunately

We in the world of academic medicine have a just a few simple rules that we hope to be followed.

1. When the weather is crap, so is clinic show-rate.  BROKEN today.

2. When a clinic is cancelled, I wish to be left alone to do whatever else I need to do, which may or may not be work related. BROKEN today.

3. If I am called while on call to come see you in the emergency room, I expect you to show up for your follow up appointment. BROKEN today.

4. Consults should be legitimate. Asking me to see your patient to evaluate for a condition which we already know the patient has does not count. BROKEN today.

I'm sure there are others, but these are the ones which stand out for the day.

What Ophthalmologists Hate About Lawyers

Had to sift through all the Jude Law pictures to find this.

Certainly not all lawyers are bad. There will be the day when I want to join a practice or contract with an academic program, and I will most certainly want my own lawer to help me iron out the finer details. But, as a physician, there is a certain breed of lawyers which annoys us more than any other.

We all know about the lawyers who dive deep into malpractice suits. We also know they don't do what they do to increase awareness about suboptimal healthcare, or to be advocates for an unfortunate patient population. After all, I firmly believe medical negligence is no more common now than one hundred years ago, except for the fact there is much more we can do for the human state nowadays and thus much more that can go wrong. True accidents, however, probably are more common only because of all the road blocks put in place from prior law suits and our so-called government.

They're in it for the money, and are there to further and to capitalize on the litigenous tendency of our society.

A particular type of malpractice lawyer is unique to ophthalmologists - ROP (retinopathy of prematurity) lawyers. There are actually folks who specialize in this. Now, tell me. Do you really think there are eye doctors out there being deliberately negligent when screening babies for ROP? Not likely. What happens is a baby is screened, the decision is made to observe rather than do laser therapy(and legitimately so based on pretty well-defined guidelines), and the poor child's disease progresses causing visual deficit. Did anyone do anything wrong here? No. It was a proper decision paired with a bad result.

And yet, we are still sued, and the bastard lawyers win on occasion. Do you really have to ask why healthcare is so expensive in our country?

Practicing Oral

 After the completion of residency, the final steps in becoming board certified include an expensive written test, followed by an even more expensive oral exam. It's obvious what the written test consists of, but let me tell you about the bazaar nature of the oral exam.

It's hosted in a hotel somewhere. A bunch of examining ophthalmologists are there, each in individual hotel rooms. As the examinee, you go into a room (past the bathrooms and beds to the little window-side work table) and sit down. The examiner begins asking questions, covering several cases over about 30 minutes. Then it's on to the next room.

Did you catch the bazaar part? How about the fact this is done in hotel rooms, the very ones the examiner stayed in the night before? This is supposed to be a very formal exam, but I think this is somewhat hampered by being in a hotel room. I hope at least the beds are made and there isn't a hooker scurrying out of the room on my way in. Do think anyone is still in pajamas?

So anyway, we (the junior residents) had a very brief practice session yesterday - one case in one room (not a hotel) that lasted 3-5 minutes at most. We were each video taped and we then conglomerated in the conference room to watch each other when the examining was done. I think we all did fairly well, but I didn't realize how soft spoken I was in this type of testing situation. Maybe next year I'll bring a megaphone.

Let's Not Make Things Difficult

Here's something you should now. If you are not feeling well, and someone happens to be examining you, please let them know when you are about to vomit.

A patient today in the ED gave me only just enough notice to this regard. And remember, as an eye doctor, I tend to examine you sitting very close, face to face with only inches separating us sometimes.

Now don't worry, I did not get spewed on today. But it was close. Close enough that I got to watch it happen, which is also not a pleasantry for me. Nor is the after effect on the breath when I have yet to finish the exam.

There Must be a Name for It

There have been many books published over time written by doctors who also happened to have a knack for writing. They have often come up with their own set of rules, sayings, constants, etc. pertaining to their experiences.

Here is one such constant. It's 4 o' clock, maybe 4:30, and in through the clinic door walks this patient as an add on/urgent care. Inevitably, the problem(s) plaguing this person is (are) not simple. Multiple people have to get involved, special tests need to be ran, and suddenly no one else is available to help.

If you've read any of the above mentioned literary pieces, perhaps you can tell me what this phenomenon has been named. If no name has been chosen, I am also open to any suggestions.

I Might Have a Chance

The Ozark Mountains - if only I could just study there.

It's funny this OKAP thing. It used to be the day would come and go. Some people studied hard for the test, some not at all. And if one did poorly on it, he or she maybe got a talking to, perhaps a gentle slap on the hand, and was told to do better next time. But then this phenomenon called "Faculty Retreat" would come around in the mid- to late-summer months, and certain faculty members would sit around and discuss how lazy or ill-prepared the residents were. Some of the most outspoken faculty members are minimally (if at all) involved with our training/education - but again, that's another discussion all together.  All the while, residents are present at the retreat but with little chance to voice a rebuttle.

So now the stakes are higher. If one does poorly, he or she must do some sort of remediation. Well no one wants to see any of us have to remediate; or at least no one wants to have to take time out of their schedule to remediate us. So now we spend a lot of time having review sessions leading up to the test (hey, anything to get out of grand rounds!).

What it has become, though, is somewhat of a pissing contest. Each facutly who is largely responsible for a particular topic, say cornea or optics or whatever, wants the residents to do the best on that section. I think there have been more review sessions this year than in past years. With all of them to attend, I might have a chance to average out okay in the end.

I need to do well. Firstly, to rub it in the faces of the above mentioned facutly. (Don't get me wrong, I like 99% of the faculty, but there are always those couple. . .) Secondly, wanting to go into oculoplastics, I need to do well. No, wait. I need to do fucking awesome.

Not Sure if I Could Do It

My day of work is done. I have gone for my jog and eaten dinner. The little one has gotten her story and has been tucked in for the night. So now it's time to sit down and study for that OKAP. I've mentioned it before, and you best be prepared to hear it mentioned in the future.

If you know me at all, you know I'm interested in oculoplastics. This would entail a two-year fellowship after the completion of residency. How that whole process works is an entirely different discussion. Suffice it to say, I have to be prepared with a backup plan. I've always thought that if the oculoplastics thing didn't work out, I would seriously consider doing a cornea fellowship. I have experience with the tissue bank and I think I would enjoy being a corneal surgeon.

Which brings me to the point. I'm focusing this week on cornea and anterior segment diseases in studying for the OKAP. And then I sit back and wonder, having to learn all this stuff, could I really become a competent corneal specialist?

I just don't know.

What's With This Test?

With lots of things to discuss, let me just start today with that which is most pressing - the OKAP. This is supposed to be an "assessment tool" in regards to our current progress with learning the required material.

All of this material, that is. The desk where I make my best attempts at studying.

This all occurs on April 16th - a Saturday. Two hundred questions about things I may have learned. Or not. This of course to be followed by a [drunken] post-OKAP celebration.

Who cares? After all, the Academy states that this test is an assessment tool for resident progress only, and should not be used in the evaluation of fellowship candidates (very nearly their exact words). The fact is, fellowships ask questions - lots of them. They're going to want to know if I bombed the plastics section of the test.

So back to it.

Although, I do need an oil change and a haircut. Hmmm. . .

The Return

After a nineteen-month (or so) hiatus from this, and after much forethought, I have decided to revive this blog. I mean, things have changed immensely since then. At the writing of the last entry, I was barely starting my dreaded intern year. Now, I am nearly finished with my first year of ophthalmology.

Things are different now. My goals are the same, but their immediacy and importance have changed. Mia, who was then a small baby, is now a dominating toddler. Rachel is far more advanced and engrossed in her blogging hobby than she was then - which I think is pretty cool. I have since remodeled (nearly) our master bathroom and kitchen.

My goals with this blog are also different. I intend to write more frequently (duh), but perhaps with more actual focus on my career. There are many things to discuss; some things are very behind-the-scenes and others not so much. The fellowship deal is just around the corner, and I know within a few blinks of an eye, residency will be over. Why not comment on its progression in the meantime?

Hey, it's better than playing computer games all the time as an excuse to take "breaks." And aren't the changes pretty cool? I thought so.