Fourth Year Lessons

It’s winter again in Boston, although the lack of snow makes it hard for me, a native of Buffalo, New York, to feel that fall has really ended. First, second, and third years are busy studying for and taking their final exams, while we fourth years are able to reminisce with the fondness of distance about days spent in the school library. In a little over a week I’ll be heading home to celebrate the holidays with my family, and in the meantime I’m beginning my third rotation of the year at a community health center in Boston. However, as I start my third rotation, I find myself thinking often about my second rotation and the lasting impact it had on my clinical perspectives.

My fall rotation was the first time I’ve had clinic in a VA hospital. Based on what I had heard from my fellow students, I expected to gain a great deal of clinical knowledge, but what I did not expect was how moved I would be by the experience.

The majority of the patients that I saw at my VA rotation were men aged sixty to ninety, although of course there were always exceptions. I was able to gain a great deal of familiarity with identifying and staging glaucoma, age-related macular degeneration, and diabetic retinopathy, and received invaluable advice from my preceptors regarding their protocol for monitoring and treating those conditions. I was also able to learn more about optometry from an interdisciplinary perspective, a viewpoint that the VA hospital emphasizes. I had the opportunity to shadow several different departments in the hospital to understand better how optometric patients are treated for systemic disease, such as audiology, the vascular clinic, and the low vision services department. I also came to appreciate the symbiotic relationship between the optometry and opthalmology departments in the hospital, and was able to observe both cataract surgeries and minor outpatient procedures performed by the opthalmologists. I learned how it is extremely beneficial for both parties to work so closely with one another; we were able to immediately refer visually significant cataracts and suspicious eyelid lesions to opthalmology, and they in turn referred postoperative cases to us for follow-up.

Before I began my rotation at the VA, I had only thought about the experience in terms of the clinical skills and knowledge that I would gain. From the very first day, however, I began to realize that the most significant aspect of the rotation for me was being able to work with our country’s veterans: to hear their stories, thank them for their service, and provide them with the best health care possible.

I have no personal experience with the military, but both of my grandfathers are veterans. One served in the Merchant Marines during World War II as an engineer, and the other served in Germany during the Korean War. I thought about my grandfathers and their stories as I listened to my patients tell me their own. I remember speaking to one patient, a Vietnam veteran, and telling him that I was impressed that he was able to see 20/20 without glasses. He told me that when he was drafted at age eighteen, he didn’t see his clear vision as much of a blessing—it was why he became a sniper and was immediately sent overseas. One female Air Force veteran with glaucoma told me, smiling, about how she had met her best friends in the world in the service, as well as her husband of over fifty years. I met a World War II veteran who, having lost a great deal of vision due to macular degeneration, has found a way to enjoy reading the war memoirs he loves on an e-reader with large print capabilities. However, he only reads the “happy stories,” the inspirational tales of sacrifice, courage, and brotherhood, because, he told me, war is a terrible thing, and he would rather spend his time reading about the good in people instead of the darkness.

Meeting these incredible men and women, who sacrificed so much on behalf of people they had never met, is an experience that I will never forget. I can’t begin to imagine the degree of selflessness it takes to enter the service. I wanted to become an optometrist, in the simplest of terms, to help people. I wanted to know, when I went to work every day, that in some small way I was giving back. I’ve been told that this is a naive notion, that it is a simplistic rendering of a multifaceted career decision. And I’m sure that, in a way, that’s true. But during my VA rotation, I was confronted with the importance of my initial motivation, and inspired all over again by the incredible people I met; not only the veterans, but the dedicated VA doctors who dedicate their time and compassion to providing veterans with the absolute best care possible. I want to extend my thanks to the veterans I was fortunate enough to work with for their inspiration, and to thank all of our country’s veterans for their service.

Happy holidays to everyone, and I’ll continue with my thoughts on my clinical experiences in the New Year.

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