Chairs Missing by Joe, resident at the New England College of Optometry


Full Measure

Well, just like that, the residency year is quickly coming to a close. Things are wrapping up nicely into a neat little package, and it's hard to believe we're almost done.  I've finished all the interviews on my three month long job search, gotten job offers, and am close to sorting out my final decision (which I'll talk about in my final post). My end of year project, a written case report and PowerPoint to be presented at the end of year residency conference, is almost finished. The conference is this coming Thursday, and I have the honor of going first to kick off the conference, so there's a a lot of pressure to bring my "A" game.

The end of year project is the culmination of the full year of residency and serves in a way to reflect back on what goals were accomplished by doing a residency. Writing the case report will also give me material to use in the future to submit for Fellowship in the American Academy of Optometry (between the residency itself and the case report, I will have thirty out of fifty of the points needed to apply). My topic is based around the most challenging case I saw during the year. In it, our patient was coming back for the first time in many years, and was having strange symptoms of the graying out of his vision only when he coughed. Based on his symptoms, along with our exam results and his blood labs, he ultimately was sent to specialists who determined he had a rare hematological malignancy. Without treatment, there is a strong possibility he could have died from his condition within a few months.

For me, this case really illustrated the reasons why I wanted to do a residency. Of course, the main reason was so I could positively affect veterans lives, whether or not they have some rare or life threatening condition. Being able to talk with them and have them share life stories with me has been worth more than the small salary I've earned this year. On top of that, being able to see patients with rare problems with the help of my attending docs, and being able to manage them without feeling scared that I was mismanaging them, has been invaluable. I know at the end of this, when I'm working somewhere else alone, I'll be able to handle emergencies, ocular or life threatening, smoothly and without fear. Finally, being immersed in an academic environment for another year and being able to use NECO's resources to dig into research as to why certain diseases affect the eye has allowed me to expand my knowledge base beyond what was possible in my four years of optometry school.

In a lot of ways, the academic part of the residency has allowed me to come full circle and tap back into the part of my brain left dormant since my (abandoned) plans as a young philosophy major to pursue a PhD in philosophy. I've spent countless hours reading, writing and debating the what and the why of research articles and papers. I've had to just sit and think about how I'm going to defend why I think something is true, or why someone else is not interpreting data properly. I've even had to think in very "meta" ways about the nature of scientific knowledge, about what counts as "good" research. Not many jobs outside of school would include after-hours discussions about the nature of probability and why research using "p values" and "confidence intervals" are the best ways to know you made the correct clinical decisions. It's been, in a very nerdy way, awesome to engage my brain in all these different ways.

Once the residency conference is over, there will only be two weeks remaining until I'm thrown out into the real world and become the sole person responsible for signing my charts and making sure my patients are properly cared for. With it will come the added stress of actually having to see more patients per hour while still being able to give good quality care. I've gotten a taste of this working part time in various commercial practices since March, but the real test is when faced with this on a daily basis. By doing a residency, I think the thought process involved in making basic or straightforward decisions has been sped up for me and will help me in that regard as I transition into that mode of practice.

And so my time as a NECO blogger is nearly at a close. It's been a wild five year journey, two and half years of which I've been able to share with you in bits and pieces in this space. This is the penultimate post,and next time will be a little bit longer as I take the time say goodbye to NECO and goodbye to the VA. It might be a bit of a tear jerker, so be sure to bring some tissues with you the next time I see you. Until then, have a happy first part of the summer!

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In Search Of….

There's only two months left of residency and yet there's still a lot left to accomplish and experience before it's done. Clinic is still busy as ever, and I continue to see interesting cases that raise my clinical skills or teach me something I didn't know before. It could be easy to come down with a case of senioritis, but it feels like these last two months will be an invaluable time where I can refine my skills to the next level, so to speak. Our end of year case projects are due in a few weeks and while I have a topic and an interesting case to go with it, I have many, many articles that I need to read before I can start writing it. 

Our current group of fourth years are graduating in about two weeks as well. It will be both sad and exciting to see them go off in to the world, much as my class did a year ago. (Crazy to think it's already been a year since graduation!) That means the new group of incoming interns will be freshly minted fourth years who will have the level of difficulty ramp up as they see challenging VA patients at the highest level of expectations for the first time. It is going to be a challenge for the residents as well, as we have become accustomed to working with super efficient, almost- doctors for the past 3 months. Our teaching philosophy will have to shift with the new group toward fostering their nascent level of experience while still trying to get patients seen in a timely manner.

But the thing that occupies nearly every spare moment as of late is the future. It seems like the 2 months since my last post have been spent mostly fine tuning my resume (or my CV), writing cover letters and figuring out times to set up interviews with potential employers. It has been a source of considerable stress; the lives of my wife and I are at a crossroads. Our lifestyle for the foreseeable future hinges on whatever job opportunity I end up landing.  Kids? House? Living in a city vs the country? Health insurance, money for retirement? All of these hang in the balance, and big choices about non-career things must wait until we know what's next for me.

A few jobs I've interviewed for have been pretty darn close to the perfect storm of location, mode of practice and benefits. I've had the chance to see what's to be offered in commercial,  private practice and medical based practices across southern New England. Each seems to have something that I know I would enjoy, and that's what makes the decision so hard. (That and both my wife and I can be indecisive when it comes to deciding what's best for the future.)  Whatever offer I accept will likely shape my career for years to come, so I had better choose wisely. Currently there are even openings at academic institutions and at VAs, but some are far away and would require a big move, something we don't think we should do at this point in our lives unless an offer blows us away.   It still remains cloudy as of now.

Whatever the future holds, it's going to be a furious race to the finish of the residency year.  Hopefully, once a job is landed it will make all the other end of year things seem less stressful and allow me to sail smoothly in to the horizon as I finish out the year.

And so that's about it for this post, really just a 600 word rambling of my hopes and fears. Going forward for this blog, I likely have at least one or two more posts left. Hopefully I'll be able to put a neat bow on my two plus years working for NECO's blogging experiment, and also be able to delve into all that I've gained from the year in residency at the VA. See you then!

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Scattered Flurries

The last month has been about as busy as it has been snowy, which is another way to say I’m oh so very tired. Part of that tiredness is related to how snowy it’s been the past month or so; it seems like we’ve had an 8-12 inch snow storm every week for the last 6 weeks. Between having to wake up earlier than usual to avoid when some snowstorm might make the roads completely jammed with traffic and unpassable, and the fact that when I get home at night I’ve had to stay up late shoveling snow so I can leave the next morning, I’m feeling tapped out. It seems more than ever that winter needs to end. Like right now. Seriously.

Luckily, today is Presidents Day, so like all federal employees, I got a free three-day weekend to refresh and catch up on all of the various projects I have going on, including writing this blog. Last week I had a Jeopardy style project due for the outgoing interns (basically a program written into PowerPoint, complete with questions, answers and all the visual/audio styles of the show).  That project took way more time than I anticipated and subsequently threw off the completion timeline for everything else I have due in the next month.

Up next, I have an hour-long hospital grand rounds presentation that is due in two weeks. The topic is ocular nutrition, which is an interesting topic but a challenging one to present to an audience of mostly non-eye care folks. I am a little nervous in how to strike the right balance of what content to include.  I am afraid that it will either be too basic and broad (the audience may well include nutritionists who will know much more than me) or it will be too esoteric and people will get lost in the fine details. It’s going to be a long two weeks of late nights and re-writes. (By the way, is the word esoteric, itself esoteric? I think it is. Apparently there is a category for words like that called “autologs,” which means words that are self-referential. Pretty coolSometimes I think I should have been a linguistics major, but I digress.) Beyond this, looming in the horizon is our giant end of year project which includes having to make a presentation and write a publishable quality paper to go with it. The topic is due in early March and I haven’t begun to sort through my interesting cases to figure out what I’m going to base it on. Yikes.

I also spent a good chunk of this weekend doing our taxes with my wife, which got me to thinking about our finances and the future. Pretty soon the time will come to start looking for a job or three (given how little I made last year and the loans are quickly coming out of the grace period). Now I know I ended my last post mentioning that I might talk about the concept of moonlighting, that is, when residents get a weekend job with a private practice in order to make some extra cash. Well, I had intended to base this post on that topic, but I’ve had too much going on to even think about a second job, for now. Probably once everything settles down a bit and the snow melts, I will have time to actually start searching.

Having re-read this post just as I’m about to hit the submit button, I realized it might seem like I’m whining about my job much like an overtired baby that needs a nap. So yeah, sorry about that. It feels good to vent and besides, all of this busy-ness is in the interest of advancing my residency learning experience. Except for the snow part -- that’s just a bummer.  I’m going to bed now. When I wake up in four weeks, the winter will be over and hopefully I’ll deliver you another stellar post about the beginnings of looking for my new job(s).

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Half Measure

Well, just like that, 2013 is over. And while everyone celebrates the New Year, for the NECO residents, the start of 2014 only marks the halfway point for us until our 12 months of extra training ends. The start of 2014 comes with some dialing up of what we need to do to complete our training, both inside the program and with respect to our futures outside the bubble of academia. We will have much more on our collective plates before we finish versus the first half, not just in extra responsibilities at work, but also in terms of doing research projects, writing papers, thinking about post residency jobs and even figuring out what state we we might be moving to or getting licensed in once it wraps up. There is a lot to consider, and its almost overwhelming to think about. But more on that in a minute.

First I wanted to comment on, and maybe sort of mourn, the passing of the year 2013. The process of leaving my philosophy grad program and re-inventing myself as a health sciences person was an intense 7 year journey, and during the process it was all about the lead up to 2013. I could imagine the year 2013 like some carrot on a stick in front of me, pushing me forward no matter how painful the interluding tasks were. It was the year I targeted as the soonest possible start of a better future for my wife and me. It was the year I could soonest become an eye doctor, when we could finally put aside school, settle down and start doing real adult things (house, cars, kids?). In short, it was an event year that seemed like it would never come. But then it came and went much quicker than I expected. And now that it's come and gone, it's a little weird to think of it as being in the past. The class of 2013 is already old news, already out and living the dream, so to speak, me along with everyone else. I'm not sure if I'll ever think of a year in that same way; I guess once you're done with school, some exact date maybe doesn't stand out so much. Now it's all about setting loose goals and figuring out a rough timeline with which to achieve them.

2014 has a much different feel, although in a way, June 30th, 2014, is a sort of motivating symbol of sorts. It's the last day of residency and the image of a counting-down clock has started to creep into the back of my head, reminding me of all the things I have to get done before then. So unlike wanting time to accelerate as I did in early 2013, I wish things could slow just a bit so I can get stuff done. In the next few months, I have to write a publishable quality paper based on clinical research that I've been collecting. I haven't really decided how I should format it; we can either do a case report on an interesting patient we've seen, or otherwise crunch numbers on findings from many patients. I can't really decide. I also have to turn that into a condensed presentation which I will give at the end of year residency conference. It's going to be a lot of work. On top of that, I need to do at least one more presentation for the VA's hospital rounds geared toward a more general, non-eye audience. And then, of course, start looking for my possible forever job. Yikes!

So as 2014 gets rolling, it seems like I will have little time left to look back and reflect on 2013, and that will probably show in the remaining posts I have left. As busy as I anticipate I'll be, at least there will no shortage of things to write about here as far as anxiety about the future. So see you next month, where I think the topic will be:  moonlighting  with a private practice part time during residency, the pros and the cons. Stay tuned.


Beyond the Wall

It's quickly approaching the middle of December, which means that we are almost at the halfway point of the residency year. Only fourteen more days until the shortened weeks that fall around Christmas and New Years. Having short work weeks back to back means the time is going to fly by even faster than before. Before we know it, we will be beyond halfway and deep into winter, which is simultaneously exciting and dread inducing.

I enjoy New England in the winter, especially when snow covers everything and the landscape takes on a foreign quality, like you moved for the season and are living in an entirely different place for a few months. A fresh, white blanket of snow can be a beautiful backdrop to a long hike or snowshoe adventure on some cold weekend morning. On the other hand,with my long commute and 15 year-old economy sized car, I'm hoping that global warming wins out again this year and New England has a mild, relatively snow-free winter. But probably that is unlikely; the forecast next week is predicting an ice storm Monday and snow later in the week. And unfortunately, the VA is open no matter what, so calling out due to inclement weather is simply not an option. I may have to purchase spiked snow tires to survive!

As I write this, I am sitting in a completely empty Pre-Clinic on the NECO campus. When I arrived this morning, I noticed how calm and quiet the building seemed. The holiday decorations are up around the building, and they glowed in silence as I walked up that familiar spiral staircase. Now I'm not at all somebody who loves the traditional sights and sounds of the holidays, in fact I'm a person who tends to get grumpier during the season. You might say I'm somewhat of a Grinch during the holidays. (I was born in Springfield, birthplace of Dr Seuss, after all.) That said, I have to admit that the holiday decor against the backdrop of its  historic architecture seems to make even the cavernous space of the rotunda that much more cozy and inviting. And with nobody around, it was almost like I stepped back in time, to when the building was an actual home, inhabited only by the small wealthy family that built it.  I'd forgotten how 424 Beacon can evoke these moments of reflection. Not being here everyday makes me re-appreciate the unique presence and charms of the building itself.  It can simultaneously be an echo of the far past, the immediate past and the future all in the same moment. This is something that you tend to overlook and let blend into the background after awhile of being a student here. Coming back on rare occasions allows you to be like an outsider, seeing it for the first time again. Pretty cool.

So while it's a ghost town up on the fourth floor, when I walked down on break to the library. it was an absolute zoo. There was not a single open desk to found in the reading room. You see, it's a week until the students take final exams and therefore no one wants to come in to practice skills in Pre-Clinic, not with stressful finals time looming over their heads. It's strange to consider how different my mindset is  two years later versus seeing how tired and stressed everyone is down the library. Finals stress to me now seems so foreign that when I saw it on the students' faces today, I could barely remember what it was like, like there was another person inhabiting my body back when I was deep in studying mode. It's moments like this that remind me how nice it is to be done with student life. As you may have guessed from this post's title, I've been having fun being able to read recreationally now that I have some free time.

As far as clinic life is concerned, it's been a fairly routine few weeks since my last post, with one exception. Our group of fourth year interns changed and it was really sad to see the old group go; we were more attached to this group because they were our first group that we worked with for a full three months at our site. The new group is really good, too, but they are still in the process of learning our electronic medical record system and how to efficiently see a VA patient. Eventually they will be the first group that we precept on a daily basis, probably after the New Year.  It will be another interesting transition as the teaching role of the residency ramps up.

Other things are going to ramp up and/or change in the remaining residency year as well. In the next post, I'll talk all about that and more, but for now I take my leave. It's going to be a very interesting final 6 months and I hope you'll join me. As this is my last post of the year, I wanted to include a few works of thanks. I have recently run into more people than I thought who say they read this blog, so to them I am thankful! I hope everyone reading this has a a good holiday season and I'll see you all in 2014! Boas ferias!

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Academy Fight Song

photo 1 (11)

The end of daylight savings is my favorite holiday of sorts. As a natural night owl, every year I'm like a kid before Christmas, counting down the days until I can regain the extra hour and be able to feel naturally sleepy at a reasonable time. Despite what I said a few posts ago, I still struggle with sleep occasionally, especially after the weekend messes up my bedtime schedule.  And after what has been a exhausting, jet lagged week and a half of educational extravaganzas,  it couldn't have come at a better time.
265_578101862162_4380_nLast Wednesday my wife drove me to Logan Airport and I hopped a plane to Seattle for the four day American Academy of Optometry's annual meeting. Among other things, the meeting provides a venue for optometrists, residents and students to attend lectures, find out about new research projects and network with fellow ODs.  It was a very worthwhile trip for me, despite feeling somewhat lonely. This was my first long trip without my wife for the first time in several years.  It's a little alienating to be in a big city alone when you're reliant on a constant travel companion over the years.  I forgot how weird it is to eat at a restaurant or drink coffee in a cafe by yourself.

I have visited Seattle once before and seeing it for a second time, I feel like it is really one of the best
265_578101792302_71_ncities in North America to visit. Since my friend, Steph, is in Seattle for residency, I was able to hang out with her a bit and revisit some of the famous sites with some of our other friends from our class. Additionally, I got to share a hotel room with my friend and classmate, Nick, who is now a resident at Nova, along with his friend Christian, another Nova resident. It was cool to hear about their experiences in residency at sites that are administered by other schools. On Friday night, there was a NECO alumni reception which proved to be a mini-reunion of sorts, where I got to catch up with many familar faces, former classmates, upper classesmen and professors alike. It was great to feel the NECO sense of community that has been absent since graduation, 3,000 miles away
265_578101882122_5710_nMuch like when the Academy was in Boston two years ago, there were tons of varied educational programs, where I feel like I learned things that I can apply to my everyday practice. For example, I attended a great lecture about changes to the retina as a side effect from treatment for Hepatitis C (many of my patients are affected by this terrible disease) and how to co-manage these patients with their primary care doctor. I also really enjoyed attending scientific poster sessions as well. Though I opted not to do a poster for this year, many of my fellow residents had done posters, many based on a case, and turned out to be as informative and interesting as any lecture I attended.

I took a red eye home Saturday night, which was probably about half filled with optometrists, faculty and students from NECO. As is usually the case for me, I was unable to sleep at all and had a wasted day Sunday trying to stay awake. I failed, and my sleep pattern was completely thrown off.  The lack of regular sleep reverberated into the week as I struggled to readjust to the time difference and still preform my usual duties.  Nevertheless, the extra  learning opportunities continued into the week.

On Friday, the residents at NECO got to attend a special grand grounds event about anterior segment diseases held at Mass Eye and Ear Institute, run by their ophthalmology department and their own residents. It was awesome to hear about some of the challenging cases they see on a regular basis.  Saturday, all the NECO residents attended the quarterly residency conference which, as a change of pace, had lectures about the business side of optometry and how to approach finding jobs post-residency. It, too, was great and I plan on writing more about this in a future post.

So to summarize, thank god daylight savings ended. All this bonus lecture learning was a fantastic way to expand my knowledge separate from the usual patient care, despite how exhausting the last week was. The entire residency experience is greatly enhanced by these activities and in my mind has justified the residency in and of itself. These have been chances to learn that I couldn't have gotten any other way and I am grateful. Hopefully I will be able to integrate all this new knowledge into better care for my patients as I go forward into the second half of the residency year.


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White Coat 2: The Legend of Curly’s Gold

Joe Rob

In the last few weeks, I've been settling into a groove over at the VA. The part of the residency where we were treated like a "super senior," basically like a student intern but with a little more trust,  is essentially over.  We are hence moving on to bigger tasks and more of a supervisory role to the students. And I've even been able to precept a few more student exams recently.  At the same time, more and more I've been feeling confident in my ability to manage difficult patients on my own (difficult patient meaning they have many ongoing disease processes effecting the eyes, not that they are personally difficult). I've found myself less stressed out and I've actually been able to see patients and do my charting in a timely matter such that most days I'm able to leave on time. The ripple effect of this means that I have had more spare time to read articles or books on interesting topics.  I've had a few patients that have had somewhat rare retinal diseases in the last few weeks, radiation retinopathy, interferon retinopathy (to name a few), and I've even seen a couple of things that we weren't exactly sure what it was just yet (pending referral). Some of these cases are interesting enough that I may end up basing one of my end-of-year research projects on one.  It  feels like it's all coming together.

So this leads into some thoughts about my other job through NECO, as a tutor and Preclinic monitor. As resident monitor, we mostly help the second year students as they learn the more difficult techniques associated with a basic eye exam, starting with biomicroscopic exams of the front of the eye. In a few weeks, they will start things that actually come in contact with the eye such as checking pressure, and then beyond to dilated exams of the back of the eye.  So just as things are coming together for me into a whole "I am confident doctor" package, I am re-hashing in bits and pieces of what was one of the more stressful times as a student. At times I feel unsure if I am able to explain things to the students in a way they can understand. Things that are so natural to me are for them so forced and unsteady. I can certainly remember what it was like and sympathize but I am unsure if I am actually conveying concepts and teaching effectively. I have gained even greater appreciation for the professors who taught me so seamlessly. I have much to learn about teaching, I think.

Being there to see the students struggle through what is old hat for me, along with the fact that my brother is currently a second year as well, means I've been reliving second year. At times it is almost like watching an also ran sequel to some old summer blockbuster (alternate title to this post White Coat 2 : Electric Boogaloo). I've been talking to my brother about his various 6 or 7 mid-terms he's studying for and how he's squeezed to find time in there to practice techniques as well.  He is understandably stressed and it makes me anxious just to talk to him about it. I really forgot what it was like. At times, over the last few months I found myself missing my friends and Boston and the worry-free student life, but more and more I realize that I am being nostalgic for a time that never really existed.  I could never go back and relive those times, and sometimes I'm not entirely sure how I survived the workload.

And so last weekend my wife and I attended my brother's white coat ceremony, which stood out when I was a second year as a monumental achievement.  I can still remember being up there like it was yesterday.  The intimacy of the small auditorium, the sound of your name being called while everyone cheered as they put on your crisp white coat. For a few brief moments you really felt very special. Now you could start to see real patients and were thus one step closer to actually being an eye doctor. You forgot all the stress of classwork.  It was almost like graduation from high school all over again, taking pictures with all your family and pals, and partying afterwards.  It was pretty much a defining experience of being an optometry student. So it was very strange to be on the other side of the stage, cheering on my brother from the audience. The cynical, knee jerk reaction as we waited for them to file into the hall was to think why so much hoopla for such a seemingly small achievement? And true, in the big scheme of things, they really have just scratched the surface. They haven't yet faced patient care with full exams or passing any second or third year classes, or even thought about studying for boards. But then the cynicism faded as I remembered again what it was like. And as I recognized many of the faces of students I have been working with in Preclinic, I felt happy for them. Knowing how tough the road is just to get the white coat is achievement enough for now. And I have personally witnessed many of them work very hard to this point. Hopefully they savored the moment as they gear up for bigger challenges to come. And hopefully I can play a small part helping them in the weeks ahead.

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Turn and Face the Strange

It's been a somewhat routine few weeks at the VA since my last post, but with a few new experiences sprinkled in. Overall the fall has brought some changes, some good and some bad. The bad is really just mildly annoying. It seems that after Labor Day, the Boston inbound commuter traffic has turned into a totally different, unpredictable beast. What used to take me about 50 minutes to drive in the mornings can now randomly take about an hour and ten minutes or more, and I avoid it completely only if I leave 20 minutes earlier than before.  It seems to be a log based curve; for every minute after 6:15 am that I leave it adds 1.25 minutes to the commute. So now I wake up the earliest I have ever since probably high school. The 17 year old me was unable to fall asleep before midnight, whereas now I am able to regularly fall asleep on the couch at about 9pm. I feel like I am finally understanding what the working adult world is all about, being really tired at the end of the day and losing track of current events because even watching TV is too sleep inducing.  On the flip side, the commute home is just about same and the Thursday and Friday traffic is actually much better than before, that is unless there is a Patriots game. Then I may as well sleep under my desk because I'm not getting home until right before the stadium parking lot fills up before kickoff.

On to the good changes, including the crisp, cooler, fall weather. Fall is my favorite season by far and now that I live in a more country setting, I feel like I can really enjoy the fall and its activities for the first time in several years. Living in Boston, you tend to forget about things like hikes in forests with changing leaves, farm stand corn mazes and cider doughnuts, Oktoberfest beer, and being able to play sports outside without immediately sweating profusely. Well, the first two things were hard to come by in Boston, the last two I guess are the same. But these are all things I'm looking forward to on the weekends for months to come.

Also, I've been able to dip my toe for the first time into teaching, which has been really exciting. I began working at the school's preclinic as a resident monitor, which means we are responsible for making sure students are practicing safely, as well as for answering questions, helping with techniques, and signing off on homework. It was a really cool but strange experience to be on the flip side of the student/doctor dichotomy. As time goes on, I'm sure to have a longer post about how I feel about this.  In addition to that, the residents at my clinic have finally started to be granted more independence and freedom. We no longer have to have our exams rechecked for every patient we see. Probably a topic for yet another upcoming post.

So that about does it for now, but I'll leave you with a nugget of unrelated good advice, particularly to any incoming 1st year students new to the Boston rental market. Renters insurance is really an awesome, overlooked thing. For a about $200 to $300 dollars a year, you can really save yourself big trouble in the event of emergency like a fire or theft, especially when at the mercy of fellow tenants in a building. Last week, our cat spilled a glass of water on a friend's brand new Macbook Pro laptop, destroying the motherboard and partially damaging the hard drive. Her warranty did not cover water damage and we thought we'd have to replace it out of pocket for her. Not only did our insurance pay her for full replacement, saving us over $1200, but it also paid for data recovery. So it covered not only our own stuff, but also other people's stuff too. Something to think about. I know I sound like an insurance company shill, but it really helped us, given money is tight for the next year as we continue to live somewhat like students on a reduced resident salary. Now you know. And knowing is half the battle.


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Road Rash

In the last week of June, leading up to the first day of residency, I was considerably more nervous than I thought I would be. It was like the feeling of starting a new school all over again; like the transition from junior high to high school. This was getting called up to the big leagues, the big show, the main stage. With that, the expectations were going to be elevated. And thus that familiar feeling of nervous anticipation filled my stomach. Yes, now I am a doctor, but am I truly ready? Would I be rusty, given my last rotation was light on letting us do complete exams? Would I flub a major finding (miss a retinal detachment) or try to initiate a treatment that was wrong (antibiotics for an allergic conjunctivitis)? Would I make my attending docs rue the day they ranked me for their program?  In the lead up, I had a series of anxiety-fueled, recurring dreams based around a traumatic incident during a summer twenty or so years ago. It is one that I have had time and time again over the last several years whenever stress levels run high.

The summer of 1990 was a transitional one.  I turned eleven and was gearing up for the big jump into sixth grade and junior high school. I wanted to make myself feel more like a teenager and ready myself for having to deal with the older, cooler kids. At the same time, this summer was the first time I was essentially left to my own devices during the long school vacation. I could leave my house free from supervision, obstensibly to keep out of my mother's hair, so long as I left in the morning and didn't come back until dinner.  The previous summer was the summer of Batman, where my friends and I had spent most of our time playing out scenes from the movie with action figures, or otherwise playing video games in our basements. That behavior wouldn't fly for someone in junior high. So the decision was made; this summer was going to be different. We needed to grow up and leave behind the toys of the past. And so we decided to venture by bike out of our neighborhoods, across town, to hang out at parks and parking lots, or if we were feeling really adventurous, at the malls in Springfield.

We also tried to co-mingle with my cousin and his older friends, some of whom were known for being "bad" kids.  They would do crazy things like race dirt bikes in the woods or jump off old train bridges into the Chicopee River. Or maybe even smoke a cigarette.  Needless to say, we were too chicken to do any of the things they did for fun, and so we were rejected pretty quickly despite my cousin's efforts to get us accepted into the group. But to my surprise, one mid-summer day I was invited on a trip with them to the local ski hill, Mount Tom. In the summer, the mountain stayed open with a mini-water park complete with a few water slides, a wave pool, and also something called an alpine slide. I didn't ask my mother as she would probably say no, so I snuck off with Jay and three carloads of kids I didn't know for a day on the mountain. It is around this time index that my dream usually begins.

After a while of hanging out in the water-based attractions, the group set its sights on the imposing alpine slide. For those who don't know what one is, it is essentially a smooth, long, winding concrete track built into the side of the mountain. This allows people to harness the awesome power of gravity to ride sled-like plastic carts down the mountain, at speeds controlled by the user via a hand brake. Kind of like a summer-time version of Olympic bobsledding. This being the early 90's, there were no helmets,  no real adult supervision, and "suggested" speed limits, and with two tracks side-by-side, people would compete and try to blaze down as fast as they could. And injury would often ensue. On a side note, amazingly there are still several of these still in operation today, and a quick YouTube search can confirm that people are still getting busted up on them to this day.

So as we all took the ski lift to the top, that sinking pit of anxiety entered my stomach. Everyone was talking about racing each other down to the bottom. I had never gone on one before, and at times from the chair lift you could just barely see the people on their sleds flying down the tracks in the distance. It seemed very dangerous, more so since I was pretty undersized for  my age, just barely able to meet the height requirement to get on. But at the same time, I had to go down, otherwise I'd look like a baby in the eyes of these older kids. Once at the top, a few of of my cousin's friends ran over with sleds and started down the track, boasting that they wouldn't use the brake for the entire ride. This prompted the attendant at the top to warn the group that if we were caught going too fast, we would be kicked off the mountain. This got a good laugh out of the group and when the signal was given, the two junior racers flew out of the gate and disappeared around the first bend of the track.

Meanwhile, I had tried to hang back in the line and maybe somehow wait until I was last so that I could go down slowly without getting called out by the others. But wise to my plan, they noticed me at the back and decided to pair me up against the shortest member of their crew, with the goal of seeing who was more aerodynamic. So I was pushed to the front of the group, plopped into a sled, and forced to wait for the signal to meet my doom. As I stared nervously down the slide, I made note of the serenity of the treeline and view from the top of mountain.

In what seemed like an eternity, the attendant finally gave the signal to go. I eased the handle of the brake backward to release the sled and the next thing I know I'm shooting down the mountain, starting off faster than the guy I was racing.  I heard the cheers of Jason's friends meander off in the distance. When I effortlessly navigated the first big bend and the first sharp drop, which I clearly can envision to this day, I remember thinking, "Hey, I got this, I can go as fast as I want." So I pulled back the handle further and picked up even more speed. I was going to win and earn the respect of everyone. The mountain side became a blur as I accelerated.  The next thing I remember was looking down the track to see a series of sharp switchback curves coming up ahead. Rather than slow down, I pushed ahead at the same speed. Somewhere inside those series of turns, going much too fast, I went up the side wall of the track and went airborne.

At some point I remember thinking, "Holy cow, I am upside down and still on the sled". I think I almost landed the flip unscathed. But at some point the sled came out from me, flew forward and landed right side up, successfully completing the 360. Somehow the brakes on the sled failed and it continued down the track on its own, all the way to the bottom. I was ghost riding the whip years before the term had been invented. I landed face first on the track and skidded from full speed to full stop. At some point, I blacked out. A while later I came to, dizzy and throbbing with pain. I realized my forehead as well as a good chunk of my arms and legs were blistered and bleeding. My sled was gone and no one else was in sight. I looked to the side of the track and saw a woodchuck in the distance. Its eyes met mine for a moment and then it ran off into the woods. As I got up, I burst into tears and began to run down the mountain side, with the taste of sweat, blood, and salty tears in my mouth, embarrassed as much as I was hurt, I prayed no one else would find me in this state.

It is at this point  that I usually wake up.

So now the first two months of residency are essentially done and the recurrent dream has stopped for now. Days have come and gone faster than I could have realized.  The first couple of weeks were actually much less stressful than I expected; in fact, my new commute of about 50 minutes was at times the most stressful thing, until I adjusted to it. As new residents, our early days were spent attending the mandatory VA training and we had several days of reduced patients to become accustomed to the patient flow again. Having been at my VA as a student helped the process to be more familiar and smooth. Then the residency conference came, giving us another day off from patient care and a chance to catch up with some old friends doing residency across New England and allowed us to hang out at 424 Beacon for the first time since graduation. It was very nice.

August was the first full month of patient care on regular schedules, with the expectation we see eight patients a day with accuracy and formulate treatment plans without help from anyone. The safety net is that our attending doctors come and double check before we leave and discuss what went right and what went wrong. For a time, my anxiety and frustration level with myself rose again. I missed my share of findings, though nothing very dangerous. I proposed treatment plans that weren't quite in line with what the attending thought was appropriate. After hours, I had (and still have) plenty to look up in terms of articles or photos of stuff I was shaky on. There were some late nights where I ran behind and was forced to catch up on charting long after patient care hours were over. In other words, the experience was exactly what I was expecting it to be: lots of learning and lots of eating humble pie.

Last week was the first week that I was able to finally say to myself, " Hey, I think I know what I am doing here, maybe I'm smart enough to be here after all." And all through the process, the people who I thought I had to impress and be mistake-free in front of, my attending docs, were simply there for me. Not to judge, but to teach like any other professor I've had over the years. Their knowledge, support, and help is what is making the experience thus far all worth it.

One thing I didn't mention. Sometimes my dream ends when I fall and scrape and pick myself up, forced to walk down the mountain bleeding and alone. Other times it keeps going, and I am able to remember what actually happened after my accident. After a few minutes of stumbling down the mountain in a daze, I hear a familiar voice. It's my cousin, coming  down the track on his sled. He comes to a stop and yells out, "Is everything is alright?" I wipe my tears with a bloody arm, trying to look tough, and say,

"Yeah, it's fine." He says,

"There's room for you on the back anyway speedy. Hop on."

I get to the bottom of the mountain and on to the first aid tent. Besides having to explain what happened that day to my parents, the rest of that summer ended up being pretty good after all.

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The Move

This weekend my wife and I packed up all of our worldly belongings into a Budget rent-a-truck, pulled out on to Harvard Ave, went through the toll booths of exit 18 in Allston/Brighton and drove west on the Mass Pike out of Boston one last time. Thus brought a close to the time I could call myself a Bostonian and gave final closure to the chapter of my life about my time in optometry school. The next time I come to Boston it's as a visitor; for that matter, the next time I step foot on 424 Beacon it's as an employee and a doctor.

Originally I was going to write about my first weeks as a resident at the VA and about the residency conference, or my first days working for the school as a resident tutor/monitor. But jammed into the middle of my first month on the job was the stress of having to pack up and move.  Unlike the last time we moved, from Springfield to Boston, I would be working full time and have to MacGyver the bulk of Move-related activities into the weekends. Every night it became a "what can we do tonight to figure out the logistics of the move" night. Did we pack up everything in the storage space yet? Did we change this or that utility to the new address? Did we reserve the right moving truck? Thu,s as it has dominated my off-hours thinking, there was little else I could focus on writing about.

Moving day was something that I dreaded for months. The dread was multifaceted. The obvious factor is the stress of leaving the relative comfort of home to a new place. Our apartment was ours for four years, unlike many other friends and fellow students who moved from one "college" style apartment to the next after each year (or more during fourth year). And our place was a recently built condo. Probably because we were older than the average student, and my wife had a real job and real credit, we were able to a get huge and comfortable space that was somewhat reasonably priced for the size (or at least relative to Boston). We had central air, a parking space and a private roof deck with panoramic views of the city skyline.  The school was 15 minutes away by bike or 25 minutes by the T. Being in Allston, it was close to good restaurants, supermarkets and parks, but relatively quiet compared to the more densely populated areas near the Back Bay where most people who attend NECO choose to live . Yet it was also only a quick bike, drive or train ride right to where everyone lived and where all the activities and night life were.  It's saddest to leave if I focus on these facts.

When came the day itself, I kept wishing I could close my eyes and it would be done on its own. Yes, we were moving a month earlier than what is locally known as Allston Christmas, August 31st.  Yes, a late July or early August move is a less stressful day to move than when all the students move and the city becomes a paralyzed crazy quilt of  U-Hall blocked side streets and sidewalks jammed with old mattresses and broken microwaves. But there are still plenty of people with the same bright idea to try to dodge the traffic, so maneuvering is still somewhat limited. We accumulated so many new things, furniture especially, since we first came to Boston that we would need a bigger truck. Being about 5'4" with limited abilty to even see over the steering wheel made driving the 10 foot truck on the move in bad enough. Back when we were moving in, I nailed the side of a gas pump returning it, unable to correctly judge the width of the truck, but luckily we had bought the extra insurance. The added twist this time was that many of my (strong) friends had already moved. Thus I was faced with the Keith Hernandez moving scenario: I would have to ask people I didn't know very well to help us move. Would they think I was too forward? Was it too soon to "go all the way" on the friendship? In the end I was able to convince a few friends' boyfriends to help with the move (along with my brother, who is legally required to assist)  and it went off quickly and smoothly, virtually complication free.  We made it out to our new suburban location with nary a scratch on the truck, the extra insurance a gamble we lost this time. Today my back only still kind of hurts, mostly when I bend to the side doing the BIO part of the exams at work.

I really came to love living in Boston, and I could go on and on about all the things to see and do. A year ago I really felt like I could have lived here forever. But as friends moved away, I came to realize that a lot of Boston was in the people. The friends I made at NECO are truly what made living in Boston the great experience it was. As people slowly left for home over the last two months, I began to notice that Boston lost a little of its charm. I came to realize that I had been able to ignore some of the downsides of Boston life (or really of life in any city), like the traffic and crowds, or the lack of forests and really large green spaces, and now couldn't really look aside. And there's the price. For four years, taking out loans and paying (roughly) triple for an equal place outside the city was fine. But since I no longer have a job in the city, and my salary is that of a resident, it was hard to justify the cost when I was having to drive 25 miles outside the city anyway. So I leave with a heavy heart but also a potentially heavier wallet. As we settle into our new place, I'm sure I'll see the ups and downs of Boston metro-west life. I'm still getting adjusted to my new commute and the new traffic patterns to deal with. And to the eerily quiet nights, where I feel like it's strange to not see any people walking around. I do miss Boston, but in a way it's mostly the Boston circa 2010. And since I still have a few friends in left Boston (some of my fellow NECO residents), I'm sure I'll be back on the weekends more often than not.

Next time: the learning curve of the resident optometrist.


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