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

18Jun/12Off

Paging Dr. Zaius…

It’s already been 4 weeks into my first rotation, yet I literally just did my orientation.  I feel like Charlton Heston in the opening scene of Planet of the Apes.  I’m in an old space ship, flying through a distortion in space, where time is passing super-fast all around me, yet I perceive things as happening at a regular rate.  At any time I’m going to look up and I’ll be years in the future and everyone that I used to know will be long gone, and I’ll be stuck in a strange new place that is nevertheless oddly familiar.  Really my life is a perfect analogy to that movie in almost every way, except for that whole talking apes thing.

Maybe this isn’t the best way to describe my early goings as a fourth year, but for whatever reason it’s what I keep thinking of.  In this case the VA Hospital’s building reminds me of an old sixty’s style space ship. In this analogy I'm the stand in for Charlton Heston, but also many of my patients remind me of his character in the movie: noble, proud, and a little like men out of time.  The time warp part, well that’s pretty much self-explanatory, with my long daily commute, the days that come and go in a blink, and the disconnection from many of my friends at NECO. And predictably it seems that before I know it, it will already be time to start the next rotation.

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Before coming here, my idea of a VA hospital was formed mostly from movies and the news.  It conjured up images of how poorly we treat our former military men and women once home from war.  From recent exposés of the Walter Reed Hospital during the waning years of the Bush era, to the harrowing scenes from Born on the Fourth of July where Ron Kovic is paralyzed and trapped in a poorly staffed and poorly funded VA ward, I was expecting perhaps not that extreme, but at least outdated facilities and a staff that was merely going through the motions.

But so far the VA has been the almost the exact opposite of these images, and I’ve really enjoyed being here.  While the building is old, and its cinder block construction and sterile smell reminds me of being back in elementary school, the rest is top notch.  Both the equipment and the space for the eye clinic is brand new; I have literally never used a better quality slit lamp or BIO, and my skill with getting clear views has improved by leaps.  The staff has been incredibly friendly and eager help everybody when they can.  They truly care for everyone who makes their way into the clinic.  All of this has put me at ease and allowed me to focus on my development of my clinical skills unabated.

And then there are the patients.  Such a diverse group of characters I have never encountered before in my life, and every last one has been very friendly and happy to let me work with them.  They seem very well cared for; the EMR system ensures that everyone on the patient’s team knows what each department is up to.  Some of them have had a tremendous amount of problems health-wise, and they often seem dazzled with how far technology has come in health care, but they all take it in stride.  The modern health care world they find themselves in is a maze for sure, but at least the care is coordinated for them and merged together in a way that the outside healthcare system is not.  They earned and deserve the best care possible, and while the VA can certainly make more improvements, the effort and the will is there.  It makes me feel good to help give a very small part back to them.

As a side note, it seems every day a different guy reminds me of some classic movie star.  I’ve seen dead ringers for the aforementioned Mr. Heston, as well as John Wayne, a middle aged Marlon Brando, Ronald Reagan and also the guy who played Blue in Old School.  One other thing that has taken me by surprise is the realization that the generation of Korean war and Vietnam war vets are now the age of my grandfather when I was growing up.  (And damn, without realizing it, I’m getting old too.) When I see someone in their late 60’s or early 70’s, I forget and start to ask about World War 2, but then stop myself as I realize that WW2 vets are now in their late 80’s or 90’s and older.  Soon we will lose the majority of that generation of vets to age, and I can’t help but feel sad.

What’s clear one month in is that I am a work in progress. I might have memorized the differential diagnosis of some retinal sign in class, but I have a lot of clinical skill development left to go before I graduate.  I’m still relatively slow in the exam room, and no matter how many multiple choice picture identifications I’ve gotten right on an exam, it’s always a different game when its real and staring you in the face.  I finally understand that it is in the repetition where you are able to expertly identify diseases, both subtitle and obvious, rather than from a single picture out of Kanski or some other textbook.  So maybe after about another 1000 patients or so I might be able to avoid confusing a tigroid fundus for a huge nevus.  (To the non-optometry reader, if you’re confused by what those two terms mean, don’t worry, pretty sure I’m still learning as well.) My preceptors have been pretty much exactly the mix of things you need in the early going.  Tough but fair in expectation and criticism; willing to teach and help you improve so long as you seek it and show initiative; and patient and understanding when you try your best but fail, as could be expected this early into our rotations.  Emphasis on the patient and understanding part for sure.

Something I touched on in my last post, which is even more evident now, is that while the learning is constant and ongoing, it no longer feels like I’m a student at NECO.  I feel like I’ve moved on and this is a sort of transition into real life.  Days go by so fast, so much that the daily commutes blend into each other.  Every time I leave in the afternoon, I forget where the car is parked versus the day before.  And I see my friends less frequently (other than my partner in carpooling, Dave).  It’s harder to get everyone together as a big group; everyone is tired or their schedules don’t match up with mine.  Nevertheless, the weekends here in Boston have been a fun oasis, and we have day trips planned into the future; this is the last summer before everyone moves away forever, after all.  Probably in the next post I’ll talk a bit about stuff to do in Boston in the summer.

So to summarize, yeah the Planet of the Ape’s analogy doesn’t exactly hold.  But for sure the idea of distance and time accelerating is something that will be continually be true for everyone as we make our way toward graduation day.

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