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

17Jun/13Off

Waiting Room

Greetings once again, noble reader. Welcome to the newer and improved version of Chairs Missing, a blog no longer about being an optometry student, but instead about the trials and tribulations of a rookie optometrist/optometry resident. To start, I shall lay some new groundwork.  The revised goals for this blog going forward are to give to the potential optometry student, as well as current students in kind, a picture of what it's like during the first year out of optometry school: the challenges, the ups, the downs, the frustrations and triumphs; the "oh yeah moments" where the training and practice click into place. Along with that, I am also going to cover what the experience of doing a residency is like: the pros, the cons, what great learning and opportunities it does or does not provide. And last, I hope to provide some insight into the choices and decisions that have to be made in this crucial first year to plan beyond residency towards one's future career, and ultimately one's life.

Now, as I wrote that last paragraph, I realized it sounded pretty self-important, or if not, maybe too broad and ambitious of a goal for a 500 word-per-post college blog.  But I figure since not only I am a doctor now but also a professional writer (of sorts), I need a stuffy sounding mission statement to keep things looking sharp.  So from here on out: Less rambling about nostalgia and feelings, less references to the difficulties I have writing this.  Less contradicting what I say in a later paragraph, more keeping on a singular message. And maybe less hidden literary illusions and obscure music references that no one gets but me.

But then again, maybe not.

Joking aside, no matter what, I hope I can come close to meeting a high standard in the coming year and get a clear point across. And hopefully I can do that without driving myself crazy with rewrites and obsessing over every last word until I miss deadlines. To this end I think I am going to keep it simpler than in the past; I plan on using a more straight forward narrative, drawing more on my day-to-day on-goings and trying to keep the posts shorter and sweeter. Well except this one. I'll take a mulligan on this one.

Long intro aside and on to the meat of this post, as expressed in the form of a question: What is residency in optometry? Aren't MD's the only health professionals that do residency? Isn't that because only THEY need to see a large amount of cases and need intense extra training in order to specialize? The short answer is no; optometrists, as well as dentists and some other professions, have the option of continuing on to more training in a sub-specialty they find interesting. It's just that with us, it's optional. Only those who feel they want more training in a particular area do this, be it in one of several recognized sub-fields such as contact lenses, ocular disease, pediatrics and so on. Each program is run in affiliation with a school of optometry and has requirements for self-improvement beyond seeing a large volume of patients, such as doing lectures at grand rounds and initiating independent research projects.

So why would someone subject themselves to this by choice, immediately after going though the stress of four intense years of school, and for close to no money (the pay is modest at best), when the tantalizing possibility of making good money is right there for the taking? Well, it seems crazy at first and the reasons are many, but for the most part it comes down to that extra training. This extra training provided by doing a residency then leads to the opening of more doors.  It allows the resident to see cases in a sub-field to the point where they will be completely comfortable managing advanced cases on their own. It therefore allows a person to prepare to be eligible for a wider range of jobs such as in industry, in hospitals and in community health centers, jobs that they otherwise could not get. It also allows a doctor to be able to teach both as a lecturer and as a clinical preceptor, as schools usually require professors to have completed a residency.

For me, since my goal is to one day work in a hospital or community health center based setting, I sought to do an ocular disease or geriatrics residency. This will in theory allow me to learn how to diagnose and treat complex ocular disease cases, ones that are often caused by the chronic systemic illnesses that plaque our health care system, such as diabetes and high blood pressure. And long story short, my position is at an area VA hospital through NECO.

And this leads into what I am doing now, beside writing this blog. Waiting. And waiting.  The residency position doesn't start until July 1st, so I am stuck with about six weeks of time off until then.  I am pretty much officially having the last summer vacation of my life, and because I can't work yet as I am without a license to practice (the process takes months, more on this next time), this is the first summer since I was a young teen where I have seemingly boundless free time. I remember the awesomeness of summer vacation back then, where I would sleep until noon everyday, forget probably everything I learned over the last year, and stay up all night skateboarding or going to hardcore shows with friends.  No job, no bills, no one to really answer to.

Well, things done changed. In a number of ways, that's for sure. So far it's a lot less fun, with a whole lot more paperwork to fill out (license applications are a maze) and a lot more freaking out that I am making no money, all while my loans accrue interest. On the plus side, my wife and I are traveling to the Carolinas for a few weeks, and that will provide the distraction I need to stop stressing out about all this time being wasted.

Since we leave soon, I'll save the details on that for next time.  Or maybe instead for my next post: Summer School, a review of the 80's movie starring Kirstie Alley, directed by Carl Reiner. Maybe Chairs Missing could become your destination for reviews of terrible movies that I watched out of boredom on HBO during the summer of 1993. Not sure which direction I'll take yet, but either way, hopefully I drew you in such that I'll see you next time. Next time being around July 1st, which coincides with day 1 of residency.

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4Jun/13Off

It’s Been a Long, Long Time Coming

It took me a week to let things sink in before I could even attempt to write this, my way-past-deadline final post.  Last weekend, every member of NECO's Class of 2013, including myself,  marched into the Back Bay Event Center's main hall, sat and listened to the commencement speakers  (it got a little dusty during Nick, Petar and Jeff's medal ceremony), went across the stage to get their degree and hood, and then went off into the audience to embrace their families and disperse out into the real world. It was so hectic I didn't even get a chance to say goodbye or take pictures with everyone that I wanted. Everyone had a tearful last party or outing with close classmates in Boston, and now almost everyone, save for the few planning to stay in Massachusetts for the long haul, have moved away. I just said goodbye to one of my last friends to leave the city for good, and now the city feels like a ghost town. If not for the luck of having my wife and my brother here with me, it would be a pretty lonely place. So needless to say, it has been a pretty surreal couple of days. I  have only now started to process this.

But let's be honest with each other, noble blog reader. I haven't posted anything here in a few months; I am about three posts behind everyone else. It's not like things haven't been happening, both for me or at the school or even in the city itself. Every time I attempted to sit down and write, I got stuck.  There was tons to write about, and I had a quite a few great but unfinished ideas. The one about doing exams for an entire day in Spanish and Portuguese, which reminded me of my hometown and my grandparents, that was a good one.  Or the one about the tragedies on Marathon Monday in Boston -- that could have been special and emotional. Or one about observing a bunch of different surgeries with ophthalmology at my last rotation and how MDs interact with ODs -- that had so many different interesting ways it could go.  And so on.  But I just couldn't get it done.

After having time this last week to reflect, I realized that I couldn't finish what I started because each time I did, it meant revisiting my leftover fears and anxieties about the future. It also meant facing that I was one step closer to school ending and all that comes with that: friends moving away, loans coming due, and generally having to face responsibilities of the working world again.  It means leaving the relative comfort and safety of being a perpetual student both physically and in mindset.

For more years tha
075n anyone else who is my contemporary, my identity has been defined through my status as being a student; this final graduation means losing that identity in a sense. I think that sort of makes me seem like a Judd Apatow-esque manchild of sorts; a 33 year old still wanting to be this youthful student and be free from career ambition and just play video games or skateboard or something. But actually I think the real truth is that I previously found more comfort in thinking of myself as having (either imaged or real) untapped potential versus actualizing that potential and making a meaningful life with it.  In some ways, so long as you remain in the realm of  the potential and not the actual, your life maintains the illusion of being wide open.  I could fall back on my "potential" as comfort and thus the future would remain a tantalizing unknown of multiple possibilities, a place to dream about,but also a place to lay any excuses upon.  My lack of direction, my working dead end jobs, that for me meant that any failures I had were no big deal, and therefore not as scary, not as real.

For a long time I was in that mindset;  I can't really say why or when it started, but it was certainly something that started in high school, where despite being smart enough, I blew off classes and assignments to hang out with friends and came dangerously close to not finishing.  It took years of community college and working on my own to afford state school to turn it around. Since then, there have been ups and downs (my lowest point may have been my failed attempt at moving to New York and going to grad school), but luckily I was able to discover optometry. I re-examined what I wanted out of life and with the help of my wife, I started down this path that I have just now finished.  I also have come to realize that seeking a grand career to give ultimate purpose is a false dilemma; you are not solely defined by your job, your life has meaning only so far as what you perceive it to be. It really took crossing the stage on commencement day to finally bring this into clearest focus and realize how far I've come. I couldn't be more happy with the decision we made together to come here. And I finally feel like I have lived up to my potential at long last.

So although it's still strange and sad to think that my time here is over, these last four whirlwind years were a blast, and reflecting on it helps to move past and look beyond. What strikes me the most is that I find myself not thinking so much about what I did, or what I accomplished, but rather what everyone else around me did to help me. I feel that no one really achieves anything in life by themselves, no matter what sort of delusional Ayn Randian fantasy one might believe. On a basic level, we all stand on the backs of those to come before us, who built our society and institutions, and the collective people who complied knowledge or blazed the paths that we use everyday without thinking about it. But we also stand on the class and position in life we were born into, on our families, and how well (or not well) they were able to take care of us. And last of all, we stand on top of those we choose to associate with willingly, our friends and significant others.

This is evident in my life through the support I relied on from my wife as she herself toiled and struggled in a job she did not like for four years to put a roof over our heads. She should have been able to hood me and get one for herself. It also is evident in the amazing friends that I was able to cobble together and rely upon for study help and to hang out and blow off steam with.  And of course very evident that we had great support from folks at NECO itself, both the faculty and the staff equally. You cannot overrate the job they did teaching us and keeping things running; yes there were minor complaints along the way, about trivial this or thats that cropped over the four years: "oh the library should be open until this time", "oh this class didn't need to repeat this material" and so on. But that was in the fog of war, so to speak.  Now that it's over, having witnessed the amount it took to put it all together from orientation day to commencement day, it really is quite amazing. So to get to the final point at long last: to all these people above, thank you!  I could not have done it with you, especially my wife, but especially everyone else. I will never be able to fully express what it has meant to me,  I'll never be able to pay back the great debt I owe you, and most of all I will never ever forget your kindness.

....

Postscript:

So now whats next? Well it turns out that this is not my final post. My plans going forward: I will be spending the next year working as a resident optometrist at a veterans hospital in the greater Boston area. We will be moving to a suburb outside of Boston in search of cheap rent and bigger space. I will also be back at NECO as an occasional resident lab monitor, clinical tutor AND I will be staying on as a resident blogger, so to speak. There should be a lot to talk about as I provide insight into my first year navigating the world as an OD and as I attempt to become licensed, complete the residency program and establish my future mode of practice for years to come. It promises to be at minimum a continued long winded and grammatically challenged year for this blog. Please join me!

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