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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