First Day on the Job

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After enjoying what could possibly be my last pre-retirement 5 week vacation with a family trip to Italy, setting an alarm last night to bring me back to the real world was a bit unwelcomed. But after my first day of residency, my main thought is, Wow! I get to do this every day for my career! That’s awesome. Being an eye doctor is great.

I felt like I was acting as someone else introducing myself as Dr. White to my patients today. It’s an interesting transition to begin to identify yourself as something different from how you previously saw yourself. I imagine it might be similar in some respects to how women who change their names feel after they get married. Most of us have spent the majority of our pasts being students, with jobs possibly throughout the school-year or in the summertime, but our main “job” was being a student. Making the transition, which academically we know we are ready to make, psychologically takes a bit longer. Each time my preceptor would refer to me as Dr. White to my patients, I was giddy and had to hide my face so my patient wouldn’t see how much I was smiling over hearing it.

I realize this is possibly a little overzealous for being only three patients deep, and after all it’s just a title, but for me it signifies all the hard work and effort me and my classmates have put in and confirms for me that I can do this. I left with a feeling of all those hours of studying, all the financial debt, all the stress will be worth it. We are going to have great careers as optometrists, Class of 2013, whatever path we choose to take.

In the office I saw a roster of all the current residents. I felt so proud seeing so many of my classmates names followed by O.D. in print. We’ve worked hard for it.

Not that having this new phase doesn’t come with its fair share of responsibilities. I’m a bit overwhelmed with a stack of papers of information from everything to parking passes to life insurance and retirement plans. Do I want my paycheck sent to my checking or savings account? What mutual funds should I be investing in? Do I file “0” or “1” for my taxes? Not to mention trying to find a parking space for my car during non-clinic hours, a task that in most other parts of the country cannot be as difficult as this to find. All these new tasks to welcome us into the world of adulthood and start us along the path of fiscal independence.

As excited as I am from day 1, I know this year will bring with it A LOT to learn, in aspects of life, not just optometry. My skills felt a bit shaky coming off nearly a month and a half without having used them, but it’ll all come back and then be refined from there. I guess that’s all a part of the game, accepting where you’re at while being open to what the future holds.

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Post-Graduation Life

Well, hello there. Does this post already look different from my previous one? Well, it should. It’s Dr. Kristin White, O.D., now. Commencement was a beautiful ceremony filled with not only the excitement of such an accomplishment, but also from seeing our classmates, some of whom we hadn’t seen since we left for rotations the previous May.

I recently had my undergraduate five year reunion. It was an interesting time to be saying “so long for now” to many NECO friends while we part ways for our upcoming opportunities as optometrists on the one hand, and then days later to be reconnecting with friends I hadn’t seen in years! It was exciting to see my friends whose own idealistic values were being developed alongside my own during our college days, and to see where so many of them have ended up five years later–doctors, lawyers, masters in public health. In introducing what I am doing, I had difficulty making the switch from saying, “I just graduated optometry school” to “I am an optometrist.”

A little bit about post-graduate optometry options: directly out of optometry school, you are able to practice on your own as an O.D. During your time in school, you will take and must pass three National Board exams which are required by all states in order to apply for licensure. Once you have graduated, you need to apply for your license in whatever state(s) you would like to practice in. Each state has its own requirements, which usually consists of filling out some forms and in some states taking a brief legal exam specific to that state’s optometry laws. Some states that have a very expanded scope of practice for optometry have an additional practical exam that must be taken in order to be licensed.

About 40% of NECO students choose to do a residency, which is an optional one year program in a specific area of optometry: pediatrics, contact lenses, ocular disease, low vision, community health or primary care. By the way, it is a paid position, but not equivalent to the salary you would make as a full time doctor. On the other hand, though, one year of residency in terms of experience is equated to at least three years of practice. Residency opens many doors depending on the type of setting and area of the country you would like to practice optometry in. For instance, many jobs especially in the northeast may even require residencies if not a few years of experience in order to be eligible to apply. But there are plenty of jobs available to new graduates. Often people choose to work for someone else either in private practice or a group practice setting before going out on their own.

For me, I chose to do a residency because I loved working in the community health centers that I interned at as a student. It was an area of optometry I didn’t even know existed beforehand. While I would love to work more long-term in a Latin American country one day, working in a health center provides a diverse ethnic and socioeconomic patient base and, in many cases, the patients have had limited previous access to eye care. In that way, I will be working with a similar population to the one I envision working with internationally one day, but while still living in Boston near family and friends. I think it’s important to recognize, too, that populations without access to care very much exist within our own communities. This is another reason I was interested in a community health residency and it is something I hope to explore further throughout the upcoming year.

Stay tuned for more adventures of the life as a first year optometrist.

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To the Class of 2013

 

Boston, the start of our optometric journey...

Boston, the start of our optometric journey…

To the Class of 2013:

We’re less than two weeks away from graduation. I remember the feeling after the first few months of first year where it felt like we had learned an entire new vocabulary —  all these words, terms, phrases I had never heard before and putting them together to make some sense of things. I remember getting so worked up before our dreaded second semester of second year and then we all got through it by taking each day moment by moment. Then third year came and we started to apply our knowledge base even more clinically. With boards and clinic, we were starting to see the light at the end of the tunnel.

Now, after twelve months of full time clinic, we’ve really begun to taste what it will be like working full time. Each doctor we’ve worked with has had a different way of doing things and our experiences, which started off identical in PPO labs at 424 Beacon St., are all extremely varied. It’s been so exciting to hear where and how my classmates have expanded their optometric interests to pursue specialties some of us didn’t even know existed within the realm of optometry four years ago.

The more optometry we learned, the more I realized the importance of trying not to forget the things we knew before we began optometry school: how to listen to others, show empathy, be kind. We’ve all gotten each other through these past four years by supporting one another, be it through study sessions, coffee breaks, or exploring Boston together. We also couldn’t have done that without the help of family, faculty, staff, and preceptors, all rooting for us, picking us up and getting us back on course when we thought we would never understand enough to call ourselves doctors of optometry.

We have had the opportunity to work with countless patients who have each taught us so much, each in their own ways: whether it be how to perform a clinical skill, how to interact with someone, how to explain something more clearly, how to understand what it is your patient needs, which sometimes may just be someone to listen for a few moments. In caring for each other these past four years, we have fine-tuned our skills to care for our patients.

I remember sitting at my college graduation and feeling a rush of excitement for my optometry school graduation, thinking how proud I would be of that accomplishment. Now that day is less than two weeks from today. While we may not have another standardized test again, the learning does not stop here. We will continue to learn as we grow as doctors to stay current in how we best treat our patients. Just as we’re reaching the light at the end of the tunnel, it’s now time to cross that threshold and venture out into the real world where we will put our skills to use.

So, to my classmates, my colleagues, my friends, to the Class of 2013: congratulations and best of luck. I’m so proud of us all and cannot wait to see what the future holds in store for us all.

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R-E-S-P-E-C-T

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Even more in this last month, I’ve been asked, “So, Dr. White…” (a bit preemptive, but I’d be lying if I said I didn’t like the sound of it), “How would you like to treat this patient?” or “When would you like to see this patient back?” Or, simply, “What would you like to do?” I know I’ve mentioned this before, when I was first taken aback by this question at my first rotation this past summer (seems like so long ago). But now, as graduation hastens upon us (is it really April already?), the question is ever more relevant. It will be me calling those shots pretty soon. I find that oftentimes, even though I know how I would treat the case, there remains a faint hesitancy in my voice and I think it stems from not trusting myself 100% yet, or a part of me asking for confirmation rather than stating my plan. I’m used to having someone else’s opinion to fall back on. And yes, ultimately we get our preceptor’s input and it is their final word over ours, but even just being asked puts me in the mindset of, “Okay, pretend this other doctor isn’t here and how should I best manage this case?”

Yesterday, I took Part II of the National Board exams, 300 questions and 7 hours of the treatment and management of ocular diseases, and hopefully my last standardized test ever. It hasn’t quite hit me yet, seeing as so much of my life up until this point has led to some sort of an exam or another, but being able to go the gym after clinic and do weeks’ worth of laundry that has been piling up feels pretty good.

Working at the VA is an entirely different culture. I’ve been challenged not only clinically, but also personally to see each patient as an individual (not as a problem list that can sometimes be a bit intimidating when reviewing before the patient enters). I’ve learned so much from my patients and work each day to catch myself in my prejudgments. I know nothing about what my patients’ lives have been like — the things they have seen, the experiences they have had that have led them to the point in their lives where they are right now. As their health care provider and as a fellow human being, I try to greet them and welcome them to their exam. One of the best pieces of advice I received at NECO was to welcome each of your patients to your exam room as if you are welcoming someone into your home. It is your job to make them feel at ease, and to try your best to make it a positive experience for them.

Oh, I almost forgot to mention, since I’ve last written, I’ve been accepted into a NECO community health residency for the upcoming year! I’m really looking forward to spending my first year in practice in a community health center where I’ll be able to work with other healthcare providers, work on a public health project, continue to be involved in an academic setting, all the while working with NECO students and extremely knowledgeable optometrists.

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4/4: The Beginning of the End

Well, since I’ve last written I’ve had a whirlwind week and a half. After spending the majority of my last week in Madrid sick in bed with strep throat, I mustered up some strength to spend my last weekend with American friends who were visiting and then squeeze in every last minute with my Spanish friends (who I miss dearly). From there, I flew home to New Jersey, spent two days there, then drove to Boston and spent the last week commuting from Boston to Providence waking up early enough to make it to clinic by 7:15 am. This past weekend, I moved into my apartment in Providence and have been spending time settling in and studying for Part II Boards which I take in less than a month.

I’ve finally started my ever infamous VA rotation (not that any VA in particular is infamous but in general it’s always the site that optometrists talk about most with stories from their final year VA rotation where they were whipped into optometry shape). I’ll be the first to admit I was a bit intimidated even before starting. My first week has been a change of pace from my last schedule. I’m glad to be ending my rotations with an experience that gives me some independence and forces me to think and act like the optometrist I will soon be. I appreciate the high standards we are held to as clinicians. While the adjustment this first week at the least took place in English, it still came with its own set of complexities: a new computer system, a different set of expectations, time constraints, and an intimidating sea of patients always in the waiting room, each one whose eyes turn to you as you open the door to call in the next patient, each one with hope in their eyes that his wait will be over and that it will now be his turn to have his eyes examined.

In a week or less, we will find out the residency match results, where we learn if we get placed in a residency program, thus determining the fate of countless final year optometry students throughout the country. In a week, we either learn where we will be for the next year or, at the least, where we will not be, to officially start our years as practicing optometrists. It’s interesting to me that depending on the part of the country, the prevalence of doing residencies varies dramatically. Here in the northeast, it’s extremely popular, and I don’t mean popular in the sense of being pressured into applying for one (although we all felt that pressure at some point or another along the way, but ultimately I think we all found our reasons to either apply or not for what makes sense for each of us), but I mean popular in the sense that they are highly valued for many job opportunities if we plan to practice in this area.

This past week, the first week of my last rotation, I’ve felt like I’ve been putting together different styles, bits and pieces of what I’ve seen the many optometrists I’ve had the opportunity to work with throughout the last four years do: realizing when and how and why to perform different tests, trying to understand the needs of my patients while balancing the goals clinically for what needs to be accomplished for that day’s exam.

As I set my alarm clock for tomorrow morning, I’m already looking forward to the extra hour I’ll be able to sleep now that my commute is 2 miles instead of 50.

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I Guess We Do Need That After All

 

 View of Avila during my visit to a friends hometown this weekend!

View of Avila during my visit to a friends hometown
this weekend!

It’s interesting to me how differently learning something in class and doing something in clinic can affect you in different ways. For instance, there have been a couple of areas of optometry that I felt no particular attachment to when learning them in class, in fact, maybe areas that while I could see their relevance and need, were things that I did not see myself doing in my “real” optometry life. For me that list included: fitting contact lenses in aphakic infants (we’ve already talked about that one), fitting specialty contact lenses for irregular corneas, performing visual perceptual testing, and performing vision therapy.

But recently, I’ve had the opportunity to do all of the above, and what do you know, I enjoyed it! Not only that, but I can see its importance and now want to be able to perform these skills in my future. I think what hit home for me with regard to aphakic and specialty contact lens fits was when one optometrist mentioned contact lenses as an option for low vision patients (a strong interest of mine). When I realized I could be missing a big opportunity to help these patients by not understanding more about how to smooth out the irregularities of their corneas with the use of contact lenses or how to eliminate excessive distortions from high prescription glasses to help maximize their limited vision, I was sold!

One of my recent patients was having difficulty with learning how to read and had fallen significantly behind her classmates in this area. She had minimal refractive error and so we did a series of visual perceptual and eye movement tests to better understand where she was struggling. The next day, already feeling more confident with this battery of testing after working with one of my Spanish colleagues to perform them the day before, I had another patient with similar troubles learning how to read. It was interesting to note differences in how the tests were performed by each of these children and to start to note how much of their performance was due to personality (impulsive versus contemplative in responding), attention span, or fatigue and then after factoring in those other concerns to see how much was actually related to difficulty performing the tasks.

Each child has a unique personality and a unique set of ocular conditions. Getting to know my patients was one reason I was interested in optometry in the first place, and I’m looking forward to having my own patients and being the one they entrust with their eye care and vision needs.

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My days consist of a good amount of traveling between different clinics/hospitals in the mornings and afternoons. I feel like I’m traveling around the city, collecting skills and information. It’s my goal from each clinic session to learn at least one new thing: whether a new technique, a better way of seeing certain pathology, a clarification of a disease process, or a rare presentation. Clearly, often I learn much more than one new piece of information, but with at least one I’m satisfied.

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Optome-what?

So much has happened since my last post. I’m two-thirds into my rotation in Madrid and less than 4 months away from graduating! (But who’s counting?) There was so much to get used to here in my first few weeks: Spanish being spoken at rapid speed with vocabulary I wasn’t used to, a very different schedule (with a two hour break in the middle of the day), re-learning my away around the city to find my way to various clinics and hospitals throughout Madrid.

Layered on top of the usual adjustments with each new fourth year clinical rotation were a whole set of cultural norms and different laws defining optometry distinctly differently than we do in the States. First of all, optometry here is a three year program after high school. This is not to be equated with a technical degree in the US, as most professional schools here are started right after high school. In fact, our idea of 4 years of a liberal arts university education is equally confusing for them to understand as their way is for us. Optometry here has been likened to optometry in the US thirty or so years ago–that is without the ability to use diagnostic or therapeutic eye drops. The opportunities for optometrists in Spain are traditionally limited to working in an optical doing refractions or essentially being a technician for an ophthalmologist.

Centro Boston, the main clinic I work at (although I rotate through a variety of hospitals and private clinics throughout the week) is run by a NECO grad and for the most part is run like a clinic in the States. Because of the limitations of optometry and the usual differences in scope of practice between optometry and ophthalmology, there exists a relatively large group of patient cases that are referred to Centro Boston namely for diplopia and other neurological cases, low vision, vision therapy and rigid contact lenses, which makes for an interesting variety of presentations in the clinic.

The expansiveness of these cases in a primary care practice really supports the idea that as “general” optometrist, we need to know these “specialty” areas because in fact, they are not specialties, but all part of the scope of our practice. It’s been interesting to have all these cases mixed into my day because they force me to stay on my toes, as I never know who’s going to walk in and what they will demand of my optometry knowledge. This rotation falls perfectly following my special pops rotation where you know, for instance, you are going to see only low vision patients one day and only pediatrics another to mentally prepare yourself. But this way is a bit more like the “real world” of optometry (unless, of course, you exclusively specialize in one area or another).

Another day of the week I work with another NECO grad at a specialty contact lens clinic run out of the bottom floor of his home. Here, we see a number of keratoconic patients fit with hybrid and scleral lenses, ortho K fits, and aphakic lenses for infants with congenital cataracts. During our peds course in third year, when we learned about putting contact lenses in infants, I remember saying to my friends that while I would love to work with children, I never wanted to do that! But, after a few times of watching the doctor here do it, I was told that the next aphakic baby we had, it was my turn to insert the lenses. And after a couple of tries on the first eye, I got the lens in fine! And putting the lens in his other eye was even easier!

I’ve had the opportunity to see eye care from many different perspectives on this rotation–observing ophthalmology a few shifts a week and even getting to see surgeries, which to me is absolutely fascinating! Everything from the preparation of the operating room, to preparing the patient, to the actual surgery itself is such an amazing process. It’s interesting to see what goes on on the other side when we refer our patients for certain conditions.

I’ve also recently started studying for Part II Boards, since I wasn’t able to take this part of the exam with the rest of my class back in December. It seems to me that every time I’m studying something, it just so happens that either that same day or that week, I end up seeing it in clinic–I suppose that’s the idea, right? But it really is incredible how many eye conditions I’ve been able to see recently that it really makes me think, wow, these things do happen!

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Madrid, Aqui Estoy

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I’m halfway through my final year of optometry school. Last week, within four days I moved out of my apartment in Boston, moved all my belongings to my parents’ house in New Jersey, re-packed a select suitcase and carry-on, and moved to Madrid. I’m looking forward to my time here not only for the optometric experiences of learning more about how to fit specialty contact lenses and observing ophthalmologic surgeries, but also to give priority to simply living life.

That being said, naturally I’ve made a list of things for me to do with my mornings off, but giving attention to living doesn’t mean not doing anything, it simply means things get done without the stress that can sometimes be associated with them.

It’s interesting to me how even after just six months in clinic full time that my classmates and I have already starting to differentiate ourselves in terms of interests, desired specialties, all factoring into our choices for the coming year. Who will only work in a VA? Who will never work in a VA? Who wants a residency–pediatric, contact lens, community health? If we think back, there are reasons why we are each choosing the paths we are. While we were all in the same classes for the past four years, our experiences at NECO have been varied depending on how we chose to live out our time here. For those just finishing your first semester at NECO, think about what areas you thought you might be interested in before you started and what sub-specialties you feel you might be interested in now. Talk to faculty in those areas. They are your best resource–get to know them. Don’t wait until you take a class in a particular area to pursue a potential interest.

Now is a good time to self-evaluate. Are we being the kind of optom
photo 1 (9)etrist each day in clinic that we want to be when we graduate? Are we being the kind of person we want to be each day? What areas are we weak or uncomfortable in? Practice those. What areas are we strong or do we feel comfortable in? Practice those as well. It’s not that when we graduate all the pieces will fall into place and we’ll magically know all the answers, but hopefully putting all we’ve learned together for the past four years, we’ll know most of the answers and those that we do not, we’ll know where to find them or who else might be able to help.

Yesterday I began seeing my first patients in Spain (after having touched down in the country roughly 24 hours prior). My second patient, a ten year-old girl, told me her favorite class was English. Her mother, in trying to get her daughter to practice speaking in English, told her, “Now look at Kristin. She didn’t know any Spanish when she first started learning it, but she had to try and look how well she speaks it now!” I think the same goes for our optometry skills. Even those with the most optometry experience possible prior to beginning our coursework at NECO know next to nothing about being an optometrist compared to what we learn during our four years here. But we wouldn’t know any of that if we let the fear of messing up win out over our desire to learn.

Stay tuned for more adventures in Madrid!

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Low Vision Clinic: A Case Study

A few days ago in the low vision clinic, I saw a thirty-three year old woman who had recently begun regaining some functional vision after years of unstable, unusable vision.  Although her vision at this point was significantly reduced, she felt like she could see and do “everything.”   She’d returned to college and is working towards a bachelor’s degree in psychology with the goal of obtaining a master’s degree in counseling.

When I saw her, she was only using a pair of low vision aids – a pair of over-the-counter reading glasses and a minimum-strength magnifier.  She told me she was only able to read for about five minutes before her eyes would feel too strained, necessitating a break.  She’d brought one of her large biology textbooks with her to the clinic, which brought me back to my own days of taking biology pre-requisites.  She was struggling to get through the course, but somehow was managing due to her determination to succeed in her coursework with the vision she had remaining, while she still had it.

We worked to get her a pair of glasses to at the least protect her functioning eye (the other eye was a prosthetic) and helped set her up with a program that could help her pay for the glasses.  So much of what we can do in a low vision clinic is to help make our patients aware of services and tools that are available to help them use the vision they have to do the things they need/like to do throughout their day.

We began by showing her video magnification systems where she could easily enlarge an image 10 to 30+ times its original size, if needed.  I left her for a few minutes to become acquainted with the device and when I returned, she had enlarged an image of a cell that I think she was really seeing for the first time.  Imagine what a difference that will make in her understanding of the material in this course!

She was blown away at the possibilities.  She used the technology with ease and fluidity.  We were confident these devices could help her.  She began to think of ways she could use these devices and all the struggles it would lessen in her daily life.  I was amazed she had been doing as much as she had without any stronger magnification systems and was truly impressed by her determination and perseverance in her pursuit of higher education, despite the difficulties she faced every day along the way.

She echoed to me something we hear so often in the low vision clinic:  “I wish I had known about these options sooner.”  I think it’s important for all of us as budding optometrists to be aware of the services available to our patients and the varieties of their visual needs.  While we are all trained to do low vision, it may not be practical depending on the mode of practice we work in down the road, but I encourage each of you to seek out a low vision specialist in your area (if you are not that person) as well as organizations in our future communities that provide services and support for the visually impaired.  We can make a world of difference for our patients by anticipating their needs and pointing them in the right direction to help them reach their goals.

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Part 3, NC and Me.

 

Although it's not found in Boston, here's a pretty mural I saw on a trip out of town last weekend.

Although it’s not found in Boston, here’s a pretty mural I saw on a trip out of town last weekend.

 

Later this week, I’ll be taking Part III of the National Board exam, required for optometric licensure. This part is a practical exam, requiring us to perform 20 skills broken into four 30 minute sections to prove our clinical competence. Oh yeah, the exam is only given at one testing site in Charlotte, North Carolina. In an effort to standardize the exam, every optometry candidate must find their way to Charlotte sometime during their fourth year to take the exam. It’s a right of passage of sorts.

I’m hoping that when I’m in the moment, I can remember which parts of the exam fall within each section, say all the right things, and have the images I see during my exam in a clear focus that transfers to the video monitors.

I wasn’t feeling particularly nervous for the exam until practicing for the last time last night. I spent my walk to clinic yesterday talking myself through giving intravenous and intramuscular injections. This morning, given the privacy of driving to clinic, I recited my patient instructions and made up findings out loud. I’m going to pretend that if anyone saw me talking to myself in the car, they assumed I was using a bluetooth that they couldn’t see, and not that I was speaking out loud to no one.

I’m actually looking forward to the weekend. Aside from being able to check it off my list, I’m able to stay a couple of extra days and see two good friends who are living closer to Charlotte than they do to Boston at the moment, one who will be making the trip down from Richmond and the other up from Atlanta for a visit. Plus, I’ve been hearing that Charlotte is quite the up and coming/modern city combined with some Southern flair, so it should be a neat place to see.

I remembered recently what one of my preceptors told me at the end of my third year rotation: to take advantage of the seemingly “free time” we have during fourth year to be actively learning, to be engaged in the cases our patients present with and not be lulled into complacency, thinking we know it all just because we’ve passed one part of our Board exam and because we’re doing eye exams all day every day now. What I am constantly reminded in clinic and in my studies is how much there is yet to learn, and how much there always will be to continue learning about optometry.

I signed up for a half marathon at the end of October and have hit a bit of a road block in my training in the past few weeks: my IT (ileotibial) band that runs down the outer side of the thigh is inflamed and causing me a lot of pain every time I try to run. I’ve been trying to change up my workouts with the hopes that I’ll still be able to run in a few weeks. I’ve decided that even if I have to walk it, it’ll still be a worthwhile experience. It just reminds me that in life, we can’t always plan everything, there will be bumps along the road, and road blocks we have to detour around, but if we keep working at it, we’ll get where we’re trying to go. Flying to Charlotte and taking this exam is just another step along the journey…

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