Routine Eye Exam

May 15, 2012

Two weeks later, after being pensive and reflective about my 5 semesters on the island, I am wide awake at 4:00 in the morning with not enough energy to work on Kaplan, but too much energy to fall back asleep and a lot on my mind.  ::sigh::

I’ve been out of touch intentionally–I can’t imagine that reading about someone who lives in the middle of nowhere waking up and studying everyday can be that interesting.  So instead, I think I’ll discuss the non-studying outliers.

Yesterday was my annual eye appointment check-up.  This was the first follow-up appointment since my big eye crisis last year where I was afraid that I was going blind/had a brain tumor.  I went to the office with the intention of getting contacts fitted and mentioned nothing to the flippant eye assistant who was updating my history about last year’s traumatic events.  I mean, after all, it should all be there in my chart anyway, I haven’t had any follow-up symptoms, and technically she asked me if I’d had any previous conditions and at that point I still didn’t know what the technical term was for what happened to me.  Eye-numbing drops, dilation drops, and subsequent ennui associated with waiting for my eyes to dilate were all routine.  Eye exam went fine until we got to the part where my ophthalmologist was in the room and went to do the advanced ophthalmoscopic exam; he spent 2 or 3 minutes shining an extremely bright light into both of my eyes then said that it looked like there was something “floating around” in my left eye (the bad one) and that he’d have to “give the drops more time to work” (i.e. more dilation).  Crap.

Half an eternity or 20 minutes later, he came back with a brighter light and after about 5 minutes of looking around, told me that I still had drusen in my left eye.  Oh, so that’s what it was.   Drusen.  We’ve talked about this in class before–now what was it concerning?  Also he mentioned that where the optic nerve enters the eye, that the vessels were still enlarged.  Papilledema?  But just on the left side.  He seemed puzzled but not panicked at all.  I calmed down.  But then he kept talking.  He also said that I needed to make sure that I kept coming back every year for check-ups, that he’d noticed a spot on my left lens.  He said it was below my field of vision, but then proceeded to show me my chart where he had marked the site on a diagram of an eye and scrawled PSCC below it. Wait a minute.  What involves a C and spots on the lens? “…cataract?”  I asked, before he could explain what PSCC completely stood for.  “Yes, how did you know that?” He responded incredulously.  At this point, I sort of tuned out.  I heard “…not anything to worry about right now…can be fast growing…” and then found myself alone in the room again, waiting on another assistant to come in and fit me with my first pair of contacts.

Before I could pull up wikipedia on my phone, I was staring at the ceiling with nervous anticipation as a freshly-washed, yet ungloved finger ::shiver:: with a small bluish disc on the tip came closer and closer to the periphery of my vision.  All I could think about was the scene from the Star Trek TNG series of movies where Picard is transformed into Locutus and has an implant drilled into his eye.  ::Grips the arm rests tightly and tries not to blink::  Contacts weren’t nearly as bad as I’d imagined them to be.  They don’t feel like there’s a disc of gel-like plastic stuck to the front of your eye, but more like you’ve got some peripheral non-compliant eyelash intruding into the white of your eye.   Before wikipedia would load on my phone so that I could get back to my previous crisis, my doc was back to check my vision with the contacts in.  20/20.  Asked me in passing if I’d been on any steroids lately, “you know, for infections and stuff.”  Stuff?  What, like pseudotumor cerebri?  “No.” I said.  “Oh.” He looked slightly crestfallen.  He asked me how the contacts felt and I admitted with honesty that I couldn’t even tell they were there.  He giggled somewhat sadistically and remarked that the anesthetic solution must still be having an effect.  And with that I was lead off to the contact room.

Much like last year’s experiences during my emergency visit to the local eye facility, I was getting to see a new room in the maze of exam rooms and rooms with sophisticated instruments and a line of 2 or 3 old people waiting outside.  This time, it was a high-traffic room.  I walked in to a room that resembled Olivander’s shop in Harry Potter–with the walls stacked with small boxes.  There were two desks with mirrors and sinks, and a chatty lady in dark blue scrubs on the other side of the desks who was rattling off numbers to a man dressed in business casual, yet not formal enough to be one of the aging doctors in snappy suits and bowties.  Hmm, must be a sales rep.  This must be the contact lady.  She greeted me warmly, but with the professionalism that’s come from the routine of breaking in hundreds of newbies with their first pair of lenses.  I smiled nervously.  She pushed a mirror towards me along with a few sheets of paper towels, a box of saline, and a couple of empty lens cases.  Then it was like someone pressed play on the VCR.  She held up and demonstrated both cases and the differences between the two; described the importance of sterile saline and the brand preference of the establishment; gave a brief lecture about the importance of removing contacts nightly as prescribed and the gruesome consequences if these directives were not followed; explained the process of starting out wearing them just 4 hours daily, then 5, 6, and so on; then just like a flight attendant, began demonstrating on her own face, the awkward poses necessary to remove one’s contact lenses.  Suddenly, I was yanked out of my trance of head nodding as she said “Ok, now you try.”  Wait, what?  You want me to take these things out?  But we just got them in, they fit so nicely.  Crap.  Like trying to play out a jingle you’ve got stuck in your head, I remembered and repeated the steps she’d acted out and low and behold, 30 seconds later, my contacts were sitting in a case in solution.  Sweet.  Now her video-like demonstration started again, except this time, the poses were even more awkward and involved more steps.  Ugh, you want me to put them back in?  Isn’t this the part they make fun of all the time on tv?  I followed the steps and on the third poke of my left eye, I managed not to blink and looked around just enough to make the contact make contact (heh) on all edges and slide into place.  That wasn’t bad at all.  ::Jinx:: 10 minutes, 8 or so re-washes and seemingly 50 tries later, I lucked out and got the right contact in after much reassurance that I was doing fine, it wasn’t taking long at all and that I would get it any minute, and would most likely be able to do it without a mirror in 2 weeks when I came back for my follow up appointment.  Wait, I have to come back and do this song and dance in front of you again?  With the distinct paranoia that she’d been lying to make me feel better and that I might soon be the subject of exasperated discussion–I’m hard on myself, no?–as soon as I was out of earshot, I went to update my insurance information, pay the “fitting fee,” schedule my 2-week follow-up appointment and be on my way back home.

With a growing, familiar unsettling feeling of camaraderie with the older patients waiting to be tested on the sophisticated machines in the unvisited rooms at the eye doctors’ office, I googled “pscc.”  Too vague.  “Ophthalmology pscc.”  From what I could glean, it is a type of cataract and is fast-growing but is NOT usually seen in young patients.  Great.  The same unfamiliarity with association with my age group was the case with “drusen” although even more unsettling was the association of drusen with “macular degeneration.”  I read on.  There was a subtype of drusen called ODD or optic disc drusen.  Wasn’t it my optic disc the doc was talking about when he brought up the term ‘drusen’? It makes me very nervous to think about what I read concerning that subject.  Here–knock yourselves out: http://en.wikipedia.org/wiki/Optic_disc_drusen.  In particular, the sections entitled “Epidemiology” and “Prognosis” are daunting.  Hmm.  Good thing I don’t want to be an air force pilot?

The rational part of me reminds my panicking self that I could be barking up completely the wrong tree.  I didn’t clarify with the doc exactly what my conditions were, HE didn’t seem to be overly worried or concerned, plus I have NOTHING as far as risk factors or family history or associated conditions that are mentioned on the ODD page.  Positives: I can see FINE right now, I’m losing weight thereby reducing my risk of developing NIDDM & HTN [and the associated ocular manifestations], and my main objective of visiting the eye doctor for my yearly checkup and leaving with contact lenses was a success.

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Side note: the Med 4 equivalent of this post that I did last semester is on valuemd if anyone is interested

WARNING: LONG POST.

Ok, so what I can I start off saying about Med 5?  Well, I think it’s probably one of the most frustrating Meds at the school.  There is no doubt in my mind that it has the WORST schedule, even worse than that horrible 4-hour block of afternoon classes in Med 4–at least you had the mornings off there.  Med 5 starts at 8am, so there’s no one in the building except you and the Med 1’s.  And then you go ALL DAY until Kaplan is over at 5:00, during the first 3 blocks, then after that you have 8 hours of Kaplan which is just torture.

The first class of the morning is ICM lecture.  It is taught by Dr. D, who is brilliant and really dedicated, but just doesn’t put that much pizzazz into lecturing.  She has anecdotes just like Dr. I from last semester, but there are no cute breaks where she gets that grin and gaping expression on her face, earnestly waiting for the class to burst into laughter like he did.  In fact, she has a really scary story about where her son almost died after an esophageal bleed secondary to a strong burp.  Anyway, I’m digressing: ICM lecture.  Unlike the short PD lectures, this lasts for an hour and a half and that extra half an hour is killer.  The late people in your class, you know who I’m talking about, learn that Dr. D isn’t terribly bothered, or at least isn’t terribly vocal about being bothered, by tardiness, so they slowly start to come in to lecture later and later until it’s not unusual to see a quarter of your class ambling through the door groggily at 8:30.  Attendance is accomplished by passing around a sign-in sheet and you’ll often notice that by the time the sheet gets to you, there are often more signatures than there are bodies in the classroom.  ::sigh:: Some things never change.  The powerpoints aren’t as long as Dr. I’s and have some great information, but they are still quite lengthy and if you’re someone who typically writes them out like I do, don’t bother.  Won’t help you.  Focus on the slides she’s got starred and remember the important things that are in bold.  You learn a lot of good clinical information.  This is somewhat of an Aha! class in that many of those little things that doctors do that you’re worried you missed/won’t learn in school or that you think you’re missing by being at a Caribbean school are elucidated in this class like, um…for example…why do I give my patient a liter bolus of normal saline instead of a liter bolus of D5water?  Or…what’s the order of drugs you use on a patient who comes in with previously untreated CHF who is having trouble breathing or presents with pink frothy sputum.  It’s a good class, it really is, it’s just tough to get through at 8:00 in the morning, every day with a monotone.  Oh, there are lots of little assignments like article worksheets and quizzes and such.  Don’t scoff at them, yes they seem right out of third grade and the frequently infrequent due dates get annoying, but you can pick up a lot of good information from them and that information WILL show up on tests and, surprisingly, on shelf exams.  She tells you not to work with other classmates, though most people do.  I would just make sure that YOU understand the work and that you can reproduce it.  Also important for this class is that you gain your BLS certification in CPR–I did mine over Christmas break at home, though it’s just 4 or 5 hours on a Saturday or Sunday if you do it on the island–AND at the end of the class, Dr. D offers you modules so that you get training in infection control and HIPPA which are required for clinicals.  If you don’t complete that, you have to pay $25 to complete an online module through the MUA clinical website, so go for the free one.

ICM lab.  THIS is your Med 5 class to look forward to.  I LOVED ICM lab.  Wanna know why?  Dr. B.  She’s awesome and easily one of my favorite teachers at the school.  We met her briefly in PD lab in Med 4 when we were learning to take histories and didn’t really get to see much of her personality.  In fact, I didn’t think I was going to like her because all that we saw of her was her making fun of people’s histories when we hadn’t really had much direction on how to do them–it was frustrating.  Anyway, she’s amazing.  She’s funny, very intelligent, and will teach you how to work with patients realistically.  She still works back in the UK and has tons of experience in family practice and can give you all kinds of helpful hints and advice.  To start off, she passes around a sheet where you can sign up into groups.  This is TERRIFIC because you can sign up to be in a group with your friends; you’re not stuck with the people who are nearest to you in the alphabet.  Our class, a big one, was split into 4 groups.  The significance of these groups are that these are the people you’ll go to lab and tutorial with every week–you meet at the same scheduled time and you have discussions and diagnoses together.  Once you are into the big groups, she’ll have you split up into groups of 3 for lab days.  Again, PICK PEOPLE YOU LIKE because you’ll be in lab with them and will be trying to diagnose them.  These groups stay the same for the duration of the lab so choose wisely.  So the way ICM lab works is that each week, you meet between 2 and 3 times for labs and tutorials.  Tutorials are days where Dr. B will pick a subject and will lecture you on the subject, then give you mock patients that you’ll try to diagnose as a class.  It’s very fun, lots of group work; very free-form, people just shout out answers and you’ll be surprised with some of the things that people come up with.  You work on history-taking, what questions you’d ask, differential diagnoses, AND the best part is that she helps you learn the last couple steps: what labs/tests you’d order and what treatments you’d begin.  Loved it.  Goes along pretty well with the schedule of the lectures but she adds in some subjects that aren’t discussed in lecture that are helpful–like Peds.  (LOVE the way Dr. B says baby–“baybeh”) Lab days, Dr. B will email you a diagnosis and you have to make up a mock patient with that diagnosis, figure out what their test results would be, what their symptoms would be, then you break off into your groups of 3 where one person is the patient, one is the attending and one is the doctor.  It’s fun, unless you get a jerk in your group who makes up weird symptoms or tries to confuse you.  (Like I said, choose your groups carefully.)  Dr. B makes rounds to all of the groups, so don’t be nervous when she comes in–she’ll help you and give you constructive criticism.

How the grading works for this class is that there are the quizzes and worksheets for the lecture, then block exams as well.  There really aren’t graded assignments for lab, except for the clinical skills assessment at the end of the 3 blocks.  It’s similar to the PD exam, where you have to go in and correctly examine a patient, but this time, you don’t choose your patient and there is already a scenario given to you…like…your patient is a 54-year-old man with chest pain, then they’ll give you his vital signs, and you’re expected to go into the room, examine the proper body systems, gather a good history, and present your patient to the faculty member, in addition to mentioning what tests you’d order and what your plan of care would be.  It counts for something like 30% of your grade, so there’s definitely a lot of pressure to perform.  Make sure you consistently practice the skills you learned in PD like how to do a chest exam or an abdominal exam, because you’ll lose points if you forget that stuff, and all those steps are very easy to forget.  Oh–the shelf exam is fine, little tricky but very do-able between what you learned in ICM lecture and in PD lecture.

Pathology.  Ugh.  It’s a direct continuation of Med 4 pathology, except that you have path for 3 hours daily.  It SUCKS.  You get less of Dr. Y this semester and more of Dr. Sr and since I have a deeply-seeded hatred for him, that sucked for me, but ::sigh:: he is at least a good teacher–he gives you all the information you’ll need to know for the shelf.  The exams are still tricky and very detailed, BUT it’s all useful information that is helpful on the shelf…just not in that much detail.  The dreaded microscope test that they made you leave the Med 1 classroom for a week for, back when you were in Med 1, is a joke.  It’s basically a histo lab session, then the “exam” is really just another histo lab test except it’s for bonus points.  Don’t sweat it.  Our slides suck and it’s hard to see anything.  Most high-yield stuff for the class?  Pay attention to the leukemias and lymphomas…that stuff never goes away, GI ISN’T very high yield (suppose that’s why it’s given to Dr. Y), cardio and respiratory come up quite a bit, um liver I thought was mostly review from Med 2–I thought Dr. Sa did a great job with that, they like to trick you with gallbladder stuff so you have to learn the basic differences in terminology.  Really, just don’t forget to review the stuff from Path 1 before the shelf–bone cancers, tumor markers all that annoying nit-picky stuff that you find yourself just memorizing.  The worst thing about this class is the time.  3 hours of path is torture, even with Dr. Sa teaching, especially now that he got rid of his jokes.  Just be careful with your absences; there were a lot of people who got really close to the limit.  Oh, and Dr. Sr failed 3 people.  People cheat on the shelf–that’s why our average is so high.  It’s not due to any particularly remarkable teaching, like Dr. Sr thinks.  Don’t cheat or you’ll regret it when it comes down to the comp, you have to know this stuff.

Kaplan.  Sucks.  Basically you’re made to sit there and watch videos at regular speed that may or may not be on material you’re studying.  One of the professor’s wives sits there and watches you like a hawk.  She won’t let you eat.  Attendance is done by signing a sheet, but she has a paper with everyone’s pictures on it, so she knows if you lie or have someone sign in for you.  If you leave early, she’ll mark you absent.  You are allowed to miss 40 hours; this seems like FOREVER when you are just doing the 2 hours daily during the first 3 blocks, but DON’T give in to temptation and waste all of your absences; save them for the 8-hour days when you really need the break or want the time to study.  Most people get through Kaplan by listening to their headphones and working on path notes, or watching Kaplan at their own [faster] speed.  There are “post-tests” you have to go take in the testing center when a section of Kaplan is finished; they’re either questions our profs have made up or Q-bank questions related to the subject.  Most people will answer one question, then click proceed and walk out of the testing center to have a free afternoon since the grades on the post tests don’t matter but I WOULD NOT recommend this.  Just sit down, give the test an hour and see what you know and what you need to work on; otherwise it’s a wasted opportunity.    The thing that kills people in this class are absences–KEEP TRACK of yours closely.  Every now and then there will be a “short day” planned where you’ll get out 30-45 minutes early.  Rejoice, they’re a godsend.  If you absolutely need a break, I’d recommend taking a Friday off every now and then to get a jump on your weekend.

Comp.  ::sigh:: People cheat on this too.  Yet again, this is why the pass rate is so high.  I, admittedly, slacked off on studying during the last 3 vacant weeks, and passed by the skin of my teeth but even the people I know who studied their butts off barely made it into the 70s or 80s.  A 68 is passing.  It is VERY DIFFICULT.  It’s not stuff you’ve memorized before, but new concepts where you must apply your knowledge.  I understand why most of the class used to fail in semesters previously; if you’ve just memorized along the way or haven’t learned or understood concepts, you will fail.  Practice questions are helpful to get you in the mindset and get your timing accurate–I recommend ExamMaster from the muacampus.org sign-in page, and Kaplan Q bank, though the Q bank questions can be lengthy and difficult…well…I guess a better way to describe them is to say out of left field.

As far as clinical stuff this semester, you don’t have to go to the hospital like in Med 4 but you do have to sign up for 1 Saturday where you go to town from 10:00-1:00 to the OB/GYN office with Dr. E.  People have had varied experiences–some, like me, only got to see an ultrasound, but others got to participate in exams.  Don’t go in expecting much and you won’t be disappointed.  You’re not grilled like you were with the surgery rotations at the hospital, it’s much more low-key, but ATTENDANCE IS TAKEN so don’t skip.  Also, on a personal note, don’t sign up for it on a block weekend.

One last thing.  For those of you already on the island, this probably won’t help much, but you can go ahead and schedule things for when you get home.  BEFORE YOU CAN REGISTER TO TAKE YOUR STEP I WHEN YOU GET BACK HOME, YOU MUST FILL OUT YOUR HEALTH FORMS!  This means getting a physical, as well as submitting titers to prove that you’re immune to Hep B and all the major immunized-against bugs.  You also need 2 TB tests.  This is what’s holding me back from scheduling my Step I right now.  MAKE SURE YOU GET IT DONE.

Well, I know that was long, but I hope this helps you kiddos going into Med 5.

When I started this blog over 2 years ago while I was still shopping for opportunity in the form of a legitimate Caribbean medical school, I didn’t dare think where I would be in 2 years and what it would feel like.

It feels great.

It’s finally sunk in that basic sciences are over.  Today, the first day of classes for the kids on the island, I am at home still in my pajamas in North Carolina while life on the island goes on without me.  There isn’t a classroom in that big shiny new building that I’m supposed to be in right now; I’m not missing the first few days of class to steal some last precious moments with my family before I miss them for a whole semester.  I’m done.  It’s very liberating.

It sounds cliche, but up until now I really couldn’t convince myself that it was over.  I actually found myself panicking last week because something in my brain was saying “It’s time to go back and you’ve not shopped for ANYTHING!”  I think back to preparing for each of the trips back, how the cynicism grew with each semester and admittedly, there’s a part of me that misses it.

Now down to business.  I have just under 2.5 months to take the USMLE step I.  After allowing myself a week back at home to acclimate and move back in, I’ve cleared out my bedroom/office of everyone else’s stuff that accumulated there while I was gone, unpacked and washed all my clothes and neatly stacked my Kaplan and DIT books on the giant L-shaped desk.  All that’s left to do is dive into those videos I’ve tried so carefully to avoid during Meds 1-5 so that they’ll be new and fresh and exciting.  With Dad retired and at home, I can tell it’s going to be difficult to study; he seems to find all these little chores and errands for me to complete and they seem so much more exciting than watching the animated Kaplan Micro lady or the dry Path guy, but I suppose I’ll have to be rude and draw the line somewhere.

Oh, the other thing I’ve done since I got home is to start trying to eliminate all the bad habits I’ve acquired both on the island and before I got to the island, which were rationalized by not having time or being stressed out because of all of the studying that I had to do.  These include eating horrible, quick & easy-to-prepare foods with little nutritive value; biting my nails; working out sporadically, when it’s convenient; and hoarding clothes that are YEARS old either because I think that I will wear them one day, or because I feel obligated to keep them because they fill a space in my closet that seems like it needs volume.  I’ve also come to the conclusion in going through my clothes, that I hate dark brown and when I wear it I feel like a giant piece of poop, thus I have removed all articles of this color from my wardrobe.  Small admissions of truth=victories.

The other big thing is that I’m back on the horse, trying to lose weight.  I did really, really well during Med 3 and 4, then kind of slacked off during Med 5, but managed to not gain all that weight back that was lost so quickly.  Now that I have access to lean protein and fresh veggies so readily available, between eating Whole30 meals and going to the gym daily for an hour of cardio, I’ve managed to lose about 12 pounds since I got home, bringing my grand total so far to just under 50 lbs.  I’m pleased, but I still have SO FAR TO GO that I am going to keep my head down and keep avoiding those carbs until I can get another 50 under my belt.

*In reviewing my immunization records, I have discovered that I’m a mere 15 lbs away from my weight before I went to NCSSM, so that’ll be the next victory.  Eep.