I’ve performed about ten pterygium excisions in the operating room so far, and the biggest challenge I’ve encountered is operating on the LEFT eye. I’d imagine that any experienced surgeon would scoff at this hurdle, but the patient’s nose seems to impede my suturing abilities significantly (I use my right hand for needling driving).  The suturing in pterygia operations involves the medial bulbar conjunctiva, which is adjacent to the nose.

On my first few cases, I used a traction suture on the cornea to help rotate the globe for access. To minimize trauma on the cornea, I now ask my assistant/attending to help rotate the globe with a muscle hook. This is impractical, since most surgeons operate solo in practice. To remedy this problem, I’ve come up with three solutions:

1. Practice more–the obvious solution, but not elegant.
2. Use my LEFT hand to drive the sutures when operating on the LEFT eye. Use my RIGHT hand to drive sutures when operating on the RIGHT eye. Switch hitters in baseball do it, right? While I am not completely ambidextrous, I’m sure that my triple-digit hours playing Quake III and other FPS’s might have helped my dexterity.
3. Operate only on RIGHT eyes. After all, there are already too many subspecializations in ophthalmology. Why not specialize on just one eye?

Which one is your favorite?

medicine humor, ophthalmology

I got a call from the emergency room several weeks ago regarding a consult for an “exploded egg” in the eye.

“Bullshit,” I initially thought. The ED frequently calls me about corneal abrasions and other minor trauma at obscene hours.

The photo on the left does not do justice to the severity of injury. Apparently, the patient had left a pot of boiling eggs on the burner, and exploded in her face. A shard of eggshell pierced the cornea through the stroma, nearly penetrating through Descemet’s membrane/endothelium.

The eggshell was removed in the operating room the next day. Unfortunately, I did not get to do the operation (but exciting nonetheless).

medicine ophthalmology

I’ve been stuck at the airport gate for hours numerous times waiting for my delayed flight to be cleared for take-off. I see the flight agents typing away at their 1970’s-style computers frantically to rebook stranded travelers. Behind them sits an aging dot-matrix printer churning out airline codes on reams of paper.  Every so often, I hear a muted announcement over the loudspeakers regarding re-routed flights. The passengers, miserable at best, are on their smartphones frantically texting their travel status to friends and family. Some of them sit in clumps near the power outlets to refuel their power-craving gadgets. How could an airport possibly function in such chaos?

In aviation design, there is no room for chance. Every detail serves a purpose. For instance, the design of airport runways required efficiency to the finest detail. Chicago’s Midway Airport is a prime example. Considered the “busiest mile”, the airport roughly consists of a square mile of runways closely surrounded by local businesses. Its longest runway runs approximately 6000-ft, which limits the size of aircraft the airport can handle. A fully fueled Boeing 747 with maximum payload requires a minimum ground speed of 200-mph for a safe take-off, not considering incoming winds. Approximately 13000-ft of runway is needed to achieve this speed. Furthermore, airfields with limited land area implement displaced threshold airstrips.

The area of the runway marked with chevrons is the displaced threshold region. This region indicates that no aircraft is to land directly on that portion of the runway. The designation applies often when noise ordinances or structural buildings prevent a gradual aircraft descent onto the runway from a particular direction. In many cases, the displaced threshold section also offers less structural support than the opposite end of the runway; the ground on which an aircraft touches down must be able to withstand a greater pressure (force / area) than the rollout region.

How the hell does air travel function with airports working the way they do now? It is futile to seek out an explanation. Airports operate the same way our eye clinic does–despite all the mis-scheduled patients, missing charts, absent technicians; all the patients are remarkably cared for at the end of the day.

medicine, misc euphemisms, travel

I had the chance to meet ophthalmology residents from Europe recently, and it’s fascinating to hear about their medical training experiences.

In particular, I learned about ophthalmology training in Portugal. As with most professional training outside of the United States, specialization begins directly after high school. Medical school totals six years of schooling, although they do not have an equivalent to “college” as we do in the U.S. During the last year of medical school, students rotate through certain medical specialties much like we do in our 3rd year of medical school.

During this 6th year, students prepare for a cumulative exam on Harrison’s Principles of Internal Medicine. It is a 100 question exam on minutiae. Several of the Portuguese residents have told me they studied for over six months for the exam. Others have taken it 3 times. Your score on the exam allows you preferential ranking into the specialty and hospital of your choice.

That’s right. No application essays. No interviews. No traveling. Your career is determined by how well you do on one single exam. Mind you, this isn’t like the SAT’s that Toby-the-school-jock (who happens to have a reasonable grasp on English) can get a 1600 (or 2400 now) without preparation. Any sort of all-inclusive exam on internal medicine borders insanity.

As far as I understand, ophthalmology training in Europe has great variability. What you learn is certainly dependent on which hospital you train at. It seems to me that much of the cerebral knowledge comes from independent learning from textbooks. Surgical training, however, can be impressive. One of the first year residents I spoke with had already performed over thirty pterygia and over ten phacoemulsifications! I would be fortunate to clock even 15 pterygia this year. A vitreoretinal fellow from India had told me he did over 500 phaco’s in addition to hundreds of extracapsular extractions during his residency.

In a way, it is humbling to hear about experiences outside of the U.S. Indeed, we have an overwhelming amount of funding and resources, yet our training isn’t necessarily superior. Where do our investments go? Research labs? Lawyers? Administration and unionized workers? The abyss?

medicine ophthalmology

I know little about non-western medicine (ie acupuncture, herbal medicine), but the moment I saw this jar of powder in a local store, I knew I needed a photo of it. Unfortunately, the photo came out fuzzy as the pharmacist shooed me away from the aisle. The jar reads:

“Stomachin: Chang Kuo Chou Strong Stomachic Powder”

I found an online store that sold an equivalent concoction of health. It appears that this medicine is intended to remedy gastritis, given that licorice and sodium bicarbonate account for the bulk of the powder. I assume that this medicine may actually be effective, given that almost a billion people have probably taken it at one point in their lives (This is a Chinese medicine).

*Note: I am not affiliated with this product. I do not endorse the use of this product either. I have neither prescribed this product nor used it myself. *

medicine humor, medicine