Several weeks ago while I was on primary call, I was called by the emergency room (ER) attending physician about a woman who had left eye pain. The ER doc had dutifully checked the vision in her eye and found it to be 20/200 while the unaffected eye was 20/20. He added that she complained a sudden loss of vision in that eye as well.

I had just stepped into my apartment right before getting called, around 12:02am. Painful loss of vision is concerning by all means, and I rushed back to the ED while glancing through my Will’s Eye Manual for help.

My patient was a 40-yr old woman comfortably sitting in the exam chair. Her eyes were white, and on first glance, I could not determine which eye was in question. On brief exam, her vision in the left eye was indeed poor, although she did not have an afferent defect or a shallow anterior chamber. The fundus on the left eye was clearly severly myopic compared to that of the other eye. I suspected that she had poor vision in the left eye all along.

I began with more questions (in broken Spanish):

Me: Which eye is the better eye?

Patient: [points to right eye]

Me: Has your vision in your eyes changed in the last year?

Patient: No, but he said my left eye was bad.

Me: Who?

Patient: The doctor

Me: What doctor?

Patient: The doctor on 186th street.

Me: What kind of doctor is he?

Patient: eye doctor

Me: As a child, did you see well out of your left eye?

Patient: No, but the doctor said I don’t see well.

Me: What doctor?

Patient: That doctor. [points out to hallway where the ED physicians work]

…

The dialogue continued for 15 more minutes with uninformative dictum speckled with non-sequiturs. I now envy those folks who specialize in pathology or radiology.

I became curious enough on the workings of the doorman world that I decided to ask José, a doorman whom I’ve known for 6 years now. He staffs a 31-floor residential building (that I don’t live in) 4 days week. I befriended him when he allowed me to park my car on the sidewalk of the building when I was moving some furniture. I usually chat with José about once a month, whenever I pass by campus. We usually speak about general world matters, and I was always impressed that José never failed to educate me in politics. Last week we chatted about medicine, and I became sidetracked (from asking him about doorman life) when I commented on his esotropia (ET).

It turns out (no pun intended) that José developed a squint when he about about one year old. He was living in Cuba (!) at the time. His mother had pushed the doctors to straighten his eyes every week for 3 years, without success. Apparently there was a huge deficiency in physicians in Cuba, and the waiting list was infinite. He finally had surgery after 3 years, only to have his ET regress after months. He waited in line for surgery for almost another year before being approved by the government. The day of his surgery, he found out that his ophthalmologist had fled to Spain by means of a fishing boat earlier that morning!

Several years later, José emigrated to Madrid with his mother and brother.  However, ophthalmologists in Madrid determined that it was too late for his amblyopia to improve with surgery, and he fell off the waiting list for surgery to straighten his eyes (non-emergent). He never got around to getting repeat surgery. The interesting part of his journey was that he decided to emigrate again, this time to the US.

“Unemployment is just too high in Spain,” remarked José, “I wanted to come to the U.S.”

Why did he become a doorman?

“I have one bad eye. It’s not safe to drive a cab.”

Too bad taxi drivers with half of José’s vision don’t have the insight to find a different job…

However, the appeal of gambling as a profession is attributed to Jon Chang, who spearheaded the MIT card club into a lucrative business. “Lucrative” is certainly not exactly an accurate description of the profession anymore, but much can be gleaned from gaming history nonetheless.

The game of choice at the time was Blackjack, which was simple enough at the time produce a probabilistic advantage to the player. The fundamental premise behind winning in Blackjack is to keep count of which cards have been cycled out, and increase your bet when there is a higher chance of obtaining face cards (table is hot).  Casinos have since implemented strategies to discourage card counting. One frequent finding in casinos is simply shoe recycling. Dealers and pit bosses have much lower thresholds to reshuffling the shoe even after about 50 cards in a 6-deck shoe. In Vegas, the tables with more lenient shuffling policies tend to have a higher minimum bet. Overall, winning in Blackjack consistently is more of a chore.

That said, I have seen a handful of people hit the card tables routinely for weekend Blackjack sessions twice a month with relative success. The gains come mostly in the form of “comp’s”; Blackjack is one of the highest compensating table games at the casino. Your “comp” status depends on the duration you spend at the tables, as well as the betting amounts you put down. The casinos keep track of your earnings/losses through their member cards at the table.

In Vegas, the standard tables are mostly located downtown. These casinos keep the cards unshuffled until over half of the shoe has been cycled through. I suspect that this is a marketing gimmick to attract business. On the Strip, most tables have horrible card movement. The $5/$10 tables at Excalibur, Luxor, MGM, Tropicana, and NYNY all keep the player’s winning percentage at a minimum. Mandalay, as I recall, has a few tables during the early hours that allow a more systematic gaming system, although they mostly require  $10/$15 minimum bets. Aria, Bellagio, Caesar’s, Wynn, and Venetian all have strict shuffling policies on all under-$25 tables. Overall, winning conditions are generally unfavorable in Vegas.

Where are the best tables? Sound out in the comments below!

Nice.

1. Family Traveler
2. Casual Traveler
3. Expert Traveler
4. First Class

While each category of traveler is self-explanatory, I can’t fathom ever opting for the Family Traveler line (conceivably the slowest moving line of all). Of course, this line is intended to prevent single travelers stuck behind a family of screaming kids with strollers.

Interestingly enough, when I checked through security last week, the Family traveler line was clearly half the length of the “Expert Traveler” line. I took a gamble on the “Family Line” and breezed through security in about five minutes–it would have taken me at least 15 minutes to get through the “Expert Line”.

The next time I travel, I’m definitely going to take note of the “Family Line”.

I had the displeasure of trekking to the post office today to pick up a piece of certified mail. The local branch opens its doors at 9am. I came at 8:50am in hopes of beating the crowd. Apparently, the lobby opens its doors 8:30am in preparation for the day. When I arrived at 8:50am, I was the 8th person in line! I waiting approximately 1 hour to reach the front of the line, and another 13 minutes for them to find my mail.

It may be time I invest in a 3rd party mailbox service, such as mailboxes at the UPS Stores. Does anyone have experience using these services?

Several weeks ago, I noticed that a few of the hospital maintenance workers were digging around the “locked” bin. Since then, I’ve acquired a cheap-o-shredder for shredding purposes.

What I’ve discovered is that the standard 6-8 page vertical shredders are junk. You can’t aggressively shred anything thicker than 5 pages without jamming the grinder. In addition, the papers shreds could actually be reconstructed without too much difficulty if all the pieces were available.

I guess I have two alternatives:

1. Buy a nicer, cross cutting shredder with larger blade.
2. Burn my documents.

Or shred AND burn them. That would be entertaining and most effective.

The NOAA has a tsunami tracker on their website. Interesting find…