Obtaining a concise and accurate medical history is an art, and it often takes a lifetime to master. For the majority of us, we train for it daily in our clinical practice. On most occasions that we successfully arrive at a diagnosis through the history, the feeling is bliss. Rarely, however, it elicits anger.
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. Read more…
misc
medicine, rant
Ever since the near doorman strike back in April, I’ve taken more notice of doormen in the buildings I enter. The NYTimes article about doormen pointed out the haphazard ways that one can become a doorman(woman). I still wonder how one finds a job opening for a doorman position without word-of-mouth referral. I’ve never seen any advertisements for doorman jobs.
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…
misc
life
I have always been fascinated by playing card manipulation, partly because there is an analytical component to card games. For the masses, Hollywood has been responsible for publicizing card gaming, through Rounders and 21.
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. Read more…
misc
work
I saw this on one of the floors of the building where I work. The interesting aspect is that there are many other parts of the building of similar age without this sign. I wonder what my patients would think if I wore an N95 mask every day.
misc
health
