It is shocking to recall how naive I was. I borrowed a suit and dress shoes from a guy named Alex who lived down the hall from me. I had no idea what a real interview entailed. Sure, I’d swept movie theater floors, washed toilets, cut trees, built houses, but never had a desk job. That is a different beast. The interview began with about a minute of pleasant conversation, and degenerated into a brain teaser session. For those of you who lived only in the Google era, convoluted brain exercises during tech interviews existed ages before Google came along.

Remarkably, I managed through about ten problems involving spilled water, 2-quart containers, and 50-cent pieces.

“Good, ” the interviewer declared, “most people never get more than two of these correct, but unfortunately we still have to check your computer science knowledge. I’ll give you an easy one, since you did so well on the logic puzzles.

“What’s negative 6 written in 8-bit twos complement notation?”

F-ck.

Twos complement is a fundamental notation found in logic systems. In integrated circuits, each wire has two states, on or off. There is either electricity flowing through the wire, or not. A wire with power is represented in binary as a ’1′. All calculations are grounded on the twos complement system. All computing circuitry invokes logic represented by twos complement. With an 8-bit register, the number 6 is represented simply in binary notation, like this:

00000110

Negative numbers are represented by inverting the bits of their positive counterparts, and adding ’1′. Thus, -6 looks like this:

00000110 => 11111001 => (add 1) => 11111010

Any geek who tinkers with computer science would have known that. Not me. I was unable to write ‘-6′ in twos complement notation, and did not get the job. However, I received a Razor scooter as a consolation prize and was offered a priority internship consideration the next year.

I never followed up on that position, and am now an ophthalmology resident. It is incredible how much one event can impact your career.

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.

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?

Take language, for example. Aside from the broken Spanish I acquire from my Hispanic patients, I rarely invoke English dictum beyond the eighth grade. Our vocabulary in the office is limited to a defined collection of complex medical terms strung together with linking verbs and qualifiers describing outcomes (hemorrhage, blindness, infection, inflammation). Outside of  the office, I’ve struggled to identify common objects like “spoon” and “basket” without using hand gestures.

Is this shift simply a result of natural selection (adaptation on steroids!)? French naturalist Jean Lamarck coined terms like “use” and “disuse” for adaptation spanning generations. Are professionals contributing to their own extinction by being good at their job?

It would be interesting to measure cortical function throughout the course of medical school. This could be followed with serial PET scans to localize metabolic activity in the brain. Areas that fail to sustain signal can be used to correlate with mapped cortical regions. Indeed, a spatial correlation in such an experiment would be damming to future physicians-to-be…

“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. *

In medical school, we were forbidden to wear open toed shoes while in the hospital. After all, who wants to have ascites or a bloody mess on your feet? The potential consequences of walking barefoot in the operating room are even more severe. Imagine delivering a C-section without proper gowns! With needles and other dangerously sharp equipment lingering around the OR, who wouldn’t be wearing shoes?

Indeed, I was uneasy the first time my attending told me to take off my shoes when I was operating as primary surgeon. Since then, I’ve realized that it’s nearly impossible to control the microscope and the Infiniti (I’ve only used the cautery mode) while wearing shoes. The pedals for the operating microscope control the focus and zoom on the operating field. A four-way joystick is situated above the pedals. An additional four buttons are also on the platform surrounding the pedals. All of this is controlled using ONLY your LEFT foot. A similar configuration to control the phacoemulsification machine is  located on a separate platform for your RIGHT foot. Having tactile sensation on the pedals eases the difficulty of learning the machine, especially for newbies like me.

Still, I cringe every time we lose a needle (or #57 blade) on the ground.

The fact is that the majority of medical students are young adults who are likely halfway through maturity. They have been wildly successful in earlier life, and have managed to sidestep many consequences of inappropriate behavior through intellect. Some, fresh out of college, have never held a real job. Others have fed off the silver-platter, growing up in families of wealth or power. This group, regardless of their lineage, tries to blend into their socially acceptable age group.

This translates to posting their thoughts on Facebook, mySpace, or any other online social networking group. Like to whine about how your clinic patients irritate you on your Facebook wall? Probably not a great idea.  What about posting hilarious but true information about your hospital on your blog? <grin> Just remember, there are consequences to all of your actions…

That anecdote reminded me that residents at one of the Georgian ophthalmology programs actually had a clinic in the local penitentiary. One day a week, the resident on service would sign in cataracts and other surgical cases in the “jail clinic”. In retrospect, it actually doesn’t sound too bad–no insurance issues to deal with (I’ve had my surgeries canceled because my patient didn’t have the right insurance) or accidental consumption of breakfast the day of surgery. Having prison inmates as your patients is a great system. They actually show up to your clinic on time and do what they are told. As their physicians, we’d be contributing to the governmental system.

In fact, my residency shares many similarities to that of a prison clinic. Last month, I examined an open globe laceration in the ED, similar to what I’d see in prison fights. Another one of my clinic patients came into the ED handcuffed (and foot-cuffed) to the exam chair. The only difference between my patients and those at the prison is that the cops guarding my patients are smoking outside the hospital while I am alone examining the criminal. What fun.

Indeed this is an exciting moment in my training career…

I ordered an important textbook last week, and apparently the UPS carrier attempted to deliver it twice without success. The first time, he left a note on my apartment door stating that he will reattempt delivery tomorrow. I left a note on my door asking him to leave it with my neighbor or at my doorstep. The second day, he left a note OUTSIDE my building stating that he will reattempt one more time. Dammit.

I called UPS that evening to hold my package for pickup, but never received a callback. I called the central office, and they told me that the UPS center in my area (Bronx) doesn’t have working phones, but I could go by within the next 15 minutes to pick it up. Given that a direct cab ride to the service center would take at least 20 minutes, I told them to reattempt deliver to ANYONE in my building the next and final time.

Later that evening (9:30pm), I heard my doorbell ring. My hopes rose as I thought that the UPS carrier had doubled back on his delivery route.

Two teenage guys dressed in starched shirts and black pants and tie greeted me at my door. One was carrying a thick, leather-bound book with gold embellishments on the edges of the pages.

“Ni hao!” one of them exclaimed.

They must have understood my disgust through my body language, and handed me a card with an address to their establishment in town.

If the UPS man were only so fortuitous in his deliveries…