I wandered into the local Banana Republic the day after Christmas. They had a 50% off every item in the store if the item was purchased before noon. Luckily for everyone, they passed out tags to all customers who entered the store before noon, since the checkout line was packed. One shopper waited 50 minutes to pay for her items. Click the image for a montage.
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…
The further I progress in specializing in medicine, the more I realize how much my daily abilities deteriorate.
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…
It is difficult to find time to relax while in residency. For the ophthalmology resident, the time consumption of residency can be overwhelming, especially if your non-call days run from 7am-7pm (Sometimes 9:30pm). Many of our hobbies and pastimes are neglected in favor of more career-oriented activities.
I spoke with Drew Mays, an ophthalmologist at UAB, about the stresses of residency and a career. Drew won the Van Cliburn Amateur piano competition a few years ago while being program director of the UAB residency. He is tangible evidence that you can allocate time for your hobbies. To those of you who are unfamiliar with this venue, it consists of a gathering of would-be classical pianists who decided to pursue a career outside of music. Drew assured me that there will be a time after my training where I will find sufficient time to pursue my hobbies. He tells me that during residency, we have to prioritize our options to create the maximal ‘amount’ of happiness.
Not too profound advice, but it is indeed a fact that we lose sight of (no pun intended). The next time you feel lost in the midst of your training, think about Drew’s reassurance. It can help get you through the day.
One of the most painful aspects of clinic, at least where I work, is that nine out of ten patients I see daily do not speak English. While I feel that I’m reaching my limit at broadening my linguistic abilities, it is disheartening not to be able to communicate fully with your patients. I occasionally use the interpreter lines only when necessary, because it adds an insurmountable delay to the schedule that cannot possibly be regained. At times, even the interpreters have difficulty understanding a patient’s native tongue.
Today a patient came into emergency triage stating that she had lost vision suddenly in one eye a month ago, but only decided to come to the clinic today. She also denied ever being here in the clinic. To no surprise, we did not have any records of their encounters in the clinic either.
I spent the next hour toiling around to find an egregious cause for her vision loss, only to find non-specific drusen in her fundus. When my attending, who was fluent in Spanish, questioned the patient again, the story was relayed in a different manner than I gathered. She had GRADUAL vision loss over a month, and she also “lost” her glasses 20 days ago. Her chart also magically appeared underneath my progress note–I suppose one of the techs found it 4 hours later–and a workup of AMD was suggested in her plan.
Lesson learned: you can’t win.