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.

Interesting use. Could someone elaborate?

I try to explain to them that there is no need to arrive so early, especially if the normal wait is already painfully long. Apparently there is a loss of communication. I suspect that there is a rumor among the patients that arriving early at an appointment translates to leaving early. This is as likely to happen as winning at Pai Gao Poker.

I once had a patient who I needed to follow daily for a herpetic corneal ulcer. After four days, he simply stopped showing up. Later, he told me that it was impossible for him to work if he spent hours at the eye clinic daily. Other patients of mine come to clinic ad lib, for prescription refills only. Then there’s the majority of them who sit patiently for 3 hours in the waiting room to be sent to fluorescein angiography for 2 more hours for a proliferative diabetic retinopathy (PDR) workup.

Indeed, to be a clinic patient is to be a special patient.

Unfortunately, I have yet to receive any surveys in the months that I’ve enrolled. Perhaps they are a front to harvest physician data? Or have they run their fund dry?

In actuality, I think that there is a limited market for ophthalmology-based medical opinions. The service appears to mediate data harvesting. In order for the physician to receive a survey, there much be a client investor on the other end to field medical questions. No funding, no money. Simple as that.

Are there any other physicians out there who have actually received surveys or been paid by TruthOnCall? Let me know!

I chuckled when he showed me the bottle. I suppose that it was entertaining only because of my limited Spanish knowledge and I had been basking in our underground clinic’s flickering fluorescent lights the entire day.

“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. *

That brought back some memories of my experience during my family medicine rotation during internship. I had carried a nylon briefcase from the AAO 2008 meeting to work and one of the FM sub-i students remarked, “Is that a man-purse? Whoa!”

Mind you, the AAO briefcases do not even compare in quality or in metrosexuality as the Timbuk2 messenger bag above. If I had my way, she would have gotten an “F” for insight. Clearly the philistine doesn’t know the difference between a briefcase and a messenger bag.

Of course, we all know that hand washing with soap and water is the only means to eliminate C. difficile, the badness responsible for super-foul diarrhea and pseudomembranous colitis.

I hated using the alcohol sanitizers. It left a sticky residue on my fingers that did not instill the feeling of cleaniness. I only used it as an intermediary agent when I could not reach a sink in the vicinity.

It was only when I returned to NYC that this slimy waterless cleaning agent became useful, not in the hospital but in the city. On a busy day, I travel via subway at least twice daily, and exchange services with weather-beaten NYC cash (many vendors do not accept credit). One can only imagine how filthy subway handrails and doors are. I once witnessed a guy scratching his unspeakable bodily areas and then gripped the subway pole. Another guy wiped orange duck sauce from his take-out food onto the subway seat. Having Purell in the subway could never hurt.

Yesterday I prided myself for bringing Purell on my trip around the city for errands. As I was waiting for Sunny, the local falafel vendor, to prepare my lunch, I witnessed a sight no amount of hand sanitizer could cleanse. The vendor loaded my falafel using the same gloved hand he handled my cash in. So much for wearing gloves.

Sunny may never get my business again…

While the rules that govern distribution of the handicap permit vary by state, the general qualifications are similar. I believe that you must meet one or two of the following criteria:

• Inability to walk at least 200 feet without stopping to rest
• Use of portable oxygen
• Diagnosis of NYS Class III or IV heart failure
• Diagnosis of COPD, either end-stage or severely limiting.
• Wheelchair bound

The list continues with about a dozen more criteria, but I don’t believe that any of those disabilities actually prevent you from being able to work a clutch on a fast car.

The driver of the Nissan 300Z was a middle-aged man wearing thick-cut jeans and a flannel shirt. He didn’t seem like the heart failure type, and he wasn’t obese either. He did, however, light up a cigarette on his way out of the car to the Papa John’s pizza store.

Ah, the luxuries we have in the U.S…