I slept about 4 hours over the course of 3 days I was on weekend call. The call day started off after a full day of clinic (about 10 hours).

Why?

Ophthalmology receives too many consults that aren’t legitimate. Despite what the emergency physicians or floor team thinks, there are many reasons why ophthalmology should NOT be consulted. For instance, a patient with diminishing vision while having a stroke in the occipital lobe probably doesn’t need at STAT (get your ass over here in 5 minutes or I’m reporting you to your program director) consult, especially if the patient’s not even on the floor.

If we were twiddling our thumbs waiting around for consults, we’d be glad to see your floor patient by the time you round in the morning, but that is not the case. Moreover, ophthalmology consults take a LONG time. Dilation drops require a good 30 minutes of wait time. A non-bullshit consult could take more than an hour for an average resident. Ten consults spaced out thirty minutes apart could potentially run over the course of an entire day.

When you do decide that your patient actually would benefit from an ophthalmology consult, tell your medical student to make sure he/she knows some basic information about the patient before calling:

1. Vision. Use a Neer card. The one on the back cover of Maxwell‘s is adequate. Know if the patient can see LIGHT.
2. Know if there’s redness in the eyes or purulent DISCHARGE. If you don’t know what that is, search for a picture online.
3. Know the patient’s name and where to find them.
4. Don’t call for a STAT consult over the phone when the ophthalmology consult is sitting next to you, and you just spoke to him less than 2 minutes ago regarding another patient–and have your STAT patient not even be on the floor for the next 2 hours.

It’s unfortunate that we never learned certain key vitals to make interactions with other services prompt, but we train for a minimum of 3 years. Hopefully we can all learn the system in that span of time.

medicine ophthalmology, rant

I received a copy of my annual residency contract, which I signed before reading. The first line reads:

This Agreement between [hospital] and [resident] is entered into for the 2009-2010 academic year, which is generally July 1, 2009 through June 30, 2010 but may begin earlier and end later if deemed necessary by the Hospital..

Aside from the grammatical inconsistencies of that statement, which includes the double period at the end, I could potentially work until December 31, 2010 under the contract on my fixed stipend!

That would be extremely uncool if it were enforced…

medicine ophthalmology, rant

One of the disadvantages of living in a building without a doorman is that you never know for certain whether you’ll receive any packages in the mail. Given that I am not home during daylight hours on every weekday, I can never be present to sign for a UPS/FedEx package.

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…

misc humor, rant

The community of patients that our ophthalmology clinic serves is notorious for providing bogus contact information. This includes phone numbers, addresses, and sometimes even ages. This is likely not intentional–they travel back and forth from their home country frequently. Many of them do not have a permanent U.S. address and provide a relative’s, friend’s, or neighbor’s when asked. This is problematic when we have to contact them.

For missed clinic appointments that is usually not a problem. They can reschedule at their own leisure, and there are usually enough patients to be seen in clinic already. Our surgical numbers, however, are dependent on our ability to reach our patients.

I had 2 patients that I’ve been trying to schedule for pterygium surgery, and none of their provided telephone numbers work. How can I reach them? I have a listed address on the demographic sheet, but should I go to their house to ask them to return to clinic for surgery?

Imagine that your doctor shows up at your doorstep to get you to have surgery. How would that feel? I wonder if he’d be treated like any other annoying traveling salesman hocking his wares.

I guess I’ll find out soon enough…

medicine ophthalmology, rant

The other day my laptop got “wormed” while I took down my firewall to do some software patches. I had forgotten to disconnect from the Internet, and after 30 mins of patching, my computer started acting weird. Before I knew it, a gazillion pop-up windows materialized on my desktop, and the computer became non-responsive, even after reboots. This is the one of the worst things that can happen to a computer literate user. I got hacked. This is what I get for not upgrading my copy of IE 6.0.

Sadly enough, the mirrored drive on my hard drive was not accessible (boot sector was hijacked), and I did not have a second computer to link up my laptop drive to recover some files. I spent the next 3 hours installing a non-IBM version of Windows XP and hunting Thinkpad drivers online. In the process of fiddling around, I discovered that my USB ports were blown–typical USB header on the laptop gets pushed back into the motherboard after long-term use. One of the capacitors were oozing as well.

Hardware and software failure almost inevitably means a new computer. What will my next computer be? Will it be a Mac? In the meantime, my computer is still functional, albeit in a limited form.

computing computing, rant