Awestruck.
I’m amazed at life right now. Last week I went to Vegas with the best apartment-mates ever and had an unforgettable time. We had countless spontaneous adventures, got to know amazing people, experienced nights like 21-year-olds should, didn’t sleep earlier than the sunrise, and made memories that I will never forget (sorry they’re secrets! Ask and maybe i’ll tell you).
That was great. But today I did a complete 180 and experienced a side that was thrilling and made me thankful for my life in a different way. I shadowed the ophthalmologist at the clinic and I swear I was on a medical high when I came out. Today, I feel, is more post-worthy to me than last week.
The day started at 9:30 when I met up with Dr. S. He was extremely friendly and understanding, and I could tell that patients were always happy to see him. It’s clear that he truly enjoys what he does for his patients, and is willing to accommodate for them as much as he can. Dr. S is one of the very few glaucoma specialists, so he knows his stuff. And I got to follow him around for the morning as he volunteered at the clinic for free, awestruck at the quick diagnostic decisions he made for patients all with different, special cases.
I have been administering 24-2’s for the past six months, and have never seen results as bad as those that i saw from the patients today. One patient had already lost vision in one eye due to glaucoma, and his IOP in his other eye indicated that if no action was taken soon, the same would happen. I watched as Dr. S catered all his treatments towards his patients, always kept them in the loop of what their options were in terms of treatment, and made an effort to make them laugh. I admitted to him that I had trouble understanding the ophthalmology lingo he used, and he reassured me that nobody really knows any of them until during their ophthalmology residency after the one year internship.
One particular case was the highlight of my day. A patient had had glaucoma in the late 1980s, and as treatment, the patient had gotten a trabeculectomy: a procedure in which the doctor peels back a small square of conjunctiva, and eventually an even smaller square of the sclera to act as a drainage hole system so that any intraocular fluid can drain through and prevent buildup (which causes the pressure symptomatic of glaucoma). Now, however, his IOP’s had gone back up and would be detrimental to his vision he didn’t receive treatment within the next month. The next step was to proceed with another surgery to implant a shunt into the eye to help with the drainage that had once again accumulated. The patient sat and listened to his options to proceed, followed by the benefits and risks of each. Then he said,
“Now here’s the kicker. I’m going to bring religion in now. And my faith says no surgery—only needles.”
Dr. S. had to rethink about what could be done. He finally let the patient know that he could take the patient back to his clinic in San Ramon, lie him in the operating room, stick a needle under his conjunctiva and try to clear up some of the scar tissue from his last procedure that could be blocking flow and causing the rise in pressure. It would be a five minute procedure. Dr. S., however, warned the patient that his office was two hours away, and would consist not only of the procedural visit itself, but also of many followups after.
The patient sat in his exam chair.
“Could you just do that now, then?” He said.
Although Dr. S looked slightly taken aback, he promptly answered that he could, but there was a higher success rate in an operating room where the patient could be lying down, Dr. S would have a better view with a microscope and conditions would be more sterile. “But if you really want me to, I can. I’ve done it before.”
The patient preferred that. Dr. S. left the room to consult with the clinic. When he came back, he informed me that he had managed to snag the clinics refractive surgery room, where he could use the operating bed there and the Lasik microscope to do it. “It’s not ideal, but it will make do,” he said to me. Then he added, “And you just thought you were coming in today to observe. You’re in for a treat.” I can’t even comprehend how excited I got.
In the room, Dr. S. prepped his instruments and tools. He told me that usually, someone else did this for him and everything was ready once he walked in. It was different to see him scrounging around in an alien operating room looking for tools that he could use. After he brought the patient in and sat him down, Dr. S. took off his own shoes. “I like to operate with my shoes off,” he said. Regular LASIK usually required the surgeon to use both hands and feet for control, so I guess he was used to it.
He looked at me. “Ready to poke some eyeballs with a needle?” I said yes.
I watched through a monitor hooked up right next to the microscope Dr. S was using as he began his procedure. His hands were steady as he used forceps to lift the conjunctiva, then insert the needle through the side of the sclera to clear the scar tissue that was blocking any drainage. Blood immediately filled the patient’s eye, but Dr. S. said this was an anomaly. The patient’s eye had started out red and inflamed to begin with, and this much bleeding usually didn’t occur.
The procedure took about ten minutes. Dr. S entered the target area from bothe sides of the sclera, using both his left and right hands to clear the area. Occasionally, Dr. S would ask his patient how he was doing as he worked on the anesthetized eye. After he finished, he showed me that around the area he had cleared, the medium around it had turned a more clearish-pink than a dense red. “That mean’s we cleared some tissue, and more aqueous fluid is flowing through now. We’ll just have to see whether or not we cleared enough.” With that, he patched up the eye and sent the patient on his way.
Dr. S had been given the challenge of doing a less than standard procedure out of the respect of someone’s personal faith, in a makeshift operating room with makeshifts tools, all the while having someone look over his shoulder while he operated. I am amazed at his confidence, his quick thinking skills, and his ability to adapt to different situations. He was also extremely genuine, as after the operation he took the time to take me back to his office and explain the physiology behind the procedure he had done and answered any questions (no matter how silly or stupid) that I had. Then he invited me to return any time to watch him again.
My shadowing day had started at 9:30 and was supposed to end at 12:00. It was now about 2 pm; time definitely flew by as I observed the fast paced environment of a doctor’s world.
I can’t wait to see what I’ll learn next!
