Posts Tagged ‘ophthalmologist’

Students playing with slit lamps

October 25, 2018

It’s as simple a one as you’ll find
And I hope that your teacher is kind
Concerning the eye,
Here’s the how, not the why
And playing beats the old grind

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania, western Nebraska and northern British Columbia. I have returned to Canada now for the 4th time. Any identifiable patient information has been included with permission.

Most doctors who take call have superstitions. We talk about not using the “q” word (quiet); to do so seems to bring disaster in the form of swarms of sick patients.

Personally, I will not answer a question about how call is going till I can do so in the past tense; I always say, “Ask me Monday.”

I can now say that call went well. I had the great pleasure of having 3 med students.

I asked the students to gather at the ER at 8:00AM, expecting a patient who didn’t show. With no clinical load, and no time pressure, I introduced them to the slit lamp at 8:30AM.

A slit lamp is, essentially, a stereoscopic microscope for examining live eyes in real-time. In larger centers, with ophthalmology (eye specialist) back up, the generalist has no need to learn to use one.  Because I shy away from those jobs, I have had to learn to use the instruments, and I did so by playing with them.

Slit lamps come in a variety of conformations and complexities; the one we have here appears old, simple and wonderfully functional by comparison to the slick, spiffy ones I’ve used in Alaska.

I showed the students the joy stick that enables a doc to focus on different eye structures, and the switch that changes the light playing on the eye from slit (hence the name) to circle to black light. Then I sat on the patient side of the instrument, put my chin and forehead in the right places, and, one by one, talked the students through the proper use.

Actually, I said, “Take off your glasses and have a play. This is about as simple a slit lamp as you’ll ever find.  We have no time pressure, you have complete support from everyone in the room, and you can’t hurt anybody.  Go for it.”

At the end, 5 minutes of play trumped the half-hour of didactics I didn’t  go into.

After we’d all played with the instrument, they asked when to use the slit lamp. “That,” I said, “Is a much longer talk and is best reserved for your ophthalmology rotation.”

I told stories about grouchy specialists and foreign bodies embedded in corneas. Eventually, I talked about Reiter’s syndrome: inflammation of the eye, urethra, and joints, frequently accompanied by fever and rash.

But I didn’t tell them the whole story about Reiter, a Nazi who did such terrible things in World War II that many in the medical community would like to use the term “reactive arthritis” and make the eponym anachronistic.

We were having too much fun playing with medical instruments.

 

 

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Even doctors have to wait to see the doctor

January 10, 2011

I don’t have a diagnosis or why,

As the tears run out of my eye.

     It’s just the creation

     Of a foreign body sensation

I’m really not one to cry.

I went to the Clinic Formerly Known As Mine as a patient today.  Despite a steady snowfall on top of six inches accumulation from yesterday, I went out into the cold, with the mercury here in Iowa reading two degrees colder than in Barrow, Alaska.

Two days ago my left eye started feeling scratchy, and I woke in the middle of the night to put in Celluvisc eye drops, which have worked well in the past.  They helped for a short time, then the sensation that I had a boulder stuck between my upper lid and my eyeball increased until, I was sure, the Rock of Gibraltar had taken up new residence.

I don’t mind waiting for my doctor.  In years past I have found a few minutes of peace and the chance to read a magazine in physician’s waiting rooms.  But today I sought relief from major, immediate physical discomfort.

During her examination the numbing drops from my doctor came as a wonderful relief, which I knew would only last twenty minutes.  The flourescein drops showed a small corneal abrasion.  My doctor inverted my upper lid but found nothing stuck there.

On the way out I received many hugs and questions about my upcoming plans.  I hope all patients are treated so warmly, especially on so cold a winter’s day.

You can’t call it a blizzard unless wind combines with cold and snow, but the white stuff has continued to fall for a day and a half and slippery doesn’t even come close to describing the roads.

On a day when going to the doctor carries significant risk, I drove to the drug store, fearing its closure.

I bought my prescriptions, and I also bought more Celluvisc.

I first made my acquaintance with this very soothing eye drop twenty-five years ago, and have recommended it frequently since.  If the problem went away in less than twenty-four hours with Celluvisc, it did not warrant a visit to the doctor. 

I broke open one of the single use units in the car before I drove away from the pharmacy, dropping the soothing artificial tears into my eye.  I waited to get home before using the antibiotic and the anti-inflammatory.

Continuing pain demanded more Celluvisc, a couple of Tylenol, and recumbent position with my eyes closed.  Two hours later, I called my friend, the ophthalmologist.  Two hours after that, he has not called me back yet. 

Just as well, most of the pain has gone.

Even doctors have to wait to see the doctor.