by Virgilio Gozum
My summer semester is coming to an end, but it has been quite eventful in clinic. I definitely feel that I’ve learned so much and that I’ve advanced my knowledge of the optometric arts, but along the way I’ve also had quite a few memorable patient encounters ranging in age from 1 to 90. Let’s talk about just a few of those within that range.
On Mondays, I started out in APC with Dr. Norton. Fourth year Adult Primary Care kept me and my suitemates – Braden, Jordan, and Jen – quite busy, and we would typically see five or six patients a day. At first, it took some acclimation, but 3rd year APC did prepare us well, especially in the spring.
Out of the many patients I saw in APC, I think I will always remember a few in particular. One patient, cap turned backwards, right pants leg cut off right above the knee, admitted to me with his greeting that he had a few…drinks before the exam. Ha! Alrighty then. I knew at that moment that this would be an eye exam to remember. Extremely nice guy, but he did have a propensity for exaggeration. For example, I highly doubt that he was a native Alaskan whose father shipped him off to Morocco as a teenager so that he could marry an exotic Moroccan princess (arranged marriage, of course) and father 25 half-Alaskan, half-Moroccan children. But all he needed were reading glasses, and he was grateful for an accurate prescription.
Another patient in APC was much, much more stately. At the young age of ninety, she hardly looked 65 to me. With just a few wrinkles of wisdom on her face and just the mildest of cataracts (!) and no systemic diseases, she possessed incredible health and vitality. This retired nurse’s secret? “Just keep busy,” she said, “and never stop moving.” Fine words to live by, and she told me fascinating stories of growing up in Memphis circa 1930-1940.
Halfway through the semester, we switched from APC to our new clinic at University Eye Care, at the University of Memphis. Still in its early phases, our schedule was a little lighter, though it has picked up it recent weeks. It was quite fun exploring the U of M, where my brother went to college. Speaking of whom…I had two patients who identified me as “Gian’s brother” as soon as they saw my nametag. Gotta love those small world moments!
Jen, Me, Jordan, and Braden – I’ve really enjoyed being with my clinic suitemates this semester.
On Tuesdays, I’ve had Vision Therapy in the morning with Drs. Eubank and Kehbein, and then halfway through we switched once again to Low Vision with Dr. Heard. Afternoon Tuesday clinics were spent with Dr. Kehbein and the Peds/VT residents. Two patients come to mind. The first was a 68 year old stroke patient that I saw with Dr. Eubank. Right before the start of the semester, he had suffered a mild stroke, which affected his memory and certain aspects of his visual perception. The week following was his first VT eval, and my first week of clinic was his first week of therapy. Throughout the first half of the semester, we worked on activities that worked on his memory and perception. I think through therapy, he realized that he had these deficits and was slightly in denial of them. However, he kept a good attitude and did the best that he could. Still, his progress from post-stroke to once again driving his familiar routes was quite something to behold, and he did say that the therapy helped.
My other Tuesday patient has turned into one of my favorites while at SCO. It all started in Pediatrics, when I first met my six year old patient. He is a rambunctious sort and is full of energy. Referred by an occupational therapist concerned about his visual function, we discovered that he has significant oculomotor dysfunction. Thus, the following week, I performed his VT evaluation, and just about every week since he’s been my most constant therapy patient.
In the beginning, I admit I was overwhelmed. I simply did not have the energy to match his own, nor did I feel creative enough to deal with all that freneticism. But after a few weeks, we started figuring things out together. I’ve learned that he performs much better when we work on activities together, as a team. Since that realization, our therapy sessions have been much more focused, and I am so proud of his progress so far. Just this week, I told him that next week would be my last, and he exclaimed, “Don’t go, ‘gilio!” That’s when it hit me that I’ve grown quite fond of our weekly vision therapy sessions and that I will miss the little guy.
As a quick aside (as if I ever have quick asides): part of the fun of working with this patient was tailoring the session to his needs and his personality. For example, as he is very active, he cannot sit still for very long for more static and “boring” (his words, not mine!) activites like Hart Chart Near/Far Rock, in which a patient reads a line of letters in the distance and then another line up close, in order to stimulate the accommodative system. So, cognizant of that fact, I came up with a more dynamic Hart Chart by typing up lines of large and small letters. I bound these lines to bean bags with rubber bands. For the procedure, I would have him read the larger line while the bean bag was in my hand, and then when I tossed it to him, he had to catch it and read the line of smaller letters. This activity was quite fun for him, and I was pleased that it actually worked. So, essentially he worked on his accommodative system with the lines and hand/eye coordination with the bean bags, all at once!
Alright, back to the discussion. Wednesdays are my Contact Lens days, and I’ve enjoyed having Dr. Cisarik and Dr. Jackson. It’s almost as if they have been my Contact Lens Mom and Dad. Having never really fit a contact lens before, I was admittedly intimidated by the prospect of it. However, my staff doctors provided much assurance and support, and I feel that I’ve learned so much about the art and science of contact lenses. As far as patients go…since Dr. Jackson has been my staff doctor in the evenings, we often see a lot of specialty fits. Keratoconus, orthokeratology (corneal rehaping), etc – these are just some of the things my group has encountered. I’ve encountered lawyers, other doctors, police officers, old people, young people, all sorts and all walks of life.
My first insertion and removal training was with a 13 year old male. He reminded me a little bit of me, as I was about that age when I first got contact lenses. Like my younger self, he had difficulty putting them in and taking them out, but got the hang of it. At his follow up exam, he proudly demonstrated that he could take them on and off in seconds and absolutely (and I mean absolutely!) loved his lenses. He made me feel like a superhero, to be honest, as if I had just changed his life. Come to think of it, however, I know mine did after contact lenses, so I shouldn’t be surprised.
Another memorable patient was about the same age. This was my very first day in contact lens, and I was working with the resident and one of her patients, a 14 year old orphan in less-than-ideal living situations. She too loved her lenses (“These are the only things keeping me happy,” she had told me), but I noticed that her lenses were switched. After mentioning this to the resident, it was elucidated to me that our patient had a history of poor compliance in the training interval with the lenses and likely did not have enough social support to continue wearing them safely. Sadly, I had to take away her lenses (remember, the only things that were keeping her happy). I tried to console her to the best of my ability, but it was little solace to her that I told her that she may be able to try again in East Tennessee when she gets older.
Oh, did I mention that the very next day she was supposed to move to a new foster home in East Tennessee? Yes, this was probably my most emotional patient encounter yet. It was heartbreaking. I hope she’s doing better.
Thursdays are my Ocular Disease days in which I alternate biweekly to having Dr. Hauser in the morning and Dr. Sharpe in the afternoon to having Drs. Kabat and Duncan in the same sequence. It’s been great, actually, seeing Ocular Disease from each of their different viewpoints. We’ve seen quite a bit – lots of glaucoma follow-ups, cataract post-ops, and red-eyes. One guy had a massive corneal abrasion but didn’t know how it got there. Another person had such wicked inflammation all over both eyes that we felt the need to refer her out; some systemic issues were likely at play. I haven’t heard yet about what the ophthalmologists have determined, but I hope we were able to catch something early.
Fridays in Pediatrics with an assortment of staff doctors (Drs. Kehbein, Taub, Bodack, Eubank, Esposito, Ashe, Tison, Harris, all at some point) started out somewhat slowly. Many families went on vacation in May/June. However, once the school year started approaching, the floodgates burst, and soon there were kids everywhere. I haven’t minded, though. I’ve come to enjoy pediatric exams. It’s fun interacting with these kids, and helping those who can’t see actually visualize their world (as I was once helped) is one of the greatest satisfactions so far. The youngest patient I’ve seen was just barely one. Happily, everything was normal. However, Braden saw a one year old who had a rather sudden onset cataract in the right eye. We were perplexed – she had seen an ophthalmologist just weeks before, and everything was fine! The surgeons did remove that cataract, but when one began to develop in the left eye, that baby was referred to a specialist all the way in Phildelphia. We have yet to hear back about the results of that exam.
Another aside: after putting dilation drops in kids’ eyes, if you don’t want to witness unhappiness, try to get them to forget the pain and stinging by having them do some physical activity. Jumping jacks, spinning around, dancing. I’ve found this an effective method on most (not all!) kids. Thanks to Dr. Bowersox (my staff doctor in SVOSH this year) for that tip, which has been a lifesaver!
What a memorable semester it’s been, and I can’t believe my time in The Eye Center is almost up. I’ve already begun saying farewell to the wonderful people I’ve been working with ever since first year, in addition to saying “see you later” to the city of Memphis. But yet, the learning will never end (thankfully!), and I am looking forward to my externship at SouthEast Eye Specialists in Chattanooga. But no matter where I go, I’ll always have great memories of my time in clinic at SCO.