(Art + Science) An Ocularist in Portland

Last night was Kaiser's annual ocular pathology forum. Every year we have education offered to all optometrists and any other people who'd like to attend. It was the first time I was back amidst the entire group (new and old docs). I used to be the person who planned these events, now I was just happy to be sitting in the audience.

One of the speakers, Fred Harwin, was a man who had a fine arts background and grew up to be a medical illustrator and was eventually recruited to make prosthetic eyes for Dever's Eye in Portland. He played for us this short artistic biographic documentary created by Vance Malone (of Portland also), which was entered into the 2003 Sundance film festival and received an honorable mention. It's a very interesting look into things that most of us are not aware of. It's a gorgeous marriage of art and science.

[Advice: Watch the film full screen size.]

The People of Walmart

"You know that orange VW van in the parking lot?" I asked my assistant, Felecia.

"Yeah, is that yours? I saw it and thought maybe it was yours and you were sleeping in the parking lot!" She was laughing.

I'm filling in at Walmart. Every day I park next to the VW van because it makes me happy. She'd seen my actual car too, with the magnets on the side for Justin's advertising business. 

It doesn't take long for the staff to figure out I'm a gypsy.

I dress up like a doctor. In corduroy skirts, sweaters and smart boots. I don't go as far as applying make up. But I wash my face and pull my hair back.

After a month and a half away from the clinic, I'm fresh and unburdened. Patient care comes naturally and I know I'm really making connections because my patients are open with me, and we're all laughing by the end.

The truth is I hate Walmart. I'm morally opposed to the place. When I returned to the states, my sister Molly used to ask me if it was ok if we went there. And it was. After four years overseas, I'd begun to understand why people liked shopping there. Everything under one roof, open 24 hours a day in some locations.

But I've gone back to my old ways, and I've personally banned the place due to their employment practices and their impact on the local community. I'm not sure how I feel about working alongside the optical shop there. But it's on a temporary basis and I need to keep my skills up to successfully pass the NC boards.

I decided that I wouldn't shop in Walmart the entire time I worked there. Then upgraded my challenge to not even set foot inside. And finally encompassed the whole shopping area surrounding the store (which includes any store you could ever dream of within about a ten block radius) to say that I am not going to buy anything except groceries.

Patients want to know what I'm doing there. When I tell them I live in the Outer Banks and just work when I want, it's met with usually acknowledgement of a good choice but sadness that I won't be there next time. The patients of Walmart are actually about half insured. Mostly black. Lots on Medicaid.  Only a few unemployed. Hard-working, basic people.

One woman who was about sixty with grey long hair and a heavily lined narrow face, asked me what I liked to read. I told her, "sustainability stuff, gardening, modern fiction, memoir." She kind of whispered, "Like Mother Earth News?" And when I nodded. "Are you a Hippie?"

I shrugged, "Maybe."

Then, "I took LSD!"

I didn't know what to say to that. Uhh thanks for sharing? I'm not that kind of hippie. But anyway. That's my patients. They spill everything.

Mostly I like the regular people who I see. I've yet to be mistreated by a patient, something which happened regularly by the retired military, ex-officer, NATO crowd.

My assistant is a sweet smart 25 year old from New Jersey. We keep the office peppy and it's actually even fun to be at work. Even if it's a Walmart. And I'm doing six days a week. It's only for a month, and then I'll be back to the Boonies of the Outer Banks for a while.

Boston Academy

Last week, the American Academy of Optometry held their annual conference in Boston. Since I'm currently living without commitments, I decided to head east less than a week before the conference commenced. I purchased a ticket out of Chicago on Spirit Airlines (a US budget carrier) and arranged to stay with my friend Xandra (Alexandra) who I met in the south island of New Zealand and now lives in Cambridge. It's a delight and surreal to re-meet people who I met on the road in their hometowns. On the road we are sort of floating about, so seeing someone indigenously helps to complete the picture of who they are.

The conference offered a wide variety of education and I surely benefited, picking up some new things and catching up on changes that have occurred in my profession during my last four years abroad. Also fun was seeing old friends and roommates from optometry school, a colleague from New Zealand, old professors, and making new friends. I was glad to go, and it's also good to be home.

Allston (below) is a suburb of Boston where Xandra and I had dinner. It's Portland-like with heaps of coffee shops, a few second hand stores, and vegetarian restaurants. I grabbed a bus there from the conference center to meet Xandra. Boston transport is very simple to figure out. I bought a one week unlimited fare pass for $15 on arrival, which covers all modes of transport in the metro area.

The last time I was here was when I was 14. My cousin Jenny and I would take the hotel shuttle down to this area, where we spent many hours shopping at Gap, which was something I did not have in North Dakota. The square looks the same but back then it seemed so amazing with possibility.

Inside Quincy Market.

Seeing soldiers return from deployment

Yesterday I read an article in Outside magazine, one I'd have originally skipped over, thinking another military story, I'm not interested. But these days it interests me. It's a chronicle of wounded veterans tackling a mountain in Nepal- a moving tale of adventure and spirit.

It's been a year since the big push to prep soldiers from the 172nd for deployment to Afghanistan. They've been trickling back for a while, but returning en masse recently, about 300 every other day. It changes the landscape- groups of greensuits are scattered alongside the road as I drive through post. For a long time, it was a ghost town.

Part of their reintegration is a trip to optometry for a vision check, so I see them in my exam chair. What a different feeling, the returning. An overall sense of ease and relief. I've asked what's the best thing about being back, and they answer: "A bed, time alone, food." The basics. But I know it's not that simple.

I'm a little sad that I'll be missing most of the soldiers- I have only nine days left in the clinic. But at least I've seen some- it makes the experience feel a little more full-circle. What I've mostly learned in these nearly two years is compassion. I didn't know much about the military except how to judge it. I now know the stories of the people behind the scenes: where they come from, their hopes and dreams, the difficulties of military life, the risks of service. I do believe that we'd benefit from some sort of mandatory national service.

Our clinic itself is in transition, with several staff members leaving this summer. Our chiropractor died of leukemia on Friday (he'd been sick for a while). The whole place feels a bit dark right now. So many emotions in the air. Life starts and stops when it wants to- what control do we really have over it? But I'm comforted that in difficult times, I've seen everyone pull together and do what should be done, for that is all you can do. One foot in front of the other... never knowing when it will be your last.

Comparing the numbers: optometrist

My grand total optometry exams over 2.5 weeks (during soldier readiness): 517
Average per day: 43
Average Army 8-hour day patient exams: 12
Average 10-hour Kaiser day patient exams: 20-22
Number of patients estimated over lifetime (since 2001, conservatively): 20,000+
Number days it takes to turn into a suicidal optometrist at 43 exams/day: 7
Number of years in school it took me to become an optometrist: 20
Number of years after graduation before I started thinking about going back to school: 3

News: Christi Himmelfahrt, Dave the Irish lad, SRP wrap up.

Heute (today) ist Vatertag und Christi (Christ) Himmelfahrt (sky-travel). It took some talking with Helga and her daughter to confirm it's Ascension day in the church and Father's day. In ten days comes Pentecost, called Pfingsten. I figured that out because of the ten day difference, being the good little Catholic girl that I am. Pfingsten doesn't translate into anything useful, just "Pentecost." Still, it's another few words.

This morning I got an email from David, the Irish guy who bought my registration. He said he did the marathon in 3:23 and the other two lads who were with him also secured registration and did it in 3:14 and 3:15. All much faster than I would've done. I'm sure the race people appreciated the improvement in time I offered by selling my registration. Thanks, foot! As always, there's good with bad- it was nice to get a note of thanks from him- makes me trust in the goodness of humanity.

Finally, the week is wrapping up and slowing down. The last few days, I've nearly been propped up at work. I've longed for Grandma's long-gone and never-used motorized cart at times! I've been going in at about 7AM every day, missing lunch and staying late to help get more soldiers through their exams, in exchange for an extra day or two off in the future. I've requested June 14th, an important national holiday, and my magnificent entrance onto earth. (Thanks mom!)

I will post the grand total exams after tomorrow. If there was a Guinness book for optometrists, I think I'd have a chance.

Mulholland Drive... strange as.

As the week progresses and my exam count mounts, I've become a nighttime couch-holder-downer. Tonight, I'd rented, okay, checked out from the library, Mulholland Drive, a David Lynch film from 2001.

I've never watched a David Lynch film. Heard about him but had no preconceived notions of what to expect.

All I can say is, it was an odd film. Odd, in a very strangely intriguing way. The sequences were shot in odd orders, like dreams, or life, and it's hard to know what really happened or what the point was, but, it made me think...

Especially since this morning I woke up wondering where I was, almost wondering who I was, laying on my cushy grey sheets, mouthguard in place, checking my watch to see the time. It was morning, before the alarm. I was still in Germany, and I knew I had loads of patients to go.

The days have stretched and my total exam record has been broken as each day begins anew. Today, with 50 exams, I was strangely calm, catching things like pigment dispersion, possible Horner's and an old paintball injury. Okay, so that last one wasn't really a catch.

Each day, there's been about 3-4 patients who really needed the full eye exam. I could just be doing glasses refractions- that's all they said I need to do. But I went to school to be an eye doctor, not a refractionist, so I'm still doing the full exam, even if it means losing lunch, staying late, not being able to feel my head at the end of the day and wondering who I am when I wake up.

I'm doing my best- it's the only thing I really can do. But I have a feeling after two and half weeks of this, the calm of a regular schedule and normal life will be strange as...

Averaging five an hour or more

What, you ask?

Exams. I say. Eye exams.

Isn't that a normal rate? That's about one every 12 minutes. Enough time to speed through a history, refraction, quick health check, order glasses and chuck 'em out the door. Your best efforts from Dr. Sara and Uncle Sam.

The patients are troopers. I go to the waiting room looking girly in my skirt and grey boots (they're the only shoes I can walk normal in since injuring my left foot) and ask, "Who's here for optometry SRP?" Six people sitting. Five raise their hands. The other's wearing glasses and just trying to be funny. They're all waiting for me. That's how it's been for the last two days, and I expect it'll be the same until the final day of our SRP, May 14th. (SRP is "Soldier Readiness Program.")

I was hired to be part of the surge team, those who prepare soldiers to leave and welcome them back upon return. This is where they really get their money's worth. This is where I'm really happy to have nearly ten years experience in my field and a background in HMO optometry. I know how to crank it up when I need to, and still remain personable. (Thanks, Kaiser!)

My patients are good sports. One of the history questions I'm required to ask is, "Are you in any pain today?" (Thanks to the folks at HEDIS.) I must then qualify, quantify and investigate it if they report anything. So far I've heard about back pain, tooth pain, big toe pain, headaches, foot pain, sinus pain, BUT NO EYE PAIN.

Today, I was asking the dumb question again, and my patient said he didn't have any pain. I said, "Thank god, I never hear anything relevant anyway." He said, "Well, my big toe kinda hurts." I laughed and said, "Someone told me about their toe pain!" He said someone told him to tell me about his toe pain. So apparently they talk to each other. I'm going to take that as they're having an good enough time in their twelve minutes with me. Enough to make a slight impression.

Hopefully they all come back safely in a year and see me again.

Slight procrastination on accomplishment posting

It's only been thirteen years since I got this diploma:
Deleted
And nine on this one:
Deleted

I finally got around to framing them since I have an office of my own for the first time in my professional life. We needed some credibility. This helps. Young women often don't look the way people imagine their eye doctor to look. I'm still getting the question, "How many years does it take to be an optometrist?" And other fishing-type questions. Now I can just refer them to the wall. With a flourish of the hand like Vanna White.

Home again, home again

Being back in Vilseck clinic today was a welcome homecoming. My little office, my little desk, my loving staff, my nice post. Sleeping in my own bed, under my covers, in my little house, above Ernst and Helga.

It's good to be away. It's good to be home.

I spent a good deal of time on the phone and email organising the logistics of my next TDY operation- two days a week covering a clinic in Katterbach, which is about an hour and a half away. I'll do a late start the first day, overnight at the hotel on post, then return home the second day. So it will be two shorter work days and one overnight. I spoke with my Katterbach assistant on the phone today and have a good feeling about it. It's not really what I was hired for, but I don't mind the change of pace and change of place. It keeps things interesting. It keeps me social.

My patients today were mostly sweet, ranging from retirees, dependents, new-to-Germany soldiers, and walk-in acutes. All races, multiple nationalities, all ages. I love the diversity in the population and the conversations I have with my patients. Of course there's a lot of eye talk, but there's also a lot surrounding life and adaption, backgrounds, and experiences. I find interesting stories every day.

Some say the army is a giant welfare system, and I guess in a way, it is. But then I guess you could say all employers, all countries are giant welfare systems. We are really all here taking care of each other in a way. And I think that is good.

Second week into my first TDY stint.

What is TDY?

It is "Temporary Duty Assignment." Yes, "Y" stands for "A." Okay, I made that one up.

I'm doing some optometry coverage in a town called Schweinfurt. I think means "pig fart" auf Deutsch. That's just my guess, so don't quote me.

The town is industrial and a business center, well off the beaten tourist path. It's interesting to be in a town again. When I first drove up, it seemed so big that I felt a touch of anxiety. Have I become a country girl again? Perhaps.

The reason I'm here is that one of our regular optometrists in Bavaria (from Katterbach) was deployed, thus creating a hole in the optometry coverage, which needs to be filled by juggling people around a bit. The regular optometrist here (Major Eddis) is going to Katterbach a couple
days a week. So I'm here in a hotel helping the locals.

I think anyway.

This morning, I racked up 12 patients in about 4 hours and this afternoon, another 8. I have to thank Kaiser for the speed of my skills and the ability to create meaningful social interactions with just ten minutes of patient contact time. Not a small feat.

In the menagerie of patients this morning, I also managed to lock up my ID card, which is how I am allowed to log into the computer and chart. I had the pleasure of driving to the other post here over lunch to plant my right index fingerprint on a reader and reset my pin, so that I would
not have a zillion charts to fix tomorrow.

The day is nearing the end. The sky is darking... My shoulder is paining. It is time to go.

Until tomorrow,
your trusty army optometrist,
Sara

Shipping delays... bosh!

I was so excited to have my stuff delivered but just got an email saying it would be delayed by at least a week, so now expected delivery is Dec 3 or 4. Ohh. I'm bummed, but what's another week in the same clothes?

Man oh man.

I'm going to move into my apartment with my sleeping bag. I don't care! I can't stay in the pension any longer.

Today we also had our first full day of patients, which went rather smoothly considering the call center accidentally scheduled every single slot and double-booked several. They also scheduled a full afternoon for two doctors even though Dr/Captain Carlson had to leave at 3PM for a meeting. (Normally optometry schedules their own patients, so this should just be a one-time affair.) I enjoy my patients, who are for the most part, coherent and upright, which is an improvement over the last two work places of mine. I also find the backstories of my patients interesting.

Case history- I'm listening.

In the New York Times this morning, I came across an editorial on the care of patients- something that's relevant for anyone in the healthcare field and also probably in many fields where we're being measured for our productivity and care by computer programs:
"Checking the right boxes, but failing the patient"

While I was learning to be an optometrist at Kaiser, I discovered that patients come in with all the answers. You just have to ask a few questions and take time to listen. Medicine is less objective than we're taught it is. Patients usually don't lie. People don't go to the doctor unless they have a problem. And they usually do have a problem when they think they do, however minor it is.

I used to have anxiety when a patient arrived with a convoluted history, when I could see their anxiety, when I felt like they needed reassurance and too much from me. Who was I? A counselor? Maybe they had hypochondria or something without explanation. Especially if they were a fifty year old female. It was implied in school that patients had a tendency to over exaggerate things and come in with too much anxiety. I should poo-poo them and send them on their way. Another dumb subconjunctival heme? That's nothing but a bruise in the eye. It will go away by itself.

But is it nothing?

Is it nothing if it's something that's causing my patient to sit at home and worry all weekend that they might be going blind? Is it worth a fifteen minute consult to discuss the dumb little thing that really doesn't need to be worried about? I think so. I figure if I can make someone's life easier, I will. And sometimes it's not a nothing, sometimes it's a big thing that we diagnose.

That is the part of medicine I like. The people. The story. The humanity. Listening.

I've come to feel that my patient's history tells the story and it truly is the most intruiguing part of the exam. If we as providers think of it as the patient's story and listen with human interest, I think it makes medicine feel very different. We're not going to get away from the checks and balances of the insurance industry. Or the productivity ratings of our employers. I still want to know if my patient's wife is having a baby this afternoon, if they are scared about their vision, and that they are human like me.



"Our lives begin to end the day we become silent about the things that matter."
-Martin Luther King

Day 1; First patient

This morning, I saw a 25 year old type two diabetic from Missouri. He' s been here three years, though has gone through deployments. Charting was successful after a few small hiccups. Once starting the exam, I realised I'm going to have to use the opposite side of my body from my prior optometry experiences. It will help improve my ambidextrous skills. In my free time at work, I've committed to studying Deutsch.

Today's word for you:
die Heftmachine: Stapler; zusammenheften: to staple. (zusammen means "together")

Computer evilness

Today I finally got computer access. It's been three weeks, two days since my arrival. However, sometime before I arrived the computer went missing (stolen) from my office, and the replacement computer in my office doesn't seem to want to grant me (or anyone) access, so I have access and no computer that works. We've opened our schedules for Monday morning. I hope I can chart. I have a class tomorrow and if my computer is not functioning on Friday, there will be hell coming from our department. Or I will just turn on my daze face and plow through the week.

It's frustrating, as all the stuff I need to do revolves around the computer. But. What can I do?

I'm excited to start seeing patients- real interactions with people should be pleasing I think. I have a feeling as a single female optometrist, it might be a little interesting also- I've been versed by another young woman what to expect and what to watch out for. The male-female ratio on the base is definitely a factor... It's entertaining at least. I think I can handle myself just fine.

Buying gas

This morning I spent with one of my assistants, Specialist Rhodes. She was trained in ophthalmology and has come with high regards from all the other optometrists in the area. There was quite a lot of shock all around from the events at Fort Hood in Texas this morning. Since I still don't have computer access at work and live off post, I hadn't heard by the time I reached work.

It's funny business working in the military but not being military. It's sort of like infiltrating the group, but having no what it really means to go through all the training they did. The benefits of the military are pretty decent, especially since I didn't have to join to get them.

However, this afternoon I spent nearly two hours getting a gas card and trying to buy gas. There were just lots of people in line. I thought, "So we're saving money with this, but all the time it's taking. What a waste." Then I guess life is just time, and is time in line really wasted? An existential question for a mundane activity, but it's what I was thinking as I waited in line to pay for my gas.

The whole proceeding went like this... I bought the car yesterday. I had it inspected (which is good for one year), registered it, and then had to wait 24 hours for it to get into the system so I could apply for a gas card. Today, I then went to the furniture store (not a typo) to get my gas (ration) card. The line wasn't particularly long, but it took about forty minutes or more to get to the front, where I was issued a card which allows me to buy 200 litres of gas per month at a subsidised rate, which is $3.10 per gallon at this time. It varies by week. Next I had to go to the front register, wait in line again to add money onto my card so that if I'm out on the economy (meaning Germany) I can purchase gas at the subsidised rates as long as I use an Esso.

I figured I should get some gas. Since I had the card. I got to the station. Pulled up on the wrong side of the car. And went to show my ID, gas card and car registration to the gas station attendent. There was a line. After I showed my IDs, I moved my car to the other side and waited as a man with a Smart car washed his windows (not bothering to move the car even though he was done filling up). Finally after filling my tank ($35 for 45 litres), I stood in line again to pay, where I had to swipe both my gas card and my debit card to pay for the gas. Now you understand how it took me two hours to fill my tank for the first time.

In other news, I've returned to the gym and took up running after one year off post-sick-Auckland-marathon. It feels good and I want to run every day, but I'm making myself ease into it. I may try another marathon yet. It's good to know I haven't lost my love for running. I thought I had! Perhaps the Prague Marathon will call to me. I wonder if they have kolaches at the finish line? Well at least there's a Turkey Trot at the end of November. I know I can handle that.



The pretesting room in my office. And our in/out board. I didn't write my name on there but I approve. :)

That's Bernie in the bakery by my pension where we used to meet before work before I got my hooptie.

The military... so far.

I'm having a great time in the military. Really. Granted I'm not IN the military, just immersed in the culture of it. Everyone's so nice. It's like a giant family. There's all colors of people. It's laid back. I laugh all the time. I got paid to walk around base and orient myself and go to the grocery store today. I took a class and test this morning and now have a temporary European driver's license- the official one'll be in the mail in about two weeks. Tried out the postal system today- US rates--- so easy. I got a military library account set up, which is good for all of Europe.
***

Yesterday, I met my techs and they're two black ladies- one about 30 and the other about 45 I'd guess-- both cool and helpful and asked, "coffee or tea" and what equipment I needed ordered. They said it's very laid back, "We listen to a lot of music back here." We'll see. I'm working with one other optometrist- Amber-something- (so our dept is all ladies) who I think is probably a newish grad. I'll only be seeing military and their families and contactors like myself also. All English- speakers. Currently the optometry department is housed in a portable building, as they've constructed a new one, which we're scheduled to move into in March 2010.
***

I decided against moving to the other pension. I was told the other place was a party place and I wouldn't get much sleep. So I am staying where I am where my bike is secure also. I've been scoping out cars- saw a cute (black inside and silver out) 1998 BMW 325i for 6,000 Euros, which is about $9,000 US or an adorable (black with camel leather) 2005 of the same for $17,000US. Any opinions, anyone? Then also a newish Ford Ka which is mini and gets kickin' gas mileage for 3400 euros. just have to keep my eyes peeled. I'm sure I'll figure it out.

California Dreamin'

Three days into my California excursion, I can't say that I'm more calm or truly on vacation, but I'm distracted and I'm not sitting in Portland waiting to see what happens next, so I guess that is all positive.

My mom came down and met me from North Dakota, so we tooled around the Southern California coast for the first two days, meeting several very nice California ladies in the towns of Carlsbad and Laguna Beach before heading back to La Jolla, where I've got three days of optometry continuing education scheduled. The first day of class was okay, mostly a bit dull, but some interesting aspects and I've come away knowing more than when I started.

Yesterday, I received a call from the Germany job regarding a physical form that needs to be completed. The stream of paperwork in this job appears to be endless, causing me to wonder sometimes what will truly happen with it. Though before I left, I met with two sets of movers to obtain quotes for shipping my 2800 lbs of belongings overseas. So that is promising.

I won't update status on the house sale just yet, only to say that closing is scheduled for October 12th. After that day occurs, I will file a full report on the fantastically horrible experience of the repossession and sale.

PDX and continuing ed fun

Store for special people.

Lulu's adorable sleeping boy.

My cabbie. Kyle.

The abstract Camry.

Nicole, walking the streets of Forest Grove, where I spent 1997 to 2001 in optometry school. You can tell she is from North Dakota too. She walks with purpose.

The Happy Shopper.

The Happy Shopper II.

Pacific Univ uses corn glasses. We are that enviro-advanced.

We were trying to pretend we were at the movies. I don't think we drank enough.

Nicole's self photos. I think this one was particularly nice with Nicole centered with people on either side of her.

She's a hottie. Did I mention she's from Fargo? That explains a lot.

How to lap your wine. In class.

Discreet disgust.

Crazy Fargo people. You saw the movie didn't you?

Abstract happiness.

Dear lord, help ,me.

ET phone us and beam us up!

Action shot.

Poor little Laotian boy. With eyelid infection. Preseptal Cellulitis.

Take us away! Please! How did I ever get through optometry school?

The answer is D. In case you didn't know.

Filling out the survey.

Optometrists learning. Look at the eagerness! The zest for new information! The thrill!

Last day

My final year students had their going away party last night in the cafe at the basement of the optometry school. A simple buffet and small speech from the head of department was the extent of the festivities. (Their formal graduation ceremony is not actually until May 2009.) We all walked over to a nearby bar afterward for a few more hours the Mustang Saloon (the same bar where I watched the televised Obama debates and election results).

It's funny to be at the end of things. I'm not graduating, but Ursula and I are both finished today along with all the students. I feel like I should have a deep realisation coming, or a firework finish to mark the end of things. But it's simply the end and the beginning for all of us, really.

This class taught me so much- mostly about life. I learned about teaching and optometry too. But more about people- the struggles that students go through to finish their degree - how caring most are underneath it all (despite my previous post).

Everyone's dispersing now. Many I won't ever see again, but I don't dwell on that. I always think you really never know. Goodbyes aren't meant to be sad.