Posted by on Apr 2, 2014 in Blogs | 0 comments

  shoes and equipment

Do you remember learning to ride a bike?

I remember the day vividly. It’s one of the more defining memories of my childhood, one I’ve been thinking about a lot these days. I’m sure my dad and twin brother have different accounts of what actually happened, but since neither of them blog, allow me to tell you the true story.

I was six. We were vacationing in Montana and it was a gorgeous summer day. My brother had already mastered riding his bike (a mere day and a half before, but of course he made it seem like he was practically the bicycle’s inventor). I was determined that today was my day. My bike was shiny and red. It deserved to soar past my gloating brother.

My dad is calm to the core. Even at my most reckless, I have always been able to rely on his steady, factual, collected demeanor to guide me. He assured me that he would hold the back of my bike seat and not let go.

With the steady weight of his hands on the seat, keeping my balance, I peddled. One leg winding around, then the other. I saw my brother in the periphery, eyes widened, watching me. I must have been having so much fun watching Montana’s landscape inch past me that I didn’t notice my dad had let go at first. But then all of a sudden it hit me: The steady guide of my dad’s hands weren’t there anymore. Instead of being excited and reacting like a normal person, I whipped my head backwards, saw my dad shrinking in the distance, screamed bloody murder, and fell.

My brother’s mirthless laughter echoed around me. I threw my bike off the path, and with eyes narrowed to slits announced to my dad that I would not be riding bikes ever ever again.

As a parent, I’m sure my dad had to learn how to let go. But at the same time, whether six or 26, it’s just as hard to learn how to be let go.

Fourth year externships are a constant reminder of my bicycling saga.

Right now, we are all students working under an attending doctor. While the independence we are afforded varies greatly from site to site, doctor to doctor, student to student, it’s something all fourth years have to face as we approach commencement in May. Ready or not, the steady hand on the back of the bike seat is coming off–and we will be signing charts and calling in prescriptions and interpreting visual fields. On our own.

This scares me senseless.

It’s not that I don’t know what I’m doing. I can spin the phoropter. My slit lamp and I have become one. (Side note: We are so lucky to have Haag-Streit machines at school. I feel like it’s the Lamborghini of slit lamps and now I don’t want a beat-up Chevy). I can prescribe multifocal soft contact lenses, evaluate diabetic retinopathy and perform vision therapy.

But let’s be real, I can do it because someone much smarter than me is looking over my shoulder and making sure I did it right.

There is a very real amount of solace that comes from knowing you aren’t the final name on the chart. Optometry is not life and death, but our findings (however small) affect people in very significant ways. I had a patient last week who complained of mild distance blur, and that it “just felt funny.” His visual acuity was 20/15 OD, OS and OU. His ocular health was perfect. My attending suggested I take his phorias at distance, and sure enough, he was esophoric. The constant strain of trying to diverge at distance the entire day had taken its toll on his fragile binocular system, contributing to his symptomatic decreased visual efficiency. We prescribed a little BO at distance and his symptoms were completely gone.

In a million years, I’m quite sure I wouldn’t have guessed that this patient’s phoric posture was contributory to his symptoms. I felt stupid and inadequate. But on the plus side, I checked phorias on the three next patients with similar complaints. I prescribed prism like a boss that day. And I learned to utilize the battery of tests we have tucked away in our pockets.

I guess that’s what externships are for.

To unearth the contents of our pockets, with the gentle prodding of a preceptor or attending, and discover what gems lie within. Like discovering a crisp $20 bill in an old pair of jeans, doing crazy tests like AC/A ratio or scleral depression can be wildly rewarding and help you hone in on a diagnosis. (Sometimes the contents of your pockets are lint, and prove to be not as useful.)

For me, externships have also been a lesson in calmness. I know you don’t believe me because I am joy and sunshine every minute of the day, but I’m a fairly frantic person. Sometimes all it takes is a little bump in the road to send me completely off my bicycle.

But after these rotations, I can honestly say I’m learning the art of zen. A bump is nothing to stumble over anymore.

A new patient came in last week with sudden decreased vision in her right eye. She had pain on EOMs, a 3+ APD, reduced color vision, red color de-saturation, and was understandably extremely worried.

My heart was racing and my brain was screaming “MS. MS. MS. MS!” But I kept my cool. I did the rest of her exam, revealing the most edematous nerve I had ever seen, and presented to my attending that she had optic neuritis and needed an immediate referral for an MRI.

In third year, this might have sent me for a tailspin. In fourth year, I’m still a little wobbly, but I’m not throwing the bike off the path and storming off anymore. Perhaps to reinforce the importance of keeping focused on pedaling forward, there were still 12 more patients to see in the morning, and another 12 after lunch. Multiple sclerosis or not, if you have a schedule, you keep to it.

Sometimes I feel like as fourth years, we are all little ducklings in a pond.

On the surface, we are nothing but poise and grace, floating effortlessly along the water. But underneath, as our little feet kick and kick, it’s commotion and turbulence everywhere.

Maybe one day I really will be more graceful and less turbulent. However, given how I reacted at age six, it seems unlikely.