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Eye Residency Peeped Through A Pinhole
Senior Ophthalmology Resident
Cardinal Santos Medical Center
By Alex Pisig, MD
The author, 3rd from left, with his co-residents in Cardinal Santos Medical Center
I find it too surreal reminiscing the 3 years that had just passed. It's unbelievable indeed, that all these times I spent training in the field of eye care will soon come to an end. Not too long ago after my medical board exams, I was in that phase of my life knowing not what to do, or where to go next. And again I'm nearing another crossroad that will literally set myself free on my own, albeit not necessarily knowing any better. And be it in a spectacular or ordinary end, that bittersweet feeling has been frantically creeping through my skin, cyclically reaching its highest sense on those days that I turn the last few pages of our OPD monthly calendar for 2013. Being sentimental is an understatement; for I'm expecting this residency training to yield the greatest impact on my medical career, not only professionally but also on those life's aspects not seen on the thickness of Kanski, Jakobiec's, and my 13-volume AAO-BCSC.
Ophthalmology residency training had taught me a LOT of things. It taught me this clinical specialty that I once considered rocket science in med school. I was struck in its sheer awesomeness back then that the mere idea of poking the eye with stainless instruments would send a chilling effect deep into my bones. And then the thought of manipulating it, puncturing and stabbing it in Olympic precision with those minuscule and expensive instruments, would send me into pre-syncope. I would be even more amazed knowing that there's actually a suture size of 10-0, which was way thinner than what I thought was the thinnest 4-0. "And how in the world would I even tie that?" I also remember wondering before.
So I treated ophthalmology as sacred. Holy. I placed it on a pedestal, and worshipped those who took its mastery. I believed it was just for the brightest, the crème dela crème, and for the über rich! That's why taking up this specialty for residency had NEVER crossed my mind during the entire course of my medical education. I was not a mediocre student! But I did not imagine draining my parents' money (again) for expensive equipments after graduation. I wanted to be a general surgeon. I still wanted to tease the human body into little pieces and reconstruct it back like Lego bricks. But not that freaky little eyeball; no, not on that one.
But things rather changed after I spent some time in the general clinics. I would observe patients who would come and go to the "Eye" cubicle at the corner of the multi-specialty center where I was in. I would notice those "blind" patients who were accompanied by some others to move around; and then after a few visits would miraculously ambulate through the hallway on his own. It would leave me dumbfounded and wondering whether Jesus came down from the heavens, entered that cubicle, and healed blindness of mankind once again. Then it would come to my senses that it was just my friendly neighbourhood ophthalmologist on the other side of the room doing his typical day job. I would be awestruck again. And these types of events would eventually awaken that desire for me to be that someone I once placed on a pedestal. I did not want to be God. I just realized I wanted to restore His precious gift of sight to people afflicted with its sickness.
I decided to jump ship (and drain my parents' pockets furthermore). I am not aware of any other specialty which requires applicants to complete a month-long basic course. That's how I find ophthalmology special because the board knew that it is completely unique from other life sciences. Of the yearly 120+ attendees of the basic course, only about 60 training slots nationwide awaits them. The screening process was painstaking and I was fortunate to land a spot for training. And throughout the course of residency, I would soon see that this modest pair of bite-sized balls in front of every person's head was not so modest at all; and that it is, certainly, rocket science. That obsessive-compulsive desire to covet the Utopian 20/20, J1 vision was imbued to our senses. Its minutiae were thoroughly imbibed and its complexities aimed to be like second nature. Eye care would then be made a daily habit and instinctive, later becoming inseparable to our psyche, like discovering how Pavlov conditioned his dogs. But this was definitely not a walk in the park. Residency is not just read-books-then-guess-what-you-see-then-do-what-you-have-just-read type of medical training. How I wish it was as simple as that.
Training is not solely a resident's function. All institutions involve the faculty, and it's them who exert a big hand on the outcome of the trainees. They are the mentors, and the tormentors depending on different circumstances, or tides of the moon. They guide us on what we should read and what we should know. They tell us what to do and what not to. The real test comes in grey circumstances, wherein one should decide whether or not to do what one was told to, and a passing mark comes when one emerges righteous after all. Grey lines in training are not uncommon, so the real tests come not infrequent. Problems would stem from patient management even though it is already written in black and white. But contentions would usually come from daily conflicts resulting from interaction with the faculty themselves, co-residents, and staff members.
Ophthalmologists, as doctors, are naturally people-oriented. So psychological and social skills would come out enhanced and developed as well, or negatively degraded among the weak during the course of training. Imagine dealing with multiple types of personalities. In government hospitals with numerous residents, that would possibly equate to dealing with tens of suck-ups or insubordinate juniors, uncooperative and selfish batchmates, histrionic and seducing seniors, and lunatic but equally bright professors. One may find a colleague and a boss whom he'll have a fun and comfortable time working with. But I still hear certain stories like someone having an explosive temperament then alludes verses from the Holy Bible to justify things in a holier-than-thou attitude. But still, many of them remains amazingly intelligent and talented in the field that their mere presence in service surgeries would already be deus ex machina in a Sophocles' tragedy.
Each hospital has its own system and environment which gives distinction to each resident's experience. But one thing fairly common to all will be the play of politics in all of these places, although perhaps in varying degrees. It is inevitable to interact with the system; and this part is what I consider taboo to all but essentially included in residency training. One may see an obsequious resident who wags his tail and looks with tantalizing eyes to please the bosses; or site a seeming introvert who wants to play coy or the anti-hero. One cannot blame them for being such. Maybe they're just genuinely Machiavellian, or only displaying their adaptive mechanism to adjust with the trying times of residency training. Residents should learn the art of interaction with others, but should avoid joining any of the bandwagon. It's all part of this improvised personality development program.
Then comes the nurses, technicians, and even anaesthesiology residents, whom trainees should approach in a courtly manner to make life easier. We cannot trash with them so they won't give their garbage to us. And we should not actually trash anyone in the first place! Our profession should be highlighted by a lot of respect and accord with our medical colleagues and non-medical personnel alike. But there's neither a print manual on this for residents to read; nor any Medical-Rapport-For-Dummies in bookstores available. Unfortunately, this has to be learned through trial and error; and that's why garbage still happens and is very much around residency. One can never quite forget the taste of his own blood.
Not everyone would enjoy residency training, but joy and happiness is fairly relative. A resident is fortunate if he sees himself like a goose prepped in time to lay golden eggs; or too unfortunate he sees a gavage-fed duck producing an exaggeratedly enlarged liver for incredibly delicious foie gras. I have enjoyed my residency training, and it will be marked as my greatest adventure in life so far. All these mentioned may be subjectively wrong. But after three years of training, I definitely have a clearer view, like peeping through a pinhole. I may still need full cyclopegic correction to glance at the clearest of things, but I would say without doubt that my residency training has succeeded. Our mentors have succeeded. Not only because they have imparted their knowledge to us, aspiring eye doctors, but also because they made us mature persons and valuable members of the medical community. And of course, all of these sacrifices are done for the benefit of our ultimate mentors, our patients, whom we dedicate our work for the preservation of God's gift of sight.
Click here to view the other published articles written by Dr. Alex Pisig:
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