My First Day in la Clinica

Yesterday was the first day I was able to see my first real patients. For two years I have been practicing techniques on fellow classmates, but that all changed yesterday as I was able to see total strangers.

My first patient was a 44 year-old male construction worker with a mini-mullet. He had bilateral bacterial conjunctivitis (eye infection) with his left eye worse than his right. I took a case history and performed pretesting (pupil responses, extra-ocular motilities, visual field testing, etc.) and did a slit lamp microscope exam on both eyes. I then instilled fluorscein dye in both eyes and looked at the corneal staining with the cobalt blue filter which allowed me to see any defects that the patient had as a result of the infection. It turned out that he had several corneal infiltrates, which are clusters of white blood cells that infiltrate the cornea in response to an infection. Corneal infiltrates are bad because they can cause a decrease in visual acuity because they can cause to overlying epithelial layers of the cornea to sluff off thus exposing the the cornea to further infection and possible ulceration. Infiltrates can also be one the pupillary axis and thus make it seem like something hazy is in front of the eye.

He was taking Vigamox (an ocular antibiotic) and Medrysone (steroid to reduce the infiltrates and inflammation). He had these medications from a previous infection. When I measured his IOP (intraocular pressure) I noticed that he had pressures that were about 30 mm Hg (about twice the average pressure). Since his pressures were high I told him to not take the steroid anymore because a possible side effect of ocular steroids is an increase in IOP. High IOP is worse than having corneal infiltrates and a little swelling so that's why I told him to stop using the steroid. The doctor wrote him a new prescription for Vigamox and I told him to come back the next day to check on the progress of his infection.

My next patient wasn't really my patient. It was another student's patient who spoke only Spanish. I was the translator during that exam. I love being able to use my Spanish skills and converse with the Latin people. They always seem so surprised that I can speak their language and are also very grateful. The only noteworthy finding was pterygia (see picture) in both eyes due to the patient being exposed to UV light in excess. The patient also had cataracts, which weren't that bad but were advanced for her age because of UV exposure. I was the only one in the clinic that day that could fluently speak Spanish, and because of that I was extremely busy as most of our patients didn't speak English (remember, Emilee and I live in Miami).

Is there a downside to being fluent in Spanish? The short answer is yes. I was so busy translating for other students and faculty that I wasn't able to see my own patients besides the construction worker that I mentioned above. Toward the end of my clinic experience yesterday, I realized that I needed concern myself more with practicing optometry and less with practicing my Spanish skills.

My friend Ben, who served his mission in Honduras, is starting a Spanish class for optometrists this summer. He asked me to help teach the class and I agreed. We start tomorrow and the class will last six weeks, during which we will cover how to get through an exam in Spanish with minimal confusion.