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The Oldest Resident in an Eye Hospital

The Oldest Resident in an Eye Hospital

Just about halfway through our residency it happens, abruptly, unexpectedly. On a given morning, sometime during the third year of training, our schedule indicates that we’re the chief resident in the Emergency Room of the Rotterdam Eye Hospital. In our hospital, the chief resident in the ER is referred to as “De Oudste,” which literally means “The Oldest.” This is a relative term, since we’re only older than the other residents working in the ER that morning, but it sounds good. When we make the sudden transition from junior resident to Oudste, our tasks multiply. Although patient care remains our most important job, we’re also there to assist the four junior residents, manage patient flow and serve as a gateway for tertiary referrals. The Dutch are highly organised, efficient workers who hate chaos, so the Oudste is also expected to manage and motivate the whole ER team. Having internalised this mentality, I remind myself: “It’s not a circus; it’s an ER. Make sure it stays that way.”

That’s easier said than done. The four other residents can come to ask for advice regarding any patient they see. Nurses from the inpatient ward wait outside our exam room door, requesting clarification of patient care instructions prescribed by other doctors. Nurses from the patient phone hotline drop by for prescription refills for patients who have run out of eye drops. General practitioners call to discuss patients who are sitting before them in their examination room. General ophthalmologists call to ask whether they can refer their patients immediately, which of course they can. Subspecialists in our own hospital refer patients who need to be fast-tracked to the inpatient ward or to the operating room. And all the while, there’s a medical student sitting next to us on a little stool, trying to find a manageable way to both learn as much as possible and stay out of the way.

While I’m examining a retinal detachment, Itsje, a junior resident, walks into my exam room. “My patient’s IOP won’t decrease. I’ve already administered all the standard meds. What next?” she asks, looking at me as though I’ve been an ophthalmologist for 25 years. I try to play the part. “What’s the etiology? Uveitis? Steroid response? Posner- Schlossman? Closed angle? Neovascularisation?” I ask. “Um, I’m not sure,” she responds. “I’ll take another look.” “Okay, report back to me when you have some more information.”

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Colin Kerr
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