Days that make you glad to be leaving.

The day wasn't all bad. I saw a few interesting people: a woman who was diagnosed with glaucoma in her 30s; a patient with diabetes who refused the doctor's advice to see a physician; and a man who woke up blind in his right eye one morning and waited 10 days to see a doctor. For the man, the diagnosis was central serous retinopathy - a self-limiting buildup of fluid around the macula that resulted in count-finger acuity. The condition is often attributed to stress, which fits in this case since the guy's wife left him about three weeks ago. However, he was accompanied today by a rather affectionate young female. Intrigue...

It was just really busy today. One lady came in to replace a temple on her frame. I couldn't get the screw out for the life of me, so I had to pass the buck on to my more experienced coworker. I hate feeling so useless. Bested by spring-loaded temples once again.

I had to deal with one lady on the phone who was not impressed with the price she got on the sunglasses she ordered yesterday. All of us at the office have no idea where she would be able to find the same Coach frame for less then what she paid, but I wasn't about to challenge her. In the end, all I could do was assure her we gave her the best value we could. She was pretty nice about it, but I was just at a loss for words. More frustration.

The cherry on the top of the day came when another patient asked to make sure I know how to use a fax machine, because the prescription I was trying to send her was not getting through. I had to call her twice to let her know that the machine was not picking up, at which point she asked if I "normally send faxes" and requested that I "reset the system and try again". After I hung up, I did the exact same thing and sent the fax to the same number - and the stupid thing actually did go through. I'm sure that woman must have felt even more smug and certain that it was a mistake on my end. A similar thing has happened in the past, but the woman today was more accusing/mocking than the one from last time.
Gotta love these people.

Work days left: 2 !!!!

What's that smell?

Thanks be to God, who always leads us in triumphal procession in Christ and through us spreads everywhere the fragrance of the knowledge of him. For we are to God the aroma of Christ among those who are being saved and those who are perishing. To the one we are the smell of death; to the other, the fragrance of life. And who is equal to such a task? Unlike so many, we do not peddle the word of God for profit. On the contrary, in Christ we speak before God with sincerity, like men sent from God.

A couple of weeks ago my friend Monica and I went downtown for lunch. We went to Salad King, visited my friend at work, got some bubble tea, and decided to head back to the Eaton Centre just to hang out and shop around before we had to go on our ways home. We wandered around aimlessly, just chatting and perusing random merchandise. Since both of us went to Hong Kong this summer and have not fully readjusted to North American prices, we had no desire to actually buy anything. Instead, we made it our goal to trek the entirety of the mall just for fun (which led to, among other things, my discovery of a bathroom on the third floor of which I was not previously aware).
The last leg of our journey was to the lower Concourse level. There really isn't much down there - a small food court, a Mind Games Store, and an Athletes World? But in the spirit of why not, we headed down the escalator to visit the land down under. And as we descended, our conversation was suddenly interrupted - by a subtle, thoroughly delectable scent. It smelled like... chocolate? Pastries? We didn't know, but it was amazing.
The frantic foodies that we are, we immediately got really excited and looked all around to find the source of the aroma. But there was nothing in sight and no stores nearby that would identify it. What exactly it was, we will never know... but it was there, wafting into our noses so intensely that although we couldn't find where it came from, we knew it was real.

That experience helped me later to appreciate the above passage, 2 Corinthians 2:14-17. I've heard before that olfaction, the sense of smell, is the most primitive of the five senses. Babies learn to recognize the scent of their mother early on in infancy. Smell is strongly linked to the sense of taste, so something that smells bad is also considered to be unappetizing, and as well as to memory. For example, the scent of gingerbread reminds us of Christmas, the smell of mothballs reminds me of grandmother's closet, and the smell of oranges reminds me of three people in my life who I know really like oranges.
Now stop for a minute and think that Christians are the aroma of Christ. That we waft into people's lives, and they sense God living in us and loving through us. They may not know the source of the scent right away, but they are making up their minds about it: "to the one we are the smell of death; to the other, the fragrance of life" (v.16). This verse makes me think of the Lush store that is at the Eaton Centre, right near the Dundas subway station entrance. Every time I walk by to get to the subway, it makes me want to gag. But I can only assume there are people out there who really like that smell (even though it smells like a fistful of potpourri and a bar of soap shoved down your throat at the same time).
In the end, for those that find the scent appealing and keep searching, they will eventually find the source, and "taste and see that the Lord is good" (Ps. 34:8). But as Children of God, we are the aroma, the first sense that many people get of Christ. An important job, but then again, not really a job at all: it's just what we are. People inviting other people to taste and see - and feel and hear - the Living God.

FDT and VFs.

I decided I should finally look into what FDT actually is, since the perimeter at work is different from the typical Humphrey Visual Field Analyzer I've seen before. Traditionally perimetry is done by presenting lights in the patient's periphery while they are fixated on a central target to see whether their retinal sensitivity is good enough to detect it or not. The FDT Perimeter uses a vertical sine wave grating as a stimulus:

It flickers at 25 Hz, with variable target size and contrast. And at a high temporal frequency, the spatial frequency appears to be doubled - thus, Frequency Doubling Technology, or FDT.

Points of interest:
1.

The large low spatial frequency targets are not significantly affected by refractive errors up to 6D, so optimal near correction is not needed

2. FDT perimetry is based on this phenomenon:

when an achromatic sinusoidal grating of low spatial frequency undergoes counterphased flickering at a high temporal frequency, the apparent spatial frequency of the grating appears to be doubled.

3.

FDT offers many advantages in that it is easy to administer and interpret, liked by most patients, not greatly affected by refractive error and cataract, has high test-retest reliability, offers rapid screening tests, and has different full threshold programs.

OC's and Δ

Today I spent like 20 minutes trying to fix a screw in a pair of glasses -- way too long. But on the plus side I finally got to learn about the nut and bolt assembly instead of using a temple screw, and I played around with some of the tools for that (ie. hexnut screwdriver, crimpers, file). I guess I should really look into finally purchasing that set of adjustment tools...
Oh also there's this adhesive called LocTite that can be used to keep temple screws tight over time. And apparently acetone can be used to remove paint from lenses without damaging the coatings.

I also received another lesson in anisometropia too. If a patient is +1.50 OD and -1.50 OS, and they look away 1 cm away from the optical centres, what do they get? Apparently... diplopia. And 3 prism dioptres of strain on the EOM. Oh this all sounds ever so vaguely familiar.


Work days left: 10

Hot potato.

Today I learned that co-management with ophthalmologists is like "a game of hot potato".. you don't wanna be the one stuck holding it! So: refer, refer, refer.
I'm also picking up a lot of tips on how to handle patients and meet their needs. Sometimes they won't give you the whole story, or say one thing when the issue is really something else, so you just need to take the time and effort to inquire a bit further.

Work days left: 11

DR and unhappy Px's

It was the Tuesday that felt like a Monday. I guess since yesterday wasn't that busy, today decided to make up for it.
Today I learned that it's important to communicate your expectations. A patient called and said that he was unhappy with the service that he received at his appointment in June, and wanted to switch healthcare providers. In the end, it turned out that there was just a miscommunication about what the doctor thought was important, and what the patient wanted at the time. Tiffs like this can also be easily cleared up by swallowing your pride and apologizing, and doing what it takes to right the wrong.
I also got to do direct ophthalmoscopy on one patient with diabetes who presented with a vitreous hemorrhage OD, just to get an idea of what the view looks like through a cloudy vitreous -- really shoddy.

Today's homework: pre-retinal and vitreous hemorrhages, prognosis, treatments; diabetic retinopathy

Work days left: 13

CLTs and BCs

For a Monday, today was not all that busy. The morning was a blur of answering phones and checking in patients, and nothing too out of the ordinary (except for one elderly lady who kept me on the phone for an extraordinarily long time). In the afternoon I did my first ever frame adjustment for a patient on my own, since my manager was busy with a contact lens teach. I also attempted a screw replacement for a spring-loaded temple, but it was unsuccessful...

I also need to get a lens clock. Apparently base curves are pretty important. If a person gets a new pair of glasses that have a front curvature that is different from what they're accustomed to wearing, it leads to perceptual problems that can be very difficult to adapt to.

Tomorrow I switched my shift with my friend so I have to open. Which means no sleeping in :(

Work days left: 14

OCT and ERM

Since summer's almost over and the countdown to my last day of work has begun, I decided that it might help the days go by faster and more memorably if I start documenting the things I see and learn at work.



Today I got to see the elusive OCT (optical coherence tomography) machine, which provides high-resolution cross-sectional images of the retina using light waves that are reflected in varying amounts by the different retinal layers. (See sample above.) Two-dimensional data sets taken in two meridians can be further used to create a three-dimensional representation of the patient's retina around the macula. This test is not part of a normal oculo-visual assessment; it incurs a separate cost ($85 where I work). It takes about 15-20 minutes for a compliant patient, and is recommended for those with macular pathology - for example, patients with diabetic retinopathy, which was the case today.

Hard deposits around the macula were evident in the patient's fundus photos. With the OCT images, you could see the edematous elevations around the macula. Focal hemorrhages were noted, as well as an epiretinal membrane OS. Epiretinal membranes (ERMs) are commonly associated with retinal vascular disorders. Cells liberated through a retinal break proliferate on the retina, resulting in tractional forces that can cause visual distortion, macular holes, and cystoid macular edema. Approximately 90% of ERMs stabilize or regress, otherwise they can be peeled away surgically.

I also learned a bit about Barter Networks, which allow people to acquire services by trading their time and services using a point system.

And there is also supposedly a new drug that 'reverses glaucoma'!

Workdays left: 16

The big question.

Are you happy?

I didn't even know what to say about this, except that I can't get this question off of my mind. The first time I was asked it, at the start of summer, I was a little thrown off. I hadn't heard anybody ask that since perhaps the days of elementary school when "Are you happy now?!" was used maliciously or sarcastically. My friend who asked me explained to me why she thought I was sad. But I assured her I wasn't.

Since that first time, two other people have on two separate occasions asked me the same thing. And I still can't figure out why I find it such an odd question to answer. Usually people can tell if you're happy or not by observation. In some ways, it is quite refreshing to pause and realize - to become fully and consciously aware - that I am happy. It's nice to know that I have friends that care enough to ask how I feel.

I guess I hadn't noticed the shift over time in the definition of happiness. It's no longer just a transient feeling, the way a child is happy when he gets a new toy, or when something good happens; it's a state of being content. People can appear outwardly happy, but be desperate and broken inside -- I should know, I've been there.

But anyway I guess there wasn't really anywhere I was going with this all, except to ask, "Are you happy?"

I am. ☺

Jesus said..."I have come that they may have life, and have it to the full." John 10:10

1 Corinthians 13.

4Love is patient, love is kind. It does not envy, it does not boast, it is not proud. 5It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. 6Love does not delight in evil but rejoices with the truth. 7It always protects, always trusts, always hopes, always perseveres.

This is one of those passages that many people grow up knowing and quoting. I remember having to memorize it in Sunday School as a child. I have since heard it countless times, reiterated zealously by pastors from the pulpits on a Sunday morning, or uttered during wedding ceremonies as a declaration of the promises that a bride and groom are making to one another.

It was no wonder then, that I applied this passage to my understanding of agape - God's love for humanity - and eros, romantic love. Yes, it also carries a lot of truth that can be applied very generally, so I did my best to be patient, kind, and so on, in order to be "loving" to other people. But in retrospect it was always one of those passages for me that sounded very nice but honestly didn't bear much weight.

But more recently I began to take this little gem and look at it back in its context. The bit that precedes it says:

1If I speak in the tongues of men and of angels, but have not love, I am only a resounding gong or a clanging cymbal. 2If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have a faith that can move mountains, but have not love, I am nothing. 3If I give all I possess to the poor and surrender my body to the flames, but have not love, I gain nothing.

The logical question that follows is, What is love? See v.4-7.

And to what effect?

8Love never fails.

Love then, is not just what we ought to have for one other because it's 'nice'. It is necessary. It is everything.

13And now these three remain: faith, hope and love. But the greatest of these is love.

"What have you learned so far?"

This is the question that I was posed by Dr. R late Thursday afternoon. He actually stopped me as I was going about, closing up for the day, and asked what I've learned in the... four days I'd spent working at his optometry office. I was caught totally off-guard, I didn't even know what to say. In my shaken state I answered something totally random and retarded about the visual field machine and how it's unlike the one we use at school. (Worst answer ever, I really shouldn't ever go on a gameshow.) And something about practice management... and... then I quickly changed the subject.

Usually I can think relatively quickly when put on the spot, and not sound like an idiot. But I guess it was so unexpected that I was left speechless to think that: 1) I should have learned something after only four days of employment, and 2) my employer would be personally interested to know that I am taking something away from the experience.

So after that incident I figured I ought to sit down and really think about what I learned. Here's what I came up with:

Lesson from Day #1: Four days of R&R is not enough time for my body to fix jet lag.
Lessons from Day #2: 1) To adjust the height of the VF machine, press the arrows on the table; 2) Clinical software is retarded.
Lesson from Day #3: ... come to think of it... it might be that I need to back up files after using the fundus camera software... Shoot, I need to check on Monday if all the images I rendered are still there.
Lesson from Day #4: Always have an answer ready for when your boss asks you a question.

OK but seriously, I guess it was a cool reminder that every day and every experience can be an opportunity to learn, even though I don't always consciously register it. It can be something small, like observing a contact lens teach done a little differently, or something more significant, like realizing that sometimes I'm really not as quick as I think I am. Either way, no matter how smart or capable we think we are, it is refreshing to know there is always something new to learn, and humbling to think that we can only learn it from other people.


Addendum: Upon further reflection I remembered that I didn't close on Wednesday so I'm sure one of my coworkers backed up the files... I hope? I'm still gonna check on Mon. And all the same, lesson learned.

Play to win.

²⁴Do you not know that in a race all the runners run, but only one gets the prize? Run in such a way as to get the prize.

²⁵Everyone who competes in the games goes into strict training. They do it to get a crown that will not last; but we do it to get a crown that will last forever. ²⁶Therefore I do not run like a man running aimlessly; I do not fight like a man beating the air. ²⁷No, I beat my body and make it my slave so that after I have preached to others, I myself will not be disqualified for the prize.

Over six weeks of vacation, I quite literally became a sloth. So yesterday, having decided it's been far too long since my last bout of any sort of physical activity, I went for a jog. Since I've been reading 1 Corinthians over the past little while, this bit from Ch 9 popped into my head while I was plodding along in the warm glow of the evening sun.

When I used to read this passage, I always skipped over it because this metaphor that Paul employs wasn't something I could really understand. In grade school, just trying something out and giving it a shot was good enough. After all, I got ribbons just for participating anyway - what was the big deal about trying so hard to win? Especially in something like running. I've run my share of races - track as well as cross-country - and there is no way in life that I could win against the 6-foot gigantors out there.

Over time, after picking up team sports, I tasted victory - and it is sweet. Winning is still not the most important thing, but you definitely don't play to lose. And in order not to lose, you train. That means dragging your butt to softball practice after a long day of work even though you don't feel like it. It means hauling yourself half-asleep out of bed at 6am on a Saturday for hockey practice when you could be sleeping on your day off. It means endless repetitive drills - shots, crossovers, passes, throws, batting practice - to train your body so that you can do it right when it matters.

Why should anything else in life be any different? Every minute, every breath - we are living in the game. Why aim merely to get a passing grade, instead of reaching for that ever elusive 90? And why call ourselves Children of God and continue to live in bondage or without a purpose?

Returning from vacation mode involves getting back into shape physically, but also sharpening myself mentally and spiritually. And in everything we know that we are never running the race alone.

Summer vacay 09 - over and out.

Things I will miss about HK:
- cheaper cost of living
- vacation mode: eating and shopping all day, sleep, and repeat
- not having to calculate tax in my head
- 7-11's everywhere
- Octopus card
- mountains and harbours
- convenience of getting around

Things I will not miss about HK:
- the insane heat and humidity
- people smoking everywhere
- population density
- not being able to read menus or signs

After six weeks abroad, it's finally time to call it a day and return to the grind.

This year's Easter reflection.

"For the message of the cross is foolishness to those who are perishing, but to us who are being saved it is the power of God." 1 Cor 1:18

Sitting in church today, watching the drama reenacting the Easter story, listening to Pastor Ken talk excitedly about Jesus resurrected, and animatedly singing songs celebrating the victory of the cross over death, I couldn't help but marvel at how silly and futile it would all be if Jesus did not indeed rise from the dead.

But He is risen. He is risen indeed.

Parents ♥.

Yesterday was UW School of Optometry's Inaugural White Coat Ceremony. It was a weeknight, so I told my parents not to come.

Today I sent a photo to my dad over msn.

His reply:

9:45:20 PM Tim_tim: what is the photo stands?
9:45:33 PM Tim_tim: some one put a jacket on u
9:45:43 PM Tim_tim: who is this gentleman>

(I explained that the ceremony is an induction of sorts into the professional community, and that is a prof at my school.)

I also emailed photos to my mom.
Her reply:

Congregation, hope you enjoy this proferssion, and ask God using you.

Mom


I loves Engrish :D

Resolution check.

Reading: good so far, have finished Charles Mulli biography and Bridget Jones's Diary. Started first page of Mere Christianity. Was supposed to continue reading it today, but got sidetracked by bigger task (mentioned later)

Swimming: have not gone yet, but started core fitness class this week

Generosity: not great, tip at Mel's today was probably too small, blame weak math skills.

Tithing: wrote check for Creekside, must remember to bring it on Sunday.

Msn: good for past while, but was online all of today, talking about aforementioned bigger task

Impulse buying: ultimate fail. The task: within 13 hours of hearing about Air Canada seat sale to HK, I decided to go, cleared with parents, picked dates, and purchased tickets. Will be vacationing May 1-June 13.

oh yah, and Drinking: signed up for winter retreat, so now definitely going and not to Andrew's open bar wedding. A little bit sad, but looking forward to retreat too, and liver will thank me later.

The plan.

She stopped and turned to Charles. "Will it work?"
"My prayers?"
"Yes."
"It will help. To what extent, I don't know."
"But how can you not know?"
Charles gave a brief smile and then returned to the gravity of the situation that surrounded them. "I don't have to know. I'm not supposed to know. I'm supposed to be obedient. That's why I'm here. This is why I've come."

Last Friday we were asked at fellowship what our goals and visions are for the term. I really had nothing smart to say or share; just some stuff about wanting to serve again, and get to know God again.
We did the same sort of thing last night at small group. And in five short days, I was able to develop more specific goals/visions, thanks in part to the Charles Mulli biography I was reading. After finishing it, I realize how hardened and skeptical I've become, and how little faith I really have. I think a major thing that I forgot was that we are called simply to obey. To seek God's will, and to follow it. It's not our job to know how things will turn out, but if you are doing things for God, you can't fail.

So, action plan:
1. be more proactive in looking for ways to serve/help, ie. at fellowship. starting with... leading discussion group tomorrow. It's been years since I've served/led at CCF, I'm scared.
2. pray for this potential mission trip to Kenya. It's still in the works, so I'm not even sure it will happen. I was really concerned about the cost - I still am - but after reading the book, I know that money is never a roadblock in doing God's work.
3. tithe/donate 10% of this term's bursaries
4. take more responsibility and learn to plan ahead (in general), ie. start applying for summer jobs, looking for sublets, etc.

To what end? So that after all is said and done, I can look up and say:

"I've done what I can. We will continue to pray and wait and see."

2009.

More.
☝ reading
☝ swimming
☝ generosity
☝ tithing

Less.
☟ msn
☟ impulse buying
☟ (binge) drinking

The birthday epiphany.

My sister likes to make fun of me because on my birthday, my favourite line to use is "It's my birthday" as an end-all-be-all. And why shouldn't it be? Birthdays are the one day of the year that allow us to throw parties and get presents for no reason of our own merit.
Throughout high school I used to love planning something to do with friends - go out for dinner, have cake, go skating, or something. But for the past several years, University exams would keep me in Waterloo until the days leading up to Christmas, and then my family and another family of our close friends would go to the States for Boxing Day shopping. As a result, I have spent my last several birthdays out of the country. My dad's friend, whose family we shopped with on these trips, also has a December birthday. But his is right on Christmas. Both our families would go out for a nice dinner together for Christmas, and at the end, we would get him a cake and sing happy birthday. Then my parents would bring the cake over to me and tell me to take a picture with it so it's like we're celebrating my birthday too. They did this every year, and somehow never stopped thinking it was funny. And every year I would get really embarrassed, because my parents were making a scene in a nice restaurant, and annoyed, because it wasn't my birthday yet and I wanted my own cake.
This year, there was no shopping trip for my family because my parents were out of town. My sister and I were faced with having our own quiet dinner at home, but at the last minute, were invited to join these aforementioned family friends at their house for Christmas dinner. My sister and I were more than glad to oblige.
And the food that night was amazing and abundant. The house was teeming with people, relatives of our friends that I'd never met. I realized I kind of missed traditional Christmases like this. And at the end, there was cake - two, in fact, for Uncle Stan. We sang happy birthday - twice, also - once in English and once in Chinese.
And as I stood there watching - taking in his beaming face as he hugged his family and cut the cake - I realized that in all the years that we celebrated together in the States, I was never able to stop thinking about myself for a second. I was annoyed at having to share my birthday hurrah with him, or that his birthday overshadowed mine, or something, I don't know, whereas it was his birthday that was getting shafted. Maybe he didn't even care, but all I know is that I had not had a moment like that in a long time, where the fog lifts and you are left with nothing but to face your own selfishness.
Anyway I still love birthdays, and I did celebrate mine a couple of days after with friends. It's always a wonderful feeling to be with the people you love, and who love you, regardless of who was born on what day.


The most difficult lie I have ever contended with is this: Life is a story about me.
I hear addicts talk about the shakes and panic attacks and the highs and lows of resisting their habit, and to some degree I understand them because I have had habits of my own, but no drug is so powerful as the drug of self. No rut in the mind is so deep as the one that says I am the world, the world belongs to me, all people are characters in my play. There is no addiction so powerful as self-addiction.
-Donald Miller, Blue Like Jazz