Typical Day
It's 6:00AM and Dr. Ai Ceeyou's phone alarm blares "Double Vision." The eye doc gropes around her bedside table until she finds her trusty pair of Tom Ford glasses, (-4.75 OD, -5.00 OS), plops them on her square face, and sighs, as focus sharpens in on the busy day ahead of her.
Dr. Ai's cat, a lazy calico named, Mr. Mac (short for Macula) eyes his master's soft, squishy pillow and pounces for the spot the minute it's available. In the kitchen, Dr. Ai mixes 225 ml of Quaker oats in a cup with 106 cc's of water, nukes in the microwave for 121 seconds, and adds some blueberries (which are full of antioxidants that improve night vision and decrease the chances of getting macular degeneration). Dr. Ai is many, many years away from worrying about age-related eye disorders, but still she believes in taking every precaution as often as possible. In fact, she tosses in an extra two ounces of blueberries into her oatmeal for that very reason.
At 9:00AM precisely, Dr. Ai enters the Clear Vision Clinic. A row of patients ranging in age from twenty-one to fifty (all in glasses) anxiously await their turn at having a high powered laser beam shot through the cornea of their eye. High hopes of being able to see clearly without glasses or contacts ever again float about the room. Each has the requisite buddy, parent, spouse, or significant other sitting next to them leafing through old People magazines.
These patients are not Dr. Ai's. They belong to her new associate, Dr. Ray Bans, a graduate of Cornell Eye Institute and a whiz with the new LASIK machine. Dr. Ai had just forked over a bundle for it in hopes of saving her practice. When she opened the Clear Vision Clinic six years ago, Dr. Ai had hopes of being on the cutting edge of eye disease and the place to go for corneal transplants (her specialty).
Almost a year later, she was close to declaring bankruptcy. Between fighting with insurance companies to get surgeries approved, navigating the murky waters of ever-changing HMOs and PPOs, and folks needing her help but being unable to afford it, Dr. Ai's dreams were blindsided by the stark light of reality. Fortunately, she hired a firm that specialized in saving medical practices from going under. It was all thanks to a recommendation from a colleague who almost lost his business too before adjustments were made.
Dr. Ai cut down her surgical team and her office staff to a bare minimum, invested in the LASIK machine, and in Dr. Ray (who was very charming and efficient with his surgeries). Typically, it only took him a half hour per patient and at about ten patients a day at a cost of $2,000 per eye—that's $20,000 a day. Dr. Ray was pulling his weight as the master of the machine, freeing Dr. Ai up to handle the difficult cases she loved to do. She even manages to spend some time at the local hospital's diabetes clinic, where she screens for and treats diabetic retinopathy. Dr. Ai makes very little money at the clinic, as most of the patients are on government supplemented Medi-Cal or Medi-Care. Still, Dr. Ai isn't hurting for money now and this sort of work leaves her feeling fulfilled and less stressed than she used to be.
Dr. Ai's first patient of the day is waiting for her in her office already. Bill Irving is a forty-year-old author and college lecturer who has a family history of glaucoma. He's been coming to see Dr. Ai for the past four years to check on it. After numbing and dilating Bill's eyes, Dr. Ai sits Bill down for the NCT test (non-contact tonometry), also known as the puff-of-air test.
"Okay, Bill, you know the drill. Put your chin in there and look straight ahead," says Dr. Ai, knowing it won't be that easy.
"Okay, I'm not gonna move this time. Watch. It's a snap," Bill says sitting in the chair and leaning into the machine.
"One, two—"
"So, it's not gonna hurt right?"
"Right," says Dr. Ai, for the thirty-first time this week.
"It's just a puff of air."
"Just a puff."
"And I have to do it."
"If you want to make sure you're not getting glaucoma, you do."
"Because if I don't, I could go blind."
"Yessir, you sure could."
Bill leans back in.
"One, two, three."
Dr. Ai pushes the lever, releases the puff of air but it's too late, Bill has jumped out of the seat. It's a natural reaction. They told about it back in med school. It seems like one out of every twenty people she sees freak out at this test. She still doesn't get it because it's only air after all. There is no contact. That's why it's called non-contact tonometry . But still, she's gotta get crafty.
"I'm sorry, Doc."
"It's okay, Bill. Let's try something else. Lean your head forward and I'll just look at the eye."
"Just look?"
"Yes. Lean in."
Bill leans in. Dr. Ai looks. Her voice gets grave.
"Bill, I'm worried. I might see something."
"You might?"
"Maybe, I can't be sure."
"Well, well, do the puffy eye thing. Maybe it's nothing."
"You sure?"
"Yeah, go ahead."
This time, Bill stays perfectly still as Dr. Ai counts to two and puffs the air in Bill's right eye. Then in the left.
"Well, is it bad?"
"Nope, you're fine Bill." Bill is relieved. So is Dr. Ai. Only about ten more of these to go today.
By 6:00PM, Dr. Ai has seen and treated two cases of moderate pink eye, given six eye tests and six prescriptions for new glasses, treated two cases of diabetic myopathy, scheduled four people for cataract surgery, diagnosed cross eyes in a newborn, had a consultation for a patient that will require a corneal transplant, discovered one case of early-stage glaucoma (which is thankfully treatable), and one case of macular degeneration that will require surgery. It's been a very busy day.
Exhausted, Dr. Ai pops in to say goodnight to Dr. Ray who is also wrapping up for the evening.
"So, when are you going to let me give you some LASIK? Come on, how about now, free of charge. You can take a couple of days off. You'll be seeing great by next week," he offers.
"No thanks," says Dr. Ai "I don't have the time for the recovery. Maybe some other time." She doesn't have the heart to tell him the truth. She happens to love her glasses. They make her feel smarter, for some reason.
And with that, she waves goodbye to the office help and is out the door, on her way home to feed Mr. Mac.