Typical Day
It's raining, it's pouring, and the tiny waiting room of Dr. I.C. Goode's ophthalmology clinic is filled with people. Iris Brown, Dr. Goode's medical assistant, sighs and looks at the clock. It's going to be a busy day: The clinic is booked with appointments until 5:00PM, and there's already a walk-in hanging around, hoping for an opening in Dr. Goode's schedule.
Iris calls for the morning's first patient: "Sally Silly, would you come with me, please?"
Mrs. Silly pops up and follows Iris into the screening area. Iris proceeds to ask her a series of questions: Why has Mrs. Silly come to the office today? Does Mrs. Silly wear glasses or contacts? Has she experienced any sudden changes in vision? Does Mrs. Silly take any medication?
As it turns out, Mrs. Silly is a new patient in need of a routine eye exam. When Iris asks Mrs. Silly if she's ever been diagnosed with an eye disease, the patient replies, "Oh, yes. I have stigma."
"Excuse me?" Iris says.
"Stigma," Mrs. Silly repeats slowly. "That's the eye disease I have."
"Do you mean that you have astigmatism?" Iris asks. Not even the shadow of a smile crosses her face—she's heard too many patients make this exact same mistake.
"Yes," Mrs. Silly responds, blushing slightly.
Iris passes over the faux pas as if it never occurred, and then proceeds to run an air puff test on Mrs. Silly to check for glaucoma.
Iris returns to the front desk as an older man enters the waiting room. "I just need to pick up my glasses," he says. Iris assists him, fields a phone call that turns out to be a cancellation for an afternoon appointment, books the walk-in for the now-available appointment, and then returns to the exam room.
Dr. Goode uses Iris as a scribe during all of his vision exams. As he runs Mrs. Silly through a cover test, a retinoscopy, an autorefractor test, and a slit-lamp examination, Iris takes notes. Although she's worked for Dr. Goode as his clinical medical assistant for two years now, Iris still seems to learn something new every time she assists Dr. Goode with an exam.
The ophthalmologist determines that Mrs. Silly's prescription is unchanged, and he sends the patient on her way. Iris returns to the waiting room, where another walk-in—a young woman—is waiting.
"What can I do for you?" Iris asks.
"All of the medicine has run out of my contacts," the woman says. "I need new ones."
This is another common complaint Iris hears at the clinic; few of her patients seem to understand how glasses and contacts actually work. Iris would love to sit this young woman down and set her straight, but she doesn't have time, so she simply pulls up the young woman's file.
"You're due in for a vision exam, Miss Moron," Iris says. "We should check your eyes for vision changes before you buy any more contacts."
"But I need my contacts now," Miss Moron whines. "I look ugly in glasses."
"You don't want to spend $200.00 on contacts that don't work properly," Iris says patiently. "I have an opening tomorrow at 11:00AM. Can you come in then?"
The rest of the morning is uneventful for Iris. She talks to patients, runs pre-tests, and then helps Dr. Goode with his examinations. The work is routine, and Iris is grateful: Yesterday, she spent almost an hour helping Dr. Goode with a patient who had managed to mistake a nail glue bottle for eye drops.
At noon, the office shuts down for half an hour so Iris and Dr. Goode can eat lunch. Iris always brings food from home—she really likes her job, but she only earns thirteen bucks an hour, so it's important for her to save money whenever she can. Dr. Goode, on the other hand, runs to the Sonic down the street every day at lunchtime.
At 12:30PM, Iris leads her first patient of the afternoon, a Mrs. Silence Smith, back to the screening area. Mrs. Smith, Iris learns, is deaf, but can lip read. They get through the pre-tests without any problem.
The vision exam with Dr. Goode is another matter. So long as the lights are on, Mrs. Smith can understand what the ophthalmologist tells her. With the lights off, however, the patient has no idea what's happening, and so fails to understand what she's supposed to do during the retinoscopy. She simply says "E," "E," "E," over and over again, not realizing she needs to differentiate between which "E" appears sharper.
Dr. Goode and Mrs. Smith are getting frustrated, so Iris steps in. Her American Sign Language is a little rusty—she hasn't used it since high school—but she's able to adequately serve as a translator for Mrs. Smith. The patient goes home with a new glasses prescription after complimenting Iris on her ASL.
Dr. Goode is also impressed. "That was awesome!" he exclaims.
Although the rest of the afternoon is busy, everything goes smoothly for Iris until just before 5:00PM, when she gets a phone call from a patient named Mr. Tool.
"I just took my prescription to the super-expensive, super-amazing specialty eyeglasses shop," Mr. Tool growls at Iris over the phone. "They told me I have astigmatism."
"Okay," Iris says as she pulls up Mr. Tool's file, not sure where this conversation is going.
"I'm so mad right now!" Mr. Tool hollers. "Why didn't Dr. Goode warn me?"
"Warn you about what?" Iris asks, puzzled. "You were diagnosed with astigmatism several years ago; that information has always been on your prescription."
Mr. Tool keeps right on talking. "The assistant at the eyeglasses shop told me that, because I have astigmatism, my eyeball is shaped more like a football than a basketball."
"Yes?" Iris interjects.
"Well, doesn't that mean my eyeballs are in danger of falling out? Why didn't Dr. Goode tell me about this? This is a medical emergency!"
It takes all of Iris' substantial self-control not to burst into laughter at Mr. Tool. She tries to calm the patient down and explain that, in spite of his astigmatism, his eyeballs are still attached to his body but, after a couple of minutes, he hangs up on her. Only then does Iris laugh until she cries.
At 5:00PM, Iris locks the office door. She's home at the tiny apartment she shares with a roommate by 5:30PM. Iris spends the evening catching up on housework and errands—while tomorrow will be a normal day at the clinic, she and Dr. Goode will be on the road the day after.
Dr. Goode's clinic is part of the largest hospital system in this part of the state. Because of that affiliation, Dr. Goode drives to rural communities four times a month to provide ophthalmological care to patients who can't make it into town, and Iris goes with him. This roadshow often turns into a fourteen-hour day for Iris, and while she appreciates the overtime and gets reimbursed for gas, the rural patient visits do wear her out.
Iris was always been interested in medicine, but after high school, she didn't feel like she was mature enough to handle college. She found work as an optometrist's medical assistant and completed on-the-job training. After two years, she felt like she knew enough to try to find more specialized work as a medical assistant, and Dr. Goode snatched her up within a month of her posting her résumé online.
Iris knows she'll never make much money in her current career, even if she were to get certified as an ophthalmic assistant or technician. However, she wants to stay in medicine and, honestly, she thinks she'd be amazing as an ophthalmologist, given that she already knows something about the field and enjoys interacting with patients (even the ones who wash their contacts out with well water and end up getting parasites in their corneas).
In the next few months, Iris will apply to four-year universities. Her plan is to earn a bachelor's degree and do pre-med, and then go on to medical school and specialize in ophthalmology. Dr. Goode has already said he'll be sad to see Iris go—she's the best medical assistant he's ever had—but he fully supports her decision to further her education and has already offered to write her as many letters of recommendation as she needs.