Residents & Young Ophthalmologists

Treating the whole patient, not just the eye

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By Vivas Tatachar

A glass half empty implies that the totality is emptiness, whereas a glass half full suggests that fullness is the entirety. But can emptiness exist without fullness? In order for an object to be seen there must be space for it to exist; similar to musical notes being heard between moments of silence. glass half empty implies it is also half full.

Osteopathy embodies the theme of holistic medicine. And yet, I do not view it as a particular field of medicine, but rather as a way of life. Searching for meaning, an explanation, is an innate human tendency. This analysis is required in scientific and technological affairs because mechanics have to repair cars and physicians must diagnose patients. But when dealing with human relation, this mental search infers a fixed perspective, concentration on a missing part, rather than giving one’s undivided attention to the whole. Awareness of this eternal pattern of searching, analyzing, and forming conclusions invites joy and empathy to any relationship and exemplifies an osteopathic approach to life.

The whole cannot be broken down into words because the word epitomizes an idea, an image. This image is the source of comparison to the myriad of other images formed by the mind, representing mental fragmentation and divided attention. This image forming capacity is part of being human; a natural reaction to any given stimulus based upon one’s prior experiences; a conditioned response. Understanding this concept is imperative in order to continue to learn as we live. In order to learn, one must be open to understanding a different perspective by observing the process of forming a conclusion, because conclusions are static entities. Life, is a constant movement, however, and one must move with it, rather than clinging on to a preconceived notion or to any image, for that matter. Self-observation and awareness of one’s thoughts, which lead to the formation of ideas, images, and ultimately form conclusions, is necessary in order to take a step back and view any situation as a whole.

Osteopathic principles may be employed through scientific research, as well. Research implies that there are physiologic processes and phenomena that have yet to be discovered.  Research involves learning something new; something that exists but has yet to be defined. Learning something new requires clarity and freedom from which to observe. Any form of mental fragmentation obscures the true essence of a moment, narrowing the scope through which one looks at life. The scientific method emphasizes attentive observation in order to prove or disprove a given hypothesis. Negating what is false points to the truth, whether one is dealing with scientific advancement or in understanding one’s relation to others. Awareness of the whole process, the entire journey, allows for a life of learning.

During my elective rotation in ophthalmology, I had the wonderful opportunity to observe and work alongside Dr. Matthew Marano. Following each cataract surgery Dr. Marano performed, he made sure to visit every patient, post-operatively, in order to ensure that they are comfortable and to answer any questions or concerns they may have. Empathy towards patients demonstrates the idea of osteopathy, treating the patient as a whole being, rather than simply as a diseased lens of the eye. Dr. Marano mentioned to me that this is why he is still practicing medicine; because his patients trust him. They not only return to him for post operative follow ups, but remain his patients for years.

This is a haiku I wrote during my elective rotation. To me, it exemplifies the theme of osteopathy as a future physician, but also as a human being:

A fixed point of view;
nailed to Time, like a Coffin,
is never Freedom.

I am currently writing a research paper under Dr. Marano that deals with the technological advancement in the ophthalmic practice over the past several decades, as well as my own perspective of the field, as a whole. I am also coordinating a prospective research study alongside Dr. Marano involving the treatment of chronic, open angle glaucoma. The study is currently in phase 4 of clinical trials and aims to determine the clinical significance of implanting Bimatoprost filled capsules intraocularly to treat chronic glaucoma, when compared to topical eye drop regimens. Furthermore, I am also coordinating a retrospective study on the impact that these intraocular implants have had on treating dry eyes.

I have also had research experience in the Palliative Care division at Garnet Health Medical Center. Working alongside Dr. Gurjinder Kaur and Dr. Emma Fattakhov, a fellow Touro student and I were able to publish a paper dealing with the efficacy of administering Low-Dose Ketamine infusions in terminally-ill patients as an analgesic substitute for opioids. Palliative care is an exceptional example of the application of osteopathic principles because pain must be managed holistically. Pain is subjective; it may be due to specific organ dysfunction but also may contain a mental component. Our paper was published in the Annals of Palliative Care Journal and we were given the opportunity to present our research to our academic community during Touro COM’s Research Day. We are currently working on another paper in the Palliative Care department; a case report describing a unique example of a primary lung adenocarcinoma metastasizing to the calvarium.

Medicine is advancing at a rapid rate and as a future physician, it is imperative that I am aware of novel developments. Research may support or refute a hypothesis, but either way, something is learned in the process. Understanding the truth is only possible if one understands the false, and awareness of the entire clinical picture is necessary to manage and treat patients appropriately. Therefore, osteopathy is a way of life, not simply a fragment of medicine. It represents a holistic approach to evaluating patients, an unbiased attitude towards one’s research, as well as an empathetic approach to understanding one’s self and others.

Mr. Tatachar is currently a student at Touro College of Osteopathic Medicine, Middletown, NY