Thru The Eyes of a Country Doctor

        This is a fiction forum, and does not discuss any “real” events.  Specific discussion of a patient’s clinical circumstances is a violation of my personal ethical code, and was long before anyone dreamed up HIPAA, so anything I write regarding patient encounters, while based on my life experience, has been “doctored” significantly.
        However, this post deviates from that standard format.  While very close to the actual events, it isn’t a HIPAA violation, though, because it is my own case.  I write it so you can get inside Doc’s head, but also for educational purposes.  I like to think the story might stick, and one of my readers might benefit someday from the heads up on this particular diagnosis.  

   “Through the Eyes of a Country Doctor”

        Before I start, I’m gonna go ahead and tell you the moral of the story. If you don’t get anything else, please realize we docs are just as human as anyone else. Still, we have a perspective on things folks should not ignore, so you’ll just have to listen for a moment.  Now, that don’t make me one bit better than anyone else.  When I drive my car into my mechanic’s shop, he often figures out what is wrong in two minutes about an issue I have struggled for days to get a handle on it. But as far as Country Doctoring, well, you don’t have to listen, but I would advise you consider my story.
        I was at a music festival digging my favorite bluegrass band, and thought I had a smudge on the bottom of my sunglasses.  It didn’t want to clear up, but we were not around any soap and water and I couldn’t clean off my glasses.  It was getting on towards dark-thirty, and in the lower light of dusk, I thought it went away.  I didn’t think much of it.
        Sunday I woke up and at first thought some swelling of my lower eyelid was in the way, but when I would pull the lid aside the faint smudge in my lower visual field didn’t clear.  I had a feeling I knew where this was going.  There didn’t seem to be much change through the day, but I put in a call first thing Monday morning to my ophthalmologist, who had done my cataract surgery a few years back.
        “Hey, Em. Dr. Oracle in?” 
        “Yes sir, what’s up?”
        “See if he can check me today.  Tell him I’ve got a right inferior nasal field deficit- stable for forty-eight hours.”
        She wasn’t gone long.  “Can you be here at 2:00?”
        “Sure thing.” At least the timing was fortuitous.  My afternoon office schedule had already been cleared off, as it was the day of the once a year company picnic.  I didn’t want to alarm everyone, so I just said I had an eye appointment I’d forgotten.  I gathered up my office guitar, and told them I’d see them at the picnic and play a few tunes.  Deep down inside I suspected it would serve as my pacifier for the day.
        I was a work in, and these were busy guys, so I knew I’d have to wait a while.  I pulled my guitar out and got off to a corner, so as not to bother anyone, but an interesting thing happened.  As I played, tranquility set it, not only for me but the staff, and the patients who were waiting. 
        One little girl was especially entranced, and I ran through a number of tunes for her.  They called me back, and I bid her farewell.  I wondered about her diagnosis, hoped she was just a kid trying to talk her folks into contacts, and said a quick prayer she didn’t have anything bad; she seemed a nice kid.
        Once in the exam room, I pulled the guitar out of the case, and contemplated my diagnostic possibilities as I played.  I could think of dozens, and several I’d rather not have.  Hm.  I had seen a few patients like this who had an ocular melanoma- that didn’t sound so good.  I liked the idea of posterior capsule clouding, but I had already gone through a post surgery laser to clear that up.  I wasn’t an eye surgeon, but my experience was this generally wasn’t something that was recurrent.  Most likely this was a small retinal tear in the top of my eyeball, and given the other possibilities, I made up my mind that would not be a hard diagnosis to accept.
        Dr. Oracle came in and went through the drill.  Drops, the “blue light special” (checking for glaucoma) then the old eye chart.  Doc had rendered me 20/20 with cataract surgery, but prior to that I had a long history going back to a myopic childhood, so I was quick to rip through the memorized lines.  He pulled out the extra bright retina scope, and in short order, had the diagnosis.
        “Peripheral retinal tear, superior segment. You need to stay, the retina man is in the house.”
        “NAP, Doc.  (Not a problem.)  You think it’ll be O.K.?”
        He contemplated an answer.  I could tell he sure wanted it to be, but didn’t have enough data yet- it wasn’t a fair question.  I answered it for him. “Hey, you guys have pulled me through the fire twice- I ain’t worried.  All we can do is our best, and I have faith everything will be O.K.”  I could see him breathe a sigh of relief- docs hate to promise what they can’t guarantee, and yet want to offer hope- it is a fine line to walk at times.
        The retina man, Dr. Smith, came in. Was he ever young.  I remember a favorite patient thinking the new surgeon couldn’t be old enough to take out his appendix.  I had a devil of a time convincing him as his Family Doc I wasn’t the right man for the job.  Smith went through his routine, and a few more tests, and gave the good and bad news.
        “As far as retinal tears go, this one is pretty good.”  I know most patients hate to hear a hole in eye ball is good, but as a doc I followed, and agreed.  He went on.  “The superiors are easier to fix, but over time gravity will work on it.  Not much choice but to fix it.  Your prognosis is good right now, but if it works its way to the macula it is a different animal.  Much harder to fix then.” 
        He discussed his schedule with his tech, then outlined my options.  “It can probably wait a day, but the OR schedule is tight tomorrow. We would go on after a vascular case, and they can be unpredictable as to what time we might go. When did you last eat?”
        “Dang it, I had a hot dog at 1:00. ” What was I thinking?  Man, you’re a doc, you saw it coming, why didn’t you stay NPO? 
        “How do you feel about doing it under local?  I can get a slot a Grace (the surgery center in the next town over) tonight.”
        Sounded like saving Grace to me.  I had  my cataracts done under local, so it wasn’t an unknown.  Hm.  Here I’d known this guy fifteen minutes, and I was turning over the future of my right eye to him on the spot.  Dr. Oracle recommended him, and he had saved me twice.  I trusted him with all my personal and professional being.  I contemplated a minute.  The way I saw it, I could get a second and third opinion, but by the time I did that I’d have several good opinions and one blind eye. “Let’s go for it.”  I sounded resolute, and was. My vision was still clear, and I didn’t see any other reasonable options.
       Well, my wife drove me over to Grace, and everyone was very nice, and they didn’t even know I was a doc at first. Someone found out, and then they got kinda nervous, but I told ‘em my eyeballs warn’t no different than any other human being, and besides they had been kind before they figured out who I was, and that was more than enough for me.
        Being awake for your eye surgery has its advantages.  I could tell from the banter and the light mood Dr. Smith was satisfied about the progress.  I told a few jokes, and we discussed guitars, but I kept the conversation to small talk- I didn’t want to distract him.  When he asked for the Vicryl, I knew he was closing. After he got a stitch in, I told him I wasn’t scared of losing an eye- I could always cash in my disability and hit the road with a black patch and a new stage persona.  I could sense his relief through the surgical drapes.  The thought of a disabled colleague, and one with a microphone no less, was not very consoling. My recommendation to patients is not to say such things until the procedure is completed.
        After it was all over, my vision came all the way back to 20/20. Thanks to Drs. Oracle, Smith and company, I am an ocular cat with nine lives.  When I was growing up in a little  N.C. town, we did not even have an ophthalmologist, much less a retina specialist who could do such fancy things on short notice.  Nowadays, in little towns all across the country, people are able to resume their lives with minimal disruption over a diagnosis that would have disabled them just a few decades ago.  I am just a country doc, but got a state of the art procedure as good as anything the President could get.  I am lucky, in that I have good insurance, but for less out of pocket than the price of a new guitar, I got a new eye.  I don’t buy many guitars- my old Martin does fine, but generally speaking you can’t buy an eye for any price.  It seemed more than reasonable to me. 
        By the way, I hope that little girl was O.K. She was a sweetie.

 Dr. B

        Post Script:  Not long after all this happened, I saw a patient who lost most of the sight in her left eye years ago.  She began to have similar symptoms, but just thought she needed new glasses and put off an appointment.  She got some vision back, but it was far from a perfect outcome.  There are no guarantees in medicine, but I hope by posting this story, one of my readers is able to recognize the symptoms earlier, and have a chance at a better result.

                                           

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4 Comments on “Thru The Eyes of a Country Doctor”

  1. hymes Says:

    I’m so glad you had the surgery quickly. My mother has had detached retinas in both eyes but both were caught quickly and at 84 now her vision is still excellent. She taught me the symptoms to watch for but it’s good to read them again. I can’t imagine talking to a surgeon while’s he working, guess that’s the difference between a doctor and a non-doctor :).

  2. drtombibey Says:

    Glad your mom is O.K. I have a favorite consultant who looks after my mom. When patients ask if I trust him, I always say, “Well, he operated on my mama.” I guess that says it all, huh?
    As far as shop talk during surgery, it was just my way of coping. In reality I was just like everyone else- scared!

    -Dr. B

  3. Elizabeth Says:

    Your story brings back memories from ten years ago, when my daughter, then 16, was assaulted at school. She experienced an inferior retinal tear of close to 90 degrees … therapy was antibiotics, watch and wait. Her doctor is at the Scheie Eye Institute in Philly. She is doing fine today and still has 20/20 vision. I’m glad your story has a happy ending, Dr. Tom, and good luck!

  4. drtombibey Says:

    It is one thing for an old guy to get one, but a kid, and in such a senseless way- glad she is O.K.
    -Dr. B


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