Reckless Wishing

Every since I started working in ophthalmology, I've had a growing interest in how the research I perform is actually translated into treatments for patients with visual disabilities. Such growing interest has led me to want to interact with real people with real problems: I've heard countless stories about visual loss, ranging from mild reduction in visual over several decades to no-light-perception over night. But only hearing these stories left a large space between myself and the patients. It's hard to really understand people when you are pinned up in a lab and, well, have no interaction with these people. I was rather recklessly wishing to see a case.

Susan (name changed) is a 51 year old accountant. She spends most of her time looking at small numbers, crunching data, you know, accounting. Several years ago she reported problems with her visual acuity, that is, it became harder and harder for her to see little numbers. Glasses didn't help. It was rather safely assumed at this point in time that she had some type of photoreceptor degeneration (and it clearly was not age-related macular degeneration or glaucoma). By last year, her visual was right around 20/100, which means what you might see at 20 feet appears to be 100 feet away from her.

Yesterday, Susan came into the clinic. Upon testing her visual acuity, her best corrected was 20/500. What you might see at 20 feet appears to be 500 feet away from her. I was given the duty of helping test her visual fields, which means figuring out what she can see in her periphery. After 20 minutes of flashing small lights all around her eye, it occurred to her that this time around, the test was much more difficult. She had already started using a computer monitor to zoom in on texts, and one of the best optometrists around had, earlier that morning, gave her a good amount of information on learning how to use a white cane. Simply put, her vision was plummeting. When I told Susan that I was done testing one eye and that she could relax, the exact opposite happened. A day where I thought I was getting great patient interaction turned into a lady sobbing about how crappy her vision has become. No doctor around to jump in. No Abort button. What do I even say? Do I tell her that everything is going to be OK? Clearly, this is a major life change for Susan. Now you see, now you don't. I can't empathize with her; my vision is good. This being my real first actual patient issue, it's even difficult to sympathize. The easy thing would have been to do nothing. Maybe play drill sergeant and tell her to get over it? Isn't this something that only doctors have to deal with? And how do they deal with it?

I told her about the research that we were doing. I told her that a lab with 35 dedicated employees are working hard every day to figure out what is going on in her eyes. I told her that her vision isn't as bad as she thought.

When the attending physician eventually saw her, he noted that her visual fields were actually the same as before. Her peripheral vision hadn't gone anywhere. Her fine-detail-abilites were getting worse, but her ability to see the world hadn't changed. It turns out that her "vision isn't as bad as she thought" was true. I thought I was stretching the truth a bit, but really I wasn't at all. Yeah, her central vision is slowly deteriorating, but looking on the bright side, she can still other things. After each tissue she went through, she threw them in the trash. Note to self: people that cannot see cannot through things in the trash. Even though her vision isn't getting better by itself, it's not horrible. If there is such a bright side, this is it.

My wish to really see something snuck right up on me. Realization unfolded right before me. Just imagine going blind.

Already I've learned an immense amount about how to deal with such issues. Next time I'll be slightly better equiped for talking about how such problems can really be addressed. About seeing the bright side of things. Let's hope the Susans out there are just as willing to see the bright side without having to really see at all.