Article

MEMORABLE PATIENT ENCOUNTER

Where’s Freud when you need him? Or…

... What to tell your patient when she thinks her eye is growing back.

I once had a patient who was crazy. Not crazy like eccentric, but crazy like seeing bats and talking to the drapes. She was in her 50s and had been living in a psychiatric ward for some time. I had been giving her regular exams for 15 years since performing an enucleation on her, forced by the pain caused by neovascular glaucoma. She had always been very pleasant with me.

In fact, the only time I had any trouble with her was when she became convinced that her eye was regrowing in her empty eye socket.

This was about 1984, within the first five years that I had opened my practice. The facility she stayed at was fairly small, with no more than two dozen residents. Nobody living there was considered dangerous to others; like my practice, it was located in Rhode Island. I would examine her in her room, using a flashlight. Her room was similar to one you’d find in a hotel.

One day, she complained of pain in what was obviously a very quiet socket. I thought I had heard it all, but then she very dramatically told me she was quite certain that her eye was growing back. She was panicked, certain that once it reached full size it would be as excruciatingly painful as it was before and would have to be removed again. I visited her for several days trying to reassure and counsel her, but she would have none of it. The whole ordeal was very frustrating — I knew she couldn’t be experiencing the pain she described, but this idea was consuming her.

Then, a light bulb went off in my noggin. The next day, I visited her in her room. She was sitting on her bed, and I told her I was stumped and had no choice but to perform an exploratory. “Finally,” she said, slapping her hand on her bed in excitement. “Now we’ll get to the bottom of this.”

I took her to the operating room of my clinic, where I made a shallow incision across the middle of the conjunctiva. I immediately closed it with chromic sutures so she would have a healing reaction.

The next day I met with her again. “I found our problem,” I told her. “You had adhesions.” I didn’t mention to her that adhesions are something generally found in the stomach during surgery, not the eye socket.

“I knew it. I knew it. I knew it!” she repeated. “My mom had adhesions after her gall bladder. Adhesions, of course!”

After that, we used a salve until the sutures dissolved. Her “pain” went away, and there was no more talk of a new eye. I saw her for several more years, and her “phantom eye” never bothered her again. OM

If you have a memorable patient encounter to share, contact chris.bahls@pentavisionmedia.com.