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MEMORABLE PATIENT ENCOUNTER

A first-time patient ... at 86 years old

About five years ago, a pleasant, unassuming woman showed up in my clinic, Siepser Laser Eyecare in Wayne, Pa. She said she couldn’t see well anymore and figured it was due to her grand age. At 86 years old, she looked at least a decade younger, was amazingly spry and in terrific shape overall.

I asked her if she had ever been seen by an ophthalmologist. “No. I don’t much believe in doctors. I’ve stayed away from them. That’s how I managed to get this old and remain in good shape,” she proudly exclaimed. “When an uncle of mine finally went to an eye doctor, he went blind.” I asked when that occurred. “Oh, it must have been back in the ‘80s. He’s long gone now.” I explained that things have changed in the last 30 years. She looked askance at me. I imagined she thought she too would end up blind now that she was seeing an eye doctor.

HER FIRST EXAM

It did not come as a surprise that she had “count fingers” vision, bilateral 28 mm Hg IOP and cupped out discs with bilateral small islands of residual visual field. “How about using some eyedrops,while I get everything ready?” I asked. Her look conveyed that wasn’t an option.

I had just started combining endoscopic cyclophotocoagulation (ECP) with cataract surgery and knew there would be just one chance to get this kind lady straightened out. I skated around the ominous “informed consent” process, afraid she’d flee if she saw the list of all the possible side effects.

Our charming patient care coordinator guided her gently through the informed consent process. I assured her that even though there could be complications, I would do my very best to have her not end up like her uncle. She didn’t look convinced, but I could see a glimmer of hope.

It was an operative challenge. She squirmed on the table, wanting to discuss her grandchildren while I wrestled through a rock-hard cataract and a difficult ECP. The incisions needed some sutures, as that much phacoemulsification power caused a wound to gape, although no burns were incurred. By the end of the procedure, her cornea already looked a bit cloudy. Fortunately, the ECP camera is a godsend and cornea clarity is not a factor.

“WAGGING YOUR TAIL”

I had a very restless night because of concerns about her recovery, and the next day I hustled off to the office. Walking into the exam lane, I was greeted with a big smile. The patient exclaimed she could see again and was astounded by how bright colors were. Lo and behold, the examination revealed that her cornea was clear, the wounds were tight, her visual acuity was 20/60 and pressure was in the mid-teens.

I was thrilled with how well she had done, so I gushed, “Wow, that looks great. Even though this was a very tough situation, I got you a fantastic result! Oops, I don’t want to break my arm patting myself on the back!” The lady sat up, looked me straight in the eye and stated, “You deserve the credit. You did a great job. And remember, it’s a sad dog that can’t wag its own tail.” It’s a saying I still use to this day, and I always attribute it to “one of my very favorite patients.” OM