So, the second part of this story happened quite recently.  I saw a lady (C) who had been tested about six months ago but was having problems with the reading glasses she had been prescribed.

When I looked at C’s card, I recognised my handwriting. I had been the pre-screener but it was a locum that had conducted the eye test.  A quick look on our order system and I discovered that I had also done the dispense.  I really couldn’t remember C.  I recalled that day well: it was a busy Saturday and the locum was running late, I remember dispensing a lovely Irish woman who had a lilting accent and a contagious laugh, I remember pre-screening a twenty-something with keratoconus, I remembered dispensing an unhappy child who was too big for the Bob the Builder glasses he really wanted.  I must have done the pre-screen and the dispense then promptly forgot about this woman – she was quiet and unremarkable and we were busy.

On the day of the recheck, C wasn’t just quiet, she was visibly deflated.  It seemed as though she was carrying the weight of the world and it was pushing her down, making her smaller.  She didn’t really want to be there, she didn’t like taking up the space that she occupied.  She barely spoke above a whisper.

Usually, I’m quite bubbly with patients.  I smile and laugh and tend to be a little larger than life.  With C, I realised straight away that my “usual self” was going to drown her.  I became quieter and, although I was asking the same questions I usually do, I was taking my time, not rushing and giving C as much time as she needed to respond.  Her last eye test was a little rushed, she said, and she had felt uncomfortable.  I told her that we had plenty of time and that, if she felt uncomfortable at any time, to let me know and we could stop the test.

Anyway, I discovered that, from the very start, C could not use her reading glasses.  She had made an effort to get her eyes tested six months ago and when the glasses didn’t work out, she was overcome with apathy again, despite being on anti-depressants.  She just stopped reading.  One of her friends had brought her in for this test and she had played along.  C was expecting me to ask why she didn’t come back sooner but I didn’t – I knew it was the depression: she had done something, it hadn’t worked so she didn’t want to come back, to make a fuss, or draw attention to herself.

About half way through the eye test, C started talking to me.  I mean, actually talking, not whispering.  The volume had slowly been turned up as she relaxed and told me about her friend, a famous writer.  She told me that she wanted to be able to read their books.  It was lovely to hear her suddenly demand attention, to subtly change from passive observer to active participant.

I found a different prescription from the locum for distance, intermediate and near.  In the end, she could read N5 with her new reading prescription and her eyes were healthy.

I had lost track of time and, when we left the test room to look at frames, her friend told her that we had been in the consulting room for over an hour.  As I had no other tests booked after C, we chose her glasses together, picking out different pairs for her reading and for intermediate.  After I had put the order through the till, I told her that I wanted to see her again if she had any problems and she promised she would come back to see me if anything was amiss.  When she left with her friend, she seemed content.  Although that unseen weight was still pressing her down, I felt that evening she had pushed back against it.

Now, the main worry I have is that, in the future, I will be that rushed locum.  I will have 25 minutes to do a complete sight test but it took C that long to engage with the process.  I can imagine why the locum struggled with her refraction and I understood why C was uncomfortable during the test.  Some people can’t be rushed and some just shouldn’t be.

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