This post isn’t going to have a happy ending.  That’s just a warning to those of you who, like me, enjoy a happy ending.  This post will just end and, whether it’s satisfying or not, it doesn’t really matter.  This post will detail a bad day that I’ve had and, although that day ended, it’s still exhausting to recall.

Anytime I ask someone how their pre-reg is going, I tend to get one of two answers.  The first is “Great! Amazing! Incredible!” and the second is “Awful, terrible, just… just don’t ask.”  The funny thing is that these answers come from the same people at different times.  One day we are on top of the world: our refractions are superb, our patients witty and any issues that arise are well within our comfort zones.  The next, we feel like the black sheep of the store: we are suddenly the ones who need help constantly, the ones who make mistakes or feel out of their depth.

I’ve had great days and I’ve had bad days.  I’m going to write about one bad day in particular.

So, on this day, the clinic is full.  It’s the weekend and everyone has suddenly decided that they need to get their eyes tested and that their children need eye tests as well.  It’s also a day when all our patients want to try contact lenses.  And they want to buy glasses.  And they want to complain about stuff.  And they want seen for sore eyes, red eyes, itchy eyes.  It’s a busy day and everyone has a problem.

Sometimes, it’s a rude awakening when I step out from my quiet little testing room after a pleasant half hour with a patient to find a crush of people at the front desk, the waiting area full, the dispensing booths full and no-one available to dispense my current patient, never mind pre-screen my next one.

On this day, I send my current patient out to have a look at frames while I get the NHS forms signed by my supervisor.  I then have to choose whether I want to pre-screen my next patient (who is waiting), start dispensing my current one (now also waiting, having picked up two pairs of specs in super-fast time), serve the next customer at the desk (who may always look like that or they may be annoyed at waiting) or answer the phone (that has been ringing non-stop).  This is my, pardon the Star Trek reference, Kobayashi Maru.  It is a no-win situation.

My next patient is a young child.  A three year old to be exact.  She has come back for a cycloplegic refraction and my supervisor booked her in with me.  I take her through to my room and pop some drops in her eyes.  The first eye is always easy, the second a bit of a struggle.  Before the first drop, I tell her that the drops are really cold so when they go in, they’ll feel chilly but they will warm up in her eyes.  She seems happy with that, until the drop actually goes in, and then the face crumples and her hands weld themselves to her eyes.  The phone is still ringing.  After some bargaining and a couple of encouraging words from her mum (it’s great when the mums and dads help out), we get the second drop in.  I ask them to go for a wander for 20 mins to give the drops time to work.

When we leave the test room, the phone is not ringing and the queue at the till now seems to be one very large family.  My previous patient is being dispensed.  Now that I’m free to help, it’s quiet.  I use that time to quickly look over the rest of my clinic.  My next patient is 2 and has been booked in by the call centre.  There’s no reason given for why the parents want their 2 year old tested.  Great.

My current patient returns clutching a bag of crisps.  She has a big smile on her face and tells me everything is blurry.  That’s good, I say, that’s what the drops do so it means they are working.  I take her over to the autorefractor and then battle begins.

Me: Look straight ahead at the hot air balloon.

Her: It’s about to take off! Mummy, look! It’s about to take off!

Me: Try to keep still. Pretend you are a statute.

Her (with eyes darting all over the place): It’s taking off in 15 minutes!

Her mum: Keep still.

Her: crunch crunch crunch (she’s started eating the crisps again)

Me: Okay, when you are finished that mouthful of crisps I want you to put your forehead right against that bar.  That’s good.  And your chin on there.  Great.  Okay, keep looking ahead.

Her (looking everywhere but ahead): The balloon is taking off!

This continues for a few minutes and I give up.  I need a hand – someone to hold her head into the headrest – but again, the store is suddenly busy.  I take them back into the test room.

I do ret on her but she keeps trying to take the lenses out of the trial frame.  She moves the trial frame up and down and takes it off.  Everytime I look at the rack of lenses, she’s managed to pull everything out.  Outside, the phone is ringing again.

I finish ret and pop the lights back on.  She’s out of the chair and trying to get out the door.  I’m speaking to her mum about referral to an orthoptist (sometimes her eye turns in) and about the (high) prescription I’ve found.   The 3 year old has now found the light switch and is turning the lights on and off while I’m trying to write my advice down and talk to her mum.  We go outside and no-one is available to dispense.  My next patient (the 2 year old) hasn’t turned up.  I’m a bit relieved.  It’s really busy again so I help them pick the glasses and then ask one of our DOs for an opinion on the frame, I think it’s a little big but she likes it (Disney princesses, sigh) and the DO agrees that it’s too big.  We go for a smaller frame and although she’s not happy, she says it feels better.  I’m about to sit down with them to dispense when the 2 year old appears (and his entourage, consisting of four generations of his family).  They are 15 minutes late.

I ask one of the DOs to take over from me and I take my next patient through.  His mum tells me that he’s just had an operation on his ears so he’s only recently started hearing.  He can’t speak at all.  He doesn’t sign.  Autorefractor is impossible but we do get a fundus photo.  I find out that his mum thinks his eye is turning in sometimes and the nursery said something about a lazy eye, although she’s not sure.

So, I couldn’t test vision since he had no means of communicating and I only have the projector chart (the other room has picture matching cards but, for some stupid reason, the second room’s projector chart has different pictures from mine).  Cover test was difficult since he didn’t want to keep still.  He grabbed anything that came within arms reach, including my face at one point.  He kept turning his head to the left and looking at me so I asked his mum if he turns his head that way usually.  “Dunno,” she replied.  I then had a quick look on ret and he seemed to be about +1.50DS in each eye but, again, he was struggling and his eyes were darting around the room.

Again, I sat and explained the situation and the fact that I was going to refer him to an orthoptist for assessment while he turned the lights off and on and then tried to escape (his mum had locked the testing room door when we went in, leading me to believe he had a history of making a run for it).

I, of course, had the first referral still to write and my drawer was filling with cards that had to be dealt with, although God knows when I would get the time that day.

When I came out, my next patient had been prescreened.  I then discovered that someone had booked a 60+ diabetic patient into my last clinic slot of the day and had shortened the appointment time to 30mins (I’m currently testing at 45 mins if dilating).  Great, well, I’d just have to deal with that when the time came.

So my next patient was a teenager.  He was monosyllabic and muttery.  He’d been tested a couple of years ago at our store and he had gotten some glasses for reading but, since then, he’d lost them and then he’d found them a year later but because he’d been fine for that year without them he hadn’t started using them again.  Recently, when he was walking home, he felt his eyes were blurry but it was only one eye at a time and when he blinked for a while, it went away.  After telling me all this, he then fell into a sulky silence and proceeded to glare at me for the rest of the test.

When I did the refraction, he was one of those patients that couldn’t give a straight answer.  When he could muster the energy to speak, he answered with “it’s bigger” and “it’s smaller” to my questions rather than “better” or “worse”.  Even though I had the previous prescription in the trial frame I just decided to take it out and use retinoscopy.  After ret, he was seeing 6/6 (down from 6/12) and I refined the prescription a little, checking on the duochrome and then doing cross-cyl.  When we were finished, we went out to choose frames.  My next patient wasn’t in yet so I thought I’d dispense the teenager.  I needed a PD from our DO but he was busy dealing with a problem so we ended up sitting at the booth, me chatting to his mum and sister while he glared at his iPhone.

My next patient was the ultimate pre-reg nightmare.  He was +9.00DS, in his late 60s, with diabetes and his IOP was 28 in one eye and 29 in the other.  It was his first time in our store and I had 30 mins to do a full eye test and dilate.  The pre-screen took longer than usual because of his mobility issues so, by the time we got into the room, it was clear that my supervisor and I would be staying late.  By the time the gentleman was tested and dispensed, the store’s shutters were halfway down.  I waved him off and opened the drawer I’d spent all day cramming things into.  I had two referrals to write, a dispense to put through the till and file, an order that needed checked off the system and some contact lenses to order.  I was exhausted and stressed and I just wanted to go home.

So, if you had asked me on that day how my pre-reg was going, I would’ve said, “Awful, terrible, just… just don’t ask.”

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