Something happened this week, a subtle change in my attitude meant that I looked at today’s fully booked clinic without feeling panicked.  I looked at the back to back booking, stretching for 11 hours, with my two 30 mins breaks slotted in, and actually felt quite confident.  I felt like I could do this – it suddenly stopped being overwhelming and started to be normal.

I also feel like a made a difference this week.  Three of my patients stand out:

1) F, who had a brain haemorrhage 7 years ago, and was unable to drive.  She came into our practice for an Estermann field test as well as an eye test.  She’d told me about her experience: a sudden haemorrhage in her head had caused her to lose consciousness for three days.  Her family were told by the doctors that, if she woke up (and this was a big “if” at the time), she would have speech and mobility deficits.  And here she was, chatting away to me after confidently striding into my test room.  She said that her memory was poor and she was unable to drive but those were the only remnants of that terrible stroke of luck.  F had went on to have children and she really wanted to drive – she worked part time and wanted her freedom back.

Her visual acuities were great but we still needed to do the peripheral vision test.  She sat down, I gave her instructions and the test started.  At the end, her visual field looked exactly the same as the one the DVLA had rejected two years ago.

My clinic was fully booked.  She asked me if she could try again.  Yes, I said, but you’ll have to come back another day – then I realised what a chore it was for her to return.  She’d taken two buses to get to our store because, of course, she was unable to drive.  Instead, the optom told me to ask her back in 30 mins (when the optom was free).

F came back and the optom took her through the test again.  I was with another patient but, when I came out, I was so happy to see the new field plot.  It was much better than the one I had obtained.  The optom had kept re-instructing F during the test, and reminding F to follow the fixation target when it moved.  It turned out that it was not a severe visual field defect I had picked up with the first test but a moderate defect coupled with poor short term memory.

Before F left, she thanked me.  She said that other places wanted her out the door as soon as possible but we took the time to really help.  I was quite touched by that (as was the optom when I told her).  Fingers crossed that the DVLA will let her drive again.

2) I tested a patient who had recently relapsed after fifteen years off drugs.  They had a big fight with their partner, felt low and started using again a few days before their eye test.  I asked if there was anyone they could talk to about this – like a sponsor? The only things I know about drug or alcohol addiction come from TV shows so I know about twelve step programs like AA and NA but that’s it.  They said they had a drugs counsellor.  I asked if they had contacted their counsellor after their relapse – no, they were clean for so long they had stopped going.

My patient obviously wanted to talk about it – they brought it up unprompted – so I think it was weighing on their mind.  I asked them to call their counsellor and go see them as soon as possible.  I told them that it’s an amazing achievement to be free from drugs for 15 years and anyone can take a misstep when they feel down.

After the test, on their way out of the room, they said that they would call the counsellor as soon as they got home.

So, we don’t just test eyes most days, we listen and we support.  I felt good about providing this patient with an outlet and for giving them some positive feedback about their situation.  Sometimes people don’t seek help because they feel that they aren’t worth helping and I think this is the saddest thing.  Depression and dependence hollow you out until you feel as if you are taking up too much of the world’s time and effort.  It’s nice to have someone, even a stranger, congratulate you on an achievement and actually care enough about you to urge you to take action.

3) G came in for an eye test today.  He was a diabetic patient and worried that his vision was “going downhill” because of his diabetes.  The hospital, when he was at the screening service, had cryptically said, “Diabetes affects the eyes” but he hadn’t asked any questions and they hadn’t said anything specific.

Anyway, G was a little long-sighted and had never worn glasses. His admin job meant every day was spent at a computer.  When I took visions, he was 6/6 and N8.  Looking at the N5 line, he asked incredulously, “Can anyone read that?!”

Being a bit cocky, I replied, “Yes, you’ll be reading it in ten minutes.”

He looked thoroughly unconvinced.

Anyway, fast forward to the reading addition and suddenly, G could see N5.  “I can’t believe I can see that, it’s so small.  I thought I had good vision,” he lamented.

At the end of the test, I showed him his fundus photo (no signs of retinopathy) and described what we would see if there were any problems with his diabetic control.  I then explained about hyperopic shifts.  G had never been given this information before so I think he was reassured by my explanations and he was absolutely ecstatic that he could read N5 (so much so, I was tempted to track down a chart with N4 on it).

Oh, well, that’s a little update on the last few days.  Please excuse any spelling or grammatical errors you came across in this post since it is almost midnight and I worked from 10am-9pm today so I am exhausted.

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