Last week, I had one of those days.  You know, the type where nothing goes right.

First I had a five year old girl who was referred in by her nursery. Her mum said there was a letter for me from them but, surprise surprise, didn’t think to bring it with them.  After a quick (unsuccessful) attempt at ret, I decided to cyclo her.  One drop went in without much issue then… well, then she screamed the place down.  Cue five minutes of her screeching and crying and me standing next to her trying to calm her down while her mum played Candy Crush on her phone.  Eventually, I declared, “Well, if I can’t get the other drop in, I’ll just refer you onto the hospital and they’ll put them in.” Suddenly, the mum became helpful and, after a brief struggle, I got the other drop in.

I explained that the cyclopentolate takes 25 minutes to work.  I was 9.55am so I would see them back at 10.25am.  I said this several times.

The girl then went out into the street and had a temper tantrum that could be heard inside the store.  The tantrum lasted a good ten minutes then suddenly, it stopped.

We run a rolling clinic so, at 10.20am, I was standing waiting for the girl to return, guiltily looking at the board that was sitting waiting.  10.25am and no sign of them.  10.30am and still not back.  At 10.35am, I took the board and asked one of the optical assistants to phone the mum and ask her to please return.

I pushed my annoyance aside and took my next patient, an older gentleman, into my room.  He was there for a routine test, his only issue that he felt his near specs weren’t quite strong enough.

History and symptoms were uneventful but when it came to recording vision, he was light perception only in his right eye.  Previously he had been 6/12 (uncorrected) in that eye.

I continued with the eye test, using +/-1.00DS to try and refine the Rx in the RE but nothing was making a difference to his vision.  The left eye was a little more hyperopic than last time but VA was 6/6 and N5.

Before jumping on the slit lamp, I asked again if he’d noticed any problems with his right eye. No, he replied.

On Volk, there was a hole in the superior peripheral retina but the main problem was the bulging inferior retina.  It came out towards me, all vessels attached but blurring as they made their way over the bump. I refocused with the slit lamp and tried to see the end of this bulging portion of retina but it continued as far inferior as my trusty 90D Superfield could see.  The macula was off (explaining the VA) and the inferior retina was pale pink-yellow in colour.  After seeing a couple of horseshoe tears, this was my first rhegmatogenous retinal detachment.

I explained to the gentleman that I was going to phone the ophthalmologist and ask for their opinion.  He seemed completely unaffected and went to sit out in the waiting area while I simultaneously called HES and wrote the referral letter (I’m actually becoming very good at typing with one hand while holding the phone with the other).

At this point, the screaming child had returned (with chips) so I had to finish off that eye exam (plus with moderate cyls) while waiting for my new friend, the ophthalmology nurse, to give me a call back.  After a quick look with ret and a rather unsuccessful post-cyclo refraction, I made a note to check VAs on collection and ushered them out of the room, only to be faced with the wife of my previous patient.

Where he was laid back, she was on edge.  She wanted to tell me that she’d noticed him bumping into and spilling things on his right side for months.  She also wanted to know exactly what was going on with regards to his referral, quizzing me while her husband stood beside her looking a little sheepish but in no way concerned.

I had not heard back from the hospital at that point so I explained what I’d seen, why I’d called HES and the different options.  I said that the hospital would probably want to see him that day or soon after and I’d know more when the nurse called me back.  In the mean time, I told her to go for a coffee and come back at 12pm.  She seemed happy about this and left.  I took in my next patient and about ten minutes later, the nurse called and told me they would see the gentleman with the detachment that afternoon.  Great, I thought, and went back to my eye test.  After that one, I printed out the referral letter and wrote the time and location of the appointment on the envelope.  I took my next patient.

The husband and wife returned early and she demanded to see me.  I was in the middle of a test so I asked that she wait for 10mins (it was, after all, 11.45am and I’d said 12pm). After I’d finished, I took the referral letter and handed it to them, telling them that the ophthalmologist had an appointment that afternoon and that they should head to the hospital.  At this point, there was much fuss made about how to get to the hospital, which eventually resolved itself when a brother-in-law was found who would give them a lift.

It wasn’t even lunchtime and I was exhausted.  I then had an afternoon of women telling me how awful it was to grow old, one of them clutching my hands and urging me to enjoy my youth while I could.

I came home that night utterly deflated.  I’ve since bounced back but, for most of that evening, I sat under a cloud.  I think it’s possible that I care too much but I can’t imagine caring less.

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