My last patient of the week was interesting for all the wrong reasons.  He stumbled out of a house across from our practice, high as a kite, and remembered he had an appointment for an eye test.  Pure luck threw him into my test room at the correct time.

He was speaking so fast, I struggled to keep up with wave after wave of information.  He had lost his dog recently, he had lost his glasses, he had lost his best friend.  He also had pretty much lost the ability to focus (both literally and figuratively).

It had been a quiet day so I was quite relaxed and slipping into weekend mode when he arrived.  I wondered if I should just refuse to see him – send him away until he sobered up – but, then, in amongst the fast and disjointed narrative, I heard that he was struggling.  He wanted to do an on-line course but he could barely see.  He was photophobic (not really a surprise because I’m sure his pupils are permanently dilated).  I saw a couple of problems that I could fix, as long as I kept my patience.

Dealing with him (a grown man in his forties) was like testing a young toddler who had just been fed raw sugar.  He was a blur of movement.  His externalised internal monologue was starting to give me a headache.  I had to continue to direct him, pulling his focus back to me.

Can you see the chart? Yes, that chart.  Can you see the letters? Can you read the letters? The letters on the chart? Yes, the chart in the mirror. Can you see it? Can you see the letters? Can you read the letters for me?

He had quite a high plus prescription but corrected he was 6/6 and N5.  His eyes looked healthy but even at the slit lamp, it was a battle to get him to stop talking and sit still.

The whole thing was completely surreal.  The best bit was when, on entering the test room, he removed his baseball cap and a large, rolled joint fell out onto the floor.  We both looked at it for a second.

“That’s not mine,” he said, seamlessly picking it up and replacing it in his cap then putting the cap down on my desk.

Upon leaving, he picked up the cap again and, once again, this large joint fell out onto the floor.

“It’s still not mine,” he said, scooping it up and putting it back in it’s rightful place.