Insight

The problems with my eyes had become alarming. Two and a half years ago I was told I had a posterior vitreous detachment in my left eye that had left me with an eye full of floating debris. Over the past 2 weeks, I had developed a similar problem in my right eye, its onset heralded by flashes of light when I turned my head. I found it almost impossible to focus a microscope on joint-fluid samples, a major inconvenience for a rheumatologist. After a MEDLINE search taught me that retinal damage was possible, I decided to consult a specialist at a large eye hospital in the city. My husband agreed to accompany me.

Outside, the massive, modern hospital was impressive. Inside, it was a different story. The entrance was a short, bare hallway ending at a reception desk. A remarkably unreceptive receptionist answered my request for “Dr. Dareeno” with bored, mechanical responses.

“Second floor. Elevators on the right. Retina services.” By this time, my predictable anxiety was affecting my bladder capacity, and I was glad to see, on exiting the elevator, a sign for restrooms.

The ladies' room was depressingly filthy, especially considering that the day was only half over. Used paper littered the floor. I had the wild fantasy of sightless women going to the bathroom and washing their hands, all the while flinging dirty toilet paper and towels toward unseen receptacles.

My destination was a cavernous, dimly lit hall, painted a sickly tan, running along one side of the building. It was lined with chairs and potted palms and was punctuated along its inner wall by counters announcing different services. One of the first, and least promising, was “Low Vision.” We thankfully left that behind. “Retina Services” was at the far end. I gave my name at that counter and was relieved to learn that I was expected. A sign posted nearby read, “If your vision has not been taken by a technician within 15 minutes after you arrive, please check with the receptionist.”

Good Lord, I thought. After they make off with your vision do you go back to the “Low Vision” station? Or was there one I missed called “No Vision”?

My morbid thoughts were interrupted by the clerk behind the counter, who was looking at me speculatively.

“Are you 65?” she asked.

I, who was only 64 and 2 months, replied emphatically, “No.”

“Then sit over there and fill out these forms,” she instructed. At last, something on which I could concentrate and that would display my superior grasp of medical paperwork. Under Occupation I proudly filled in “physician” and wrote, in the space indicated, a brief (21-word) medical history of my eye problem, using “O.D.” and “O.S.” to display my knowledge of ophthalmologic terminology.

I had long since finished the forms when the technician assigned to “take” my vision called my name for a turn at the eye chart. Why hadn't I cleaned my contact lenses? Now they would think my vision was worse than it really was. I blinked to try to separate the junk on the lenses from the junk in my eyes. Why did the technician's manner give me the feeling that I was flunking an IQ test? When I had humiliated myself sufficiently, she introduced drops into my eyes, careful to give no clue about the effect they would have. Gradually, a nauseating fog involved my visual world.

“Mary Moore,” A voice called out through the fog. “Come in and sit down, Mary,” requested a young woman, whom I had never met before, in unexpectedly familiar terms. At least she was smiling, the only smile I had seen anywhere in the hospital. A middle-aged man in a white coat approached. Thank goodness, a colleague.

“I'm Dr. Dareeno,” the man announced briskly, avoiding my pleading-for-empathy gaze. “Tell me about your eye problems.” I could sense I had to talk fast. I began the first of my 21 words. “Yes, yes,” he interrupted impatiently. “You've had floaters and flashing lights. Is that correct?”

“Yes,” I replied, avoiding any editorializing. I am a quick learner.

“Put your forehead here,” he instructed. Moving around his lights and lenses, he peered into my eyes, all the while addressing cryptic dictation to the young woman. Unconnected phrases were alternatingly frightening and baffling. “Lens opacity.” “Stone.” “PVD.” “Pressure.” Finally, one that was reassuring. “Retina normal.” The examination then abruptly changed. “Lie down here,” he said, indicating an examination table. He began a series of very firm pokes, using a cotton-tipped swab. Was the swab poking into my eyeball? Because of the anesthetic he had applied, I couldn't tell—and he certainly had no intention of informing me. What would he do next? “Sit up,” he commanded. “Well,” he said, gazing at a point over my head, “there is no retinal damage. So everything is fine. But to play it safe, I'd like to check you again in 1 month.”

Not exactly fine, I thought. I still had the vision of someone snorkeling in dirty water. “Is there nothing to be done for these floaters?” I asked timidly.

“No. We could drain the vitreous, but it is very risky and you could lose your sight.” He started to turn away. My plan to ask about a procedure I had found described in the British Journal of Ophthalmology to treat vitreous floaters with neomydium: yttrium-aluminum-garnet lasers suddenly seemed wildly impractical.

“Thank you,” I replied with reflexive politeness. I got off the Table and stumbled toward the waiting room. There, the dim outline of my husband appeared, as welcome as a familiar landfall after hours lost at sea.

“Everything all right?” he inquired.

“My retina is fine.” I paused to consider. “And I learned a lot.”

“About your eyes?”

I took his arm for support. “About being a patient … . Let's go home.”

• Copyright ©2004 by the American College of Physicians