Individuals become physicians for a variety of reasons. Underlying all of them, I assert, is a desire to help others. I offer this story as an example of why we do it.
“Where have you been?” asked the charge nurse. “The natives are restless!” I was a young ophthalmology resident hurrying into the eye clinic waiting room at the county mental hospital. I was late, as usual, and the room was packed with patients.
“Sorry, so sorry. Our schedules are a nightmare; I had to finish treating the patients at our other clinic across town before I can make the trip over here. Don’t even ask about lunch.”
The charge nurse smiled. She had suffered through a generation of young physicians at her clinic. She knew their hectic schedules very well. But she still liked to “needle” us just the same.
“Your first patient is already in the exam chair. His name is Willard Jones.”
“Thanks,” I said, and rushed into the exam room. Seated in the chair was a young black man who looked alert. “Hello, Willard.”
“Hi, doc,” answered the patent. “How’s it going?”
I looked over the chart: “Nurse reports that Mr. Jones is walking into walls. She suspects that his vision is very poor.”
Looking at this patient, I was puzzled.
“So, Willard, you have a problem seeing?”
“That’s right, doc. I think my eyes are goin’ out.”
“OK, let’s check it out.” I adjusted the vision chart. “What can you read?”
“Let’s see… At the bottom is E,V,O,T,Z.”
“Really! That’s 20/20! What makes you think you cannot see?”
“Well,” answered the patient, “when I read, it gets all bleary.”
“I understand…” Then, I had a sudden realization: “Are you Willard Jones, a patient here at County?”
“No, sir,” answered the smiling patient. “My name is Willie Johnson. I thought the nurse called my name, and I come down to the exam room.”
“Sorry, Willie, but you’ll have to wait your turn. The patient who was supposed to be first has a much more serious problem than you do.”
With that, I began to look in the waiting area for someone who fit the description of Willard Jones. I asked several patients and called out the name loudly. But there was no response. Then I noticed a patient sitting in the corner facing the wall. “Mr. Jones?”
No response. But he had a name tag on his robe, and I saw his name: Willard Jones, 209A. Once again, I asked: “Are you Willard Jones?” No response. I guided Mr. Jones to the exam room. It was obvious that he did not see very well; it seemed he was also mute.
According to the chart, he was a simple schizophrenic who had been hospitalized for 10 years. He was on a number of medications that could affect vision, and there were numerous chart notes about both his poor vision and lack of communication.
“Can you see anything,” I asked, “anything at all?” No response.
I was momentarily stumped. We had been trained to carry out an exam, even on non-communicating patients like children or Mr. Jones. So I checked the pupillary response to light: normal. I moved my penlight, and Mr. Jones appeared to follow it. I then eased him up to the slit lamp microscope and examined the front section of his eyes: cornea clear, anterior chamber—deep and quiet, lens— completely white! “Well that explains his vision,” I thought. I still attempted to see into the back of his eyes with the slit lamp: no view. Then I tried my direct ophthalmoscope: no view. Finally, I placed dilating drops into both eyes and tried my most powerful indirect ophthalmoscope: no view.
“Mrs. Horton, can you come in, please.” The charge nurse left her desk and came into the exam room. “Mr. Jones has nearly mature cataracts in both eyes. He definitely needs surgery. Will you please take care of getting all the paperwork done? If there is any family to speak with, I’ll be happy to explain. Otherwise, let’s see if we can keep him from walking into any more walls.”
Mrs. Horton nodded and smiled. “Yes, Doctor Knopf, I’ll make all the arrangements.” and she led the patient out of the room and over to her desk. “This will be a problem,” she said softly.
I finished my clinic and returned to the teaching hospital across town. My surgery day at the hospital was Friday, and I wondered if Mr. Jones would be scheduled that soon. I checked the schedule, and found his name. “Great,” I said half out-loud, “Mrs. Horton may be a pill, but she is a great nurse!”
Friday came and Mr. Jones was my first case. I explained to my assistant resident that Mr. Jones was a mute schizophrenic and would need to be done under general anesthesia. He had been cleared by the anesthesia service, so the surgery ought to be straight forward.
For the next six days, Mr. Jones remained in the hospital for post-operative care. He progressed well, but remained mute. No one could tell if he understood any instructions, but he gave no one any trouble. The nurses and I were taken by his cooperative attitude, and we all assumed someone was “there” inside him. He was then ready for surgery on his other eye.
Once again, everything was routine, and Mr. Jones recovered well. He was discharged from the teaching hospital and returned to the county mental hospital for his follow-up care. By one month, his eyes had nearly recovered from the surgery. I was able to examine the retinas of both eyes and found them to be normal. He was ready for some help with visual correction. The surgery had already made a difference: Willard could navigate the halls without running into the walls. How much better would he see with glasses? How would anyone know, since he was still non-communicative?
I obtained a pair of “temporary” glasses. These were mass produced for the “average” refractive error produced by cataract surgery. This was before the development of the permanent intraocular prosthetic lenses. Glasses in hand, I visited Mr. Jones in his hospital room.
“How are you doing, Willard?” I said, assuming there would be no response. “I’ve brought you a present.” With that I took out the temps and placed them on his quizzical face. “How’s that?” I asked. And Willard looked at me and smiled.
As I left the room, he waved goodbye, still smiling.
The practice of medicine is filled with moments of elation and disappointment, triumphs and tragedies. As physicians, we learn to accept our defeats and revel in our victories. Sure, we need to be compensated for our efforts, but the richest remuneration I’ve found is “Thanks a lot, Doc. You sure did a good job.” It doesn’t buy groceries, but it restores the soul. And don’t all of us need some of that?
Biography
Harry L. S. Knopf, MD, MSMA member since 1977, is a Professor of Clinical Ophthalmology and Visual Sciences at the Washington University School of Medicine.
Contact: hlskmd02@earthlink.net