One of the neat things about being an optometrist is the variety of people I interact with on a daily basis. While some days make me wish for people with no vision issues, I tend to enjoy figuring out problems and helping people coordinate eye health and vision as a part of maintaining overall health. I learn lots of things from my patients. Sometimes they inspire me to be better or smarter. Sometimes I see examples of what I don’t want to do. Many times, it’s really hard to be neutral and keep my emotion in check. I’m sure most jobs in the public sector are similar. How do you deal with keeping personal emotions on the sidelines when all you want to do is scream at the top of your lungs when someone is making a bad choice?
It’s funny what people will share with an eye doctor. I do get a full medical and family history on every patient, so maybe they feel I already know their story. Maybe some just need to talk. While I am bound by patient privacy laws when it comes to sharing identifying personal information, I am allowed to share cases if I don’t identify the patient. If you’ve ever read a medical journal, you’ll realize all case reports are shared this way so that we can learn from other doctors and their cases. One commenter was very upset with me for talking about patients, but if I can’t do that, it leaves very little for me to say about my job. I am in no way disparaging anyone, but merely sharing stories that certainly make me think, and hopefully, they’ll make you think a little bit too.
One such patient story really makes me sad, and I feel maybe there is more I should have done. When I first began in my current practice, I had a patient in his mid 30’s who had a hereditary retinal disease. It gets progressively worse and eventually leads to blindness. There is no treatment or cure. This particular patient knew he had this disease, but really had nothing other than a diagnosis. At that point he was already legally blind due to loss of peripheral vision, but he still had pretty good acuity in the very center. (Imagine looking through a keyhole all the time).
I was taught that giving a diagnosis is no good unless you can offer the options of what to do with it. It’s never an easy conversation to tell someone they are going blind and there isn’t any treatment, but it’s part of the job. I also think it is my responsibilty to be aware of services that might benefit patients such as this and ask if they need help in applying. This patient was very proud. He was a pipe layer for one of the oil companies but was let go because he could’t see to do the job, and he was a danger to himself and others. His wife was a teacher. They were also trying to earn money by growing hay on their family farm, but they were struggling. I suggested he apply for disability.
Now, I am not one to go around suggesting disability status. I have tons of patient who have applied on the basis of everything from eye inflammation to just having a strong prescription. Those are not disabilities, and I strongly point that out on the forms I have to fill out for the state. This gentleman was truly disabled. Legal blindness limits your ability to do most jobs and to be able to drive yourself to and from work. It was a very legimate case, but you would have thought I threw acid in his face. He was very upset with me for suggesting it, but he eventually came around, and we helped him get approved. He has continued to refuse help from services for the blind as far as classes to read braille or how to navigate with a cane. It’s painful to watch him stumble around, trying to act like nothing is wrong.
The family still struggles, not just financially, but with having a very proud bread winner who cannot support them anymore. They have three kids, two boys and a girl, and with this particular eye disease, there is about a 25% chance that the sons will develop the same problem. I began seeing them in their early teens, but signs don’t show up usually until the 20’s, so I’ve always, in a very nonchalant way, tried to stress the need to find a career that doesn’t rely on good eyesight. I always kept it lighthearted and never said things like, “What will you do if you go blind?”
Both boys are smart. The younger one was actually an honor student and very excited to major in political science and move to Washington DC. They also are from a very rural farming town that often feels leaving home to get an education is like thinking you’re better than all the rest, and it can certainly ostracize anyone without a thick skin.
I was incredibly happy when the older son went away to college. He was the iffy one as far as leaving home, and although I only see him once a year for his eye exam, I was really proud. I was equally as sad when he dropped out after two semesters. I know he enjoyed school, had decent grades. and made some good friends. I can’t say for sure why he quit, but I believe money was a big problem. Not necessarily for school, but with his family. I think he felt a need to help out since his Dad wasn’t able to. Anyway, he is working as a ranch hand and general laborer currently. He got married this summer.
The younger son was much more cerebral, so I wasn’t worried about where he would land. He got several scholarship and ended up at a small school in Minnesota. I found out last week that he too dropped out and is now working in the oil fields, just like Dad used to.
I hope as hard as I can that the eye disease gene has skipped these two boys. I hope they have long lives as fully sighted individuals and can earn good livings for their families. However, if they do end up going blind, they will likely struggle financially without the training and skills to get a job beyond heavy labor. Maybe I’m wrong, but I can’ t help feeling like these boys passed up some opportunities they will regret later.
I can’t help but wonder if it would have made any difference if I’d become one of those doctors I can’t stand who lecture patients about bad things that will happen if they don’t do exactly as I say. Maybe I should have been more blunt and less nonchalant? We’ll know pretty soon as both of them are approaching the age when symptoms of the eye disease should show up.
How do you handle seeing people make choices that aren’t in their best interests? Should I have been more forceful? Would it have mattered? Would you change anything if you might lose your eyesight?