Both of his eyes were tightly closed with tears streaming down his face. He covered the left eye, apparently it had the dust or something in it. “Doctor Johnson please help me. This pain is unbearable. Please, please do something quickly. Can you please help me, Mr. BJ cried? This is awful.”
Immediately, the differential diagnoses came to mind. Glaucoma? Detached retina? Retinal hemorrhage? Or, maybe just simply, dust.
I did this recitation at the same time as I reached for the emergency eye tray. In the emergency eye tray are an assortment of drops, ointments, solutions and instruments to retrieve foreign bodies. However, before doing anything, I must relieve his pain. A few drops of Proparacaine instilled and he is smiling. Proparacaine is a VERY EFFECTIVE AND VERY SHORT, BRIEF acting anesthetic.
Wow! Doctor Johnson! That is awesome. That is like magic. Thank you.
You are most welcome, I respond. Having said that, I ask the medical assistant to take Mr. BJ to the visual acuity chart. This allows me to see another patient and at the same time reconsider the broad differential of life and vision challenging illnesses. I see the patient with the sprained ankle, another with bronchitis and another who has been non-compliant with either her blood pressure or diabetes medications. I comfort one, treat the other and scold the last. Then, I return to Mr. BJ and his eye pain.
He is a bit calmer now. “Dr, Johnson those eye drops are excellent. I was able to pass the eye exam. I saw all of the letters clearly. Can I go now?
I respond. “Well let me examine you first sir. I want to make sure there are no foreign bodies or injuries to your cornea or conjunctiva. Having said that, I instill more of the Proparacaine and do a Fluorescein stain of the eye. This allows me to see under an ultraviolet light any evidence of scratches or scars to the outer eye. Then I take a cotton swab, turn the upper eyelid upside down and search for particles under magnification.
You are good to go Mr. BJ. I don’t see any damage to your eye. There is just some irritation that will resolve with these other prescribed antibiotic eye drops. Use these drops four times daily and within one week, your eye will heal. If you have any problems between now and then call me and I can refer you to an eye doctor.” I say this in hope that Mr. BJ will be healed and with the knowledge that he can’t afford or easily access and eye doctor. I pray to myself, ‘Lord please heal Mr. BJ’.
Mr. BJ is excited and so thankful. “That is good Dr. Johnson. The best part, I don’t have any more pain. I feel perfect. By the way, how long will these eye drops for pain work?”
I mumble an answer. “Probably until you get to the parking lot. Not much longer than that.”
Mr. BJ looks on me with both eyes wide open now, with unbelief. “You can’t be serious, Dr. Johnson. What happens after that?”
I go on to explain that the pain relief is temporary and these eye drops of Proparacaine are not available commercially as the intent is that Dr.’s do not prescribe this in an effort to not mask the pain. We need to know our patients are not in pain while in our presence. Once they are out of sight, they may as well be out of mind.
How often do I practice this ‘out of the parking lot’ medicine? How often do I ignore the fact that the Mr. BJs in my clinic are going back home to job loss, limited or no income, caring for very sick family members, addicted children and unsafe housing? How often do I ignore the beyond out the parking lot situations? I am very callous. As long as I have made you feel better, right here, right now, I have done my duty. The rest is up to you. The pain relief will last 6 minutes, 6 days, or 6 months, while the circumstances of Mr. BJ’s life remain unmet. Lord help me to think beyond the parking lot.
Colossians 3:12 Therefore, as God’s chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience.