Friday, December 27, 2013

Floaters, flashes, and pain

Reading lying down is a dangerous sport. Yesterday, on the couch, I was hit smack in the eye by a mis-tossed rubber ball, the dog quickly retrieved while I held my eye closed, letting the pain subside.
The pain was 5 out 10 and 'sore' initially but I did feel like my eyeball had been compressed, the ball smacking into the open eye.
My vision was unaffected but later in the evening I began seeing frequent flashes in a circle around the periphery of my vision.  It was irritating.  Tiny pinhead lights flashing on and off rapidly then with diminishing frequency.  Floaters came next. That concerned me.  I didn't think anything of the flashing lights because they'd gone from every minute to minutes.  But the floaters moving about and not obstructing vision bothered me.
I am a doctor.  I don't react appropriately to injury.  I do most of things I tell my patients not to do. I live in denial. I depend on denial. I minimize matters to the maximum.  If I even considered for a moment the risks I take daily in my work, sick strangers with unknown diseases,  ex convicts, ex murderers, HIV, Hep C, psychotic, drug crazed, delirious, lice ridden, MRSA, new diseases, flus, coughing, wet sores dripping……that's good days. I'm now one of those unknowns and some doctor will see me. Like soldiers walking through dangerous enemy controlled territories doctors (and nurses) face the unknown routinely.
When I've been injured, ill or sick, I don't want to know what it is. I believe that if I think something is bad I make whatever it is worse. I believe in mind over matter. I'm now a psychiatrist.  I did rural and emergency physical medicine, started in Surgery , but today I know it's all in my head. If only I pray right or ignore something sufficiently then I'll be healed. Isn't that what SECRET and all that NEW AGE stuff implies, as well as HEALTH and WEALTH Christianity.
Lots of Yuppies and Baby Boomers live circumscribed lives of quiet desperation avoiding risk and stress. Their God is money and the talisman health supplements and political correctness group think. The Money Conscious Superstitious Chinese wear face masks and now teen agers are avoiding shaking hands and bumping elbows because the environment is unsafe. Like cave men before them the superstitious are random targets of a merciless world. They don't even have Karma to protect them but live in an arbitrary atheistic reality where their insignificance is their vulnerability. Even the rich most consumer capable can't hide sufficiently from life. And I'm a front line worker and people think my recreational life is risky.
Disease is not to be invited. I've limited my 'dare devil' escapades especially now I'm older. I avoid some adventures I might have earlier indulged in ,but there I was lying on a couch reading when I was nearly blinded.  Smaller harder ball and I wouldn't have needed a tv villain to crush my eyeball with thumb. The random tossed ball would have done the trick.
I know a man who was blinded in one eye when a champagne cork hit him as a friend 'popped' the top without consideration of trajectory at a wedding.
Accidents happen. Whether they are accidental, attracted or brought on by masturbation in one's past , it's not certain. Judges in high court would declare a 'culprit', blame being more easily 'ascribed' than 'proven'. Truth isn't so conveniently man made.
JOB is still the most interesting book in the Bible, least read and least preached on. It overturns all manner of prejudice and theological crap.  Today Job would have HIV and Hep C as would his family but we can't talk of that.  Job wasn't homosexual so no one in some churches wants to reflect on Job. The Old Testament explanation of disease or even Jesus and the 'demons' doesn't fit as neatly as stigma. Lepers live among us but they have a different name. We have our distances and districts.
I'm not innoscent.  I have a whole lot of sins. I'm a doctor.  No doctor is without imperfection and we all know it.  We pit ourselves against death and disease and we don't always win.  We won when we competed against exams and each other but not when we wrestle with the devil and advocate with God for our patients.  We try desperately to change the direction of life and death, extending it or relieving pain. As psychiatrists we mess with reality.
Maybe someone deserves to experience rats gnawing their genitals according to their own ideas and culture but we change that.  We stop the rats and the rat like thoughts.  We do things.  We act.  I touch my patients.  I move out with them into community.  There are institutions and associations that cause disease.  To help my patients I must stand with them. The stigma of mental illness and addiction is passed on to the caregivers as much as the patients.
Today I woke up and the flashes were still there.  There were more floaters.  Denial wasn't working. This really could be a retinal detachment or retinal tear. If it was, an opthalmologic surgeon could just zap it with a laser and "cure' the process that could otherwise lead to blindness.  Jesus used mud to cure the blind.  The son of man and healer of all time. Now doctors have supernatural skills and talent.  I might not be able to think myself out of this injury.  I might have to ask for help.  I hate asking for help. I hate asking for help from physical doctors as much as they hate asking me for help with mental illness.
I would rather have gone to a psychologist, a shaman or a minister.  Maybe prayer would work if I got someone else involved. St. Thomas is a scientific sort of doubting saint. My kind of guy.
I asked my brother to drive me to the hospital.  He wanted to take me to the optometrist. He had to take my dad to the hospital dozens of time and wait hours and hours every time till someone our elderly father with heart disease and kidney disease.  He'd taken his children and his wife to hospital. He told me about one seizing in the seat where I was.  I realized how diabolical the governments health care rationing and consequent  'wait lists' were. Not just the ill were off work and in limbo, so were the caregivers.  
I heard him tell me about taking his children to the hospital,when I told him "I don't want to see a fucking optometrist or optician, I need to see a doctor."  I knew that even the ER doctor, if he was like me, might want to have me seen by a eye surgeon.  I knew all the time my brother had devoted to my father in the final years.  I loved him more for his love and sacrifice.  My dad was special like my brother is.
It's just that that's what these symptoms say one needs. Ophtalmologic assessment. I know. I've sent patients to ophthalmologists and they've had emergency eye surgery within an hour of my seeing the retinal detaching with the fundoscopic examination.
I needed a fundoscopic examination now. Once the denial stopped working,  I couldn't hold back the gates of despair and fear any longer.  I began crying.  Doctors make the worst patients. It's because it takes so much denial and so much energy and we know so much about so many really bad things.  If I even let my mind off the chain leash I was blind and dying .  I hold back the gates to despair.  I rationalize and convince myself moment by moment everything is going to be okay.
But these days I'm under attack by bureaucrats,  lawyers, judges, and the media and all those people who are so far removed from reality they couldn't find their ass with both hands. They even know what is right in their mind even years ago because they can ignore and choose all manner of what they think is relevant.  They're also easily duped by sociopaths or maybe incompetence or maybe they just sell out.  They think it's okay to 'bear false witness'. At least the military courts respect the 'fog of war'.
They, all these institutions, defend the wealthy who lie and blame me when I tell the truth.  I'm a truth teller and it's not a healthy trait in a deceitful society where our leading politicians admit to breaking laws, smoking dope,  and everyone thinks that that's okay.  It's okay if our leaders break laws in office and  do drugs.   But I don't do drugs. I tell the truth but even that doesn't protect you here.
And I'm afraid of hospitals.  Because my life was threatened by a doctor who was a friend of a doctor who I reported for killing a patient and I've never been forgiven for 'doing the right thing'.  All the doctors who are 'loyal to the group' and 'covered up' the killings were promoted to high position. I may well be the last surviving witness.  As a witness to the truth I live in fear. I know judges who despise me for telling the truth.  I know doctors who hate me.  I know nurses who think I shouldn't have stopped a serial nurse killer but then most people don't know the truth. The media is propaganda and cover up.  I've seen the bodies.  I don't think of all the good people and good doctors and good judges and good lawyers and good experiences in hospital.
I'm afraid of being sick.  I've seen too much sickness and disease and death.
I'm not afraid of dying. Being dead has it's own attraction.  It's the getting there.
I'm  afraid of dirty doctors, dirty hospital administrators, dirty judges, and dirty nurses.  I know they're rare. They're as rare as HIV but I can't wear a condom when I go to the hospital.
I'm crying.  I'm terrified.  My brother drives me to the ER. Queensway Carlton Hospital, Ottawa Canada.
The nurse is some kind of really beautiful, she has a row of earring on her right lower ear lobe.  She is efficient and caring and asks all the right questions.  The equipment is older. The waiting room is full.
I am thinking of the dead man in the Winnipeg Health Science Emergency.  He sat dead for 34 hours before someone noticed him. I'd taken my dad to the Victoria Hospital emergency there after he had a car accident. The seat belt had crushed his chest. He'd had chest pain. He's had a heart attack. He'd had multiple physical injuries and back trauma in his life working as an engineer, doing hard mechanical work, and now was hobbling and worried about his breathing, chest pain. He has a  pace maker. He was in his late 87 at the time. We didn't see a doctor for 9 hours.
I never tell people I'm a doctor.
I never tell people I'm a doctor, well, mostly.
I watched a senior bureaucrat from the Ministry of Health in Manitoba get a hospital ward cleared for his care alone, very special, very special, very privileged health care. He was sick and needed the emergency care but I didn't like that beds were closed for him to have more privacy.  I believe that the deterioration in the Canadian Health Care system which has gone on these last 20 years is directly a consequence of senior levels of government being able to bypass the health care system and get care across the border or with special insurance get private care.  If the officers eat what the men and women eat then the men and women are going to get better grub.
I know the way things are is right in a certain way.  I have patients jump queue all the time. Queues in medicine are to be decided by 'need' but increasingly people are 'buying' the 'express lane'.  In medicine that means someone is dying. It's not like airplanes and first class. It's different but the fact is I can pull rank and I have.  It's a hard call and 'baksheesh' in Canada is 'institutional."  I believe doctors need to be the ones who make the call based on the 'emergency' of the case, not on 'money' alone.  I know that my symptoms are 'emergency' material. I couldn't deny them and haven't described all of them.  They are the kind of thing that gets attention.  Some people now read the internet and get all the symptoms then present to the emergency with classic hypochondriasis.  They don't know as I do that hypochondriasis can get you killed. I have a healthy respect for 'investigations'.  Do enough and something will be wrong and if something is wrong then someone will try to put it right. I err in the other direction.  I  depend on denial to breathe.
I know some animals are more equal. It's not right but looking for justice in the courts is like looking for love in a whore house. Just as our courts and health care system are better than most alternatives I'm blessed beyond belief.  God is good.
When my father was in congestive heart failure and had pylonephritis and was delirious and the woman at the front desk was doing her nails and superciliously obnoxious, telling us to take a seat like sick people were inferior,, well,  she'd call a doctor, but I watched her and watched my father and 15 minutes later knew she'd just continued her union job talking on the phone to someone, not a doctor. She'd not called a doctor. I was watching.
Well I did, walk over, tell her who I was.  I don't like to tell people I'm a doctor to get special care but I sure let people know I'm a doctor to get appropriate care.  Walk softly but carry a big stick was the way my grandfather figured. I told her that if my father with the swollen feet,  short ness of breath and increasing heart rate,  I'd told her,  with his rapid breathing getting worse, if he died because she was fucking talking on the phone some other fat cow,  I'd hunt her down myself so she would beg me to call a lawyer so I wouldn't take matters into my own hands. The doctor, a very good doctor, quite amused by the response, obviously aware of the weak "union' link in the 'system' saw my dad immediately and had the lasix in minutes later. My father's breathing and colour improved immediately. I don't know what happened to the woman but I hope she left health care.
I'm afraid of petty women with power.  I'm afraid of the Borg.
I'm afraid a lot but really afraid when I'm now thinking I might go blind. It's possible. The denial hasn't worked and there aren't a lot more defences.
The nurse really was beautiful and efficient and competent. I knew because she asked exactly the right questions and did exactly the right thing. It's like watching a Canucks game when the doctors and nurses are doing it right, and you know because you're in the league.
Then the girl who took all the money information had that bit done.
And another nurse checked my vision.
And then a doctor arrived and he did the history and asked the right questions, and was calm and examined me with the fundoscope and told me what he saw, as I hoped. There wasn't a detached retina. You can see that with a fundocope and you can see blood.
And he referred me to an opthomological surgeon. He did that because otherwise he'd have to dilate my eye. When I was alone in the north and didn't have specialists to refer to I dilated the eye to look more closely. It's hard to see. I had slit lamps and all that stuff too. I've actually seen retinal detachments and tears in the opthalmoscope. It's not that common.  I've been around.
But if you're going to see a surgeon, he'll do all that dilation stuff and then you don't do it.
It was vacation and I'm on my way to see an ophthalmologist on call at the eye centre. No one was at the hospital available but that's okay, I'm not going to blind.
The pace of everything has changed to  okay now. I can see. I'm not going to be blind today.
When the doctor was discussing his findings with me I told him I was a doctor, had been an ER doctor, and was now a psychiatrist.  He understood I understood and could just send me on my way without a much longer explanation.  He was a very good doctor, Dr. Chandria, I think his name was, really fine young doctor.
I'm going to see the specialist in an hour.  I"m not going to be blind.  The pace is slower. There's no emergency of minutes or hours. Maybe days. Maybe there's a concern today but it's not like a sneeze is going to make it worse now.
I'm going to be able to get back to denial mode soon. I can feel the panic backing off.  It was silly of me to swear and cry.  A better person wouldn't swear or cry.  All the superior people I deal with so often,, they'd not swear and cry.  I know they're perfect. I'm not. I'm going to be okay, though.
I've got half my smell and am only a bit of a gimp, chronic pain and getting older.  I worry way to much about my patients.  I'm a mess.
But I'm able to see and write and I will still be able to suture someone up if I need to and I'll be able to see if they're anemic and watch for jaundice and study their expressions when they are lying to me or holding back something essential, because they're afraid.
It's going to be okay. I 'm praying. I m breathing. I don't think I was breathing normally there for a bit

I was seen by Dr. Thomas K. Lee, MD, FRCSC (2211 Carling Avenue, Ottawa, Ontario, K1Z 8R1 - tel 613-226-7061) at the Retinal Centre of Ottawa in Ottawa General. He and his colleague were the epitome of professional competence and concern.  They were extremely thorough in their examination.  They said that the retina was fine, I could fly home and that things should be okay but if they weren't I could contact the UBC Eye Centre. I told them that my ophthalmologist was Dr. MacIntosh. I said I'd be sure to tell her that their examination had caused psychosomatic retinal healing of my retina by inducing my placebo response. They laughed and I was really thankful.  Dr. Lee and his colleague saved my sight today.

The Eye Clinic had had 15 patients book and was inundated with another 50 emergencies. The staff were as amazing as the staff we have in our Methadone Clinic in DTES Vancouver. The patients, though were better behaved. We all waited hours and when I left there were more waiting.

My brother picked me up. With dilated pupils I was thankful for the shades my sister in law had offered as I left.  Driving home I remembered the incredibly good care I got in Winnipeg General the time I was hit by another car and mine bounced head over heels before rolling sideways and righting itself. Then I remembered the time I was on my bicycle and hit by a car going through a stop sign.That day the UBC hospital doctors saved my life. The ER care was beyond good.  Now I'm going to live I'm able to see that whole catalogue of great doctor experiences I've had. I can remember all the good nurses and know that I was working there for years and helped countless people myself in a half dozen different hospitals.  But on the way to hospital, all I could remember was the horrors, especially the corruption.  Perception is so keyed to emotion.

Dr. Lee may well be a world renowned retinal specialist but he's a pretty good psychiatrist too.    

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