lessons learned

Strange Episode With a Rara Avis

It all started with a call at 3 a.m. from a patient who needed the eye doctor.

JACK RUNNINGER, O.D.

One of the strangest patient communications episodes I've ever heard was described in, "On The Shoulders of Giants," a history of the Washington University Department of Ophthalmology and Visual Sciences, written by ophthalmologist Dr. Ben Milder.

In the book, Dr. David Meltzer tells of his dealings with what he calls a "rara avis," on his very first night as ophthalmology resident. Following are excerpts from his story:

At 3:00 A.M., I was awakened by a call from a woman. She said she needed to talk to the eye doctor, because she had been operated a week earlier and was having pain.

Surgery where?

When I asked what surgery had been performed, she had no idea. She had given uninformed consent for the surgery, and had no idea of what had been done. I engaged in some conversation with the patient about her surgery. After a few minutes and some graphic description, I formed the hypothesis that her surgery did not involve the eye, and had not indeed been performed on any structure above her neck. So I tried a direct attack.

"Where was the pain when it started?" I asked.

"In the bedroom." I realized that this was not going to be the simple bagging of a rabbit for the stew pot. I decided to test my hypothesis that her surgery was not of the eye. So I asked her if her surgery was above or below the waist.

"Below," was her response. So in a moment of inspiration, I asked her if they had removed her womb. She replied in the affirmative.

Closing in

A smile of satisfaction crossed my lips. The trophy was now in my sights. I knew the eager expectation of the hunter about to dispatch an elephant contentedly grazing at one end, and feeding beetles at the other. I told her that of course she wanted to speak to the GYN resident, and I would transfer her call.

"No," she replied, again as to a child. "I do not need the GYN doctor, I need the eye doctor."

The shot having missed, the trophy had escaped, and the taxidermist would have to wait.

"Surely," I pleaded, "if you had a hysterectomy and are having pain, you need the hysterectomy doctor."

"Surely not," was her curt response. So again pleadingly I asked her if the pain was in her eye. When she said no, I asked her if the pain…. (Here the reader is to understand that I asked if the pain was in the region of her surgery.) When she replied in the affirmative, I was defeated and appealed for quarter.

The reason why

"Could you tell me why, if you had a hysterectomy, and now have pain in the area of the hysterectomy, you need the eye doctor?" I asked with becoming submission.

"Because," she began, triumph in her voice, "I have been told that I have a narrowing in the front of my eyes, and if I ever wake up with pain, I am to call the eye doctor. I woke up and I am having pain, and I am calling the eye doctor."

I was later able to reflect with some satisfaction on being in a training program that had, on my first call, provided me with a specimen of that rare Ophthalmic entity, "acute glaucoma hysteroides media noche." OM

Editor's note: Dr. Runninger has received the permission of Dr. Meltzer to reprint this excerpt.