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Ways of Seeing and the (Mis)Treatment of Our Elderly

mustard flowersRecently, an elderly friend asked me to accompany her to a doctor’s appointment.  She needed a ride and someone to observe her appointment to help glean whatever the doctor was going to say.  She suffers from short-term memory loss, and at 93 years young, also wears a hearing aid in each ear.  I had the week from hell, was behind in everything, was leaving early the next morning for a long, somewhat arduous trip and was feeling exhausted, but said yes because that is what friends do.  The experience left me gutted, and here’s why:

My elderly friend has been having trouble seeing.  She now complains of feeling dizzy all the time.  She said everything is blurry.  One of her eyes was damaged a decade ago in a botched cataract removal surgery. Her “good” eye has been suffering age-related glaucoma and macular degeneration.  Aside from these maladies, my friend is a two-time cancer survivor and otherwise trim and fit as a fiddle.  Her decreasing eyesight, however, leaves her vulnerable and far less active than she would be if she could see.

This, after a lifetime of hard, dedicated, ambitious work.

It would be hard enough to be alone/widowed, elderly, somewhat dependent on others and losing one’s eyesight, without having to be all of these things and then subjected to what I witnessed my friend endure during this appointment at her ophthalmologist’s office.

Because she was told to arrive early, we arrived fifteen minutes ahead of her 9:40 a.m. appointment.  The multi-section waiting room was nearly filled to capacity, and we waited a good 45 minutes to an hour before my friend was called for one of the day’s first appointments.  When she got to an examining room, a middle-aged woman began asking my friend questions.  These questions, delivered in a bold voice with no greeting and with no introduction whatsoever, led to a full-blown exam accompanied by a bit of an interrogation and lecture about whether and why not my friend wasn’t using saline drops four times a day, as she was apparently told to do in her last appointment.  My friend was confused, and said she didn’t recall being told to use them.  The interrogator who never introduced herself or her position proceeded to open a drawer and show my friend the saline containers that she should have been using or should start using. She didn’t give my friend the sample, and by the time we left we weren’t sure whether the saline applications were still expected or not. Like the decorum that was lacking, the addition of saline drops just sort of got lost in the waits and shuffles.

My friend announced that she had some specific questions she wanted to ask the doctor.  The mystery female/examiner said nothing.  My friend said she wanted to know if she was losing her eyesight; my friend intimated that she suspected she was.  The middle-aged woman, never looking up much at all, directed most of my friend’s questions and responses to the paper she was writing on.  She administered several standard eye exams that led to shocking realizations for me that my friend could scarcely read any text whatsoever, no matter the line or size.  My friend kept joking about another “Blue Light Special” as the diagnostician directed and re-directed her to the ophthalmoscope. After approximately 45 minutes of this and without explanation, we were shuffled off to a second waiting room.  “Come this way,” was all that was said, and we followed.

In the second waiting room a second assistant called my friend’s first name, approached us, and then again without introduction or explanation told my friend to open wide while she inserted liquid chemicals into each of her eyes.  She did not tell my friend that this was to dilate her pupils or even that it was preparation for further testing.  She just did it, while pushing a kleenex to my friend’s hand, telling her between each application to dab her eyes.

For hours later, my friend would complain about the way her eyes felt, about their cloudiness and how they had yet to settle down. For the remainder of the day, she would seek shelter from all light, both indoor and outdoor.

As we continued waiting for my friend’s eyes to dilate, I observed across the room another elderly gentleman, looking as if he were about to burst into tears.  It was a compelling image that may have had nothing to do with the environment, but seemed representational of it.  I couldn’t tell what was hurting him, but I knew he was in some sort of serious pain. A nation of our elderly and their sufferings struck my heart as I watched him stand to leave on crippled legs.

At this point, the second waiting room assistant (distinguished only by having shorter hair, a smaller waistline and a thicker accent) returned without a word to check the dilation of my friend’s eyes, left for another 8-10 minutes, then returned.  Again this woman told my friend to go now with her, but told me to stay put while she ran “a test.”  As my friend stood to walk, she wavered unsteadily, grasping for chair arms and walls to hang onto as she attempted to follow the assistant into the second examining room.

After some time, the assistant came to direct me to “Examining Room #1,” where my friend waited.  More questions ensued.  My friend looked exhausted.  She seemed more anxious than I had ever seen her.  She appeared to have grown tired from all of the poking and prodding, pressure-testing, power-adjusting, and light-shining into her eyes.  She blinked her eyes and reported having difficulty seeing.

Finally a youngish doctor entered.  He was probably in his mid to possibly-late thirties.  He was wearing a Toews jersey. I thought “a-ha,” that he might be “the captain.”  I mostly noticed a huge splash of red.

All of the staff at this office–the receptionists, the assistants, the diagnosticians and opticians, all the questioners and re-directors, as well as the ophthalmologist–were clad in Blackhawks t-shirts or jerseys in a show of some sort of odd solidarity.  After all, it was the middle of the Stanley Cup playoff series and this was a Chicago suburb.  I got it.  I could see the enthusiasm.  At first I even felt a glee, the connectedness of it all, but my approval shifted when I observed what happened next.

The only way to tell the doctor as the doctor was by his gender…and possibly by his captain jersey?  Even this was not definitive.  Without so much as a handshake, a nod or nametag to glance, we were left to the observation that the doctor was whoever was the last to appear in what turned out to be the last waiting space.  This was it.  The moment for which we had waited over two hours.

“I haven’t seen you in a long time,” my friend said to the man who seemed not to recognize her.  Looking at her file he replied, “You were just here in March.”

He stepped over me to the little swivel recording chair that was strangely becoming notorious.  Like the “assistants,” this “doctor”/ophthalmologist delivered his words directly to the paper in front of him that sat on the desk beyond the chair, clearly placed for recording patient records.  My friend had trouble hearing and asked for him to repeat himself.  He seemed distracted and not at all engaged…as if he were present only as the final step before being free for the day.  My friend’s age, my attendance, my friend’s medical history, my relationship to my friend–all seemed of slight if any consequence to him.

My friend told him she was wearing new glasses.  She explained to him how she goes to bed and wakes up in the morning seeing big masses of black spots everywhere she looks; she asked what these were, and she said that they drive her crazy.  At first I thought she was talking about floaters, which everyone has; but as she spoke, it became apparent that she was describing something more serious.  This doctor/third consultant told my friend that her prescription had not changed.  My friend repeated that she had new lenses and a new frame.  The doctor/poor listener said that her glasses were the same.  I impatiently interjected, “She’s been telling you those are new glasses.”  He looked at her; he looked at her glasses; he read over her chart, shuffling through the papers on the desk that he otherwise kept talking to, and then he said, “Oh, those glasses are different from the ones you had last time you were here.”  He finally understood.  But even then, and rather starkly, he said, “It isn’t the glasses.”  He added that her prescription is essentially the same, with no change–meaning, no significant change.

My friend got the answer she sought, that the changes she was experiencing was not from the new prescription but from a literal change in her eyesight.  My friend asked the man if she was losing her eyesight.  She said she wanted to know; she said that when she comes in from outside, it takes her over half an hour to be able to see “in her own home” which she has “lived in for over sixty years.”  The man/doctor answered by saying that her vision had dropped three levels since her last appointment in March (fewer than three months ago).  He said to the paper that “this is macular-degeneration, but that she is lucky she had the “dry” kind and not the “wet” kind, because “wet” macular-degeneration is the really bad kind.”  He said she didn’t want her “dry degeneration to progress into the wet kind.”  My friend asked him to explain it to me.  He showed me a printout that had a graph-photo of her visual acuity three months ago, and then he showed me a similar graph-photo from now.  You could see what could be considered the deterioration.

I asked if either could be treated. He said the “wet” kind (the worse kind) could be; he said “with shots.”  He said the “dry” kind, which my friend currently has, is treated only with vitamins…vitamins that she should take once in the morning and once in the evening.  He gave her a package of one dosage of eyesight vitamins that included a $4.00 coupon, and told her she could buy them anywhere.

I looked at my friend, who had aged notably since the last time I saw her two months prior.  She looked sad and anxious and confused.  She is normally pleasant, even ebullient.  I asked the doctor if stress was bad for macular-degeneration.  He said stress is bad for everything.

The doctor gave a plastic card to my friend and told her to follow the directions on it and said that she should call if she noticed any changes when she checked the card.  My friend said she already had that card. My friend asked if she should keep her pre-scheduled upcoming appointment in August, as she had come in on a bit of an emergency.  The emergency was prompted by my friend who recently received a new eyeglass prescription that seemed to be making everything blurry…but she wasn’t sure.  And she was dizzy all the time.  She repeated that she couldn’t tell if it was the glasses or her eyes.  The doctor said she would now need to be checked every four months instead of six, but if she noticed anything (like she had this time?), she should call immediately (as she did).  I intervened and said I thought that she probably should then keep her August appointment–she could always reschedule if her she didn’t notice any further deterioration by that time.  Everyone agreed.

I asked if there were any lifestyle changes for my friend.  The doctor/man surprised us by saying she could still drive, “legally; if she wanted to; if she still was; but only during the daytime” emphasizing, “but not at nighttime.”  My friend said that she stopped driving over ten years ago.  I guessed he hadn’t seen that on the chart he kept talking to.

I almost wondered for a minute what that doctor was thinking…

“C’mon, it’s almost 1:00!”

“Why didn’t I study architecture?”

“Tee time is in 40 minutes!”

“Let’s Go, Hawks!”

Over three hours after the start of our appointment, the girl at the front counter was telling my 93½ year old friend (who had cooperated so patiently) that she needed to pay an additional $40.00 for one of the tests. My friend asserted, “My daughter already paid for that test.”  The girl countered, “Not for today’s repeat of that test.”  I didn’t get the name of whatever test they were charging extra for that my friend had also taken just two months ago, but I knew for certain that there were a lot of tests taken and that my friend is insured.  What wasn’t given here or throughout this appointment was standard information, explanation, or any semblance of compassion.  I cannot imagine what it would be like to be losing one’s vision and to have that event so dismissed—particularly by those who have supposedly dedicated their lives to eye science. Perhaps they see this all the time; perhaps a person’s going blind is routine to them.  They don’t have to be dramatic, but they could show a little more empathy.  I suppose a Stanley Cup loss is something they might find more devastating.

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