In med school, we occasionally talk about patients whose symptoms or disorder we can’t explain. Often times, it comes in the context of the “difficult patient” or “factitious disorders.” In both cases, there’s this subtle, inward eye-rolling by both the teachers and the students. Difficult patients are just a part of life. And some people just make stuff up. Sigh. Ah well.
It’s quite a striking difference from the normally top-notch empaths that fill the room. Everyone in that class can identify with the struggle to control high blood pressure or diabetes. But one mention of conversion disorder or a patient who wants an MRI for having a “fuzzy feeling” in their head… people tune out.
I don’t know if I can change any of that with this story, but here goes.
I’ve had glasses since I was about 12. Not a great year for me – I got braces, glasses, and a personal posse of bullies in grade 7. A few years later, I discovered the wonders of contacts and ditched the braces for a retainer.
My eyesight has never been great; even now at 22, my eyes are much worse than my dad’s, sitting at a -5.0 and -5.25 in terms of prescription. So I go every year to my optometrist to get the latest update on how my eyes are abandoning their duties and leaving me to grope around in a fog. Traitors.
The summer before med school started, I went to get my eyes checked, as per usual. My eyes seemed to be easing off on their attempt to sabotage me (especially my toes – I don’t know what my lower digits ever did to them) so I didn’t expect much change.
The exam took a little longer than usual. He spent an awful lot of time looking at my retina, shining his light back and forth, back and forth. If I was a cartoon character, I’m sure a little bubble with “?” would have been hanging over my head. Usually quite a positive and calm fellow, my optometrist looked puzzled. Even worried. He had a permanent little line between his eyebrows that wouldn’t move.
He told me there were some “suspicious spots” on my retina. They were probably nothing, but it’s hard to tell without having an opthamologist look at it with Special Equipment. But whatever, I thought. I’m young and healthy. It’s not like I’m getting glaucoma or retinal detachment. This might actually be a great opportunity to do a mini-shadowing session with a specialist! (O, the obnoxious pre-med enthusiasm. Those were the days.)
When I showed up to hospital, I was triaged pretty much dead last. Honestly, my “suspicious spots” weren’t quite as important as a guy with metal in his eye.
The ophthalmologist was just fantastic. He was positively tickled that I was going to attend medical school in a few months and immediately bombarded me with the anatomy of the eye. Most of that rebounded off my brain, needless to say. But one thing that did stick was the fact that I had little nicks and tears on my retina. At 20. I had holes in my retina. No symptoms, nothing. Since starting neurology, I know it as PVD or posterior vitreous detachment.
After wrapping my head around the fact that I could have been blind at 25, I quickly signed away my life and asked him to laser my retinas. Weird sensation, that. Imagine a rubber band snapping the back of your eye. Basically it just puts a little circle of scar tissue around each tear so they can’t pull off any more than they already have. Simple. Took all of 30 minutes.
I left feeling relieved and super-duper educated. My retina was gonna make it. I wasn’t going blind. And I was told that I have an excellent signature for a physician.
After the weekend, I was back to work at the diagnostic lab. Spinning blood, spinning urine, labelling blood, labelling urine… Except something was off. Over a few days, I noticed there were a multitude of fast-moving floaters in my right peripheral vision. It’s almost like looking at a spinning fan out of the corner of your eye. Very distracting. And frightening, too – what if something went wrong? What if he damaged the optic nerve back there? What if my retina’s coming off after all? Traitorous eyes, what the hell is wrong with you?!
It didn’t get better over a week, so I went back to my optometrist, hoping he’d find something. Much to my disappointment, there was nothing except a couple of perfectly round, well-healing scars. So he sent me home with assurances not to worry.
Obviously I did anyway. I’ve never so much as broken a bone, I was perfectly healthy… so why was this happening to me? Some days, when it was really bad, I looked like a crazy person – I kept getting startled, thinking there’s something on my right. It was maddening.
But to some degree, I believed my optometrist. And I had faith in my ophthalmologist. They were both very good at what they did. I was just going to have to put my vision in their capable hands.
I still have it. To this very day, there’ still a bunch of squiggly lines going nuts way off to my right. It’s a lot better than it was a few years ago and I’m better at ignoring it, but it’s never really gone away. I have an unexplained symptom with absolutely no findings. I’m one of those patients.
So the next time you’re tempted to play down a patient with somatic disorder or who feels like their head is “fuzzy,” please remember that everything we feel is very real to us, even if we don’t have tests good enough to explain it. It’s not our fault for wanting answers. So even if you can’t give us what we want, please at least listen. Because sometimes the only treatment we have is our faith in the listener.