After about a dozen people returned to the clinic concerned that their eyes were still dilated the next day and the angle closure of Tuesday, we decided that the 1% cyclogel was too strong. In the most sterile manner that I could manage, I diluted it down to 0.5% cyclogel. It took longer for the patient to dilate, but better to take a little longer and be safe.
Every time a person came in with a concern, my stomach dropped until we measured their pressures and made sure they were fine.
And then we had a second angle closure. This quite simply freaked me out. Once again, we administered drops to get the process started and then sent the patient to the ophthalmologist at the local hospital. In their kind wisdom, Sandy and Natalie could see how upset I was and suggested I walk down to the hospital and check on her. I took a bag of the required drops to give to the doctor so he could just give out any medication that was needed. The surgeon was kind enough to talk to me in between surgeries and assured me that with the drops we provided and the diamox he prescribed, that she would be just fine. In general, it seems that surgeons are much calmer and accustomed to dealing with complications than this OD is. On the way back to the clinic, I bought some diamox to have on hand. Just in case.
It is so easy to connect with some of the patients. Because Randall is in acuities, which is the first step of the clinical process after registration, he gets the first chance to really interact with the patients. And, shush, don’t tell anyone, he brings me his favorites. In this case, he brought me a charming fourteen-year-old boy with Down’s syndrome. Not surprisingly, he had high farsightedness, high astigmatism and his right out was turned significantly out. The auto-refractor showed that his right eye was +14 with 4D of astigmatism and his left eye +4 with 4D of astigmatism. Knowing that nobody would ever tolerate and actually wear such a prescription I put. +4 -4 in both eyes in a trial frame. The beaming smile was a gift that restored my hurt soul. The lovely Sandy Bury gave me a monkey stuffed animal to give him and he kissed his nose. My heart just swelled. And my eyes may have welled up just a bit. I did get a mild chastisement from Emily because I pulled rank and stole this patient.
Randall also brought me a young man, about 17 years old. He had had surgery for congenital cataracts in his right eye that was anything but successful. Because of the damage from the surgery, he had virtually no sight in his right eye and glasses was not going to be of any help. So the goal becomes getting the left eye seeing as well as possible and protecting that good eye. Another super grateful smile when I put the trial frame on him and showed him what his vision would be with his new glasses. The rest of the story came out that his mother had had surgery for congenital cataracts and that his two younger siblings had congenital cataracts that needed treatment.
There will be no cataract surgeries tomorrow. There is an emergency appendectomy tonight and they are concerned with potential contamination. However, another 7 cataract surgeries today.
We have an amazing team. Everyone, ODs, students, volunteers (US and local) flow where they are needed. Everyone pitches in without complaint and the feeling of team unity is evident.
There was a short interruption in the patient flow when the President of CRE showed up with TV cameras to make a speech and tour the clinic.
We took care of a couple of Quechua people who spoke Aymara. It’s really interesting to watch the translation chain. English (doctor) to Spanish (volunteer) to Aymara (patient) back to Spanish and back to English.
Always a bit of organized chaos.