Frosted Glasses

With both eyes open, it feels as though someone took a stick of butter and smeared across my right eye. I can see well enough to function (well enough to have driven this morning, even), but am impaired enough to be mindful of the fact that there's something wrong. When I close my left eye, however, the situation is very different. It's as though the world is covered with wax paper: I know there's something interesting on the other side of it, but it's just as likely to be a tray of brownies or dog shit.

I am struck by my frightening inability to take in the world around me. But the experience of my corneal abrasion has thus far been enlightening in terms of enhancing my appreciation for handling impairment, and relation to those affected and unaffected.

Typically when I reflect upon an experience in the role of "Patient," it's after-the-fact -- once I've already come out on the other side, restored to health (even when I took notes via Crackberry on my distressing experience at the NYU ED on my last day in New York -- which I will one day make time to write about on this blog -- I was stabilized and very much improved). This is different: I'm in the thick of it, whatever "it" means.

I decided years ago that I would do whatever I could to learn about how other people experience things I've never experienced -- not for any great noble good, mostly so that I sound like less of an idiot when I encounter other people who have experienced the same things. In clinical settings, I've found that people really like to talk about their symptoms and experiences-- to get an extra ear of someone who has more TIME to really listen, even if said someone (i.e., me) can't do a damned thing to improve their state of affairs. Sure, listening counts, but it certainly has its limitations -- and, to me, acknowledging those limitations of what one is able to do FOR a patient also means acknowledging the limitations of what one *should* seek FROM a patient. I've always limited the directions of my questioning to the specific areas that either a) directly inform me in areas important to my research or as a follow-up to an area of their clinical care that I can impart to a patient's physician; b) work to establish rapport, to facilitate criterion "a." That's it -- anything more, I experience as unfair -- regardless of the "contribution" it would make to my learning process. In non-clinical settings, I've had varying degrees of success of acquiring specifics without getting too "clinical" -- though that has indeed been easier once people in my life forgot I was ever in Mental Health World (there is a fascinating correlation between "years since abandoning psychology as a profession" and "extent of misperception that I am forever 'psychoanalyzing' the world"). I've learned quite a bit through gentle, casual efforts at merely projecting (genuine) interest in people's experiences. It's one of my favorite medical training tools -- and, yes, I do conceptualize it as such. It always amazes me at how casually the Welnerisms I've retained from what I initially encoded as "forensic interviewing techniques" -- but, in reality, are just "good ways of interacting with human beings" sneak out, and successfully so.

A few weeks ago, I had a date that almost turned into an experience like this. We got to talking about his struggles with quitting smoking -- a struggle so profound that he couldn't get through our 20 minute picnic lunch without breaking out a cigarette, or at every two miles of our bike ride. He was apologetic, and expected judgment - of which he found none. While this was certainly a deal-breaker for me from a dating perspective, I was more curious than displeased. I asked him what a cigarette craving felt like, that I wanted to try to understand it and how it differed from other kinds of experiences (actually, I don't think I phrased it like that -- and looking back, I should have. That was very 'Welner,' and I think it would have been effective). He was surprised, but not unwilling, to answer. I disclosed my own (diagonally related) struggles, and he appreciated the comparison. Did his answer enlighten me to the depths of addiction? No. Did it change my life at all, even? Not really. Its value was moreso in relating to someone with a common inability to express a common phenomenon. I'll be more likely in my life to have discussions with people who CAN'T articulate their struggles than with those who can. Did I ask the question for "practice?" No. I asked for knowledge. But was it good practice, even if not good knowledge? Absolutely.

As it relates to vision specifically, I once read an article that mentioned a few medical school programs that required their third-year students to walk around wearing frosted glasses so as to experience what a patient suffering from glaucoma felt like. I made a 'note to self' that I want to do that. I didn't connect this with asking someone whom I KNOW who suffers from this (which I do know, and knew that I know...). I don't know why. And it's this very limited impairment (by comparison) to my own vision that is only now prompting me to seek this information out. I haven't attached a value-judgment to my delayed decision; I don't think it needs one. Just observing.

I'll (mostly) limit the discussion of my experience with medical treatment of this injury to that of my post-consultation self-care. After waiting in an exam room for 90 minutes to get examined by a nurse practitioner who didn't even wash her hands (as I was supposed to be studying for my exam on the spread of bacterial infection and its relationship to hand hygiene!! Oh, the irony.), I was diagnosed and provided with a patch to wear for 24 hours. At my own request for a prophylactic antibiotic, I was given a thick, goopy antibiotic ointment for a week. I didn't want to appear ungrateful for my request being honored -- and not having to pay for the ointment, so I said nothing about being totally unable to reach the site of my injury (my tear is at the very top of my eyeball, essentially -- I can't even reach it with a q-tip, really. A drop would reach it fine; a gel, which requires active direct spreading, not so much). Since I can't apply the gel to the site of injury, I instead have to apply to the likely entrances for bacteria -- and when I do that, I can't see a damned thing. So, I had to make a decision to only apply the ointment before bed -- so that it minimally compromises my vision when I wake up, as opposed to my ability to FUNCTION all day long.

When I share this with any of my fellow medical students, I get the same reaction: "You're so (GASP) non-compliant!"

During my first week of medical school, I attended a lecture on clinical decision-making -- which featured a review of how the "ideal" patient encounter is never as such. At the treatment stage, the lecturer encouraged us to drop the term "non-compliance" from our vocabularies -- that the patriarchal notion of "I, doctor, tell you, patient, what to do --- and you do not comply!" is entitled and short-sighted; it does not take into account a patient's psychological, social, economic, and other life circumstances that may be in direct or indirect conflict with all or part of a treatment plan. Hearing it presented that way, I totally agreed! I'd been using the concept of "compliance" and lack thereof for years already -- it was so part of the medical culture to which I'd been exposed, both among the physicians at TFP and Sinai alike. Never thought twice about it. Once that lecture changed my reference frame, I found my friends' reactions to my antibiotic debacle to be utterly offensive.

"Non-compliance" really does fail to take into account very REAL conflicts between this antibiotic gel and my life. Namely:
* USE ANTIBIOTIC --> CAN'T SEE A DAMNED THING
* USE ANTIBIOTIC --> EYELID WEIGHED DOWN TO THE POINT WHERE EYE IS ENTIRELY CLOSED --> FALL ASLEEP IN LECTURE --> FALL BEHIND WHEN THERE'S A TEST IN 3 DAYS
* USE ANTIBIOTIC --> CAN'T DRIVE --> CAN'T GET TO WORK AT 5:45AM --> GET FIRED

Non-compliant? How about "practical?"

An hour after I began this post, I still can't take external stimuli in from the world to the extent that I would want to. But I feel better for having brought my internal stimuli out to the world, in a way that no big ol' chunk scraped off my cornea can take away.