Category Archives: Random Ramblings

Reduced vision; increased insight

An entirely rational fear of going blind probably isn’t something which most people in their late thirties and early forties even give a passing thought to.  However, after multiple retinal detachments, it’s now pretty much top of my greatest fears list.  I fear more for my ‘good’ left eye than I do for my bad right eye, because I rely on it for everything.  If my left eye was in the same state as my right, I wouldn’t be able to drive, I wouldn’t be able to see people’s faces properly, I wouldn’t be able to read, or do my job, I wouldn’t be able to enjoy beautiful colours, or watch the birds in my garden, or admire art exhibitions, or go geocaching… the list is endless.  Sometimes I get very gloomy and depressed thinking about all the things I wouldn’t be able to do, and other times I just try not to focus on it (pun intended).

However, my sight problems have also made me think a lot more about how I might do certain things if the worst ever does happen to my ‘good’ eye, and it’s also made me wonder how people who are blind or severely visually impaired manage with certain tasks.  A while ago, I explored one aspect of this in terms of how visually impaired (VI) people cope with cooking.  You can read about this in my posts Dinner in the dark and Blind baking.  The latter also contains a YouTube video of my sister attempting to bake a cake with her eyes closed: I defy anyone to watch it and manage not to laugh, although hopefully it will also make people think.

As a result of all this wondering about how people cope, and internal torture as I contemplate my own visual future, I seem to have developed an increased awareness of VI people when they cross my path as I go about my daily life.  A few times now I’ve seen a guy with a white cane on campus at the university where I work, walking purposefully along, swiping his cane from side to side in front of him.  One day, he was walking along a very narrow, uneven path, flanked on one side by a bank down to the road and on the other side by a somewhat unruly hedge.  I wanted to stop him and ask him how he managed it; whether it was difficult using the cane and how he copes on the rest of campus.  I often notice things on campus and mutter to myself, “That would be a nightmare for a severely visually impaired person!”  Of course, I didn’t stop him.  Mainly because a lesser fear of mine is that of talking to people I don’t know.

Instead, I went home and listened to a podcast about how severely VI or blind people navigate.  I learned that they rely on sound a good deal, and that some tap their cane along the ground and  listen to the sound coming back to help them orient themselves  and get around.  I learned that weather conditions can have a huge impact on navigation.  Apparently snow is the worst, because of course it covers paths making it very easy to rapidly become completely lost.  One person said that she hates the rain because it dampens down sounds and makes it much more difficult to hear things properly.  She said that she can’t wear a hood as that blocks out even more sound, and she can’t use an umbrella as it’s too difficult to navigate with a cane or a guide dog in one hand and an umbrella in the other.  So as well as the annoyance of the rain making navigation more difficult, she also inevitably gets soaked.

Some time after listening to all this, I was standing waiting in the railway station one day when I spotted an older man with a white cane making his way through the door.  He walked past me and then stopped, fished his wallet out of his pocket, and proceeded to hold several bank cards very close to his face and scrutinise them carefully.  This took a few minutes, but he must have found the one he needed, as he put the other one back in his wallet and moved to return it to his pocket.  As he juggled wallet, card, and cane, he then dropped the card.  Immediately, he knelt down and began running his hands across the floor, searching for it.  Just imagine for a few minutes, having to run your hands over a filthy station floor in order to locate an object you’ve dropped, without knowing what they may come into contact with as you do so.  I quickly moved to find it for him, but then realised that he probably wouldn’t a) be able to see me properly, and b) realise that I was trying to help him.  So I said (which seemed a bit of a weird thing to say), “Do you want me to pick it up for you?”  “Yes please!”, he answered with relief in his voice, adding apologetically, “Sorry”.  I wanted to say, “No, no – don’t be sorry!”, and ask him how much he was able to see, and what was wrong with his eyes, and how he managed on the train… but I didn’t.  Instead I just said, “Don’t worry”, as I retrieved his bank card from where it had fallen almost underneath one of his feet, and placed it in his hand.  “Thank you”, he said, before moving off slowly to the ticket office.

Afterward, I wondered how long it would have taken him to find his card if I hadn’t picked it up for him, or whether anyone else would have helped him.  There were a few people around, but they all seemed busy with ticket machines / children / timetables and didn’t appear to notice.  Public places present so many more difficulties and variables than the home environment, and it seems just sheer common sense that people would surely help if they’re fortunate enough to have decent vision and see someone else struggling.

I’m voting for the NHS

I’ve never felt so utterly let down and helpless in relation to my own health as I did on Wednesday 27 May 2015 when, after a dash to Moorfields Eye Hospital at the crack of dawn, I was diagnosed with my fifth retinal detachment.  After several hours of waiting and various examinations, I was advised to go home as they wouldn’t be able to operate that day.  As any RD patient will know, retinal detachment is a medical emergency, leading to loss of sight if not treated swiftly.  In cases where the macula has detached, a delay in surgery of up to one week won’t really affect the final visual outcome, but if the macula is still attached, surgery within 24 hours is strongly recommended.*

At the point of this diagnosis, my macula was still on.  The reason Moorfields couldn’t fit me in for surgery that day was that they’d had a number of other patients in that morning with retinal detachments.  As I’d already had multiple detachments, the prognosis for a good visual outcome in my case was poor, and I was told that I wasn’t a clinical priority.  To say that I was upset by this was a massive understatement.  “But I’m in hospital… you’re supposed to help me, not send me home!  It isn’t even just any old hospital – this is the world-renowned Moorfields Eye Hospital!”, screamed the voice inside my head, in disbelief and dismay.  But there was nothing to be done.  When I asked one of the doctors if it was worth waiting in case they were able to operate that day after all, he advised me to go home and wait for a ‘phone call.

I trudged back to the station along with my sister, with a heavy heart and failing eyesight as the detachment continued its relentless progression.  My sister was furious, and fumed about the unfairness of them sending me away.  Although hugely upset, I pointed out that there was little which the hospital could do.  If they didn’t have the resources to cope with the number of patients, it was only logical that they’d prioritise cases which had the best chance of a good outcome.  I didn’t blame the hospital, but understanding the situation did nothing to diminish its terror.  I spent the rest of that day, and the night, and most of the following day gradually losing more vision in my eye and feeling absolutely petrified that my macula would detach again.  Eventually, I received the long-awaited ‘phone call from Moorfields in the early afternoon of the following day.  I was told to go in immediately, but warned that they still may not be in a position to operate that day.  Fortunately, I eventually went into surgery that evening, and it was around 9pm when I emerged from the operating theatre.

It’s bad enough having to cope with the trauma and ongoing anxiety of RD, without having the additional worry that the hospital may not have the resources to be able to help when needed.  Clearly, this goes for any serious health issue.  If something grim happens, we want to be able to rest assured that at least we’ll receive the best treatment available and will be well cared for.  But how can we expect this to happen if the NHS isn’t cared for itself?  In January, the British Red Cross warned that the NHS was facing a ‘humanitarian crisis’ as hospitals and ambulance services struggled to keep up with increased demand.  There were horrific newspaper articles describing patients on hospital trolleys piled up in corridors, as well as chronic bed shortages and staffing problems.  There were shocking reports of deaths which occurred partly as a result of these issues.  It’s common knowledge that there are serious problems in the NHS and unfortunately many people have first-hand knowledge of this, to a greater or lesser extent.

Yet, despite the fact that demands on the NHS are increasing, it appears that the Conservative and Liberal Democrat coalition and the current Conservative government have put less money into it than it has received in the past.  Have a read of this BBC article, which states that the average annual rise of money going into the NHS since it was created in 1948 has been just over 4%.  During the Labour government under Tony Blair and Gordon Brown, it was almost 7%.  Now, numbers aren’t my strong point so bear with me here and please correct me if I’m wrong, but if you have a look at the chart under paragraph 6 of the above article, it looks as if the average annual increase in government spending on health from 2009/10 to 2014/15 was only just over 1%.  Note the points made beneath the chart:

As you can see the period since 2010 has seen the tightest financial settlements. What is more, the spending squeeze is continuing during this Parliament at almost exactly the same rate, even with England’s extra £8bn going in.

Ministers in England are right to say they are increasing funding – it’s been frozen in Wales and Scotland – but it’s just that it doesn’t compare favourably with what the NHS has traditionally got.

Indeed, the Institute for Fiscal Studies believes over the 10 years to 2020, the NHS budget across the UK will not have increased enough to keep pace with the ageing and growing population.

Not only has the Conservatives’ lack of sufficient funding for the NHS had a hugely detrimental effect, they also appear to be pretty much kicking the NHS into the ground with many of their other policies.  We had the junior doctors’ strikes as a result of dangerous contracts being enforced upon them; we currently have the risk of EU workers (including doctors and nurses) relocating because the Tory government won’t guarantee their rights following the referendum result; the 1% pay cap for NHS staff is resulting in nurses resorting to food banks and creating a recruitment and retention crisis; and the abolition of NHS bursaries has led to a 23% drop in applications by students in England to nursing and midwifery courses at British universities.  The Tories really do seem to be a tad short-sighted when it comes to planning for the future, don’t they?  I’d recommend that they all go and get themselves checked out at the nearest decent eye clinic, but then that would just clog up the clinics even more than they are already…

As well as doing a considerable amount of highly depressing background reading on this matter, I decided to check out the opinion of friends and people I know who actually work for the NHS and who therefore have inside knowledge of the situation.  I think it speaks volumes that I haven’t yet found anyone who thinks that it would be a good idea to vote Conservative in the General Election on 8 June.  Several of the people I know who work for the NHS are already actively and urgently encouraging people not to vote Conservative if they care for the NHS.  One friend responded to my quick ‘poll’ question of, ‘Do you think it’s a good or a bad idea to vote Conservative with the NHS in mind?’ with the comment:

I think it’s a bad idea to vote Conservative full stop, but yes, a Tory win will be bad for the NHS because they are privatising by stealth and setting us up to fail so that they can sell it off.

She ended this comment with a red, frowny, ANGRY face.  This is someone who always seems relaxed and chilled-out, and I don’t think I’ve ever heard her raise her voice.  Someone else who works for the NHS and responded to my poll told me that she doesn’t know anyone at her workplace who would vote Conservative.

There are numerous additional reason as to why I won’t be voting Conservative on 8 June but – for me – the NHS is the most important one.  From everything I’ve read and people I’ve spoken to, it seems very clear that in order to vote for the NHS I need to vote for the party most likely to keep the Tories out, and so that is exactly what I shall be doing.

*I’m sure this was previously stated in the NICE guidelines concerning retinal detachment but, upon checking, I found that they appear to have been amended… hmmm.

 

Christmas lights and wire cutters

I spotted the first sign of impending irritation on Sunday 27 November, as i was heading out for a chilly weekend walk.  A very long ladder set up against the side of one of the houses opposite me, with a man at the top, carefully tacking something along the edge of the roof.  At first glance it looked innocent enough, but I knew exactly what he was doing.  I briefly contemplated the idea of kicking the ladder out from underneath him or grabbing my neighbour’s garden hose with its handy power-spray and dousing him with freezing water.  I suspected that, although bringing a moment of personal satisfaction, such behaviour in this season of goodwill would probably be frowned upon by the majority of people.  So instead I simply snorted the same kind of snort expressing disbelief mixed with resigned annoyance which I’d used when I spotted a towering display of deep-filled mince pies in Sainsbury’s way back in September.  I mean, whatever happened to the twelve days of Christmas?  When did it become four and a half months of Christmas, for goodness sake?!  I have an annual competition with one of my friends as to which of us first hears the utterance, “Christmas is just around the corner!”.  I believe the record so far is late October.

However, I digress.  The point is that Sunday 27th November marked the start of the determined march of the Christmas lights of torture.  By nightfall that evening, it became dazzlingly clear that a number of residents along my road had joined in.  Okay, so maybe ‘torture’ is putting it a bit strongly, but they’re certainly hugely irritating.  I’m not the only one to find them so either.  Earlier today, a member of the online retinal detachment support group I belong to posted the following question: “Is anyone else  with RD completely annoyed by Christmas lights?  I used to love looking at Christmas lights and now they are just one blurry distraction.  :-(”  Another member of the group commented that for the first two or three years after her surgery in 2007, she was unable to look at Christmas lights for very long.  She went on to relate: I remember my family all going to pick out an ornament at a local Santa shop later that year and when I walked in (50+ trees lit up and decorated), I got dizzy and had to leave. I wasn’t close to 20/20 yet, both eyes were different rx and I had double vision, so each tree having 1000 lights on them was overload! I was pretty upset, as it was a tradition to go to that store and I felt like it was all over.

Just as any bright lights can be a challenge for many RD patients to deal with (fluorescent lights and those other horribly bright lights in supermarkets or some workplaces; car headlights, sunlight, bright computer screens… the list goes on and on), it’s just the same with Christmas lights.  I’m sure they’re brighter than they ever used to be, and the flashing ones are particularly irritating.  I genuinely think that the blue flashing ones are downright dangerous, as on several occasions whilst driving I’ve pulled over, thinking an ambulance was approaching, only to discover that it was just a resident with extremely bad taste who had decorated their house with hundreds of blue flashing fairy lights.  Therein lies another issue – taste.  What happened to the ‘less is more’ philosophy?!  Even before my RD issues, I was of the opinion that while sparing decorations of (non-flashing) white lights could actually be quite inviting and attractive; any more than this rapidly achieved the opposite effect of cheap ‘Santa’s grotto’.  Ironic really, as it must cost some people a small fortune in additional electricity each year.

The house just across the road from me now has bright blue lights lining the edge of the roof, a huge star beneath the eaves which flashes first blue then white, a giant multi-coloured flashing ‘Merry Christmas’ set high on the wall, a scribble of bright blue lights above the porch, and tiny red lights decorating a small tree beside the front door.  As if this isn’t enough, on some evenings one of the first floor windows lights up in slow flashes of red and green, as if some kind of psychedelic disco is in progress within.  When I’m driving down the road, I have to keep my eyes firmly focused on the opposite side, or it plays havoc with my vision.  Each time I drive past, I find myself wishing I’d indulged my original idea involving the ladder or the garden hose while I had the chance.  However, I have a cunning plan which involves wire cutters at dusk.  Just don’t let on that it was me who plunged my entire street back into respectable dimly-lit gloom on this chilly December evening.  I think I might go and polish off that bag of humbugs now…

Dietary dilemmas

After a member of the Retinal Detachment support group on Facebook gave us all the heads up that the question of whether certain foods or nutritional supplements could improve eyesight was going to be explored on the BBC2 programme ‘Trust me, I’m a Doctor’, I decided I’d better dust off the TV and  tune in.  As the haunted fish tank is something which no longer features in my life, I completely forgot.  But – hurrah for iPlayer – I managed to catch up with it a couple of weeks later.

The programme mentioned the three carotenoids which are important for eye health: lutein, zeaxanthin, and meso-zeaxanthin.  These are pigments found in plants, which protect our eyes from damaging blue or UV light.  Lutein and zeaxanthin are found in green leafy vegetables such as kale and spinach, brightly coloured peppers, sweetcorn, broccoli, and a number of other fruits and vegetables (check out ‘Good Eye Food’ for a more complete list).  Meso-zeaxanthin can’t be found in plants but it’s believed that it’s made in our bodies from lutein.

The programme went on to refer to recent research undertaken by Professor John Nolan at the Waterford Institute of Technology in Ireland, which suggests that increasing the levels of these three carotenoids in our diets can improve our eyesight.  The programme makers put this to the test by conducting an experiment in which ten volunteers drank a green smoothie every day for five weeks.  The recipe had been designed so that it contained high levels of lutein and zeaxanthin, in order to find out whether it was possible to improve the eyesight of the volunteers through diet.  The presenter, Michael Moseley (by the way, he really *did* qualify as a doctor… I checked), also took part in the experiment, but he took supplements containing lutein, zeaxanthin, and meso-zeaxanthin every day for twelve weeks.  Now, I’m not even going to start discussing the results because these experiments are clearly flawed.  The sample size of ten volunteers for an experiment such as this is miniscule.  Not only that, but the viewer was given no information about the other variables or whether they had even been considered.  For example: were the volunteers all of the same age; did they have any medical conditions; what was their eyesight like to start with; what was the rest of their diet like… etc.  The timespan of five weeks also seems extremely short.  Not only that, but the programme didn’t compare like for like.  Results of ten volunteers over five weeks were directly compared to results of one (!) volunteer over twelve weeks.  Making the claim, “Research suggests that it’s cheaper and more effective to take supplements” based on these experiments is dodgy to say the least.

Upon reading a couple of articles associated with the programme, I discovered that the Waterford Institute of Technology had carried out a year-long study of approximately 100 volunteers who all took the same supplements.  “I don’t get it!”, I complained to my sister, in annoyance.  “Why have they done this pseudo-scientific experiment when an actual proper researcher has carried out the work to obtain far more convincing data?  Why didn’t they just discuss the real research?”  “It’s telly, isn’t it?”, observed my sister with the wisdom of one who’s watched a fair amount of trash over the years.  “They’ve just dumbed it all down to reach a wider audience.”

As I was a little frustrated by all this TV malarkey, I went off to look up some information about the research undertaken by the Waterford Institute of Technology.  I learned that Professor Nolan is Principal Investigator of the Macular Pigment Research Group, the mission of which is to “study the role of nutrition for optimising visual function and prevention of blindness, cognitive function and prevention of Alzheimer’s disease”.  In conducting trials for their research, they recruited volunteers with normal eyesight and volunteers who had been diagnosed with early-stage age-related macular degeneration (AMD) in one eye.  Their website specifically states that people with diabetes or who have had laser eye surgery were not suitable.

After further reading around the subject, I was still no closer to an answer as to whether or not supplements containing lutein, zeaxanthin, and meso-zeaxanthin would help me, as an RD patient.  So, I turned to my eye buddies, posting a question on the RD support group site asking whether anyone had specifically been recommended to take nutritional supplements by their ophthalmologist.  Unusually, there was a fairly resounding silence.  Only one person said that she had been recommended a supplement containing lutein by an ophthalmologist.  Someone else said that her retinal surgeon had told her that lutein may be helpful but that it couldn’t be known for certain.  Another person made the sensible comment that even supplements can be harmful so it’s best to seek medical advice to ensure the benefits outweigh the risks.  So I guess that’s one more question for the ophthalmologist at my next appointment…

“Double, double toil and trouble”

The gas bubble always reminded me of the song of the three witches in ‘Macbeth’, so I thought I’d borrow from the Bard and have a bash at turning it into the song of the RD patient…

Double, double, toil and trouble;
Vitrectomy and large* gas bubble.

Stinging drops in open eye;
Lying flat, afraid to cry.
Holding breath and keeping still
In a mighty act of will.
Bright lights dim to dusky dark;
Tight clenched fists and beating heart.
Waiting for the surgeon’s hand;
Wishing to escape this land.

Double double, toil and trouble;
Vitrectomy and large gas bubble.

Instruments dive in and out;
Causing urge to scream and shout.
Listening to voices low;
“Cutter please”, (do take it slow!).
“Laser” next, then “Gas now, please”;
Clearly not the time to sneeze!
Stitches last then almost done;
Head and roof of mouth feel numb.

Double, double, toil and trouble;
Vitrectomy and large gas bubble.

Now more torture, lying flat;
Face down only, not on back.
Aching neck and shoulders tight;
Difficult to sleep at night.
Eye drops in ten-minute break;
“Hold head still, try not to shake!”
Gritting teeth and ploughing on,
Wishing it would all be gone.

Double, double, toil and trouble;
Vitrectomy and large gas bubble.

Finally the gas breaks down,
Upright now, so lost the frown.
Magically, above the line
Vision, though ’tis strange this time.
Colours dim and lines not sharp;
Lava lamps and flickers dart.
Bubble waves and disappears;
Left lonely, facing sightless fears.

Double, double toil and trouble;
Vitrectomy and large gas bubble.

* Try as I might, I simply couldn’t get ‘intraocular gas bubble’ to fit with Shakespeare’s metre and rhyme scheme, so I had to go for ‘large gas bubble’ instead.

Hurrah for Jules Gonin!

At approximately 3am on Tuesday 15 April 2014, shortly after being diagnosed with a macula-off retinal detachment in the eye hospital in Berlin, the nice German doctor (who was reassuringly wide awake for such an unearthly hour) told me that not so very long ago there would have been no treatment available for cases of retinal detachment.  The patient would have been advised to lie down on the same side as the retinal tear for weeks, if not months, and hope to eventually regain some sight.  I stared at her in horror.  Already struggling to deal with the quite literally blindingly obvious loss of vision in my right eye and the prospect of emergency surgery in a foreign country, my shocked brain simply couldn’t cope with this incomprehensibly horrifying piece of information.  (Read https://rdramblings.wordpress.com/2015/06/15/how-it-all-began/ if you’d like a full run-down of my night of trauma.)  It was only months later that my curiosity compelled me to have a hunt around for further information on the history of RD surgery, and this is what I discovered…

Before the early twentieth century, there was pretty much no hope of successful treatment for retinal detachment, with success rates following the early surgical techniques being less than 5%. [1]  Retinal tears were first spotted in 1853, around the time that the ophthalmoscope (the instrument which allows the doctor to see inside the eye) came into common use. [2, 3, 4]  However, at first it was thought that the tears were a side-effect of the detachment rather than its cause.  It was believed that the retina detached as a result of force from behind it, resulting in holes and tears as the detachment progressed.  This belief led to surgeons concluding that the progress of the detachment could be halted by making cuts in the retina to drain the fluid. [2]  Upon reading this, I actually gasped aloud in horror, because of course the exact opposite is true.  Detachment occurs as a result of a tear or hole in the retina through which vitreous fluid escapes and then pulls the retina away from its place at the back of the eye.  I won’t go into further detail about the treatment which was attempted at this point in history,  but suffice it to say that reading about it made me shudder and I wasn’t surprised to learn that the results of treatment up until the turn of the twentieth century were so bad that it was generally considered insane to even attempt surgery. [2]

Cue our hero, Jules Gonin, who rode into battle on his white charger, with his cape billowing in the wind and an expression of grim determination on his face as he lifted his chin defiantly in response to cruel jeers from the other side of the battlefield.  Okay, that’s not actually historically accurate, but you get the general picture.  Born in Lausanne, Switzerland, in 1870, Jules Gonin studied medicine at the university there and eventually settled down to working in ophthalmology at Lausanne Eye Hospital in 1896.  He became particularly interested in the cause and development of retinal detachment, and its subsequent treatment.  He published a number of papers, on the subject, co-founded the Swiss Ophthalmological Society in 1908, became director of the Eye Hospital in Lausanne in 1918, and was appointed Professor of Ophthalmology at the University of Lausanne in 1920. [1,2]  So basically, he knew his onions.  Or rather, his eyes.  Or, to be strictly accurate: other people’s RD eyes. 

As a result of his extensive research, he became convinced that the hole or tear in the retina was the cause of the detachment, rather than the other way around.  He logically concluded that treatment would only be successful if the hole or tear was mended, although at first he couldn’t work out how this could be done.  Despite this, and the fact that many of his fellow ophthalmologists continued to oppose his views, sticking rigidly to their original dangerous beliefs, Jules Gonin continued his efforts to figure out a cure. [1,2,4]

He went on to develop the ignipuncture, a surgical procedure by which the retinal break was sealed by cauterisation.  He gave details of this technique at the German Opthalmological Society meeting in 1925 and emphasised that the process of finding the retinal tears was just as important as the actual surgery.  His ability to find retinal tears increased dramatically over the years, in contrast to the surgeons who still refused to believe that the tear was the cause of the detachment. [2]  This emphasis on the importance of locating the tear is vital, and an issue which I’m very aware of, particularly after speaking to a fellow patient once, who told me that one surgeon found a tear in her retina and assumed that was the only one until she was examined by another surgeon who discovered two additional tears in a different location.  Obviously, all tears must be found and treated for the re-attachment surgery to stand a chance of succeeding. 

Eventually, as more surgeons learnt the technique developed by Jules Gonin and observed successful results for themselves, his findings were accepted.  In 1931, he reported a success rate of 53% based on 221 detachments on which he operated using the same technique; and a success rate of 67% for detachments which were less than three weeks old. [2]  In the last few years of his life, he was swamped with difficult cases and visitors from all over the world.  He died in 1935, leaving a large portion of his assets to people who had lost their sight late in life. [1]  I think this gesture underlines what a remarkable man he must have been, not only in his relentless pursuit of a solution to the apparently hopeless conundrum of retinal detachment, but also in demonstrating compassion for those who had lost their sight.  If I ever get a cat, I shall name it Jules.  In the meantime, who will join me in a great big resounding cheer, as I lift my mug of tea and cry, “Hurrah for Jules Gonin!”?

References
1. Wolfensberger TJ. Jules Gonin. Pioneer of retinal detachment surgery. Indian J Ophthalmol [serial online] 2003 [cited 2016 Apr 15];51:303-8. Available from: http://www.ijo.in/text.asp?2003/51/4/303/14656

2. Gloor, BP and Marmor, MF. Controversy over the etiology and therapy of retinal detachment: the struggles of Jules Gonin. Survey of Ophthalmology [serial online] 2013 [cited 2016 Apr 16];58;2;184-195. Available from: http://www.surveyophthalmol.com/article/S0039-6257(12)00193-2/fulltext

3. Keeler, CR. A brief history of the Ophthalmoscope. Optometry in Practice [serial online] 2003 [cited 2016 May 8];4;137-145. Available from: http://www.optometryinpractice.org/en/utilities/document-summary.cfm/docid/401E0411-F197-4ED1-99936804BFEADC23

4. Albert, DM, Gloor, BP, McPherson, AR. Why Jules Gonin achieved his “audacious goal initiative” – and why he is a model for the present day. Ophthalmology [serial online] 2015 [cited 2016 May 13];122;10;1955-1957. Available from: http://www.aaojournal.org/article/S0161-6420(15)00536-9/fulltext

The irritating issue of the emotionally unintelligent idiot

Life can be pretty stressful at times.  Add eye issues to the mix, and I sometimes feel as if I’m dangling precariously off the edge of a jagged cliff in gale-force winds at high tide, hanging on by my fingernails (and I have very short fingernails).  People who know me are well aware of how much I struggle each day to battle the ongoing fear, uncertainty, and paranoia caused as a result of multiple retinal detachments.  So why is it that some people (and these are people whom I thought knew me pretty well) consistently come out with unhelpful, shallow, and downright stupid remarks?  Clearly, their mothers never told them, as mine did, “If you can’t say anything helpful, don’t say anything at all!”.

Anyway… Arnold Wesker famously made the point that “you can’t change people” so instead, I’ve come up with a number of potential solutions for dealing with such people.

  1. Shoot them.
    Pros:
    – Deals directly and permanently with the problem.
    Cons:
    – May make a mess.
    – Tricky when not in possession of a shotgun.
    – May result in prosecution on a murder charge.
  2. Poke them in the eye or deliver a swift blow to their head in an effort to cause a retinal detachment.
    Pros:
    – They will then know exactly what it feels like and will never again make such unhelpful and stupid remarks.
    Cons:
    – This action may not lead to a detached retina.
    – Could result in an eyeball being empaled on the end of a digit.
    – Could cause other unplanned unjuries.
    – May result in being prosecuted for GBH.
  3. Ignore them.
    Pros:
    – Where possible, this is an effective solution; e.g. with an acquaintance or ‘friend’, it’s relatively easy to simply stop contacting them.
    Cons:
    – Tricky if it’s someone with whom enforced contact is required on a regular basis; e.g. a work colleague or a spouse (although in the case of the latter, I recommend divorce).
  4. Replace them.
    Pros:
    – This means getting to meet a lot of new people.  Potentially, understanding people!
    Cons:
    – It could be quite tiring having to find new friends / doctors / family members / jobs / spouses.
    – In the case of new spouses, it may not be financially viable when taking into account wedding and divorce costs.
  5. Explain the situation.
    Pros:
    – This may result in an epiphany, leading to enlightenment, understanding, and therefore changed behaviour.
    Cons:
    – When dealing with more extreme cases of idiocy, this is unfortunately more likely to result in further frustration, leading to a desire to attempt potential solution number 1.
  6. Grit teeth and say nothing.
    Pros:
    – They may give up and go away.
    Cons:
    – This may cause a sore jaw, and/or toothache.
    – They may think that silence signifies a speech problem as well as an eye problem.
    – They may take silence as agreement and reach the conclusion that their foolish comments are perfectly acceptable, in which case they will never  learn.
  7. Employ sarcasm in responding to them.
    Pros:
    – This can be quite satisfying.
    Cons:
    – As with potential solution number 5, such people are unlikely to understand sarcasm and may instead take it literally, in which case – again – they will never learn.

I’m now almost two years into my RD journey and so far I’ve attempted solutions 3, 4, 5, 6, and 7, with varying degrees of success.  I’ll keep you posted on my progress, but if you don’t hear from me for a while it may be that I’ve resorted to solution 1 or 2.  In the meantime, should anyone need a handy reminder of unhelpful versus helpful things to say to an RD patient, please read: https://rdramblings.wordpress.com/2015/06/19/im-not-usually-a-violent-person-but/.

Note: Reading and acting on the above blog post could save lives!