Day 4 without caffeine. I think I can do this. A week and a half ago, I noticed my right eye was out of focus. I have worn corrective lenses for most of my life, and my eyesight has gotten worse over the years, but this was the first time I noticed a worsening overnight. I was sitting in a morning meeting, trying to read a document when I realized my right eye wasn’t focusing. Being a man, I chose to ignore it. When it hadn’t self-corrected after a week, I decided to get a professional opinion. Tuesday morning, my eye doctor’s assistant administered dilating drops so they could take some pictures of the interior of my eyes. I settled my chin and forehead into their respective rests and stared into the business end of the large camera. She asked if I could see the flashing green circle, and when I confirmed I could, lightning struck. After two intense bursts of light in each eye, she had what she needed for the doctor to make a diagnosis. Based on my symptoms and what he saw in the pictures, my doctor diagnosed me with central serous retinopathy. I thought the name was cool – like the title of a Carcass song, the metal band that wrote such ditties as “Hepatic Tissue Fermentation” – but I had some anxiety about the prognosis. It’s an idiopathic condition, meaning they aren’t sure what causes it, but it tends to happen to people who experience a lot of stress and are users of caffeine and corticosteroids, which, it turns out, is an apt description of me, emotionally and pharmaceutically. I have a stressful job, feel a fierce attachment to my morning cup of coffee, and I have been inhaling corticosteroids for many years to treat allergies. The recommended treatment was to give up all three. I told my doctor that I could, reluctantly, give up the coffee, but the stress and steroids would be a little trickier. My employer seems committed to generating a significant amount of stress, and I have grown attached to breathing deeply through my nose and mouth. It’s hard to imagine life without either.
My doctor referred me to a specialist to confirm his diagnosis, and that specialist advised that I have a driver for the appointment. That was code for more dilation. I hate having my eyes dilated. It ruins my visual field for five or more hours, which my doctor tells me is the common among people with gorgeous blue eyes. Well, he didn’t actually say “gorgeous”, but I have testimonial evidence that my eyes are pretty. I was not excited about having it done twice in one week and wondered if the dilation procedure might exacerbate my condition.
I was brought into a room for dilation and pictures. This camera was similar to the one from Tuesday, but the flashing was a bit more intense. After a few pictures of my baby blues, I returned to the lobby until I was summoned to a different room with a different camera. I positioned my head in the chin and forehead rests, and the technician explained he was going to take another series of pictures before injecting the dye. I stared at more flashing green lights and nuclear bomb-style camera flashes and thought about having dye injected. Since I was there to be treated for an eye problem, I assumed he would inject the dye into my eye. I am not an expert on physiology, but I’ve always had confidence in my common sense. After a round of pictures, he prepared the syringe, pulling back on the plunger to draw the dye from a small glass bottle. My blood pressure rose at roughly the same rate as the level of dye in the chamber. I wanted to tell him that, based on my diagnosis, I was supposed to avoid stress, and he wasn’t helping, but I was rendered mute by the terror of how it would feel to have a needle inserted into my eye. When he told me to extend my arm – so that he could inject the dye into a vein there – I exhaled deeply, realizing I had been holding my breath in dread.
He began injecting the dye and asked if I felt any burning. I told him no, that I was just relieved he didn’t stick the needle in my eye. He giggled, but I wasn’t trying to be funny. I was giving some indirect feedback about his bedside manner. He could have let me know up from that he wasn’t going to stick a needle in my eye and alleviated a lot of anxiety. I learned a little later that bedside manner is not one of the specialties of this specialist. As I’m wont to do when confronted with situations that don’t conform to my sense of how the universe should be ordered, I started making a list:
1. Always let the patient know where you’re going to stick the needle. Depending on the condition, or body part, under evaluation, this can be source of unnecessary apprehension.
The technician took more pictures, this time to observe the flow of the dye through the blood vessels in my eye, and the process was putting a strain on my eyes. Being fully dilated and having bright lights flashed into your eyes seems a bit cruel and unusual, and when he said he was done, I was thrilled and all too happy to tell him everything I knew about ISIS and al-Qaeda. He moved me into yet another room that did not include a camera. I took a seat in a chair facing the door of the room and noticed a set of colored plastic signal flags. A similar set of flags was affixed to each exam room door in the office. Each set included a blue, yellow, green, and red flag. After I was situated, the technician left the room and flipped the red flag.
2. Don’t use red signal flags if the patient can see them. I’m sure the color-coding system in this office indicated varying stages of patient processing, but as a patient concerned about the results of the macular photography, I was sure that the red flag was a signal to the staff that I was near death. I would have felt better with yellow or green. Even the nondescript blue flag would have been more reassuring than red, traditionally associated with blood, fire, danger, and disaster relief organizations.
When the doctor arrived to let me know the results, she didn’t have any red alert-worthy news. She used a tool akin to a jewelers loupe to look into my eyes. As she navigated around – asking me to look up, up and to the right, to the right, down and to the right, etc. – she called out to her assistant who was tracking information on a computer. She used words including “blunt” and “quiet” to describe what she saw in my eyes. I took comfort in those unexpected adjectives, much more than if she had said “red” or “yellow.” After completing her exam, she told me she concurred with my other doctor’s assessment, including the need to give up caffeine and steroids. It was too much to hope that she would say increasing my coffee intake was the proper course of treatment. Fate decided, my wife drove me home so I could spend the first sunny day of Spring cowering in the darkness waiting for my eyes to constrict voluntarily. It was shortly after we got home that I added one more item to my list of suggestions for the doctor:
3. Let the patient know about side effects from the dye. Not only does a dye injected into your arm travel to the blood vessels in your eye, but it also finds its way into your urinary tract. When I relieved myself, I was quite startled by the vibrant stream. The water in the toilet bowl looked like a vat of yellow highlighter marker ink. It glowed. I almost screamed until I realized why I had become a liquid light saber.
That was two days ago. Since then, my pee has returned to its normal color, the caffeine withdrawal symptoms are diminishing, I’m starting to ween off my allergy medication, and, if all goes well, my right eye will come back into focus in the next couple months. Nothing to do now but wait, and send my list of free advice to the doctor.
P.S., I read this to my daughter who has worked in a veterinary clinic. She tells me that a red light outside an exam room there is the signal for euthanasia. Exactly my point.